Ch 13 Therapies

8/12/2019 Ch 13 Therapies

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Copyright McGraw-Hill, Inc. 2013


Chapter 13

Therapies


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Chapter Preview

In the previous session you learned about psychological

disorders. In this chapter well focus on the methods used to

treat these disorders, and the philosophies underpinning

them.

This study guide will highlight the concepts upon which you

should focus your reading in the chapter.


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Biological Therapies

Also called biomedicaltherapies

Treatments that reduce symptoms of psychological disorders

by altering aspects of body functioning

Drug therapy Electroconvulsive therapy

Psychosurgery


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Drug Therapy

Revolutionized mental health care in the 20thcentury

Today there are many psychoactive drugs on the market

for various disorders

However, effectiveness is often disputed, and the exactmechanisms by which some of them work are not fully

understood

In this guide well review the major categories of drugs

used in treatment of disorders


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AntianxietyDrugs

Commonly known as tranquilizers

Bind to receptor sites of neurotransmitters that become

overactive during anxiety

Benzodiazepinese.g. Xanax, Valium

Relatively fast acting

Side effects include drowsiness, loss of coordination,

fatigue, and mental slowing

Can become addictive, so intended for short-term use, but

often abused


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AntidepressantDrugs

Regulate mood through effects on neurotransmitters

Tricyclics

Increase norepinephrine and serotonin levels

Monoamineoxidase (MAO) inhibitors

Block enzyme that breaks down serotonin and

norepinephrine

Selective serotoninreuptake inhibitors (SSRI)e.g. Prozac,

Zoloft, Paxil Inhibit the reabsorption of serotonin in brain

Lithium

Solid element used to treat bipolar disorder


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Antipsychotic Drugs

Neuroleptics

Block dopaminesaction in brain

Powerful drugs, which often have serious side effects,

including: Dysphoria: Lack of pleasure

TardiveDyskinesia: Movement disorder

Atypicalantipsychotic medications

Claimed to have lower risk of side effects

Block reuptake of serotoninin addition to affecting

dopamine


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Overview of Drug Therapy for

Psychological Disorders



ElectroconvulsiveTherapy

Commonly called shock therapy

Goal is to set off seizure in brain

Patient receives anesthesia and muscle relaxants

Used primarily to treat severe depressionthat has beennonresponsive to other treatments

Controversial because of potential for side effects, especially

in the domain of memory loss



Psychosurgery

Irreversible removal or destruction of brain tissue to improve

adjustment

Historically, the most common (and notorious) form was the

prefrontal lobotomy

Severing of fibers connecting frontal lobewith thalamus Actual effectiveness questioned, but widely used in the US

from 1930s-1950s

Ethical concerns regarding long-term brain damage,

pressure to consent to the surgery as a condition ofrelease from treatment, and use of treatment as a means

of social controlover undesirable behavior



Biological Approach

That summarizes the state of the biological approach to

treatment. Understand, though, that this is still a very young

science, with a history tied mostly to the last 60 years or so.

We still have a long way to go in understanding the biological

bases of behavior and psychological disorder.



Psychotherapy

Nonbiological process that helps individuals with psychological

disorders recognize and overcome their problems

Approaches include:

Psychodynamic

Humanistic

Behavioral

Cognitive

There are many different types of professionals who practicepsychotherapy. Be sure to review these in your book ahead of

your next exam



PsychodynamicTherapies

Stress importance of:

Unconsciousmind

Extensive interpretationby therapist

Role of early childhood experiences



Psychodynamic Therapies

Freudian psychoanalysiswas the first major psychodynamic

approach

The goal was to bring unconscious conflictsinto conscious

awareness, using techniques such as free associationand

dream analysis, in order to trigger a release of emotional

tension called catharsis



Contemporary

Psychodynamic Therapies Contemporary (post-Freudian) approaches place more

importance on the conscious mind and a persons current

relationships

Heinz Kohutsview says that early social relationshipswith

attachment figures are critical. We internalize these

relationships as a basis for developing our sense of our own

self


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Behavior Therapies

Use principles of learningto reduce or eliminate maladaptive

behavior

Classical conditioning techniques include systematic

desensitization, a technique used to associate deep relaxation

with situations that usually trigger anxiety. These are often

used to treat phobias. They also include aversivetherapy,

which tries to create automatic, negative associative responses

Operant conditioning techniques include applied behavior

analysis, which was discussed in chapter 5



CognitiveTherapies

Emphasize thoughts as main source of psychological problems

Attempt to change feelings and behaviors by changing

cognitions

Cognitive restructuring

Changing pattern of thought presumed to be causing

maladaptive behavior or emotion

Widely used in treatment of anxiety disorders, mood

disorders, schizophrenia and personality disorders



Examples of Cognitive Therapy

Rational-Emotive Behavior Therapy(Albert Ellis)

Emotional reactions to life events are a product of

irrational beliefs and expectations

Central false belief that feelings cannot be controlled

Demands create dysfunctional, exaggerated beliefs Goal is to eliminate self-defeating beliefs by rationally

examining them

Approach is directive, persuasive, and sometimes

confrontational


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Examples of Cognitive Therapy

Cognitive-BehavioralTherapy

Combination of:

Cognitive therapy to reduce self-defeating thoughts

Behavior therapy to changer maladaptive behavior Banduraplaces emphasis on developing self-efficacyin

order to better handle situations and produce positive

outcomes

Self-instructionalmethods Teach person to modify own behavior

Using reinforcing self-statements to take positive steps



Therapy Integrations

Many therapists do not subscribe strictly to one particular

approach

Integrative therapy: a combination of techniques from

different therapies based on therapists judgment

Integration often involves combining psychotherapy anddrug therapy

Conceptually compatible with biopsychosocial model

which, as we saw in the previous chapter, is a framework

for understanding many disorders



Sociocultural Approaches &

Issues The sociocultural approach says we should regard and treat

individuals as part of social system of relationships, influenced

by social and cultural factors

Thus, cultural norms must be understood, and sometimes

therapy may include not just the person with the disorder,

but others in the immediate social group (e.g. family) or

others who also have the disorder



Cultural Perspectives

Understanding cultural issues is necessary in order to best

understand the disorder from the perspective of an individual

who belongs to that culture

For instance. collectivisticcultures place more importance on

social groups, rather than on the individual. So, individual

psychotherapy may not be as effective within such cultures

Ethnicity

An ethnic match between therapist and client also may be

helpful in forging both trust and understanding of

experiences related to ethnicity in society

Changing genderroles in society may also be relevant within

therapy



Group Therapy

Individuals sharing psychological disorder brought together in

sessions typically led by a professional

Features (see book for more details)

Information

Universality

Altruism

Experiencing a positive family group

Development of social skills

Interpersonal learning



Family and Couples Therapy

Familytherapy

Group therapy among family members

Uses techniques such as validation, reframing,

detriangulation, and structural changeto address role of

family in both disorder and treatment (detailed in book)

Couplestherapy

Group therapy with married or unmarried couples with

relationship problems

Views symptoms as function of relationship, and thus

treatment needs to involve relationship change, not just

individual change

Focus on rolesand communicationbetween partners


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Self-HelpSupport Groups

Voluntary organizations of individuals who get together to

discuss relevant topics (e.g. Alcoholics Anonymous)

May rarely be conducted by professionals, but more often

by paraprofessionals, or by those who have the disorder

Provide a sympathetic audience for confession, sharing, andemotional release, as well as social support, role modeling,

and sharing of concrete problem-solving strategies

Increase accessibility of care, because they are often free or

very low-cost However, they need to be managed well, otherwise they may

have risk of giving poor advice or developing groupthink


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Community Mental Health

Movement born in 1960s, which argued that individuals with

disorders ought to remain in society, rather than being treated

in mental health institutions

The deinstitutionalizationmovement aimed to release

people from such hospitals and re-integrate them into the

community

Success depends on resources and commitment of

community; some communities offer more mental-health

outpatient support than do others


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Effectiveness of Psychotherapy

Research indicates that psychotherapy works

A meta-analysisis a statistical combination of results of

different studies; meta-analyses of research on different

therapies finds them to be more effective than no treatment

No specific therapy is significantly better than the others

in general, though some specific techniques may work

better for specific disorders

Increasing move to evidence-based practice, which aims

to integrate best available research in treatment of

disorders

Research indicates therapy effective at least for 6 months, if

not longer.


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Common Themes

The similarity of effectiveness of different psychotherapies

may be because most have common elements:

Expectationsof improvement

Masteryof difficulties

The idea that you are not alone, but dealing with your

problems in atherapeutic alliancewith your therapist

Client factors

The quality of participationby the client is the best

predictor of success. So, motivated clients will dobetter, but those who are not motivated (e.g. ordered

into therapy by the court system) are less likely to

succeed.

Ch 13 Therapies

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