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Chapter 17

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Richard B Day

Psych 2AP3: Abnormal Psychology – Major Disorders Chapter 17: Therapy An Overview of Treatment - Why do people seek therapy?  Stressful current life circumstances: experiencing sudden and highly stressful situations  People with long standing problems: seek psychological assistance out of dissatisfaction and despair  Reluctant clients: entering therapy through indirect route. Males are more reluctant to enter therapy than females  People who seek personal growth: not lived up to own expectation - Who provides psychotherapeutic services?  Physicians, clergy  Clinical psychologist, psychiatrists and clinical social workers  Psychiatrists can prescribe psychoactive medications  Psychiatrist differ from psychologist in their predilection for treating mental disorders with a biological approach whereas psychologists treat patients’ psychopathology by examining and changing patients’ behaviour and thought patterns - The therapeutic relationship  The therapeutic alliance: how well clients do in treatment is related to strength of the alliance they have with their therapists  Other qualities that enhance therapy:  Client’s motivation  Client’s expectation of receiving help  Gain new perspective  Safe environment 17.1 The World Around Us: Why Are Men So Reluctant to Enter Therapy? - Men are less able than women to recognize and label feelings of distress - Masculine stereotypes, giving up control - More poorly informed about treatment - Develop treatment that’s based on theories of how men are socialized and that provide a better fit for men constrained by gender-role expectations Measuring Success in Psychotherapy - Therapist’s impression of changes that have occurred - Client’s reports of change - Reports from the client’s family or friends - Comparison of pretreatment and post-treatment scores on personality tests or on other instruments designed to measure relevant facets of psychological functioning - Measures of change in selected overt behaviours - Objectifying and quantifying change: client self-monitoring and fMRIs - Would change occur anyway: disturbed people may improve over time for reasons that are not apparent - Can therapy be hurtful: positive, neutral or negative 17.2 Developments in Research: Using Brain Activation to Measure Therapeutic Change - fMRI: technique used to measure changes in activation in human brain - When certain areas of the brain are active, they require more oxygen What Therapeutic Approaches should be used? - Evidence-based treatment:  Drugs must receive approval  Drug has efficacy: it does what it is supposed to do in curing or relieving some target conditions  Randomized control trials: tests using voluntary and informed patients by randomly assigning patients to active or inactive (placebo)  Double-blind procedure: neither patient nor prescriber is informed which is to be administered  Manualized therapies: researchers tried to minimize variability in patients’ clinical outcomes that might result from characteristics of the therapist themselves (randomized controlled trial)  Efficacy studies have been criticized for testing treatments under the most ideal conditions  Effectiveness: extent to which a treatment leads to change under less than optimal conditions, similar to conditions in real-life clinical settings - Medication or Psychotherapy:  Psychopharmacology has lead to a more favourable hospital climate  Side effects, complexity of matching drug and dosage, medication change, isolation from other treatment, relapse - Combined treatments:  Medication and psychotherapy 17.3 The World Around Us: Osherhoff v. Chestnut Lodge - Therapist may be liable for failing to provide medication to patients with certain disorders for which medication is known to be effective Pharmacological Approaches to Treatment - Antipsychotic drugs:  Used to treat psychotic disorders such as schizophrenia and psychotic mood disorders  Alleviate or reduce intensity of delusions and hallucinations by blocking dopamine receptors  Half-life: time taken for level of active drug to be reduced by 50%: less frequent dosing, less variation in concentration of drug in plasma, less severe withdrawals, risk drug will accumulate, increased sedation and psychomotor impairment  Daily or depot neuroleptics  Tardive dyskinesia: movement abnormality that is a delayed result of taking antipsychotic medication  May treat positive and negative symptoms of schizophrenia  Weight gain and diabetes  Clozapine: drop in white blood cells - Antidepressant drugs:  Selective serotonin reuptake inhibitors:  Inhibits reuptake of serotonin following release into synapse  Fewer side effects, not fatal in overdose  SNRIs: inhibits reuptake of serotonin and norepinephrine  Patients tend to improve after 3-5 weeks  Nausea, diarrhea, nervousness, insomnia and sexual problems  Monoamine oxidase inhibitors:  Inhibit the activity of monoamine oxidase, an enzyme present in the synaptic cleft that helps break down the monoamine neurotransmitters that have been released into the cleft  Must avoid foods rich in amino acid tyramine  Tricyclic antidepressants:  Inhibit reuptake of norepinephrine and serotonin  Other antidepressants:  Trazodone: inhibits reuptake of serotonin, sedating properties, can cause priapism in men  Bupropion: doesn’t block reuptake of serotonin or norepinephrine, but increases noradrenergic function, doesn’t inhibit sexual function  Mirtazapine: facilitates serotonin and norepinephrine neurotransmission, weight gain  Using antidepressants to treat anxiety disorders, bulimia, and personality disorders:  SSRIs: panic disorder, social phobia, generalized anxiety disorder, OCD, bulimia, borderline personality disorders  Tricyclic antidepressants: bulimia - Anti-anxiety drugs:  Benzodiazepines:  Brief treatment of acute anxiety and agitation  Rapidly absorbed from digestive tract and work quickly  Help quell anxiety, sleep-inducing agent  Dependency, withdrawal (seizures)  High relapse rates  Enhance activity of GABA receptors, limbic system  Other anti-anxiety medications:  Busiprone: serotonergic functioning, non-sedating, low dependency, not useful in acute situations - Lithium and other mood-stabilizing drugs:  Bipolar disorder, depression  May affect electrolyte balances that alter activities of neurotransmitters  70-80% show improvements after 2-3 weeks  Preventing future episodes of mania  Relapse  Side effects: increased thirst, gastrointestinal difficulties, weight gain, tremor, fatigue  Toxic if recommended dose is exceeded or if kidneys fail to excrete  Other mood-stabiliz
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