Chapter Three ___________________________________ Treatment of - - PDF document

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Chapter Three

Treatment of Abnormal Behavior

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Classification and Assessment

• DSM-IV-TR

 Purpose: Classification system that allows

clinician to match their client’s problems the form of treatment that is mot likely to be

• effective. The system classifies disorders

according to a specific set of symptoms which helps in diagnosis and stimulates research for treatment and possible prevention of the disorder.

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Diagnositc Manual

• United States-DSM!V-TR

 Five axis descriptive classification system with each

axis concerned with a different domain of information.

 Axis one and two: clinical symptoms and Personality  Axis 3, 4 & 5: Medical and environmental factors

including overall level of function.

• International Classification of Disease-ICD-

developed by the World Health organization.

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Major Domains of Information of DSM IV-TR (text pg 109)

• Axis One -clinical disorders and other conditions-

includes all mental disorders except personality disorders.

• Axis Two – Personality disorders and presence of mental

retardation.

• Axis Three- General Medical Condition
• Axis Four- Psychosocial and environmental problems

that could have an impact on diagnosis or treatment (e.g. divorce, unemployment)

• Axis Five- Usually a number from 1-100 that asseses the

person’s level of psychological, social and occupational function.

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Biological

• Goal of Treatment: Alter biology to relieve

psychological distress.

• Primary Methods: Diagnosis and

medication

 Psychopharmacology--study of the use of

medications to treat psychological disturbances.

• Psychotropic medications: chemical substances that

affect the psychological state.

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Treatment with Pharmacology

• Neurotransmitter systems involved in

Pharmacological Treatment

 Serotonin-Depression, Anxiety  Norepinephrine-Depression, Anxiety, OCD  Dopamine-Depression, Schizophrenia, ADD

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Synthesis of Serotonin

Tryptophan 5HTP Serotonin Inactivated by MAO-A 5 HTP Decarboxylase Tryptophan hydroxylase MAO-inhibitors will stop the breakdown of serotonin and therefore make serotonin available at the synapse longer

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Synthesis of NE

Dopamine Norepinephrine Beta-hydroxylase (enzyme) Epinephrine Phenethanolamine N-methyltransferase

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Synthesis of Dopamine Tyrosine L-dopa Tryosine hydroxylase (enzyme) Dopamine Aromatic amino acid decarboxylase 3MT Methylated by COMT HVA Converted by MAO-B HVA is a catabolite which are cleared from the brain primarily by the CSF, also found in urine and blood Drugs that act upon any of these metabolites or enzymes can affect the amount of NT available

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Biological

• Primary Methods (cont)

 Psychopharmacology

• Onset of effectiveness
• Effects in people with mental disorders vs. people

who are functioning normally.

• Psychotropics alleviate symptoms but are not a cure

for the underlying problem.

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Biological

Primary Treatment Methods (cont)

Electroconvulsive Therapy- deliberate induction

• f a seizure by passing electricity through the

brain.

• Unilateral vs. bilateral
• Course of treatment
• Side effects

Psychosurgery-controversial treatment that involves the surgical removal of specific regions of the brain.

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Biological

• Role of Therapist:

Active, directive diagnostician-psychiatrist

• Length of visit:

Brief with occasional follow-up visits.

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Psychodynamic Therapies

• Goal of Treatment- Gain insight into

defenses and unconscious motives.

• Primary Methods- Interpretation of defense

mechanisms.

 Freudian Psychoanalysis  Psychodynamic Psychoanalysis

• Role of Therapist- Passive, non-directive

interpreter.

• Length of Treatment- Usually long term,

some new short-term treatments.

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Cognitive-Behavior Therapy

• Focuses on emotional, cognitive, and

behavior changes in the present and not insight about the past.

• Goal of Treatment- Learn more adaptive

behaviors and cognitions.

• Primary Methods- Instruction, Guided

Learning, Homework

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Cognitive-Behavior Therapy

Exposure therapies- based on Pavlov’s theory

• f classical conditioning.

Systematic Desensitization-if fears could be learned they could be unlearned through learning relaxation techniques and systematic exposure. Flooding-exposure to the feared stimulus all at once without any attempt to calm anxiety. Aversion Therapy-create an unpleasant response to behaviors such as addiction via drugs or shock.

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• Contingency Management- goal is to reward

desirable behavior and extinguish or punish undesirable behavior.

• Social Skills Training- goal is to teach clients new

ways of behaving that are both desirable and likely to be rewarded in every day life.

• Cognition Techniques- based on correcting

negative thinking.

• Beck’s Cognitive Theory -Therapy challenges the

negative distortions by gently confronting client’s cognitive errors in therapy.

• Rational Emotive Therapy (RET)-also designed to

challenge cognitive distortions thought to be caused by irrational beliefs.

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Humanistic Therapies

• believe that emotional distress results from

the frustrations of human existence.

• Goal of Treatment- Increase emotional

awareness.

• Primary Methods-Empathy, Support,

Exploring Emotions.

 Client Centered Therapy  Gestalt

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Humanistic Therapies

• Role of Therapist- Passive, nondirective,

warm, supporter. Humanistic Therapist endeavors to share in another human’s experience and does not take the role of an expert.

• Length of Treatment-Varies, length not

typically structured.

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Research on Effectiveness of Different Types of Therapy

Does Therapy Work? Types of Psychotherapy Research Psychotherapy Outcome Research

• -meta-analysis-a statistical technique which

allows the results from different studies to be combined and compared in a standardized way.

Psychotherapy Process Research: if it does

work, then how does it work

• -common factors.

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Common Factors in Process of Psychotherapy

• Meta-analysis comparisons reveal few

differences in effectiveness of treatments.

• Common Factors include:

 Psychotherapy as social support  Psychotherapy as Social Influence

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Changing Social Systems: Couples, Family & Group Therapy-

• Social Interventions
• Couples Therapy-
• Family Therapy-
• Group Therapy
• Prevention-

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