1. Just a few things before we start the notes for today… Rational Emotive Therapy isn’t a bold vocab word but you need to know about this for the AP Exam. –A quite aggressive approach in dealing with cognitive issues. –Albert Ellis would often employ a technique called “thought stopping,” where he’d yell “STOP” at patients when they expressed a thought that was self defeating or detrimental

2. Therapists & Their Training Counselors: Marriage & family counselors specialize in problems arising from family relations; Pastoral counselors provide counseling to countless people; Abuse counselors work with substance abusers & with spouse & child abusers. Clinical or Psychiatric Social Workers: A 2 yr master of social work grad program + postgrad supervision preps them to offer psychotherapy, mostly to people w/ everyday personal & family problems; ½ have earned the Nat’l Assoc. of Social Workers’ designation of clinical social worker.

3. Clinical Psychologists: Most are psychologists w/ a Ph.D. or Psy.D. & expertise in research, assessment & therapy, supplemented by a supervised internship & often, post-doctoral training; ½ work in agencies/institutions & ½ in private practice. Psychiatrists: Physicians who specialize in the Tx of psych. disorders & can prescribe meds thus they tend to see those with the most serious problems; many have own private practice

4. The most widely used biomedical Tx today are the drug therapies. Since the 50’s, discoveries in psychopharmacology (study of drug effects on mind & behavior) have revolutionized the Tx of those w/ severe disorders. After the widespread intro of antipsychotic drugs (1955), # of residents in state/county mental hospitals declined sharply…in the rush to deinstitutionalize the mentally ill, many who were left homeless on city streets.

5. Antipsychotic Drugs Drugs used to treat schizophrenia & other forms of severe thought disorder. Chlorpromazine (sold as Thorazine) helps those w/ positive Sx (hallucinations/paranoia). Antipsychotics are similar enough to the NT dopamine to occupy its receptor sites & block its activity. They are very powerful drugs; some can produce sluggishness, tremors, & twitches. Long term use can produce tardive dyskinesia-involuntary movements of the facial muscles, tongue & limbs. Newer atypical antipsychotics, such as Clozapine (Clorazil) or Risperdal, target both dopamine & serotonin receptors; can help alleviate negative Sx sometimes enabling “awakenings”

6. Antianxiety Drugs Drugs used to control anxiety/agitation. Drugs such as Xanax or Ativan depress central nervous system activity (& should never be used in combo w/ alcohol). Often used in combo w/ psychotherapy A new drug, D-cycloserine, acts upon a receptor that facilitates the extinction of learned fears; enhances the benefits of exposure therapy & helps relieve Sx of PTSD & OCD. Criticism: “Popping a Xanax” at onset of anxiety can produce psychological dependence; These drugs can also cause physiological dependence

7. Antidepressant Drugs Drugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various NTs. They work by increasing availability of norepinephrine or serotonin. Fluoxetine (Prozac), partially blocks the reabsorption & removal of serotonin from synapses. Bc they slow the synaptic vacuuming of serotonin, Prozac & its cousins Zoloft & Paxil are called selective-serotonin reuptake inhibitors (SSRIs); usually take 4 weeks to work After the intro of SSRI’s patients getting meds for depression jumped from 70% (1987) or 89% (2001). In the U.S. 11% women & 5% men take SSRI’s

8. Mood-Stabilizing Medications The simple salt lithium can be an effective mood stabilizer for those suffering w/ bipolar disorder; not fully sure how it works but it does… So does Depacote, a drug originally used to treat epilepsy & now found to be very effective in controlling manic episodes.

9. Brain Stimulation Electroconvulsive Therapy (ECT): Formerly seen as barbaric b/c it was…today patient gets general anesthesia & a muscle relaxant (to prevent injury from the convulsions) before a psychiatrist delivers 30-60 sec. of electric current to patient’s brain; Patient wakes up & remembers nothing of the Tx or of the preceding hours. After 3 sessions each week for 2-4 weeks, 80%+ report remarkable improvement, showing some memory loss for Tx pd but no discernible brain damage. Study after study has proven ECT to be quite effective for severe depression that’s not reacting to drug therapy. After more than 50 yrs, no one knows for sure how it alleviates depression; Perhaps the shock-induced seizures calm neural centers where overactivity produces depression.

10. Alternative Neurostimulation Therapies: Magnetic Stimulation: Depressed moods seem to improve when repeated pulses surge through a magnetic coil held close to a person’s skull; The magnetic energy penetrates only to brain’s surface; Painless procedure is called repetitive transcranial magnetic stimulation (rTMS). Deep-Brain Stimulation: Implanted electrodes & a pacemaker stimulator designed to excite the neurons that inhibit the negative emotions of depression; of 12 patients 8 experienced relief

11. Psychosurgery Surgery that removes or destroys brain tissue in an effort to change behavior; most drastic & least used biomedical intervention. Lobotomy: a now rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to limbic system –Procedure took 10 min. –Neurosurgeon shocks patient into coma, hammer an icepick like instrument through each eye socket into the brain, & then wiggle it to sever the connections running up to the frontal lobes. –Effect: decreased patient’s misery but also produced a permanently lethargic, immature, uncreative person.

12. Therapeutic Life-Style Changes Aerobic exercise: 30 min/day & 3x/week stimulates endorphins Adequate sleep: 7-8 hrs/night increases energy/alertness & boosts immunity Light exposure: 30min/each morning w/ a light box amplifies arousal & influences hormones Social connection: w/ less alone time & at least 2 meaningful social engagements weekly satisfies the human need to belong Anti-rumination: by identifying & redirecting negative thoughts (enhancing positive thinking) Nutritional supplements: daily fish oil w/ omega-3 fatty acids for healthy brain functioning.