408 final Flashcards
1
Q
what is the goal of psychodynamic therapies and what are some examples
A
- focus on unconscious processes that impact client’s present behaviour
- originate from psychoanalysis (lacking the analysis part and doesn’t go on for many years)
- short-term psychodynamic
- mentalization-based therapy (understanding your own and others’ emotions, used for BPD)
- transference-focused psychotherapy (focus on therapist-client processes, used for PDs)
2
Q
short-term psychodynamic goals
A
- symptom relief AND limited but significant character change
- long-term psychodynamic makes more personality and interpersonal changes (which necessarily take longer because you need practice to engage in new habits and patterns of behaviour)
- work on one circumscribed area of focus (presenting symptoms, interpersonal problem)
3
Q
short-term psychodynamic structure
A
- once/week for less than one year
- in research, usually 16 sessions (esp. if being compared to CBT)
- therapist must maintain therapeutic eye on chosen focus (guide client to focus on mandate)
4
Q
short-term psychodynamic candidature
A
- patients should be psychologically minded, insightful, motivated
- unable to make meaningful change if the person isn’t ready or able to stay on task
- capacity to engage and disengage readily (from distractors)
5
Q
psychodynamic techniques
A
- supportive
- expressive
- monitoring countertransference
6
Q
psychodynamic supportive technique
A
- defining the therapeutic frame (the boundaries around therapy, your therapist is not your friend, they have a particular role)
- therapist demonstrating genuine interest and respect
- noting gains (helping with self-efficacy and progress = making more success)
- maintain here-and-now perspective
7
Q
psychodynamic expressive technique
A
- offering empathic comments
- confrontation when needed (questioning people if they don’t know how they’re affecting others)
- interpretation: summarizing info, reflecting it back to the client, and suggesting things based on what the client has said based on patterns in relationships, how the past impacts the present + get feedback from client
8
Q
monitoring countertransference psychodynamic technique
A
- can slow therapy down if therapist is having negative feelings toward the client, takes away from progress
- do this in any therapy, but specifically taught for psychodynamic
9
Q
Steinert et al. meta-analysis for psychodynamic
A
- assumption that psychodynamic isn’t as effective as CBT or good at producing symptom change
- meta-analysis of 23 RCTs comparing psychodynamic to an established treatment (CBT or others, comparability across session lengths)
- both treatments using manuals
- primary outcome: target symptoms
- secondary outcome: general symptoms and functioning
- testing for equivalence of two treatments
- results: no meaningful or significant difference between psychodynamic and comparator treatments at post- and FU
- statistical difference (small effect size) favouring psychodynamic treatment for functioning at FU
10
Q
humanistic/experiential therapies origins, focus, and examples
A
- originate from client-centered therapy
- based on the premise that individuals are self-actualizing
- Gestalt therapy, existential therapy, emotion-focused therapy
11
Q
what distinguishes psychodynamic/humanistic/interpersonal from CBT
A
- focus on affect and expression of patient emotions (while CBT does focus on emotions, they’re only relevant in how they lead to automatic thoughts–focus on cognitive change)
- exploration of patient’s attempts to avoid topics or engage in activities that hinder therapy progress
- identification of patterns in patient’s actions, thoughts, feelings, experiences, relationships (beyond the patterns found in thoughts)
- an emphasis on past experiences
- focus on interpersonal experiences
- emphasis on the therapeutic relationship as a vehicle or medium of change
- exploration of patient’s wishes, dreams, fantasies as clues to unconscious functioning
12
Q
focus on affect and expression of emotions (PDT, humanistic, interpersonal)
A
- idea that intellectual insight is not sufficient, we need emotional insight (truly believe)
- encourage expression of emotions rather than management or control (psychic conflict coming from bottled up emotions)
- draw attention to feelings regarded as uncomfortable
13
Q
pattern identification in PDT, humanistic, etc.
A
- how patterns in interpersonal functioning repeat over time, settings, people
- maybe mirroring early childhood relationships
- interacting with the therapist in that pattern
- patterns are identified through interpretations (therapist suggesting a pattern they’ve observed to see if it rings true, then explore patient reaction)
14
Q
emphasis on past in PDT, humanistic, etc.
A
- identify origin of patient difficulties and understand how they have manifested in lifetime (past and present)
- emphasize both pre-adult and adult past
- recent trend for PI (interpersonal?) to be more present-focused (current maintenance so it doesn’t take too long)
15
Q
focus on interpersonal experiences PDT, humanistic
A
- problematic relationships interfere with ability to fulfill needs and wishes
- compare patient functioning with that of others (how is your behaviour impacting other people)
16
Q
therapeutic relationship PDT, humanistic
A
- a good therapeutic relationship can generalize to other relationships
- transference = patient’s projections onto therapist
- therapist elicits feedback about client’s reactions to therapy (how do you feel opening up to another person)
17
Q
emotion-focused therapy basics
A
- originally process-experiential therapy
- 16-20 sessions
- theoretical basis: emotion is a key determinant of self-organization
- emotions are useful from an evolutionary perspective, but how we make sense of our emotional experiences is influenced by culture (tells us when to act/retreat, who to associate with)
- we should re-learn how to make sense of our emotions
18
Q
types of emotions
A
- primary: direct initial reaction (instinctual)
- secondary: our judgment of our emotions, happen after primary emotions (guilt or shame about feeling some emotion) - we work on these emotions
- adaptive: primary emotions that communicate information (fight-or-flight: how we use emotions to navigate our environment)
- maladaptive: ‘old familiar feelings’ that do not change with the situation, experienced habitually (not communicating information) - focus of treatment
19
Q
three principles targeted in EFT
A
- emotion awareness
- emotion regulation
- emotion transformation
20
Q
emotion awareness EFT
A
- become aware of primary adaptive emotions (so we can use that information)
- not thinking about feeling, but actually feeling the emotion (arouse emotional experiences and feel them, don’t talk about them)
- accept, don’t avoid emotions
- express emotions, including what you feel in words (behavioural urges, what does the emotion make you want to do)
21
Q
emotion regulation EFT
A
- which emotions need to be regulated
- some primary emotions don’t need to be regulated (adaptive vs. maladaptive)
- teach emotion regulation skills, including tolerance and self-soothing like deep breathing
- not specific to EFT (cognitive reappraisal is a form of emotion regulation, also very important in DBT)
22
Q
emotion transformation (EFT)
A
- process of changing emotion with emotion: undo a maladaptive emotional response with a more adaptive emotion (fight fire with fire)
- CBT is thinking about the situation differently, but here we throw a new emotion into the mix (this aspect is more specific to EFT)
- techniques: shifting attention, positive imagery, remembering another emotion
23
Q
other techniques in EFT
A
two-chair dialogue for self-critical conflicts
- person is trying to gain confidence, but they’re criticizing themselves (so having trouble merging these two aspects of themselves)
- play out both sides of the conflict, externalize or look at yourself from an outsider’s perspective
empty-chair work for unfinished business
- getting out old familiar feelings by sharing them with a literal empty chair
24
Q
research evidence for EFT
A
- EFT for depression
- similar in EFT and CBT, greater decrease in interpersonal problems in EFT than CBT
- symptom remission greater in EFT compared to client-centered therapy (emotions do matter, not just being supportive like in client-centered therapy)
25
Q
interpersonal psychotherapy
A
- designed as a control condition, but found it to be as effective as psychopharmacology
- shows good efficacy for depression, BN, BED (interpersonal events triggering negative affect)
26
Q
interpersonal psychotherapy basics
A
- Klerman and Weissman 1970s
- concerned with interpersonal context (relational factors that predispose (vulnerability factors), precipitate, and perpetuate (maintenance factors) distress)
- 12-16 sessions
- clients should have a secure attachment style, a specific interpersonal focus of distress, and a good support system (you shouldn’t do this with an emotionally abusive spouse)
27
Q
IPT problem areas
A
- role transitions (stressful life events; moving, new job, divorce)
- role disputes (infidelity, unmet expectations)
- grief
- interpersonal sensitivity (pattern of difficulty forming and maintaining relationships): only focus on this if there isn’t another target focus, will be difficult to treat because it’s a longstanding pattern
28
Q
IPT structure
A
- interpersonal inventory administered to choose the problem area
- work collaboratively to develop solutions to the problem
- patient implements solutions between sessions
29
Q
IPT techniques
A
- interpersonal incidents: something happened (like a fight with a partner), so we detail those incidents to understand what happened
- communication analysis: ineffective communication underlying problems people are experiencing (what happened and what would be done differently), understanding communication patterns (but very similar to technique #1)
- problem-solving (practical strategies) and role-playing (rehearsing new ways of interacting)
- encouragement of affect: content (what’s happening) AND process (being able to talk about things that are difficult)
30
Q
IPT video example
A
- what could you have done differently to avoid the conflict
- going through the situation step by step, then problem-solving for the future
- what was her reaction to the situation and what were others’ reactions (emotionally and what did you actually say, what could you have said differently)
31
Q
research evidence for IPT
A
- meta-analysis of 62 RCTs for depression
- d = .62 in favour of IPT compared to control
- d = .06 for IPT compared to other psychotherapies
- can be used for BN and BED
- CBT more rapidly improves BN Sx compared to IPT (slower to improve with IPT), but those treated with IPT continue to improve post-treatment (no differences at FU)
- learning skills for interpersonal situations that they continue to practice when therapy is over
- group IPT comparable to group CBT
32
Q
mindfulness
A
awareness that arises from paying attention on purpose, in the present moment, and non-judgmentally
33
Q
three components of mindfulness
A
- attention: full attention to the present moment, not past or future
- intention: knowing why we’re doing what we’re doing
- attitude: the way in which we pay attention (kind, open, curious)
34
Q
seven attitudinal foundations of mindfulness
A
- non-judging: impartial witness to your own experience
- patience: letting things unfold on their own without rushing it
- beginner’s mind: being receptive to new things that mindfulness might bring you
- trust: yourself, your feelings, the process
- non-striving: not trying to achieve anything or move anything forward, just be where you are
- acceptance: see things as they are now
- letting go or letting be or non-attachment: like letting yourself fall into sleep
35
Q
formal mindfulness meditation practice
A
- set aside a time, in a certain place
- mindful breathing (counting breaths or breathing in for a set amount of time)
- body scan (notice sensations or pain)
- mountain meditation: picture yourself as a mountain that doesn’t move and will always be there, there may be weather around the mountain, but you’re always steady
- loving kindness meditation: foster warm kind thoughts for yourself and others
36
Q
informal mindfulness practice
A
- awareness of thoughts, emotions, bodily sensations, and sensory input during everyday activities
37
Q
mindfulness-based stress reduction (MBSR)
A
- NOT a psychotherapy
- 8-week workship with 2-3 hour group sessions, daily homework, one-day retreat
- complements traditional medical or psychological treatment
- very commercialized
38
Q
mindfulness-based cognitive therapy (MBCT)
A
- formal treatment developed for depression relapse prevention
- not yet a first-line treatment for current depression, but was for people who were vulnerable to multiple episodes
- group Tx integrating MBSR with CBT
- different from CBT: moves away from CBT’s emphasis on changing content of negative thinking toward attending to the way in which all experiences are processed (thoughts, emotions, sensations)
- early RCT: after CBT, people randomized to TAU or MBCT = MBCT had fewer relapses
39
Q
MBSR and MBCT efficacy
A
- mindfulness-based therapy for depression and anxiety across a range of conditions (physical and psychological)
- mindfulness has been examined for physical pain
- moderate-to-large Tx effects
- in actual mood and anxiety disorders = very large Tx effects
- MBSR in healthy individuals = medium effect size in change in mindfulness, large effects on stress, moderate effects on depression, anxiety, distress, quality of life
- changing our relationship with our emotional experiences and thoughts
40
Q
ACT (Stephen Hayes)
A
- therapeutic approach that uses acceptance and mindfulness processes, and commitment and behaviour change processes to produce greater psychological flexibility
- not a Tx for a particular disorder
- works on psychological flexibility: ability to relate to the world in a more open-to-experience way
- ACT perspective on suffering: negative emotions and thoughts are normal human experiences, suffering is due to use to language and our attempts to control our internal human experiences (attempts to change or get rid of them)
- traditional approach: humans are naturally psychologically healthy and, if we experience psychological pain, it means something is wrong and needs to be fixed
41
Q
philosophical foundations of ACT
A
- based on relational frame theory
- our mind makes arbitrary connections between things, with connections based on history and context (the way we navigate our world is based on what we’ve learned)
- ex: melon = bigger than apple and not as yummy as an apple (interpreting your experience of a melon compared to your experience of an apple)
- we make sense of our world based on the context we’re in and what we’re thinking (our thoughts and emotions work in the same way; just words that may differ or diminish in importance based on the context we’re in)
- our suffering is based on our use of language (limitation of language is our attaching words to negative emotions and thoughts = they become real so we take them too literally)
42
Q
ACT model hexaflex
A
- psychological inflexibility to psychological flexibility (the center of the hexaflex)
- cognitive fusion toward defusion
- experiential avoidance toward acceptance
- loss of flexible contact with present toward attention to the present moment
- attachment to the conceptualized self toward self as context (contact with observing self)
- lack of value clarity toward value clarification
- inaction, impulsivity, and avoidance persistence toward committed action
43
Q
cognitive fusion and defusion
A
- fusion: verbal dominance over behavioural regulation (taking your thoughts too literally, that our thoughts are reality, experiencing your self as your thoughts)
- defusion: mindfully noticing thinking as it occurs (“I am having the thought that…” instead of “I am…”)
- watching thoughts go by as if they were leaves floating down a stream (that’s the thought, it doesn’t mean it’s me)
44
Q
experiential avoidance and acceptance
A
- attempt to alter form, frequency, or function or private experiences, even when doing so is costly or ineffective
- trying to stop, change, suppress negative emotions
- acceptance: adopt an intentionally open and flexible position about moment-to-moment experiences (curious and open and non-judgmental)
45
Q
loss of flexible contact with the present
A
- fusions and experiential avoidance lead to the desire to be somewhere else (we want to be in the past or in the future, anything but right now with our thoughts)
- attend to what is present in a focused, voluntary, and flexible way
- use language to describe internal events, rather than to predict and judge them
46
Q
attachment to conceptualized self
A
- idea of ourselves that we hold, maybe from the past or from others or society
- promote contact with sense of self based on here-and-now
- ‘noticing self’ or ‘observer perspective’
47
Q
values problems
A
- commitment behaviour change
- values are different than goals; not things we achieve, more ongoing and guide our behaviour
- persist or change in behaviour in the service of one’s chosen values
- continue acting in ways that promote values or stop acting in ways that don’t
- values: predominant reinforcer is intrinsic to behaviour pattern itself; a direction rather than a destination
- problems we can have with values: not your own, unclear to you, based on avoidance (trying to prevent something from happening rather than trying to promote something)
48
Q
inaction, impulsivity, and avoidance persistence
A
- inaction: depression, impulsivity: SUDs, avoidance persistence: anxiety
- not linked to values
- instead, develop patterns of action linked to chosen values
- set short-term, medium-term, long-term concrete goals that are value-consistent (SMART goal setting)
49
Q
ACT in practice
A
- psychoeducation isn’t explaining a maintenance process or a particular disorder
- due to problems with language, use metaphors to explain ACT concepts (experience the idea rather than talking about it)
- explain creative hopelessness with metaphors
50
Q
creative hopelessness
A
- bring people into experiential contact with the fact that what they have done so far has not worked
- people have tried to get rid of their suffering, but it’s not working = creative hopelessness
- chinese fingertrap metaphor: the more you struggle, the more it tightens
- tug-of-war: right now it’s a tug of war with all negative thoughts and feelings = stuckness and exertion of energe (encourage putting down the rope to stop the war = you won’t be stuck, but the other side will still be there)
51
Q
ACT evidence
A
- not RCTs comparing to other treatments
- has evidence for treating depression, mixed anxiety conditions, OCD (people fused with thoughts), chronic pain, psychosis
- research focused on testing processes of change and on functional (not symptom-based) outcomes (since ACT isn’t tied to a particular disorder, more about value-based living)
- mediation analyses that examine whether the treatment predicts change in ACT processes, which then predict change in outcome
- medium effect sizes compared to TAU, large effect sizes compared to waitlist
- could be especially useful for comorbid conditions
- psychological flexibility mediating benefits of ACT on depression and anxiety and BPD
52
Q
PDT interpretive interventions vs. supportive interventions and PDT (Steinert)
A
- interpretive: conscious and unconscious processes or conflict and aim at enhancing the patient’s insight in repetitive patterns assumed to sustain their problems
- supportive: aim to strengthen abilities that are temporarily inaccessible to a patient because of acute stress or they aren’t sufficiently developed
- PDT: fostering a therapeutic relationship, focusing on affect and expression of emotion, exploring avoidance patterns and resistance to change, identifying recurring themes, discussing past experiences, exploring fantasies and dreams, focus on interpersonal issues
53
Q
original vs. new ACT model
A
- original: experiential avoidance = avoidance and escape = long-term consequences as the central factor contributing to distress
- now psychological flexibility is the main therapeutic process
54
Q
six core skills cultivated to achieve psychological flexibility
A
- flexibly and purposefully remaining in the present moment (mindfulness vs. losing contact with the present)
- keeping balanced and broad perspective on thinking and feeling to stop maladaptive avoidance (vs. poor perspective-taking skills)
- clarifying fundamental hopes, values, goals (vs. disconnection from things that matter)
- cultivating commitment to valued actions
- willingly accepting unwanted feelings (vs. trying to control/eliminate difficult internal experiences)
- defusion (steeping back from thoughts that interfere with valued actions vs. seeing thoughts as literal truths)
55
Q
workability in ACT
A
- helping develop greater awareness of one’s behaviours and whether those behaviours are working to solve the problem and moving to valued ends
56
Q
flexible delivery of ACT
A
- as 1-day workshops: ensures adherence and completion, reduces stigma about mental health, better suited for primary care settings
- embedding ACT in medical settings: more comprehensive and integrative Tx approach for both physical and mental health
- brief: workshops, telehealth calls, online and smartphone interventions, 20-min sessions in primary care visits
57
Q
kinds of mindfulness (Beck reading)
A
- mindfulness of thoughts: for clients who excessively ruminate, worry, or try to suppress intrusive thoughts or images
- mindfulness of internal stimuli: for intense emotion and other distressing internal experiences
- mindfulness for self-compassion: for clients who experience lots of self-criticism
58
Q
when to use mindfulness in CBT
A
- if responding to thoughts isn’t enough, you use mindfulness to deal with rumination
59
Q
techniques before introducing mindfulness into CBT
A
- educate about the cognitive model
- advantages and disadvantages of rumination vs. focus on here-and-now
- socratic questioning for the advantages of rumination, how does rumination prevent valued living
- start the thought process in-session (engage with the unhelpful thoughts to simulate the conditions of rumination)
- rate intensity of negative emotion, then do formal mindfulness, then re-rate negative emotion
- draw conclusions about the experience to further challenge dysfunctional thoughts
- set Action Plan to do mindfulness
60
Q
DBT origins
A
- designed for individuals with chronic suicidality or parasuicidality (cutting NSSI) who didn’t respond to CBT or other treatments
- most patients with chronic suicidality have BPD, but not everyone with BPD has chronic suicidality (DBT not designed for BPD patients, but the subset)
- patients engage in behaviours that interfere with therapy (and clinicians experience burnout and have negative reactions to these patients)
61
Q
Linehan’s biosocial theory of BPD
A
- emotionally vulnerable (trait characteristics: strong emotional reactions, quick reactions, trouble disengaging from those reactions)
- invalidating environment (told that emotions are not justified)
- combinations results in problems with emotional skills (emotional tendencies are genetically transmitted AND triggers parent’s tendencies = genetic and environmental transmission) like:
- ability to understand and label feelings
- coping skills
- emotion modulation
