Presentation on theme: "Approaches to treatment and therapy"— Presentation transcript:
1 Approaches to treatment and therapy 17Approaches to treatment and therapy
2 17Antipsychotic drugsMany block or reduce sensitivity of dopamine receptors.Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activityCan relieve positive symptoms of schizophrenia, but ineffective—or even worsen—negative symptoms
3 17 Antidepressant drugs Monoamine oxidase inhibitors (MAOI’s) Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmittersTricyclic antidepressantsBoost norepinephrine and serotonin by preventing reuptakeSelective serotonin reuptake inhibitors (SSRI’s)Boost serotonin by preventing reuptakeHerbs such as St. John’s Wort have also been used.
4 17 Tranquilizers Increase the activity of GABA Developed for treatment of mild anxietyOften prescribed inappropriately by general practitioners for any patient mood complaints
5 17 Lithium carbonate Used to treat bipolar disorder Moderates levels of norepinephrine by protecting cells from being over-stimulated by neurotransmitter glutamateMust be given in right dose, bloodstream levels monitoredNewer treatments include Tegetrol and Depakote.
6 17Your turnYour friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe?1. An MAOI2. An SSRI (e.g., Prozac)3. A tranquilizer (e.g., Valium)4. Lithium carbonate
7 17Your turnYour friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe?1. An MAOI2. An SSRI (e.g., Prozac)3. A tranquilizer (e.g., Valium)4. Lithium carbonate
8 17Placebo effectThe apparent success of a treatment due to patient’s expectation rather than the treatment itselfMeta-analysis indicates that clinicians consider medication helpful, yet patient ratings in treatment groups were no greater than those in placebo groups.
9 High relapse and dropout rate 17High relapse and dropout rateThere may be short-term success, but 50–66% of patients stop taking medication due to side effects.Individuals who take antidepressants without learning to cope with problems are more likely to relapse.
10 17Dosage problemsFinding the therapeutic window, the dosage that is enough but not too muchDrugs may be metabolized differently in. . .Men and womenOld and youngDifferent ethnic groupsAppropriate dosage also affected by metabolic rates, amount of body fat, number and type of drug receptors in the brain, smoking, and eating habits.
11 17Long-term risksAntipsychotic drugs can be dangerous, even fatal if taken for many years.Tardive dyskinesiaAntidepressants are assumed to be safe, but no long-term studies have been conducted.
12 Direct brain intervention 17Direct brain interventionPsychosurgeryAny surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior.Electroconvulsive therapy (ECT)Procedure used in cases of prolonged and severe major depressionBrief brain seizure is induced
13 Transcranial magnetic stimulation 17Transcranial magnetic stimulationInvolves use of pulsing magnetic coil held to a person’s skull over the left prefrontal cortexThis area is less active in those with depression.Treatment does not result in pain or memory problems, controlled studies have suggested positive results.
14 Psychodynamic therapy 17Psychodynamic therapyPsychoanalysisA method of psychotherapy developed by Freud, emphasizes the exploration of unconscious motives and conflictsFree associationIn psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind
15 Psychodynamic therapy 17Psychodynamic therapyOther psychodynamic therapies also explore unconscious dynamics, but differ from Freudian analysis.TransferenceIn psychodynamic therapies, a critical step in which the client transfers unconscious emotions or reactions, such as conflicts with parents, onto the therapist
16 17Behavior therapyA form of therapy that applies classical and operant conditioning to help people change own defeating or problematic behaviors
17 17Graduated exposureIn behavior therapy, a method in which a person suffering from an anxiety disorder, such as a phobia, is gradually taken into the feared situation or exposed to a traumatic memory, until the anxiety subsides
18 17FloodingA technique whereby a person suffering from an anxiety disorder, such as a phobia, is taken directly into the feared situation until the anxiety subsides
19 Systematic desensitization 17Systematic desensitizationA step-by-step process of desensitizing a client to a feared object or experienceBased on counter conditioning
20 Behavioral self-monitoring 17Behavioral self-monitoringA method of keeping careful data on the frequency and consequences of a behavior to be changed
21 17Skills trainingAn effort to teach a client skills or new more constructive behaviors to replace self-defeating ones
22 17 Cognitive techniques Examine the evidence for beliefs. Consider other explanations for the behavior of other people.Identify assumptions and biases.
23 Rational emotive therapy 17Rational emotive therapyA form of cognitive therapy devised by Albert Ellis, designed to challenge the client’s unrealistic or irrational thoughts
24 17 Humanist therapy Humanist therapy Client-centered therapy Based on assumption that people seek self-actualization, self-fulfillmentEmphasized people’s free will to change, not past conflictsClient-centered therapyDeveloped by Carl Rogers, emphasizes therapist’s empathy with client, and communication of unconditional positive regard
25 17Existential therapyHelps clients explore the meaning of existence and face with courage the great issues of life such as death, freedom, free will, alienation, and loneliness
26 Family and couples therapy 17Family and couples therapyAssumes that problems develop in the context of family, that they are sustained by family dynamics, and that any changes will affect whole familyCan look for patterns of behavior across generations and create a family tree of psychologically significant events
27 Family-systems perspective 17Family-systems perspectiveTherapy with individuals or families that focuses on how each member forms part of a larger interacting system
28 One family’s history of mental illness 17One family’s history of mental illness
29 The scientist-practitioner gap 17The scientist-practitioner gapSome psychotherapists believe that evaluating therapy using research methods is futile.Scientists find that therapists who do not keep up with empirical findings are less effective and can even harm clients.Economic pressures require empirical assessment of therapies.
30 17Is more better?Additional sessions, up to 26, increase the percentage of people who improve.Rate of improvement then levels off.Patients’ sense of improvement slower but more steady.
31 17Research questionsWhat are the common ingredients in successful therapies?What kinds of therapy best suited for which problems?When is therapy harmful?
32 17Common ingredientsTherapeutic alliance: bond between therapist and clientWhen clients want to be helpedWhen therapists distinguish normal cultural patterns from individual psychological problems
33 17 Which therapy? Depression Anxiety disorders Cognitive therapyAnxiety disordersExposure techniquesAnger and impulsive violenceHealth problemsCognitive and behavior therapiesChildhood and adolescent behavior problemsBehavior therapy
35 17Your turnYou have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem?1. Direct brain intervention2. Cognitive therapy3. Psychodynamic therapy4. Behavioral therapy
36 17Your turnYou have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem?1. Direct brain intervention2. Cognitive therapy3. Psychodynamic therapy4. Behavioral therapy
37 17When therapy harmsUse of empirically unsupported, potentially dangerous therapeutic techniquesInappropriate or coercive influence, which can create new problems for the clientPrejudice or cultural ignorance on the part of the therapistUnethical behavior, especially sexual intimacy, on the part of the therapist