Exam 3 Vocabulary Flashcards
Diagnosis
= clients classified as having one or more mental disorders based on their behavior, cognition, or emotion
Investigational approach
= focusing on largely biological processes
Case formulation
= focus is on understanding client behavior, cognition, and emotion in context using research-supported conceptual models
Mental disorder
=a clinically significant emotional, cognitive, or behavioral disturbance
-reflects a dysfunction in psychological, biological, or developmental processes
-significant distress or disability in social, occupational, or other important activities
DSM Signs
= outwardly observable phenomenon
○ Things that can be observed
DSM Symptoms
= subjective experience reported by the client
○ Described by client
DSM Associated features
= aspect of a psychiatric disorder such as its prevalence, course, prognostic factors, or common co-occurring diagnoses.
○ Ex: both parents diagnosed with something
Etiology
= how did it start; what brought you to this point
Prognosis
= how is it going to move from here
Research Domain Criteria (RDoC)
= an initiative by the National Institute of Mental Health (NIMH).
It’s an alternative to the DSM, focusing on genetics, neuroscience, and behavioral science.
It aims to create a biologically-based diagnostic system for better treatment.
Valence
=whether things are pleasant or not
RDoC Domain: Negative valence systems
Brain responses to fear, anxiety, prolonged threats, grief, and frustration.
RDoC Domain: Positive valence systems
Brain responses to rewards, reward learning, and valuation.
RDoC Domain: Cognitive systems
Brain processes for attention, memory, language, decision-making, and working memory.
RDoC Domain: Social processes
Brain regulation of social connections, communication, self-awareness, and understanding others.
RDoC Domain: Arousal and regulatory systems
Body regulation of hunger, sleep, sex, and circadian rhythms.
RDoC Domain: Sensorimotor systems
Processes responsible for motor learning and control
Case formulation component: Problem list
= psychological signs and symptoms, and difficulties with various areas of life (e.g., social, academic)
Case formulation component: Mechanisms
= empirically supported factors that maintain the problem (e.g., cognitive distortions, classical conditioning)
Case formulation component: Predisposing factors
= factors that predispose the client to developing problems (e.g., traumatic brain injury, sexual abuse)
Case formulation component: Precipitants
= factors that trigger or worsen the client’s problems (e.g., being turned down for a date
Psychotherapy
=a planned, emotionally charged, confiding interaction between a trained, socially sanctioned healer and sufferer
○ “Talk therapy”
○ Methods of inducing changes in behavior, thought, and feelings
○ Healer seeks to relieve sufferer’s distress and disability
○ May not be derived from theory or tested
○ A much broader term for a variety of tools and strategies that mental health (and sometimes medical) professionals and paraprofessionals might use when working with their clients. These therapies may or may not be derived from psychological theory and have generally not have been tested scientifically (or shown to be effective in rigorously conducted studies)
Psychological treatment
= involves a client and clinician working together using scientifically supported interventions to understand and solve the client’s particular problems
○ Interventions that are
§ Derived from psychological science
§ Tailored to the psychological processes that cause and maintain particular problems and disorders
§ Shown to work in controlled treatment outcome studies
○ Describes specific research-supported techniques and procedures that are grounded in psychological theory and derived from models of psychopathology to target particular causal or maintenance mechanisms and improve specific aspects of psychological, emotional, behavioral, or physical health and related functioning
Spontaneous remission
= improvement observed was likely due to natural fluctuations in the severity of clients’ problems
Provocative 1952 article “The effects of psychotherapy
= evaluation challenged the field of clinical psychology to more rigorously examine the outcomes of its interventions before assuming that they work
Primary outcomes
= main psychological changes or effects
ex: reducing # of panic attacks
Secondary outcomes
= functional interference
ex: depressive symptoms; are they able to go to school more days?
Meta-analysis
= a method of research in which one compiles all studies relevant to a topic or question and combines the results statistically
Dodo bird verdict
=different types of treatment all seemed equally effective
□ That the different treatments are more alike than they present themselves to be, and that it is the therapeutic qualities they have in common, rather than their unique features, that are most crucial to promoting improvement and therefore responsible for the equivalent outcomes. The name refers to a scene from Alice in Wonderland in which the characters have a race and the Dodo bird declares that “everybody has won”.
□ All therapy types win; Eysenck wasn’t right in it just being spontaneous/nonfunctional
□ Treatment better than no treatment
Randomized Controlled Trials (RCT)
= studies in which one or more groups of clients (all with the same problem) receive a particular treatment (the experimental condition) and another group receives a control condition.
§ Gold standard study design; optimal internal validity (within the test; testing if think testing; do they still apply in the real-world vs lab)
§ Completely randomized, don’t get to know who is in what group
§ However, difference between those in the morning vs afternoon
§ Those who were in the control group were put on the waitlist (don’t receive therapy yet)
Empirically supported treatment (EST)
= Treatment for various psychological conditions that has been shown through careful empirical study to be either “well established” or “probably efficacious.” A list of ESTs is updated and published periodically by the APA’s Division of Clinical Psychology.
□ Ex: Come in for OCD, given most effective treatment for OCD
□ Disorder based guidelines
Efficacy
= how well a treatment performs in research studies
§ Case studies (repeated measurements of single client) cannot be generalized to others similar cases
§ Single group pre-post studies address it but often lack control group
○ Randomized Control Trials (RCTs) determine efficacy of a treatment; gold standard
Common factors
= a set of features that characterize many therapy orientations and that may be the source of positive changes effected by psychological treatment
Specific factors perspective
= holds that theories and procedures particular to a given approach to treatment are necessary for psychological or behavioral change
Dismantling studies
= treatments with multiple components; identifying most beneficial ones
○ Some interventions are harmful
§ When clinicians deviate from, or misapply helpful interventions
§ Client functioning deteriorates, new problems appear, depends on clinician, and drops from treatment
Interactional perspective
○ Common and specific factors work together
§ Client-clinician relationship may work in specific theory-based techniques
§ Techniques work best when client trusts therapist and suggest treatments
§ Perception of strong client-therapist alliance leads to smooth treatment
Multicultural humility
= Awareness and skills in recognizing what psychologists don’t know about clients due to unique life experiences, challenging personal assumptions and biases.
Psychoeducation
= Educational component in treatment helping clients understand themselves, their problems, and treatment, while correcting misinformation.
Bibliotherapy
= Client reads informative material independently as part of treatment to address psychological issues
ACT (acceptance and commitment therapy)
metaphors
= = progressive muscle relaxation
-harness the strength of language in order to comprehend and address stuckness, as well as facilitate behavioral change.
ACT metaphor: The Passengers on the Bus
i. You’re the bus driver, and your thoughts/feelings are passengers
ii. Some passengers are loud and demanding, trying to tell you where to go
iii. You can acknowledge them but still choose your direction
iv. Shows how we can move forward with our values despite difficult thoughts/feelings
ACT metaphor: Quicksand
i. Struggling against difficult emotions is like thrashing in quicksand
ii. The more you fight, the deeper you sink
iii. Relaxing and accepting helps you stay afloat
iv. Demonstrates how acceptance can be more helpful than resistance
ACT metaphor: The Chess Board
i. You are the board, not the pieces
ii. Thoughts and feelings are like chess pieces moving around
iii. The board holds all pieces without being any single piece
iv. Illustrates the observing self and cognitive diffusion
ACT metaphor: Leaves on a Stream
i. Imagine placing thoughts on leaves floating down a stream
ii. Watch them drift away without trying to grab them
iii. Shows how we can observe thoughts without getting caught up in them
ACT metaphor: The Polygraph Machine
i. Trying to control anxiety is like trying to trick a polygraph
ii. The harder you try to stay calm, the more anxious you become
iii. Demonstrates the paradox of emotional control
Description for rival explanation: Placebo effects
By instilling hope and belief that one can rise above life’s challenges, most credible treatments can be at least somewhat helpful for combating demoralization, which is a central component of many psychological problems.
Description for rival explanation: Spontaneous remission
The longer people remain in treatment, the greater the opportunity for factors such as natural healing processes, social support, and positive experiences in everyday life to foster change.
Description for rival explanation: Regression to the mean and natural fluctuations in psychological problems
Many clients seek help when they have reached extreme levels of distress, which are naturally inclined to moderate over time, giving the illusion of treatment as the cause of improvement
Description for rival explanation: Effort justification
Clients invest a great deal of time, energy, effort, and money in treatment, and may feel a psychological need to justify this commitment and report improvement to their therapist
Description for rival explanation: Multiple treatment interference
When clients seek help, they often make multiple changes simultaneously, which makes it impossible to conclusively attribute improvement to a particular intervention
Description for rival explanation: Reporting bias
Clients might tell their clinicians they are doing better because this is socially desirable; and those who do not improve might drop out of treatment and never explain their lack of change to their therapist
Assertiveness training
= using behavioral rehearsal and other techniques to train people to express their needs effectively without infringing on the rights of others
Aversive conditioning
= a treatment in which an undesired behavior is followed consistently by an unpleasant consequence (e.g., nausea, disgust), thus decreasing the strength of the behavior over time
Awareness training
= first stage of habit reversal training in which clients keep a running log of each incident of the target behavior throughout the day
Behavioral activation
= behavioral treatment in which clients are helped to (a) more routinely engage in pleasurable and rewarding activities that provide consistent positive reinforcement to improve their mood and (b) decrease engagement in activities that increase the risk of feeling depressed
Behavioral treatment
= A framework for treating disorders that is based on the principles of conditioning or learning. The behavioral approach is scientific in nature and deemphasizes the role of inferred (i.e., unobservable) variables on behavior
○ clinical techniques derived from learning theory
○ Theoretical basis of behavioral interventions
Competing response practice
= responding to the urge to perform the target behavior by instead engaging in a behavior that is incompatible with the target
Contracting
= a contingency management technique in which the therapist and client draw up a contract that specifies the behaviors that are desired and undesired as well as the consequences of engaging or failing to engage in these behaviors.
Contingency management
= any one of a variety of operant conditioning techniques that attempts to control a behavior by manipulating its consequences
Covert sensitization
= a form of aversion therapy in which clients are directed to imagine themselves engaging in an undesired behavior and then are instructed to imagine extremely aversive events occurring once they have the undesired behavior clearly in mind
Cue exposure
= repeated exposure to conditioned stimuli while resisting the usual behavioral response (e.g., drinking, gambling, and pornography use)
Danger-based expectations
= prediction about what the client assumes will happen when exposed to the feared situation
Exposure therapy
= a behavioral technique for reducing anxiety in which clients expose themselves (in real life or in fantasy) to stimuli or situations that are feared or avoided.
-To be effective, the exposure must provoke anxiety, must be of sufficient duration, and must be repeated until all anxiety is eliminated
Exposure hierarchy
= a list or “menu” of the feared situations, thoughts, body sensations, and other stimuli that will be confronted during exposure trials. (Discussed in Chapter 7)
Extinction
= the elimination of an undesired response (e.g., behavioral, emotional)
Habit reversal training
= behavior change technique that involves a series of steps including awareness training, stimulus control, and competing response practice
Habituation
= the elimination of a response that comes about from the repeated and/or prolonged presentation of the provoking stimulus
-Helps the client learn that anxiety itself is safe, manageable, and temporary.
Imaginal exposure
= confronting oneself with unwanted thoughts, doubts, and memories that provoke elevated fear (such as by writing or talking about them)
Interoceptive exposure
= self-generating bodily sensations that trigger inappropriate fear, such as a racing heart, breathlessness, and feeling lightheaded
-Such sensations are activated using exercises such as hyperventilation, breathing through a straw, and spinning in a swivel chair. (Discussed some in Chapters 7 and 10)
In vivo exposure
= direct confrontation with actual situations and objects, such as animals (e.g., spiders, dogs), social or evaluative situations (e.g., speaking up in class), and environments (e.g., shopping malls, elevators)
Premack principle
= also known as “ Grandma’s rule ,” the contingency management technique in which a behavior is reinforced by allowing the individual to engage in a more attractive activity once the target behavior is completed
-The basic idea here is akin to Grandma’s exhortation “Work before play!” E.g., the child is allowed to use electronic devices only after homework is finished.
Progressive muscle relaxation
= a series of actions to produce a state of lowered anxiety, stress, and physiological arousal. Relaxation may be induced by tensing and then relaxing various muscle groups or via breathing exercises, imagery exercises, or hypnosis
Punishment
= the notion that when a behavior is followed by an unpleasant consequence, it will diminish
Sensate focus
= involves a series of structured touching and discovery exercises that a couple performs together to extinguish performance-related anxiety, enhance communication, and learn about one’s own and their partner’s sexual response
Shaping
= a contingency management technique in which a behavior is developed by first rewarding any behavior that approximates it and then by selectively reinforcing behaviors that more and more resemble the target behavior
Social skills training
= behavioral intervention to improve social skills necessary for healthy interpersonal relationships and successful employment (e.g., communicate effectively, display appropriate manners, use good hygiene, show empathy and consideration for others, and tactfully express one’s own needs and opinions)
Stimulus control
= stage in habit reversal training in which the client and therapist use the data from awareness training logs to design strategies for reducing the influence of conditioned stimuli that trigger the target behavior
Systematic desensitization
= a behavioral technique for reducing anxiety in which clients practice relaxation while visualizing anxiety-provoking situations of increasing intensity. In this way, the client becomes “desensitized” to the feared stimulus
○ Historical perspective of Behavioral Treatment
○ Paved by John B. Watson and Rosalie Rayner + Mary Cover Jones
Target behavior
= initial focus of behavioral assessment in which the problematic behavior is defined and characterized by how often it occurs (frequency), its severity (intensity), and how long each instance lasts (duration)
○ Clinician first assesses this before treatment begins
Time-out
= a contingency management technique in which a person is removed temporarily from the situation that is reinforcing the undesired behavior
Token economy
= a system in which desired behaviors are promoted through the strict control of reinforcements. Establishing such a system requires specifying the immediate reinforcers for each behavior as well as the backup reinforcers for which clients can exchange their immediate reinforcers
Stage of behavioral treatment: Target definition and baseline assessment
a. Defining the target problem and collecting data to measure its frequency, intensity, and duration before any treatment is implemented
b. Clinician assesses target behavior’s frequency, intensity, and duration before treatment begins
c. Baseline (pretreatment) established
i. Behavioral intervention targets are under client’s voluntary control
ii. Performed with very high or low frequency, intensity, and duration
Stage of behavioral treatment: Functional analysis and treatment planning
a. Assessing the antecedents and consequences of the target problem, using functional analysis to understand the factors that influence it, deriving treatment goals and plans
b. Clinician relates target behavior and factors controlling it
i. Identifies antecedents and consequences of behavior
ii. Predictors of associative (classical/operant) conditioning
c. Treatment plan developed for modifying frequency, intensity, and duration of behavior
Stage of behavioral treatment: Implementation
a. Applying the interventions specified in the treatment plan
b. Behavioral treatment may occur in natural environment
c. Carefully planned “field trips”, “homework assignments” are common
i. Discussed ahead to clarify goals and confidentiality issues
ii. Homework is reviewed
iii. The behavior therapist’s role is similar to that of a teacher or coach who helps the client (or those close to the client) learn and practice skills to foster behavior change
Stage of behavioral treatment: Outcome assessment
a. Measuring the frequency, intensity, and duration of the target behavior during or after treatment has been implemented to determine changes from the baseline assessment
b. Observation and assessment of target behavior continues throughout treatment
c. Progress monitored to evaluate effects of intervention
i. Behavior therapists assess outcomes
ii. Frequently re-administer same self-report, self-monitoring, observations, and interviews
d. Process concludes if successful
Stage of behavioral treatment: Reformulation (as necessary)
a. Modifying the functional assessment and treatment plan based on results of the outcome assessment as needed
b. Functional analysis and treatment plan revised if target behavior doesn’t change
c. Client NOT thought to be “treatment resistant”
d. Case formulations are reformulated
e. Each iteration increases chances of success
Appraisal
= judgment we make; type of automatic thought
Attribution
= explanation we come up with in our mind to explain why something happened; type of automatic thought
Automatic thought
= maladaptive pattern of self-talk that may become habitual
Behavioral thought
= the focus on how behavior is learned and influenced by the environment, often through conditioning (classical or operant). It emphasizes changing observable actions to address psychological issues
Behavioral experiments
= method for clients to “put their beliefs to the test”
Cognition
= the way we think about events and situations in our environment
Cognitive perspective
= emphasizes how our thinking — that is, our beliefs, interpretations, judgments, attributions, expectations, and other forms of “self-talk” — influence our emotions and behaviors
Collaborative empiricism
= practitioners and clients discover together how the client’s maladaptive thinking contributes to distress and how adopting healthier thinking patterns can reduce this distress
Constructive negative emotions
= universal experience that may be an appropriate response in certain circumstances
Culturally responsive modification
= the notion that CBT methods can pivot in order to incorporate experiences and stressors in order to make the intervention more appropriate to the client
Downward arrow technique
= involves (1) identifying a particular activating event, (2) asking the client what this situation means, and (3) continuing to ask the same question until one or more dysfunctional beliefs are revealed
Dysfunctional beliefs
= inaccurate, logically flawed, exaggerated, inflexible, way of thinking that is incongruent with goal attainment
Guided discovery
= (a form of collaborative empiricism) Used in cognitive therapy where clients are helped to notice and challenge their own thinking mistakes
Interpretation
= meaning that we assign when there is uncertainty in a particular situation; type of automatic thought
Irrational beliefs
dysfunctional thinking pattern
Rational emotive behavior therapy (REBT)
= a form of CBT developed by Albert Ellis that expanded the ABC model to place more emphasis on emotions and to recognize the integration of behavioral and cognitive therapy
Rational thinking
= the ability to objectively consider facts, opinions, judgments, and data to arrive at a sound conclusion; can include both positive and negative ideas
Schema
= the way we make sense of the world, driven by frameworks of knowledge and associations; exist in our long-term memory
Socratic dialogue
= a method in which the therapist asks the client pointed, open-ended questions that encourage reflection and promote new and more logical perspectives
Unconditional self-acceptance
becoming comfortable viewing oneself as fallible and seeing one’s own self-worth as separate from one’s behaviors and circumstances
