Ch 15.3 - Special topics

Behaviour Therapies

Therapies based on learning principles that aim to change maladaptive behaviours. They assume behaviour is learned and can be unlearned using classical conditioning, operant conditioning, and observational learning.
Example: A person learns new coping behaviours to replace avoidance in social situations.

Systematic Desensitization (SD)

A behavioural therapy that reduces anxiety by gradually exposing a person to feared situations while they stay relaxed. It uses counterconditioning to replace fear with relaxation.
Example: A person afraid of flying slowly works from imagining planes to eventually taking short flights while using relaxation techniques.

Steps in Systematic Desensitization

First, the client creates an anxiety hierarchy. Second, they learn deep relaxation skills. Third, they are gradually exposed to feared situations while staying relaxed (in imagination or real life).
Example: A person ranks fear situations from looking at a spider picture to holding a spider and works through them step by step.

Effectiveness of Systematic Desensitization

It is effective for treating specific phobias, PTSD, and other anxiety-related disorders.
Example: A person overcomes a severe dog phobia through gradual exposure and relaxation training.

Cognitive Behavioural Therapy (CBT)

A therapy that combines changing thoughts and behaviours to reduce psychological distress. It uses techniques like exposure, relaxation, modelling, and activity scheduling.
Example: A person with depression learns to challenge negative thinking while increasing daily activities.

Cognitive Restructuring

A CBT technique where clients identify negative automatic thoughts, test their accuracy, and replace them with more realistic thoughts.
Example: A person changes the thought “I always fail” to “I didn’t succeed this time, but I can improve.”

Effectiveness of CBT

CBT is effective for many disorders including depression, anxiety, PTSD, OCD, eating disorders, schizophrenia, substance use problems, ASD, and insomnia (considered a gold standard treatment for insomnia).
Example: A person with panic disorder reduces symptoms by learning thought-challenging and exposure strategies.

Biomedical Therapies

Treatments that reduce symptoms of psychological disorders by directly affecting the body or brain, based on the idea that some disorders have biological causes.
Example: Medication is used to reduce symptoms of depression.

Electroconvulsive Therapy (ECT)

A biomedical treatment where a controlled electric current is used to trigger a brief brain seizure under anesthesia, usually for severe cases.
Example: A person with severe depression that hasn’t improved with medication receives ECT sessions.

ECT Procedure and Schedule

The patient is anesthetized, electrodes are placed on the head, and a brief electrical pulse triggers a short seizure. Treatments are usually given 2–3 times per week for several weeks (about 6–12 sessions).
Example: A patient undergoes ECT three times weekly over a month to treat severe depression.

Criticisms of ECT

Some argue ECT may be no better than placebo in some studies and can cause serious side effects, including memory loss and cognitive confusion.
Example: A patient reports difficulty remembering personal events after treatment.

ECT Side Effects

Short-term effects include confusion, memory loss, and attention problems; in some cases, long-term autobiographical memory loss can occur.
Example: A person struggles to recall events from before treatment.

Antidepressant Drugs

Medications that improve mood and treat depression, and can also help with anxiety disorders like OCD and panic disorder.
Example: A person with depression takes SSRIs to increase serotonin levels.

SSRIs (Selective Serotonin Reuptake Inhibitors)

A common type of antidepressant that increases serotonin availability in the brain by slowing its reabsorption.
Example: A person takes an SSRI daily to reduce depressive symptoms.

Anti-Anxiety Drugs (Benzodiazepines)

Medications that quickly reduce anxiety, tension, and nervousness, but are usually used short-term or as needed.
Example: A person takes a benzodiazepine before a panic-inducing situation.

Antipsychotic Drugs

Medications used to reduce symptoms like hallucinations, delusions, and disorganized thinking, mainly in schizophrenia and severe mood disorders.
Example: A person with schizophrenia takes medication to reduce hallucinations over time.

Mood Stabilizers

Medications used to control mood swings in bipolar disorder and prevent future episodes of mania and depression.
Example: A person with bipolar disorder takes lithium to stabilize mood.

Eclectic Therapy Approach

A modern approach where therapists combine techniques from different types of therapy depending on the client’s needs.
Example: A therapist uses CBT techniques along with supportive counselling.

Effectiveness and Criticisms of Drug Therapy

Drug treatments are widely used but debated because they may only reduce symptoms temporarily and can be overused compared to talk therapy, which can be equally effective and safer long-term.
Example: Medication reduces anxiety quickly but doesn’t teach coping skills for stress.

Combination Therapy Effectiveness

Research shows that combining medication and psychotherapy often leads to the best outcomes.
Example: A person with depression improves most when using both antidepressants and CBT.

Common Factors in Psychotherapy (Lambert, 1992)

Therapy effectiveness is mainly due to shared factors across all therapies: client factors (40%), therapist-client relationship (30%), expectancy/placebo effects (15%), and specific techniques (15%).
Example: A supportive therapist relationship contributes more to improvement than the specific therapy type used.

Telepsychology

Online therapy and psychological services delivered through digital platforms, often found to be as effective as in-person therapy.
Example: A client attends therapy sessions over video call and shows improvement.

Computerized Therapy

Digital programs that teach mental health strategies through modules, exercises, and sometimes limited therapist support.
Example: A person completes an online CBT program for anxiety.

Effectiveness of Computerized Therapy

Research shows these programs can effectively treat disorders like anxiety and depression, with lasting benefits and low risk of harm.
Example: A person reduces depressive symptoms by completing structured online therapy modules.

Drowsy Driving

Driving while overly tired, which increases the risk of accidents due to reduced attention, slower reactions, and brief “micro-sleep” episodes.
Example: A driver drifts off the road after staying awake all night.

Typical Features of Drowsy Driving Accidents

Often happen late at night or early morning, involve high speeds, usually single-vehicle crashes, and drivers fail to react or correct their path.
Example: A tired driver veers off the highway without braking or swerving.

People Most at Risk for Drowsy Driving

Sleep-deprived individuals, people who use alcohol or sedating medication, shift workers, teens/young adults, and those with untreated sleep disorders.
Example: A night-shift worker falls asleep while driving home in the morning.

Effects of Sleep Deprivation

Causes poor focus, slower thinking, increased errors, mental distress, delayed reactions, and micro-sleeps (brief uncontrollable sleep episodes).
Example: A student misses traffic lights due to slowed reaction time from lack of sleep.

Prevention of Drowsy Driving

Can be reduced through adequate sleep, road rumble strips, and driver alertness monitoring systems.
Example: A car alarm system warns a driver when they begin to drift out of their lane.

Sleep Habits to Prevent Drowsy Driving

Good sleep routines include consistent sleep schedules, limiting naps, reducing caffeine late in the day, avoiding screens before bed, and creating a dark, relaxing sleep environment.
Example: A person stops late-night studying and goes to bed at a fixed time to stay alert while driving.

Borderline Personality Disorder (DSM-5 Criteria)

A disorder involving unstable emotions, relationships, self-image, and impulsive behaviour beginning in early adulthood. Diagnosis requires 5+ symptoms such as fear of abandonment, identity disturbance, impulsivity, mood instability, anger issues, self-harm, emptiness, and paranoia under stress.
Example: A person has intense mood swings, unstable relationships, and repeated self-harming behaviour.

Prevalence and Causes of BPD

Affects about 1.6%–5.9% of people. Linked to genetic vulnerability combined with environmental factors like childhood abuse, neglect, or early loss.
Example: A person with a history of childhood trauma develops emotional instability and impulsive behaviour.

Treatments for Borderline Personality Disorder

Includes therapies like DBT, MBT, TFT, GPM, medication for symptoms, and self-care. Many people improve significantly over time with treatment.
Example: A person reduces self-harm and emotional instability after consistent therapy.

Dialectical Behaviour Therapy (DBT)

A CBT-based therapy that balances acceptance and change, teaching skills to manage emotions, reduce self-harm, and improve relationships through individual therapy, group training, and coaching.
Example: A person learns mindfulness skills to calm intense emotional reactions.

Outcome of BPD Treatment

While emotional sensitivity may persist, many individuals improve within the first year of therapy, and symptoms often do not return after remission.
Example: A person who once had severe impulsivity maintains stable relationships after therapy.

Hikikomori

Severe and long-term social withdrawal lasting at least 6 months, where individuals isolate themselves from school, work, and social life, often staying in their rooms.
Example: A young adult stops attending school and rarely leaves their bedroom for months.

Impact of Hikikomori on Families

Families often experience stress, stigma, emotional distress, and difficulty supporting the isolated individual.
Example: Parents struggle emotionally while trying to care for a withdrawn child who refuses to leave their room.

Treatment for Hikikomori

Includes therapy (individual, group, family), psychoeducation for families, home visits, and gradual social/recreational re-engagement programs.
Example: A support worker visits a home to slowly encourage a person to re-engage with society.

Hikikomori vs Agoraphobia

Agoraphobia is fear of being trapped or unable to escape panic in public places, while hikikomori is social withdrawal driven by shame, failure avoidance, and social pressure rather than panic fear.
Example: A person with agoraphobia avoids malls due to panic fears, while a hikikomori avoids leaving home due to social withdrawal and shame.

Parasomnias

Sleep disorders involving abnormal behaviours or physical experiences that happen during sleep, sleep stages, or transitions between sleep and wakefulness. Common examples include sleepwalking, sleep terrors, nightmares, sleep paralysis, REM behaviour disorder, and sleep-related eating disorder.
Example: A child sleepwalks around the house during the night.

Sleep Paralysis

A temporary state where a person is conscious but cannot move or speak, often occurring between sleep and wakefulness. It may include intense fear, chest pressure, and hallucinations, and usually lasts seconds to minutes.
Example: A person wakes up unable to move and feels like someone is sitting on their chest.

Sleep Paralysis and Sleep Physiology

Occurs when REM sleep muscle paralysis happens while the person is awake and aware, instead of during dreaming.
Example: A person is conscious but their body remains “locked” like in REM sleep.

Risk Factors for Sleep Paralysis

More likely with sleep deprivation, high stress, and sleep-related physical issues like leg cramps.
Example: A stressed student pulling all-nighters experiences sleep paralysis episodes.

Cultural Interpretations of Sleep Paralysis

Different cultures explain it through supernatural beliefs such as spirits, ghosts, or alien encounters.
Example: In some cultures, it is described as a “ghost sitting on the chest.”

Narcolepsy

A neurological sleep disorder involving sudden sleep attacks and excessive daytime sleepiness; sleep paralysis can sometimes be a symptom.
Example: A person suddenly falls asleep during conversations or while eating.

REM Behaviour Disorder (RBD)

A parasomnia where a person physically acts out vivid dreams due to lack of normal muscle paralysis during REM sleep, sometimes leading to injury.
Example: A person punches or kicks while dreaming they are in a fight.

REM Behaviour Disorder Features and Risk

Often goes unnoticed until injury occurs, matches dream content, and is linked to other sleep disorders. More common in men over 50 and associated with neurological conditions like Parkinson’s disease and dementia.
Example: An older man acts out violent dreams and injures his partner during sleep.