Psychological Treatments

barriers to treatment: external issues

Systemic issues - time, money, local area

barriers to treatment: internal issues

• Ego dystonic: having a negative rltshp w the disorder

  • No benefit

  • Better to have at start of therapy

• Ego syntonic: having a positive rltshp w the disorder

  • Acceptance

  • Keeps on top

  • Safety net / coping mechanism

    • But more like trap

  • Less likely to engage w treatment

• Not inherent to specific disorders

stages of change

stepwise change of problematic thoughts & behaves

1. pre-contemplation

2. contemplation

3. preparation

4. action

5. maintenance

parable of the bridge - pos mental health reqs upkeep & sustained effort

stages of change: 1. pre-contemplation

inability or unwillingness to acknowledge the existence of a problem

• Ego syntonic rltshp

stages of change: 2. contemplation

acknowledges existence of problem but may be unsure/unwilling to change

stages of change: 3. preparation

inds recognize the prob & prepare for change

stages of change: 4. action

taking active steps to change the behaviour

stages of change: 5. maintenance

inds cont the healthy habits formed at action

• Stressors can re-emerge unhealthy behavs

  • Relapse: return of old unhealthy behavs, back to precontemplation

clinical psychologist

• Education: Ph.D in clinical psychology

• Typical approach: holistic (e.g. biopsychosocial)

• Typical focus: psychological therapies

• Prescribing medication: no

• Do they work w complementary professionals? yes

psychiatrist

• Education: MD

• Typical approach: medical (e.g. physiological)

• Typical focus: pharmacology

• Prescribing medication: yes

• Do they work w complementary professionals? Yes

designing treatment

evidence-based design

efficacy studies progress —> effectiveness studies

designing treatment: efficacy studies

• does the treatment work under perfectly ideal setting

  • Highly selected & specific homogenous pops

designing treatment: effectiveness studies

• experimental control is critically relaxed, does the treatment work in real-world settings

  • Highly inclusive heterogenous pops

approaches to treatment: early

• Supernatural: non-empirical concepts like religion, mythology, & astrology

• Exorcisms: religious ritual seeking to expunge afflicted inds of supernatural possession & curses

approaches to treatment: biomedical therapy

treat patients by adjusting physiology & neurochemistry

approaches to treatment: origins of biomedical therapy

• Humoral theory of disorders: disorder was a result of an imbalance in 4 bodily fluids(humors)

  • Blood, black bile, yellow bile, phlegm

• Hysteria: conds where physical symptoms appeared to result from non-physical causes

• Electroconvulsive therapy (ECT): brief passage of high-dosage electrical current thru scalp, stimulating a short generalized seizure involving loss of consciousness & full0body convulsions

• Psychosurgery: treatment of psychological disorders thru brain surgery

approaches to treatment: biomedical therapy: pharmacotherapy (meds) critique

• Over-embracing & prescribing b4 dangers & complications become evident

• Still researched & debated

approaches to treatment: biomedical therapy: psychosis

detachment from reality

• Medication: anti-psychotics

• Target ntsm activity: dec dopamine activity

• Mechanism: bind & hold on to postsynaptic dopamine receptors = inhibit dopamine = ineffective

approaches to treatment: biomedical therapy: anxiety & panic

• Medication: benzodiazepines

  • Short term anxiety

• Target ntsm activity: inc GABA activity

• Mechanism: bind to GABA postsynaptic receptors = calm & sedated

approaches to treatment: biomedical therapy: depression

• Medication: SSRIs

  • Long-term anxiety

• Target ntsm activity: inc serotonin

• Mechanism: inhibit collect/reuptake process of serotonin into presynaptic neuron = prolonged activity

approaches to treatment: psychological therapy & origins

considers psychological, social, & cultural factors

Institutionalization: abnormally behaved inds sent to isolated asylums

approaches to treatment: psychological therapy: psychoanalysis

• Conscious / Preconscious / Unconscious

• Id / Superego / Ego

• Defense mechanisms

approaches to treatment: psychological therapy: psychoanalysis techniques

• Free association: encouraged to let the mind wander & report back to therapist w/o self-censorship

• Analysis of resistance: psychoanalyst analyzes which topics patient wants to avoid in order to gain insight into their unconscious

• Transference: process by which a patients early childhood thoughts, feelings, & drives are 'transferred' onto the rltshp w their analyst e.g. feel same way abt therapists as he used to abt his mother

approaches to treatment: psychological therapy: psychoanalysis critiques

• Relies heavily on unobservable constructs - cant validate scientifically

• Doesn’t allow for patient outcome that would negate psychoanalysis' effectiveness

• Modern --> psychodynamic approaches:

• A shift toward empiricism

  • Behaviourism - observable constructs that are easily testable

    • Systematic desentization

approaches to treatment: psychological therapy: CBT

behavioural & cog techniques, disrupt harmful coping strategies & replace them w healthy ones

• Cognitive = challenges worry thoughts

• Behavioural = challenges ineffective coping mechanisms

• Learn healthy coping mechanisms

approaches to treatment: psychological therapy: CBT: anxiety cycle

• triggers cause worry thoughts: cognitions about things that can go wrong

  • Create feelings of anxiety

  • Cause ineffective coping mechanisms

    • But affirms worry thought (cycle)

grief model (old)

• DAB-DA

  • Denial Anger Bargaining, Depression, Acceptance

  • Not scientifically backed up

models of psychopathology: psychodynamic & cons

• strong uncon conflicts w/in mind, stress management

  • Cons:

    1. Therapy is resource intensive

    2. Underlying theory cant be disproved

models of psychopathology: behavioural

• Focus on observable behaviour

• Conditioning

• Cons:

  • ignores deeper mechanisms

  • cannot explain all (e.g. hallucinations)

models of psychopathology: cognitive

• disorders result from maladaptive selection & interpretation of stimuli

  • Therapy focus on pos interpretations of sits

  • CBT: how do u think abt urself & others? How do actions affect ur thoughts?