treatments for psychological disorders biological and psychological based treatments
Post on 20-Dec-2015
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Early Attempts at Biological Intervention
Coma and convulsive therapies Insulin coma therapy Electroconvulsive shock therapy (ECT)
Bilateral ECT and Unilateral ECT Shock lasting 1.5 Seconds 3 x week (2-4 weeks) Memory Impairment for Months After
Neurosurgery Psychosurgery or Neurosurgery The prefrontal lobotomy Very, Very Seldom Today Due to Medications
Psychopharmacological Methods of Treatment
Note: Keep in mind that the role of neuro-transmitters in mental illness is not well known. The use of medication is based on theory not fact
Psychopharmacology- the science of determining which drugs alleviate which mental disorders and why they do so
Antipsychotic Medications Neuroleptics or Major Tranquilizers
Traditional Antipsychotics included side effects including Tardive Dyskinesia- a disfiguring disturbance of motor control, particularly of the facial muscles
Atypical Antipsychotics Zyprexa, Geodon, Risperdal, Clozaril, Seraquil
Side Effects Include: Dry Mouth, Motor Disturbances, Sedation,
Weight Gain, Damage to Liver (blood levels need to be taken), Risperdal (lactation in females)
Effectiveness (20-30% do not respond)
Antidepressant Medications
Monoamine oxidase (MAO) inhibitors Inhibits breakdown of neurotransmitters Used in depression with hypersomnia Requires Dietary Supplement
Tricyclic antidepressants (TCAs) Inhibits reuptake of serotonin & norepinephrine Cause death with overdose
Selective serotonin re-uptake inhibitors (SSRI) Prozac, Zoloft, Paxil, Luvox, Lexapro, Celexa Not as selective as once thought
Should be taken for minimum of 9-12 months
Antianxiety MedicationsAnxiolytics or Minor Tranquilizers
Benzodiazepines Sedative effect Dependency Issues Used to Treat Alcohol Withdrawal High Relapse Rate After Termination of Medication Probably stimulate GABA an inhibitory
neurotransmitter
Side Effects Include: Drowsiness and Lethargy Lithium for the bipolar mood disorders
Long Term Use Side Effects Include: thyroid dysfunction, kidney damage, memory and motor speed problems
Medication and Children
Do anti-depressants increase suicidality? Natural increase in likelihood to suicide when
mood improves Medications do result in an initial adjustment for
the body that can be agitating Important to monitor the individuals mood in the
first 10 days
A client’s response to a medication in the first 10-14 days is often predictive of how effective the medication will be in alleviating antidepressant
An Overview of Psychological Treatment
Who provides psychotherapeutic services? Psychologists, Psychiatrists, Social Workers
Educational Backgrounds Vary Theories of Change Vary (see next slide)
Commonalities in Effective Therapists Form a Therapeutic Alliance with Their Clients Focus on Client Goals Use Research Based Interventions
Psychotherapy
Psychotherapy- the treatment of mental disorders by psychological methods.
To Achieve changes a therapist may: Change maladaptive behavior patterns Minimize or eliminate influences from the environmental
condition Improve interpersonal skills or other competencies Resolve disabling conflicts among motives Modify dysfunctional beliefs Reduce or remove distressing or disabling emotional
reactions. Foster a clear cut sense of identity
An Overview of Psychological Treatment
Why do people seek therapy? Those in highly stressful situations. Referred by physician or other professional. Forced by spouse, parent, or court.
Who has the best prognosis? (YAVIS) Young, Attractive, Verbal, Intelligent, and
Successful Individuals. Why YAVIS?
Motivation, Cognitive Abilities, Malleable The client’s contribution to the success of
treatment includes his or her motivation and expectation
Successful Therapy
Qualities of the client (personality, motivation) Qualities of the therapist (relational skills) Qualities of the relationship (therapeutic alliance) Qualities of the method being used.
Stages of Change Prochaska’s Levels of Change
Pre-contemplation Contemplation Preparation Action Maintenance Termination
Customer or not a customer
Psychodynamic Therapies:Freudian psychoanalysis
Four Basic Techniques Free association Analysis of dreams
Manifest content Latent content
Analysis of resistance An unwillingness or inability to talk about certain thoughts,
motives or experiences Analysis of transference
Transference- the process whereby clients project onto the therapist attitudes and feelings they had in a past relationship with a parent or other person close to them
Countertransference- the process in which the therapist reacts in accord with the client’s transferred attributions rather than objectively
Psychodynamic Therapies:Since Freud
Interpersonal therapy Object relations Self psychology Other interpersonal variations
Psychodynamic therapies tend to be time consuming and expensive They suggest that past issues need to be
resolved for change to occur Efficacy vs Effectiveness of of Psychodynamic
Approaches
Behavior Therapy
Guided exposure Systematic desensitization
Graduated scenes Require an inconsistent bx from the client
while exposed (real or imagined) to the feared stimuli
In Vivo Exposure
Aversion therapy Use of Punishment (antabuse) Driving Movie Pornography and Children Walking In
Modeling, Imitation, and Role Playing
Behavior Therapy
Systematic Use of Reinforcement Also referred to as Contingency Management Response Shaping- a behavior therapy technique using
positive reinforcement to establish by gradual approximation a response that is actively resisted or is not initially in a person’s behavioral repertoire
Remove Reinforcements or Add Reinforcements Super-Nanny
Token Economies Behavioral Contracting (marital tx and social exchange) Biofeedback Treatment
Monitor Physical, Convert to Signal, Prompt Feedback
Cognitive & Cognitive-Behavioral Tx
Rational emotive behavior therapy (REBT) Focus on changing core irrational beliefs
See table 3.5 Stress-inoculation therapy (SIT)
Three stages include: cognitive preparation, skill acquisition & rehearsal, and application and process.
Beck’s cognitive therapies Focus on illogical thinking about self, world, and
future.
Humanistic-Experiential Therapies
Client-Centered (person-centered) therapy Nondirective Unconditional Positive Regard Self-actualization
Existential Therapy The human predicament Focus on here and now Therapist is to be authentic
Gestalt Therapy Integration of thought, feeling, and action into
one’s self-awareness
Therapy for Interpersonal Relationships
Couples Counseling (Marital Therapy) Family Systems Therapy
Systemic Recursiveness Identified Patient Homeostasis
Structural Family Therapy (Salvador Minuchin) Family Rules and Boundaries
How Does One Measure Success in Psychotherapy?
Objectifying and quantifying change Would change occur anyway? Can therapy be harmful?
EVALUATING PSYCHOTHERAPIES
Is psychotherapy effective Client perceptions
indicates that 3 out of 4 are satisfied while 1 in 2 are very satisfied.
Reports may be inaccurate due to crisis effect, effort effect, and liking the therapist
Clinician’s Perceptions Most testify to therapy success (big surprise)
Outcome Research Indicates that the average therapy outcome for clients who
receive treatment surpasses that of the client who remains untreated.
“Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.”
On average psychotherapy is somewhat effective (it depends on the diagnosis obviously)
Psychotherapy has been shown to decrease medical costs. Contrary to Myer’s presentation, some treatment approaches
have been proven to be more effective than others.