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Flashcards in Interventions for Common Diagnosis Deck (21)
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1

Acute Stress Disorder

Exposure-based interventions are useful for ameliorating the symptoms of Acute Stress Disorder and reducing the risk for the development of PTSD.

The effectiveness of exposure may be increased when it is combined with crisis intervention, support, psychoeducation, and/or emotional first aid.

2

Anorexia Nervosa

The treatment of Anorexia begins with getting the individual to gain weight to avoid or reduce medical complications.

This may require hospitalization and often entails the use of contingency management that makes rewards contingent on maintaining weight at a minimal level.

Individualgroup, and family therapy are then used to ensure that weight gain is maintained. Cognitive-behavioral therapy (CBT) emphasizes modifying the individual's erroneous beliefs about weight and food, including the value of being thin and the consequences of eating (Garner & Bemis, 1985).

The antidepressant fluoxetine or other SSRI may be useful for preventing relapse after normal weight has been restored. 

3

Attention-Deficit/Hyperactivity Disorder (ADHD)

Treatment involves a multimodal approach that usually includes a combination of medication and psychosocial interventions.

Methylphenidate (Ritalin) and other central nervous stimulants often have beneficial effects on the core symptoms of ADHD and appear to be effective for both children and adults.

Psychosocial interventions include cognitive-behavioral skills training that focuses on

  • correcting maladaptive cognitive processing and improving problem-solving skills
  • parent training in child behavior management and teacher training in classroom management
  • support groups for individuals with ADHD and their family members
  • play therapy for younger children
  • family therapy to help family members handle stress and resolve conflicts

4

Autism Spectrum Disorder

Interventions focus on

  • improving adaptive functioning, social skills, and academic functioning
  • modifying the individual's environment so that it optimizes support for learning and socialization
  • using behavioral techniques (e.g. shaping, differential reinforcement) to reduce and replace disruptive, self-injurious, and other undesirable behaviors and promoting desirable ones.

Interventions for adults include providing community resources and services (e.g. supported employment and supported residential living arrangements).

5

Bipolar I Disorder

Treatment for Bipolar I Disorder usually includes a combination of medication and psychotherapy.

In terms of medication, lithium is effective in most cases of "classic" Bipolar Disorder and not only reduces manic symptoms but also prevents recurrent mood swings.

For people who do not respond to lithium or who have rapid cycling or dysphoric mania (prominent anxiety or depressive symptoms), carbamazepine or other anti-seizure drug may be effective.

Therapies that have been found effective include cognitive-behavior therapyinterpersonal social rhythm therapy, and family-focused therapy.

6

Bulimia Nervosa

The key objectives in the treatment of Bulimia include helping the individual gain control over his/her eating and modifying dysfunctional beliefs about eating, shape, and weight.

Treatment often involves a combination of medication (usually an antidepressant) and cognitive-behavioral therapy that incorporates a number of strategies including

  • self-monitoring
  • stimulus control
  • cognitive restructuring
  • problem-solving
  • self-distraction during periods of high-risk for binge eating

7

Conduct Disorder

Interventions for Conduct Disorder are most effective when they target pre-adolescents (rather than adolescents) and when they are comprehensive and include the individual's family, peers, school, and community.

Interventions include

  • Patterson et al.‘s (1992) parent management training which teaches parents to reward their child‘s positive behaviors and replace physical punishment with time-outm response cost, and similar techniques
  • functional family therapy which integrates systems, behavioral, and cognitive approaches and focuses on altering the interpersonal factors that are maintaining undesirable behaviors 
  • multisystemic therapy which is an intensive family- and community-based approach that targets children and adolescents who are at high-risk for out-of-home placement.

In severe cases, a therapeutic school or residential program may be the appropriate initial intervention.

8

Enuresis

The most common treatment for Enuresis is the night alarm (also known as the bell-and-pad), which causes a bell to ring when the sleeping child begins to urinate.

The effectiveness of the night alarm may be increased when it is combined with other behavioral techniques such as behavioral rehearsal or overcorrection.

The antidepressant imipramine and the synthetic diuretic desmopressin reduce or suppress wetting in many cases but, when used alone, have a high relapse rate.

9

Generalized Anxiety Disorder (GAD)

Treatment for GAD usually involves a multicomponent cognitive-behavioral intervention, and for many individuals, a combination of cognitive-behavioral therapy (CBT) and pharmacotherapy is most beneficial.

CBT incorporates several techniques to help the individual

  • tolerate uncertainty
  • identify and replace maladaptive cognitions
  • and reduce anxiety
  • including psychoeducation
  • self-monitoring
  • relaxation training
  • worry exposure
  • cognitive restructuring

Drugs that have been found useful include the SSRls and the anxiolytic buspirone (Buspar)

10

Major and Mild Neurocognitlve Disorder

Interventions for Neurocogpitive Disorder due to Alzheimer‘s disease and other Neurocognitive Disorders often include a combination of

  • group therapy (especially therapy that emphasizes reality orientation and reminiscence);
  • antidepressant drugs to alleviate depression;
  • behavioral techniques and antipsychotic drugs to reduce agitation;
  • environmental manipulation and pharmacotherapy to enhance memory and cognitive functioning 

The provision of family/caregiver interventions has been linked to delayed out-of-home home placement for individuals with the disorder and better quality of life and emotional well-being for their caregivers.

Family/caregjver interventions include

  • psychoeducation
  • stress management
  • support groups
  • family therapy
  • adult daycare for the patient and other respite services

11

Major Depressive Disorder

Treatment for depression often consists of a combination of an antidepressant drug and psychotherapy.

Three classes of antidepressants are most commonly prescribed:

  1. The serotonin reuptake inhibitors (SSRls) are considered the first-line drug treatment for moderate to severe depression and have fewer side effects and a lower risk for a fatal overdose than the tricyclics.
  2. The tricyclics (TCAs) are most effective for "classic" depressions that involve vegetative (bodily) symptoms, a worsening of symptoms in the morning, an acute onset and short duration of symptoms, and symptoms of moderate severity.
  3. The monoamine oxidase inhibitors (MAOls) are usually prescribed for indniduals who do not respond to TCAs or SSRls or have atypical symptoms (eg., anxiety, increased appetite, hypersomnia, and mood worsening late in the day).

In terms of psychosocial interventions, Becks cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are empirically supported treatments for depression.

12

Obsessive-Compulsive Disorder (OCD)

A combination of exposure with response prevention (ERP) and the tricyclic clomipramine or an SSRI is usually the treatment-of-choice for OCD.

ERP combines prolonged exposure to objects or situations that trigger obsessions with procedures that block the individual‘s ability to perform compulsive rituals. The benefits of exposure may be enhanced when it is combined with social skills training or cognitive restructuring and other cognitive-behavioral techniques.

13

Panic Disorder

Panic-focused cognitive-behavioral therapy (CBT) is an empirically supported treatment for Panic Disorder and integrates

  • self-monitoring
  • cognitive restructuring
  • breathing retraining
  • applied relaxation
  • in vivo exposure
  • relapse prevention

Exposure to internal and external cues that trigger panic attacks is an essential component of treatment, with internal cues being addressed by interoceptive exposure, which involves exposing the individual to the bodily sensations associated with panic through cardiovascular exercise, spinning in a chair, or hyperventilation.

Medication (e.g. an SSRI or benzodiazepine) may be beneficial when used in combination with CBT, especially during the acute phase of treatment.

14

Personality Disorders

People with Personality Disorders are often unaware of their disorder and, if they seek treatment, it is often for comorbid conditions. Consequently, they are likely to be noncompliant with treatments that target the Personality Disorder (rather than comorbid conditions) and may drop out of therapy prematurely.

Psychodynamic psychotherapy and cognitive-behavioral therapy are effective in some cases, and their effects may be increased when accompanied by social skills traininggroup therapyfamily or couple therapy, and/or psychoeducation.

Dialectical behavior therapy (Linehan, 1987) is an empirically supported treatment for Borderline Personality Disorder and incorporates three strateges:

  1. goup skills training to help clients regulate their emotions and improve their social and coping skills
  2. individual outpatient therapy to strengthen motivation and newly acquired skills 
  3. telephone consultations to provide additional support and between-sessions coaching  

15

Posttrsumstic Stress Disorder (PTSD)

The most effective treatment for PTSD is a comprehensive cognitive-behavioral intervention that incorporates

  • psychoeducation 
  • exposure
  • cognitive restructuring
  • anxiety management techniques

An SSRI or other antidepressant may be useful for reducing comorbid depression, anxiety, or substance abuse.

16

Schizophrenia

Schizophrenia is treated with a combination of medication and psychosocial interventions.

Although the effects of haloperidol, chlorpromazine, and other traditional (first-generation) antipsychotics vary from person to person, they seem to be most useful for eliminating positive symptoms (e.g. delusions. hallucinations).

The main liability of these drugs is the potential for severe side effects, especially tardive dyskinesia (which involves involuntary rhythmic movements of the jaw. lips, tongue, and extremities).

Clozapine and other atypical (second-generation) antipsychotics reduce both positive and negative symptoms and are less likely to cause tardive dyskinesia.

Psychosocial interventions include

  • individual therapy (especially cognitive-behavioral therapy)
  • family therapy
  • psychoeduction
  • social skills and problem-solving training
  • vocational counseling or rehabilitation

17

Sexual Dysfunctions

The first step in the treatment of a suspected Sexual Dysfunction should be referral for a medical evaluation. After it has been determined that the problem is due to psychological factors, treatment includes the use of behavioral and cognitive-behavioral techniques that target the problematic behaviors themselves, related anxiety (e.g., performance anxiety), faulty attitudes and beliefs, and deficient knowledge and skills.

For example, sensate focus helps reduce performance anxiety and increase sexual excitement; while the start-stop and squeeze techniques are used to treat premature ejaculation and are designed to increase the male‘s control over the ejaculatory reflex. 

18

Social Anxiety Disorder

Cognitive-behavioral therapy (CBT) is usually the treatment of choice for Social Anxiety Disorder and includes

  • psychoeducation
  • cognitive restructuring
  • exposure with response prevention
  • social skills training
  • applied relaxation.

An SSRI or a beta blocker may also be useful.  

19

Specific Learning Disorder

In addition to individualized educational interventions, treatment for a Specific Learning Disorder may include

  • speech/language and occupational therapy
  • social skills training
  • individual and family therapy

Behavioral interventions are used to alleviate co-existing behavioral problems and may include the use of behavior modification programs at home and school.

For example, behavioral contracting might be used to reduce disruptive or oppositional behavior and increase on-task behavior.  

20

Specific Phobia

Exposure with response prevention (ERP) is an empirically supported treatment for Specific Phobia and involves exposing the individual to the feared object or situation while preventing him or her from engaging in cognitive or behavioral avoidance (Wolitzky-Taylor, Horowitz, Powers, & Telch, 2008).

Its benefits may be increased when it is combined with cognitive restructuring, relaxation training, and other cognitive-behavioral strategies.

21

Substance Use Disorder

The treatment of a Substance Use Disorder requires a multimodal, multidisciplinary approach that may include both pharmacological and psychosocial interventions:

Medications are used to

  • alleviate symptoms of intoxication and withdrawal 
  • promote abstinence and relapse prevention
  • and treat comorbid psychiatric conditions

Psychosocial interventions include

  • individual behavioral and cognitive-behavioral therapy
  • group therapy
  • couple and family therapy
  • and 12-step and other self-help groups.

Treatment is a long-term process that involves several stages. For example, the Institute of Medicine (1990) describes three stages of treatment for alcoholism:

  1. Acute intervention consists of emergency treatment, detoxification, and screening 
  2. Rehabilitation consists of evaluation/assessment, primary care (brief and intensive interventions), and extended care and stabilization 
  3. Maintenance includes aftercare, relapse prevention, and, when necessary, domiciliary care.