Therapies Flashcards
BIOLOGICAL: What are the main components of Drug therapy?
Antipsychotic drugs: - antipsychotic drugs treat psychotic mental disorders such as schizophrenia. A patient with a psychotic mental disorder has lost touch with reality and has little insight into his or her condition. Conventional antipsychotics are used primarily to combat the positive symptoms of schizophrenia (delusions etc), These drugs block the action of the neurotransmitters dopamine in the brain by binding to, but not stimulating, dopamine receptors.
Antidepressants: Depression is thought to be due to insufficient amounts of neurotransmitters such as serotonin being produced in the nerve endings (synapse). In normal brains, neurotransmitters are constantly being released from the nerve endings, stimulating the neighbouring neurons. To terminate their action, neurotransmitters are reabsorbed into the nerve endings and are broken down by an enzyme . antidepressants work either by reducing the rate of absorption, or by blocking the enzyme that breaks down the neurotransmitters. Both of these mechanisms increase the amount of neurotransmitter available to excite neighbouring cells.
Antianxiety drugs:
- the group of drugs most commonly used to treat anxiety and stress and benzodiazepines (BZs). They are sold under various names like librium and valium. BZs slow down the activity of the central nervous system. They do this by enhancing the activity of GABA, a biochemical substance that is the body’s natural form of anxiety relief
BIOLOGICAL: Evaluate the effectiveness of Drug therapy?
- Soomro et al. (2008) reviewed 17 studies of the use of SSRI’s with OCD (which has a component of depression) patients and found them to be more effective than placebos in reducing the symptoms of OCD up to three months after treatment i.e in the short term.
- While drugs are extremely effective in treating psychological disorders, many have serious side effects, for example SSRI’s can cause nausea, headache and insomnia.
- One of the common criticisms of of drug therapy is that, while drugs may be effective in treating the symptoms of psychological disorders, this type of therapy does not address the underlying cause.
- relative to other treatments (psychotherapy), drug therapy is cheap for the patient – in the UK they would be prescribed their drugs on the NHS. the practitioner has to invest less time in the patient, because they only need to meet with the patient every couple of months after initial consultation to discus whether the drugs are having a positive effect and whether the patient is making progress.
BIOLOGICAL: Evaluate the ethical issues of Drug therapy?
- Use of placebos; biological treatments raise important ethical issues. first, there is an issue related to studying the effectiveness of drugs. a fundamental research ethic is that no patient should be given a treatment known to be inferior.
- Patient information; Another ethical problem is the issue of valid consent, or lack of it. Many patients will find it difficult to remember all the facts relating to the potential side effects of the drug prescribed or they simply may not be in a frame of mind to digest this information. Therefore truly valid consent is an illusion.
furthermore, medical professionals may withhold some information about the drugs, for example, they may not fully explain the pharmalogical benefits of the drugs are slim.
What are the main stages of CBT?
- CASEConceptualisation: The client needs to understand the nature of CBT, the therapist creates a list of problems experienced by the client using self report and questioning, initial goals are set and a treatment plan
- Skills acquisition and application: the therapist works with the client on intervention techniques including teaching new skills. Ongoing evaluation and assessment of success of techniques and skills. goals and targets are set.
intervention techniques are refined. - Ending and follow up: Final assessment of progress using self report and questioning. ending treatment discussed and change of maintenance. End treatment; client and therapist agree when this is appropriate. Top up sessions can take place three to six months after completion of treatment.
What are the main components of Cognitive Behavioural Therapy? Aim
- According to the cognitive approach (Beck 1976), negative thought processes are the cause of dysfunctional behaviour and emotional distress. The main aim of cognitive-behavioural therapy (CBT), therefore, is to help an individual to identify negative and irrational thoughts and replace these with more rational ways of thinking.
- this takes place over 20 one hour sessions.
Evaluate the effectiveness of CBT.
- A study by DeRubeis et al. (2005) demonstrates the effectiveness of CBT in treating depression. The researchers studied three groups of participants who all suffered from depression. Group 1 were treated using CBT, group 2 ere given antidepressants and group 3 acted as the placebo (given a pill with no affect). After eight weeks, 43% of the CBT group had improved compared with only 25% of the placebo group. The greatest improvement after an 8 week period was for those participants taking the antidepressants; 50% showed signs of improvement.
- However conclusions drawn from this study need to be viewed with caution since it only shows what happened after eight weeks of treatment.
- Drugs may only offer a ‘quick fix’
- Hensley et al (2004) state that relapse rate for CBT is relatively low compared with that of antidepressants. It is estimated that 50% of those treated for depression with antidepressants will relapse will relapse within two years whereas persevering with CBT offers the individual long term benefits with a llower chance of relapse.
What are the ethical considerations of CBT?
- The relationship between the client and the CBT practitioner may raise negative ethical issues
- CBT states the importance of equality in the relationship between the client and the therapist as good ethical practice. This is only achievable once the client fully understands the nature of CBT, however so in the first instance the therapist is in a position of power over the client and is considered an expert in the client’s issues.
- The equality of the relationship becomes more obvious once therapy is established and client and therapist are working together to establish the goals of the treatment
- CBT may also raise ethical issues because the therapist could be seen as the teacher and the client as their pupil, again leading to an imbalance of power.
What are the main components of Dream Analysis?
- The most important aspects of a dream do not appear literally but in symbolic form and are often a representation of unconscious desires and wishes which the conscious mind cannot tolerate.
- Dreams have Manifest content and Latent content; Manifest is the reported event in the dream, and Latent is the underlying meaning behind the dream
- A key aim of psychoanalysis is to unlock unconscious memories and bring them into conscious awareness so that the patient gains insight into the reasons for their behaviour. Repression uses a lot of mental energy, a sense of catharsis is released when one doesn’t have to use this mental energy.
- There are four dreamwork processes, they are Condensation, Displacement, Symbolisation, and secondary revision
What are the Four Dreamwork processes
- Condensation: A number of elements are combined into one in the dream so the dream becomes more compact. One image may have several associations or be made up of a combination of images
- Displacement: The emotion centred on something or someone is detached from that object or person and moved onto another, perhaps less significant, object or person.
- Symbolisation: Abstract concepts are represented in a symbolic form
- Secondary revision: The creation of a narrative to give the dream coherence and structure.
Evaluate the effectiveness of Dream Analysis?
- Dream analysis is just one technique used in psychoanalysis which is designed to find the underlying cause of abnormal behaviour.
- Dream analysis seeks to treat the cause of behaviour unlike other therapies that deal with the symptoms, e.g. drug therapy
- Finding the cause of the behaviour can take a very long time. Treatment can be 2-3 times a week for two to five years. This can be very tie consuming and expensive
- Eyseck (1952) found that dream therapy from psychoanalysis was no better at treating patients than behavioural therapies.
What are Ethical Considerations of Dream Therapy?
- Grunbaum (1993) considers the power the therapist has in the relationship with the patient, he says any apparent benefits of psychoanalysis are the result of a placebo effect: it is the action of being treated itself that cures the patient rather than the use of techniques such as dream analysis.
- Part of the power of the therapist is that they can never be wrong, the patient is under a lot of pressure to conform to the therapist’s expectation
- Psychodynamic therapists cannot always gain fully informed consent from their patients before beginning treatment. They cannot tell the patient too much about the approach or what they may be agreeing to because explaining the treatment is very difficult.
- The patient needs to experience psychoanalysis in order to fully understand it. This again means that the therapist is the expert in the relationship and therefore in a position of power over the patient.
What are the main components of Aversion therapy?
- Individuals are repeatedly presented with an aversive (that is, unpleasant, stimulus, such as an electric shock or a drug that makes them feel nauseous at the same timethat they are engaging in the undesirable behaviour being treated. (Note the use of the electric is not the same as electroconvulsive therapy.
- The aversive stimulus (the shock) is a UCS which produces a UCR, such as avoidance. When the stimulus (the shock) is repeatedly paired with the undesirable behaviour (such as drinking alcohol), the behaviour (for example, violence, which was an NS and is now a CS), leads to the same consequences . As a result clients lose their wish to engage in the undesirable behaviour.
- Aversion therapy uses operant conditioning to help patients. By making the association between a pleasant stimulus (alcohol) and an unpleasant response (feelings of sickness), the person should tend to avoid future contact with the stimulus, for example, an alcoholic might avoid going to a pub or other social situations where people are drinking. thus negative reinforcement is in operation.
Evaluate the effectiveness of Aversion Therapy?
- In a study on alcoholics, Miller (1978) compared the effectiveness of three types of treatment:
1: Aversion therapy (using shock)
2: Counselling therapy + aversion
3: Counselling
ONe year later, recovery was the same for all groups, indicating that aversion theory offered no benefit.
In contrast, smith et al (1997) found that alcoholics treated with aversion therapy (using shocks or a drug to induce nausea) had higher abstinence rates after one year than those treated with counselling alone. Smith (1988) also reported success with a group of 300 smokers; 52% of those treated with shocks maintained abstinence after one year.
Dropout: - Bancroft (1992) reported that up to 50% of patients either refuse treatment or drop out of aversion therapy programmes, which makes it difficult to evaluate.
Symptom substitution: - Although therapies based on behaviourist assumptions can be effective in modifying behaviour, critics argue that the therapies fail to treat the possible underlying causes. The problem of this is that the original symptom may be removed (alcoholism) yet a new one will appear for example gambling.
Evaluate the ethical issues of Aversion Therapy.
The treatment of homosexuality;
- For many years aversion therapy was used in the UK and USA as a treatment to cure homosexuality. Shockingly it wasn’t until 2006 that the American Psychiatric Society (APA) considered this method too unethical. The method was used on men, and involved them being given drugs to make them feel nauseous, as well as being placed in dirty surroundings whilst being shown pin up pictures of males. it was thought this would cause them to form an association between negative feelings and the images in order to turn them straight.
Control;
- Aversion therapy is seriously unpleasant for the patient, and for this reason has been branded unethical. Techniques which involved punishment in particular, for example electric shocks have been criticised for exercising too much control over the patient, and brainwashing them into treatment.
- However this therapy cannot be administered without full patient consent, where all the other attempts at treatment have failed. Also, new developments in aversion therapy have resulted in more refined treatments.
In response to such ethical criticism, some therapists will use covert sensitisation as an alternative ‘milder’ form of therapy.
What is Mindfulness?
- Mindfulness is a therapy based on the art of meditation and has its origins in Buddhist practices. Jon Kabat- Zinn brought mindfulness into mainstream therapy with the launch of his mindfulness based stress reduction (MSBR) programme in 1979.
- The main aim of mindfulness is to develop a sense of here and now. Individuals are taught to tune in to the present moment and tune out any thoughts of the past or future.
- Links to the positive approach can be seen through the benefits of mindfulness in improving cognitive functioning and inducing an improved sense of well being.
