Exam 1 Flashcards
Examples of Expressive Therapy
Rituals, Language arts, Visual arts, Drama, dance
What is expressive therapy?
Offers support and introspection by looking at negative thoughts and sad mood
Uses arts to look a difficult emotions
Counter conditioning is where the patient perceives safety, nurturing, and acceptance in the session –> fear diminishes
What is supportive therapy
Based on the patient’s psychodynamics, strengthen the defenses
More like talk therapy –> not as structured as expressive psychotherapy
Goals of treatment for supportive therapy
Strengthen the defense mechanisms that the patient already has
Promote problem-solving
restore adaptive functioning
Provide symptom relief
What is the diathesis-stress model
Genetic vulnerability + Nurture as our BDNF forms = how we’ll react to stress
Explains why some people can handle more amounts of stress and others cannot
HPA axis and stress
Stress occurs –> hypothalamus goes into overdrive –> produces cortisol
endocrine/nervous/immune systems = stress response
EMDR
- what does it stand for
- what model does it follow
Eye Movement Desensitization and Reprocessing
Adaptive information processing model
Psychodynamic therapy change agent
classical - insight
psychoanalytic therapy
aims to restructure defenses
based on freud
how the unconscious mind influences
Who would use group therapy
difficult with anger
lonely, loss, really shy, depression, social anxiety, addictions
Supportive therapy goals
therapeutic alliance to help patient
aims to strengthen defenses, promote problem solving
improve self-esteem to cope with life stressors
Who would use supportive therapy
learning how to live alone (widow),
Who would use Trauma Focused Cognitive Behavioral Therapy
people dealing with the negative effects of trauma
Who would use psychoanalytic therapy
abusive relationship - can’t remember that time period
someone who is experiencing repression - ie can’t remember parts of their childhood
repressed memories
nightmares
because it looks at how the unconscious mind can influence us
What are the contraindications of EMDR
strabismus and other eye disorders
Which defense mechanism improves empathy, insight, immune function, attention, and emotional regulation?
mindfulness
What is reframing
Developing a new conceptual or emotional outlook relation to situations experienced, and putting it into another frame which follows the facts or evidence equally well, changing its whole definition. Restarting
Looking at something from a different angle
ie. Looking at a problem as a challenge rather than a defeat
What is the Adaptive Information processing model (AIP)
Humans have an inherent information processing system that usually processes experiences to a physiological adaptive state in which information can be taken in and learning can occur. Memory is stored in a way that allows for connection with other adaptive memory networks
What disorders use EMDR?
Schizophrenia and bipolar disorder
Function of acetylcholine
and where the tracts are
Decrease levels is associated with memory and cognitive impairments. An increase is associated with Alzheimer’s disease
present in cholinergic track - extending from the limbic structure to the cortex
Function of cortisol
-and r/t PTSD
Stress hormone, inhibits inflammatory
PTSD - chronically lower cortisol
Function of dopamine
responsible for motor action and the reward system. Too much may change mood, increase motor behavior, and disturb frontal lobe functioning, resulting in depression, memory impairment, and apathy. Too little-parkinson’s/EPS symptoms; Too much-hallucinations
Function of Gaba
Calming neurotransmitter;
- too much-sedation
- too little: anxiety
Glutamate
Excitatory neurotransmitter involved in memory. Can cause problems with ACH if dysfunctional. Too much agitate neurons and can be toxic
What is the defense mechanism? Ex: Anger and hostility are transformed into pain and somatic complaints
Hypochondria
What is the defense mechanism? Ex: Identification with the aggressor through which the person becomes aggressive to gain control
Unconscious adoption of other people’s thoughts and or traits
introjection
What is the defense mechanism? Avoiding, no social engagement
isolation
What is the defense mechanism? Ex: a child begins wetting the bed after a sibling is born
Regression
What is the defense mechanism? Ex: Instead of feeling sad, a person gets drunk
Acting out
What is the defense mechanism? Ex: The child cannot remember her anger or hitting her mother
Repression
What is the bilateral and unilateral approach of EMDR
Bilateral –> activation of both sides of brain –> use bilateral stimulation of sight and touch (tappers)
Neuroplasticity
brains ability to adapt
chronic stress decreases neuroplasticity
having good self coping skills helps the brain process change and adapt
Serotonin
helps calm you down and makes you happy
main NT in depression –> Rx SSRI
What type of assessment question is this? How many drinks did you have? Do you smoke? Are you anxious or depressed?
Closed-ended questions
What type of assessment question is this? You must have been so hurt by that. That is very frustrating. It is hard to lose someone you love.
Empathetic statement
What type of assessment question is this? Tell me about your family situation. Try to describe how you felt when…. Share with me what you think a good outcome would be
Gentle command
What type of assessment question is this? How have you been sleeping? How is school going?
Qualitative questions
What type of assessment question is this? Can you describe the depressive symptoms? Can you tell me anything more about that?
Swing questions
The following is an example of which type of interpersonal style: “I try to change other people too much”
Domineering
The following is an example of which type of interpersonal style: “It’s hard for me to stay out of other people’s business”
Intrusive
The following is an example of which type of interpersonal style: “I put other people’s needs before my own”
Overly nuturing
The following is an example of which type of interpersonal style: “I fight with other people too much”
Vindictive
What is the change agent of classical psychodynmic therapy?
Insight
What is relational psychodynamic therapy
better understand how your mind, body, and interpersonal life
Therapeutic alliance
relieve your emotional pain a
discover how your unconscious mind creates problems for you
What is the change agent for relational psychodynamic therapy
mindfulness
Which type of therapy would be recommended for people who suffer from grief, substance abuse, and addiction?
group
Which therapy for patients with mature defenses
psychoanalytic therapy
Which therapy for someone with trust issues or primitive defenses
supportive therapy
Which therapy for PTSD
trauma focused CBT
Which defense mechanism involves behaving in such a way, that subtle interpersonal pressure is placed on the therapist to take on dimensions of an experience or unconsciously identify with aspects of the patient?
A person projects qualities of themselves that are not acceptable onto another individual and that person internalizes those qualities
ie. Sam is feeling self-conscious because he gained weight but can’t accept it so he convinces himself that Mike has actually gained weight.
projective identification
Which defense mechanism is the following example: A young aggressive and impulsive man pursues a career as a boxing coach?
Socially unacceptable qualities are transformed into something socially acceptable.
Sublimation
Which defense mechanism refers to the patient’s thoughts, feelings, and behaviors that are associated with early important relationships with caretakers and significant others that are felt toward the therapist?
transference
What are atypical patient responses to EMDR?
increased anxiety, dizziness, lightheadedness, fatigue, numbing, and nightmares
What part of the brain is affected by EMDR?
Hippocampus gets bigger and increased inhibition of the amygdala
Affirming statement
This must be difficult for you
EMDR procedures
8 steps:
1. Hx taking
—- s/s, life constraints, screening
- client preparation
—- establish therapeutic alliance, educate about EMDR, practice safe space - assessing the memory target
—- patient identifies, assigns value - processing the memory target
—- Desensitization - bilat stimuli - Installation
—- Install PC - Body Scan
—- note tension and sensation in body - Closure
—- keep log, educate about distrubances - Evaluating treatment results
What is OARS associate with?
What does OARS stand for?
- motivational interviewing
O: Open-ended questions
A: Affirmation
R: Reflection
S: Summarizing
OARS: Engagement
getting to know patient, estabilsihing trust
OARS: Evoking
Eliciting motivation for a specific change
OARS: Focusing
Guiding interaction to identify a direction of change
OARS: Planning
Planning a specific change strategy
What is cognitive restructuring?
- Strategy used to help retrain the thinking
- May be helpful to use a thought diary
- Start the “stinking thinking”
- Change those negative into positive thoughts
Social Skills Training
- Helpful to introduce self and help people make eye contact and feel comfortable
- Identify socially acceptable boundaries
What diagnosis is social skills training beneficial
- Beneficial for patients with Autism, schizophrenia
—– Have so much going on in their minds that they aren’t paying attention to social cues or social skills
Shame attacking exercises
When people are afraid of doing something in public –> give them exercise to do in public and hopefully help them to realize its not as bad as they think
Eating disorders - key risk factors
OCD traits
low self esteem
distorted body image
adolescents
females
OCD - describe
- Feel like they have to depend on themselves to see that things get done
- Run a very tight, strict, regimen in the home
- Overboard on rules, systems, and orders
Defense mechanism: no it’s not true, I don’t’ hate you, I just love you so so much
A young boy bullies a girl because he likes her
Reaction formation
Defense mechanism: I am not selfish. You are the one that always betrays me,
run into someone you don’t like – but are nice to them
Projection
reflects feelings that the therapist has toward the patient and is similar in some respects to transference
countertransference
What style: Its hard for me to be assertive with another person
Non-assertive
Interpersonal therapy
- adolescents
Reduced sessions for adolescents (12 sessions)
– helps them recognize feelings, improve communication, enhance socialization
Also minimal use of the “sick role”
Addition of parents to treatment
Highly effective for depression
Interpersonal therapy
- goals
- example
Assess the problem – identify problem and the area of interpersonal relationships that it is effecting
Active treatment – delineation of specific goals for the identified problem area, create new relational patterns, discuss events between session as they relate to the identified problem area
Termination – finishing treatment, grieve loss of therapist and discuss relapse prevention
Example = patients that struggle with addiction is to stop the addiction/stop using drugs
Psychodynamic Therapy: general
- self-awareness and the influence of the past on present behavior
- emotions not just behavior
- communication and relationship with others
Psychodynamic therapy motivation: classic and relational
classic - drives; sex and agression
relational - emotional communication and affect regulation
CAGE
USE: identify alcohol abuse/dependence
QUESTIONS:
* Have you ever tried to Cut down on your drinking?
* Have people ever Annoyed you by criticizing your drinking?
* Have you ever felt bad or Guilty about your drinking?
* Have you ever had a drink first thing in the morning as an Eye-opener, to steady your nerves or get rid of a hangover?
What is Socratic dialogue?
Mutual discovery in which the therapist asks a series of questions to help the patient discover the issue themselves
What are the steps of cognitive restructuring?
- Tune in - self-monitoring
- Question Assumptions
- Gather evidence: keep the thought diary
- Perform Cost-benefit analysis
- Generate alternatives - stop them and change them to positive words
Attunement
recognizes other’s emotions and is able to read social cues
Egocentrism
inability to differentiate b/w self and others. “All about me” (especially in teens and kids)
Minimizing
Downplaying the significance of an event or emotion; common strategy in dealing with feelings of guilt
Erikson’s: Infant
Infant (-18 mo)
– Trust vs Mistrust
– Psychosis, addictions, depression
Erickson’s: Early Childhood (18mo - 3 yo)
– Autonomy vs Self dought
– Paranoia, obsessions, compulsions, impulsivity
Late childhood (3-6)
– Initiative vs. guilt
– Conversion disorder, phobias, psychosomatic disorder
Erickson’s: School age (6-12)
– Industry vs inferiority
– Inertia, creative inhibition
Adolescent (12-20)
– Identity vs role confusion
– Delinquency, gender-related identity disorders, borderline psychotic episodes
Young adult (20-30)
– Intimacy vs isolation
– Schizoid personality
Adulthood (30-65)
– Generativity vs stagnation
– Midlife crisis, premature invalidism
Older adult (65 - death)
– Ego integrity vs despair
– Extreme alienation, despair
Gestalt Therapy
- Goal
– Goal: assist the patient in returning to natural state of organismic self-regulation
Gestalt Therapy
- Cycle of retroflection
Turning back onto self what is meant for someone else. Instead of engaging with the environment and directing energy outward, energy is redirected inward.
Examples: biting one’s lip, self-harm, symptoms of depression and psychophysiological disorder
Contraindications of EMDR
Strabismus, seizures… And possibly nightmares??
Signs that EMDR is working
Better emotional regulation, positive self-belief, increased self-esteem, and getting better sleep
Steps of cognitive restructuring
Situation, feeling, and evaluate thought
And decision
What therapy for borderline personality
DBT or psychoanalytic/psychodynamic
What is interpersonal therapy focused on
Relationships
Bad breakup and end up with depression
What therapy for panic disorder
Psychodynamic
What therapy for MDD
CBT
Freud’s stages: Birth - 1 yr
Oral stage
main interaction through mouth
- rooting reflex, sucking reflex, tasting,eating
- establish trust
Freud’s stages: 1 - 3 yr
Anal stage
controlling bladder and bowel movements
- potty training
- learn independance
Freud’s stages: 3 - 6 yr
Phallic stage
primary focus is genitals
- discover differences between males and females
- boys begin to view their fathers as rivals for mom’s affection
- Oedipus complex
Oedipus complex
unconscious sexual desire for the parent of the opposite sex and wish to exclude the parent of the same sex
Freud’s stages: 6 - puberty
Latent stage
sexual feelings are inactive
- super ego continues to develop while Id is suppressed
- develop social skills, values, and relationships with peers and adults outside of family
Freud’s stages: puberty - death
Genital stage
- maturing sexual interest
- interest in the welfare of others
Amygdala
mediates: fear, anger, and rage
hypersensitive = irritability, anger, hypervigilance, exaggerated startle response in PTSD
Cohesion
sense of belonging, solidarity, and attractiveness
Egocentrism
tendency of young children to think that everyone sees things in the same way as the child
Hippocampus
midbrain
- memory
- inhibition of amygdala
- allows coherent narrative about personal history (what happened when and where so explicit memory can weave an autobiography.)
Hypothalamus
-regulates BP, body temp, sleep, appetite, glucose lvls and ANS
Cognitive distortion: emotional reasoning
Because I feel inadequate I am inadequtate
Cognitive distortion: personalization
That comment must have been directed towards me
Cognitive distortion: Global labeling
everything I do turns out wrong
Cognitive distortion: Catastrophizing
If I go to the party it will be a disaster
Cognitive distortion: Overgeneralization
Everything always goes wrong for me.
Cognitive distortion: Control Fallacies
If I’m not in complete control all the time, I will go out of control
Cognitive distortion: Objectifying the subjective
I have to be funny to be liked. It is a fact.
Cognitive distortion: Selective abstraction
All of the good men are taken or are gay.
Cognitive distortion: Fallacy of worrying
If I worry about it enough, it will be resolved.
Cognitive distortion: Ostritch technique
If I ignore it, maybe it will go away.
Overdeterminism
Refers to the idea that a problem most often has many different causes.
The patient may not be able to provide a full description of these contributions and most likely is unaware of the multiple reasons for the current symptom
Resilience
ability to cope
Thalamus
above brainstem
- relay station for top-down bottom-up neural networks that connect the cortex to the limbic system
- PTSD: decreased thalamic activity
- Dysregulation can result in significant memory issues
—- may lead to flashbacks, nightmares, avoidance, dissociation
Retroflection
doing to oneself what one wanted to have done to oneself by others
Why use motivational interviewing?
Help individuals resolve
ambivalence and plan for change
It can be used alone to increase motivation for engaging in
psychotherapy or in combination with other forms of therapy when resistance is encountered.
Narcissistic Personality Disorder
- what is it
- what therapy
- Consider themselves special &
expect special treatment; sense
of entitlement is striking; handle
criticism poorly; want own way;
frequently ambitious to achieve
fortune & fame; relationships
are tenuous
psychoanalytic
DBT
lithium
antidepressants
OCD
- what is it
- what therapy
Preoccupied with rules,
regulations, orderliness,
neatness, details & achievement
of perfection
CBT, Group
Clonazepam; Clomipramine;
fluoxetine 60-80mg;
Nefazodone
