Forms Of Psychotherapy
Initial examination involves diagnosis of mood disorder and chronic pain. Psychotherapy is prescribed as a treatment following psychoanalysis and diagnosis of mood disorder. Psychiatrist, clinical psychologist and mental health provider are involved in diagnosis and treatment with psychotherapy. Psychotherapy is often combined with medications. Psychiatrists who are qualified as MD or DO write most of the prescription medications.
Forms of psychotherapy treatment are as follows:
Talk Psychotherapy or Talk Therapy:
Talk psychotherapy involves patient as an individual client or in-group with spouse and member of the families. Number of treatments are often restricted by insurance provider. Maximum therapy allowed is about 10 outpatient treatment sessions. Treatment is scheduled once a week for 30 to 60 minutes. Nossrat Peseschkian (1933- 2010) introduced the word positive psychotherapy. Nossrat Peseschkian was a specialist in neurology, psychiatry, psychotherapy and psychotherapeutic medicine. Talk therapy is often combined with behavioral therapy, cognitive therapy, biofeedback and hypnosis. Psychotherapy is often repeated every 4 to 6 months as permitted by insurance payer. Objective, goal and method of psychotherapy is discussed in detail by treatment provider with patient, spouse and if necessary immediate family members during initial visit.
Talk psychotherapy involves conversation and discussion with the clients. The format of the consultation is as follows:
- One on One Counseling
- Mental Health Counseling
- Rehabilitation Counseling
- Marriage Counseling
- School Counseling
- Occupational Therapy
- Narrative Story Telling Sessions
Talk psychotherapy is sometimes combined with the following art and instrumental therapy:
- Music Therapy
- Art Therapy
- Dance Therapy
- Drama Therapy
- Movement Therapy
Objective of Talk Therapy
- Mood Disorder
- Suicidal Ideation
- Opioid Addiction and Dependence
- Opioid Pain Medications
- How to Respond to Challenging Situations
- Coping Skills
- How to Improve Quality of Life
- Learn How to Pace
Treatment of behavioral therapy is based on either classical conditioning or operant conditioning.
- Classical Conditioning Therapy is directed to modify and alter the behavior, which is either unwanted or harmful behavior. The therapy uses number of different techniques to assist to modify behavior. Techniques used in Classical Conditioning are as follows:
Flooding Conditioning Therapy:
Behavior changes such as anger, phobia or anxiety caused by fear or worries are treated with Flooding Classical Conditioning Therapy. Patient is repeatedly exposed to the surroundings, which has caused fear or worries. If patient is afraid of walking or travelling in a vehicle because of increased pain then patient is encouraged to travel in vehicle or ambulate under supervision of expert. Immediate appropriate treatment is provided if mood disorder or pain is observed during treatment. Patient once knows the mood disorder or pain will be treated immediately on occurrence then patient will volunteer to go through flooding conditioning. Treatment has often shown positive results in treating anger, anxiety, pain and phobia caused by recurrent chronic pain.
Systematic Desensitization Conditioning Therapy:
Systemic desensitization technique is useful in treating mood disorder such as sleep disorder, phobia, anger, pain and anxiety. During systemic desensitization therapy, patient is encouraged to perform the act, which provokes the pain. Similar act is repeated several times a day or week until patient feels confident to cope up with the mood changes and pain.
Aversion Conditioning Therapy
Aversion therapy is one of the choice of classical conditioning therapy. Therapy is recommended to patient suffering with mood disorder secondary to drug abuse or addiction. Patient dependent on opioid or alcohol are treated with withdrawal of the drug or prescription of medication that will antagonize alcohol or opioids. Symptoms of opioid withdrawal are monitored and discussed with patients by therapist. The fear of severity of side effects may deter patient from taking opioids.
- Operant Conditioning Behavioral Therapyutilizes a technique of reinforcement, punishment, and modeling techniques to alter behavior. Operant conditioning produces rapid successful results.
Reinforcement Operant Therapy:
Treatment is offered to patient suffering with anxiety, pain or phobia associated with chronic pain. Mood disorder such as anxiety or fear is often triggered by certain activities and may be associated with pain. Activities that could trigger mood disorder are walking, climbing and changing position from sitting or lying down to standing posture. Patients are requested to perform certain task, which provokes pain. Patient is given the assignment to complete same task several times a day under supervision of therapist. Patient is applauded or praised during the therapy sessions for completing the assignment and rewarded with gift or some kind of award.
Contingency Operant Behavior Therapy:
Performing certain activities provokes mood changes and severe pain. Therapist sets the goal for patients to tolerate the mood changes and severe pain. Therapist and patient are bound by signed written agreement suggesting patient will complete the task and therapist will provide guidelines. Contract describes the goal to tolerate mood changes and complete the task, which may provoke pain. Patient and therapist are expected to keep their side of the efforts to accomplish the set goal according to agreement. Failure of either party or one of the parties is considered as failure to accomplish the agreement.
Modeling Operant Behavior Therapy:
The operant behavior therapy of modeling involves a model patient as an example of an ideal patient coping with his problems of mood disorder and chronic pain. Patient following multiple back surgeries often suffer with mood disorder and chronic pain. Modeling technique involves participation of patient and model suffering with mood disorder and chronic pain. Therapist will discuss with patient how the model patient who has mood disorder and pain, secondary to multiple back surgeries is coping up with his problems. Modeling technique is sometimes combined with reinforcement therapy.
Extinction Operant Behavior Therapy:
Patient suffering with anxiety, anger and phobia are treated with extinction behavior therapy. Patient sometimes is afraid or is discouraged to continue the task because of possible increase in symptoms such as pain. Patient is given a choice of time out. So patient can stop the activities, which may provoke pain, which is defined as extinction of activities. Patient is encouraged to continue after few minutes.
Cognitive behavioral therapy refers to a range of techniques that focus on the construction and re-construction of people's cognition, emotions and behaviors.
Therapy involves analysis of negative thoughts, analysis of alternative thoughts and reinforces positive activities. Patients are educated to build a skill to manage emotional difficulties.
Following Conditions Are Treated With Cognitive Therapy:
- Chronic Pain
- Panic Disorder
- Eating Disorder
- Substance Abuse
Biofeedback is the method of treatment used by physical therapists and psychologists. Biofeedback involves teaching physiological method to control certain involuntary bodily processes such as heart rate, blood pressure, muscle tension and skin temperature. Information is monitor and feedback is given to the patients. Patients are taught to manipulate the reading of these instruments by using involuntary physiological mind to body control.
Monitoring Devices Are:
- Electroencephalograph (EEG) - Measures electrical activities of brain.
- Electromyography (EMG) - Measures skin electrical activities.
- Photoplethysmograph - Feedback thermometer.
- Electrocardiograph (EKG) - Monitors heart rate variability.
- Pneumograph - Monitors respiration rate.
- Rheoencephalograph - Monitors brain blood flow.
- Hemoencephalography - Monitors oxygenated or deoxygenated blood in brain by using infrared imaging technique.
Psychodynamic therapy tends to be briefer and less intense than traditional psychoanalysis. Psychodynamic therapy is also known as insight-oriented therapy. Psychodynamic therapy is effective in treatment of mood disorder and change of behavior that is influenced by unresolved conflicts and childhood maladaptation. Therapy is conducted at a frequency of once or twice per week. The therapy involves discussion, analysis, recognizing resistance, recollection of painful memories and Talk Psychotherapy.
Group therapy involves more than one patient or one or more therapists. Group of patients involved in psychotherapy are always small.
Group Therapy Includes:
- Talk Psychotherapy
- Cognitive Behavioral Therapy
- Support Therapy for Anger Management and Social Skills Development.
Gestalt therapy is also known as concentration therapy. This therapy is developed by Frederick and Laura Perls. Gestalt Therapy is a humanistic, holistic and experiential approach that does not rely on talking alone. Therapy facilitates awareness in the various contexts of life.
Gestalt Therapy Involves:
- Phenomenological Method
- Dialogical Relationship
- Field-Theoretical Strategies
Hypnotherapy is performed to achieve an unconscious level of thoughts, attitude, behavior, feeling and response. Therapist tries to explore and evaluate past thoughts, feelings and memories of the patients during hypnotic stage. Hypnotic state allows the patient to block the mood and chronic pain. Stage of hypnosis allows therapist to open the discussion without any modification by awake thoughts.
Hypnotherapy is useful in treating following mood disorders:
- Chronic Pain
- Panic Disorder
- Eating Disorder
- Substance Abuse