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Treatments and Therapies for Anxiety Disorders'

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Useful for treating agoraphobia, OCD & PTSD ... Useful for specific phobias & not so useful for agoraphobia ... Less effective for agoraphobia than other therapies ... – PowerPoint PPT presentation

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Title: Treatments and Therapies for Anxiety Disorders'


1
Treatments and Therapies for Anxiety Disorders.
  • Biological Approach-
  • 1. Chemotherapy (Drugs)
  • Anti-anxiety drugs/minor tranquillisers
    (benzodiazepines such as valium librium)
  • All used for treating GAD and phobias, some for
    Panic attacks but not used for OCD or PTSD. Fast
    acting benzodiazepines (alprazolam) used for
    panic attacks (put under tongue can work in 5
    mins!)
  • Probably work by mimicking / blocking the action
    of naturally occurring neurotransmitter
    substances.
  • Depresses CNS activity therefore reduces
    Symp.NS activity. This leads to a decrease in HR,
    RR e.t.c.
  • Side effects-
  • Drowsiness Lethargy Dependence
  • Withdrawal Rebound anxiety when stopped
  • Dangerous if overdose taken -gt death.

2
  • Antidepressant drugs such as tricyclic
    antidepresseants and SSRIs. (e.g. Tofranil,
    Prozac)
  • Useful for treating agoraphobia, OCD PTSD
  • Piccinelli(1995) - antidepressants (e.g.
    clomipramine) most effective for short term
    treatment of OCD.
  • Buspirone mild tranquilizer used for GAD and
    OCD
  • Mode of action effective at the synapses of
    neurons
  • involved in the action of serotonin
    noradrenaline, results in elevated levels of
    both.
  • Side effects each drug may have one /more of -
  • Some require patient to stick to special diet
  • Dry mouth Heart arrhythmias
  • Blurred vision Urinary retention
  • Weight gain Hand tremors
  • Depresses reactions Impaired memory

3
  • 2. Psychosurgery
  • Last resort very rarely used because of risks.
  • Used to treat OCD effective (Hey et al, 1993)
  • Cingulotomy cuts the cingulum bundle a small
    bundle of fibres connecting the prefrontal cortex
    with parts of the limbic system.
  • Many side effects possible, some severe
    permanent. Irreversible.
  • Continues to have a negative image both with
    public professionals due to misuse in the
    past.
  • 3. Electro-Convulsive Therapy
  • (see text book for details on this treatment
    method)
  • Was used widely but much more restricted now.
  • Occasionally used in the treatment of certain
    OCDs.

4
Behavioural Approach-
  • Implosion and Flooding - used in treatment of
    phobias.
  • Based on producing extinction of fear response.
  • Flooding is more effective than systematic
    desensitisation (Marks, 1987)
  • Effectiveness of Implosion systematic
    desensitisation (Gelder et al, 1989)
  • Systematic Desensitisation
  • Developed by Wolpe,1958.
  • Useful for specific phobias not so useful for
    agoraphobia
  • Live desensitisation more effective than other
    desensitisation techniques Wilson OLeary
    (1978)
  • More ethical than flooding therapy

5
  • Techniques modified slightly and used to treat
    OCD PTSD exposure therapy Ritual or
    response prevention
  • Berman Norton(1995) - behaviour therapies are
    significantly better than other approaches in the
    treatment of agoraphobia.
  • Behaviour Modification -Three steps
  • 1.Identify the undesirable behaviour
  • 2.Identify the reinforcers that maintain the
    behaviour
  • 3. Restructure the environment so that the
    maladaptive behaviour is no longer reinforced.

6
  • Removal of reinforcers extinction
  • Use aversive stimuli to punish voluntary
    maladaptive behaviours.
  • Use positive reinforcement to increase desirable
    behaviours.
  • May be used to treat Compulsive behaviour
    phobias.
  • Probably not useful in treating PTSD GAD/PD

7
  • Psychodynamic Approach - Psychoanalysis
  • Example of Little Hans phobia real source of
    fear must be identified.
  • Identify the problem
  • Free association
  • Dream analysis
  • Behaviour interpretation
  • Producing improvement
  • Catharsis
  • Transference
  • Insight
  • According to Freud useful for all kinds of
    anxiety disorders, but may not be appropriate for
    OCD.

8
  • Effectiveness?
  • Eysenck(1952) less effective than other
    therapies spontaneous remission this study
    has been severely criticised.
  • Smith Glass(1977) show it is more effective
    than no treatment at all.
  • Sloans et al (1975) - more effective with less
    severe problems.

9
Cognitive Approach (Cognitive behavioural
approach)
  • Modelling (Albert Bandura)
  • useful in treatment of phobias. Aims to change
    thoughts as well as behaviour. Participant
    modelling more effective than symbolic modelling.
  • Assertiveness training / social skills training
    use principles of modelling and behavioural
    rehearsal useful in treating social phobias.
  • Ellis REBT
  • Less effective for agoraphobia than other
    therapies
  • Its effectiveness is limited to certain types of
    people. (Bransma et al,1978)

10
  • Becks Cognitive Restructuring Therapy
  • Useful in counteracting panic attacks (Clark et
    al,1994) phobias
  • Not useful for treating OCD (James Blackburn,
    1995)
  • One-to-one therapist-client
  • Therapist client work together to identify
    restructure faulty thinking.
  • Therapist gently points out errors in thinking,
    client has to decide for themselves whether their
    thinking is accurate.

11
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