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W7 psychotherapies and other modes of treatment lecture
- 1. BEHAVIORAL MEDICINE PSYCHOTHERAPIES AND OTHERMODES OF TREATMENT Gia Pauline S. Castillo-Mojica, MD, DSBPP, DPCAM, FPPA, FPSMSI, MHA Raymond Joseph S. Valdez, MD, DSBPP
- 2. Objectives: I. Definition ofPsychotherapy II. Discuss Psychosocial Therapy III. Types of Psychotherapy IV. Contraindication V. Unwanted Effects VI. Supportive Therapy VII. Psychodynamic/Expressive VIII. Behavioral Therapies IX. Biofeedback X. CBT XI. Group Therapy XII. Family Therapy XIII. Marital Therapy XIV.Rehab XV. Milieu
- 3. ◦“A practice oftreatment based on the development of intimate and therapeutic relationship between client and therapist for the purpose of exploring & modifying the client behavior in satisfying direction.” Definition: Psychotherapy
- 4. ◦“A technique whichattempts to help the patient relieve symptoms, resolve problems or seek personal growth through a structured relation (i.e. specified goals and methods) with a trained professional therapist.” ◦The therapist may be a psychiatrist, a psychologist, a nurse, etc... Definition: Psychotherapy
- 5. Goals of PsychosocialTherapy ◦Changing maladaptive behavior pattern. ◦Reducing of environmental conditions that may be causing such a behavior. ◦Improvement of interpersonal & other competencies i.e communication skill
- 6. Goals of PsychosocialTherapy ◦Help the patient to resolve inner conflict & overcome feelings ◦Change an individual’s accurate assessment of himself & everyone/everything else ◦Helping him to develop a sense of self-identity
- 7. Types of Psychotherapy A.According to Format ◦ 1- Individual therapy. ◦ 2- Group therapy. ◦ 3- Family therapy. ◦ 4- Marital therapy. ◦ 5- Community or Milieu therapy. B. According to content (the applied personality theory) ◦ 1 - Supportive. ◦ 2- Expressive (dynamic or insight oriented). ◦ 3- Behavioral. ◦ 4- Biofeedback ◦ 5- Cognitive-Behavioral ◦ 6- Experiential (Humanistic approach). ◦ 7- Rehabilitation and activity therapies
- 8. Contradiction of Psychotherapy ◦Psychoticpatient ◦Organic psychosis ◦Unmotivated & unwilling to accept it. ◦Group psychotherapy in hysteria, hypochondriasis etc. ◦Unlikely to respond
- 9. Unwanted Effects ofPsychotherapy ◦Dependent on therapy or therapist. ◦Exacerbation of symptoms ◦Deterioration in relationship. ◦Missed physical treatment ◦Ineffective psychotherapy
- 10. Supportive Psychotherapy Definition andAims ◦It is the type of therapy that deals with conscious conflicts and current problems. ◦It aims at supporting the patient and helping him to: 1- Relieve symptoms and resolve problems. 2- Regain equilibrium and maintain stability. 3- Achieve better adaptation, coping and functioning.
- 11. Supportive Psychotherapy Indications ◦1 -Crisis, acute distress or acute adjustment disorders. ◦2- Chronic or handicapped patients. ◦3- Patients who are not motivated for deeper therapy.
- 12. Techniques of SupportivePsychotherapy ◦ Establishing a therapeutic alliance. ◦ Empathic listening. ◦ Encouragement. ◦ Reassurance ◦ Suggestion, advice and persuasion. ◦ Clarification and explanation (education)
- 13. Techniques of SupportivePsychotherapy ◦ Strengthening useful defenses. ◦ Suppressing unwanted conflicts. ◦ Help in improve insight ◦ Improving ego strength and functioning ◦ Environmental manipulation and modification.
- 14. Supportive Psychotherapy Duration ofPsychotherapy ◦Depends on patient's needs, Format ◦Depends per patient Complications ◦Mainly dependent on therapist
- 15. Psychodynamic (Expressive) Therapy ◦Agroup of deep therapies that aim at symptom resolution as well as producing positive fundamental changes in the patient's character or individuality.
- 16. Types of PsychodynamicTherapy ◦Psychodynamic psychotherapy includes a variety) of models: ◦Classical psychoanalysis (of limited use now) ◦Psychoanalytic oriented models ◦Short-term models ◦Object relation ◦Self-psychologv models ◦Etc.
- 17. Psychodynamic (Expressive) Therapy ◦Thereis enough ego-strength to tolerate the experience of change and growth. ◦The patient should also be capable of expressing his thoughts and emotions. ◦Duration may vary.
- 18. Psychodynamic (Expressive) Therapy ◦The short-term techniques are characterized by being: 1- Time-limited. 2- Problem-focused.
- 19. Behavioral Therapies ◦This isbased on the theory that symptoms are persistent maladaptive behaviors acquired by conditioning or learning.
- 20. Techniques of BehavioralTherapy 1- Systematic desensitization 2- Graded exposure 3- Flooding 4- Aversive conditioning 5- Positive reinforcement 6- Participant modeling
- 21. Biofeedback ◦ Biofeedback isbased on the idea that physiological functions which are not controlled voluntarily. ◦ It can be brought under voluntary control through operant conditioning if a person is provided with feedback information about these functions.
- 22. Indications of Biofeedback ◦It is used in the management of a lot of psychosomatic conditions ◦including hypertension, arrhythmias, migraine, tension headache, etc.
- 23. Cognitive-Behavioral Therapy ◦Based onthe theory that a person's affect and behavior are largely caused by the way in which he cognitively structures and interprets the world (cognitive schemata developed from previous experience). ◦automatic thoughts
- 24. Aim of Cognitive-BehavioralTherapy ◦To identify and correct cognitive distortions and maladaptive behaviors that result from them like correcting automatic thoughts.
- 25. Techniques of CBT A.Cognitive (verbal) techniques ◦ 1- Identify and test automatic thoughts ◦ 2- Identify and test the underlying postulations or core beliefs. ◦ 3- Correcting the distorted cognitions and replacing them with positive and more adaptive cognitive habits. ◦ 4- Rehearsal of the new cognitive and behavioral responses.
- 26. Techniques of CBT B-Behavioral Techniques ◦ 1- Activity scheduling. ◦ 2- Graded task assignment (e.g., graded social activity to correct social withdrawal). ◦ 3- Rehearsal of new behavior. ◦ 4- Rating of progress in the amount of mastery and pleasure. ◦ 5- Diversion techniques: e.g., physical activity and exercise, work, social contact.
- 27. Characteristic Features ofCBT 1- Duration: ◦ Short-term and time limited ◦ usually 15-20 sessions, over 3 months 2- Therapist role: ◦ Active, directive, understanding and empathic 3- Focused on: a. Conscious aspects of experience and behavior. b. Present problems.
- 28. Characteristic Features ofCBT 4- Structured: a. Problems and goals operationally defined. b. Agenda prepared for each session. 5- Format: ◦ can be used in other formats
- 29. Indications of CBT 1-Non psychotic Depressive disorders 2- Anxiety disorders 3- Obesity and eating disorders. 4- Substance related disorders
- 30. Group Therapy Definition - Aform of therapy in which corrective changes occur as a result of the interactions of patients with other patients and at least one trained professional therapist in a group setting.
- 31. Group Therapy Goals 1- Reliefof symptoms. 2- Resolution of intrapsychic and interpersonal difficulties through insight and corrective experiences. 3- Encouraging personality growth and development.
- 32. Group Therapy Characteristics: • Size:6-12 patients (optimum 8). • Time: 1-2 hours once or twice weekly. • Duration: months to years
- 33. Group Therapy Type ofpatients: 1. Heterogeneous 2. Homogeneous
- 34. Group Therapy Indications May beused in most disorders except: •acute manic or Acute psychotic episodes •antisocial personality disorder
- 35. Family Therapy •Family therapyis centered on the idea that the patient's psychological disturbance reflects a significant disturbance of his family
- 36. Family Therapy •The objectiveis to help family members gain insight into their problems and disturbed relational patterns and change their dysfunctional behavior and emotions into a healthier pattern.
- 37. Family Therapy • Thetherapy is centered to the family as a whole rather than the individual patient. •The family is viewed as a system suffering from defective functioning resulting from disturbed rules, roles and relations among its members
- 38. Marital Therapy •A formof therapy concerned with unstable marital couples. •It aims at resolving interpersonal and related intrapsychic individual problems of the couple. •The therapy is focused on the "relationship" rather than any of the individual partners
- 39. Rehabilitation •It is managementof disabilities and handicaps resulting from psychiatric disorder conducted by trained therapists. •It is particularly important in long playing psychiatric disorders (such as chronic schizophrenia and mood disorders)
- 40. Rehabilitation •Aims to improvethe patient's performance in different functional domains including: 1. Personal hygiene and self-care skills. 2. Social and interpersonal skills 3. Vocational and/or educational skills. 4. Recreation and activity therapies
- 41. Milieu Therapy •An environmentthat is designed to assist patients to: 1. Control and modify problematic (maladaptive) behaviors. 2. Promote adaptive psychosocial skills in coping with the self, others and the environment.
- 42. Milieu Therapy •The emphasisis on social relationships as well as occupational and recreational activities. •To achieve its goals it uses different therapeutic modalities particularly: 1- Group therapies. 2- Different rehabilitative techniques. 3- Structured activities of daily living for all patients
- 43. Team involved inMilieu Therapy Therapy is based on the coordinated work of a holistic team which includes: •the psychiatrists •Psychologists •psychiatric nursing staff •social workers •It also includes occupational, art, play and recreational therapists
- 44. View theses videos: ◦Psychotherapy https://www.youtube.com/watch?v=OxuZiqY5ypU ◦ The different models (theories) of psychotherapy https://www.youtube.com/watch?v=vCQNtQA9Lg0
- 45. Activity: ◦ Discuss thedifferent types of Psychotherapy and list the indications for each.
- 46. References: ◦ Kaplan &Sadock’s Synopsis of Psychiatry 11th Edition Copyright 2015 ◦ Psychotherapy https://www.youtube.com/watch?v=OxuZiqY5ypU ◦ The different models (theories) of psychotherapy https://www.youtube.com/watch?v=vCQNtQA9Lg0
- 47.