PSYC100_Chapter 15

Antidepressants and other disorders

1. Depression 2. OCD - In the treatment: combination of SSRIs and CBT therapy (exposure and response prevention) are the best treatment plan - The symptoms do get better faster if they combine medications and CBT 3. Anxiety disorders 4. Eating disorders - Anorexia is usually treated with SSRIs along with intensive therapy

Goals of psychodynamic therapy

1. Expose unconscious influences - The way we make decisions, personality traits etc: are due to unconscious events. - The therapist is going to bring these unconscious things to the surface 2. Achieve insight: the "aha moment" - Weakness: just because you have insight on an issues does not mean that you can change your behaviour change. It doesn't include behavioural restructuring

Behavioral therapies

1. Exposure and Response Prevention 2. Systematic desensitisation 3. Introduction of positively-reinforcing experiences 4. Social skills training

What does psychodynamic therapy look like?

1. Free association - Talking from topic to topic in an unfiltered manner. Full disclosure. It takes a lot of time - They ask a lot of open ended questions 2. Uncovering attempts to avoid distressing thoughts and feelings - When you start talking about sensitive issues: the therapist will try to circle back to these uncomfortable topics 3. They are looking for recurrent themes and patterns in your life 4. Discussing past experiences - It is not a focus on the past. Focus on the past to the points that it seems relevant in the present 5. Exploration of wishes and fantasies - What do you want? What are your hopes and dreams? - Dream analysis can sometimes be used but it is not required - What does your mind wonder to? 6. Heavily focused on relationships - It can be any kind of significant relationships - Transference to therapist: considered progress. The client starts treating the therapist as if they are in their personal life. The client is talking to the therapist as if they are dating, are in their family, or in a way that seems a bit inappropriate - The therapist notices this and talks to the patients about it

System desensitization

1. Make a fear hierarchy: a list of situations where they feel fear in ascending order 2. Exposure. Imagine or enact scenarios that become progressively more upsetting Exposure to the threatening stimulus will extinguish as the client learns new, nonthreatening associations Practitioners may use virtual realities Therapy is likely to begin by increasing the client's awareness of the thought processes that maintain the fear of the stimulus

Exposure

A behavioral therapy technique that involves repeated exposure to an anxiety-producing stimulus or situation. Based on classical conditioning Confronting feared stimuli in the absence of negative consequences, the person learns new, nonthreatening associations

Anti-anxiety drugs

A class of psychotropic medications used for the treatment of anxiety: Short-term treatment of anxiety Benzodiazepines: increase activity of GABA. Reduce anxiety and promote relaxation but are also highly addictive and can create drowsiness Tranquilizers Anxiety-reducing drugs are also beneficial in some cases but they can have side effects and can have a risk of relapse when they are stopped They work instantly (if you take the drug, by 20 minutes you will feel better) They are highly addictive and the tolerance builds quickly In therapy there really should not be any need to use these drugs to treat anxiety-related. Instead people will be given anti-depressants The brain activity is very similar between depressed patients and anxiety patients

Antidepressants

A class of psychotropic medications used for the treatment of depression: Block the reuptake of both serotonin and norepinephrine have been effective for treating generalized anxiety disorders Limited to the period the drug is taken Mostly used to treat depression. Also used to treat anxiety There are three classes of antidepressants: Monoamine oxidase (MAO) inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) Critics: too often used to treat people who are sad and have low self-esteem but who are not clinically depressed. Have side effects: sexual dysfunction

Antipsychotics

A class of psychotropic medications used for the treatment of schizophrenia and other disorders that involve psychosis: Reduce symptoms: delusions and hallucinations Traditional drugs: bind to dopamine receptors and block the effects of dopamine Not always affective and have side effects that can be irreversible Not always affective in treating negative symptoms of schizophrenia Anticonvulsants: prevent seizures but can also stabilize moods in bipolar disorder

Family therapy

A form of group therapy Family therapy offers the opportunity to change attitudes and behaviors that are disruptive to the family The reason that families go to therapies is usually because of some sort of upheaval - Divorce - 1 person in the family is struggling with a very significant disorder and the family doesn't know how to help the struggling individual It is usually pretty rough getting people into therapy It can be a group session and individual sessions In the session: lots of turn-taking, perspective-taking, acceptance Over the course of therapy the way a person thinks, acts, and interacts with others may change which can affect family dynamics Critical to long term prognoses Some therapists insist that family members be involved when practical. Sometimes it can be counter productive however Family members are together considered the client Helping families provide appropriate support leads to better therapy outcomes and reduces relapses Expressed emotion

Expressed emotion

A pattern of negative actions by a client's family members; the pattern includes critical comments, hostility directed toward the person by family members, and emotional over involvement. Level of expressed emotion from family members corresponds to the relapse rate for those with schizophrenia. Rates are highest if the person has a great deal of contact with the family Predicts relapse in many countries Culture affects the relationship between expressed emotion and relapse

Cognitive restructuring

Aaron T Beck a therapy that strives to help clients recognize maladaptive thought patterns and replace them with ways of viewing the world that are more in tune with reality

Rational-emotive therapy

Albert Allis. Therapist acts as a teacher, explaining the clients errors in thinking and demonstrates more-adaptive ways to think and behave

Client-centered therapy (humanistic therapy)

An empathic approach to therapy; encourages people to fulfill their individual potentials for personal growth through greater self-understanding. Humanism: Carl Rodgers Create a safe and comforting setting Therapists: empathetic, take their clients perspective, accept the client through unconditional positive regard Helps the client focus on his or her subjective experiences Reflective listening Few practitioners follow the tenets of humanistic theory strictly, they are used to help establish a good relationship Non-directive approach: the therapist does not tell the client the cause for why they are feeling anxious or upset and you don't tell them what the solution is. You have to help the client figure out their issues and solutions on their own Broad goal: achieving self-activation. The therapist may talk about "growth" Reconcile incongruence between real and ideal selves

Placebo effect

An improvement in physical or mental health following treatment with a placebo—that is, with a drug or treatment that has no active component on the disorder being treated Randomization helps ensure that groups are comparable and also controls for many potential confounds For a placebo to reduce symptoms of psychopathology, the participant must believe it will. Placebos also can produce minor physical reactions Neural processes involved in responding to it are similar to the ones activated in response to a biologically active treatment

Family systems approach

An individual is part of a larger context. Each person in the family plays a specific role and interacts with the other members in a specific way. Everyone influence everyone else Everyone has a mutual influence over everything Take the emphasis off the struggling individual and make it more community oriented

Antidepressants for depression

Antidepressants: may help treat the symptoms of depression without having any influence on the underlying cause For the relief of depression, the greatest help comes from just boosting the serotonin instead of all of the neurotransmitters. The other drugs are still beneficial but not as beneficial as SSRIs If SSRI's don't work then people are prescribed the other two medications Tricyclics might be most beneficial for the most serious depressive disorders

Treatment for anxiety

Anxiety-reducing drugs are also beneficial in some cases but they can have side effects and can have a risk of relapse when they are stopped Antidepresents block the reuptake of both serotonin and norepinephrine have been effective for treating generalized anxiety disorders - Limited to the period the drug is taken - Sometimes include tranquilizers which can help manage immediate fear but not long term Prozac and CBT were equally effective in treating anxiety disorder CBT is long term - Alters the brains processing of fear - Decreased frontal lobe activity - Psychotherapy "rewires" the brain

Risperdal and Zypreza and schizophrenia

Are atypical antipsychotics and are the first line of defense in the treatment of schizophrenia. Clozapine is usually reserved for more severe cases

Psychosurgery

Areas of the frontal cortex were selectively damaged Used to treat serious disorders

Medication in treatment

Assumption: disorders result from imbalances in neurotransmitters or because receptors are not functioning properly

Treatment for bipolar disorder

Bipolar and Related Disorders has been placed between disorder related to schizophrenia and those related to depression Lithium is an "anti-manic" drug Anticonvulsive medications Combining mood stabilizers with atypical antipsychotics improves treatment outcomes

Alternative biological treatments

Brain surgery, magnetic fields, and electrical stimulation. Used as a last resort, more likely to have serious side effects

MAO inhibitor for depression

Can be toxic because their effects on various physiological symptoms. People have to avoid ingesting any substance that contains tyramine. Interaction of MAOI and tyramine can result in severe and lethal elevations in blood pressure Blocks the enzyme that breaks down norepinephrine, dopamine, and serotonin neurotransmitters MA break down a lot of other neurotransmitters but the ones mentioned above are the most relevant to depression Can impact cardiovascular health and raise blood pressure.

Atypical antipsychotic

Causes serious problems with white blood cells. Risperdal and Zyprexa are often used because they are safer than Clozapine Clozapine: acts on dopamine, serotonin, norepinephrine, acetylcholine and histamine receptors. Lithium: was considered the most effective treatment for bipolar disorder but its neural mechanisms of how it works are unknown.

Phobias

Characterized by the fear and avoidance of particular stimuli Exposure therapy is the most effective System desensitization

Haloperidol

Chemically different and has less of a sedating effect than chlorpromazine. Can cause motor side effects that are similar to Parkisons disease: immobility of facial muscles, trembling of extremities, muscle spasms, uncontrollable salivation, and a shuffling walk Have little or no impact on the negative symptoms of schizophrenia

RDoC

Classifies disorders according to similar genetic and neurophysiological findings Drugs from one category to treat symptoms of another category may reflect similar underlying disturbances across diagnostic categories. Drugs treat symptoms not disorders

Free association

Client would say whatever came to mind and the therapist would look for signs of unconscious conflicts

Clozapine for schizophrenia

Clozapine is an atypical antipsychotic: Significantly different than haloperidol and chlorpromazine Those who did not improve on haloperidol and chlorpromazine improved on Clozapine Fewer side effects than haloperidol and chlorpromazine It's side effects include: seizures, heart arrhythmias, and weight gain. It can cause fatal reduction in white blood cells Acts on receptors for dopamine, serotonin, norepinephrine, acetylcholine, and histamine Beneficial in treating the negative as well as the positive symptoms of schizophrenia No signs of Parkinson's symptoms or of tardive dyskinesia in any of the people taking the drug

Cultural beliefs and treatment

Cultural beliefs affect treatment. Psychotherapy is accepted to different extents in different countries Providers need to be sensitive to cultural meanings of disorders and how psychological treatments are regarded in different countries Religious minorities need to find healthy ways to reaffirm their faith and deal with discrimination Therapists can modify the type and style of therapy so that it can be more culturally appropriate Culture plays a critical role in determining whether various cultural or ethnic groups will find psychotherapy available and will use it.

Therapies not supported by evidence

Dangerous Many available therapies do not have a scientific basis. Some treatments that are believed to be effective can be counterproductive Lack of adequate evidence produces results opposite to those intended

Single-pulse TMS

Disrupts brain activity only during a brief period of stimulation

Trepanning

Drilling a hole in the skull to let the evil spirits escape. Used in African and the Pacific. Various groups still practice it as a treatment for epilepsy, headaches and symptoms of mental distrubrance

Treatment for schizophrenia

Drugs are generally considered essential Dogbane: toxic herb has been used to clam highly agitated people. Main ingredient is reserpine which was given to people with schizophrenia because it had a sedative effect and was effective in reducing the positive symptoms of schizophrenia Haloperidol and chlorpromazine revolutionized the treatment of schizophrenia and became the most frequently used treatment for this disorder Two main types of drugs for treating Schizophrenia: typical and atypical

Psychotropic medications

Drugs that affect mental processes. They change brain neurochemistry Three categories: anti-anxiety, antidepressants, and antipsychotics Sometimes drugs from one category are used to treat a disorder from another: comorbidity Insufficient evidence about why a particular drug is effective in reducing symptoms of a psychological disorder

Prolonged exposure

Effective for PTSD. With PTSD: client repeatedly revisits and recounts their traumatic experience and gradually approaches the situation they have been avoiding

Tricyclics for depression

Effective in relieving clinical depression. Act on neurotransmitters as well as on an histamine system. Extremely effective antidepressant. Have a number of side effects: drowsiness, weight gain, sweating, constipation, heart palpitations, dry mouth

Transcranial magnetic stimulation (TMS)

Electrical pulses are used to disrupt neural activity, aiming to reduce depression. Powerful electrical current produces a magnetic field Magnetic field induces an electrical current in the brain region directly below the wire coil, thereby interrupting neural function in that region It can be used to increase or decrease neural activity (excitatory or inhibitory) In depression: excitatory Growing in use and application Transcranial magnetic stimulation (TMS) over the left frontal regions results in a significant reduction in depression

Deep brain stimulation (DBS)

Electrical stimulation is delivered from electrodes implanted in the brain, aiming to alleviate depression and obsessive-compulsive symptoms. Location of electrodes depends on which disorder is being treated Mild electricity is then used to stimulate the brain at an optimal frequency and intensity Used for Parkinson's disease - It is now the treatment of choice Has few side effects and a low complication ate Used to treat other disorders: maybe OCD and depression DBS for treatment-resistant depression is effective at least half of the people treated. Valuable for treating severe depressive disorders Useful in helping people lead more productive lives Researchers can easily alter the electrical current without the person knowing which demonstrates that the DBS is responsible for improvements in psychological findin

Electroconvulsive therapy (ECT) for depression

Electroconvulsive therapy (ECT) is a very effective treatment for those who are severely depressed and do not respond to conventional treatments. Antidepressants can take weeks to be effective while ECT works quickly Used to treat depression in pregnant women because it does not harm the fetus Has a high relapse rate, can lead to memory impairments (limited to the day of the ECT treatment, but some people experience substantial permanent memory loss)

Seasonal Affective Disorder (SAD)

Episodes of depression are most likely to occur during the winter Phototherapy: exposure to a high-intensity light source for part of each day Regular aerobic exercise: reduce depression because it releases endorphins. These neurotransmitters are chemically related to norepinephrine, which is implicated in depression. It also regularizes bodily rhythms, improves self-esteem, and provides social support

Antidepressants and monoamine oxidase (MAO) inhibitors

First antidepressants. Monoamine oxidase is an enzyme that breaks down serotonin in the synapse. The inhibitor stops the process and results in more serotonin in the synapse. They raise the levels of norepinephrine and dopamine

Interpersonal therapy

Focuses on circumstances, mostly relationships the clients attempts to avoid. Integrates cognitive therapy with psychodynamic insight therapy How people relate to one another, and gaining more insight into their social relationships Helps the client explore their interpersonal experiences and express their emotions

Exposure and response prevention

From of behavioral therapy Exposing yourself to something you are afraid of and preventing yourself from exhibiting in the behaviour This is one of the types of therapist that can be successful in the time period that insurance will reimburse for Usually used to treat OCD (harming yourself or others, or cleaning) - If you don't maintain the exposure it can come back Highly effective for OCD

SSRI's for depression

Generally considered first-line medications because they have the fewest serious side effects Prozac: does not affect histamine or acetylcholine and does not have the side effects associated with tricyclic antidepressants but can cause insomnia, headache, weight loss, and sexual dysfunction Bupropion affects many neurotransmitters but has fewer side effects. It does not cause sexual dysfunction. Not an effective treatment for panic disorder and OCD

Cognitive therapy

Goal: aims for cognitive restructuring Albert Ellis - Developed the first few theories and is best known for the ABC model - ABC: Activating Events —> Beliefs —> Consequences - Albert focused on the belief about that event Often involves homework - Journal exercise that is physical. You would be writing down instances in everyday life that you had a very strong reaction, how you thought and felt about it, and the consequences of that. Later you would write how you changed the way you thought about it - Goal: for the cognition to change outside of therapy sessions Treatment based on the idea that distorted thoughts produce maladaptive behaviors and emotions; treatment strategies attempt to modify these thought patterns. Treat the thoughts and behaviors as a the problem Behavior is assumed to result from individual belief systems and ways of thinking rather than from objective conditions Cognitive restructuring, rational-emotive therapy, interpersonal therapy

Group therapy

Group therapy offers the opportunity to improve by hearing another's experiences. Less expensive Improve social skills and learn from one another Behavioral and cognitive-behavioral groups are more often highly-structured which specific goals and techniques designed to modify the thought and behavior patterns of group members - Effective for OCD Less structured groups usually focus on increasing insight and providing support Often used to augment individual therapy Often humanistic and cognitive orientations - Humanistic: unconditional positive regard: warm and supportive disposition towards others; - Cognitive: how you think about yourself and situations. Your peers or the therapist will try to help you not to be critical Everyone can say and feel anything they want Thematic: - Most times it has 8 people. Continue over a long time period. - Same disorder, some broad concern in life, or life event - You are all tied together for a reason - It is sometimes very structured and other times it is more structured. The therapists have to respond to the people they get - People feel supported and validated

Counseling psychologist

Has a Ph.D. Deals with adjustment problems that do not involve mental illness

Clinical psychologist

Has a Ph.D. or Psy.D. Is skilled in working with individuals with mental illness

Psychiatric nurse

Has a bachelor's degree and usually a master's degree, both in nursing. Works in a hospital or residential program that specializes in serious mental illness.

Psychiatric social worker

Has a master's degree in social work (MSW). Deals with issues of psychiatrically ill patients and their families

Psychiatrist

Has an M.D. Can prescribe psychotropic drugs.

Paraprofessional

Has limited advanced training. Assists individuals with mental illness.

Bipolar and lithium

Historically treated with lithium Drug seems to modulate neurotransmitter levels, balancing excitatory and inhibitory activities It isn't really understood what it does It has a lot of side effect: bodily effects, drops the levels of energy, impacts creatively. It makes people feel as though they are in a drugged state and feel sedated People take it when they have to but when people start to feel better than a lot of people stop taking it but then another manic episode happens. It does help with mania but it doesn't have a huge retention rate Side effects: thirst, hand tremors, excessive urination, and memory problems

Panic disorder

Imipramine CBT can be effective Cognitive restructuring addresses ways of reacting to the symptoms of a panic attack. 1) Client identifies their specific fear 2) client estimates how many panic attacks they have 3) client assigns percentages to specific fears and compares these numbers with the actual number of times the fears have been released - Even if people understand the irrationality of their fears they still have panic attacks CB perspective: attacks continue because of a conditioned response to the trigger - Use exposure therapy - Done repeatedly to induce habituation and then extinction CBT is more effective than medication

Cognitive-behavioral therapy (CBT)

Incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and change maladaptive behaviors Most widely used version of psychotherapy. Most effective form for many types of disorders: anxiety and mood Evidence-based therapy Directive approach: the therapist is given direction to the client. The therapist has the responsibility to identify the root of the problem Major emphases: 1. Cognitive: 1) Identifying and 2) changing irrational or self-defeating thought patterns Your thoughts are out of the scope of what they need to be 2. Behavioural: Developing new behavioural responses through conditioning, reinforcement and modelling Therapist: typically has a Ph.D in CBT or in therapy

Tricyclic antidepressants

Inhibit the reuptake of certain neurotransmitters making more neurotransmitters available in the synapse Block reuptake of serotonin and norepinephrine

Selective serotonin reuptake inhibitors (SSRIs) and antidepressents

Inhibit the reuptake of serotonin. Act on other neurotransmitters to a lesser extent Block serotonin from being reuptake into the cells and there are more in the synapse so they can mind with more receptors By 8 weeks the effects have evened out. It usually 3-5 weeks for the SSRIs to kick in

Tardive dyskinesia

Involuntary twitching of muscles especially in the face and neck Basal ganglia. Receptive movements typically in the face, neck, mouth, and maybe the hands. But it usually isolated to the upper body It can make people avoid others who demonstrate these symptoms which can highly impact people who previously struggled with severe schizophrenia The cells stop producing enough cells or neurotransmitters which causes the symptoms

Evaluation of client-centered therapy

It has affected other types of therapy: therapists are now very warm, empathetic, transparent - The reason people kept going back to therapy was because their therapist demonstrated these traits Before: it was very formal Incongruence, unconditional positive regard and other humanistic ideas/methods are more commonly used for daily life struggles and less for intensive disorders Client centered therapy works really well for daily life struggles and so it is usually found in counselling and social work - These people could have adjustment problems and have trouble handling stress and life decisions - Usually after client centered therapy, clients tend to have higher self-esteem

Psychodynamic therapy

It has evolved to be it's "own thing" It is not typically trained in graduate school or Ph.D programs. It is not as evidence based There is an assumption that people don't do well on their own and that we need someone to do that for us. Our issues are unconscious and we are very protective and we are not equip to fix ourselves A form of therapy based on Freudian theory; aims to help clients examine needs, defenses, and motives as a way of understanding distress Talking tends to be more conversational Explores clients avoidance of distressing thoughts, looking for recurring themes and patterns in thoughts and feelings, discussing early traumatic experiences, focusing on interpersonal relations and childhood attachments, emphasizing the relationship with the therapist, and exploring fantasies, dreams, and daydreams Has become increasingly controversial New approach to psychodynamic therapy: fewer sessions, focus on more current relationships - Could be useful in treating certain disorders: depression, eating disorders, and substance abuse. - Dropout rate is very high Therapists who practice this approach do not necessarily believe that people have underlying conflicts that need to be resolved Evidence weak for its effectiveness in treating most psychological disorders

Evaluation of CBT

It is the most empirically-supported for of therapy It is better than placebo therapy for all of these disorders: when you randomly assign people to groups with cognitive therapy and therapies that do not involve any cognitive restructuring - Anxiety (phobia, panic) - Obsessive-Compulsive Disorder - Depression - Habit breaking or addiction treatment - Interpersonal conflict Many studies find that CBT is at least as effective (or equal) without medication for mild to moderate depression and anxiety - 8 weeks and 16 weeks testing placebo, SSRIs, and cognitive therapy. At 8 weeks the SSRI group is doing better than the CT. By 16 weeks the CT has even better results than the SSRI group, but just barely. It is common to treat with both therapy and medication. Even if you are taking the medication and are getting better, after they stop taking the drugs (and they haven't changed their behaviours) then they can get worse again

Mindfulness-based cognitive therapy

John Teasdale People who recover from depression continue to be vulnerable to faulty thinking when they experience negative moods. Based on principles derived from mindfulness medication. Has 2 goals: 1) help clients become more aware of their negative thoughts and feelings and times when they are vulnerable 2) help them learn to disengage from ruminative thinking through meditation Quite effective in preventing recurrence of major depression

Cognitive-behavioral therapy

Just as effective as antidepressants in treating depressive disorders Cognitive distortion model: depression is the result of a cognitive triad of negative thoughts about oneself, the situation, and the future. The thought patterns of people with depressive disorders differ from the thought patterns of people with anxiety disorders. People with anxiety disorders worry about the future. People with depressive disorders think about how they have failed in the past, how poorly they are dealing with the present situation, and how terrible the future will be. - The goal of the cognitive-behavioral treatment of depression is to help the person think more adaptively. Treatment is adaptive People may be asked to recognize and record their negative thoughts - Patterns are identified and monitored and the clinician can then help the client recognize other ways of viewing the same situation CBT can be effective on its own but combining it with antidepressants can be more effective. Response rate and remission rate of the combined-treatment approach are very good Treatment of depression with psychotherapy leads to changes in brain activation similar to those observed for drug treatments. Psychotherapy and drugs operate through different mechanism; effects of the drugs and psychotherapy are largely independent of one another

Atypical drugs for schizophrenia

Less common to produce tardive dyskinesia but it still does happen It does block dopamine but they are more specific It also has a lot of effects on other areas of the brain. They have a varied effect on serotonin receptors. But this helps people's frontal lobes function better Atypical psychotic are favoured over the typical because of the reduced side effects and the impact seems to be as good or better They eliminate positive symptoms but it doesn't seem to really help negative symptoms

Why should anti-anxiety drugs be taken?

May help people face phobic situations when they don't have time to get treatment When people are in grief, they have a combination of depression and lack of sleep and they need immediate support Clams combative patients

Motivational interviewing

Modern form of humanistic treatment, client-centered approach over a very short period of time (1-2 interviews). Addresses clients ambivalence about problematic behavior, identifies discrepancies between their current state and "where they would like to be. Sparks the clients motivation for change Valuable for drug and alcohol abuse and for increasing healthy eating habits and exercise William Miller: psychologists who developed this technique

Antipsychotics for bipolar disorder

More preferred over lithium and it tends to help bipolar symptoms Sometimes people are given low levels of lithium and antipsychotics

Prognosis for schizophrenia

Most individuals with schizophrenia improve over time. People experience multiple episodes over the course of the disorder No one knows why most people with schizophrenia improve with age The prognosis for people with schizophrenia depends on factors that include: 1. Age of onset. - Those diagnosed later in life tend to have more favorable outcomes 2. Gender. - Women tend to have better prognoses than men 3. Culture. - Developing countries schizophrenia is often not as severe in developed countries

Treatment for personality disorders

Most therapists agree that personality disorders are notoriously difficult to treat. Usually being treated for another disorder at the same time People rarely seek therapy for personality disorders Patients see the environment rather than their own behavior as the cause of their problems

Depressed brains

Overactive amygdala (it is specific to depression but also anxiety disorders) Underachieve prefrontal cortex (can't pay attention, can't regulate) - When people are first put on SSRIs: their brains start showing pretty immediate effect. By week 1 their amygdala starts to calm down. After a few weeks the prefrontal cortex begins to function more normally. - When people go to CT: it doesn't quite down the amygdala at first but it strengthens the prefrontal cortex. It is like "brain training" where you learn to quite down the negative thoughts and reactions. Increases PFC which inhibits amygdala In the end, the brains look the same at the end of a few weeks but they take different paths.

Prefrontal lobotomies

Patients were listless and had flat affect. Impaired many important mental functions: abstract thought, planning, motivation, and social interaction Egas Moniz: bringing the practice to the attention of the medical world in the 30s

Psychotherapy

Psychotherapy is the generic name given to formal psychological treatment. Interactions between client and therapist. Wants to help the patient understand his or her symptoms and problems and provide solutions for them Understanding does not always lead to further insight into how to best treat the disorder Generally aimed at changing patterns of thoughts, emotions, or behavior Good relationship with the therapist can be key Freud: disorders are caused by prior experiences (mostly traumatic experiences

Introduction of positively-reinforcing experiences

Rejoin the activities they dropped out of because of their current concerns (activities and social support)

Qualities of therapists in client-centered therapies

Rodgers was outspoken about the qualities that he thought therapists should possess - Up to this point no one said that a therapist should have certain traits Rodgers believed that therapists should be: genuine, transparent (what this therapy can and can't, what the therapist's role is and what the patient's role is), empathetic (showing the person that you care). A therapist should not seem distracted

Social skills training and schizophrenia

Social skills training can be a useful adjunct to pharmacological treatment. Modelling and imitating positive social interactions The patient will practice it multiple times with the therapist and then the client will feel more comfortable doing it in real life Medication effectively reduces delusions and hallucinations, it does not substantially affect the person's social functioning. Drugs must be combined with other treatment Intensive training in regulating affect, recognizing social cues, and predicting the effects of their behavior in social situations. Hopefully they can generalize the skills to other environments Behavioral interventions can focus on areas such as grooming and bathing, management of medications, and financial planning

Science supporting treatment

Some debate regarding the most appropriate methods and criteria used to assess clinical research David Barlow: leading researcher on anxiety disorders points out that medical studies often lead to dramatic changes in treatment practice. He argues that disorders should always be treated in ways that scientific research has shown to be effective Psychological treatment: distinguish evidence-based treatment from the more genetic term psychotherapy, which refers to any form of therapy Treatment varies according to the particular disorder. Techniques used in these treatments have been developed in the laboratory by psychologist No overall grand theory guides treatment

Anti-convulsants in treating bipolar disorder

Stabilize mood and can be effective for intense bipolar episodes - The drug Quetiapine (better known as Seroquel) is an atypical antipsychotic that has grown in popularity and is now the most commonly prescribed drug for bipolar disorders. - Antipsychotic mediations have been found to be effective in stabilizing moods and reducing episodes of mania

Electroconvulsive therapy (ECT)

Strong electrical current is delivered to the brain, aiming to reduce depression Developed in Europe Public had a negative view Now occurs under anesthesia, uses powerful muscle relaxants to eliminate motor convulsions and confine seizures to the brain Helpful in severe cases of depression Often used for patients who are suicidal and they may be inpatients They will come in for 3 sessions a week for a couple of weeks. Usually on one brain hemisphere a seizure is induced and it usually gets better in 3-6 session. People feel much better and their depressive thoughts and reduced and their suicidal thoughts are limited Side effects: memory loss (typically that day or the few hours surrounding the treatment), dizziness, nausea

Antidepressants for treating bipolar disorder

The boosting of neurotransmitters can sometimes lead to an increase of mania They typically don't need. If they prevent mania than they don't tend to get depressive episodes. Because lithium and atypical antipsychotics work better on mania than on depression, people are sometimes given an antidepressant as well. SSRI's are preferable to other antidepressants because they are less likely to trigger episodes of mania - People are sometimes given antidepressants with lithium. Risk of triggering a manic episode makes the use of antidepressants controversial, and they are generally not recommended

Psychopharmacology

The use of medications that affect brain or body functions. These forms of treatment can be particularly effective for some disorders, at least on a short-term basis Drug treatments 1. Antidepressant 2. Anti-anxiety (anxiolytics) and tranquilliser 3. Anti-convulsants (boost GABA and cause wide spread inhibition in the brain) 4. "Stabilizers" or mood stabilisers (most common is lithium) 5. Anti-psychotic (been around since the 1950s and in wide use since the 1960s). Had a very extensive impact on psychological field. When people exhibit intensive issues they had to be institutionalised but now people can still live in residential settings. Very strong, not very well understood, has bad side effects

Systematic desensitization

Therapist exposes the client to increasingly anxiety-producing situations by having the client imagine them an then teaching the client to relax at the same time. Uses classical conditioning to replace fear Three steps: 1. Relaxation training 2. Anxiety hierarchy - List of things that you need to work through and eventually do 3. Counterconditioning - You're pairing the relaxation technique (unconditioned stimulus) with the beard situation (conditioned stimulus) which triggers the relaxed state (unconditioned response)

Reflective listening

Therapist repeats the clients concerns to help the person clarify his or her feelings

Dream analysis

Therapist would interpret the hidden meaning of the client's dreams

Men and women with depression

There are differences in the rates of depression and treatment in men and in women. Domestic violence, reduced economic resources, and inequalities at work Women are the primary consumers of psychotherapy Women of color, lesbians, and women with disabilities are often stereotyped in ways that signal disregard for the choices they have made and the challenges they face Men: reluctance to admit to depression and even greater reluctance to seek appropriate therapy have been describes as "a conspiracy of silence that has long surrounded depression in men" We need to help men stop masking their depression with alcohol, isolation, and irritability

Trained people in therapy

There are not enough trained people Number of programs have been developed to broaden the reach of treatment

Evaluation of psychodynamic therapy

There aren't a ton of studies in compared to CBT or humanistic because there aren't that many people practicing it It is harder to quantify the results CBT - Tends to be faster - Targets more specific outcomes Psychodynamic therapy aim's for broader things and tends to take longer - Reduced guilt or shame (harder to measure) - Sense of fulfilment in life, capacity for self-expression - Lots of people love psychodynamic therapy because they can connect the dots and they feel better - There are some studies that show that it does help depression

Depression

There is no best way to treat depressive disorders Often have to use a trial-and-error approach Decision on medication depends on the person's overall health and the possible side effects of each medication

Psychoanalysis

To help the patient gain insight into his or her psychological processes and how it impacts their daily functioning Client lies on couch while the therapist sat out of view. This was used to reduce the clients inhibitions and allow freer access to unconscious thought processes. Treatmnet involved uncovering unconscious feelings drives that gave rise to maladaptive thoughts and behaviors Insight 1) The sudden realization of a solution to a problem 2) The goal of psychoanalysis; a client's awareness of his or her own unconscious psychological processes and how these processes affect daily functioning. Client's symptoms will diminish as a result of reducing unconscious conflicts

OCD treatment

Traditional antianxiety drugs are completely ineffective for OCD SSRI's: effective for OCD because they helped reduce the constant feeling of worthlessness Drug of choice for OCD is clomipramine: a potent serotonin reuptake inhibitor. Not a true SSRI but its strong enhancement of the effects of serotonin appears to make it affective for OCD Cognitive-behavioral therapy with exposure and response prevention Psychotherapies in which people reinterpret their fears and change their behaviors can change the way their brains function CBT may be more effective than medication especially in the long-term. Adding CTB to SSRI treatment may improve symptoms Deep brain stimulation - DBS leads to a clinically significant reduction of symptoms and increased daily functioning in about two-thirds of those receiving treatment

Chlorpromazine

Tranquilizer. Reduces anxiety, sedated without inducing sleep, and decreases the severity and frequency of the positive symptoms of schizophrenia. Can cause constipation, weight gain, and cause cardiovascular damage Have little or no impact on the negative symptoms of schizophrenia

Behavior therapy

Treatment based on the premise that behavior is learned and therefore can be unlearned through the use of classical and operant conditioning Treat the thoughts and behaviors as a the problem Desired behaviors are rewarded and unwanted behaviors are ignored or punished Token economies: people earn tokens for good behavior and can trade the tokens for rewards or privileges Social skill training

Biological therapies

Treatment of psychological disorders based on medical approaches to disease (what is wrong with the body) and to illness (what a person feels as a result). Based on the idea that disorders result form abnormalities in neural and bodily processes Long-term success may require the person to continue treatment Non-biological treatment may prove to be more effective

Imipramine

Tricyclic antidepressant, prevents panic attacks but does not reduce the anticipatory anxiety that occurs when people fear they might have an attack

Treatment for psychological disorders

Two main categories: biological and psychological Research over the past three decades has shown that certain types of treatments are particularly effective for specific types of psychological disorders. When you are in grad school you can "major" in one type of therapeutic approach but you will still know a lot about the other styles - ~45% of therapists report eclectic approaches - A lot of therapist use many different styles together Therapy can be in the form of individual or group Therapy is very valuable 1. Cognitive-Behavioral Therapy (CBT) - Would study this at a research based institute 2. Humanistic ("Client-centered") - Would study this at a research based institute 3. Psychodynamic/Psychoanalytic - Functions slightly independently from the other two types of styles. If you wanted to style this you would most likely study this at a professional school

Typical drugs for schizophrenia

Typical anti-psychotic block dopamine receptors When you block dopamine receptors than you block disorder speech and delusional thinking. When you block dopamine you block positive symptoms. The downside than it also inhibits the brain. This can make people develop tardive dyskinesia. Don't help with negative symptoms at all

Technology-based treatments

Use minimal contact with therapists. Rely on smartphones, computer programs, or the Internet to offer some form of psychological treatment.

Social skill training

Used to elicit desired behavior. Patient learns appropriate ways to act in specific social situations. First step is often modeling when the therapist acts out an appropriate behavior. The client is encouraged to imitate the displayed behavior, rehearse it in therapy, and later apply it in real world situations

Technology-based treatment

Uses minimal contact with therapist and rely on smartphones, computer programs, or the Internet to offer some form of psychological treatment Useful for treating addiction, drug abuse, gambling, smoking, anxiety disorders, panic attacks Has lead to long-term improvement in alcohol abstention