Chapter 2 Flashcards
What is the multidimensional integrative approach to the causes of psychological disorders?
The interaction of dimensions:
- genetic, nervous system,
- behavioural and cognitive processes,
- emotional, social and interpersonal influences,
- and developmental factors.
As a psyc you must identify
- What causes symptoms/problems in a patient
- What maintains symptoms/problems in a patient
- What can help or resolve the symptoms/problems of the patient.
What are the 2 Common Models to explain a disorder?
Biomedical Models Psychological Models: -Psychodynamic models -Social/Interpersonal models -Behavioural models -Cognitive-behavioural models
Biomedical Models Causes
- Genetic influence
- Focus on neural functioning, especially the role of neurotransmitters and neurohormones in mood and behaviour
Biomedical Models Treatments
medications:
-Selective serotonin reuptake inhibitors (SSRIs and SNRIs)
-Tricyclic antidepressants (TCA) early 1950s med. good but side effects so rarely administered
-Monoamine oxidase inhibitors (MAOIs)
Other biomedical interventions:
-Electroconvulsive Therapy (ECT) effective for medication resistant patients
-Transcranial Magnetic Stimulation (TMS)
-Rationale for efficacy is less clear
- Many people experience a relapse once they stop taking anti-depressants so kinda like diabetes most people have to take medication for the rest of their lives
- Sometimes like hayfever meds need to switch it up so it remains effective
- Takes a few weeks to be effective
- Best to combine with psychotherapy
Psychodynamic models causes
- Early experience/trauma, unconscious drives, conflict, and unhealthy repression causes symptoms
- Lack of insight maintains symptoms
Psychodynamic Models Interventions
- “Make the unconscious conscious”
- Change of personality rather just alleviate symptoms
- As insight increases, symptoms resolve
Psychodynamic Model Interventions:
Techniques meant to access unconscious materials and conflicts
- Free association (“just say whatever comes to your mind”)
- Dream Analysis
- Noticing slips of tongue, or “Freudian slips”
- Noticing aspects of the therapeutic relationship:
- Transference and counter-transference, resistance
Counter-Transference
What feelings arised in you as a therapist in response to the client. E.g. Felt client was being rude to you.
Psychodynamic models Interventions: Techniques to foster Insight
- Interpretation
- Confrontation
Social/Interpersonal Models
- major disruptions/losses in social relationships
- Adolph Meyer
- Harry Stack Sullivan and the Interpersonal School:
- Bowlby and Attachment Theory
What is Interpersonal Psychotherapy?
- A psychotherapeutic approach that focuses on social/interpersonal factors in depression.
- Developed in the 1970s as part of a research trial of antidepressant medication (newer than CBT).
Interpersonal Psychotherapy: An IPT model of depression
- Predisposing factors (e.g., early childhood IP experiences, personality factors, biology, inadequate attachments) place a person at increased risk of developing depression.
- Current IP/social factors (IP loss or disruption, PLUS inadequate social support) cause and maintain acute depressive symptoms
Interpersonal psychotherapy: IPT model for psychotherapeutic change
- focus is on CURRENT SOCIAL RELATIONSHIPS as an agent for change
- symptom reduction is thought to occur by helping the person better manage the IP problems associated with depressive symptoms AND helping the person access social support
IPT Interventions
- “Common techniques” - provision of support and reassurance, empathy, warmth, clarification questions
- Communication analysis and Interpersonal incidents (“tell me about the last fight you had with your partner”)
- Recognising and communicating affect
Behavioural Models
- Focus not on person’s cognition but on person’s behaviours as cause for depression
- Behavioural models can be strict type and focus solely on Stimulus-Response pairing in learning (classical and operant conditioning), including learning of maladaptive behaviours/symptoms - with no role for cognitive mediation.
- more contemporary behavioural models allow a role for the internal experience of the person in causing and maintaining symptoms
Behaviour model Intervention
- Scheduling Pleasant Events - technique meant to restore intrinsic rewards of daily life, e.g., use of weekly activity schedule
- Structured Problem-Solving
- Assertiveness Training -for people being bullied and are too passive
- Social Skills Training
- For more anxiety based disorders (e.g., phobias)
- Systematic desensitisation/Exposure therapy
- Relaxation Training
Cognitive Behavioural Models
- “for there is nothing either good or bad, but thinking makes it so” -Shakespeare in Hamlet
- How we interpret things
- Cognition/beliefs affect mood and behaviour; INACCURATE or DISTORTED cognitions/beliefs can lead to psychological dysfunction
- CBT also incorporates much of the behavioural approach in conceptualisation and treatment
CBT: The ABCs of a mood - the role of beliefs and appraisals
Activating Event -> Beliefs-> Consequence
CBT Interventions
- CBT therapists would attempt to intervene at both
- the level of belief
- behavioural consequence
- A primary cognitive-based intervention is Cognitive Restructuring
Cognitive Restructuring
- Identify and challenge distorted beliefs - Where is the distortion? “What is the evidence?”
- Assists client in:
- identifying the negative automatic thoughts (NATs)
- becoming more aware of NATs as they happen
- ultimately change the habitual dysfunctional thought patterns
Cognitive Restructuring: nuts and bolts
- Client asked to describe situation in which they became upset
- Identify which emotion (mad, sad, scared)
- Rate the intensity of the emotion
- Write down all thoughts that occurred just before and during the distress
- With therapist’s assistance, identify the thoughts likely related to the distress, and challenge them in one or more ways.
What is a schema?
A bias to the way people think
-In CBT interventions the therapist would give you homework to help stop your negative schema
What are randomised clinical trials (RCT)?
- Where all participants have a diagnosis
- Generally have a treatment and no-treatment condition
Why might diverse therapies produce similar outcomes?
- Different paths to the same goal?
- Interestingly, most therapies involve:
- A therapeutic relationship, “Warm support, reassurance, suggestion, credibility, therapist attention”
- Encouraging accurate identification and expression of emotion
- Instilling hope and expectation for improvement
- Exposing people to their fears
- improving client perceptions of their own effectiveness
- improving insight into problems
Final thoughts
- Helping people change is complex, challenging and rewarding
- Complex…many factors contribute to causing and maintaining problems
- Challenging…by the time they enter therapy behaviour patterns can be very entrenched. Clients may be in a great deal of distress
- Rewarding…to be present at, and contribute to, a time of positive change in a person’s life.
