Final Exam prep Flashcards

Question

Example of efficacy and specificity: participants - randomly assigned to two levels of independent variable Experimental condition: write in a journal for 15 min/day for 4 weeks about their emotions that day Control condition: do nothing - life as usual Measure: Beck Depression Inventory What is the efficacy and specificity in this experiment?

Answer 1

Efficacy: random assignment to two conditions and there was change in the experimental condition compared with the control condition But… was the change because they were writing about emotions or was it simply because they had something to do every day? Specificity: the control has to be a credible sham placebo or another treatment that already has proven efficacy (e.g., write in a journal for 15/day for 4 weeks about that day or CBT for depression) – if we find that the experimental condition produces a greater change then there is specificity

Answer 2

Does the treatment actually work in real-world clinical settings? Studies in naturalistic settings Quasi-experimental, uncontrolled designs are common Can be conducted after efficacy research

Answer 3

Cost effectiveness Treamtents that cost the least are likely to be preferred if there is no great difference in outcome Need to consider short-term and long-term gain (the more expensive therapy may be more effective in the long-term (cheaper in the long run))

Answer 4

Therapist training and monitoring -need to know that the researcher was well trained and monitored Consider investigator allegiance -Any treatment tends to do better than other treatments when it’s conducted by people who are expert in its use To deal with this, try and balance (e.g., if CBT is the focus of the study and IBT is the control used, have CBT experts conduct that therapy and IBT experts conduct that therapy Comprehensive outcome -Looking at general measures (quality of life, daily functioning) or, at least, looking at several measures (not just one specific diagnostic measure) Follow-up studies: -To see if gains are maintained Clinical significance: -Rather than only statistical significance (real-world change can be very different from statistical significance)

Answer 5

RCTs are too rigid - inclusion/exclusion criteria are too strict RCT designs place undue weight on efficacy rather than effectiveness Selection of uncomplicated diagnostic groups fails to represent needs and responses of usual, complex, comorbid patients seen in practice Not applicable to a diverse range of patients varying in personality, race, ethnicity, culture, etc. Focus on brief, manuliazed treatment does not adequately or validly represent psychotherapy that is conventionally practiced

Answer 6

“...the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” (APA, 2006) Going beyond the ESTs and looking at other types of research (including case studies, etc.), integrating with expertise and patient characteristics, etc. More flexible and realistic approach than simple focus on ESTs

Answer 7

Best available research Patient characteristics, culture, and preferences Clinical expertise Bauer, 2007 evidence-based practice

Answer 8

a summary of scientific research (dealing with the diagnosis, assessment, and/or treatment of a disorder) designed to provide guidance to clinicians providing services to patients with the disorder. The American Psychiatric Association, for example, has practice guidelines listed on its website that address the treatment of dementias, mood disorders, panic disorder, OCD, PTSD, borderline personality disorder, eating disorders, substance use disorders, and schizophrenia

Answer 9

involves using the results of efficacy trials to form a standard (or a benchmark) against which the services provided to regular patients by regular clinicians can be compared based on the benchmarking strategy, there is evidence from various countries that evidence-based treatments can be very effective when used in routine practice settings

Answer 10

Was there a control group? Was it an appropriate control group? Was there random assignment to groups? Would we be able to determine efficacy? Is the treatment possibly efficacious or efficacious? What would need to occur for this therapy to meet criteria for specificity? Were the therapists trained adequately? Who were the participants? Were there enough study participants for the results to be meaningful? Did the study evaluate adherence to treatment? Did the investigators evaluate appropriate outcomes?

Answer 11

Evidence-based: requires psychologists to be not only sensitive and empathic but also well informed about current research relevant to the services they provide. The effective scientist-practitioner thinks in a scientific manner and applies knowledge derived from research with care and compassion. Eminence-based: practice based on tradition and authority; recommendations are accepted because the person delivering them is seen as an expert

Answer 12

opinions of even recognized experts are just that—opinions—unless their views are supported by the best available empirical evidence

Answer 13

Faulty Reasoning False Dilemma Golden Mean Fallacy The Straw Person Argument Affirming the Consequent Appeal to Ignorance

Answer 14

-A form of argument that is inaccurate or misleading in some way. “Psychologists have provided effective services for decades without having research available on what makes treatment effective." -This fallacy takes the form of reducing the range of options available to just two (usually extreme) options. “Either I accept the treatment that the psychologist is suggesting, or I just give up trying to change.” -This logical error involves assuming that the most valid conclusion to reach is a compromise of two competing positions. “I have heard that both cognitive and psychodynamic treatments can be helpful for the type of problems I have, so I really should look for a treatment that combines both cognitive and psychodynamic elements.”

Answer 15

-This involves mischaracterizing a position in order to make it look absurd or unpalatable. “Anyone who would prescribe a drug to treat my son’s symptoms just wants to turn active kids into zombies.” -This logical error takes the following form: first, assume that x is a cause of y. Then, when y is observed, conclude that x must have caused it. “People who have schizophrenia always act in a bizarre manner. This person is acting bizarrely. So, obviously, this person has schizophrenia.” -This mistake takes the form of arguing that, because there is no evidence to prove a position is wrong, the position must be correct. “There is no scientific evidence that having my patients sing and dance while they remember the trauma that they experienced harms them or is ineffective. So, of course, this new form of therapy has to be helpful.”

Answer 16

Deductive: the researcher uses a formal theory to generate a research idea Inductive: for example, deriving an idea from repeated observations of everyday events. Even though the inductive process is not explicitly guided by theory, it is influenced by the researcher’s informal theories, including his or her theoretical orientation and general world view

Answer 17

First, the researcher conducts a systematic search of the published research on the phenomenon of interest. Second, assuming that there is no research that has directly tested the idea, the researcher begins to formalize ideas so that they can be tested in a scientific manner - requires translating abstract ideas into something that can be measured (operationalizing an abstract concept) Third, the researcher must carefully consider the extent to which the research idea may be based on cultural assumptions that may limit the applicability or relevance of the planned research Fourth, the researcher must consider ethical issues in testing of the idea. For example, ethical considerations might make some research designs unsuitable, such as using random assignment in an experiment to determine the effects of violence Finally, the researcher must draw together all the results of the previous steps to sketch out the study procedures. Along the way, some aspects of the planned study may need to be dropped or modified due to practical constraints (e.g., insufficient funds or a lack of appropriate measures).

Answer 18

participants may be vulnerable due to their psychological distress and/or may be receiving psychological services as part of the research Psychologists are expected to apply the general principles (respect for the dignity of persons, responsible caring, integrity in relationships, and responsibility to society) Prior to data collection, the researcher must obtain approval for conducting the research from the institution in which he or she works. In Canadian institutions, research ethics boards (REBs) ensure that the proposed research conforms to the Tri-Council Policy statement Ethical Conduct for Research Involving Humans attention to the welfare of research participants (and animal subjects) and to honesty in the presentation of research findings an ethical obligation to share their data with other researchers (once published)

Answer 19

internal: the extent to which the interpretations drawn from the results of a study can be justified and alternative interpretations can be reasonably ruled out external: the extent to which the interpretations drawn from the results of a study can be generalized beyond the narrow boundaries of the specific study

Answer 20

History: influence of events that occur outside the context of the study Maturation: Changes in the participants due to their psychological or physical development Testing: Repeated testing may influence the results Instrumentation: In longitudinal studies, changes in the definition of constructs and in their measurement Statistical regression: Extreme scores on measures, both high and low, tend to be less extreme upon retesting Selection biases: systematic differences in recruiting participants or assigning participants to experimental conditions Attrition: loss of participants in a study over time

Answer 21

Sample characteristics: the degree to which the characteristics of the research participants, such as their sociodemographic and psychological characteristics, map onto other samples and populations Stimulus Characteristics and Settings: features of the study such as the institutional setting and the characteristics of those involved in the conduct of the study (e.g., therapists in a treatment study) may constrain the generalizability Reactivity of Research Arrangements: By virtue of being in a study, participants may respond differently Reactivity of Assessment: Participants’ awareness that their behaviours, moods, attitudes, etc. are being monitored Timing of Measurement: The decision about when to measure variables may result in conclusions that are not true for all time points - may not be stable between measurement periods

Answer 22

once a research area is well developed, correlational designs are unlikely to add anything new to the scientific literature. On the other hand, in a relatively new research area, even a relatively simple case study may make a meaningful contribution to the literature Designs such as these are often used in early research on a particular topic. As the knowledge on a topic evolves, there is a tendency for the research designs to become progressively more rigorous.

Answer 23

a detailed presentation of an individual patient, couple, or family illustrating some new or rare observation or treatment innovation

Answer 24

a valuable format for making preliminary connections between events, behaviours, and symptoms that have not been addressed in extant research include a lot of detail (e.g., about treatment methods) making it easy to follow and replicate can be a rich source of research hypotheses regarding the etiology or maintenance of disorders can also be the initial testing ground for innovative assessment or intervention strategies have heuristic value—that is, they draw the attention of other professionals to a phenomenon

Answer 25

do not allow for the rigorous testing of hypotheses major weakness is that most threats to internal validity cannot be adequately addressed alternative explanations cannot be ruled out in this simple research design

Answer 26

A = period representing the level of symptoms prior to the intervention (also known as the baseline) B = period representing the level of symptoms following the intervention intervention effects are typically determined by visual inspection of graphed data a number of statistical tests can be used to determine if statistically significant changes occurred

Answer 27

similar to the A-B design except that the treatment is withdrawn after a few weeks and data continue to be collected for a second A period (i.e., a period in which no treatment occurs) If symptoms return to pre-treatment levels, then a strong case can be made for the effectiveness of the intervention

Answer 28

it may not be possible to have the person refrain from using the treatment strategies during the second A period, especially if the strategies have been effective in reducing symptom levels for a few weeks ethical considerations may make clinicians unwilling to remove, however briefly, a treatment strategy that appears to be working well

Answer 29

correlational

Answer 30

can be analyzed with all types of statistics, including correlations, partial correlations, multiple regression, t-tests, or analysis of variance (ANOVA) Come in many forms Can be used to examine the underlying structure of a measure or a set of measures. This is known as factor analysis Most frequently, correlational designs are employed to examine the relations among discrete variables in an effort to develop or test a conceptual model (e.g., moderator and mediator variables)

Answer 31

a statistical procedure used to determine the conceptual dimensions or factors that underlie a set of variables, test items, or tests can reveal which items “work” and which don’t

Answer 32

Exploratory factor analysis: is used when the researcher has no prior hypotheses about the structure of the data Confirmatory factor analysis: is used to test a specific hypothesis regarding the nature of the factor structure

Answer 33

a variable that influences the strength of the relation between a predictor variable and a criterion variable For example, the relation between the experience of stressful life events and psychological distress may be moderated by the type of coping strategies used

Answer 34

a variable that explains the mechanism by which a predictor variable influences a criterion variable For example, the relation between parental psychopathology and child adjustment may be due, partially or entirely, to the quality of the relationship between parent and child.

Answer 35

a comprehensive statistical procedure that involves testing all components of a theoretical model which combines elements of confirmatory factor analysis and mediator analyses First, the researcher lays out a structural model that shows how all the variables in the model are related to each other - akin to mediator analyses In a second step, the researcher considers how best to measure each variable in the model and selects multiple measures for each variable - akin to confirmatory factor analysis

Answer 36

a causal connection cannot be established, as the apparent effect of the first variable on the second could be due to the influence of an unmeasured third variable experimental manipulation and random assignment to conditions are absent

Answer 37

SEM can determine only the extent to which a hypothesized causal model fits the study’s data—it cannot unequivocally demonstrate that the hypothesized causal model is true SEM requires a relatively large sample (i.e., more than 200 participants)

Answer 38

involve some form of manipulation by the researcher (although no random assignment) in many situations, it is simply not ethical or feasible to randomly assign participants to conditions so this design provides a compromise The most frequently used quasi-experimental designs involve the comparison of two previously established groups of participants. In the simplest design, one group receives the intervention, the other doesn’t. Data are collected after the intervention and then analyzed. This design is cost effective and relatively straightforward because only one wave of data collection is required.

Answer 39

do not involve random assignment to experimental conditions - the effect of the independent variable on the dependent variable may be confounded with extraneous influences In the frequent design in which data are collected once after the intervention: the two groups may differ substantially before the intervention, thereby confounding the results. (pre-intervention testing can be done but is less cost effective)

Answer 40

involve both random assignment to condition and experimental manipulation. These features allow the researcher to draw relatively unambiguous conclusions about the effects of the independent variable on the dependent variable provide the best protection against threats to internal validity

Answer 41

often more costly As with quasi-experimental designs, the strongest design is one in which both pre-intervention and post-intervention data are collected - concerns about reactivity to testing may lead a researcher to dispense with obtaining pre-intervention data - weakens the ability to determine the initial equivalence of groups

Answer 42

the validity and generalizability of a study

Answer 43

focuses on the use of numerous strategies to ensure that the research sample is representative of the population the researcher knows the probability of selecting participants from the population of interest required when the researcher is interested in obtaining an accurate and precise estimate of the strength, level, or frequency of some construct in the population Typically used in: -surveys that are frequently reported in the media on topics such as preferences for political parties or candidates -epidemiological studies of the prevalence of mental disorders or the utilization of mental health services

Answer 44

it is not possible to determine the probability of obtaining participants from the pool of potential participants may include advertising for research participants in a newspaper, on a website, or in a mental health treatment setting - or university students psychologists more commonly rely on non-probability sampling approaches

Answer 45

probability - less convenient and more costly non-probability - unlikely to be as generalizable as data obtained from probability samples - in much psychological research, this is assumed not to be a major problem

Answer 46

number statistical power

Answer 47

reliable and valid consistency accuracy of measurement (is it measuring what its supposed to)

Answer 48

the extent to which the results of a study are accurate and valid based on the type of statistical procedures used in the research

Answer 49

Low Statistical Power: If a study has low statistical power, often caused by the use of samples that are too small, the researcher may not be able to accurately conclude that group differences were found in the study. Multiple Comparisons and Their Effects on Error Rates: consider how many analyses to conduct and the error rate to use for analyses in order to have a reasonable balance between the desire to avoid Type I errors (i.e., concluding there is an effect when no true effect exists) and Type II errors (i.e., concluding there is no effect when a true effect exists). Procedural Variability: those conducting the research (such as interviewers, observational raters, and therapists) may differ in how they interpret or use the instructions and procedures. Increases in variability in a study decrease the ability to detect a phenomenon or experimental effect. Participant Heterogeneity: Variability in participant characteristics may result in differential results within the sample. Measurement Unreliability: The less reliable a measure, the more that measurement error influences the data obtained from participants.

Answer 50

the findings of an initial study in a research domain are not always replicated in subsequent research - research in many areas may include substantial numbers of false-positive findings journals are more likely to accept studies with statistically significant findings. So, the most likely explanations involve the selective use of statistical analyses and the selective reporting of outcomes in a study researchers are likely conducting multiple statistical tests on their data without correcting the significance level for the fact that multiple tests were conducted - This is considered to be “cherry picking” the significant results researchers sometimes report values that are significant at a larger p value than .05. For example, a result that was significant at p <.08 might be described as showing a “trend toward significance” and then discussed as a statistically significant finding

Answer 51

Ensuring that: (a) research studies have sufficient statistical power, (b) adjustments are made for conducting multiple statistical analyses, and (c) researchers accurately report and represent major analyses of their data.

Answer 52

Because many psychological measures have an arbitrary metric with limited or no real-world correspondence, it is important that researchers learn more about what the score on a measure actually means in the life of a person and just how meaningful, in real-life terms, differences in scores really are clinical significance: in addition to the results of a study attaining statistical significance, the results are of a magnitude that there are changes in some aspects of participants’ daily functioning.

Answer 53

One commonly used approach is to evaluate, for each participant, whether the participant could be said to be in the normal range of functioning. This may involve the use of norms, cut-off scores on scales, or pre-determined criteria (such as being employed or being able to function without assistance when performing self-care tasks) to operationalize normal range functioning A second commonly used method, developed by Neil Jacobson and colleagues and called the reliable change index, determines whether a participant’s pre-treatment to post-treatment change on a scale is statistically greater than what would be expected due to measurement error - has moved to within two standard deviations of the mean score for a non-disordered sample, then a clinically significant change is said to have occurred different methods for calculating clinical significance may yield different conclusions

Answer 54

the use of a systematic and explicit set of methods to identify, select, and critically appraise research studies Extremely detailed in the methods section Information includes how studies were searched for and then included/discluded - this allows for replication

Answer 55

a set of statistical procedures for quantitatively summarizing the results of a research domain (developed in the 1980s) is now the standard for making a general statement about the findings in a research field - brings scientific rigour to the process of reviewing the results of research, allowing investigators to use explicit decision rules and computations in reporting findings

Answer 56

Following the steps employed in systematic reviews, researchers attempt to obtain all relevant studies to include in their analyses. Data are then extracted from these studies and subjected to statistical analysis - combines the results of prior research using a common metric called an effect size

Answer 57

statistical analyses, rather than the author’s impressions, guide the conclusions drawn about a research topic by including data from many studies, the number of research participants on whom conclusions are based is dramatically increased - greatly enhancing the researcher’s power to detect an effect can also address the issue of publication bias—Unpublished studies (e.g., dissertations) can be included improves the generalizability of the conclusions drawn on the basis of the literature

Answer 58

practised by professionals from many disciplines, including psychology, psychiatry, social work, medicine, and nursing not licensed or restricted in any fashion, which means that anyone can advertise his or her services as a psychotherapist in most jurisdictions the College has no authority over unregulated service providers

Answer 59

evidence-based treatment options. This includes medication options, psychological interventions the psychologist can provide, and psychological interventions the psychologist does not have the training to provide (in which case a referral would be necessary)

Answer 60

clients must be assured of the confidentiality of the services they receive, as well as informed of the limits to confidentiality when a person’s safety is in danger. They must also receive clear descriptions of the steps taken by the psychologist to protect their privacy.

Answer 61

informed of this and asked to consent to treatment with full knowledge about the limited scientific basis for the treatment

Answer 62

Yes - there is a growing awareness and research base on psychological treatments that can cause harm and even if a treatment is not directly harmful, it can interfere with patients’ efforts to deal with their problems. Cause harm: -"Scared straight” programs that try to frighten adolescents at risk for ongoing criminal behaviour actually increase the odds of subsequent criminal offending. -Rebirthing therapy, in which children are wrapped in blankets and squeezed repeatedly to “simulate” the “trauma” of birth, has resulted in a number of deaths. Indirect: -adults with psychosis or schizophrenia not receive generic counselling, as research has not found it to be helpful (wastes time that could be spent using effective therapy)

Answer 63

Adopt - If there is a reasonable fit between client characteristics and the research samples Adapt - If the fit is reasonable but it seems highly likely that some modification is required to respect important cultural characteristics or practices Abandon - If other evidence-based treatment options offer a better fit to the client’s characteristics and preferences

Answer 64

very active role in service provision

Answer 65

probe the precise nature of the problem, seeking information on its intensity, frequency, and duration as well as contextual factors that are associated with variation in the problem. collaborate with clients in establishing concrete treatment goals and in translating vague complaints into measurable outcomes toward which the client will work provide information about the process of treatment, explaining the central role of homework assignments in gathering data, carrying out experiments, and practising new skills take responsibility for structuring each session, setting an agenda, and teaching new skills

Answer 66

didactic teaching methods (i.e., directions and instructions) Socratic questioning (i.e., asking questions that encourage the client to examine his or her beliefs and to be self-directed in skill acquisition)

Answer 67

CBT the client and therapist develop strategies to concretely test the client’s dysfunctional beliefs. By encouraging self-examination and then working with the client to test the validity of his or her beliefs, the therapist actively encourages a process of guided discovery for the client

Answer 68

in contrast to many other forms of therapy, the most important changes are presumed to take place not in sessions but between sessions as the client completes and learns from homework assignments Termination phase: The other theoretical orientations we have discussed consider termination in terms of the end of the therapeutic relationship. In CBT, the termination phase is seen as a time for consolidating skills, anticipating future challenges, and preparing the client to face inevitable slip-ups. (future oriented) also allows for the possibility of clients requiring one or two future “booster” sessions to help them get back on track

Answer 69

the use of medication rather than psychological treatment greater patient access to physicians than to mental health specialists, the ease of taking medication relative to engaging in psychotherapy, the commonly held assumption that mental disorders stem from biochemical imbalances possible insurance coverage for meds rather than therapy

Answer 70

there is considerable research evidence that evidence-based psychological treatments are at least as efficacious as psychotropic medication in the treatment of depression and anxiety disorders decades of research has found that people are three times more likely to prefer psychological treatment to medication for the treatment of mental disorders

Answer 71

two-thirds of psychotherapy clients are female, half have a college or university education, half are married, and the majority are young to middle-aged adults

Answer 72

economic burden psychological challenges associated with coming to terms with the need for treatment, combined with the many practical obstacles that can interfere with actually engaging in treatment access to all health care professionals, including psychologists, is much lower in rural settings

Answer 73

10 very active

Answer 74

35% 44.3% most patients attended too few sessions, and most therapists did not provide evidence-based treatments

Answer 75

57.6% of patients meeting criteria for recovery (and 67.2% meeting criteria for improvement or recovery) with more treatment, and treatment that is evidence based, the success rate of psychotherapy improves substantially compared with treatment as usual yes, because of the use of untreated control groups in these studies

Answer 76

process group approaches, designed to capitalize on the dynamics of the group structured group approaches, which are extensions of treatments that are also offered in an individual format

Answer 77

groups allow the modelling of both positive and negative behaviours (e.g., when adolescents with significant problem behaviours received peer-group interventions, they learned aggressive behaviours from one another. Thus, group treatment had an iatrogenic effect, in that youth who received the group treatment did more poorly than did youth who did not receive the treatment.)

Answer 78

treatment that the client engages in with no or minimal contact with a mental health professional. there is little evidence that many of the self-help books do much for improving the quality of the readers’ lives. However, there are now self-help materials that have been demonstrated to have a meaningful clinical impact (based on both well-established psychological principles and treatment protocols for psychotherapies that are evidence based) firm evidence that self-administered treatments, across this continuum, can be clinically effective in treating depression, anxiety disorders, OCD, psychosis, and substance abuse disorders in adults

Answer 79

treatment can be entirely self-administered, with the only therapist contact being an initial assessment of patient suitability treatment can be predominantly self-administered, with occasional therapist contact beyond an initial assessment to teach patients how to use the materials and check on their progress minimal-contact therapy where the therapist actively aids the patient in using the self-help materials (which still remain the central focus of therapy) in traditional, predominantly therapist-administered treatments, self-help materials can be used as an adjunct to treatment

Answer 80

the delivery of health care services via telephone, videoconferencing, or computer-mediated communications growing literature on the efficacy of videoconferencing psychotherapy demonstrates that it can be successfully delivered to a wide range of clients and that the outcomes are comparable with those of face-to-face psychotherapy

Answer 81

CBT depression anxiety

Answer 82

an approach to health care service delivery in which lower-cost interventions are offered first, with more intensive and more costly interventions being provided only to those for whom the first-line intervention was insufficient

Answer 83

a stepped care approach involving therapist-assisted self-help, augmented by medication and individual therapy with CBT when necessary, resulted in substantial client improvement even one year after termination of treatment

Answer 84

behavioural activation tasks, such as getting the client to re-engage in some of the pleasurable activities that he or she used to do prior to the depressive episode

Answer 85

CBT task - the use of a thought record that includes a description of the situation (e.g., an event, a memory, or an attempt to do something), associated behaviours (e.g., getting into an argument and yelling at someone), associated emotions (e.g., frustration, sadness, and discouragement), and associated thoughts (e.g., What’s the point? I’m such a pushover, I’m such a total failure.). therapist and client work together to examine how these thoughts influence decisions around behaviours - client is then coached to challenge the accuracy of these negative thoughts

Answer 86

use of relaxation skills, imaginal exposure, and in vivo exposure

Answer 87

used in CBT for PTSD patients are asked to close their eyes and to recount these traumatic experiences for an extended period (typically more than 30 minutes), using the present tense and providing as much contextual details as possible (e.g., smells, sounds, their own thoughts, and physical reactions) sessions are usually recorded, and the patient is asked to listen to the recording repeatedly between sessions in order to promote emotional processing

Answer 88

used in CBT for PTSD can include stimuli such as sounds (for a patient traumatized in a car accident, this could be hearing a car braking hard) and smells (for a patient who was raped, this could be the smell of the rapist’s cologne), as well as common situations such as driving a car (for the car accident victim) or walking by a body of water (for someone who almost died in a flash flood) psychologist develops a hierarchy of feared stimuli with the patient and encourages the patient to intentionally expose himself or herself to increasingly fearful stimuli

Answer 89

Addresses unresolved conflict to lead to catharsis Problems occur if the Id drives are too intense or if our defences become too strict - develop pathologies (e.g., excessive anxiety, depression)

Answer 90

Time consuming (2-4 times/week for 4-6 years) Costly Specific type of patient needed (self-directed) Sometimes told NOT to make major life changes while in therapy (long period) Sometimes told to give up meds Training - most have to undergo personal therapy themselves Evidence - hard to quantify/operationalize concepts such as transference or consciousness Effectiveness: Supported almost entirely by case studies

Answer 91

STPP: 1-2 times/week, 16-30 sessions (as opposed to 2-4 times a week for years) More therapist-directed and more active (face-to-face is typical rather than couch) Support medication use and continued life changes More likely to focus on client’s current life situations, and may teach the client specific interpersonal and emotional-control skills More flexible approach Outcomes: APA lists this as having “modest research support” Simpson et al (2003) = “limited evidence of improved outcome”

Answer 92

Aim to understand how clients fit into their worlds, and how family and cultural background shape clients and influence their therapeutic processes and individual needs Not listed by the APA as evidence-based - not much evidence/research base (however, the Glass study showed some treatment efficacy)

Answer 93

Developed first for depression Based on understanding triggers in the client’s life Time limited therapy Therapist is active (not passive) Depression as an illness (no fault) Therapy is centered on current life events (not past issues) Problems result from and are maintained by disruptions in interpersonal relationships: Grief Interpersonal disputes Role transitions Interpersonal deficits (isolation, loneliness)

Answer 94

APA lists IPT as having “strong research support” for: Binge eating disorder Bulimia nervosa Depression Several clinical trials showing that it’s at least as good as other treatments and better than controls

Answer 95

APA does not list any of these as being empirically validated but Smith, Glass meta analysis shows some efficacy Existential - No controlled research - suggests that testing is dehumanizing and not authentic

Answer 96

Existence is at three levels: Nature Social Self Healthy existence is being authentic at each level - authenticity is anxiety provoking so this is why it is sometimes avoided - we have to confront and survive this anxiety rather than lying about it (lying is the foundation of psychopathology) Therapist is not very active (mostly passive) Therapist does not need unconditional positive regard (i.e., does not hold positive regard for lying)

Answer 97

Humanistic Therapist is not especially active (mostly passive) The therapist wants to create an environment for the client to engage in self-exploration and remove barriers that block their natural ability to be their personal best

Answer 98

Positive self regard (unconditional) - persons judges themself to be worthy Self-actualization - motivating force to develop one’s own potential Incongruence happens when a person doesn’t have unconditional positive self regard - then they can’t develop self-actualization - therapist helps person move towards congruence Therapist provides three components: Empathy Unconditional positive regard Genuine (open, him/herself)

Answer 99

Not much strong data - how to operationalize concepts like unconditional positive regard and self-actualization? Smith, Glass… some evidence of treatment efficacy (.63 = 74%) Re-analysis showed effectiveness comes mainly with problems in academic settings (other studies showed that this therapy works mainly with college students with mild problems)

Answer 100

Humanistic and person-centered approach developed by Frederick Perls (had anti-scientific attitude) Mental health problems result from ignoring feelings, desires, thoughts Therapy goal is to bring the factors into awareness for the client, so that he/she can be “whole” again Not much research data to support (not listed by APA) but Smith, Glass… showed some treatment efficacy (but only based on 8 studies)

Answer 101

In any given situation, we have thoughts, that are related to our feelings/emotions, and to our behaviours/actions… all three of these components exist, and are very much related to one another (form a triangle) Sometimes our automatic thoughts/interpretations are accurate but often our interpretations tend to be baised, based on our own lives, our experiences, messages we’ve received, and might not be accurate

Answer 102

Emotion = sad Behaviour = withdraw Thoughts = I’m not interested, It’s not worth it, no point, no hope Working on the cognitive piece (thinking patterns) and behavioural piece (activation) in order to affect the emotional piece (if one piece changes, the others will as well)

Answer 103

positive; realistic

Answer 104

Identify thoughts - What are my thoughts and feelings? challenge thoughts - Are there any other possibilities about what is happening? replace thoughts - What is the most balanced point of view?

Answer 105

Emotions: Anxiety Fear Behaviours/actions: Avoids places Gets others to kill spiders Runs away Hides Cognitive/Thoughts: Spiders are… Horrible Dirty If it crawls on me I will... Lose control Not be able to stand it Have a seizure

Answer 106

Behavioural: Fear hierarchy (for assessment and treatment) Exposures Decrease safety behaviours Generalization Probe (other locations) Cognitive: Education Guided threat reappraisal (confronting thoughts and then seeing if those things happen) Feedback (e.g., with heart-rate monitor)

Answer 107

Emotional Processing Model (Foa & Kozak, 1986) Fear structures in memory exist Fear structures must be activated in order to be treated Habituation must occur in session and between sessions Extinction can occur: Extinction: decrease in learned response as a result of repeated presentation and the absence of reinforcement (e.g., the link between the spider–fear was no longer reinforced) New ideas/thought/memories are formed: Eg., spider = safe

Answer 108

Mindfulness and acceptance therapies Several listed by the APA as empirically supported treatments ACT for OCD (modest), pain (strong), depression (modest), mixed anxiety disorders (modest), psychosis (modest) DBT for BPD (strong)

Answer 109

In traditional CBT the client works on changing their thoughts, behaviors, and emotions Acceptance-Oriented Treatments encourage: Flexibility (psychological) Adaptiveness There are circumstances where things cannot be changed these things need to be accepted - using energy to change these things is wasted and causes more distress - also causes person to miss the other things that are happening (joy) If we push too hard for change, clients can feel invalidated (and they can push against the change)

Answer 110

Justified vs. unjustified responses When a response is justified then the most effective way is to accept the response E.g., if a client is angry but it makes sense for them to be angry (appropriate), the therapist should not try to change the anger (not practical) When a response is unjustified then the most effective way to deal with it is to help them change E.g., out of proportion fear to something (e.g., spider) Changeability vs. unchangeability E.g., blindness is not changeable Effective vs. ineffective Will the change be effective?

Answer 111

Increased awareness of the present moment (nonjudgmentally) A skill that can be practiced - focusing on one thing at a time Can change your response to stimuli in the moment - refocus attention and decrease emotion attending; attended Gestalt practice of looking at the whole picture is slightly like mindfulness (increased awareness)

Answer 112

Behaviour techniques: skills training, exposure, contingency management Cognitive techniques: cognitive restructuring and problem solving Humanistic techniques: validation, reflective listening, empathy, focus on patient-therapist relationship Mindfulness: acceptance

Answer 113

very active Skills to have flexibility in responding to life A life worth living

Answer 114

Individual Therapy Skills Training Group Telephone Consultation Therapist Consultation Team

Answer 115

Interpersonal Effectiveness (6 wks) Mindfulness (2 wks) Emotion Regulation (6 wks) Mindfulness (2 wks) Distress Tolerance (6 wks) Mindfulness (2 wks)

Answer 116

Interpersonal effectiveness skills: Getting what you want while maintaining a relationship and keeping self respect Distress tolerance / crisis intervention skills: Distraction - in a crisis (urges to use drugs, self harm, suicide) Rapid intervention to bring down arousal - set of strategies (e.g., paced breathing) Emotion regulation skills: Module of strategies developed from science of emotions and evidence-based treatment First thing is to teach them to identify their emotions and then to regulate

Answer 117

Patient tracks what is going on week-to-week which therapist checks Tracks levels of emotions, self harm, lying, joy, using skills Tracks urges (using drugs, quitting therapy, self harm) Helps therapist track problems and gives them a place to start/focus

Answer 118

- this is the order in which things need to be addressed in each session: Life-threatening behaviours (e.g., self-harm, suicide) Therapy interfering behaviours (e.g., showing up late, not doing therapy homework) Quality of life interfering behaviours/patterns (e.g., symptoms associated with psychological disorders) Increasing behavioural skills (e.g., assertiveness, relationship issues, workplace stress) - integrated in the other levels as well

Answer 119

101 patients with BPD aged 18-45 years Randomized to 1 year DBT or Community Treatment by Expert (CTBE) - Allowed for treatment specificity to be determined Looked at: suicidal behaviours, ER use, general psychological functioning DBT< CTBE (more of the following in CTBE): Suicide attempts (23% vs. 46%) ER visits Hospitalization rates Angry behaviour Therapist drop (25% vs. 59%) Complete study drop outs (19% vs. 43%)

Answer 120

BPD patients are extremely costly to the medical system (psychiatric-related inpatient hospitalizations, medical visits) and the social system (unemployment, psychiatric disability, public assistance, incarceration) DBT: Cost of psychiatric-related inpatient hospitaliations one year into DBT treatment resulted in overall savings of $21,703 DBT program in Manchester, NH found overall savings of $26,786 in hospital and mental health costs for clients that participated in DBT program Koons et al (2006) - 75% of patients in DBT program were employed at least part-time at follow-up in comparison to 50% of subjects at pre-treatment

Answer 121

No, also shown efficacious with other psychological problems (e.g., eating disorders)

Answer 122

Mindfulness Acceptance Commitment and Values-Based Living

Answer 123

APA - listed as having research support for: Depression OCD Chronic pain Mixed anxiety disorders Psychosis

Answer 124

Are you living the life you want to live right now? Is your life focused on what is most meaningful to you? Is your life characterized by vitality and engagement, or by the weight of your problems? When we are caught in a struggle with psychological problems we often put life on hold, believing that our pain needs to lessen before we can really begin to live again What if you could have your life be about what you want it to be about right now? Values: What do you value? -Client is asked to make a list - then asked if they are living in a way that is consistent with their top values. Living in way that is inconsistent causes stress. Commitment: Find the means to pursue your values You can live them right now Set goals Make them happen through action

Answer 125

ACT study of rehospitalization with psychotic patients (Bach & Hayes, 2002) Randomly assigned to 4 sessions of ACT + TAU vs. TAU (N = 80) ACT patients taught: Noticing but not acting on thoughts Dropping the struggle to control discomfort Values, goals and barriers Review Results: ACT patients reported more psychotic features than TAU patients: Because they were taught to be more mindful/more aware of what was happening ACT patients had ¼ the rate of rehospitalization than the TAU patients

Answer 126

William Miller: Technique is mostly written about by him began in 1970s, was treating problem drinkers with behavioural techniques and running studies with control groups. The control groups were using self-help tools and doing surprisingly well so he examined the factors contributing to their success - developed motivational interviewing Applies methods primarily to treatment of addictions Enhances intrinsic motivation to change (the person’s own motivation) - uses specific steps and techniques to do this Helps clients explore and resolve ambivalence (learn why they might not be changing)

Answer 127

Precontemplation: Not really thinking about problems or about changing Historically labeled as “resistant” or “defensive” If they come into therapy, it is usually due to pressure from loved ones Contemplation: Increasingly aware that a problem exists (negative consequences) Open to consciousness-raising methods (e.g., feedback, observations, educational info) Not quite ready to change yet Preparation: On the verge of taking action Intend to change Need to set goals and priorities Make firm commitments May start to take steps towards action (delayed use, stimulus control - i.e. avoiding troublesome environments) Develop sense of self-efficacy (belief that they can change) Action: Modify their behaviour, experiences, environment to overcome problem Use techniques (such as contingency management, stimulus control) In action stage if they have successfully altered a behaviour for 1 day to 6 months Maintenance: Work to prevent relapse Consolidate gains 6 months onwards

Answer 128

Clients entering therapy will be at different stages - important because it relates to their prognosis Stage of change can predict premature terminators (e.g., Brogan et al., 1999) 40% of dropouts were in precontemplation stage Stage of change should be matched to treatment techniques - Intensive action-oriented approach would likely not be appropriate for people in the precontemplation or contemplation stages but might be effective in the preparation or action stages

Answer 129

Match intervention to stage of change Get the client moving along the stages towards change Develop discrepancies (e.g., looking at the discrepancies in a person’s life - differences between how they see themselves and their behaviours) Empathetic listening Minimizing resistance (instead of pushing towards change, let it go - dance with the client around change, let them argue both sides) Amplifying ambivalence (pros and cons;

Answer 130

Addictive disorders Anxiety Depression PTSD Eating disorders Prelude, stand-alone or combined (can be used before another treatment, by itself or with other treatments)

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