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Treatments for Psychological Disorders. Biological and Psychological Based Treatments . Early Attempts at Biological Intervention. Coma and convulsive therapies Insulin coma therapy Electroconvulsive shock therapy (ECT) Bilateral ECT and Unilateral ECT

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treatments for psychological disorders

Treatments for Psychological Disorders

Biological and Psychological Based Treatments

early attempts at biological intervention
Early Attempts at Biological Intervention
  • Coma and convulsive therapies
    • Insulin coma therapy
    • Electroconvulsive shock therapy (ECT)
      • Bilateral ECT and Unilateral ECT
      • Shock lasting 1.5 Seconds 3 x week (2-4 weeks)
      • Memory Impairment for Months After
  • Neurosurgery
    • Psychosurgery or Neurosurgery
    • The prefrontal lobotomy
    • Very, Very Seldom Today Due to Medications
psychopharmacological methods of treatment
Psychopharmacological Methods of Treatment
  • Note: Keep in mind that the role of neuro-transmitters in mental illness is not well known. The use of medication is based on theory not fact
  • Psychopharmacology- the science of determining which drugs alleviate which mental disorders and why they do so
antipsychotic medications neuroleptics or major tranquilizers
Antipsychotic MedicationsNeuroleptics or Major Tranquilizers
  • Traditional Antipsychotics included side effects including Tardive Dyskinesia- a disfiguring disturbance of motor control, particularly of the facial muscles
  • Atypical Antipsychotics
    • Zyprexa, Geodon, Risperdal, Clozaril, Seraquil
  • Side Effects
    • Include: Dry Mouth, Motor Disturbances, Sedation, Weight Gain, Damage to Liver (blood levels need to be taken), Risperdal (lactation in females)
    • Effectiveness (20-30% do not respond)
antidepressant medications
Antidepressant Medications
  • Monoamine oxidase (MAO) inhibitors
      • Inhibits breakdown of neurotransmitters
      • Used in depression with hypersomnia
      • Requires Dietary Supplement
  • Tricyclic antidepressants (TCAs)
      • Inhibits reuptake of serotonin & norepinephrine
      • Cause death with overdose
  • Selective serotonin re-uptake inhibitors (SSRI)
      • Prozac, Zoloft, Paxil, Luvox, Lexapro, Celexa
      • Not as selective as once thought
  • Should be taken for minimum of 9-12 months
antianxiety medications anxiolytics or minor tranquilizers
Antianxiety MedicationsAnxiolytics or Minor Tranquilizers
  • Benzodiazepines
      • Sedative effect
      • Dependency Issues
      • Used to Treat Alcohol Withdrawal
      • High Relapse Rate After Termination of Medication
      • Probably stimulate GABA an inhibitory neurotransmitter
    • Side Effects Include: Drowsiness and Lethargy
    • Lithium for the bipolar mood disorders
      • Long Term Use Side Effects Include: thyroid dysfunction, kidney damage, memory and motor speed problems
medication and children
Medication and Children
  • Do anti-depressants increase suicidality?
    • Natural increase in likelihood to suicide when mood improves
    • Medications do result in an initial adjustment for the body that can be agitating
      • Important to monitor the individuals mood in the first 10 days
  • A client’s response to a medication in the first 10-14 days is often predictive of how effective the medication will be in alleviating antidepressant
an overview of psychological treatment
An Overview of Psychological Treatment
  • Who provides psychotherapeutic services?
    • Psychologists, Psychiatrists, Social Workers
  • Educational Backgrounds Vary
  • Theories of Change Vary (see next slide)
  • Commonalities in Effective Therapists
    • Form a Therapeutic Alliance with Their Clients
    • Focus on Client Goals
    • Use Research Based Interventions
  • Psychotherapy- the treatment of mental disorders by psychological methods.
  • To Achieve changes a therapist may:
    • Change maladaptive behavior patterns
    • Minimize or eliminate influences from the environmental condition
    • Improve interpersonal skills or other competencies
    • Resolve disabling conflicts among motives
    • Modify dysfunctional beliefs
    • Reduce or remove distressing or disabling emotional reactions.
    • Foster a clear cut sense of identity
an overview of psychological treatment12
An Overview of Psychological Treatment
  • Why do people seek therapy?
    • Those in highly stressful situations.
    • Referred by physician or other professional.
    • Forced by spouse, parent, or court.
  • Who has the best prognosis? (YAVIS)
    • Young, Attractive, Verbal, Intelligent, and Successful Individuals.
    • Why YAVIS?
      • Motivation, Cognitive Abilities, Malleable
    • The client’s contribution to the success of treatment includes his or her motivation and expectation
successful therapy
Successful Therapy
  • Qualities of the client (personality, motivation)
  • Qualities of the therapist (relational skills)
  • Qualities of the relationship (therapeutic alliance)
  • Qualities of the method being used.
stages of change
Stages of Change
  • Prochaska’s Levels of Change
    • Pre-contemplation
    • Contemplation
    • Preparation
    • Action
    • Maintenance
    • Termination
  • Customer or not a customer
psychodynamic therapies freudian psychoanalysis
Psychodynamic Therapies:Freudian psychoanalysis
  • Four Basic Techniques
    • Free association
    • Analysis of dreams
      • Manifest content
      • Latent content
    • Analysis of resistance
      • An unwillingness or inability to talk about certain thoughts, motives or experiences
    • Analysis of transference
      • Transference- the process whereby clients project onto the therapist attitudes and feelings they had in a past relationship with a parent or other person close to them
      • Countertransference- the process in which the therapist reacts in accord with the client’s transferred attributions rather than objectively
psychodynamic therapies since freud
Psychodynamic Therapies:Since Freud
  • Interpersonal therapy
  • Object relations
  • Self psychology
  • Other interpersonal variations
  • Psychodynamic therapies tend to be time consuming and expensive
    • They suggest that past issues need to be resolved for change to occur
  • Efficacy vs Effectiveness of of Psychodynamic Approaches
behavior therapy
Behavior Therapy
  • Guided exposure
    • Systematic desensitization
      • Graduated scenes
      • Require an inconsistent bx from the client while exposed (real or imagined) to the feared stimuli
    • In Vivo Exposure
  • Aversion therapy
    • Use of Punishment (antabuse)
    • Driving Movie
    • Pornography and Children Walking In
  • Modeling, Imitation, and Role Playing
behavior therapy18
Behavior Therapy
  • Systematic Use of Reinforcement
    • Also referred to as Contingency Management
    • Response Shaping- a behavior therapy technique using positive reinforcement to establish by gradual approximation a response that is actively resisted or is not initially in a person’s behavioral repertoire
      • Remove Reinforcements or Add Reinforcements
        • Super-Nanny
    • Token Economies
    • Behavioral Contracting (marital tx and social exchange)
    • Biofeedback Treatment
      • Monitor Physical, Convert to Signal, Prompt Feedback
cognitive cognitive behavioral tx
Cognitive & Cognitive-Behavioral Tx
  • Rational emotive behavior therapy (REBT)
    • Focus on changing core irrational beliefs
      • See table 3.5
  • Stress-inoculation therapy (SIT)
    • Three stages include: cognitive preparation, skill acquisition & rehearsal, and application and process.
  • Beck’s cognitive therapies
    • Focus on illogical thinking about self, world, and future.
humanistic experiential therapies
Humanistic-Experiential Therapies
  • Client-Centered (person-centered) therapy
    • Nondirective
    • Unconditional Positive Regard
    • Self-actualization
  • Existential Therapy
    • The human predicament
    • Focus on here and now
    • Therapist is to be authentic
  • Gestalt Therapy
    • Integration of thought, feeling, and action into one’s self-awareness
therapy for interpersonal relationships
Therapy for Interpersonal Relationships
  • Couples Counseling (Marital Therapy)
  • Family Systems Therapy
    • Systemic Recursiveness
    • Identified Patient
    • Homeostasis
  • Structural Family Therapy (Salvador Minuchin)
      • Family Rules and Boundaries
how does one measure success in psychotherapy
How Does One Measure Success in Psychotherapy?
  • Objectifying and quantifying change
  • Would change occur anyway?
  • Can therapy be harmful?
psychotherapy and society
Psychotherapy and Society
  • Social values and psychotherapy
  • Psychotherapy and cultural diversity
evaluating psychotherapies
  • Is psychotherapy effective
      • Client perceptions
        • indicates that 3 out of 4 are satisfied while 1 in 2 are very satisfied.
        • Reports may be inaccurate due to crisis effect, effort effect, and liking the therapist
      • Clinician’s Perceptions
        • Most testify to therapy success (big surprise)
      • Outcome Research
        • Indicates that the average therapy outcome for clients who receive treatment surpasses that of the client who remains untreated.
        • “Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.”
        • On average psychotherapy is somewhat effective (it depends on the diagnosis obviously)
        • Psychotherapy has been shown to decrease medical costs.
        • Contrary to Myer’s presentation, some treatment approaches have been proven to be more effective than others.
unresolved issues
  • Efficacy versus effectiveness