Nonpharm Treatment

Motivational

Motivational therapy is a form of therapy that attempts to motivate change in patients, attempting to make them care about their problem by addressing their denial or ambivalence.

Motivational therapy has particular utility in patients suffering from substance abuse.

Family Therapy

Family therapy focuses on reducing conflict between family members, by helping them understand and accomodate one another.

Patients with anorexia nervosa may benefit from family therapy, as their feelings of inadequacy tied to their weight may be rooted in maladaptive parental dynamics (e.g. unreasonable expectations, excessive criticism).

Psychoanalysis

Psychoanalysis seeks to resolve conflicts of the unconscious mind by providing an environment in which unconscious conflicts can be reconciled by the conscious mind. It is a subset of psychotherapy. There are three important types of psychoanalysis:

• Psychodynamic psychoanalysis

• Interpersonal psychoanalysis

• Supportive psychoanalysis

Psychodynamic psychoanalysis explores past events and utilizes transference to help patients solve problems that may be due to unresolved trauma. It is best used in everyday, high-functioning people, who may have a history of bereavement, rape, or other emotional trauma.

Interpersonal psychoanalysis helps patients improve interpersonal communication to resolve relationship problems.

Supportive psychoanalysis helps patients feel safe and cope during an acute crisis or other difficult time. It is the treatment of choice for adjustment disorder.

Transference and Counter

Transference occurs when subconscious feelings regarding close, influential people in a patient's life are experienced in the present relationship with the therapist and are analyzed. Essentially, the therapist emulates such figures in the person's life.

Countertransference occurs when the therapist unconsciously re-experiences feelings about important persons in his/her life with the patient. It is essentially the transference in the opposite direction.

Behavioral Therapy

Operant Conditioning

Reinforcement theory (operant conditioning) includes:

• Positive reinforcement

• Negative reinforcement

• Punishment

Don't confuse punishment with negative reinforcement! Punishment is the addition of a negative stimulus to discourage an action, while negative reinforcement is the subtraction of a negative stimulus to encourage an action.

Positive reinforcement is giving a reward for a correct behavior.

• Example: Giving a child a cookie for completing her homework.

Negative reinforcement is a reward that comes in the form of removal/prevention of a negative event. Subjects learn to perform actions that prevent adverse situations.

• Example: A man living with chronic joint pain takes medication that relieves his pain.

Punishment is a negative stimulus that discourages an unwanted action.

• Example: Being charged with a jail sentence for a crime.

Classical conditioning

Classical conditioning, as opposed to operant conditioning, is a simple behavioral association of a stimulus with a response by linking two simultaneously experienced stimuli. The stimulus is paired with an existing stimulus frequently and consistently, such that the new stimulus will begin to evoke a similar behavioral response to the one the existing stimulus had.

• Example: Pavlov's classic experiment, where dogs were conditioned to salivate when hearing a bell. The existing stimulus-behavior pair was that of food with salivation; the dogs began to associate the bell with food after the bell always rang when food arrived.

Deconditioning

Behavioral therapy utilizes various strategies to decondition a patient, allowing them to unpair a pathological response for a given stimulus. There are multiple strategies that can be used in this type of therapy:

• systematic

• flooding

• Aversion

• Token economy

• Biofeedback

Systematic desensitization is the gradual exposure to a fear-provoking stimulus,typically increasing in intensity in a step-wise fashion. It is commonly used to treat phobias.

• Example: A man with a fear of snakes is first shown a picture of a snake, then is given a snake toy to hold, then is shown a documentary on snakes, etc.

Flooding is sudden, full exposure to the fear-producing stimulus, until the patient adjusts to his/her fear. It is commonly used to treat phobias.

• Example: A man who is afraid of heights goes on a high-altitude hiking trip.

Aversion therapy pairs a negative stimulus to a behavior the therapist is seeking to modulate. Often used to treat addiction and paraphilias.

• Example: An alcoholic woman taking disulfiram experiences nausea and emesis when drinking alcohol.

Token economy refers to using positive reinforcement to incentivize certain behaviors. It has particular utility in highly disorganized (e.g. schizophrenic) or mentally incapacitated patients.

• Example: A patient receives "privilege tokens" for showering, shaving, brushing teeth, etc. that can be redeemed for time watching TV.

Biofeedback is the process of mentally controlling physiologic parameters. It has particular utility in psychiatric conditions where physical symptoms are prominent, allowing the patient to gain better mental control of these symptoms.

• Example: A woman with panic attacks tracks her heart rate during episodes to attempt to mentally alleviate her tachycardia.

Cognitive Therapy

CBT

Cognitive-behavioral therapy (CBT) is a combination of behavioral therapy and cognitive therapy (focused on correcting maladaptive thought patterns). The patient learns how one's behavior is influenced by one's thoughts:

• learn what emotions feeling right now

• what thoughts are leading to that emotion

• what are some distortions causes those thoughts (making up stories in head)

CBT has particular utility in correcting destructive thought patterns, such as inadequacy, depression, and other self-defeating thoughts.

CBT may be one of the most common answer choices for non-pharmacological therapy on the Psych shelf and Step 2, due to its widespread applicability. When in doubt, choose it over other types.

DBT

Dialectical behavioral therapy (DBT) is a form of therapy used to prevent self-injury and to encourage patients to be more adaptive to stressors and change.

Dialectical behavioral therapy has particular utility in borderline personality disorder.