Treatments for Psychological Disorders Biological and Psychological Based

Treatments for Psychological Disorders Biological and Psychological Based Treatments

Early Attempts at Biological Intervention n Coma and convulsive therapies n Insulin coma therapy n Electroconvulsive shock therapy (ECT) n n n Bilateral ECT and Unilateral ECT Shock lasting 1. 5 Seconds 3 x week (2 -4 weeks) Memory Impairment for Months After n Neurosurgery n Psychosurgery or Neurosurgery n The prefrontal lobotomy n Very, Very Seldom Today Due to Medications

Psychopharmacological Methods of Treatment n 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 n Psychopharmacology- the science of determining which drugs alleviate which mental disorders and why they do so

Antipsychotic Medications Neuroleptics or Major Tranquilizers n Traditional Antipsychotics included side effects including Tardive Dyskinesia- a disfiguring disturbance of motor control, particularly of the facial muscles n Atypical Antipsychotics n Zyprexa, Geodon, Risperdal, Clozaril, Seraquil n Side Effects n n 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)

Neurotransmitter Functioning

Antidepressant Medications n Monoamine oxidase (MAO) inhibitors n n n Inhibits breakdown of neurotransmitters Used in depression with hypersomnia Requires Dietary Supplement n Tricyclic antidepressants (TCAs) n n Inhibits reuptake of serotonin & norepinephrine Cause death with overdose n Selective serotonin re-uptake inhibitors (SSRI) n n Prozac, Zoloft, Paxil, Luvox, Lexapro, Celexa Not as selective as once thought n Should be taken for minimum of 9 -12 months

Antianxiety Medications Anxiolytics or Minor Tranquilizers n Benzodiazepines n n n 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 n Lithium for the bipolar mood disorders n n Long Term Use Side Effects Include: thyroid dysfunction, kidney damage, memory and motor speed problems

Medication and Children n Do anti-depressants increase suicidality? n Natural increase in likelihood to suicide when mood improves n Medications do result in an initial adjustment for the body that can be agitating n Important to monitor the individuals mood in the first 10 days n 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

Psychologically Based Therapies

An Overview of Psychological Treatment n Who provides psychotherapeutic services? n Psychologists, Psychiatrists, Social Workers n Educational Backgrounds Vary n Theories of Change Vary (see next slide) n Commonalities in Effective Therapists n Form a Therapeutic Alliance with Their Clients n Focus on Client Goals n Use Research Based Interventions

Psychotherapy n Psychotherapy- the treatment of mental disorders by psychological methods. n To Achieve changes a therapist may: n n n n 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 n Why do people seek therapy? n Those in highly stressful situations. n Referred by physician or other professional. n Forced by spouse, parent, or court. n Who has the best prognosis? (YAVIS) n Young, Attractive, Verbal, Intelligent, and Successful Individuals. n Why YAVIS? n n Motivation, Cognitive Abilities, Malleable The client’s contribution to the success of treatment includes his or her motivation and expectation

Successful Therapy n Qualities of the client (personality, motivation) n Qualities of therapist (relational skills) n Qualities of the relationship (therapeutic alliance) n Qualities of the method being used.

Stages of Change n Prochaska’s Levels of Change n Pre-contemplation n Contemplation n Preparation n Action n Maintenance n Termination n Customer or not a customer

Psychodynamic Therapies: Freudian psychoanalysis n Four Basic Techniques n Free association n Analysis of dreams n Manifest content n Latent content n Analysis of resistance n An unwillingness or inability to talk about certain thoughts, motives or experiences n Analysis of transference n Transference- the process whereby clients project onto therapist attitudes and feelings they had in a past relationship with a parent or other person close to them n Countertransference- the process in which therapist reacts in accord with the client’s transferred attributions rather than objectively

Psychodynamic Therapies: Since Freud n n Interpersonal therapy Object relations Self psychology Other interpersonal variations n Psychodynamic therapies tend to be time consuming and expensive n They suggest that past issues need to be resolved for change to occur n Efficacy vs Effectiveness of of Psychodynamic Approaches

Behavior Therapy n Guided exposure n Systematic desensitization n Graduated scenes Require an inconsistent bx from the client while exposed (real or imagined) to the feared stimuli In Vivo Exposure n Aversion therapy n Use of Punishment (antabuse) n Driving Movie n Pornography and Children Walking In n Modeling, Imitation, and Role Playing

Behavior Therapy n Systematic Use of Reinforcement n Also referred to as Contingency Management n 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 n Remove Reinforcements or Add Reinforcements § Super-Nanny n n n Token Economies Behavioral Contracting (marital tx and social exchange) Biofeedback Treatment n Monitor Physical, Convert to Signal, Prompt Feedback

Cognitive & Cognitive-Behavioral Tx n Rational emotive behavior therapy (REBT) n Focus on changing core irrational beliefs n See table 3. 5 n Stress-inoculation therapy (SIT) n Three stages include: cognitive preparation, skill acquisition & rehearsal, and application and process. n Beck’s cognitive therapies n Focus on illogical thinking about self, world, and future.

Humanistic-Experiential Therapies n Client-Centered (person-centered) therapy n Nondirective n Unconditional Positive Regard n Self-actualization n Existential Therapy n The human predicament n Focus on here and now n Therapist is to be authentic n Gestalt Therapy n Integration of thought, feeling, and action into one’s self-awareness

Therapy for Interpersonal Relationships n Couples Counseling (Marital Therapy) n Family Systems Therapy n Systemic Recursiveness n Identified Patient n Homeostasis n Structural Family Therapy (Salvador Minuchin) n Family Rules and Boundaries

Eclecticism and the Integration of the Psychotherapies n How do they all fit together?

How Does One Measure Success in Psychotherapy? n Objectifying and quantifying change n Would change occur anyway? n Can therapy be harmful?

Psychotherapy and Society n Social values and psychotherapy n Psychotherapy and cultural diversity

EVALUATING PSYCHOTHERAPIES n Is psychotherapy effective n 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 therapist n Clinician’s Perceptions § Most testify to therapy success (big surprise) n 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.

UNRESOLVED ISSUES n Efficacy versus effectiveness