Psychoanalysis p546 Behavioral p548 Cognitive p552-553 Biomedical p565 Antidepressants p566 Mood stabilizers p567 Antianxiety p568 ECT

Psychoanalysis (p. 546)

Psychoanalysis is a type of treatment pioneered by Sigmund Freud that delves into a patient's unconscious mind to unearth repressed emotions, thoughts, and conflicts that drive maladaptive behaviors. The primary goal of psychoanalysis is to provide patients with insight into these unconscious processes, thereby resolving internal conflicts and alleviating psychological distress. Traditional psychoanalysis is a lengthy process, often involving multiple sessions per week over several years.

• Techniques:

  • Free Association: Patients are encouraged to speak freely about whatever comes to mind, without censorship or self-editing. This spontaneous expression helps uncover unconscious associations.
  • Dream Analysis: Dreams are considered a window into the unconscious. Psychoanalysts interpret the manifest (surface) content of dreams to reveal the latent (hidden) content, which contains symbolic representations of unconscious desires and conflicts.
  • Transference: Patients may unconsciously redirect feelings and attitudes from significant relationships in their past onto the therapist. Analyzing these transference patterns provides insights into the patient's relational dynamics and unresolved issues.
  • Interpretation: The therapist offers interpretations of the patient's thoughts, feelings, and behaviors, helping them gain new understanding and perspective.

Behavioral Therapy (p. 548)

Behavioral therapy focuses on changing observable behaviors through the application of learning principles. Unlike psychoanalysis, behavioral therapy does not emphasize exploring the unconscious. Instead, it targets specific behaviors that are causing distress or impairment and aims to modify them directly.

• Techniques:

  • Classical Conditioning Techniques:

  • Exposure Therapy: Used to treat anxiety disorders, such as phobias and PTSD. Patients are gradually exposed to feared stimuli or situations in a safe and controlled environment, allowing them to extinguish conditioned fear responses.

  • Aversion Therapy: Pairs an undesirable behavior with an unpleasant stimulus to reduce its occurrence. For example, pairing alcohol consumption with a nausea-inducing drug to treat alcoholism.

  • Operant Conditioning Techniques:

  • Token Economy: Commonly used in institutional settings, such as psychiatric hospitals or schools. Patients earn tokens for engaging in desired behaviors, which can then be exchanged for rewards or privileges.

  • Contingency Management: A similar approach where specific behaviors are reinforced or punished to promote behavior change. This is often used in substance abuse treatment.

  • Social Learning Techniques:

  • Modeling: Patients learn new behaviors by observing and imitating others. This is particularly useful for developing social skills or overcoming fears.

Cognitive Therapy (pp. 552-553)

Cognitive therapy focuses on identifying and changing maladaptive thought patterns that contribute to emotional distress and behavioral problems. The underlying assumption of cognitive therapy is that thoughts, feelings, and behaviors are interconnected, and that changing negative or distorted thoughts can lead to improvements in mood and behavior.

• Techniques:

  • Cognitive Restructuring: Patients learn to identify and challenge negative automatic thoughts, cognitive distortions, and irrational beliefs. They are taught to replace these maladaptive thoughts with more realistic and adaptive ones.
  • Behavioral Experiments: Patients engage in real-world experiments to test the validity of their negative thoughts and beliefs. This helps them gather evidence that contradicts their distorted thinking.
  • Socratic Questioning: The therapist uses open-ended questions to guide the patient in exploring their thoughts and beliefs, promoting self-discovery and insight.

Biomedical Therapies (p. 565)

Biomedical therapies involve interventions that target the biological and physiological aspects of psychological disorders. These treatments are typically administered by medical professionals, such as psychiatrists, and often involve the use of medications or other medical procedures.

• Types:

  • Pharmacotherapy: The use of medications to treat psychological disorders. Different classes of medications are used to target specific symptoms or underlying neurochemical imbalances.

  • Antidepressants (p. 566): Used to treat depression, anxiety disorders, and other conditions. Common types of antidepressants include:

    • Selective Serotonin Reuptake Inhibitors (SSRIs): Increase serotonin levels in the brain by blocking their reuptake. Examples include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).
    • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Increase both serotonin and norepinephrine levels in the brain. Examples include venlafaxine (Effexor) and duloxetine (Cymbalta).
    • Tricyclic Antidepressants (TCAs): Older antidepressants that also increase serotonin and norepinephrine levels but have more side effects than SSRIs and SNRIs. Example include amitriptyline (Elavil).
    • Monoamine Oxidase Inhibitors (MAOIs): Inhibit the enzyme monoamine oxidase, which breaks down serotonin, norepinephrine, and dopamine. MAOIs are typically reserved for patients who have not responded to other antidepressants due to their potential for serious side effects and interactions with certain foods and medications.

  • Mood Stabilizers (p. 567): Used primarily to treat bipolar disorder, which is characterized by alternating episodes of mania and depression. Mood stabilizers help to reduce the severity and frequency of mood swings.

    • Lithium: A naturally occurring salt that is effective in treating mania and preventing recurrent mood episodes. It requires regular monitoring of blood levels to ensure safety and efficacy.
    • Anticonvulsants: Certain anticonvulsant medications, such as valproic acid (Depakote) and lamotrigine (Lamictal), are also used as mood stabilizers. They are thought to work by modulating neurotransmitter activity in the brain.

  • Antianxiety Medications (p. 568): Used to relieve symptoms of anxiety, panic, and related disorders. Common types of antianxiety medications include:

    • Benzodiazepines: Enhance the effects of the neurotransmitter GABA, which has a calming effect on the brain. Examples include alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium). Benzodiazepines are fast-acting but can be addictive and have potential side effects, such as drowsiness and impaired coordination.
    • Buspirone (Buspar): A non-benzodiazepine antianxiety medication that is thought to affect serotonin and dopamine levels in the brain. It has a lower risk of dependence than benzodiazepines but may take several weeks to become fully effective.

  • Antipsychotic Medications: Primarily used to treat psychotic disorders, such as schizophrenia, which are characterized by distorted thinking, hallucinations, and delusions. Antipsychotic medications help to reduce these symptoms by blocking dopamine receptors in the brain.

  • Electroconvulsive Therapy (ECT):

  • ECT is a procedure in which a brief electrical current is passed through the brain to induce a controlled seizure. It is typically used to treat severe depression or other mental illnesses that have not responded to other treatments. While the exact mechanisms of ECT are not fully understood, it is thought to work by altering neurotransmitter activity and promoting neuroplasticity in the brain.

  • Procedure: During ECT, the patient is given anesthesia and muscle relaxants to minimize discomfort and prevent injury. Electrodes are placed on the scalp, and a brief electrical stimulus is administered. The seizure typically lasts for about 30-60 seconds. Patients usually receive a