Transcript Treatments For Psychological Disorders

Treatments for
Psychological Disorders
Biological and Psychological Based
Treatments
Early Attempts at Biological Intervention
 Coma and convulsive therapies
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Insulin coma therapy
Electroconvulsive shock therapy (ECT)
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Bilateral ECT and Unilateral ECT
Shock lasting 1.5 Seconds 3 x week (2-4 weeks)
Memory Impairment for Months After
 Neurosurgery
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Psychosurgery or Neurosurgery
The prefrontal lobotomy
Very, Very Seldom Today Due to Medications
Psychopharmacological Methods of Treatment
 Note: Keep in mind that the role of neuro-
transmitters in mental illness is not well known.
The use of medication is based on theory not
fact
 Psychopharmacology- the science of
determining which drugs alleviate which mental
disorders and why they do so
Antipsychotic Medications
Neuroleptics or Major Tranquilizers
 Traditional Antipsychotics included side effects
including Tardive Dyskinesia- a disfiguring disturbance
of motor control, particularly of the facial muscles
 Atypical Antipsychotics
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Zyprexa, Geodon, Risperdal, Clozaril, Seraquil
 Side Effects
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Include: Dry Mouth, Motor Disturbances, Sedation,
Weight Gain, Damage to Liver (blood levels need to
be taken), Risperdal (lactation in females)
Effectiveness (20-30% do not respond)
Neurotransmitter Functioning
Antidepressant Medications
 Monoamine oxidase (MAO) inhibitors
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Inhibits breakdown of neurotransmitters
Used in depression with hypersomnia
Requires Dietary Supplement
 Tricyclic antidepressants (TCAs)
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Inhibits reuptake of serotonin & norepinephrine
Cause death with overdose
 Selective serotonin re-uptake inhibitors (SSRI)
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Prozac, Zoloft, Paxil, Luvox, Lexapro, Celexa
Not as selective as once thought
 Should be taken for minimum of 9-12 months
Antianxiety Medications
Anxiolytics or Minor Tranquilizers
 Benzodiazepines
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Sedative effect
Dependency Issues
Used to Treat Alcohol Withdrawal
High Relapse Rate After Termination of Medication
Probably stimulate GABA an inhibitory neurotransmitter
Side Effects Include: Drowsiness and Lethargy
Lithium for the bipolar mood disorders
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Long Term Use Side Effects Include: thyroid
dysfunction, kidney damage, memory and motor speed
problems
Medication and Children
 Do anti-depressants increase suicidality?
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Natural increase in likelihood to suicide when
mood improves
Medications do result in an initial adjustment for
the body that can be agitating
 Important to monitor the individuals mood in the
first 10 days
 A client’s response to a medication in the first 10-
14 days is often predictive of how effective the
medication will be in alleviating antidepressant
Psychologically
Based Therapies
An Overview of Psychological Treatment
 Who provides psychotherapeutic services?
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Psychologists, Psychiatrists, Social Workers
 Educational Backgrounds Vary
 Theories of Change Vary (see next slide)
 Commonalities in Effective Therapists
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Form a Therapeutic Alliance with Their Clients
Focus on Client Goals
Use Research Based Interventions
Psychotherapy
 Psychotherapy- the treatment of mental disorders by
psychological methods.
 To Achieve changes a therapist may:
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Change maladaptive behavior patterns
Minimize or eliminate influences from the environmental
condition
Improve interpersonal skills or other competencies
Resolve disabling conflicts among motives
Modify dysfunctional beliefs
Reduce or remove distressing or disabling emotional
reactions.
Foster a clear cut sense of identity
An Overview of Psychological Treatment
 Why do people seek therapy?
 Those in highly stressful situations.
 Referred by physician or other professional.
 Forced by spouse, parent, or court.
 Who has the best prognosis? (YAVIS)
 Young, Attractive, Verbal, Intelligent, and
Successful Individuals.
 Why YAVIS?
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Motivation, Cognitive Abilities, Malleable
The client’s contribution to the success of
treatment includes his or her motivation and
expectation
Successful Therapy
 Qualities of the client (personality, motivation)
 Qualities of the therapist (relational skills)
 Qualities of the relationship (therapeutic alliance)
 Qualities of the method being used.
Stages of Change
 Prochaska’s Levels of Change
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Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Termination
 Customer or not a customer
Psychodynamic Therapies:
Freudian psychoanalysis
 Four Basic Techniques
 Free association
 Analysis of dreams
 Manifest content
 Latent content
 Analysis of resistance
 An unwillingness or inability to talk about certain thoughts,
motives or experiences
 Analysis of transference
 Transference- the process whereby clients project onto the
therapist attitudes and feelings they had in a past
relationship with a parent or other person close to them
 Countertransference- the process in which the therapist
reacts in accord with the client’s transferred attributions
rather than objectively
Psychodynamic Therapies:
Since Freud
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Interpersonal therapy
Object relations
Self psychology
Other interpersonal variations
 Psychodynamic therapies tend to be time
consuming and expensive
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They suggest that past issues need to be
resolved for change to occur
 Efficacy vs Effectiveness of of Psychodynamic
Approaches
Behavior Therapy
 Guided exposure
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Systematic desensitization
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Graduated scenes
Require an inconsistent bx from the client
while exposed (real or imagined) to the
feared stimuli
In Vivo Exposure
 Aversion therapy
 Use of Punishment (antabuse)
 Driving Movie
 Pornography and Children Walking In
 Modeling, Imitation, and Role Playing
Behavior Therapy
 Systematic Use of Reinforcement
 Also referred to as Contingency Management
 Response Shaping- a behavior therapy technique using
positive reinforcement to establish by gradual
approximation a response that is actively resisted or is
not initially in a person’s behavioral repertoire
 Remove Reinforcements or Add Reinforcements
 Super-Nanny
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Token Economies
Behavioral Contracting (marital tx and social exchange)
Biofeedback Treatment
 Monitor Physical, Convert to Signal, Prompt Feedback
Cognitive & Cognitive-Behavioral Tx
 Rational emotive behavior therapy (REBT)
 Focus on changing core irrational beliefs
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See table 3.5
 Stress-inoculation therapy (SIT)
 Three stages include: cognitive preparation, skill
acquisition & rehearsal, and application and
process.
 Beck’s cognitive therapies
 Focus on illogical thinking about self, world, and
future.
Humanistic-Experiential Therapies
 Client-Centered (person-centered) therapy
 Nondirective
 Unconditional Positive Regard
 Self-actualization
 Existential Therapy
 The human predicament
 Focus on here and now
 Therapist is to be authentic
 Gestalt Therapy
 Integration of thought, feeling, and action into
one’s self-awareness
Therapy for Interpersonal
Relationships
 Couples Counseling (Marital Therapy)
 Family Systems Therapy
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Systemic Recursiveness
Identified Patient
Homeostasis
 Structural Family Therapy (Salvador Minuchin)
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Family Rules and Boundaries
Eclecticism and the Integration of
the Psychotherapies
 How do they all fit together?
How Does One Measure Success
in Psychotherapy?
 Objectifying and quantifying change
 Would change occur anyway?
 Can therapy be harmful?
Psychotherapy and Society
 Social values and psychotherapy
 Psychotherapy and cultural diversity
EVALUATING PSYCHOTHERAPIES
 Is psychotherapy effective
 Client perceptions
 indicates that 3 out of 4 are satisfied while 1 in 2 are very
satisfied.
 Reports may be inaccurate due to crisis effect, effort effect, and
liking the therapist
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Clinician’s Perceptions
 Most testify to therapy success (big surprise)
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Outcome Research
 Indicates that the average therapy outcome for clients who
receive treatment surpasses that of the client who remains
untreated.
 “Those not undergoing therapy often improve, but those
undergoing therapy are more likely to improve.”
 On average psychotherapy is somewhat effective (it depends on
the diagnosis obviously)
 Psychotherapy has been shown to decrease medical costs.
 Contrary to Myer’s presentation, some treatment approaches
have been proven to be more effective than others.
UNRESOLVED ISSUES
 Efficacy versus effectiveness