Treatment of Psychological Disorders

Transcription

1 Treatment of Psychological Disorders Psychodynamic Therapies Psychodynamic therapies revolve around: 1. Insight Understanding one s own psychological processes Symptom comes from Maladaptive ways of viewing self and relationships Unconscious conflicts among competing motives Maladaptive ways of dealing with unpleasant emotions Psychodynamic Therapies Psychodynamic therapies revolve around: 2. Therapist-patient relationship Therapeutic Alliance: must be able to speak about emotionally significant events with therapist Being with someone who listens empathically rather than critically is inherently therapeutic patients often bring enduring and troubling interpersonal patterns into the relationship with the therapist 1

2 Therapeutic Techniques Free Association Patient responds to verbal/visual cues with the first thing that comes to mind Done to example unconscious thoughts Interpretation Clinician interprets patient responses Resistance involves patient s efforts to hide the unconscious conflict Therapeutic Techniques Analysis of Transference Patient plays out other relationship roles with therapist Opportunity to model relationship dynamics Pti Patient tti tries to please therapist itin the same way he/she h/h tried to please parent Fears that your new partner will cheat on you just like your last partner cheated on you Psychodynamic Therapies Psychoanalysis Patient on couch and therapist on chair behind couch Intense discussions over a long period of time Goal is exploration of unconscious processes Psychodynamic Psychotherapy Sessions are face to face Discussion is less intense, more conversational, than in psychoanalysis Goal is still exploration of unconscious processes 2

3 Cognitive-Behavioral Therapies Symptom is maladaptive learned behavior patterns that could be changed by applying behaviorist principles Cognitive behavioral therapy integrates understanding of classical and operant conditioning with a cognitive-social perspective Cognitive-Behavioral Therapies Therapy begins with Behavioral Analysis Assessing the symptom and the stimuli or thoughts associated with it Therapy integrates theories of classical conditioning: desensitization and exposure Systematic desensitization Gradual exposure of a phobic stimulus as a means of neutralizing the impact of the stimulus Cognitive-Behavioral Therapies Phobia Irrational fear of a given stimulus Behavioral analysis Determine the symptom (s) and the stimuli or thoughts associated with it which then become the targets of treatment Systematic desensitization Gradual exposure of a phobic stimulus as a means of neutralizing the impact of the stimulus 3

4 Systematic Desensitization Step 1 Therapist teaches patient relaxation techniques Step 2 Therapist questions patient about fears & then constructs a hierarchy of feared stimuli Step 3 Desensitization process begins possibly with the use of virtual reality therapy Step 4 Patient encouraged to face feared stimuli in real life Cognitive-Behavioral Therapies Exposure Techniques Present patients with actual phobic stimulus in real life rather than imagine it Based on classical conditioning, designed to extinguish the response Very effective for simple phobias Possible to do with virtual reality Flooding Patient confronts the phobic stimulus all at once Graded Exposure or virtual reality Key is response prevention Cognitive-Behavioral Therapies Operant Conditioning Techniques Use reward and punishment to achieve desired behavior Effective in many settings, including psychiatric treatment, family therapy, alcohol counseling 4

5 Social Learning Techniques Participatory modeling Therapist models the behavior and gradually induces the patient to participate in the behavior Role playing Effective for treating ti phobias Alters efficacy beliefs (if therapist can do it, so can I) Skills training Involves teaching behaviors necessary to accomplish relevant goals Teaching how to control emotions or social skills Cognitive Therapy Focus on changing cognitions that underlie a psychological disorder Change Automatic thoughts: the things people say spontaneously to themselves, which can lead to irrational feelings and behaviors Cognitive Therapies Ellis s Rational-Emotive Therapy what people think and say to themselves about a situation affects the way they respond to it ABC theory of psychopathology Activating Conditions Belief Systems emotional Consequences Idea is that the maladaptive belief systems lead to negative emotional consequences Goal of therapy is to identify illogical thoughts and teach more rational ways to solve problems 5

6 Cognitive Therapy Beck s Cognitive Therapy Focus on cognitive distortions and changing maladaptive patterns of thought and behavior Questions data on which assumptions are based, and identified errors in thinking Humanistic Therapies Goal of Humanistic theory is to help people get in touch with their feelings, with their true selves, and with a sense of meaning in life Two most practiced are gestalt therapy and Client Centered therapy Gestalt Therapy Gestalt therapy assumes that psychological distress results from losing touch with one s emotions and one s authentic inner voice Focus on present state rather than historical contributors to one s present state Focus on awareness of one s own feelings versus attempts to conform to social expectations Goal is for patient to respond to their true inner voice and thus become more authentic 6

7 Gestalt Therapy Gestalt therapy: Commonly used technique is empty chair Client speaks to imagined person in other chair to express feelings without consequences Allows client to practice emotional expression Client Centered Therapy Assumes people come to therapy for help solving problems not because of disorders People experience psychological difficulties when their concept of self is incongruent with their actual experience Learn to accept one s self as one actually is Therapist creates environment of unconditional positive regard Evaluates comments for authenticity to self, not unconscious meaning or rationality Group Therapies Multiple individuals in same sessions Usually 5-10 people weekly for two hours Group members share same issue such as Death of a child or coping with cancer Benefits include: Group perspective on problems Sense of hope or efficacy from successful others Relieve shame, sense of only one with problem Members can see irrationality in others when they don t yet see it in selves 7

8 Family Therapies Goal is to change maladaptive family interaction patterns Focus on process (how session develops), content All members of a nuclear family participate in therapy Often focus on structure and strategy of family Genogram Typical treatment technique Map of family dynamics over 3-4 generations Family Therapies Couples therapy Focus on problematic communications patterns within dyad Goal of psychodynamic marital therapy is to identify patterns of interacting ti that t reflect patterns from the past. Negative reciprocity: tendency of members of a couple to respond to negative comments or actions by their partner with negative behaviors in return Strong predictor of marital dissatisfaction and divorce Culture and Psychotherapy Methods of treatment depend on cultural value systems Focus on individual from psychodynamic approach is good fit for Western society 8

9 Psychotherapy Integration Many practitioners use a combination of approaches Focus on individual from psychodynamic approach is good fit for Western society Biological Treatments Goal: use medication to restore the brain to as normal functioning as possible Psychotropic medications act on the brain to affect mental processes Antipsychotic Medications Most act at neurotransmitter sites Some inhibit, others stimulate neurotransmitter Used to treat schizophrenia and other acute psychotic py states They have sedating impact by inhibiting dopamine which is linked to hallucinations Don t work well with negative symptoms such as interpersonal difficulties Serious side effects such as tardive dyskinesia (slow motions) 9

10 Antidepressant & Mood Stabilizing Medications Tricyclic Antidepressants 70-80% improvement rate MAO Inhibitors Works better than tricyclics for patients with depression and personality disorders Requires food restrictions Antidepressant & Mood Stabilizing Medications Selective serotonin reuptake inhibitors (SSRIs) First-line medical treatment for chronic low-grade depression Fewer side effects than other antidepressants t Lithium Used with bipolar disease Takes 3-4 weeks to begin having an impact 30-80% of patients respond well to lithium Anti-anxiety Medications Valium and Xanax are used for short term treatment of anxiety disorders Antidepressants are also used for anxiety disorders Patients can become psychologically and physiologically addicted 10

11 Electroconvulsive (ECT) Therapy & Psychosurgery Considered treatments of last resort Not clear what ECT does to be effective ECT currently used to treat severe depression Electric shocks administered to the brain Can move patient out of a state of severe depression Psychosurgery Comparing forms of treatment Efficacy Studies Assess treatment outcome under controlled experimental conditions (control group) Effectiveness Studies Assess treatment as practiced by clinicians in the community 11