Week 14 Flashcards
What were some treatments aimed at supernatural forces and in asylums
Treatments aimed at supernatural forces:
- Exorcism: incantations & prayers said over a person by a priest/religious figure
- Trephining: hole made in the skull to release spirits
- Execution/imprisonment
- Witch trials, etc.
In asylums:
* Cold water submersion
* Electroshock treatment etc.
When are individuals usually hospitalized
Individuals usually only hospitalized if they are an imminent threat to themselves or others (voluntary OR involuntary)
When are indidvuals admitted to the hospital against their will
Involuntary: risk of serious harm to themselves or others, inability to care for themselves (Form 1 – certificate of involuntary admission)
Name some sources of psychologocial treatment
Family doctors & primary care clinics - provide initial assessments, prescribe meds, refer
* Psychiatrists (covered by OHIP) – medical doctors, referral required
- Private psychologists & therapists – provide therapy and assessments
BUT cannot prescribe, offer talk therapy, not covered by public health
care - Community mental health services – sometimes offer low-cost mental health support. Include therapy, crisis support, case management (e.g., CMHA, CAMH, etc)
- Crisis & emergency services
Difference between clinical psychologist, counselling psychologists, and psychiatrists
**Clinical Psychologists
**Registered Psychologists with a PhD or PsyD or master’s degree (in certain provinces) who specialize in assessment and treatment of psychological difficulties.
**Counselling Psychologists
**Registered Psychologists with a PhD or EdD or master’s degree (in certain provinces) typically treat day-to-day adjustment
problems.
Psychiatrists
MDs with postgraduate training in abnormal behaviour. They can prescribe medication and often treat the most severe psychological disorders.
Psychoanalysts
**Psychoanalysts
**Either MDs or Psychologists who specialize in psychoanalysis, the treatment technique first developed by Freud.
Registered Psychotherapists
Professionals with educational training and professional certification in the field of psychotherapy. Psychotherapists may provide therapy to clients with a wide range of mental health issues. Psychotherapists have different educational qualifications ranging from diplomas to graduate degrees, and certain insurance providers may cover only psychotherapists with specific credentials (e.g.,
master’s level training).
Licensed Professional Counsellors or Clinical Mental Health Counsellors
Professionals with a master’s degree, and who hold a federal or provincial certification. They provide therapy to individuals, couples, and families
Clinical or psychiatric social workers
Professionals with a master’s degree and specialized training who provide therapy, usually regarding common family and personal problems.
Psychoanalysis
+ techniques
- First form of psychotherapy,
developed by Freud in early 20th
century - Aimed to release hidden unconscious thoughts & feelings to reduce their power in controlling behaviour
Techniques:
Free association – patient relaxes and says whatever comes to mind
Dream analysis- therapist interprets
meaning of treats
Psychoanalysis (resistance and transference)
Resistance: inability/unwillingness to discuss
or reveal particular memories, thoughts, motivations – can be expressed in many ways
- Therapist should pick up on resistance and interpret meaning – ensure patient returns to topic
- Transference: transfer of feelings to a
psychoanalyst
Psychodynamic therapy
+ evaluation
- Today, shorter duration (in the past, would see therapist multiple times a week for years!)
- Less emphasis on past & childhood, more about current relationships and complaints
- Controversial, unclear if it is effective – no proven “unconscious)
Evaluation:
* Time consuming & expensive
* Requires person to be very articulat
Behavioral approaches
+aversuve conditioing
Applying principles of learning to change undesirable behaviours
Classical conditioning techniques
- Aversive conditioning: uses an unpleasant stimulus to stop an undesirable behaviour (e.g., mild electric shock, bitter taste when engaging in certain behaviours) – client associates unpleasant stimulus & unwanted behaviour (e.g., Antabuse)
- Works well for some substance-abuse problems, sexual disorders
BUT - Ethical concerns around aversion techniques
- Long-term effectiveness
Classical conditioning techniques: systematic
desensitization
- Gradual exposure to anxiety-provoking stimulus is paired with relaxation to extinguish anxiety response
- Client trained in relaxation technique to construct a hierarchy of fears to put self
in relaxed state and make a visit to anxiety making situation - Most successful CC-based behavioural treatment
- Used for phobias, anxiety disorders, impotence, fear of sexual context, etc.
Classical conditioning techniques: flooding
Exposing the person to the anxiety provoking stimulus at the beginning
* Exposure is rapid - e.g., person who is fearful of dogs would be placed in a room with dogs
* At first, anxiety – overtime realize they are safe & unharmed, associating fear with
positive experience
* Newest forms use VR technology!
* Debate as to whether this is ethical or trauma-inducing
Operant conditioning techniques
token system, contingency contracting, observational learning
Reward desirable behaviour, extinguish negative
behaviours through ignoring or punishing
* Token system: person rewarded for desirable behaviours with tokens
* Contingency contracting: written agreement that outlines goals and consequences
* Observational learning: behaviour is modelled to
teach new skills or new ways of handling fears/anxieties (e.g., Fearless Peer)
Dialectical behavioural therapy
Focuses on getting people to accept who they are, regardless of whether it matches ideal
- Two choices: remain unhappy OR change
- Teaches people behavioural skills to help them behave
more effectively & keep emotions I check - Patients taught negative behaviours don’t need to rule
behaviour - Distress tolerance – negative emotions are inevitable but they don’t last forever
- Mindfulness training – purposely bring one’s attention to experiences in present moment without judgment
- New therapy BUT effectiveness promising, especially with
some personality disorders
How does behaviour therapy stack up?
advantages + disadvantages
**Advantages
*** Works well for phobias, compulsions, getting control over impulses, learning complex social skills to replace maladaptive behaviours
* Efficient – solves carefully defined problems
**Disadvantages
*** Doesn’t gain insight into thoughts & expectations that may foster maladaptive behavior
* Does not treat deep depression or other severe disorders
Cognitive therapy
Developed by Aaron Beck in 1960s
* Assumes that anxiety, depression, and negative emotions develop from
maladaptive thought processes
* Encourages client to find more logical ways of interpreting situations and positive ways of thinking
1) Cognitive therapists help clients become aware of cognitive distortions,
for example:
* Overgeneralizing- taking a small situation & making it huge
* Polarized thinking – seeing things in absolutes
2) Clients helped to change dysfunctional thinking patterns by challenging beliefs, focusing on illogical basis, and correcting them with more rational
thoughts/beliefs
What does cognitive therapy say around themes of loss & defeat
If you consistently interpret events & emotions around the themes of loss & defeat, then you are likely to be depressed
Rational emotive therapy
cognitive approach to therapy
Rational-emotive therapy: attempts to restructure a person’s belief system in a more realistic, rational and logical set of views by challenging dysfunctional beliefs that maintain irrational behaviour
- Help clients eliminate maladaptive cognitions & adopt more effective thinking
- Ellis: many people lead unhappy lives because they harbor irrational, unrealistic ideas (e.g., it is horrible when things don’t turn out the way we want them to – what are some irrational beliefs students may have?)
- Belief leads to negative emotion which leads to irrational beliefs = self-defeating cycle
A-B-C model of rational-emotive behavior
therapy
- Negative activating conditions (A)
- lead to the activation of an irrational belief system (B),
- which leads to emotional consequences (C).
- Those emotional consequences then feedback and support the belief system
cognitive behavioral therapy
cognitive approach to therapy
Cognitive-behavioral therapy (CBT): works to change cognitive
distortions & self-defeating behaviours (how people think and act)
- Helps clients examine how thoughts affect behaviour
= cognitive therapy (making people aware of irrational, negative thoughts and replacing them with positive ways of thinking)
+
behavioral therapies (teaches people to practice & engage in more positive, healthy approaches)
Interoceptive exposure therapy
Used to treat panic disorder – getting used to normal physical sensations (e.g., dizziness,
shortness of breath, de realization)
* Involves purposefully arousing some of the symptoms of a panic attack – goal is to perceive them as harmless
- Spinning around in a chair
- Hold your nose while breathing through straw
- Stair climbing
- Hyperventilating
- Staring at your hand for 2 minutes
How does cognitive therapy stack up?
advantage + disadvtange
**Advantages
*** Successful treating anxiety disorders, depression, substance abuse, eating disorders, etc.
* Combining with other approaches (e.g., CBT) makes this an effective form of treatment
**Disadvantages
*** Life is sometimes irrational! It doesn’t acknowledge this
* Logical thinking might not always be helpful
Humanistic therapy
People have control of their behaviour, can make choices about their lives, essentially responsible for solving their own problems
* Therapist as guide or facilitator
* Psychological disorders are the result of people’s inability to find
meaning in life, feeling lonely, unconnected, etc.
* Several different therapeutic technique (e.g., client-centered therapy, gestalt therapy)
Person-centered therapy
Aims to enable people to reach their potential for self-actualization
- Provide warm and accepting environment, motivate clients to air their problems and
feelings to enable client to make realistic & constructive choices & decisions about issues
in their life - Therapist provides unconditional positive
regard – nonjudgmental, empathetic, understanding of emotional experiences (not
approving of everything!) - Rarely used in purest form today – clients nudged toward insight
How does humanistic therapy stack up?
advantage + disadvantage
Advantages
* Idea that psychological disorders result from restricted growth potential appeals to many people
**Disadvantages
*** Lacks specificity
* Not very precise, probably the least scientifically & theoretically
developed treatment
* Works best for highly verbal clients
Interpersonal therapy
Short-term (6-12 wks) that focuses on context of individual’s current social relationships (e.g., social skills deficits, conflicts with others, grief, major life transitions)
- Therapists make concrete suggestions on improving relations with others, offer recommendations & advice
- Effective in dealing with depression, anxiety, addictions, eating disorders etc.
Group therapy
People meet in a group with therapist – support and advice for group members
* Economical!
* Doesn’t always involve a professional therapist
Different types:
* Self-help groups (AA)
* Family therapy – get families to adopt new, more constructive roles & patterns of behaviour
Does therapy work?
- Psychotherapy is effective for most people but may not be effective for everyone
- Different treatments for different problems
- Therapists tend to use eclectic
approach
Biomedical therapy: biological approaches to
treatment
anti psychotic drugs and antianxiety drugs
Drug therapies work by altering neurotransmission (agonist/antagonist)
Antipsychotic drugs : temporarily reduce psychotic symptoms by blocking dopamine receptors – newer antipsychotics (e.g., clozapine) increase dopamine levels in certain parts of brain (e.g., planning & goal- directed)
Antianxiety drugs –> benzodiazepines (Xanax, Valium)– reduce excitability & increase feelings of well-being – concerns with dependance and lethality with alcohol
Antidepressant Drugs
tricylic drugs, mao inhiibitors, selective serotonin reuptake inhibitors
Antidepressant drugs à improve feelings of well-being, also being
used for anxiety disorders
Tricyclic drugs : increase norepinephrine
MAO inhibitors : prevent monoamine oxidase from breaking down neurotransmitters
Selective Serotonin Reuptake Inhibitors : target serotonin, allows it to linger at synapse
Can produce lasting, long-term recovery!
Prozac (SSRI)
Fluoxetine (Prozac) is a best-selling SSRI
- Daily dose around $2
- Prozac (also Luvox, Paxil, Celexa, Zoloft) has relatively few side effects
- Many who don’t respond to other antidepressants do well with Prozac
- 20-30% experience nausea & diarrhea, small number have sexual dysfunction
New directions in psychopharmacology
- Ketamine blocks neural receptor NDMA, which affects Glutamate (plays role in mood
regulation) - Promising for treatment-resistant depression
- Side effects: affects cognitive functioning, some experience increase in depressive
symptoms over time – concerns over addiction
Electroconvulsive therapy (ECT)
Used in treatment of severe depression
- Electric current of 70 to 150 volts briefly administered
- Patient is sedated & receives muscle relaxants
- Usually 10 treatments in the course of a month
- Controversial – potential serious side effects (e.g., memory loss)
- We do not know why ECT works! May produce permanent damage in brain
Transcranial magnetic stimulation (TMS)
- Precise magnetic pulse directed to a specific area of the brain – activates particular neurons
- Effective in relieving symptoms of depression
- Side effects include seizures and convulsions
Psychosurgery
- Historically, lobotomies - frequent in 1940s & 50s
- 1960s- lesions in amygdala or areas of limbic system (emotion)
- Primitive procedures replaced with ultrasound, electricity, freezing of tissues, implants of radioactive materials
- Today last resort for people with severe OCD, major depression, bipolar
Biomedical therapies in perspective
- Arguably the greatest revolution in the field of mental health!
- More patients that can be treated as outpatients
**Not a cure-all for disorders
*** Temporary symptom relief
* May not solve the underlying problem
* Serious side effects – especially antipsychotic medications
Eye movement desensitization &
Reprocessing (EDMR)
- Involves patients conjuring up image associated with a traumatic event, then
performing rapid left-right eye movements while tracking an object waved in front of
the eye - Controversial – not a strong body of research, lack of evidence in reduction in
physiological/behavioral anxiety - No basis for why it works
On being sane in insane places (Rosenhan,
70s)
- 8 sane people gained admission to 12 different mental hosiptals by complaining about hearing voices that said, “empty, hollow & thud”
- Behaved normally for the rest of admission interview and stay
- Hospitalized between 7 to 52 days – released as “schizophrenics in remission”
- Received almost no attention from nurses, doctors, or attendants
- Sedated with over 2,000 pills
- Felt hopeless & depersonalized
