exam 3 Flashcards
1
Q
counsellor/therapist
A
unregulated
-may be registered with BCACC or CCPA
2
Q
psychiatrist
A
MD specializing in mental health
3
Q
psychologist
A
PhD in psychology and licensing -> registered psychologist
4
Q
psychological disorder
Ac
Er
B
A
broadly, a condition characterized by abnormal cognition, emotional regulation, and behaviours
5
Q
note about disorder/atypical
A
just because something is atypical does not mean it is disordered
6
Q
American psychiatric association: abnormal behaviour
A
-violates a norm in society, is maladaptive, and causes the person in distress in their daily life
7
Q
diagnosis of psychiatric disorders
what is done with symptoms to diagnose
how is it helpful
what manual is used
A
- identify and label symptoms
- helpful to determine common language to communicate w the patient, other health professionals, and guide treatment
- uses DSM-5 / DSM-V
8
Q
DSM (diagnostic and statistic manual)
most recent edition; when was it published
what does it give
what influences it
A
- 5th edition published in 2013 (DSM-5 or DSM-V)
- first one published in 1952
- gives explicit guidelines for id and categorize symptoms
- influenced by not only empirical research but also prevailing social attitudes (abnormal is relative)
- -eg, homosexuality was classified as a disorder up to 1973 (DSM-3)
9
Q
anxiety disorders
marked by: EPDfa or Darb
includes which disorders P,Pd,Sa,GAD
A
marked by excessive, persistent, and distressing fear and anxiety, or by dysfunctional anxiety-reducing behaviours
-incl phobias, panic disorders, social anxiety, GAD
10
Q
anxiety (AAC) vs fear (Rtit)
A
- fear involves a reaction to an imminent threat
- anxiety involves apprehension, avoidance, and caution regarding a potential threat
- typically, anxiety levels match magnitude of potential threat
- Eg, anxiety about psyc grade and you have exam on thursday, you may feel anxiety about the potential threat of a bad grade on the exam; this anxiety may act as a motivator to encourage you to review your lecture notes and study for the test, by engaging in these behaviours and preparing for the exam, you are reducing the magnitude of the threat and your anxiety
- If event is more major, like being evicted, it is bigger threat so it is normal to have more anxiety than before a test
11
Q
panic attack
what is it
duration and development
is it a disorder
A
- panic attacks are not a disorder
- intense anxiety can escalate to a panic attack
- develops abruptly, peaks in minutes (about 10 mins total); but feels much longer
- can be expected or unexpected
12
Q
panic attack - symptoms
they feel like:
physical symptoms
often think they are having:
A
- intense fear; feel like losing control or losing mind or dying
- palpitations and/or accelerated heart rate, trembling, sweating, feeling like they are choking or can’t breathe, dizziness, lightheaded, unsteady feeling, hot flashes, chills, chest pain, nausea or abdominal distress
- many ppl think they are having heart attack bc some similar signs
13
Q
panic disorder
characterization:
genetic link?:
A
- recurrent (>1) panic attacks
- and at least 1 month of persistent concern about additional panic attacks; or self-defeating changes in behaviour relating to the attacks
- possible genetic link
- -children are at higher risk if their parents have it
- 3/4 of ppl with it dont have close relative with it
14
Q
anticipatory attacks
A
- panicking about potential panic attacks
- may lead to agoraphobia
15
Q
agoraphobia
translation
what is it
specific
A
- translates to fear of the marketplace
- fear and avoidance of situations where help or escape from panic attacks would not be possible
- not a specific phobia
16
Q
panic disorder
what often precedes it
treatment and 3 month outcomes
A
- -major life changes often precede the onset of panic disorder
- can be successfully treated with cognitive behavioural therapy, >85% of patients w panic disorder recover within 3 months
- therapy may also be used in conjunction with medication
17
Q
specific phobia
used to be known as
most ppl realize
characterized by
evolution
A
used to be known as simple phobia
- characterized by excessive, distressing and, persistent fear/anxiety about a specific object or situation
- most ppl realize their level of fear/anxiety is irrational
- this typically is not sufficient to stop the fear of dysfunctional avoidant behaviours
- may be an evolutionary predisposition to certain phobias; bc not many fear of legitimate dangers like car crash or guns but fear of snakes, spiders etc which would have been useful during evolution
18
Q
5 general categories/examples of specific phobia
A
environmental -fear of lightning, flooding etc animal -snakes, bears blood injury -getting shot, stabbed, blood situational -heights, public speaking other -Eg, hippopotomonstrosesquippedaliophobia
19
Q
monkeys and fear study - cook and mikena 1989 - specific phobia
A
monkeys watched vids of other monkey reacting fearfully to fear-relevant stimuli (like toy snakes or alligators) and fear irrelevant stimulus (toy rabbit or flowers)
-observer monkeys only developed fear of fear-relevant stimuli
20
Q
treatment of specific phobias
5 options
A
- systematic desensitization
- virtual reality
- CBT
- eye movement desensitization and reprocessing (EMDR)
- antidepressant medication
21
Q
social anxiety
A
formerly social phobia
- extreme and persistent fear or anxiety and avoidance of social situations in which the person could potentially be evaluated negatively by others
- adults w social anxiety more likely to experience lower earnings and higher unemployment
- high comorbidity with substance abuse; may be due to coping mechanism/self medication
- women more likely to be diagnosed
- est avg duration of 20 years
- treatment of CBT and medication
22
Q
safety behaviours
examples
who uses them
A
mental or behavioural acts to reduce anxiety by reducing the chance of negative social outcomes
- eg, avoiding eye contact, rehearsing before speaking, wearing neutral clothing, redirecting the conversation (they often dont like talking about themselves so they deflect the questions)
- commonly used in social situations by persons with social anxiety
23
Q
generalized anxiety disorder (GAD)
characterized by
trigger?
can result in problems with
heritability
genetic
recovery
A
- chronic anxiety that is excessive, uncontrollable
- typically has no definite trigger
- resolving one source of anxiety associated with a new source arising
- can contribute to problems with sleep, work, responsibilities and relationships
- estimated 30% heritability
- those w genetic predisposition more likely to develop; especially in response to a life stressor
- generally long term
- recovery in about 50% of cases
24
Q
diagnosis of GAD
A
when excessive anxiety and worry is experienced more days than not over at least 6 months
- excessive worry must interfere with life
- must not be attributed to the effects of a substance of other medical disorder
diagnosis with at least 3 of the following
- restlessness or feeling on edge
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
25
treatment of GAD
- antidepressant medication
- CBT
- applied relaxation (muscle relaxation)
26
OCRDs
includes:
misunderstood as:
obsessive compulsive related disorders
- OCD
- hoarding disorder
- body-dysmorphia
- trichotillamania (hair pulling)
- excoriation (skin picking)
-commonly misunderstood as a tendency and preference to be tidy highly organized and/or clean
27
concordance rate
usually means the presence of the same trait in both members of a pair of twins. however, the strict definition is the probability that a pair of individuals will both have a certain characteristic given that one of the pair has the characteristic; twins are concordant when both have or both lack a given trait
-the larger the difference, the stronger the evidence of a genetic effect of that disorder
28
obsessive compulsive disorder - OCD
- has a fairly strong genetic link
- has a high concordance rate of 57% for identical twins, and 22% for fraternal
- in children/adolescents it can be caused by autoimmune response to strep infection
- -symptoms tend to fade over time, but sometimes OCD symptoms may remain permanently
29
treatment of OCD
- CBT
- medications
- electroconvulsive therapy (ECT)
- psychosurgery
30
Trauma and stressor related disorders
a group of disorders in which a person experiences a trauma or major life change
-unique bc only disorders that need event to be present
includes
- post traumatic stress disorder (PTSD)
- acute stress disorder
- adjustment disorder
- attachment disorders
31
acute stress disorder
much like PTSD but is a shorter period of time; couple days to just under a month
32
adjustment disorder
abnormal stress responses to stressful events;
eg, like if you lose your job or experience break-up, and the severity of the stress response does not match the situation
33
attachment disorder
when ppl have difficulties forming healthy attachments with other ppl; related to failure of normal attachment to ones primary caregiver in childhood, such as abuse, neglect, separation
34
post traumatic stress disorder - PTSD
used to be called "shell shock"
| -with symptoms lasting for at least 1 month
35
traumatic events that can cause PTSD
```
Physical assault
Other sexual trauma sexual assault
Sudden death of loved one
Transportation
illness/injury
Weapon assault
Severe suffering
Accident
Natural disaster
```
36
common symptoms of PTSD
- psychological re-experiencing of trauma (nightmares and flashbacks)
- avoiding reminders of trauma
- emotional numbing
- hyperarousal (irritability, constantly on alert, jumpiness)
37
risk factors of PTSD
- greater severity of trauma
- events involving harm by others (see graph)
- lack of immediate social support
- subsequent life stress
- history of childhood adversity (eg, abuse or neglect)
- low SES
- high neuroticism
- being female
- a strong genetic risk component as well
- the diathesis-stress model
38
therapy for PTSD
- CBT
- Exposure therapy
- EMDR
39
mood disorder
a group of disorders in which the person experiences disturbances in moods and emotions
40
depressive disorders defining feature
depression is the defining feature
41
bipolar disorders defining feature
mania is the defining feature
42
major depressive disorder (MDD)
2 key symptoms
duration for diagnosis
key symptoms
- depressed mood for most of the day, nearly every day
- and loss of interest and pleasure in usual activities (anhedonia)
-must be for a period of at least 2 weeks
in additional 1-2 key symptoms, need 3-4 additional symptoms of:
- difficulty sleeping (too much or too little)
- significant change in appetite
- fatigue
- difficulty concentrating and indecisiveness
- feelings of worthlessness or guilt
- motor agitation or retardation
- suicidal ideation
43
MDD - Gotlib et al., 2004
MDD and information processing bias
- they were biased towards the sad face
- depressed individuals tend not to show the self serving bias
- -they tend to focus on failure
44
Episodic occurrence of MDD
- MDD is episodic
- chance of experiencing another episode increases w each episode
- 1 episode, 50% second
- 2 episode, 70% have third
- 3 episode, 90% have fourth
- average onset is mid twenties
- women diagnosed 2x as much
45
genetic link of MDD
concordance rates
- identical twins: 50%
- Fraternal twins: 10%
likely a combination (and interaction) of genetic, environmental, and psychological factors
--can apply diathesis stress model
46
biopsychosocial model
end of page 9
47
bipolar disorder
individuals often experience mood stages altering between depression and mania
48
types of bipolar
bipolar 1
-experience full manic episode, MAY or MAY NOT experience full major depressive episode
bipolar 2
-experience hypomania, AND a major depressive episode
diagnosis can only change from 2 to 1
49
Manic episode
characterized by a period of abnormally and persistently elevated, expansive, or irritable mood and persistently increased energy lasting at least one week
-hypomania lasts a few days, and not a full week
50
symptoms of mania or hypomania
may include
- euphoria and excessive talkativeness
- -may talk with random people on the bus etc
- high irritability and hostility
- taking on multiple projects
- grandiosity (unjustified self esteem and self confidence)
- -eg, Kanye running for president
- engagement in pleasurable activities that may have negative consequences
- often do not 'feel' ill
- -so they may stop taking meds
51
concordance rate of bipolar
identical: 67%
| fraternal 16%
52
schizophrenia
classified under schizophrenia spectrum and other psychotic disorders
- a group of disorders marked by irrationality in thoughts or actions, distorted perceptions, and losing contact with reality
- usually follows pattern related to the age of individual; typically onset is around the 20s; men are usually diagnosed younger than women
- 1 out of 100 people have schizo
- mortality rate is 2.8x higher
53
schizophrenia symptoms
positive
-presence or addition of thoughts/behvaiours/perceptions; eg, hallucinations, delusions
negative
-absence or subtraction of thoughts/behvaoiurs/perceptions; eg, adhedonia
disorganized thoughts, speech, and behaviour
54
schizophrenic hallucinations
positive symptom
- perceptual experiences that occur in the absence of external stimulation
- 2/3 of patients with schizophrenia experience auditory hallucinations; commonly in the form of hearing voices
- visual hallucinations are less common, or tactile (may feel like organs are moving across the body or something is walking on their skin
- even less common is olfactory hallucinations
55
cross cultural schizo hallucinations - Luhrmann et al 2015
- US, Ghana, India
- many in Ghana and India experience positive hallucinations; they tend to view it more as a relationship, someone to share a bond with and talk to
- US more likely to report violent and hateful experiences; they view the voices as an intrusion; they can't stop the voices and they want to
-suggested that the difference is reflective of US being more individualistic culture; whereas in collectivist cultures, people imagine that their mind and self are interwoven
56
schizo delusions
-beliefs that are contrary to reality, and are held even when facing contradictory evidence
57
paranoid delusions
- belief that other people/agencies are plotting to harm the person
- eg, might think that roommate works for FBI and is building a case on them and when they make calls they are contacting the agency
58
grandiose delusions
beliefs that one holds special powers or is uniquely important in some way
-eg, may think they are jesus or second coming of a religious figure, or they know a state secret that they figured out on their own
59
somatic delusion
belief that something abnormal is happening to ones body
- may be rated to tactile hallucination like thinking organs are moving
- may think that bugs are inside the body pushing organs around
60
thought insertion
a schizo delusion where they think somebody is putting thoughts into their head
61
thought withdrawal
schizo delusion where they think someone is stealing/removing their thoughts
62
schizophrenic disorganized thoughts, speech, and behaviour
- may seem like person is randomly combining words or thoughts
- making loose associations that are not typical
- -may not even be a content related association
- -eg, ask them if they are going to take the bus or walk; they may talk about the time their friend ross went to florida because “bus” and “ross” sound similar
-may take the form of repeated or purposeless movement
63
schizophrenia diagnosis
when two or more of the key symptoms: delusions, hallucinations, disorganized speed, disorganized behaviours, negative symptoms, are present for at least 1 month
64
prodromal phase
- clinical deterioration begins here and occurs throughout the 5-10 years before the first episode
- before the 'onset'
- before schizo is diagnosed but they may experience things like psychosis symptoms like more paranoia than a normal person
- period of time marked by changes of behaviour and minor symptoms of psychosis
- -eg, paranoid, difficulty in personal care, suicidal ideation, increased religiosity, social difficulties
65
prodromal phase
- clinical deterioration begins here and occurs throughout the 5-10 years before the first episode
- before the 'onset'
- before schizo is diagnosed but they may experience things like psychosis symptoms like more paranoia than a normal person
- period of time marked by changes of behaviour and minor symptoms of psychosis
- -eg, paranoid, difficulty in personal care, suicidal ideation, increased religiosity, social difficulties
- not everybody that experiences these will develop schizophrenia and not everybody with schizophrenia experiences the early stage (about 75% experience this stage)
66
risks for developing schizophrenia
-risk is 6x higher if you have a parent with schizophrenia
- Tienari et al 2004
- -145 adopted children - biological mothers w schizo
- -healthy enviro: 5.8%
- -disturbed enviro: 36.8%
increased risk with
- problems in prenatal development (stress, infection, malnutrition)
- Those whose mothers experienced a death of close relative in first trimester showed higher rate of schizo than experienced later in pregnancy
- complications during birth (eg, lack of oxygen)
- cannabis use
67
cannabis and schizophrenia
- causal relationship?
- is cannabis use higher in those w schizo bc of self medication or bc it causes it (likely a bit of both)
Anderasson, et al., 1987
- Followed up with 45000 conscripts after 15 years
- Low cannabis users (1-6 times) developed schizophrenia at 2x the rate of non users
- High users (50 or more times) developed schizophrenia at 6x the rate of non users
- risk increases with frequency and with lower age of consumption; hypothesized to disrupt brain development because of the endocannabinoid system
- but cannabis use is not necessary or sufficient for the development of schizophrenia
68
the dopamine hypothesis
- drugs that increase dopamine can cause schizophrenia-like symptoms; namely, hallucinations
- drugs that block dopamine (such as antipsychotic medications) reduce symptoms
69
personality disorders
- personality style that is inflexible; not changing a lot
- marked by personality style that differs from cultural expectations, and causes distress or impairment
- 3 clusters of 10 disorders in DSM-5
- -cluster A - odd and eccentric (paranoid personality disorder)
- -cluster B - impulsive and erratic (antisocial, borderline, narcissistic)
- -cluster C - nervous and fearful (avoidant personality disorder)
70
borderline personality disorder
cluster B
- characterized by instability in interpersonal relationships, self image, and mood
- extreme behaviours to avoid abandonment or separation (eg, if you break up with me ill kill myself)
- impulsive behaviours - often reckless (spending money they don't have, driving dangerously, risky sexual behaviour, gambling)
71
antisocial personality disorder
cluster B
also called psychopathy; some also say sociopath, but that is not an official diagnostic
-characterized by individual showing little or no regard for other peoples rights or feelings
--may lie, perform illegal acts, show aggression or violence; and feel no remorse
-signs can emerge early but must be 18 to diagnose
-3-4% of population; 3x more common in men
-highly impulsive
- Men are also more likely to be overtly violent like killing animals or assault
- Women more likely to do things like forge documents for fraud or lying and manipulating
-high levels of incarceration
72
psychiatric/psychological disorders in Canadian prison
~44% have antisocial personality disorder
| -70% of those incarcerated met criteria from some psychological disorder
73
most lethal psychological disorder
anorexia nervosa, 6x higher
- depression is 1.5x higher
- bipolar is 2x higher
- schizophrenia is 2.8x higher
74
eating disorders
- extreme disturbances in eating behaviour
- ~95% of those w eating disorders are 12-25
- ~50% also have depression
- men are less likely to seek help for ED
- ~20% of ppl suffering from anorexia die prematurely from complications
75
anorexia nervosa - symptoms
- refusal to maintain body weight at minimum normal weight for height and age
- intense fear of gaining weight, even when underweight
- disturbance in cognitive experience of weight (such as denial of the problem)
- In women, amenorrhea
76
anorexia nervosa - types
restricting type
-weight loss through dieting, fasting, or excessive exercise
binge eating/purging type
-weight loss through inducing vomiting, misuse of laxatives etc
77
bulimia nervosa - symptoms
recurrent binge eating
-compulsive/uncontrollable
compensatory behaviour to prevent weight gain
- ie, they do something to make up for the binge; purging, laxatives, excessive exercise, fasting etc
- self evaluation unduly influenced by body shape
- with each of symptoms occurring at least 2x a week for at least 3 months
- no requirement for weight
78
approaches to treatment
psychotherapy
-including psychoanalysis, humanistic, behavioural, and cognitive therapy
biomedical approach
-including medication, and brain intervention techniques (ECT, psychosurgery, etc)
```
eclectic approach (aka multimodal therapy)
-combines elements from multiple types of therapies
```
79
psychoanalysis
freud's theory
-based on hypothesis that psychological problems are the result of repressed impulses of childhood trauma
-intensive, multiple sessions a week for year(s)
- therapist was to remain detached (eg, like seen in movies where client lays facing away from therapist)
- -to avoid transference
- not commonly practiced today
- -no real way to test validity
- -not grounded in evidence based practice
80
psychoanalysis goals and techniques
goals: uncover buried feelings
techniques:
- free association: basically just talking about things and exploring the possible link such as if you start with talking about your mother and end up talking about sadness at the end then it was thought that there was an unconscious connection,
-dream interpretation: if you can remember your dreams and analyze different symbols and unconscious things your brain is trying to communicate then you can gain insights
81
humanistic approach
- developed from psychoanalysis; but a more positive view of human nature
- focuses on striving for improvement, rather than fighting unconscious forces
- assumes people develop psychological problems due to limits and expectations on them
- Ie, if someone is experiencing psychological distress its because they want to improve and they have placed big expectations on themselves (or from others) and they are not able to let these expectations go, so they cant get fulfillment and meet their maximum potential
82
person-centred therapy (client-entered therapy) - Rodgers
goals
humanistic approach
| -goals: developing self awareness (insight), and self acceptance to foster personal growth
83
person centred therapy
techniques
- empathy (from therapist)
- unconditional positive regard; no critiquing or judging thought process, they just show support; idea is that if the therapist has an unconditional positive regard, then the client will start to adopt the idea for themselves and remove the burdening conditions
- active listening; therapist acknowledges, restates and clarifies what the client expresses; allows client to have their own ideas reflected back at them; allowing them to understand their thoughts/ideas better
84
gestalt therapy
humanistic approach
-idea is that people need to view themselves as a whole; by creating this view they are able to remove feelings of psychological distress bc they understand themselves as a person
85
gestalt therapy goals and techniques
goal: for a patient to confront their thoughts, feelings, and behaviours and take full responsibility for them
techniques: the empty chair
- pretend someone they have issue with is in the chair and they engage in role-play/talking; this allows the therapist to get perspective of how a person is thinking and their issues and the client will gain insight into their relationship and into their thought processes (bc they may see that they are assuming an unreasonable response from the person)
86
behavioural therapy
-focusing on behavioural responses; using punishment and reward to extinguish undesired behaviours/emotions or increase desired behaviours/emotions
87
aversion therapy
- pairing a to-be-extinuished behaviour with an unpleasant stimulus
- -eg, snapping rubber band when you say "um"
- most help in the short term but not so much in long term
- Ie, instead of associating the word ‘um’ with a painful stimulus anymore, they might associate that stimulus just with snapping the rubber band
88
exposure therapy
involves repeatedly confronting a feared stimulus in order to decrease the negative emotional response to that stimulus
89
flooding technique
type of exposure therapy
| -exposes the person to the worst-case scenario upfront
90
exposure therapy for OCD
response prevention
| -exposing patient to the situation that will trigger an obsession, and preventing them from engaging in a compulsion
91
systematic desensitization
type of exposure therapy
- -fear of cockroach video
- -involves increasing threatening stimuli, and teaching relaxation techniques; though trained relaxation might not actually be necessary to the process
may be
- in vivo
- imaginative
- virtual reality
92
reinforcement
to increase frequency of behaviours
- associating behaviours with pleasant outcomes to make them more likely
- may use token economies - systems of rewards for particular behaviours
- -eg, social anxiety, every time they interact with a stranger, they gain a token, they can use these to get a reward
93
what happens when token economies stop?
- overjustification effect?
- no, it is not the same bc there was not the intrinsic motivation in the first place
- the behaviours themselves often become their own reward as the skills are practiced
94
cognitive therapy - beck
goal
techniques
goals: focus on changing patterns of thoughts to eliminate psychological distress
techniques: cognitive restructuring
designed as a short term therapy
- few sessions to few months; rarely up to a year
- aims to set up the patient with the skills and tools that they need to deal with problems on their own moving forwards
95
cognitive restructuring
- identify distorted views about the world, self, and others (the cognitive triad)
- correct these view by challenging them
96
examples of cognitive distortions
-filtering: Ignoring positive information and focusing on negative information
-polarized thinking: I failed my exam so im dumb and I will fail so I should drop out
-jumping to conclusions: Everybody stopped talking when I walked in so they were probably talking about me; but it could have been something else like the door making a loud noise
-catastrophizing: Think of the worst thing that can happen bc of their action;
I failed chem test so I am going to fail this course and university and then never have any success in life
-control fallacies: everything that happens is someone's fault
-fairness fallacies: people expect that everything should be fair so they have lots of resentment
97
cognitive behavioural therapy (CBT)
- combines elements of cognitive and behavioural therapies
- focuses on changing patters of thoughts, as a means of changing feelings and behaviour
- very goal focused; They will come up with goals/desired outcome and create plan to accomplish this
- typically involves homework
may also include:
- activity scheduling; scheduling activities that induce anxiety
- progressive relaxation; tensing and relaxing muscles
- journaling
- exposure therapy
- playing out a script; eg, what happens if you failed a test, dropped out, can't find a job etc
98
clinical psychologist
asses, diagnose and treat a variety of psychological disorders
- PhD
- evidence based therapeutic approaches to treat psychological disorders
- often see therapy clients over many months or years
-can train and specialize in many different therapeutic approaches
99
psychiatrist
- MD
- screening for diagnoses, shorter visits (~20 mins)
- prescribe medications
100
counselling psychology
- masters degree
| - exclusive therapy
101
qualities of a good therapist
- empathetic, unconditional positive regard
| - warm and genuine, active and engaging, flexible and creative
102
therapeutic alliance
- a strong relationship with the client is key to successful treatment outcome
- more important than the type to treatment approach
- Establish trust
- Non judgemental
- Collaborative
- Normalize and validate
- Client needs to feel safe
- Good client-therapist fit
- Not advice giving
103
colleen's specialization: CBT
-One of the most widely researched and practiced therapies
-Shown to effectively treat many disorders, but especially used in the treatment of depressive and anxiety disorders
-Criticisms: can seem rigid and too structured for some, required intellectualization, very present and focused, and less focused on influence of environment and relationships
Integrative therapy: combining pieces of different psychotherapies to best fit the client (eg, may use techniques from CBT and DBT)
104
typical CBT session
- Check in - set goals, mood rating, continue to build therapeutic alliance
- Set the agenda, aka the plan for the session
- Provide psychoeducation, discuss success and challenges
- Choose an intervention that best helps client’s current needs
- Collaboratively set new homework
105
cognitive intervention - thought record
automatic thoughts
-unconscious thoughts that negatively impact mood and behaviour
thought distortions
-categories of automatic thoughts
106
example of thought distortion
situation: you have an upcoming class presentation
- automatic thought: I will forget what to say and get abad grade, then fail the course
- emotions: anxious, worried, frozen
- distortion: jumping to conclusions, catastrophizing
- alternative thoughts: I will remember most things and if I forget something it will be fine; if I get a bad grade I can still do well in the class
- outcomes: how did the presentation go? usually the outcome isn't as bad as we think
107
types of thought distortions
- filtering: focusing on the negative; ignoring the positive
- polarized thinking: all or nothing thinking; ignoring complexity
- control fallacies: assumes only other to blame; assumes only self to blame
- fallacy of fairness: assumes life should be fair
- overgeneralization: assumes a rule from one experience
- emotional reasoning: expects others to change
- "shoulds": holds tight to personal rules of behaviour; judges self and others if rules broken
- always being right: being wrong is unacceptable; being right supersedes everything
- personalization: always assuming self responsible
- jumping to conclusions: makes assumptions based on little evidence
- blaming: assumes everyone else at fault
- global labelling: extreme generalization
108
what does CBT treat
- depression
- GAD
- OCD
- social phobia
- panic disorder
- PTSD
109
challenges and rewards (of CBT? or therapy?)
rewards
- creating a safe space and non judgemental space for others
- no two cases are alike
- chance to make positive, long term change in someone's life
challenges
- supporting your own mental health while caring for others
- expecting the unexpected
- experiencing extreme emotions with clients
110
decolonization and anti-racism considerations in therapy
- Clients facing racism
- -Is it a disorder or a valid response to an unsafe environment
- -How can psychologists advocate for better client care and access in the community
- Decolonization
- -Incorporating first nations values on health and healing into therapy
- -Advocate for decolonization within community systems
- Sex and gender
- -Importance of pronouns
- -Creating a safe space for LGBTQ2S+
- Clinical psychologists have taken part in ongoing harm to gender and racial minorities
- Clinical training programs need to put in the work
111
psychopharmacology
the study of drug treatments for influencing thoughts, feelings, and behaviours
- medication is often used in combination with psychotherapy
- medications have broad effects, some undesired
112
antipsychotic medications
aka neuroleptics
- used for treating schizophrenia spectrum and other psychotic disorders
- block dopamine activity
- -most helpful for positive symptoms
- -not as effective at relieving negative symptoms
most typical side effects influence the motor system
- loss of motor control
- tremors/tics
- akathisia (unable to sit still)
113
atypical antipsychotic medications
second generation
- work on both dopamine and serotonin systems
- effective for positive and negative symptoms
- less likely to cause motor side effects
- -can still have undesirable side effects
- -metabolic problems, weight gain, sexual side effects
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anti anxiety medications
anxiolytics
- can help reduce and aid in extinction of phobias and learned fears
- eg, benzodiazepines
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benzodiazepines
anxiolytic
- works in minutes to slow heart rate; but is it treating anxiety or masking it?
- risk of addiction/dependance
- risk of death with alcohol
side effects
- drowsiness
- dizziness
- headache
- fatigue
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antidepressants
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SSRI
atypical antidepressants
lithium (more of a mood stabilizer)
ECT
TMS
psychosurgery
nutrition
exercise
nature
light exposure
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selective serotonin reuptake inhibitors - SSRI
- more serotonin available for use
| - side effects: nausea, agitation, sexual dysfunction, discontinuation syndrome, increased risk of suicide
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atypical antidepressants
have less influence on serotonin, more on norepinephrine and dopamine
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is depression a chemical imbalance in the brain?
- antidepressants influence neurotransmitter levels very quickly; this is an extreme oversimplification, outdated idea; but most don't see improvements for several weeks
- depleting serotonin in healthy individuals does not directly lower mood
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new models of depression
focus on disruptions to neural circuitry; connections may be weakened in those w depression bc those cells are not firing together for long periods of time, so it takes a long time for them to wire together and fire together which may be why antidepressants can take so long to work
"neurons that fire together wire together" - Donald Hebb
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lithium
mood stabilizer used to treat bipolar
- levels in the blood fluctuate naturally
- trace levels in drinking water
- patients need blood monitoring to adjust dosages
- high levels have impact on kidney and thyroid functioning
- is a teratogen; heart abnormalities
- 60-70% of patients w bipolar who take lithium see an improvement
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direct brain intervention: electroconvulsive therapy (ECT)
- use of an electrical current to induce seizures
- effective for patients with severe depression not treated by drugs
- works by trying to get cells to fire in certain ways to strengthen neural circuitry
- about 85% of treated individuals show improvement
- risk of memory loss
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direct brain intervention: transcranial magnetic stimulation (TMS)
- passes a current through the brain for a short duration of time
- does not cause seizures or memory loss
- can be just as effective as ECT
- also used to treat schizophrenia
- and is used for research
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direct brain intervention: psychosurgery
- reserved for the most severe cases
- historically, the prefrontal lobotomy is most well known; but it was never scientifically validates and left thousands of patients worse off
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direct brain intervention: psychosurgery - cinugulotomy
cinugulotomy: smaller lesion of areas of the brain associated with emotion and pain; used in treatment of MDD and OCD
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direct brain intervention: psychosurgery - deep brain stimulation (DBS)
electrodes implicated in Brian, controlled by a pacemaker
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lifestyle changes for treatment
Nutrition
- Observational studies
- -Lowered risk of depression with diets low in animal products, high in vegetable, fruit and whole grains (opposite diet tends to be associated w significant increase in depression)
- Exercise
- -Aerobic exercise - increased mood, decreased anxiety, improve cognitive functioning
- Nature
- -Exposure to nature linked to lower stress, better mood, reduced risk of psychological disorders
- Light exposure
- -Natural and artificial bright light (especially in the morning) helpful in treating depression and seasonal affective disorder
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textbook section:
section on evaluating psychotherapies 626-627; don't need to memorize but be familiar with them; client's perceptions and clinicians perceptions, and outcome research
