BIOPSYCHOSOCIAL MANAGEMENT OF PSYCHIATRIC DISORDER Psychotherapies and social interventions

1. BIOPSYCHOSOCIAL MANAGEMENT OF
PSYCHIATRIC DISORDER
Psychotherapies and social interventions
Nur Fadzlina Zabri
082013100006

2. Psychotherapy
Treatment by psychological means, of the problems of an
emotional nature, in which a therapist deliberately establishes
a professional relationship with patient to :
I. Remove, modify or retard existing symptoms
II. mediate disturbed patterns of behavior
III. promote positive personality growth and development

3. The approaches used in Psychotherapy
• Psychodynamic: insight-oriented therapy. An approach to
therapy that involved delving into a patients thoughts and past
experiences to seek out unconscious desires or fantasies.
• Cognitive-behavioural: A type of psychotherapy that involves
cognitive and behavioural techniques to change negative
thoughts and maladaptive behaviours.
• Humanistic: A form of therapy that focuses on helping people
maximize their potential.

4. • A type of psychotherapy which is based on theories of
learning that all behaviors are acquired or received through
“conditioning” (state of shaping behavior)
• Aims at modifying maladaptive behavior and substituting with
adaptive behavior
• Conditioning occurs through interaction with the
environment. Behaviorists believe that our responses to
environmental stimuli shapes our behaviors
BEHAVIOUR THERAPY

5. 2 major types of conditioning
Operant conditioning
model (Skinner)
Classical conditioning
model (Pavlov)
Technique used in behavioral training in which a
naturally occuring stimulus is paired with a response
Technique of learning that occurs through
reinforcement for behavior

6. In order to understand how each of these behavior modification
techniques can be used, it is also essential to understand how
classical conditioning and operant conditioning differ from
one another.

7. Classical Conditioning:
• First described by Ivan Petrovich Pavlov, a Russian physiologist.
• Involves placing a neutral signal (stimulus) before a reflex (response).
• Focuses on involuntary (unconditional or automatic) behaviors.
Operant Conditioning:
• First described by Burrhus Frederic Skinner, an American
psychologist.
• Involves applying reinforcement after a behavior.
• Focuses on strengthening or weakening voluntary (conditional)
behaviors.

8. • Short duration : 6-8weeks
• Easy to train and cost-effective
• Initial sessions are scheduled daily, later session are
spaced out
• Behavioural analysis
Behavioural therapy

9. Classical conditioning model (Pavlov)
• Derived from principles of Ivan Pavlov’s experiment
• Mowrer’s bell and pad method helped children learn to
stop wetting the bed
• Learned response can be unlearned through
Counterconditioning

11. Behavioral therapy Psychodynamic therapy
Trying to uncover unresolved
conflicts from childhood (i.e. the
cause of abnormal behavior
Focus on current problems and
behavior
Attempts to remove behavior the
patient finds troublesome
Examples of classical condition :
–Systematic Desensitization
–Aversion Therapy
–Flooding

12. a) Systematic desensitisation
• Principle based on reciprocal inhibition (Wolpe)
• Associates a pleasant relaxed state with gradually
increasing anxiety-triggering stimuli until anxiety towards
stimuli is eliminated (Graduated Exposure Theory)
• Comprise of 3 steps
i. Relaxation training
ii. Hierarchy construction
iii. Systematic desensitisation proper

13. I. Relaxation therapy
– Characterised by immobility of the body, control over the
focus of attention, low muscle tone, cultivation of a specific
frame of mind
– Methods used ;
• Jacobson’s progressive muscular relaxation
• Hypnosis
• Yoga, zen

14. II. Hierarchy construction
– List of fears related to phobia from least to most terrifying
– Eg ; school phobia
• Thinking about school
• Riding the bus
• Sitting in class
• Teachers

15. iii. Systematic desensitisation proper
– Patients proceed systematically through the list from least to
the most anxiety-provoking scene in a deeply relaxed state
– Treatment of choice in phobia or obsessive compulsive
disorder

16. b) Aversion therapy
• Used for the treatment of conditions which are pleasant
but felt undesirable by the patient
• Principle : pairing the pleasant stimulus (alcohol) with an
unpleasant response (low voltage electric, drugs,fantasy),
the pleasant stimulus becomes unpleasant by association
• The use has decline as it violate the human rights of
patient

17. `

18. c) Flooding
• Usually used in treatment of phobias and
anxiety disorder
• The patient is directly exposed to the phobic
stimulus and escape is made impossible.
• By prolonged contact with the phobic
stimulus, therapist’s guidance and
encouragement, the therapist’s modeling
behaviour, anxiety decreases and the phobic
diminishes.
• Flooding can lead to extinction of fear

19. • Reinforcement is a term used in operant conditioning which
refers to anything that increases the possibility that a response
will occur.
• Reinforcement increases or strengthens the behavior.
Operant conditioning model (Pavlov)

20. Operant conditioning procedures
increasing behaviour
• Common methods :
I. Positive
reinforcement
II. Negative
reinforcement
III. Modelling
Operant conditioning procedures
decreasing behaviour
• Methods
include :
I. Time out -
II. Punishment
III. Satiation

21. There are Two Different Types of Reinforcement
Positive reinforcement:
Involves the addition of something to increase a response, such as
giving a bit of candy to a child after she cleans up her room or token is
given to patient with mental disorder for performing desired behaviour
Negative reinforcement:
Negative reinforcement is when a certain stimulus/item is removed
after a particular behavior is exhibited.
The likelihood (possibility) of the particular behavior occurring again in
the future is increased because of removing or avoiding the negative
stimuli.

22. Modelling
Patient learn new behaviour by imitation , primarily by observation
Useful in phobic children who are placed with other children of their age
Irrational fears can be unlearned by observing fearless model confront the
feared object
A hierarchy of activities is established, with least anxiety-provoking

23. Punishment :
Is designed to stop behavior, not to make it occur more often
When undesired response occurs, punishment is given
Time out :
Reinforcement is withdrawn for some time

25. COGNITIVE THERAPY OR COGNITIVE
BEHAVIOUR THERAPY
• Definition : Type of psychotherapy which aims at correcting the maladaptive
methods thinking , thus providing relief from consequent symptoms.
• Developed separately by Beck and Meichenbaum.
• Indication :
1) depression
2) anxiety disorder
3) panic disorder
4) phobias
5) eating disorder
6) anticipatory anxiety
7) teaching problem-solving method.
8) delusion and hallucination ( rarely )

26. HOT CROSS BUN MODEL

27. Typically the CBT consist of about 15 visit over 3 months.
Important techniques in CBT :
• COGNITIVE TECHNIQUES – recognising and correcting negative
autonomic thoughts, identifying and testing maladaptive
assumptions
• BEHAVIOURAL TECHNIQUES – activity scheduling, homework
assignments, graded task assignment, behavioural rehearsal, role
playing
• TEACHINGPROBLEM- SOLVING SKILLS.
• MINDFULNESS

28. EXPOSURE AND RESPONSE PREVENTION (ERP)
• ERP is a type of cognitive behavioural therapy which is used
for a variety of anxiety disorder especially the obsessive
compulsive disorder (OCD) and phobias.
• How the ERP works ?
It works by breaking the link between your obsessional
thoughts, images, urges or impulses and the compulsive
things that you do to reduce the distress or anxiety that they
cause. During ERP exercises you gradually expose yourself to
situations that bring on or cue your obsessions, whilst not
carrying out your compulsions.

30. Remember the five conditions:
Condition 1: Graded
List things in your exposure hierarchy that give you at least 50-60% anxiety from the easier things up to more difficult things.
Remember not to grade an exercise by time. When you have been repeating an exercise and it no longer gives you at least 40%
anxiety at the start of
the exercise, you are then ready to move up to the next item on your exposure hierarchy.
Condition 2: Prolonged
Stay in the exposure exercise situation, without using distraction until your anxiety drops by 50% from the start of the exercise. So for
example if you were 80% anxious, you would stay in the situation until your anxiety drops to 40%. You would then repeat the exercise
until it no longer gets above 40% at the start of the exercise.
Condition 3: Repeated
Expose yourself to each step on the hierarchy at a time. You should repeat each step until the exercise no longer makes you feel
anxious, say if it no longer goes above 40% anxiety at the start of the exercise. Then it is time to move up to the next exercise on
your hierarchy ladder. On average you should aim to do exposure treatment 4-5 times per week (these may be different exercises
depending on your ratings).
Condition 4: Without Distraction Try to remove things from your hierarchy that reduce your anxiety artificially or
distract you from how you are feeling during your exposure exercises. Whist these may seem like the give temporary relief from
feeling anxious, they
are keeping you stuck in that vicious circle.
Condition 5: Without Compulsion Each time you expose yourself to an exercise
on your hierarchy, you need to remain in the situation, resisting the urge to carry out a compulsion to reduce your distress (either one
that you have done before, or a new one).

31. Quiz

34. References
• Kaplan & Sadock’s concise Textbook of Clinical Psychiatry
• A Guide to Treatments That Work by Peter E. Nathan
• 7th Edition, A Short Textbook of Psychiatry by Niraj Ahuja
• Internets
– http://www.mhhe.com/cls/psy/ch06/ccapps.mhtml
– http://www.simplypsychology.org/behavioral-therapy.html