Chapter 14 Treatments, continued

Behavioral Therapies - Types 1. Systematic Desensitization - used to help phobias - weakens CR by getting closer to CS - weakens associations in pt’s mind - A. therapist helps create “anxiety hierarchy” > pt tells how frightening on Likert scale - B. use relaxation techniques - C. relaxed pt imagines a lower-level anxiety – works way up - D. try to experience

Behavioral Therapies 2. Aversion Therapy - condition with negative response > Antabuse for alcoholism – take med & drink = vomit - some success for alcoholism - less use today - sex offenders, smoking - A Clockwork Orange

Behavioral Therapies 3. Social Skills Training - show pts how to interact – get along – be with others > eye contact, talk, listen - esp for SMI – autistic, schizophrenics - A. modeling – watch others - B. behavioral rehearsal – practice role-play - C. shaping – encouraged to build skills

Behavioral Therapies 4. Cognitive-Behavioral Therapy (CBT) - focus on thinking – use verbal tech, behavior modification to change thinking - related to cognitive therapy, rational-emotive therapy - helps depression Blame themselves > concentrate on the bad > predict the worst > feel bad about themselves

Do Behavioral Therapies Work ? Stress results Success has to be considered Types of pts

Biomedical Therapies Work at physiological level Try to change psychological sx Pharma most common Drugs 1950s Major types: antianxiety drugs, antipsychotic drugs, antidepressants & mood stabilizers

Antianxiety Drugs Should feel less nervous Tranquilizers – Valium, Xanax – work fast, short-term effects – many take them; not all clinical cases Addictive > withdrawal Side effects – sleepiness, dizzy, GI, dry mouth

Antipsychotic Drugs Schizophrenics & extreme cases of Mood Disorders Reduce positive sx Uncertain – may reduce DA Help 70% pts Take time to “kick in” Pts usually take them for life > or sx return Side-effects – sleepy, Parkinsonian sx > tardive dyskinesia – tics, pill-rolling, tremors – incurable Atypical antipsychotics – newer, work differently, fewer side-effects, but risk of CAD & DM; expensive

Antidepressants Lift the mood Most work on serotonin > keep it working longer; slow metab SSRIs – selective serotonin reuptake inhibitors Prozac, Paxil, Zoloft Good for depressions, not bipolar d/o Fewer side-effects, except for suicide (uncertain) > hard to est meaningful correlation > not for teens, children SNRIs – both NE & serotonin – stronger, health issues

Mood Stabilizers For bipolar d/o Lithium – the classic – natural salt Best for control both kinds of episodes Tricky to dose Monitor – health problems, esp kidney, thyroid & Htn Newer tx – valproate – for epilepsy, but works – fewer side-effects

Do Drugs Work ? Can help – esp w extreme cases Not a cure – what is real problem Hype Too often prescribed Are there guidelines Big Pharma > $$$ for professors > honest research ?? Conflicts of interest

ECT For MDD > controversies Risks Labor-intensive Forgetting Sx may return

Treatments & Trends Paying Out of pocket v. insurance Private insurance v. govt managed care HMOs (health maintenance organizations) – care is cheaper, but fewer choices Pts usually get some tx Cheaper meds referrals

Multiculturalism Shamans, healers, religious authorities Language issues Racial issues Class issues Training Get the therapeutic alliance

Are there mental hospitals ? 1960s-70s deinstitutionalization Short stays Community mental health movement Homelessness & SMI