INTERVENTIONS AND TREATMENTS

• Treatments for Anxiety Disorders


  • Benzodiazepines
  • Antidepressants (SSRI)
  • Psychological treatments
• Benzodiazepines


  Give short term relief, carry risks - impair both cognitive and motor functioning, associated with falls in older adults resulting in hip fractures, produce both psychological and physical dependence
• Psychological treatments for Generalized Anxiety Disorder


  • Using images to feel (rather than avoid feeling) anxious
  • Relaxing deeply to combat tension
• Panic Disorder and Agoraphobia treatment


  1. Gradual exposure exercises, combined with anxiety-reducing coping mechanisms such as relaxation or breathing retraining

  2. Panic Control Treatment (PCT) - Exposing patients to the cluster of interoceptive (physical) sensations that remind them of their panic attack

  3. Cognitive-behavioral program - Calm Tools for Living - Clinician and patient sit side-by-side as they both view the program on screen, helps patient establish a fear hierarchy, demonstrate breathing skills, or design exposure assignments
• Specific Phobia treatment


  Structured and consistent exposure-based exercises
• Treatments for Social Anxiety Disorder (Social Phobia)


  • Cognitive therapy program - Emphasizes real-life experiences to disprove automatic perceptions of danger
  • Interpersonal Psychotherapy (IPT)
  • Family-based treatment - Better than individual treatment if parents also have an anxiety disorder
  • Drugs - Paxil (SSRI), Zoloft (SSRI), Effexor (SSRI), D-cycloserine (DCS) + CBT treatments = enhanced effect of treatment
• Treatments for Posttraumatic Stress Disorder


  • Psychoanalytic therapy - Catharsis, Imaginal exposure
  • Cognitive therapy - To correct negative assumptions about the trauma e.g., blaming oneself, feeling guilty
  • Drugs - Prozac (SSRI), Paxil (SSRI)
• Treatments for Obsessive-Compulsive Disorder


  • Drugs (SSRI) - Clomipramine (Anafranil)
  • Exposure and Ritual Prevention (ERP) - Most effective approach, rituals are actively prevented and patient is systematically and gradually exposed to the feared thoughts or situations
  • Cognitive treatments - Focus: overestimation of threat, importance and control of intrusive thoughts, sense of inflated responsibility, need for perfectionism and certainty
  • Psychosurgery - A misnomer that refers to neurosurgery for a psychological disorder
• Treatments for Body Dysmorphic Disorder


  • Drugs (SSRI) - Clomipramine (Anafranil), Fluvoxamine
  • Cognitive-Behavioral Therapy (CBT) - Exposure and response prevention, produce better and longer lasting outcomes than medication alone
  • Dermatology (skin) treatment - Most often received
  • Plastic surgery - Most common procedures: rhinoplasties (nose jobs), facelifts, eyeshadow elevations, liposuction, breast augmentation, surgery to alter the jawline
• Hoarding Disorder treatment


  Teaching people to assign different values to objects, reducing anxiety about throwing away items that are somewhat less valued
• Treatments for Trichotillomania and Excoriation


  • Habit Reversal Training - Patients are carefully taught to be more aware of their repetitive behavior, particularly as it is just about to begin, and to then substitute a different behavior
  • SSRIs (for Trichotillomania)
• Treatments for Somatic Symptom Disorder and Illness Anxiety Disorder

  • Reassurance and education
  • Reducing the frequency of help-seeking behaviors (e.g., assigning a gatekeeper physician to each patient to screen all physical complaints)
  • Cognitive-Behavioral Therapy (CBT)
  • Antidepressant (SSRI) - Paroxetine (Paxil)
• Conversion Disorder (Functional Neurological Symptom Disorder) treatment


  Identify and attend to the traumatic or stressful life event, if it is still present (either in real life or memory), reduce any reinforcing or supportive consequences of the conversion symptoms (secondary gain)
• Treatments for Depersonalization-Derealization Disorder

  • Psychological treatments similar to those for panic disorder may be helpful
  • Stresses associated with onset of disorder should be addressed
• Treatments for Dissociative Fugue

  • Recalling what happened during the amnesic or fugue state, often with the help of friends and family who know what happened, so the patient can confront the information and integrate it into their conscious experience
  • Hypnosis
  • Benzodiazepines (minor tranquilizers)
• Treatments for Dissociative Identity Disorder

  • Patient must identify cues or triggers that provoke memories of trauma, dissociation, or both, and to neutralize them
  • Patient must confront and relive the early trauma and gain control over the horrible events
  • Therapist must help the patient visualize and relive aspects of the trauma until it is simply a terrible memory
  • Hypnosis - to access unconscious memories and bring various alters into awareness
• Treatments for Depression


  • Antidepressants - SSRIs, Mixed reuptake inhibitors, Tricyclic antidepressants, Monoamine oxidase (MOA) inhibitors, Lithium carbonate (Lithium)
  • Biological treatments - Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation
  • Psychological treatments - Cognitive-Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT)
• Lithium


  Found in our drinking water, side effects: toxicity (poisoning), lowered thyroid functioning, substantial weight gain, major advantage: effective in preventing and treating manic episodes, most often referred to as a 'mood-stabilizing drug'
• Electroconvulsive Therapy (ECT)


  Most controversial treatment for psychological disorders after psychosurgery, electric shock is administered directly through the brain for less than 1 second, producing a seizure and a series of brief convulsions that usually lasts for several minutes
• Treatments for Bipolar Disorder

  • Lithium
  • Psychological treatments - Increasing compliance with drug treatments, Interpersonal and Social Rhythm Therapy (IPSRT) - Regulates circadian rhythm by helping patients regulate their eating and sleep cycles
• Seasonal Affective Disorder treatment

  Light therapy
• Suicide prevention methods


  • Implicit (unconscious) cognition - To assess implicit suicidal ideation; Stroop test
  • Agreeing to or signing a no-suicide contract
  • Limiting access to lethal weapons for anyone at risk for suicide
  • Cognitive-behavioral interventions
• Treatments for Bulimia Nervosa

  • Drugs - Fluoxetine (Prozac)
  • Psychological treatments - Short-term cognitive-behavioral treatments, Cognitive-Behavioral Therapy-Enhanced (CBT-E) - Focus is on the distorted evaluation of body shape and weight, and maladaptive attempts to control weight, Interpersonal Psychotherapy (IPT)
• Treatments for Binge-Eating Disorder

  • Cognitive-Behavioral Therapy (CBT)
  • Interpersonal Psychotherapy (IPT)
• Treatments for Anorexia Nervosa


  • Most important initial goal: restore the patient's weight to a point that is at least within the low normal range
  • Cognitive-Behavioral Therapy (CBT)
  • Cognitive-Behavioral Therapy-Enhanced (CBT-E)
  • Family-based Treatment (FBT)
• Treatments for Obesity


  • Self-directed weight-loss program (e.g., by buying a popular diet book)
  • Diet programs - Atkins (carbohydrate restriction) diet, Ornish (fat restriction) diet, Zone (micronutrients balance) diet, Weight Watchers (calorie restriction) diet
  • Commercial self-help programs - Weight Watchers, Jenny Craig
  • Bariatric surgery - A surgical approach to extreme obesity
• Treatments for Insomnia


  • Medical treatments - Benzodiazepine, Triazolam (Halcion), Zaleplon (Sonata), Zolpidem (Ambien), Flurazepam (Dalmane)
• Treatments for Circadian Rhythm Sleep Disorder

  • Environmental treatments - Phase delays (moving bedtime later), Phototherapy - Using bright light to trick the brain into readjusting the biological clock
  • Psychological treatments - Stimulus control, Progressive relaxation or sleep hygiene, Sleep restriction, Confronting unrealistic expectations about how much sleep is enough for a person, Cognitive-Behavioral Therapy (CBT)
• Treatments for Nightmares (or Nightmare Disorder)


  • Cognitive-Behavioral Therapy (CBT)
  • Pharmacological treatment - Prazosin
• Sleep Terrors treatment


  Scheduled awakenings
• Psychosocial treatments for Physical Disorders

  • Biofeedback - Making patients aware of specific physiological functions that, ordinarily, they would not notice consciously
  • Relaxation and Meditation - Progressive muscle relaxation, Transcendental meditation, Relaxation response
  • A Comprehensive Stress-and-Pain-Reduction Program - Time-management training, Assertiveness training
  • Drugs and Stress-Reduction Programs
  • Denial as a Means of Coping - Shelley Taylor points out that most individuals who are functioning well deny the implications of a potentially serious condition, at least initially
  • Modifying Behaviors to Promote Health - Injury Prevention, AIDS Prevention
• Providing basic education about sex is a treatment for Sexual Dysfunction
• Treatments for Psychological Disorders


  • Cognitive-Behavioral Therapy (CBT)
  • Pharmacological treatment
  • Prazosin for Sleep Terrors
  • Scheduled awakenings
• Treatments for Physical Disorders


  • Psychosocial treatment
  • Biofeedback
  • Relaxation and Meditation
  • Comprehensive Stress-and-Pain-Reduction Program
  • Drugs and Stress-Reduction Programs
  • Denial as a Means of Coping
  • Modifying Behaviors to Promote Health
• Treatments for Sexual Dysfunction


  • Providing basic education about sexual functioning, altering deep-seated myths, and increasing communication
  • Psychosocial treatment (Sensate focus, Nondemand pleasuring)
  • Medical treatments (Sildenafil, Levitra, Cialis, Injection of vasodilating drugs, Surgery, Vacuum Device Therapy)
  • Squeeze technique for Premature Ejaculation
• Treatments for Paraphilic Disorders

  • Psychological treatment (Covert sensitization, Orgasmic reconditioning, Relapse prevention)
  • Drugs (Cyproterone acetate, Medroxyprogesterone)
• Treatments for Gender Dysphoria


  • Psychological evaluation and education
  • Administration of gonadal hormones
  • Sex Reassignment Surgery
• Treatments for Gender Nonconformity in Children


  • Work with the child and caregivers to lessen gender dysphoria and decrease cross-gender behaviors
  • "watchful waiting"
  • Actively affirming and encouraging cross-gender identification
• Treatments for Disorders of Sex Development (Intersexuality)


  • Surgery
  • Hormonal Replacement Therapy (HRT)
  • Psychological treatments
• Treatments for Substance-Related Disorders


  • Help someone through the withdrawal process
  • Biological treatments (Clonidine, Sedative drugs)
  • Agonist substitution (Methadone, Buprenorphine, Nicotine, Bupropion)
  • Antagonist treatments (Naltrexone, Acomprosate)
  • Aversive treatments (Disulfiram, Silver nitrate)
  • Psychosocial treatments (Inpatient facilities, Alcoholics Anonymous, Cocaine Anonymous, Narcotics Anonymous, Rational Recovery, Moderation Management, Women for Sobriety, SMART Recovery)
  • Component treatment (Contingency Management, Community Reinforcement Approach, Motivational Enhancement Therapy, Cognitive-Behavioral Therapy)