Transcript Biomedical Therapies

Treatment Modalities for
Psychological Disorders
“Brutal” to “Gentle” Transition
• Dorothea Dix and Philippe Pinel (mid 1800s)
– Advocates of mental hospitals to provide
more human treatment
• Mid 1950s: exodus from mental hospitals:
– Introduction of therapeutic drugs
– Community-based treatment programs
Two Main Treatment Modalities
• Psychotherapy
• Biomedical therapy
• Combination of the two
• 50% of psychotherapists say they use an
“ecclectic approach,” using a blend of
therapies
4 Main Psychological Therapies
• 1. Psychoanalysis
• Sigmund Freud
• 2. Humanistic
• Carl Rogers
• 3. Behavioral
• Pavlov/Skinner
• 4. Cognitive
• Aaron Beck
1. Psychoanalysis
• Psychological problems =
• Repressed impulses and conflicts from
childhood
• Aim: work through ‘buried’ feelings and take
responsibility for their own growth
• Release energy ‘wasted’ on id-ego-superego
conflicts
1. Psychoanalysis
• How does it work?
• Free association
• But watch out for “resistance”… blocks in the
flow of free association
• Therapist would interpret the ‘meaning’ of
your resistance
• Interpretation of latent content in dreams
1. Psychoanalysis
• One result of therapy:
• Transference
• Occasionally followed by
“Countertransference”
• This is why the APA has a “Code of Ethics”!
1. Psychoanalysis
• Be ready to open you wallet!
• Traditional psychoanalysis is 3-4 visits/week
for several years
• Conservatively speaking, at $125/hour, this is
$68,250 for 3 years
• Maybe just take a few nice vacations!
1. Psychoanalysis
• Modern “alternative” is:
– Psychodynamic Therapy
• Goal is to understand current symptoms in
terms of childhood and important
relationships
• Face-to-face; generally once a week for
several months
2. Humanistic Therapy
• Carl Rogers (1902-1987)
• “Client-centered therapy” (Not “patient”)
– Aim is to grow in self-awareness and
acceptance
• Focus is on:
– Dealing with present & future
– Conscious thoughts rather than unconscious
– Taking responsibility for one’s feelings & actions
2. Humanistic Therapy
• Therapists strive to exhibit :
– Genuineness
– Acceptance
– Empathy
• Which leads to “unconditional positive
regard”
• Mechanism: “Active Listening”
3. Behavior Therapies
• You don’t need “self-awareness” to heal from
psychological problems!
• A. Classical Conditioning Techniques
• B. Operant Conditioning Techniques
3A. Classical Conditioning
• “Counter-conditioning”: Pair the trigger
stimulus with a new response (relaxation)
• Idea: can’t be both fearful AND relaxed
• Two techniques:
– Exposure therapy
– Aversive conditioning
3A. Classical Conditioning
• Exposure Therapy/Response Prevention
(ERP)
3A. Classical Conditioning
• Aversive Conditioning: Substitute an aversive
response for a positive response to a harmful
stimulus
Also, Faradic
aversion
conditioning!
3B. Operant Conditioning
• Behavior Modification
• Use positive reinforcers to shape behavior
3B. Operant Conditioning
• Token Economies
3B. Operant Conditioning
• Concerns with Behavior Modification
• How ‘durable’ are the effects?
• It is OK for one human to control
another’s behavior?
4. Cognitive Therapy
• Works with the assumption that our
thoughts color our feelings
• Aaron Beck: Expose irrational thinking,
and then persuade the person to
remove the dark glasses through which
they view life
4. Cognitive Therapy
Therapies to Avoid!
• Energy therapy – manipulating invisible
energy fields
• Recovered-memory therapy
• Rebirthing therapy
• Facilitated communication
• Crisis debriefing
Biomedical Therapies: Drugs
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Antipsychotic Drugs
Antianxiety Drugs
Antidepressant Drugs
Mood-Stabilizing Drugs
Biomedical Therapies: Adjuncts or
Alternatives to Drugs
• Electroconvulsive Therapy
• Magnetic Stimulation
• Deep-Brain Stimulation
Biomedical Therapies: Drugs
• Antipsychotic Drugs
• Most common drugs help alleviate
“positive” symptoms of schizophrenia
• Ex. Chlorpromazine (Thorazine)
• Work by blocking activity of dopamine
• Major side-effects: tardive dyskinesia,
obesity, diabetes
Biomedical Therapies: Drugs
• “Atypical” Antipsychotic Drugs
• Help alleviate ‘negative’ symptoms of
schizophrenia
• Ex. clozapine (Clozaril)
Biomedical Therapies: Drugs
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Anti-anxiety Drugs
Examples: Xanax, Atavan, Valium
ALL depress the central nervous system
Anti-anxiety drugs plus ________ make a
lethal combination?
–ALCOHOL!
Biomedical Therapies: Drugs
• Anti-anxiety Drugs
• Criticisms:
– 1. do not treat underlying problem, just
symptoms
– 2. Psychological dependence: “popping a Xanax”
– 3. Physiological dependence: cessation of drug
can lead to great anxiety and insomnia
–New standard drug treatment
for anxiety….
Biomedical Therapies: Drugs
• Antidepressant Drugs
• Also successfully treat anxiety disorders
in addition to depression
• Selective-serotonin-reuptake inhibitors
(SSRIs)
–Prozac (fluoxetine), Zoloft (sertraline),
Paxil (paroxetine)
Biomedical Therapies: Drugs
Biomedical Therapies:
Brain Stimulation
• Electroconvulsive Therapy
• 1938: 100 volts administered to wideawake patient
• Today: general anesthesia, muscle
relaxant, 30 second electrical stimulation
• Refractory Depression: 80% of patients
improve with ECT, but 4 in 10
relapse within 6 months
Biomedical Therapies:
Brain Stimulation
• Electroconvulsive Therapy
Biomedical Therapies:
Brain Stimulation
• Alternative Neurostimulation
• 1. Magnetic Stimulation: repetitive transcranial
megnetic stimulation (rTMS)
Biomedical Therapies:
Brain Stimulation
• Alternative Neurostimulation
• 2. Deep-Brain Stimulation
Biomedical Therapies:
Psychosurgery
• Frontal Lobotomy
• 1930s, Portuguese physician, Dr. Moniz
• In the U.S. during 1950s: 35,000
lobotomies performed
• J.F. Kennedy’s sister, Rosemary, received
a lobotomy
–No longer performed
–Nobel Peace Prize awarded to Moniz
Therapeutic Life-Style Change
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Aerobic exercise: 30 min. 3x a week
Adequate sleep: 7-8 hours per night
Light exposure
Social connection
Anti-rumination
Nutritional supplements: omega-3 fatty
acids