Transcript Document 7615980

Treatments
History of Treatments
• Early treatments brutal
transitioned to more
humane methods
• Dorothea Dix – 1st to
transition to gentler
treatments in U.S.
• Today - Biomedical Drugs
and better therapy has led
deinstitutionalization.
Categories of Therapy
2 Main Categories
1. Psychotherapy – interaction between
therapist and patient
–
Phobias
2. Biomedical – prescription meds that act
on central nervous system
–
Schizophrenia
Eclectic Approach– uses a variety of psych
theories and approaches
Example:
Perspectives and Disorders
Psychological
School/Perspective
Psychoanalytic/Psychody
namic
Cause of the Disorder
Treatments
Internal, unconscious
drives and conflicts
Psychoanalytic
Psychodynamic
Humanistic
Failure to strive to one’s
potential or being out of
touch with one’s feelings.
Insight Therapy
Client Centered Therapy
Behavioral
Reinforcement history, the
environment.
Behavioral Therapies
Classical – counterconditioning,
exposure therapy, flooding,
systematic desensitization, virtual
reality, aversive
Operant – behavior modification,
Token economy
Cognitive
Irrational, dysfunctional
thoughts or ways of
thinking.
Cognitive Therapy
Dysfunctional Society
Group or Family Therapy
Sociocultural
Biomedical/Neuroscience Organic problems,
biochemical imbalances,
genetic predispositions.
Biomedical Drug Therapy
Insight Therapies
• Insight therapies – try to improve
mental state by increasing client’s
awareness of underlying motives and
defenses
1. Psychoanalytic Therapy
2. Psychodynamic Therapy
3. Humanistic Therapy
Psychoanalytic Therapy
• Psychoanalysis – uncovering
childhood experiences to gain
insight into the unconscious
origins of the disorder
– dream analysis – manifest and
latent
– free association – uncensored
reporting of any thoughts that come
to mind.
• Resistance - blocking from
consciousness anxiety-laden material
during therapy.
– Example:
Psychoanalytic Therapy
– Transferring expression toward a
therapist of feelings
linked with earlier
relationships
• Example
Psychoanalytic Therapy
• Criticisms
– Interpretations can’t
be proven or
disproven
– Costly and time
consuming (2 or more
sessions/week for 2
or more years)
Psychodynamic Therapy
• Psychodynamic therapy - try to
understand patients' current
symptoms by focusing on recurring
patterns in their interpersonal
relationships
– Patients gain insight into unconscious
conflicts
– Face to face, once per week, several
months
• Interpersonal psychotherapy effective in treating depression by
helping patients improve their
interpersonal skills
– variation of psychodynamic therapy
– 14-16 sessions
– Example:
Humanistic Therapy
• Humanistic Therapy - emphasize the
importance of self-awareness and
take responsibility for own feelings
and actions to improve mental state
– seek to promote personal growth and
self-fulfillment.
• Client-Centered Therapy (Rogers) patients' discover their own ways of
effectively dealing with difficulties
– non-directive therapies – therapist
listens without judging or giving insight
– Genuineness, acceptance and empathy
– Unconditional Positive Regard
– Active listening – echoing, restating and
seeking clarification of clients feelings
Behavioral Therapies
Behavior Therapies – applies
learning principles to
unwanted behaviors
• Classical Conditioning
– Maladaptive symptoms are
conditioned responses
• Operant Conditioning
– Maladaptive symptoms are
reinforced
Behavioral Therapy
• Classical Conditioning
– Counterconditioning (Pavlov)procedure that trains people to
make new responses to stimuli
that currently trigger unwanted
responses
– 2 Types
1.
Exposure Therapies
– Flooding
– Systematic Desensitization
– Virtual Reality Exposure Therapy
2. Aversive Conditioning
Exposure Therapies
• Exposure Therapies - Repeatedly introducing
people to things they fear and avoid
1. Flooding – forced exposure to the stimulus that
is feared
•
Example:
2. Systematic Desensitization – gradual exposure to
the actual stimulus by replacing a positive
response with a negative response.
•
Progressive relaxation – imagined scene is repeatedly
paired with relaxation and progresses to eventually
facing the worst fear
•
Example:
Exposure Therapies
3. Virtual Reality
Therapy –
progressively
exposing people to
simulations of their
greatest fears
–
Example:
Aversion Therapy
• Aversion Therapy – unwanted
behavior systematically
associated with unpleasant
experiences
– Examples:
– Problem: cognition influences
conditioning
Operant Conditioning
1. Behavior Modification - reinforcing
desired behaviors, giving punishments
for undesired behaviors
–
Example:
2. Token Economy – earning a token for
desired behavior that can be traded
in for privileges
–
Example:
Cognitive Therapy
• Cognitive Therapy – change the way
patient thinks (change schemas)
– Irrational, Self-blaming, overgeneralized thoughts, negative
interpretations
– Anxiety Disorders, Major Depressive
Disorder, Suicide
– Example:
• Beck’s Therapy for Depression
• Stress Inoculation Training
– Changes thinking in stressful events
Cognitive-Behavioral Therapy
• Cognitive Behavioral Changes the way we think
and act
– Example:
Family and Group Therapy
• Group Therapy
– Offered for: family
conflict, stressful
relationships, patients with
similar problems
– Improves communication
skills and conflict resolution
• Examples:
– Family Therapy – unwanted
behaviors are influenced by
other family members
Example:
Evaluating Psychotherapy
• Placebo effect – the beneficial
consequences of merely expecting
that a treatment will be effective.
• Regression toward the mean – the
tendency for unusual events or
emotion to return to their ave. state .
• Selective Justification –
overestimating the actual benefits
(both patients and therapists)
• Eysenck and Eysenck – no more
beneficial than no treatment at all
Evaluating Psychotherapy
• Randomized Clinical Trials – compare
treatment groups with control
groups
• Meta-analysis – a procedure for
statistically combining the results of
many different studies.
• Bottom line – Those not undergoing
therapy often improve, but those
undergoing therapy are more likely
to improve
Comparison of Psychotherapies
Evidence Based Practices - Clinical decision making that integrates the
best available research with clinical expertise and an understanding of
patient characteristics
**Scientifically Unsupported Therapies - Energy Therapy, Recovered-memory
Therapy, Rebirthing Therapies, Facilitated Communication, Crisis Debriefing
Alternative Therapies
• EMDR (Eye Movement
Desensitization and Reprocessing Rapidly moving one's eyes while
recalling traumatic experiences
– similar to exposure treatment
– Originally developed for anxiety
– Value in placebo effect and exposure
therapy
• Light Exposure Therapy – exposure
to intense light that mimics outdoor
light
– activity in the brain region responsible
for arousal
– Seasonal Affective Disorder –
depression caused by lack of exposure
to natural light
Biomedical Therapy
Biomedical Therapy – drugs, or
treatments that act on the brain’s
central nervous system
– Examples:
– Drugs,
– Electroconvulsive therapy,
– Magnetic impulses
– Psychosurgery
Biomedical Therapy
Psychopharmacology – study of
the effects of drugs on the
mind and behavior
– Antipsychotics
(thorazine,Chlorpromazine,
Clozapine)
– Anti-anxiety ( Xanax,
Ativan d-cycloserine)
– Anti-depressants (Paxil,
Prozac, Zoloft – SSRI’s)
– Mood Stabilizers Bipolar
(lithium, Depakote)
Brain Stimulation
• 3 Types Used to Treat
Depression
1.
ECT (Electroconvulsive therapy) –
electric shock therapy for patients
with severe depression
1.
Can trigger seizures and memory loss
2. rTMS (repetitive transcranial
magnetic stimulation)- repeated
pulses of magnetic energy to brain’s
surface
1.
2.
No seizures or memory loss
Triggers long-term potentiation of
frontal lobe nerve cells.
3. Deep Brain Stimulation – uses
implanted electrodes to inhibit
activity in an area of the cortex
that triggers negative emotions
Psychosurgery
• Psychosurgery – removes
or destroys brain tissue
– Lobotomy - cut the nerves
connecting the frontal lobes
to the emotion controlling
centers of inner-brain
• Once used to calm severely
emotional or violent patients
– MRI-guided precision
surgery – cut brain circuits
of severe OCD
Preventing Psychological
Disorders
• Therapeutic Lifestyle Change
– reverses the symptoms of
psychological disorders
– Aerobic exercise, adequate
sleep, light exposure, and social
engagement, anti-rumination,
nutrition
– Resilience – ability to cope with
stress and recover from
adversity