16 Approaches to Treatment and Therapy

Biological treatments for mental disorders Biological explanations and treatments are dominant today: Evidence that some disorders have a genetic component or involve chemical or neurological abnormality Physicians and pharmaceutical companies have been aggressively promoting biomedical solutions

Biological Treatments for Mental Disorders LO16 Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each. Antipsychotic drugs Many block or reduce sensitivity of dopamine receptors. Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activity. Can relieve positive symptoms of schizophrenia, but can be ineffective for—or even worsen—negative symptoms.

Biological Treatments for Mental Disorders LO16 Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each. Antidepressant drugs Monoamine oxidase inhibitors (MAOIs): Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters Tricyclic antidepressants: Boost norepinephrine and serotonin by preventing reuptake Selective serotonin reuptake inhibitors (SSRIs): Boost serotonin by preventing reuptake

Anti-anxiety drugs (tranquilizers) Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each. Anti-anxiety drugs (tranquilizers) Increase the activity of GABA Developed for treatment of mild anxiety Often prescribed inappropriately by general practitioners for any patient mood complaints

Biological Treatments for Mental Disorders LO16 Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each. Lithium carbonate Used to treat bipolar disorder. Must be given in right dose, bloodstream levels monitored Newer treatments include Tegetrol and Depakote.

Biological Treatments, cont’ LO16 Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each. Placebo effect The apparent success of a treatment due to patient’s expectation rather than the treatment itself Meta-analysis indicates that clinicians consider medication helpful, yet patient ratings in treatment groups were no greater than those in placebo groups.

Biological Treatments, cont’ LO16 Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each. High relapse and dropout rate There 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. Appropriate dosage is also affected by metabolic rates, amount of body fat, number and type of drug receptors in the brain, smoking, and eating habits.

Biological Treatments, cont’ LO16 Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each. Disregard for nonmedical treatments The popularity of drugs has been fueled by pressure from managed-care organizations and by drug companies’ marketing and advertising efforts. Research shows that nonmedical treatments may work as well or even better.

Biological Treatments, cont’ LO16 Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each. Unknown risks over time and drug interations Antidepressants are assumed to be safe, but no long-term studies have been conducted. Medication “cocktails” are sometimes prescribed, but the risks and benefits of this approach have not been investigated.

Biological Treatments, cont’ LO16 Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each. Untested off-label uses The use of antipsychotics for nonpsychotic disorders Antidepressants being used to treat “social phobias”

Biological Treatments, cont’ LO16 Biological Treatments, cont’ LO16.3 Identify four forms of direct brain intervention used in treating mental disorders, and discuss the limitations of each. Direct brain intervention Prefrontal lobotomy Never assessed or validated scientifically Electroconvulsive therapy (ECT) Procedure used in cases of prolonged and severe major depression. Brief brain seizure is induced. The mood-improving effect of ECT is usually short-lived, and the depression almost always returns within a few weeks or months.

Biological Treatments, cont’ LO16 Biological Treatments, cont’ LO16.3 Identify four forms of direct brain intervention used in treating mental disorders, and discuss the limitations of each. Transcranial magnetic stimulation (TMS) Involves use of pulsing magnetic coil held to a person’s skull over the left prefrontal cortex Deep brain simulation Has been approved for patients with Parkinson’s disease and epilepsy; it requires surgery to implant electrodes into the brain and to embed a small box, like a pacemaker, under the collarbone.

Major Schools of Psychotherapy LO16 Major Schools of Psychotherapy LO16.4 Summarize the main elements of psychodynamic therapy. Major schools of psychotherapy Psychoanalysis A method of psychotherapy developed by Sigmund Freud, that emphasizes the exploration of unconscious motives and conflicts. Transference In psychodynamic therapies, a critical process in which the client transfers unconscious emotions or reactions, such as emotional feelings about his or her parents, onto the therapist.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.5 Describe four methods of behavioral therapy, and provide an example of each. Behavior and cognitive therapy Behavior therapy: A form of therapy that applies principles of classical and operant conditioning to help people change self-defeating or problematic behaviors. Graduated exposure: In behavior therapy, a method in which a person suffering from a phobia or panic attacks is gradually taken into the feared situation or exposed to a traumatic memory until the anxiety subsides. Flooding: In behavior therapy, a form of exposure treatment in which the client is taken directly into a feared situation until his or her panic subsides.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.5 Describe four methods of behavioral therapy, and provide an example of each. (behavior and cognitive therapy, cont’) Systematic desensitization: In behavior therapy, a step-by-step process of desensitizing a client to a feared object or experience; it is based on the classical- conditioning procedure of counter conditioning. Behavioral self-monitoring: In behavior therapy, a method of keeping careful data on the frequency and consequences of the behavior to be changed. Skills training: In behavior therapy, an effort to teach the client skills that he or she may lack, as well as new constructive behaviors to replace self-defeating ones.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.6 Discuss the main techniques used in cognitive therapy. Cognitive techniques Cognitive therapy: A form of therapy designed to identify and change irrational, unproductive ways of thinking and, hence, to reduce negative emotions. Rational emotive behavior therapy (REBT): A form of cognitive therapy devised by Albert Ellis, designed to challenge the client’s unrealistic thoughts.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.6 Discuss the main techniques used in cognitive therapy. Cognitive-behavior therapy (CBT) Clients learn to explicitly identify and accept whatever negative thoughts and feelings arise, without trying to eradicate them or letting them derail healthy behavior. More common than behavior or cognitive therapy alone

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.7 Summarize the similarities and differences between client-centered therapy and existential therapy. Humanist and existential therapy Humanist therapy Based on the philosophy of humanism Emphasizes people’s free will to change, not past conflicts Client-centered (nondirective) therapy Developed by Carl Rogers, which emphasizes the therapist’s empathy with the client and the use of unconditional positive regard.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.7 Summarize the similarities and differences between client-centered therapy and existential therapy. Existential therapy Helps clients explore the meaning of existence and face with courage the great issues of life such as death, freedom, free will, alienation, and loneliness.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy. Family and couples therapy Assumes that problems develop in the context of family, that they are sustained by family dynamics, and that any changes will affect whole family Can look for patterns of behavior across generations and create a family tree of psychologically significant events

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy. Family-systems perspective Therapy with individuals or families by identifying how each family member forms part of a larger interacting system.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy. Family-systems perspective Therapy with individuals or families by identifying how each family member forms part of a larger interacting system.

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy. Evaluating psychotherapy Therapeutic alliance The bond of confidence and mutual understanding established between therapist and client, which allows them to work together to solve the client’s problems

Schools of Psychotherapy, cont’ LO16 Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy. Therapist-client “match” When there is a cultural match, clients and psychotherapists are more likely to share perceptions of what the client’s problem is, agree on the best way of coping, and have the same expectations about what therapy can accomplish.

Compare schools of therapy Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy. Compare schools of therapy

Evaluating Psychotherapy LO16 Evaluating Psychotherapy LO16.9 Define the scientist-practitioner gap, and explain how it contributes to dilemmas in the practice of psychotherapy. The scientist-practitioner gap Some 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.

Evaluating Psychotherapy LO16 Evaluating Psychotherapy LO16.9 Define the scientist-practitioner gap, and explain how it contributes to dilemmas in the practice of psychotherapy. Problems assessing therapy Justification of effort This is just one example of the difficulties in assessing therapeutic results. Randomized controlled trials E.g. Some trials suggest that Critical Incident Stress Debriefing (CISD) may delay recovery in survivors of a traumatic event.

Evaluating Psychotherapy, cont’ LO16 Evaluating Psychotherapy, cont’ LO16.10 Identify some of the problems associated with assessing the effectiveness of therapy. Posttraumatic interventions

Evaluating Psychotherapy, cont’ LO16 Evaluating Psychotherapy, cont’ LO16.11 Provide three examples of areas in which cognitive and behavioral therapies have shown themselves to be particularly effective. When therapy helps Depression Cognitive therapy Anxiety disorders Exposure techniques Anger and impulsive violence Health problems Cognitive and behavior therapies Childhood and adolescent behavior problems Behavior therapy

Evaluating Psychotherapy, cont’ LO16 Evaluating Psychotherapy, cont’ LO16.12 Discuss four ways in which therapy has the potential to harm clients, and give an example of each. When therapy harms Use of empirically unsupported, potentially dangerous therapeutic techniques Inappropriate or coercive influence, which can create new problems for the client Prejudice or cultural ignorance on the part of the therapist Unethical behavior, especially sexual intimacy, on the part of the therapist

The value and values of psychotherapy The Value and Values of Psychotherapy LO16.13 List some benefits that effective psychotherapy can have for a client, and some limitations to what psychotherapy can do for a client. The value and values of psychotherapy Psychotherapy can: Help you make decisions and clarify your values and goals Teach you new skill and new ways of thinking Help you get along better with your family Get you through bad times Teach you how to manage depression, anxiety, and anger