Category: Mental Health Treatment

What is Integrative Psychotherapy?

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Introduction

Integrative psychotherapy is the integration of elements from different schools of psychotherapy in the treatment of a client. Integrative psychotherapy may also refer to the psychotherapeutic process of integrating the personality: uniting the “affective, cognitive, behavioral, and physiological systems within a person”.

Background

Initially, Sigmund Freud developed a talking cure called psychoanalysis; then he wrote about his therapy and popularised psychoanalysis. After Freud, many different disciplines splintered off. Some of the more common therapies include: psychodynamic psychotherapy, transactional analysis, cognitive behavioural therapy, gestalt therapy, body psychotherapy, family systems therapy, person-centred psychotherapy, and existential therapy. Many different theories of psychotherapy are practiced.

A new therapy is born in several stages. After being trained in an existing school of psychotherapy, the therapist begins to practice. Then, after follow up training in other schools, the therapist may combine the different theories as a basis of a new practice. Then, some practitioners write about their new approach and label this approach with a new name.

A pragmatic or a theoretical approach can be taken when fusing schools of psychotherapy. Pragmatic practitioners blend a few strands of theory from a few schools as well as various techniques; such practitioners are sometimes called eclectic psychotherapists and are primarily concerned with what works. Alternatively, other therapists consider themselves to be more theoretically grounded as they blend their theories; they are called integrative psychotherapists and are not only concerned with what works, but also why it works.

For example, an eclectic therapist might experience a change in their client after administering a particular technique and be satisfied with a positive result. In contrast, an integrative therapist is curious about the “why and how” of the change as well. A theoretical emphasis is important: for example, the client may only have been trying to please the therapist and was adapting to the therapist rather than becoming more fully empowered in themselves.

Different Routes to Integration

The most recent edition of the Handbook of Psychotherapy Integration (Norcross & Goldfried, 2005) recognised four general routes to integration: common factors, technical eclecticism, theoretical integration, and assimilative integration (Norcross, 2005).

Common Factors

The first route to integration is called common factors and “seeks to determine the core ingredients that different therapies share in common” (Norcross, 2005, p.9). The advantage of a common factors approach is the emphasis on therapeutic actions that have been demonstrated to be effective. The disadvantage is that common factors may overlook specific techniques that have been developed within particular theories. Common factors have been described by Jerome Frank (Frank & Frank, 1991), Bruce Wampold (Wampold & Imel, 2015), and Miller, Duncan and Hubble (2005). Common factors theory asserts it is precisely the factors common to the most psychotherapies that make any psychotherapy successful.

Some psychologists have converged on the conclusion that a wide variety of different psychotherapies can be integrated via their common ability to trigger the neurobiological mechanism of memory reconsolidation in such a way as to lead to deconsolidation (Ecker, Ticic & Hulley 2012; Lane et al. 2015; Welling 2012—but for a more hesitant view of the role of memory reconsolidation in psychotherapy see the objections in some of the invited comments in: Lane et al. 2015).

Technical Eclecticism

The second route to integration is technical eclecticism which is designed “to improve our ability to select the best treatment for the person and the problem…guided primarily by data on what has worked best for others in the past” (Norcross, 2005, p.8). The advantage of technical eclecticism is that it encourages the use of diverse strategies without being hindered by theoretical differences. A disadvantage is that there may not be a clear conceptual framework describing how techniques drawn from divergent theories might fit together. The most well known model of technical eclectic psychotherapy is Arnold Lazarus’ (2005) multimodal therapy. Another model of technical eclecticism is Larry E. Beutler and colleagues’ systematic treatment selection (Beutler, Consoli, & Lane, 2005).

Theoretical Integration

The third route to integration commonly recognised in the literature is theoretical integration in which “two or more therapies are integrated in the hope that the result will be better than the constituent therapies alone” (Norcross, 2005, p.8). Some models of theoretical integration focus on combining and synthesizing a small number of theories at a deep level, whereas others describe the relationship between several systems of psychotherapy. One prominent example of theoretical synthesis is Paul Wachtel’s model of cyclical psychodynamics that integrates psychodynamic, behavioural, and family systems theories (Wachtel, Kruk, & McKinney, 2005). Another example of synthesis is Anthony Ryle’s model of cognitive analytic therapy, integrating ideas from psychoanalytic object relations theory and cognitive psychotherapy (Ryle, 2005). Another model of theoretical integration is specifically called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010). The most notable model describing the relationship between several different theories is the transtheoretical model (Prochaska & DiClemente, 2005).

Assimilative Integration

Assimilative integration is the fourth route and acknowledges that most psychotherapists select a theoretical orientation that serves as their foundation but, with experience, incorporate ideas and strategies from other sources into their practice. “This mode of integration favours a firm grounding in any one system of psychotherapy, but with a willingness to incorporate or assimilate, in a considered fashion, perspectives or practices from other schools” (Messer, 1992, p. 151). Some counsellors may prefer the security of one foundational theory as they begin the process of integrative exploration. Formal models of assimilative integration have been described based on a psychodynamic foundation (Frank, 1999; Stricker & Gold, 2005) and based on cognitive behavioural therapy (Castonguay, Newman, Borkovec, Holtforth, & Maramba, 2005).

Govrin (2015) pointed out a form of integration, which he called “integration by conversion”, whereby theorists import into their own system of psychotherapy a foreign and quite alien concept, but they give the concept a new meaning that allows them to claim that the newly imported concept was really an integral part of their original system of psychotherapy, even if the imported concept significantly changes the original system. Govrin gave as two examples Heinz Kohut’s novel emphasis on empathy in psychoanalysis in the 1970s and the novel emphasis on mindfulness and acceptance in “third-wave” cognitive behavioural therapy in the 1990s to 2000s.

Other Models that Combine Routes

In addition to well-established approaches that fit into the five routes mentioned above, there are newer models that combine aspects of the traditional routes.

Clara E. Hill’s (2014) three-stage model of helping skills encourages counsellors to emphasize skills from different theories during different stages of helping. Hill’s model might be considered a combination of theoretical integration and technical eclecticism. The first stage is the exploration stage. This is based on client-centred therapy. The second stage is entitled insight. Interventions used in this stage are based on psychoanalytic therapy. The last stage, the action stage, is based on behavioural therapy.

Good and Beitman (2006) described an integrative approach highlighting both core components of effective therapy and specific techniques designed to target clients’ particular areas of concern. This approach can be described as an integration of common factors and technical eclecticism.

Multitheoretical psychotherapy (Brooks-Harris, 2008) is an integrative model that combines elements of technical eclecticism and theoretical integration. Therapists are encouraged to make intentional choices about combining theories and intervention strategies.

An approach called integral psychotherapy (Forman, 2010; Ingersoll & Zeitler, 2010) is grounded in the work of theoretical psychologist and philosopher Ken Wilber (2000), who integrates insights from contemplative and meditative traditions. Integral theory is a meta-theory that recognises that reality can be organized from four major perspectives: subjective, intersubjective, objective, and inter-objective. Various psychotherapies typically ground themselves in one of these four foundational perspectives, often minimising the others. Integral psychotherapy includes all four. For example, psychotherapeutic integration using this model would include subjective approaches (cognitive, existential), intersubjective approaches (interpersonal, object relations, multicultural), objective approaches (behavioural, pharmacological), and inter-objective approaches (systems science). By understanding that each of these four basic perspectives all simultaneously co-occur, each can be seen as essential to a comprehensive view of the life of the client. Integral theory also includes a stage model that suggests that various psychotherapies seek to address issues arising from different stages of psychological development (Wilber, 2000).

The generic term, integrative psychotherapy, can be used to describe any multi-modal approach which combines therapies. For example, an effective form of treatment for some clients is psychodynamic psychotherapy combined with hypnotherapy. Kraft & Kraft (2007) gave a detailed account of this treatment with a 54-year-old female client with refractory IBS in a setting of a phobic anxiety state. The client made a full recovery and this was maintained at the follow-up a year later.

Comparison with Eclecticism

In Integrative and Eclectic Counselling and Psychotherapy (Woolfe & Palmer, 2000, pp.55, 256), the authors make clear the distinction between integrative and eclectic psychotherapy approaches: “Integration suggests that the elements are part of one combined approach to theory and practice, as opposed to eclecticism which draws ad hoc from several approaches in the approach to a particular case.” Psychotherapy’s eclectic practitioners are not bound by the theories, dogma, conventions or methodology of any one particular school. Instead, they may use what they believe or feel or experience tells them will work best, either in general or suiting the often immediate needs of individual clients; and working within their own preferences and capabilities as practitioners (Norcross & Goldfried, 2005, pp.3–23).

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Relaxation Revolution: How Hypnotherapy can Alleviate Stress and Anxiety?

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Introduction

We live in a very busy world where stress and anxiety are very normal. Whether it is due to work pressures, personal challenges, or simply the overwhelming nature of modern life, many people find themselves struggling to maintain a sense of calm and balance. Fortunately, there is a powerful tool that can offer relief: hypnotherapy.

Hypnotherapy, also known as hypnosis therapy, often misunderstood and misrepresented in popular culture, is a legitimate therapeutic technique that taps into the power of the subconscious mind to bring about positive change. Through a state of focused relaxation, guided by a trained hypnotherapist, individuals can access deeper parts of their psyche and reframe negative thought patterns, leading to reduced stress and anxiety levels. Let’s explore how hypnotherapy works and its efficacy in alleviating stress and anxiety.

Introduction to Hypnotherapy

Hypnotherapy is not about surrendering control or being controlled by a hypnotist, unlike what many people believe. Instead, it is a collaborative process between the therapist and the client, where the client remains fully conscious and in control at all times. The hypnotic state induced during hypnotherapy is akin to a deeply relaxed state, similar to the moments before falling asleep or waking up. During this condition, the mind is extremely open to suggestions, which makes it the perfect opportunity to confront deeply rooted habits and beliefs.

Reprogramming the Subconscious Mind

One of the key mechanisms through which hypnotherapy alleviates stress and anxiety is by reprogramming the subconscious mind. Many of our stress responses and anxious thoughts are rooted in unconscious patterns that we have developed over time. Through hypnosis, these patterns can be identified and reframed, allowing individuals to adopt healthier coping mechanisms and responses to stressors.

For example, an individual who experiences panic attacks triggered by social situations may have underlying beliefs about their worthiness or likability. Hypnosis can be used to refute these beliefs and replace them with narratives that are more empowering, which will lessen the symptoms of anxiety. In a 2016 study, scientists scanned the brains of 57 people undergoing hypnosis. They found changes in the areas of the brain that allowed for greater emotional control and reduced feelings of self-consciousness.

Relaxation Techniques in Hypnotherapy

Central to the practice of stress hypnotherapy is the use of relaxation techniques to induce a state of deep calm and receptivity. Depending on the client’s preferences and the therapist’s style, these methods can differ greatly. Common methods include guided imagery, progressive muscle relaxation, and deep breathing exercises.

During a hypnotherapy session focused on stress and anxiety relief, the therapist may guide the client through visualisations of serene landscapes, instruct them to progressively relax each part of their body, or encourage them to focus on their breath to promote relaxation. These techniques not only help alleviate immediate feelings of stress and anxiety but also train the mind to enter a state of relaxation more easily in the future. The results of a 2021 study published in the Journal of Affective Disorders found that hypnotherapy was not inferior to cognitive behavioural therapy (CBT) for treating mild to moderate depression. The results indicated that where CBT led to a 38.5% reduction in symptom severity, hypnotherapy resulted in a 44.6% reduction.

Addressing Underlying Trauma

In many cases, stress and anxiety are symptoms of deeper underlying issues, such as past trauma or unresolved emotional wounds. A secure and efficient method for addressing these problems and promoting subconscious healing is hypnosis.

Through techniques like regression therapy, clients can revisit past experiences and reframe their interpretations of traumatic events, allowing for resolution and closure. Hypnotherapy provides enduring comfort and transformation by targeting the underlying causes of stress and anxiety instead of just treating their symptoms. Hypnotised volunteers are up to 50% more capable of handling painful stimuli (Faymonville et al., 2006). Scans reveal that hypnosis can lower activity in the brain’s anterior cingulate cortex, linking sensory stimuli to emotional and behavioural responses, and switch off pain signals.

Research by Leonard S. Milling and colleagues in 2019 suggests that “Clinicians may wish to give serious consideration to hypnosis as a treatment option when working with clients and patients who are depressed.” Other research from 2015 by Zhao and colleagues suggests that hypnotherapy using augmented reality technology in the treatment of psychological stress and anxiety also has potential.

Empowering Self-Help Tools

One of the most empowering aspects of hypnotherapy is its ability to teach clients self-help tools that they can use outside of sessions to manage their stress and anxiety independently. People can learn to be more resilient to life’s obstacles and to have a deeper sense of inner calm by practicing practices like self-hypnosis and mindfulness meditation.

Self-hypnosis involves using hypnotic techniques on oneself to induce a state of relaxation and suggest positive affirmations or imagery. It is a useful tool for handling stress and anxiety in daily life because people can learn to enter this condition on their own with practice. Hypnotherapy is increasingly recognized as a powerful tool in the context of anxiety treatment, offering individuals a holistic approach to addressing underlying issues and promoting lasting relief from stress and anxiety.

Summary

In conclusion, hypnotherapy offers a different approach to alleviating stress and anxiety by tapping into the power of the subconscious mind. Through relaxation techniques, subconscious reprogramming, and exploration of underlying issues, hypnotherapy helps individuals achieve calm and resilience.

What is Immersion Therapy?

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Introduction

Immersion therapy is a psychological technique which allows a patient to overcome fears (phobias), but can be used for anxiety and panic disorders.

Refer to Flooding.

Outline

First a fear-hierarchy is created: the patient is asked a series of questions to determine the level of discomfort the fear causes in various conditions. Can the patient talk about the object of their fear, can the patient tolerate a picture of it or watch a movie which has the object of their fear, can they be in the same room with the object of their fear, and/or can they be in physical contact with it?

Once these questions have been ordered beginning with least discomfort to most discomfort, the patient is taught a relaxation exercise. Such an exercise might be tensing all the muscles in the patient’s body then relaxing them and saying “relax”, and then repeating this process until the patient is calm.

Next, the patient is exposed to the object of their fear in a condition with which they are most comfortable – such as merely talking about the object of their fear. Then, while in such an environment, the patient performs the relaxation exercise until they are comfortable at that level.

After that, the patient moves up the hierarchy to the next condition, such as a picture or movie of the object of fear, and then to the next level in the hierarchy and so on until the patient is able to cope with the fear directly.

This specific therapy can create a safe space, where individuals are able to become comfortable with their fears, anxieties or traumatic experiences. One may say it is linked to exposure, as the patient is immersed into an experience until they eventually become much more relaxed in it.

Although it may take several sessions to achieve a resolution, the technique is regarded as successful. Many research studies are being conducted in regard to achieving immersion therapy goals in a virtual computer based programme, although results are not conclusive.

‘Immersive therapy through virtual reality represents a novel strategy used in psychological interventions, but there is still a need to strengthen the evidence on its effects on health professionals’ mental health’ (Linares-Chamorro et al., 2022).

Virtual Therapy

As mentioned previously, Immersion Therapy can occur in the form of a virtual reality (VR) therapy. This usually involves transporting the user to a simulated environment, creating a realistic real life setting, and combining video, audio, haptic and motion sensory input to create an immersive experience. Virtual therapy may use videos in either a 2D or 3D immersion using a head-mounted display (Hodges et al., 2002).

There have been many studies looking at this type of therapy and combatting anxiety and phobias, such as acrophobia. It assesses a patient’s cognitive, emotional and physiological functioning. It can be useful for both prevention and treatment of psychiatric conditions. This method goes beyond the simple exposure therapy, as it can be a more comprehensive treatment compared to other interventions. A study conducted in Olot, Spain aimed to look at levels of anxiety and the wellbeing of female hospital staff. A sample size of 35 female health professionals undertook immersive therapy for 8 weeks. The way the anxiety levels were measured was through the Hamilton scale and well-being through the Eudemon scale. This specific immersive therapy was executed through Virtual Reality, in which the VR experience used a projection device with light and sound control that provided an immersive experience, creating an environment that enhanced self awareness to approach anxiety management. Results suggested that a significant improvement was found in anxiety and wellbeing, both statistically and clinically.

Another study in the UK looking at helping acrophobia. Researchers recruited 100 adults with a fear of heights, if they scored more than 29 on the heights interpretation questionnaire, suggested they had a fear of heights. Participants were randomly allocated by computer to either an automated VR delivered in roughly six 30 minute sessions, administered about 2-3 times a week over 2 weeks and a control group was present which received no treatment. The virtual coach worked alongside the VR programmed and would mention things like “We’re discovering what happens when we venture into a situation we’d normally try to avoid.” The aim of the virtual coach was to put the participants’ expectations to the test and experiencing citations where they would usually feel anxious. Then the tasks began, where they underwent different levels of heights in different activities. Overall, participants in the control group compared to the VR group had reduced fear of heights by the end of the treatment.

Although, this is evidence to suggest how virtual computer based immersion therapy works, the research within this area of psychology is scare, thus more testing needs to occur, to fully implement this type of technology.

Advantages

Immersive virtual reality may be identified as something that is a potentially revolutionary tool for psychological treatment of mental disorders, which may gradually be adopted in regular clinical practice in the coming years. (Geraets et al., 2021). Virtual reality has significantly been evolving over the last few years due to many advancements in technology, thus enabling us to understand the constant need for new research to take place.

The benefits of Immersive virtual reality therapy could significantly enhance effective psychological interventions. Treatments can be given automatically, without a therapist’s physical presence, resulting in a more low cost route. Another benefit of VR is that it can offer ‘direct therapeutic intervention’, which is often lacking in conventional clinical settings, allowing for treatments to be delivered faster and more efficiently. Patients can be placed in simulated environments whilst wearing a VR headset, teaching them how to react more effectively. Additionally, patients are more open to experimenting with new therapies because they are aware they are in a secure stimulation setting, in which the exposure to the stimuli can occur in different stages and not just one go.

VR has been used successfully over the past 25 years for assessment, understanding, and treatment of mental health disorders. The increased accessibility and affordability of VR mean that this technique is now ready to move from specialist laboratories into clinics (Freeman et al., 2018).

Immersive therapy can provide a distinctive and engaging experience that allows for overcoming fears, gaining self-confidence and creating coping strategies. It allows people to experience real life situations in a controlled and safe setting. It is much more interactive and rather than just talking about their phobia or anxiety, they can actually relive it but overcome it too, generating a greater sense of self-confidence, reducing the feelings of anxieties and managing their feelings during stressful situations.

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What is Flooding?

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Introduction

Flooding, in psychology terms, sometimes referred to as in vivo exposure therapy, is a form of behaviour therapy and desensitisation — or exposure therapy—based on the principles of respondent conditioning. As a psychotherapeutic technique, it is used to treat phobia and anxiety disorders including post-traumatic stress disorder (PTSD). It works by exposing the patient to their painful memories, with the goal of reintegrating their repressed emotions with their current awareness. Flooding was invented by psychologist Thomas Stampfl in 1967. It is still used in behaviour therapy today.

Refer to Immersion Therapy.

Outline

Flooding is a psychotherapeutic method for overcoming phobias. In order to demonstrate the irrationality of the fear, a psychologist would put a person in a situation where they would face their phobia. Under controlled conditions and using psychologically-proven relaxation techniques, the subject attempts to replace their fear with relaxation. The experience can often be traumatic for a person, but may be necessary if the phobia is causing them significant life disturbances. The advantage to flooding is that it is quick and usually effective. There is, however, a possibility that a fear may spontaneously recur. This can be made less likely with systematic desensitisation, another form of a classical condition procedure for the elimination of phobias.

How it Works

“Flooding” works on the principles of classical conditioning or respondent conditioning—a form of Pavlov’s classical conditioning—where patients change their behaviours to avoid negative stimuli. According to Pavlov, people can learn through associations, so if one has a phobia, it is because one associates the feared stimulus with a negative outcome.

Flooding uses a technique based on Pavlov’s classical conditioning that uses exposure. There are different forms of exposure, such as imaginal exposure, virtual reality exposure, and in vivo exposure. While systematic desensitisation may use these other types of exposure, flooding uses in vivo exposure, actual exposure to the feared stimulus. A patient is confronted with a situation in which the stimulus that provoked the original trauma is present. The psychologist there usually offers very little assistance or reassurance other than to help the patient to use relaxation techniques in order to calm themselves. Relaxation techniques such as progressive muscle relaxation are common in these kinds of classical conditioning procedures. The theory is that the adrenaline and fear response has a time limit, so a person should eventually have to calm down and realize that their phobia is unwarranted. Flooding can be done through the use of virtual reality and has been shown to be fairly effective in patients with flight phobia.

Psychiatrist Joseph Wolpe (1973) carried out an experiment which demonstrated flooding. He took a girl who was scared of cars, and drove her around for hours. Initially the girl was panicky but she eventually calmed down when she realized that her situation was safe. From then on she associated a sense of ease with cars. Psychologist Aletha Solter used flooding successfully with a 5-month-old infant who showed symptoms of post-traumatic stress following surgery.

Flooding therapy is not for every individual, and the therapist will discuss with the patient the levels of anxiety they are prepared to endure during the session. It may also be true that exposure is not for every therapist and therapists seem to shy away from use of the technique.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Flooding_(psychology) >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Systematic Desensitisation?

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Introduction

Systematic desensitisation, or graduated exposure therapy, is a behaviour therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioural therapy and applied behaviour analysis. When used in applied behaviour analysis, it is based on radical behaviourism as it incorporates counterconditioning principles. These include meditation (a private behaviour or covert conditioning) and breathing (a public behaviour or overt conditioning). From the cognitive psychology perspective, cognitions and feelings precede behaviour, so it initially uses cognitive restructuring.

The goal of the therapy is for the individual to learn how to cope with and overcome their fear in each level of an exposure hierarchy. The process of systematic desensitisation occurs in three steps. The first step is to identify the hierarchy of fears. The second step is to learn relaxation or coping techniques. Finally, the individual uses these techniques to manage their fear during a situation from the hierarchy. The third step is repeated for each level of the hierarchy, starting from the least fear-inducing situation.

Refer to Flooding.

Brief History

In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and systematic exposure. Wolpe studied Ivan Pavlov’s work on artificial neuroses and the research done on elimination of children’s fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead substituted relaxation as a treatment to relieve the anxiety symptoms.

Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today.

Three steps of desensitisation

There are three main steps that Wolpe identified to successfully desensitize an individual.

Establish anxiety stimulus hierarchy1. The individual should first identify the items that are causing the anxiety problems.
2. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety.
3. If the individual is experiencing great anxiety to many different triggers, each item is dealt with separately.
4. For each trigger or stimulus, a list is created to rank the events from least anxiety-provoking to most anxiety-provoking.
Learn the mechanism response1. Relaxation training, such as meditation, is one type of best coping strategies.
2. Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same time.
3. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a state of serenity.
4. This is necessary because it provides the patient with a means of controlling their fear, rather than letting it increase to intolerable levels.
5. Only a few sessions are needed for a patient to learn appropriate coping mechanisms.
6.Additional coping strategies include anti-anxiety medicine and breathing exercises.
7. Another example of relaxation is cognitive reappraisal of imagined outcomes.
8. The therapist might encourage patients to examine what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to replace the imagined catastrophic situation with any of the imagined positive outcomes.
Connect stimulus to the incompatible response or coping method by counter conditioning1. In this step the client completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of anxiety phobias.
2. When the patient has reached a state of serenity again after being presented with the first stimuli, the second stimuli that should present a higher level of anxiety is presented.
3. This will help the patient overcome their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without inducing any anxiety in the client at all.
4. If at any time during the exercise the coping mechanisms fail or became a failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then stopped.
5. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again and the exercise is then continued depending on the patient outcomes.


Example

A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the client using the three steps of systematic desensitisation:

Establish anxiety stimulus hierarchy1. A therapist may begin by asking the patient to identify a fear hierarchy.
2. This fear hierarchy would list the relative unpleasantness of various levels of exposure to a snake.
3. For example, seeing a picture of a snake might elicit a low fear rating, compared to live snakes crawling on the individual—the latter scenario becoming highest on the fear hierarchy.
Learn coping mechanisms or incompatible responses1. The therapist would work with the client to learn appropriate coping and relaxation techniques such as meditation and deep muscle relaxation responses.
Connect the stimulus to the incompatible response or coping method1. The client would be presented with increasingly unpleasant levels of the feared stimuli, from lowest to highest—while utilising the deep relaxation techniques (i.e. progressive muscle relaxation) previously learned.
2. The imagined stimuli to help with a phobia of snakes may include: a picture of a snake; a small snake in a nearby room; a snake in full view; touching of the snake, etc.
3. At each step in the imagined progression, the patient is desensitised to the phobia through exposure to the stimulus while in a state of relaxation.
4. As the fear hierarchy is unlearned, anxiety gradually becomes extinguished.


Uses

Specific Phobias

Specific phobias are one class of mental disorder often treated via systematic desensitisation. When persons experience such phobias (for example fears of heights, dogs, snakes, closed spaces, etc.), they tend to avoid the feared stimuli; this avoidance, in turn, can temporarily reduce anxiety but is not necessarily an adaptive way of coping with it. In this regard, patients’ avoidance behaviours can become reinforced – a concept defined by the tenets of operant conditioning. Thus, the goal of systematic desensitisation is to overcome avoidance by gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated. Wolpe found that systematic desensitisation was successful 90% of the time when treating phobias.

Test Anxiety

Between 25 and 40 percent of students experience test anxiety. Children can suffer from low self-esteem and stress-induced symptoms as a result of test anxiety. The principles of systematic desensitisation can be used by children to help reduce their test anxiety. Children can practice the muscle relaxation techniques by tensing and relaxing different muscle groups. With older children and college students, an explanation of desensitisation can help to increase the effectiveness of the process. After these students learn the relaxation techniques, they can create an anxiety inducing hierarchy. For test anxiety these items could include not understanding directions, finishing on time, marking the answers properly, spending too little time on tasks, or underperforming. Teachers, school counsellors or school psychologists could instruct children on the methods of systematic desensitisation.

Recent Use

Desensitisation is widely known as one of the most effective therapy techniques. In recent decades, systematic desensitisation has become less commonly used as a treatment of choice for anxiety disorders. Since 1970 academic research on systematic desensitisation has declined, and the current focus has been on other therapies. In addition, the number of clinicians using systematic desensitisation has also declined since 1980. Those clinicians that continue to regularly use systematic desensitisation were trained before 1986. It is believed that the decrease of systematic desensitisation by practicing psychologist is due to the increase in other techniques such as flooding, implosive therapy, and participant modelling.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Systematic_desensitization >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What are Drug Addiction Recovery Groups?

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Introduction

Drug addiction recovery groups are voluntary associations of people who share a common desire to overcome their drug addiction.

Outline

Different groups use different methods, ranging from completely secular to explicitly spiritual. Some programmes may advocate a reduction in the use of drugs rather than outright abstention. One survey of members who found active involvement in any addiction recovery group correlates with higher chances of maintaining sobriety. Although there is not a difference in whether group or individual therapy is better for the patient, studies show that any therapy increases positive outcomes for patients with substance use disorder. The survey found group participation increased when the individual members’ beliefs matched those of their primary support group (many addicts are members of multiple addiction recovery groups). Analysis of the survey results found a significant positive correlation between the religiosity of members and their participation in twelve-step programs (these programs describe themselves as spiritual rather than religious) and to a lesser level in non-religious SMART Recovery groups, the correlation factor being three times smaller for SMART Recovery than for the twelve-step addiction recovery groups. Religiosity was inversely related to participation in Secular Organisations for Sobriety.

A survey of a cross-sectional sample of clinicians working in outpatient facilities (selected from the SAMHSA On-line Treatment Facility Locator) found that clinicians only referring clients to twelve-step groups were more likely than those referring their clients to twelve-step groups and “twelve-step alternatives” to believe less strongly in the effectiveness of Cognitive Behavioural and psychodynamic-oriented therapy, and were likely to be unfamiliar with twelve-step alternatives. A logistic regression of clinician’s knowledge and awareness of Cognitive Behavioural Therapy effectiveness and preference for the twelve-step model was correlated with referring exclusively to twelve-step groups.

Twelve-Step Recovery Groups

Twelve-step programs are mutual aid organizations for the purpose of recovery from substance addictions, behavioural addictions and compulsions. Developed in the 1930s by alcoholics, the first twelve-step programme, Alcoholics Anonymous (AA), aided its membership to overcome alcoholism. Since that time, dozens of other organisations have been derived from AA’s approach to address problems as varied as drug addiction, compulsive gambling, sex and overeating. All twelve-step programmes utilise a version of AA’s suggested twelve steps first published in the 1939 book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.

As summarised by the American Psychological Association (APA), the process involves the following:

  • Admitting that one cannot control one’s alcoholism, addiction, or compulsion;
  • Coming to believe in a Higher Power that can give strength;
  • Examining past errors with the help of a sponsor (experienced member);
  • Making amends for these errors;
  • Learning to live a new life with a new code of behaviour; and
  • Helping others who suffer from the same alcoholism, addictions, or compulsions.

Participants attend meetings and are able to make new connections with other members who are striving towards a similar goal. If a person is unable to attend a meeting face-to-face, many of the groups have meetings by phone or online as another option. Each group has its own textbook, workbooks or both, which provide information about their program of recovery and suggestions on how to “work the steps”. Often, free literature is available for anyone who asks for it at a meeting. This provides potential new members or family members with relevant information about both the addiction and that specific groups’ version of the twelve-step process of recovery. New members are invited to work with another member who has already been through the twelve-steps at least once. That person serves as a guide to the new member, answers questions and provides feedback as the new member goes through the steps. These groups are spiritually based and encourage a belief in a power greater than the members. Most do not have one specific conception of what that means and allow the member to decide what spirituality means to them as it applies to their recovery. The groups emphasize living on a spiritual yet not necessarily religious basis. Groups typically advocate for complete abstinence, usually from all drugs including alcohol. This is because of the perceived potential for cross-addiction, the idea that there is a tendency to trade one addiction for another. Despite the idea of cross-addiction being accepted as real in many addiction recovery groups, there is said to be little empirical evidence to support it and recent research suggests that the opposite is more likely to be true.

The following is a list of twelve-step drug addiction recovery groups. Twelve-step programmes for problems other than drug addiction also exist.

  • Alcoholics Anonymous (AA) – This group gave birth to the twelve-step programme of recovery. Meetings are focused on alcoholism only and advocate complete abstinence. Meetings are held all over the world.
  • Cocaine Anonymous (CA) – This group is focused on cessation of cocaine and all other mind-altering substances. The programme advocates complete abstinence from all mind-altering substances in order to recover from the disease of addiction. Meetings are held all over the world.
  • Celebrate Recovery (CR) – Celebrate recovery is a recovery programme for any life problem, including addiction to alcohol and other drugs. In contrast to most 12-step programmes, the group recognises Jesus Christ as their higher power. Their groups are located in the United States.
  • Crystal Meth Anonymous (CMA) – This group focuses on abstinence from crystal meth although it does recognise the potential for cross-addiction, the tendency for an addict to substitute one addiction for another. Meetings are currently available in eight countries.
  • Heroin Anonymous (HA) – This group is focused on abstinence from heroin along with all other drugs including alcohol. Meetings are held in England and the United States.
  • Marijuana Anonymous (MA) – This group focuses of recovery from marijuana addiction. Groups meet in eleven countries.
  • Nicotine Anonymous (NicA) – This group is for those desiring to stop the use of nicotine in all forms. Groups are available in many countries.
  • Narcotics Anonymous (NA) – This group has meetings in 139 countries and focuses on recovery from the use of all drugs and alcohol. The group makes no distinction between any mood or mind-altering substance and encourages members to look for similarities the common problem they all share, rather than focusing on the differences.
  • Pagans in Recovery (PIR) – Pagans in recovery have adapted the twelve-step programme of recovery into language that is not overtly Christian as it was originally written so that those with other belief systems can more comfortably work the programme. They have their own literature but do not currently have an official site for meeting availability.
  • Pills Anonymous (PA) – This group is focused on addiction to pills and all other mind-altering substances. Groups are available in seven countries.

Non-Twelve-Step Recovery Groups

These groups do not follow the twelve-step recovery method, although their members may also attend twelve-step meetings. It is common for individuals to try many different meetings and groups while in recovery. What works for one may not work for another, so trying different types of meetings can be helpful to someone seeking recovery from drugs and alcohol.

  • The Washingtonians – A defunct 19th Century mutual aid society founded by alcoholics with a desire to maintain sobriety
  • Association of Recovering Motorcyclists (ARM) – This association of recovering motorcyclists is a brotherhood of men recovering from alcohol and/or drug addiction. They support one another in remaining abstinent from drugs and alcohol while continuing to ride motorcycles together regularly.
  • Recovering Women Riders (RWR) – Recovering women riders is a sisterhood of recovering women motorcyclists. Affiliated with the association of recovering motorcyclists, they also seek to support one another in remaining abstinent from drugs and alcohol while continuing to enjoy the lifestyle of riding bikes together.
  • LifeRing Secular Recovery (LSR)
  • Moderation Management (MM)
  • Rational Recovery (largely defunct)
  • Recovery Dharma (RD)
  • Refuge Recovery (RR)
  • Secular Organizations for Sobriety (SOS)
  • SMART Recovery
  • Women for Sobriety (WFS)

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What is 8-OH-DPAT?

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Introduction

8-OH-DPAT is a research chemical of the aminotetralin chemical class which was developed in the 1980s and has been widely used to study the function of the 5-HT1A receptor. It was one of the first major 5-HT1A receptor full agonists to be discovered.

Refer to Azapirone.

Originally believed to be selective for the 5-HT1A receptor, 8-OH-DPAT was later found to act as a 5-HT7 receptor agonist and serotonin reuptake inhibitor/releasing agent as well.

In animal studies, 8-OH-DPAT has been shown to possess antidepressant, anxiolytic, serenic, anorectic, antiemetic, hypothermic, hypotensive, bradycardic, hyperventilative, and analgesic effects.

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What is Tandospirone?

Published on by Andrew Marshall2 Comments

Introduction

Tandospirone, sold under the brand name Sediel, is an anxiolytic and antidepressant medication used in Japan and China, where it is marketed by Dainippon Sumitomo Pharma. It is a member of the azapirone class of drugs and is closely related to other azapirones like buspirone and gepirone.

Tandospirone was introduced for medical use in Japan in 1996 and in China in 2004.

Medical Uses

Anxiety and Depression

Tandospirone is most commonly used as a treatment for anxiety and depressive disorders, such as generalised anxiety disorder and dysthymia respectively. For both indications it usually takes a couple of weeks for therapeutic effects to begin to be seen, although at higher doses more rapid anxiolytic responses have been seen. It has also been used successfully as a treatment for bruxism.

Augmentation for Depression

Tandospirone can be used as an effective augmentation, especially when coupled with fluoxetine or clomipramine.

Other Uses

Tandospirone has been tried successfully as an adjunctive treatment for cognitive symptoms in schizophrenic individuals.

Side Effects

Common adverse effects include:

  • Dizziness
  • Drowsiness
  • Insomnia
  • Headache
  • Gastrointestinal disorders
  • Dry mouth
  • Negative influence on explicit memory function
  • Nausea

Adverse effects with unknown frequency include:

  • Hypotension (low blood pressure)
  • Dysphoria
  • Tachycardia
  • Malaise
  • Psychomotor impairment

It is not believed to be addictive but is known to produce mild withdrawal effects (e.g. anorexia) after abrupt discontinuation.

Pharmacology

Pharmacodynamics

Tandospirone acts as a potent and selective 5-HT1A receptor partial agonist, with a Ki affinity value of 27 ± 5 nM and approximately 55 to 85% intrinsic activity. It has relatively weak affinity for the 5-HT2A (1,300 ± 200), 5-HT2C (2,600 ± 60), α1-adrenergic (1,600 ± 80), α2-adrenergic (1,900 ± 400), D1 (41,000 ± 10,000), and D2 (1,700 ± 300) receptors, and is essentially inactive at the 5-HT1B, 5-HT1D, β-adrenergic, and muscarinic acetylcholine receptors, serotonin transporter, and benzodiazepine allosteric site of the GABAA receptor (all of which are > 100,000). There is evidence of tandospirone having low but significant antagonistic activity at the α2-adrenergic receptor through its active metabolite 1-(2-pyrimidinyl)piperazine (1-PP).

Society and Culture

Name

Tandospirone is also known as metanopirone and by the developmental code name SM-3997. It is marketed in Japan under the brand name Sediel.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Tandospirone >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Perospirone?

Published on by Andrew Marshall1 Comment

Introduction

Perospirone (Lullan) is an atypical antipsychotic of the azapirone family. It was introduced in Japan by Dainippon Sumitomo Pharma in 2001 for the treatment of schizophrenia and acute cases of bipolar mania.

Medical Uses

Its primary uses are in the treatment of schizophrenia and bipolar mania.

Schizophrenia

In a clinical trial that compared it to haloperidol in the treatment of schizophrenia it was found to produce significantly superior overall symptom control. In another clinical trial perospirone was compared with mosapramine and produced a similar reduction in total PANSS score, except with respect to the blunted affect part of the PANSS negative score, in which perospirone produced a significantly greater improvement. In an open-label clinical trial comparing aripiprazole with perospirone there was no significant difference between the two treatments discovered in terms of both efficacy and tolerability. In 2009 a clinical trial found that perospirone produced a similar reduction of PANSS score than risperidone and the extrapyramidal side effects was similar in both frequency and severity between groups.

A meta-analysis published in 2013 found that it is statistically significantly less efficacious than other second-generation antipsychotics.

Adverse Effects

Has a higher incidence of extrapyramidal side effects than the other atypical antipsychotics, but still less than that seen with typical antipsychotics. A trend was observed in a clinical trial comparing mosapramine with perospirone that favoured perospirone for producing less prominent extrapyramidal side effects than mosapramine although statistical significant was not reached. It may produce less QT interval (measurement made on an electrocardiogram used to assess some of the electrical properties of the heart) prolongation than zotepine, as in one patient who had previously been on zotepine switching to perospirone corrected their prolonged QT interval. It also tended to produce less severe extrapyramidal side effects than haloperidol in a clinical trial comparing the two (although statistical significance was not reached).

Discontinuation

The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a felling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time.

There is tentative evidence that discontinuation of antipsychotics can result in psychosis. It may also result in reoccurrence of the condition that is being treated. Rarely tardive dyskinesia can occur when the medication is stopped.

Pharmacology

Perospirone binds to the following receptors with very high affinity (as an antagonist unless otherwise specified):

  • 5-HT1A (partial agonist; Ki=2.9 nM)
  • 5-HT2A (inverse agonist; Ki=1.3 nM)
  • D2 (Ki = 0.6 nM)

And the following receptor with high affinity:

  • H1 (inverse agonist)

And the following with moderate affinity:

  • D4
  • α1 adrenoceptor

And with low affinity for the following receptor:

  • D1

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Perospirone >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Umespirone?

Published on by Andrew Marshall1 Comment

Introduction

Umespirone (KC-9172) is a drug of the azapirone class which possesses anxiolytic and antipsychotic properties.

Outline

It behaves as a 5-HT1A receptor partial agonist (Ki = 15 nM), D2 receptor partial agonist (Ki = 23 nM), and α1-adrenoceptor receptor antagonist (Ki = 14 nM), and also has weak affinity for the sigma receptor (Ki = 558 nM).

Unlike many other anxiolytics and antipsychotics, umespirone produces minimal sedation, cognitive/memory impairment, catalepsy, and extrapyramidal symptoms.

Synthesis

The condensation between ethyl cyanoacetate and acetone gives ethylisopropylidenecyanoacetate 759-58-0. This product is reacted with N-butylcyanoacetamide 39581-21-0 in sodium methoxide solution to give N-butyl-2,4-dicyano-3,3-dimethylglutarimide, CID:10681941. The glutarimide is cyclized with phosphoric acid to yield 3-butyl-9,9-dimethyl-3,7-diazabicyclo[3.3.1]nonane-2,4,6,8-tetraone, https://pubchem.ncbi.nlm.nih.gov/compound/10825633 CID:10825633.

The reaction between 1-(o-anisyl)piperazine 35386-24-4 and 1,4-dibromobutane 110-52-1 gives the Quat salt CID:15895413.

Convergent synthesis (in the presence of potassium carbonate) affords Umespirone (KC-9172).

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Umespirone >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.