Chapter 16 Treatment of Psychological Disorders Flashcards
1
Q
What is the most effective treatment for OCD?
A
Exposure and Response Prevention (ERP)
2
Q
Describe Exposure and Response Prevention (ERP)
A
The person learns to face the source of their fear and anxiety by graduated exposure to the content of their obsessions while they are prevented from engaging in their compulsions.
3
Q
Approximately how many Canadians suffer from a mental disorder (including addiction) in a given year?
A
1/5 or 20%
4
Q
What are two personal costs of suffering from a mental disorder?
A
anguish and interference in their ability to carry on their activities of daily lives such as attending school or work, problems in families and personal relationships
5
Q
Do physical or mental disorders have an earlier age of onset?
A
mental disorders
6
Q
What is the economic (financial burden) for all mental illnesses in Canada due to employees needing to miss work?
A
approximately $14.4 billion dollars per year
7
Q
What mental disorder is the second leading cause of disability worldwide?
A
depression
8
Q
Approximately how many people suffering from a mental disorder for depression receive treatment in Canada?
A
about 1/2
9
Q
How many children in Canada with mental disorders don’t have access to specialized mental health care
A
75%
10
Q
Name three reasons why many people fail to seek treatment?
A
- People may not realize that they have a mental disorder that can be effectively treated.
- Barriers to treatment such as beliefs and circumstances may keep people from getting help.
- Structural barriers prevent people from physically getting to treatment (costs, lack of clinician availability, the inconvenience of attending treatment and trouble finding transportation to the clinic)
11
Q
Are evidence-based psychological services delivered by psychologists and other professionals publicly funded?
A
typically now, and private coverage is generally only available to those with good employment.
12
Q
Name four types of psychotherapists in Canada and explain their differences?
A
- Psychologist - PhD or doctoral degree with specialization in clinical psychology, must be licensed by the province, 2 years of supervised practice and a competency exam.
- Psychiatrist - medical doctor who has completed an M.D. with specializing training in assessing and treating mental disorders, can prescribe medications and practice psychotherapy.
- Clinical/psychiatric Social Worker - master’s degree in social work and training in working with people in dire life situations, often work in government or private social service agencies, hospitals, or private practice.
- Counsellors - have a wide range of training, provinces vary in how they define counsellors, some need a masters degree and other have minimal training or relevant education.
13
Q
What are three questions you should ask before you see a therapist?
A
- What type of treatment do you provide?
- How effective is this type of therapy for the problem I am having?
- How will you know if my problem is improving? What kind of measures do you use to test this?
14
Q
What are the two kinds of treatments generally used for patients with mental disorders?
A
- psychological treatment - in which people interact with a clinician in order to use the environment to change their brain and behaviour
- biological treatment, in which drugs , surgery, or some other direct intervention directly treat the brain.
**In some cases, patients receive both psychological and biological treatments
15
Q
Define psychotherapy
A
an interaction between a socially sanctioned clinician and someone suffering from a psychological problem, with the goal of providing support or relief from the problem
16
Q
Define psychotherapy
A
an interaction between a socially sanctioned clinician and someone suffering from a psychological problem, with the goal of providing support or relief from the problem
17
Q
eclectic psychotherapy
A
a form of psychotherapy that involves drawing on techniques from different forms of therapy, depending on the client and the problem
18
Q
What are the five major orientations for therapy?
A
- cognitive behavioural (CBT)
- humanistic/existential
- psychodynamic
- interpersonal
- family systems
19
Q
define psychodynamic psychotherapies
A
therapies that explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems
20
Q
What was the first psychodynamic therapy?
A
psychoanalysis
21
Q
What was psychoanalysis largely replaced by?
A
interpersonal psychotherapy
22
Q
What does psychoanalysis assume?
A
That people are born with aggressive and sexual urges that are repressed during childhood development through the use of defence mechanisms.
23
Q
What do psychoanalysts encourage clients to do?
A
to bring their repressed conflicts into consciousness so that they c Ana understand them and reduce their unwanted influences
24
Q
How many sessions per week/years does traditional psychoanalysis involve?
A
4-5 sessions per week over an average of 3-6 years
25
What did a typical psychoanalysis session look like?
the client reclines on a couch, facing away from the analyst, who asks the client to make free associations, in which the client expresses whatever thoughts and feelings come to mind.
**the therapist does not express their values and judgements.
26
What is the main goal of psychoanalysis?
to understand the unconscious through a process Freud called "developing insight"
27
What is one of the most common modern psychodynamic treatment?
interpersonal psychotherapy
28
Describe interpersonal psychotherapy
a form of psychotherapy that focuses on helping clients improve current relationships
29
What do therapists who practice psychotherapy pay attention to in session? (4 things)
1. grief (an exaggerated response to loss of a loved one)
2. role disputes (conflicts with significant others)
3. role transitions (changes in life status, such as starting a new job, getting married, or retiring)
4. interpersonal deficits (lack of the skills needed to start or maintain a relationship)
30
What is the main assumption of interpersonal psychotherapy?
by treating interpersonal functioning, interpersonal relations will improve and symptoms will subside.
31
What are some differences between modern psychodynamic and traditional psychotherapies
1. therapist and client typically sit face to face.
2. therapy is less intensive, typically one appointment per week and months rather than years
3. more likely to offer support or advice in addition to interpretation
4. Therapists are also now less likely to interpret a client's statement as a sign of unconscious sexual or aggressive impulses
32
When did humanistic and existential therapies emerge and why?
- in the middle of the 20th century
- in part as a reaction to the negative views that psychoanalysis holds about humans (ex. that we are focused on life and death)
33
What is a basic assumption of humanistic and existential therapy?
They share the assumption that psychological problems stem from feelings of alienation and loneliness, and that those feelings can be traced to failure to reach one's potential (in the humanistic approach) or from failure to find meaning in life (in the existential approach)
34
Name two well-know types of humanistic and existential therapies?
1. person-centred therapy (humanistic)
2. gestalt therapy
(existential)
35
describe person-centred therapy
assumes that all individuals have a tendency towards growth and that this growth can be facilitated by acceptance by genuine reactions from the therapist
36
What psychologist developed person-centred therapy and when?
Carl Rogers (1940s and 1950s)
37
What is the basic assumption of the person-centred therapy approach?
that each person is qualified to determine his or her own goals for therapy and even the frequency and length of therapy
38
How does the therapist in person-centred therapy generally operate?
non directive, does not provide advice or suggestions about what the clients should be doing
-paraphrases the client's words, mirroring the client's thoughts
- belief is that with adequate support, the client will recognize the right thing to do.
39
What are the three qualities that Carl Rogers encouraged therapists to demonstrate?
1. congruence
2. empathy
3. unconditional postive regard
40
Describe congruence in person-centred therapy
openness and honesty in the therapeutic relationship and ensuring that the therapist communicates the same message at all levels: words, facial expressions, and body language
41
Describe empathy in person-centred therapy
the continuous process of trying to understand the clients by getting inside his or her way of thinking, feeling, and understanding the world
42
describe unconditional positive regard in person-centred therapy
providing a nonjudgemental, warm, and accepting environment in which the client can feel safe expressing his or her thoughts and feelings
43
gestalt therapy
a form of psychotherapy whose goal is helping the client become aware of his or her thoughts, behaviours, experiences, and feelings and to "own" or take responsibility for them
44
Who developed gestalt therapy and when?
Frederick "Fritz" Perls and colleagues in the 1940s and 1950s
45
What does gestalt therapy emphasize in a session?
the experiences and behaviours that are occurring at that particular moment in the therapy session
46
what is the "focusing" technique in gestalt therapy
when a client is talking about something stressful that has occurred, the therapist might shift attention to the client's current experience by asking "How do you feel as you describe what happened to you?"
47
What is the empty chair technique?
The client imagines that a person in their life (e.g., a spouse, a parent, or a coworker) is in an empty chair sitting directly across from the client. The client then moves from chair to chair, alternating from role-playing what he or she would say to the other person and then role-playing how he or she imagines the other person would respond.
48
What is the emphasis of behavioural and cognitive treatments in psychotherapy?
actively changing a person's current thoughts and behaviours as a way to mitigate or eliminate their psychopathology
49
On what was behaviour therapy developed?
lab findings of behavioural psychologists
50
Describe behaviour therapy
assumes that disordered behaviour is learned and that symptom relief is achieved through changing overt, maladaptive behaviours into more constructive behaviours
51
What are three examples of behaviour therapy techniques?
1. eliminating unwanted behaviours - often by using operant conditioning that shows that behaviour can be influenced by its consequences and adjusting these might help change the behaviour.
2. promoting desired behaviours (ex. token economy)
3. reducing unwanted emotional responses (exposure therapy)
52
define token economy
a form of behaviour therapy in which clients are given "tokens" for desired behaviours, which they can later trade for rewards
53
define exposure therapy
an approach to treatment that involves confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response
54
Define cognitive therapy
focuses on helping a client identify and correct any distorted thinking about self, others, or world
55
what are two principal techniques of cognitive therapies?
cognitive restructuring and mindfulness meditation
56
define cognitive restructuring
teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs. (changing irrational beliefs and the emotional responses they can cause by examining the evidence for them)
57
define mindfulness meditation
teaches an individual to be fully present in each moment; to be aware of his or her thoughts, feelings, and sensations; and to detect symptoms before they become a problem
58
define cognitive behavioural therapy
a blend of cognitive and behavioural therapeutic strategies
59
What does CBT acknowledge?
that there may be behaviours that people cannot control through rational thought, but also that there are ways of helping people think more rationally when thought does play a role.
60
What is the difference between CBT and traditional behavioural and cognitive therapy
CBT is problem-focused and action-oriented. The client is expected to do things, such as engage in exposure exercises, practice behaviour change skills, or use a diary to monitor relevant symptoms
61
Name one of the world's leading researchers of traditional psychological treatments that has called for a "rebooting" of psychotherapy research and practice.
Alan Kazdin
62
What are some examples of modern psychotherapy using technology?
computer and phone based apps that can identify people at risk and provide support
63
How is CBT problem and solution focused?
it is undertaken for specific problems, and the therapist tries to assist the client in selecting specific strategies that could help address those problems
64
Describe couple therapy
when a married, co-habiting, or dating couple is seen together in therapy to work on problems usually arising within the relationship; treatment strategies target changes in both parties, focusing on ways to break their repetitive dysfunctional pattern
65
Describe family therapy
psychotherapy involving members of a family - can be particularly effective when adolescent children are having problems
66
Define group therapy
a type of therapy in which multiple participants (who often do not know each other at the outset) work on their individual problems in a group atmosphere
67
What is an advantage of group therapy?
attention a group with others who have similar problems shows clients that they are not alone in their suffering
- group members model appropriate behaviours for each other and share their insights about how to deal with their problems
68
What are some disadvantages of group therapy?
- it may be difficult to assemble a group of individuals who have similar needs
- may become a problem if one or more members undermine the treatment of other group members by dominating discussions or making the group members uncomfortable
-clients in group therapy get less attention then each might receive in individual psychotherapy
69
How do self-help and support groups differ from traditional psychotherapy?
Are discussion groups that are often run by peers who have themselves struggled with the same issues
70
antipsychotic drugs
medications that are used to treat schizophrenia and related psychotic disorders
71
what was the first in a series of antipsychotic drugs used to treat schizophrenia and related psychotic disorders?
chlorpromazine
72
What happened to people with schizophrenia before antipsychotic drugs were introduced?
they often exhibited bizarre symptoms and were sometimes so disruptive and difficult to manage that the only way to protect them (and other people) was to keep them in hospitals for people with mental disorders; initially called asylums, now called psychiatric hospitals.
73
psychopharmacology
the study of drug effects on psychological states and symptoms
74
How do researchers believe that antipsychotic medications effect the brain?
by blocking dopamine receptors in certain parts of the brain
75
What is the dopamine hypothesis?
suggests that schizophrenia may be caused by excess dopamine in the synapse - research has found that dopamine overactivity in the mesolimbic pathway of the brain is related to positive symptoms of schizophrenia such as hallucinations and delusions
76
Why do antipsychotic medications not relieve negative symptoms of schizophrenia such as emotional numbing and withdrawal?
Because the negative symptoms may be related to dopamine underactivity
77
What are the most recent classes of antipsychotic drugs called and some examples?
"atypical antipsychotics"
- clozapine, risperidone, olanzepine
78
How are atypical antipsychotics different from more conventional antipsychotic drugs?
they appear to affect both the dopamine and serotonin systems, blocking both types of receptors.
79
What is a side effect that often occurs with long-term use of antipsychotic drugs called? Name and describe.
tardive dyskinesia
- a condition of involuntary movements of the face, mouth, and extremities.
80
anti anxiety medications
drugs that help reduce a person's experience of fear or anxiety
81
what are the most commonly used anti anxiety medications called?
benzodiazepines
82
How do benzodiazepines work?
by facilitating the action of the GABA neurotransmitter
83
What does GABA do?
inhibits certain neurons in the brain.
84
How does GABA affect people with anxiety?
By inhibiting certain neutrons in the brain, this action can produce a calming effect for the person
85
Name 3 commonly prescribed benzodiazepines.
diazepam (Valium)
lorazepam (Ativan)
alprazolam (Xanax)
86
Why are doctors cautious when prescribing benzodiazepines?
they have potential for abuse and also are associated with the development of drug tolerance, which is the need for higher dosages over long-term use to achieve the same effects
87
What are some withdrawal symptoms when discontinuing benzodiazepines?
increased heart rate, shakiness, insomnia, agitation, and anxiety
88
What are some side effects of benzodiazepines?
drowsiness and sometimes coordination and memory
89
What is a common drug that is prescribed for when anxiety leads to insomnia?
zolpidem (Ambien)
90
define antidepressants
a class of drugs that help lift people's moods
91
What was the name of the first class of antidepressants and when were they introduced?
1950s - monoamine oxidase inhibitor (MAOI)
92
How does a MAOI work?
prevents the enzyme monoamine oxidase from breaking down neurotransmitters such as norepinephrine, serotonin, and dopamine
93
When was the second class of antidepressants introduced and what was it called?
1950s - tricyclic antidepressants.
94
How do tricyclic antidepressants work?
by blocking the reuptake of norepinephrine and serotonin, thereby increasing the amount of neurotransmitter in the synaptic space between neurons
95
Why are MAOIs and tricyclic antidepressants used sparingly?
due to side effects: potentially dangerous increases in blood pressure, constipation, difficulty urinating, blurred vision, and a racing heart
96
What are the most commonly used antidepressants today called?
selective serotonin reuptake inhibitors (SSRIs) includes drugs such as fluoxetine, citalopram, and paroxetine
97
How do SSRIs work?
By blocking the reuptake of serotonin in the brain, which makes more serotonin available in the synaptic space between neurons.
The greater availability of serotonin in the synapse gives the neuron a better chance of "recognizing" and using this neurotransmitter in sending the desired signal.
98
What is an alternative use other than depression for antidepressants?
they all almost effectively treat anxiety disorders and can often resolve other problems such as eating disorders
99
Why are antidepressants not used to treat bipolar disorder?
because in the process of lifting the person's mood, they might actually trigger a manic episode in a person with bipolar disorder.
100
What medication is used to treat bipolar disorder?
mood stablizers
101
What are two commonly used mood stabilizer?
lithium and valproate
102
What is phototherapy and what is it used for?
a therapy that involves repeated exposure to bright light and is used as a natural treatment that may be helpful to people who have a seasonal pattern to their depression
103
Why aren't herbal and natural products given the same scrutiny as pharmacological drugs are given?
They impose some regulations to ensure quality and to document side effects, but there is little scientific information about herbal products, including possible interactions with other medications, possible tolerance and withdrawal symptoms, appropriate dosages, how they work, or even whether they work.
104
Which herbal remedies have been proven to be effective?
inositol ( a sugar alcohol), kava (an herb related to black pepper), omega-3 fatty acid (a fish oil), and SAMe-
105
Do therapy and medications work similarly in treating mental illness?
both therapy and medication affect the brain in regions associated with a reaction to a threat in cases such as a social anxiety
106
What are the benefits of electroconvulsive therapy (ECT)? The risks?
benefits - more effective then antidepressant drugs
risks: impaired short term memory, headaches, muscle aches
107
What is the procedure for (trans cranial magnetic stimulation)TMS?
involves placing a powerful pulsed magnet over a person's scalp to alter neuronal activity in the brain.
108
When would psychosurgery be appropriate?
when a psychological disorder is severe and unresponsive to treatment
109
What is treatment illusion?
That improvements were produced by natural improvement, by placebo effects, and by reconstructive memory
110
define natural improvement
the tendency of symptoms to return to their mean or average level
111
define placebo effect
the result of nonspecific treatment effects that are not related to the proposed active ingredient of the treatment
