17 Antipsychotic drugs. 17 Tranquilizers. Approaches to treatment and therapy. Antidepressant drugs

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1 Approaches to treatment and therapy Antipsychotic drugs Many 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 Antidepressant drugs Tranquilizers Monoamine oxidase inhibitors (MAOI s) Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters Increase the activity of GABA Developed for treatment of mild anxiety Tricyclic antidepressants Boost norepinephrine and serotonin by preventing reuptake Selective serotonin reuptake inhibitors (SSRI s) Boost serotonin by preventing reuptake Often prescribed inappropriately by general practitioners for any patient mood complaints Herbs such as St. John s Wort have also been used.

2 Lithium carbonate Your turn 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. Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment.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 MAOI 2. An SSRI (e.g., Prozac) 3. A tranquilizer (e.g., Valium) 4. Lithium carbonate Your turn Placebo effect Your friend has largely withdrawn from social activities, and has stopped maintaining her appearance or apartment.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 MAOI 2. An SSRI (e.g., Prozac) 3. A tranquilizer (e.g., Valium) 4. Lithium carbonate 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.

3 High relapse and dropout rate There may be short-term success, but 50 66% of patients stop taking medication due to side effects. Individuals who take antidepressants without learning how to cope with their problems are much more likely to relapse. Dosage problems Finding the therapeutic window, the dosage that is enough but not too much Drugs may be metabolized differently in... Men and women Old and young Different 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. Long-term risks Antipsychotic drugs can be dangerous, even fatal if taken for many years. tardive dyskinesia Antidepressants are often assumed to be safe, but no long-term studies have been conducted. Suicidal effects have been found in young people. (4 of 100 vs. 2 of 100 with placebo (sugar pills) Psychological Therapy MUST accompany drugs. Final Drug Cautions Medications have improved the lives of thousands..even saved lives. But the popularity of drugs has been fueled by pressure form managed care organizations who would rather pay for one visit for a prescription than 10 visits of psychotherapy. psychotic drugs can be dangerous, even fatal if taken for many years. Also by drug advertising Only 11 years ago(1997) did the FDA approve direct advertising of drugs to consumers. This is still forbidden in Canada and Europe. Number of antidepressants given to Preschoolers has doubled in that time. Most consumers do not realize that once a drug is approved doctors can prescribe it for other conditions.

4 Direct brain intervention Psychosurgery Any 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 Transcranial magnetic stimulation Involves 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. Psychodynamic therapy Psychoanalysis A method of psychotherapy developed by Freud, emphasizes the exploration of unconscious motives and conflicts Free association In psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind Psychodynamic therapy Other psychodynamic therapies also explore unconscious dynamics, but differ from Freudian analysis. Transference In psychodynamic therapies, a critical step in which the client transfers unconscious emotions or reactions, such as conflicts with parents, onto the therapist

5 Behavior therapy Graduated exposure A form of therapy that applies classical and operant conditioning to help people change own defeating or problematic behaviors In 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 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 Systematic desensitization A step-by-step process of desensitizing a client to a feared object or experience Based on counter conditioning

6 Behavioral selfmonitoring A method of keeping careful data on the frequency and consequences of a behavior to be changed Skills training An effort to teach a client skills or new more constructive behaviors to replace self-defeating ones Cognitive techniques Examine the evidence for beliefs. Consider other explanations for the behavior of other people. Identify assumptions and biases. Rational emotive therapy A form of cognitive therapy devised by Albert Ellis, designed to challenge the client s unrealistic or irrational thoughts

7 Humanist therapy Existential therapy Humanist therapy Based on assumption that people seek selfactualization, self-fulfillment Emphasized people s free will to change, not past conflicts 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 Client-centered therapy Developed by Carl Rogers, emphasizes therapist s empathy with client, and communication of unconditional positive regard Family and couples therapy Assumes that problems develop in the context of family, that they are sustained by family dynamics, and that any changes will affect whole family Family-systems perspective Therapy with individuals or families that focuses on how each member forms part of a larger interacting system Can look for patterns of behavior across generations and create a family tree of psychologically significant events

8 One family s history of mental illness The scientistpractitioner gap Some 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. Is more better? Research questions Additional sessions, up to 26, increase the percentage of people who improve. Rate of improvement then levels off. What are the common ingredients in successful therapies? What kinds of therapy best suited for which problems? When is therapy harmful? Patients sense of improvement slower but more steady.

9 Common ingredients Which therapy? Therapeutic alliance: bond between therapist and client When clients want to be helped Depression Cognitive therapy Anxiety disorders Exposure techniques When therapists distinguish normal cultural patterns from individual psychological problems Anger and impulsive violence Cognitive therapy Health problems Cognitive and behavior therapies Childhood and adolescent behavior problems Behavior therapy Successful therapy 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 intervention 2. Cognitive therapy 3. Psychodynamic therapy 4. Behavioral therapy

10 Your turn When therapy harms 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 intervention 2. Cognitive therapy 3. Psychodynamic therapy 4. Behavioral therapy 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 The Value and Values of therapy We learned about the let s fix it Western attitude whereas and Eastern attitude is more about learning to live with troubling emotions rather than eradicate them. Some Western psychotherapists now also teach techniques of mindful meditation and greater selfacceptance. This is available in Santa Cruz. Many people get all the help they need from talking things over with good friends or others who are in the same situation. But if you have a persistent problem that you can t seem to solve and that causes you a lot of unhappiness for 6 months or longer you might look for some help. How to start AND end therapy 1. Start with the school counseling clinic. They will give 6 free sessions (sometimes enough! ) and refer you to the community for other or longer term options 2. Check the web and local phone book for specific kinds of therapy and then ask them about fees and insurance coverage. Ask about credentials and training. Take notes. 3. Choose the appropriate TYPE of therapy. You shouldn t spend four years in psychodynamic therapy for panic attacks. These can usually be helped in just a few sessions of cognitivebehavior therapy. Anger or Depression also respond well to Cognitive and Behavior therapy. 4. Decide when to leave. For the emotional problems of life, some improve in 2-3 sessions, 50% improve in 8-11 sessions, and 3/4 in 6-12 mos. Severe disorders do require continued care. 5. YOU have the right to determine when enough is enough.if you have made a real effort and their has been no result after enough time and effort, it may have as much to do with the treatment or the therapist as with you.

11 Cabrillo College Student Health Services -Personal Counseling Student Health Services provides strength based brief counseling for students with the goal of maximizing success. Personal Counseling is offered to help students cope with stressors that are affecting their academic, career, or personal goals. Issues may include wellness, stress, anxiety, alcohol or drug problems, depression, relationship difficulties, anger, low motivation, grief, parenting issues, abuse or other issues affecting your personal well being. We are here to support you and offer up to six sessions a semester. We also offer community referrals. Please contact Health Services at today to make an appointment. Appointments may also be made at the Watsonville Student Resource Center