Psychotherapy (Behavior)

Goals of Psychotherapy

Understand the behaviors, emotions, and ideas that contribute to illness and learn how to modify them

Understand and identify psychosocial stressors that contribute to illness and which aspects of those problems a patient may be able to solve or improve

Types of Psychotherapy

Individual

Couple

Family

Group

Goal of Famil Psychotherapy

Improve communication and impaired relationships as a means of helping the entire family, including the patient with the psychiatric disorder

Psychoanalytic

Childhood experiences, past unresolved conflicts, and previous relationships significantly influence an individual’s current situation in life

Who founded psychoanalysis

Sigmund Freud

What should be done with psychoanalysis

Patients should verbalize their thoughts so they are not channeled physically or behaviorally

Requires neutrality of provider

Tends to require significant time and financial means

an environment to promote relaxation and regression

Indications for Psychanalysis

Personality disorders

Depression

Anorexia nervosa

Cognitive Therapy

dysfunctional thinking leads to dysfunctional emotions or behaviors

By changing their thoughts, people can change how they feel and what they do

Behavioral Therapy

changing behavior rather than reasons behind behavior

Conditioning

Form of behavioral therapy where a certain behavoir is conditined in the patient

Exposure therapy

Form of behavioral therapy

Repeated, systematic confrontation of the feared stimulus to facilitate fear reduction through extinction learning

Operant conditioning

Form of behavioral thearpy

Relies on rewards and punishments to shape people's behavior

Flooding

Extreme exposure therapy

Types of Exposure for Exposure Therapy

In vivo: actual exposure

Imaginal

Virtual reality

Cognitive Behavioral Therapy (CBT)

Identify and change inaccurate perceptions that the patient may have of themselves and the world around them

therapist helps the patient establish new ways of thinking by directing attention to both the "wrong" and "right" assumptions they make about themselves and others which will then change the patient’s reaction

Thought records-

Keep track of thoughts in a journal/on a worksheet

Cognitive restructuring-

Identify a negative thought, evaluate its validity, and replace it with a more balanced thought

Goals of CBT

Distress tolerance:

Emotion regulation

Mindfulness

Interpersonal effectiveness

Distress tolerance:

Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress

Emotion regulation

Recognizing, labeling, and adjusting emotions

Mindfulness

Becoming more aware of self and others and attentive to the present moment

Interpersonal effectiveness

Navigating conflict and interacting assertively

Indication for CBT

Personality disorders

Depression

Anxiety

Post-traumatic stress disorder

Panic disorder

Eating disorders

Obsessive compulsive disorder

Several medical conditions (insomnia, smoking, low back pain)

Dialectical Behavioral Therapy (DBT)

Group and/or individual but often groups that meet 2 or more times weekly with homework in between with participants being held to strict expectations about what is and is not acceptable, dismissal from group if self harming

Indications for DBT

Borderline personality disorder

Emotional dysregulation

Self-destructive impulses

Humanistic/Existential Therapy

Emphasizes people's capacity to make rational choices and develop to their maximum potential

Therapist is more of a guide than an authority figure

Gestalt Therapy

Recognize thoughts/desires and put into action

Do “work”- role playing, actively speaking to oneself in a mirror, etc.

Eclecticism/Integrative Therapy

No one right way to approach a patient

Uses techniques from all schools the thought

Biofeedback

the idea that the autonomic nervous system can come under voluntary control through operant conditioning

What instruments can be used to measure biofeedback

Electromyogram (EMG)

Electroencephalogram (EEG)

Galvanic skin response gauge (GSR)

Progressive muscle relaxation

relax major muscle groups in a fixed order, usually starting at feet

Guided imagery

ask patient to put themselves in a calming scenario (i.e. the beach) in which they imagine using their senses to make it more real

Indications for Biofeedback

Bruxism

Managing stress

Insomnia

Supplemented with psychotherapy for anxiety and somatoform disorders

Eye Movement Desensitization and Reprocessing (EMDR)

Uses bilateral stimulation such as guided eye movements, tapping, or auditory cues while the patient focuses on the memory in an attempt to reduce the emotional intensity of the memory and allow adaptive processing of the experience

Indications for EMDR

Post Traumatic Stress Disorder

Anxiety, panic, phobias

Depression

Anger management

Pain management