14. Psychological disorders and interventions Flashcards
What is a panic attack?
• Discrete period in which there is a sudden onset of intense apprehension, terror etc. • Often associated with a feeling of impending doom • May be accompanied by: - shortness of breath - palpitations - chest pain/discomfort - choking or smothering sensations - fear of losing control
What is agoraphobia?
- Disorder which develops as a complication of panic attacks
- May arise the fear of having a panic attack in a setting from which escape is difficult
- Sufferers avoid public or unfamiliar places where it is hard to escape
What does psychodynamic therapy involve?
Bring out our preconscious ideas into conscious awareness
e.g. exploring childhood traumatic experience can lead to symptom relief
What does behaviour therapy involve?
• Less focused on the cause of distress
• Belief that maladaptive behaviours are not symptoms of an underlying problem
- these behaviours are the problem
• Uses learning theory to understand the difficulties
What type of conditioning is a phobia development associated with?
Classical conditioning
• Experiencing a traumatic event in the presence of something unrelated
What conditioning reinforces a phobia?
Operant conditioning
• Avoiding the conditioned stimulus reduces fear
• This increases the tendency to avoid it
How can you treat a phobia?
- Exposure to the feared conditioned stimulus e.g. a car, in the absence of the unconditioned stimulus e.g. accident
- Controversial because of intense temporary anxiety
What does CBT for cardiac anxiety comprise?
- Psycho-education
- Relaxation techniques
- Cognitive restructuring
- Behavioural experiments
- Graded exposure
- Relapse prevention
What are the core features of CBT?
- Focus on problematic beliefs and behaviours that maintain disorders
- Here and now rather than original causes
- Goal oriented
- Collaborative relationship
- Brief
- Scientific approach
(Most useful for anxiety disorders)
Does CBT or anti-depressant medication lower relapse rates more?
CBT
What must be present to confirm someone is depressed?
5+ of the following symptoms present during the same 2-week period:
• Depressed mood or loss of interest
• Loss of appetite
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive guilt
• Recurrent thoughts of death
What 2 questions should you consider asking people who may have depression?
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?
Who should you consider anti-depressants for?
People with either:
• Past history of moderate or severe depression
• Sub-threshold depressive symptoms present for a long time
• Sub-threshold depressive symptoms or mild depression that persists after other interventions
Who should you not consider anti-depressants for?
To routinely treat persistent sub-threshold depressive symptoms or mild depression
Is there a clinical significance between the use of anti-depressants and placebo?
No, apart from at the more severe end of depression
For people at risk of relapse of depression, what should be offered to them?
Individual CBT
• For people who have relapsed despite medication
• For people with a significant history of depression and residual symptoms, despite treatment
Mindfulness-based CT
• For people who are currently well but have experienced 3+ episodes of depression
What is mindfulness-based cognitive therapy?
- Paying attention in a particular way - on purpose, in the present, non-judgementally
- Recognising thoughts as thoughts
What does acceptance and commitment therapy (ACT) involve?
- Form of cognitive therapy
- Focuses on ideas of being present, observing thoughts, discovering what is important to you and seeing yourself as unchanged
When has ACT been useful?
Chronic pain
• Due to physical progressive de-conditioning - reinforced avoidance cycle
• Pain comes with decreasing activity
• Lower mood also increases perception of pain
• So ACT helps with this
• Enhances general, physical functioning compared to CBT
