5.3 Abnormal psychology: implementing treatment

1. 5.3 Abnormal psychology: implementing treatment

2. Introduction - History • “madness” was attributed to the supernatural forces, or possession of evil spirits • Treatment was drilling holes in the skull to release the evil spirit, this is known as trepanation. • Diagnosis was occurring and treatment was being sought.

3. Possible relationship between etiology and treatment Pages 166 - 169

4. Contemporary approach to treatment • Biomedical • Individual or group therapy • Biopsychosocial approach: Multifaceted approach is know considered to be the most efficient. • Includes drug therapy • cognitive therapy (individual) • or family therapy (group therapy) • Stress related environmental management • ‘Client’ has replaced the term ‘patient’

5. Drug Therapy • Not all people will respond to drug therapy the same • Side effects may occur • Dosage levels take time to assess • No conclusive data to pinpoint specific biophysiology to behavior, but rather a general knowledge that neurotransmitters and hormones may contribute.

6. Individual therapy • Therapist work one-on –one with the client • Most therapy involves some form of cognitive • Works to change negative thought pattern • Highly effective • Personalized/individualized to the client.

7. Group Therapy • A group if clients with similar issues meet with one or two therapist. • Women who have experiences sexual abuse • Abusive family • Depression • Group therapy allows individuals to openly discuss shared experiences in a safe environment; • It provides group support (collectivism), • Cost effective for client • Therapist can work with multiple clients at once • The group setting diminishes the role of the therapist and thus buts the client on the path to self management. • Many disorders are caused or promote poor social skills – group works allows individuals to interact in a safe environment.

8. Disadvantages of Group • Some individuals may not want to express themselves • Confidentiality • Group dynamics

9. Culture Considerations in treatment Pages 168-169

10. Culture and treatment • Not all cultures respond to all treatments the same. • Mutlaq and Chaleby (1995) – problems with group therapy with Arab culture • Gender roles • Deference to members in the group based on age or tribal status • Misperception that this is simply a social activity

11. Indigenous healing practices • Indigenous healing practices – a combination of western psychotherapy and therapeutic beliefs and practices that are rooted within a given culture. • Commonalities in nonwestern countries of indigenous practices include: • Heavy reliance on family and community networks. • Incorporation of traditional, spiritual and religious beliefs • Malaysia, religion has been incorporated into psychotherapy • Chinese Taoist cognitive psychotherapy – verses from the Taoist writings that highlight main principles, such as restricting selfish desires, learning how to be content, and learning to let go, are read and reflected. • This was found to be more effective in the long term reduction of anxiety disorders than drug therapy

12. Community Psychologist • Analyze psychological health from a community level. • Ecological model – Miller (2000), looks at the relationship between people and the settings they live in • Identifies naturally occurring resource within the community that can promote healing/healthy adaptations • Enhancement of coping strategies/response to stress • Development of collaborative, culturally grounded community interventions that actively involve community members in the process of solving their own problems.

13. The use of eclectic approaches • Eclectic approach to therapy – an approach that incorporates principles or techniques from various systems and theories. • Eclectic approach allows for an individualistic approach to each client’s needs. • Cognitive therapy may not be ideal based on the age of the individual or the current state of mind of the individual. • Group therapy is appropriate in all cases – the level of development of the client must be considered. • Drug therapy alone is not significant for long term success. • Rush et al ( 1977) high relapse rate for patients only treated with drug therapy (i.e. no cognitive therapy).

14. Cognitive therapies are more effective than drug treatment alone at preventing relapse or reoccurrence, except when drug treatment is long term (Hollon and Beck 1994) • A combination of drug and psychotherapy appears to be moderately more successful than either therapy alone (Klerman et al., 1994)

15. Measuring the effectiveness of Therapy • Eysenck (1961) proposed the idea of spontaneous remission, recovery that came about due to no treatment other than time. • How does one assess is a treatment works? • How long must an individual be symptom free for treatment to be successful? • Should the total absence of symptoms be the only criteria? • Should only observable behavior be the measuring stick? • Can you gather both quantitative and qualitative data when measuring the disorder? • Who decides is the therapy is successful?

16. Determining Effectiveness • Outcome Studies: focus on the results – did the patient show improvements or not? • Not all studies are equal - much depends upon the interpretation and style of the therapist, and the compliance of the patient. • Most treatments have positive effect (Smith et al., 1980) – meta analysis of 475 studies • Some approaches work better for some disorders while other approaches are best for others. • Thus eclectic styles of treatment are often applied.