Exam 1 Flashcards
Foundations of psychotherapy
- pre- christian retreats centers, tribal ceremonies, religious healing, hellenist physicians, hippocrates- “hippocrate oath” - DO NO HARM
- trying to understand what human body is doing
Early interest in the unconcious
Golfried Wilhem Lebiniz
- understanding unconcious in a science way
- sublimal
- perceptions we can have not in our concious awarness
Franz Anton Mesmer
- mesmerize hypnotsis
4 key componenets
1. patient/therapist rapore
2. importance of (age/gender)
3. Patient confidence in treatment
4. spontaneous remission
- when symptoms get better on there own, must have some level of waxing/waining over time
- have to prove treatment made them better
Natural Science empiricists (19th century psychology)
- idea that we can observe/record info, info than becomes our knowledge
- studying unconscious
- Gustav Fechner and Herman Van Helmholtz
Emi; Kraeplin - lays foundation for diagnostically and statistical manual
- says we have a real disconnect bw whats happening in research and knowledge
- we need to classify according to cause and natural tract of diagnosis
- benchmark to acess what pt they are at
Arthur Schopenhauer
- driven by blind irrational forces
- we know things we don’t even know
Carl Gustav Carus
- role of unconscious in communication
Neitzsche
- we lie to ourselves more than we lie to others
- unconscious is a form of self deception we lie to ourselves more than we lie to others
impacts of biological science
- importance of recognizing none of this is happening in a vacum
- psychology can’t possibly be separated from biology
epigenetic = study of gene expression altered by enviormental triggers - biosocial approach - we can separate out biology, psych, or sociology
Cultural factors
- consider roles of culture, lots of psychotherapy developed by old white men
- demographics, culture, langiage, shape experience
- stigma
- evidence based treatment - we care about whom and in what context therapy works
- what works, why it works, and whom it works for
What is a psychiatric disorder
-“theory of personality” - what causes distress?. every type of psychotherapy has one
- think about it as a continuem from health–> illness
- health
- frequency, intensity, disruption to daily life will help figure out psychiatric diagnosis, disorder is helpful in deterermining what is going on.
1952 - development of DSM
- evolving doc. changes over time
- decide what gets put in, what fits
- socioeconomic status
- doctors only can see select group of people
impact of psychiatric diagnoses
- help us understand how to prevent and treat
- be careful how we choose to use these diagnosis
- real implications in peoples life how diagnosis
- homosexuality being in the DSM, minoritized them.
impact of psychiatricic diagnoses
1956 - evelyn hooker present landmark study
- all early research on homosexual men
- purpose was to show something is going on
- all people survey institutionalized
1972- John freyer speaks to APA convention in disguise bc worried about career ending
1973 - APA votes to reclassify homosexuality as “sexual orinetation disturbance”
1980 - diagnosis of “ego dystonic homosexuality” is used in DSM -III, not the fact of being gay is disorder but fact if you aren’t okay with that can be disturbance
What is race?
- constructed by people for a purpose - 16th/17th century started to be used to describe lineage
- colonialism - arose in context of colonialism
- the great chain of being
- categorize all living things into a hierarchy
- race used to put us in hierarchy
Racism in early psychology
- problematization - groups of individuals used as a problem to be studied
- in group/out group
- also out group has a problem which needs to be fixed
- Eugenics
- goal in eugenics creating superior populations
- took form in forced sterilization, convincing people not worthy of reproduction
- IQ tests used to determine mental reproducing disabilities
- demonstrate what things, you have expected to
Racism in early psychotherapy
- slavery
- Drapetomania “fake diagnosis”, runaway slave disorder
- diasthesia aethiopica
- institutionalization
- forming basis of Jim crown
- black patients forced into labor
- psychologists have real power determining what is/isn’t normal
Racism in modern psychotherapy
- psychiatric diagnoses used to combat civil rights movement
- criminalization of mental health in America
- shifted psychiatric beds out of institutions/hospitals into prisons
- schizophrenia originally viewed as white women, shiften as a way to classify black men in activist group, psychiatric treatment required
Anti racism in psychology
- Drs. Mamie Phipps Clark and Kenneth Clark Doll Study
- asked about what doll was prettier, smaller. the end would ask what doll looks like you
- first idea of internal racism
- brown vs board of education
- current research - ongoing research about harmful sterotypes
- clinical practice
Stages of intervention development
Stage 0 - basic science, biology of brain, nueroimaging, role of other systems, endocrine, family history, what’s already available, where treatment gap is
Stage 1A: developing intervention components, very clear idea what intervention will be, can be repeated, done with patient input/opinions, create materials, bring in focus group, repeat, end = materials that will be used in clinical
Stage 1B: Feasibility: can we get people to sign up for trial, can we keep them in intervention, is there a reason to invest more
Stage 2: Pure efficacy
- (takes place in a lab extremely controlled)
- efficacy how well it works under perfectly controlled conditions
vs effectivnesss how well does it work in real world
- Stage 3: Real world efficacy
- clincial trial has many controls inside, real world setting, clinic. therapists trained closely monitored
Stage 4: Effectiveness: want to understand what happens, when you take controls off, therapists train
Stage 5: implementation and Dissemination: How do we get these interventions to be used.
Prospective treatment assignments
- more than one group assigned them before, whatever type of treatment takes place.
- used for observational studies. sometimes we need observational study to tell us something to acess, more external valididty –> things measured. plenty of experiemental studies not ehtical, can be done in a much shorter timeline, way lower cost
Descriptive Studies
- establishes that something is going on
- can tell us how frequently something happens
- looks for correlation
- conformation bias
- only looking for one thing and trying to prove it
- selection bias- selecting a sample going to provide a specific result
Analytical study
- comparing two groups of people in some way
- observational
Cohort Studies (type 1 of observational studies)
- identify two groups - one group received treatment, one did not
- one received a treatment
- one who did not receive a treatment
- follow the groups forward in time to determine if they experience different outcomes
- keep in mind spontaneous remission can also occur
Cohort Studies ( type 2 of observational studies)
(follows people forward in time)
- strengths
treatment comes before outcome temporal precedence - less prone to recall bias - remember what you want to remember, people are not good at recall
- provides estimates of incidence of outcomes over time
Limitations: - cost -adds up very quickly, tracking down big groups of people
- rare outcomes are hard to observe
- studies may need to be very long to observe outcomes
- can be hard to keep up with people
Case control studies (observational study type 3)
- identify two groups- go in opposite direction, 2 groups of people what has happened look backwards, to see what happened
- one with identified outcome
- one without the otucome
- asess whether there were differences in treatment exposure retrospectivly
Chart reviews, self reports, interviews
ex - one group quit smoking, one group still smoking, why did one group quit
Case control studies (strengths vs limitations)
strengths
- useful for rare outcomes - don’t have to follow people, just ask about the past
- can save time and money
Limitations
- difficult to select and appropriate control group
- recall bias
- cannot tell you how prevalent the outcome or treatment is- only odds of experiencing both
cross sectional studies
- use one time point to assess both outcome and treatment to exposure simalationously
- can provide estimates of frequency or prevalence of an outcome or treatment
- cannot tell you which came first
- subject to recall bias
rate
- frequency of an event in the population over a defined period of time
proportion
- frequency of an event without a defined time period
ratio
- number of people in one condition, relative to the number in another
absolute risk
probability of an outcome
relative risk
ratio representing how often the outcome happens in the treatment group, relative to the untreated group (you are twice as likely)
- does not tell you the actual size of the risk for each groups, just the amount of risk relative to one another
odds ratio
likelihood of membership in one group, given membership in another (also relative)
- membership in the treatment group vs non treatment group, how likely are you to be in the outcome group
Randomized controlled trial
- treatment conditions randomly assigned
- we randomize so we don’t bias the groups, and at the end can use data to make predictions
Non randomized controlled trial
- happens are earlier stage of testing, stage 1
- people chose there own group
- selection bias is possible
- because treatment conditions are not randomly assigned
Methodological considerations for Randomized control trials
- inclusion criteria - who get to be in our study, if you have limits on inclusion, excluding people
- diagnosis
- clinical staging - a way to grade out symptoms of psychiatric diagnosis continuum, can be used to talk about course/progression of a disorder
- prior treatment and iatrogenic comorbidity - when you’ve had other treatments haven’t worked made things work, may make people scared to try something new
Methodological considerations for RCT’s - recruitment
- how are participants identified
- is the sample representative?
Methodological considerations for RCT’s - control groups
- no treatment of wailist
- minimal attention
- treatment as usual - do as much to mimic intervention without doing actual treatment, attention placebo control, other active treatment, additional controls needed when pharmocotherapy is involved
Methodological considerations for RCT’s - designs
- parallel treatment - groups are assigned, followed simultaneously
- adaptive - changing course of treatment based on response, escalate amount of care based on response
Dismantling - tries to figure out what pieces are the active ingredients, take apart intervention
Methodological considerations for RCT’s- assessments
- treatment allocation should be blind concealed from those administering assessment
- pre and post treatment, consider length of follow up
- must be sensitive to change
- incremental valididty
- patient reported vs observer rated
- asess for adverse effects, not just desired effects
Methodological considerations for RCT’s- outcomes
define a priori - established before started what a sucess is concisdered
- what level of improvement will mean the treatment worked
- remission - no longer meet criteria for a diagnosis
- reduction of symptoms - less symptoms quality of life is better, but still have diagnosis
- longevity of change
translating research into practice
- clinicians face challenges to staying up to date
- scientific literacy necessary to ultiize research in practice
- drift = therapist does something that doesn’t agree with the treatment
- possibly because don’t agree with treatment
- therapist may forget
- challenges - therapists have there own lives and patients who’s going to train them
efficacy vs effectiveness
efficacy - highly controlled, what people are doing outside of treatment
effectiveness - how effective is this in real world, not controlling as many variables
empirically supported treatments
- stringent criteria for study designs
- must have active control, large sample sizes, support from mroe than one study conducted by different research group
- subject to limitations of RCT’s
- efficacy vs effectivness
- manualized interventions
- may be difficult to adapt or nto applicable to a wide range of patients
evidence based practice
- what most psychologists are using in there practice
- clinical expertise
- best research evidence - important that they know how to administer
- patient values and preferences - explicit values and challenges
