Approaches to treatment and therapy 17 Approaches to treatment and therapy

17 Antipsychotic drugs Many block or reduce sensitivity of dopamine receptors. Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activity Can relieve positive symptoms of schizophrenia, but ineffective—or even worsen—negative symptoms

17 Antidepressant drugs Monoamine oxidase inhibitors (MAOI’s) Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters Tricyclic antidepressants Boost norepinephrine and serotonin by preventing reuptake Selective serotonin reuptake inhibitors (SSRI’s) Boost serotonin by preventing reuptake Herbs such as St. John’s Wort have also been used.

17 Tranquilizers Increase the activity of GABA Developed for treatment of mild anxiety Often prescribed inappropriately by general practitioners for any patient mood complaints

17 Lithium carbonate Used to treat bipolar disorder Moderates levels of norepinephrine by protecting cells from being over-stimulated by neurotransmitter glutamate Must be given in right dose, bloodstream levels monitored Newer treatments include Tegetrol and Depakote.

17 Your turn Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe? 1. An MAOI 2. An SSRI (e.g., Prozac) 3. A tranquilizer (e.g., Valium) 4. Lithium carbonate

17 Your turn Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe? 1. An MAOI 2. An SSRI (e.g., Prozac) 3. A tranquilizer (e.g., Valium) 4. Lithium carbonate

17 Placebo effect The apparent success of a treatment due to patient’s expectation rather than the treatment itself Meta-analysis indicates that clinicians consider medication helpful, yet patient ratings in treatment groups were no greater than those in placebo groups.

High relapse and dropout rate 17 High relapse and dropout rate There may be short-term success, but 50–66% of patients stop taking medication due to side effects. Individuals who take antidepressants without learning to cope with problems are more likely to relapse.

17 Dosage problems Finding the therapeutic window, the dosage that is enough but not too much Drugs may be metabolized differently in. . . Men and women Old and young Different ethnic groups Appropriate dosage also affected by metabolic rates, amount of body fat, number and type of drug receptors in the brain, smoking, and eating habits.

17 Long-term risks Antipsychotic drugs can be dangerous, even fatal if taken for many years. Tardive dyskinesia Antidepressants are assumed to be safe, but no long-term studies have been conducted.

Direct brain intervention 17 Direct brain intervention Psychosurgery Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior. Electroconvulsive therapy (ECT) Procedure used in cases of prolonged and severe major depression Brief brain seizure is induced

Transcranial magnetic stimulation 17 Transcranial magnetic stimulation Involves use of pulsing magnetic coil held to a person’s skull over the left prefrontal cortex This area is less active in those with depression. Treatment does not result in pain or memory problems, controlled studies have suggested positive results.

Psychodynamic therapy 17 Psychodynamic therapy Psychoanalysis A method of psychotherapy developed by Freud, emphasizes the exploration of unconscious motives and conflicts Free association In psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind

Psychodynamic therapy 17 Psychodynamic therapy Other psychodynamic therapies also explore unconscious dynamics, but differ from Freudian analysis. Transference In psychodynamic therapies, a critical step in which the client transfers unconscious emotions or reactions, such as conflicts with parents, onto the therapist

17 Behavior therapy A form of therapy that applies classical and operant conditioning to help people change own defeating or problematic behaviors

17 Graduated exposure In behavior therapy, a method in which a person suffering from an anxiety disorder, such as a phobia, is gradually taken into the feared situation or exposed to a traumatic memory, until the anxiety subsides

17 Flooding A technique whereby a person suffering from an anxiety disorder, such as a phobia, is taken directly into the feared situation until the anxiety subsides

Systematic desensitization 17 Systematic desensitization A step-by-step process of desensitizing a client to a feared object or experience Based on counter conditioning

Behavioral self-monitoring 17 Behavioral self-monitoring A method of keeping careful data on the frequency and consequences of a behavior to be changed

17 Skills training An effort to teach a client skills or new more constructive behaviors to replace self-defeating ones

17 Cognitive techniques Examine the evidence for beliefs. Consider other explanations for the behavior of other people. Identify assumptions and biases.

Rational emotive therapy 17 Rational emotive therapy A form of cognitive therapy devised by Albert Ellis, designed to challenge the client’s unrealistic or irrational thoughts

17 Humanist therapy Humanist therapy Client-centered therapy Based on assumption that people seek self-actualization, self-fulfillment Emphasized people’s free will to change, not past conflicts Client-centered therapy Developed by Carl Rogers, emphasizes therapist’s empathy with client, and communication of unconditional positive regard

17 Existential therapy 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 17 Family and couples therapy Assumes that problems develop in the context of family, that they are sustained by family dynamics, and that any changes will affect whole family Can look for patterns of behavior across generations and create a family tree of psychologically significant events

Family-systems perspective 17 Family-systems perspective Therapy with individuals or families that focuses on how each member forms part of a larger interacting system

One family’s history of mental illness 17 One family’s history of mental illness

The scientist-practitioner gap 17 The scientist-practitioner gap Some 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 even harm clients. Economic pressures require empirical assessment of therapies.

17 Is more better? Additional sessions, up to 26, increase the percentage of people who improve. Rate of improvement then levels off. Patients’ sense of improvement slower but more steady.

17 Research questions What are the common ingredients in successful therapies? What kinds of therapy best suited for which problems? When is therapy harmful?

17 Common ingredients Therapeutic alliance: bond between therapist and client When clients want to be helped When therapists distinguish normal cultural patterns from individual psychological problems

17 Which therapy? Depression Anxiety disorders Cognitive therapy Anxiety disorders Exposure techniques Anger and impulsive violence Health problems Cognitive and behavior therapies Childhood and adolescent behavior problems Behavior therapy

17 Successful therapy

17 Your turn You have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem? 1. Direct brain intervention 2. Cognitive therapy 3. Psychodynamic therapy 4. Behavioral therapy

17 Your turn You have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem? 1. Direct brain intervention 2. Cognitive therapy 3. Psychodynamic therapy 4. Behavioral therapy

17 When therapy harms Use of empirically unsupported, potentially dangerous therapeutic techniques Inappropriate or coercive influence, which can create new problems for the client Prejudice or cultural ignorance on the part of the therapist Unethical behavior, especially sexual intimacy, on the part of the therapist