PSYCH 1XX3 Chapter Notes - Chapter 6: Psychosurgery, Imipramine

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30 Mar 2015
Department
Professor
Psychological Treatments
Section 1: Diversity of Treatment Consumers
Barriers to seeking Psychological Treatment- diversity of individuals, providers and
treatment options available present significant challenges to the utility of databases when
ranges are never the same.
Internal
External
Tailoring Treatments to the Disorder
Accurate and comprehensive clinical diagnosis is an important precursor to the treatment
– similar questions to the 4D’s must be asked.
The type of disorder can influence is someone seeks out treatment.
Ego Syntonic Disorders: characterized by the symptoms of the disorder being perceived
by the individual as valued or advantageous “Going with ego”
Ego Dystonic Disorders: characterized by symptoms of the disorder being perceived by
the individual as undesirable “D- dystonic, unDesirable”
Tailoring treatment to the Individual
Select risk and protective factors can influence the development and expression of mental
health problems – effective psychological treatment needs to take into account the
individual, familial, social, circumstantial and cultural context of the disorder.
Prochaska and DiClement proposed:
Stages of Change:
Pre-contemplation: inability or unwillingness to acknowledge the existence of
the problem. Denial.
Contemplation: the individual acknowledges the existence of the problem but
may be unsure or unwilling to change it.
Preparation: acknowledgement of the problem and preparation for change.
Action: involves taking active steps to change the behaviour.
Maintenance: continuation of healthy habits formed in the action stage, watching
out for potential stressors that may trigger re-emergence of unhealthy behaviours.
Relapse: Full re-emergence of old unhealthy patterns of behaviour, often returning
the individual all the way back to the pre-contemplation stage of change.
Section 2: Diversity of Treatment Providers
Range of Providers Backgrounds and Licensure
Licensed psychologists: psychologists with specific training and certification in clinical
or counselling psychology
Psychiatrist: medical doctors who have advanced training and certification in the practice
of psychology
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Psychological Treatments
However, not all those that have psychology in their name can provide all forms of
treatment or any at all. There are also a wide range of other professionals that provide
psychological treatments including social workers, family and marriage counsellors etc.
that pursue specific treatments and offer types of psychological treatment.
Subject to a licensure requirements- obtaining a professional license demonstrates
that the provider has the basic competencies to practice according to the ethical
and professional standard of their chosen field.
Advisable to choose a licensed professional and research specific requirements for
licensure in that individuals field
The Art and Science of Psychological Treatment
One key factor that had been shown to have and important effect on treatment
outcomes is the therapeutic relationship between the therapist and patient.
Relationship qualities shown to be ‘demonstrably effective’ include:
oThe degree of working alliance (individual therapy) or group cohesion
(group therapy)
oDegree of therapist ability to demonstrate empathy- understanding the
patient’s emotions and thought
oDegree to which therapist collects and responds to feedback from the
patient
Qualities shown to be ‘probably effective include:
oPositive regard- therapist views patient as a fundamentally good person
oGoal consensus
oCollaboration
Section 3: Diversity of Treatment Options
Treatments of psychological disorders can be broken up into two categories:
Psychological
Biomedical
In practice they can form a combination treatment, sometimes together, sometimes one
after the other depending on presenting symptoms, consumer preferences and provider
offerings.
Evidence-Based Practice movement proposes:
1. Patient care is enhanced by the use of up-to-date knowledge
2. There is a gap between advances in knowledge and individual clinicians abilities
to keep up with these advances
3. Summaries of evidence presented by experts will bridge this gap and enable
clinicians to keep up with important advances
Trainees should learn the most up to date treatments and clinicians should be held
accountable for keeping the practices up to date.
This movement led to the creation of expert panels within major professional bodies of
psychology that set up decisions rules for evaluation evidence for specific treatments and
applied these rules to create lists of empirically supported therapies for specific
psychological disorders.
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Psychological Treatments
Concerns:
The extent to which clinicians would be forced to restrict their practices to
treatments on the list by managed care companies or by threat of potential
malpractice law suit
Prevent clinicians from using treatments that they had previously found useful,
but lacked formal research support
Prevent clinicians from trying new and potentially innovative strategies
Validity of the process by which treatments were deemed to be empirically
supported
Efficacy
Efficacy: the ability of a treatment to produce a desired effect in highly controlled
settings
Evaluate the utility of a treatment for an ‘ideal patient within a highly controlled
treatment setting
These studies are designed to demonstrate, that a medication has a desirable effect on a
medical condition of interest.
A randomized controlled trail design is used wherein participants with the
condition (and no other conditions) are randomly assigned to enter either:
oTreatment group: gets new medicine
oControl group: gets a placebo
Single-blind trial: participants are not aware of which group they are in
Double-blind trial: neither the participant nor the researcher is aware of the groups
that each patient is in
Because the only difference is the active medication, results of these trials can be used to
conclusively determine the efficacy of the medicine
Although desirable, complicated to implement with issues by researchers designing such
studies including:
Identifying patients with a single, specific condition of interest
Operationalizing the new treatment ie. Writing detailed treatment manuals for
psychological treatments
Selecting appropriate placebos
‘Blinding both participants and researchers
Evaluating treatment outcomes
Efficacy studies are often criticized for failing to differentiate between statistical and
clinical significance (patients felt noticeably better)
Effectiveness
Effectiveness: the ability of a treatment to produce a desired effect in real-world settings
Attempt to gauge utility of a treatment for a real patient in an ordinary treatment
setting.
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