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Abnormal Behavior
Chapter Seventeen
Therapeutic Interventions
Therapeutic Interventions
Biology-based approaches
Individual psychotherapy:
Insight approaches
Action approaches
Group approaches:
Group therapy
Family therapy
Couples therapy
Biology-Based Treatment
Biological/somatic techniques use physical means to
alter the patient’s physiological and psychological
state
Goes back to ancient times (trephining [boring a hole
in the heads of mentally ill patients to allow demons
to escape], bleeding and purging)
Modern techniques:
Electroconvulsive therapy
Psychosurgery
Psychopharmacology
Biology-Based Treatment (cont’d)
Electroconvulsive therapy (ECT): The application of
electric voltage to the brain to induce convulsions
Application of electric voltage to the brain to induce
convulsions
Particularly useful for severe depression
Patient is first given a muscle relaxant, then 65-140
volts of electricity are applied causing convulsions
and coma.
Confusion and memory loss occurs for events
immediately before and after the ECT
Biology-Based Treatment (cont’d)
Use of ECT declined in 1960’s-1970’s
because:
Concerns about permanent brain damage
Fracture/dislocation of bones
Beneficial effects not long-term
Abuses and side effects
Advances in medication diminished the need
for ECT
Not sure why it works.
Biology-Based Treatment (cont’d)
Psychosurgery: Brain surgery performed to
correct severe mental disorders
Prefrontal lobotomy
Transorbital lobotomy
Lobectomy
Cauterization
Biology-Based Treatment (cont’d)
Criticisms of psychosurgery:
Patient improvement/lack of improvement is
independent of psychosurgical treatment
Serious negative and irreversible side effects,
e.g., impaired cognitive and intellectual
functioning, listlessness, uninhibited impulsive
behavior, death
Continuing seizures for some
Humanitarian grounds: Psychosurgery always
produces permanent brain damage
Biology-Based Treatment (cont’d)
Psychopharmacology: Study of the effects of
drugs on the mind and on behavior
Advantages (reducing institutionalization) and
disadvantages (e.g., addiction and abuse;
gender bias, side effects)
Four major categories:
Antianxiety (minor tranquilizers)
Antipsychotic (major tranquilizers)
Antidepressant (MAOIs, tricyclics, SSRIs)
Antimanic (lithium)
Table 17.1: Drugs Most Commonly Used in Drug Therapy
Barbiturates
Barbiturates: highly addictive sedatives that have a
calming effect and were used before the 1950s.
Result in tolerance
Overdose can be deadly
Withdrawal occurs with abrupt discontinuance
Even appropriate doses can cause muscular
incoordination and mental confusion
Were replaced by
Antianxiety Drugs (minor
tranquilizers)
During the 1940s and 50s, the propanediols
and benzodiazepines became preferred
Can be addictive and can cause withdrawal
symptoms, but are safer than the barbiturates
Must be carefully monitored to prevent
overuse and overreliance
Antipsychotic Drugs (Major
Tranquilizers)
Thorazine was developed as a sedative in the 1950 and had the
side effect of reducing psychotic symptoms.
Drugs such as Thorazine, Stelazine, Prolixin and others
increase social interaction and self-management, and decrease
agitation for psychotic patients.
Do not always reduce anxiety
May lead to psychomotor symptoms (including tardive
dyskinesia), sensitivity to light, dry mouth, drowsiness or
liver disease.
Do not lead to social recovery and patients must keep taking
them to prevent resurgence of symptoms
Antidepressant Drugs
Discovered accidentally in the 1950s.
Iponiazid (antitubercolosis medication) made people happier
and more optimistic
Three classes of antidepressants
MAOIs: Monoamineoxiydase Inhibitors – work by inhibiting
monoamineoxydase (an enzyme that breaks down
dopamine, norepinephrine and serotonin). Short-acting but
can produce toxic effects.
Tricyclics: work like MAOIs but with fewer side effects
SSRIs: work by inhibiting reuptake of serotonin (Prozac,
Zoloft). Fewer side effects and less likely to lead to
overdose than tricyclics. Associated with jitteriness and
stomach irritation.
Antimanic Drugs
Lithium: mood-controlling (anti-manic) drug that controls about
70-80% of bipolar disorders
Little is known about how it works.
May limit availability of serotonin and norepinephrine…
however, it also decreases depression, which is inconsistent
with this effect
Lithium is administered as a salt and appears to have no known
physiological function.
Lithium is largely preventive and must be taken before
symptoms begin.
It is extremely difficult to determine an effective yet non-toxic
dose.
Biology-Based Treatment (cont’d)
Psychopharmacological considerations:
Which medication to use with which kind of patient
under which circumstances
Increases effectiveness of other types of treatment
Medications reduce active symptoms and
hospitalizations, but do not cure mental disorders
Women receive twice as many anti-anxiety
prescriptions, and 73% of all psychiatric prescriptions,
although they make up half of all clients seen by
psychiatrists.
Not effective with passive symptoms and do not
improve living skills
Lack of compliance is a problem
Psychotherapy
Psychotherapy: Systematic application, by a
professional therapist, of techniques derived
from psychological principles, for the purpose
of helping psychologically troubled people
Common therapeutic factors:
Development of a therapeutic alliance
Opportunity for catharsis
Acquisition and practice of new behaviors
Clients’ positive expectancies
Psychotherapy (cont’d)
Korchin’s characteristics of psychotherapy:
A chance for the client to relearn
Help generating the development of new,
emotionally important experiences
Therapeutic relationship
Clients in psychotherapy have certain
motivations and expectations
Psychotherapy’s Goals:
Change maladaptive behavior
Minimize or eliminate environmental
conditions that may be causing or maintaining
such behavior
Improveinterpersonal (and other) skills
Resolve disabling conflicts among motives
Modify dysfunctional beliefs
Reduce or remove distress
Foster a clear sense of identity
Why do people seek therapy?
Sudden and highly stressful situations
Referred by a physician for “physical” symptoms
Referred by a spouse or attorney
Chronic unhappiness and an inability to feel confident
and secure
Vague dissatisfaction with self/life
Intolerable mental states
Psychodynamic Therapies
2 basic forms:
Classical psychoanalysis
Psychoanalytically oriented therapy