1. Chapter 14
Treatments, continued

2. Behavioral Therapies - Types
1. Systematic Desensitization
- used to help phobias
- weakens CR by getting closer to CS
- weakens associations in pt’s mind
- A. therapist helps create “anxiety hierarchy” > pt tells how frightening on Likert scale
- B. use relaxation techniques
- C. relaxed pt imagines a lower-level anxiety – works way up
- D. try to experience

3. Behavioral Therapies 2. Aversion Therapy
- condition with negative response > Antabuse for alcoholism – take med & drink = vomit
- some success for alcoholism
- less use today
- sex offenders, smoking
- A Clockwork Orange

4. Behavioral Therapies 3. Social Skills Training
- show pts how to interact – get along – be with others
> eye contact, talk, listen
- esp for SMI – autistic, schizophrenics
- A. modeling – watch others
- B. behavioral rehearsal – practice role-play
- C. shaping – encouraged to build skills

5. Behavioral Therapies 4. Cognitive-Behavioral Therapy (CBT)
- focus on thinking – use verbal tech, behavior modification to change thinking
- related to cognitive therapy, rational-emotive therapy
- helps depression
Blame themselves > concentrate on the bad > predict the worst > feel bad about themselves

6. Do Behavioral Therapies Work ?
Stress results
Success has to be considered
Types of pts

7. Biomedical Therapies Work at physiological level
Try to change psychological sx
Pharma most common
Drugs
1950s
Major types: antianxiety drugs, antipsychotic drugs, antidepressants & mood stabilizers

8. Antianxiety Drugs Should feel less nervous
Tranquilizers – Valium, Xanax – work fast, short-term effects – many take them; not all clinical cases
Addictive > withdrawal
Side effects – sleepiness, dizzy, GI, dry mouth

9. Antipsychotic Drugs Schizophrenics & extreme cases of Mood Disorders
Reduce positive sx
Uncertain – may reduce DA
Help 70% pts
Take time to “kick in”
Pts usually take them for life > or sx return
Side-effects – sleepy, Parkinsonian sx > tardive dyskinesia – tics, pill-rolling, tremors – incurable
Atypical antipsychotics – newer, work differently, fewer side-effects, but risk of CAD & DM; expensive

10. Antidepressants Lift the mood
Most work on serotonin > keep it working longer; slow metab
SSRIs – selective serotonin reuptake inhibitors
Prozac, Paxil, Zoloft
Good for depressions, not bipolar d/o
Fewer side-effects, except for suicide (uncertain)
> hard to est meaningful correlation
> not for teens, children
SNRIs – both NE & serotonin – stronger, health issues

11. Mood Stabilizers For bipolar d/o Lithium – the classic – natural salt
Best for control both kinds of episodes
Tricky to dose
Monitor – health problems, esp kidney, thyroid & Htn
Newer tx – valproate – for epilepsy, but works – fewer side-effects

12. Do Drugs Work ? Can help – esp w extreme cases
Not a cure – what is real problem
Hype
Too often prescribed
Are there guidelines
Big Pharma > $$$ for professors > honest research ??
Conflicts of interest

13. ECT For MDD > controversies Risks Labor-intensive Forgetting
Sx may return

14. Treatments & Trends Paying Out of pocket v. insurance
Private insurance v. govt
managed care
HMOs (health maintenance organizations) – care is cheaper, but fewer choices
Pts usually get some tx
Cheaper meds
referrals

15. Multiculturalism Shamans, healers, religious authorities
Language issues
Racial issues
Class issues
Training
Get the therapeutic alliance

16. Are there mental hospitals ?
1960s-70s deinstitutionalization
Short stays
Community mental health movement
Homelessness & SMI