Approaches to Treatment and Therapy Chapter 17

Approaches to Treatment and Therapy Biological treatments for mental disorders Kinds of psychotherapy Evaluating psychotherapy

Biological Treatments The question of drugs Surgery and electroshock

The Question of Drugs

Antipsychotic Drugs 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 Monoamine oxidase inhibitors (MAOIs) Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters. Tricyclic antidepressants Boost norepinephrine and serotonin in brain by preventing normal reuptake of these substances. Selective serotonin reuptake inhibitors (e.g, Prozac) work same way as tricyclic antidepressants but target serotonin.

Tranquilizers 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 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 Placebo effect High Relapse and dropout rates Dosage problems Long-term risks

Placebo Effect 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 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 Finding the therapeutic window or the amount of medication that is enough but not too much. Drugs may be metabolized differently in: 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 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. Many doctors and the public overlook the possibility of long-term dangers when a drug shows short run benefits.

Surgery and Electroshock Psychosurgery Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behaviour. Electroconvulsive Therapy (ECT) A procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is induced.

Kinds of Psychotherapy Psychodynamic therapy Behavioural and cognitive therapy Humanist and existential therapy Family and couples therapy

Psychodynamic Therapy Goal is exploring the unconscious Free Association In psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind. Transference 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 Behaviour therapy Systematic desensitization Exposure treatments Behavioural records Skills training Cognitive therapy

Behaviour Therapy A form therapy that applies principles and techniques of classical and operant conditioning to help people change self- defeating or problematic behaviours.

Systematic Desensitization A step by step process of desensitizing a client to a feared object or experience, based on counterconditioning.

Exposure (Flooding) 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 A method of keeping careful data on the frequency and consequences of the behaviour to be changed.

Skills Training 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 Examine the evidence for beliefs. Consider other explanations for the behaviour of others. Identify assumptions and biases. Rational Emotive Behaviour Therapy (REBT): a form of cognitive therapy designed to challenge the client’s unrealistic or irrational thoughts.

Cognitive Techniques Meichenbaum developed a form of cognitive therapy to treat excessive anxiety called “stress inoculation.” Involves 3 stages: Education phase Rehearsal phase Implementation phase

Humanist Therapy Humanist therapy Based on the assumption that people seek self- actualization and self-fulfillment. Emphasized people’s free will to change, not past conflicts. Client-Centered (Nondirective) Therapy 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 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 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 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 Psychodynamic Probing the unconscious through dream analysis, free association, transference. Cognitive-behavioural Behavioural techniques such as systematic desensitization, flooding; cognitive exercises to identify and change faulty beliefs. Humanist Providing a safe, non-judgmental setting in which to discuss life issues. Family Working with couples, families, and sometimes individuals to identify and change patterns that perpetuate problems.

Evaluating Psychotherapy The scientist-practitioner gap The therapeutic alliance When therapy helps When therapy harms

The Scientist-Practitioner Gap 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? With additional therapy sessions, the percentage of people improved increased up to 26 sessions. Rate of improvement then levels off Based on a summary of 15 studies, 2400 clients (Howard, et al., 1996). Patients’ sense of improvement slower but more steady.

Psychotherapy Research Questions 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 Qualities of the Participants Motivation to improve and solve problems. Support from families and actively deal with problems. Empathic, warm, and genuine therapists. Culture and the Therapeutic Connection 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 Problems of assessing therapy 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? Depression Cognitive therapy’s greatest success has come in treatment of mood disorders. Anxiety Disorders Exposure techniques are more effective than others. Anger and Impulsive Violence Cognitive therapy is extremely successful.

What works? Health Problems Cognitive and Behaviour therapies are effective for a wide range of health problems. Childhood and Adolescent Behaviour Problems Behaviour therapy is the most effective treatment.

Successful Therapy Psychotherapy outcome depends not only on method of therapy. Qualities of client and therapist, and their alliance, also determine success.

When Therapy Harms 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.