Approaches to Treatment and Therapy Chapter 16 Chapter

Chapter Outline Biological Treatments for Mental Disorders Biological Treatments for Mental Disorders Kinds of Psychotherapy Kinds of Psychotherapy Evaluating Psychotherapy Evaluating Psychotherapy

Challenging Life Events 3

Biological Treatments Contemporary view alternates between mental disorders as diseases (medical treatment) & emotional problems (psychological treatment) Contemporary view alternates between mental disorders as diseases (medical treatment) & emotional problems (psychological treatment)

Antipsychotic Drugs Drugs used primarily in the treatment of schizophrenia & other psychotic disorders Drugs used primarily in the treatment of schizophrenia & other psychotic disorders Blocks or reduces sensitivity of dopamine receptors Blocks or reduces sensitivity of dopamine receptors Reduce agitation, delusions, and hallucinations Reduce agitation, delusions, and hallucinations Side effects such as muscular rigidity, tremors, and involuntary muscle movements, drastic weight gain (up to 100 pounds a year) leading to further health problems Side effects such as muscular rigidity, tremors, and involuntary muscle movements, drastic weight gain (up to 100 pounds a year) leading to further health problems

Antidepressant Drugs Drugs used primarily in the treatment of mood disorders, especially depression & anxiety Drugs used primarily in the treatment of mood disorders, especially depression & anxiety Produce unpleasant physical reactions (dry mouth, stomach problems, headaches, weight gain, reduced sex drive) Produce unpleasant physical reactions (dry mouth, stomach problems, headaches, weight gain, reduced sex drive) ?v=OTZvnAF7UsA ?v=OTZvnAF7UsA ?v=OTZvnAF7UsA ?v=OTZvnAF7UsA

Selective Serotonin Reuptake Inhibitors 7

Anti-anxiety Drugs (Tranquilizers) Addictive Addictive Useful as short-term treatment of panic disorder Useful as short-term treatment of panic disorder Increase activity of GABA Increase activity of GABA

Cautions About Drug Treatments Limitations to drug treatments: Limitations to drug treatments: 1.The placebo effect – –The apparent success of a medication or treatment due to the patient’s expectations or hope rather than to the drug itself 2.High relapse and dropout rates 3.Dosage problems - issues with different metabolisms

Cautions About Drug Treatments More limitations to drug treatments More limitations to drug treatments 4.Disregard for effective, possibly better, nonmedical treatments – – - Medication is easier, faster, often cheaper but not the best solution 5.Unknown long-term risks 6.Untested off-label uses – Drugs are sometimes prescribed for conditions outside their intended use

Direct Brain Intervention Psychosurgery Psychosurgery – Any surgical procedure that destroys selected areas of the brain Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT) – A procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is induced – Newer alternatives like transcranial magnetic stimulation (TMS) used for milder stimulation

Brain 12 versus Mind

Psychodynamic Therapy Freud Freud minutes 50 seconds 4 minutes 50 seconds

Psychodynamic Therapy Relied on Freud’s method of psychoanalysis Relied on Freud’s method of psychoanalysis “The talking cure” Intense analysis of dreams and childhood memories would provide insight into the unconscious and emotional release

Several Kinds of Psychotherapy Behavioural therapy Behavioural therapy Cognitive therapy Cognitive therapy Humanist therapy Humanist therapy

Behavioural Therapy Therapy that applies principles of classical and operant conditioning to help people change self- defeating or problematic behaviours Therapy that applies principles of classical and operant conditioning to help people change self- defeating or problematic behaviours Uses a variety of methods depending on the problem or situations Uses a variety of methods depending on the problem or situations – systematic desensitization, behavioural self-monitoring, skills training

Behavioural Techniques Systematic desensitization Systematic desensitization: step-by-step process of desensitizing a client to a feared object or experience Systematic desensitization: step-by-step process of desensitizing a client to a feared object or experience Based on counterconditioning: process of pairing a conditioned stimulus with a stimulus that elicits a response that is incompatible with an unwanted conditioned response Based on counterconditioning: process of pairing a conditioned stimulus with a stimulus that elicits a response that is incompatible with an unwanted conditioned response Copyright © 2013 Pearson Canada

Behavioural Techniques Behavioural self-monitoring – A method of keeping careful data on the frequency and consequences of the behaviour to be changed Skills training – An effort to teach the client skills the he or she may lack, as well as new constructive behaviours to replace self- defeating ones

Cognitive Therapy Form of therapy designed to identify and change irrational, unproductive ways of thinking – teach cognitive coping mechanisms Form of therapy designed to identify and change irrational, unproductive ways of thinking – teach cognitive coping mechanisms Challenge client’s unrealistic thoughts (e.g., overgeneralizations, catastrophizing) Challenge client’s unrealistic thoughts (e.g., overgeneralizations, catastrophizing) For depression and for anxiety For depression and for anxiety

Challenge Negative Thoughts 1. Are these thoughts really true? 2. Are the negative aspects of this situation overemphasized? 3. What is the worst thing that could really happen? 4. Is there anything that might be positive about this situation? 5. Was a negative outcome assumed? 20

Challenge Negative Thoughts 6. How do you know the situation will turn out badly? 7. Is there another way to look at this situation? 8. What difference will this make next week? In a month? In a year? 9. If you had one month to live, how important would this be? 10. Are you setting unrealistic standards for yourself? Would you be this harsh if the event had happened to a friend? 21

Humanist Therapy Form of psychotherapy based on the philosophy of humanism, which emphasizes the client’s free will to change rather than past conflicts Form of psychotherapy based on the philosophy of humanism, which emphasizes the client’s free will to change rather than past conflicts Client-centered therapy: emphasizes therapist’s empathy with the client and the use of unconditional positive regard Client-centered therapy: emphasizes therapist’s empathy with the client and the use of unconditional positive regard Goal is to build the client’s self-esteem and self- acceptance and become more productive at problem solving Goal is to build the client’s self-esteem and self- acceptance and become more productive at problem solving

Evaluating Psychotherapy Complexity of situation Complexity of situation i.e., Qualities of the therapist and client, the kind of therapy, the nature of the problem, and the duration of the therapy. i.e., Qualities of the therapist and client, the kind of therapy, the nature of the problem, and the duration of the therapy. Client effort? Client effort? Defining success? Defining success?

Evaluating Psychotherapy Therapeutic alliance – the client and therapist both respect and understand each other and agree on the goals of treatment Therapeutic alliance – the client and therapist both respect and understand each other and agree on the goals of treatment – Recognition of cultural differences Evaluating Therapy scientifically Evaluating Therapy scientifically Therapist vs Scientist Therapist vs Scientist Testimonials vs randomized control trials Testimonials vs randomized control trials

Evaluating Crisis Debreifing Critical Incident Stress Debriefing (CISD) used as an intervention immediately following disasters to decrease rates of PTSD Critical Incident Stress Debriefing (CISD) used as an intervention immediately following disasters to decrease rates of PTSD Found that highly emotional reactions to incidents + CISD showed higher stress symptoms Found that highly emotional reactions to incidents + CISD showed higher stress symptoms

Values of Psychotherapy Self-acceptance versus self-improving? Self-acceptance versus self-improving? Consumers thinking about psychotherapy should carefully consider how they go about: Consumers thinking about psychotherapy should carefully consider how they go about: – Choosing a therapist – credentials and training – Choosing a therapy – depends on the condition – Deciding when to leave – short-term is usually sufficient

When Therapy Harms Risks to clients increase under these conditions: Risks to clients increase under these conditions: 1.The use of empirically unsupported, potentially dangerous techniques (e.g., rebirthing, recovered memory therapies) 2 min scared straight 2. Inappropriate or coercive influence, which can create new problems for the client

When Therapy Harms Risks to clients increase under these conditions: Risks to clients increase under these conditions: 3.Prejudice or cultural ignorance on the part of the therapist h?v=UAhb4mQ6Pj0https:// h?v=UAhb4mQ6Pj0 2 minutes h?v=UAhb4mQ6Pj0 4. Sexual intimacies or other unethical behaviour on the part of the therapist

The Brain That Changes Itself g-your-mind g-your-mind g-your-mind g-your-mind 23 minutes – 41 minutes 23 minutes – 41 minutes 29

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