2. Treatment of Psychological Disorders:1
• Learning Goals:
• What are the aims and methods of psychoanalysis and how have they been adapted in psychodynamic
therapy?
• What are the basic themes of humanistic therapy, such as Roger’s client-centered therapy?
• What are the assumptions and techniques of behavioral therapies?
• What are the goals and techniques of the cognitive therapies?
2
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3. From Brutal to Humane Treatments
• In the 1800’s,
• Philippe Pinel
• Dorothea Dix
• helped restructure
mental institutions
from brutal asylums to
humane hospitals that
operate in the medical
model.
3
4. Therapy Methods Overview
• Two Basic Types of Therapy
1. Psychotherapy
1. Any type of therapy that involves talking
2. Examples: Psychodynamic or Cognitive
2. Biomedical Therapy
1. Any type of therapy that involves medication or medical
procedures
2. Examples: Antidepressants or Prefrontal Lobotomy
* Today most psychologists practice Eclectic therapy, which
combines different methods of various types of therapies
4
5. Psychoanalysis/Psychodynamic
Therapies
• Psychoanalysis (Sigmund Freud)
– Seeks to explore the unconscious to the patient
may gain a better understanding of their problems.
– Assumes most disorders stem from repressed
impulses and conflicts the originated from their
childhood experiences.
5
6. Psychoanalysis Methods
These methods were used to get into a person’s
unconscious mind:
–Free Association: Saying what ever comes to
mind while relaxed
–Resistance: patient abruptly ends the free
association session (headache or stuttering)
–Transference: projects feelings onto therapist
(attends to positive and negative feelings towards
the client)
–Countertransference: therapist projects feelings
onto the client
–Hypnosis: Alternative way to enter the
unconscious mind
–Dream interpretation: Manifest vs. Latent Content
6
Sigmund Freud
7. Psychoanalysis/Psychodynamic
Therapies
• Psychodynamic Therapy
– A short, more modern version of Psychoanalysis
– Interpersonal psychotherapy is a sub-version of
psychodynamic therapy that focuses on gaining
insight to problems while relieving the symptoms.
• Psychoanalysis is still used, although rarely because:
1.Very time consuming
2.Very expensive
7
8. Humanistic Therapy
• Psychoanalysis and humanistic therapies are
referred to as Insight therapies, but for
different reasons.
• Humanistic therapies differ from
Psychoanalysis by:
– Exploring the present and future more than the
past.
– Developing conscious thoughts, not unconscious
awareness
– Taking responsibility for their own feelings
– Assumes that the person is striving to reach their
full potential and while experiencing mental
growth
– Empowers the client, giving them control over the
therapy sessions (opposite of psychoanalysis)
8
9. Humanistic Therapy
• Client/Person-Centered Therapy was
created by Carl Rogers
• Nondirective therapy where the client
is in control
• Therapist exhibits genuineness,
acceptance and empathy
9
Gestalt Therapy (Fritz Perls)
Investigates a person’s perception of
reality and Looks at body language of
people
10. Humanistic Therapy
• Humanistic Techniques:
– Active Listening
• Paraphrasing what the client says to show
understanding
– Unconditional Positive Regard
• Nonjudgmental when the client speaks
10
11. Behavior Therapies
• Therapy that applies learning principles to
the elimination of unwanted behaviors.
•The behaviors are the problems- so we must
change the behaviors.
12. Behavioral Therapies
• Classical Conditioning Methods
– Derived from the principles of Ivan Pavlov's early
experiments in conditioning.
– Mowrer’s bell and pad method helped children
learn to stop wetting the bed through classical
conditioning.
– Counterconditioning
• Exposure therapy, Systematic Desensitization
& Aversive therapy
• Seek to stop an unwanted responses
12
13. Behavioral Therapies
• Mary Cover Jones
– A Student of John B. Watson’s
– Researched learned phobias
– Famous experiment: “Peter and
the Rabbit”
– Peter was afraid of rabbits, but
she would have Peter eat a food
he found pleasurable and slowly
bring the rabbit closer to him at
the same time. Eventually Peter
became less afraid of the rabbit
through Mary’s process of
counterconditioning.
13
14. Behavioral Therapies
• Types of Exposure Therapies
• Flooding
– Doing it over and Over again until
you are no longer afraid (i.e. riding
a rollercoaster)
• Systematic Desensitization
– Created by Joseph Wolpe
– Looks at hierarchies of fears
– Slowly pair relaxation with fears
– Example: Reduce fear of specific
animal or social phobia slowly
14
(Classical Conditioning)
16. Systematic Desensitization: Fear of Heights
16
• Step 1: Teach Relaxation
Technique
(Breathing/Visualization)
• Step 2: Write the word
height and relax
• Step 3: Enter bottom floor
of tall building and relax
• Step 4: Progress to a
higher floor and relax
• Step 5: Progress to an
even higher floor and relax
18. Behavioral Therapies
• Aversive Therapies
(Classical Conditioning)
• A type of
counterconditioning
that associates an
unpleasant state with an
unwanted behavior.
With this technique,
temporary conditioned
aversion to alcohol has
been reported.
18
20. Behavioral Therapies
• Operant Conditioning Methods
– Behavior Modification Techniques
• Token Economy (positive
reinforcement)
– Earn coins or tokens that can
be traded in for rewards later
– Works well with kids, those
with low IQs, jail inmates or
mental hospital patients
• Critics to behavior modification
argue:
– Is it right to control another’s
behavior?
– What happens when the
reinforcers stop?
20
21. Cognitive Therapy Methods
• Cognitive Therapy
involves changing the
way a person thinks to
change their behavior.
• Can be completed in a
short amount of time
• Most effective for
patients suffering
depression (feeling
worthlessness and
hopelessness)
21
Dr. Phil practices cognitive therapy
22. Cognitive Therapy Methods
• Two Main Types
– Aaron Beck’s Cognitive Therapy
• Through gentle questioning, Beck seeks to reveal
irrational thoughts and persuade people to think
differently about negative events
• Seeks to change Attribution Style and Negative
Thinking
• Example “Why are you thinking that way?”
• Stop catastrophizing everything
– Albert Ellis’ Rational Emotive Behavioral Therapy
• Uses ABC strategy to change thinking
• Seeks to change not just thinking, but life
philosophy
22
23. 23
Stress Inoculation Training
Meichenbaum (1977, 1985) trained
people to restructure their thinking in
stressful situations.
“Relax, the exam may be hard, but it will
be hard for everyone else too. I studied
harder than most people. Besides, I don’t
need a perfect score to get a good
grade.”
24. Cognitive-Behavioral Therapy (CBT)
• CBT seeks to:
1. Make people aware of their irrational thinking
2. Replace negative thinking with rational or positive
thoughts
3. Practice the new thoughts/behaviors in everyday life
• Useful for people suffering from depression and anxiety
24
25. • What are the aims and methods of psychoanalysis and how have they been
adapted in psychodynamic therapy?
• What are the basic themes of humanistic therapy, such as Roger’s client-centered
therapy?
• What are the assumptions and techniques of behavioral therapies?
• What are the goals and techniques of the cognitive therapies?
25
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26. Treatment of Psychological Disorders: 2
• Learning Goals:
• Does psychotherapy work? Who decides?
• Are some therapies more effective than others?
• How do alternative therapies (light exposure & EMDR) fare under scientific scrutiny?
• What three elements are shared by all forms of psychotherapy?
26
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27. 27
The Relative Effectiveness of Different
Therapies
Which psychotherapy would be most effective
for treating a particular problem?
Disorder Therapy
Depression Behavior, Cognition, Interpersonal
Anxiety Cognition, Exposure, Stress Inoculation
Bulimia Cognitive-behavior
Phobia Behavior
Bed Wetting Behavior Modification
28. Family, Group & Encounter Therapy
• Family
– Assumes that no person is an island
– Helps family members with coping
strategies
– Seeks to find if others in the family are
contributing to the problem.
• Self-Help Groups
– People with the same disorders meet
weekly
– Allow people to talk about their struggles
and take advantage of others’ coping tips
– 12-step program by Alcoholics
Anonymous
• Encounter Groups
– People with different disorders meet
weekly
– Shows that people are not alone
28
31. Other Therapy Considerations
• Placebo Effect
– The belief that the mere expectation of the therapy or
medication will work, so the person feels better
• A Focus on Prevention
– National, psychology is switching from treating
disorders to preventing disorders before they start
31
32. Modern Alternative Therapies
• EMDR
– Eye Movement Desensitization and Reprocessing
– Used to Treat PTSD and Depression
– The client recalls a bad memory while moving eyes
back and forth while following finger or light bar
32
Many scientists say that any
success of EMDR is nothing
more than placebo effect
combined with exposure
therapy after telling the
traumatic story over and over
again in a safe environment.
35. Modern Alternative Therapies
• Light Exposure Therapy
– Clients use special lights 30 minutes a day to
simulate the sun and reset circadian rhythms.
– Used to treat Seasonal Affective Disorder
(A type of depression associated with wintertime)
35
39. 39
Therapists & Their Training
Clinical psychologists: They have PhDs
mostly. They are experts in research,
assessment, and therapy, all of which is
verified through a supervised internship.
Clinical or Psychiatric Social Worker: They have a
Masters of Social Work. Postgraduate supervision
prepares some social workers to offer psychotherapy,
mostly to people with everyday personal and family
problems.
40. 40
Therapists & Their Training
Counselors: Pastoral counselors or abuse counselors
work with problems arising from family relations,
spouse and child abusers and their victims, and
substance abusers.
Psychiatrists: They are physicians who specialize in the
treatment of psychological disorders. Not all
psychiatrists have extensive training in psychotherapy,
but as MDs they can prescribe medications.
41. • Does psychotherapy work? Who decides?
• Are some therapies more effective than others?
• How do alternative therapies (light exposure & EMDR) fare under scientific scrutiny?
• What three elements are shared by all forms of psychotherapy?
41
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42. Treatment of Psychological Disorders: 3
• Learning Goals:
• How do culture and values influence the therapist-client relationship?
• What are the drug therapies? What criticisms have been leveled against drug therapies?
• How effective is electroconvulsive therapy, and what other brain-stimulation options may offer
relief from severe depression?
• What is psychosurgery?
42
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43. Culture and Values in Therapy
• For better therapeutic results, clients and
their therapists should be matched on
their culture and religious values they
have in common
– Example: Asian-Americans should be
matched with a collectivistic therapists,
whereas Western Europeans should be
matched with individualistic therapists
• Clients will sometimes take on the values
of their therapists
43
45. Biomedical: Psychopharmacology
• Antipsychotics/Neuroleptics
– Treats Schizophrenia by blocking dopamine,
henceforth decreasing hallucinations
– Example: Thorazine (Chlorpromazine), Clozapine
– One major side effect of the D2-Neuroleptics after
long-term use is Tardive Dyskinesia which results
in involuntary muscle control of the face.
45
46. Biomedical: Psychopharmacology
• Antianxiety Meds
– Treats Anxiety by depressing
the central nervous system
– Sometimes called Tranquilizers,
Benzodiazepines
– Increases neurotransmitter
GABA to reduce anxiety
– NEWER DRUG: D-cycloserine
helps with PTSD and OCD
– Typical Examples: Xanax,
Valium, Ativan
46
47. Biomedical: Psychopharmacology
• Antidepressants
– Treats Depression and
Some Anxiety
– SSRIs, MAOIs, Tricyclic
– Works on elevating levels
of serotonin
– Examples: Paxil, Prozac,
Lexapro, Zoloft
– Aerobic exercise has been
shown to be just as
effective as antidepressant
drugs in some cases
47
51. Biomedical: Other Treatments
Electroconvulsive Therapy (ECT)
– Puts major electroshocks into
clients head while they are
sedated
– Treats Depression that doesn’t
respond to drugs
– We think it helps by either
resetting cells or creating new
brain cells
– Side Effect: Short-term
memory loss.
51
52. Biomedical: Other Treatments
• Repetitive Trans-cranial Magnetic Stimulation (rTMS)
– Sometimes referred to as deep brain stimulation
– Treats the disorder of Depression
52
54. Biomedical: Other Treatments
• Deep-brain stimulation
– Implanting a pacemaker in the brain that
stimulates inhibitory neurons to reduce
depression, Parkinson's tremors or OCD
thoughts.
54
55. Biomedical: Other Treatments
• Prefrontal Lobotomy (Developed by Moniz and
Freeman)
– Surgically removes part of the frontal lobe
– Treats violent schizophrenia that doesn’t respond
to drugs
55
57. • How do culture and values influence the therapist-client relationship?
• What are the drug therapies? What criticisms have been leveled against
drug therapies?
• How effective is electroconvulsive therapy, and what other brain-
stimulation options may offer relief from severe depression?
• What is psychosurgery?
57
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Notes de l'éditeur
In psychotherapy, a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth.
The biomedical therapies are prescribed medications or medical procedures that act directly on the patient’s nervous system.
Half of all psychotherapists describe themselves as taking an eclectic approach in which they use techniques from various forms of therapy, depending on the client’s problem. Psychotherapy integration combines a selection of assorted techniques into a single, coherent system.
Psychoanalysis is Sigmund Freud’s therapeutic approach of using the patient’s free associations, resistances, dreams, and transference, and the therapist’s interpretations of them, to help the person release repressed feelings and gain self-insight.
The goal of psychoanalysis is to help people gain insight into the unconscious origins of their disorders, to work through the accompanying feelings, and to take responsibility for their own growth.
Classic Psychotherapy’s goal is for the person to gain insight into their own unconscious and then work through the problems. It would take 3-5 sessions per week for several years. The main focus was childhood problems.
Psychoanalysts draw on techniques such as free association (saying aloud anything that comes to mind), resistances (the defensive blocking from awareness of anxiety-laden material) and their interpretation, and other behaviors such as transference (transferring to the therapist of long- repressed feelings). Freud also believed that the latent content of dreams was another clue to unconscious conflicts. Like the psychoanalytic perspective on personality, psychoanalysis is criticized because its interpretations are hard to prove or disprove and because it is time-consuming and costly.
Transference- expressing love, hostility or dependency toward Freud himself. By allowing this projection of emotions, Freud would become a surrogate to which the unconscious feelings could be brought out in a safe environment. Examples: A patient who struggles with anger issues becomes angry towards the therapist. A patient who struggles with rejection becomes overly worried about the Therapist leaving them
Countertransference- Freud called this a dangerous problem associated with being human and a therapist. The therapist starts to play the role of the father or mother to a patient and becomes locked into the patients script.
Psychoanalysts draw on techniques such as free association (saying aloud anything that comes to mind), resistances (the defensive blocking from awareness of anxiety-laden material) and their interpretation, and other behaviors such as transference (transferring to the therapist of long- repressed feelings). Freud also believed that the latent content of dreams was another clue to unconscious conflicts. Like the psychoanalytic perspective on personality, psychoanalysis is criticized because its interpretations are hard to prove or disprove and because it is time-consuming and costly.
Influenced by Freud, psychodynamic therapists try to understand patients’ current symptoms by exploring their childhood experiences and the therapist-patient relationship. They may also help the person explore and gain perspective on defended-against thoughts and feelings.
However, they talk with the patient face-to-face, once a week, and for only a few weeks or months.
Interpersonal psychotherapy, a brief variation of psychodynamic therapy, emphasizes symptom relief in the present, not overall personality change. The therapist also focuses on current relationships and the mastery of relationship skills. It has been found effective with depressed patients.
Both psychoanalytic and humanistic therapies are referred to as insight therapies, which attempt to improve psychological functioning by increasing the client’s awareness of underlying motives and defenses. However, in contrast to psychoanalysis, humanistic therapists focus on the present and the future more than the past, on clients’ conscious feelings, and taking immediate responsibility for their feelings and actions. In emphasizing people’s inherent potential for self-fulfillment, they aim to promote growth rather than to cure illness.
The main focus
n his nondirective client-centered therapy, Rogers used active listening to express genuineness, acceptance, and empathy. This technique, he believed, would help clients to increase their self-awareness and self-acceptance. The therapist interrupts only to restate and confirm the client’s feelings, to accept what the client is expressing, or to seek clarification. The client-centered counselor seeks to provide a psychological mirror that helps clients see themselves more clearly. In a therapeutic environment that provides unconditional positive regard, clients may come to accept even their worst traits and feel valued and whole.
Example of active listening: Client- “This has been such a bad day. I have felt ready to cry any minute, and I’m not even sure what is wrong!”
Therapist: “You really do feel so bad. The tears just seem to well up inside, and I wonder if it’s a little scary to not even know why you feel this way.” Although it doesn’t seem like it is doing much for the client, active listening helps clarify the client’s feelings and also promotes self-understanding and self-awareness. Hearing the therapist say this back to you might help you understand your feelings much better, sort of like a sounding board.
Gestalt Therapy developed by Fritz Perls is a subtype of humanistic therapy. Gestalt therapy is based on the idea that we create our own perceptions of reality and when those perceptions are unclear or unrealistic, we feel anxiety. Their goal is again for people to become self-aware of their incongruence of perspective, but unlike Roger’s method of letting the cleint move at their own pace, Gestalt therapists prod the client along, asking probing questions and trying to bring self awareness quicker to the client. They may even address body language of the client and hold hypothetical conversations with the client.
The downfall to Humanistic therapy is that you need to be very intelligent and self aware to engage with the therapist. Over the years it has declined in popularity, although many of its techniques have been adapted into other therapies.
behavior therapists question the therapeutic power of increased self-awareness. They assume problem behaviors are the problems and thus do not look for inner causes. Instead, they apply learning principles to eliminate a troubling behavior.
Counterconditioning is a behavior therapy procedure, based on classical conditioning, that conditions new responses to stimuli that trigger unwanted behaviors. Exposure therapies treat anxieties by exposing people to the things they fear and avoid.
Don’t care about underlying causes, just with removing specific symptoms. (opposite of psychoanalysis)
In systematic desensitization, a prime example of exposure therapy, a pleasant, relaxed state is associated with gradually increasing anxiety- triggering stimuli. This procedure is commonly used to treat phobias
Flooding
SD is a form of counterconditioning
In systematic desensitization, a prime example of exposure therapy, a pleasant, relaxed state is associated with gradually increasing anxiety- triggering stimuli. This procedure is commonly used to treat phobias
Flooding
SD is a form of counterconditioning
In systematic desensitization, a prime example of exposure therapy, a pleasant, relaxed state is associated with gradually increasing anxiety- triggering stimuli. This procedure is commonly used to treat phobias
Flooding
SD is a form of counterconditioning
n aversive conditioning, an unpleasant state (such as nausea) is associated with an unwanted behavior (such as drinking alcohol). This method works in the short run, but for long-term effectiveness it is combined with other methods.
n aversive conditioning, an unpleasant state (such as nausea) is associated with an unwanted behavior (such as drinking alcohol). This method works in the short run, but for long-term effectiveness it is combined with other methods.
Operant conditioning therapies are based on the premise that voluntary behaviors are strongly influenced by their consequences. Behavior therapists apply operant conditioning principles in behavior modification. They reinforce desired behaviors and withhold reinforcement for undesired behaviors or punish them. The rewards used to modify behavior vary from attention or praise to more concrete rewards such as food.
In institutional settings, therapists may create a token economy in which a patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats.
Critics express two concerns: First, what happens when the reinforcers stop? Might the person have become so dependent upon the extrinsic rewards that the appropriate behaviors quickly disap- pear? Second, is it ethical for one person to control another’s behavior?
Cognitive therapists assume that our thinking colors our feelings, and so they try to teach people who suffer psychological disorders new, more constructive ways of thinking.
Cognitive-behavioral therapists combine the reversal of self-defeating thinking with efforts to modify behavior. They aim to make people aware of their irrational negative thinking, to replace it with new ways of thinking and talking, and to practice the more positive approach in everyday settings.
ABC- A-Activating Event, B-Belief, C- Consequence of behavior
In treating depression, Aaron Beck seeks to reverse clients’ catastrophizing beliefs about them- selves, their situations, and their futures. His technique is a gentle questioning that aims to help people discover their irrationalities. In stress inoculation training, people suffering from depression learn to dispute their negative thoughts and to restructure their thinking in stressful situations.
ABC- A-Activating Event, B-Belief, C- Consequence of behavior
OBJECTIVE 14| Summarize the findings on which psychotherapies are most effective for specific disorders.
The social context provided by group therapy allows people to discover that others have problems similar to their own and to try out new ways of behaving. Receiving honest feedback can be very helpful, and it can be reassuring to find that you are not alone. Family therapy assumes that we live and grow in relation to others, especially our families. It views an individual’s unwanted behaviors as influenced by or directed at other family members. In an effort to heal relationships, therapists attempt to guide family members toward positive relationships and improved communication.
The social context provided by group therapy allows people to discover that others have problems similar to their own and to try out new ways of behaving. Receiving honest feedback can be very helpful, and it can be reassuring to find that you are not alone. Family therapy assumes that we live and grow in relation to others, especially our families. It views an individual’s unwanted behaviors as influenced by or directed at other family members. In an effort to heal relationships, therapists attempt to guide family members toward positive relationships and improved communication.
Randomized clinical trials assign people on a waiting list to therapy or no therapy. The results of many such studies are then digested by meta-analysis, a statistical procedure that combines the conclusions of a large number of different studies. The results reveal that (1) people who remain untreated often improve; (2) those who receive psychotherapy are more likely to improve; and (3) when people seek psychological treatment, their search for other medical treatment declines.
In EMDR (eye movement desensitization and reprocessing) therapy, the therapist waves a finger in front of the eyes of the client to unlock and reprocess previously frozen trauma memories. Con- trolled studies have not supported the effectiveness of EMDR; belief in its effectiveness may be explained in terms of the combination of exposure therapy—repeatedly reliving traumatic memo- ries in a reassuring environment—and a robust placebo effect.
In EMDR (eye movement desensitization and reprocessing) therapy, the therapist waves a finger in front of the eyes of the client to unlock and reprocess previously frozen trauma memories. Con- trolled studies have not supported the effectiveness of EMDR; belief in its effectiveness may be explained in terms of the combination of exposure therapy—repeatedly reliving traumatic memo- ries in a reassuring environment—and a robust placebo effect.
In EMDR (eye movement desensitization and reprocessing) therapy, the therapist waves a finger in front of the eyes of the client to unlock and reprocess previously frozen trauma memories. Con- trolled studies have not supported the effectiveness of EMDR; belief in its effectiveness may be explained in terms of the combination of exposure therapy—repeatedly reliving traumatic memo- ries in a reassuring environment—and a robust placebo effect.
. In contrast, light exposure therapy (exposure to daily doses of light that mimics outdoor light) has proven effective in treating people with seasonal affective disorder, a form of depression linked to periods of decreased sunlight
. In contrast, light exposure therapy (exposure to daily doses of light that mimics outdoor light) has proven effective in treating people with seasonal affective disorder, a form of depression linked to periods of decreased sunlight
OBJECTIVE 16| Describe the three benefits attributed to all psychotherapies.
OBJECTIVE 16| Describe the three benefits attributed to all psychotherapies.
sychotherapists’ personal beliefs and values influence their therapy. While nearly all agree on the importance of encouraging clients’ sensitivity, openness, and personal responsibility, they differ sharply on the pursuit of self-gratification, self-sacrifice, and interpersonal commitment. Value differences also become important when a client from one culture meets a therapist from another. For example, clients from a culture where people are mindful of others’ expectations may have difficulty with a therapist who gives priority to personal desires and identity. Such differences may help explain the reluctance of some minorities to use mental health services. Some psychologists believe that therapists should divulge their values more openly.
Another area of potential value conflict is religion. Highly religious people may prefer and benefit from religiously similar therapists. They may have trouble establishing an emotional bond with a therapist who does not share their values.
With a few exceptions, only psychiatrists (as medical doctors) offer biomedical therapies. Psychopharmacology, the study of the effects of drugs on mind and behavior, has revolutionized the treatment of people with severe disorders. To evaluate the effects of any new drug, researchers use the double-blind technique, in which half the patients receive the drug while the other half receive a placebo. Because neither staff nor patients know who gets which, this research strategy eliminates bias that results from therapists’ and patients’ expectations of improvement. Using this approach, several types of drugs have proven effective in treating psychological disorders.
Antipsychotic drugs, such as chlorpromazine (sold as Thorazine), provide help to people experiencing the positive symptoms of auditory hallucinations and paranoia by dampening their responsiveness to irrelevant stimuli. Newer atypical antipsychotics, such as clozapine (sold as Clozaril), help reanimate schizophrenia patients with the negative symptoms of apathy and withdrawal. Long-term use of some of these drugs block dopamine receptors and can produce tardive dyskinesia, which is marked by involuntary movements of facial muscles, tongue, and limbs. Many of the newer antipsychotics have fewer such side effects, but they may increase the risk of obesity and diabetes.
Antianxiety drugs, such as Xanax and Ativan, depress central nervous system activity. A new antianxiety drug, the antibiotic D-cycloserine, acts upon a receptor that facilitates the extinction of learned fears. Used in combination with other therapy, antianxiety drugs can help people learn to cope with frightening stimuli. However, they can produce both psychological and physiological dependence.
Antidepressant drugs aim to lift people up, typically by increasing the availability of the neuro- transmitters norepinephrine and serotonin. For example, fluoxetine (Prozac) partially blocks the reabsorption and removal of serotonin from the synapses, and so Prozac and its cousins Zoloft and Paxil are called selective-serotonin-reuptake-inhibitors (SSRIs). They also are increasingly being used to treat anxiety disorders such as obsessive-compulsive disorder. Other dual-action antide- pressants work by blocking the reabsorption or breakdown of both norepinephrine and serotonin. Although no less effective, these dual-action drugs have more potential side effects, such as dry mouth, weight gain, hypertension, or dizzy spells. Administering them by means of a patch helps reduce such side effects. Although antidepressants influence neurotransmitter systems almost immediately, their full psychological effects may take weeks. The delay may occur because increased serotonin seems to promote neurogenesis. The risk of suicide for those taking these drugs has probably been overestimated.
Antidepressant drugs aim to lift people up, typically by increasing the availability of the neuro- transmitters norepinephrine and serotonin. For example, fluoxetine (Prozac) partially blocks the reabsorption and removal of serotonin from the synapses, and so Prozac and its cousins Zoloft and Paxil are called selective-serotonin-reuptake-inhibitors (SSRIs). They also are increasingly being used to treat anxiety disorders such as obsessive-compulsive disorder. Other dual-action antide- pressants work by blocking the reabsorption or breakdown of both norepinephrine and serotonin. Although no less effective, these dual-action drugs have more potential side effects, such as dry mouth, weight gain, hypertension, or dizzy spells. Administering them by means of a patch helps reduce such side effects. Although antidepressants influence neurotransmitter systems almost immediately, their full psychological effects may take weeks. The delay may occur because increased serotonin seems to promote neurogenesis. The risk of suicide for those taking these drugs has probably been overestimated.
The simple salt lithium is often an effective mood stabilizer for those suffering the emotional highs and lows of bipolar disorder. Although lithium significantly lowers the risk of suicide, we do not fully understand how it works.
Electroconvulsive therapy (ECT), or shock treatment, is used for severely depressed patients. A brief electric current is sent through the brain of an anesthetized patient. Although ECT is credited with saving many from suicide, no one knows for sure how it works. Some patients with chronic depression have found relief through a chest implant that intermittently stimulates the vagus nerve, which sends signals to the brain’s mood-related limbic system.
Repetitive transcranial magnetic stimulation (rTMS) is performed on wide-awake patients. Magnetic energy penetrates only to the brain’s surface (although tests are under way with a higher energy field that penetrates more deeply). Unlike ECT, the rTMS procedure produces no seizures, memory loss, or other side effects. Several recent studies have confirmed its therapeutic effect. Deep brain stimulation has shown potential in calming a brain area that appears active in people who are depressed or sad.
Repetitive transcranial magnetic stimulation (rTMS) is performed on wide-awake patients. Magnetic energy penetrates only to the brain’s surface (although tests are under way with a higher energy field that penetrates more deeply). Unlike ECT, the rTMS procedure produces no seizures, memory loss, or other side effects. Several recent studies have confirmed its therapeutic effect. Deep brain stimulation has shown potential in calming a brain area that appears active in people who are depressed or sad.
Psychosurgery removes or destroys brain tissue in an effort to change behavior. For example, the lobotomy was once used to calm uncontrollably emotional or violent patients. The nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain are cut. The lobotomy usually produced a permanently lethargic, immature, impulsive personality. Because of these effects and the introduction of drug treatments in the 1950s, the procedure has been abandoned. Other psychosurgery is used only in extreme cases. For example, for patients who suffer uncontrollable seizures, surgeons may deactivate the specific nerve clusters that cause or transmit the convulsions. MRI-guided precision surgery may also be used to cut the circuits involved in severe obsessive-compulsive disorder.
Psychosurgery removes or destroys brain tissue in an effort to change behavior. For example, the lobotomy was once used to calm uncontrollably emotional or violent patients. The nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain are cut. The lobotomy usually produced a permanently lethargic, immature, impulsive personality. Because of these effects and the introduction of drug treatments in the 1950s, the procedure has been abandoned. Other psychosurgery is used only in extreme cases. For example, for patients who suffer uncontrollable seizures, surgeons may deactivate the specific nerve clusters that cause or transmit the convulsions. MRI-guided precision surgery may also be used to cut the circuits involved in severe obsessive-compulsive disorder.
