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1. Describe and Evaluate ONE treatment/therapy from each of the five AS approaches1. BIOLOGICAL APPROACH – DRUG TREATMENTReminder of assumptions of bio approach: ã…
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  • 1. Describe and Evaluate ONE treatment/therapy from each of the five AS approaches1. BIOLOGICAL APPROACH – DRUG TREATMENTReminder of assumptions of bio approach: • Psychological disorders are caused by biological malfunction so can be understood in same way as biological illnesses • Therefore treatable is same way as physical illnesses e.g. drugs, surgeryDescription  Based on idea that neurological functioning and therefore behaviour can be altered directly using chemical that block or mimic the role of neurotransmitters  These drugs can be targeted to influence the action of specific neurotransmitters in particular brain regions  For example antipsychotics such as phenothiazines inhibit (stop) the action of dopamine by blocking the receptor sites  This led to the understanding that people with schizophrenia have an excess of dopamine and by blocking receptors symptoms are reducedEvaluation - identify the strengths and weaknessesDRUGS HAVE SIDE EFFECTS E.G. LITHIUM CARBONATE IS HIGHLY TOXIC SO BLOODLEVELS MUST BE CAREFULLY MONITOREDDRUGS ARE WIDELY USED BY OVER 15 MILLION PEOPLE WORLDWIDETHE SUCCESS OF DRUG THERAPIES RELIES ON PATIENT TAKING THE MEDICATIONAND MOST SEVERELY AFFECTED PATIENTS MAY NOT BE ABLE TO FOLLOW THETREATMENT REGIMETHE RISK OF ADDICTION OR OVERDOSE IS MUCH LOWER FOR MODERN DRUGS THANEARLIER ONESNOT ALL PATIENTS RESPOND SUCCESSFULLY TO DRUG TREATMENTMODERN DRUGS HAVE FEW SIDE EFFECTS E.G. ANTIPSYCHOTICS SUCH AS
  • 2. CLOZAPINE DO NOT HAVE THE RISKS OF EARLY DRUGS USED FOR SCHIZOPHRENIASOME DRUGS ARE HIGHLY EFFECTIVE E.G. LITHIUM CARBONATE CONTROLS BIPOLARDISORDER IN 70-80% OF CASESEVEN SOME MODERN DRUGS ARE ADDICTIVE E.G. TRANQUILLIZERS SUCH ASVALIUM AND CAUSE WITHDRAWAL SYMPTOMSDRUGS HAVE ALLOWED PATIENTS TO LIVE IN SOCIETY RATHER THAN BEINGHOSPITALISEDSOME DRUGS MAY BE DANGEROUS – MAY BE AN INCREASED RISK OF SUICIDE INFIRST FEW WEEKS OF TAKING PROZAC FOR DEPRESSIONDRUGS OFFERING AN ‘INSTANT SOLUTION’ MAY BE PRESCRIBED WHEN THEY ONLYMASK SYMPTOMS RATHER THAN SOLVING THE PROBLEMSOME DRUGS WORK VERY QUICKLY, PROVIDING RELIEF SO OTHER THERAPIES, SUCHAS COUNSELLING, CAN BE CONSIDERED2. SOCIAL APPROACH – ASSERTIVE COMMUNITY THERAPYASSUMPTIONS: • Social factors e.g. stress and poor relationships trigger mental disorders • There is a need for social support to help reintegrate patients into societyDescription - Assertive Community TherapyUsed by community mental health services with clients who have difficulties meetingpersonal goals, getting on with people and living independently. ACT links to theidea of deinstitutionalisation and care in the community • Help with independence, rehabilitation and recovery to avoid homelessness and re-hospitalisation • Treatment involves visiting, helping and supporting clients • Work with other professionals e.g. psychiatrists, social workers so whole team can focus on the person • Holistic approach looking at all of the individual’s needs in a multidisciplinary approach
  • 3. EvaluationComplete the evaluation table using the words in the box;Symptoms effective responsibility staff relapses societyStrengths Weaknesses+ Thought to be effective for those who - ACT can help prevent relapse but dohave constant ______________ as it not reduce ___________ e.g. + or –might be problems living outside of symptoms of schizophreniahospital that lead to relapse. Therefore - Access to community centres andimproving person’s ability to live in qualified________ may be limited (not__________ can help. always available+ Bond (2002) found ACT to be - May not be as empowering as first____________ in most mental health assumed – Gomery (2001) said client isdisorders, across gender, age and offered little choice and surrendersculture and suggests is allows client _______________ for decisions andchoice (empowering). Only 11% of taking care of themselvesclients said they found it restricting3. COGNITIVE APPROACH – RATIONAL EMOTIVE THERAPY ASSUMPTIONS: • Focus is on explaining specific symptoms e.g. thought insertion in schizophrenia rather than entire disorder • Emphasises the role of cognitive processes e.g. perception, reasoning, memory, irrational beliefs such as in schizophrenia or anorexiaDescriptionRATIONAL EMOTIVE THERAPY – ELLIS (1962) • Ellis suggested we have two goals – to be happy and pain-free • Rational thinking helps us attain these goals and irrationality blocks them • Ellis proposed a link between thoughts and emotions (self-talk) • He said we can generate and modify emotions by what we say – therefore controlling how we feel • Aim of RET is to challenge the irrational, negative belief and substitute with a rational, positive belief • Proposed ABC model, provide an example;
  • 4. A B CActivating event Belief ConsequenceEvaluation - Identify the strengths and weaknessesEngles (1993) found that RET was more effective for treating anxiety than systematicdesensitisationIt is impossible to study the thinking processes before the disorder so problem withthe assumption that faulty thought processes have caused mental disorderDavid (2008) found RET significantly more effective than drugs in treatment ofdepressionMost of the studies only look at the short term effectsWhat is irrational to therapist may be a rational belief to the patient e.g. hearingvoices from the dead (remember in some cultures this is rational)Osinowo 2003 – found it reduced anxiety and depression in patients undergoingoperationsOnly changes the person’s belief system not the unconscious causes behind thosebeliefsSilverman (1992) reviewed 89 studies – found in 49 RET was the most effectivetreatment whilst in the other 40 it was just as effective as other treatments4. PSYCHODYNAMIC APPROACH – FREE ASSOCIATIONASSUMPTIONS OF PSYCHODYNAMIC APPROACH: • Freud suggested that early relationships, especially with our parents, affect our later mental health • Early trauma e.g. loss of attachment can cause later mental health problems • Early experiences are hidden by defence mechanisms but retained in the unconscious where they can affect our later feelings, motives and relationships • Mental disorder viewed as an emotional response to trauma, unmet needs or unsatisfied instincts
  • 5. Description  A key goal is catharsis – to relieve anxiety through the release of dammed-up psychic energy, as the therapist unearths the unconscious cause of the problem  This is achieved through interpretative techniques which aim to give insight  FREE ASSOCIATION – the patient speaks without direction from the therapist, saying everything that comes to mind, so could eventually find a memory that enables the therapist to understand the underlying cause of the problem  Patient lies on couch in a position where they cannot see the therapist to avoid demand characteristicsEvaluationExperiences unique psychosis subjective unconscious superegoStrengths Weaknesses+It is in-depth – taking all - Inappropriate for some disorders e.g._____________ into account (from early __________ or obsessive compulsivechildhood to present) disorder (talking may strengthen+ _________ method aimed at obsessions)uncovering unmeasurable unconscious - Interpretation by therapist is+ Appears to provide access to the ___________ = unscientific. Not possible______________ allowing subsequent to validate the interpretation of freeinterpretation by therapist e.g. anorexia associationmay be result of underlying unconsciousconflicts between id and ___________5. LEARNING APPROACH – SYSTEMATIC DESENSITISATION
  • 6. Description * Systematic – gradually facing up to the phobic object throughout a hierarchy of exposure (least fearful to most fearful). * Desensitisation – brought about through relaxation techniques taught before facing up to the phobic object. The Process • Therapist and client jointly agree what the therapeutic goal should be and therapy is seen as successful once this goal is reached • Process can be in vitro – Imaginary exposure to feared object or in vivo – exposure to real object (or combination of both) 4 STAGES 1) FUNCTIONAL ANALYSIS – Therapist questions client to discover nature of the anxiety and possible triggers 2) ANXIETY HIERARCHY – Therapist and client create a hierarchy of anxiety provoking situations from least to most fearful 3) RELAXATION TRAINING – Client taught to relax e.g. deep muscle relaxation technique, deep breathing, listening to music 4) GRADUAL EXPOSURE – Phobic object is slowly introduced Most feared Think of the ‘Hierarchy’ as a ladder – before moving up to the next rung the client must be completely relaxed at their current stage.Relaxation Relaxation TASK; A3 sheet of paper – You are to Least feared create a hierarchy for a phobia
  • 7. Evaluation – identify the strengths and weaknessesBecause the goals are clearly specified from the outset the outcomes are easy tomeasure – i.e. data on the effectiveness of the treatment can be easily compiledCraske & Barlow (1993) found between 60-80% of agoraphobics showed someimprovement but it was only slight and clients often relapse after 6 monthsSD only works with people who can maintain the imagery necessary for relaxationand who can transfer their learning from the safe environment with the therapist totheir life outsideMcGrath (1990) found 75% of patients with specific phobias showed clinicallysignificant improvement following treatmentEmmelkamp (1994) reported that SD worked for a range of phobias and also PTSD(post traumatic stress disorder).Treatment only focused on observable symptoms - SD does not solve underlyingissues so may be effective in short term but not long termSD is a therapy that gives the client some control over what they agree to and it is agradual therapy – Ethical (R to W and IC). Also more ethical than flooding.There is a risk of spontaneous recovery of the maladaptive response
  • 8. It is limited to people with insight and some control over their thoughts andemotionsTASKCreate an overview table, summary sheet or mind map covering the following areas; - Assumptions of the approach – RATIONALE - How the treatment works – PROCESS - Role of the therapist - What disorders it works best on - Effectiveness – how well it works(Make sure you can confidently answer the all of these treatments.)
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