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PSYCHOLOGICAL TREATMENT - Coggle Diagram

- - - - anxiety disorders
      - systematic desensitization
      - in vivo (vr) > imaginal exposure
    - - modifying undesirable behavior by the old-fashioned method of punishment
      - antabuse, snapping an elastic band
      - smoking, drinking, overeating, drugs, gambling, sexual deviance...
      - not very popular
    - - learning new skills by imitating another person who performs the behavior that needs to be acquired
      - children w/ intellectual disabilities, withdrawn adolescent, snake phobia
    - - typically in institutional settings
      - requires extremely careful and detailed observation for the therapist to learn what is maintaining the maladaptive behavior
      - eliminating behavior by eliminating reinforcers
    - - establishing missing behaviors by adding reinforcement
      - response shaping (child w/ selective mutism)
      - typically in institutional settings
    - - advantages
        
        results in a short period of time
        
        directed to specific symptoms
        
        easily evaluated results
        
        very favorable outcomes
      - disadvantages
        
        works better w/ certain problems than w/ others
        
        rarely employed for treatment of complex personality disorders; DBT excluded
  - - - changing maladaptive thought processes -- changing maladaptive emotional responses and behavior
      - learned unrealistic beliefs and perfectionistic values that cause to expect too much of ourselves, leading us to behave irrationally and then to feel that we are worthless
      - restructuring an individual's belief system and self-evaluation and having a more positive sense of self-worth and an emotionally satisfying, fulfilling life
      - homework assignments, rational confrontation, increasing self.worth by removing false beliefs that have been hindrances to personal growth
    - - problems result from biased processing of external events or internal stimuli; these biases distort the way a person makes sense of the experiences they have in the world, leading to cognitive errors
      - relatively stable set of cognitive schemas w/ dysfunctional beliefs -- activated by external or internal triggers -- biased information processing
      - identifying automatic thoughts--identifying logical errors in thinking--challenging the validity of these automatic thoughts
      - no debate or confrontation as in REBT, rather collecting info ab themselves
      - panic disorder, bulimia nervosa...
    - - REBT = everyday stress, not developing full-blown anxiety and depressive disorders; moderate to strong effects
      - CBT comparable to drug treatment in severe cases of depression; prevention of relapse, treatment of choice for bulimia, also for conduct disorder in children, substance abuse, certain personality disorders, panic disorder, GAD...
      - effectiveness: females > males, more experienced clinicians, effectiveness decreases over time (more inexperienced clinicians are intervening or expectations of improvement has decreased)..?
  - - - lack of agreed-upon therapeutic procedures, vagueness -- people are different so they need different techniques
      - helps w/ depression, anxiety, trauma, marital difficulties, substance abuse...
    - - unity of the mind and the body; integrating thought, feeling, and action
      - increasing self-awareness and self-acceptance
      - group setting
      - recognizing bodily processes and emotions that have been blocked off from awareness + dreams (kind of like psychoanalysis)
    - - brief form of therapy administered in 1-2 sessions
      - supportive and emphatic style of relating to the client
      - helping people resolve their ambivalence about change and make a commitment to treatment
      - substance abuse, addiction; large effect w/ ethnic minorities (Native American) and adolescents
    - - a process of removing the constraints that grow out of unrealistic demands that people tend to place on themselves
      - helping clients accept and be themselves
      - unconditional positive regard, nondirective techniques (empathic reflecting, restatement of the client's descriptions)
      - contrast to other forms: therapist does not "give answers", but rather listens acceptively and interrupting only to restate the client's words; devoid of any judgement or inerpretation
  - - - free association
        
        saying everything that comes to mind regardless of how personal, painful, or seemingly irrelevant it may be
        
        exploring the preconscious; tying together the maladaptive behavior and the unconscious
      - analysis of dreams
        
        forbidden desires and feelings expressed in disguised and symbolic form
        
        manifest content: the dream as it appears to the dreamer
        
        latent content: actual motives that are seeking expression but are so painful or unacceptable that they are disguised
      - analysis of resistance
        
        an unwillingness or inability to talk about certain thoughts, motives, or experiences
      - analysis of transference
        
        often people carry over and unconsciously transfer attitudes and feelings to their therapist
        
        clients may react to their therapist in the same way as they did to an earlier person
        
        transference neurosis = a person's reliving of a pathogenic past relationship in a sense re-creates the neurosis in real life
        
        countertransference = distrusting the therapist and feeling hostile as a symbol of authority, but at the same time seeking acceptance and love
        
        resolution of transference neurosis = cure
    - - original version practiced rarely today (time, money, emotional commitment,...)
      - focus on interpersonal issues, particularly as they play themselves out in the client-therapist relationship
      - some concentrate on the past, some on the present, or some balance of the two
      - most seek to expose and modify the effects of the developmental sources of current difficulties; retaining the classical goal of understanding the present in terms of the past, but ignoring the libidinal energy transformations and entirely internal and impersonal drives
    - - no rigorous, controlled outcome studies of classical, uncertain if the benefits justify the expenses
      - newer: PTSD, substance abuse, BPD (transference-focused psychotherapy; as good as DBT)
      - insight (cognitive and emotional understanding of inner conflicts) must occur before long-term clinical change
  - - - social-learning model, reinforcement; CHANGE
      - short-term (10-26 sessions), guided by a manual
      - 2/3 do well, does not work on all couples, improvement not maintained
    - - ACCEPTANCE of limitations of parter, change not forbidden
      - 80% success rate; self-help website
    - - reducing high levels of criticism and family tension to reduce relapse in patients w/ schizophrenia and mood disorders, anorexia nervosa
      - focused on present interactions; changing the family context so everyone will behave differently
  - - - depression, bulimia nervosa, anxiety disorders, borderline personality disorder
- - - - first-line meds
        
        easier to use, fewer side effects, not fatal in overdose, no more effective than others
      - inhibit the reuptake of serotonin following its release into the synapse
      - SNRIs
        
        block the reuptake of both norepinephrine and serotonin
        
        slightly more effective than SSRIs in depression
        
        similar side effects
      - 3-5 weeks; not fully well -period of remission (has to last for 6-12 months to be considered fully well again)
      - side effects: nausea, diarrhea, nervousness, insomnia, sexual problems (diminished sexual interest and difficulty with orgasm)
    - - first antidepressants, used infrequently (atypical depression w/ hypersomnia and overeating)
      - inhibit the activity of monoamine oxidase that breaks down serotonin and norepinephrine
      - must avoid food rich w/ tyramine (salami and stilton cheese) bc it limits the drug's clinical usefulness
    - - inhibit the reuptake of norepinephrine and (to a lesser extent) serotonin
    - - Trazodone (Desyrel) = not lethal when taken in overdose, inhibits the reuptake of serotonin, heavy sedating properties (combo w/ SSRIs), can induce a priapism (prolonged erection in the absence of any sexual stimulation)
      - Bupropion (Wellbutrin) = inhibits reuptake of both norepinephrine and dopamine, reduces nicotine cravings and symptoms of withdrawal, does not inhibit sexual functioning
      - ketamine, psilocybin, MDMA = not mainstream
  - - - acute anxiety and agitation-- rapidly absorbed
      - low dose: quell anxiety, high dose: sleep-inducing
      - barbiturates = controling seizures, anesthetics during electroconvulsive therapy
      - psychological and physiological dependence (withdrawal symptoms may include seizures), high relapse rates
      - enhanzing activity of GABA receptors (GABA inhibits anxiety in stressful situations)
    - - buspirone (Buspar)
        
        only released other than bezos, completely unrelated to it
        
        acts on serotonergic functioning
        
        as effective as benzos in GAD, but low potential for abuse (not sedative or muscle-relaxing, less pleasurable), BUT takes 2-4 weeks to have any effects (not useful in acute situations) and cannot be used to treat insomnia
  - - - passing an electric current through a patient's head
      - safe and effective
      - severely depressed or suicidal patients who may have not responded to other forms of treatment, pregnant women, elderly people
      - leads to structural change, but not to damage in the brain (downregulates receptors for norepinephrine; not fully clear how it works)
      - bilateral > unilateral (nondominant side) + general anesthetic + bit block
      - dozen sessions, 2-3 times a week
      - anterograde amnesia for ab 3 mo
    - - pulsed magnet over a carefully selected area of the patient's scalp is used to create a magnetic field that increases or decreases neuronal activity in the brain
      - major depression
      - less invasive and fewer side effects than ECT; mild headache and small risk of seizure; no impairments in memory or concentration
    - - prefrontal lobotomy
      - side effects: permanent inability to control impulses or unnatural tranquility with shallowness or absence of feeling, impaired functioning on cognitive tests, apathy
      - rare; no response to any kind of treatment for 5 years and still experiencing extreme and disabling symptoms
      - OCD, severe self-injury, anorexia nervosa
      - selective destruction of minute areas of the brain