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Ch. 14 Therapies

Psychological Disorder
Troubling thoughts, feelings, or behaviors that cause psychological discomfort or interfere with a person’s ability to function
-Two broad forms of therapy that mental health professionals use to help people: psychotherapy and biomedical therapy
The treatment of emotional, behavioral, and interpersonal problems through the use of psychological techniques designed to encourage understanding of problems and modify troubling feelings, behaviors, or relationships
Biomedical Therapies
The use of medications, electroconvulsive therapy, or other medical treatments to treat the symptoms associated with psychological disorders
-Drugs that are used to treat psychological or mental disorders are termed psychotropic medications
-Biomedical therapies are based on the assumption that the symptoms of many psychological disorders involve biological factors, such as abnormal brain chemistry
A type of psychotherapy originated by Sigmund Freud in which free association, dream interpretation, and analysis of resistance and transference are used to explore repressed or unconscious impulses, anxieties, and internal conflicts
Sigmund Freud
Developed a form of psychotherapy, psychoanalysis
Pushed out of conscious awareness
-Usually happens with early experiences that result in unresolved conflicts and frustrated urges
-Repressed conflicts continue to influence a person’s thoughts and behavior
Free Association
A technique used in psychoanalysis in which the patient spontaneously reports all thoughts, feelings, and mental images as they come to mind, as a way of revealing unconscious thoughts and emotions
-Psychoanalyst usually sits out of view, occasionally asking questions to encourage the flow of associations
In psychoanalysis, the patient’s unconscious attempts to block the revelation of repressed memories and conflicts
-Ex: Sudden silence or an abrupt change of topic
-Sign that the patient is uncomfortably close to uncovering psychologically threatening material
Dream Interpretation
A technique used in psychoanalysis in which the content of dreams is analyzed for disguised or symbolic wishes, meanings, and motivations
-Because psychological defenses are reduced during sleep, Freud believed that unconscious conflicts and repressed impulses were expressed symbolically in dream images
-Ex: Lion in a woman’s dream referred to her father who had a “beard which encircled his face like a Mane”
-Often, dream images were used to trigger free associations that might shed light on the dream’s symbolic meaning
A technique used in psychoanalysis in which the psychoanalyst offers a carefully timed explanation of the patient’s dreams, free associations, or behaviors to facilitate the recognition of unconscious conflicts or motivations
-Timing of such interpretations is important. If an interpretation is offered before the patient is psychologically ready to confront an issue, she may reject the interpretation or respond defensively, increasing resistance
In psychoanalysis, the process by which emotions and desires originally associated with a significant person in the patient’s life, such as a parent, are unconsciously transferred onto the psychoanalyst
-Ex: The patient sees his analyst the return–the reincarnation–of some important figure out of his childhood or past, and consequently transfers on to him the feelings and reactions that undoubtedly applied to this model
-Encourages transference by remaining as neutral as possible (does not reveal personal feelings, take sides, make judgments, or actively advise the patient)
-This produces “optimal frustration” so that the patient transfers and projects unresolved conflicts onto the psychoanalyst
-As the transference becomes more intense, the patient relives unconscious emotional conflicts that have been repressed since childhood
-Designed to help patient see how past conflicts influence her current behavior and relationships
Short-Term Dynamic Therapies
Type of psychotherapy that is based on psychoanalytic theory but differs in that it is typically time-limited, has specific goals, and involves an active, rather than neutral, role for the therapist
-Last no more than a few months
-pg. 584 for more info
Interpersonal Therapy (IPT)
A brief, psychodynamic psychotherapy that focuses on current relationships and is based on the assumption that symptoms are caused and maintained by interpersonal problems
-Also focuses on social interactions
-Highly structured
-Unresolved grief: refers to problems dealing with the death of significant others, while role disputes refer to repetitive conflicts with significant others, such as the person’s partner, family members, friends, or co-workers
-Role transitions: Problems involving major life changes, such as going away to college, becoming a parent, getting married or divorced, or retiring
Interpersonal deficits: Absent or faulty social skills that limit the ability to start or maintain healthy relationships with others. During treatment, the therapist helps the person understand his particular interpersonal problem and develop strategies to resolve it
-Used to treat eating disorders and substance abuse as well as major depressive disorder, also marital conflict, parenting issues, and conflicts at work
-pg. 584 for more info
Humanistic Perspective
Emphasizes human potential, self-awareness, and freedom of choice
-The most important factor in personality is the individual’s conscious, subjective perception of his or her self
-People as innately good and motivated by the need to grow psychologically
Client-Centered Therapy
A type of psychotherapy developed by humanistic psychologist Carl Rogers in which the therapist is nondirective and reflective, and the client directs the focus of each therapy session; also called person-centered therapy
-Deliberately used the word client instead of patient because he believed that the medical term patient implied that people in therapy were “sick” and were seeking treatment from an all-knowing authority figure who could “heal” or “cure”
-Client-centered therapy emphasizes the client’s subjective perception of himself and his environment
-Believed that the three qualities of the therapist are necessary: genuineness, unconditional positive regard, and empathic understanding
-pg. 595 for more info
What Rogers believed that therapists should be
-Therapist must not direct the client, make decisions for the client, offer solutions, or pass judgment on the client’s thoughts or feelings
-Believed change in therapy must be chosen and directed by the client
Means that the therapist honestly and openly shares her thoughts and feelings with the client
-By modeling genuineness, the therapist indirectly encourages the client to exercise this capability more fully in himself
Unconditional Positive Regard
The therapist must value, accept, and care for the client, whatever her problems or behavior
Conditional Acceptance
Rogers believed that people develop psychological problems largely because they have consistently experienced this
-That is, parents, teachers, and others have communicated this message to the client: “I will accept you only if you conform to my expectations.”
-Because acceptance by significant others has been conditional, the person has cut off or denied unacceptable aspects of herself, distorting her self-concept
-In turn, these distorted perceptions affect her thoughts and behaviors in unhealthy, unproductive ways
Empathetic Understanding
Therapist must communicate this by reflecting the content and personal meaning of the feelings being experienced by the client
-This creates a psychological mirror, reflecting the client’s thoughts and feelings as they exist in the client’s private inner world
-Goal is to help the client explore and clarify his feelings, thoughts, and perceptions
-Requires therapist to listen actively for the personal meaning beneath the surface of what the client is saying
The realization of his or her unique potentials and talents
Motivational Interviewing (MI)
Designed to help clients overcome the mixed feelings or reluctance they might have about committing to change
-Usually lasting only a session or two, MI is more directive than traditional client-centered therapy
-Main goal is to encourage and strengthen the client’s self-motivating statements or “change talk”
Behavior Therapy
A psychotherapy that focuses on directly changing maladaptive behavior patters by using basic learning principles and techniques; also called behavior modification
-Goal is to modify specific problem behaviors, not to change entire personalities
-Behavior therapists focus on current behaviors
-Behavior therapists assume that maladaptive behaviors are learned, just as adaptive behaviors are
-Basic strategy i to unlearn maladaptive behaviors and learning more adaptive behaviors
-Techniques are classical conditioning, operant conditioning, and observational conditioning
Mary Cover Jones
Explored ways of reversing conditioned fears
-Treated a 3 year old named Peter (like Little Albert)
-He was fearful of various furry objects
-Regarded as the first behavior therapist
A behavior therapy technique based on classical conditioning that involves modifying behavior by conditioning a new response that is incompatible with a previously learned response
Social Imitation or Observational Learning
Peter observed other children petting or holding the tame rabbit. Eventually, Peter imitated the actions of the nonfearful children
-Used to eliminate Peter’s fear of rabbits
Systematic Desensitization
A type of behavior therapy in which phobic responses are reduced by pairing relaxation with a series of mental images or real-life situations that the person finds progressively more fear-provoking; based on the principle of counterconditioning
-Developed by South African psychiatrist Joseph Wolpe in the 1950s
-Involves learning a new conditioned response (relaxation) that is incompatible with or inhibits the old conditioned response (fear and anxiety)
-Three basic steps:
1. Progressive Relaxation- Which involves successively relaxing one muscle group after another until a deep state of relaxation is achieved.
2. The behavior therapist helps the patient construct an anxiety hierarchy, which is a list of anxiety-provoking images associated with the feared situation, arranged in a hierarchy from least to most anxiety-producing. The patient also develops an image of a relaxing control scene, such as walking on a secluded beach on a sunny day.
3. Third step involves the actual process of desensitization. While deeply relaxed, the patient imagines the least threatening scene on the anxiety hierarchy. After he can maintain complete relaxation while imagining this scene, he moves to the next. If the patient begins to feel anxiety or tension, the behavior therapist guides him back to imagining the previous scene or the control scene
-pg. 589 for more info.
Virtual Reality Therapy (VR)
Consists of computer-generated Scenes that you view wearing goggles and a special motion-sensitive headset
-First used in treatment of specific phobias, including fear of flying, heights, spiders, driving, and enclosed places
-For ex: Psychologist Ralph Lamson used virtual reality as a form of computer-assisted systematic desensitization to help more than 60 patients conquer their fear of heights
Aversive Conditioning
A relatively ineffective type of behavior therapy that involves repeatedly pairing an aversive stimulus with the occurrence of undesirable behaviors or thoughts
-Attempts to create an unpleasant conditioned response to a harmful stimulus, such as cigarette smoking or alcohol consumption
-For substance use disorder and addiction, taste aversions are commonly induced with the use of nausea-inducing drugs
-Mental professionals are cautious about the use of such techniques, partly because of their potential to harm or produce discomfort for clients
-Aversive techniques are generally not very effective
A medication used in aversion therapy for alcoholism
-Consuming alcohol while taking Antabuse produces bouts of extreme, highly unpleasant nausea
Operant Conditioning
B.F. Skinner’s model of learning based on the simple principle that behavior is shaped and maintained byits consequences
Involves reinforcing successive approximations of a desired behavior
-Often used to teach appropriate behaviors to patients who are mentally disabled by autism spectrum disorder, intellectual disability, or severe mental illness
-Ex: Shaping has been used to increase attention span of hospitalized patients with severe schizophrenia
Positive and Negative Reinforcement
Used to increase incidence of desired behaviors
The absence of reinforcement, is used to reduce the occurrence of undesired behaviors
Baseline Rate
How often each problem occurred before treatment began
Token Economy
A form of behavior therapy in which the therapeutic environment is structured to reward desired behaviors with tokens or points that may eventually be exchanged for tangible rewards
-Another example of the use of operant conditioning techniques to modify behavior
-System is good for strengthening desired behaviors through positive reinforcement in a very structured environment
-Basically, tokens or points are awarded as positive reinforcers for desirable behaviors and withheld or taken away for undesirable behaviors
-Has been most successful in controlled environments in which the behavior of the client is under ongoing surveillance or supervision
-Token economies have been used in classrooms, inpatient psychiatric units, and group homes
Contingency Management
This is a modified version of the token economy that has been used with outpatients in treatment programs
-A contingency management intervention involves carefully specified behaviors that “earn” the individual concrete rewards
-Unlike token economies, which cover many behaviors, contingency management strategies are typically more narrowly focused on one or a small number of specific behaviors
-Proved to be especially effective in the outpatient treatment of people who are addicted to heroin, cocaine, alcohol, or multiple drugs
Cognitive Therapies
A group of psychotherapies based on the assumption that psychological problems are due to illogical patterns of thinking; treatment techniques focus on recognizing and altering these unhealthy thinking patterns
-Assume that the culprit is faulty thinking
-Most people blame their unhappiness and problems on external events and situations, but the real cause of unhappiness is the way the person thinks about the events, not the events themselves
-1. Identify faulty, irrational patterns of thinking
2. Change them to be more adaptive, healthy patterns of thinking
Albert Ellis
Psychologist who has expressed the same sentiment: “You largely feel the way you think.” He developed Rational-Emotive Therapy (RET)
Rational-Emotive Therapy (RET)
A type of cognitive therapy, developed by psychologist Albert Ellis, that focuses on changing the client’s irrational beliefs
-Based on the assumption that “people are not disturbed by things but rather by their view of things”
-Key premise is that people’s difficulties are caused by their faulty expectations and irrational beliefs
-Ellis argues that it’s their interpretation of those events that make the people miserable
-Result is self-defeating behaviors, anxiety disorders, major depressive disorder, and other psychological problems
-Therapists should vigorously dispute the irrational beliefs by being very direct and even confrontational
ABC Model
When an Activating event (A) occurs, it is the person’s Beliefs (B) about the event that cause emotional Consequences (C)
Aaron T. Beck
Psychiatrist who was initially trained as a psychoanalyst
-Developed cognitive therapy (CT)
-Grew out of his research on depression
Cognitive Therapy (CT)
Therapy developed by Aaron T. Beck that focuses on changing the client’s unrealistic and maladaptive beliefs
-Same with Ellis, believes that what people think creates their moods and emotions
-Like RET, CT involves helping clients identify faulty thinking and replace unhealthy patterns of thinking with healthier ones
-In contrast with Ellis’s emphasis on “irrational” thinking, Beck believes that major depressive disorder and other psychological problems are caused by distorted thinking and unrealistic beliefs
-Rather than debating the “irrationality” of a client’s beliefs, the CT therapist encourages the client to empirically test the accuracy of his or her assumptions and beliefs
-1. Help client learn to recognize and monitor the automatic thoughts that occur without conscious effort or control
2. The therapist helps the client learn how to empirically test the reality of the automatic thoughts that are so upsetting. For ex: to test the belief that “I always say the wrong thing,” the therapist might assign the person the task of initiating a conversation with three acquaintances and noting how often he actually said the wrong thing
-CT therapist also strives to create a therapeutic climate of collaboration (contrasts with confrontational approach used by RET)
-Effective for major depressive disorder, and other psychological disorders, including anxiety disorders, borderline personality disorders, eating disorders, post-traumatic stress disorder, and relationship problems
-CT may also prevent it major depressive disorder from recurring
Negative Cognitive Bias
Consistently distorting experiences in a negative way
Cognitive-Behavioral Therapy (CBT)
Therapy that integrates cognitive and behavioral techniques and that is based on the assumption that thoughts, moods, and behaviors are interrelated
-Changes in thought patterns will affect moods and behaviors, and changes in behaviors will affect thoughts and moods
-Pragmatic approach: therapists design an integrated treatment plan, utilizing the techniques that are most appropriate for specific problems
-Used for treatment of children, adolescents, and the elderly
-Effective for major depressive disorder, eating disorders, substance use disorder, anxiety disorders, etc.
-New therapies: mindfulness-based interventions, mindfulness-based therapies, or mindfulness and acceptance therapies
A meditation technique that involves present-centered awareness without judgment
One important technique to help monitor thoughts and feelings without judgment ideally allowing people to experience disturbing thoughts and feelings without reacting to them
-Individuals are taught to notice, label, and relate to their thoughts and emotions as “just passing events”
Mindfulness-Based Stress Reduction (MBSR)
First mindfulness-based therapy to earn broad acceptance
-Developed by Jon Kabat-Zinn
-MBSR involves a strucutred program of mindfulness meditation, yoga and mindful body practices, and group disussion
Mindfulness-Based Cognitive Therapy (MBCT)
Developed to treat major depressive disorder, although it has been expanded to include other disorders
-One study found that MBCT was as effective as antidepressant medications in preventing relapse after an acute episode of major depressive disorder
Group Therapy
A form of psychotherapy that involves one or more therapists working simultaneously with a small group of clients
-Provided by a therapist in private practice or at a community mental health clinic
1. Cost-effective
2. Rather than relying on a client’s self-perceptions about how she relates to other people, the therapist can observe her actual interactions with others
3. The support and encouragement provided by the other group members may help a person feel less alone and understand that his or her problems are not unique
4. Group members may provide each other with helpful, practical advice for solving common problems and can act as models for successfully overcoming difficulties
5. Working within a group gives people an opportunity to try out new behaviors in a safe, supportive environment
Family Therapy
A form of psychotherapy that is based on the assumption that the family is a system and that treats the family as a unit
-Major goal is to alter and improve the ongoing interactions among family members
An interdependent unit, not just a collection of separate individuals
-what family therapy is based on the assumption of
Behavioral Couple Therapy
Based on the assumption that couples are satisfied when they experience more reinforcement than punishment in their relationship
-Focuses on increasing caring behaviors and teaching couples how to constructively resolve conflicts and problems
Spontaneous Remission
A phenomenon in which people eventually improve simply with the passage of time
Involves pooling the results of several studies into a single analysis, essentially creating one large study that can reveal overall trends in the data
-Found that psychotherapy is significantly more effective than no treatment and also found that In general, there is little or no difference in the effectiveness of different psychotherapies
Therapeutic relationship
Related to a positive therapy outcome
-When psychotherapy is helpful, the therapist-client relationship is characterized by mutual respect, trust, and hope
-Cooperative alliance
Therapist Characteristics
Related to a positive therapy outcome
-Helpful therapists have a caring attitude and the ability to listen emphatically
-Regardless of approach, they tend to be warm, sensitive, and responsible people, and they are perceived as sincere and genuine
Client Characteristics
Related to a positive therapy outcome
-If client is motivated, committed to therapy, and actively involved in the process, a successful outcome is much more likely
-Emotional and social maturity and ability to express thoughts and feelings are important
-Clients who are optimistic, who expect psychotherapy to help them with their problems, and who don’t have a previous history of psychological disorders are more likely to benefit from therapy
External Circumstances
Related to a positive therapy outcome
-Stable living situation, and supportive family members, can enhance the effectiveness of therapy
Cultural Differences
Related to a positive therapy outcome
-Fifth, perhaps
-Effective therapists are sensitive to this (differences that may exist between themselves and their clients)
The pragmatic and integrated use of techniques from different psychotherapies
Eclectic Psychotherapists
Carefully tailor the therapy approach to the problems and characteristics of the person seeking help
-Ex: An eclectic therapist might integrate insight-oriented techniques with specific behavioral techniques to help someone suffering from extreme shyness
Integrative Psychotherapy
Integrative psychotherapists also use multiple approaches to therapy, but they tend to blend them together rather than choosing different approaches for different clients
Eye Movement Desensitization Reprocessing (EMDR)
Therapy technique in which the client holds a vivid mental image of a troubling event or situation while rapidly moving his or her eyes back and forth in response to the therapist’s waving finger or while the therapist administers some other form of bilateral stimulation
-Fastest growing and most lucrative therapeutic techniques of the past decades
-Involves 8 phases, which combine elements of pscyhodynamic, behavioral, and cognitive therapies
-Along with eye movements, other forms of “bilateral stimulation” may be used, such as tones in alternating ears or taps on different sides of the body
-Used to treat PTSD, panic disorder, and other anxiety disorders, addiction, substance use disorder, and sleep disorders
-Also effective in overcoming major depressive disorder, phobias, pathological gambling, and self-esteem problems, as well as helping athletes and workers achieve “peak performance”
Exposure Therapy
Behavioral therapy for phobias, panic disorder, post-traumatic stress disorder, or related anxiety disorders in which the person is repeatedly exposed to the disturbing object or situation under controlled conditions
-One technique that has been long recognized as an effective treatment for PTSD and phobias
-Related to systematic desensitization: The person gradually and repeatedly relieves the frightening experience under controlled conditions to help him overcome his fear of the dreaded object or situation and establish more adaptive beliefs and cognitions
-High rate of success in treatment of anxiety disorders
-EDMR is not more effective not other cognitive-behavioral treatments. No more effective than standard treatments for anxiety disorders, including PTSD
Network Therapy
A type of therapy conducted in the person’s home and can involve as many as 70 members of the individual’s community or tribe
The importance of the extended family network. Because the sense of family is so central to Latino culture, some psychologists recommend that members of the client’s extended family, such as grandparents and in-laws, be actively involved in psychological treatment
Naikan Therapy
Japanese psychotherapy, a good example of how such cultural values affect the goals of psychotherapy
-According to Naikan therapy, being self-absorbed is the surest path to psychological suffering. Thus, the goal of Naikan therapy is to replace the focus on the self with a sense of gratitude and obligation toward others
Psychotropic Medications
Drugs that alter mental functions, alleviate psychological symptoms, and are used to treat psychological or mental disorders
-Prescription drugs
-Often used alone, psychotropic medications are increasingly combined with psychotherapy
Primitive surgery on the brain, presumably as a treatment to allow evil spirits to leave the body
Tranquilizing chain
Developed in the early 1880s to restrain and sedate unmanageable patients
A synthetic version of the herb’s active ingredient that Indian physicians discovered that was helpful in the treatment of high blood pressure
-Also effective for treating schizophrenia
French scientists began investigating the psychoactive properties of this drug
-Like reserpine, chlorpromazine diminished the psychotic symptoms commonly seen in schizophrenia
-Resepine and chlorpromazine were dubbed antipsychotic medications
-Has fewer side effects than reserpine
-Known by trade name Thorazine, still used to treat psychotic symptoms
Anitpsychotic Medications
Prescription drugs that are used to reduce psychotic symptoms; frequently used in the treatment of schizophrenia; also called neuroleptics
-Reserpine and chlorpromazine diminish psychotic symptoms by reducing levels of the neurotransmitter called dopamine
-First antipsychotics effectively reduced the positive symptoms of schizophrenia–hallucinations, delusions, and disordered thinking
1. Psychotic symptoms often returned if a person stopped taking the medication
2. Early antipsychotic medications were not very effective in eliminating the negative symptoms of schizophrenia–social withdrawal, apathy, and lack of emotional expressiveness. In some cases, the drugs even made the symptoms worse.
3. The antipsychotics often produced unwanted side effects, such as dry mouth, weight gain, constipation, sleepiness, and poor concentration.
4. The fact that the early antipsychotics globally altered brain levels of dopamine turned out to be a double-edged sword. Dopamine pathways in the brain are involved not only in psychotic symptoms but also in normal motor movements. Consequently, the early antipsychotic medications could produce motor-related side effects-muscle tremors, rigid movements, a shuffling gait, and a masklike facial expression (These side effects were often referred to as “Thorazine shuffle”)
5. The “revolving door” pattern of hospitalization, discharge, and rehospitalization
-Long term use of antipsychotic medications causes a small percentage of people to develop a potentially irreversible motor disorder called tardive dyskinesia
Tardive Dyskinesia
Characterized by severe, uncontrollable facial tics and grimaces, chewing movements, and other involuntary movements of the lips, jaw, and tongue
Atypical Antipsychotic Medications
Newer antipsychotic medications that, in contrast to the early antipsychotic drugs, block dopamine receptors in brain regions associated with psychotic symptoms rather than more globally throughout the brain, resulting in fewer side effects
-beginning around 1990
-Affect brain levels of dopamine and serotonin
-First were clozapine and risperidone. More recent atypical antipsychotics include olanzapine, sertindole, and quetiapine
-Advantages over older antipsychotic drugs:
1. New drugs are less likely to cause movement-related side effects because they do not block dopamine receptors in the movement areas of the brain. Instead they more selectively target dopamine receptors in brain areas associated with psychotic symtpoms.
2. The atypical antipsychotics are also much more effective in treating the negative symptoms of schizophrenia–apathy, social withdrawal, and flat emotions
3. Also appear to lessen the incidence of the “revolving door” pattern of hospitalization and rehospitalization
Antianxiety Medications
Prescription drugs that are used to alleviate the symptoms of anxiety
-Prescribed to help people deal with the problems and symptoms associated with pathological anxiety
-Best known drugs are benzodiazepines, which include the trade-name drugs Valium and Xanax
-Best known drugs are benzodiazepines, which include the trade-name drugs Valium and Xanax
-Calm jittery feelings, relax the muscles, and promote sleep
-Usually go by the name “tranquilizers” because of the effect
-Take effect rapidly, usually within an hour or so
-In general, the benzodiazepines produce their effects by increasing the level of GABA, a neurotransmitter that inhibits the transmission of nerve impulses in the brain and slows brain activity
-Taken for a week or two, and in therapeutic doses, the benzodiazepines can effectively reduce anxiety levels
-However, the benzodiazepines have several potentially dangerous side effects
1. They can reduce coordination, alterness, and reaction time
2. Their effects can be intensified when they are combined with alcohol and many other drugs, including over-the-counter antihistamines. Such a combination can produce severe drug intoxication, even death
3. Benzodiazepines can be physically addictive if taken in large quantities or over a long period of time. If physical dependence occurs, the person must withdraw from the drug gradually, as abrupt withdrawal can produce life-threatening symptoms.
-Less widely prescribed today because of their addictive potential
Newer antianxiety drug with this trade name
-Has fewer side effects
-Believed to affect brain dopamine and serotonin levels
-Relieves anxiety while allowing the individual to maintain normal alertness
-Does not cause drowsiness, sedation, and cognitive impairment that are associated with the benzodiazepines
-Seems to have low risk of dependency and physical addiction
-One MAJOR drawback: Must be taken for 2-3 weeks before anxiety is reduced. While this decreases Buspar’s potential for abuse, it also decreases its effectiveness for treating acute anxiety
-For immediate, short-term relief from anxiety, benzodiazepines are still regarded as the most effective medications currently available
A naturally occurring substance that is used in the treatment of bipolar disorder
-Counteracts both manic and depressive symptoms in bipolar patients
-Can prevent acute manic episodes over the course of a week or two
-Can also prevent relapses into either mania or major depressive disorder once acute manic episode is under control
-Side effects:
–If lithium level is too low, manic symptoms persist
–If it’s too high, lithium poisoning may occur, with symptoms such as vomiting, muscle weakness, and reduced muscle coordination
-Patient’s lithium blood level must be carefully monitored
-Affects levels of an excitatory neurotransmitter called glutamate, which is found in many areas of the brain
-Lithium stabilizes the availability of glutamate within a narrow, normal range preventing both abnormal highs and abnormal lows
-An anticonvulsant medicine that can treat bipolar disorder
-Originally used to prevent epileptic seizures
-Seems to be especially helpful in treating those who rapidly cycle through bouts of bipolar disorder several times a year
-Also useful for treating bipolar patients who do not respond to lithium
Antidepressant Medications
Prescription drugs that are used to reduce symptoms associated with major depressive disorder
-Counteracts hopelessness, guilt, dejection, suicidal thoughts, difficulty concentrating, and disruptions in sleep, energy, appetite, and sexual desire
-First generation of antidepressants consists of two classes of drugs, called tricyclics and MAO inhibitors
-Tricyclics and MAO inhibitors affect multiple neurotransmitter pathways in the brain
-Evidence suggests that these medications alleviate symptoms of major depressive disorder by increasing the availability of two key brain neurotransmitters, norepinephrine and serotonin
-However, it take up to 6 weeks before depressive symptoms begin to lift
-Tricyclics Side effects: weight gain, dizziness, dry mouth and eyes, and sedation. Because it can affect the cardiovascular system, overdoze can be fatal
-MAO Inhibitors Side Effects: can interact with a chemical found in many foods, including cheese, smoked meats, and red wine. Eating these foods with this medication can result in dangerously high blood pressure, leading to stroke or even death
Trazodone and Bupropion
Second-generation antidepressants
-Generally no more effective than first-generation ones, and they turned out to have many of the same side effects
Selective Serotonin Reuptake Inhibitors (SSRIs)
Class of antidepressant medications that increase availability of serotonin in the brain and cause fewer side effects than earlier antidepressants; they include Prozac, Paxil, and Zoloft
-Rather than acting on multiple neurotransmitter pathways, SSRIs primarily affect the availability of a single neurotransmitter–serotonin
-Act much more selectively in targeting specific serotonin pathways in the brain
-First SSRI to be released was fluoxetine, which is better known by its trade name, Prozac
-Prozac was quickly followed by its chemical cousins, Zoloft and Paxil
-Prozac was specifically designed to alleviate depressive symptoms with fewer side effects than earlier antidepressants.
-Prozac and other SSRI antidepressants tend to produce fewer, and milder effects
-Prozac’s Side Effects: headaches, nervousness, difficulty sleeping, loss of appetite, and sexual dysfunction
Dual-Action Antidepressants
-Also affect serotonin levels, but their mechanism is somewhat different from that of the SSRIs
-includes Serzone and Remeron
-Effexor and Cymbalta belong to another class of antidepressants called dual-reuptake inhibitors
Dual-Reuptake Inhibitors
Affect levels of both serotonin and norepinephrine
Dopamine-Norephinephrine Inhibitor
Wellbutrin is one that does not affect serotonin neurons
-Wellbutrin is used in treatment of anxiety and bipolar disorders (also under the name Zyban), also prescribed to help people stop smoking
Study of how genes influence an individual’s response to drugs
PET scans on 24 people
Depressed individuals showed increased activity in three areas of the brain: the prefrontal cortex, the caudate nucleus, and the thalamus
-Significant decrease in metabolic activity in the prefrontal cortex after treatment
Eletroconvulsive Therapy (ECT)
A biomedical therapy used primarily in the treatment of major depressive disorder that involves electrically inducing a brief brain seizure; also called electroshock therapy
-AKA electroshock therapy or shock therapy
-Involves using a brief burst of electric current to induce a seizure in the brain, much like an epileptic seizure
-Also treats mania, schizophrenia, and other severe mental disordrs
-Relatively simple and quick medical procedure, usually performed in a hospital
-Biggest drawback is that its antidepressive effects can be short-lived. Relapses within four months are relatively common
Transcranial Magnetic Stimulation (TMS)
Involves stimulation of certain regions of the brain with magnetic pulses of various frequencies
-Unlike ECT, it requires no anesthetic, induces no seizures, and can be conducted in a private doctor’s office rather than a hospital
Vagus Nerve Stimulation (VNS)
Involves the surgical implantation of a device about the size of a pacemaker into the left chest wall
-Device provides brief, intermittent electrical stimulation to the left vagus nerve, which runs through the neck and connects to the brain stem
Deep Brain Stimulation (DBS)
Utilizes electrodes surgically implanted in the brain and a battery-powered neurostimulator surgically implanted in the chest
The emotional release that people experience from the simple act of talking about their problems

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