week 12: clinical treatment

approaches to treatment + goals

• two kinds:

  1. psychotherapy treatment: ppl interact with a clinician to use the environment to change their brain and behaviour

  2. biomedical treatment: drugs, surgery, or direct intervention directly treat the brain. → used for most clinical disorders (anxiety, depression, bipolar etc)

     • in some cases, ppl recieve both

       • ie: to treat OCD one might be treated with both ERP and medication to reduce obsession thoughts and compulsive urges

• goals:

  • direct intervention: addressing the cause to hopefully cure the disorder

  • symptom support: reduce the impact of symptoms

  • insight: help patient learn about the cause of the disorder and how to fix it

antipsychotic drugs

• treat schizophrenia and related psychotic disorders

  • ie: chlorpromazine, thioridazine (mellaril), and haloperidol (haldol)

• before drugs, ppl with schizophrenia (and other mental disorders) were so difficult to handle that they were sent to asylums → now known as psychiatric hospitals

  • divided into two types:

    1. conventional/typical: exclusively block dopamine receptors, reducing effect of dopamine in the brain and good for positive symptoms

    2. atypical: block activity of both serotonin and dopamine → less side effects and treats negative symptoms

psychopharmacology

• following the deinstitutionalization of many ppl, psychopharmacology: study of drug effects on psychological states and symptoms

  • researchers believe that antipsychotic medications exert their effect by blocking dopamine receptors in certain parts of the brain (dopamine hypothesis)

    • increased dopamine → bizarre positive symptoms: hallucinations, and delusions

  • however, decrease in dopamine → increase in negative symptoms such as sociaal withdrawal

    • NOW there is a new class of drugs introduced known as atypical antipsychotics

      • affect both the dopamine and serotonin levels → blocking both receptors

      • side effectde: tardive dyskinesia:a condition of involuntary movements of the face,mouth, and extremities

antianxiety medication

• drugs that help reduce a persons experience of fear or anxiety

  • usually are benzodiazepines → a type of tranquilizer that calms a person down by releasing the neurotransmitter GABA

    • effective for reducing symptoms fo anxiety disorders HOWEVER can result in development of drug tolerance

antidepressants and mood stabilizers → iproniazid + tricyclic antidepressants + SSRI

• Antidepressants are a class of drugs that help lift people’s moods

  • iproniazid is a monoamine oxidase inhibitor (MAOI) → prevents the enzyme monoamine oxidase from breaking down neurotransmitters such as norepinephrine, serotonin and dopamine

  • tricyclic antidepressants: block the reuptake of norepinephrine and serotonin → increasing the amount of neurotransmitter in the synaptic space between neurons

  1. SSRIs (selective serotonin reuptake inhibitors): block the reuptake of serotonin in the brain

  • SSRI work only on the serotonin system but tricyclic work on serotonin and norepinephrine

  2. Bupropion: increases norepinephrine and dopamine, and has fewer side effects that SSRI

  3. SNRI (serotonin-norepinephrine reuptake inhibitors): increase both serotonin and norepinephrine; rapidly increasing in popularity

Mood stabilizers: drugs used to treat bipolar disorder that attempt to decrease the severity of depressive and manic episodes

• two major types:

  • Mineral salts/ lithium: decrease epinephrine (adrenaline) and increase serotonin → helping most mania and depression

  • Anticonvulsant: increases norepinephrine GABA and norepinephrine → and especially helping during manic episodes + preventing seizures in epileptic patients

should mood stabilizers be used for bipolar disorder?

• antidepressants are used to treat major depression, BUT not recommended for treating bipolar disorder

• however, mood stabilizers are used to treat bipolar disorder → by suppressing swings between mania and depression

placebo effect

• an inert substance or procedure that has been applied with the expectation that it will produce a healing response

  • ie: if you have a headache, and taking a sugar pill that does not contain any painkiller, thinking it is Tylenol and aspirin, the pill is a placebo if the headache goes away

• ppl with medical and emotional problems experience significant improvement after a placebo treatment

reconstructive memory

• when the clients motivation to get well causes errors in reconstructive memory for the original symptoms.

  • ie: remembering that your symptoms before treatment were worse than they actually were

how to make sure if treatment is working → 4 problems

1. self report is unreliable → possible existence of biases and patients tend to misremember how bad their symptoms were

2. natural improvement → worst symptoms often go away on their own + patients tend to seek treatment when they are at their worst so how do we know if they improved

3. placebo effect → using something with the expectation that it will fix me

4. nocebo effect → trying to just gauge how my mental disorder is and how my treatment is going to be → leads to increased levels of stress which worsens the symptoms

efficacy v effectiveness

efficacy: how well treatment works in best case scenario

effectiveness: how well the treatment actually works → most closely related to external validity

• efficacy is always higher than effectiveness as there are no limitations and in most ideal cases

treatment outcome research/ randomized control trial (rct)

• measures the effectiveness of the treatment

  • gold standard experiment assessing the efficacy of an intervention → to test treatment

• no treatment: tells us how well natural improvement works and gives measure for patient bias for assessing pre v post symptoms

• active control: measures efficacy in compariosn to doing something → placebo and nocebo effects

serotonin v dopamine v gaba v norepinephrine

serotonin: related to feelings of wellbeing, appetite, and sleep → depression

dopamine: primarily related to increasing activity in various brain regions + related to reward and pleasurable feelings → schizophrenia

gaba: related to neuronal activity (more gaba = less activity)

norepinephrine: increases arousal and sense of alertness during stress response → depression → stress reponse → fight or flight

anxiolytics/anti-anxiety

• drugs used to treat anxiety, but not as popular due to its tendency for abuse and adverse interactions → only alleviates symptoms and builds strong drug tolerance

• three main types:

  1. benzodiazepines: drugs increasing GABA (reducing neuron activity), most common, and most efective

  2. beta blockers: block norepinephrine and help with physiological reaction of anxiety → ie: slow down heart rate

  3. buspirone: increases serotonin levels and used for GAD and for anxiety with comorbid depression

Psychosimulants

• drugs used to treat attentional disorders + selectively releasing norepinephrine, serotonin, dopamine, boosting attention, wakefulness, and persistence

  • Frequently abused and can be fatal

    • Used for adhd, depression, and eating disorders

psychodynamic psychotherapies + psychoanalysis/psychodynamic

• focuses on exploring childhood events and encourage individuals to use the understanding gained from the exploration to develop insight into their psychological problems → reading between the lines

  • psychoanalysis: assume that ppl born with aggressive and sexual urges that are repressed during childhood development through the use of defense mechanisms → relates to freudian theory

• unique features:

  1. interpretation: therapist helps client understand what is wrong

  2. transference: client projects their unconscious desires and defense mechanism onto therapist who analyzes them → similar to projection (coping method)

  3. removing interference: client MUST be distraction free

  4. long time: takes nearly 2 years and meeting with therapist multiple times a week

• techniques:

  1. unstructured talk: its like having a convo with your friend

  2. free association: generating ideas as they come to mind and the quicker you get the more unfiltered you get

  3. dream analysis: therapist analyzes dreams

  4. resistance: when client becomes upset about what is being discussed → therapy is on right track

interpersonal psychotherapy (ipt)

• a form of psychotherapy that focuses on helping clients improve current relationships

  • used to help clients understand their interpersonal behaviours and feelings, rather than using free association

  • pay attention to: clients grief (losing a loved one), role disputes (conflicts with a significant other), role transitions (changes in life status ie getting married), or interpersonal deficits (lack of skills to maintain a relationship)

effectiveness of therapy

• IPT and cognitive behaviour (or behavioural) therapy are more efective than psychodynamic and other treatments, especially in the treatment of depressive and anxiety disorders

humanistic and existential therapies

• assume that human nature is generally positive, and they emphasize the natural tendency of each individual to strive for personal improvement

  • share the assumption that psychological problems stem from feelings of loneliness and that those feelings can be traced to failure to reach ones potential (in humanistic approach) or failure to find meaning in life (in the existential approach)

• two types include: (1) personal centred therapy (a humanistic approach) and (2) gestalt therapy (an existential approach)

personal centred therapy/client centred (a humanistic approach)

• personal centred therapy (a humanistic approach) → opposite of psychoanalysis

  • assumes that all individuals have a tendency towards growth and that this growth can be faciliated by acceptance by and genuine reactions from the therapist

    • allows each person to determine their own goals fo therapy → instead of directing, the therapist paraphrases words to help client recognize

      1. demonstrate basic qualities: congruence (openness and honesty in the therapeutic relationship → body language and words match)

      2. empathy (trying to understand the client by putting yourself in their shoes)

      3. unconditional positive regard (must be warm and accepting to help client feel safe in expressing thoughts and feelings)

      4. active listening/mirroring: listening in which therapist restates what the patient said without interpretation

      5. motivational interviewing: therapist recognizes cognitive dissonance in how client acts and asks for clarification but not change

Psychotherapy/psychoanalysis + insight and intervention focused therapies

• insight focused therapies: educate client about the cause of their disorder and how to address it

  • diff types: psychodynamic (freudian theory of id, ego, superego), humanistic (person centred), and existential (gestalt)

• intervention focused therapies: helping client learn to cope

  • behavioural, cognitive, cbt (cognitive and behavioural), and third wave (dot, act)

gestalt therapy (an existential approach)

• gestalt therapy (an existential approach)

  • has the goal of helping the client become aware oftheir thoughts, behaviours, experiences, and feelings and to “own” or take responsibility for them

    • encouraged to be enthusiastic and warm to clients

    • emphasizes the experiences and behaviours that occur during therapy session → asking “how do you feel as you describe what happened to you” → known as focusing

      • another method is the empty chair in which you sit across from an empty chair and role play the way the other person would respond.