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MBC > Chapter 15 > Flashcards

Chapter 15 Flashcards

1
Q

Anxiety

A
  • Specific phobias
  • Social anxiety disorder
  • Generalized anxiety disorder
  • PTSD
  • Panic disorder (with and without agoraphobia)
  • Most effective treatment is Exposure Therapy
    and Cognitive Behavioural Therapy
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2
Q

Exposure
Approaches

A

Used to change behaviours involving fear
and anxiety
* Imaginal or in vivo
* Graduated or intense
* Spaced out sessions or en masse
* One session or multiple sessions

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3
Q

Exposure
Techniques

A

Common element: client is exposed to
anxiety-eliciting stimuli without
experiencing the feared negative
consequences

Treatment includes:
Modification of the operant
escape and avoidance
behaviours
Modification of the
respondent behaviours (the
Conditioned Responses)

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4
Q

Avoidance
Diagram

A

2 parts: Escape + Avoidance

  • Escape – removal of negative reinforcer
  • Avoidance – prevention of further
    negative reinforcers

Maintains the cycle
* HARD to extinguish because of
intermittent reinforcement

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5
Q

Exposure
Interventions

A

Systematic Desensitization
In Vivo Desensitization (Exposure)
Prolonged Exposure (PE) Therapy
Virtual Reality Exposure Therapy (VRET)
Eye Movement Desensitization Reprocessing (EMDR)
Exposure and Response Prevention (ERP)

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6
Q

Systematic
Desensitization

A

Techniques
* Imaginal exposure (generalizes to real life)
* Decrease phobic responses
* Using a graduated hierarchy of feared stimuli
* Relaxation Techniques
* Don’t focus on what US initially created the fear (UR), but on
what is maintaining the CRs now

Three steps:
* Relaxation Training
* Construction of anxiety hierarchies
* Pair the relaxation + phobic stimuli until phobic stimuli no
longer elicits anxious symptoms

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7
Q

In Vivo
Desensitization
(Exposure)

A

Similar to Systematic Desensitization → extinction of the
anxiety and avoidance response
* Except uses real-life situations (not just imagined)

  • Remain in the presence of the feared stimulus for brief
    periods of time → longer and longer time
  • Don’t need to worry about generalization because it’s already
    happening in the real-life already
  • Phobia Treatment:
  • Anxiety CRs are extinguished by repeated presentation of
    the conditioned stimulus (CS) in the absence of the US.
  • The operant avoidance response also extinguishes
    because of the removal of the negative reinforcement
    contingency established previously.
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8
Q

Prolonged Exposure Therapy

A
  • Rather than graduated exposure, this is at fullintensity for a prolonged approach (either
    imagined or in vivo)
  • Flooding – sometimes even 1 session
  • Prevent any escape or avoidance from the
    feared stimulus
  • Absence of feared consequences
  • Develop a tolerance for the anxiety
  • Associate the feared stimulus with being safe
  • Panic disorder – this is an essential aspect of
    treatment
  • PTSD – equivocal (not enough RCTs)
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9
Q

Virtual Reality
Exposure Therapy
(VRET)

A
  • Computer-generated exposure
    environment
  • Visual, auditory, and olfactory
    stimuli
  • Effective in PTSD * Augmented reality
    – enhances
    aspects of the “real
    -world”
  • Good for specific phobias (e.g.,
    spider)
  • Generalizable??
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10
Q

Eye movement
Desensitization
Reprocessing (EMDR)

A
  • Imaginal exposure of a stressful/traumatic event (PTSD)
  • Performing rapid eye movements back-and-forth

Controversial whether the eye moments add to the effectiveness, or if
the cognitive processing part is the key element.
* Other treatments:
* Cognitive Processing Therapy (CPT) - https://www.apa.org/ptsdguideline/treatments/cognitive-processing-therapy
* Trauma-Focused CBT -

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11
Q

Exposure and Response
Prevention (ERP)

A

Often used in OCD
* Obsessions – repetitive, unwanted
thoughts or images
* Compulsions – repetitive, excessive overt
acts or responses that have negative
consequences for them or others

  • Two components:
  • In vivo exposure
  • Strict response prevention
  • Efficacy rates high (75-85%), but high dropout
    rates (20-30%)
  • Similar outcomes to medication alone
  • Helpful if you can involve social support
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12
Q

Habit
Reversal
Training

A

From Chapter 4:
1. Awareness Training – detect pre-urge signs
2. Competing Response Training
* Blocks the behaviour over the duration of
time (fixed/variable)
3. Motivational and Social Support
* Behavioural Reward System,
Parent/Peer/Teacher praise
Comprehensive behavioural intervention for tics (CBIT)
Dr. Ali Mattu

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13
Q

Aversion Therapy

A
  • Used to treat behavioural excesses
  • Aversive stimulus is presented with the stimulus to
    prevent the undesired response
  • Enhances escape/avoidance behaviours through
    negative reinforcement
  • Not used frequently, ethical concerns, complex
    intervention
  • Requires extra supervision and monitoring, explicitly
    discourages in the College of Psychologists of Ontario
    (CPO).
  • More emphasis on the use of positive reinforcement
    currently
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14
Q

Cognitive Behavioural
Therapies
(CBT)

A
  • Rational Emotive Behaviour
    Therapy (REBT)
  • Cognitive Behavioural
    Therapy (CBT)
  • Family-Based Cognitive
    Behavioural Therapy (CBFT)
  • Panic Control Treatment
    (PCT)
  • Behavioural Activation
    Therapy
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15
Q

Cognitive biases

A

*Most powerful, hardest to change,
and most likely to be in our moment-to-moment awareness
Perceptions
selective attention
attributions
expectancies
assumptions
standards

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16
Q

Cognitive
Distortions

A

arbitrary inference
selective abstractions
overgeneralization
magnification/minimization
personalization
dichotomous thinking
labeling/mislabeling
tunnel vision
biased explanations
mind reading

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17
Q

Rational Emotive Behaviour
Therapy (REBT)

A

Albert Ellis (1961): Rational-Emotive Therapy (RET)
* Problems (anxiety, depression, anger, guilt) occur when individuals:
* Hold irrational or dysfunctional beliefs
* Make negative evaluations and interpretations of self or others because of these beliefs
* Negative cognitive processes (irrational thought patterns) → strong negative emotions (distress)
→behave in negative ways toward self or others

  • Irrational beliefs:
  • Identify
  • Challenge
  • Change these irrational beliefs by use of rational argument → “rational beliefs”
  • Added “behaviour” to the name to emphasize changing overt behaviour through behavioural
    assignments/homework (*key component)
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18
Q

Cognitive Therapy (CT) Principles

A

Changing thought processes
is a key part (“reframing”
and “change talk”)
* Expectancies
* Beliefs
* Attributions

Cognitions represent an
underlying belief system in
the individual
* Learn to evaluate and
modify problematic or
dysfunctional cognitions by
looking for evidence (not
just rational arguments)
* Learn to communicate and
problem-solve

CBT – uses both the
cognitive and behavioural
interventions
* Adds in the use of
homework assignments to
collect data
* Clients and therapists work
collaboratively
* Need more work in diverse
populations

19
Q

Cognitive
Restructuring

A

thought diary

20
Q

Additional CBT
Techniques, thought stopping

A
  • Covert technique used to decrease
    frequency of recurring negative or selfdefeating thoughts
  • Interrupt the undesired thoughts →
    redirect the client’s attention to coping
    thoughts that are incompatible with the
    undesired thoughts
  • Positive self-statements
21
Q

Additional CBT
Techniques
* Self-Instruction Training (SelfTalk)

A
  • Cognitive modeling
  • Cognitive behavioural rehearsal
  • Shift from overt external
    instructions (therapist) → covert,
    self-instructions through fading
    techniques
22
Q

Motivational
Interviewing
(Miller & Rollnick, 1991)

A

A patient-centered, therapeutic style that
incorporates:
Patient-provider relationship:
* collaborative, empathetic & non-judgmental
* quiet and eliciting responses from provider
Self-efficacy:
* Change is internally, not externally, motivated
* Maintains patient’s autonomy
Creating and resolving discrepancies/ambivalence:
* Between current behavior and future goals
Advice giving:
* In a non-confrontational style

23
Q

Transtheoretical Model (TTM)
(Prochaska & DiClemente, 1982)

A

“Readiness to Change”

  1. Precontemplation – not yet considering change
  2. Contemplation – evaluating reasons for and against change
  3. Preparation – planning for change
  4. Action – making the identified change
  5. Maintenance – working to sustain changes
24
Q

General Tenets of the Spirit of MI

A

Three Communication Styles
1. Directing (Advice only)
2. Guiding (Listen & encourage ideas)
3. Following (Empathetic listening only)

→ Guiding is thought to provide the best outcomes. The overuse
of the directing style is part of well-intentioned efforts, but is not
as effective. Following is too passive.

Three core skills
1. Asking (to understand the problems)
2. Listening (actively)
3. Informing (to convey knowledge)

25
Q

Cognitive
Behavioural
Family
Therapy
(CBFT)

A

Multiple forces occurring in a family – open systems approach
* Cognitive
* Behavioral
* Emotional
* Expressed emotion: the degree to which family members
exhibit criticism, hostility, overinvolvement
Interpersonal transactions
* Communication tools & PSST (to increase family functioning)
* Double-bind hypothesis (refuted in causing mental health
disorders, but still acts as a stressor on the family)
Contextual factors (extended family, cultural)
Explore all systems operating on each person
* Multidirectional and reciprocal influences

26
Q

Panic Control Treatment (PCT)

A

Psychoeducation
* The causes of anxiety and panic
(fight-and-flight)
Cognitive restructuring
* Overestimating the danger of a
panic attack
* Catastrophizing the
consequences of a panic attack
In vivo exposure
* Settings or situations
Interoceptive exposure
(recreate physical
sensations of a panic attack)
* Dizziness, heart racing, shortness
of breath
Breathing retraining (to
prevent hyperventilation)
* Biofeedback tools used
Relapse prevention
* Develop coping strategies to
manage setbacks and “worst
case” scenarios

27
Q

Interoceptive
Exposure
Worksheet

A

feel sensation record

28
Q

Behavioural
Activation
Therapy

A

Major Depression:
* Increasing activities that are pleasurable or demonstrate
accomplishment
* Receive more positive reinforcement form the
environment
* Reduce escape and avoidance behaviours that maintain
depressive symptoms

Components:
* Daily activity monitoring
* Mood ratings
* Assessment of pleasure and mastery activities
* Social Skills training
* Behavioural Assignments
*often used in conjunction with other CBT treatment techniques

29
Q

Three “Waves” of Behavior Change

A

First Generation (1950s)
* Classical Conditioning and Operant Conditioning

Second Generation
* Negative thoughts, images, feelings and beliefs → undesired/maladaptive behaviors
* Cognitive Behavioural Therapy (CBT) – learn to modify these cognitions constructively
* Most evidence base for effectiveness in many psychosocial problems

Third Generation (1990s)
* Accept negative cognitions AND pursue your valued goals
* Be present-oriented, nonjudgmental awareness of bodily states
* Psychological flexibility – bigger range of coping strategies
* Built on the 1st and 2nd generation waves
* Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), and
Mindfulness-based therapies

30
Q

Third Generation Behaviour Change Approaches

A

Mindfulness-Based Interventions
* Mindfulness-based stress
reduction (MBSR)
* Mindfulness-based cognitive
therapy (MBCT)
* Acceptance and Commitment
Therapy (ACT)
* Dialectical Behaviour Therapy (DBT)

31
Q

Mindfulness

A
  • Buddhist form of meditation
  • Develop a purposeful, present-oriented, nonjudgmental
    awareness of one’s bodily states (see, hear, taste, smell,
    touch, think, feel):
  • Thoughts
  • Emotions
  • Sensations
  • Perceptions
    Regulate your focus of attention to the ever-changing internal and external stimuli
  • Minimizes the fight-and-flight response
  • Openness, curiosity, and acceptance
32
Q

Central Tenet of Mindfulness

A
  • Thoughts do not cause distress
  • The way in which you react to the thoughts cause distress
  • Thoughts are not resisted, but acknowledged and released
  • You do not have to believe all your thoughts
  • Defuse yourself from your thoughts (decentering/distancing)
  • Thoughts ≠ reality

Goal is psychological flexibility
* Greater range of coping skills to respond to cognitive processes
that contribute to emotional distress or problem behavior

33
Q

Mindfulnessbased Stress
Reduction
(MBSR)

A

Goal: to cope with stress, pain, and illness
* Mindfulness meditation
* Yoga
* Body awareness/scanning
* Daily homework
* Outcomes: similar to CBT, but better than
supportive care and nutrition education programs
Mindfulness Apps:
* Eternal Sunshine
* Stop, Breathe, and Think for Kids

34
Q

MindfulnessBased
Cognitive
Therapy
(MBCT)

A

Goal: to reduce symptoms of depression
* Combines mindfulness-based stress reduction and
components of CBT
* Increase awareness of negative thoughts and
emotions
* Recognize the role of these thoughts in
maintaining the depressive symptoms
* Stay in the here-and-now to decrease
rumination about negative thoughts

  • Outcomes: Better than treatment as usual, and as
    effective as antidepressant medication treatment, helps
    with relapse prevention
  • May be able to extend to Bipolar Disorder, panic
    disorder, and medical conditions
35
Q

Acceptance and
Commitment
Therapy (ACT)

A

Goal: to help individuals accept
their thoughts, sensations, and
feelings without attempting to
change or suppress them
* Decrease experiential avoidance
– avoidance of negative thoughts,
emotions, and physical
sensations

36
Q

DNA-V Model

A
  • Discoverer
  • Noticer
  • Advisor
  • Values
37
Q

Central
Tenant of
ACT

A

Functional contextualism (FC) – how cognitions and overt
behaviours function in specific contexts
* A thought, memory, feeling, or behaviour is only
problematic/pathological/dysfunctional depending on
the context in which you experience them
* Less impactful on one’s life if a painful cognition is
processed using cognitive defusion and acceptance
* Focus is living a value-drive life, and ensuring
behaviours are congruent

  • Outcomes: similar to CBT, better than treatment as usual, useful in anxiety, depression, addiction, and somatic health
    problems
38
Q

Dialectical Behaviour
Therapy (DBT)

A

Marsha Linehan – developed for those who have Borderline Personality
Disorder and chronic suicidality

  • Goal: to address emotional dysregulation, impulsivity, chronic suicidal
    ideation, and self-harming behaviours by replacing/disrupting these
    behaviours with more effective coping strategies.
  • Through both individual and group therapy:
  • Behaviour Change Principles (contingency management, exposure)
  • CBT (cognitive restructuring and problem-solving)
  • Mindfulness practices to regulate emotions (distress tolerance,
    reality acceptance)
39
Q

Central Tenant of DBT

A
  • Need to develop a more dialectical worldview – synthesis of polar extremes
  • Replace rigid, dichotomous thinking (all-or-nothing), with a more balanced
    perspective
  • Need to be accepting of client as who they are and validating them, while also
    motivating them for change
  • Outcomes: In addition to BPD and suicidal behaviours (including in adolescents),
    also effective in treatment of eating disorders, substance use, and PTSD
40
Q

Summary of Techniques Used in
CBT, DBT, and ACT

A

graph

41
Q

Choosing Interventions

A

Evidence-based practice
Using the best evidence to guide delivery of services

Ethical Guidelines:
Practitioners should select evidence-based
interventions
Training institutions and licensing boards should
differentiate evidence-based treatments from
those who lack such support

42
Q

Future Trends

A

Common Elements
Transdiagnostic perspective – commonly occurring practice
elements (e.g., modeling) that help with suffering and
distress regardless of one’s specific diagnosis

Common Factors
* Therapist-specific – warmth, empathy, relationship
* Client-specific – psychological-mindedness, stress reactivity
* Interaction of the two

Studies show that the some
of the biggest variability in
outcomes is due to:
* quality therapist > specific treatment > placebo treatment

43
Q

Future Trends in technology

A

Inside the “black box”
* fMRI – detect changes in neuronal
connections
* Connectome – structural and functional
connections in the brain
* Future research may be able to show the
connection between connectome and
psychological functioning (and whether
interventions can impact them!)

Technology/Telemedicine
* Smartphones, FitBits, Sensors
* Teams, Zoom and other client-therapist
computer platforms
* Socially assistive robots

44
Q

Efficacy vs.
effectiveness
gap

A

*Transfer of
knowledge from
research to practice
is lagging
*Need more
interaction between
researchers,
practitioners, and
consumers

MBC (15 decks)

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