1st wave: Behavioural interventions Flashcards
who referred to them and what are the 3 waves?
why are they called waves?
Hayes (2004)
behavioural interventions
cognitive and cognitive behavioural therapy
acceptance of mindfulness based therapies
they follow each other
why was the first wave developed?
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
what does the behavioural model say?
behaviour, including abnormal/maladaptive behaviour, is learned
environmental conditions shape and maintain behaviour
happens through classical and operant conditioning
link between behaviour and MH
for MH problems to develop the environment is not providing you with what you need
locates the problem within the environment not the individual
what are behavioural interventions?
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
Carvelho and Hopko
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
Farmer and Chapman (2015)
cause is not located within the individual
reduction in access to positive reinforcers
depression results from person-behaviour interactions
Behavioural changes that maintain depression
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
TRAP and TRAC model
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
Jacobson, Martell and Dimijian (2001)
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
What is behavioural activation (BA)
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
Farmer and Chapman (2015)
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
Phases of BA
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
Jacobson et al (1996)
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
Dimidjian et al (2006)
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
Mazzuchelli, Kane and Rees (2009)
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
Strenghts of BA
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
Limitations of BA
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
Exposure-based interventions
for anxiety
repeated and systematic confrontation of feared stimuli
thought to be essential for psychological interventions focused on anxiety
How do Exposure-based interventions work?
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
What is extinction learning
gradual decrease in response to a conditioned stimulus that occurs when the stimulus is presented without reinforcement
Does extinction involve learning a prior conditioned association?
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
Types of behavioural interventions for anxiety
Flooding Modelling Systematic desensitisation In-vivo exposure - best evidence for - in real life, gradual and done in NHS
what is In-Vivo exposure?
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
