Methods of Treatment

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Methods of Treatment
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Therapy and Change
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Psychotherapy

• Psychotherapy translates as Healing of the soul
• Systematic interaction between client and
  therapist that incorporates psychological
  principles to help bring about changes in
  clients, thoughts, feelings, and behaviors.
• Focus is to help client overcome abnormal
  behaviors, solve problems in living, or develop
  as an individual

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Goals of Psychotherapy

• Strengthen clients motivation to help themselves
• Decrease emotional pressure by facilitating
  expression of intense feelings
• Habit change
• Modify cognitive structure of client
• Increase clients knowledge of self (insight)
  for making life decisions
• Improving interpersonal relationships

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Qualities For Being An Effective Therapist

• Need to be an attentive listener
• Attentive to non-verbal cues
• Able to convey empathy, genuineness, and warmth
  (verbally nonverbally)
• Able to convey a sense of hope for improvement
• Matching gender, culture, or age may be important
  to client, but not clear if improves
  effectiveness
• Cultural sensitivity very important

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Types of Treatments

• Psychotherapy
• Psychodynamic
• Behavioral
• Cognitive and Cognitive-Behavioral
• Humanistic
• Biological
• Psychopharmacology
• Electroconvulsive Therapy (ECT)

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Psychodynamic Psychotherapy

• First formulated by Freud
• focuses on past
• Duration/Frequency Long term/ 3x/week
• Premise repressed thoughts/feelings from
  childhood cause distress symptom removal not
  sufficient to solve the problem

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Psychodynamic Psychotherapy

• Techniques
• Reconstruction of personality by insight
  (uncovering of motives, emotions, conflicts
  operating in the unconscious) and expression of
  unresolved conflicts
• Uses Free Association (exploration of
  preconscious by saying whatever comes to mind
  without censoring),
• Dream Interpretation (to reveal hidden motives
  conflicts)
• Transference (patient transfers childhood
  feelings toward loved or hated people to
  therapist)

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Humanistic Psychotherapy

• Focuses on Here Now, although assumes past
  affects present
• Focuses on clients subjective, conscious
  experiences to release potential for happiness
  growth through full acceptance of self freedom
  responsibility of acting on choices
• Persons value, dignity, worth are emphasized
• Belief that the client and therapist are partners

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Humanistic Psychotherapy

• Techniques
• Unconditional positive regard (total acceptance
  non-judgment of client)
• Empathy (therapist attempts to see world through
  clients eyes)
• Reflection (acts as mirror, summarizing clients
  emotions)
• Active listening (therapist tries to understand
  content emotion of whats said)
• Types
• Client-Centered (Carl Rogers)-Unconditional
  Positive Regard
• Gestalt (Fritz Perls)

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Behavior Therapy

• Systematic use of learning principles to change
  maladaptive behavior
• Focuses on target symptoms Here Now, not
  the past
• Based on Operant and Classical Conditioning
  principles

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Behavior Therapy

• Duration/Frequency relatively brief (8-20
  sessions)/ 1-5x/week
• Techniques
• Relaxation
• Systematic Desensitization
• Modeling
• Exposure/Flooding
• Response Prevention
• Token Economies
• Biofeedback
• Assertion Training

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Systematic Desensitization

• A technique used to help a patient overcome
  irrational fears and anxieties
• Pairing relaxation techniques with
  anxiety-producing situations
• Person builds an anxiety hierarchy, with the
  least feared situation at the bottom and the most
  feared at the top.

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Exposure/Flooding

• The opposite of systematic desensitization
• Person exposed to anxiety evoking situation for
  extended period of time, until anxiety subsides
• Premise is worst fear, does not occur anxiety
  must diminish after some amount of time

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Aversive Conditioning

• Links an unpleasant state with an unwanted
  behavior in an attempt to eliminate the behavior
• Use of drugs with alcohol that cause nausea
• 50 success rate takes 6 months

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Operant Conditioning

• Behavior that is reinforced tends to be repeated
• Contingency management undesirable behavior is
  not reinforced, while desirable behavior is
  reinforced
• Used in prisons and mental hospitals

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Token Economies

• Desirable behavior is reinforced with valueless
  objects or points which can be accumulated and
  exchanged for various rewards

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Cognitive and Cognitive-Behavioral Therapy

• Cognitive Therapy - identification and correction
  of maladaptive beliefs and self-defeating
  attitudes that create or compound emotional
  problems
• Cognitive-Behavioral Therapy -premise is that
  thinking patterns and beliefs affect behavior
  that changes in these cognitions can lead to
  desirable behavior changes
• Both Present Focused w/relative brief duration

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Rational-Emotive Therapy (RET)

• Albert Ellis aimed at changing unrealistic
  assumptions
• People behave in rational ways
• Role playing

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Elliss A B C

• A Activating event
• B Persons belief system
• C Consequences that follow

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Becks Cognitive Therapy

• Maladaptive thought patterns cause a distorted
  view of oneself and lead to problems
• Works well with depressed people

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Therapeutic Modalities

• Individual
• Couple
• Family
• Group (diagnosis based, theme/symptom focused,
  time-limited, etc.)

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Biological Therapy

• Assumes an underlying physiological problem
• Psychopharmacology (medication), electric shock
  (ECT), psychosurgery
• Must be administered by a psychiatrist or nurse
  practioner
• Used when talking and learning theories do not
  work

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Biomedical Therapy

• Regulation of functions of the brain
  neurotransmitters or compensation for brain
  abnormalities or effects of genetics
• Psychopharmacology
• Advantages quick, effective, appeal to
  non-psychologically minded, cost effective(?)
• Disadvantages may have unwelcome or dangerous
  side effects, potential for abuse
• Electroconvulsive Therapy (ECT)
• primarily for non-responsive Major Depression

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Major Psychotropic Drugs

• Antianxiety Agents (Anxiolytics)
• Benzodiazepines (Xanax, Ativan, Klonopin, Valium)
• Barbiturates (Miltown)
• Hypnotics (Ambien, Halcion, Dalmane)
• Others (BuSpar)
• Antipsychotic Drugs (Neuroleptics)
• Phenothiazines (Thorazine, Stelazine, Prolixin,
  Trilafon)
• Atypical Antipsychotics (Risperdal, Zyprexa,
  Seraquel, Abilify)

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Major Psychotropic Drugs

• Antidepressants
• Tricyclics (Tofranil, Elavil, Sinequan)
• MAO Inhibitors (Nardil, Parnate)
• SSRIs (Paxil, Prozac, Zoloft, Lexapro, Celexa)
• Others (Wellbutrin, Effexor, Cymbalta, Pristiq)
• Mood Stabilizers (Lithium, Depakote,
  Trileptal,Tegretol, Lamictal)
• Psycho stimulants (Ritalin, Adderal, Cylert,
  Concerta)

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Electroconvulsive Therapy (ECT)

• ECT sends an electric shock through the brain to
  try to reduce the symptoms of mental disturbance,
  causing a convulsion in the brain similar to an
  epileptic seizure
• Patients receive a series of brief shocks that
  measure approximately 70150 volts and last for
  0.11.0 seconds
• Treatment involves multiple sessions administered
  over the course of several weeks

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Electroconvulsive Therapy (ECT)

• ECT has proven extremely effective in the
  treatment of severe depression
• ECT involves very little discomfort. A patient
  receives sedatives and muscle relaxants prior to
  the treatment
• In the past, ECT was often abused and
  administered brutally the seizures sometimes
  caused muscular contractions so intense that a
  patients bones would break

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Psychosurgery

• Pre-frontal lobotomy (a radical procedure that
  cuts off parts of the frontal lobes of the
  brain), done routinely in the 1940s 50s
• Destroys part of the brain to make the patient
  calmer and freer of symptoms
• Impaired intellect, loss of motivation,
  personality changes
• Only done rarely today, in very extreme cases