Alternative therapies behavioral therapy

Twenty years ago the dislike of traditional treatment may have presented some real challenges. Today, however, there are many more treatment alternatives to which a client can be referred to if she or he would not match well with a traditional treatment facility. A good referral might be to a psychologist or other therapist who practices cognitive behavioral therapy for individuals. In addition, the advent of the Internet era allows for new and creative treatment alternatives even for people in small communities. 

Considering the need, if any, for alternative treatments (e.g., psychotherapy, behavioral therapy, or alternative medications)... 

Alternative, nondrug management of anxiety (e.g., behavioral therapies, relaxation techniques, psychotherapy, or cessation of stimulants such as caffeine whenever possible)... 

When it comes to alternative medicines and therapies that, like gingko biloba, claim to enhance your brain function, never underestimate the power of your own expectations. Not only does your brain influence how you think and feel, but the nature of your thoughts and expectations can influence how your brain and body functions. Thus, if you expect that a drug will act in a certain way on your brain and behavior, then it is much more likely to do so, at least for a while this is the essence of the placebo effect. It s ironic, and possibly way too convenient, that your brain decides for itself how it will experience the drug that it has decided to take. 

When they occur, depressive symptoms should be treated actively using a combination of cognitive-behavioral therapy and an antidepressant drug. Of the available antidepressants, selective serotonin reuptake inhibitors (SSRIs) have the most favourable combination of efficacy and side-effect profile for the elderly, regardless of the presence of medical co-morbidities. Although the dual agent venlafaxine has been proposed as an alternative agent for older patients who are either non-responders or partial responders to SSRIs, the frail elderly may be particularly vulnerable to its side effects (Hayes 2004). 

Alternatively, consider memantine or cholinesterase inhibitor therapy alone. Behavioral symptoms may require additional pharmacologic approaches. 

Stimulants. A handful of case reports hint that treatment with stimulants (meth-ylphenidate or dextroamphetamine) can help manage behavioral agitation in patients who have suffered a TBI. Certainly, stimulant therapy helps control the impulsivity and hyperactivity of children with attention deficit-hyperactivity disorder. Despite these encouraging signs, we have to discourage any routine use of stimulants when attempting to manage behavioral lability in TBI patients. Because stimulants have the potential to exacerbate behavioral lability, we recommend that they only be considered when other medication alternatives have been exhausted. 

Because antipsychotic therapy has shown only modest efficacy and poses a substantial risk of undesirable side effects, medications traditionally used to treat disruptive behaviors and aggression in other psychiatric and neurologic disorders have been suggested as potential alternatives. These alternatives include benzodiazepines, buspirone, carbamazepine, selegiline, and SSRls. 

Should antipsychotics fail to manage noncognitive behaviors, available evidence suggests that a trial of citalopram or carbamazepme may be appropriate second-bne alternatives. Only minimal evidence exists to support the use of valproate in this population. Lithium has shown no benefit and frequent toxicity. Clearly, more rigorous placebo-controUed studies are needed to determine the relative efficacy and place in therapy for these medication alternatives. 

Narcolepsy is characterized by hypersomnia. Some patients respond to treatment with tricyclic antidepressants or MAO inhibitors. Alternatively, CNS stimulants such as amphetamines may be useful. Therapy with amphetamines is complicated by the risk of abuse and the likelihood of the development of tolerance and a variety of behavioral changes (see above). Amphetamines may... 

C. Clinical Use Lithium carbonate is used in the treatment of bipolar affective disorder (manic-depressive disease). Maintenance therapy with lithium decreases manic behavior and reduces both the frequency and the magnitude of mood swings. Drug therapy with neuroleptics or benzodiazepines may also be required at the initiation of lithium treatment. Antidepressant drugs may be required adjunctively during maintenance. Alternative drugs of value in bipolar affective disorder include carbamazepine, clonazepam, gabapentin, and valproic acid. 

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