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Anorexia Nervosa

Anorexia Nervosa

The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as “fat,” and commonly expresses dissatisfaction with a particular aspect of her physical appearance. Although the term anorexia suggests that the patient’s weight loss is associated with a loss of appetite, this is rare.

Anorexia nervosa and bulimia nervosa can occur simultaneously. In anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self­induced vomiting, or abuse of laxatives or diuretics.

Anorexia occurs in 5% to 10% of the population; more than 90% of those affected are females. It occurs primarily in adolescents and young adults but also may affect older women and, occasionally, males.

Causes

The cause of anorexia nervosa is unknown. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over life or to protect oneself from dealing with issues surrounding sexuality.

Signs and symptoms

One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated.

Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis.

Treatment

Appropriate treatment aims to promote weight gain or control the patient’s compulsive binge eating and purging and to correct malnutrition and the underlying psychological dysfunction. Hospitalization in a medical or psychiatric unit may be required to improve the patient’s precarious physical state. Hospitalization may be as brief as 2 weeks or may stretch from a few months to 2 years or longer.

A team approach to care – combining aggressive medical management, nutritional counseling, and individual. group, or family psychotherapy or behavior modification therapy – is the best approach. Treatment is difficult, and results may be discouraging. Many clinical centers are now developing inpatient and outpatient programs specifically for managing eating disorders.

Treatment may include behavior modification (privileges depend on weight gain); curtailed activity for physical reasons (such as arrhythmias); vitamin and mineral supplements; a reasonable diet, with or without liquid supplements; subclavian, peripheral, or enteral hyperalimentation (enteral and peripheral routes carry less risk of infection); and group, family, or individual psychotherapy.

Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require intravenous feeding.

Prevention

Preventive measures to reduce the incidence of anorexia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child’s normal growth and development, and improve the quality of life experienced by children or adolescents with anorexia nervosa. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.

References

  1. https://en.wikipedia.org/wiki/Anorexia_nervosa
  2. https://www.nhs.uk/conditions/anorexia/

Delusional Disorders

Delusional Disorders

According to the DSM-IV. delusional disorders are characterized by false beliefs with a plausible basis in reality. Formerly referred to as paranoid disorders, delusional disorders are known to involve erotomanic, grandiose, jealous, or somatic themes as well as persecutory delusions. Some patients experience several types of delusions; other patients experience unspecified delusions that have no dominant theme.

Delusional disorders commonly begin in middle or late adulthood, usually between ages 40 and 55, but they can occur at a younger age. These uncommon illnesses affect less than 1 % of the population; the incidence is about equal in men and women. Typically chronic, these disorders often interfere with social and marital relationships but seldom impair intellectual or occupational functioning significantly.

Causes

Delusional disorders of later life strongly suggest a hereditary predisposition. At least one study has linked the development of delusional disorders to inferiority feelings in the family. Some researchers suggest that delusional disorders are the product of specific early childhood experiences with an authoritarian family structure. Others hold that anyone with a sensitive personality is particularly vulnerable to developing a delusional disorder.

Certain medical conditions are known to exaggerate the risks of delusional disorders: head injury, chronic alcoholism, deafness, and aging. Predisposing factors linked to aging include isolation, lack of stimulating interpersonal relationships, physical illness, and diminished hearing and vision. In addition, severe stress (such as a move to a foreign country) may precipitate a delusional disorder.

Symptoms

The presence of non-bizarre delusions is the most obvious symptom of this disorder. Other symptoms that might appear include:

  • An irritable, angry, or low mood
  • Hallucinations (seeing, hearing, or feeling things that are not really there) that are related to the delusion (For example, a person who believes he or she has an odor problem may smell a bad odor.)

Diagnosis

Patients with delusional symptoms should undergo a thorough physical examination and patient history to rule out possible organic causes (such as dementia). If a psychological cause is suspected, a mental health professional will typically conduct an interview with the patient and administer one of several clinical inventories, or tests, to evaluate mental status

Treatment

Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient’s mistaken belief system. Treatment also may include mobilizing a support system for the isolated, aged patient.

Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.

High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine succinate, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents. Haloperidol decanoate, fluphenazine decanoate, and fluphenazine enanthate are depot formulations that are implanted I.M. and release the drug gradually over a 30-day period, improving compliance.

Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard neuroleptic treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.

However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures, as well as agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia. Routine blood monitoring is essential to detect the estimated 1 % to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, the disorder is reversible.

Prevention

Effective means of prevention have not been identified.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874764/
  2. https://www.health.harvard.edu/diseases-and-conditions/delusional-disorder

Conversion Disorder

Conversion Disorder

Previously called hysterical neurosis, conversion type, a conversion disorder allows a patient to resolve a psychological conflict through the loss of a specific physical function, for example, by paralysis, blindness, or the inability to swallow. Unlike factitious disorders or malingering, the patient’s loss of physical function is involuntary. However, laboratory tests and diagnostic procedures don’t disclose an organic cause.

Conversion disorder can occur in either sex at any age. An uncommon disorder, it usually begins in adolescence or early adulthood. The conversion symptom itself isn’t life-threatening and usually has a short duration.

Causes

The patient suddenly develops the conversion symptom soon after experiencing a traumatic conflict that he believes he can’t handle. Two theories explain why this occurs. According to the first, the patient achieves a “primary gap,” when the symptom keeps a psychological conflict out of conscious awareness. For example, a person may experience blindness after witnessing a violent crime.

The second theory suggests that the patient achieves secondary gain from the symptom by avoiding a traumatic activity. For example, a soldier may develop a “paralyzed” hand that prevents him from entering into combat.

Signs and symptoms

Common signs of a conversion disorder include:

  • Sudden onset of physical symptoms
  • Recent history of a stressful experience
  • Inappropriate lack of concern over the physical symptoms

The symptoms of conversion disorder involve the loss of one or more bodily functions. These may include blindness, paralysis or the inability to speak. The loss of physical function is involuntary and diagnostic testing does not show a physical cause for the dysfunction.

Treatment

Psychotherapy, family therapy, relaxation therapy, behavior therapy, or hypnosis may be used alone or in combination (two or more) to treat conversion disorder.

References

  1. https://medlineplus.gov/ency/article/000954.htm
  2. https://www.msdmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/conversion-disorder

Autistic Disorder

Autistic Disorder

Autistic disorder is a severe, pervasive developmental disorder marked by unresponsiveness to social contact, gross deficits in intelligence and language development, ritualistic and compulsive behaviors, restricted capacity for developmentally appropriate activities and interests, and bizarre responses to the environment.

The disorder usually becomes apparent before the child reaches age 3, but in some children the actual onset is difficult to determine. Occasionally, autistic disorder isn’t recognized until the child enters school. when his abnormal social development becomes obvious.

Autistic disorder is rare, affecting 4 to 5 children per 10,000 births. It affects four to five times more males than females, usually the firstborn male. Although the degree of impairment varies, the prognosis is poor and most patients require a structured environment throughout life.

Causes

The causes of autistic disorder remain unclear but are thought to include psychological. physiologic, and sociologic factors. Previously, it was thought that most parents of autistic children were intelligent, educated people of high socioeconomic status; recent studies suggest that this may not be true.

The parents of an autistic child may appear distant and unaffectionate toward the child. However, because autistic children are clearly different from birth, and because they are unresponsive or respond with rigid, screaming resistance to touch and attention, parental remoteness may be merely a frustrated, helpless reaction to this disorder, not its cause.

Some theorists consider autistic disorder related to early under stimulation that causes the child to seek contact with the world through self-stimulating behaviors or consider it related to overwhelming over stimulation that leads to regression, muteness, and unresponsiveness to external stimuli. Controlled studies haven’t confirmed this etiology.

Recent studies have pointed to an association between neurobiological factors and autism. Defects in the central nervous system that may arise from prenatal complications (such as rubella or phenylketonuria), high maternal stress in the first trimester, and genetic factors appear to playa role in the development of autism.

Signs and symptoms

  • does not socially interact well with others, including parents
    • shows a lack of interest in, or rejection of physical contact. Parents describe autistic infants as “unaffectionate.” Autistic infants and children are not comforted by physical contact.
    • avoids making eye contact with others, including parents
    • fails to develop friends or interact with other children
  • does not communicate well with others
    • is delayed or does not develop language
    • once language is developed, does not use language to communicate with others
    • has echolalia (repeats words or phrases repeatedly, like an echo)
  • demonstrates repetitive behaviors
    • has repetitive motor movements (such as rocking and hand or finger flapping)
  • is preoccupied, usually with lights, moving objects, or parts of objects
  • does not like noise
  • has rituals
  • requires routines

Treatment

The difficult and prolonged treatment of autistic disorder must begin early, continue for years (through adolescence), and involve the child, parents, teachers, and therapists in coordinated efforts to encourage social adjustment and speech development and to reduce self-destructive behavior.

Behavioral techniques are used to decrease symptoms and increase the child’s ability to respond. Positive reinforcement, using food and other rewards, can enhance language and social skills. Providing pleasurable sensory and motor stimulation (jogging, playing with a ball) encourages appropriate behavior and helps eliminate inappropriate behavior. Pharmacologic intervention may be helpful. Haloperidol often
mitigates withdrawn and stereotypical behavior patterns, making the child more amenable to behavior modification therapies.

Treatment may take place in a psychiatric institution, in a specialized school, or in a day-care program, but the current trend is toward home treatment. Helping family members to develop strong one-on-one relationships with the autistic child commonly initiates responsive, imitative behavior. Because family members tend to feel inadequate and guilty, they may need counseling.

Prevention

Until the causes of infantile autism are known, prevention isn’t possible.

References

  1. https://www.chw.org/medical-care/child-development-center/developmental-disorders/pervasive-developmental-disorders-pdd/autistic-disorder
  2. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
  3. https://medlineplus.gov/autismspectrumdisorder.html

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD

The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they’re less likely to be diagnosed and receive treatment.

Attention-deficit hyperactivity disorder (ADHD) is one of the most common reasons children are referred for mental health services.  It affects as many as one in every 20 children. This disorder occurs in roughly 3% to 5% of school­age children. Males are three times more likely to be affected than females. The presence of other psychiatric disorders also needs to be determined.

Causes

Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain.

Signs and symptoms

The kinds of symptoms professionals look for in diagnosing ADHD include

  • difficulty following instructions or completing tasks
  • difficulty ‘sticking to’ an activity
  • easily distracted and forgetful
  • Having trouble waiting his or her turn
  • Interrupting or intruding on others
  • difficulty playing quietly
  • always seeming to be “on the go”
  • blurts out answers without waiting for the question to finish
  • difficulty in waiting or taking turns

In order to be diagnosed with ADHD some of these problems would have been apparent before the age of six or seven years.

These behaviours must normally occur in more than one setting (for example at home as well as at school) for ADHD to be diagnosed.

Treatment

Education is the first step in effective treatment of attention deficit hyperactivity disorder. The entire treatment team (which ideally includes parents, teachers, and therapists as well as the patient and the doctor) must fully understand the nature of this disorder as well as the disorder’s effect on the individual’s ability to function.

Specific treatments vary, depending on the severity of signs and symptoms and their effects on the patient’s ability to function adequately. Behavior modification, coaching, external structure, use of planning and organizing systems, and supportive psychotherapy can all help the patient more effectively cope with the disorder.

Some patients benefit from medication to relieve symptoms. Ideally, the treatment team identifies the symptoms to be managed, selects appropriate medication, and then tracks the patient’s symptoms carefully to determine the effectiveness of the medication. Stimulants, such as methylphenidate and dextroamphetamine, are the most commonly used agents. However, other drugs, including tricyclic antidepressants (such as desipramine and nortriptyline), mood stabilizers, and beta blockers, sometimes help control symptoms. Tomoxetine, currently in clinical trials, has been found in preliminary studies to be effective; further research will involve extending the duration of treatment to determine the effects of the medication.

Special parenting skills are often required because children with AD/HD may not respond as well to typical parenting practices. Also, because ADHD tends to run in families, parents often have some problems with organization and consistency themselves and need active coaching to help learn these skills.

Prevention

Preventive measures to reduce the incidence of ADHD in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the adolescent’s normal growth and development, and improve the quality of life experienced by children or adolescents with ADHD.

References

  1. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
  2. https://www.cdc.gov/ncbddd/adhd/index.html
  3. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/

Alcoholism Fact – Signs & Symptoms, Treatment

Alcoholism

Alcoholism is a chronic disorder most often described as the uncontrolled intake of alcoholic beverages that interferes with physical and mental health, social and familial relationships, and occupational responsibilities. Alcoholism cuts across all social and economic groups, involves both sexes, and occurs at all stages of the life cycle. beginning as early as elementary school age.

Most adults in the United States are light drinkers; a minority – about 10% of the population – account for 50% of all alcohol consumption. About 13% of all adults over age 18 have suffered from alcohol abuse or dependence at some time in their lives. The prevalence of drinking is highest between the ages of 21 and 34, but current statistics show that up to 19% of 12- to 17-year-olds have a serious drinking problem. Males are, two to five times more likely to abuse alcohol than are females. According to some statistics, alcohol abuse is a factor in 60% of all automobile accidents. Alcoholism has no known cure.

Causes

Numerous biological, psychological, and sociocultural factors may cause alcohol addiction, but no clear evidence confirms the influence of any of these factors. Family background may playa significant part: An offspring of one alcoholic parent is seven to eight times more likely to become an alcoholic than is a peer without such a parent. Biological factors may include genetic or biochemical abnormalities, nutritional deficiencies, endocrine imbalances, and allergic responses.

Psychological factors may include the urge to drink alcohol to reduce anxiety or symptoms of mental illness; the desire to avoid responsibility in familial, social, and work relationships; and the need to bolster self-esteem.

Sociocultural factors include the availability of alcoholic beverages, group or peer pressure, an excessively stressful lifestyle, and social attitudes that approve frequent imbibing. Advertising supports society’s message that alcohol consumption is part of a healthy lifestyle. Paradoxically, many alcoholics come from families in which alcohol is forbidden.

Signs and symptoms

Most alcoholics deny that they have a drinking problem. Other indications of alcoholism and alcohol abuse include:

  • Keeping alcohol in unlikely places at home, at work or in the car
  • Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel “normal”
  • Nausea and vomiting
  • Having legal problems or problems with relationships, employment or finances
  • Rapid heart rate and sweating
  • Restlessness or agitation

Treatment

Total abstinence is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce long-term results.

Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.

Treatment of chronic alcoholism relies on medications to deter alcohol use and treat effects of withdrawal; psychotherapy, using behavior modification techniques, group therapy, and family therapy; and appropriate measures to relieve associated physical problems.

Aversion, or deterrent, therapy uses a daily oral dose of disulfiram to prevent compulsive drinking. This drug interferes with alcohol metabolism and allows toxic levels of acetaldehyde to accumulate in the patient’s blood, producing immediate and potentially fatal distress if the patient consumes alcohol up to 2 weeks after taking it.

Disulfiram is contraindicated during pregnancy and in patients with diabetes, heart disease, severe hepatic disease, or any disorder in which such a reaction could be especially dangerous. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic.

For long-term success with aversion, or deterrent, therapy, the sober alcoholic must learn to fill the place alcohol once occupied in his life with something constructive. For patients with abnormal dependence or for those who also abuse other drugs, aversion therapy with disulfiram may only substitute one drug dependence for another; so it should be used prudently.

Tranquilizers, particularly benzodiazepines, occasionally are used to relieve overwhelming anxiety during rehabilitation. However, these drugs have addictive potential (substituting one substance abuse problem for another), and they can precipitate coma or even death when combined with alcohol. Naltrexone may be useful as an adjunct to psychotherapy, especially when there are high levels of cravings. Antipsychotics are prescribed to control hyperactivity and psychosis. Anticonvulsants, anti emetics, and antidiarrheals also are used to treat symptoms of alcohol withdrawal.

Supportive counseling or individual. group, or family psychotherapy may improve the alcoholic’s ability to cope with stress, anxiety, and frustration and help him gain insight into the personal problems and conflicts that may have led him to alcohol abuse. Ongoing support groups also can help him overcome his dependence on alcohol. In AA, a self-help group with more than a million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA members stay sober as long as 5 years, and 30% stay sober longer than 5 years.

Prevention

Educational programs and medical advice about alcohol abuse have been successful in decreasing alcohol abuse and its associated problems. Alcohol dependency requires more intensive management.

The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.

References

  1. https://medlineplus.gov/alcoholismandalcoholabuse.html
  2. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS)

Repetitive transcranial magnetic stimulation (rTMS) is a new technology that is showing promise as a treatment for depression.

Transcranial magnetic stimulation (TMS) is a technique for gently stimulating the brain. It utilizes a specialized electromagnet placed on the patient’s scalp that generates short magnetic pulses, roughly the strength of an MRI scanner’s magnetic field but much more focused. The magnetic pulses pass easily through the skull just like the MRI scanner fields do, but because they are short pulses and not a static field, they can stimulate the underlying cerebral cortex (brain). Low frequency (once per second) TMS has been shown to induce reductions in brain activation while stimulation at higher frequencies (> 5 pulses per second) has been shown to increase brain activation. It has also been shown that these changes can last for periods of time after stimulation is stopped. TMS was first developed in 1985, and has been studied significantly since 1995.

How Transcranial magnetic stimulation works?

The exact details of how TMS functions are still being explored, but the MIT Technology Review listed some potential mechanisms:

A doctor typically holds a powerful magnet over the frontal regions of the patient’s skull and delivers magnetic pulses for a few minutes a day, over the course of a few weeks. The treatment alters the biochemistry and firing patterns of neurons in the cortex, the part of the brain nearest the surface. Preliminary research indicates that the treatment affects gene activity, levels of neurotransmitters like serotonin and dopamine, and the formation of proteins important for cellular signaling-any of which could play a role in alleviating depression. What’s more, magnetic stimulation seems to affect several interconnected brain regions, starting in the cortex and moving to the deep brain, where new cell growth may be important in regulating moods.

In practice, TMS and rTMS are able to influence many brain functions, including movement, visual perception, memory, reaction time, speech and mood. The effects produced are genuine but temporary, lasting only a short time after actual stimulation has stopped.

How many times do you need to receive TMS?

Research protocols vary in the treatment duration, but most require at least two weeks of daily stimulation given five times per week, some require up to 6 weeks.

Safety Issues

Generally, TMS appears to be free from harmful effects. Research using animals and human volunteers has showed little effect on the body in general as a result of stimulation, and examination of brain tissue submitted to thousands of TMS pulses has shown no detectable structural changes. It is possible in unusual circumstances to trigger a seizure in normal patients, but a set of guidelines which virtually eliminate this risk are available. Research continues, but TMS is certainly free of obvious side-effects like those of electro-convulsive therapy (ECT), which still makes quite an impact on patients despite refinements in technique.

Conclusions

TMS shows promise as a novel antidepressant treatment. Systematic and large-scale studies are needed to identify patient populations most likely to benefit and treatment parameters most likely to produce success. In addition to its potential clinical role, TMS promises to provide insights into the pathophysiology of depression through research designs in which the ability of TMS to alter brain activity is coupled with functional neuroimaging.

References

  1. https://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation
  2. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
  3. https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335

Reality Therapy

Reality Therapy

Reality Therapy is the method of counseling that Dr. Glasser has been teaching since 1965. It is now firmly based on Choice Theory and its successful application is dependent on the counselor’s familiarity with, and knowledge of, that theory. In fact, teaching Choice Theory to counselees (whether clients or students) is now part of Reality Therapy. Since unsatisfactory or non-existent connections with people we need are the source of almost all human problems, the goal of Reality Therapy is to help people reconnect. This reconnection almost always starts with the counselor/teacher first connecting with the individual and then using this connection as a model for how the disconnected person can begin to connect with the people he or she needs.

In Reality Therapy they are classified under five headings:

  • Power – which includes achievement and feeling worthwhile as well as winning.
  • Love & Belonging – this includes groups as well as families or loved ones.
  • Freedom – includes independence, autonomy, your own ‘space’.
  • Fun – includes pleasure and enjoyment.
  • Survival – includes nourishment, shelter, sex.

One of the core principles of Reality Therapy is that, whether we are aware of it or not, we are all the time acting to meet these needs.

In reality therapy sessions, the person’s thoughts and actions are considered the most appropriate material to actively work on, as these are within a person’s control, rather than feelings or symptoms, which are affected by changes in made in the relevant thoughts and actions. Blame and externalizing control are avoided, as these are viewed as impediments to developing healthy relationships. Regardless of the particular complaint, the best possible solution lies in improving connections with others, and specific changes in thoughts and behavior are made in the service of this goal. The practice of Reality Therapy is an ongoing process made up of two major components:

  1. Creating a trusting environment; and
  2. Using techniques which help a person discover what they really want , reflect on what they are doing now, and create a new plan for fulfilling that ‘want’ more effectively in the future.

Virtual Reality Therapy (VRT)

The first research for VRT was done in the early 1990s. Virtually Better, the company Zimand works for, was founded in 1995. VRT was first used for people who had a fear of heights. Virtual reality has been studied in recent years as a possible treatment for phobias. A new study shows that virtual reality therapy combined with cognitive-behavioral therapy is just as effective as conventional treatment for panic disorder with agoraphobia, reports the Doctor’s Guide. An added benefit is that the process is quicker. Developed by Dr. Young-Hee Choi, the process known as experiential cognitive therapy consists of only four sessions

Virtual Reality (VR) is a new, state of the art, powerful technique that immerses you into a virtual environment, using a head mounted display and trackers. This technique creates a visual, auditory and sensory environment that psychologically exposes you to your fear, whether it be flying in an airplane, speaking in front of a large group of people or driving on the highway. Fears and phobias are overcome by combining virtual reality and biofeedback/cognitive-behavioral therapy techniques, through a process known as counter-conditioning, leading to success rates of 93%.

References

  1. https://www.psychologytoday.com/us/therapy-types/reality-therapy
  2. https://en.wikipedia.org/wiki/Reality_therapy
  3. https://www.goodtherapy.org/learn-about-therapy/types/reality-therapy

Rational Emotive Behavior Therapy (REBT)

Rational Emotive Behavior Therapy

Rational Emotive Behavior Therapy (REBT) is a cognitive-behavioral approach to treatment developed by Dr. Albert Ellis in 1955.

According to this therapy, emotional and behavioral ailments are the result of irrational thoughts, assumptions and beliefs. This therapy identifies those problematic and erroneous ideas and replace them with more rational, reality-based thoughts and perspectives.

REBT- Rational Emotive Behavior Therapy since its inception, has flourished and spawned a variety of other cognitive-behavior therapies. Its effectiveness, short-term nature, and low cost are major reasons for its wide acceptance and popularity.

The goal is to help clients develop a rational philosophy that will allow them to reduce their emotional distress and self-defeating behaviors. A number of techniques are used in this active approach, such as rational-emotive imagery (in which clients imagine themselves thinking, feeling and behaving in ways they would like to think, feel and behave in real life), role-playing, homework assignments, desensitization, and assertiveness exercises. The goal is freedom from emotional upheaval and a more authentic and joyful engagement in life.

How Rational Emotive Behavior Therapy (REBT) Works?

Recalling the A-B-C theory of personality, successful REBT therapy adds steps D, E, and F. The D stands for disputing: the therapist helps the client to challenge the irrational belief (B). REBT teaching suggests that the therapist ask the client if there is any evidence for the belief, or what would be the worst possible outcome if the client were to give up that belief. In therapy the counselor may point out faulty beliefs, but he or she also teaches the client how to dispute them in day-to-day life outside of therapy. The result of disputing the self-defeating belief and replacing it with a rational one yields an effective philosophy (E), and also a new set of feelings (F) which are not debilitating. Although REBT teaches that the counselor should demonstrate unconditional full acceptance, the therapist is not encouraged to build a warm and caring relationship with the client. The counselor’s only task is to aid the client in identifying and confronting irrational beliefs and replacing them with rational ones. The therapist usually is not even interested in the past events which are the source of the irrational belief; all that matters is getting rid of that belief in the present.

REBT distinguishes between practical problems and emotional problems. Practical problems are actual events and situations that are problematic, whereas emotional problems are reactions to such events and situations that are inappropriate, inaccurate (overreactions or underreactions), and actually or potentially harmful.

Strengths and weaknesses of REBT with suicidal adolescents

Some of the potential strengths of REBT and its application to suicidal youths would be its simplicity. REBT seems to be a model which takes into consideration, developmental levels – an important ingredient when working with teenagers. REBT, in some respect, may not seem like psychotherapy from the teenager’s perspective, due to its direct approach, didactic style, and reliance on empiricism. Where other models of therapy come across as mysterious and intimidating to teenagers, REBT is exactly the opposite.

Weinrach (1990) has indicated that REBT has the capability of rubbing individuals the wrong way. Another criticism, or to be more accurate, a misconception regarding REBT, is its failure to discuss the emotionality aspects of emotional disturbances (Garcia, 1977 ; Satzberg, 1979). REBT has also been lambasted for being a model for tough-minded individuals. In A New Guide to Rational Living, Ellis (1961) corroborates this idea that he/she has a right to decide what to do with his/her life. Surprisingly, Ellis (1961) suggests that one address suicide forthrightly and also with the addition of what Ellis refers to as causal humor. This type of approach may or may not be effective with adolescents. Yet, some may suggest it lacks the necessary degree of empathy to efficiently work with suicidal patients.

References

  1. https://en.wikipedia.org/wiki/Rational_emotive_behavior_therapy
  2. https://psychcentral.com/lib/rational-emotive-behavior-therapy/
  3. https://www.verywellmind.com/rational-emotive-behavior-therapy-2796000

Person Centered Therapy

Person Centered Therapy

Person-centered therapy, which is also known as client-centered, non-directive, or Rogerian therapy, is an approach to counseling and psychotherapy that places much of the responsibility for the treatment process on the client, with the therapist taking a nondirective role.

Purpose

Two primary goals of person-centered therapy are increased self-esteem and greater openness to experience. Some of the related changes that this form of therapy seeks to foster in clients include closer agreement between the client’s idealized and actual selves; better self-understanding; lower levels of defensiveness, guilt, and insecurity; more positive and comfortable relationships with others; and an increased capacity to experience and express feelings at the moment they occur.

The three critical attitudes or values in Person or Client-Centered Therapy are:

  1. Unconditional Positive Regard (Nonpossessive Warmth):
  2. Empathy
  3. Genuineness (Congruence)

Person-Centred Psychotherapy is a way of relating with persons, one to one or in groups, which fosters personality development through personal encounter. It assumes that every person has the capability and tendency to make use of his or her resources in a constructive way. Living in a satisfying way, both personally and in relationships is achieved through increasing self-understanding and less defensive openness to the continuous flow of experiencing. This tendency to actualise one’s own possibilities is stimulated and supported by person-to-person encounter. This encounter of another person is a form of relationship characterised by the fundamental and unequivocal respect held by the therapist. The therapist’s quality of presence in this encounter is authentic, congruent, unconditionally acknowledging the individual otherness of the client, deeply empathic and non-judgemental. Both therapist and client, develop together in this relationship.

Effects of Person – Centered Therapy

  • Responsibility for self
  • Empathy and unconditional positive regard
  • Self-Exploration
  • Therapeutic change

References

  1. https://www.psychologytoday.com/us/therapy-types/person-centered-therapy
  2. https://en.wikipedia.org/wiki/Person-centered_therapy
  3. https://www.verywellmind.com/client-centered-therapy-2795999