approaches to treatment and therapy
DESCRIPTION
Approaches to Treatment and Therapy. Chapter 17. Approaches to Treatment and Therapy. Biological treatments for mental disorders Kinds of psychotherapy Evaluating psychotherapy. Biological Treatments. The question of drugs Surgery and electroshock. The Question of Drugs. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/1.jpg)
Approaches to Treatment and Therapy
Chapter 17
![Page 2: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/2.jpg)
Approaches to Treatment and Therapy Biological treatments for mental disorders Kinds of psychotherapy Evaluating psychotherapy
![Page 3: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/3.jpg)
Biological Treatments The question of drugs Surgery and electroshock
![Page 4: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/4.jpg)
The Question of Drugs
![Page 5: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/5.jpg)
Antipsychotic Drugs Many block or reduce sensitivity of brain
receptors that respond to dopamine. Some increase levels of serotonin, a
neurotransmitter that inhibits dopamine activity.
Can relieve positive symptoms of schizophrenia but are ineffective for or even worsen negative symptoms.
![Page 6: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/6.jpg)
Antidepressant Drugs Monoamine oxidase inhibitors (MAOIs)
Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters.
Tricyclic antidepressants Boost norepinephrine and serotonin in brain by
preventing normal reuptake of these substances.
Selective serotonin reuptake inhibitors (e.g, Prozac) work same way as tricyclic
antidepressants but target serotonin.
![Page 7: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/7.jpg)
Tranquilizers Increase the activity of the neurotransmitter
gamma-aminobutyric acid (GABA). Developed for treatment of mild anxiety
and often overprescribed by general physicians for patients who complain of any mood disorder.
Not effective for depression.
![Page 8: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/8.jpg)
Lithium Carbonate Used to treat bipolar disorder. Moderates levels of norepinephrine or by
protecting cells from being overstimulated by the neurotransmitter, glutamate.
Must be given in right dose and bloodstream levels need to be monitored.
Newer drug treatments for bipolar disorder include Tegetrol and Depakote.
![Page 9: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/9.jpg)
Cautions About Drug Treatment
Placebo effect High Relapse and dropout rates Dosage problems Long-term risks
![Page 10: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/10.jpg)
Placebo Effect The apparent success of a treatment that is
due to the patient’s expectation of hopes rather than to the drug or treatment itself.
Meta-analyses indicate that clinicians considered medication helpful yet patient ratings in treatment groups were no greater than patient ratings in placebo groups.
![Page 11: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/11.jpg)
High Relapse and Dropout Rate There may be short term success but many
patients (50% to 66%) stop taking medication due to side effects.
Individuals who take antidepressants without learning to cope with problems are more likely to relapse.
![Page 12: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/12.jpg)
Dosage Problems Finding the therapeutic window or the amount
of medication that is enough but not too much. Drugs may be metabolized differently in:
men and women, old and young, and in different ethnic groups.
Groups may differ in tolerable dosages due to variations in metabolic rates, amount of body fat, number or type of drug receptors in the brain, smoking and eating habits.
![Page 13: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/13.jpg)
Long-Term Risks Antipsychotic drugs can be dangerous,
even fatal if taken for many years. Tardive dyskinesia
Antidepressants are assumed to be safe but no long term studies have been conducted.
Many doctors and the public overlook the possibility of long-term dangers when a drug shows short run benefits.
![Page 14: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/14.jpg)
Surgery and Electroshock Psychosurgery
Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behaviour.
Electroconvulsive Therapy (ECT) A procedure used in cases of prolonged and
severe major depression, in which a brief brain seizure is induced.
![Page 15: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/15.jpg)
Kinds of Psychotherapy Psychodynamic therapy Behavioural and cognitive therapy Humanist and existential therapy Family and couples therapy
![Page 16: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/16.jpg)
Psychodynamic Therapy Goal is exploring the unconscious
Free Association In psychoanalysis, a method of uncovering
unconscious conflicts by saying freely whatever comes to mind.
Transference In psychodynamic therapies, a critical step in which
the client transfers unconscious emotions or reactions, such as conflicts about his or her parents, onto the therapist.
![Page 17: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/17.jpg)
Behaviour and Cognitive Therapy Behaviour therapy
Systematic desensitization Exposure treatments Behavioural records Skills training
Cognitive therapy
![Page 18: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/18.jpg)
Behaviour Therapy A form therapy that applies principles and
techniques of classical and operant conditioning to help people change self-defeating or problematic behaviours.
![Page 19: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/19.jpg)
Systematic Desensitization A step by step process of desensitizing a
client to a feared object or experience, based on counterconditioning.
![Page 20: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/20.jpg)
Exposure (Flooding) A technique whereby a person suffering
from an anxiety disorder such as a phobia or panic attack, is taken directly into the feared situation until the anxiety subsides.
![Page 21: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/21.jpg)
Behavioural Records A method of keeping careful data on the
frequency and consequences of the behaviour to be changed.
![Page 22: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/22.jpg)
Skills Training An effort to teach a client skills he or she
may lack, as well as new more constructive behaviours to replace self-defeating ones.
![Page 23: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/23.jpg)
Cognitive Techniques Examine the evidence for beliefs. Consider other explanations for the
behaviour of others. Identify assumptions and biases. Rational Emotive Behaviour Therapy
(REBT): a form of cognitive therapy designed to
challenge the client’s unrealistic or irrational thoughts.
![Page 24: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/24.jpg)
Cognitive Techniques
Meichenbaum developed a form of cognitive therapy to treat excessive anxiety called “stress inoculation.” Involves 3 stages:
Education phase Rehearsal phase Implementation phase
![Page 25: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/25.jpg)
Humanist Therapy Humanist therapy
Based on the assumption that people seek self-actualization and self-fulfillment.
Emphasized people’s free will to change, not past conflicts.
Client-Centered (Nondirective) Therapy Developed by Carl Rogers and emphasizes the
therapist’s empathy with the client, seeing the world as client does, and creating climate of Unconditional Positive Regard.
![Page 26: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/26.jpg)
Existential Therapy Helps clients explore the meaning of existence
and face with courage the great issues of life such as death, freedom, free will, alienation and loneliness.
![Page 27: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/27.jpg)
Family and Couples Therapy Problems develop in the context of family, are
sustained by the dynamics of the family and any changes made will affect all members of the family.
Can look for patterns of behaviour across generations and create a family tree of psychologically significant events.
Family-System Perspective Therapy with individuals or families that focuses
on how each member forms part of a larger interacting system.
![Page 28: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/28.jpg)
One Family’s Genogram
![Page 29: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/29.jpg)
Primary Goals of Therapies Psychodynamic
Insight into unconscious motives and feelings. Cognitive-Behavioural
Modification of behaviour and irrational beliefs. Humanist
Insight; self-acceptance and self-fulfillment. Family
Modification of individual habits and family patterns.
![Page 30: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/30.jpg)
Primary Methods of Therapies Psychodynamic
Probing the unconscious through dream analysis, free association, transference.
Cognitive-behavioural Behavioural techniques such as systematic desensitization,
flooding; cognitive exercises to identify and change faulty beliefs. Humanist
Providing a safe, non-judgmental setting in which to discuss life issues.
Family Working with couples, families, and sometimes individuals to
identify and change patterns that perpetuate problems.
![Page 31: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/31.jpg)
Evaluating Psychotherapy The scientist-practitioner gap The therapeutic alliance When therapy helps When therapy harms
![Page 32: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/32.jpg)
The Scientist-Practitioner Gap Many psychotherapists believe that
evaluating therapy using research methods is futile.
Scientists find that therapists who do not keep up with empirical findings are less effective and can do harm to clients.
Economic pressures require empirical assessment of therapies.
![Page 33: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/33.jpg)
Is More Psychotherapy Better? With additional therapy
sessions, the percentage of people improved increased up to 26 sessions.
Rate of improvement then levels off Based on a summary of 15
studies, 2400 clients (Howard, et al., 1996).
Patients’ sense of improvement slower but more steady.
![Page 34: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/34.jpg)
Psychotherapy Research Questions What are the common ingredients in
successful therapies? What kinds of therapy are best suited for
which problems? Under what conditions can therapy be
harmful?
![Page 35: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/35.jpg)
The Therapeutic Alliance Qualities of the Participants
Motivation to improve and solve problems. Support from families and actively deal with
problems. Empathic, warm, and genuine therapists.
Culture and the Therapeutic Connection In Canada, group therapy is popular with
Indigenous clients, in part because it bears more similarity to traditional healing practices in these groups.
![Page 36: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/36.jpg)
When Therapy Helps Problems of assessing therapy
Justification of effort effect Clinical researchers conduct randomized
controlled trials designed to determine the effectiveness of a new medication or form of therapy, in which people with a given problem are randomly assigned to one or more treatment groups or to a control group.
![Page 37: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/37.jpg)
What works? Depression
Cognitive therapy’s greatest success has come in treatment of mood disorders.
Anxiety Disorders Exposure techniques are more effective than
others. Anger and Impulsive Violence
Cognitive therapy is extremely successful.
![Page 38: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/38.jpg)
What works? Health Problems
Cognitive and Behaviour therapies are effective for a wide range of health problems.
Childhood and Adolescent Behaviour Problems Behaviour therapy is the most effective
treatment.
![Page 39: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/39.jpg)
Successful Therapy
Psychotherapy outcome depends not only on method of therapy.
Qualities of client and therapist, and their alliance, also determine success.
![Page 40: Approaches to Treatment and Therapy](https://reader033.vdocuments.site/reader033/viewer/2022061511/56812fee550346895d9565ab/html5/thumbnails/40.jpg)
When Therapy Harms Sexual intimacies, or other unethical
behaviour on the part of the therapist. Prejudice or cultural ignorance on the part
of the therapist. Inappropriate or coercive influence, which
can create new problems for the client. The use of empirically unsupported,
potentially dangerous techniques.