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Chapter 15

Chapter 15

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PSYC 100
Jens C Pruessner

15.1 how are psyc disorders treated? Two categories of techniques: psyc and bio. Psychotherapy: formal psyc treatment, interactions btwn practitioner and client, help client understand symptoms, provide solutions. Bio therapies: treatment based on medical approaches to illness / disease, based on notion that mental disorders result from abnormalities in neural/bodily processes.  Psychotherapy based on psyc principles: aimed at changing patterns of thought/behavior o Psychodynamic therapy focuses on insight: therapist out of view, client less inhibited, free association/ dream analysis. insight: goal, patient’s awareness of unconscious psyc processes, how they affect daily functioning, symptoms diminish as result of reducing unconscious conflicts. Psychodynamic therapy: reformulation of Freud ideas, help patient examine needs/defenses/motives to understand why distressed. Not very affective, expensive and time-consuming. o Health benefits of talking, expression emotion: reduces blood pressure, muscle tension, skin conduction, improves immune function o Humanistic therapies focus on whole person: Client-centered therapy: encourages to fulfill individual potentials for personal growth through greater self-understanding, reflective listening. Motivational interviewing - short period of time. o Cognitive and behavioral therapies target thoughts/behaviors: treat thoughts/behaviors as problem (instead of maladaptive behavior considered result of underlying problem). Behavior therapy: based on premise that behavior learned, can be unlearned through use of classical/operant conditioning. Social skills training used to elicit desired behavior, modeling. Cognitive therapy: based on theory that distorted thoughts produce maladaptive behaviors/emotions, treatment strategies attempt to modify these thought patterns. Cognitive restructuring: help patients recognize maladaptive thoughts patterns and replace them with ways of viewing world that are more in tune with reality. Rational-emotive therapy: therapist acts as teacher, explains client errors in thinking, show more-adaptive ways to think/ behave. These therapies assume maladaptive behavior is result of individual belief systems and ways of thinking, not objective conditions. In interpersonal therapy, focus on circumstances. Mindfulness- based cognitive therapy: people who recover from depression continue to be vulnerable to faulty thinking, goal of therapy is to help them become more aware of these feelings when they are vulnerable to learn to disengage from ruminative thinking through meditation. Cognitive-behavioral therapy (CBT): incorporates techniques from cognitive and behavior therapy to correct faulty thinking, change maladaptive behaviors. Exposure: repeated exposure to anxiety-producing stimulus/situation. Exposure and response prevention, systematic desensitization. o Group therapy builds social support: popular after WWII, less expensive, opp to improve social skills, learn from others’ experiences. Usually very structured in behavioral and cognitive-behavioral groups, specific goals/techniques to modify thought/behavior patterns of group members. o Family therapy focuses on family context: systems approach: individual is part of larger context. Expressed emotion: pattern of negative actions by client’s family members, includes critical comments, hostility, emotional over-involvement. Patterns of expressed emotion that affect relapse differ across countries/cultures, b/c some behaviors more acceptable in some cultures, which affects relationship between expressed emotion and relapse.  Culture can affect therapeutic process: stigma, level of acceptance for psychotherapy, etc.  Medication is effective for certain disorders: psychotropic medications: drugs that affect mental processes, change brain neurochem by inhibiting action potential or altering synaptic transmission to increase/decrease action of particular neurotransmitters. Anti-anxiety drugs/tranquilizers: used for short-term treatment of anxiety. Benzodiazepines increases GABA activity, most pervasive inhibitory neurotransmitter. Antidepressants: used for depression. Monoamine oxidase (MAO) inhibitors first, enzyme that breaks down serotonin in synapse, when inhibited, more serotonin. Tricyclic antidepressants: inhibit reuptake of certain neurotransmitters, resulting in more available in synapse. Selective serotonin reuptake inhibitors (SSRIs) such as Prozac inhibit reuptake of serotonin but act on other neurotransmitters to lesser extent. Antipsychotics/ neuroleptics: used to treat schizophrenia and other disorders w/ psychosis, reduce symptoms. Bind to dopamine receptors to block effects. Side effects: tardive dyskinesia – involuntary muscle twitching. Clozapine acts on dopamine receptors and serotonin, norepinephrine, acetylcholine and histamine receptors, but affects white blood cells. Lithium good for bipolar disorder.  Alternative bio treatments used in extreme cases: treatment-resistant people may try brain surgery, magnetic fields, electrical stimulation, all alter brain function, last resort. Psychosurgery: areas of frontal cortex selectively damaged to treat mental disorders (schizophrenia, depression, anxiety). Moniz prefrontal lobotomy – severing nerve-fiber pathways in prefrontal cortex, impairs many important mental functions. o Electroconvulsive therapy ECT: strong current to brainseizure, for severe depression. o Transcranial magnetic stimulation (TMS): powerful current  magnetic field, rapidly switched on/off,  induces electrical current in brain, interrupting neural function. Single pulse TMS: disruption of brain activity occurs during period of stimulation. Repeated TMS: disruption can last o Deep brain stimulation DBS: surgically implanting electrodes deep in brain, then mild electricity used to stimulate brain at optimal frequency/intensity, used on Parkinson’s successfully.  Therapies not supported by scientific evidence can be dangerous: encouraging people to describe post- traumatic experiences, scaring adolescent straight, using hypnosis, screaming, questionable self-help books  Variety of providers can assist in treatment for psychological disorders: clinical psychologists (phD, emphasizes research and use of treatments), PsyD (emphasizes clinical skills), psychiatrists (MD, authorized to prescribe drugs), counseling psychologists (PhD in counseling, deal w/ problems of adjustment and life stress that don’t involve mental illness), psychiatric social workers (master’s degree, specialized training in mental health care), psychiatric nurses, paraprofessionals. Important to find right therapist w/ appropriate training/experience for specific mental disorder, should be trustworthy/caring. Not enough in the world. Technology-based treatments have minimal contact w/ therapists. 15.2 what are the most effective treatments? People often show natural improvement no matter what therapy received  Effectiveness of treatment is determined by empirical evidence: randomized clinical trials. Evidence-based treatments; psyc disorders should always be treated in ways that scientific research has shown to be effective (psyc treatments vs. psychotherapy – any kind). Three features characterize psyc treatments – vary according to particular disorder and client’s specific symptoms; techniques have been developed in lab by psychologists, no overall theory guides treatment, but based on evidence of effectiveness  Treatments that focus on behavior and on cognition are superior for anxiety disorders: cognitive-behavioral therapy works best to treat most adult anxiety disorders, effects last longer than drugs o Specific phobias: behavioral techniques are best treatment. Systematic desensitization – client makes fear hierarchy, then relaxation training, then exposure therapy, relaxation response eventually replaces fear response – may be exposure to object rather than relxation that extinguishes phobic response. Psychotherapy “rewires” brain, affects underlyinb iology of mental disorders like medication – decreased activation in frontal brain region involved I nregulation of emotion. o Panic disorder: goal of therapy is to break connection between trigger symptom and resulting panic, via exposure treatment. CBT perspective that attacks continue because of conditioned response to trigger, e.g. shortness of breath o Obsessive-compulsive disorder: combination of recurrent intrusive thoughts (obsessions) and behavior that individuals feels compelled to perform repeatedly (compulsions). Partly genetic, can be treated
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