Download Approaches to Treatment and Therapy

Approaches to Treatment and
Therapy
Chapter 17
Approaches to Treatment and
Therapy
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Biological treatments for mental disorders
Kinds of psychotherapy
Evaluating psychotherapy
Biological Treatments
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The question of drugs
Surgery and electroshock
The Question of Drugs
Antipsychotic Drugs
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Many block or reduce sensitivity of brain
receptors that respond to dopamine.
Some increase levels of serotonin, a
neurotransmitter that inhibits dopamine
activity.
Can relieve positive symptoms of
schizophrenia but are ineffective for or
even worsen negative symptoms.
Antidepressant Drugs
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Monoamine oxidase inhibitors (MAOIs)
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Tricyclic antidepressants
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Elevate norepinephrine and serotonin in brain by
blocking an enzyme that deactivates these
neurotransmitters.
Boost norepinephrine and serotonin in brain by
preventing normal reuptake of these substances.
Selective serotonin reuptake inhibitors
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(e.g, Prozac) work same way as tricyclic
antidepressants but target serotonin.
Tranquilizers
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Increase the activity of the neurotransmitter
gamma-aminobutyric acid (GABA).
Developed for treatment of mild anxiety
and often overprescribed by general
physicians for patients who complain of
any mood disorder.
Not effective for depression.
Lithium Carbonate
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Used to treat bipolar disorder.
Moderates levels of norepinephrine or by
protecting cells from being overstimulated
by the neurotransmitter, glutamate.
Must be given in right dose and
bloodstream levels need to be monitored.
Newer drug treatments for bipolar disorder
include Tegetrol and Depakote.
Cautions About Drug Treatment
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Placebo effect
High Relapse and dropout rates
Dosage problems
Long-term risks
Placebo Effect
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The apparent success of a treatment that is
due to the patient’s expectation of hopes
rather than to the drug or treatment itself.
Meta-analyses indicate that clinicians
considered medication helpful yet patient
ratings in treatment groups were no greater
than patient ratings in placebo groups.
High Relapse and Dropout Rate
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There may be short term success but many
patients (50% to 66%) stop taking
medication due to side effects.
Individuals who take antidepressants
without learning to cope with problems are
more likely to relapse.
Dosage Problems
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Finding the therapeutic window or the
amount of medication that is enough but
not too much.
Drugs may be metabolized differently in:
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men and women, old and young, and in
different ethnic groups.
Groups may differ in tolerable dosages due
to variations in metabolic rates, amount of
body fat, number or type of drug receptors in
the brain, smoking and eating habits.
Long-Term Risks
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Antipsychotic drugs can be dangerous,
even fatal if taken for many years.
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Tardive dyskinesia
Antidepressants are assumed to be safe but
no long term studies have been conducted.
Many doctors and the public overlook the
possibility of long-term dangers when a
drug shows short run benefits.
Surgery and Electroshock
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Psychosurgery
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Any surgical procedure that destroys selected
areas of the brain believed to be involved in
emotional disorders or violent, impulsive
behaviour.
Electroconvulsive Therapy (ECT)
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A procedure used in cases of prolonged and
severe major depression, in which a brief
brain seizure is induced.
Kinds of Psychotherapy
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Psychodynamic therapy
Behavioural and cognitive therapy
Humanist and existential therapy
Family and couples therapy
Psychodynamic Therapy
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Goal is exploring the unconscious
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Free Association
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In psychoanalysis, a method of uncovering
unconscious conflicts by saying freely whatever
comes to mind.
Transference
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In psychodynamic therapies, a critical step in which
the client transfers unconscious emotions or
reactions, such as conflicts about his or her parents,
onto the therapist.
Behaviour and Cognitive
Therapy
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Behaviour therapy
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Systematic desensitization
Exposure treatments
Behavioural records
Skills training
Cognitive therapy
Behaviour Therapy
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A form therapy that applies principles and
techniques of classical and operant
conditioning to help people change selfdefeating or problematic behaviours.
Systematic Desensitization
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A step by step process of desensitizing a
client to a feared object or experience,
based on counterconditioning.
Exposure (Flooding)
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A technique whereby a person suffering
from an anxiety disorder such as a phobia
or panic attack, is taken directly into the
feared situation until the anxiety subsides.
Behavioural Records
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A method of keeping careful data on the
frequency and consequences of the
behaviour to be changed.
Skills Training
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An effort to teach a client skills he or she
may lack, as well as new more constructive
behaviours to replace self-defeating ones.
Cognitive Techniques
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Examine the evidence for beliefs.
Consider other explanations for the
behaviour of others.
Identify assumptions and biases.
Rational Emotive Behaviour Therapy
(REBT):
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a form of cognitive therapy designed to
challenge the client’s unrealistic or irrational
thoughts.
Cognitive Techniques
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Meichenbaum developed a form of
cognitive therapy to treat excessive anxiety
called “stress inoculation.”
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Involves 3 stages:
Education phase
 Rehearsal phase
 Implementation phase
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Humanist Therapy
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Humanist therapy
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Based on the assumption that people seek selfactualization and self-fulfillment.
Emphasized people’s free will to change, not past
conflicts.
Client-Centered (Nondirective) Therapy
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Developed by Carl Rogers and emphasizes the
therapist’s empathy with the client, seeing the
world as client does, and creating climate of
Unconditional Positive Regard.
Existential Therapy
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Helps clients explore the meaning of existence
and face with courage the great issues of life such
as death, freedom, free will, alienation and
loneliness.
Family and Couples Therapy
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Problems develop in the context of family, are
sustained by the dynamics of the family and any
changes made will affect all members of the family.
Can look for patterns of behaviour across
generations and create a family tree of
psychologically significant events.
Family-System Perspective
 Therapy with individuals or families that focuses
on how each member forms part of a larger
interacting system.
One Family’s Genogram
Primary Goals of Therapies
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Psychodynamic
 Insight into unconscious motives and feelings.
Cognitive-Behavioural
 Modification of behaviour and irrational
beliefs.
Humanist
 Insight; self-acceptance and self-fulfillment.
Family
 Modification of individual habits and family
patterns.
Primary Methods of Therapies
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Psychodynamic
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Cognitive-behavioural
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Behavioural techniques such as systematic
desensitization, flooding; cognitive exercises to identify
and change faulty beliefs.
Humanist
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Probing the unconscious through dream analysis, free
association, transference.
Providing a safe, non-judgmental setting in which to
discuss life issues.
Family
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Working with couples, families, and sometimes
individuals to identify and change patterns that perpetuate
problems.
Evaluating Psychotherapy
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The scientist-practitioner gap
The therapeutic alliance
When therapy helps
When therapy harms
The Scientist-Practitioner Gap
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Many psychotherapists believe that
evaluating therapy using research methods
is futile.
Scientists find that therapists who do not
keep up with empirical findings are less
effective and can do harm to clients.
Economic pressures require empirical
assessment of therapies.
Is More Psychotherapy Better?
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With additional therapy
sessions, the percentage
of people improved
increased up to 26
sessions.
Rate of improvement
then levels off
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Based on a summary of
15 studies, 2400 clients
(Howard, et al., 1996).
Patients’ sense of
improvement slower but
more steady.
Psychotherapy Research Questions
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What are the common ingredients in
successful therapies?
What kinds of therapy are best suited for
which problems?
Under what conditions can therapy be
harmful?
The Therapeutic Alliance
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Qualities of the Participants
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Motivation to improve and solve problems.
Support from families and actively deal with
problems.
Empathic, warm, and genuine therapists.
Culture and the Therapeutic Connection
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In Canada, group therapy is popular with
Indigenous clients, in part because it bears
more similarity to traditional healing
practices in these groups.
When Therapy Helps
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Problems of assessing therapy
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Justification of effort effect
Clinical researchers conduct randomized
controlled trials designed to determine the
effectiveness of a new medication or form of
therapy, in which people with a given problem
are randomly assigned to one or more
treatment groups or to a control group.
What works?
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Depression
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Anxiety Disorders
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Cognitive therapy’s greatest success has come
in treatment of mood disorders.
Exposure techniques are more effective than
others.
Anger and Impulsive Violence
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Cognitive therapy is extremely successful.
What works?
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Health Problems
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Cognitive and Behaviour therapies are
effective for a wide range of health problems.
Childhood and Adolescent Behaviour
Problems
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Behaviour therapy is the most effective
treatment.
Successful Therapy
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Psychotherapy outcome depends not only on
method of therapy.
Qualities of client and therapist, and their alliance,
also determine success.
When Therapy Harms
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Sexual intimacies, or other unethical
behaviour on the part of the therapist.
Prejudice or cultural ignorance on the part
of the therapist.
Inappropriate or coercive influence, which
can create new problems for the client.
The use of empirically unsupported,
potentially dangerous techniques.