THERAPEUTIC APPROACHES FOR MENTAL DISORDERS 1. Psychotherapy Approaches 2. BiologicalBiomedical Ther

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THERAPEUTIC APPROACHES FOR MENTAL DISORDERS1.
Psychotherapy Approaches2. Biological/Biomedical
Therapies
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TECHNIQUES IN PSYCHOTHERAPY

• Psychoanalytic Approach
• Humanistic/Phenomenological Therapies
• Behavior Techniques
• Cognitive Techniques

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I.   Psychoanalytic Therapy Freud

• Basic contention of psychoanalytic theory is that
  psychopathology results from a struggle between
  naturally opposing forces.

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Several procedures in psychoanalysis

• 1). Free Association freely say out loud
  whatever comes to mind analyst at times assist
  by giving a word and having patient honestly
  respond to it.
• 2). Resistance unwillingness or inability to
  explore some aspect of ones life. Resistance
  may be seen by a person shutting down when a
  certain subject is brought up, avoiding the
  subject all together by joking or ignoring,
  missing sessions, coming late and/or being
  disruptive.
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• 3). Dream Interpretation analyzing and
  interpreting patients dreams. Freud believed
  that dreams were wish fulfillment. When
  unconscious desires conflict with conscious
  restraints it is necessary for a person to pursue
  paths to express the wish. Freud believed that
  dreams were a rich source to unconscious material
  he called dreams the royal road to the
  unconscious mind.
• 2 levels of dreams
• 1.     Manifest content what the person can
  remember and reports.
• 2.     Latent content symbolic representation
  of the contents of the unconscious. Unconscious
  desires usually related to sex and aggression

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• 4). Transference patient interacts or reacts to
  analyst as if he/she were someone important in
  their life, usually a parent. This is allowed
  and is good for interpretation purposes, however,
  therapist has to be careful not to become
  emotional and let their feelings get in the way
  and influence how they react to clients this is
  called countertransference.
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2. Humanistic/Phenomenological Therapies

• Focus- Mental disorders dont come from
  unresolved inner conflicts, but from something in
  the environment that keeps us from personal
  growth and psychological adjustment, from being
  fully functioning.
• This approach is based on three principles
• understanding other persons requirements, trying
  to see the world through their eyes
  (phenomenological approach)
• clients should be treated as equals and
• the therapeutic relationship with the client is
  central to the benefits of therapy.

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• Client-centered therapy Rogerian therapy
  client is the center of the therapeutic
  interaction.
• Goal is to help the person self-actualize to
  become whole, to become congruent (ideal self and
  real self).
• Focus on
• The present not the past or childhood
  experiences,
• Feelings or affect not beliefs or cognitions,
• Mirror or reflect not interpret.

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• One of the most essential features to therapeutic
  change in P-C therapy is the relationship between
  the client and the therapist.
• There should be
• 1) Genuineness
• 2) Unconditional Positive Regard
• 3) Accurate Empathy (and understanding)
• 4) Perception of Genuineness

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III.   Behavior Techniques

• Stimulus Response
• Main principle maladaptive behaviors are
  learned and so they can be unlearned.
• Focus here and now, not childhood experiences,
  not worried about feelings, but behaviors.

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Methods

• Therapies based on Classical Conditioning
•  It is believed that classical conditioning leads
  to the development of phobias. Because anxiety
  (phobia) is learned (conditioning) they can be
  unlearned (counter conditioning).
• Examples 
• Systematic desensitization,
• In vivo desensitization (in vivo exposure)
• Flooding
• Aversion therapy

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• Therapies based on Operant Conditioning
• behaviors that are reinforced increases
• behaviors that are punished decreases.
• Example Contingency management/Contingency
  contract (point sheet) Behavioral Modification
  Program
• Therapies based on Observational Learning
• Example Modeling
• Mainly used to treat two broad psychological
  problems 1) skills deficits and 2) fear.

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IV.  Cognitive Techniques

• What matters most are clients beliefs, thoughts,
  perceptions and attitudes about himself or
  herself and their environment.
• Major principle in order to change how one feels
  and acts you should just change how one thinks.
  They dont deny the importance of behavior
  which is usually incorporated called
  cognitive-behavior therapy.
• 2 types of cognitive techniques
• 1). Rational-Emotive Therapy (RET) Albert Ellis
  
• 2). Cognitive Restructuring Therapy Aaron Beck

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• Rational-Emotive Therapy (RET) Albert Ellis
• What causes pathology is the persons irrational
  interpretation of the stimuli. People largely
  disturb themselves by thinking in a
  self-defeating, illogical and unrealistic manner.
  
• Example Therapist provides homework to client
  therapist takes an active role interpreting the
  clients system of beliefs and encourages active
  change.
• Formula ABCDE of therapy
• A (activating events), B (irrational beliefs), C
  (consequences), D (disputing irrational beliefs),
  E (effective new philosophy) of therapy.

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• Cognitive Restructuring Therapy Aaron Beck
• Worked mainly with depressed individuals.
  Assumption is that considerable psychological
  distress stems from a few simple, but misguided
  beliefs.
• People with disorders share certain
  characteristics
• They tend to have very negative self-images.
• They do not value themselves or what they do.
• They tend to take a very negative view of life
  experiences
• They overgeneralize
• They actually seek out experiences that reinforce
  their negative expectations
• They tend to hold a rather dismal outlook for the
  future
• They tend to avoid seeing the bright side of any
  experience.

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Biological/Biomedical Therapies

• Psychosurgery
• Electroconvulsive Therapy ECT
• Drug Therapy-

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Psychosurgery

• Surgical procedures used to change psychological
  reactions, usually directed at the brain.
• I Examples
• corpus callosum (band of fibers that connect the
  two hemispheres of the brain) splitting of the
  brain used for epilepsy
• Cingulectomy used to help reduce anxiety and
  OCD cutting nerve fibers that connect the
  frontal lobes with the limbic system.
• Lobotomy most commonly used severs neural
  connections between the prefrontal lobes and
  lower brain centers.

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Electroconvulsive Therapy ECT

• Electric shock with currents between 70 and 150
  volts are passed through the patients brain.
  used on severely depressed patients.
• It is believe that depressed patients have
  biochemical imbalances - the neurotransmitters
  norepinephrine (NO REP-E NEPHEW REEN),
  serotonin, and dopamine are lowered in the brain
  these neurotransmitters influence mood.
• ECT shock induces seizure reaction in the brain
  seizures change your neurochemical functioning.
• Patient also receives muscle relaxant to minimize
  muscular contractions.

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Drug Therapy

• Psychoactive drugs chemicals used to alter
  persons affect, behavior and cognitive.
• 3 Major types
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• Antipsychotic drugs
• Antidepressant drugs
• Antianxiety drugs

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Antipsychotic drugs

• Drugs that alleviate or eliminate psychotic
  symptoms - loss of contact with reality, such as
  delusions, hallucinations and a gross impairment
  of functioning.
• Primarily designed for use with Schizophrenia.
  block dopamine receptor
• higher levels of dopamine is believed to cause
  psychosis
• breakthrough drug (Thorazine)
• Chlorpromazine and other antipsychotic drugs are
  most effective in treating positive symptoms.
  With exception of
• Clozapine is effective in treating negative
  symptoms

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Antidepressant drugs

• Elevate the mood of persons who are depressed.
• 3 classes of antidepressants
• 1. Monoamine Oxidase inhibitors (MAO) MAO is an
  enzyme that breaks down the level of serotonin,
  norepinephrine (N0-REP-E-NEPHEW-REEN), and
  dopamine in brain the MAO inhibitors block this
  enzyme and the result is an increase in these
  neurotransmitters and elevated moods. Some of
  the names Parnate, Marplan Nardil.

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• 2. Tricyclics safer and more effective affect
  the operation of neurotransmitter serotonin
• Examples Imipramine, Desipramine, Trimpramine.
• 3. Selective Serotonin Reuptake Inhibitors
  (SSRIs) act on neurotransmitter receptor sites
  (serotonin and norepinephrine)
• no more effective than tricyclics, but acts
  faster and fewer side-effects,
• Example Prozac works by inhibiting the
  re-uptake (breaking down) of serotonin causing
  higher levels of serotonin in brain
• Other SSRI Zoloft, Luvox Praxil.
• Lithium mood stabilizers most useful in
  controlling the manic stage of bipolar disorders

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Antianxiety drugs

• Helps reduce the felt aspect of anxiety.
• Major variety is the group of chemicals called
  Benzodiazepines included in this group is
  Librium, Valium and Xanax.
• Work directly on the nervous system. Effect is
  not long lasting and patients fall in a pattern
  of relying on the drugs and may become addicting.
  
• Remain in the body for long periods of time and
  can reach toxic levels long-term use is
  dangerous.

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Other Issues of Psychotherapy

• Cultural differences clients sometimes have
  difficulty relating to a therapist from a
  different cultural background.
• Therapist need to be culturally sensitive read,
  ask questions, dont make assumptions. If all
  else fail refer.
• Ethical issues confidentiality and the rules of
  breaking confidentiality.
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• Try to avoid dual-relationships. Therapist and
  client should not get involved in sexual
  relationship