Transcript PSY100-treatment11 - University of Toronto Mississauga

Introduction to Psychology
Treatment of Psychological Disorders
Psychological Therapies
• Whereas the biological therapies view mental
disorders through the medical model,
psychological therapies view the roots of
abnormal behavior in mental states
– Each therapy has its own view as to the cause of
mental disorder
– Each therapy has its own approach to the
treatment of mental disorder
Insight-Oriented Therapy
• E.g. psychoanalysis, humanistic, gestalt
• Help person understand the basis of their
thinking, behavior, emotions and
perceptions
• Insight into the cause will lead to change
• Emotion focused therapy or process
experiential
Action-Oriented Therapy
• E.g. Cognitive-Behavioral therapy,
Rational-Emotive therapy
• Encourages individuals to change behavior
or thinking
• Multifaceted and individually tailored
• Strong therapeutic relationship
• Behavioral techniques and cognitive
restructuring
Varieties of Psychological
Treatment
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Psychodynamic
Humanistic
Cognitive-behavioral
Biological/Biomedical
Group therapy
Family and marital therapy
Psychodynamic Approach
• The psychodynamic approach was created by S.
Freud
– Mental symptoms reflect unconscious conflicts that
induce anxiety
– Insight refers to the situation in a person comes to
understand their unconscious conflicts
– Therapeutic change requires an alliance
(relationship) between the patient and therapist
Psychodynamic Techniques
• The goal of psychodynamic therapy is to
achieve insight into unconscious conflicts
– Free Association refers to a technique in which the
patient is encouraged to say whatever comes to
mind to reveal the unconscious processes of the
patient
– Interpretation: Therapist interprets the thoughts,
and feelings of the patient in order to reveal the
hidden conflicts and motivations
– Analysis of transference: Patients bring into
therapy their past troubled relationships; these are
transferred to the therapist
Humanistic Therapy
• Roger’s Client-centered therapy
• Therapeutic Climate
1) Genuineness
2) Unconditional Positive Regard
3) Empathy
• TherapeuticProcess
Guidance, clarification, become more comfortable
with genuine self
Behavior Therapies
• Classical conditioning techniques can alter
emotional responses
– Systematic desensitization: Patient is encouraged
to confront a feared stimulus (snake) while in a
relaxed state
• Therapist trains relaxation
• Patient constructs an image hierarchy
• While relaxing, patient imagines the least fearful of
the images in their hierarchy (e.g. being on the planet
as a snake)
– Exposure: Patient is exposed to the stimulus that
they fear (locked in a room full of snakes)
Cognitive Therapies
• Focus of cognitive therapies is on changing
dysfunctional thought patterns
• Rational Emotive Therapy focuses on the
hurtful thought patterns of the patient
– Ellis’s theory suggests that pathology results when
persons adopt illogic in response to life situations
– Therapist notes illogical and self-defeating
thoughts and teaches alternative thinking that
promotes rational thought
Cognitive-Behavioral Therapies
• Cognitive-behavioral therapies focus on the
current behaviors of a person
– Emphasis is on the present rather than the past
– Cognitive-Behavioral therapists are very directive
– Therapy duration is short-term rather than years
long
– Initial focus is on a detailed behavioral analysis:
focus is on the problem behavior and the stimuli
associated with it
Cognitive Restructuring
• Beck or Ellis
• Irrational beliefs
• Extreme emotional reactions
• ABC’s or Rational Emotive Therapy
A – activating event
B – belief
C – consequences (emotional)
D – disputing beliefs
Research indicates:
• Receiving psychotherapy is considerably
more effective than no treatment
• CBT shows a slight but consistent
advantage with regards to effectiveness
compared to insight-oriented therapy
• People who do best in therapy are those
who have the least problems
• personality disorders show less benefit
The Medical Model
• The Medical Model views abnormal behavior
as reflecting a biological disorder
– Usually localized within the brain
– Involving either brain damage or a disruption of
the neurotransmitter processes of the brain
– Person is viewed as a patient, treated by doctors in
a mental hospital
– Therapies tend to be physical in nature
• Drugs (Pharmacotherapy)
• Surgical alteration of brain (Psychosurgery)
Pharmacotherapy
• Psychotropic medications are drugs that act on
the brain to alter mental function
• Prior to 1956, schizophrenia was virtually
untreatable with many patients confined for
life in mental hospitals
– Chlorpromazine (Thorazine) was found to reduce
severity of psychotic thought, allowing people to
live outside of mental institutions
• Reduced size of institutions
– The psychotropic actions of many drugs are often
accidentally discoveries
Antipsychotic Medications
• Schizophrenia can be viewed as composed of:
– Positive Symptoms: Presence of hallucinations
– Negative Symptoms: Absence of affect
• Antipsychotic medications refer to drugs that
alleviate schizophrenia
– Antipsychotic medications are more effective for the
positive symptoms than for negative symptoms of
schizophrenia
Dopamine and Schizophrenia
• The positive symptoms of schizophrenia
reflect too much brain dopamine activity
– Antipsychotic drugs are effective antagonists of
dopamine receptors (block the action of
dopamine)
– Drugs such as amphetamine release dopamine
from terminals; too much amphetamine exposure
can induce a psychotic state in humans
• Negative schizophrenic symptoms may reflect
brain damage enlarged ventricles)
Antidepressant Medications
• Depression reflects a disturbance of mood,
sleep, and appetite
• Psychotropic antidepressant drugs can lift
depression (require 3-4 weeks for effect)
– Tricylic antidepressants: Act by blocking the
reuptake of norepinephrine and serotonin
– Monoamine oxidase (MAO) inhibitors: MAO
degrades transmitters; drugs that inhibit MAO
allow the transmitter to work for longer periods
– Selective serotonin reuptake inhibitors: Prozac
blocks the reuptake of serotonin
Antianxiety Medications
• Anxiety reflects an intense emotional state of
dread and apprehension
• Drugs such as Valium increase the activity of
the transmitter GABA to dampen the neural
activity of the brain
– Valium is useful in the short-term treatment of
anxiety
• Antianxiety medications can result in drug
dependence
Electroconvulsive Therapy
• Antidepressant drugs require 3-4 weeks to take
action on mood; the person may be at risk for suicide
or is not responding to drug treatment
• Electroconvulsive shock therapy (ECT) refers to the
intentional induction of a brain seizure by shock
administered to either or both hemispheres
– ECT produces immediate improvement in mood
(explanation is unknown)
– Side effects of ECT include memory loss
Common Factors in
Psychotherapy
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Development of a therapeutic alliance
Providing a rationale
Opportunity for catharsis or venting
Acquisition and practice of new behaviors
Beneficial therapist qualities (objective,
confidential, professional)
• Patient positive expectations and hope
Eclecticism
• Involves using different treatments for
different clients with different problems
• Using a reasonable combination of various
treatments for the same client (technical
eclecticism)
- all populations can receive different types of
group therapy
Advantages to groups
1. Efficiency
3. Empathy
5. Acceptance
7. Modeling
9. Practice
11. Transference
2. Universality
4. Interaction
6. Altruism
8. Pressure
10. Reality testing
Suicide Risk Factors
Diathesis
• psychological disorder (90%)
• substance use and abuse (25-50%)
• family history of suicide
• family breakdown
• societal breakdown
• past suicide attempts
Suicide Risk Factors
Stress
- changes in relationships, academic/work, or
financial situation
- life event that is shameful or humiliating
- significant loss
- homosexuality
- recent suicide
Suicide
Warning Signs
- withdrawal
- change in eating, sleeping, friends
- writing and talking about death
- telling statements
- agitation followed by calm resignation
- giving away valued possessions
What to do as a friend
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Take suicide threats seriously
Don’t be afraid to discuss suicide
Recognize the warning signs and the risk
factors
Don’t leave the person alone
Get help
What to do as a therapist
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Ask directly about suicide
Find out if they have a plan
Do they feel like they are in control of their
behaviour?
Develop a safety plan
Make a contract
Treat the psychological disorder
Crisis situation – break confidentiality
Grief after suicide...