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After reading this article you will learn about the treatment of psychoneurotic disorders.
The knowledge of the patient’s symptoms, past history and overall personality is essential for diagnosis and treatment. Hence most psychiatrists prefer to conduct initial interview to obtain detailed case history of the patient. When the case history is supplemented with intelligence and personality tests, the treatment becomes more effective.
Though it appears from the case history that the patient is suffering from psychoneuroses, a physical examination also becomes essential as physical disorders occasionally give rise to typical psychoneurotic symptoms. Therefore, case history, psychological tests and physical examinations become essential to diagnose psychoneurotic disorders.
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While many medical, psychological and sociological treatment procedures seem to enter into the therapy of neurotic disorders the exact treatment depends upon the individual disease of the patient. Treatment in-fact, varies with the type of neurotic disorder that a person is suffering from.
Coming to the traditional individual psychotherapies, psychoanalysis, client centred and Gestalt therapies deal with neurotic disorders. More recently other methods have come into existence; such as behaviour modification, bio feedback and chemical treatment, etc. These recent therapeutic procedures seem to be helpful depending upon the type of neurotic disorder.
Individual Psychotherapy:
Psychoanalysis is a major form of individual therapy. Under this method psychoneurotic are required to talk about their problems and conflicts, stresses and critical life events to a therapist. Freud realized that the success of Psychoanalysis as a method of treatment depended on the patient’s ability to understand the emotional significance of an experience and to retain the insight.
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Psychoanalysis tries to bring repressed materials back to the consciousness, so that the patient can understand his own needs and motives and thereby may find a realistic solution to the conflict.
Freud therefore emphasised on the classical psychoanalysis technique which attaches least importance to the immediate relief of the symptoms but gives moral support to the patient along with guidance and counselling.
The regression induced by the analytical situation allows for emergence of infantile conflicts and thus induces the formation of a transference neuroses where the original infantile conflicts and wishes become focused in the analyst and are re-experienced. Free association is the cornerstone of psychoanalysis where the patient relates freely everything that passes through his mind.
The analysis of resistance is the basic function of the analyst and interpretation is the chief tool. The patient projects his love or hatred towards the specific people on the analyst. Thus the analyst alternatively becomes a friend or an enemy and accordingly loved or hatred.
For the success to such therapeutic procedure, the neurotic person must show some sort of evidence of stability on and off the job situation, and with the family in particular. He should be able to deal with his emotions in a more or less normal way and should have symptoms which are well defined.
Thus, “the neurotics who are not very disturbed and can focus on and deal with a clearly defined set of problems, probably will do best in individual psychotherapy.” In fact, the clearly delineated phobic disorders respond well to individual psychotherapies.
Currently some psychoanalysts have attempted to bring some modifications in classical analysis technique by means of psychopharmacologic agents. In view of this a number of psycho-pharmacologists work as consultants currently for the implementation of psychoanalysis. Some psychoanalysts have also modified time and frequency of psychoanalytical session keeping in view the need of the patient.
Behaviour Modification Therapy:
More recently much attention has been diverted to the application of behaviour therapy for the treatment of neuroses. While the analyst’s goal is to search the underlying conflicts leading to the formation of symptoms the behaviour modifiers view the symptoms themselves as the most important aspect of a disorder.
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Behaviour modification therapy stresses that the maladaptive responses and neurotic symptoms occur because of learning and hence can be unlearned. De conditioning procedure is a fine example of this.
Watson and Rayner (1920) suggested that repeatedly presenting the feared object alone and then presenting it in pair with pleasurable events can neutralize fear response. Currently, these two approaches are called habituation and reciprocal inhibition and these methods have been successfully used specially with phobic patients.
Wolpe (1958) reports that out of 210 neurotic patients, mostly anxiety neurotics, 188 recovered by the conditioning procedure, using group desensitization procedure. Lazarer (1961) could be able to cure 13 out of 18 phobic patients.
Coleman concludes that although the precise advantage and limitations of behaviour therapy remain to be worked out, it appears to have most promising implications for the treatment of neurotic reactions.
Goldfried and Davison (1976) view that “of all neurotic disorders, phobic disorders appear to be most amenable to behaviour modification such as the reciprocal inhibition.” Similarly, Response Prevention has been effectively used with obsessive compulsive individuals.
In this technique people are placed in the type of environmental situation that produces the obsessive compulsive behaviour, but they are prevented from expressing the behaviour.
In Flooding, the patient is forced to experience the obsession or fear a number of times. After repeated trials in which the obsessive thought is experienced, the patient appears to adopt to the presence of the fear or obsession. As a result of such adaptation, the person may no longer need to use the phobic or obsessive strategy.
According to Hebbs (1962), “today increased emphases are put on modifying patterns of behaviour which are disturbing the patient and impairing his immediate adjustment. In this process an attempt is made to help the patient correct faulty assumptions about himself and his world, to perceive the full range of possibilities in his situation to develop more effective coping techniques and to attain greater personality integration,”
In short, insight must be implemented to learning experiences if it is to be of maximal therapeutic value. Sociological aspects of treatment similarly tries to modify the circumstances in the patient’s life situations responsible to elevate his neuroses. Through sociological treatment for example, pathogenic family interactions, increasing stresses strains can be reduced and conditions for good adjustment can be produced.
Bio-Feed Back:
The above discussed therapeutic procedures deal anxiety through cognitive and behavioural means. These methods view the automatic anxiety responses as targets of change. Duke (1979) holds that in bio-feed back the person is more directly taught to control automatic functioning and control decreases the feeling of anxiety.
Blanchard and Young (1974) have got the proof of successful treatment of anxiety neuroses through bio-feed back as reported by Duke. The patient, a 50 years old anxiety neurotic with weakness and speeded up heart beat was attached to bio-feed back equipment that sounded a change in audio tone when he was able to relax enough to show his heart beat.
As reinforcement, the man was paid out for every 10 seconds; his heart beat was below a certain rate. At the beginning of training, the man had a rate of 96 beats per minute. At the end of 19 trials, his rate was 14 beats slower and remained so even after training and rewards were stopped.
The man also reported that he felt less anxious and stronger. Though the effectiveness and worth of this method cannot be proved from a single case, further research in this area is essential to establish bio-feed back as a promising technique to deal with anxiety.
Biological Approaches:
Psychoanalyst and learning theorists have been debating over the effectiveness of drug therapy. It is a fact that tranquilizers deal only with the symptoms of neurotics. Duke holds that although tranquilizers such as meprobamate and valium would probably decrease the anxiety level of a dissociative hysteria, the person might still show the characteristic picture of dissociative hysteria minus anxiety.
Similarly barbiturates may alleviate symptoms of insomnia in anxiety neuroses and depressants like imipramine may elevate mood in depressive neuroses.
However, drugs have proved highly effective in reducing depression, anxiety and tension in neurotic patients. Electro convulsive therapy and counselling jointly help in depressive reactions. Shock therapy in combination with drug therapy shortens the duration of treatment Electric shock has also been replaced by anti depressant drugs in the treatment of reactive depressions.
In reducing anxiety and tension and stabilizing emotional reactivity tranquilizing drugs have also proved very helpful. As a result of the application of and depressant and tranquilizing drugs, the patients have been able to function more effectively in meeting the demands of life.
Rothman and Sword report favourable effect on the use of sodium pentothal in obsessive compulsion reactions. Similarly the technique “Thought stopping” is being used successfully in the case of obsessives.
In general, such biological and medical approaches are only auxiliary and supplementary to psychological treatment which emphasises on to helping the patient to understand the dynamic significance of his symptoms, how they come about and why he uses them. It also helps him to find more adequate and effective means of dealing with his personal, social and emotional problems.
One of the important disadvantages of drug treatment is that drugs may have several undesirable after effects, starting from minor symptoms like nasal congestion and drowsiness to gastro intestinal bleeding and hepatitis. In several cases drugs are also habit forming. However, drug treatment may relieve one from anxiety, tension and depression.
It is to be accepted without reservation that psychotherapy or socio- therapy is always above drug therapy, specially where personality changes are necessary or where incidents of life lead to neuroses. Drugs should be therefore supplemented with some form of psychotherapy.
Within such a therapeutic relationship, the danger of becoming psychologically and in some cases physiologically addicted to the tranquilizing increases dramatically.
As Nemiah (1975) states “Drugs should never be allowed to become a substitute for a relationship with a doctor.” An overall analysis of the common therapeutic procedures does reveal that a common limitation in therapy is the treatment of the symptoms, rather than underlying personality difficulties.
Hysterical symptoms for instance, may be removed through hypnosis. But unless the underlying conflicts are properly handled by psychotherapy the same neurotic symptoms may soon reappear.
In-spite of these pitfalls and shortcomings, psychotherapy it is true does help many patients. Psychotherapy in particular is helpful to those who have sufficient insight into their problems and who seriously desire to have a well adjusted personality, keeping in view, brief forms of psychotherapy, psychoanalysis and psychobiology.
Client centred psychotherapy, group therapy are also being largely used in the treatment of psychoneurotic disorders.