Psych 100 Lesson 17 Treatment (2)

  1. Behavior Therapies - involve the application of learning principles to direct efforts to change clients' maladaptive behaviors
    1. Behaviorist perspective
      1. No insights, no defense mechanisms, unconscious conflicts, childhood trauma, no parents
      2. Problems arise from bad behaviors learned behaviors
      3. Fix is to learn good behaviors
      4. "psychological" problems all disappear with the bad behaviors
      5. Usually apply the classical conditioning model (Pavlov)
        1. Conditioning results from pairing of CS with UCS so that CS now elicts a UCR
        2. Counterconditioning pairs CS with UCS without UCR, connection extinguishes
    2. Sytematic desensitization -Wolpe 58- behavior therapy used to reduce phobic clients' anxiety responses through counterconditioning
      1. Therapist builds anxiety hierarchy, what is bothering the patient
      2. Train deep muscle relaxation, relaxed state is incompatible with anxiety
      3. Patient works through hierarchy by imagining each source of anxiety
      4. Another approach is gradual physical approximation: fear of flying
      5. Recent variation, virtual reality: treatment for post traumatic stress disorder
    3. Aversion Therapy - a behavior therapy in which an aversive stimulus is paired with a stimulis that elicits an undesirable response.
      1. Pairs aversive UCS with target CS of bad behavior so CS elicits aversive UCR
      2. Bingeing and sickness, my job as a bartender
      3. Emetic drug (Anabuse) makes alcoholic sick when he/she drinks alcohol
      4. Basis for therapy in "Clockwork Orange"
    4. Social Skills Training - a behavior therapy designed to improve interpersonal skills emphasized modeling, behavioral rehearsal, and shaping.
      1. Modeling, emulating others to acquire correct behavior "Desperately Seeking Susan"
      2. Behavioral rehearsal, role playing to correct inappropriate behaviors
      3. Shaping, multiple approximations to the desired behavior
      4. Can be used in schizophrenic and autistic, when positive and negative stimuli identifiable
    5. Biofeedback - monitor body states (heartrate, GSR, EMG, etc) and feedback results so person can achieve relaxation
      1. Does not alter person, can be done with or without supervision (not considered biological)
      2. Successfully used in treating anxiety, tension, migranes
    6. Evaluating behavior therapies
      1. Measure objective behavior progress, not subjective feelings of wellness
      2. Controversial, prisons have had behavioral programs halted because of prisoner rights
      3. Effectiveness varies greatly with therapist skills
  2. Biomedical Therapies - physiological interventions intended to reduce symptoms associated with psychological disorders
    1. Background
      1. Includes drugs, ECT, surgery
      2. Widely employed today, often first approach
    2. Psychopharmacotherapy
      1. Delay and Deniker 52 first use chlorpromazine on schizophrenic patients, first drug therapy
      2. Antianxiety drug therapy- relieve tension, apprehension, nervousness
        1. Benzodiazepine tranquilizers
        2. Include diazepam (valium) and alprazolam (Xanax)
        3. Chemically prevent tension or anxiety
        4. Side effects of drowsiness, depression, anxiety and confusion
        5. Can cause withdrawal symptoms
        6. Newer drugs buspirone (Buspar) have fewer side effects
        7. Meant to be used as short term facilitators of therapy, abuse problems
      3. Antipsychotic drug therapy- reduce psychotic symptoms including hyeractivity, confusion, hallucinations, and delusions
        1. Chlorpromazine (Thorazine), thioridazine (Mellaril), haloperidol (Haldol)
        2. Most patients respond to drugs, but with varying degrees of success
        3. Side effect of drowsiness, constipation, cotton mouth, tremmors, rigidity, impaired motor coordination drive patients to stop drug, 2/3 relapse
        4. Tardive dyskinesia involuntary writhing, tics in mouth face, tongue, hands, feet
        5. New drugs atypical antipsychotics (clozapine, olanzapine,quetiapine) reduce but do not eliminate side effects
      4. Antidepressant drug therapy - elevate mood and reduce depressive symptoms
        1. Early drugs include tricyclics (Elavil) and MAO inhibitors (Nardil), have serious side effects
        2. New drugs include selective serotonin reuptake inhibitors SSRIs like fleoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) with fewer side effects
        3. Side effects include sexual and withdrawal symptoms
      5. Antibipolar drug therapy
        1. Metal Lithium dampens mood swings of bipolar mood disorders
        2. Requires careful monitoring, too little has no effect, too much toxic, affects kidneys and thyroid
      6. Evaluating drug therapies
        1. Drugs offer temporary relief, not long term solutions
        2. Side effects may be nearly as bad as mental illness
        3. Over prescription and abuse
    3. Electroconvulsive Therapy (ECT) biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions
      1. Background
        1. Seizures & schizophrenia, von Meduna 30's, electrical Cerletti and Bini, 38
      2. Method
        1. light anesthetic, protective countermeasures
        2. Uni- or Bi-lateral application of current
        3. Mechanisms of effect unknown
        4. Some data supports use in severe mood disorders
        5. Side effects include short term cognitive deficiency, memory loss
        6. Bill's theory, patients get better for fear they will get brains fried!
  3. Other treatment issues
    1. Managed care and restricting insurance for psychological problems
    2. Evaluation methods lacking
    3. Blending multiple approaches, drugs with others may be most effective
    4. Eclecticism runs contrary to the "school" approach to therapy
    5. Multicultural issues in an increasingly pluralistic society
      1. Cultural barriers
      2. Language barriers
      3. Access barriers
      4. Institutional barriers
    6. Institutional treatment
      1. History of poor care
      2. Deinstitutionalization - from inpatient to community-based facilities offering out-patient
      3. Mental Illness, revolving door and homelessness
    7. Perspective
      1. Mental health care in America is only fair among industrialized nations
      2. HMOs have exacerbated the problem