PSYCH 1XX3 - Psych treatments

External barriers

• systemic obstacles to receiving treatment

  • Treatment takes time and money

  • People can't afford treatment

  • Healthcare systems don't offer the treatment required

Internal barriers

• restrictive beliefs held by the person, ego dystonic or ego syntonic

Ego dystonic

•  having a negative relationship with the disorder

  • Recognise the issues it causes and dislike the symptoms

Ego syntonic

• having a positive relationship with the disorder

  • Accepted disorder and found ways to embrace it 

  • Can act as a coping mechanism that trap the bearer (symptoms cause more trouble than realized, trapping)

  • People are less likely to engage with treatment

    • Don't recognize disorder as a problem, limiting you in your ability to solve the problem

Stages of change

• describe the progression to healthy behaviour, describe the stepwise change of problematic thoughts/behaviours

  • Step 1: precontemplation

    • inability/unwillingness to acknowledge existence of a problem

    • People with ego syntonic relationship are in this stage

  • Stage 2: contemplation

    • Acknowledges existence of problem, but unsure or unwilling to change the problem

  • Stage 3: preparation 

    • Recognize the problem and prepare for change

  • Stage 4: action

    • Taking active steps to change the behaviour 

  • Stage 5: maintenance

    • Continue the healthy habits formed at the action stage

Relapse

return of old unhealthy behaviour driving a person back to the precontemplation stage

Clinical psychologist  

• Phd in clinical psychology, not medical doctor

• Trained in psychological therapy

• Study psychology from a holistic perspective → physiology and social and environmental

• Unqualified to prescribe medication

Psychiatrist

• Medical doctors

• Less training in psychological therapy

• Advanced in pharmacology

• Qualified to prescribe medication

Efficacy trials/studies

• Evaluate if treatment works under ideal settings → if fails here, will fail in the non ideal real world

• Use a small participant pool, from highly selected and specific homogenous populations → tested on ideal participant, and monitor their adherence to the treatment plan

• Informs effectiveness research

Effectiveness trials/studies

• accounts for other factors that might moderate a treatment effect

  • Does the treatment work in real-world clinical settings

  • Highly inclusive, heterogeneous populations

  • Informs healthcare decisions

Biomedical therapies

Treat patients by adjusting neurochemistry, target physiology and neurochemistry

Antipsychotic medication mechanism

treat psychosis

•  reduce symptoms by reducing dopamine activity

  • Medication bind and hold onto post synaptic dopamine receptors preventing the dopamine from binding, making it ineffective

Benzodiazepines purpose and mechanism

• reduce anxiety and panic

• Bind to gaba receptors, bind at a site on the receptor that increases GABA activity

  • GABA allows chloride ions into the post synaptic cell, hyperpolarizing it making it less likely to fire an action potential → feel calm and sedated

SSRI’s (selective serotonin reuptake inhibitors) purpose and mechanism

treat the low serotonin activity associated with depression

• increase serotonin activity

• After neurotransmitter released into a synapse, transporter proteins released to collect/reuptake them into the presynaptic neuron to cease their effect

  • SSRI’s inhibit the reuptake process allowing more prolonged serotonin activity in synaptic cleft

Cognitive behavioural therapy (CBT)

• Goal is to break the cycle of having worry thoughts that cause debilitating feelings, then  ineffective coping mechanisms affirm the worry thoughts

  • Cognitive component challenges the worry thoughts, and behavioural component challenges the ineffective coping mechanisms 

  • Cognitive behavioural therapists works with patients to help them learn healthy coping mechanisms and adaptive thought patterns for when they encounter their personal triggers

psychoanalytic techniques

• Free association

• Analysis of resistance

• Transference

Free association

•  the patient is encouraged to let their mind wander, reporting the content to the therapist without self-censorship

  • analyst attends to the content, minimal verbal feedback, search for clues regarding the secrets of the unconscious.

Analysis of resistance

• A psychoanalytic approach where the psychoanalyst analyzes which topics patients want to avoid in order to gain insight into their unconscious.

  • the more potentially damaging an unconscious thought or memory could be, the more patients would be motivated to avoid it

Transference

• The process by which a patient's thoughts, feelings, and drives developed in early childhood and experienced in significant relationships, are re-expressed, or 'transferred' onto the relationship with the analyst.

  • analysis of the patient’s behaviour toward the analyst provides insight into unconscious conflicts causing distress in the patient’s relationships with others

psychodynamic approaches /  Interpersonal therapy

• psychodynamic approach that is time-limited, present-focused, empirically supported for the treatment of depression, and applicable to a broader range of psychological problems

• focuses on current relationships and issues within those relationships. By helping the patient learn to solve present relationship problems, therapists provide them with skills to develop healthier relationships, and reduce the psychological symptoms.

Chlorpromazine

• psychotropic medication, member of antipsychotic class of drugs

• calming effects on severely agitated patients, reduce patients’ hallucinations and delusions.

• reduce the potency of schizophrenia’s positive symptoms

• antipsychotics work by blocking dopamine receptors in the brain

tricyclic class of antidepressants and example

block the reuptake of the neurotransmitters norepinephrine and serotonin at presynaptic nerve endings, elevating the levels of these neurotransmitters in the synapse.

• eg. Imipramine

second class of antidepressants (monoamine oxidase inhibitors)

• blocks the enzyme that degrades the tyramine, serotonin, dopamine, and norepinephrine neurotransmitters, elevating their synaptic concentrations.

third class of antidepressants (selective serotonin reuptake inhibitors (SSRIs))

• block the reuptake of serotonin, elevating serotonin levels at the synapse. SSRIs

• most commonly used today -- generally effective, well tolerated, and are relatively safe.

Antianxiety medications (anxiolytics) common type

• Benzodiazepines

  • activate the benzodiazepine receptor, enhancing the attachment of the neurotransmitter gamma-aminobutyric acid (GABA) at the postsynaptic neuron.

  • fast-acting and few side effects = high potential for abuse = prescribed for short-term use.

factors that account for most therapeutic change. 

• extratherapeutic factors: factors that operate outside of the therapy itself

  • the internal and external resources that a client brings into the therapeutic relationship

• therapeutic relationship: the degree to which the patient and therapist establish a relationship in which the client feels safe and understood

• Expectancy: the patient’s belief that therapy and the therapist are likely to be helpful

Pharmacotherapy

The treatment of psychological conditions using medications