Approaches to treatment and therapy 17. Antipsychotic drugs Many block or reduce sensitivity of dopamine receptors. Some increase levels of serotonin,

Approaches to treatment and therapy

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Antipsychotic drugsMany block or reduce sensitivity of dopamine receptors.

Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activity

Can relieve positive symptoms of schizophrenia, but ineffective—or even worsen—negative symptoms

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Antidepressant drugs

Monoamine oxidase inhibitors (MAOI’s)Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters

Tricyclic antidepressantsBoost norepinephrine and serotonin by preventing reuptake

Selective serotonin reuptake inhibitors (SSRI’s)Boost serotonin by preventing reuptake

Herbs such as St. John’s Wort have also been used.

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Tranquilizers

Increase the activity of GABA

Developed for treatment of mild anxiety

Often prescribed inappropriately by general practitioners for any patient mood complaints

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Lithium carbonate

Used to treat bipolar disorder

Moderates levels of norepinephrine by protecting cells from being over-stimulated by neurotransmitter glutamate

Must be given in right dose, bloodstream levels monitored

Newer treatments include Tegetrol and Depakote.

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Your turn

Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe?1. An MAOI2. An SSRI (e.g., Prozac)3. A tranquilizer (e.g., Valium)4. Lithium carbonate

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Your turn

Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment. If she goes to see a doctor, what do you expect her doctor to prescribe?1. An MAOI2. An SSRI (e.g., Prozac)3. A tranquilizer (e.g., Valium)4. Lithium carbonate

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Placebo effect17

The apparent success of a treatment due to patient’s expectation rather than the treatment itself

Meta-analysis indicates that clinicians consider medication helpful, yet patient ratings in treatment groups were no greater than those in placebo groups.

High relapse and dropout rateThere may be short-term success, but 50–66% of patients stop taking medication due to side effects.

Individuals who take antidepressants without learning to cope with problems are more likely to relapse.

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Dosage problems

Finding the therapeutic window, the dosage that is enough but not too much

Drugs may be metabolized differently in. . .Men and womenOld and youngDifferent ethnic groups

Appropriate dosage also affected by metabolic rates, amount of body fat, number and type of drug receptors in the brain, smoking, and eating habits.

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Long-term risks

Antipsychotic drugs can be dangerous, even fatal if taken for many years.Tardive dyskinesia

Antidepressants are assumed to be safe, but no long-term studies have been conducted.

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Direct brain interventionPsychosurgeryAny surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior.

Electroconvulsive therapy (ECT)Procedure used in cases of prolonged and severe major depression

Brief brain seizure is induced

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Transcranial magnetic stimulationInvolves use of pulsing magnetic coil held to a person’s skull over the left prefrontal cortex

This area is less active in those with depression.

Treatment does not result in pain or memory problems, controlled studies have suggested positive results.

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Psychodynamic therapy

PsychoanalysisA method of psychotherapy developed by Freud, emphasizes the exploration of unconscious motives and conflicts

Free associationIn psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind

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Psychodynamic therapy17

Other psychodynamic therapies also explore unconscious dynamics, but differ from Freudian analysis.

TransferenceIn psychodynamic therapies, a critical step in which the client transfers unconscious emotions or reactions, such as conflicts with parents, onto the therapist

Behavior therapy17

A form of therapy that applies classical and operant conditioning to help people change own defeating or problematic behaviors

Graduated exposureIn behavior therapy, a method in which a person suffering from an anxiety disorder, such as a phobia, is gradually taken into the feared situation or exposed to a traumatic memory, until the anxiety subsides

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Flooding

A technique whereby a person suffering from an anxiety disorder, such as a phobia, is taken directly into the feared situation until the anxiety subsides

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Systematic desensitizationA step-by-step process of desensitizing a client to a feared object or experience

Based on counter conditioning

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Behavioral self-monitoringA method of keeping careful data on the frequency and consequences of a behavior to be changed

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Skills training

An effort to teach a client skills or new more constructive behaviors to replace self-defeating ones

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Cognitive techniques

Examine the evidence for beliefs.

Consider other explanations for the behavior of other people.

Identify assumptions and biases.

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Rational emotive therapyA form of cognitive therapy devised by Albert Ellis, designed to challenge the client’s unrealistic or irrational thoughts

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Humanist therapy

Humanist therapyBased on assumption that people seek self-actualization, self-fulfillmentEmphasized people’s free will to change, not past conflicts

Client-centered therapyDeveloped by Carl Rogers, emphasizes therapist’s empathy with client, and communication of unconditional positive regard

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Existential therapy

Helps clients explore the meaning of existence and face with courage the great issues of life such as death, freedom, free will, alienation, and loneliness

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Family and couples therapyAssumes that problems develop in the context of family, that they are sustained by family dynamics, and that any changes will affect whole family

Can look for patterns of behavior across generations and create a family tree of psychologically significant events

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Family-systems perspective

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Therapy with individuals or families that focuses on how each member forms part of a larger interacting system

One family’s history of mental illness

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The scientist-practitioner gapSome psychotherapists believe that evaluating therapy using research methods is futile.

Scientists find that therapists who do not keep up with empirical findings are less effective and can even harm clients.

Economic pressures require empirical assessment of therapies.

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Is more better?

Additional sessions, up to 26, increase the percentage of people who improve.

Rate of improvement then levels off.

Patients’ sense of improvement slower but more steady.

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Research questions

What are the common ingredients in successful therapies?

What kinds of therapy best suited for which problems?

When is therapy harmful?

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Common ingredients17

Therapeutic alliance: bond between therapist and client

When clients want to be helped

When therapists distinguish normal cultural patterns from individual psychological problems

Which therapy?DepressionCognitive therapy

Anxiety disordersExposure techniques

Anger and impulsive violenceCognitive therapy

Health problemsCognitive and behavior therapies

Childhood and adolescent behavior problemsBehavior therapy

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Successful therapy17

Your turn

You have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem?1. Direct brain intervention2. Cognitive therapy3. Psychodynamic therapy4. Behavioral therapy

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Your turn

You have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem?1. Direct brain intervention2. Cognitive therapy3. Psychodynamic therapy4. Behavioral therapy

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When therapy harms

Use of empirically unsupported, potentially dangerous therapeutic techniques

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

Prejudice or cultural ignorance on the part of the therapist

Unethical behavior, especially sexual intimacy, on the part of the therapist

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