Download Description (Ao1) & Evaluation (Ao2) of treatments

TREATMENT METHODS
• Biological Approach (Drug (chemo) Therapy (anti
anxiety /anti depressant and sedatives etc.) – ECT,
Psychosurgery)
• Behavioural Approach (Aversion Therapy (counter
conditioning), Systematic Desensitisation Therapy,
Flooding & Token Economy)
• Psychodynamic Approach
(Psychotherapy which
may include: Dream Analysis, Projective Therapy – ink
blot/pictures, Hypnosis, Free & Word Association)
• Cognitive Approach (Cognitive Behavioural Therapy
– (CBT))
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Biological
Therapies
Psychosurgery
Antonio Egas Moniz
• MOA: Removes brain tissue
in an effort to change
behaviour. (unsure of how!)
• Lobotomy (Moniz - Nobel
Prize).
– Calmed violent patients,
but produced lethargy &
could destroy patients
personalities (zombies).
– Side-effects also included:
apathy, diminished
intellectual powers,
impaired judgements,
coma, and even death
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Psychosurgery Summary
• Modern methods
– Stereotactic neurosurgery (most common method
today)
• much more accurate and do less damage
• Effectiveness
– Effective if performed precisely and on the
appropriate patient i.e. severely depressed/suicidal
as ‘last resort’
– Research shows: 33% high effectiveness, 33%
moderate effect, 33% minimal or no effect
• Appropriateness
– Only appropriate in severely depressed or
compulsive and suicidal patients who have not
responded to other therapies.
– Only appropriate under BMA rules if have patients
fully informed consent.
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Electroconvulsive Therapy (ECT)
Video clip of ECT used in the past
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Electroconvulsive Therapy
• Appropriate for treating severely
(ECT)
depressed / suicidal patients.
L2
Sometimes given without
their consent (if sectioned).
• Introduced during the late 1930s
(Ugo Cerletti).
• Effective in lifting mood. Can
stop suicidal thoughts rapidly –
therefore can save lives.
• MOA: Increases norepinephrine
(neurotransmitter that elevates
mood) but not sure of MOA
• Perform about 20,000 per year in
the U.K.
• May cause brain damage as…..
• Substantial memory loss
(especially short term memory).
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E.C.T.
• The guidelines for the
administration of ECT. In general
are:
– Patient is anesthetized.
– Given muscle relaxant.
– Shocked with about 100 volts
for a half to 3-4 seconds.
– Patient experiences slight
seizures that last from 30
seconds to 1 minute.
– 3-6 treatments per week for
several weeks (Though this
protocol varies).
– Entire session (from prep. time
to recovery time) takes between
1 to 2 hours.
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– Effectiveness >70% improve
Drug (Chemo) Therapy
• Most widely used Biomedical Therapy, as it is cheap,
relatively fast acting and ‘easy’ to give.
• Appropriateness: treatment when taken responsibly,
and with the close supervision of a doctor. Drugs are
given appropriate to a ‘specific’ symptom e.g. anti (anxiety, depressive and psychotic drugs).
• Effectiveness: they are generally extremely effective at
treating symptoms. (but many have side effects such
as addiction). Drugs have liberated many people from
mental hospitals – deinstitutionalization (a big +).
Since the mid 50's, 70% of persons diagnosed with
schizophrenia lived in mental hospitals - today, less
than 5%.
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Types of drugs:
•
Anti Anxiety Drugs: Benzodiazepines (BZs)
– Reduce tension and anxiety. (downers) e.g. (Valium)
– MOA : Enhance the action of neurotransmitter GABA resulting in
reduction in activity of brain – calming effect
•
•
– Common Side Effects : drowsiness, fatigue, weight gain,
interactions with other medications.
Anti Depressive Drugs:
– Opposite of anti-anxiety drugs (uppers).
– MOA: Increase of serotonin etc. (arousal-inducing
neurotransmitters). SSRI (e.g., Prozac) interferes with reabsorption of serotonin, creating high levels (brain arousal).
– Common Side Effects: dizziness, dry mouth, nausea.
Anti Psychotic Drugs: Neuroleptics
– Major Tranquilizers.
– MOA: Decrease production of the neurotransmitter Dopamine.
– Relieves hallucinations, hostility.
– Requires very close supervision by a physician/psychiatrist.
– Most popular: Thorazine.
– Common Side Effects: Weight gain, constipation, dizziness,
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drowsiness, dry mouth, nasal congestion
Strengths & Limitations
Strengths of drug treatment:
• Research (Kahn) showed that compared to a placebo, BZs were
more effective at reducing anxiety.
• Drugs are generally extremely effective at treating symptoms
• Drugs are easy, relatively fast acting and cheap to use.
Weaknesses of drug treatment:
• Addiction: BZs create a physiological dependence creating
marked withdrawal symptoms when stopped. Should be limited to
4 weeks use because of this.
• Side Effects: General (see individual drugs) In BZs they can be
paradoxical (opposite to that expected) i.e. can cause
aggressiveness. Also memory problems – storage difficulty.
• Sticking Plaster: Treats the symptoms not the problem so when
drugs are stopped the symptoms return. So best paired with
psychological therapies that address the problems.
• Drugs have liberated many people from mental hospitals –
deinstitutionalization (a big +). Since the mid 50's, 70% of persons
diagnosed with schizophrenia lived in mental hospitals - today,
less than 5%.
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Psychodynamic Therapies
• Psychoanalysis – MOA: treatments concentrate
on making the unconscious conscious (gaining
INSIGHT – discovering the reasons for their
problems). Then the mind can be cleansed of
maladaptive thoughts and emotions (lancing the
psychological boil – release of negative energy or
CATHARSIS) This is accomplished by using
interviews to ask about past, early experiences,
parents, and siblings, inner fears and innate
drives. It may include: Dream analysis –
interpretation of symbolism in dreams. Projective
tasks and/or Free and word association – saying
whatever enters your head!
• Catharsis can then lead to healing (CLOSURE)10
Activity: Psychoanalytical
Techniques
Have a go at some of the Psychoanalytical
treatment techniques:
• Word Association
• Projective Task (Ink blots)
Be prepared to criticise each technique.
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Freud’s Dream Analysis
Latent Content
Male genitals,
especially penis
Manifest Content of Dream
Umbrellas, knives, poles, swords,
airplanes, guns, serpents, neckties
Female genitals, Boxes, caves, pockets, pouches, the mouth,
especially vagina jewel cases, ovens, closets
Sexual
intercourse
Climbing, swimming, flying, riding (a horse,
an elevator, a roller coaster)
Parents
Kings, queens, emperors, empresses
Siblings
Little animals
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80
70
Percent improved
Appropriateness,
Effectiveness, Evidence &
Strenths & Limitations
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50
40
30
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• Bergin (1971) : Meta-analysis (Effectiveness)
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Psychotheapy
Placebo
No treatment
– Psychoanalysis produced an 73% success rate and was better than a placebo or
no treatment.
• H.J. Eysenck (1952)
– Psychoanalysis is bad for you!
• Sloane et al. (1975)
•
– Behaviour therapy and Psychoanalysis both had 80% improvement rate vs
48% control group
Luborksy and Spence (1978) (Appropriateness)
– Useful in the treatment of anxiety disorders, depression, sexual disorders, but
not schizophrenia
– Useful with patients who are better educated
• Strengths & Limitations:
– Unscientific, un-falsifiable, unqualified therapists, expensive and time
consuming, techniques require subjective interpretation and rely on the
memory of the client, making them unreliable.
– Good for treating Sexual Problems.
– Recognises the importance of early childhood in development of personality
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and behaviour, so may aid prevention of mental illnesses.
1.Behavioural Therapies
Based on Classical Conditioning
• MOA; Re-learning adaptive new behaviours
to replace the maladaptive behaviour.
• Flooding or Implosion Therapy
– Exposure to the feared stimulus = 70%
effective!
• Systematic desensitisation
– Wolpe (1958)
– Based on counter-conditioning (gradually
learning to re-associate the stimulus with a more
positive response).
• Aversion therapy
– Associate unwanted behaviour with a very
unpleasant unconditioned stimulus:-
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Behaviour Therapies
• All these Learning techniques are used to alter
behaviours; these techniques include using:
– Classical conditioning as in
•Aversion therapy… e.g.
•Systematic desensitization… e.g. Driving
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phobia?!!!!
Systematic Desensitization
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Appropriateness & Effectiveness
• Appropriate ONLY for behaviour that has been
learned.
• Behaviour therapy is as effective as other forms of
therapy (Smith et al., 1980)
• It is very effective with:
– Anxiety disorders (Ost, 1989)
– Obsessive-compulsive disorder (van Oppen et al.,
1995)
– Specific phobia (Ost, 1989) ( i.e. flooding 70%
effective)
• Not very effective with disorders with a genetic
component, such as schizophrenia
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Limitations / Criticisms
- Simplistic and Deterministic – limits all behaviour to
simple cause and effect.
- Mechanical in its application – do this and this will happen
- There are ethical questions relating to both research and
treatment methods. (Little Albert – Treating Gay Men)
- Treats only the behaviour not the causes of the
behaviour.
- Does not consider individual differences (blank slate?) –
we may all learn differently.
+ Scientific approach with good supporting evidence &
easy to research.
+ Therapies are successful for phobias, OCD and anxiety
disorders etc
? New learning or re-education is it always possible?
? What is unwanted behaviour? How is it defined and who
by? Used for punishment/social control (gay men) 18
COGNITIVE
THERAPIES
•
•
•
•
Cognitive Behavioural Therapy
Cognitive Restructuring Therapy
Rational Emotive Therapy
Stress Inoculation & Hardiness
Training.
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Cognitive Behavioural Therapy
Appropriateness: Cognitive behavioural therapy (CBT) is used to help solve
problems in people's lives, such as anxiety, depression, post-traumatic stress
disorder (PTSD) or drug misuse. CBT was developed from two earlier types
of psychotherapy:
•Cognitive therapy, designed to change people's thoughts, beliefs, attitudes
and expectations. (i.e. Changing negative thoughts to positive) Includes
Stress Innoculation and Hardiness training (both cognitive methods)
•Behavioural therapy (designed to change how people acted/behaved).
American psychotherapist Aaron Beck developed CBT believing that the
way we think about a situation affects how we act but also that our
actions/behaviours can affect how we think and feel.
MOA: It is therefore necessary to change both the act of thinking (cognition)
and behaviour at the same time. This is known as cognitive behavioural
therapy. CBT says that your problems are often created by you. It is not the
situation itself that is making you unhappy, but how you think about it and
how you react to it. Video Clip (Trust me I am a Dr.)
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Effectiveness of CBT
• CBT is often favoured over other therapies
because it aims to get rid of the problem not
just the symptoms.
• Evans (1992) CBT is at least as good as
drug therapy in preventing a relapse
• Keller (2001) combination of CBT and drug
therapy more effective than either therapy
alone
• Butler (2006) effectiveness depends on the
disorder. When the problem is severe, a
combination of drugs and CBT is best. E.g.
Drugs may reduce disturbed thoughts of
Schizophrenics allowing CBT to be used
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effectively.
Strengths and Limitations
• Treatment very effective, especially when
combined with drug therapy.
• Patient has a certain amount of control
over their treatment and can use the
techniques taught to them to deal with
future problems and situations.
• Assumption is that patient is to ‘blame’ for
their problems. This is the only therapy
that assumes that the patient is at fault.
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The Therapy Game
• You will be put in groups of either Psychiatrists,
Psychotherapists, Behavioural Therapists or
Cognitive Therapists
• You are now the potential therapists of the following
patients.
• Can you explain their abnormal behaviour?
• Can you suggest an appropriate treatment?
• You must stick strictly to the model/approach of your
particular group when answering these questions.
• The team with the most appropriate explanation and
treatment will win the patient.
• The team with the most patients wins the game! 23
Patient No. 1
• You have 2 minutes to discuss the case with
your fellow therapists and decide:
• What is the likely cause of the patients
abnormal behaviour?
• Which treatment is the most suitable and why? 24
Patient No. 2
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 25
Patient No. 3
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 26
Patient No. 4
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 27
Patient No. 5
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 28
The End
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Key Term: Abnormality
• Behaviour that is considered to deviate from
the norm (statistical or social), or ideal mental
health. It is dysfunctional because it is harmful
or causes distress to the individual or others
and so is considered to be a failure to function
adequately. Abnormality is characterised by
the fact that it is an undesirable state that
causes severe impairment in the personal and
social functioning of the individual, and often
causes the person great anguish depending
on how much insight they have into their
illness
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Key Term: Anorexia nervosa
• An eating disorder characterised by the
individual being severely underweight; 85%
or less than expected for size and height.
There is also anxiety, as the anorexic has
an intense fear of becoming fat and a
distorted body image. The individual does
not have an accurate perception of their
body size, seeing themselves as “normal”,
when they are in fact significantly
underweight, and they may minimise the
dangers of being severely underweight
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Key Term: Bulimia nervosa
• An eating disorder in which excessive
(binge) eating is followed by compensatory
behaviour such as self-induced vomiting or
misuse of laxatives. It is often experienced
as an unbreakable cycle where the bulimic
impulsively overeats and then has to purge
to reduce anxiety and feelings of guilt about
the amount of food consumed, which can be
thousands of calories at a time. This
disorder is not associated with excessive
weight loss
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Key Term: Cultural relativism
• The view that one cannot judge behaviour
properly unless it is viewed in the context from
which it originates. This is because different
cultures have different constructions of
behaviour and so interpretations of behaviour
may differ across cultures. A lack of cultural
relativism can lead to ethnocentrism, where
only the perspective of one’s own culture is
taken
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Key Term:
Deviation from ideal mental health
• Deviation from optimal psychological wellbeing (a state of contentment that we all strive
to achieve). Deviation is characterised by a
lack of positive self-attitudes, personal growth,
autonomy, accurate view of reality,
environmental mastery, and resistance to
stress; all of which prevent the individual from
accessing their potential, which is known as
self-actualisation
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Key Term: Eating disorder
• A dysfunctional relationship with food. The
dysfunction may be gross under-eating
(anorexia), binge–purging (bulimia), overeating (obesity), or healthy eating (orthorexia).
These disorders may be characterised by faulty
cognition and emotional responses to food,
maladaptive conditioning, dysfunctional family
relationships, early childhood conflicts, or a
biological and genetic basis, but the nature and
expression of eating disorders show great
individual variation
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Key Term: Statistical
infrequency/deviation from
statistical norms
• Behaviours that are statistically rare or
deviate from the average/statistical norm as
illustrated by the normal distribution curve,
are classed as abnormal. Thus, any
behaviour that is atypical of the majority
would be statistically infrequent, and so
abnormal (e.g., schizophrenia is suffered by
1 in 100 people and so is statistically rare)
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Factors Important to Mental Health
The factors that
drive or motivate
individuals,
according to
Maslow (1954)
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