Therapy: Does it Work?

1. Therapy: Does it Work? Last Lecture 5/03/04

2. Trustworthy Testimonials? “My therapist works wonders” “I work wonders”

3. Consumer Reports: 22,000 • Rate laundry detergents; Breakfast cereals; home appliances, automobiles… AND • “If at any time over the past 3 years, you experienced stress of other emotional problems for which you sought help…” • How much did it help? • Were you satisfied?

4. Indicated treatment made things: A lot worse Somewhat worse No different Somewhat better A lot better Indicated they were: Not satisfied at all Fairly satisfied Highly satisfied What percentage of patients? • 2,900 (40%) sought help from psychologist, psychiatrist, social worker, or marriage counselor

5. Indicated treatment made things Somewhat better A lot better Indicated they were Fairly satisfied Highly satisfied Most people… 86% 89%

6. So long…

7. Hello Psychotherapy • Psychoanalytic Therapy • Behavioral Therapy • Cognitive Therapy • Humanistic • Group • Biological Therapies • Drugs, ECT, Psychosurgery

8. Behavioral Therapy: tell me what you want to change… • Behavior = problem, not result • Behaviors are learned • Therefore, can be unlearned • Classical Conditioning Techniques • Flooding, Systematic Desensitization, Aversion Therapy • Operant-Conditioning Techniques • Reward and Punishment, Token Economy, Biofeedback, Social Skills Training

9. Flooding • Patient saturated with fear-provoking stimulus until anxiety is extinguished • After repeatedly presenting bell without food… • Stopped salivating • Repeatedly expose phobic to fearful situation w/out negative consequences…

10. Systematic Desensitization • Treat anxiety disorders by pairing gradual exposure to anxiety-provoking situation with relaxation • Condition to respond to fear w/ calm, not anxiety • Relaxation Training • Anxiety hierarchy • Gradual exposure

11. Sit back comfortably, loosen clothing, take shoes off, take a deep breath, let muscles get loose and heavy • Wrinkle forehead, tighter, tighter, tighter, clinch jaw, purse lips… • Stop tensing and Relax. Picture smooth forehead, open mouth, loosen lips

12. Now that you can relax on cue • You see a newspaper ad for discount airfares (0) • You look out window as plane leaves ground (100)

13. Close your eyes and imagine… • Start with mildest fear-provoking situation • If you keep your cool, progress • If anxious, stop and relax • Can be imaginal or in vivo… • Phobias, OCD, bulimia, etc.

14. Aversion Therapy • Technique to react with aversion to harmful substances • Calm doesn’t apply to smoking, drinking, overeating and other destructive habits • Goal: e.g. get drinkers to feel sick to stomach at sight, smell, and taste of liquor

15. Cognitive Therapy • Distorted thoughts produce maladaptive behavior (depression, anxiety, emotional/ mood disorders) • Open your minds, think about old problems in new ways, challenge assumptions… • Rational-Emotive Behavior Therapy • Beck’s Cognitive Therapy • Therapist = partner, friend, teacher • Sessions focused on concrete problems

16. Rational Emotive Therapy (RET) • Distress caused by rigid, maladaptive ways ppl construe events, not upsetting events per se… • Irrational beliefs: • I have to be perfect at everything I do • Everyone must like me

17. Ellis’ A-B-C Theory of Emotional Distress • Activating Event - Beliefs – Consequences “ My approach to psychotherapy is to zero in as quickly as possible on the client’s basic philosophy of life; get him to see exactly what this is and how it’s self-defeating; and to persuade him to work his ass off, cognitively, emotionally, and behaviorally, to profoundly change it”

18. Where is it written that life’s supposed to be fair? • Not easy to rid ppl of lifelong assumptions • Blunt, confrontational techniques • E.g. shy woman in subway • Step out of character • Psychoeducation • “Not just to FEEL better, but to get better” • SHAPE UP ALREADY!

19. Get real, get smart, get going!

20. Beck: It’s my fault, I can’t do anything right, It’s the story of my life… • Same idea, gentler, more collaborative approach • Restructure interpretations by questioning • “Is there another way to look at the sitch.?” • “What’s the worst thing that could happen?” • Distress in therapy • Keep diary: situation, felt, thinking, rational? • Bibliotherapy: You feel the way you think

21. The Bottom Line: Does Psychotherapy Work? • Based on the results of 475 studies (Smith et al., 1980), the average psychotherapy client shows more improvement than 80% of those in the no-treatment control group.

22. BUT: • Untreated ppl improve • Ppl who receive therapy are somewhat more likely to improve regardless of kind • All approaches are equally effective • For some disorders, certain types of therapy tend to be more successful. • Placebo treatments also improve

23. What are the Active Ingredients? • Common, nonspecific factors apparent in all types of psychotherapy: • Supportive Relationship • A Ray of Hope • Opportunity to Open Up

24. On opening up… Preventative medicine?

25. Writing Paradigm: Overview For the next four days, I would like for you to write your very deepest thoughts and feelings about the most traumatic experience of your life. In your writing, I’d like you to really let go and explore your very deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends, or relatives. You may also want to link your experience to your past, your present, or your future, or to who you have been, who you would like to be, or who you are now. You may write about the same general issues or experiences on all days of writing, or on different traumas each day. All of your writing will be completely confidential.

26. Monthly Health Center Visits:(Across four studies)

27. Samples of Participants • Students (undergraduates, medical students, adolescents) • Maximum security prisoners • Unemployed engineers • Holocaust survivors • University staff members • Chronic pain, arthritis, and asthma patients • Recently bereaved adults • PTSD samples

28. Objective Health Improvements following writing • Reduced physician visits for illness • Fewer absentee days among university staff • Reduced medication use among pain patients • Reduced alcohol consumption (older, non-college samples only) • Reduced blood pressure, skin conductance, muscle tension • Long-term physiological markers (e.g. NK cell activity, CD-4 (t-lymphocyte) levels)

29. Emotional Expression: NO WORDS? • Dance study (Krantz, 1993) • Conditions: • Dance only • Dance + write • Exercise

30. Changes in Handwriting

31. Linguistic Inquiry and Word Count LIWC A computer-based text analysis program

32. LIWC Dimensions • I. Standard linguistic dimensions Word count, pronouns, articles, prepositions • II. Psychological processes Emotions Sensory Processes Cognitive processes Social Processes • III. Relativity Time, space, motion • IV. Personal concerns Occupation Religion Leisure Physical states (illness, sex, sleeping) Money

33. Language Dimensions Predicting Health

34. To Health • Personal upheavals cause havoc by: • disrupting normal cognitive activity • undermining social interactions and relationships • Writing about an upheaval: • reduces the need to inhibit thoughts, emotions, behaviors • brings about cognitive resolution, freeing up working memory • allows for more open social relationships

35. The End