Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

617

Psychotherapies

Other Therapies Hypnosis

Hypnosis is a complex mental state in which consciousness is altered in such a way that the subject is amenable to suggestion and receptive to direction by the therapist. When hypnotized, the patient is in a trance state, during which mem ories can be recalled and events experienced. The material can be used to gain insight into the makeup of a personality. Though far less popular than it once was, hypnosis is used to treat many disorders, including obesity, substance use disorders (especially nicotine depen dence), sexual disorders, dissociative states, and sleep problems. Guided imagery Used alone or with hypnosis, with guided imagery the patient is instructed to imagine scenes with associated colors, sounds, smells, and feelings. The scene may be pleasant (used to decrease anxiety) or unpleasant (used to master anxiety). Imagery has been used to treat patients with generalized anxiety disorders, PTSD, and specific phobias, and as an adjunct therapy for medical or surgical disease. Biofeedback Biofeedback provides information to a person about their physiologic func tions, usually related to the autonomic nervous system (eg, blood pressure), with the goal of producing a relaxed, euthymic mental state. It is based on the idea that the autonomic nervous system can be brought under voluntary control through operant conditioning. It is used in the management of tension states associated with medical illness (eg, to increase hand temperature in patients with Raynaud syndrome and to treat headaches and hypertension) (see Table 29-6) . Paradoxical therapy With paradoxical therapy, the therapist suggests that the patient intentionally en gage in an unwanted or undesirable behavior (called paradoxical injunction )— for example, avoiding a phobic object or performing a compulsive ritual. This approach can create new insights for some patients. Sex therapy In sex therapy, the therapist discusses the psychological and physiologic aspects of sexual functioning in great detail. Therapists adopt an educative attitude, and aids such as models of genitalia and digital media may be used. Treatment is on a short term basis and behaviorally oriented. Specific exercises are prescribed, depend ing on the disorder being treated (eg, graduated dilators for vaginismus). In many cases, sex therapy involves couples, but individual sex therapy is also effective. Narrative psychotherapy Narrative psychotherapy emerges out of increased interest in clinical stories and incorporates two different sides of psychiatry: narrative medicine and nar rative psychotherapy. Narrative medicine uses narrative approaches to augment

Psychotherapies

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.