Treatment 1 Flashcards
What are the 2 broad families of treatment that are typically available?
Biomedical treatments: treatments aimed at directly altering the functioning of the brain (e.g., drugs, electric shocks, etc.)
Psychotherapy: treatments done through an interaction with a psychotherapist aiming to provide support and/or relief from the problem.
Which professions are responsible for administering the 2 different tratements?
Psychiatrist: a medical doctor (MD) who is allowed to prescribe medication but is often not trained in psychotherapy. (this is a specialization like pedeatrics for example.)
Clinical Psychologist: a psychologist with a doctorate degree who does research in clinical psychology and is trained in various forms of psychotherapy, but is not allowed to prescribe medication. (most psychologists take on an eclectic approach and apply a large variety of therapies dependent on the clients needs)
What are the 3 different aims/approached to treatment?
Direct intervention: address the “root of the problem” in hopes of eliminating the disorder. (Ex: if you think that automatic behaviours are the cause of a disorder we would focus on that, if we think that seratonin is the problem we will try to fix this)
Symptom support: alleviate the impairment of symptoms, but not the underlying cause. (there are many situations where we don’t think we can get to the root of the disorder. Will often teach coping or ways to minimize the impact. Most forms of psycho therapy are based on this.)
Insight: learn about likely causes of disorder to have patient decide how to deal with them. (belief that if a person gains understanding into why they are acting the way that they are acting, they may be able to fix the problem on their own.)
What are the 3 different aims/approached to treatment?
Direct intervention: address the “root of the problem” in hopes of eliminating the disorder. (Ex: if you think that automatic behaviours are the cause of a disorder we would focus on that, if we think that seratonin is the problem we will try to fix this)
Symptom support: alleviate the impairment of symptoms, but not the underlying cause. (there are many situations where we don’t think we can get to the root of the disorder. Will often teach coping or ways to minimize the impact. Most forms of psycho therapy are based on this.)
Insight: learn about likely causes of disorder to have patient decide how to deal with them. (belief that if a person gains understanding into why they are acting the way that they are acting, they may be able to fix the problem on their own.)
What are the problems with measuring the effectiveness of treatment?
- self report is unreliable.
- the relationship you form with your psychologist (theraputic alliance), may make you think that the treatment is helping, but it may actually be that the psychologist as a person is the thing that is helping.
- Patients tend to misremember how bad their symptoms were, and thus feel that the treatment must have worked.
- The worst symptoms often go on their own
- Symptoms naturally vary in severity, so some will go away on their own (“natural improvement”).
- Patients tend to seek treatment when they are at their worst, so they might improve even if they never got help. (This is a third variable problem. we don’t know the causal effect)
- Placebo effects
- Placebo: an inert substance or procedure that is applied with the expectation that
a healing response will be produced.
- a treatment has to work better than a placebo effect in order for us to know that it truly works.
What are the 2 key concepts you need to consider when evaluating treatment? Which one is always higher and why?
Efficacy: how well the treatment works in ideal conditions.
Effectiveness: how well the treatment works in real-life conditions.
Efficacy is always higher than effectiveness because: Treatment might be prohibitively expensive. Treatment might produce severe side-effects. Treatment might be stigmatized.
What is treatment outcome research/randomized Control Trial (RCT)? What is the procedure?
the “gold standard” type of experiment that assesses the efficacy and/or effectiveness of an intervention.
- Treatment group: assess initial symptoms, administer new treatments, assess symptoms again. We are testing the efficacy in this group.
- active control: assess initial symptoms, administer ‘standard’ or ‘mock’ treatment, assess symptoms again. A mock treatment is essentially a placebo treatment and it is only used when there is no standard.
- Inactive control: Assess initial symptoms, do nothing, assess symptoms again.
What is the point of the inactive control group? The active control?
inactive:
- Measures efficacy/effectiveness in comparison to doing nothing.
- Measures degree of natural improvement.
- Gives measure of patient bias for assessing pre- vs. post-symptoms.
- any difference seen in inactive control is natural improvement so we want to see more change than that
Active:
- Measures efficacy/effectiveness in comparison to doing something.
- Measures placebo effects
- if your treatment is better than the mock treatment you know that it is better than placebo, if you have something better than standard, then you know you have something better than the standard.
What is the biomedical approach?
treatments aimed at directly altering the functioning of the brain through drugs, stimulation, surgery, etc.
Type: biomedical.
Mechanism: direct intervention or symptom alleviation
Effectiveness: high; generally cheap and easy to administer with few side- effects.
Used for: most clinical disorders, but especially anxiety, depressive, bipolar, schizophrenia, and neurodevelopmental.
What are the 4 relevant neurotransmitters and what do they do?
Serotonin: primarily related to feelings of well-being, appetite, and sleep.
Dopamine: primarily related to increasing activity in various brain regions, especially those related to reward and pleasurable feelings.
GABA: primarily related to inhibiting neuronal activity (more GABA = less activity).
Norepinephrine: primarily related to increasing arousal and sense of altertness,
especially during the stress response.
What are antipsychotics? What are the 2 major types?
Antipsychotics: drugs primarily used to treat psychotic conditions.
Two major types:
- Conventional/Typical: exclusively block dopamine receptors, reducing the effects of dopamine in the brain. Especially good for helping treat positive symptoms, including auditory hallucinations. (this used to be the gold standard because they are really effective at treating symptoms of schizophrenia. Believed to reduce institutionalization of people with schizophrenia.)
- Atypical: block activity of both serotonin and dopamine. Results in fewer side- effects and help with some of the negative symptoms. (these result in fewer side effects and help more with a lot of the negative symptoms.)
What are antipsychotics used for? What is the effectiveness, limitations, and side effects?
Used For: schizophrenia, bipolar, treatment-resistant depression.
Effectiveness: the most effective treatment available for schizophrenia (especially positive symptoms), and have over the years cut the number of patients in psychiatric hospitals by two thirds.
Limitations: significant side-effects and not always as good for negative symptoms.
Side-Effects: weight-gain, involuntary muscle movements (dykinesia), diabetes, potential for some serious drug interactions. (it is the best available treatment but it is really difficult to treat overtime.)
What are anxiolytics/anti-anxiety? What are the three major types?
drugs used to treat anxiety; their popularity has
been decreasing due to tendency for abuse and adverse interactions.
Three major types:
- Benzodiazepines: drugs that increase GABA and decrease brain activity; most commonly administered and most effective anxiolytic. (leads to some dangerous longterm conditions)
- Buspirone / Wellbutrin: drug that stabilizes serotonin levels and is often used with comorbid depression.
- Beta Blockers: drugs that block norepinephrine and thus control muscle tension, blood pressure, and heart rate.
What are anxiolytics used for? effectiveness, limitations, side effects?
Used For: anxiety (general and specific), sleep disorders, PTSD, OCD.
Effectiveness: very high for most people, but not prescribed as often as they used to be.
Limitations: only alleviates symptoms, builds strong drug-tolerance, requiring higher and higher doses that can lead to addiction.
Side-Effects: withdrawal after tolerance, drowsiness, issues with motor coordination, potentially deadly when combined with alcohol (especially benzodiazepines).
What are antidepressants? What are the 2 major types?
Antidepressants: medication used to treat depression, anxiety, and several other disorders; the most commonly prescribed psychopharmacological medication in the world.
Two major types used today:
Selective Serotonin Reuptake Inhibitors (SSRIs): drugs that increase the amount of serotonin in the brain; historically the most popular anti-depressants.
Serotonin-Norepinehprine Reuptake Inhibitors (SNRIs): drugs that increase both serotonin and norepinephrine, and are increasing in popularity today due to lower side-effects than SSRIs.
What are antideperessants used for? effectiveness, limitations, side effects?
Used For: depression, anxiety, addiction, PTSD, OCD. Effectiveness: very high (when they are working)
Limitations: take time to start working (usually 1-3 months); require increasing dosage or change over time.
Side-Effects: very few for modern antidepressants – weight gain, reduced sexual desire, and rarely serotonin toxicity.
What are mood stabilalizers? What are the 2 major types?
Mood Stabilizers: drugs used to treat bipolar disorder that attempt to
decrease the severity of depressive and manic episodes.
Two major types:
Mineral Salts/Lithium: class of drugs that occur naturally and help decrease adrenaline and increase serotonin, thus helping with both mania and depression. Most commonly administered mood stabilizers.
Anticonvulsant: class of drugs that increase GABA and norepinepherine and especially help during manic episodes. They are also used to help prevent seizures in epileptic patients.
What are mood stabilizers used for? effectiveness, limitations, side-effects?
Used For: bipolar.
Effectiveness: very high in correct dose for many patients, but doesn’t work universally for everybody.
Limitations: big individual differences, thus requiring frequent visits to psychiatrist to adjust dose; required dose can also change over time.
Side-Effects: can cause kidney and thyroid damage if dose is wrong, drowsiness, muscle weakness.
What are psychostimulants?
Psychostimulants: drugs used to treat attentional disorders, including ADHD. Selectively release norepinephrine, serotonin, and dopamine in prefrontal cortex of the brain, boosting ability to pay attention.
Unlike other psychoactive drugs, psychostimulants are frequently abused, and overdoses can be fatal.
There is continued debate over whether psychostimulants should be allowed for people not suffering from attention problems to generally boost performance.
what are psychostimulants used for? Effectivness, limitations, side effects?
Used For: ADHD, depression, eating disorders.
Effectiveness: very high, though likely overprescribed.
Limitations: tolerance build-up; addictive, especially with recreational use.
Side-Effects: insomnia, irritability, weight-loss drowsiness, decreased inhibitory control in high doses.
how do biomedical approaches function?
by changing the functioning of the brain, either through neurotransmitters (drugs) or by more invasive measures (e.g., ECT – check out your textbook).
What is true about the variability, efficacy and effectiveness of biomedical approaches?
They are generally high in effectiveness and efficacy, but also show widespread individual differences and often do not treat the underlying problem.
How are most disorders treated today?
As we will learn on Wednesday and Friday, most clinical disorders today are therefore treated by a mixture of medication and psychotherapy.
what is psychotherapy? What are the 2 broad families?
Psychotherapy: treatments done through an interaction with a professional
psychotherapist. (the building of a therapeutic alliance)
Two broad “families”:
Insight-focused therapies: goal is primarily to give client insight into the cause of their disorder.
Intervention-focused therapies: goal is primarily to help client change their thinking and behaving to help them cope with symptoms and/or directly address the cause of the disorder.
What are the 3 insight based therapies?
psychodynamic, interpersonal, humanistic
What are the 3 intervention based therapies?
behavioural, cognitive, CBT, Third-wave (DBT, ACT)
What is psychoanalysis/psychodynamic therapy? What is it used for? what is the type, mechanism, effectiveness,?
therapy based on Freudian principles of identifying and resolving unconscious conflicts.
Type: insight
Mechanism: reveal unconscious causes of disorder then relieve them
through personality change
Effectiveness: mixed – works for some high-functioning clients, but generally dispreferred to other therapies (there is some work that suggests it does work for some people in some situations)
Used for: depression, anxiety, and personality disorders.
What are 4 unique features of psychodynamic therapy?
- Interpretation: the client doesn’t understand their problems, so the therapist must reveal it to them.
2.Transference: the client will project their unconscious desires and defence mechanisms onto the therapist, who analyzes them. - Removing Interference: the client must be distraction-free.
- Longtime: on average, takes 2 years and requires meeting with the
therapist multiple times a week.
What are the 5 things that psychodynamic techniques are focused on?
Finding things that the client doesn’t want to talk about.
Early childhood experiences and attachments (i.e., past, not present).
Possible sources of trauma (conscious and unconscious).
Talking about fantasies, dreams, hopes, and fears.
Reading “between the lines” in what the client is saying, and building a narrative for what is really going on.
What is unstructured talk?
the client and the therapist talk back-and-forth to reveal
patterns of thoughts, but there is no pre-determined topic.
What is free association?
client to freely generates ideas as they come to mind.
what is dream analysis?
therapist analyzes dream journals clients are asked to keep.
What is resistance?
clients becoming upset, refusing to discuss things, or even walking out of therapy are seen as evidence of defence mechanisms, which usually means the therapy is on the right track.
do psychoanalysts believe that effectiveness can be measured? What does the research that has been done show?
Good for some clients: high-functioning and can come into treatment very frequently and achieve insight. (high functioning means that they can afford both mentally and financially a long term treatment)
Good for some disorders: especially panic disorder and borderline personality disorder.
Good for some goals: if insight and a long-term relationship with a professional is desired, psychoanalysis provides good outcomes.
What is interpersonal psychotherapy? What is it used for? Type, mechanism, effectiveness?
Interpersonal Psychotherapy: a mixture of psychodynamic and attachment theory aimed at helping people improve current relationships.
Type: Brief insight psychotherapy (usually 12 sessions).
Mechanism: help clients gain insight into how current interaction patterns are
causing significant issues in their life. (looks at how those patterns have been created and changed as well)
Effectiveness: more than classical psychodynamic therapy.
Used for: grief counselling, life role transition, depression, anxiety, eating disorders. (used a lot when interactions between other people is the main root of a problem.)
What are the unique features of interpersonal psychoanalysis? (4 things)
Unlike classic psychoanalysis:
Focus is on present-day unconscious attachment. (more like what is relationship with your attachments like now, not when you were a child)
Therapist is not a passive listener, but actively guides the client through their thoughts and feelings.
The client and the therapist collaboratively reach insight. (still an understanding that the client doesn’t really understand whats going on but they are also in control of the narrative in some way)
Progress occurs as much outside the office, as it does inside.
What is communication analysis?
asking the client to create a narrative around a recent interpersonal event, with a focus on intended vs. actual communication.
What is open Generation?
giving the client a set of options for what they might do and how they might accomplish it. when the insight is built, the insight might not be sufficient for them to change their behaviour
What is role play?
Role Play: the therapist may pretend to be somebody else to both observe transference and have client practice interpersonal skills. (we’re very interested in transference. We try to simulate their interaction patterns with people outside of the office)
What is person-centred therapy (CPT)? What is it used for? Type, mechanism, effectiveness?
a humanistic therapy (a family of therapies) in which the therapist acts as a mirror through which the client reaches their own insight and becomes their “authentic self”.
Type: insight psychotherapy.
Mechanism: by focusing on empathy and radical acceptance of the client, they
accept themselves and find their own ways of dealing with their problems. (the client is assumed to have all of the tools they need to get better but their relationships or interactions with people affect this.)
Effectiveness: good for high-functioning people seeking insight.
Used for: primarily for depression, anxiety, and addictions.
What are the unique features of person-centred therapy?
Opposite of psychodynamic therapy:
Insight comes from patient, not from therapist.
The therapist provides compassionate and judgment-free environment.
Therapist is genuinely themselves and acts as a model for the client.
Emphasis is on open communication, empathy, total acceptance.
What is unconditional Positive regard?
a caring, empathic, nonjudgmental attitude
adopted by PCT therapists.
What is Active Listening/Mirroring?
empathic listening in which the therapist echoes, restates, and clarifies what the patient said, but doesn’t add their own interpretation. (they are demonstrating that they are listening to you but saying back to you what they said in their own words. No interpretation can be present.)
What is motivational Interviewing?
a style of therapy whereby the therapist that attempts to clarify reasons that the client may want to or may not want to change their behaviour, but never directly suggest reasons to them. Ask questions like why do you feel that way? Why do you want to do that? etc.
What is the effectiveness of person-centred therapy.
While PCT has been decreasing in popularity, its impact on the field has been immense, especially in counselling psychology.
Evidence for effectiveness:
Self-Esteem and Openness to Experience: PCT increases the patient’s self-esteem and openness, which can especially help in cases of depression and anxiety.
Long-Term: the effects are very long-lasting for people for whom it works.
For high-functioning patients.
Who are providers who are licensed to offer psychological therapies?
- psychiatrists
- psychiatric nurses
- marriage
- family and child counsellors
- school and vocational counsellors
- mental health counsellors
- clinical social workers
what are the duties and settings of a clinical psychologist?
duties: assessments and psychological treatment
setting: Private practice, medical centres, agencies, clinics
what are the duties and settings of a Marriage , family, and child counsellor?
duties: psychological treatment, with a focus on couples, families, and children
Setting: Private practice, clinics
what are the duties and settings of a school psychologist and vocational counselor?
duties: assessment and counselling, with a focus on vocation and adjustment
Setting: schools
what are the duties and settings of a mental health counsellor?
duties: assessment and counselling
setting: private practice, medical centres, agencies, clinics
what are the duties and settings of a clinical social worker?
duties: psychological treatment and assistance with housing, health care, and treatment.
what are the duties and settings of a psychiatrist?
duties: Assessment and psychological and biological treatment
settings: Private practice, medical centers, clinics
what are the duties and settings of a general medical practitioner?
duties: Assessment and biological treatment
settings: Private practice, medical centres, clinics
what are the duties and settings of a neurologist?
duties: Assessment and treatment, with a focus on the brain and nervous system
setting: private practice, medical centres, clinics
what are the duties and settings of a psychiatric nurse?
duties: Assessment and psychological and biological treatment
setting: medical centres, clinics
