Treatments

What contribution did Freud have in modern psychotherapy?

Freud had developed psychoanalysis. This was developed by Freud’s patient, who’s symptoms had cleared up after talking about things in the past. He theorized that the bottled up (unconscious) emotions had led her to develop such symptoms. This was a big step in psychiatry and psychopathology.

Types of treatments: Insight Therapy

Derived from: Psychoanalysis

Clients engage in lengthy and complex conversations in efforts to understand the cause of the difficulties and find solutions

Types of Treatment: Behavior Therapies

Derived from: Principles of Learning

Making direct efforts to change problematic behaviors (phobias, drug use) through conditioning techniques, such as reinforcement and punishment.

Types of Treatment: Biomedical Therapies

It is the use of medications and medical procedures to treat psychological disorders by changing biological factors.

Who seeks therapy the most?

Women are more likely to seek therapy than men. Whites are more like to seek therapy than black or hispanic people. People with more education and unmarried/separated people.

What are the obstacles to seeking therapy?

The stigma in seeking therapy (usually seen as a sign of weakness) and the lack of insurance/worry about cost.

What disorders are the most common? what’s a common trend?

Depression and anxiety. Many people who need therapy are less likely to receive it due to elongating the treatment seeking process.

What does the type of insurance have to do with the seeking of therapy?

People with public insurance are more likely to get therapy, compared to people with private insurance. People with no insurance are at the lowest with seeking/getting therapy.

Clinical Psychologist

They treat people with mental disorders, working to treat or diagnose those disorders. Their degrees consists of PhD or PsyD (5-7 years)

Counseling Psychologists

They treat people who are having day to day problems such as work, career, etc. Their degree consists of PhD, PsyD or EdD (5-7)

Psychiatrists

Medical doctors who specialize in mental health with severe psychological disorders, through biomedical processes and insight therapy. Their degree consists of MD (8 yrs)

Clinical Social worker

Their degree is of 2 to 5 years after bachelors. They do insight and behavioral therapies to help individuals cope with psychological, emotional, or social issues.

Psychiatric Nurse

A trained nursing professional who specializes in mental health care, providing treatment and medication management for patients with psychiatric disorders. Degree consists of RN, PhD, MA.

Counselor

Consists of drug counseling and rehab counseling, as well as employment counseling. (0-2 yrs after bachelors)

Marriage and family therapist

Says it in the name. Degree is MA or PhD (2-5 yrs)

What matters when choosing a therapist?

The relationship between the client and the therapist matters a lot. The degree does matters because that’s an indication of the therapists training and creditability.

Insight Therapies

The talkative therapy that works to enhance the clients self-knowledge.

Psychoanalysis

created by sigmund freud, it’s an insight therapy. It focuses on unconscious conflicts and how they influence behavior. This is thought to be due to unconscious conflicts from early childhood.

How does psychological disorders develop according to psychoanalysis? what’s the goal?

Through unconscious and unresolved conflicts from unsuccessful achievement of the psychosexual stages of development. The goal is to resolve such unconscious conflicts to achieve insight and catharsis: repressed emotinal relieve.

What’s free association and dream analysis?

It’s techniques used by psychoanalysis to access the unconscious. Free association is the patient speaking about anything that comes to mind as it is, while dream analysis interprets dreams to uncover unconscious material.

What’s resistance and transference?

Resistance is unconscious defensive maneuvers that hinder the effect and process of therapy. Transference is the transfer of conflicting feelings about someone towards the therapist.

Psychodynamic Therapies

Descendant of psychoanalysis, focuses on the unconscious of a person, but treatments are shorter and less intense.

What are the core features of psychodynamic therapies?

Core features include exploring the unconscious, therapeutic relationship, insight development, and addressing unresolved conflicts from the past, etc.

What’s client-centered therapy?

An insight therapy developed by Rogers. It emphasizes making a supportive emotional climate for clients.

How do psychological disorders develop according to the client-centered therapy? Goal?

It develops through incongruence. Rogers believed the unhealthy self-concept and experiences caused by “conditional love” causes psychological issues. The goal is to achieve self-actualization and decrease incongruence.

What are the treatments?

Creating a positive emotional climate through three conditions: genuineness (honest communication), unconditional positive regard and accurate empathy (mirroring).

What do researchers day about Rogers approaches? especially about empathy?

Research suggests that the components of Roger’s therapy (esp. empathy) are critical for good outcomes for other therapies as well

Do insight therapies work?

There can be difficulty in determining their effectiveness due to the variety of insight approaches. But, in general, they are effective.

What’s the statistics of the therapies working?

Roughly as effective as drug therapies (but without side effects)

• First 10-20 weeks of treatment = greatest effects

• Durable effects

• They do not work for everyone (many studies show that about 1/3 have spontaneous remission, treatment is particularly effective for 1/3 and treatment is not as effective for the last third).

• Insight therapies an also be combined with medication

Common factors with insight therapies about how they work:

• Relationship with therapist

• Emotional support and empathy

• Cultivation of hope and positive expectations in client

• Explanation of the issues and plausible solution(s)

• “Opportunity to express feelings, confront problems and gain new
  insights”

Group Therapy

The simultaneously treating of a small group. Therapist screens potential group members, sets goals for group, initiates and maintains the therapeutic process, prevents harmful
interactions between groups members

• 4-12 people (6-8 ideal)

• Costs less

• Other benefits: people who can relate/normalization, practical tips

Couples and family therapy

Couples or marital therapy involves the treatment of both partners in a committed, intimate relationship and family therapy involves the treatment of a family unit as a whole, in which the main focus is on family dynamics and communication.

Behavior Therapy (CBT)

Treating maladaptive behavior through learning tactics like conditioning

How do psychological disorders arise according to behavior therapy? goals?

Due to learned maladaptive behaviors in response to stimuli. to unlearn does maladaptive behaviors and replace with healthier coping strategies.

Systematic desensitization therapy

This is used to reduce clients phobic responses as it assumes most fears are due to classical conditioning. It works to:

• build anxiety hierarchy

• teach relaxation techniques

• Imagined exposure to feared stimuli.

• exposure therapy: exposing the person to the feared stimuli

• virtual reality presentations

What’s social skills training?

It’s a behavioral therapy designed to improve interpersonal skills with shaping, modeling and behavioral rehearsal.

• modeling: watch social people to acquire those social skills

• shaping: reinforcing gradual approximations of desired behaviors

• behavioral techniques: practicing social skills in role-playing exercises to enhance confidence and communication.

Aversion Therapy

Biomedical and learning principles

To condition an repulsed response to an undesirable behavior, often using unpleasant stimuli as the cause.

ex. drinking a pill that, if you drank alcohol later would make you sick and throw up, to condition the action of being not wanting alc.

Effectiveness of behavior therapies

Effective for a wide variety of issues, though some treatments are appropriate for some issues and not others.

How do psychological disorders arise according to cognitive therapy? goals?

Through maladaptive thinking (ex. thinking of only the negative rather than the positive). To change said maladaptive thinking.

Cognitive therapy treatments? What’s beck’s cognitive therapy?

Beck’s cognitive therapy: uses cognitive techniques to address and reshape negative thought patterns, helping clients develop healthier thinking habits.

Behavioral activation and cognitive bias modification?

• Behavioral activation that helps people engage in meaningful or enjoyable activities to improve mood and reduce depression. (depression, anxiety and ptsd)

• Cognitive bias modification is a computerized intervention that aims to change automatic, negative thought patterns (generalized anxiety disorder, social anxiety, depression related thoughts)

Cognitive behavioral therapies (CBT)

CBT uses both verbal interventions and behavior modification to help change the clients maladaptive patterns of thinking. (often used with behavioral therapy)

Is CBT affective?

It is very affective (even UNC uses it). the effects are durable, there’s no side effects.

Ellis’ rational-emotive behavior therapy

This therapy focuses on you think the way you feel using both behavioral and cognitive aspects. We get distressed due to the meaning of what happens, not the event itself.

Dialectical Behavior Therapy (DBT)

This is a type of CBT that targets managing intense emotions and tolerating distress in intense situations.

• Moderate – severely emotionally distressed should seek DBT therapy with a clinician.

What’s the difference between CBT & DBT?

CBT primarily focuses on changing negative thought patterns, while DBT focuses more on intense emotions and how to regulate them.

Biomedical Therapies (medications)

Physiological interventions (medication) intended to reduce symptoms associated with psychological disorders.

Anti-anxiety drugs

These medications are also called sedatives, anxiolytics, and tranquilizers.

• drugs: Valium (diazepam) and Xanax (alprazolam)

These medications have short-lived effects (only for hours)

can also treat depression

What are the side effects of anti-anxiety drugs?

Short-term effects: Possible drowsiness, dizziness, fatigue, depression, nausea, cottonmouth and constipation

Long-term effects: dependency of the drug, abuse of the drug, overdose, synergistic effects (when two things interact, they amplify each other)

• withdrawal effects

Anti-psychotic drugs

aka psychotropic, neuroleptics

• it is a dopamine antagonist

70% of patients respond, but in different ways

It takes 2-7 days to take effect (can keep improving)

What are the side effects of anti-psychotic drugs? tardive dyskinesia?

short term effects: drowsiness, cottonmouth, tremors, rigidity.

long term effects: tardive dyskinesia (15-25% of traditional drugs caused this) - involuntary repetitive movement usually of the tongue

70% relapse

2nd generation of anti-psychotic drugs

aka. atypical anti-psychotics

• less risk for tardive dyskinesia

• partial agonists can help both positive and negative symptoms of schizophrenia or bipolar disorder

• 70% relapse: returning to using the drug

• increases the chances of diabetes or cardiovascular problems

What’s affinity and efficacy?

Affinity is how well a drug binds to a receptor, while efficacy refers to the ability of that drug to activate the receptor and produce a biological response.

What’s the dopamine theory & what’s does a partial agonist do for anti-psychotic drugs?

The dopamine theory suggests that schizophrenia is linked to overactivity of dopamine in the brain. The partial agonist is unable to produce maximum activation to all receptor sites, therefore having a much larger effect on the frontal lobe compared to the nucleus accumbens.

Anti-depressants drugs

Tricyclics (Tofranil), MAO Inhibitors (Iprozid, cheese effect), SNRIs (Strattera): will block Norepinephrine reuptake, buproprion (Wellbutrin)

Especially: SSRIs which are the most widely prescribed slowing the reuptake of serotonin (e.g. Prozac [fluoxetine], Paxil [paroxetine], Zoloft [sertraline])

• 60% = effects in the first 2 weeks...but effects usually take longer

• works better on severely depressed

Anti-depressants drugs side effects?

Side effects, possibly including increased suicidal thinking in adolescents and
young adults (though they are at risk when untreated as well) – research results
are mixed

Mood stabilizers

Drugs: Lithium, valproate

To prevent future episodes as well as to bring someone out of a current episode

effective for many people and can treat some cases where talk therapy does not seem to be effective

Mood stabilizers side effect

a small therapeutic index - the dosage of treatment vs the toxic dosage is small

treats the symptoms not the cause = relapse

• but… can combine talk therapy with medication to decrease dosage of medication

ECT: Electro-convulsive therapy

Electroconvulsive Therapy (ECT)
- Electrical current (~1 sec) which triggers a seizure
- Patient awakens in 1-2 hours
- 2-3x per week for about 2-7 weeks/6 to 12 sessions
- Use has been declining

ECT side effects

This type of treatment is very controversial, but it is pretty effective for severe depression

side effects: can short or long term cognitive effects, retrograde amnesia

Relapse is high (may be due to the patient)

• used on people were medication did not work

Trends in treatment:

• Previous negative experience with institutions/services, language barrier, may
  be a financial barrier as well

• Outcomes tend to be better when clients’ ethnicity and therapists’ ethnicity
  match

• Increasing multicultural sensitivity in treatment (Minorities underutilize treatments

Efforts to imporve trends in treatment:

• Recruiting more minority therapists

• Fostering cultural competence and humility

How does technology help with the shortage in clinicians?

Technology can increase the reach of treatment by having video conferences and telehealth.

Blending treatment approaches

Can increase effectiveness of treatments in general, though not for all types of
disorders (eclectic approach)

Problems of mental institutions

underfunded

• untrained and overworked personnel

• isolation from social support networks

(1960s) Community mental health movement

push for local care
o less dependent on hospitalization
o prevention

(1960s) Deinstitutionalization

the process of reducing the population of mental hospitals by transferring individuals to community-based services.

Mixed success in deinstulization

There was mixed success: alternative, less costly option, can be near loved ones

however, “revolving door” for many of the most seriously ill and increased homeless mentally ill