General Flashcards
Guided self help is effective for mild-moderate depression
Anderson et al 2005
Gellatly et al 2007
Guided self-help methods
Books Brosan and Hogan 2006
Worksheets CCI
E-CBT Mood gym
Factors impacting on attendance
Stigma
Symptoms
Disability
Motivation
During assessment you should attain…
Problem Exploring symptoms Maintaining factors Expectations Goals
4 recommended LICBT Treatments recommended by NICE 2009b
BA
Cognitive
problem solving
Sleep hygiene
Three deciding factors in LICBT intervention decision
Client choice
Goals
Symptom target
PWP Training Review (2015)
Problem statement review
Pavlov
Classical condition
Phobias: baby Albert, learning via association
Behaviour
Pavlov
Skinner
Cognitive
Beck
Ellis
Beck
Cognition
Ellis
Belief base
Emotional response
Reflection learning through
Gibbs 1988
Kolb 2014
Benefits of a problem statement
Time keeping
Silent member
Negativity
Over disclosure
Cognitive strategies are used in LICBT to…
Challenge negative thoughts and unhelpful thinking patterns
Depression key features:
Lack of motivation
Negative thinking
CBT model of depression suggests…
depressed people show cognitive biases or systemic thinking errors (Beck et al 1979) aka unhelpful thinking styles
Unhelpful thinking style (4 areas)
Westbrook et al 2007
Self-reproach eg taking things personally, self-criticism and name-calling
Intuitive thinking eg mind reading, making negative predictions about the future, basing reasoning on emotional responses
selective attention eg overgeneralising, discounting positives, taking all responsibility, magnifying negative events
Extreme thinking eg all or nothing thinking, unrealistic standards & catastrophising
An example of a GSH material to challenge negative thoughts
Beck et al 1979
Greenberger & Padesky 1995
Thought records
Negative triad
Beck et al 1979
Thoughts develop and are reinforced habitually and enter frequently into patients’ minds - NAT
Purpose of a thought diary
Client to become aware of thoughts and secondly to evaluate their validity… client therefore is encouraged to find a more balanced alternative preventing vicious cycles
Mynors-Wallis & Lau 2010
Most work happens between sessions
Kupfer 1991
At least half of people who recover from depression will relapse
Anxiety is…
the assumption that something is more dangerous than it really is
Most treatment will include…
Assessment of the anxiety and an agreement on the goals to be worked on
Psycho-ed
Skills to better enable the client to manage
Some form of exposure to the situation or object
Relapse management
Clearest support for LICBT evidence working with Anxiety is for…
Social anxiety & panic
Furmark et al 2009
Abramowitz et al 2009
Found significant results for a range of LICBT interventions for social anxiety
Robinson et al 2010
Strong results for evidence for the use of LICBT for panic
Tolin et al 2011
OCD can be treated using exposure techniques effectively
NICE guidelines for GAD
LICBT should be administered as a first line treatment, supported by Wilkinson 2011
Coull & Morris 2011
Comprehensive review of controlled trials, demonstrated some success but overall varying results- LICBT lacks longitudinal follow up reported within studies
- However they did not include diagnoses that were not confidently presented thus mild to moderate symptoms were not included
Newman et al 2003
LICBT is most effective for motivated clients
Gellatly et al 2007
LICBT is only effective for anxiety if continued support is offered
Typical structure of anxiety LICBT treatment
- Assessment of current difficulties
- Match presentations to treatment options
- Self-help sheets to psychoeducate around treatment options and the condition
- If the symptoms do not correlate with a specific diagnosis, the symptoms/experiences themselves can be worked on White et al 1992
Cave & Dunwoodie 2012
services have different treatment options depending on locality
White et al 1992
Stress course- generic course- non-specific diagnosis
Roth &Piling 2007
Standards set for Goal Setting
SMART type idea
Measuring goals…
It is important to agree with the client collaboratively how they are going to measure the success of their treatment
Eckam & Shean 1997
High levels of anxiety that does not habituate should be HICBT
Larun et al 2009
Exercise is effective treatment for mild to moderate anxiety although research is limited
Very few mental health services provide this as an option
Herring et al 2011a, 2012
exercise is effective treatment
Herring et al 2011b
Prescribed exercise for GAD
Abrantes et al 2009
Prescribed exercise for OCD
Brooks et al 1998
Prescribed exercise for panic
Newman & Motta 2007
Prescribed exercise for children and adolescents effective
Knapen et al 2009
Prescribed exercise for working aged adults
Chodzko-Zajko et al 2009
Prescribed exercise for Older adults effective
Roth & Holmes 1987
Intensity of exercise is irrelevant
Beaulac et al 2011
Mnemonic
Exercise can prevent CMH problems
Collaborative working is important factor in effectivity particular when considering physical exercise Mnemonic Assess Advise Agree Assist Arrange
Which pathways does exercise work on?
Cog and physical
Sabourin et al 2008
How exercise helps mental health/anxiety.
Physical - Habituating anxiety of physical arousal eg heart rate
Cog- helps the client to understand the situation without it being threat based i.e. exercise induced
Strohle 2008
Exercise increases sense of mastery, distraction and change of self-concept
Petrella & Lattanzio 2002
Treatment compliance can be an issue, recommend regular brief practitioner support to improve compliance and outcomes
Cognitive treatments for anxiety
thought records- raise awareness of typical anxious thoughts, thoughts can be a trigger for anxiety and so this is the rationale behind it
thought challenging - CR, provides rationale for behavioural responses
worry time
Behavioural Experiments- as it is developing new information and relearning
Nelson & Hayes 1981
For LICBT awareness and self-monitoring may result in spontaneous change in thought content
Olson & Winchester 2008
monitoring the frequency of a thought may increase the occurrence - think cognitive priming
Clark et al 1991
Priming tends to occur when a thought is suppressed rather than monitoring alone
Clark 1995
Cognitive treatments encourage…logical analysis and empirical hypothesis testing which leads to realignment of their thinking with reality
When is behavioural treatment favoured over cognitive?
When the best evidence available reaffirms the anxious thought eg speaking in public having had a bad experience
Bennett-Levy et al 2004
Behavioural experiments:
in-between sessions
derived from a cognitive formulation
primary purpose- obtain new information, testing validity and beliefs
Holly et al 2010
BE are powerful when bringing change in unhelpful thinking and related behaviours as they offer reflective and active parts
Kolb 1984
Benefits of reflection
Bystritsky et al 2005
Prediction of medication compliance
- help to cope?
- does it work?
- are they addictive?
- physically better?
Beck 2001
Specific targeted questions should be asked around medication
- fears
- impact medication has on decisions
review unhelpful beliefs using CR
Evans &Spelman 1983
Half of the people taking MH meds will stop taking their mediation when they start to feel better
Enhancing compliance
Psycho-ed
- rationale
- delay onset
- time course
- side effects
- problems with relapse if they are withdrawn too quickly
- concerns about addictions and cravings
Mitchell & Selmes 2007
medication compliance as a goal: - basic communication -stratefy-specific interventions -reminders evaluating adherence
Goals for relapse prevention
preventing it
increasing wellness
developing skills to promote and sustain wellbeing
