BROOKHAVEN HOSPITAL AUGUST 1, 2012 “THE CASE FOR PSYCHOTHERAPY”

1. BROOKHAVEN HOSPITALAUGUST 1, 2012“THE CASE FOR PSYCHOTHERAPY” DENNIS CAVENAH, MS, LPC, LMFT, CEAP

2. THE CASE FOR PSYCHOTHERAPY • Psychotherapy: • Licensed Health Care Providers: Licensed Professional Counselors LPC Licensed Behavioral Therapist LBP Licensed Marital & Family Counselors LMFT Licensed Social Workers LCSW Licensed Alcohol & Drug Counselor LADC MD Specialty In Psychiatry RN with Psychiatric Training

3. THE CASE FOR PSYCHOTHERAPY • Therapy & Your Brain: • Involves the Limbic System & Prefrontal Cortex • Limbic = memory & emotion • Prefrontal Cortex = planning, judgment, self-control

4. THE CASE FOR PSYCHOTHERAPY • Psychotherapist Practice: • Neuroscience? • Rumpelstilskin Affect • Voodoo? • Witch Doctors? • Shamans?

5. THE CASE FOR PSYCHOTHERAPY • What psychiatric disorders benefit from psychotherapy treatments?????? • Phobias • Obsessive-Compulsive Disorders • Depression • Bi-Polar Disorder (Whatever that means!!) • Addictions • Anxiety Disorders • Panic Disorders • Ptsd

6. THE CASE FOR PSYCHOTHERAPY • When are Antidepressants Better Than Psychotherapy? • 2005 DeRubeis et al., study of 240 patients: • 1. Pts. On Anti-depressant got better quicker. • 2. Pts. Cognitive therapy worked as well as antidepressant therapy on moderate to severe depression. • 3. @ 16 weeks 58% of both groups were better. • 4. Pts. Who quit Paxil after 16 weeks relapse rate twice that of psychotherapy patients. • 5. Concluded psychotherapy more effective and less costly in long run.

7. THE CASE FOR PSYCHOTHERAPY • SSRIs vs. Placebo • 2005 Arrol et. Al., based on 15 studies concluded: • 1. Adults responded to 56% to 60% to antidepressants. • 2. compared to 42% to 47% for placebo. • 3. 40% to 44% did not improve at all.!!!!!! • 4. Concluded only 13 to 18% actually benefited from antidepressant treatment.

8. THE CASE FOR PSYCHOTHERAPY • 2000, VHA-DOD; Veterans Health Administration of Department of Defense. • 1. Pharmacotherapy & psychotherapy recommended for tx. of moderate to severe depression. • 2. Mild to moderate depression with a motivated patient psychotherapy is warranted,

9. THE CASE FOR PSYCHOTHERAPY

10. THE CASE FOR PSYCHOTHERAPY • Effective Therapist Vs. Ineffective Therapists (?) • 1. Professional training is of little importance. • 2. Years of experience have little impact. • 3. Little difference in theoretical training. • 4. Have more positive alliance with their pts. • 5. “Master Therapists”; emotionally receptive, psychologically healthy, good relationship skills. • 6. Some differences in understanding clinical materials, greater complex cognitive skills, have curiosity in difficult cases.

11. THE CASE FOR PSYCHOTHERAPY • The Psychotherapist as a Neuroscientist • A Safe and Emphatic Relationship • The Importance of Stress • The Importance of Language(co-construction of narratives) • Language of Therapeutic Alliance: • 1. Reflexive Social language. • 2. Internal language. • 3. Self-Reflection.

12. THE CASE FOR PSYCHOTHERAPY • The positive affects of psychotherapy on the treatment of depression. • Identify distorted thinking patterns. • Understand everyday circumstances and events. • Regain a sense of control and pleasure in life. • Explore behaviors that might contribute to a low mood.

13. THE CASE FOR PSYCHOTHERAPY • Treatments for PTSD: returning soldiers, etc. • Exposure Based Therapy • In Vivo-Imaginal Therapy • Systematic Desensitization Cognitive Therapy Anxiety Management Therapy ++EMDR vs. CBT CBT significantly better treatment for PTSD (Deville & Spence 1999)

14. THE CASE FOR PSYCHOTHERAPY • Shared common feature of most psychotherapists • An office, designated to help with emotional distress; i.e., “edifice complex,” diplomas etc. • The client and the therapist have well defined roles. • A conceptual scheme or theoretical system to explain a client’s suffering. • The therapists conceptual scheme which drives the treatment procedure both participate in.

15. THE CASE FOR PSYCHOTHERAPY • THE BUY IN • 1. Psycho-education. • 2. Define the diagnosis vs. the problem. • 3. Review the tx. Methods, referrals. • 4. Coordination of care letter to other tx. Providers. • 5. Written material to review.

16. THE CASE FOR PSYCHOTHERAPY • TRUTH OR MYTHS • Therapists can predict behavior. • Therapists are experts. • Therapists have inherit intuition. • Therapists years of experience make them better. • Therapist can use diagnosis and prediction for future behavior. • Licensing protects the public.

17. THE CASE FOR PSYCHOTHERAPY • DEPRESSION FACTS: • 1. 4TH LARGEST MEDICAL PROBLEM IN THE WORLD. • 2. TREATMENT COSTS ESTIMATED $50 BILLION • 3. 50% CTS. WITH SEVERE DEPRESSION DO NOT RESPOND TO ANTI-DEPRESSANT MEDICATIONS. • 4. MULTIPLE STUDIES INDICATE CBT MORE EFFECTIVE THAT ANTI-DEPRESSANT EVEN WITH SEVERE OR VEGETATIVE DEPRESSION.

18. The case for psychotherapy • DEPRESSION FACTS: • 5. 1ST LINE TREATMENT FOR MOST PTS. IS MEDICATION, RX. PCP. • 6. HIGHER RELAPSE RATE WITH THOSE TX. WITH ANTI-DEPRESSANTS ONLY. • 7. AVERAGE LENGTH OF DEPRESSION UNTREATED = 8 MONTHS. • 8. DEPRESSION IS NOT A RESULT OF • “CHEMICAL IMBALANCE.” • 9. ANTI-DEPRESSANTS DO NOT TX. DEPRESSION ONLY TX. SYMPTOMS.

19. The case for psychotherapy • 10. RELAPSE RATE CONNECTED TO SIDE AFFECTS OF MEDICATIONS. • 11.TAKES 6 WEEKS FOR MEDICATIONS TO WORK MINIMUM LENGTH OF TX. WITH MEDICATIONS IS 6 MONTHS. • 12. PTS. TX. ONLY WITH MEDICATIONS HAVE A 80% CHANCE OF RELAPSE. • 13. COMBINATION OF PSYCHOTHERAPY AND MEDICATIONS WORKS WELL WITH SOME DEPRESSION.

20. THE CASE FOR PYSCHOTHERAPY References: • Antonuccio, David O., Danton, William G., & DeNelsky, Garland Y. Psychotherapy Versus Medication for Depression: Challenging the Conventional Wisdom With Data Professional Psychology: Research and Practice. December 1995 Vol.26, No. 6, 574-585. • Kirsch I, Moore TJ, Scoboria A, Nicholls SS (2002) The emperor's new drugs: an analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prev Treat. 5. article 23. Available: Accessed 15 July 2002. • Frank & Frank, “Persuasion and Healing, A Comparative Study of Psychotherapy, 3rd Edition, 1993. • Fancher, Robert T. Cultures Of Healing, 1995. • Lilienfeld, Lynn, Lohr, Ed., Science & Pseudoscience in Clinical Psychology, 2003. • Dawes, Robin, House of Cards, “Psychology & Psychotherapy Built on myth, 1996 • Cozolino, Louis, The Neuroscience of Psychotherapy, 2002 • Torrey EF. Witchdoctors and Psychiatrists - The Common Roots of Psychotherapy and Its Future. revised ed. New York: Harper & Row, 1986.