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Chapter 15

PSY100 Chapter 15

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Dan Dolderman

Chapter 15 - Treatment of Psychological Disorders How are psychological disorders treated? 1. Psychotherapy: changing patterns of thought or behaviour • Relation b/t client and therapist is critical • Psychodynamic theory • Freud believed disorder were caused by prior traumatic experiences • Psychoanalysis- goal: uncovering unconscious feelings and drives that lead to maladaptive thoughts and behaviours • Free association (client says whatever comes to mind) & dream analysis (therapist interprets hidden message behind client’s dreams) • By increasing client’s awareness of own unconscious psych processes (gain insight) client’s free themselves from them and symptoms disappear • Still used today therapists help ppl understand why they are distressed by examining their needs, defences and motives • Humanistic therapies • Goal: treat person as a whole, not a collection of behaviours or repressed thoughts • Client-centered therapy: encourages people to fulfill individual potentials for personal growth through greater self-understanding • Therapists need to be empathetic, take on client’s perspective, always see client in positive terms uses reflective listening (repeats client’s concerns to help the person clarify his or her feelings) • Another technique: motivational interviewing- effective for drug and alcohol abuse • Success might be attributed to empathy and warmth expressed by therapist • Cognitive behavioural therapy • Behaviour modification: based on operant conditioning, rewards positive behaviours, punishes negative ones • To elicit desired behaviour, might use social-skills training • Ex: person has interpersonal difficulties learns particular ways of acting in certain situations changed behaviour • Cognitive therapy: based on theory that distorted thoughts can produce maladaptive behaviours and emotions, by modifying these thought patterns, can get rid of them • Cognitive restructuring: therapists help clients recognize maladaptive thought patterns and replace them with ways of viewing the world as it actually is • Rational-emotive therapy: therapist act as teachers who explain and demonstrate more adaptive ways of thinking and behaving • Interpersonal therapy: focuses on relationships the client attempts to avoid • CBT incorporates techniques from both behavioural therapy and cognitive therapy (correct faulty cognitions and train client to engage in new behaviours) Ex: social phobia teach social skills (behaviour), help client realize that other’s aren’t judging him (cognitive) Ex: CBT to phobia include exposure: repeated exposure to anxiety-producing stimulus or situation • Group therapy • Social support of group members is beneficial, learn from other’s experiences • Family therapy • Systems approach: individual is part of a larger context, any change in individual behaviour will affect the whole system (family) • Family structure important in determining relapse rates • Negative expressed emotion (family members making critical comments, being hostile, being emotionally overinvolved (crying, overprotective) )  highest relapse rates • Confession: reinterpreting event in less threatening ways is helpful • Pennebaker- when ppl reveal intimate and highly emotional material, they go into an almost trancelike state, pitch of voice goes down, speech speeds up, lose track of time and place • Confessional therapies improve immune system function, increases perf, improve memory and cognition Culture can affect Therapeutic processes • Cultural stigmas against metal disorders ppl don’t seek help • Also plays a critical role in determining availability, use and effectiveness of different types of psychotherapy for various cultural groups • Problem: psychotherapy and definitions of mental health are based on the dominant cultural paradigm • Consequently, therapists have to consider cultural differences, understand black man’s experiences will differ, can’t pretend same mental disorder of white man 2. Biological therapies: medical approaches to illness and disease • Psychotropic medication- medications that affect mental processes, change brain’s neurochemistry • Antianxiety drugs: tranquilizers, ST treatment of anxiety, increase activity of GABA (inhibitory NT) • Antidepressants : used to treat depression- MAO inhibitors (MAO- enzyme that converts serotonin into different forms want to keep serotonin), also raises levels of dopamine and norepinephrine • Tricyclic antidepressants- inhibit reuptake of NT ex: SSRI • Antipsychotics: neuroleptics- used to treat schizophrenia and other disorders involved in psychosis, reduce delusions and hallucinations • Work by binding and blocking action of dopamine receptors • May lead to tardive dyskinesia: irreversible involuntary twitching of muscles 3. Alternative biological treatments are used in extreme cases • Psychosurgery: surgery to selectively damage parts of frontal cortex pre frontal lobotomies (severing nerve-fibre pathways in prefrontal cortex) • Nowadays, brain surgery can be used for mental disorders, performed as last resort • Electroconvulsive therapy: involves placing electrodes on patient’s head and administering electrical current strong enough to produce a seizure • Nowadays, only done with anaesthesia, with powerful relaxants to eliminate motor convulsions and confine seizure to brain • Transcranial magnetic stimulation • Powerful electrical current produces a magnetic field that rapidly induces an electrical current that interrupts neural function in a particular brain region • Single pulse: disruption of brain activity only during that time of stimulation • Repeated pulse: disruption can last beyond periods of stimulation • Deep brain stimulation • Surgically implanting electrodes deep within brain and then using mild electricity to stimulate the brain at an optimal frequency and intensity (kind of like a pacemaker) • Used to treat symptoms of Parkinson’s disease- plan electrodes onto motor regions, reverse motor problems associated with disease What are the most effective treatments? • Evidence based treatments- psych disorders should always be treated in ways that scientific research has shown to be effective Anxiety disorders • CBT works best to treat most adult anxiety disorders • Anxiety-reducing drugs are also beneficial in some cases but with all drugs, effects limited to period in which drug is being taken • Specific phobias • Learning theory suggests that fears are acquired wither through experiencing a trauma or by observing similar fear in others • Behaviour techniques treatment of choice for phobias • Systematic desensitization therapy • Client first makes a fear hierarchy, list of situations in which is around, in ascending order • Client engages in relaxation training • Relaxation + small progressive doses of exposure therapy (may use virtual environments, person imagines virtually standing on tall building) (theory that relaxation response competes with and eventually replaces the fear response) • Can also use cognitive strategies • Increasing client’s awareness of thought processes that maintain the fear of the stimulus • Has been shown to decrease activation in frontal brain region involved in emotion regulation • Suggests that psychotherapy effectively “rewires the brain” Panic Disorder • Disorder with multiple components, therefore, may require different treatment approaches • Imipramine (tricyclic antidepressant) prevents panic attacks but does not reduce the anticipatory anxiety that occurs when ppl fear that they might have an attack • CBT useful to break learned association b/t physical symptoms
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