Download - Approaches to Treatment and Therapy Chapter 16 Chapter 16 16 - 1.

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Page 1: Approaches to Treatment and Therapy Chapter 16 Chapter 16 16 - 1.

Approaches to Approaches to Treatment and TherapyTreatment and Therapy• Chapter 16Chapter 16

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Chapter OutlineChapter Outline

• Biological Treatments for Mental DisordersBiological Treatments for Mental Disorders

• Kinds of PsychotherapyKinds of Psychotherapy

• Evaluating PsychotherapyEvaluating Psychotherapy

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Challenging Life EventsChallenging Life Events

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Biological TreatmentsBiological Treatments

• Contemporary view alternates between Contemporary view alternates between mental disorders as diseases (medical mental disorders as diseases (medical treatment) & emotional problems treatment) & emotional problems (psychological treatment)(psychological treatment)

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Antipsychotic DrugsAntipsychotic Drugs

• Drugs used primarily in the treatment of schizophrenia Drugs used primarily in the treatment of schizophrenia & other psychotic disorders & other psychotic disorders

• Blocks or reduces sensitivity of dopamine receptorsBlocks or reduces sensitivity of dopamine receptors• Reduce agitation, delusions, and hallucinationsReduce agitation, delusions, and hallucinations• Side effects such as muscular rigidity, tremors, and Side effects such as muscular rigidity, tremors, and

involuntary muscle movements, drastic weight gain (up involuntary muscle movements, drastic weight gain (up to 100 pounds a year) leading to further health to 100 pounds a year) leading to further health problems problems

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Antidepressant DrugsAntidepressant Drugs

• Drugs used primarily in the Drugs used primarily in the treatment of mood disorders, treatment of mood disorders, especially depression & anxietyespecially depression & anxiety

• Produce unpleasant physical Produce unpleasant physical reactions (dry mouth, stomach reactions (dry mouth, stomach problems, headaches, weight problems, headaches, weight gain, reduced sex drive) gain, reduced sex drive)

• https://www.youtube.com/www.youtube.com/watch?v=OTZvnAF7UsAwatch?v=OTZvnAF7UsA

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Selective Serotonin Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors

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Anti-anxiety Drugs (Tranquilizers)Anti-anxiety Drugs (Tranquilizers)

• Addictive Addictive • Useful as short-term treatment of panic Useful as short-term treatment of panic

disorderdisorder• Increase activity of GABAIncrease activity of GABA

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Cautions About Drug TreatmentsCautions About Drug Treatments

• Limitations to drug treatments:Limitations to drug treatments:

1.1. TheThe placeboplacebo effecteffect– The apparent success of a medication or treatment

due to the patient’s expectations or hope rather than to the drug itself

2.2. High relapse and dropout ratesHigh relapse and dropout rates

3.3. Dosage problems Dosage problems - issues with different metabolisms - issues with different metabolisms

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Cautions About Drug TreatmentsCautions About Drug Treatments

• More limitations to drug treatmentsMore limitations to drug treatments

4.4. Disregard for effective, possibly better, nonmedical Disregard for effective, possibly better, nonmedical treatmentstreatments– - Medication is easier, faster, often cheaper but not the

best solution

5.5. Unknown long-term risksUnknown long-term risks

6.6. Untested off-label usesUntested off-label uses– Drugs are sometimes prescribed for conditions outside Drugs are sometimes prescribed for conditions outside

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Direct Brain InterventionDirect Brain Intervention

• PsychosurgeryPsychosurgery

– Any surgical procedure that destroys selected areas of the Any surgical procedure that destroys selected areas of the brainbrain

• Electroconvulsive therapy (ECT)Electroconvulsive therapy (ECT)

– A procedure used in cases of prolonged and severe major A procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is induceddepression, in which a brief brain seizure is induced

– Newer alternatives like Newer alternatives like transcranial magnetic stimulation transcranial magnetic stimulation (TMS)(TMS) used for milder stimulation used for milder stimulation

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BrainBrain

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versus Mind

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Psychodynamic TherapyPsychodynamic Therapy

• Freud Freud • https://www.youtube.com/watch?v=hQh9LBIhjyMhttps://www.youtube.com/watch?v=hQh9LBIhjyM• 4 minutes 50 seconds4 minutes 50 seconds

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Psychodynamic TherapyPsychodynamic Therapy

• Relied on Freud’s method of Relied on Freud’s method of psychoanalysispsychoanalysis• “The talking cure”• Intense analysis of dreams and

childhood memories would provide insight into the unconscious and emotional release

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Several Kinds of PsychotherapySeveral Kinds of Psychotherapy

• Behavioural therapyBehavioural therapy• Cognitive therapyCognitive therapy• Humanist therapyHumanist therapy

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Behavioural TherapyBehavioural Therapy

• Therapy that applies principles of classical and Therapy that applies principles of classical and operant conditioning to help people change self-operant conditioning to help people change self-defeating or problematic behavioursdefeating or problematic behaviours

• Uses a variety of methods depending on the problem Uses a variety of methods depending on the problem or situationsor situations– systematic desensitization, behavioural self-monitoring, systematic desensitization, behavioural self-monitoring,

skills trainingskills training

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Behavioural TechniquesBehavioural Techniques

Systematic desensitization

• Systematic desensitization: Systematic desensitization: step-by-step process of step-by-step process of desensitizing a client to a feared object or experiencedesensitizing a client to a feared object or experience

• Based on Based on counterconditioning: counterconditioning: process of pairing a process of pairing a conditioned stimulus with a stimulus that elicits a conditioned stimulus with a stimulus that elicits a response that is incompatible with an unwanted response that is incompatible with an unwanted conditioned responseconditioned response

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Behavioural TechniquesBehavioural Techniques

Behavioural self-monitoring

– A method of keeping careful data on the frequency and A method of keeping careful data on the frequency and consequences of the behaviour to be changedconsequences of the behaviour to be changed

Skills training

– An effort to teach the client skills the he or she may lack, An effort to teach the client skills the he or she may lack, as well as new constructive behaviours to replace self-as well as new constructive behaviours to replace self-defeating onesdefeating ones

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Cognitive TherapyCognitive Therapy

• Form of therapy designed to identify and change Form of therapy designed to identify and change irrational, unproductive ways of thinking – teach irrational, unproductive ways of thinking – teach cognitive coping mechanismscognitive coping mechanisms

• Challenge client’s unrealistic thoughts (e.g., Challenge client’s unrealistic thoughts (e.g., overgeneralizations, catastrophizing) overgeneralizations, catastrophizing)

• For depression and for anxietyFor depression and for anxiety

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Challenge Negative ThoughtsChallenge Negative Thoughts

1. Are these thoughts really true?1. Are these thoughts really true?2. Are the negative aspects of this situation 2. Are the negative aspects of this situation overemphasized?overemphasized?3. What is the worst thing that could really happen?3. What is the worst thing that could really happen?4. Is there anything that might be positive about this 4. Is there anything that might be positive about this situation?situation?5. Was a negative outcome assumed?5. Was a negative outcome assumed?

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Challenge Negative ThoughtsChallenge Negative Thoughts

6. How do you know the situation will turn out badly?6. How do you know the situation will turn out badly?7. Is there another way to look at this situation?7. Is there another way to look at this situation?8. What difference will this make next week? In a 8. What difference will this make next week? In a month? In a year?month? In a year?9. If you had one month to live, how important would 9. If you had one month to live, how important would this be?this be?10. Are you setting unrealistic standards for yourself? 10. Are you setting unrealistic standards for yourself? Would you be this harsh if the event had happened to a Would you be this harsh if the event had happened to a friend?friend?

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Humanist TherapyHumanist Therapy

• Form of psychotherapy based on the philosophy of Form of psychotherapy based on the philosophy of humanism, which emphasizes the client’s free will to humanism, which emphasizes the client’s free will to change rather than past conflictschange rather than past conflicts

• Client-centered therapy:Client-centered therapy: emphasizes therapist’s emphasizes therapist’s empathy with the client and the use of empathy with the client and the use of unconditional unconditional positive regardpositive regard

• Goal is to build the client’s self-esteem and self-Goal is to build the client’s self-esteem and self-acceptance and become more productive at problem acceptance and become more productive at problem solving solving

• https://www.youtube.com/watch?v=m30jsZx_Ngshttps://www.youtube.com/watch?v=m30jsZx_Ngs

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Evaluating PsychotherapyEvaluating Psychotherapy

• Complexity of situation Complexity of situation • i.e., i.e., Qualities of the therapist and client, the kind of therapy, Qualities of the therapist and client, the kind of therapy,

the nature of the problem, and the duration of the therapy. the nature of the problem, and the duration of the therapy.

• Client effort? Client effort? • Defining success?Defining success?

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Evaluating PsychotherapyEvaluating Psychotherapy

• Therapeutic alliance Therapeutic alliance – the client and therapist both – the client and therapist both respect and understand each other and agree on respect and understand each other and agree on the goals of treatment the goals of treatment – Recognition of cultural differences Recognition of cultural differences

• Evaluating Therapy scientifically Evaluating Therapy scientifically • Therapist vs Scientist Therapist vs Scientist • Testimonials vs randomized control trials Testimonials vs randomized control trials

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Evaluating Crisis Debreifing

• Critical Incident Stress Debriefing (CISD) used as an Critical Incident Stress Debriefing (CISD) used as an intervention immediately following disasters to decrease rates intervention immediately following disasters to decrease rates of PTSDof PTSD

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• Found that highly Found that highly emotional reactions emotional reactions to incidents + CISD to incidents + CISD showed higher showed higher stress symptomsstress symptoms

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Values of PsychotherapyValues of Psychotherapy

• Self-acceptance versus self-improving? Self-acceptance versus self-improving? • Consumers thinking about psychotherapy should Consumers thinking about psychotherapy should

carefully consider how they go about:carefully consider how they go about:

– Choosing a therapist – credentials and trainingChoosing a therapist – credentials and training– Choosing a therapy – depends on the conditionChoosing a therapy – depends on the condition– Deciding when to leave – short-term is usually sufficientDeciding when to leave – short-term is usually sufficient

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When Therapy HarmsWhen Therapy Harms

• Risks to clients increase under Risks to clients increase under these conditions:these conditions:

1.1. The use of empirically unsupported, The use of empirically unsupported, potentially dangerous techniques potentially dangerous techniques (e.g., rebirthing, recovered memory (e.g., rebirthing, recovered memory therapies)therapies)

https://www.youtube.com/watch?v=-MfjWBhoM2k 2 min https://www.youtube.com/watch?v=-MfjWBhoM2k 2 min scared straight scared straight

2. Inappropriate or coercive influence, 2. Inappropriate or coercive influence, which can create new problems for which can create new problems for the clientthe client

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When Therapy HarmsWhen Therapy Harms

• Risks to clients increase Risks to clients increase under these conditions:under these conditions:

3.3. Prejudice or cultural Prejudice or cultural ignorance on the part of the ignorance on the part of the therapisttherapist

https://www.youtube.com/https://www.youtube.com/watch?v=UAhb4mQ6Pj0 2 watch?v=UAhb4mQ6Pj0 2 minutesminutes

4. Sexual intimacies or other 4. Sexual intimacies or other unethical behaviour on the unethical behaviour on the part of the therapistpart of the therapist

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The Brain That The Brain That Changes ItselfChanges Itself

• http://www.cbc.ca/natureofthings/episodes/http://www.cbc.ca/natureofthings/episodes/changing-your-mindchanging-your-mind

• 23 minutes – 41 minutes23 minutes – 41 minutes

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End of Chapter 16End of Chapter 16

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