Chapter 13

• The causes and treatment of psychological dis Therapy are included in the history of Therapy.
• The role biological mechanisms play in shaping normal and abnormal behaviors can now be appreciated.

• As we will see, even biomedical treatments can be influenced by these factors.

• The people who experience the psychological disorders discussed in Chapter 12 are more likely to seek treatment or therapy.
• We try to answer the questions in this chapter.

• Our ancestors used to attribute earthquakes, lightning, and thunder to evil spirits.
• A successful hunt could be seen as the work of good spirits.
• A person's strange behavior was often seen as the work of a demon that had taken control of the person's body.
• The elders were able to treat Oag.
• The question suggests earlier notions of demon possession.

• There were holes in the blood, phlegm, and yellow bile.

• In ancient Rome, people received treatments such as baths, exercise, and massage.

• Some people were accused of being witches during the 16th and 17th centuries because they may have suffered from psychological disorders.
• The body of an accused witch could be examined for signs of a pact with Satan.
• The "witch" was tortured and killed a lot.

• Some mentally ill people were put to death.
• Patients were kept in chains and slept on straw beds in institutions such as St. Mary of Bethlehem Hospital in London.
• Visitors could pay a penny to watch these patients.
• The hospital had disorganization, unsanitary conditions, and inhumane treatment of patients.

• In the 18th century, mentally ill people in Paris used to sit in the Tranquilizer chair.

• The attendants, or "keepers" as they were called, rarely showed com rush, and even administered punishment when they deemed it necessary.
• Philippe Pinel argued that these patients needed humane care and chair for patients suffering from treatment.
• His ideas were counter to the idea of mental hos mania.
• Many of Pinel's ideas were based on the work of Jean-Baptiste Pussin, a former patient of Pinel's who died in the hospital.
• Pussin got a job at a hospital in Paris after being discharged.

• He insisted that the staff should be kind and gentle, dismiss those who mistreated patients, and remove the patients' chains.

• After being named chief physician at another hospital, Pinel followed in the foot steps of Pussin and removed the patients' chains, directed the staff to treat the patients kindly, and stopped the use of bloodletting and punishment.
• The term did not suggest a moralistic con tent of the treatment, but rather a belief that a relaxed environment could change a person's behavior.

• Philadelphia's Pennsyl vania Hospital is the first general hospital in the United States with a separate unit for the mentally ill.
• Rush thought staff members would be friends with the patients.
• He restrained manic patients in his tranquilizer chair because he thought it was more humane than other restrains.

• The plight of homeless and dis institutions to treat people suffering from mental disorders became the concern of a former teacher who convinced many states to build 1887.
• She turbed people.
• Many examples of misery and horror were found in her survey of Massachusetts institutions that housed the mentally ill. She convinced legislatures in 20 states to establish or enlarge mental facilities with criminals.
• She spent time in hospitals.

• Massachusetts built larger institutions to handle more patients as the states assumed more responsibility for custodial care of the mentally ill.
• The use of restraining devices increased as the insti where mental y il patients were expanded.

• There is a mind that finds itself.
• The book is based on Beers's experiences in expanding the hospital for the mentally ill. His hands were covered in a canvas to build other facilities.
• She had a similar strategy in other states, where the sack was strapped to the man's wrists, making it impossible for her to use him.
• The early institutions presented her findings to the legislature.

• There is a different view of psychological disorders and their treat ment offered by the idea of animal magnetism.
• Mesmer believed magnetism could be used to treat patients.
• His techniques evolved into hypnotism.
• The idea that psychological disorders result from unconscious feelings and conflicts was developed by Sigmund Freud, who was an early advocate of hypnotism.
• At first he thought that hypnotism was the best way to deal with these feelings and conflicts, but he turned to other techniques when he realized that it wasn't as effective as he had thought.

• Freud was exploring the unconscious for clues to the causes and treatment of psychological disorders.

• This finding stimulated the search for biological causes of other psychological disorders, as well as the development of biomedical treatments such as psychosurgery and shock therapy, which are described later in this chapter.

• Despite the availability of new treatments, many institutions for the mentally ill seriously disturbed patients continued to be housed in overcrowded and understaffed.
• The populations of these hospitals began to decline in the 1950s.
• Drugs made it possible to decline in the 1800s.
• Many serious symptoms can be controlled with the use of restrains.
• With the time, there was a growing belief that community care was more effective than antipsychotic drugs.

• States could only involuntarily commit patients if they were judged to be dangerous to themselves or others or in need of treatment.

• There is a policy of discharging mentally and care.
• The population of mental hospitals decreased from more than 500,000 in the 1950s to less than 100,000 in 1995 despite a substantial increase in the overall population.
• By 1995 an estimated 90 percent of the people who would have been in institutions in the 1950s were living outside of them.

• The Community Mental Health Centers Act was passed in 1963.
• The law provided funds for the establishment of community mental health centers in which patients would be treated.

• The law helped finance community-based programs to prevent mental illness.
• Mental health professionals put more emphasis on preventing and treating psychological disorders.
• There are three forms of prevention: primary, secondary, and tertiary.
• Workshops on stress reduction or community recreation programs are possible.
• An example is a crisis telephone line.

• An after-care program for former patients of psychiatric hospitals is an example of how many people are homeless.

• The abuse of the homeless will need attention in the future.
• One in five children and teens suffers from mental health problems, and the number population, and the mental health needs of children and youth are escalating.

• Chapter thirteen is growing.
• The number of college students with mental health problems is increasing.
• Even though complete data on drug safety and long-term effects may be lacking, the prescriber of psychotropic drugs for children is on the rise.
• Hispanic psychologists are needed to work with the rapidly expanding Hispanic population.
• The need for general cultural com petence is a major issue in contemporary mental health services.
• It is difficult to lure professionals from urban centers to more rural environments, as there continues to be a long-standing need for psychologists in rural areas.

• Some people who seek therapy do not suffer from a psychological disorder.
• Some people need help to cope with lifestyle events such as job loss, school related difficulties, and family disagreements.

• The poster is intended to prevent a substance abuse problem from becoming a psychological disorder, and 15% received some developing.
• It is a good example of mental health service.
• Only 30% of people with a disorder have primary prevention.

• Half of the people who sought treatment were suffering from a disorder.
• Mental health services did not meet the potential need.

• The nature of the disorder is a key factor.
• The use of mental health services is high among people who have been diagnosed with a mental illness.

• A timeline of the history is more likely to be used for therapy.

• The importance of seeking treatment has been underscored by research.
• Each era is estimated in your timelines.

• It's important for people to seek treatment when they need it.

• Only 5% of patients receive in-patient care only, 10% receive a combination of drugs, psychosurgery, and hospital and outpatient treatment, and 85% are exclusively and electroconvulsive therapy outpatients.

• There are many different treatments for psychological disorders.

• The therapies use drugs that affect the brain to alter brain function and reduce symptoms.
• There are treatments based on the principles of learning.

• The primary means of achieving these goals is for a therapist to engage a client in discussions and interactions.

• Professionals and paraprofessionals provide psycho therapeutic services.
• There are people with a master's or doctorate degree in psychology and people with a medical degree and special training in Psychiatry, as well as self-designated therapists.
• Clinical and counseling psychologists, psychi atric nurses, psychiatrists, and social workers are some of the most common types of licensed psychotherapists.
• More and more states have granted prescription privileges to clinical psy chologists who have undergone additional training.
• The change was driven by a growing awareness of the limits of available ser vices for those with mental illness.

• A one-year internship in a mental hospital or community mental health center is included in their training.
• They take courses on the diagnosis and treatment of psychological disorders.
• They must meet state certification or licensing requirements that include an internship, a number of hours of supervised clinical work, and a national licensing examination.

• They may be members of the clergy or professional educators and trained to work with specific populations such as drug and alcohol abusers.

• Some people who claim to be counselors have little formal training.

• Usually, but not always, a two-year master's program is required.
• Two or more years of supervised work is usually followed by their training in therapy with couples and families.
• These therapists are trained to deal with family problems.
• Marriage and family therapists are allowed in some states.

• They treat a wide range of problems.
• In addition to drug and other medical treatments, they can use a full range of individual and group psychotherapies.

• Sometimes an M.D.
• is held.

• The largest group of mental health professionals.
• Most of them have a master's degree in social work.
• They may have private practices.
• State to state, licensing requirements vary.

• Counselors are social workers.

• Some practitioners who offer psycho Psychiatric therapeutic services have little or no training.

• Mental health continuing education is provided by members of several professions.
• Most health insurance policies pay for therapy.
• The largest group requires the services to be provided by licensed professionals.

• Regardless of the type of therapist, the American psychological association is the success source.

• The stages may blend or even occur at the same time.
• They don't have to happen at the same time for the therapy to be successful.

• They will look at any changes in the client over time to see how well the ther apy has done.
• Depending on what they decide, they may alter the therapy plan and/or begin working on some new goals that may not have been apparent at the start of therapy.

• The movement led to state chological disorders.
• Some people worked in custodial institutions.

• The community mental health movement has recommended treatments.

• Belief in demon possession was common during the 16th of drugs, as well as growing awareness of the ineffectiveness.

• The chains were removed from the mental state.

• There are two treatment categories for psychiatrists.

• They looked at the influence of the weather.

• Disorders in ancient Greece were seen as punishment by the gods.

• naturalistic explanations were offered for the disorders.

• The patients were placed in the community mental health movement.

• A mental health professional would have a medical in a hospital.

• Curita is overwhelmed with doubt, does not sleep well, and feels isolated from her friends and coworkers.

• Some forms of therapy focus on individuals.
• The therapist can be active or passive in some forms of therapy.

• Some psychotherapies try to help clients develop insight into their troubling behavior, while others try to change the client's distressing behaviors.
• Clinical psychologists are increasingly using elements of different therapeutic approaches in treating their clients.
• The approach has gained popularity because of the complexity of each client.
• The kind of therapy and the number of sessions a client receives have been impacted by managed care and insurance companies.
• There are two key characteristics of most forms of therapy.
• There is a special relationship between a distressed person and a trained therapist.
• The relationship is special because the therapist tries to create an atmosphere in which the son feels comfortable expressing important and often confidential information.

• Freud believed that the symptoms of psychological disorders are due to unconscious feelings and conflicts, especially those involving sexual or aggressive urges that conflict with societal prohibitions.
• The view of psychological disorders called for a new treatment approach that could uncover unconscious feelings and conflicts that were protected by defense mechanisms.
• Freud searched for ways to understand a patient's thoughts and feelings.
• The development of special therapeutic techniques and processes that are hallmarks of psychoanalytic therapy was required.
• We talk about four processes: free asso ciation, dream interpretation, resistance and transference.

• Freud used hypnotism as a technique for treating his patients after graduating from medical school.
• The treatment of maladaptive behavior is the center of the disorder.
• Psychoanalysts want to uncover unconscious beliefs that patients will reveal unconscious thoughts, conflicts and feelings and bring fears and desires.

• Free association gives clues to help a Freudian technique in which the patient is asked to identify hidden conflicts.

• There are two forms of dream content, manifest and latent, and they are distinguished by Freud's description of dreams as the royal road to the unconscious.

• There is a hidden version of the dream.
• The dream interpretation is done by the psychoanalyst.
• A man's dream of riding in the back seat of a car driven by another man is the manifest content.
• The Freudian attempts to uncover the deeper meaning of the dream.
• A possible interpretation of the dream is that the man wants his father to stop running his life.

• Patients were asked to report whatever came to mind without being told not to.
• The flow of words, thoughts, and images was halted often.
• If the therapy was to succeed, Freud believed the patient was close to significant information that needed to be uncovered.
• The cessation of associations might indicate that the defense mechanism is operating to protect the ego from the anxiety generated by the thoughts and feelings revealed through the associations.

• People undergoing therapy reveal associations.
• The therapist's confidential and emotionally wrenching information is to someone who just a short time sits out of the patient's line of vision.

• The bond between the patient and the therapist can foster strong feelings.
• Sometimes a patient transfers feelings about a significant person to the psycho analyst.
• The patient becomes a screen for feelings about other people.
• The psychoana lyst's responses to significant persons in his or her life are the basis of this transfer.

• It is difficult for researchers of psychoanalytic therapy to know when the essential elements of the treatment are present.
• The patient might reject the psychoanalyst's interpretation.

• The patient's analytic therapy is not effective with patients who have lost contact with reality.

• There are therapies that emphasize determination.
• Humanistic therapies try to reduce blocks to growth that can create a present and poor self-concept.
• Humanistic therapists believe that clients who are more accepting to solve their own problems will be better able to solve their own problems.

• Carl Rogers was dissatisfied with the form of therapy he used and created a completely different approach.

• Personal problems can arise when a person's ideal self differs from his or her real self.
• If a person trusts other people's evaluations instead of his or her own, there can be discrepancies.
• Rogers believed that people could cure themselves if they were in a caring and accepting environment.
• The goal of client-centered therapy is to provide an environment.

• People have an innate drive towards self-actualization.

• It is possible for clients to assume responsibility.
• Therapists don't ask questions, give advice or encourage clients to make decisions.

• The responsiveness of them helps the client understand themselves.

• Within a facilitating relationship, clients can resolve their own problems.

• The therapist respects the client as a person of worth.

• The key to successful client-centered therapy is the therapist's ability to create an regard for clients, is genuine, environment in which the client feels accepted and able to find solutions to his or her problems.

• Positive regard, empathy, and genuineness are some of the qualities that client-centered therapists show in their sessions.

• Therapists do not evaluate, judge, or create a cizing when they show positive regard.
• They listen to the client.
• Sitting back, listening, and not environment in which the client is offering advice may be difficult for some therapists; however, the act of offering advice able to find solutions to his or her problems conveys the message that the client cannot solve problems without outside help.
• The client feels at every moment.

• The dialogue shows how client-centered therapy proceeds.

• I'm not feeling well today.

I feel bad because I'm really 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609- 888-609-

• You're angry and feel like you can't do anything about it.

• He yells back louder if I yell at him.
• He keeps getting on my case if I don't speak up.

• You are between a rock and a hard place.
• You end up feeling bad no matter what.

• The New Yorker Collection 1991, a source of cognitive therapies, shows that a woman named "Gayle" storms into the office of the director of cartoonbank.com because she was upset with her therapist.

• The therapies were designed to change.

• The goal of cognitive therapy is to change distorted cognitives in order to get rid of maladaptive behaviors.
• The cognitive therapist's targets are the client's thoughts the therapist challenges and beliefs, which are more accessible than the unconscious feelings and conflicts that questions the client's irrational psychoanalysts seek to uncover.
• The techniques used by a cognitive therapist are more directive than those used by client-centered ideas therapists.
• Clients may not be aware of the targets of cognitive therapy until they are asked to confront their thought patterns.

• This principle has been around for a long time.

• The basis for rational-emotive behavior therapy was described by Albert Ellis.
• Suppose you see a job ad in the newspaper and think it's the perfect job for you.
• You apply for a job.
• Three weeks later, you get a letter telling you that your perfect job was offered to someone else.

• Ellis believes that failing to get a job shouldn't make you unhappy.
• If you think the situation is due to lack of ability on your part, you are on your way to negative consequences.
• It's not a reflection on your ability if you don't get the job because there were hundreds of applicants.
• The employer won't benefit from your hard work.
• You might feel different about the same event now.

• According to Ellis, we have a lot of irrational beliefs that interfere with our ability to perceive events.
• You can stop disturbing yourself about anything if you understand how you upset yourself by slipping into irrational shoulds, oughts, demands, and commands.
• Ellis identified several irrational beliefs based on his clinical experience.

• Rational-emotive behavior therapy is a very active form of therapy.
• I don't think clearly at the moment.

• Beck has devoted a lifetime to treating psychological disorders.
• They rely on cognitive distortions to maintain their negative views, and they often interpret events in ways that lead to self-blame.
• The distorted inter pretations and errors are caused by automatic thoughts that are contrary to objective reality.

• Although they are followed by unpleasant emotions, we are not aware of their influ ence on our emotional reactions.
• Beck's clients reported a variety of automatic thoughts, such as "I'm not capable of having any friends" that can intervene between outside events and son's emotional reactions.
• These thoughts become part of the way the person thinks when they are repeated many times.

• A person who only focuses on the negative aspects of an event and ignores the positive details is relying onselective abstraction.
• A student who focuses on a single error in an otherwise excel lent term paper becomes depressed.
• A generalization is made based on limited information.

• The salesperson concludes that the employee no longer wants to work with him in the future.

• A politician gives a rousing speech at the conclusion of a rally but mispronounces one word about himself.

• A college senior is looking for his first full-time job and has begun sending his resume to potential employers.

• The college senior believes that he will never have a good career.

• In magnifica ertheless, the teenager concludes that a person feels depressed because his car is close to being totaled.

• The teacher of the year in her son was a young professor who won a prestigious minimization.

• Take a moment to think about a situation that is close to home.
• You have taken many tests in school.
• An example of overgeneralization is when you get a poor grade on an exam.

• Your thought processes show overgeneralization if your conclusions are similar to these.
• You exaggerated the significance of a single incident for your life.

• Beck wants the depressed person to consider these automatic thoughts and cognitive distortions from a more scientific perspective.
• Chapter thirteen was adapted from Young, Beck, and Weinberger.

• Let's do an experiment to see if we can respond to automatic and designate pairs.
• Let's see what happens when you write on the same thought.
• See if the folded pieces of paper make you feel worse or better.

• That is the situation.

• I didn't hear the question right.

• I'm not perfect, so it's possible that I didn't express the feelings of one person as a therapist.

• I would still say that I made a mistake.

• We will have to watch the video.

• I did.

• The effectiveness of cognitive therapy and drug therapy for depression were compared.
• They found that cognitive therapy was at least as effective as antide pressant drugs.
• If cognitive therapy helps clients learn new skills that can be useful in warding off the return of symptoms, it may prevent the return of depression.

• Current factors such as reinforcers that are maintaining maladaptive behaviors are what behavior therapists focus on.
• The application of behavioral techniques to behaviors in nonclinical settings is behavior modification.
• Programs to reduce litter or increase the use of seat belts are examples of behavior modification.
• In clinical settings, behavior therapy involves applying behavioral principles to change maladaptive behaviors.

• Most behavioral techniques come from the work of psychologists.
• The most frequently used behavioral techniques are systematic desensitization, aversion therapy, modeling, extinction, pun ishment, and the token economy.

• The case of Little Albert was used to demonstrate how classical principles can be used to create an emotional response.
• Peter received his favorite food from Jones.
• The child's fear diminished as the pleasant feelings evoked by the behavioral technique became associated with the rabbit.

• A procedure that counteracts the relaxation with exposure to imagined scenes related to a fear of snakes is the first step in desensitization.
• Drug use has been used to counter anxiety, but progressive relaxation is the most popular choice.
• Most people can reach a state of calm that they may not have known they could achieve with instruction in progressive relaxation and practice outside of therapy sessions.

• The client and therapist work together to make a list of scenes related to the phobic object.
• It's possible that you walk into a room with a dozen snakes on the floor and hear the door lock behind you.
• The scenes are arranged in a hierarchy, starting with one that causes no fear and progressing to one that causes great fear.

• Write down a procedure that you think might work on the question.

• The scenes start with the one that causes the least fear and end with the one that causes the greatest fear.

• The plane made a stop at the terminal.

• For times and flight numbers, I call a travel agent.

• The day before the trip, I pack my suitcase.

• I entered the terminal with my bags in hand.

• I walk to the counter and wait for the agent to check my bags.

• I am waiting in the lounge for my flight to arrive.

• I enter the door of the plane after walking down the ramp.

• I sit in my assigned seat after walking down the aisle.

• I walk to the restroom when the plane is in the air.

• The seat belt signs are illuminated and the pilot is about to land.

• The plane is on the runway.

• There is a Copyright in 1995 by Joseph pear.

• The relaxed client is asked to imagine US (Antabuse) UR one scene at a time, starting with the scene that arouses no anxiety.
• There are scenes that create more and more anxiety when the client moves through the hierarchy.
• As the scenes are imagined, the client is likely to experience some degree of anxiety.
• When this happens, the therapist goes back to the instructions for relaxation in order to make sure the client is completely relaxed.
• The client learns that relaxation is associated with scenes for alcoholics.
• The repeated related to the phobias as he or she proceeds through the list to the scene that arouses the most fear.
• The nausea caused by the drug is replaced with more relaxed feelings as the fear is reduced or completely eliminated.

• More fear reduction is achieved with real objects than with imagined scenes, which is why some courts rely more on real objects.

• Although there is debate about the theoretical explanation of the success of systematic with alcohol to undergo this form desensitization, there is little doubt that it is very effective in reducing a number of phobias.

• Aversion therapy is based on classical conditioning principles and involves aversive stimuli.
• In treating alcoholism, a person is given a drug that will induce nausea.
• The sight, smell, and taste of the drink are followed by nausea.
• The alcohol and drug combination is repeated over and over again.
• The person may avoid alcohol in the future due to the nausea caused by the alcohol.
• There is a problem with this treatment when clients fail to take the drug.

• Aversion therapy can be used to reduce cigarette smoking, alcoholism, and sexual deviations.
• Only qualified personnel should carry out this procedure because it involves aversive stimulation.

• We may miss the potential of modeling as a therapeutic technique because it is so common.
• A per son procedure shows gradual contact with a feared object under controlled or protected circumstances.
• The client can engage in similar behaviors if they observe them.
• Albert Bandura explained the success of this therapy as the result of providing experiences that enhance the perception of self-efficacy.

• The behavior is likely to be zero under these circumstances.
• The amount of reinforcement that was given in the past affects the speed with which a behavior is extinguished.
• Intermittent or partial rein forcement schedules and larger reinforcements result in greater resistance to extinction.

• The use of extinction in the case of Bruce, Classical conditioning technique for reducing or eliminating behavior an institutionalized, severely retarded adolescent who constantly demanded his attention, was described by Richard Foxx.
• Bruce exposed himself in order to get their attention.

Are you one of Bruce's instructors?

• To extinguish a behavior, you need to know what reinforcer is maintaining it.
• Bruce's instructors believed that their attention kept this behavior going.
• They recorded the behavior for a week and found that Bruce engaged in it about 14 times a day.

• They told him to raise his pants without looking at him.
• On the first day of extinction training, Bruce exposed himself 30 times, on the second day he exposed himself 40 times, and on the third day he exposed himself 40 times.
• Bruce stopped exposing himself after two and a half weeks.

• Another procedure used by behavior therapists is punishment, which can be either the withdrawal of a positive stimuli (such as candy) or event or the presenta tion of a negative stimuli or event.
• When used as a technique for altering maladaptive behaviors, punishment can have serious drawbacks and is not always effective.
• Less distressing forms of treatment should be tried before punishment is considered.

• Some maladaptive behaviors are so resistant to change that they may be used as a last resort.

• A profoundly retarded girl hit herself thousands of times each day.
• One of the side effects of medication was that the girl cried.
• The hitting increased when the medication was stopped.
• Changing the dose did not change the behavior.
• extinction with no success was tried by psychologists.
• An electrical shock was delivered to the child's leg when she hit herself.
• The rate of hitting dropped so much that the psychologist was able to end the treatment.
• Over the next five years, there were only 250 hits compared to the 5 million that would have been anticipated.

• There are a number of factors that influence the effectiveness of punishment.
• She didn't find hitting herself to be aversive, but when control of the punisher was in the therapist's hands, it became aversive.

• A number of patients in mental hospitals lose their social skills.
• Social skills such as knowing how to greet another person and respond when spoken to are important for getting along outside the hospital.
• It is important for psychologists to reward patients for displaying skills immediately after desired behaviors occur.
• Patients can exchange their token for food once they have earned them.
• Poker chips, gold stars, and check marks can be called a token.

• It is unlikely that awarding poker chips will alter maladaptive behaviors.
• If you recall our dis reinforcers, you can redeem them in Chapter 6.
• Write down your answers and give these questions some thought.

• There are three important steps in establishing a token economy.
• The psychologist needs to identify the target behaviors and then establish contingencies for each of them.
• As soon as they are earned, points are usually awarded.
• The exchange rules for using the token must be set by the developer.

• Patients can exchange token for desired reinforcers such as candy, television time, and grounds privileges.
• Money is used outside the hospital in the same way that the token is used.
• Patients would lose their reinforcing value if psychol ogists used primary reinforcers to reward each occurrence of a desired behavior.
• Patients can accumulate them and exchange them later for the primary reinforcers they want, so they are less likely to lose their value.

• The behavior therapy techniques are summarized in the study chart.

• CBT has been used by clinicians for many years, but it always seems to be changing.

• The importance of understanding language and cognitive skills is emphasized in this theory.
• We either directly or indirectly associate words and events to form frames.
• When you were a child, you may have said the word "bee" and learned that bees are insects.
• You formed a frame that included the word "bee", seeing a bee and seeing an insect.
• If you are stung by a bee on a later date, you may fear seeing bees, but also fear hearing the word "bee" and seeing other insects, even though you didn't hear the word or see any other insects.
• Understanding and modifying human behavior is dependent on an understanding of language and cognitive skills.

• Write down your answer before you read further.

• Specific techniques have been developed to treat specific problems, which is the main reason for the large number of CBT techniques.

• This record can be used to provide information to the client and propose an intervention.

• It works well with obsessive-compulsive behaviors.

• The client learns how to test the validity of their thoughts.
• The goal is to bring the client's thoughts in line with reality.
• Depression and eating disorders can be treated with this technique.

• The therapist teaches clients how to observe their own thoughts without judging them.
• People with posttraumatic stress disorder often experience recurring trauma-related thoughts.
• One way to treat post traumatic stress disorder is for the client to learn how to not have these thoughts.
• This approach doesn't have very good long-term results.
• A more effective solution to the problem can be found in the fact that clients learn how to experience trauma related thoughts without judging them as good or bad.

• There are many other CBT techniques designed for use with specific disorders.

• A therapist and a client interact in most forms of therapy.
• Life outside thera pist's office may not reflect therapy sessions.
• A behavior therapist will not be able to reinforce appropriate behaviors, nor will a client-centered therapist be present to offer positive regard, because they are not likely to have a psychoanalyst available to offer interpretations of their actions.
• Problems that bring clients to therapists don't happen in a vacuum, they reflect the clients' difficulties in interacting with family, friends, coworkers, and even strangers.

• Group therapy can be used to treat a number of psychological disorders.
• It's useful in reducing stress and anger, as well as resolving difficulties in social behavior that can cause distress.

• Group therapies share many of the same features.

• Group therapy advantages are given by these features.

• One can tell the group about their problems and concerns.

• Being valued by the other group members is a feeling of belongingness.

• One's problems are not unique or more serious than those of other group members.

• Being able to relate in a constructive way to the group.

• Through the observation of other group members, the therapist can learn about themselves.

• It is possible to find out about one's behavior in the group setting.

• Different types of therapists can use group therapy, such as psychodynamic, humanis tic, cognitive, and behavioral therapists.

• Two forms of group therapy--marital and family therapy--are based on the assumption that problems presented for treatment should be addressed within a larger family unit.
• Therapists from all mental health professions use these therapies to treat a variety of problems.

• Sometimes a child is brought in for therapy for a specific problem, such as school difficulties, delinquency, or aggressive behavior, and the therapist finds that the problems exist in the context of the family setting, especially in the ways parents and children interact.
• The problems are not alleviated by returning the child to the family.
• Parents, spouses, and children should be involved in therapy for the client's problems.
• Incorporating spirituality into family therapy is beneficial to the treatment process according to a growing number of psychologists.

• A person who feels overwhelmed by life's problems may turn to friends, relatives, or teachers for help.
• There are other sources of assistance for people in need.
• The need for mental health ser vices was not met by therapists alone.
• Paraprofessionals can be found in a variety of roles, such as staffing telephone crisis lines.
• An estimated 7 to 15 million people are helped by the self-help group.

• Some self-help groups invite professional therapists to help with unusual cases, but most are run by laypersons.
• Compassion and understanding don't need advanced degrees according to a guiding principle.
• The people in these groups pool their knowledge.

• Self-help groups have the ability to prevent more serious problems by providing social support during a time of need and by helping people develop cope skills.
• For people suffering from specific medical conditions, for people facing acute crises, and for individuals with mental illness, some of the best known are designed.
• The parent of an adult child with a mental illness is a typical member of the National Alliance for the Mentally Ill.

• The oldest and largest self-help group is Alcoholics Anonymous, with over 1.5 million members worldwide.

• Two rapidly expanding sources of self-help are telephone- and Internet-based groups.
• Requests for information and emotional support are the focus of the electronic communications of online groups.

• Internet self-help groups can be found at times when traditional sources of support are not always available.
• John Grohol's PsychCentral is one of the Internet sites we recommend.

• Users of telephone self-help programs like the flexibility, accessibility, and autonomy afforded by telephone-based guidance for problems such as binge eating.
• Table 13-6 shows contact data for self-help groups.

• The managed health care system was brought about by the health care reforms of the 1970s.
• The quality of care in managed care of mental health ser vices has generated a lot of debate.
• It is easy for con sumers to use their home PC.
• The Internet is seen as a means to improve the bottom line by managed-care firms.

• The files of local self-help groups are maintained by most of the national organizations.
• Literature can be provided on the problem.

• There is a chapter on the internet for mental health services.
• Consumers need to be very careful about the services they receive on the internet.
• The information given by the pro-anorexia sites has the potential to be very dangerous.

• Mental health services on the internet aren't the only new forms of mental health service that come under close scrutiny.
• Some forms of therapy have been sensationalized and their presentation by the media may strain our credibility.
• The use of pets to reduce psychological problems falls into this category for some critics.
• According to advertisements featuring winsome puppies and kittens, having a pet can cure everything from loneliness to hypertension and heart disease.

• The presence of a pet dog kept blood pressure from rising, while the presence of the person's best friend increased blood pressure.
• A researcher was led to investigate further after finding something odd.
• People who were experiencing a stressor in the presence of other people had large increases in blood pressure.
• The people who only had their pet present showed slight increases.
• Researchers conducted a study in which half the participants were randomly selected to adopt a pet cat or dog from an animal shelter.
• The participants were stockbrokers with high blood pressure.

• The participants had not owned a pet in the previous five years.
• The partici pants were supposed to begin drug therapy with a drug that reduces resting blood pressure but does not reduce responses to stress.

• Pets provide social support, according to the results.
• Indi viduals who acquired pets had blood pressure increases that were less than half the increases of their counterparts without pets, despite the fact that Lisinopril reduced resting blood pressure in all participants.
• People who reported the least social contacts benefited the most from their pets.
• Independent mechanisms affect resting blood pressure and stress-related blood pressure.
• Adding a pet to the environment can affect stress responses and affect resting blood pressure.
• Pets can be a healthy pleasure for people with few social con tacts.

• Maybe pet therapy should be considered more seriously by the scientific community.

• The primary reinforcers can use the token.

• The occurrence of maladaptive behaviors is reduced by Mari.

• Judy's therapist doesn't say anything about evaluating or judging her.

• The therapy is based on what happened in our sessions.

• There are many reasons why these questions are hard to answer.
• It is difficult to define what success is in therapy.
• It's difficult to know when a person has insight.
• Second, therapies can be used to treat a wide variety of problems that have little in common.
• When people seek therapy, they make a decision to change an aspect of their lives that may differ from one person to another.

• The first major study of the effectiveness of therapy was published in 1952 by a British psychologist.
• More than 8,000 clients with moderate to severe disorders received either psycho analytic therapy, eclectic therapy or no therapy.
• According to Eysenck, the results show that roughly two-thirds of a group.
• The publica tion of Eysenck's report caused a furor, and his review was subjected to many appraisals.
• Critics noted that the therapists who had published the studies Eysenck reviewed had different goals and orientations in evaluating ther apy and probably used different criteria when judging success.
• Eysenck reviewed some studies and it appeared that he had overstated the rate of remission.

• According to the results of several meta-analyses,psychotherapy is generally effective, although we are unsure as to why.

• Their effectiveness is supported by testimonials from satisfied clients, which should give us pause.

• It's not surprising that culture, ethnicity, and sex have profound effects on our behavior, values, and attitudes.
• In Japan, a therapy called "look within at oneself" is used to discover how a client has been troublesome to people who have extended themselves, such as parents and teachers.
• The primary goal of the therapy is to find ways for the client to show gratitude and alliance with these people.
• We can't fully understand this therapy if we don't know Japanese culture, in which the focus is on the group rather than the individual.

• The United States is a multicultural nation with a variety of ethnicities.
• Patterns of therapy are affected by this reality.
• In the United States, ethnic minority group members don't use or provide psychotherapy in the same way that the population does.
• Do not confuse this pattern of use with the need for emotional help.
• A higher proportion of poverty and social stressors can contribute to psychological disorders.
• Men tal health services for U.S. minority groups are not good.
• African Americans, Native Americans, Asian Americans, and Latinos average fewer sessions of therapy than whites.
• Between 42% and 45% of minority clients failed to return after a single session, compared with 30% of white clients.

• It is necessary for intimate conversations between socially distant people.
• Communication patterns that are similar to their own and respectful of their values are what clients want.
• Many ethnic groups and cultures don't allow intimate conversations with family members.
• Formal and polite but non revealing patterns of communication are used with outsiders.
• Latino clients are more comfortable with a therapist with the same sex or ethnic background.

• Chapter thirteen clients use Spanish at home and English in therapy.
• Clients may see the relationship as similar to previous formal relationships that minimized self-disclosure because of the formality of the therapy situation and the therapist's use of English.

• Language differences between therapists and clients can affect treatment.
• The way the client and therapist relate is influenced by identification with the therapist.

• Clients may seek therapists of the same ethnic group, race, and sex because they anticipate a feeling of shared values and understanding that will make them more comfortable in revealing intimate details of their lives.

• A lack of bilingual therapists and therapists' stereotypes about ethnic clients is one of the reasons why ethnic clients end therapy early.
• The most important reason is that therapists don't provide culturally responsive forms of therapy.
• They might be unaware of values and customs within a culture that would help them understand and treat certain behaviors.

• A Latino went through training at the suggestion of his therapist.

• The young man got a negative reaction when he asserted himself with his father.
• In this case, proper respectful behavior toward one's father was included in therapy.

• Some psychologists suggest that therapists develop cultural understanding and knowledge in order to counter the high rate of early termination of treatment by minority clients.
• Ethnic-specific therapeutic services and therapists from diverse ethnic background are needed.
• There is a need for more bilingual and bicultural personnel who can work with clients from different cultures and those for whom English is a second language.
• Sue and his colleagues looked at the services, length of treatment, and out comes of therapy for several ethnic groups in Los Angeles.
• The length and success of treatment for Mexican Americans was related to ethnic match.
• When the therapist had the same ethnic background and spoke the same language as the client, treatment was more likely to last longer and be more successful.
• Matching is important because of the length of treatment.

• The ethnic and racial diversity of the U.S. population has led therapists to consider these factors in providing treatment.

• The use of the humanistic approach provides a safe, open, and caring relationship with gay and lesbian clients.
• Therapists should be sensitive to the physical limitations of elderly clients.

• A range of considerations should be used to answer the question.
• People may decide to enter therapy for a variety of reasons.

• If you answer yes to any or all of the questions, you may want to consider entering therapy.
• One of the best ways to start is to get recommendations from people you know.
• It is a good idea to call the mental health center in your area.

• The majority of clients don't anticipate lengthy treatment.
• Long-term therapy doesn't offer much to patients who need immediate intervention.
• Short-term therapy is carried out in fewer sessions.
• The therapist states at the beginning of therapy that there will be a fixed number of sessions.
• removal or reduction of the client's most troubling symptoms are some of the goals of short-term psychotherapy.
• Clients should be prepared to listen to suggestions for changes in their behavior, as the new short-term forms of psychotherapy are quite active.
• The therapist may give the client homework assignments such as analyzing emo tional reactions or practicing relaxation techniques because of the limited time.
• The client and therapist can use their limited time together.
• As therapies have become shorter and more active, the image of the client on a couch has become outdated.
• The majority of therapy programs involve 12 or fewer sessions.

• We live in a culture that encourages us to make changes in our lives.
• New forms of therapy for both old and newly discovered problems are promoted on the talk shows.
• It would be helpful to know if the change you are considering is feasible.
• Some problem behaviors are more difficult to change than others.
• Some behaviors are hard to change because of our biology.
• If you have this kind of information, you can assess your situation and decide if you like yourself the way you are.
• It is possible to save yourself from the self-reproach and remorse that often accompany failed efforts to alter problem behaviors.

• Stigma is a final concern about beginning and continuing therapy.

• Many people who would benefit from mental health services opt not to pursue them or fail to fully participate once they have begun.

• The first goal of the New Commission on Mental Health is to understand that mental health is essential for good physical health.
• Hopefully, antistigma programs will be developed that will enable everyone who is in need of professional mental health services to benefit from them without fear.
• Our country will only be able to achieve this goal if there are certain circumstances.

• Asking a number of studies should be part of the decision to enter therapy.
• Using this technique, researchers have questions about the degree of distress one is experiencing; one's found that therapy does lead to greater improvement than no ability to cope with that distress; and the effect of the symptoms treatment and that differences among the various forms of ther on oneself, one' Current forms of psy apy are not very good.

• The influ treatment is becoming more understood by therapists.
• There are ethnic and cultural factors that can affect the outcome of a therapy.
• Members limit what behavior can be changed.

What impact did their approach have?

• Carol has a fear of enclosed spaces.

Does the drugs work or are they safe?

• Every breath you take, every word you utter, every experience you have-- the brain plays a crucial role.
• The proposal that altering the brain may be useful in treating psychological disorders is not radical.
• The use of psychotropic drugs has been hailed as a breakthrough in treating psycholog ical disorders.
• Drug therapies can have harmful side effects.
• Several therapies for psychological disorders are described in this section.

• In Chapters 2 and 5, we learned that neurotransmitters have powerful effects on behav ior, emotions, and thinking.
• Drugs affect neurotransmitter levels and can be used to treat psychological disorders.
• Several states have passed laws that allow specially trained psychologists to prescribe certain drugs for the treatment of mental health disorders.
• Drug therapy focuses on the biology of a disorder.
• The drugs most frequently prescribed to treat psychological disorders are examined in this section.

• Several of the disorders discussed in Chapter 12 are caused by anxiety.
• Antianxiety drugs are often prescribed to treat generalized anxiety disorder, and they are also used to treat other conditions.

• The amount of time it takes for a drug to act in the body is one of the differences between drugs in this class.
• Valium is 10 times stronger than Librium and will affect the body about an hour sooner.
• Valium can be used to treat the symptoms of alcohol withdrawal when quick action is needed.
• The drugs increase the ability of GABA to bind to thereceptors in the brain.
• The increase in the firing of inhibitory neurons lowers the level of neurological activity that pro-duces anxiety.

• A large amount of the drug is needed for a lethal overdose.
• The respiratory centers of the brain are unaffected by Benzodiazepine drugs.
• Depression can be caused by combining antianxiety drugs with alcohol or other drugs.
• Patients with toler Minor tranquilizers need larger doses to maintain their initial effect.

• Most patients who take antianxiety drugs every day for several months run the risk of anxiety, which will be followed by withdrawal symptoms if they stop ability of the neurotransmitter GaBa taking the drugs.

• Significant strides have been made in the treatment of depression.
• Antidepres sant drugs are the most frequently prescribed drugs in the United States.
• The increase is due to the increasing number of disorders for which antidepressants are prescribed.
• There are three main classes of antide pressant drugs.

• The drugs in this class make more of the chemical messengers available at syn apses.
• 10 to 14 days usually pass before there is a reduction in the symptoms of depression.
• Constipation, dizziness, and dry mouth are some of the side effects of anti depressants.

• The MAO breaks down the neurotransmitters before they can be used again.
• The levels of drug increase when MAO is blocked.
• A second class of drugs is used to treat depression.

• If you don't respond to tricyclic antidepressants, you may be switched to one of the MAO inhibitors.
• The side effects of MAO are similar to those of the tricyclic antidepressants, but they tend to be more serious.
• If taken at the same time as tyramine, MAO inhibitors can cause a dangerous rise in blood pressure.
• High levels of tyramine can be found in any food product or drink that involves aging.

• People who are taking an MAO inhibitor are warned not to drink or eat alcoholic beverages.

• Many drugs have side effects that range from annoying to life threatening.
• There are many side effects of tricyclic antidepressants.
• Prozac is the most widely prescribed drug for the treatment of depression.
• A low rate of short-term side effects is one reason for its popu larity.
• It is not certain that Prozac is superior to other drugs used to treat depression.
• Prozac is prescribed for a growing number of problems, including obsessive-compulsive disorder, panic disorder, and anorexia nervosa.

• The most popular mood stabilizer is lithium.
• 70% to 80% of patients respond to lith ium treatment within 5 to 14 days.
• When symptoms of ma nia or depression are no longer present, it's not uncommon for patients to continue taking the drug.
• As many as 50% of patients do not respond to treatment.

• There is a small margin of safe use of lithium.
• The toxic level in the blood required for effective treatment is close to the level that can cause symptoms such as vomiting, nausea, and even death.
• Patients need to have blood tests to check their levels.
• Side effects of therapeutic levels of lithium include hand tremors, excessive thirst, and excessive urination.

• A number of mechanisms have been proposed to explain the reduction of mood swings.

• The search for other treatments continues because some patients do not respond adequately to lithium therapy.

• Anticonvulsant drugs are especially effective for the rapid-cy cling form of bipolar disorder, which can occur four or more times in a year.

• Henri Laborit, a surgeon in France, noticed that a new anestic soothed his patients without causing them to lose consciousness.
• David Sipress was persuaded to try the drug on patients with schizophrenia.

• The development of schizophrenia is thought to be linked to dopaminergic sites in the brain being occupied bypsychotic drugs.
• Nerve con duction is reduced when these sites are occupied.
• Antipsychotic drugs are more effective at decreasing positive symptoms such as delusions and hallucinations than they are at reducing negative symptoms.
• Schizophrenia and other psychotic disorders are not cured by drugs, but they are effective in controlling many of the symptoms.

• A major change in the treatment of mentally ill patients was the development of antipsychotic drugs.
• Many patients stop taking their medication because of movement disorders.
• Anti psychotic drugs can cause a chronic and sometimes irreversible effect.
• People with brain damage or diabetes are more likely to develop tardive dyskinesia.
• This condition can be seen in its early stages if the symptoms develop gradually.
• Reducing the dose of the antipsy chotic drug to the lowest effective level is one of the changes in treatment.

• About 30% to 40% of patients with schizophrenia don't respond to typical drugs.
• clozapine has effec tiveness in some patients who do not respond to other drugs, and it also has low rates of tardive dyskinesia.
• Drugs that reduce the symptoms of the bone marrow to produce white blood cells can leave individuals of schizophrenia vulnerable to infections.
• Patients who take clozapine must have weekly blood tests to determine if their white blood count is within normal limits, because this problem occurs in about 1% of patients.
• Clozapine is only recommended for use in patients who have not responded adequately to two or more typical psychotic drugs.
• The history of the drugs shows that they are free of risk.

• There may be differences in the response of drugs used in drug therapy and psychotropic drugs.

• Ethnicity and culture can affect a person's writing of a song or a poem in a way that makes them respond to drug treatment.
• When Keh-Ming Lin came up with an acronym.

• Lin and his colleagues are investigating ethnic differences in response to drug treatment for psychological disorders.
• There are group differences in the concentration of a drug in the blood after taking the same dose.
• The different response to drug therapies may be caused by ethnic differences.
• East Asian patients with scurvy need lower doses of Haldol to get an optimal response.
• The side effects of antipsychotic drugs become evident in East Asian patients at lower doses than in Caucasian patients.
• Similar responses were found in American- and foreign-born East Asians living in the United States, which does not seem to result from lifestyle factors.
• East Asian men seem to be more sensitive to the drug Xanax, which is used to treat anxiety and panic symptoms.
• East Asian patients have higher levels of Xanax and Haldol in their system than Caucasian patients do.

• The results suggest that East Asians may need lower doses than Caucasians.
• The same effects can be achieved with lower doses of tricyclic antidepressants and lithium.

• There may be differences in the number of drugreceptors in the brain, the effects of enzymes in the body, or the way the body metabolizes drugs.
• Regardless of the causes of the differences, remember that the ultimate goal of this research is not to stereotype any individual or group; rather, it is to provide more appropriate treatment for all individuals suffering from psychologi cal disorders.

• The answer is important in making treatment decisions, but the question is not easy to answer.
• The FDA's 1977 guidelines limited the inclusion of women of childbearing potential in drug studies until the drugs had been tested on animals and shown to be effective in men or older women.
• The FDA replaced the earlier guidelines with new ones requesting the study of sex differences.

• Drugs that are taken by the oral route are more likely to be metabolized by the stomach than through the kidneys.
• Less than 10% of a drug can reach the brain.
• There may be differences between women and men at any of these steps.

• Women tend to have higher levels of a drug in their blood streams because they weigh less than men.
• Complicating the picture is the hormones estrogen and progesterone, which slow down the emptying of the stomach, which can lower the amount of a drug that reaches the brain.

• Women can require more drugs than men.
• Women often need lower doses of these drugs.

• Sex differences are not easy to categorize; sometimes women need higher levels of drugs than men do, and sometimes they need lower levels.
• More information about sex differences in determining the appropriate levels of drugs will be made available by the FDA guide lines.

• The drugs used to treat psychological disorders are summarized in Table 13-8 The increased use and effectiveness of drugs heralded a new era in treating psychological disorders, according to proponents of drug therapy.
• They think that drugs are used more frequently and quickly than psychotherapy is.

• Drugs can make some patients more manageable for therapists and hospital staff.

• They can't replace lost social skills or teach patients how to interact.
• Drug therapy combined with efforts to enhance patients' social skills and to assist family members in dealing with former patients have shown promise.

• Many psychotropic drugs reduce the symptoms of various psychological disorders, however, they are also associated with side effects.
• The adverse effects of antipsychotic drugs can include tardive dys kinesia.
• If the drug is withdrawn, the symptoms can get worse and there can be a return of symptoms.
• A study found that half of the patients with schizophrenia who were taking antipsychotic drugs relapsed when they were stopped.
• Researchers suggest a program of slowly reducing the dosage to the lowest effective level that controls the symptoms because half of the patients did not suffer a relapse.

• A man with a mental illness was found wandering through a train station.
• They sent him to two psychiatrists who were experimenting with a new procedure to induce seizures.
• Seizures were thought to be beneficial.
• The psychiatrists applied an electrical current to the man's head, which caused him to have a seizure.

• The man appeared to recover from his seizure after the third one.

• Some patients suffered broken bones and a few died when ECT was first used.
• It has been stigmatized due to past misuse and over use.
• ECT is a successful treatment for severe depression, especially in cases that have not responded to antidepressants, according to repeated evaluations.

• ECT was modified to reduce the more serious side effects.

• The brain is attached to the patient's head to induce a seizure.
• In bilateral ECT, the electrodes are attached to each of the patient's most often used to treat severe temples, while in unilateral ECT they are attached to one side of the head.

• Before the 1950s, the equipment used delivered longer bursts of electricity.
• The current causes a convulsion which should last at least 25 seconds.
• For a total of 8 to 12 treatments, the recommended procedure is 3 treatments per week.

• It was reduced to no more than three times a week.

• Typically 10 or fewer sessions are reduced from up to 20 sessions.

• Previously there were no anesthetics or muscle relaxants used.

• Both brain waves and the electrical functioning of the heart are monitored through eeG and eKG.

• On both sides of the head, but now on the nondominant side only or on the left side of the forehead.

• The patient is about to be treated.

• Give these questions some thought and write down your answers.
• After undergoing ECT, patients are confused, do not remember what happened, and may experience memory impairment for about an hour.
• The process of consolidation is crucial to the formation of long-term memories and is disrupted by the electrical shock.
• The brain hemisphere that is responsible for language is usually not administered to the brain hemisphere that is used for ECT.
• There is concern that ECT may not be as effective as bilateral treatment.

• The application of electrodes to a person's skull to induce a seizure as a form of therapy has been controversial.
• Critics question the treatment because it looks like punishment and they wonder if ECT harms the brain.
• Researchers were not able to provide answers to questions about the effects of ECT on the brain because they did not have data on the condition of the patient's brain.
• Before and after administration of bilateral ECT, they have obtained magnetic resonance images.
• There is no evidence of brain changes a few days or six months after the treatment.

• Although this finding is encouraging, it can't tell us if ECT causes subtle changes that aren't seen by the magnetic resonance machine.

• Patients who have undergone ECT treatments tend to improve, often remarkably, after several treatments and are typically prescribed antidepressants as part of their continuing treatment.
• The reason for the effectiveness of ECT is not known.
• It has been suggested that ECT increases the levels of several neurotransmitters in the brain.
• The changes that occur with drug treatments are similar to the biochemical changes that reverse depression.
• The effects of ECT on the central nervous system and hormone levels may be responsible for lifting the depression.

• This depiction is not science fiction.

• In 1935, Egas Moniz, a Portuguese neurologist, suggested that psychological problems might be caused by what he termed "reverberating circuits" in the brain.
• Moniz proposed a simple surgical procedure to break these circuits.
• When Walter Freeman, a neurosurgeon, read an article by Moniz and decided to try the procedure in 1936, psychosurgery found its way to the United States.
• There was nothing compelling about any of Moniz's arguments that should have persuaded a prudent man to attempt psychosurgery.

• There were no alternative treatments for the thousands of chronically ill patients in overcrowded hospitals.
• These procedures were evaluated by surgeons who were enthusiastic about them.
• Dramatic changes in a few patients were widely reported; some patients who were given local anesthesia reported symptom relief.
• Without doing anything close to a scientific examination of the procedure, the doctors performed it and advocated its widespread use.
• More long-term evaluations were conducted.
• There were studies that were less enthusiastic about psychosurgery.
• Drug treatments in the 1950s provided a less drastic alternative to psychosurgery.

• Psycho surgical procedures are more refined than before, but are rarely performed and only as a last resort.

• Some cases of obsessive-compulsive disorder are so serious and unresponsive to drug or behavioral treatments that patients seek a surgical alternative.

• A bundle of nerve fibers that play a role in the obsessions and compulsions is cut by a surgeon in both operations.
• Although this surgical procedure has reduced symptom severity in some cases, most patients exhibit little, if any, change as a result of this surgery and the operations have what has been termed a substantial risk of adverse effects.

• The brain is one of the three categories of drugs used to treat depression.
• The drugs are more effective at reducing positive tricyclic antidepressants.
• MaO inhibitors prevent the breakdown of the adverse reaction.

• There are modified procedures for administering eCT.