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Chapter 15

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Dan Dolderman

Chapter 15 – Treatment of Psychological Disorders HOW ARE PSYCHOLOGICAL DISORDERS TREATED? - Psychologists use two basic categories of techniques to treat mental disorders: psychological and biological - Psychotherapy- the generic name given to formal psychological treatment - Biological therapies- treatment based on medical approaches to illness and to diseasefocusing on the brain regions - Psychopharmacology- the use of medications that affect brain or body functions, has proved to be effective on a short-term basis - Just because you know the cause, doesn’t certainly mean that you can cure it (i.e. autism) - PSYCHOTHERAPY IS BASED ON PSYCHOLOGICAL PRINCIPLES: - Psychotherapy is aimed at changing the behaviours or thoughts of the person - Must have good relationship between client and the treatment provider - PSYCHODYNAMIC THERAPY FOCUSES ON INSIGHT: - Insight- a goal of some types of therapy; a patient’s understanding of his or her own psychological processes - Sigmund Freud felt that mental disorders occurred because of past traumatic experiences - In early forms of treatment the therapist would sit away from the patient while the patient lay down on a couch - Techniques included; - free association- the client would say whatever came to mind - Dream analysis- the therapist would interpret the hidden meaning of the client’s dreams - Psychodynamic therapy- help people understand why they are distressed by examining their needs, defences and motives - Negative- time consuming, and expensive ( good for borderline personality disorder, depression, eating disorders, substance use but not very effective for other mental disorders) - HUMANISTIC THERAPIES FOCUS ON THE WHOLE PERSON: - Emphasizes personal experiences and belief systems and the phenomenology of individualstreat person as a whole, rather than as a collection of behaviours - Client-centered therapy – an empathic approach to therapy; it encourages personal growth through greater self-understanding - ^ should be able to create a safe and comforting setting for clients to access their true feelings - Uses reflective listening - COGNITIVE – BEHAVIOURAL THERAPY TARGETS THOUGHTS AND BEHAVIOURS: - Cognitive therapies treat the thoughts and behaviours as the problem and directly target them in therapy - Behaviour can be unlearned through classical and operant conditioning - Operant behaviour-rewarding for good behaviour - Social skills training – effective way to elicit good behaviour - First step is often modelling- where the therapist acts out the appropriate behaviour - Cognitive therapy – treatment based on the idea that distorted thoughts produce maladaptive behaviours and emotionstry to eliminate the bad - Cognitive restructuring- a therapy that strives to help patients recognize maladaptive thought patterns and replace them with ways of viewing the world that are more in tune with reality - Rational emotive therapy – therapists act as teachers who explain and demonstrate more-adaptive ways of thinking and behaving - Interpersonal therapy intertwines insight therapy and cognitive therapy  focuses on relationships the client attempts to avoid - Cognitive-behavioural therapy (CBT) – most widely used a therapy that incorporates techniques from behavioural therapy and cognitive therapy to correct faulty thinking and change maladaptive behavioursreally good for mood disorders and anxiety disorders - Exposure – a behavioural therapy technique that involves repeated exposure to an anxiety-producing stimulus or situation - Repeated exposure to a feared stimulus increases the client’s anxiety, but if the client is not allowed to avoid the stimulus the avoidance response is eventually extinguished - Reliable for many phobias - GROUP THERAPY BUILDS SOCIAL SUPPORT: - Group therapy is much less expensive than individual sessions, provides them to improve their social skills and learn from one another’s experiences - Practitioners believe 8 people is the ideal number for therapeutic sessions - CBT are usually highly structured good for bulimia and OCD - FAMILY THERAPY FOCUSES ON THE FAMILY CONTEXT: - Clients family often plays an important role - Systems approach- an individual is part of a larger context and any change in individual behaviour will affect the whole system - Each person in a family plays a particular role and interacts with the other members in specific ways - If a family exerts a negative expressed emotion towards the patient, it is just going to make them relapse more - Expressed emotion- a pattern of interactions that includes emotional over involvement, critical comments and hostility directed toward a patient by family members - Culture affects the relationship between expressed emotion and relapse - CONFESSION IS GOOD FOR THE SPIRIT: - Uncovering unconscious material and talking about it would bring about catharsis (describes the way certain messages evoke powerful emotional reactions and relief) when people reveal intimate and highly emotional material, they go into a weird state - Talking or writing about emotionally charged events lowers blood pressure, muscle tension - Evidence indicates that writing about emotional events improves immune system function - CULTURE CAN AFFECT THE THERAPEUTIC PROCESS: - Culture influences the way mental disorders are expressed, which people with mental disorders are likely to recover and people’s willingness to seek help - Therapeutic solutions differentiate between different cultures (i.e. different when a black man has a disorder and when a white has one, because their cultural experiences vary) - MEDICATION IS EFFECTIVE FOR CERTAIN DISORDERS: - Psychotropic medications- drugs that affect mental processes change brain neurochemistry - Psychotropic medications fall into 3 categories: - Anti-anxiety drugs, antidepressants, and antipsychotics - Anti-anxiety drugs- called tranquilizers, used for the treatment for anxiety - Benzodiazepines increase the activity of GABA, can reduce anxiety but cause drowsiness and become very addictive - Antidepressants- a class of psychotropic medications used to treat depression - Monoamine oxidase were the first anti-depressants to be discovered, enzyme that converts serotonin into another chemical form - MAO inhibitors therefore result in more serotonin being available in the brain synapses - Tricyclic antidepressants- inhibit the reuptake of certain neurotransmitters resulting in more of each neurotransmitter - PROZAC- selective serotonin reuptake inhibitors(SSRIs)- used to try treat people that are sad (used too often, and can have side effects) - Antipsychotics- also known as neuroleptics- a class of drugs used to treat schizophrenia and other disorders that involve psychosis - Used to treat schizophrenia, and reduce delusions and hallucinations - They bind to dopamine receptors, blocking the effects of dopamine - Significant side effects that can be irreversible- i.e.-tardive dyskinesia, the involuntary twitching of muscles, especially in the neck and face - Lithium is most effective treatment for bipolar disorder - ALTERNATIVE BIOLOGICAL TREATMENTS ARE USED IN EXTREME CASES: - Brain surgery, use of magnetic fields, or electrical stimulation - Trepanning- putting holes in the brain to remove headaches, and anxiety - Psychosurgery- areas of the frontal cortex were selectively damaged - Prefrontal lobotomy-involved severing nerve fibre pathways in the prefrontal cortex - Damaged social interaction and parts of brain that controlled motivation and thought - ELECTROCONVULSIVE THERAPY: - ECT- a procedure used to treat depression; it involves administering a strong electrical current to the patient’s brain - ECT is particularly effective for some cases of severe depression - TRANSCRANIAL MAGNETIC STIMULATION: - A powerful electrical current produces a magnetic field, that when rapidly switched on and off induces an electrical current in the brain region directly below the coil - Single pulse TMS disruption of brain activity occurs only during the brief period of stimulation - DEEP BRAIN STIMULATION: - Deep brain stimulation- was first used to treat Parkinson’s disease (problems with movement) - Few side effects, however helps a lot with OCD and depression - THERAPIES NOT SUPPORTED BY SCIENTIFIC EVIDENCE CAN BE DANGEROUS: - Need to avoid therapies with no scientific basis to confirm they are effective - Some methods may produce results opposite to those intended - READ SUM UP PART 2 WHAT ARE THE MOST EFFECTIVE TREATMENTS? - Some disorders are more easy to treat than others - Have empirical evidence that the treatment will work - Psychological treatments (evidence based) while psychotherapy is generic and refers to any form of therapy - Barlow – says that there are three features that characterize psychological treatments: - 1. They vary according to the particular mental disorder and the client’s specific psychological symptoms - 2. The techniques used in these treatments have been developed in the laboratory by psychological scientists, especially behavioural, cognitive and social - 3. No overall grand theory guides treatments, rather treatment is based on evidence of its effectiveness - TREATMENTS THAT FOCUS ON BEHAVIOUR AND ON COGNITION ARE SUPERIOR FOR ANXIETY DISORDERS: - Anxiety disorders were thought to result from repressed sexual and aggressive impulses - CBT works best to treat most adult anxiety disorders - Tranquilizers help for short term, and are addictive - SPECIFIC PHOBIAS: - Specific phobias are characterized by the fear and avoidance of particular stimuli, such as heights, blood, and spiders - Most phobias apparently develop in the absence of any particular precipitating - Behavioural techniques are best way to solve phobias - 1 -Systematic desensitization therapy- the client first makes a fear hierarchy a list of situations in which fear is aroused, in ascending order nd - 2 -Use relaxation techniques rd - 3 -Exposure techniques - Exposure to the feared object rather than the relaxation that extinguishes the phobic response - Use visual reality to help cope with the fear - Cognitive strategies also help, by bringing awareness to the patient that the fear Is simply irrational - Psychotherapy rewires the brain - SSRI help to cope with phobias - CBT are best for phobias! - PANIC DISORDER: - Imipramine- a tricyclic antidepressant, prevents panic attacks but does not reduce the anticipatory anxiety that occurs when they undergo the panic attack - CBT is very much effective - When people feel anxious they overthink the probability of dangercognitive restructuring helps - Even if clients recognize the irrationality of their fears, they often still suffer panic attacks - Can be helped by exposure treatment - CBT better than medications - CBT better than placebo effects - CBT IS BEST FOR PANIC ATTACKS! - OBSESSIVE-COMPULSIVE DISORDER: - OCD is a combination of recurrent intrusive thoughts and behaviours that an individual feels compelled to perform over and over - People with OCD would best respond to drug treatment - Best drug for OCD is SSRI CLOMIPRAMINE - CBT also work, for those who do not want to use medication - ^ best CBT techniques are exposure and response prevention - The client is directly exposed to the stimuli that trigger OCD but is prevented from engaging in it - Opposite for phobias ^ - Exposure and response prevention proved superior to clomipramine, although both are superior to placebos - Deep brain stimulation may also be an effective treatment for those with OCD who have not found relief from the above two ^ - Brain surgery is irreversible hence risky, but many studies show that it is effective - MANY EFFECTIVE TREATMENTS ARE AVAILABLE FOR DEPRESSION: - Depression – characterized by low mood or loss of interest in pleasurable activities, is one of the most widespread mental disorders among teenagers and adults - No best way to treat depression - PHARMACOLOGICAL TREATMENT: - When tuberculosis was a huge problem, iproniazid was given, their appetites were increased and energy levels increased - Although MAO inhibitors can relieve depression, MAO inhibitors can be toxic because of their effects on various physiological systems - Tricyclics, another type of antidepressant- act on neurotransmitters as well as on the histamine system, extremely effective, but a lot of side effects - PROZAC- does not affect histamine, it has none of the side effects associated with the tricyclic antidepressants, a
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