Biological therapies
Electroconvulsive Therapy
* 1930s: Schizophrenics with seizures - not a good treatment
* Still used to treat severe, non-
responsive MDD - useful for depression, but last option
* Side effects greatly reduced
Psychopharmacology
* It is difficult to understand the
process that is causing the
disorder and then finding an agent
that will modify that process.
- eases symptoms - manages disorders
Antipsychotics
* Developed in the 1950s
* Allowed for deinstitutionalization of
mental patients, especially people with
schizophrenia
Side effects:
* Extrapyramidal effects
* Newer drugs have fewer side
extrapyramidal side effects but are
no more effective
Anxiolytics - not used for anxiety anymore due to high dose of toxins
* Used to alleviate symptoms of anxiety
and muscle tension
* Barbiturates and benzodiazepines
* Problems: Tolerance & Addiction
Antidepressants
* Four major categories
* MAOIs
* TCAs
* SSRIs
* SNRIs
* Not effective immediately
* Can increase suicidal thoughts in
youths
Anxiolytics
* Used to alleviate symptoms of anxiety
and muscle tension
* Barbiturates and benzodiazepines
* Problems: Tolerance & Addiction
Mood Stabilizers
* Typically used to treat bipolar
disorder (BPD)
* Lithium
* Divalproex
* Very narrow window of effectiveness
* Low = not effective
* High = toxic
Stimulants
* Most commonly used to treat
children and adults with ADHD
* Side effects:
* appetite suppression
* sleep disturbance
* mood disturbance
* Headaches
* abdominal discomfort
* fatigue
Therapies
Psychotherapy
- A process in which a professionally trained therapist systematically uses techniques derived from psychological principles to
relieve another person’s psychological distress or to facilitate growth. - In Canada, the title psychotherapist is not licensed or restricted in any fashion.
- Many forms:
- individuals, couples, family & group
Therapies Psychodynamic - Freud
Techniques:
* Free association - link insights - therapist says one word and they respond with another
* Dream interpretation - understand what was subconscious
* Analysis of resistance - resistance on certain topics
* Analysis of transference - transfer conflict to another person - eg. seeing therapist as a father figure, causes you to act in the same way
Brief Psychodynamic Psychotherapy
* Neo-Freudians modified the techniques.
* Active and flexible
* Short term and 2xs/week
* Goals are concrete
* Conversation
* Empathy
* Current focus
Ego analysis - reliance on defence mechanisms - move away from focus on the ID
Adler’s Individual Psychology
* Focus on striving to overcome personal weakness
* Deeply held mistaken beliefs that lead to maladaptive style of life that protects insight into own imperfections
Interpersonal
Psychodynamic
* Harry Stack Sullivan
* Mental disorders result from maladaptive early parent-
child interactions.
* Emphasis on interactions between the client and his or her social environment
Therapies
Humanistic-Experiential Approaches
Client centered therapy - Carl Rogers - don’t focus on diagnosing, rather focus on overcoming maladaptive behaciour
Existential - inspired by Sartre and Kierkegaard - feelings of lack of meaning - support search for meaning, connect with others
Gestalt therapy - Fredrich Perls - emphasised that distortions exist when you make sense of yourself, which is responsible for impairments on personal growth
- empty chair technique - interpersonal conflict - help see situation from different perspective - speak to empty chair - then move - role play conversation
Emotion focused therapy - les greenberg - client has relationship with therapist that is full of empathy - initially introduced for couples therapy
Therapies
Behavioural Approaches
Based on operant conditioning treatment - problematic behaviours are learnt and this learning can be reversed with new learning
Contingency management
* Formal contract outlining goals, reinforcements, rewards - behaviour change
Response Shaping
* Shaping behaviour in gradual steps toward a goal - rewards to be successive - little reinforcement along the way
Behavioural Activation
*Identification of natural reinforcers - do things that are new - eg. exercise (natural reinforcers)
- Relaxation Training
Practical + accessible relaxation skills - Exposure
- Systematic desensitization - gradual exposure to stimuli that provokes anxiety - could be done in real life or imagination - in order of heriarchy of what stresses you
Assertiveness training
* behavior modeling (ex. Role play)
Dialectical behavior therapy - talk therapy
Therapies
Cognitive Approaches
Identifying automatic thoughts using
thought record/journal - identify cognitive biases
* identifying links between
cognitions and emotions
- Cognitive restructuring involves
identifying and modifying maladaptive thoughts (general technique) - asking questions to see the inconsistencies you have
Mindfulness practices
* Let go of your thoughts or change the way you engage with your negative thoughts would be ok.
Cognitive Behavioural therapy
Situation -> Thoughts about this situation -> Emotions and Behaviours (reaction)
- Based on the idea that how we think and feel influences our behaviour
- Techniques: Journaling, cognitive restructuring, play the script until the end, examining the evidence
- you become your own therapist
- Many takes on CBT:
- Albert Bandura: self-efficacy - more social mix - thinking about interactions with the social world and how we learn to behave based on different models around us and how we view ourself
- Albert Ellis: rational-emotive therapy
- Aaron Beck: cognitive therapy
- Maladaptive patterns of thinking → distress
- helps you be aware of the present
- thoughts are just thoughts - not reality
Integrative Approaches
- What makes a therapy effective? (Frank, 1961)
1. Hope (in client)
2. Alternative explanation for the problem
3. Expectations of change (think/feel/act in a different way) - Evidence Based Therapy Relationships
- Therapeutic alliance/cohesion in group therapy
- Therapist empathy
- Monitoring (accountability)
- Consensus and collaboration (need to consent to the treatment plan)
- One-third of therapists identify with a certain school of therapy but claim to have integrated aspects of diverse approaches.
Treatment Modalities
Individual Therapy
* Individual therapy remains the
most common modality.
* Significant others may be invited
to participate.
* Practiced with adults,
adolescents, and children.
Couples Therapy
* The goal is to enhance each partner’s
satisfaction with the relationship.
* Useful for problems that once were
considered individual issues.
Family Therapy
* Originated in social work and the
child guidance movement
* Family as solution to the problem
* Identify interactions between
family members that may
inadvertently contribute to
problems
Group Therapy
* Cost effective
* Post WW II initiative
* Group context offers feedback
* Universality → can reduce feelings
of stigma
Treatment of Anxiety Disorders
Specific phobias
Winning combo:
- Cognitive restructuring + Exposure
Feeling of anxiety is not life threatening
Obsessive-Compulsive Disorder
Winning combo:
- Exposure + response prevention
& cognitive restructuring
What fuels the anxiety
- cognitive - attention shift to perceived dangers - activation of threat relevant memories - thought patterns fuel the anxiety
- behavioural - motivation to escape or avoid the perceived threat, behavioural rituals to minimise danger
- physiological - increased heart rate, muscle tension, respiration sweating, etc - physical signs of anxiety
Treatment of Depression
CBT & IPT particularly effective
Key techniques from CBT
* Behavioral activation (ex. activity scheduling)
* Behavioural experiments
Common cognitive distorsions
* Overgeneralization (broad conclusions)
* All or nothing thinking (extreme)
* Jumping to conclusions (evidence?)
* Magnification (importance)
Medication
* No effect (medication vs placebo) for mild and moderate cases
* Most helpful for severe depression
* Higher risk of relapse with medication
Treatment for Unipolar Depression
Cognitive-Behaviour Therapy
- Emotional reactions to a
situation are determined,
at least in part, by one’s
thoughts about the
situation. - The person’s
psychological distress
could be alleviated by
identifying and modifying
the maladaptive patterns
of thinking that are at the
root of distress
Treatment for Unipolar Depression
Interpersonal psychotherapy (IPT)
- IPT focuses on the disruptions
that occur in the person’s
interpersonal world as a result
of depression
Interpersonal model:
* Negative feedback seeking
* Excessive reassurance
seeking
* Stress generation
hypothesis
Life Stress Perspective
* Stressful life events can trigger a
downward spiral into depression
* “Diatheses” (vulnerability)
Treatments for
Schizophrenia
- Early interventions during
the prodromal phase - high risk for developing schizophrenia - negative symptoms and functioning deficits are present - medication, CBT, cognitive
remediation, and social skills
training - Effective, but… deficits in
cognition, functioning and
quality of life appear to persist - Medication
- Antipsychotic medications
Treatment for Schizophrenia
CBT
- The way that individuals interpret their experiences plays an important role in the maintenance of symptoms.
- Components:
- Psychoeducation, belief modification and fostering of adaptive coping strategies.
- Therapy involves a number of stages.
- Establish a strong therapeutic alliance – trust and collaboration are important.
- Normalize symptoms
- Diaries to keep track of their symptoms as well as their emotional and behavioural
reactions to them (e.g., voices). - The therapist works with the client to arrive at alternative interpretations of these
experiences. - Increase rewarding experiences.
Treatment for Personality Disorders
Three general approaches
- when there is distress - they want something to change - antisocial personality disorder
- object relations therapy - psychodynamic - correcting flaws - aknowledging and focusing on new relationships
- cognitive-behavioural therapy - challenging underlying beliefs - aknowledging strengths
- antidepressants
- antipsychotic
anticonvulsant - helps with impulsiveness
Dialectical Behavior Therapy (DBT)
Marsha Linehan
- based on cognitive behavioural principles
Effective treatment for Borderline
Personality Disorder
- What is it?
- Mindfulness skills - consultation - unstable sense of self - mood swings
- Observing (environment, self,
body)
- Describing
- Participating (letting go, go with
the flow)
- Non judgmental approach
- Here & now
- Being effective (not being right)
Examples of strategies:
Find the factors making you
vulnerable to your emotions
today
Prompting event
- Problem solving skills?
- Check the facts (to counter
misinterpretations)
