# Therapy ## History - Early treatment "Trepanning" - drilling a hole on the skull so that the soul can leave - "Bedlam" asylum - Modern Therapies - Insight Therapies, aka. talk therapy - Cognitive-Behavioral Therapy - Drug Therapy ## Insight Therapy Insight Therapies - [[psychoanalysis]] - Started by [[freud|Sigmund Freud]] - The patient does not know what the real problem is (e.g. sexual abuse in the childhood), defense mechanism has built up - But, we cannot do direct confrontation, as it will bring up the defenses of the patient - Free association, dreams, other projective tests - Counter Transference: the therapist is taken as the abuser, a therapist need a therapist ## Humanistic Therapy - Humanistic Therapy - Client-Centered Therapy - e.g. Carl Rogers - Non-directive, no patient, only client - Incongruence - the distance between who they are and why they want to be - Limitations - A client must be intelligent, articulate, motivated, and perhaps rich enough - Not many scientific studies assessing effectives. ## Cognitive Behavioral Therapy - _Systematic Desensitization_, based on _[[learning#Pavlov and Classical Conditioning|Classical Conditioning]]_ - Relaxation - Learn to relax. - Associate feeling with a trigger. - Practice using the trigger. - Hierarchy of Fears - Create Hierarchy. - Go through it slowly, using trigger. - One cannot progress until they can remain relaxed on the previous step. - Therapies based on _[[learning#Learning by Consequence|Operant Conditioning]]_ (all about consequences) - Reinforcement of Adaptive Behaviors - Token Economies - Punishment ```mermaid graph LR A[Negative Event] B1[Rational Belief] B2[Irrational Belief] C1[Healthy Negative Emotion] C2[Unhealthy Negative Emotion] A --> B1 & B2 B1 --> C1 B2 --> C2 ``` - [[cbt|CBT]] and [[depression|Depression]] - Write down all the good things and ignore all the bad things. - At the end of the day, read the good things to yourself. ## Biological Treatments ![[nueral-transmitter.png]] - Transmitters - Norepinephrine and Serotonin are involved in **whole brain**, Dopamine is more mid-brain-ish. - The brain is complex, thus drugs may be addictive. - Anti-maniac and anti-depression drugs - Tricyclics: Slow the up-take of **norepinephrine and serotonin**. Many side effects (e.g. weight gain, poor concentration.) - Monamine Oxidase Inhibitors (MOI):  Prevent enzymes from destroying **norepinephrine and serotonin**. Many side effects (e.g. high BP, blurred vision, insomnia) - Selective **Serotonin** Re-uptake Inhibitors (SSRI): Fewer side effects, which allows for larger doses - Lithium Carbonate: Most effective for **bipolar disorder or mania**.  Ends manic episodes as soon as blood level is high enough, and when mania is contained depressive periods also end. - Anti-psychotic drugs - [[mental-illness#Schizophrenia|Schizophrenia]] is biological issue. Drugs are good at dealing with positive symptoms. - Long term use of drugs lead to tardive dyskinesia (lip smacking, drooling) - Psychosurgery and Electro-Convulsive Shock