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Treatment Modalities for Psychological Disorders

Treatment Modalities for Psychological Disorders. “Brutal” to “Gentle” Transition. Dorothea Dix and Philippe Pinel (mid 1800s) Advocates of mental hospitals to provide more human treatment Mid 1950s: exodus from mental hospitals: Introduction of therapeutic drugs

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Treatment Modalities for Psychological Disorders

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  1. Treatment Modalities for Psychological Disorders

  2. “Brutal” to “Gentle” Transition • Dorothea Dix and Philippe Pinel (mid 1800s) • Advocates of mental hospitals to provide more human treatment • Mid 1950s: exodus from mental hospitals: • Introduction of therapeutic drugs • Community-based treatment programs

  3. Two Main Treatment Modalities • Psychotherapy • Biomedical therapy • Combination of the two • 50% of psychotherapists say they use an “ecclectic approach,” using a blend of therapies

  4. 4 Main Psychological Therapies • 1. Psychoanalysis • Sigmund Freud • 2. Humanistic • Carl Rogers • 3. Behavioral • Pavlov/Skinner • 4. Cognitive • Aaron Beck

  5. 1. Psychoanalysis • Psychological problems = • Repressed impulses and conflicts from childhood • Aim: work through ‘buried’ feelings and take responsibility for their own growth • Release energy ‘wasted’ on id-ego-superego conflicts

  6. 1. Psychoanalysis • How does it work? • Free association • But watch out for “resistance”… blocks in the flow of free association • Therapist would interpret the ‘meaning’ of your resistance • Interpretation of latent content in dreams

  7. 1. Psychoanalysis • One result of therapy: • Transference • Occasionally followed by “Countertransference” • This is why the APA has a “Code of Ethics”!

  8. 1. Psychoanalysis • Be ready to open you wallet! • Traditional psychoanalysis is 3-4 visits/week for several years • Conservatively speaking, at $125/hour, this is $68,250 for 3 years • Maybe just take a few nice vacations!

  9. 1. Psychoanalysis • Modern “alternative” is: • Psychodynamic Therapy • Goal is to understand current symptoms in terms of childhood and important relationships • Face-to-face; generally once a week for several months

  10. 2. Humanistic Therapy • Carl Rogers (1902-1987) • “Client-centered therapy” (Not “patient”) • Aim is to grow in self-awareness and acceptance • Focus is on: • Dealing with present & future • Conscious thoughts rather than unconscious • Taking responsibility for one’s feelings & actions

  11. 2. Humanistic Therapy • Therapists strive to exhibit : • Genuineness • Acceptance • Empathy • Which leads to “unconditional positive regard” • Mechanism: “Active Listening”

  12. 3. Behavior Therapies • You don’t need “self-awareness” to heal from psychological problems! • A. Classical Conditioning Techniques • B. Operant Conditioning Techniques

  13. 3A. Classical Conditioning • “Counter-conditioning”: Pair the trigger stimulus with a new response (relaxation) • Idea: can’t be both fearful AND relaxed • Two techniques: • Exposure therapy • Aversive conditioning

  14. 3A. Classical Conditioning • Exposure Therapy/Response Prevention (ERP)

  15. 3A. Classical Conditioning • Aversive Conditioning: Substitute an aversive response for a positive response to a harmful stimulus Also, Faradic aversion conditioning!

  16. 3B. Operant Conditioning • Behavior Modification • Use positive reinforcers to shape behavior

  17. 3B. Operant Conditioning • Token Economies

  18. 3B. Operant Conditioning • Concerns with Behavior Modification • How ‘durable’ are the effects? • It is OK for one human to control another’s behavior?

  19. 4. Cognitive Therapy • Works with the assumption that our thoughts color our feelings • Aaron Beck: Expose irrational thinking, and then persuade the person to remove the dark glasses through which they view life

  20. 4. Cognitive Therapy

  21. Therapies to Avoid! • Energy therapy – manipulating invisible energy fields • Recovered-memory therapy • Rebirthing therapy • Facilitated communication • Crisis debriefing

  22. Biomedical Therapies: Drugs • Antipsychotic Drugs • Antianxiety Drugs • Antidepressant Drugs • Mood-Stabilizing Drugs

  23. Biomedical Therapies: Adjuncts or Alternatives to Drugs • Electroconvulsive Therapy • Magnetic Stimulation • Deep-Brain Stimulation

  24. Biomedical Therapies: Drugs • Antipsychotic Drugs • Most common drugs help alleviate “positive” symptoms of schizophrenia • Ex. Chlorpromazine (Thorazine) • Work by blocking activity of dopamine • Major side-effects: tardivedyskinesia, obesity, diabetes

  25. Biomedical Therapies: Drugs • “Atypical” Antipsychotic Drugs • Help alleviate ‘negative’ symptoms of schizophrenia • Ex. clozapine (Clozaril)

  26. Biomedical Therapies: Drugs • Anti-anxiety Drugs • Examples: Xanax, Atavan, Valium • ALL depress the central nervous system • Anti-anxiety drugs plus ________ make a lethal combination? • ALCOHOL!

  27. Biomedical Therapies: Drugs • Anti-anxiety Drugs • Criticisms: • 1. do not treat underlying problem, just symptoms • 2. Psychological dependence: “popping a Xanax” • 3. Physiological dependence: cessation of drug can lead to great anxiety and insomnia • New standard drug treatment for anxiety….

  28. Biomedical Therapies: Drugs • Antidepressant Drugs • Also successfully treat anxiety disorders in addition to depression • Selective-serotonin-reuptake inhibitors (SSRIs) • Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine)

  29. Biomedical Therapies: Drugs

  30. Biomedical Therapies: Brain Stimulation • Electroconvulsive Therapy • 1938: 100 volts administered to wide-awake patient • Today: general anesthesia, muscle relaxant, 30 second electrical stimulation • Refractory Depression: 80% of patients improve with ECT, but 4 in 10 relapse within 6 months

  31. Biomedical Therapies: Brain Stimulation • Electroconvulsive Therapy

  32. Biomedical Therapies: Brain Stimulation • Alternative Neurostimulation • 1. Magnetic Stimulation: repetitive transcranialmegnetic stimulation (rTMS)

  33. Biomedical Therapies: Brain Stimulation • Alternative Neurostimulation • 2. Deep-Brain Stimulation

  34. Biomedical Therapies: Psychosurgery • Frontal Lobotomy • 1930s, Portuguese physician, Dr. Moniz • In the U.S. during 1950s: 35,000 lobotomies performed • J.F. Kennedy’s sister, Rosemary, received a lobotomy • No longer performed • Nobel Peace Prize awarded to Moniz

  35. Therapeutic Life-Style Change • Aerobic exercise: 30 min. 3x a week • Adequate sleep: 7-8 hours per night • Light exposure • Social connection • Anti-rumination • Nutritional supplements: omega-3 fatty acids

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