Transcript therapy

Treatment for psychological
disorders
PSYCHIATRISTS: medical doctors, can prescribe
medicines, generally take a biomedical
approach
CLINICAL PSYCHOLOGISTS: doctoral degree
(PhD or PsyD), supervised internship,
licensing exam, treat more serious disorders
COUNSELING PSYCHOLOGISTS: advanced
degree, less severe problems, marital and
family therapy
Historically seen as possessed by evil spirits or
given other supernatural causes
Trephining: drilled holes
in skull to release spirits
Hippocrates: Greek1st to believe physical
causes
http://commons.wikimedia.org/wiki/File:Trepanated_skull,_Bronze_Age.JPG
Medieval: burned at stake, tortured
REFORMERS:
Dorothea Dix (US),
Philippe Pinel (France)
http://upload.wikimedia.org/wikipedia/commons/a/a0/Dix-Dorothea-LOC.jpg
-advocate for separate
institutions from
criminals, get treatment
http://commons.wikimedia.org/wiki/File:The_Rake%27s_Progress_8.jpg
Movement to remove patients from hospitals
Why:
1. Overcrowding
2. Cost
3. Better medicines
4. Improve quality of life
http://upload.wikimedia.org/wikipedia/commons/thumb/2/2b/Homeless_II.jpg/640pxHomeless_II.jpg
Unintended result: increase in homeless
population of schizophrenics who stopped
taking their medicines
2 Main Approaches to Therapy:
1. BIOMEDICAL: disorders have physiological
cause, need medical treatment
-psychiatrists more likely to use (can prescribe
medicines)
2. PSYCHOTHERAPIES: disorders are
psychological in nature
-psychologists more likely to use
Many disorders require both approaches
Cause of disorders: neurochemical
imbalances, brain structure abnormalities,
genetic predispositions
Goal of treatment: change physiology
Treatment techniques: psychopharmacology,
electroconvulsive therapy, psychosurgery
Drug therapies
Neurochemical imbalances cause disorders,
medicines affect neurotransmitters
http://commons.wikimedia.org/wiki/File:Prozac_pills.jpg
Treats: Schizophrenia
How: block dopamine receptors, decreasing
amount of dopamine
Exs: Thorazine, Haldol, Clozaril
Side Effects: Involuntary muscle twitches,
tardive dyskinesia, drooling, fatal blood
disorder
Treats: anxiety disorders
How: increases availability of GABA
Exs: Benzodiazepines (Valium, Xanax,
Librium), BuSpar
Side Effects: tolerance, increased anxiety when
stop taking, sluggishness, apathy, addiction
Treats: Depression
How: increase amount of serotonin
(norepinephrine, dopamine) available
Exs: SSRIs (Prozac, Paxil, Zoloft), Non-SSRIs,
MAOIs, Tricyclics
Side Effects: nausea, weight gain, sweating,
decreased sex drive, anxiety
Treats: Bipolar Disorder
How: unknown
Exs: Lithium
Side Effects: excessive thirst, memory
problems
Treats: ADHD
How: activate sympathetic nervous system,
reduce inhibitory centers
Exs: Ritalin, Dexedrine, Adderall
Side Effects: insomnia, loss of appetite,
increased heart rate, anxiety
Treats: major depression (last resort)
How: administer electric shock (about 6x over
2 weeks) that causes seizure
-given muscle relaxant
and anesthesia
Side Effects: memory loss
http://historypsychiatry.com/2010/09/15/electroconvulsive-therapy-past-and-present/
Removal of brain tissue-last, last resort
Lobotomy: 1935-1955-cut frontal lobe from
rest of brain
-used for many disorders, left many brain
damaged
Corpus callosum transection (split-brain): to
treat epilepsy
Are psychologically based therapies
Insight therapies:
-Psychoanalysis
-Humanistic therapies
Action therapies:
-Behavioral therapies
-Cognitive therapies
-Cognitive-Behavioral Therapies
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Causes of disorders: unconscious, repressed
traumatic events usually from childhood
Goal of treatment: reveal unconscious conflicts,
urges and desires
Founder: Sigmund
Freud
http://commons.wikimedia.org/wiki/File:Sigmund_Freud.jpg
Treatment techniques:
-Free association: “talk therapy”-saying
whatever comes to mind
-Dream interpretation: “royal road to
unconscious”-still protect-symbolic
-manifest content: actual events of dream
-latent content: hidden underlying meaning
-Resistance: unwillingness to talk (good stuff)
-Transference: patient projects unconscious
feelings onto therapist
Evaluation: long-term (23x/week for years),
expensive, unconscious
is scientifically
unverifiable, too much
emphasis on sex
Psychodynamic therapy:
based on psychoanalysis,
shorter treatment time,
more direct
http://upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Diva_de_Freud.jpg/320pxDiva_de_Freud.jpg
Causes of disorders: poor self-concept, low
self-esteem due to conditions of worth, too
much difference between real self and ideal
self
Goal of treatment: know self, accept self, work
toward self-actualization
Approaches to therapy: Client-centered
therapy, Gestalt therapy
CLIENT (PERSON)CENTERED THERAPY:
Founder: Carl Rogers
Treatment techniques:
Nondirective: client leads
discussion, therapist
says little
Active listening: therapist
mirrors back what client
says
Unconditional positive
regard: acceptance
Empathy: understanding
http://commons.wikimedia.org/wiki/File:Carl_Ransom_Rogers.jpg
GESTALT THERAPY:
Founder: Fritz Perls
Treatment: directive therapy helps clients
accept all parts of self
Evaluation of Humanistic: little research to
support, not practical for more serious
disorders, good for career choices
Causes of disorders:
Maladaptive behavior learned
the same way as
adaptive behaviors
http://commons.wikimedia.org/wiki/File:John_Watson.jpg
Goal of treatment: change unwanted behavior
and replace it will healthy behaviors
Treatment techniques: use principles of
classical, operant, and observational learning
Counterconditioning: uses classical
conditioning
-Systematic desensitization: (Joseph Wolpe)
phobias-associate fear with relaxation
1.Taught relaxation techniques
2. Create hierarchy of phobia
3. Work through hierarchy, staying relaxed
-Flooding: for phobias-directly confront fear,
extinction occurs
-Aversive conditioning: associate unpleasant
stimuli with unwanted behavior (chemical
on fingernails to stop biting)
Operant conditioning: uses rewards
-Behavior modification: given small reward as
get closer to goal
-Token economies: given token (secondary
reinforcer) for desired behavior, can
exchange for external rewards
Observational learning: observe others, and
imitate behavior
Evaluation of behavioral: only treat
symptoms, not cause of disorder, very
effective with many disorders, especially
anxiety
Cognitive Therapies
Causes of disorders: maladaptive thinking
Goals of treatment: cognitive
restructuring/change to more adaptive,
realistic thinking
Types: Rational Emotive Therapy, Cognitive
Triad Therapy
Rational Emotive Behavioral Therapies (REBT)
Founder: Albert Ellis
Techniques:
-Confrontation of ABCs: address irrational
thoughts by discussing Actions, Beliefs,
Consequences
-Homework: journaling, readings
Cognitive Triad Therapy
Founder: Aaron Beck
Beliefs: depression is caused by negative
thinking about triad: self, world, future
Techniques: non-confrontational, change
negative beliefs