Interventions for Common Diagnosis Flashcards
Acute Stress Disorder
Exposure-based interventions are useful for ameliorating the symptoms of Acute Stress Disorder and reducing the risk for the development of PTSD.
The effectiveness of exposure may be increased when it is combined with crisis intervention, support, psychoeducation, and/or emotional first aid.
Anorexia Nervosa
The treatment of Anorexia begins with getting the individual to gain weight to avoid or reduce medical complications.
This may require hospitalization and often entails the use of contingency management that makes rewards contingent on maintaining weight at a minimal level.
Individual, group, and family therapy are then used to ensure that weight gain is maintained. Cognitive-behavioral therapy (CBT) emphasizes modifying the individual’s erroneous beliefs about weight and food, including the value of being thin and the consequences of eating (Garner & Bemis, 1985).
The antidepressant fluoxetine or other SSRI may be useful for preventing relapse after normal weight has been restored.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Treatment involves a multimodal approach that usually includes a combination of medication and psychosocial interventions.
Methylphenidate (Ritalin) and other central nervous stimulants often have beneficial effects on the core symptoms of ADHD and appear to be effective for both children and adults.
Psychosocial interventions include cognitive-behavioral skills training that focuses on
- correcting maladaptive cognitive processing and improving problem-solving skills
- parent training in child behavior management and teacher training in classroom management
- support groups for individuals with ADHD and their family members
- play therapy for younger children
- family therapy to help family members handle stress and resolve conflicts
Autism Spectrum Disorder
Interventions focus on
- improving adaptive functioning, social skills, and academic functioning
- modifying the individual’s environment so that it optimizes support for learning and socialization
- using behavioral techniques (e.g. shaping, differential reinforcement) to reduce and replace disruptive, self-injurious, and other undesirable behaviors and promoting desirable ones.
Interventions for adults include providing community resources and services (e.g. supported employment and supported residential living arrangements).
Bipolar I Disorder
Treatment for Bipolar I Disorder usually includes a combination of medication and psychotherapy.
In terms of medication, lithium is effective in most cases of “classic” Bipolar Disorder and not only reduces manic symptoms but also prevents recurrent mood swings.
For people who do not respond to lithium or who have rapid cycling or dysphoric mania (prominent anxiety or depressive symptoms), carbamazepine or other anti-seizure drug may be effective.
Therapies that have been found effective include cognitive-behavior therapy, interpersonal social rhythm therapy, and family-focused therapy.
Bulimia Nervosa
The key objectives in the treatment of Bulimia include helping the individual gain control over his/her eating and modifying dysfunctional beliefs about eating, shape, and weight.
Treatment often involves a combination of medication (usually an antidepressant) and cognitive-behavioral therapy that incorporates a number of strategies including
- self-monitoring
- stimulus control
- cognitive restructuring
- problem-solving
- self-distraction during periods of high-risk for binge eating
Conduct Disorder
Interventions for Conduct Disorder are most effective when they target pre-adolescents (rather than adolescents) and when they are comprehensive and include the individual’s family, peers, school, and community.
Interventions include
- Patterson et al.‘s (1992) parent management training which teaches parents to reward their child‘s positive behaviors and replace physical punishment with time-outm response cost, and similar techniques
- functional family therapy which integrates systems, behavioral, and cognitive approaches and focuses on altering the interpersonal factors that are maintaining undesirable behaviors
- multisystemic therapy which is an intensive family- and community-based approach that targets children and adolescents who are at high-risk for out-of-home placement.
In severe cases, a therapeutic school or residential program may be the appropriate initial intervention.
Enuresis
The most common treatment for Enuresis is the night alarm (also known as the bell-and-pad), which causes a bell to ring when the sleeping child begins to urinate.
The effectiveness of the night alarm may be increased when it is combined with other behavioral techniques such as behavioral rehearsal or overcorrection.
The antidepressant imipramine and the synthetic diuretic desmopressin reduce or suppress wetting in many cases but, when used alone, have a high relapse rate.
Generalized Anxiety Disorder (GAD)
Treatment for GAD usually involves a multicomponent cognitive-behavioral intervention, and for many individuals, a combination of cognitive-behavioral therapy (CBT) and pharmacotherapy is most beneficial.
CBT incorporates several techniques to help the individual
- tolerate uncertainty
- identify and replace maladaptive cognitions
- and reduce anxiety
- including psychoeducation
- self-monitoring
- relaxation training
- worry exposure
- cognitive restructuring
Drugs that have been found useful include the SSRls and the anxiolytic buspirone (Buspar).
Major and Mild Neurocognitlve Disorder
Interventions for Neurocogpitive Disorder due to Alzheimer‘s disease and other Neurocognitive Disorders often include a combination of
- group therapy (especially therapy that emphasizes reality orientation and reminiscence);
- antidepressant drugs to alleviate depression;
- behavioral techniques and antipsychotic drugs to reduce agitation;
- environmental manipulation and pharmacotherapy to enhance memory and cognitive functioning
The provision of family/caregiver interventions has been linked to delayed out-of-home home placement for individuals with the disorder and better quality of life and emotional well-being for their caregivers.
Family/caregjver interventions include
- psychoeducation
- stress management
- support groups
- family therapy
- adult daycare for the patient and other respite services
Major Depressive Disorder
Treatment for depression often consists of a combination of an antidepressant drug and psychotherapy.
Three classes of antidepressants are most commonly prescribed:
- The serotonin reuptake inhibitors (SSRls) are considered the first-line drug treatment for moderate to severe depression and have fewer side effects and a lower risk for a fatal overdose than the tricyclics.
- The tricyclics (TCAs) are most effective for “classic” depressions that involve vegetative (bodily) symptoms, a worsening of symptoms in the morning, an acute onset and short duration of symptoms, and symptoms of moderate severity.
- The monoamine oxidase inhibitors (MAOls) are usually prescribed for indniduals who do not respond to TCAs or SSRls or have atypical symptoms (eg., anxiety, increased appetite, hypersomnia, and mood worsening late in the day).
In terms of psychosocial interventions, Becks cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are empirically supported treatments for depression.
Obsessive-Compulsive Disorder (OCD)
A combination of exposure with response prevention (ERP) and the tricyclic clomipramine or an SSRI is usually the treatment-of-choice for OCD.
ERP combines prolonged exposure to objects or situations that trigger obsessions with procedures that block the individual‘s ability to perform compulsive rituals. The benefits of exposure may be enhanced when it is combined with social skills training or cognitive restructuring and other cognitive-behavioral techniques.
Panic Disorder
Panic-focused cognitive-behavioral therapy (CBT) is an empirically supported treatment for Panic Disorder and integrates
- self-monitoring
- cognitive restructuring
- breathing retraining
- applied relaxation
- in vivo exposure
- relapse prevention
Exposure to internal and external cues that trigger panic attacks is an essential component of treatment, with internal cues being addressed by interoceptive exposure, which involves exposing the individual to the bodily sensations associated with panic through cardiovascular exercise, spinning in a chair, or hyperventilation.
Medication (e.g. an SSRI or benzodiazepine) may be beneficial when used in combination with CBT, especially during the acute phase of treatment.
Personality Disorders
People with Personality Disorders are often unaware of their disorder and, if they seek treatment, it is often for comorbid conditions. Consequently, they are likely to be noncompliant with treatments that target the Personality Disorder (rather than comorbid conditions) and may drop out of therapy prematurely.
Psychodynamic psychotherapy and cognitive-behavioral therapy are effective in some cases, and their effects may be increased when accompanied by social skills training, group therapy, family or couple therapy, and/or psychoeducation.
Dialectical behavior therapy (Linehan, 1987) is an empirically supported treatment for Borderline Personality Disorder and incorporates three strateges:
- goup skills training to help clients regulate their emotions and improve their social and coping skills
- individual outpatient therapy to strengthen motivation and newly acquired skills
- telephone consultations to provide additional support and between-sessions coaching
Posttrsumstic Stress Disorder (PTSD)
The most effective treatment for PTSD is a comprehensive cognitive-behavioral intervention that incorporates
- psychoeducation
- exposure
- cognitive restructuring
- anxiety management techniques
An SSRI or other antidepressant may be useful for reducing comorbid depression, anxiety, or substance abuse.
