5.3 Abnormal psychology:

implementing treatment

“madness” was attributed to the supernatural

forces, or possession of evil spirits Treatment was drilling holes in the skull to

release the evil spirit, this is known as trepanation.

Diagnosis was occurring and treatment was being sought.

Introduction - History

Possible relationship between etiology and

treatmentPages 166 - 169

Biomedical Individual or group therapy Biopsychosocial approach: Multifaceted

approach is know considered to be the most efficient. Includes drug therapy cognitive therapy (individual) or family therapy (group therapy) Stress related environmental management

‘Client’ has replaced the term ‘patient’

Contemporary approach to treatment

Not all people will respond to drug therapy the

same Side effects may occur Dosage levels take time to assess No conclusive data to pinpoint specific

biophysiology to behavior, but rather a general knowledge that neurotransmitters and hormones may contribute.

Drug Therapy

Therapist work one-on –one with the client Most therapy involves some form of cognitive

Works to change negative thought pattern Highly effective Personalized/individualized to the client.

Individual therapy

A group if clients with similar issues meet with one or two

therapist. Women who have experiences sexual abuse Abusive family Depression

Group therapy allows individuals to openly discuss shared experiences in a safe environment; It provides group support (collectivism), Cost effective for client Therapist can work with multiple clients at once The group setting diminishes the role of the therapist and thus

buts the client on the path to self management. Many disorders are caused or promote poor social skills – group

works allows individuals to interact in a safe environment.

Group Therapy

Some individuals may not want to express

themselves Confidentiality Group dynamics

Disadvantages of Group

Culture Considerations in

treatmentPages 168-169

Not all cultures respond to all treatments the

same. Mutlaq and Chaleby (1995) – problems with

group therapy with Arab culture Gender roles Deference to members in the group based on

age or tribal status Misperception that this is simply a social activity

Culture and treatment

Indigenous healing practices – a combination of western

psychotherapy and therapeutic beliefs and practices that are rooted within a given culture.

Commonalities in nonwestern countries of indigenous practices include: Heavy reliance on family and community networks. Incorporation of traditional, spiritual and religious beliefs

Malaysia, religion has been incorporated into psychotherapy Chinese Taoist cognitive psychotherapy – verses from the

Taoist writings that highlight main principles, such as restricting selfish desires, learning how to be content, and learning to let go, are read and reflected. This was found to be more effective in the long term reduction of

anxiety disorders than drug therapy

Indigenous healing practices

Analyze psychological health from a community level. Ecological model – Miller (2000), looks at the

relationship between people and the settings they live in Identifies naturally occurring resource within the

community that can promote healing/healthy adaptations

Enhancement of coping strategies/response to stress Development of collaborative, culturally grounded

community interventions that actively involve community members in the process of solving their own problems.

Community Psychologist

Eclectic approach to therapy – an approach that

incorporates principles or techniques from various systems and theories.

Eclectic approach allows for an individualistic approach to each client’s needs. Cognitive therapy may not be ideal based on the age of the

individual or the current state of mind of the individual. Group therapy is appropriate in all cases – the level of

development of the client must be considered. Drug therapy alone is not significant for long term success. Rush et al ( 1977) high relapse rate for patients only

treated with drug therapy (i.e. no cognitive therapy).

The use of eclectic approaches

Cognitive therapies are more effective than

drug treatment alone at preventing relapse or reoccurrence, except when drug treatment is long term (Hollon and Beck 1994)

A combination of drug and psychotherapy appears to be moderately more successful than either therapy alone (Klerman et al., 1994)

Eysenck (1961) proposed the idea of spontaneous

remission, recovery that came about due to no treatment other than time.

How does one assess is a treatment works? How long must an individual be symptom free for

treatment to be successful? Should the total absence of symptoms be the only

criteria? Should only observable behavior be the measuring stick? Can you gather both quantitative and qualitative data

when measuring the disorder? Who decides is the therapy is successful?

Measuring the effectiveness of

Therapy

Outcome Studies: focus on the results – did the

patient show improvements or not? Not all studies are equal - much depends upon the

interpretation and style of the therapist, and the compliance of the patient.

Most treatments have positive effect (Smith et al., 1980) – meta analysis of 475 studies

Some approaches work better for some disorders while other approaches are best for others.

Thus eclectic styles of treatment are often applied.

Determining Effectiveness