hi I'm Michael Carrera and this is psych
exam review in this video we're gonna
take a look at a few more approaches to
psychotherapy so in the previous video I
talked about the psychoanalytic approach
to psychotherapy the humanistic approach
and behavioral therapy and so in this
video we're gonna look at cognitive
therapy cognitive behavioral therapy and
some group approaches to the treatment
of mental illness so we'll start by
looking at cognitive therapy and this
has an emphasis on thinking patterns and
the role they might play in certain
symptoms of mental illness so certain
thinking patterns might be associated
with symptoms of disorders and the goal
is to try to change those thinking
patterns and improve a person's
reasoning their self-control and their
responses to certain types of events so
we can start by looking at the cognitive
therapy of Aaron Beck and Beck believe
that many people suffering from mental
illnesses had distorted views and they
had distorted views of themselves of
others or of the future and he referred
to this as the cognitive triad and by
trying to correct these views about the
self others and the future he thought
you could reduce the symptoms of certain
mental illnesses and one way to try to
correct these views was to challenge the
person's beliefs and this would help
them to avoid certain negative beliefs
so one example of this would be
catastrophizing so this is the idea that
a person has a tendency to fall into
thought patterns that are the worst
possible consequences of something that
has happened some negative event has
occurred and this sort of spirals into
the worst possible outcome and that's
what the person keeps thinking about so
for instance we might have a student who
has just failed a math test and in this
case the students thought patterns and
then lead them to think well because I'm
failing my tests I'm not gonna get into
college and if I don't get into college
then my life is ruined and so this has
now led them to this worst possible
consequence instead of saying well it's
just one test I can improve or I can do
better in the future
saying my life is ruined right that's an
example of catastrophizing and so in a
therapy session in cognitive therapy the
role of the therapist would be first to
try to identify where the person might
be engaging in these sort of faulty
thinking patterns and then by revealing
these to the patient they can try to
change those thinking
patterns right they can first challenge
them and try to improve the person's
awareness of when this is happening
and then once they can begin to
recognize it on their own they can
gradually start thinking about how they
could change those patterns how could
they reinterpret the events so that
they're not for instance jumping to the
worst possible conclusion whenever
something bad happens okay a similar
approach by Albert Ellis was a bit more
direct and this is what's known as
rational emotive behavior therapy and in
this case the therapist would more
directly point out the errors in the
person's thinking and then they would
work together with the patient to try to
resolve those errors or change those
thinking patterns and this is what L is
called cognitive restructuring where at
first the therapist will question the
assumptions that the patient is making
and they'll also question their
predictions about how the world works so
for instance in the case of you know
failing a test leading to College
rejection leading to my life being
ruined they might challenge those
predictions about the world really well
you know does everybody who doesn't go
to college their life is ruined well no
that's that's not really an accurate
prediction of how the world works or
everybody who fails a math test doesn't
get into the college's that they want to
go to you think that's necessarily true
about the world and so this kind of
direct challenging of those beliefs or
those predictions would be the first
step and then the person would try to
replace those with more realistic and
productive ways of thinking okay you
know maybe it's not realistic me for me
to think that one failure is gonna lead
to you know my life being ruined what
would be a more productive way of
thinking about this what could I learn
from this experience how could I use
this to maybe motivate me to do better
in the future and so they're trying to
replace the negative thinking patterns
and the faulty habits that the person
might have and they're thinking with
more productive ways of viewing the
world now modern approaches to cognitive
therapy tend to draw on the work of both
Aaron Beck and Albert Ellis and they
also can include some other techniques
that weren't included by Beck or Ellis
and these include things like the use of
mindfulness meditation and the goal here
is to try to get the person to detect
certain thought patterns or certain
emotional issues before they grow into
larger problems so by engaging in
meditation they can become more aware of
their thoughts or more aware of some of
their emotional reactions to things and
then they can work to resolve those next
we'll look at cognitive behavioral
therapy or CBT and this is a combination
of cognitive techniques that I've just
described and some of the behavioral
techniques that I talked about in the
previous video the use of rewards these
punishments the attempts to change
certain emotional responses to certain
stimuli and so cognitive behavioral
therapy is going to include both of
those but it also has some unique
aspects that we don't see in either of
those separate approaches and one thing
that's unique about it is it's much more
problem focused and action oriented that
means it's very direct the therapist and
the patient work together to have a very
narrow focus on specific areas for
improvement
and then they try to structure a program
of behaviors that will help them to make
more rapid progress in those specific
areas and this means there's a greater
sense of transparency to the therapy
where the therapist will make it very
clear to the patient why they're doing
certain things and what the end goal is
that's in mind for a particular program
of behaviors okay so each session will
usually have an agenda that says it this
is what we're going to work on in this
session and then we're gonna focus on
restructuring certain beliefs or certain
thoughts that are relevant to this
particular outcome that we want and then
the patient is often given homework and
this refers to certain practices there
that they're meant to do before the next
session and that way they have something
they can discuss how did it go what went
well what didn't work what do we need to
change for the future so I'll give you
an example of this if we imagine
somebody who is suffering from
obsessive-compulsive disorder okay so a
specific therapy session in cognitive
behavioral therapy might begin by
looking at where this person is having
these obsessive thoughts when is this
occurring what stimuli are leading to
this triggering of these obsessive
thoughts so firstly okay we want to
identify when two thoughts occur let's
make a list of all those occasions and
then we might say okay in this
particular occasion you've said that
these obsessive thoughts occur let's
create some options for you let's say if
it tends to happen when you're at work
at a certain time of day or a certain
situation triggers these thoughts what
are some alternative behaviors you can
do in that situation that you could
actually do that would help you to get
your mind off of these obsessive
thoughts so maybe right now the tendency
is to then engage in a compulsive
behavior like in the case of compulsive
hand
so okay what could you do instead what
would maybe get your mind off of those
obsessive thoughts and then the homework
might be all right you're going to put
this into practice you're going to be in
that situation a few times this week
and I want you to really try this you'll
have this list with you and when you
feel those obsessive thoughts coming on
I want you to go to that and try some of
these behaviors and then we can assess
did this actually help you to reduce
your obsessive thinking or maybe it
wasn't very effective and we can have a
better plan for next time and so this
will be one way and this approach has
been successful for patience in treating
certain symptoms or in this case for
obsessive-compulsive disorder and it's
also worth noting that when this is
successful we can also see changes in
brain activity over time so we can see
that certain areas may be associated
with certain emotional responses or
certain repetitive thought patterns that
these can actually change over the
course of successful therapy and this is
an important reminder when it comes to
psychotherapy because it can often be
dismissed as seeming kind of abstract
but we should remember that these types
of psychological interventions can
actually influence a person's biology
okay so lastly we will look at some
group approaches to therapy and the
first few types we have look at
relationships so we have couples therapy
and family therapy and in couples
therapy a couple will work with a
therapist to try to improve their
communication or perhaps to deal with
specific problems maybe related to
sexual dysfunction or domestic violence
or specific problems that might be
influencing the relationship so for
instance if one person in the
relationship has been diagnosed with an
illness or diagnosed with a mental
illness like depression then this is
going to affect the relationship and so
both partners need to be involved in
this process of trying to determine
which issues might arise what problems
might occur and how can they address
these and communicate better to prevent
these from perhaps ruining the
relationship and another group approach
is family therapy and this is a therapy
that looks at families as a system of
relationships so these relationships are
going to influence all members of the
family and this can be relevant for some
disorders so there might be some
disorders that the system of
relationships in the family are actually
increasing stress for the person
suffering or they can relate to some of
the symptoms that are involved in math
disorder so if
instance in the case of something like
an eating disorder with a teenage girl
then it might be relevant to look at
what kinds of pressures or expectations
are parents putting on this child or is
there you know situations of sibling
rivalry that is influencing certain
symptoms or expression of certain
symptoms and so that would be something
that will be addressed in Family Therapy
and we also have what's called group
therapy and this is where individuals
work on their own individual problems
but in a group setting so for instance
you might have a group of 10 patients
who are all suffering from an eating
disorder like bulimia nervosa and each
of them of course is suffering they have
their own individual problem but they're
working on it in a group and there's a
number of benefits that can come from
working on this type of problem in a
group setting and one of these is that
it encourages social behaviors and
social skills so particularly if there
are some symptoms that are associated
with withdrawal or reduced social
activity then this can help the person
to be more social they have to get along
with other people and be able to
communicate with a range of people and
then they also can get feedback from
multiple sources so they can hear other
views on their own symptoms or their own
expression of symptoms or anything that
might be relevant to the disorder and
then this means they can improve and how
they relate to others and this can
reduce some of the feelings of isolation
and also some feelings of stigma often
people with a mental illness might feel
that they're the only one suffering with
it nobody else could understand what
they're going through and so by meeting
in a group they can see you know there
are other people going through the same
things or other people who have improved
and they can share their advice with me
and this can reduce the stigma and help
them feel more like they're part of a
community and lastly it's important to
note that this is often cost effective
and sometimes cost can be prohibitive
for people and prevent them from seeking
treatment so if we can have a situation
where maybe a single therapist is
meeting with ten patients at once then
this can be a lot cheaper for each
patient and that might mean people who
otherwise might not get treatment would
now be able to afford the treatment but
there are some drawbacks to group
therapy and these are also important to
be aware of so one drawback drawback is
the assumption that people with the same
disorder will have similar needs and
that might not necessarily be the case
and as a result of meeting in a group of
course the attention of the therapist is
necessarily going to be less focused for
each patient
and that means they might not be aware
of particular aspects of somebody's
disorder or somebody's symptoms because
it just doesn't come up in the group
conversation that there's not enough
time to get that level of detail from
each patient and it's also possible that
groups can have group dynamics that are
causing discomfort for some of the
patients so maybe some people kind of
dominate the discussion or maybe people
feel that they aren't comfortable
sharing certain things in a group
setting that they would be able to share
with a single therapist one-on-one and
as a result they don't express those and
so now nobody really knows those aspects
of the person's symptoms and it's also
possible that being in a group can cause
the normalization of symptoms or it can
cause comparison between members that
can actually be counterproductive for
what they want to achieve so for
instance let's say somebody suffering
from bulimia nervosa and they go to a
group therapy session which is fairly
common for eating disorders and now they
might hear that well there's a bunch of
other people who are purging you know
before I felt kind of isolated and then
I thought I was the only one suffering
from this and maybe that's not a very
good thing but now I say well kind of
normal like I know a bunch of people who
are engaging in these behaviors and so
maybe I have less motivation to change I
feel like well you know this isn't so
bad
or I compare myself to other people who
are worse well yeah sure my symptoms
seem bad but I'm not nearly as bad as
this other person so I don't need to
work so hard to improve I mean they need
to get you know their act together but
I'm doing okay I'm not nearly as bad as
this other person and that can be
counterproductive to the goals of the
therapy session and lastly people can
also learn negative techniques from
other members of the group and so for
instance in the case of bulimia nervosa
they might learn how others engaged in
certain purging techniques or in the
case of anorexia nervosa they might
learn how other people hit some of their
weight loss from family members and this
means that they're learning negative
things they're not actually learning how
to cope with their symptoms or to
improve and lastly we can look at
self-help and support groups and this is
a type of group therapy that offers
cost-effective support for specific
problems so you're probably familiar
with a number
these types of self-help groups there
are groups like Alcoholics Anonymous for
dealing with alcoholism or groups for
gambling addiction or other drug
problems groups for social phobias and
these can have the benefits that I just
described for other group therapy
reducing isolation making feel like
making people feel like they're part of
a community and it can also provide a
sense of commitment in the case of
something like Alcoholics Anonymous
people are expected to continue
attending meetings even when they're
doing well and this commitment is seen
within their community so other people
can say you know why weren't you at this
meeting you know is something going on
what's happening did you have some issue
that maybe you you felt you couldn't
come to the meeting anymore and so the
sense of public commitment to
improvement and change can be beneficial
for many people but it's important
remember that these self-help groups and
support groups are often not run by
trained therapists or by trained
counselors and that means that not all
of the advice that's given is
necessarily going to be active accurate
or productive for all the members there
it's possible that there will be some
counterproductive advice some things
that aren't necessarily supported as
being the best practices for certain
symptoms or certain behavioral issues
and so it's important to keep that in
mind and it's also possible that these
groups can become insular so in the unit
on social psychology I talked about some
aspects of group behavior we talked
about things like group polarization
which is the tendency for groups to
become more extreme we also have
possibility of things like conformity
and groupthink occurring and groups may
in extreme cases become insular adopter
radical views and in real extremes they
could potentially even form cults around
certain practices because the group is
so isolated from others okay so those
are some other types of psychotherapy I
hope you found this helpful if so please
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you