clinical applications Flashcards
what is psychotherapy?
systematic efforts to apply psychosocial intervention to reduce distress or maladaptive behavior or enhance adaptive functioning.
in a given year in the united states, approximately how much of the population meets criteria for one or more psychiatric disorders?
25%.
over the course of a lifetime, approximately how much of the population meets criteria for at least one disorder?
50%.
in the united states, approximately how much of individuals with a diagnosable mental disorder are not receiving treatment of any kind?
- 70%
- this is also higher for minority groups, specially african americans and hispanics
how much does alcoholism and substance use cost the U.S. each year?
approximately $500 billion.
how many people in the U.S. have alcoholism or a substance use disorder?
over 20 million americans.
how much do anxiety disorders cost the U.S. each year?
approximately $42 billion.
why are advocacy numbers important?
for governmental funding as it is often necessary to provide data to show the seriousness of the issue.
what do changing definitions overtime do?
they can influence the prevalence/how much a disorder seems to appear.
why was there dissatisfaction with traditional treatment (psychoanalysis)?
methods often required people to go to therapy for their entire lives because they were ineffective.
where did psychoanalysis come from?
freud, but he was not a researcher.
what was the view of traditional treatments (psychoanalysis)?
psychological problems emerged in relationships (e.g., parent, family) and that those problems had to be resolved in a very special relationship in the context of therapy.
why did many people use traditional treatments (psychoanalysis)?
people went because at the time, having a psychoanalysis was seen as a status symbol.
research indicated that approximately of children, adolescents, and adults who received therapy improved by the end of treatment?
about two-thirds.
although two-thirds of children, adolescents, and adults who received therapy improved by the end of treatment, about how many improved with no treatment?
also about two-thirds.
behaviorism was an effort to what?
bring all topics toward a more scientific and objective approach.
what was much of behaviorism work based off of?
the work of pavlov and conditioning.
the learning based approach seems more what?
more rational for a basis of treatment compared to traditional methods.
what does the learning based approach state?
people behave the way they do because they learned that behavior.
what tended to emerge because of a more objective, behavioral, and learning-based approach?
animal laboratory research on operant conditioning (e.g., how do animals respond to various reinforcement contingencies?).
what did wolpe do?
- said that we can treat anxiety disorders by using extinction
- however, he knew that extinction was hard, so he said we have to be smart about it
- what can a person tolerate in extinction?
- start with the easiest behavior a person wants to do and then increase it
by the 1970s intervention techniques had been applied in what?
schools (elementary through college), business and industry, the home, the military, and community settings and for an endless set of target behaviors (e.g., academics, socialization, exercise, nutrition, conservation, work and medical safety practices).
what is a cognitive process?
an array of mental events (self-statements, thoughts, perceptions, beliefs, expectations, and attributions).
how the environment is perceived and cognitively processed can greatly influence what?
- the impact of environmental events
- ex: two persons riding a roller coaster may react quite differently, in part because of the different ways in which they perceive the experience
what is stimulus-response (S-R) learning?
- stimuli is referred to environmental events outside of the individual and responses are referred to what the organism (e.g., laboratory animal) actually did in the experiment
- learning takes place by pairing stimuli (e.g., classical conditioning) or various behaviors and consequences (e.g., operant conditioning)
what is stimulus-organism-response (S-O-R)?
one could better explain learning by considering internal processes in addition to environmental cues.
what are the four paradigms for studying learning?
- classical conditioning
- operant conditioning
- observational learning (modeling)
- rational behaviorism
cognitive processes have been shown to relate to or from a central part of what?
a number of clinical disorders, including depression, schizophrenia, and anxiety.
what are cognitively based techniques?
a family of procedures that are distinguished by adherence to one or both of these propositions: (1) maladaptive, distorted, or deficient cognitions underlie the clinical problem that is being treated; and (2) cognitive processes are central to therapeutic change independently of the underpinnings of the clinical problem.
most cognitively based techniques are applied in the context of what?
psychotherapy sessions in which children, adolescents, or adults are seen individually or in a group by professional therapists.
what is mindfulness?
an awareness of one’s current experience, including bodily functions, consciousness, and other aspects of the moment.
what is mindfulness mainly used for?
anxiety and stress management.
where did mindfulness come from?
buddhist meditation.
acceptance complements what?
- mindfulness
- emphasizes accepting and embracing one’s private thoughts and experiences
what is acceptance and commitment therapy?
the treatment assumes that much of psychological suffering stems from avoiding experience, maladaptive cognitions, and psychological rigidity.
what does acceptance and commitment therapy include?
attention to current experience (mindfulness, acceptance) and strategies to change behaviors and cognitions (cognitive-behavioral strategies).
what are evidence-based treatments (EBTs)?
those therapies that had strong support.
what is commonly used to determine if a treatment is evidence-based?
- if there is random assignment
- careful specification of the patient population
- use of treatment models
- multiple outcome measures
- statistically significant differences between the treatment and control groups
- treatment can be replicated
what is experimental neurosis?
basically an anxiety reaction.
what is systematic desensitization?
training someone to be deeply relaxed and pairing relaxation with exposure to the situations that evoke anxiety or to imagination of those situations.
what are key features of systematic desensitization?
the use of one’s imagination and gradual exposure.
what is flooding?
no relaxation but instead exposure with full intensity with the hope that the person habituates to it.
what is the problem with flooding?
it works but there is a huge drop out rate.
what is in vivo treatment (e.g., in vivo desensitization)?
exposure to the actual situations with the use of relaxation.
what are key features of in vivo treatment?
- it tends to be more effective than exposure in imagery
- uses modeling sometimes
what is graduated exposure?
the gradualness of desensitization, i.e., more like a hierarchy or successive approximations toward the most feared stimuli.
what is parent management training?
procedures in which parents are trained to alter their child’s behavior in the home.
why is parent management training often used for antisocial/aggressive behavior?
- the problem behaviors of the child may be inadvertently developed and sustained in the home by maladaptive parent-child interactions
- even if current behavioral problems in the home cannot be specifically traced to coercive parent–child interactions or harsh punishment, PMT can effect changes by building prosocial behaviors at home and at school
what is the goal of parent management?
to develop specific skills in the parents.
what is autism?
includes deficits in social interaction, verbal and nonverbal communication, delays in cognitive development and adaptive functioning, and repetitive or ritualistic behaviors.
autism affects 1 in every what?
1 in every 110 children.
autism is often evident by what?
three years of age.
what did early intervention autism do?
consisted of intensive focus in one-to-one situations where children were taught basic language and communication skills, play, social interaction, and other skills.
how developed early intervention autism?
pioneered by ivar lovaas in the 1960s.
currently, what does autism intervention focus on?
intervening when children are no older than 4 years of age where intervention is intensive and includes 20–40 hours per week of individualized training and continues for 2 or more years.
what did autism treatment often lead to?
big improvement in functioning and IQ.
what is pivotal response training?
it is directed to behaviors that are labeled as pivotal responses and emphasizes a training approach that is more “natural” than traditional training.
what are pivotal responses?
a target or domain of functioning that when focused on leads to wide- spread changes in many other behaviors that have not been targeted.
what are three pivotal behaviors?
- motivation to respond to social and environmental stimuli: as children become responsive to these influences they will have many opportunities to develop behaviors that draw on these influences
- self-initiation: activities include seeking information, seeking assistance, asking questions, and engaging with others socially
- socializing: engaging in social interactions with their families and peers who are functioning normatively in everyday life and activities could include play and games (e.g., tag) that are inherently social
what are four key program features that illustrate what distinguishes the intervention from others?
- parents use child-selected stimuli (those children prefer)
- direct and natural reinforcers are used when possible
- maintenance trials are interspersed during the acquisition or development of behavior
- children’s attempts to respond to instructional materials are reinforced even if the attempts are not part of a shaping program working toward a specific terminal response
rational emotive behavior psychotherapy was developed by who?
albert ellis.
what is rational emotive behavior psychotherapy based on?
the view that psychological problems arise from faulty or irrational thought patterns.
what is the purpose of rational emotive behavior psychotherapy?
to examine the implicit self-verbalizations that people make, to challenge them and point to their irrationality, and, importantly, to substitute more adaptive self-verbalizations.
cognitive therapy for depression was developed by who?
aaron beck.
cognitive processes are considered to what?
underlie depression.
what is the negative cognitive triad?
three concepts central to the theory are negative thoughts toward oneself, the world, and the future, particularly in relation to depression.
what is cognitive therapy (CT)?
focuses on beliefs and negative cognitive processes that promote depression.
what assignments does cognitive therapy (CT) give?
to behave in particular ways and to engage in goal-directed activities are central to therapy.
when compared to medications the effects of cognitive therapy are much more what?
enduring.
early work proved that problem solving skills were effective if it led to better access to what?
reinforcement.
children with adjustment problems often have difficulty identifying what?
- alternative solutions to interpersonal problems (e.g., resolving an argument), the consequences of their behaviors (e.g., the reactions of others), and the steps that need to be taken to achieve a goal (e.g., how to make friends)
- often fixed by training the children to use problem-solving steps and self-statement
what is alternative solution thinking?
the ability to generate differnent options that can solve problems in interpersonal situations.
what is means-end thinking?
awareness of the intermediate steps required to achieve a particular goal.
what is consequential thinking?
the ability to identify what might happen as a direct result of acting in a particular way or choosing a particular solution.
what is causal thinking?
the ability to relate one event to another over time and to understand why.
what is sensitivity to interpersonal problems?
the ability to perceive a problem when it exists and to identify the interpersonal aspects of confrontations that may emerge.
several studies have shown that problem-solving skills training can decrease what?
disruptive and impulsive behavior and increase peer popularity among children and adolescents.
problem-solving skills training has been used extensively in what?
the context of treatment with children and adolescents who show disruptive, aggressive, and delinquent behavior.
what is dialectical behavior therapy?
a cognitive behavioral treatment designed for difficult-to-treat psychological disorders.
who developed dialectical behavior therapy?
marsha linehan.
what is dialectical behavior therapy often used for?
those with BPD.
what did dialectical behavior therapy grow out of?
the experience that standard cognitive and behavioral procedures did not work well with chronically suicidal patients.
what does dialectical behavior therapy treatment include
components designed to accept and validate the capacities, experiences, and functioning of the individual along with using practices from behavior and cognitive therapy that are designed to promote adaptive functioning.
what is the overall goal of dialectical behavior therapy?
address deficits in a variety of self-management skills (e.g., regulating emotions, interpersonal effectiveness, tolerating distress).
problems in dialectical behavior therapy are addressed in what?
a hierarchical order from life-threatening behaviors, then to behaviors related to participating in treatment, then to reducing behaviors or areas of dysfunction that interfere with the quality of life, and finally developing life skills to increase quality of life and capacity for joy.
what can therapy tend to be?
expensive, especially one-on-one therapy.
what is another challenge in delivering evidence-based treatments?
getting them to clinicians.
getting treatment to people in need is what?
an issue as most mental-health professionals are concentrated in cities and not spread throughout the country in small towns, and rural areas
how has the web helped with therapy?
therapy and resources are starting to become more easily accessible.
what are quit lines?
telephone-based counseling technique that is offered in all 50 states to help reach underserved populations.
what is the most prevalent mental disorder in the U.S.?
alcoholism or a substance use disorders.
