Let's talk now about behavioral therapy. So, the goal is to reduce symptoms via relaxation,
reinforcement, and graduated exposure to distressing stimuli.
This treats psychiatric disorders by helping patients change behaviors,
sometimes substituting maladaptive behaviors with healthy alternatives
that contribute to their symptoms. Some types of behavioral therapy are learning, conditioning,
and deconditioning. Learning theory is where behaviors can be learned by conditioning
and can similarly be unlearned by deconditioning. Let's consider a classic conditioning.
A stimulus can eventually evoke a conditioned response.
So, you may have heard of the classic example of Pavlov's dog.
This is where every time a bell rang, a dog was fed his dinner.
Therefore, over time, whenever the dog would hear a bell rang, he would start to salivate.
That's classic conditioning. Now, let's compare that to operant conditioning
which is where behaviors can be learned when followed by positive or negative reinforcement.
Skinner's box is the example here. So, the example was that a rat was put in a cage
and every time it pushed a lever, it would receive a treat.
So therefore, it learned to associate pushing the lever with a positive response.
Now, let's look at a deconditioning approach. Let's say a patient is afraid of dogs.
So, the way you would decondition this patient is to first, show her a picture of dogs
and then maybe give her a stuffed animal. Maybe then she'll watch a movie with dogs in it
and then she might actually go out and meet a dog, and pet it. That is systematic desensitization
and here, the patient will perform relaxation techniques while being exposed to increasing doses
of an anxiety provoking stimulus. Eventually, that patient may be made
to imagine going to a dog park, this is called implosion and then eventually that patient
will actually go to a dog park, and that is flooding. So, implosion involves intensive recollection
or thought of an anxiety-producing situation or event in a patient's life.
Whereas flooding is when the individual is actually immersed in their feared situation.
Let's look at an approach to deconditioning. Let's take an alcoholic patient.
That patient can be given Antabuse which is aversive therapy.
So, basically when the patient drinks alcohol, they'll get violently sick.
Again, aversion therapy, a negative stimulus is repeatedly paired with specific behavior
to create an unpleasant response and so, this is the classic example I shared with you
of the alcoholic patient being given Antabuse to help them with their problem.
Now, let's consider a patient with schizophrenia. They're on a locked psychiatric unit
and given a reward every time that patient takes a shower or takes care of their ADLs,
that's called a token economy and the idea here is that rewards are given after specific behaviors
to positively reinforce them. So, it's commonly used to encourage showering, shaving,
and other ADLs on in-patient units. Now, let's consider a patient with a migraine.
She's encouraged to visualize the dilation of her arteries whenever experiencing pain.
This is biofeedback which is where physiological data like heart rate, blood pressure, etc.
are actually given to the patient during times of distress so then they can be coached
to mentally imagine the problem going away and that helps to control the physiological state.
Let's talk about cognitive therapy. Cognitive behavioral therapy or CBT is a therapy
that seeks to correct faulty assumptions and negative feelings that exacerbate psychopathology.
It's a manual driven therapy first described by Aaron Beck and very popular and very well studied.
It actually has proven efficacy with controlled research. The fundamentals of CBT
include education, relaxation, coping skills training, stress management, and assertiveness training.
The best type of patients for CBT are highly motivated, they're self-observers,
and they're real problem solvers. Now, interpersonal therapy.
This addresses relationships in the 'here and now' and it's also manual driven just like CBT.
Interpersonal therapy focuses on the individual's life in four problem areas, grief,
interpersonal disputes, role transitions, and also interpersonal skills defects.
Now, let's talk about motivational interviewing. This is an approach to help patients change
maladaptive behaviors via recognition of problematic behaviors and matching strategies
to the patient's stage of readiness to change. Motivational interviewing really
includes expressing empathy and it's all about meeting the patient where they're at right now
and helping them to create an idea of what they want to see change.
There's a cycle of change that we think about when we are addressing issues
with patients through motivational interviewing. So, let's take for example the chronic alcoholic
and we're hoping to motivate them through stages of change.
Most people start at a pre-contemplated stage. Later, they'll become contemplative,
then motivated, and often there's a relapse in their symptoms, and the cycle starts all over again.
So, it's an ever evolving cycle that patients kind of shift in and out of
and our goal is to keep motivating them to moving towards the motivated stage of health.
The patients that respond best are in fact highly motivated, they're self-observers,
again problem solvers, and they actually want to make a change.
Key elements in motivational interviewing are again, expressing empathy,
identifying discrepancies to the patient between their problematic behavior
and their actual personal values. Also, expecting the patient to resist change and accept it.
It's going to happen when you're using this kind of therapy but you're really trying to enhance
your patient's sense of self-efficacy that they in fact are their own agent of positive change.
Dialectical behavioral therapy, this was actually developed by Marsha Linehan
and it's a special treatment for borderline personality disorder.
It focuses on the main goals of reducing self-injurious behavior and also reducing the number
of hospitalizations a patient might incur. So, there are four areas that DBT focuses on,
teaching patients about mindfulness, interpersonal effectiveness, emotion regulation,
and distress tolerance. Now, supportive psychotherapy, this is another approach that one can take,
it's usually brief but has an active focus on helping the patient deal with a life crisis.
The therapist will offer advice, sympathy, and support while reinforcing the patient's strengths.
Group therapy, this is a therapeutic approach that incorporates discussion, sharing of feelings,
and peer supports. 12 step programs such as Alcoholics Anonymous or AA are great examples
of group therapies. Group therapy is especially useful in the treatment of not only substance abuse
but also adjustment disorders and personality disorders, of note they can also help a lot in grief
and bereavement, they can help a lot with major depression and anxiety.
Advantages of group therapy over individual therapy include the fact that the patient
gets immediate feedback and from their peers, so it usually fosters a non-judgemental approach.
Patients can gain insight into their own condition by listening to others with a similar problem
and then they feel less alone. If a therapist is present, there's an opportunity
to observe interactions between others who may be eliciting a variety of transferences
and then the therapist can intervene and point this out to the patients.
Family or marital therapy, this allows the entire family or unit to come together
and better understand how psychopathology can affect the entire group
and be aware of how tensions and conflicts may affect them
and how each person responds a little bit differently. The goals are to actually reduce the conflict
and help members understand each other better, help the unit cope with internally destructive forces.
In family therapy, the therapist will be attuned to boundaries between family members
which sometimes can either be too rigid or maybe too permeable.
The therapist can point this out and show that triangles may actually result
when two family members kind of form an alliance against the third.
That's another valuable tool that requires a therapist to see that objectively
and point that out and then help the family make adjustments to accommodate for each other.
Marital therapy is especially useful in the treatment of conflicts involving sexual problems
and communication problems, and the therapist can help each party to safely express their needs
and desires and identify obstacles that are coming in the way of achieving all of this.
Usually, sessions are conjoint and often each person will have a separate therapist
whom they're seeing one-on-one, we call this collaborative therapy.
So, that's a summary of some of the more common and important therapies.
You now are familiar with their names, a little bit about what they do,
and you can apply this knowledge to your exam.