Treatment

= = toc **Examine biomedical, individual and group approaches to treatment.** Biomedical Drugs [|Inappropriate prescribing] [|A review of Gary Greenberg's Manufacturing Depression and Irving Kirsch's The Emperor's New drugs: The New Yorker]
 * Reading**


 * Learning outcome: Examine biomedical, individual and group approaches to treatment.**

Sources:
 * Crane pages 166 – 171
 * Jamison – Handout (see below) – this gives an overview

An overview of the learning outcome

 * //Examine//** – Consider an argument or concept in a way that uncovers the assumptions and interrelationships of the issue.
 * Don’t confuse //Examine// with the next learning outcome which asks you to //Evaluate//. When you evaluate, you are assessing the strengths and limitations.
 * Crane discusses ‘approaches’ and then ‘evaluation of each approach’. For this learning outcome, your notes only include information on the approaches (eg. for biomedical, you would only use the section on pages 171 – 172 in relation to the info on SSRIs and their use in treating depression)

Essentially, when dealing with this learning outcome, you need to have answers to the following questions:


 * Biomedical **
 * What is this approach? What does it consist of?
 * What are the assumptions underlying biomedical treatments?(ie. how are mental illnesses viewed; how do you know if the treatments work;)
 * What research supports its efficacy?


 * Individual approach to treatment **
 * What is this approach? What does it consist of?
 * What are the assumptions underlying the individual approach to treatment?
 * What research supports its efficacy?


 * Group approach to treatment **
 * What is this approach? What does it consist of?
 * What are the assumptions underlying the group approach to treatment?
 * What research supports its efficacy?


 * What are the cultural considerations in treatment? **


 * As you can see, when we move to the next learning outcome, this information will provide the foundation from which you will evaluate those treatments. **


 * Create full answers to the above questions. While you can use bullet points (as study notes), you still have to be able to add explanations in your own words) – you do not need to summarize every piece of research evidence, but you do need to include a variety in your notes – pick what is most relevant. **

**Answers**

 * 1. Biomedical **

What is this approach? What does it consist of?
 * Connecting treatment to brain chemistry - treating this disorder with drugs - chemotherapy

What are the assumptions underlying biomedical treatments? (ie. how are mental illnesses viewed; how do you know if the treatments work;)
 * Mental illness is a disease that can be treated with drugs
 * Biological factors are part of the etiology of the disorder
 * Associated with changes in brain chemistry
 * Treatments work if symptoms are reduced

Caveat (a //caveat// is a warning of specific limitations or conditions)
 * We cannot assume that if this treatment works, then psych factors are not effective ie. psychological treatment may also work
 * Medical research does not fully understand how neurotransmitters and symptoms are linked or why drugs work in some cases or not others; why some individuals respond and others don’t

What research supports its efficacy?
 * How drugs work
 * The serotonin hypothesis
 * Use of SSRIs in depression
 * Generally effective and generally safe
 * Fewer side-effects
 * Research about efficacy
 * Costello
 * Elkin et. al.
 * Bernstein


 * 2.Individual approach to treatment **

What is this approach? What does it consist of?
 * Clear overall definition needed – working one-on-one
 * Includes cognitive therapy (coping strategies)
 * More personal
 * Highly individualized

What are the assumptions underlying the individual approach to treatment?
 * Individual has the power to change and can be helped by one-on-one treatment
 * Assumption of cognitive therapy is that disorder is caused by faulty cognitions and unhealthy behavior

How CBT works
 * Explain Beck
 * Caveat (a //caveat// is a warning of specific limitations or conditions)
 * relationship between psychiatrist and patient very important to success of treatment (cultural views important here)
 * client has to be open to treatment
 * What research supports CBT's efficacy?
 * Rush
 * Dobson
 * Riggs


 * 3.Group approach to treatment **

What is this approach? What does it consist of?
 * Therapies delivered to more than 1 person at a time
 * For depression – mostly ‘couples’ therapy
 * Most therapies can use this approach
 * P. 168 of Crane – how it works

What are the assumptions underlying the group approach to treatment?
 * Group dynamics - Support provided by group is important – ‘not alone’
 * Effective in improving social skills in a safe, supportive environment – provides you with a venue for interaction
 * Cost-effective

Disadvantages
 * Individual’s reluctance to speak honestly to group
 * Confidentiality
 * Group dynamics can also be a disadvantage

What research supports its efficacy?
 * Truax
 * McDermott
 * Toseland & Siporin (Crane, p. 177)


 * 4.What are the cultural considerations in treatment? **

We must consider the role that culture plays in success of treatment
 * some therapies are not appropriate
 * Japanese are reluctant to take antidepressants
 * Buddhists in Sri Lanka also reluctant (Jamison page 244)
 * for some individuals, cultural therapy combined with western therapy works better
 * Miller’s ecological model


 * Review class work for discussions of therapies from the core perspectives and for supporting studies **