L12.2 - Disorder Treatment Flashcards
Psychodynamic psychotherapy (Rooted in Freud’s psychoanalysis)
Focus on:
- Recurrent themes and patterns in thoughts and feelings
- Development
- How repressed emotions influence current behaviours & thoughts
- Interpersonal relationships (object relations, attachments)
Resistance
In psychoanalysis, a patient’s self-censorship or avoidance of certain topics
Person-centered therapy
- Based on Humanistic Psychology (Carl Rogers)
3 components:
- Unconditional positive self-regard:
-> Therapist’s acceptance and support of the client without judgment or conditions fostering self-exploration and personal growth - Empathy:
-> Therapist’s ability to understand and share the client’s feelings and experiences - Congruence (genuineness; authenticity):
-> Transparency of therapist in interactions with the client. Therapist is real, and open about their own feelings and experiences
Person-centered relationship btw therapist and patient
- No hierarchy
- Non-directive, therapist does not guide advise client, who is considered being expert on themselves
- Goal of treatment is to increase the insight of patients
Cognitive Behavioural Therapy - First Wave
First wave: Classic Behavioural therapies
- Classical & operant conditioning
- Systematic desensitization
- Focus on behaviours, not thoughts
Cognitive Behavioural Therapy - Second Wave
Incorporation of cognitions
- Rise of CBT
Cognitive Behavioural Therapy - Third Wave
Less about change, more about acceptance
- Acceptance and commitment therapy
- Mindfulness-based CBT
- Dialectical Behavioural therapy
Basics of CBT
Central factors to consider in a client:
- Thought
- Emotion (hardest to change, but we can change this by changing how we think and act)
- Behaviour
Critiques of CBT
- Challenging the negative automatic thoughts of client can have paradoxical effects and can be ineffective
-> Ex. not thinking has little effect on classically conditioned fear responses
Acceptance and Commitment Therapy
- Fosters acceptance of unwanted thoughts and feelings
- Stimulates actions that improve the circumstances of living
- Discourages client’s avoidance to experience negativity
ACT hypothesizes that psychopathology
Stems from the client’s efforts to escape unpleasant feelings using avoidance behaviours like:
-> Substance use disorder
-> Eating disorders
-> Panic disoredrs
-> PTSD
-> OCD
ACT Components
Psychological flexibility at the focus
- Acceptance: reducing the motivation for experimental avoidance
- Cognitive De-fusion: Watching negative thoughts with the awareness that they are only thoughts
- Self as Context: Realizing that one’s identity is separate from one’s thoughts
- Being Present: mindful awareness of thoughts and feelings
- Values: clarifying values
- Committed Action: setting tasks to live in accordance with values
ACT Critique of CBT
- CBT too mechanistic
- Too focused on symptom change
-> Attention should be on changing context and broadening focus of change - Few techniques in traditional CBT developed in basic science laboratories (not much evidence)
CBT Critique of ACT
- ACT is reframing of CBT
- Cognitive restructuring and de-fusion share similar processes
-> Restructuring is incompatible with thought suppression
-> Disputing decreases experimential avoidance and defusion of “thought as fact” - Exploring schemas and rule is similar to exploring “values” in ACT
Cognitive Distortions
- All or nothing thinking
- Over-generalising
- Mental filter
- Disqualifying the positive
- Jumping to conclusions
- Emotional reasoning
- Magnifying (catastrophising) & minimization
- “should” “must” “ought” make us feel guilty like we have already failed
Cognitive restructuring
Set of cognitive therapy techniques for challenging a persons’ maladaptive beliefs through persuasion/confrontation
CBT Thought Record
- Where were u?
- Emotion or feeling
- Negative automatic thought
- Evidence that supports thought
- Alternative thought
- Emotion or feeling
Behavioural Activation
Used mainly in Depression
- Aims to increase engagement in adaptive activities
- Ex. jogging, movie, walking, exercise
- Worksheets to keep track of how you feel after each acitivity
Behaviour - Exposure
Used in treating Anxiety and OCD
- Operates according to the principles of Pavlovian extinction
- Fearful stimulus gets presented without the negative reinforcer that client expects with focus on NOT engaging in safety behaviours
Types:
- In-vivo exposure (Systematic Desensitization)
- Introspective exposure
- Imaginal exposure
- NEW: Reconsolidation-based exposure
Dodo Bird Effect
- Saul Rosenzweig (1936): All therapies produce equivalent outcome
Testing the Dodo Bird effect
The DSM
- 295 studies comparing efficacy of multiple psychotherapies (are they equal)
- Null hypothesis: If Dodo bird conjecture is true, effect sizes will be roughly equivalent
- Alternate hypothesis: if Dodo bird conjecture is false, effect sizes will not be homogenous
- Result: effect sizes very similar, null hypothesis NOT rejected
- Conclusion: all therapies seem similarly effective
Common Factors - Client Characteristics
Positive expectancies distress
Common Factors - Treatment structure
- Techniques/structures
- Exploration of “inner world”
- Adherence to theory
Common Factors - Therapist qualities
- Cultivates hope
- Warmth/positive regard
- Empathy
Common Factors - Change processes
- Opportunity for catharsis (releasing repressed emotions)
- Practice of new behaviours
- Foster insight/awareness
