Therapy of Psychological Disorders--论文代写范文精选

然而,即使很难接受,声称暴露疗法使患者理性思考。它似乎不合理的,正常的成年个体认知发展会突然觉得公共场所可以是危险的。下面的essay代写范文进行详述。

Abstract
Despite striking differences in theoretical backgrounds and techniques, various forms of therapy are effective in treating neuroses (see review by Rofé 2000, Chapter 7). This section aims to integrate these findings into PBTs theoretical framework by showing that the efficacy of a therapy depends on its ability to undo those factors, which according to PBT originally motivated the adoption and maintenance of the symptoms.

Exposure therapy: Exposure therapy is the most effective treatment for certain anxiety disorders, such as agoraphobia and OCD (see Rofé 2000, Chapter 7). Although it is a behaviorist technique, developed following experimental studies with animals, research evidence indicates that its efficacy is the consequence of cognitive, rather than conditioning processes (e.g., Hoffart 1993; Rofé 2000, Chapter 7). However, it is even difficult to accept cognitivists explanation, claiming that exposure therapy re-educates patients to think rationally. For example, it does not seem plausible (without assuming the existence of uncontrollable mechanisms such as the unconscious or neurochemical changes) that adult individuals with normal cognitive development would suddenly think that a public place such as a supermarket could be dangerous, and then need the assistance of a therapist to educate them to think otherwise. Indeed, a large body of evidence argues against the validity of both behavioral and cognitive explanations regarding the development of anxiety disorders (see Rofé 2000, Chapter 2) and the therapeutic efficacy of exposure therapy (see Rofé 2000, Chapter 7).

As an alternative, PBT suggests that exposure therapy invalidates the patients self-deceptive belief. Patients are exposed to situations that challenge their beliefs (e.g., supermarkets and dirt) but are not allowed to exercise their ritualistic escape behavior that produces the deceptive proofs that would revalidate their deception (see Figure 1). Since exposure continues until anxiety is reduced, patients are inevitably confronted with extrospective observations of normal behavior and introspective experiences of self-control, which invalidate the self-deceptive belief. Hence, since a state of unawareness cannot be maintained without the self-deceptive belief, the symptom loses its distractive value. Unless patients employ self-deceptive excuses to defend their self-deceptive beliefs (e.g., see Hoffart 1993) they will have to abandon the symptom. Although cognitive therapy also claims that exposure therapy invalidates the patients belief (see Rofé 2000, Chapter 7), there is a striking difference between the two theoretical paradigms. Cognitivists view anxiety disorders as reflections of irrational mechanisms, claiming that exposure therapy repairs patients maladaptive thinking. In contrast, PBT defines these behaviors as rational coping mechanisms and asserts that exposure therapy simply prevents patients from utilizing their rational resources for maintaining their self-deceptive belief that their behavior is out of their control.
 
Cognitive Therapy: Cognitive therapy, the most effective intervention for panic disorder (Clark 1988; Rofé 2000, Chapter 7), focuses patients attention, using either verbal or experimental procedures, on the sequence of bodily sensations and catastrophic misinterpretations. The patient is then led to conclude that the sensations are not themselves dangerous, its just what you think about them that can make them frightening (Salkovskis et al. 1991, pl. 163). Thus, cognitive therapy increases patients awareness of the catastrophic misinterpretation of bodily sensations and confronts them with evidence that is incompatible with the belief that these sensations signify a cardiovascular disease (e.g., Clark 1988). In contrast, PBT contends that the misinterpretation is deliberate, aiming to provide deceptive proof for the self-deceptive belief of heart disease. Accordingly, when cognitive therapy focuses patients attention on the harmless nature of their bodily sensations, it sabotages the apparent reality basis of patientsself-deceptive belief. Consequently, as with exposure therapy, patients are unable to maintain their state of unawareness in the absence of a self-deceptive belief. Hence, the symptom loses its distractive values and patients are motivated to abandon it.
 
Psychoanalysis and religious therapy: Both exposure and cognitive therapy confront patients with specific stimuli that can experimentally challenge their self-deceptive belief. However, it is not always possible to challenge patients beliefs by reality testing, as with MPD and spiritual possession where patients attribute their symptoms to the unconscious (e.g., Spanos et al. 1985) and supernatural forces (e.g., Pattison & Wintrob 1981), respectively. In these cases a more effective method for sabotaging the patients deceptive endeavors is a therapeutic ritual (e.g., psychoanalytic techniques or religious ceremonies) conducted by a prestigious therapist (or healer), to whom the patient attributes the ability to undo the underlying maintaining forces(e.g., repressed traumas or evil spirits). Consequently, when the deceptive therapeutic ritual is completed patients are left with no deceptive measures to preserve a state of unawareness. As a result, the symptom loses its distractive value and patients are thereby motivated to abandon the symptom. This theoretical approach may explain the fact that while psychoanalysis is a less ineffective therapy for anxiety disorders than behavioral therapy (e.g., Eysenck 1994), psychoanalysis constitutes the most effective intervention for MPD (e.g., Kluft 1987; Putnam & Loewenstein 1993). Similarly, it is no wonder that religious figures, are effective therapists for spiritual possession or situations where patients believe that their maladaptive behavior is controlled by supernatural forces (e.g., Hoffman et al. 1990; Pattison & Wintrob 1981; Wijesinghe et al. 1976).

Thus, there seems to be one common mechanism for all the aforementioned therapeutic methods (exposure, cognitive, psychoanalysis and religious therapy). They all motivate patients to abandon the symptom by diminishing its distractive value. This is achieved either by invalidating the self-deceptive belief through a reality-testing technique or nullifying its deceptive value via deceptive ritual therapy.

Undoing controllability
Another type of therapeutic measure that may motivate patients to abandon the symptom is behaviorist technique that nullifies the symptoms controllability value. For example, while soldiers are more likely to develop deviant behaviors when the symptom allows escape (i.e., the soldier is evacuated and treated behind the military zone; Dohrenwend & Dohrenwend 1969; pp. 114-115), they are less likely to do so when the controllability value of the symptom is reduced by treating the patient in close proximity to the combat zone (Solomon & Benbenishty 1986).

Another example is extinction procedures, which nullify the symptoms ability to manipulate the social environment to comply with patients demands for attention and social rewards. Although these techniques were also employed with anxiety disorders such as OCD (see Rofé 2000, p. 229), they were typically used with conversion disorder (e.g., Blanchard & Hersen 1976; Goldblatt & Munitz 1976) and anorexia nervosa (e.g., Touyz & Beumont 1997). The reason for this might be that unlike anxiety disorders, in the case of the latter two disorders it may be easier to undo the controllability value of the symptom rather than to challenge the patients self-deceptive belief.
 
Undoing motivational factors
In light of PBTs assumption that the emotional function of bizarre behavior is primarily to relieve depression and studies indicating that depression is characteristic of all types of neuroses (Rofé 2000, pp. 105-106), it is not surprising that antidepressants are an effective therapeutic measure (Rofé 2000, pp. 249-251). This theoretical approach, which views drugs merely as pain relievers, is no less plausible than the biological theory which regards neurosis as an organic illness and accounts for the therapeutic effects of medication in these terms. Not only does this approach lack supporting evidence, it is also confronted with theoretical difficulties (Rofé 2000, Chapter 3). For example, biological concepts would not only have difficulty explaining the success of psychological interventions in treatment of neuroses, but even more so their superiority to drug therapy (Rofé 2000, pp. 68-69, 75-76; and Chapter 7).

Another therapeutic method that deals with underlying motivational factors (i.e., depression and stress) is coping skills training (see review by Rofé 2000, pp. 222-226; 229-233). Most studies examined the effect of this method in combination with behavioral-cognitive methods, such as exposure and extinction/punishment procedures, which treat the symptoms, rather than their underlying cause. Although coping skills training alone can result in significant therapeutic effects, the aforementioned evidence suggests that this method is most effective when combined with symptomatic treatment. Apparently, patients are so comfortable with the coping benefit of their symptoms that they do not feel the need to improve their coping skills. However, once therapy undoes the controllability or distractive value of the symptom, the utility of the coping skills training is much greater, providing patients with the alternative that they might then need. 
 
Undoing unawareness: Insight therapy
In some cases, patients can be motivated to abandon the symptom by therapeutic techniques that induce insight regarding their self-involvement in adopting and maintaining the symptom. For example, Symonds (In Merskey 1979) told his dissociative fugue patients I know from experience that your pretended loss of memory is the result of some intolerable emotional situation (pp. 264-265). The therapist further stated that if the patient would tell the whole story he would respect the patients confidence, even to the point of telling the patients doctor and relatives that he or she has been cured by hypnotism. Symonds reported that all of his subjects admitted to having faked their symptoms.

It is unlikely that Symonds method would be effective in inducing insight in other types of neuroses, such as anxiety disorders, where the self-deceptive belief is more strongly established (see Rofé 2000, pp. 203-204). In these cases, a more lengthy and sophisticated intervention, gradually focusing patients attention on their self-deceptive maneuvers and causing awareness of current underlying stressors, may result in an effective therapeutic outcome. Such a direction is especially relevant, as it lends itself to empirical testing of PBTs theoretical claims (see Rofé 2000, pp. 320-322).
 
Variability of therapeutic efficacy
The above discussion only addresses the variability between different therapeutic methods, but not the variability in the efficacy of a given therapy. For example, while early behaviorists (e.g., Giles 1983) optimistically predicted that the prospect of success would be between 89.5% and 94.2%, the success rate is much lower than expected. About one third of patients in exposure therapy for agoraphobia and OCD either drops out, fails to improve or experiences a relapse. Another third demonstrates a moderate improvement and only about one third displays a high level of improvement. A similar trend is found for cognitive therapy, extinction/punishment therapy and drug treatment (Rofé 2000, Chapter 7).

Patients who demonstrate a moderate improvement choose a more sophisticated way to cope with the therapists threat to their pathological coping mechanism. As specified above, bizarre behaviors are displayed not only when patients are exposed to stress, but also in situations where no coping response is truly needed. These include belief challenging conditions and intervals between episodes, which motivate the patient to display the symptom in order to preserve the validity of their deceptive belief. Thus, following therapy, patients who still need the symptom can continue to display it when confronted with stress and avoid doing so in the latter two situations, utilizing the therapy to rationalize the reduction in their symptomatic behavior.Only a minority of patients, about one third, shows a high level improvement in response to treatment such as exposure therapy. Research data indicate that these patients include those equipped with better coping skills who can manage without the bizarre behavior when the symptomatic treatment undoes the coping value of these behaviors (Rofé 2000, Chapter 7, pp. 221-222).
 
Spontaneous Remission and Placebo
The underlying mechanisms of spontaneous remission and placebo remain unclear, despite theoretical efforts to explain these phenomena in mechanistic terms (see review by Eysenck 1994). This inadequacy is demonstrated by the following two case studies. In one case, agoraphobic symptoms were suspended for about three months when the patient left her husband, resurfaced when they were reunited and then permanently disappeared after divorce (Wolpe 1982, pp. 286-287). The second case was reported by Carl Gustav Jung (1963). In an attempt to demonstrate to his students the effects of hypnosis, Jung had informed a middle-aged female patient, who had been suffering from painful paralysis of the leg for seventeen years, that he was going to hypnotize her. Without any hypnotic manipulation, the patient immediately fell into a deep trance and talked without pause for more than half an hour, resisting Jungs attempts to wake her. Soon afterward, she cried out that she was cured, threw away her crutches and proceeded to walk. Jung, whose psychoanalytic terms could not account for this shocking result, announced in an attempt to explain the situation to his students, now youve seen what can be done with hypnosis (p. 120). Mechanistically, nothing happened in terms of psychoanalysis (e.g., removal of repression; see Eysenck 1994) or behavioral-cognitive concepts (e.g., extinction trials; Seligman 1988) that can account for spontaneous remission in the first case and the placebo effect in the second case.（essay代写)
   
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