Treatment - Lecture 17

Psychiatric Medication

• for some disorders, medication is the “first line” treatment option

• still, a combined approach is typically best

  • effectiveness of antipsychotics is enhanced when patients have access to individual therapy and support

• for others, psychotherapy is the recommended first treatment option

• selective serotonin reuptake inhibitors (SSRIs) are also common in treatment

Psychotherapy

• uses psychological techniques to treat mental health concerns

• many different psychotherapy approaches, but all share some common elements

  • address symptoms of psychological distress

  • provide new tools/new perspective

  • involves a trusting relationship between patient and therapist

Accurate Empathy

• Carl Rogers, founder of the person-centered approach (humanistic) emphasized the importance of accurate empathy in achieving good outcomes

• today, research is clear on the importance of empathy in building a strong working alliance across different therapeutic approaches

Practicing Empathy

• importance of viewing empathy as a skill, not as a personality trait

• therapists communicate empathic understanding by reflecting the content and personal meaning of what is being experienced by the patient

• a key intervention = the skills of active listening

  • includes the basic skill of summarizing/paraphrasing what has been said to demonstrate understanding, or to convey empathy

Humanistic Therapy

3 core conditions for change

1. Empathy

2. Unconditional positive regard (therapist may not agree with/ client’s actions, but still should show that it is a safe space for them to share)

3. Congruence (therapist can still be themselves, showing a version of themselves that is congruent with who they are)

Cognitive Behavioral Therapy (CBT)

Behavior Therapy: uses principles of classical conditioning

ERP: effective treatment for OCD + related concerns

• Exposure - person is gradually and repeatedly exposed to their feared situation under controlled conditions

• Response prevention - typical response if prevented

  • first step is typically to develop an exposure “hierarchy”

Behavioral Activation (BA)

• A structured, brief approach to:

  • increased engagement in adaptive activities that make us feel good

  • decrease behaviors that make us feel bad

• Change behavior = restore positive reinforcement

• Vicious cycle of depression: feel low —> stop doing things that matter —> get less out of life —> again

• **Do more of what matters.

Behavioral Activation Techniques

• self-monitoring of activities and mood, etc

• Activity scheduling —> pleasant activities list

• Hierarchy construction —> rank activities based on difficulty

Cognitive Approaches

• behavior therapy targets maladaptive behaviors while cognitive therapy targets how a person thinks

• The ABC Model

  • A —> Activating Event occurs,

  • B —> the person’s Beliefs about the event

  • C —> cause the emotional Consequences

Cognitive Restructuring

• Aaron Beck’s cognitive therapy focuses on what the cognitive biases actually are

  • Arbitrary inference - drawing a negative conclusion with no evidence

  • Selective abstraction - focusing on a single negative detail

  • Overgeneralization - drawing a sweeping, global conclusion based on an isolated incident and applying that to unrelated areas of life

  • Personalization - taking responsibility and blaming oneself without basis

After Identifying

• therapist encourages patient to test the accuracy of their assumptions, or to “weigh the evidence”