Chapter 16 Reading

The most important and widely used class of antianxiety drugs; They are rapidly absorbed from the digestive tract and start to work very quickly. At low doses they help quell anxiety; at higher doses they act as sleep-inducing agents and can be used to treat insomnia

benzodiazepines

A fundamental assumption of the cognitive model is that problems result from ________________. These biases distort the way that a person makes sense of the experiences that she or he has in the world, leading to cognitive errors.

biased processing of external events or internal stimuli

In ____________ ECT, electrodes are placed on either side of the patient's head and brief constant-current electrical pulses of either high or low intensity are passed from one side of the head to the other for up to about 1.5 seconds

bilateral

__________ ECT is also associated with more severe cognitive side effects and memory problems

bilateral

ECT can be administered in one of two ways:

bilateral and unilateral

Empirical evidence suggests that __________ ECT is more effective than ___________ ECT.

bilateral; unilateral

Psychiatrists differ from psychologists in that they treat mental disorders using ____________

biological approaches

Psychoanalytically oriented treatments are also showing promise in the treatment of ______________. One example is transference-focused psychotherapy, or TFP.

borderline personality disorder

SSRIs and TCAs are also used in the treatment of _________

bulimia nervosa

The only new class of antianxiety medication that has been released since the early 1960s is ______________, which is completely unrelated to the benzodiazepines and is thought to act in complex ways on serotonergic functioning rather than on GABA. It has been shown to be as effective as the benzodiazepines in treating generalized anxiety disorder

buspirone (Buspar)

______________ has been associated with significant side effects including blood problems, hepatitis, and serious skin conditions

carbamazepine

As developed by Freud and his immediate followers, ____________ is an intensive (at least three sessions per week), long-term procedure for uncovering repressed memories, thoughts, fears, and conflicts presumably stemming from problems in early psychosexual development—and helping individuals come to terms with them in light of the realities of adult life

classical psychoanalysis

Two forms of psychodynamic therapy:

classical psychoanalysis and psychodynamically oriented psychotherapy

The three types of mental health professionals who most often administer psychological treatment in mental health settings are:

clinical psychologists, psychiatrists, and psychiatric social workers

An even more serious side effect of __________ is a potentially life-threatening drop in white blood cell count called agranulocytosis, which occurs in 1 percent of patients

clozapine

In 1988 ________________ became the first SSRI to be released in the United States. Its pharmacological cousins include sertraline (Zoloft) and paroxetine (Paxil)

fluoxetine (Prozac)

Behavior therapy usually achieves results in a __________ because it is generally directed to specific symptoms

short period of time

This approach, which is based on systems theory, holds that if the family context can be changed, then the individual members will have altered experiences in the family and will behave differently in accordance with the changed requirements of the new family context

structural family therapy

Motivational interviewing is most often used in the areas of ______________

substance abuse and addiction

Even the atypical neuroleptics have side effects, however. ______________ are a major source of clinical concern

weight gain and diabetes

Extreme exposure therapy where the patient directly confronts the feared stimulus at full strength

flooding

Approximately ______ percent of adults in the United States receive mental health care treatment each year

15

The primary drawback to the use of buspirone is that it takes ______________ to exert any anxiolytic effects. It is therefore not useful in acute situations. Because it is nonsedating, it cannot be used to treat insomnia.

2 to 4 weeks

The probability of relapse is estimated to be _________ times higher after withdrawal than when the patient is on lithium, with about 50 percent relapsing within 6 months

28

Clinical trials with the SSRIs indicate that patients tend to improve after about ______________ of treatment.

3 to 5 weeks

Studies have found that approximately _______ percent of patients with schizophrenia who are treated with traditional antipsychotic medications have a resolution of their positive symptoms within 6 weeks, compared to only about 20 percent of those treated with placebo

60

Even though we still do not know exactly how it works, there is no doubt about the effectiveness of lithium. As many as ______________ percent of patients in a clear manic state show marked improvement after 2 to 3 weeks of taking lithium

70 to 80

____________, an antipsychotic medication, is also now being marketed as a treatment for bipolar disorder.

Abilify

Antipsychotic medications are sometimes used to treat the delusions, hallucinations, paranoia, and agitation that can occur with _______________. However, antipsychotic medications pose great risks to patients with dementia because they are associated with increased rates of death

Alzheimer's disease

Involves modifying undesirable behavior by the old-fashioned method of punishment

Aversion therapy

The ____________ (a self-report measure of depression severity) is widely used to measure the degree of severity of a client's depression

Beck Depression Inventory

The newest antidepressant, which received FDA approval in 2011, is called ____________ It is a novel combination of an SSRI and a serotonin receptor agonist.

Viibryd (vilazodone).

_________________ was originally developed for the treatment of depression and later for anxiety disorders. Now, however, this form of treatment is used for a broad range of conditions, including eating disorders and obesity, personality disorders, substance abuse, and even schizophrenia

Beck's cognitive therapy approach

______________ is an antidepressant that is not structurally related to other antidepressants. It inhibits the reuptake of both norepinephrine and dopamine. In addition to being an antidepressant medication it also reduces nicotine cravings and symptoms of withdrawal in people who want to stop smoking; it does not inhibit sexual functioning

Bupropion (Wellbutrin)

The _______________ is a rating scale used by clinicians to measure the severity of a patient's depression

Hamilton Rating Scale for Depression

Psychosurgery is sometimes used for patients with debilitating _________

OCD

More recent additions to the _________ family are fluvoxamine (Luvox), which is used in the treatment of OCD; citalopram (Celexa); and escitalopram (Lexapro)

SSRI

the drugs that were discovered first (so-called classical antidepressants such as monoamine oxidase inhibitors [MAOIs] and tricyclic antidepressants [TCAs]) have now been replaced in routine clinical practice by "second-generation" treatments such as the ____________

SSRIs

______________ probably has the fewest and mildest side effects, which can include nausea, diarrhea, sedation, tremor, and weight gain

Valproate

Attempts at estimating clients' gains in therapy generally depend on one or more of the following sources of information:

a client's reports of change in their symptoms or functioning, a clinician's ratings of changes that have occurred, reports from the client's family or friends, comparison of pretreatment and posttreatment scores on instruments designed to measure relevant facets of psychological functioning, measures of change in selected overt behaviors

Key elements of therapeutic alliance

a sense of working collaboratively on the problem, agreement between patient and therapist about the goals and tasks of therapy, and an affective bond between patient and therapist

The humanistic-experiential therapies see psychopathology as stemming in many cases from problems of ____________________

alienation, depersonalization, loneliness, and a failure to find meaning and genuine fulfillment

The key therapeutic benefit of antipsychotics derives from their ability to ____________________. They do this by blocking dopamine receptors

alleviate or reduce the intensity of delusions and hallucinations.

Induces nausea and vomiting when a person who has taken it ingests alcohol

antabuse

Used for conditions in which tension and anxiety are significant components. They do not provide a cure. However, these medications can keep symptoms under control until patients are able to receive other forms of effective psychological treatments. (The fact that they are so widely prescribed has caused concern among some leaders in the medical and psychiatric fields because of these drugs' addictive potential and sedating effects)

antianxiety medications

__________ are the most commonly prescribed psychiatric medications.

antidepressants

It is important to note that combined treatments are not always superior to single treatments. Adding psychiatric medications does not generally improve the clinical efficacy of psychosocial treatments for ___________, for example. However, for people suffering from chronic or recurrent ________, combined treatments often result in better clinical outcomes

anxiety disorders; depression

Because movement-related side effects are a little less common with _________ antipsychotic medications such as clozapine (Clozaril) and olanzapine (Zyprexa), these medications are often preferred in the clinical management of schizophrenia

atypical

Another class of antianxiety drugs that are seldom used today except to control seizures or as anesthetics during electroconvulsive therapy

barbiturates

A direct and active treatment that recognizes the importance of behavior, acknowledges the role of learning, and includes thorough assessment and evaluation.

behavior therapy

The therapist may also have a mixture of feelings toward the client. This ______________, wherein the therapist reacts in accord with the client's transferred attributions rather than objectively, must be recognized and handled properly by the therapist.

countertransference

Patients with Cluster B personality disorders such as borderline personality disorder may show a _________________, if they take SSRIs

decrease in certain symptoms, most notably mood lability

There are signs that psychodynamic approaches may be helpful in the treatment of ________________________

depression, panic disorder, PTSD, and substance abuse disorders

ECT is known to _____________, increasing the functional availability of this neurotransmitter. However, exactly how ECT works is still not fully clear

downregulate the receptors for norepinephrine

In a situation where treatment is tested under ideal conditions (usually in a controlled clinical trial), __________ is how well a given treatment improves clinical outcome compared to a control or comparison condition.

efficacy

Benzodiazepines and related anxiolytic medications are believed to work by ___________________.

enhancing the activity of GABA receptors

A behavior therapy technique that is widely used in the treatment of anxiety disorders

exposure therapy

Other drugs that are currently being researched and used clinically as treatments for rapid cycling bipolar disorders are _____________________. Many of these drugs are also used in the treatment of epilepsy and are anticonvulsant agents

gabapentin (Neurontin), lamotrigine (Lamictal), and topiramate (Topamax)

Beck's cognitive therapy, clients do not change their beliefs by debate and confrontation as is common in REBT. Rather, they are encouraged to ___________________.

gather information about themselves

Emphasizes the unity of mind and body—placing strong emphasis on the need to integrate thought, feeling, and action; developed by Frederick (Fritz) Perls (1969) as a means of teaching clients to recognize the bodily processes and emotions they had been blocking off from awareness

gestalt therapy

The ___________ therapies are based on the assumption that people have both the freedom and the responsibility to control their own behavior—that they can reflect on their problems, make choices, and take positive action.

humanistic-experiential

Recently there has also been concern that, when used during pregnancy, fluoxetine (Prozac) and paroxetine (Paxil) may _________________.

increase the risk of heart abnormalities in the baby

Side effects of lithium include _____________________. In addition, lithium can be toxic if the recommended dose is exceeded or if the kidneys fail to excrete it from the body at a normal rate.

increased thirst, gastrointestinal difficulties, weight gain, tremor, and fatigue

Instead of emphasizing change (which sometimes has the paradoxical effect of making people not want to change), ______________ focuses on acceptance and includes strategies that help each member of the couple come to terms with and accept some of the limitations of his or her partner.

integrative behavioral couple therapy (IBCT)

One example of an eclectic form of therapy is ________________. This therapy focuses on current relationships in the patient's life and has the goals of reducing symptoms and improving functioning

interpersonal therapy (IPT)

Monoamine oxidase inhibitors include ______________; They inhibit the activity of monoamine oxidase, an enzyme present in the synaptic cleft that helps break down the monoamine neurotransmitters (such as serotonin and norepinephrine) that have been released into the cleft. Patients taking MAOIs must avoid foods rich in the amino acid tyramine (such as salami and Stilton cheese). This limits the drugs' clinical usefulness.

isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and selegiline (Eldepryl)

The actual motives that are seeking expression but are so painful or unacceptable that they are disguised in the dream

latent content

___________________, combined with instruction and guided exposure, was the most effective treatment for snake phobia, resulting in the elimination of phobic reactions in over 90 percent of the cases treated

live modeling of fearlessness

The dream as it appears to the dreamer

manifest content

The most commonly reported side effects from repeated TMS sessions are ______________

mild headache and a small risk of seizure

When the client learns new skills by imitating another person, such as a parent or therapist, who performs the behavior to be acquired. A younger client may be exposed to behaviors or roles in peers who act as assistants to the therapist and then be encouraged to imitate and practice the desired new responses

modeling

A brief form of therapy that can be delivered in one or two sessions. It was developed as a way to help people resolve their ambivalence about change and make a commitment to treatment At its center is a supportive and empathic style of relating to the client that has its origins in the work of Carl Rogers

motivational interviewing (MI)

Side effects of the SSRIs include:

nausea, diarrhea, nervousness, insomnia, and sexual problems such as diminished sexual interest and difficulty with orgasm

Most antidepressants work by increasing the availability of _______________, or both.

serotonin, norepinephrine

In addition to their usefulness in treating depression, the antidepressant drugs are also widely used in the treatment of various other disorders. For example, SSRIs are often used in the treatment of ________________

panic disorder, social anxiety disorder, and generalized anxiety disorder, and OCD

Clients who are _________ about their chances of recovery or who are ambivalent about dealing with their problems and symptoms respond less well to treatment

pessimistic

One problem with benzodiazepines is that patients can become psychologically and _______________________

physiologically dependent on them

In _________________________, the treatment and the ideas guiding it may depart substantially from the principles and procedures laid out by orthodox Freudian theory, yet the therapy is still loosely based on psychoanalytic concepts

psychoanalytically oriented psychotherapy

A broad treatment approach that focuses on individual personality dynamics, usually from a psychoanalytic or some psychoanalytically derived perspective; The oldest form of psychological therapy and began with Sigmund Freud

psychodynamic therapy

What does RTC stand for?

randomized clinical trials

The first form of behaviorally oriented cognitive therapy was developed by Albert Ellis and called _____________. It attempts to change a client's maladaptive thought processes, on which maladaptive emotional responses and, thus, behavior are presumed to depend.

rational emotive behavior therapy (REBT)

When positive reinforcement is used to establish, by gradual approximation, a response that is actively resisted or is not initially in an individual's behavioral repertoire

response shaping

More recently, another class of antidepressant medications has been introduced. These are called ______________________; They block the reuptake of both norepinephrine and serotonin. They have similar side effects to the SSRIs, and they are relatively safe in overdose

serotonin and norepinephrine reuptake inhibitors (SNRIs)

Controlled, slow, and gradual exposure therapy

systematic desensitization

One problematic side effect that can result from treatment with conventional antipsychotic medications such as chlorpromazine is _______________.

tardive dyskinesia

No single set of techniques defines cognitively oriented treatment approaches. However, two main themes are important:

the conviction that cognitive processes influence emotion, motivation, and behavior; and the use of cognitive and behavior-change techniques in a pragmatic manner

For many years the gold standard of Couple therapy has been __________________ . It is based on a social-learning model and views marital satisfaction and marital distress in terms of reinforcement. The treatment is usually short term (10 to 26 sessions) and is guided by a manual. The goal is to increase caring behaviors in the relationship and to teach partners to resolve their conflicts in a more constructive way through training in communication skills and adaptive problem solving.

traditional behavioral couple therapy (TBCT)

A newer, more targeted approach that uses electricity to change brain functioning is _________________, a treatment in which the clinician positions a pulsed magnet over a carefully selected area of the patient's scalp and uses it to create an electrical field that increases or decreases neuronal activity in the brain

transcranial magnetic stimulation (TMS)

Often people carry over, and unconsciously apply (or "transfer") to their therapist, attitudes and feelings that they had in their relations with a parent or other person close to them in the past, a process known as __________

transference

A person's reliving of a pathogenic past relationship in a sense re-creates the neurosis in real life, and therefore this experience is often referred to as a ______________.

transference neurosis

Developed by Kernberg and colleagues, this treatment approach uses such techniques as clarification, confrontation, and interpretation to help the patient understand and correct the distortions that occur in his or her perception of other people, including the therapist.

transference-focused psychotherapy (TFP)

_____________ was the first antidepressant to be introduced in the United States that was not lethal when taken in overdose. It specifically inhibits the reuptake of serotonin; It has heavy sedating properties that limit its usefulness. It is sometimes used in combination with SSRIs and taken at night to help counter the adverse effects the SSRIs often have on sleep. In rare cases, it can produce a condition in men called priapism

trazodone (Desyrel)

____________ ETC involves limiting current flow to one side of the brain, typically the nondominant side (right side, for most people). A general anesthetic allows the patient to sleep through the procedure, and muscle relaxants are used to prevent the violent contractions that, in the early days of ECT, could be so severe as to cause the patient to fracture bones

unilateral

Although lithium is still widely used, other drugs are also considered first-line treatments for bipolar disorder. These include _______________

valproic acid (Depakote) and carbamazepine (Tegretol)

Examples of antidepressants in the SNRI family are ____________

venlafaxine (Effexor) and duloxetine (Cymbalta)