Chapter 2

Question 1

What is the multidimensional integrative approach to the causes of psychological disorders?

Answer 1

The interaction of dimensions:

• genetic, nervous system,
• behavioural and cognitive processes,
• emotional, social and interpersonal influences,
• and developmental factors.

Question 2

As a psyc you must identify

Answer 2

• 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.

Question 3

What are the 2 Common Models to explain a disorder?

Answer 3

Biomedical Models
Psychological Models:
 -Psychodynamic models
 -Social/Interpersonal models
 -Behavioural models
 -Cognitive-behavioural models

Question 4

Biomedical Models Causes

Answer 4

• Genetic influence

- Focus on neural functioning, especially the role of neurotransmitters and neurohormones in mood and behaviour

Question 5

Biomedical Models Treatments

Answer 5

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

Question 6

Psychodynamic models causes

Answer 6

• Early experience/trauma, unconscious drives, conflict, and unhealthy repression causes symptoms
• Lack of insight maintains symptoms

Question 7

Psychodynamic Models Interventions

Answer 7

• “Make the unconscious conscious”
• Change of personality rather just alleviate symptoms
• As insight increases, symptoms resolve

Question 8

Psychodynamic Model Interventions:

Techniques meant to access unconscious materials and conflicts

Answer 8

• 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

Question 9

Counter-Transference

Answer 9

What feelings arised in you as a therapist in response to the client. E.g. Felt client was being rude to you.

Question 10

Psychodynamic models Interventions: Techniques to foster Insight

Answer 10

• Interpretation

- Confrontation

Question 11

Social/Interpersonal Models

Answer 11

• major disruptions/losses in social relationships
• Adolph Meyer
• Harry Stack Sullivan and the Interpersonal School:
• Bowlby and Attachment Theory

Question 12

What is Interpersonal Psychotherapy?

Answer 12

• 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).

Question 13

Interpersonal Psychotherapy: An IPT model of depression

Answer 13

• 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

Question 14

Interpersonal psychotherapy: IPT model for psychotherapeutic change

Answer 14

• 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

Question 15

IPT Interventions

Answer 15

• “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

Question 16

Behavioural Models

Answer 16

• 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

Question 17

Behaviour model Intervention

Answer 17

• 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

Question 18

Cognitive Behavioural Models

Answer 18

• “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

Question 19

CBT: The ABCs of a mood - the role of beliefs and appraisals

Answer 19

Activating Event -> Beliefs-> Consequence

Question 20

CBT Interventions

Answer 20

• CBT therapists would attempt to intervene at both
  
  • the level of belief
  • behavioural consequence
• A primary cognitive-based intervention is Cognitive Restructuring

Question 21

Cognitive Restructuring

Answer 21

• 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

Question 22

Cognitive Restructuring: nuts and bolts

Answer 22

• 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.

Question 23

What is a schema?

Answer 23

A bias to the way people think

-In CBT interventions the therapist would give you homework to help stop your negative schema

Question 24

What are randomised clinical trials (RCT)?

Answer 24

• Where all participants have a diagnosis

- Generally have a treatment and no-treatment condition

Question 25

Why might diverse therapies produce similar outcomes?

Answer 25

• 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

Question 26

Final thoughts

Answer 26

• 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.