Biomedical Treatment Case Study

Examine biomedical, individual and group approaches to treatment.

Biomedical: 1. Phobias: As a treatment for phobias rarely used on its own – Benzodiazepines (Valium, Sobril, Xanax, Xanor, Mogadon, Rohypnol) enhance the effectiveness of GABA. When a single dose is compared to a single psychotherapy session for dental anxiety, the dose was worse.

2. Depression: Serotonin hypothesis: inadequate amount between synaptic gap for effective transmission to occur. Drugs aim to increase the amount of serotonin in the brain. Fluoextine ie. Prozac is a selective serotonin reuptake inhibitor SSRI (does similar sort of job as physostigmine with acetylcholine ie it prevents ‘mopping up.’)

3. Research: * Kirsch 2008 – metanalysis
suggests that there is only a small difference between the drug and a placebo. * Cuijpers 2009 – metanalysis: i/ Control (spontaneous remission) ii/ psychotherapy better, iii/ medication best. Besterist = combination of ii and iii. * ECT electroconvulsive therapy: used where other forms of therapy have failed, use is declining, over half who receive at are over 65, the majority are female. * Somatic/biomedical treatments, PG 218-9 Grahame Hill

Individual: 1.
Phobias: * Behavioral therapy * i/ Systematic desensitization: hierarchical set of fear situations related to phobic stimulus, and training in muscle relaxation. Choy 2007 can reduce anxiety but not necessarily the avoiding behavior. When effective, the benefits are long lasting. Benefit over drugs is that it corrects the problem, doesn’t just alleviate the symptoms. * Flooding. The opposite of SD. * Aversion therapy: uses emetics or electrical shocks. * Cognitive therapy: a phobia sufferer believes that the feared situation is inherently dangerous. This belief leads to negative automatic thoughts that occur as soon as the feared situation is encountered. The automatic thoughts lead to a phobic reaction. Cognitive techniques include cognitive reframing and psychoeducational techniques to break down the cycle. * Eclectic approach: Cognitive – behavioral therapy, or CBT, is the most common form of therapy today. CBT is based on the interconnectedness of thoughts, beliefs, feelings and behaviors. a) First: identify automatic (negative)
thoughts. b) Help person see the connection between thoughts and their emotional state. c) Homework arising out of this might include a diary where they note their triggering thoughts. d) Gradually change the negative schemas.

2. Depression:
CBT:
Negative thoughts = Albert Ellis
Behavioral Component = depressed people can lose interest in activities that used to give pleasure. Its aim is to reward people re-engaging in their former activities. Patients reward themselves for this activity.

Interpersonal Therapy (IPT):
A sympathetic person discusses past experiences but with no theoretical guidelines (as in CBT). It concentrates on helping clients develop and use positive social support networks with improved social skills. One consequence is that it adjusts clients’ expectations to be more realistic.

3. Research:
Butler 2006 meta analysis: CBT is extremely effective but not greater than medication alone.
CBT seems to work better in China (a Western Therapy works better in an Eastern Culture!). The power distance ratio between client and therapist is bigger, so the client is more likely (the therapist doesn’t need to be as persuasive) to accept the therapist’s observations/arguments.
Eclectic approach: most commonly used medication is initiated, then CBT initiated once patient is stable.
If medication is used alone they are likely to relapse, once medication stops. If CBT is used alone the patient isn’t thinking rationally and unlikely to get the benefit from it.

“Behavioral Treatments – behavior therapy” – Page 220 Grahame Hill
“Key application – of psychodynamic concepts to mental health.” - P222 G Hill
“Psychotherapy- cognitive therapies” – P224, also “Humanistic Therapies” Page 225.

Group: 1. Phobias:
Different types: family therapy, peer counseling, group therapy, counseling via media.
Many group cognitive-behavioral therapy sessions for phobias are advertised as seminars. A group of nervous flyers, for example, may assemble at an airport hotel for the weekend. A combination of psychoeduactional classes and exposure sessions inside the airport may be performed. P 808-9 GROSS.
Ost 1998 treated spider fear therapy in groups of 8. a) Group 1: each participant had a set of four spiders of increasing size that each person had to learn to touch. b) Group 2: The 8 watched one person receiving the treatment. c) Group 3: The 8 watched a video receive the treatment.
Group As group was best because of increased efficacy that everybody got.

2. Depression:
Why group and not individual
therapy? a) Clients may disclose more easily in a sharing environment. b) Vicarious learning (BOBOS)

3. Research:
Hyen 2005 South Korea: 2 randomly selected groups of depressed teenagers, 1 group CBT, 2 no treatment. CBT group was extremely effective at relieving the depression symptoms.
Truax 2001 meta analysis confirms group therapy is empirically validated, but the study excluded severely depressed patients.