Chapter 17/18 - Prevention and treatment Flashcards
1
Q
Why do most Canadians with mood disorders take primarily medications to manage their mental health problems?
A
- Most management of mental health problems is done in primary care settings
- Only physicians can prescribe psychotropic medications in Canada. Many are not trained in psychotherapy
2
Q
What are carceral institutions?
A
- Programs offered by prisons/penitentiaries
3
Q
What is the most frequent cause of delayed treatment in public agencies?
A
- Long waiting lists
4
Q
What disorders may require more extended forms of treatment?
A
- May include eating disorders and borderline personality disorder, substance abuse disorders as well
- Bipolar and schizophrenia may involve life-long follow-ups
5
Q
What regulations regarding mental health practitioners are found among all provinces?
A
- All provinces require professional registration for psychologists and clinical social workers at the master’s or PhD level
- ‘Counselors’ are regulated in some provinces, most recently Alberta
6
Q
What are the different neurostimulation treatments?
A
- ECT (depression and bipolar)
- TMS (depression)
- Vagus nerve stimulation (coil wraps around nerve and stimulates it to help with depression; not commonly done, difficult to remove coil once implanted)
*ECT and TMS most common
7
Q
What are the most common psychopharmacological treatments?
A
- Antidepressants - MAO inhibitors, TCAs, SSRIs, SNRIs, NDRI
- Anxiolytics - Anxiety/panic attacks (benzodiazepines, some antidepressants)
- Antipsychotics
- Mood stabilizers (BPD)
- Stimulants - ADHD. Adderall
8
Q
What are the key features of psychodynamic psychotherapies?
A
- Focus is on current life circumstances, affect and expression of emotion
- Exploration of attempts to avoid thoughts and feelings (why does this occur)
- Identification of themes and patterns
- Focus on interpersonal relations
- Focus on the therapy relationship (ex. issue transference)
- Exploration of fantasy life (this is special to psychodynamic therapies)
9
Q
What is time-limited psychotherapy (TLDP) and supportive-expressive therapy?
A
- Therapy has a goal
- Therapist actively directs patient recollections, facilitate the expressions, offer interpretations quickly and directly, and clearly supportive of patients
- Have individual and group applications
- Often ‘medium’ term (20-30 sessions)
- Is outcome oriented
- TLPD uses some psychoanalytic techniques
10
Q
What’s the general focus of behavioural and cognitive therapies?
A
- Focus on behaviour change in the present
- Is outcome-oriented
11
Q
What are some of the behavioural techniques based on classical conditioning?
A
- Systematic desensitization
- In-vivo desensitization
- Flooding
- Aversion therapy
*All used for anxiety
12
Q
What are some of the first-wave behavioural therapies?
A
*Many based on classical conditioning and operant conditioning
- Contingency management - used a lot with kids, control over rewards/penalties
- Social skills training
13
Q
What are some of the ‘second wave’ behavioural therapies and cognitive techniques?
A
- Problem-solving therapy
- Self-instruction training
- Cognitive therapy - challenging negative/distorted beliefs
- Rational Emotive Therapy (RET) - challenging irrational beliefs through direct disputation
- Behavioural activation therapy for depression
14
Q
What are some of the third-wave cognitive therapies?
A
- Acceptance and commitment therapy (ACT)
- Mindfulness-based cognitive therapy (MBCT)
- Dialect behaviour therapy (DBT)
15
Q
What therapies do ACT, MBCT, and DBT all have in common?
A
- Emphasize principles such as acceptance, mindfulness, values-based living, and examining one’s thoughts in a dispassionate way
- Third-wave therapies employ trans-diagnostic techniques that can be applied to many disorders (ex. meditation).
- Emphasis on wellness ans quality of life
16
Q
What’s cognitive diffusion?
A
- Helping people realize that what they think about becomes them, and that this isn’t true
- Cannot think ideas into real events
17
Q
What are the general principles of humanistic therapies?
A
- Psychotherapy is client-centered
- Therapy is non-directive. Change is largely client-determined. The patient is encouraged to make his choices
- Empathy, warmth, and genuineness are seen as essential to produce change
18
Q
What are the different types of humanistic therapies?
A
- Client-centered therapy
- Existential therapy
- Gestalt therapy (relations with others)
- Emotion-focused therapy
19
Q
What is humanistic therapy most commonly used for?
A
- Depression, interpersonal issues, distress associated with chronic and life-threatening conditions
20
Q
How is the effectiveness of treatments for mental disorders measured?
A
- Use randomized clinical trials, which were initially developed for medical studies
- Can be difficult to replicate methodology since there’s a lot of diversity within types of psychotherapies
21
Q
What are the major benefits of psychotherapy?
A
- People who receive therapy are better off than 80% of untreated people
- 2/3 patients improve significantly in therapy; 1/3 of those who don’t seek therapy improve over time
- Also very economical, may even pay for themselves
22
Q
Why do most people often only attend less than 10 sessions?
A
- They start to feel better and so they stop going
- Not good
- Ideally, for depression, 10-20 sessions are ideal
23
Q
What’s the major controversy concerning psychotherapies?
A
- Should psychotherapies that have not been shown to be effective be taught or used?
- Ex. CBTs largely dominate the field of efficacy research, therefore are promoted as most effective
24
Q
What are Jerome Frank’s common factors regarding why psychotherapy works?
A
- A trained healer in whom the sufferer believes and from whom he/she seeks treatment
- A structured interaction between the healer and sufferer in which change occurs as a consequence of words, acts or rituals (i.e., corrective experiences)
- Major ingredients of healing: The instillation of hope, the provision of alternative explanations for problems, the expectation that the client will think, act, or feel differently as a result of the interaction
25
What's a major factor of success for psychotherapy?
- The therapist-client relationship ('the therapeutic alliance')
- Severity of diagnosis also plays a big role
- YAVIS - young, attractive, verbal, intelligent, successful
26
What's your typical psychotherapy client?
- Most likely younger, middle-class, female, with at least some post-secondary education
27
What's special about the national Institute for Health and Care Excellence (NICE) in the UK?
- They provide guidelines for evidence-based practice, especially with anxiety and mood disorders
28
What's community intervention and prevention?
- Community psychology provides an ecological perspective which emphasizes the interdependence of individuals, families, and communities, and society
29
What are some general statistics regarding mental disorders in Canada?
- About 20% of Canadians (around 7 million people)
- It is estimated that at any given time, 14% of Canadian children aged 4 to 17 suffer from a mental disorder
30
Why are young people usually the main targets in public mental health strategies?
- Because approximately 70% of mental health problems start in childhood and/or adolescence
31
What's the difference between primary, secondary, and tertiary prevention?
- Primary - interventions aimed at preventing the occurrence of the problem (ex. sex education)
- Secondary - interventions performed after the problem is identified but before it has caused suffering, losses, or disability (ex. adolescents with low SES)
- Tertiary - interventions aimed at preventing further deterioration once the problem has caused damage 9ex. drug rehab)
32
What is mental health promotion?
- An approach to mental health which emphasizes strengths, resilience, and positive mental health as opposed to reacting to pathology
- Mental health is more than the absence of disorder
33
What's universal prevention?
- Includes all individuals in a geographical area or particular setting
34
What's selective prevention?
- Assumes that there are known factors that affect mental health and an intervention is directed at a population where those factors are most prevalent
- Ex. schools in a low-income part of the city
35
What's indicated prevention/early intervention?
- Programs directed at individuals showing early signs of mental health problems
36
What are major principles that contribute to positive mental health?
- The ability to enjoy life
- The ability to deal with life's challenges
- Emotional well-being
- Spiritual well-being
- Social connections and respect for culture, equity, social justice and personal dignity
37
What are some current approaches to prevention?
- The identification of risk factors and the issue of cumulative risk
- The identification of protective factors
- Wellness enhancement and the promotion of resilience
- Social justice perspectives
38
What does wellness enhancement and the promotion of resilience involve?
- Fostering secure attachment of children to caregivers
- Encouraging the development of age-appropriate competencies
- Creating healthy, safe, and 'just' social environments
- Empowering people psychologically and politically
- Helping people develop the resources to cope effectively with stressful life events
39
According to Rutter (1987) what are some important risk and protective factors?
1) reducing risk impact
2) Interrupting unhealthy chain reactions stemming from stressful events
3) Enhancing self-esteem and self efficacy
4) Creating opportunities for personal growth
40
What's the general cost-effectiveness of intervention programs?
- In the US, early intervention and prevention programs show that returns range from $1.50 to $17.00 for every dollar invested
- Savings in sectors such as the criminal justice system, health system, and lifetime savings
41
What's cultural competence?
- The degree of compatibility between cultural and linguistic characteristics of a community and the manner in which the combined policies, structures, and processes underlying local mental health services seek to make these services available
42
What's the difference between interactionist and constructionist perspectives?
- Interactionist - understands that risk factors and protective factors do not affect everyone in the same way
- Constructionist - the nature of resilience is influenced by how people construct meaning from their experiences
43
What does a prevention program's fidelity mean?
- The extent to which the innovation corresponds to the originally intended program
