Chapter 17 - treatment of psycological disorders Flashcards
1
Q
The Helping Relationship
• Goal of Treatment:
A
• Help change maladaptive thoughts, feelings, behaviours
2
Q
Two elements in all of psychotherapy
A
Therapeutic relationship and therapy techniques
3
Q
Therapies found in psychodynamic
A
- Psychoanalysis (Freud)
- Brief psychodynamic therapies
4
Q
Therapies found in humanistic
A
- client centred therapy (roger)
- Gastalt therapy
5
Q
Therapies found in cognitive
A
- rational emotive therapy (Ellis)
- cognitive therapy (beck)
- mindfulness based behavioural treatments
6
Q
Therapies found in behavioural
A
- classical conditioning
- operant conditioning
- modelling
7
Q
Therapies found in biological
A
- drug therapy
- electroconvulsion therapy
- psycho surgery
8
Q
Psychoanalysis
• Based on Freudian principles
• Goal:
A
Help patients achieve insight
9
Q
Insight =
A
conscious awareness of psychodynamics underlying problems
• Adjust behaviour underlying problems learned in childhood
10
Q
Free Association
A
- Uncensored conversation
* Verbal reports of thoughts, feelings, or images that enter awareness without censorship
11
Q
Dream Interpretation
A
• Therapist helps client understand the symbolic meaning of their dreams
12
Q
Resistance
A
- Defensive maneuvers that hinder process of therapy
* Sign that anxiety-arousing material is being approached
13
Q
Transference
A
• Client responds irrationally to therapist like he/she was important figure from client’s past
• Brings out repressed feelings & maladaptive
behaviours
14
Q
Two types of transference
A
Positive:
• Feelings of affection, dependency, love
Negative:
• Irrational expressions of anger, hatred, disappointment
15
Q
Interpretation
A
- Statements by therapist, Provide client with insight into behaviour
- Time consuming as client must arrive at ‘insight’
16
Q
Brief Psychodynamic Therapies
A
- Briefer, more economical
- Focus on maladaptive past influences
- Employ psychoanalytic concept in focused, active fashion
- interpersonal therapy
17
Q
Interpersonal Therapy
A
• Focus on client’s current relationships with important people in their lives
18
Q
Humanistic Psychotherapies
• Focus:
A
- Conscious control of behaviour
- Personal responsibility
- Disordered behaviour caused by lack of awareness and negative self image
19
Q
Client-Centered Therapy
- Carl rogers
Focus:
A
Focus on therapeutic environment
20
Q
In client entered therapy, how it the therapeutic environment focused on?
A
- Unconditional positive regard (no judgement)
- Empathy
- genuineness
21
Q
Gestalt Therapy
• Goal:
A
Bring feelings, wishes, and thoughts into awareness
• Make client “whole” again
22
Q
Methods of gestalt therapy
A
- Often carried out in groups
- More active and dramatic approaches than client-centered approaches
- Role-play
23
Q
Cognitive Therapies
• Key Figures: Aaron Beck & Albert Ellis
• Focus
A
- Role of irrational and self-defeating thought patterns
* Help clients discover & change cognitions that underlie problems
24
Q
Rational Emotive Therapy
A
• Activating event • Belief system • Consequences • (emotional & behavioural) • Disputing or challenging maladaptive emotions, behaviours
25
Beck’s Cognitive Therapy
* Irrational beliefs
* Ideas underlie maladaptive response
* Point out errors of thinking
* Help clients identify & reprogram “automated” thought patterns
26
Behaviour Therapies
• Maladaptive behaviours are the problem, not a symptom
- they are learned, therefore they can be unlearned through CC or OC or modelling
27
Classical Conditioning Treatments
- Exposure
- flooding
- implosion
- systematic desensitization
- in-vivo desensitization
- aversion therapy
28
Exposure
* Treat phobias through exposure to feared CS in the absence of UCS
* Response prevention used to keep the operant avoidance response from occurring
29
Flooding
• Exposed to real-life stimuli
30
Implosion
• Imagine scenes involving stimuli
31
Systematic Desensitization
* Learning-based treatment for anxiety disorders
| * Eliminate anxiety through counterconditioning
32
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
33
In-Vivo desensitization
• Controlled exposure to ‘real life’ situations
• Creates more anxiety during treatment than
systematic desensitization
• Anxiety may reduce more quickly though
34
Aversion Therapy
• Condition an aversion to a CS
(e.g. alcoholic drink)
• CS paired with noxious UCS
35
Operant Conditioning Treatments
• Aka behaviour modification
* Use positive reinforcement, extinction, negative reinforcement, or punishment
* Attempt to increase or reduce behaviour
- token economies
- punishment
36
Operant conditioning treatment Successful when \
traditional therapies are difficult to implement
E.g., Profoundly disturbed children, mentally retarded
37
Token Economies
* System for strengthening desired behaviours through application of positive reinforcement
* Tokens given for desirable behaviours
* Tokens exchanged for tangible reinforcers
38
Token economies
| Goal:
* Achieve desired behaviours with reinforcers
| * Become reinforced with social reinforcers & self-reinforcement processes (e.g., self pride)
39
Use of Punishment:
- only if no alternatives and with consent
| - Success with severely disturbed, self-destructive children
40
Modelling
• Social Skills Training
41
Social Skills Training
* Modeling approach
* Learning of new skills by observing and imitating a model who performs a socially skillful behaviour
- need self efficacy
42
“Third-wave” Cognitive-behavioural Therapies
• Concepts of mindfulness
Mindfulness-based approaches
• Acceptance
• Commitment
• Dialectical behaviour therapy
43
Acceptance and commitment therapy
* Focus on mindfulness as vehicle of change
| * Exert control over thoughts and feelings
44
Dialectical behaviour therapy
* Borderline personality disorder treatment
| * Elements from cognitive, humanistic, behavioural, psychodynamic therapies
45
Culturally Competent Therapists
* Use knowledge about client’s culture to achieve broad understanding of client
* Attentive to differences from cultural stereotype as well
46
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
47
Evaluating Psychotherapies
| • Specificity Question
1. Which types of therapy
2. Which kinds of therapists
3. Which kinds of clients
4. Which kinds of problems
5. Which kinds of effects
48
Evaluating Psychotherapies
| • Difficulties:
* Many variables not controlled
* Therapist-client interactions varied
* Measuring therapeutic effects
* which kind of therapists measure outcomes
49
Spontaneous remission
• Symptom reduction in absence of treatment was as high as success rate reported by therapists
50
Randomized Clinical Trials
• Random assignment of clients to experimental or control groups
51
In Randomized Clinical Trials
Types of control groups:
* No-treatment
* Placebo control condition
* Other effective treatment
52
Meta-Analysis
• Researchers combine statistical results of many studies to reach overall conclusion
- effect size
53
Effect Size
• What percentage of clients receiving therapy had a more favourable outcome than average control client
54
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
55
Factors affecting the outcome of therapy
- client variables
- therapist variables
- techniques
56
Client Variables
* Openness: Willingness to invest self in therapy; take risks
* Self-Relatedness
* Nature of Problem: Needs to “fit” with therapy being used
57
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
58
Therapist Variables
```
Quality of relationship with client:
• Empathy
• Unconditional acceptance
• Genuineness
• Trust
• Caring
```
59
Techniques
* Selecting & implementing appropriate techniques for client and situation
* Dose-response effect
60
Dose-response effect
• Amount of treatment & quality of outcome
61
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
62
biological factors
• Drugs, Electroconvulsive therapy, Psychosurgery
63
Antidepressant Drugs
* Tricyclics
* Monoamine oxidase (MAO) inhibitors
* Selective serotonin reuptake inhibitors (SSRIs)
64
Tricyclics
* Increase activity of norepinephrine & serotonin
| * Prevent reuptake of excitatory neurotransmitters
65
Monoamine oxidase (MAO) inhibitors
* Increase activity of norepinephrine & serotonin
* Monamine oxidase breaksdown neurotransmitters
- severe side effects
66
Selective serotonin reuptake inhibitors (SSRIs)
* Block reuptake of serotonin
* Milder side effects than other antidepressants
* Reduce depressive symptoms more rapidly
- least side effects
67
Antipsychotic drugs
* Decrease action of dopamine
* Reduce positive symptoms of schizophrenia (e.g. delusions and hallucinations)
* Little effect on negative symptoms
68
Tardive dyskinesia
Uncontrollable motor movements, caused by antipsychotic drugs, permanent
69
clozapine (Clozaril)
reduces not only positive symptoms, but also negative ones, and it appears not to produce tardive dyskinesia
70
reserpine (tranquilizers)
calmed psychotic patients. Decrease dopamine
71
Electroconvulsive Therapy
• Useful in treating severe depression
* Effects can be immediate
* 60-70% improve
72
Electroconvulsive Therapy
| • Criticisms
* Possibility of relapse is high
* Possibility of permanent memory loss
* Possibility of permanent brain damage
73
Electroconvulsive Therapy
Currently
* # of treatments limited
| * MRI scans reveal no brain damage
74
Psychosurgery
* Remove or destroy parts of brain
* Least used of biomedical procedures
- lobotomy
- Cingulotomy
75
Lobotomy
* Destroy nerve tracts to frontal lobes
| * Psychosis decreased with antipsychotic drugs
76
Cingulotomy
* Cut fibres that connect frontal lobes & limbic system
| * Useful in severe depression & OCD
77
PET scans show differences in the following brain regions in response ot psychotherapy and SSRI drugs
- amygdala
- hippocampus
- temporal cortex
78
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…..
```
79
Deinstitutionalization
• Revolving door phenomenon
* Repeated rehospitalizations
| * Large # of disturbed people who live on streets
80
Preventive Mental Health
* Situation-focused prevention
| * Competency-focused prevention
81
Situation-focused prevention
* Reduce or eliminate environmental causes of disorders
| * Enhance situational factors that prevent disorders
82
Competency-focused prevention
• Designed to increase personal resources & coping skills
