Treatments (1)

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PBI288

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Psychology

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Oct 30, 2023

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Treatments -Psychotherapy -Mindfulness -Collaborative Therapeutic Neuropsychological Assessment

The one that you might be most familiar with…. Psychotherapy Psychotherapy is an intensely personal dialogue between two individuals that results in a working (or therapeutic) relationship in which one person (the therapist) attempts to help another (the patient or client) cope with a personal problem or problems the latter individual seems to have difficulty managing on his or her own. Therapist Musts: 1. Therapist = professional training in understanding the nature of the patient’s personal struggles as well as his or her neuropsychological strengths and limitations (know their role) 2. The therapist must have the capacity to form a therapeutic relationship and skill at guiding this learning process. (have ability to execute their role) 3. Finally, the therapist must have the time and willingness to help the patient. (be available for their role) Client Musts: 1. The patient (or client) needs the financial resources to pay for this service (pay) 2. Have adequate cognitive and emotional/motivational skills to learn from the dialogue, and the willingness to “face the truths” in his or her life. (be able and willing) https://www.youtube.com/watch?v=ZdyOwZ4_RnI https://www.youtube.com/watch?v=ltNhwj-F7c8

Several Types Psychotherapy Cognitive Behavioural Therapy : A type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression • Viewed as highly effective and used in clinic frequently Psychodynamic psychotherapy or psychoanalytic psychotherapy: is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension Goals of psychodynamic therapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something), but also foster the positive presence of psychological capacities and resources • Misconception that it is not well scientifically studied • Shedler (2010) : meta-analyses reveal that the overall effect sizes of psychotherapy for treating depression can be substantial (size effect of 0.73, mean effect size for antidepressant medications approved by the FDA between 1987 and 2004 was 0.31 ) It is normal that patients may report increased irritability, anxiety, and depression as they attempt to cope with their cognitive limitations

Your Role Psychotherapy and the NP Psychotherapy should be attempted by the clinical neuropsychologist , who understands the patient’s brain- behavior difficulties and has a willingness and professional training to help the patient improve his/her/their psychological adjustment to the effects of the brain disorder We will Discuss Three Case Studies where the NP + Psychotherapy can be useful: 1. Depression and Psychotherapy After Cerebral Vascular Accident (or Stroke) 2. Multiple Sclerosis, Anxiety, and Depression 3. Denial/Unawareness of Impaired Neuropsychological Functioning after Severe Traumatic Brain Injury

Clinically defined depression is common after stroke -estimates of major depressive disorder are in the range of 20%, while estimates of minor depression range from 9% to 18%. Depression after Stroke Severely depressed 33 year old woman - three years post a ruptured arteriouvenous malformation (AVM) involving the right parietal lobe, currently working as a statistician in a hospital She had been a physician in a residency program in radiology, after surgical resection of her AVM and apparent neurological recovery she had returned to her program but she was not knowledgeable/did not understand why she had difficulty perceiving different “shadows” on the imaging films and consequently left her residency program because she could not meet academic requirements She was asked to keep a journal and encouraged to express herself in it: -her dreams and poetry revealed all of the frustrations and psychodynamics of not living up to one’s personal aspirations in life -through psychotherapy she was probed about her medical aspirations -Should you leave the game (i.e., the aspiration to be a radiologist) or be a doctor in a substantially reduced capacity) since you love the “game” so much Conclusion: She chose to work for an insurance company conducting histories and physicals. She enjoyed patient care (it gave her a sense of meaning in life) and as a consequence her depression slowly resolved into predictable human sadness over a major loss in life. Her neuropsychological rehabilitation was successful in large part due to the impact of psychotherapy.

MS is a common neurological disorder that results in demyelination of axons and the formulation of sclerotic plagues - which may manifest as neurocognitive deficits For MS specifically - they specially noted that the variable and unpredictable nature of symptoms could certainly increase the psychological distress level of patients. -Feinstein (2011) suggests that significant depression can affect up to 50% of patients with MS and anxiety is also very common in depressed MS patients Multiple Sclerosis, Anxiety, and Depression 50-year-old male who had been diagnosed as having MS for at least ten years. He was now complaining of memory difficulties. At that time, many neurologists did not believe that MS patients should have memory difficulties, but the NP at the time tested and illustrated that this patient did indeed have memory deficits. This caused the patient to seek out the NP to help with his his depression and anger over having MS . He told NP general facts about his childhood and why he choose to be an engineer. With time he also spoke about how he often was uncomfortable with women, but eventually married his wife of some 30 years. In conjoint sessions with his wife, she talked about her husband getting very angry, very quickly over what appeared to be slight frustrations in life. After several other individual sessions with this patient, he asked the NP to pull out the Rorschach cards and specially show him Card VIII (a card he had previously avoided). He then gave me his perceptions of what the card looked like to him and stated that when he looked at this card he was reminded of his mother. As an adolescent boy his mother would approach him in a negligee and ask him to rub her back. He was both sexually excited and scared by these repeated experiences. This always occurred when his father was not home. He did not want to be alone with his mother (and now knew why he probably was uncomfortable as a man when being alone with women). This is a prime example frequently observed in psychodynamic psychotherapy. The goal is not to simply focus on the past, but to understand how the past sheds light on current psychological difficulties With the help of psychotherapy, he began to be less angry and less frightened about his disease. He accepted his wife’s help with his physical limitations and could also accept he could no longer function as an engineer in light of his memory difficulties. He experienced a certain internal peace of mind and his anger was substantially reduced.

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