1st wave: Behavioural interventions

Question 1

who referred to them and what are the 3 waves?

why are they called waves?

Answer 1

Hayes (2004)
behavioural interventions
cognitive and cognitive behavioural therapy
acceptance of mindfulness based therapies

they follow each other

Question 2

why was the first wave developed?

Answer 2

criticisms of what came before
Eysenk (1900)
- critical lack of empirical support for lengthy psychodynamic approach which took 8-10 years, this is too long and expensive for NHS

Question 3

what does the behavioural model say?

Answer 3

behaviour, including abnormal/maladaptive behaviour, is learned
environmental conditions shape and maintain behaviour
happens through classical and operant conditioning

Question 4

link between behaviour and MH

Answer 4

for MH problems to develop the environment is not providing you with what you need
locates the problem within the environment not the individual

Question 5

what are behavioural interventions?

Answer 5

not just one specific method - multiple methods
primarily aimed at helping the individual change their behaviour
graded exposure rather than flooding
changes in behaviour can lead to changes in thoughts/feelings

Question 6

Carvelho and Hopko

Answer 6

Behavioural model of depression
Certain environmental changes and avoidant behaviour inhibit individuals from experiencing rewards and punishments leading to development and maintenance of behaviour
decreases in interactivity with environment leads to reduction in positively reinforced healthy behaviour
avoidance is central to development and maintenance of depressive symptoms

Question 7

Farmer and Chapman (2015)

Answer 7

cause is not located within the individual
reduction in access to positive reinforcers
depression results from person-behaviour interactions

Question 8

Behavioural changes that maintain depression

Answer 8

sleeping for long periods of time and rumination
engagement in fewer pleasant activities - reduced exposure to environmental reinforcers which may have an antidepressant effect
low motivation/energy - less reward from doing things, feel worse, repeat

Question 9

TRAP and TRAC model

Answer 9

Jacobson, Martell and Dimidjian (2001)
model of behavioural maintentance of depression
an event serves an a trigger for an aversive response
client then avoids the activity resulting in a pattern of avoidane behaviour
this prevents them from resolving problmes or contacting possible reinforcers

Question 10

Jacobson, Martell and Dimijian (2001)

Answer 10

Re-engaging in activities is initially stressful
avoidance leads to greater long-term consequences
- adds new problems from avoidance
- reduces exposure to potentially antidepressant reinforcers

avoidance is negatively reinforced by associated reduction in short-term stress

Question 11

What is behavioural activation (BA)

Answer 11

attempts to increase behaviours bringing the client in contact with positively reinforcing environments

developed as a stand along treatment

helps identify environmental sources of depression

targets behaviours that may maintain/worse depression

also focuses on avoidance behaviours

Question 12

Farmer and Chapman (2015)

Answer 12

BA is an effective, economical therapy for reducing depressive symptoms
all about person-environment interaction
BA focuses on life content not the inner causes, flaws or defects

Question 13

Phases of BA

Answer 13

Farmer and Chapman (2015)

1) self monitoring activities and mood and association between the two
2) using problem solving and behavioural experiments to identify activities associated wit positive moods
3) blocking avoidance behaviours and facilitating approach behaviour
4) decreasing vulnerability to future episodes of depression

Question 14

Jacobson et al (1996)

Answer 14

RCT based component study of CBT for depression
3 conditions
1) BA
2) BA and modifying automatic negative thoughts
3) BA and ANT and addressing core schemas

all 3 conditions

• equally effective at reducing depressive symptoms post therapy and 6+24 month follow up
• associated with increases in engagement in enjoyable activities and reduction in negative thoughts
• included BA but BA doesn’t focus on negative thoughts therefore negative thinking can be changed without CT

Question 15

Dimidjian et al (2006)

Answer 15

Component study + Partial replication of Jacobson et al (2010)
compared BA vs full CBT vs Antidepressant medication VS placebo
for high severity depression
- BA and ADM equivalent but more effective than CBT
for low severity depression
- no difference in effectiveness between active treatments
suggests changing negative thoughts doesn’t necessarily help

Question 16

Mazzuchelli, Kane and Rees (2009)

Answer 16

Meta analysis of 34 studies comparing BA to control conditions (wait-list and TAU)
4 different forms of BA
- significant difference in favour of BA compared to controls
No sig difference between BA and CT

Question 17

Strenghts of BA

Answer 17

suitable for range of clients
suitable for self-help
cheaper to deliver - use of less experienced staff
easier to train staff
simpler treatment
based on current evidence - BA just as effective for depression as CT and CBT

Question 18

Limitations of BA

Answer 18

Mazzuchelli, Kane and Rees (2009)
some had poor quality design
some used wait-list controls - tells us only that better than nothing
few studies included a follow up of more than 3 months- need it to be longer if want treatment to last longer
unclear what the active ingredients are - need to look at all components to see effectiveness
more recent versions of BA only tested small number of studies - not a large evidence base

Question 19

Exposure-based interventions

Answer 19

for anxiety
repeated and systematic confrontation of feared stimuli
thought to be essential for psychological interventions focused on anxiety

Question 20

How do Exposure-based interventions work?

Answer 20

client is gradually exposure to the situation that causes them distress
the goal is to create a safe environment to reduce anxiety, decrease avoidance and improve quality of life
extinction learning is the mechanism of change

Question 21

What is extinction learning

Answer 21

gradual decrease in response to a conditioned stimulus that occurs when the stimulus is presented without reinforcement

Question 22

Does extinction involve learning a prior conditioned association?

Answer 22

suggests that it does not
involves a new learning process when the individual comes to hold two meanings and a potential response to the same stimuli
old conditioned response doesn’t disappear, if a similar situation appears it may make it come out

Question 23

Types of behavioural interventions for anxiety

Answer 23

Flooding 
Modelling 
Systematic desensitisation
In-vivo exposure - best evidence for
- in real life, gradual and done in NHS

Question 24

what is In-Vivo exposure?

Answer 24

goal is the extinction of phobic reaction not suppression like SD
gradual approach not flooding
requires client to leave consulting room to work on hierarchy - this takes time

Bring exposed in real life to the thing/situation you are afraid of

Question 25

Case study for in-vivo exposure

Answer 25

Sara aged 24 - agoraphobia
hadnt left the flat in 8 years
gets panic attacks
feels panicky just thinking about leaving her flat
even with partner won’t use public transport or go to busy places
wants to be independent and able to pick her daughter up from school

Used Graded exposure hierarchy
begin by looking at the door eventually leave and go to shops
each stop needs to have some anxiety otherwise motivation may be lost

Question 26

Ougrin (2011)

Answer 26

Systematic review and meta analysis of 20 RCT
comparing CT to exposure therapy
exposure as effective as CT for panic disorders with or without agoraphobia, OCD or PTSD
CT more effective than just exposure for SAD but that’s more thought based, key feature = worry
In practice CBT offered but like depression may not need to directly address cognition with some anxiety disorders

Question 27

Limitations of exposure-based interventions

Answer 27

Concerns about whether learning theory can adequately explain and predict MH problems
- why don’t all people develop phobias after traumatic experiences?
two people can have same experience but have different responses - role of cognition
not all benefit
not all individuals find interventions acceptable; high drop out rates

Question 28

Behavioural intervention general strengths

Answer 28

Can quickly produce significant improvements for some people
relatively simple and cheap to train therapists and provide treatment
based on testable, evidence-based theory