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FALL 2024 > 408 Midterm 1 > Flashcards

408 Midterm 1 Flashcards

1
Q

Zeitgeist and contextual considerations

A
  • “spirit of the times”
  • the dominant form of therapy has changed over time, dependent on culture
  • what is the believed etiology of psychological problems?
  • who is believed to be qualified to perform psychotherapy?
  • can we use the scientific method to understand human behaviour?
  • can we study psychotherapy using the scientific method?
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2
Q

early treatment (prior to 19th century)

A
  • removal from society = prisons where people were treated like prisoners
  • the animal tradition like zoos
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3
Q

19th century treatment

A
  • moral treatment: giving people relaxing environments and allowing them to contribute to society
  • big nice asylums with gardens and a ballroom for socializing, everyone given a job
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4
Q

psychoanalysis

A
  • the first formal outpatient psychotherapy (used to be only medication)
  • Freud trained as a neurologist and established the first private psychotherapy practice
  • hysteria and dream interpretation (case of Anna O. translated into English)
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5
Q

Freud’s major contributions

A
  • drive theory: everything comes down to sex instinct, avoiding death, facing mortality
  • levels of consciousness: pre-conscious, conscious, unconscious
  • personality structure: id, ego, superego
  • psychosexual stages of development: oral, anal, phallic, latency, genital stage
  • defense mechanisms: repression (preventing thoughts from consciousness), denial
  • therapy techniques: dream analysis and free association didn’t stick around
  • therapy processes: transference and counter-transference (client-therapist relationship)
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6
Q

transference and counter-transference

A
  • transference: client projecting feelings onto the therapist
  • counter: therapist feeling some way about the client related to the behaviours the client is showing
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7
Q

Stanley Hall

A
  • established APA dedicated to research (science not practice)
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8
Q

Lightner Witmer

A
  • first to use the term clinical psychology and to develop a training clinic at a university
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9
Q

psychological developments in 1900s

A
  • intelligence testing
  • personality testing
  • WWII soldiers returning with shell shock syndrome, so academics became interested in practice, not just academics
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10
Q

Eysenck’s critique of psychotherapy

A
  • examine 19 studies for psychoanalytic or eclectic psychotherapy looking at neurotic patients for ‘recovery’ (defined by practitioner)
  • 44% recovered from psychoanalytic
  • 64% with eclectic
  • 72% with general practitioner
  • concluded that recovery was inversely correlated with amount of psychotherapy received
  • 2/3 of patients recovered regardless of psychotherapy
  • inspired controlled research studies of psychotherapy (this critique wasn’t based on random assignment or follow-up)
  • inspired development of alternatives to psychoanalysis
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11
Q

client-centered therapy

A
  • Carl Rogers
  • focused on the therapy process and the therapeutic relationship over the techniques
  • success of therapy depends on the therapist (different from psychoanalysis where the therapist is a blank slate for the client to project onto)
  • focus on person over problem, developing a relationship with the client
  • three core therapist qualities: genuineness, empathy, unconditional positive regard
  • mobilize self-actualizing tendency (people have the ability to get better)
  • Rogers was the first to conduct research on psychotherapy process and outcomes
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12
Q

three waves of behaviour therapy

A
  • first: focus on observable behaviour and objective environment (learning and behaviour)
  • second: focus on cognitive representations of the environment (your interpretation of the objective environment), emotions and behaviour not just reinforcement
  • third: focus on how internal processes are functionally related to the objective environment (thoughts and emotions are normal outcomes of the world)
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13
Q

origins of behaviour therapy

A
  • british empiricism: knowledge comes from experience (a blank slate for experience)
  • learning theory: we can shape people based on experience (Pavlov’s classical conditioning and Edward Thorndike’s Law of Effect)
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14
Q

Behaviourism

A
  • John Watson: Little Albert conditioning and generalization (father of behaviourism)
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15
Q

Behaviour therapy

A
  • Mary Cover Jones: de-conditioning a fear in Little Peter (precursor to treatment of phobias and anxiety)
  • Mowrer & Mowrer: Bell and pad method for treating enuresis
  • Skinner: applied operant conditioning to increase social behaviour in patients with psychosis
  • Joseph Wolpe: systematic desensitization (based on classical conditioning) for fear and anxiety - first formal alternative treatment to psychoanalysis
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16
Q

Cognitive therapy Bandura & Beck

A
  • Albert Bandura: social learning theory (behaviour influenced by stimuli, reinforcement AND cognitive processes), learning through modelling not just reinforcement
  • Aaron Beck: cognitive theory (people respond to cognitive representations of the environment that aren’t always right), biased information processing
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17
Q

Cognitive therapy Mahoney & Ellis

A
  • Mahoney mediational approach: need cognition for things to generalize beyond a single situation (goes from stimulus-response to stimulus-organism/interpretation-response)
  • Ellis: rational emotive behaviour therapy (unsatisfied with psychoanalysis, so involved cognitions), beliefs as irrational so used persuasion to help patients see thinking errors and adopt more rational philosophies (ABCDE model, therapist has an active role), a clinician but not a researcher
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18
Q

ABCDE model

A

Activating Event/Adversity (situation) = Belief about adversity (interpretation) = Consequences (emotions) = Disputations (therapy challenging beliefs) = Effective new beliefs to replace irrational ones

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19
Q

Aaron Beck

A
  • depression due to beliefs of inadequacy and being unlovable (generalized beliefs that people had trouble unlearning)
  • beliefs as inaccurate but not irrational
  • used empirical disconfirmation to test beliefs (helping people see inaccuracy for themselves, therapist is more passive)
  • negative cognitive triad in schemas (negative beliefs about self, world, future)
  • conducted RCTs on cognitive therapy vs. medication and showed that it was as effective as pharma, and maintained at follow-up
  • developed treatment manuals for research and practice (disseminating)
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20
Q

third wave behaviour therapy

A
  • distinct from traditional CBT; emphasis on learning to accept emotions, cognitions, behaviours rather than trying to change them
  • thoughts don’t correspond to objective reality, distance yourself instead of engaging with them (don’t need to act in accordance with them)
  • focus on valued living instead of symptom reduction (change impairment from Sx)
  • ACT, mindfulness-based CT, dialectical behaviour therapy
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21
Q

CPA principles for psychotherapy

A

in ascending order of importance:
(1) respect for dignity of persons and peoples
(2) responsible caring
(3) integrity in relationships
(4) responsibility to society

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22
Q

(1) respect for dignity of persons and peoples

A
  • informed consent: understanding the nature of psychotherapy, limits of confidentiality, opportunity to ask questions
  • privacy: collect minimal information necessary and keep all records secure
  • confidentiality: do not share client information unless required by law
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23
Q

(2) responsible caring

A
  • competence and self-knowledge: practice within areas of competence or seek consultation, supervision, training, engage in self-care
  • maximize benefit: provide best service possible according to research
  • minimize harm: be aware of power differential in therapy, no sexual intimacy
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24
Q

integrity in relationships

A
  • accuracy/honesty: accurately represent your credentials and qualifications
  • straightforwardness, openness: be clear about fees, policies, limits of confidentiality
  • avoidance of conflict of interest: avoid anything that gets in the way of treating your client (avoid multiple relationships)
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25
Q

responsibility to society

A
  • respect for society: familiarize yourself with laws and regulations in your jurisdiction
  • development of society: act to change aspects of the discipline that detract from beneficial societal change
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26
Q

limits of confidentiality

A
  • harm to self or someone else (risk of suicide or homicide) or harm/neglect of a vulnerable person (children, elderly, people with disabilities)
  • assessment of degree of risk so clients can still disclose suicidal thoughts
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27
Q

Tarasoff v. Board of Regents

A
  • patient had a high likelihood of harming someone else, doctor notified the police
  • police questioned the patient but determined no risk, patient later killed Tarasoff
  • doctor found liable for the death; duty to warn AND protect (should have contacted Tarasoff to ensure their protection)
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28
Q

confidentiality and treating adolescents

A
  • disclosure increases when teens expect confidentiality BUT guardians hold rights to records by providing informed consent so can request info
  • therapist should make rules and enforce them (everyone agrees)
  • NSSI or suicidal thinking? unsafe sexual activity? drugs and alcohol? violence?
  • considerations for disclosure: immediate and future harm (pattern of behaviour?), parental reaction and client-parent relationship, best interest of client and therapeutic relationship
  • if disclosure is needed: involve the teen and how to handle it
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29
Q

multiple relationships

A
  • multiple roles with the same person or someone closely associated with the client
  • not all multiple relationships are unethical, cannot always be avoided, but can create conflicts of interest
  • clear violations: sexual relationship with current client
  • guiding questions: is the multiple relationship necessary? is it exploitative? who does the multiple relationship benefit? could it damage the client or disrupt the therapeutic relationship?
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30
Q

telepsychology

A
  • benefits: increased access, availability, flexibility, rural communities, access to specialist care
  • benefits: convenience, satisfaction, increased demand, anonymity and privacy
  • ethical concerns: privacy, confidentiality, security (how to secure disclosure, using encrypted tools)
  • concerns: therapist competence for technology, therapeutic relationship, informed consent and emergency issues (verifying patient identity and location)
  • concern: practicing across borders - therapist needs to be licensed where the client is located (PsyPact for practicing across state borders)
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31
Q

recommendations for telepsychology

A
  • comprehensive informed consent procedure
  • know emergency care options in client’s area
  • ensure clinical and technological competence
  • verify client identity
  • ensure client and presenting problem are appropriate for telepsychology (social anxiety or agoraphobia)
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32
Q

methods to evaluate psychotherapy

A
  • case studies
  • naturalistic (how do your clients compare to before with a new form of psychotherapy)
  • quasi-experiments (comparing outcomes from different forms of psychotherapy but no random assignment)
  • randomized controlled trials (cause-and-effect experimental design) - main tool for efficacy and effectiveness
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33
Q

RCT steps

A

(1) develop the protocol (2) choose a comparison to treatment of interest (3) select participants of interest which will generalize to the population (4) random assignment (5) administer Tx and assess fidelity (6) evaluate outcomes at end of treatment and follow-up

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34
Q

RCT step 1

A
  • what is the treatment?
  • comes from a theoretical model about the maintenance of a psychological problem
  • comes from basic psychological research, armchair theorizing, clinical observation
  • treatment techniques: what to do in therapy to change problems
  • how will the Tx be administered (needs to be standardized): treatment manual, training, supervision
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35
Q

RCT step 2

A
  • comparison Tx
  • waitlist control (not very useful anymore since people know they’re not receiving Tx so not like placebo)
  • supportive psychotherapy (controlling for interaction with therapist and common factors): doesn’t contain active ingredients so equivalent to placebo
  • gold-standard Tx (CBT) to show that it’s at least equivalent, so provides another Tx option
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36
Q

RCT step 3

A
  • selecting participants
  • balance concerns of internal validity (quality of experimental design and control of extraneous factors) vs. external validity (generalizability to other people and settings)
  • want sample to be representative of the population (demographic factors: gender, ethnicity, comorbid diagnoses exclusion vs. inclusion)
  • exclusion of comorbidity will improve internal validity but reduce external validity
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37
Q

RCT step 4

A
  • random assignment
  • assess baseline characteristics
  • random assignment minimizes preexisting differences between groups that could affect outcome
  • single-blind: P doesn’t know what condition they’re in (may be possible if Ps don’t know much about psychotherapy)
  • double-blind: neither P or experimenter knows what condition they’re in (impossible in psychotherapy trials)
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38
Q

RCT step 5

A
  • administer Tx
  • fidelity checks: ongoing supervision, sessions are recorded and coded to check adherence to treatment
  • some therapists are better than others (general interpersonal factors)
  • therapist factors: strong therapists doing the Tx and non-skilled doing supportive psychotherapy (confound)
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39
Q

RCT step 6

A
  • evaluate Tx
  • what is the outcome of interest: decrease in symptoms? not meeting criteria? increase in functioning (more meaningful than statistical significance)
  • statistical significance will depend on both magnitude of effect and sample size (larger sample size = more statistical power)
  • effect size: magnitude of difference independent of sample size
  • therapist and site effects: random factors unrelated to Tx
  • attrition: once people are assigned to groups, we account for them in our analyses
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40
Q

effect size norms

A
  • Cohen’s d (0.2 small, 0.5 medium, 0.8 large)
  • usually we want people to move from being within 1SD of a clinical group to within 1SD of a non-clinical group
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41
Q

RCT step 7

A
  • follow-up: relapse or sleeper effect
  • sleeper effect: during the Tx people don’t do well, but continue to get better after the treatment (continue practicing skills)
  • psychological treatments are more enduring than medication: CBT maintains its improvements better than antidepressants
  • CONSORT flow diagram: why people were excluded, how people were randomized, who followed-up, who dropped out
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42
Q

meta-analysis

A
  • pools effect size estimates about psychotherapy body of research
  • considers sample size into account, weighting more heavily according to the quality of the study
  • looks at moderators of efficacy that determine the strength or direction of a relationship
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43
Q

Smith & Glass (1977)

A
  • first meta-analysis of psychotherapy of 375 controlled studies
  • typical therapy client did better than 75% of untreated clients (compared to Eysenck’s inverse correlation)
  • combined effect size = 0.68
  • effect sizes similar across treatments
44
Q

Chambless & Hollon criteria for well-established treatments

A
  • at least two ‘good’ between-group design experiments that show that Tx is better to meds, psychotherapy placebo or other treatment OR equivalent to an established Tx OR
  • a large series of single-case design experiments with good experimental design and comparison to another treatment AND
  • must be conducted with treatment manuals
  • characteristics of samples must be clearly defined
  • effects must be demonstrated by at least two different investigators or teams
45
Q

probably efficacious treatment criteria

A
  • two studies show Tx is better to waitlist control OR
  • one or more experiments meeting criteria for well-established but have not been replicated by independent investigators OR
  • a small series of single case design experiments
46
Q

Tolin et al. (2015) criteria

A
  • criticism of Chambless: no consideration of what to do with many studies showing ‘no effect’ or a mixed effect
  • focus on systematic reviews and meta-analyses + consider quality and risk of bias of individual studies and systematic review
  • focus used to be on Sx reduction, now measure functional impairment and quality of life
  • criticism of Chambless: no guidelines for how to choose an EST from the list
  • so include information on the strength of treatment and evaluate clinical and statistical significance
47
Q

common factors

A
  • factors characterizing psychotherapy in general: therapeutic alliance, empathy, expectation for improvement, therapist skills
48
Q

history of common factors

A
  • Salu Rosenzweig Dodo bird verdict (all therapies are helpful)
  • Jerome and Julia Frank: common factors model (therapist should clarify Sx, inspire hope, facilitate successes and mastery to re-moralize patient to make changes themselves)
  • Wampold contextual model
49
Q

Wampold contextual model

A
  • three pathways through which psychotherapy exerts effects
  • initial therapeutic relationship (first impression): more clients drop out of therapy after the first session than at any other point
  • first pathway: real relationship (genuineness and perception that you’re getting to know the person)
  • second: expectations (idea that participation in therapy will aid coping which motivates action = expectations that they can get better)
  • third: healthy patient actions (the actions will depend on the type of therapy, but any type of healthy action will be helpful)
50
Q

therapeutic alliance

A
  • an aspect of common factors
  • affective bond: do you like the person, respect them, feel good in their company
  • agreement on end goals: how do we know when therapy is over, when is there sufficient improvement
  • agreement on in-session tasks: what do we do in therapy
  • measured with Working Alliance Inventory (can be done after every session to measure a drop or improvement)
  • correlation between early therapeutic alliance and therapy outcome is medium
51
Q

empathy

A
  • an aspect of common factors
  • an individual can be affected by and share emotional state of another, assess reasons for that state and identify with others’ perspectives
  • related constructs: positive regard, affirmation, congruence, genuineness
  • when rated by clients, therapists, observers, empathy correlates with therapy outcome (strongest when rated by client)
52
Q

expectations

A
  • an aspect of common factors
  • explanation of patient disorder, rationale for treatment, participating in therapeutic actions
  • basis for placebo effect: you think it will be helpful, so it will be
  • relationship with outcome is small (but patients must understand the rationale to engage in helpful actions)
53
Q

therapist effects

A
  • some therapists produce better outcomes, regardless of nature of patients and treatments delivered
  • effects are small-medium in clinical trials (because the treatment delivery is highly controlled), but higher in naturalistic settings (not being supervised as much)
54
Q

facilitative interpersonal skills (FIS) with 8 skill domains

A
  • verbal fluency, therapist’s emotional expression, persuasiveness, warm and positive regard, therapist’s hopefulness, empathy, alliance bond capacity, alliance-rupture-repair responsiveness (recognizing the problem, talk about it and repair it)
  • thought to be pre-existing skills that predict client outcome
  • self-report assessments are biased (using performance-based measure instead)
55
Q

Anderson et al. (2016)

A
  • self-reported social skills and FIS performance task during first two weeks of graduate program
  • clients (2 years later) reported on general Sx and functioning for each session
  • higher FIS therapists had clients with better outcomes later on
  • effect only present for shorter duration (less than 8 weeks)
  • therapist FIS could contribute to sudden gains early on (getting better quicker then leaving therapy)
  • if lower FIS therapists can form a strong relationship earlier in therapy and retains the client for longer, the effect goes away
56
Q

evidence for common over specific factors

A
  • any therapy is better than no therapy
  • therapies often do not differ when directly compared (and any differences usually reduce when controlling for investigator alliance)
  • within a therapy, the therapist who adheres to the manual doesn’t outperform another therapist (null correlation between therapist fidelity and outcome)
  • but agree that there need to be actions by the client to elicit change AND that some techniques are better for some conditions
57
Q

evidence for specific factors over common

A
  • no controlled studies exist to demonstrate common factors are sufficient for causing therapeutic change (cannot study common factors experimentally)
  • but most people agree that common factors are important and the therapeutic relationship is necessary (though not sufficient)
58
Q

meta-analyses for common factors

A
  • 17 meta-analyses comparing forms of psychotherapy (mean effect size, d - .21 which lowers when controlling for investigator allegiance)
  • meta-analysis of 198 studies comparing psychotherapies for depression (each intervention more effective than waitlist, but effect sizes similar for different interventions, except that interpersonal was better than supportive)
  • CBT vs. other psychotherapies = CBT only better than psychodynamic only for depression and anxiety
59
Q

suggestions for the future in common vs. specific debate

A
  • prioritize treatment process over treatment outcome research (how the therapy works rather than what works)
  • evidence for efficacy from RCTs doesn’t mean that the treatment is valid or will be effective in all situations
  • train people on therapeutic principles instead of very specific techniques (only do this if there is very strong support for those techniques)
60
Q

Wampold vs. Fonagy debate

A
  • Fonagy: some therapies work, others don’t - try to figure out which ones work best according to patient needs
  • Wampold: the therapies that are more helpful are ones that make patients take actions toward change, just empathy doesn’t work (difference between focused and unfocused unstructured therapy)
  • psychodynamic therapy doesn’t work for EDs because just talking doesn’t tackle the focal problem (but CBT does)
  • we keep developing new therapies, but patient outcomes don’t change (what changes the outcome is the therapist)
61
Q

conflict between research and therapy

A
  • research is nomothetic (how well does a therapy work, on average, for a population of people)
  • therapy is idiographic (conducted one-on-one with a person who may or may not be represented in research studies - lower SES, minorities)
  • trying to generalize from nomothetic research to idiographic practice
62
Q

what is the difference between EST and EBP

A
  • EBP is a comprehensive concept including but not limited to EST
  • three legs of EBP: best scientific evidence from research + clinical expertise and experience + client perspective and input
63
Q

best available research evidence

A
  • upper levels of the hierarchy minimize sources of error, only go down the levels if nothing else is available
  • systematic reviews, meta-analyses (1)
  • RCTs (2)
  • cohort studies (3)
  • case control studies (4)
  • case series, case reports (5)
  • editorials, expert opinion (6)
  • research studies must move beyond best outcome and consider patient or Tx characteristics
64
Q

sources of evidence for EBP

A
  • treatment efficacy: strength of evidence about causal relationships between intervention and disorder (RCTs - carefully designed studies prioritizing internal validity)
  • treatment effectiveness or clinical utility: how well does the therapy work in real-world clinical settings (generalizability, feasibility, costs and benefits of intervention)
  • basic psychological processes relevant to treatment (memory, attention, emotion, etc.; are these improving in the course of a treatment)
65
Q

patient or treatment characteristics to consider in EBP and research studies

A
  • does a Tx work better for certain patients (patient diversity)
  • mode of delivery of treatment (group therapy vs. individual), feasibility of delivery, treatment costs, therapeutic relationship (what role does it play in the treatment)
66
Q

clinical expertise

A
  • competence attained by psychologists thought education, training, and experience that results in effective treatment
  • need continuing education
  • clinical case conceptualization, treatment planning and implementation, interpersonal expertise (FIS), self-reflection, knowledge and use of research literature, understanding the influence of diversity and culture on treatment, seeking consultation and resources if necessary
  • cannot use research evidence for every decision, so make use of clinical judgment (though still grounded in research)
67
Q

patient characteristics, culture, preferences

A
  • just because something works in a RCT doesn’t mean it works for your individual clients
  • research can examine patient moderators of Tx effects (is something less helpful for a certain group)
  • do treatments generalize to minority groups
  • how do comorbid conditions affect effectiveness
  • not everyone has the same etiology or maintenance mechanisms
68
Q

CPA report on EBP

A
  • treatment planning comes from RCTs, treatment process research, basic psychological research
  • use best available evidence (hierarchy) like replicated studies and studies that address threats to validity
  • if no treatment research exists, use practice guidelines (expert consensus)
  • monitor client reactions, Sx, functioning (see if they’re responding) & prepare to alter Tx based on this, discussion with client, and reconsideration of the evidence
  • include treatment process research in the evidence
69
Q

treatment process research

A

research looking at therapeutic relationship, empathy, etc. (how does therapy produce its outcome)

70
Q

advantages of EBP

A
  • improves quality and cost effectiveness of treatment
  • enhances accountability (public knows which Tx is recommended so they hold the therapist accountable)
71
Q

criticisms of EBP

A
  • treatment amenable to research is more likely to be included in the list of ESTs (CBT is shorter than psychodynamic, easier to train people, easier to study)
  • inappropriately restricting access to certain treatments (insurance won’t pay for non-ESTs even if they might work)
72
Q

relationship between the theoretical base of a treatment and its outcome

A
  • proposed mechanisms of change should be validated in basic research to be shown to be related to the techniques being used
  • proposed mechanisms of change should be related to proposed mechanisms of disorder
  • change in proposed mechanisms should relate to change in symptoms in treatment studies (changes in emotion regulation should be the mediator between the treatment and the symptoms of the disorder)
73
Q

unvalidated treatments

A

not sufficiently researched (not EST, but may still work)

74
Q

invalidated treatments

A
  • shown not to work
  • suggestion: make a list of invalidated treatments and make it available to the public
75
Q

caste study EBP

A
  • Leg 1: CBT is the only Tx with strong research support for PD and GAD (cognitive techniques for catastrophic thinking and the adaptive function of worry and behavioural techniques like interoceptive exposure and worry time)
  • Leg 2: case conceptualization (externalizing statements, irritability, lack of trust, difficulty with mentalization, etc.)
  • Leg 3: presented for help with anxiety (target of treatment because this is what the patient wants), personality and emotional characteristics may impact effectiveness, bad experiences with previous therapists
  • treatment approach: focus on building therapeutic alliance, mood monitoring and thought restructuring, exposures, mentalization-based therapy eventually
76
Q

behaviour modification

A
  • classical conditioning
  • operant conditioning
  • observational learning
  • rational behaviourism
77
Q

classical conditioning

A

reflexive responses elicited by a new stimulus (phobias and anxiety)

78
Q

operant conditioning

A
  • behaviour influences by consequences (reinforcement and punishment)
  • Skinner and pigeons
79
Q

observational learning

A
  • learning through observation of another’s behaviour without direct reinforcement or punishment
  • Bandura and bobo dolls
80
Q

rational behaviourism

A
  • learning and performance of responses that have not been directly trained
  • organisms look for cause-and-effect relationships in their environment and learn from them
  • imbedded in the organism to learn these things (like a baby knowing how to swim)
81
Q

reinforcement and punishment

A
  • reinforcements INCREASE the likelihood of that behaviour occurring again
  • punishments DECREASE that behaviour
  • you can add or remove things from the environment
  • something you think is punishment could be acting as reinforcement
82
Q

Jenny has no candy, she cleans her toys and receives candy - what is the behaviour and type of consequence?

A
  • behaviour: cleaning up toys
  • positive reinforcement
83
Q

Adena has access to toys, she hits her brother and her toys are removed - what is the behaviour and type of consequence?

A
  • behaviour: hitting her brother
  • consequence: negative punishment (behaviour decreases, toys are removed from her environment)
84
Q

Li is cold, she puts on a sweater, and she is no longer cold - what is the behaviour and type of consequence?

A
  • behaviour: putting on a sweater
  • consequence: negative reinforcement (removing the aversive state of coldness = behaviour increases)
85
Q

John has no pain in his hand, he touches a hot stove and has a painful hand - what is the behaviour and type of consequence?

A
  • behaviour: touching a hot stove
  • consequence: positive punishment
86
Q

escape conditioning

A
  • negative reinforcement
  • immediate response-contingent removal of aversive condition that increases the frequency of future behaviour
  • starting to feel anxiety in a situation = leave that situation to remove the fear = more likely to leave again in the future
  • important starting point in anxiety (no opportunity to learn that anxiety will decrease naturally)
87
Q

avoidance conditioning

A
  • negative reinforcement
  • immediate, response-contingent prevention of aversive condition that increases frequency of future behaviour
  • not even putting yourself in the situation that causes your anxiety
  • the second step in anxiety after escape conditioning
88
Q

extinction

A
  • stop reinforcing the behaviour to hopefully reduce the pairing and behaviour will decrease over time
89
Q

differential reinforcement

A
  • reinforce some behaviours and not others, or reinforce behaviours under some conditions but not others
90
Q

schedules of reinforcement

A
  • fixed vs. variable: time-based (on a fixed schedule or random?)
  • ratio vs. interval: after a certain number of times the event has to happen
91
Q

shaping

A
  • reinforcement of successive approximations of a final response
  • used when the organism doesn’t have the desired response in their repertoire so you reinforce partial responses
92
Q

chaining

A
  • create a series of behaviours from distinct behaviours
  • each individual behaviour is in the individual’s repertoire, you have to teach them to put them together
93
Q

discrimination

A
  • different responses under different stimulus conditions
  • we behave differently with our friends vs. work
94
Q

generalization

A
  • stimulus generalization: having the same response to different stimuli
  • response generalization: having different responses to the same stimulus
95
Q

ABCs of behaviour

A
  • antecedent: stimuli, settings, context that occur before and influence behaviour
  • behaviour: things the individual does or doesn’t do
  • consequences: events that follow behaviours and may or may not influence future behaviour (make note of everything that follows)
96
Q

functional behaviour analysis

A
  • application of scientific approach to human behaviour
  • what behaviour do you want to change? specific operational definition (objective and observable, clarity, completeness
  • assess behaviour at baseline (frequency, duration, latency, intensity)
  • determine functions of behaviour (what is its purpose? what are the maintaining contingencies)
  • use this info to develop an intervention
97
Q

steps of FBA

A
  • collect information (define behaviour, assess baseline, determine consequences - the ABCs)
  • generate hypotheses about the functions
  • test the hypotheses to isolate each individual function
  • devise an intervention
98
Q

assessing ABC relations

A
  • indirect assessments: self-report, interview (person, parent, school)
  • direct assessment: naturalistic or analog
99
Q

Peter took his sister’s cake and threw it on the floor while everyone was singing happy birthday to her, so his parents took him aside and yelled at him - what are the ABCs and function and maintaining contingencies?

A
  • behaviour: picking up the cake and throwing it on the floor
  • antecedent: parents singing happy birthday to the sister (sister getting more attention)
  • consequence: parents yelled at Peter
  • function: behaviour shifted attention from his sister to him
  • maintaining contingencies: likely to increase this behaviour in the future to get attention from parents again
100
Q

Ellis reading main takeaways

A
  • history of cognition in psychotherapy comes from self-help
  • early philosophers = cognitive therapists (self-help)
  • before Freud, psychotherapy was cognitive, but Freud was interested in emotion
  • self-concept is a definition that people can change
  • rational-emotive therapy: philosophy + behavioural therapy + cognitive debating to change philosophy/attitude
  • evidence for RET comes from success in sex therapy
101
Q

Stoll telepyschology reading

A
  • ethics in favour: increased access, availability, flexibility (rural areas, limited mobility), convenience, satisfaction, economic advantages, anonymity and privacy
  • ethics against: privacy, confidentiality, security, therapist competence and training, communication issues (missing non-verbal cues, emails lack warmth), research gaps (long-term outcomes?), emergency issues, cross-border practice guidelines
102
Q

Wonderlich BN reading takeways for research methods

A
  • RCT for testing integrative cognitive-affecting therapy (maintenance areas like self-directed behaviour, interpersonal problems, self-discrepancy and evaluative standards)
  • comparison group: enhanced CBT (gold standard)
  • outcomes: bulimic symptoms, severity, co-occurring conditions, measures of maintenance mechanisms
  • included sub-clinical presentations since they tend to resemble people with diagnosed BN (generalizing to population)
  • therapist adherence monitored throughout, clinicians trained in both types and administered both types
  • within-group improvement at end of treatment and follow-up, but no between-group differences (ICAT equivalent to CBT-E so alternative Tx option)
103
Q

Wampold common factors reading

A
  • contextual model 3 pathways which depend on the initial therapeutic relationship
  • therapeutic alliance: therapist contribution is more important than patient contribution
  • empathy can have a threat to validity (easier to be empathetic to a collaborative client than an aggressive one)
  • cultural adaptation of EBP has a medium effect size
104
Q

Anderson FIS reading

A
  • therapist FIS improves alliance and outcome
  • prospective study pointing to a causal relationship
  • greater effect for shorter therapy durations (less than 8 sessions)
  • rapid improvement due to nonspecific and therapist factors (implicates common factors)
  • nonexistant effect for longer durations (more than 16 sessions): maybe due to client dropout and since harder-to-treat patients tend to stay for longer and may not benefit from high-FIS or any other intervention
  • unclear whether therapist FIS could change over time
  • clients not randomly assigned
105
Q

Dozois EBP reading

A
  • APA list of ESTs based on Chambless criteria didn’t narrow the gap between research and clinical practice
  • EBP isn’t narrowly focused on evidence, just incorporates evidence
  • first consider studies that have addressed threats to validity (internal and external) and are replicated
106
Q

FBA reading

A
  • identifying relations between antecedents, behaviour, consequences AND developing interventions (behaviour’s function within its environment)
  • maintaining contingency: factors that lead to maintenance of the behaviour
  • frequent functions: social attention, escape or avoidance, automatic reinforcement (like sensations), tangible reinforcement
  • indirect assessment (interviews and questionnaires are convenient, easy, but fallible)
  • direct observation: naturalistic (informal and unstructured or rigorous) or lab analog (antecedents and consequences are manipulated)

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