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Chapter 14

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Dan Dolderman

Chapter 14 Treating disorders of mind and body  agoraphobia  Relaxation  modify maladaptive thought patterns  construct hierarchy of increasing stressful situations as therapy for patient to try  psychotherapy, biological therapy, (psychopharmacology) How is mental illnesses treated Psychotherapy is based on psychological principles  mix of techniques from 400 of them used psychodynamic therapy focuses on insight  freud developed psychoanalysis  aly on couch to reduce inhibition and allow freer access to unconscious thoughts  unconscious feelings exposed  technique called free association and dream analysis  hope to increase patients awareness of unconscious thoughts  psychodynamic approaches: talking therapy  expensive and time consuming treatment  new approach of offering smaller number of sessions and focusing on current relationships humanistic therapies focus on the whole person  client centered therapy: by carl rogers, encourages people to fulfill their individual potentials for personal growth through greater self understanding  therapists strive to be empathetic  reflective listening: repeat back concerns  motivational interviewing to treat eating disorders Behavioural therapy focuses on observable behaviour  behaviour modification based on operant conditioning  social skills training- modeling:  1. modeling  2. imitate and apply  Interpersonal therapy  Focus on relationships patient attempt to avoid  Exposure: therapy for phobia  Systematic desensitization: exposure technique that pairs the anxiety producing stimulus with relaxation techniques Cognitive behaivoural therapy focuses on faulty cognitions  Cognitive therapy: based on idea that distorted thoughts produce maladaptive behaviors and emotions  Cognitive restructuring: help patient recognize maladaptive thought patterns and replace them with ways of viewing the world that are more in tune with reality  Cognitive behavioural therapy (CBT): incorporate both  cognitive and behaviour therapy Group therapies  Less expansive  Discussion  Specific goals designed  Effective for disorders such as bulimia and obsessive compulsive disorder  Social support group members provide each other is beneficial Family therapy focuss on the family context  Personal behaviour can have profound effecdts on family dynamics  Family members can have impact on client outcome  Negative expressed emotions include making critical comments about patient…  Family levels of negative emotion to patients correspond to relapse rate for patients with schizo (pg 571 diagram) Biological therapies are necessary for some disorders  Drugs  Electrical stimulation of brain regions  Surgical interventions  Psychotropic medication: act on brain to affect mental processes  Anti-anxiety drugs (tranquilizers) to treat anxiety like benzodiazepine increase GABA activity which is an inhibitory neruroransmitter  Drugs reduce anxiey and promote relaxation but induce drowsiness as well  Antidepressants: MAO inhibitors result in more serotinoin available because MAO converts serotonin into another chemical form, raise epinephrine and dopamine level  Tricyclic antidep:essants inhibit reuptake of number of different neurotransmitters  Selective serotonin reuptake inhibitors (SSRI) act on other neurotransmitter to lesser extent  Prozac is one SSRI used, but have side effects like sexual dysfunction  Antipsychotic (neuroleptic) treat schizo and others  Reduce delusions and hallucinations  Antipsychotic bind to dopamine receptors without activating them blocking effects of dompamine  Side effect like involuntary twitching of muscle  Clozpine a drug proven to not only act on serotonin but also nor, acetylcholine, histamine…  Anticonvulsants prevent seizuires and to regulate moods in bipolar disorder Common factors enhance treatment Evaluating effectiveness of therapy  Receiving both drugs and psychotherapy produced the best effect from survey  75 % of neurotic patients improved whether or not they were in therapy  Helped them gain insight in to problem seen as most important help  Doesn’t matter the type of therapy, if gotten therapy, it had a positive effect A caring therapist  Relationship between patient and therapist  Confessional therapy is good What are the most effective treatments  Treaments should be tailored specifically to the symptom of the client  Techniques used in treatment developed by psychological scientist  No overall grand theory guides treamtne, but based on evidence of its effectiveness Treatments that focus on behaviour and cognition are superior for anxiety disorders Specific phobias  Behavioural techniques: systematic desensitization therapy, client makes a fear hierarchy (list of situations they fear)  Next is relaxation training  Exposure therapy  Success shown by dereace in frontal region acitivy  Tranquilizers, SSRI usedful for social phobia  Virtual environment therapy (computer generated images to simulate feared environemtns) done before exposure to actual environment Panic disorder  Imipramine, a tricyclic antidepressant, prevents panic attacks but does nothing to reduce anticipatory anxiety patient have when they fear they might have a panic attack  Cognitive therapy to trea t his  1. asked to identify fears they have  2. asked to assign percentage to these fears, and they would say 085% would likely to faint but in fact It’s 0, because panic attack don’t lead to fainting  Therapy want to break connection between trigger symptoms and resulting panic  Cognitive behavioural therapy appears to be as effective as medication Obsessive-compulsive disorder (OCD)  Combination of recurrent intrusive thoughts (obsession) and behaviours that client feels compelled to perform over and over (compulsion)  Related to tourette’s syndrome (motor and vocal lics)  Biological antianxiety drugs are ineffective for OCD  SSRI really effect in reducing obsessional component  Clomipramine  Combine with dopamine receptor blocker  Cognitive behavioural therapy effective for OCD  Exposure and response prevention  Goal is to break the conditioned link between particular stimuli and compulsive behaviour Many effective treatments are available for depression Pharmacological treatment:  Iproniazid an MAO inhibitor  Imipramine (antihistamine)  Tricyclic extremely effective antidepressants, but has side effects like sedationand weightgain • Prozac began to be used because has fewer serious side effects than MAO inhibitor • Placebo treatment for depression lead to changes in brain activity • 38% responded to placebo • increased prefrontal cortex activity • trial and error approach for treating depression if no drugs stand out Cognitive-behavioral treatment of depression • help person think more adaptively, to improve mood and behaviour • combined therapy with antidepressants is more effective alternative treatments • seasonal affective disorder • depression during winter • electroconvulsive therapy: placing electrodes on pateint’s head and administering electrical current strong enough to produce a seizure
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