Part I
 Biological

Drug Therapy
 Cognitive

(Psychological)
Individual Therapies
 Social

Group Therapy
 Must
we know the causes prior to providing
treatment?
 Can
we identify specific causes of disorders?
 Drugs
are used due to a chemical imbalance
 Antidepressants


Elevate the mood of people suffering from
depression
Serve to increase or decrease levels of
neurotransmitters

Selective serotonin re-uptake inhibitors (SSRIs)
 Prozac (fluoxetine)
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•
Effective in short term treatment
(60-80%)
Kirsch and Sapirstein (1998/2008))
–
(1998) Analyzed results 19 studies of
patients who had been treated with the
antidepressant prozac
•
–
Found that antidepressants were only 25%
more effective than placebos, and no
more effective than tranquillizers.
(2008) review of 47 clinical trials on the
effectiveness of antiedepressants
•
Found that antidepressants are not more
effective than placebos, and that patients
can improve without the drug. Also the
drug should only be prescribed in most
depressed patients when other therapy
has failed.
 Blumenthal

EXERCISE was as effective as
SSRIs
 Leuchter


et al. (1999)
and Witte (2002)
Drug treatment was as effective
as placebos.
Changes to same area of brain
(PREFRONTAL CORTEX)


Drug lessoned activity in
prefrontal cortex
Placebo increased activity in
prefrontal cortex
•
Elkin et al. (1989) 28 clinicians worked with
280 patients diagnosed with major
depression.
Group 1: Antidepressant drug (imipramine)50% recovered
– Group 2: Interpersonal therapy (IPT)- 50%
recovered
– Group 3: Cognitive- Behavioral therapy (CBT)50% recovered
– Control Group: Placebo pill w/ weekly therapy
sessions- 29% recovered
–
•
–
All patients were assessed at the:
– Start
– 16 weeks
– 18 months
It did not matter which treatment the patients
received, all the treatments had the same
results. The groups with drugs had faster
results.
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•
Distorted Cognitions cause depression
Cognitive psychologists (Aaron Beck, 1960’s)
developed Cognitive Restructuring.
Negative self-schemas bias a persons thinking
1. Identify negative, self critical thoughts
2. Note the connection between negative thought
and depression
3. Examine each negative thought and decide
whether it can be supported
4. Replace distorted negative thoughts with
realistic interpretations of each situation
Aims of CBT
1. Identify and Correct faulty
cognitions and unhealthy
behaviors (Cognitive
Restructuring)
2. Encourage people to increase
gradually any activities that
could be rewarding (coping
strategies)
–
Teasdale (1997)
•
Teach the client meta-awareness, the
ability to think about their own thoughts
•
Riggs et al. (2007) studied
effectiveness of CBT in
combination with either a
placebo or an SSRI
–
126 adolescents suffering from
depression and substance abuse
•
•
Found:
– 67% Placebo and CBT were judged as
“Very much improved”
– 76% SSRI and CBT were judged as
“Very much improved”
CBT is criticized for focusing on
symptoms rather than causes
•
Couples Therapy (marital problems)
– focus on teaching couples to
communicate and problem-solve
more effectively, while increasing
positive, pleasurable interactions
and reducing negative interchanges.
–
Toseland and Siporin (1986) reviewed
74 studies comparing individual and
group treatment.
•
•
•
•
75% Group treatment was as effective as
individual treatment
25% Group treatment was more effective
In no case was individual treatment found
to be more effective than group
treatment.
group therapy is more cost effective than
individual therapy.
 McDermut
et al. (2001) meta-analysis (48
studies)



43 studies showed reduction in depressive
symptoms following group psychotherapy
9 showed no difference between group and
individual
8 showed CBT to be more effective than group
•
Factors to consider:
–
–
Group Cohesion: all people must
belong to the group
Exclusion: any characteristics that
should be excluded?
•
–
Substance abusers, married men,
certain health conditions
Relationship with Therapist:
therapist is not “one of us”.
Therapist must show empathy to
group members and try to
understand their reality
 Multifaceted

Approach to Treatment
Biopsychosocial (bio-psycho-social) perspective
 Prescribed

Antidepressants:


drugs:
Antidepressants used because many
PTSD patients suffer from
depression. Marshall (1994) found
that improvements in depression
contribute to improvement in PTSD,
regardless of how PTSD is treated.
Tranquilizers:

Valium and Xanax – regulates
anxiety levels

CBT and PTSD – “talking
about the trauma”

Foa (1986) argues there are
four goals of CBT when
treating a person with PTSD:
1.
2.
3.
4.
Create a same
environment that shows
that the trauma cannot
hurt them.
Show that remembering
the trauma is not
equivalent to experiencing
it again
Show that anxiety is
alleviated over time.
Acknowledge that
experiencing PTSD
symptoms does not lead to
a loss of control.
 CBT
has had positive results. Keane (1992)
found that patients become initially worse in
the initial stages of therapy, and the
therapists become upset when they hear
about the patient’s experiences.
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As a result of such traumatic events as school shootings, we
have seen the development of a field of psychology called
traumatology.
Crisis intervention are teams of psychologists that arrive at the
scene to help the survivors and witnesses of a traumatic event.
It is based on the assumption that it is best to intervene with
survivors 24 – 72 hours after the traumatic incident, before PTSD
sets in.
Its effectiveness, however, is open to debate. First, the majority
of people who experience trauma never develop PTSD. It
appears that PTSD manifests itself in approximately 25% of
people exposed to trauma.
In cases of rape and ethnic cleansing, the numbers are
significantly higher.
Mayou et al (2000) argues that crisis intervention may do more
harm than good; Immediately following a disaster, people are
best served by the social support usually available to them in
their families and communities; the coercion to be treated by
strangers, even if well-intentioned, is not helpful and may even
be intrusive and harmful.
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In his work with Bosnian refugees,
Stevan Weine (1998) has employed
testimony psychotherapy as means of
helping patients overcome their PTSD.
According to Weine, traditional
treatment is said to work by deactivating
“networks of fear” in the psyche.
Testimony is based on theories that
consider collective traumatization to be
at least as significant as individual
traumatization.
Bosnians approach matters of
traumatization as a matter of collective
as well as individual experience. What
was targeted in the genocide was not
only their individual lives, but also their
collective way of life.
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•
An essential component of testimony therapy is the
creation of an oral history archive to collect, study, and
disseminate the survivors’ memories. This gives meaning
and purpose to the experience of the survivor.
Testimony therapy is integrative. It is an opportunity for
the survivor to assimilate dissociated fragments of
traumatic memory and to associate affective and cognitive
aspects of the experience through the guidance of a
therapist who has adequate knowledge of the historical
events that the survivor has experienced.
Testimony provides a time for an individual to look back
over and reconsider his or her previous attitudes
concerning ethnic identity, forgiveness, and violence. It
also allows them to consider how their experience has
affected how they feel about their lives today. For the
survivor, the process of testimony permits the “entry into
meaning.”
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In Weine’s study, all patients were diagnosed
by using the PTSD symptom scale, which had
been translated into Bosnian and then back
translated for accuracy.
All testimonies were conducted in Bosnian,
translated into English, and then translated
back so that the interpreter and the survivor
could together correct mistakes and add
possible new recollections and details.
The final document was given back to the
survivor at the final session, and the survivor
signed the document – verifying its accuracy.
 There
are many survivors who are highly
disinclined to seek or accept psychiatric
treatment from a clinician but who would
participate in testimony psychotherapy in the
community. Weine found that the rate of
PTSD decreased from 100% at pre-testimony
to 75% post-testimony, 70% at 2-month follow
up, and 53% at 6-month follow-up.
 Since
people suffering with bulimia often
suffer from depression, antidepressants and
SSRIs are used to treat bulimia.

McGilley and Pryor (1998) treated bulimic
patients with Prozac



Reduction in vomiting of 29% of those receiving the
drug
There was only a 5% reduction in vomiting for those
that were receiving the placebo.
Goldstein et al. (1995) found that Prozac reduced
binge eating 51% compared with 17% given the
placebo.
 Most
bulimics are in denial about their
problem, it is estimated that 90% of those
that suffer from eating disorders do not seek
treatment.
•
The most widely used individual therapy to
treat bulimia is the CBT.
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Addresses cognitive aspects of bulimia, such as
obsession with body weight, negative self-image, “all
or nothing” thinking, and binge eating and vomiting.
Aim: restore some control of eating, but avoid dieting
because this is known to trigger binge eating.
Patients keep a log of what they eat, and how it
makes them feel.
They are taught to identify and deal with symptom
triggers.
Patients learn cognitive techniques for improving selfesteem, and how to develop adequate feelings and
avoid damaging thought patterns.
 Wilson
(1996) found that CBT was superior to
medication alone and that the combination
of CBT and medication was superior to
medication alone.
 Wilson (1996) found that 50% of patients who
receive CBT stop binge eating and purging.
The remaining patients only show partial
improvement, and some do not benefit at
all.
 Use

of group therapy for bulimia is growing
McKisack et al. (1997) found that group therapy
was widely used and that it was relatively
effective, especially if people were matched by
certain characteristics, and it was long and had
additional treatment components.
•
Concerns for group therapy:
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–
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Patients may get negative ideas
from each other. Ways to hide
weight loss or induce vomiting.
The group may adopt a
pessimistic view toward
improvement, and this may be
resistant to change.
The group may reinforce that
such eating behaviors are
normal.
Competition from the group
may lead members to engage in
behavior to gain attention of
the therapist.
Well-meaning group members
often become co-therapists.
They insist change and judge
other group members.