Treatment

QOTD

Austin Gregg et al

Which Therapy option is most beneficial to you?

A) 1 on 1 counseling

B) Self-Help therapy

C) Group Therapy

D) Other

E) None / never needed

Mary Gibbs, Luke Leinberger

If you've ever seen a therapist, what model did they use?

A) psychoanalysis

B) behavorist

C) cognitive

D) humanistic

E) Never seen a therapist

Veronica Cortez

Do you believe psychotherapy is really helpful?

a) yes

b) no

Samantha Stone, Logan Young

Do you believe that, in some cases, therapy can be harmful to one's mental health?

A. Yes

B. No

Logan Young

Have you ever used drugs to treat a psychological dissorder?

A. Yes and I still do

B. Yes but I no longer use them

C. No, I have used therapy

D. No, but I wish I did

E. No, never needed

Jared Keschl

If you or someone you know has depression, who is treated via prescription drugs, do you think the pills work?

A) Yes they work

B) No they don't

C) Don't know anyone personally w/ depression

Rachel Armbrust

If a depressed patient is treated with pills they are....

A) cured of depression

B) cured of depression until taken off medication

C) not cured of depression

D) in need of other forms of treatment allongside pills to be effective

Carly Mazure

Do you know anyone who actively abuses Benzodiazepines such as xanax, valium?

A) Yes

B) No

Mitchell Freydenlund

With evidence that 80-90% of the effects of antidepressant can be duplicated by placebos, does that hurt or help the stigma surrounding mental disorders?

A) Reduces Stigma

B) Increases Stigma

C) No Effect

Alivia Blumenstein

Do you feel as though there is a negative conotation surrounding "seeing a therapist"? And if so would that inhibit you from seeking out help from one?

a) yes

b) no

Leo McClung

Long term, which do you think is a more effective treatment for psychological disorders: medication or psychiatric therapy?

A) Medication

B) Therapy

Brady Goldsworthy, Wyatt Haines

Should anyone be forced to take medication for their mental disorders?

A) Yes

B) Only in severe circumstances

C) No

D) No, it can cause more problems than it cures

Nicola Cave

Is it unethical for a doctor to not reveal to a patient that they are prescribing a placebo?

a) Yes, a medical professional should always be honest with their patients.

b) No, there is no problem if the treatment works.

Nicola Cave

Do placebos work if the recipient knows they are taking a placebo?

a) yes

b) no

Ellen Kyger

Has anyone or known anyone who has successfully been 100% treated from a mental disorder?

A) yes

B) no

James Seto-Templeton, Yang Li

Is ECT a valid treatment for psychological disorders?

a) yes, it is definetly effective and has helped some patients

b) yes, but there are other forms of therapy that are more effective and less dangerous

c) absolutely not, it is very dangerous, barbabic and an outdated form of therepy

d) i'd like to try it before I buy it!

Keira Maldonado

Do you believe that CU has enough treatment resources for students?

A. Yes

B. No

C. Idk / I haven't looked into treatment

Ryan Taylor

It is clear that treatment for a number of causes can be effective for people. How would you refer a friend to treatment if you think they may need it?

a) Give them the contact info for a local therapist

b) Suggest to them face-to-face they need to seek help

c) hope they can figure it out on their own

d) tell them the benefits that therapy can provide

Madeleine Mason

In the future, do you think we will look back on psychological treatments today and think they are as primitive as shock therapy or trephination?

A. Yes

B. No

The Big Questions / Issues

Are all good forms of therapy equivalent? “Dodo bird verdict” If so, what makes them all work?

Do drugs work, enough to be worth the risks? No better than therapy for most people Most people don’t have a “brain” disorder!?

First, Important DistinctionsCritical to distinguish classes of disorders: Anxiety and Depression (by far most common)

Probably not “biological” for most people Drugs may help, but not because they are fixing a

broken biological mechanism – just make u feel better (in which case, why not just take MDMA?)

Schizophrenia and Bipolar are more biological Not very well treated by drugs, but could be!? Scz is common failure mode of many diff causes:

hard to fix with one intervention.

What All Therapies Do

Theraputic alliance; Therapist allegiance and competence. (Huh?)

Why do these factors make people feel better? Hope, confidence, positive emotions,

willingness to commit effort.. In other words, therapy imparts self-efficacy

and reboots goal-driven cognitive system!

Two Phases of Mental Life

Goal selection Careful weighing of costs / benefits to select goal

Multiple constraint satisfaction of needs, “drives”, opportunities, risks, costs, effort, etc..

Goal engaged Selected goal robustly held – hard to give up..

Continuous evaluation of proximity to goal

Dopamine bursts, dips as function of changes

Costs are significantly downplayed (but learned)

Strong dissociations in value functions

Why is it so hard to start something (packing for a trip, writing a paper, paying bills, cleaning desk…) But once started, it really isn’t so bad..

Goal selection process carefully weighs costs / benefits, considering many different possible goals

Applied to Phenomenology

Applied to Phenomenology

Ever find yourself playing mindless video games for far longer than you should?

Why can’t I stop myself from organizing my kid’s Legos, or cleaning leaves from pool?

Goal is engaged: incremental progress drives dopamine – video games engineered to deliver

Costs, alternatives are downplayed

Dopamine = progress toward goal

LV = phasic dopamine driven by engaged goalPV = was goal achieved or not; time to select new

Distributed Goal Network

Striatum: helps select, maintain coordinated reps throughout network (BG gated WM)

Goal-based Clinical Disorders

Depression Vicious cycle of: negative affect -> inability to select

goals -> negative affect -> .. (hopelessness) Everything has high cost, low gain

OCD Insatiable goals constantly re-selected, driving

habitual motor plans.. Avoidance goals: when is avoiding over?

Bottom line

It takes serious work to overcome strength of negative emotional systems: Easy to be overcome with defeatist, negative

thoughts, worries, anxieties, etc Sometimes you need some help! Someone who

can talk you through it, get you pointed in a new direction, etc..

First step is always recognition and acceptance, and understanding that this is just how your brain works, and you just need to work at it to overcome..

Pharmacotherapy

No more effective than “placebo” for most people

Massive conspiracy marketing from drug companies, pushing a “miracle cure” for shiny happy people!

Major side effects and risks, including extreme violence, suicide in some cases..

Depression and SSRI’s

Have you:

A. Been severely depressed, but not taken SSRI

B. Been severely depressed, taken SSRI

C. Not been severely depressed, taken SSRI (?)

D. Not been severely depressed, no SSRI

Serotonin is VERY Complex

Many different 5HT pathways, receptors, each with different, opposing effects “Happy” 5HT pathway: interfascicular raphe (DRI) “Sad” 5HT pathway: caudal raphe? Many others..!

Chemical imbalance vs. chemical intervention / jumpstart?

Placebo Data

Telling people about placebo (“postreveal”) doesn’t overcome prior long conditioning, but does for short amount of prior conditioning!

Hey, what about ADHD??

Neurodevelopmental: in a different category from other disorders

Volkow et al (2011): “These findings provide evidence that disruption of the dopamine reward pathway is associated with motivation deficits in ADHD adults, which may contribute to attention deficits and supports the use of therapeutic interventions to enhance motivation in ADHD.”

Volkow et al, 2011

ADHD

Do you have ADHD?

A. Yes, diagnosed, on meds

B. Yes, diagnosed, not on meds

C. Yes, not diagnosed, on meds

D. Yes, not diagnosed, not on meds

E. No.

ADHD

If you answered Yes to ADHD, what is your handedness?

A. Right handed

B. Left handed

C. Bimanual

D. Don’t have ADHD already