Download Chapter 5

Psy 239
Chapter 5
Wayne Hooke
Chapter 5
Treatments for Abnormality
Learning Objectives
1. Give examples of antipsychotic, antidepressant, mood stabilizing, and antianxiety
drugs, and know their appropriate uses and limitations.
2. Distinguish among MAO inhibitors, tricyclic antidepressants, and SSRIs.
3. Identify the appropriate and inappropriate uses of ECT, psychosurgery, and
repetitive transcranial magnetic stimulation.
4. Give examples of herbal remedies for the treatment of psychological problems
and discuss what is known about their effectiveness
5. Describe the components of psychodynamic therapy and how it is thought to
work.
6. Describe humanistic therapy and how it is conducted.
7. Describe techniques used in behavior therapy.
8. Describe the elements of cognitive therapy and how it is similar to behavior
therapy.
9. Discuss IPT and how it is both similar to and different from psychodynamic
therapy.
10. Discuss alternatives to individual therapy (e.g., family and group therapy).
11. Describe how mental health treatment may be carried out in the community
12. Discuss how cultural issues may affect treatment and the extent to which research
suggests that these issues should affect therapist-client matching.
13. Summarize the common components of successful therapies.
14. Discuss the special issues that can arise when treating children.
1
Psy 239
Chapter 5
Wayne Hooke
Biological Treatments: Drug
Therapies
z Antipsychotic Drugs
z
Reduce symptoms of psychosis.
Examples: Thorazine, Clozaril,
Haldol
z Antidepressant
z
Reduce symptoms of depression.
•
Examples: Parnate, Elavil, Prozac
z
Stabilize mood.
•
Examples: Lithobid, Cibalith-S
z
Reduce symptoms of anxiety.
•
Examples: Nembutal, Valium
Drugs
z Lithium/Mood
Stabilizers
z Antianxiety Drugs
Biological Treatments: Drug Therapies
Antipsychotic/neuroleptic drugs
•
•
•
•
Aka: major tranquilizers
Atypicals: risperidone, olanzapine, clozapine not known as major tranquilizers
Typical neuropleptics may work on the brain’s dopamine system
(http://en.wikipedia.org/wiki/Dopamine)
FACTS ABOUT ANTIPSYCHOTIC MEDICATIONS.pdf
Antidepressants: SSRIs
•
•
•
Selective serotonin reuptake inhibitors
20% of Americans have a disorder treatable by means of an SSRI
2004 meta-analysis found a modest effect of SSRIs on the treatment of depression
with substance abuse
2
Psy 239
Chapter 5
Wayne Hooke
Antidepressants: SSRIs
•
•
Recent systematic review that included almost 90,000 subjects found a 2x increase in
suicide attempts with SSRIs compared to placebo
2004 systematic review found some evidence for using SSRIs rather than tricyclics*
in bipolar disorder
– “The exact mechanism of action is not well understood, however it is generally
thought that tricylic antidepressants work by inhibiting the re-uptake of the
neurotransmitters norepinephrine, dopamine or serotonin by nerve cells.”
Wikipedia
Antidepressants: SSRIs
The Center for Science in the Public Interest’s review of studies on SSRI treatment for
children found that industry-funded studies are 50 percent more likely to report
positive treatment outcomes than government or university-funded studies.
Antidepressants: SSRIs
•
•
With the exception of Prozac, SSRIs may be more dangerous to adolescents than
published data suggest
Clomapramine (Anafranil - trycylic) seems more effective in treating childhood OCD
Antidepressants: SSRIs
•
•
•
Initial studies found reports of reduced libido and anorgasmia in 10% of cases
Recent studies and clinical experience find this side effect much more frequently
Why?
Antidepressants: SSRIs
“The ‘best buys in second-generation antidepressants, based on safety, effectiveness and
cost, are generic fluoxetine (Prozac and Sarafem), citalopram (Celexa) and buproprion
(Wellbutrin), according to a 2005 Consumers Union report.’”
SSRI effectiveness.pdf
Lithium/Mood Stabilizers
•
•
Medline Plus Drug Information_ Lithium (Systemic).pdf
http://en.wikipedia.org/wiki/Mood_stabilizer
3
Psy 239
Chapter 5
Wayne Hooke
Anti-anxiety Drugs: SSRIs and Social Anxiety
•
•
Comprehensive review
– 25 published studies
– 8 randomized, double-blind, placebo-controlled
“It may be concluded with a high degree of confidence that SSRI treatment for social
anxiety disorder is effective, both in reducing total levels of social anxiety and in
improving patients' overall clinical condition.”
Activity:
Treating a Fear of Giving Classroom Presentations
Using a Biological Therapy
Anxiety before having to give a presentation in class is very common among students but
for some, it is more than just normal anxiety. Imagine a student so anxious about
giving class presentations that she usually does not even sign up for classes in which
such presentations are required. If she absolutely cannot avoid giving a class
presentation, she gets so nervous the night before that she vomits and sleeps poorly,
often calling in sick the day of the presentation so that she can avoid the stress of
public speaking. At times she has refused to give a presentation, claiming that she
forgot her materials, or that she had a sore throat and couldn't talk. While she is a very
good student in all her classes, this problem has caused her to get less than satisfactory
grades in those classes that require presentation. The student realizes that she has a
problem and is thinking about getting professional help.
You are a psychiatrist. What do you think is the cause of this student's problem, and
how will you treat it
Electroconvulsive Therapy
•
•
•
An alternative to drug therapies in the treatment of some disorders is ECT
(electroconvulsive therapy).
ECT consists of a series of treatments in which a brain seizure is induced by passing
electrical current through the patient’s brain.
http://en.wikipedia.org/wiki/Electroconvulsive_therapy
Psychosurgery
Prefrontal lobotomies were eventually criticized as a cruel and ineffective means of
treating psychosis.
ƒ Moniz & Lima (1935)
ƒ Walter Freeman, his ice pick, and his lobotomobile
ƒ 40-50,000 lobotomies, for a number of problems: including misbehavior in
children
ƒ http://www.cerebromente.org.br/n02/historia/psicocirg_i.htm
4
Psy 239
Chapter 5
Wayne Hooke
Psychosurgery
Psychosurgery declined after the 1950s, rarely used today and only with the most severe
cases with patients who do not respond to other forms of treatment.
Repetitive Transcranial Magnetic Stimulation
Repeated, high-intensity magnetic pulses focused on specific brain structures
•
•
Preliminary research supports use of RTMS for depression, auditory hallucinations, &
migraine headaches
Being researched as a treatment for mania, ptsd, & tinnitus
The Social Impact of the Biological Approach to Therapy
•
•
•
•
What is the responsibility of the sufferer?
What side effects could produce unwanted social harms?
Is there an ease to drugs that allows us to forget or over-look other issues?
Are there alternatives within the biological approach to therapy? What about herbs or
holistic approaches?
Psychological Therapies
5
Psy 239
Chapter 5
Wayne Hooke
Does therapy work?
80
70
60
50
No Therapy
Psychoanalytic
Eclectic
40
30
20
Eysenck’s 1952 review of 24
effectiveness studies
10
0
% Improved
Does therapy work?
Smith, Glass, & Miller (1980)
• Created meta-analysis
• 375 studies/25,000 clients
• “average person who received therapy was 75% better”
• What does “75%” better mean?
• About the same improvement as is gained from one year of reading instruction in
elementary school
Does therapy work?
•
•
•
•
Average duration of therapy is:
6 sessions
Modal number of sessions is:
1 session
After 58 sessions:
75% recovered
After 11 sessions:
50% recovered
6
Psy 239
Chapter 5
Wayne Hooke
Does therapy work?
•
•
•
Characterological improvement after 52 weeks:
50%
Chronic distress after 52 weeks:
66-86%
Acute distress after 52 weeks:
68-95%
Consumer Reports Study
z
z
z
z
z
There was no substantial difference in terms of reported satisfaction for readers who
saw a social worker, psychologist, or psychiatrist; but there was less satisfaction for
those who saw marriage counselors.
Family doctors also seemed to be able to provide help, but people who received help
from a mental-health specialist for more than six months did much better than those
who had shorter term therapy.
There was little difference between psychotherapy and a combination of
psychotherapy and medications such as Prozac or Xanax, although many persons on
medications reported side effects.
There was greater improvement over time with longer term therapy as opposed to
short-term therapy.
Members of self-help groups found the groups to be very helpful, and members of
Alcoholics Anonymous were particularly grateful.
Psychodynamic Therapies
Therapeutic
Alliance
Free
Association
Concepts
Working
Through
CounterTransference
Resistance
Transference
7
Psy 239
Chapter 5
Wayne Hooke
Activity: Treating a Fear of Giving Classroom Presentations
Using Psychodynamic Therapy
Anxiety before having to give a presentation in class is very common among students but
for some, it is more than just normal anxiety. Imagine a student so anxious about
giving class presentations that she usually does not even sign up for classes in which
such presentations are required. If she absolutely cannot avoid giving a class
presentation, she gets so nervous the night before that she vomits and sleeps poorly,
often calling in sick the day of the presentation so that she can avoid the stress of
public speaking. At times she has refused to give a presentation, claiming that she
forgot her materials, or that she had a sore throat and couldn't talk. While she is a very
good student in all her classes, this problem has caused her to get less than satisfactory
grades in those classes that require presentation. The student realizes that she has a
problem and is thinking about getting professional help.
You are a psychodynamic therapist. What do you think is the cause of this student's
problem, and how will you treat it
Humanistic Therapy
•
•
Also known as person-centered therapy.
Client-centered therapy is the best known of these therapies.
Essential Ingredients of Client-Centered Therapy
•
•
•
The therapist communicates a genuineness in his or her role as helper to the client.
The therapist shows unconditional positive regard for the client.
The therapist communicates an empathic understanding of the client by making it
clear that he or she understands and accepts the client’s underlying feelings and
search for self.
Activity: Treating a Fear of Giving Classroom Presentations
Using Humanistic Therapy
Anxiety before having to give a presentation in class is very common among students but
for some, it is more than just normal anxiety. Imagine a student so anxious about
giving class presentations that she usually does not even sign up for classes in which
such presentations are required. If she absolutely cannot avoid giving a class
presentation, she gets so nervous the night before that she vomits and sleeps poorly,
often calling in sick the day of the presentation so that she can avoid the stress of
public speaking. At times she has refused to give a presentation, claiming that she
forgot her materials, or that she had a sore throat and couldn't talk. While she is a very
good student in all her classes, this problem has caused her to get less than satisfactory
grades in those classes that require presentation. The student realizes that she has a
problem and is thinking about getting professional help.
8
Psy 239
Chapter 5
Wayne Hooke
You are a humanistic therapist. What do you think is the cause of this student's
problem, and how will you treat it
Behavior Therapies
•
•
The behavioral assessment is the foundation for behavior therapy.
Therapist works with the client to identify the specific circumstances that seem to
elicit the client’s negative behavior or emotional responses.
Methods Used In Behavior Therapies
•
•
•
•
•
•
•
•
•
Removal of reinforcements
Aversion therapy
Relaxation exercises
Distraction techniques
Flooding or implosive therapy
Systematic desensitization
Response shaping through operant conditioning (What Shamu Taught Me About a
Happy Marriage - New York Times.pdf)
Behavioral contracting
Modeling and observational learning
Activity: Treating a Fear of Giving Classroom Presentations
Using Behavioral Therapy
Anxiety before having to give a presentation in class is very common among students but
for some, it is more than just normal anxiety. Imagine a student so anxious about
giving class presentations that she usually does not even sign up for classes in which
such presentations are required. If she absolutely cannot avoid giving a class
presentation, she gets so nervous the night before that she vomits and sleeps poorly,
often calling in sick the day of the presentation so that she can avoid the stress of
public speaking. At times she has refused to give a presentation, claiming that she
forgot her materials, or that she had a sore throat and couldn't talk. While she is a very
good student in all her classes, this problem has caused her to get less than satisfactory
grades in those classes that require presentation. The student realizes that she has a
problem and is thinking about getting professional help.
You are a behavioral therapist. What do you think is the cause of this student's
problem, and how will you treat it
9
Psy 239
Chapter 5
Wayne Hooke
Cognitive Therapies
Assist clients in identifying their irrational and maladaptive thoughts and replacing them
with more adaptive ways of thinking.
Techniques in Cognitive Therapies
•
•
•
•
•
•
z
z
z
z
z
z
z
Challenge idiosyncratic meanings
Question the evidence
Reattribution
Examine options and alternatives
“Decatastrophize”
Fantasize consequences
Examine advantages and disadvantages
Turn adversity to advantage
Guided association
Scaling
Thought stopping
Distraction
Labeling of distortions
10
Psy 239
Chapter 5
Wayne Hooke
Cognitive Therapies
CTRS.pdf
Activity: Treating a Fear of Giving Classroom Presentations
Using Cognitive Therapy
Anxiety before having to give a presentation in class is very common among students but
for some, it is more than just normal anxiety. Imagine a student so anxious about
giving class presentations that she usually does not even sign up for classes in which
such presentations are required. If she absolutely cannot avoid giving a class
presentation, she gets so nervous the night before that she vomits and sleeps poorly,
often calling in sick the day of the presentation so that she can avoid the stress of
public speaking. At times she has refused to give a presentation, claiming that she
forgot her materials, or that she had a sore throat and couldn't talk. While she is a very
good student in all her classes, this problem has caused her to get less than satisfactory
grades in those classes that require presentation. The student realizes that she has a
problem and is thinking about getting professional help.
You are a cognitive therapist. What do you think is the cause of this student's
problem, and how will you treat it
Group Therapy Should Provide
Examples of
appropriate conduct
Information and
advice for members
A safe place to take
risks and accept
criticism
Opportunities to
acquire and
improve skills
Information that
other people share
the same problem
Opportunities to
express feelings and
gain selfunderstanding
Opportunities for
growth and personal
satisfaction by
helping others
11
Psy 239
Chapter 5
Wayne Hooke
Therapy for Groups and the Community
•
•
•
•
•
Must the therapist and the client come from the same ethnic group or nationality?
How and when does it matter?
Must the therapist and the client be of the same sex and gender?
How and when does it matter?
What values are important in each of these questions?
Factors of Successful Therapy
•
•
•
A positive relationship with the therapist
An explanation or interpretation of why the client is suffering
Other factors
– Encouragement to confront negative emotions
– An integrative approach
12