treatment Flashcards
questions
1) Discuss assessing the effectiveness of one treatment.
2) Discuss ethical considerations in the treatment of disorders
Cognitive treatment (and types)
Cognitive approaches to therapy are called Psychotherapies; they involve face-to-face interactions with a therapist. Psychotherapy is seen as more personal than drug therapy and can be highly individualized to meet the needs of the client. generally focus on addressing a persons life situation and subjective understanding of their psychological problems. Examples include Cognitive Behavioral Therapy (CBT) and Mindfulness-based Cognitive Therapy (MBCT)
Cognitive Behavioral Treatment methods
Beck
Beck argues that people with emotional difficulties tend to commit “logical errors” that lead to self-deprecation. In CBT, the client is encouraged to find out which thoughts are associated with depressed feelings, and to correct them – this is called cognitive restructuring. The aim of the therapy is to teach clients to monitor thought processes and then to test them against reality so that they can eventually change their behavior
3 methods:
1) validity testing- a therapist asks the client to defend his or her beliefs. If the patient cannot produce evidence supporting the assumptions, the faulty nature of the belief is challenged to show the assumption is not rational
2) cognitive rehearsal- a client is asked to imagine a difficult situation from the past and then together they practice how to cope with the problem. The hope is that by developing new schema for coping with problems when the real problems occur, the client will be better able to handle them.
3) homework- The goal of homework is to encourage self-discovery and reinforce what is happening in the therapy sessions. Homework could be to read an article about a specific issue, to keep a diary of positive experiences on a day-to-day basis or to try out a new strategy that was learned in therapy
aims:
1: to identify and correct faulty cognitions and unhealthy behaviours
2: help clients develop effective coping strategies and problem-solving skills
Drug/ biological treatment
Biomedical approaches to treatment are based on the assumption that if the problem is based on biological malfunctioning, drugs should be used to restore the biological system. Since depression is assumed to involve an imbalance in neurotransmission, antidepressant medications are used to restore an appropriate chemical balance in the brain. However this method does not explain biological origins of depression, as chemical imbalances may only be a part of one’s developing depression.
Drug treatment study
Geddes et al
Aim: to determine how long drug treatments should be continued to prevent relapse.
sample: 4410 participants in 31 randomized trials
method: systematic overview of evidence from randomized trials of continuing treatment with antidepressants in patients with depressive disorders who have responded to acute treatment
findings:
Continuing treatment with antidepressants reduced the odds of relapse by 70% compared with treatment discontinuation. The average rate of relapse on placebo was 41% compared with 18% on active treatment. The treatment effect seemed to persist for up to 36 months, although most trials were of 12 months’ duration, and so the evidence on longer-term treatment requires confirmation.
conclusion:
continuation of anti-depressant use reduced the risk of relapse
multi-faceted approach study
Elkin et al
aim: to see if there was any significant difference in the effectiveness of the three approaches of CBT, Interpersonal Therapy (IPT) and drug therapy.
sample:250 patients were assigned to treatment. The sample came from three different treatment centers located in Pittsburg, Washington DC and Oklahoma City. To be included in the study, patients had to meet the diagnosis of major depressive disorder with symptoms present at least in the two weeks previous to the study. Patients were excluded from the study if they had any other disorder in addition to MDD.
method: Depressed clients were randomly assigned to one of four treatment conditions for four months: IPT, CBT, the drug imipramine or a placebo pill. The imipramine and placebo conditions were paired with clinical management in which minimal supportive therapy was provided because of the ethical need to provide some therapy for clients in those conditions.
findings: no significant difference in improvement of functioning between CBT and IPPT, or between either of them and drug+therapist
Drug treatment was the fastest acting, but by the end of the 16 weeks of therapy the psychotherapies had caught up with the drug in terms of effectiveness.
evaluation:
strengths- Keller (2008) compared the effectiveness of drug treatment with CBT or a combination of both, and found that Participants in the drug group improved more rapidly, but by the end of the 12 weeks, the therapy groups had caught up. The combination group showed the greatest change - an 85% improvement. support for elkin
- data triangulation from patient, therapist and objective observer
limitations:
- patients excluded for other mental health issues such as addiction, not representative or generalizable
-different therapists use different strategies, not a generalizable approach to the method
- difficult to compare treatments when each patient has a different experience of the disorder
Drug treatment pros
-Drug therapy shows results more quickly than psychological therapies. Often drug therapy is necessary so that the patient is able to engage in psychological therapy.
-The use of drug therapies has increased the amount of out-patient care and decreased institutionalization.
Drug treatment cons
-side effects (e.g. nausea, weight gain, insomnia, dizziness, anxiety etc.)
- heavy reliance is a reductionist approach, alleviates biological symptoms but does not address life stressors
-discontinuation syndrome, if use is discontinued there is a high chance of relapse
-increased dosage over time makes them loose effect
CBT pros
- no side effects
- reduces risk of relapse after treatment has stopped
-lower relapse rates than drug therapy alone
-personal, the relationship between therapist and client allows the client to feel supported (however this may depend on the specific relationship, those who like their therapist more tended to get better more quickly)
CBT cons
- not helpful in an emergency (e.g. patient is suicidal)
-focuses on symptoms instead of causes
-ignores biological causes
-directive therapy, therapist assesses clients situation and makes judgements on the best course of action (cultural and gender biases may play a role in decision)
