Chapter 17 - treatment of psycological disorders Flashcards
The Helping Relationship
• Goal of Treatment:
• Help change maladaptive thoughts, feelings, behaviours
Two elements in all of psychotherapy
Therapeutic relationship and therapy techniques
Therapies found in psychodynamic
- Psychoanalysis (Freud)
- Brief psychodynamic therapies
Therapies found in humanistic
- client centred therapy (roger)
- Gastalt therapy
Therapies found in cognitive
- rational emotive therapy (Ellis)
- cognitive therapy (beck)
- mindfulness based behavioural treatments
Therapies found in behavioural
- classical conditioning
- operant conditioning
- modelling
Therapies found in biological
- drug therapy
- electroconvulsion therapy
- psycho surgery
Psychoanalysis
• Based on Freudian principles
• Goal:
Help patients achieve insight
Insight =
conscious awareness of psychodynamics underlying problems
• Adjust behaviour underlying problems learned in childhood
Free Association
- Uncensored conversation
* Verbal reports of thoughts, feelings, or images that enter awareness without censorship
Dream Interpretation
• Therapist helps client understand the symbolic meaning of their dreams
Resistance
- Defensive maneuvers that hinder process of therapy
* Sign that anxiety-arousing material is being approached
Transference
• Client responds irrationally to therapist like he/she was important figure from client’s past
• Brings out repressed feelings & maladaptive
behaviours
Two types of transference
Positive:
• Feelings of affection, dependency, love
Negative:
• Irrational expressions of anger, hatred, disappointment
Interpretation
- Statements by therapist, Provide client with insight into behaviour
- Time consuming as client must arrive at ‘insight’
Brief Psychodynamic Therapies
- Briefer, more economical
- Focus on maladaptive past influences
- Employ psychoanalytic concept in focused, active fashion
- interpersonal therapy
Interpersonal Therapy
• Focus on client’s current relationships with important people in their lives
Humanistic Psychotherapies
• Focus:
- Conscious control of behaviour
- Personal responsibility
- Disordered behaviour caused by lack of awareness and negative self image
Client-Centered Therapy
- Carl rogers
Focus:
Focus on therapeutic environment
In client entered therapy, how it the therapeutic environment focused on?
- Unconditional positive regard (no judgement)
- Empathy
- genuineness
Gestalt Therapy
• Goal:
Bring feelings, wishes, and thoughts into awareness
• Make client “whole” again
Methods of gestalt therapy
- Often carried out in groups
- More active and dramatic approaches than client-centered approaches
- Role-play
Cognitive Therapies
• Key Figures: Aaron Beck & Albert Ellis
• Focus
- Role of irrational and self-defeating thought patterns
* Help clients discover & change cognitions that underlie problems
Rational Emotive Therapy
• Activating event • Belief system • Consequences • (emotional & behavioural) • Disputing or challenging maladaptive emotions, behaviours
Beck’s Cognitive Therapy
- Irrational beliefs
- Ideas underlie maladaptive response
- Point out errors of thinking
- Help clients identify & reprogram “automated” thought patterns
Behaviour Therapies
• Maladaptive behaviours are the problem, not a symptom
- they are learned, therefore they can be unlearned through CC or OC or modelling
Classical Conditioning Treatments
- Exposure
- flooding
- implosion
- systematic desensitization
- in-vivo desensitization
- aversion therapy
Exposure
- Treat phobias through exposure to feared CS in the absence of UCS
- Response prevention used to keep the operant avoidance response from occurring
Flooding
• Exposed to real-life stimuli
Implosion
• Imagine scenes involving stimuli
Systematic Desensitization
- Learning-based treatment for anxiety disorders
* Eliminate anxiety through counterconditioning
Steps to Systematic Desensitization
1) Train muscle relaxation skills
• Anxiety & relaxation cannot co-exist
2) Stimulus hierarchy
• Low-anxiety to high-anxiety scenes (10-15)
3) Relaxation & progressive association with stimulus hierarchy
In-Vivo desensitization
• Controlled exposure to ‘real life’ situations
• Creates more anxiety during treatment than
systematic desensitization
• Anxiety may reduce more quickly though
Aversion Therapy
• Condition an aversion to a CS
(e.g. alcoholic drink)
• CS paired with noxious UCS
Operant Conditioning Treatments
• Aka behaviour modification
- Use positive reinforcement, extinction, negative reinforcement, or punishment
- Attempt to increase or reduce behaviour
- token economies
- punishment
Operant conditioning treatment Successful when \
traditional therapies are difficult to implement
E.g., Profoundly disturbed children, mentally retarded
Token Economies
- System for strengthening desired behaviours through application of positive reinforcement
- Tokens given for desirable behaviours
- Tokens exchanged for tangible reinforcers
Token economies
Goal:
- Achieve desired behaviours with reinforcers
* Become reinforced with social reinforcers & self-reinforcement processes (e.g., self pride)
Use of Punishment:
- only if no alternatives and with consent
- Success with severely disturbed, self-destructive children
Modelling
• Social Skills Training
Social Skills Training
- Modeling approach
- Learning of new skills by observing and imitating a model who performs a socially skillful behaviour
- need self efficacy
“Third-wave” Cognitive-behavioural Therapies
• Concepts of mindfulness
Mindfulness-based approaches
• Acceptance
• Commitment
• Dialectical behaviour therapy
Acceptance and commitment therapy
- Focus on mindfulness as vehicle of change
* Exert control over thoughts and feelings
Dialectical behaviour therapy
- Borderline personality disorder treatment
* Elements from cognitive, humanistic, behavioural, psychodynamic therapies
Culturally Competent Therapists
- Use knowledge about client’s culture to achieve broad understanding of client
- Attentive to differences from cultural stereotype as well
Gender Issues In Psychotherapy • For females
- Focus on changing women’s life circumstances
- Aware of oppressive environmental conditions
- Focus on supporting people in choices that meet their needs
Evaluating Psychotherapies
• Specificity Question
- Which types of therapy
- Which kinds of therapists
- Which kinds of clients
- Which kinds of problems
- Which kinds of effects
Evaluating Psychotherapies
• Difficulties:
- Many variables not controlled
- Therapist-client interactions varied
- Measuring therapeutic effects
- which kind of therapists measure outcomes
Spontaneous remission
• Symptom reduction in absence of treatment was as high as success rate reported by therapists
Randomized Clinical Trials
• Random assignment of clients to experimental or control groups
In Randomized Clinical Trials
Types of control groups:
- No-treatment
- Placebo control condition
- Other effective treatment
Meta-Analysis
• Researchers combine statistical results of many studies to reach overall conclusion
- effect size
Effect Size
• What percentage of clients receiving therapy had a more favourable outcome than average control client
Clinical significance
• Require that at the end of therapy, clients’ seeking treatment for a particular disorder, falls within the range of those not experiencing the particular problem
Factors affecting the outcome of therapy
- client variables
- therapist variables
- techniques
Client Variables
- Openness: Willingness to invest self in therapy; take risks
- Self-Relatedness
- Nature of Problem: Needs to “fit” with therapy being used
Self-Relatedness: Ability to:
- Experience & understand internal states
- Be attuned to processes in relationship with therapist
- Apply what is learned in therapy to their lives
Therapist Variables
Quality of relationship with client: • Empathy • Unconditional acceptance • Genuineness • Trust • Caring
Techniques
- Selecting & implementing appropriate techniques for client and situation
- Dose-response effect
Dose-response effect
• Amount of treatment & quality of outcome
Factors in Effective Therapy
- Faith in therapist: Client’s belief that they’re receiving help
- Plausible explanation for problems: Alternative way of looking at selves & problems
- Protective setting & supportive relationship • Opportunity to practice new behaviours
- Increased optimism & self-efficacy
biological factors
• Drugs, Electroconvulsive therapy, Psychosurgery
Antidepressant Drugs
- Tricyclics
- Monoamine oxidase (MAO) inhibitors
- Selective serotonin reuptake inhibitors (SSRIs)
Tricyclics
- Increase activity of norepinephrine & serotonin
* Prevent reuptake of excitatory neurotransmitters
Monoamine oxidase (MAO) inhibitors
- Increase activity of norepinephrine & serotonin
- Monamine oxidase breaksdown neurotransmitters
- severe side effects
Selective serotonin reuptake inhibitors (SSRIs)
- Block reuptake of serotonin
- Milder side effects than other antidepressants
- Reduce depressive symptoms more rapidly
- least side effects
Antipsychotic drugs
- Decrease action of dopamine
- Reduce positive symptoms of schizophrenia (e.g. delusions and hallucinations)
- Little effect on negative symptoms
Tardive dyskinesia
Uncontrollable motor movements, caused by antipsychotic drugs, permanent
clozapine (Clozaril)
reduces not only positive symptoms, but also negative ones, and it appears not to produce tardive dyskinesia
reserpine (tranquilizers)
calmed psychotic patients. Decrease dopamine
Electroconvulsive Therapy
• Useful in treating severe depression
- Effects can be immediate
- 60-70% improve
Electroconvulsive Therapy
• Criticisms
- Possibility of relapse is high
- Possibility of permanent memory loss
- Possibility of permanent brain damage
Electroconvulsive Therapy
Currently
- # of treatments limited
* MRI scans reveal no brain damage
Psychosurgery
- Remove or destroy parts of brain
- Least used of biomedical procedures
- lobotomy
- Cingulotomy
Lobotomy
- Destroy nerve tracts to frontal lobes
* Psychosis decreased with antipsychotic drugs
Cingulotomy
- Cut fibres that connect frontal lobes & limbic system
* Useful in severe depression & OCD
PET scans show differences in the following brain regions in response ot psychotherapy and SSRI drugs
- amygdala
- hippocampus
- temporal cortex
Deinstitutionalization
Deinstitutionalization • Transfer of treatment to community • 77.4% treated as in-patients in 1955 • 27.1% in 1990 • Good concept • Requires availability of mental health care in community. Otherwise…..
Deinstitutionalization
• Revolving door phenomenon
- Repeated rehospitalizations
* Large # of disturbed people who live on streets
Preventive Mental Health
- Situation-focused prevention
* Competency-focused prevention
Situation-focused prevention
- Reduce or eliminate environmental causes of disorders
* Enhance situational factors that prevent disorders
Competency-focused prevention
• Designed to increase personal resources & coping skills
