Biomedical Therapies

*Psychotherapeutic Drugs

Antipsychotics

Antidepressants

Antianxiety Drugs

Electroconvulsive Therapy

Psychosurgery

"Typical" antipsychotics like the Thorazine or chlorpromazine; Haldol or haloperidol)

Block DA receptors in all brain areas

Effective at reducing positive symptoms, but frequently produce serious motor problems (Parkinson’s symptoms & Tardive Dyskinesia)

Clozaril (clozapine); Risperdal (risperidone)

Block only the DA receptors in thought/emotion areas; also affect serotonin

Much less risk of motor problems

Improve negative as well as positive symptoms as well; improve previously unresponsive patients

Most important group = Benzodiazepines

Examples: Librium, Valium (diazepam), Xanax (alprazolam)

These depressant drugs can help decrease the symptoms of GAD, panic disorder, phobias, PTSD, insomnia by increasing the effects of GABA

But: can cause side effects & dependency

Buspar - doesn’t cause drowsiness, incoordination, or dependency

But: not immmediately effective - must take 2-3 weeks

3 groups of antidepressants for treating major depression - all promote 5HT and/or NE but in different ways

Older groups (MAO inhibitors & tricyclics

had annoying side effects)

Newest group (Selective serotonin reuptake inhibitors or SSRIs)(Prozac or fluoxetine) has fewer side effects

These drugs can also improve some anxiety disorders (OCD, Panic disorder)

All antidepressants take a while to work (~6 weeks)

Bipolar disorder is most often treated with lithium. Anticonvulsant drugs (usually used for epilepsy) offer a second alternative.

~40,000/yr receive ECT for major depression

Effective and fast effects

Operating on the brain to change behavior

Early example: frontal lobotomy

Recent surgeries are much more focussed

Over 250 types based on different perspectives, theories & techniques

We’ll consider examples based on the psychoanalytic, humanistic, behavioral and cognitive perspectives.

Goal: Help patient gain insight into unconscious conflicts that are the roots of psychological problems

Techniques to reveal the unconscious:

Free association, watching for resistances

Dream interpretation

Analysis of slips of the tongue

Watching for transference

Traditional psychoanalysis could take years (~600 sessions)

Today dynamic psychotherapy is more likely to be

More directive

Shorter term (25-30 sessions)

Have a broader focus than Freud’s

Based on Carl Rogers’ self theory & principles of humanistic psychology

Therapist is not an expert, but as empathetic, supportive listener/helper

Therapist provides unconditional positive regard & "active listening", reflecting back or restating what client says

In a supportive setting client has capacity to make choices/changes to move towards self-actualization.

Take a learning theory approach: abnormal behaviors were learned & can be replaced by new learned responses.

Uses principles of operant & classical conditioning to modify behaviors & improve functioning - counter-conditioning new learned associations, reinforcement of desired behaviors; extinction (no rf) of undesired behaviors

Systematic desensitization: a)Learn relaxation techniques, b) Create a stimulus hierarchy, c) Work thru the hierarchy, using relaxation techniques to change your response to each stimulus - replace old CER

Exposure therapy- repeated expose client to feared stimuli - gradually adapt

Replace a positive association to a harmful stimulus (alcohol, smoking) with a negative association by pairing with shock or nausea.

Decrease maladaptive behaviors and increase adaptive behaviors through operant conditioning (controlling the antecedents & consequences)

Example - use of a token economy to improve behavior

Focuses on thoughts such as:

Overgeneralization - making blanket judgments about yourself based on single or insignificant incidents

Selective attention - only noticing certain details (e.g. bad things) while not noticing the other, good things.

Learn to self-monitor thoughts, recognize & stop maladaptive thoughts, and substitute more rational thoughts.