EBP 2

Question 1

What does a clinical psychologist do? (2)

Answer 1

• Work within ethical guidelines and within an evidence-based framework
• Provide interventions for individuals, couples, or families to improve their mental health and wellbeing

Question 2

What are the 4 steps to provide intervention?

Answer 2

1. Psychological assessment
2. Diagnosis
3. Formulation
4. Psychological assessment

Question 3

What do clinical psychologist do in a psychological assessment?

Answer 3

• Undertake assessment with clients who present for treatment
• Aim of assessment is to accurately identify and understand the presenting problem and other relevant factors: Clinical disorders, personality disorders, Medical conditions, Personal history, childhood, Social/ environmental, Overall functioning

Question 4

What are psychological assessments? (2)

What are some examples? (3)

Answer 4

• Assessment outcomes informs diagnosis and formulation, in order to guide treatment decisions and planning.
• Identify strengths (can draw on these in treatment) and weaknesses (potential barriers)

Examples:

• Diagnostic questionnaires or psychological tests
• Structured, semi-structured, or clinical interviews
• Behavioural observation

Question 5

What can a diagnosis tell us? (5)

Answer 5

• Diagnosis guides treatment planning
• Selection of empirically supported treatment appropriate for individual client
• Understanding factors likely to influence treatment progress
• A diagnosis may enable clients to access certain funding and support
• A diagnosis can help clients better understand and ‘explain’ their current experience

Question 6

What entails formulation? (4) What are the examples? (2)

Answer 6

• Develop and share understanding of the why — Why this problem? Why for this person? Why now?
• Based on known risks and associated factors of the condition
• Helps client gain understanding (and feel understood) — important part of therapy because it helps in client engagement and therapeutic alliance/ relationship
• Helps guide treatment

Example:
- 4 P’s (predisposing, precipitating, perpetuating, protective)

• Generally based on etiological model of presenting problem (share this with client). E.g. cognitive model of depression

Question 7

What are psychological treatments?

Answer 7

• Selection of Empirically Support Treatment (ESTs), following the three legged stool analogy

Question 8

What are some common ESTs?(3)

Answer 8

• Cognitive Behavioural Therapy (CBT)
• Acceptance and Commitment Therapy (ACT)
• Interpersonal Therapy (IPT)

Question 9

What are some factors to consider when administering psychological treatment? (5)

Answer 9

• Who else is in the treatment team? Are they having regular contact with GP or psychiatrist? Make sure to get into contact and ensure they are on the same page to allow for cohesive treatment
• Who are the client’s supports/support network? social support is a strong predictive factor, be informed of the client’s social network and how it can leverage treatment
• Can we deliver this therapy in this particular setting? Make sure treatment corresponds to capability of therapist (practical things)
• What are the client’s goals? imperative to check out with client to see what they want to get out of seeing a therapist e.g. work on confidence, relationship issues
• Is there any comorbidity? Consult with literature and clinical judgement to decide which disorder to prioritise. Will presence of one disorder interfere with regular treatment of the other?

Question 10

How can theory in developmental psychology inform the practice of a clinical psychologist? (3)

Answer 10

• Understand what is expected development so we know when something might be atypical
• Providing psychological interventions that are developmentally appropriate
• Being able to communicate appropriately with the client

Question 11

How can theory in biological psychology inform the practice of a clinical psychologist?

Answer 11

• Understanding underlying brain mechanisms that account for thoughts, emotions, behaviours, etc.
• Understanding what happens when issues arise

Question 12

How can theory in social psychology and cognitive psychology inform the practice of a clinical psychologist?

Answer 12

• Understanding how people function in relationships and in communities
• Understanding of cognitive processes, e.g., learning, memory, motivation, emotion

Question 13

Which EST has the strongest empirical support?

Answer 13

CBT

Question 14

What are some the unhelpful patterns of thinking? (10)

Answer 14

1. Mental filter
2. jumping to conclusions
3. should-ing and must-ing
4. overgeneralisation
5. personalisation
6. catastrophising
7. black&white thinking
8. labelling
9. emotional reasoning
10. magnification and minimisation

Question 15

What are negative automatic thoughts? (2)

Answer 15

• Thoughts are often automatic and can be difficult to identify
• May follow a ‘theme’ — based on a core belief about oneself

Question 16

What are core beliefs?

Answer 16

‘Young’s maladaptive schemas’

• Schemas are core beliefs based on early life experiences
• Assumptions about how the world works
• Schemas act as a ‘filter’ through which subsequent information processed
• Influencing content of negative automatic thoughts
• Schemas are often self-perpetuating

Question 17

What are the core beliefs? (17)

Answer 17

1. Abandonment/instability
2. Mistrust/abuse
3. Defectiveness/shame
4. Social isolation/alienation
5. Dependence/incompetence
6. Vulnerability to harm or illness
7. Enmeshment/under developed self
8. Failure
9. Entitlement/grandiosity
10. Insufficient self-control
11. Subjugation
12. Self-sacrifice
13. Approval seeking
14. Negativity
15. Emotional inhibition
16. Unrelenting standards
17. Punitiveness

Question 18

How does cognitive restructuring happen? (7)

Answer 18

• Helping clients understand that individuals may develop unhelpful patterns of thinking they unconsciously apply across various situations in life (thoughts are influential)
• Identify unhelpful thinking styles
• Educating clients to understand link between triggering events, thoughts, and emotions/behaviours (ABC model).
• Helping clients identify and uncover their own ABC patterns and NATs
• Assisting clients to understand how these patterns have arisen
• Aiding clients in ‘restructuring’ these though patterns
• Helping client generate alternate thoughts

Question 19

What is the behavioural component in CBT?

Answer 19

• Behaviours that individuals do/do not engage in often reinforce the underlying problem. E.g. if you are feeling depressed, you may refuse to see a friend, and later feel even worse.
• Treatment may include identifying the behavioural cycles in which a client is engaging

Question 20

What are the key component for treatment of low mood? (6)

Answer 20

• Behavioural activation aims to disrupt the behavioural cycle of depression
• E.g. pleasant activity scheduling, self-care activities, small tasks that give a sense of accomplishment, light exercise
• Uses behavioural experiments
• Test beliefs that maintain the disorder, e.g., “If I go to the BBQ, I will have a terrible time and no one will speak to me.”
  Experiment: “Go and strike up a conversation”
• Relaxation activities
  e. g. Physiological de-arousal, activate parasympathetic nervous system, Controlled breathing, visualisation, mindfulness, other relaxing activities

Question 21

What are other CBT interventions? (5)

Answer 21

1. Problem solving: A structured process including defining the problem, brainstorming possible solutions, evaluating pros/cons of each solution, and selecting a solution
2. Behaviour change: Set plan for changing specific behaviour, can use principles of operant conditioning e.g., rewards, setting small goals, etc.
3. Graded exposure: Gradually exposing client to feared situation/stimuli, such that at each step, client’s anxiety reduces before the next step is attempted (e.g., thinking of a spider)
4. Sleep hygiene: Providing evidence-based information and tips to help address sleep issues
5. Psycho-education: Providing client with with psychological education regarding their presenting problem

Question 22

What is the active role of the client? (5)

Answer 22

• CBT generally includes ‘homework’ for client
• E.g., Recording or self-monitoring behaviours, completing thought diaries, relaxation charts, etc.
• Emphasis teaching skills and skills-based approach
• Clinical psychologist guides the client, teaches skills, facilitates insights — but client has active role in sessions and between sessions
• Treatment generally time-limited with a structured approach

Question 23

What model does CBT operate under? (2)

Answer 23

• CBT inherently operates under a biopsychosocial model

- Social element important too — not just something the client does ‘to solve their own problems in their heads’.

Question 24

What are the social components of CBT? (4)

Answer 24

• Person understood within their social context
• Involves client activating their social supports
• Behavioural activation often involves engaging with friends, family, or the community
• Strengthening interpersonal functioning a common goal