Treatment of Disorders
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Transcript of Treatment of Disorders
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Treatment of Disorders
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History of Treatment
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Ethical Issues in Treatment• Deinstitutionalization occurred during
the mental health movement of the 1960sDon’t exclude mentally ill from society, but
help them function within societyShorten in-patient treatment (only keep in
hospital if necessary) More out-patient care
• APA guidelines
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Who Provides Treatment?• Psychiatrists – Medical doctors, MD• Psychologists – PhD, PsyD, some MA• Clinical Social Workers, MA• Marriage/Family Therapists, MA• Licensed Professional
Counselors, MA• Psychiatric Nurses, RN• Substance Abuse Counselors,
CADC• Pastoral Counselors
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• Psychotherapy – trained therapist uses psychological techniques to help someone to overcome problems or difficulties
• Biomedical therapy – prescribed medication that acts on nervous system
• Eclectic approach – use a blend of therapies and approaches
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Psychoanalysis• Free association– Say whatever comes to mind,
no censoring of thoughts – Overcome resistance
(blocking of anxiety-laden material)
• Transference– Patient transfers unconscious
feelings towards someone else onto the therapist
– i.e. patient w/Electra complex has attraction to Freud (transfers attraction to father onto therapist)
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Type of Therapy Cause/Problem Aim of TreatmentPsychodynamic Unconscious forces &
childhood experiencesReduce anxiety through self-insight; analysis & interpretation
Client-centered (Humanistic)
Barriers to self-understanding & self-acceptance
Personal growth through self-insight
Behavior Maladaptive behaviors (learned or observed)
Extinguish maladaptive behaviors
Cognitive Negative, self-defeating thoughts
Healthier thinking, positive self-talk
Group (Family) Stressful relationships Relationship healing, better communication
Biomedical Chemical imbalances or nervous system dysfunction
Prescribed medications of medical surgery
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Psychodynamic• Childhood experiences• Enhance self-insight • Interpersonal therapy – brief
(12-16 session) treatment, effective for depression
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Psychoanalysis v. Humanistic
• Humanistic therapies differ from psychoanalysts in focusing on…1) Present & future (not past)2) Conscious rather than
unconscious3) Immediate responsibility 4) Promoting growth instead of
curing illness
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Client-Centered Therapy (Carl Rogers) • Nondirective Active listening– Clarification or “reflect” what has been
said back to patient• Genuineness, acceptance, empathy• Unconditional positive regard no
judgment
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Behavior Therapies – Classical Conditioning
• Counterconditioning– Pair feared stimulus w/good
outcome• Exposure therapy – expose patient to feared
stimulus– Learn relaxation techniques– Systematic desensitization
hierarchy • Aversive conditioning– Pair the undesirable
behavior with bad outcome
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Behavior Therapy Systematic Desensitization
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Behavior Therapy Aversion
therapy for alcoholics
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Behavior Therapies – OperantBehavior Modification – use reinforcement to increase desired behaviors
Token Economy – provide “tokens” each time desired behavior is performed that can be redeemed later for a bigger reward
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Cognitive Therapies• Cause = irrational thinking patterns• Aim = correct habitual thinking errors• Aaron Beck’s Cognitive(-Behavioral) Therapy
Cognitive Triad1) Negative feelings about self
“I am a failure”2) Negative feelings about world
“The world is unfair”3) Negative feelings about future
“The future is hopeless, itwill never get better”
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Beck’s Cognitive Therapy for Depression• Over-generalization drawing general conclusions
from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come.
• Minimalization and Maximization Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event.
• Dichotomous thinking Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.
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Cognitive-Behavioral Therapies
Albert Ellis’s Rational Emotive Behavior Therapy (REBT)The A-B-C modelA= Adversity (anticipating event)B = Belief about “A”C = Consequences (behavioral, emotional)
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Stress Inoculation Training• SIT is a form of cognitive
restructuring as it is a method of changing an individual’s thinking patterns about themselves and their lives. The aim is to change their emotional responses and their behavior ideally before the individual becomes very anxious or depressed as a result of stress.
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Nontraditional Psychotherapies• Eye movement desensitization and
reprocessing (EMDR)• Often used for PTSD• Uses patients’ rhythmic eye movements• Therapist moves finger from left to right while
patient recalls disturbing event or issue
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Evaluating Psychotherapies
To whom do people turn for help for psychological difficulties?
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Is Psychotherapy Effective?• Overestimation– Clients enter in crisis (temporary)–Want to believe it was worth the effort– Placebo effect (expect to get better)– Regression toward the mean (the usual
state is better than rock bottom, which is where most patients start)
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Is Psychotherapy Effective?• Those not treated often improve, but those
undergoing therapy are more likely to improve
• No one therapy is best in all cases• Evidence-based practice – clinical decision
making that integrates best available research w/clinical expertise and patient characteristics
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Three Benefits of Psychotherapies
1) Offer expectation that things can and will get better
2) Offers plausible explanation for symptoms and alternative way of thinking
3) Effective therapists are empathetic and seek to understand builds trust
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Evaluating Psychotherapies
Poor outcome Good outcome
Averageuntreated
person
Averagepsychotherapy
client
Number ofpersons
80% of untreated people have pooreroutcomes than average treated person
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Biomedical Therapies• Psychopharmacology – study of
drugs and their effects on mind and behavior
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Antipsychotic Drugs• Treats schizophrenia• Decrease receptiveness to
irrelevant stimuli• Block dopamine • Thorazine, Haldol, neuroleptics• Atypical antipsychotics
(Clozapine)• Tardive dyskinesia – involuntary
movements of face, tongue, limbs
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Antianxiety Drugs• Depress CNS activity (tranquilizers –
benzodiazepines)• Boost GABA• Xanax, Ativan, D-cycloserine• Can lead to psychological and physiological
dependence• Treats anxiety disorders
(PTSD, OCD)
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Antidepressant Drugs• Increase serotonin & norepinephrine• Selective Serotonin Reuptake Inhibitors (SSRIs)
– Prozac, Zoloft, Paxil– Block reabsorption of
serotonin from synapse• Treat depression, some
anxiety disorders (OCD)• Tricyclics are more
effective (serotonin & norepinephrine)
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Lithium• Mood stabilizer• Treats bipolar disorder• Lowers risk of suicide
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Brain Stimulation Techniques• Electroconvulsive Therapy (ECT)– Side effects (memory loss)
• Repetitive transcranial magnetic stimulation (rTMS)– Less side effects
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Psychosurgery• Removes or destroys brain tissue to
change behavior• Lobotomy • ONLY USED IN
EXTREME CASES