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therapy

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Therapy

History

  • Early treatment “Trepanning” - drilling a hole on the skull so that the soul can leave
  • “Bedlam” asylum
  • Modern Therapies
    • Insight Therapies, aka. talk therapy
    • Cognitive-Behavioral Therapy
    • Drug Therapy

Insight Therapy

Insight Therapies - psychoanalysis

  • Started by Sigmund Freud
  • The patient does not know what the real problem is (e.g. sexual abuse in the childhood), defense mechanism has built up
  • But, we cannot do direct confrontation, as it will bring up the defenses of the patient
  • Free association, dreams, other projective tests
  • Counter Transference: the therapist is taken as the abuser, a therapist need a therapist

Humanistic Therapy

  • Humanistic Therapy - Client-Centered Therapy
    • e.g. Carl Rogers
    • Non-directive, no patient, only client
    • Incongruence - the distance between who they are and why they want to be
  • Limitations
    • A client must be intelligent, articulate, motivated, and perhaps rich enough
    • Not many scientific studies assessing effectives.

Cognitive Behavioral Therapy

  • Systematic Desensitization, based on Classical Conditioning
    • Relaxation
      • Learn to relax.
      • Associate feeling with a trigger.
      • Practice using the trigger.
    • Hierarchy of Fears
      • Create Hierarchy.
      • Go through it slowly, using trigger.
      • One cannot progress until they can remain relaxed on the previous step.
  • Therapies based on Operant Conditioning (all about consequences)
    • Reinforcement of Adaptive Behaviors
    • Token Economies
    • Punishment
graph LR
A[Negative Event]
B1[Rational Belief]
B2[Irrational Belief]
C1[Healthy Negative Emotion]
C2[Unhealthy Negative Emotion]
A --> B1 & B2
B1 --> C1
B2 --> C2
  • CBT and Depression
    • Write down all the good things and ignore all the bad things.
    • At the end of the day, read the good things to yourself.

Biological Treatments

  • Transmitters
    • Norepinephrine and Serotonin are involved in whole brain, Dopamine is more mid-brain-ish.
    • The brain is complex, thus drugs may be addictive.
  • Anti-maniac and anti-depression drugs
    • Tricyclics: Slow the up-take of norepinephrine and serotonin. Many side effects (e.g. weight gain, poor concentration.)
    • Monamine Oxidase Inhibitors (MOI):  Prevent enzymes from destroying norepinephrine and serotonin. Many side effects (e.g. high BP, blurred vision, insomnia)
    • Selective Serotonin Re-uptake Inhibitors (SSRI): Fewer side effects, which allows for larger doses
    • Lithium Carbonate: Most effective for bipolar disorder or mania.  Ends manic episodes as soon as blood level is high enough, and when mania is contained depressive periods also end.
  • Anti-psychotic drugs
    • Schizophrenia is biological issue. Drugs are good at dealing with positive symptoms.
    • Long term use of drugs lead to tardive dyskinesia (lip smacking, drooling)
  • Psychosurgery and Electro-Convulsive Shock

Graph View

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