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
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.
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.