Introduction
In this essay, we will discuss questions about how depression, schizophrenia and eating disorders are explained in different theories and approaches. Also, there will be addressed questions about the treatment of these mental diseases, about techniques used by therapists of different psychotherapy approaches in the treatment of listed diseases and effectiveness of some approaches.
1. Description of different explanation of depression, schizophrenia and eating disorders
1. 1. Psychodynamic explanation of schizophrenia
According to the psychodynamic theory, one of the reasons of schizophrenia is a destruction of the organization "ego", which affects the interpretation of reality and the needs of the internal control (aggression, sexual needs, etc.). The source of these conditions is disruption of the relationship between an infant and a mother.
1.2. Family-centred explanation of schizophrenia
Despite the fact that the role of the family is not proved as an etiologic factor in the development of schizophrenia, there are some theories, considering a family as a possible factor in developing this mental disease. The theory of Bateson indicated the role of specific family situation in which a child is forced to make constantly a choice between two alternatives. Every choice is emotionally undesirable for a child, and a child experience a constant stress and confusion.
In his theory, Lidz describes two types of pathological behavior in the family. The first is a significant "split" between parents, one of which is very close to a child of the opposite sex. The second is the dominance of one of the parents, in connection with what is expressed "imbalance" in the family structure and family relationships (Cullin, 2006).
1.3. Family-centred explanation of eating disorders
One of the theories on is the theory “psychosomatic family”. Minuchin and his colleagues suggested that there is some family context which can influence the development of anorexia nervosa. Authors indicated that families of patients with eating disorder had some similar features. For example, Minuchin points out that there are also ignoring of emotional family conflicts, avoiding conflicts and involving children in conflicts between parents among other causes of anorexia. Also, a family interaction of a teenager suffering from anorexia can be characterized by features such as overprotection of a child by parents and high control over a child. Because of this overprotection and control of parents for a teenager, the body can remain the only "space", where he/she can guard her/his autonomy and separate oneself from parental demands (Latzer, Merrick, & Stein, 2011, p. 226).
Another theory discussed the role of the family in the development of eating disorders is the AMC theory of Treasure et al. Authors of the theory suggested that family members have some antecedents (A) which influence the development of an eating disorder of another family member. For example, if parents demonstrate a high level of anxious, their child also feel anxiety and cope with this feelings by engaging in symptoms of eating disorders. Also, parents can give different meanings (M) to an eating disorder of their child. For example, they can believe that their child tries to take revenge on them; they can be sure that the eating disorder of a child is linked to his/her personality type or that this disorder is a form of suicidal, self-destructive behaviour. Different meaning applied to eating disorders by parents cause different maladaptive behaviours such as overprotection of a child, hostility and criticism toward a child (Latzer, Merrick, & Stein, 2011, p. 230).
1.4. Sociocultural explanation of eating disorders
One of the most common explanations for the eating disorder is a theory according to which sources of eating disorders are beauty ideals, socio-cultural standards of beauty, broadcasted by mass media (Shapiro, 2011, p. 10).
For example, the survey, conducted by D. Garner among readers of Psychology Today magazine, men and women answered questions about the impact of media images have on their perception of their appearance. About 27% of women and 12% of men answered that they always or often compare themselves with models from magazines. Among women who were not satisfied with their appearance, 43% of respondents often compared themselves with models from magazines.
Behavioural approaches based on the concept of depression as a consequence of a lack of positive reinforcement because of the environmental problems or lack of communication skills. Intervention is expected to control the circumstances, to provide social skills training, including development of self-confidence, problem-solving and self-training.
For example, individuals suffering from depression may try to avoid various unpleasant for them situations. But this inefficient behaviour of patients with depression only increases their isolation and depressive symptoms (Harris, Kelley& Shepard, 2015, p. 360).
Cognitive approach in explanation of depression
One of the cognitive-behavioural theories is REBT. Ellis, the author of REBT (Rational Emotive Behaviour Therapy), indicates that people, as a rule, think, behave, feel emotions and perceive a situation simultaneously. That`s why emotions, thoughts, behaviour and perception of a situation are connected with each other and can influence each other. Irrational thoughts, unrealistic expectancies, etc. can become the reason of negative emotions and feelings. Consequently, if a person wants to get rid of own fears and other destructive emotions, feelings, he/she need to explore and to change his/her irrational thoughts.
2. Different therapeutic strategies used in the treatment of psychological disorders and explanation for theoretical basis of different therapeutic strategies
2.1. Maudsley family-centred model in treatment of patients with eating disorders
According to Maudsley model, work is done with the entire family of the patient with eating disorders. The therapist helps the family to cope with the symptoms of the disease, to determine the correct diet for the patient. Also, the therapist helps the family to cope with feelings of guilt and self-blame, helps parents learn how to interact effectively with their children to help them to recover (Fox & Goss, 2012, p. 266).
2.2. Behavioural therapy for eating disorders
Cognitive-behavioural therapy is used to treat mental and emotional elements of an eating disorder. This type of therapy is carried out to change attitudes towards food, process food and body image; help to correct the wrong eating habits, and to prevent relapses.
2.3. Behavioural therapy of depression
Behavioural therapy of depression may be focused for such purposes as identifying those situations that trigger avoidance, defining behaviour that can result in positive reinforcement, setting achievable goals, developing skills of realistic evaluation of own actions, developing ability of praising yourself for goal-orientation actions (Harris, Kelley& Shepard, 2015, p. 360).
2.4. Cognitive therapy of depression
The primary goal of rational emotive behavioural therapy, one of the cognitive therapy approaches, is to change a thinking process of a client. Cognitive therapists believe that different symptoms of depression are caused by negative thoughts, prejudices, biases, ideas. An individual with depression, as a rule, tends to believe that his/her ideas are facts. That`s why cognitive therapeutic techniques are directed to teaching a client to think more rationally, to observe own thinking process, to explore own irrational thoughts.
Techniques used by REB therapists are Socratic dialog, designing of cognitive experiments, making of daily records about own dysfunctional thoughts by a client, doing homework, etc. Cognitive experiments, for example, are used to check if some idea, belief or bias of a client corresponds to reality and facts (Beck & Alford, 2009).
2.5. Supportive psychodynamic psychotherapy for schizophrenia
Supportive, psychodynamic psychotherapy focuses on different difficulties of patients with schizophrenia. Main purposes of SPP are developing of realistic cognition of surrounding world in patients with schizophrenia, developing a capability to maintain a daily living, to support oneself and to maintain an interpersonal relationship, etc. Also, SPP aimed to help people with schizophrenia to recover from psychosocial losses associated with their condition, to understand better the nature of their disease, etc. Therapists using psychodynamic approach can analyse phenomena such as transference, countertransference, unconscious states and thoughts. Therapists use a therapeutic relationship with a patient to understand better what problems can arise in a patient`s daily interpersonal interactions (Rosenbaum, Harder, Knudsen, Køster, Lindhardt, Lajer, Valbak & Winther, 2012, p. 334-335).
2.6. Culturally Informed Therapy for Schizophrenia
Culture Informed strategies include different segments of family therapy and other approaches. This type of therapy aimed to help not only patients with schizophrenia but also their family members. CIT directed to change or encourage adaptive and maladaptive behaviour, beliefs and practices which can influence the illness in a positive or negative way.
The first goal of CIT is encouraging family collectivism. Therapist help patients and their family members to understand that all they are a part of a family unit, that they have similar goal (to improve patients` health), etc. at this stage of intervention, participants of therapy write narratives where they identifying their family roles and their impact on other family members, etc. A therapist directs family members and patients to understand that family system works as whole, and family members can influence each other as well as they can influence patients` psychiatric condition (Weisman de Mamani, Weintraub, Gurak & Maura, 2014, p. 802).
Spiritual coping, the next step of CIT, includes questions about the meaning of life, God, spiritual practices, etc. family members and patients can discuss their practice and beliefs associated with GOD and religion, or just talk about philosophic problems or spiritual practices such as forgiveness, empathy, etc. The therapist also can indicate some maladaptive ideas of family members and patients about schizophrenia (for instance, that this mental disorder is a punishment from GOD) and try to refute these ideas.
The next module of CIT includes training of communication skills. It helps patient and family members to learn how to interact and communicate with each other in a more supportive way, more efficiently. At this stage of therapeutic intervention role-play and discussion is used.
The last module of CIT is associated with development problem-solving skills. It is expected to teach patients and family members to manage different challenges linked with the mental condition (Weisman de Mamani, Weintraub, Gurak & Maura, 2014, p. 803).
3. Evaluation of the effectiveness of different treatments for schizophrenia
The study of Rosenbaum et al. showed that two years of using supportive, psychodynamic therapy for patients with schizophrenia had an influence of improvement in the social functioning of patients with schizophrenia. Researchers compared the effect of usual treatment and treatment with using psychodynamic therapy. Of course, psychotherapy was used as an additional method of treatment. The total sample included 269 patients, 119 patients were exposed to SP psychotherapy (Rosenbaum, Harder, Knudsen, Køster, Lindhardt, Lajer, Valbak & Winther, 2012, p. 338).
Results of study conducted by Weisman de Mamani et al. also showed that patients who went through of Culture Informed therapy together with their family members, demonstrated lower degree of severe psychiatric symptoms rather than patients who went through psychoeducation only (Weisman de Mamani, Weintraub, Gurak & Maura, 2014, p. 806).
Conclusion
There are many approaches and theories that explain the cause of the depression, eating disorders and schizophrenia, as well as practical psychotherapeutic models that offer different perspectives on the treatment of these disorders.
Analysis of data on the treatment of listed disorders shows that modern therapeutic approaches often focus on the integration of different therapeutic models in therapy with depressive patients, individuals with eating disorders and schizophrenia. In most cases, however, psychotherapeutic methods are an additional means of treatment rather than the necessary treatment. Psychotherapeutic techniques aimed to adapt individuals with certain disabilities to social life and restore their capacity for interpersonal interaction. Psychotherapy can significantly improve the efficiency of primary treatment and to provide the individual with a particular disorder, not only to get rid of the symptoms but also to promote well-being.
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