L7 - Formulations Flashcards
1
Q
What is the clinical cycle?
A
- Assessment
- Formulation
- Intervention
- Evaluation
- Stages can blur
2
Q
Why focus on formulation?
A
- Key formal skill
- Joint effort between person and psychologist to understand and explain person’s difficulties and experiences
- Not storytelling as application of psych knowledge and understanding gained through assessment
- Goal is not to create formal clinical formulations BUT understand processes
3
Q
How does existing knowledge help? (learning theory as an example)
A
- Anxiety = avoidance of anxiety provoking situations = neg reinforcement
- Depression = loss of pos reinforcement = loss of motivation = do less
4
Q
What is health anxiety?
A
- High level of anxiety
- Can be present when someone does have another illness
- Interpret symptoms or thoughts as signs of serious illness
- Interpreted as catastrophic threat they cannot cope = cognitive bias
- Focus on symptoms to near exclusion of all else = attention
- Avoid situations that stimulate symptoms e.g exercise
- People report fatigue, forgetfulness = attentional capacity
5
Q
What is the CBT model of health anxiety?
A
- Attention: Focus on leads to amplification
- Attentional capacity is limited = less problem solving
- Attention is key to memory = forgetful
- Learning theory: avoidance of neg situation = neg reinforcement
- Physiological aspect of anxiety: overlap with alarming diagnosis
6
Q
What is formulation?
A
- Theoretically based conceptualisation of a person’s distress, providing insight into potential intervention options
- Explanation of hypothesis of how someone with a disorder presents. Number of factors can be involved in understanding etiology of disorder/condition
7
Q
What are the guidelines of Formulation?
A
- Helps clinical psych how to formulate
- Argue that formulation needs to be grounded int theory and evidence
- Person not problem specific = draw on models and factors
- Based on western models e.g spiritualty is ignored
- Can build this into a 5 Ps approach
8
Q
What is the difference between diagnosis and formulation?
A
- Diagnosis = linking distress to specific category = assumes condition
- Formulation = tries to understand what links to the person’s presentation, not necessarily wedded to a diagnostic model
- Formulation based on psychological model NOT medical, based on experiences and psych processes
9
Q
Types of formulation?
A
- Diagnosis driven = strongly evidenced links
- Longitudinal = used for depression and CBT
- Psychodynamic = patterns of behaviour and ways of behaving
- Systemic = interaction patterns e.g parent/child
- Narrative approaches = storytelling
10
Q
What is the CBT formulation for Social anxiety?
A
- Social situation = activates assumptions = perceived social danger = safety behaviours/somatic and cognitive symptoms (blushing or getting stressed)
- Each link is evidence based
- Focuses on elements specific to social anxiety
11
Q
What are positives of CBT?
A
- Highly specific and evidence based
- Provide clear template for areas for intervention
- Theory and evidence provide links between the elements
Negs: - Ignores non-CBT factors
- Assumes a single presentation in focus
- People have comorbid conditions
12
Q
What are the 5Ps?
A
- Presenting: What are the difficulties now? Signs and symptoms can relate to DSM
- Predisposing: what factors led to this from past
- Precipitating: what triggered this problem recently
- Perpetuating: what is keeping in going
- Protecting: what is going well
13
Q
What is the multiperspective model?
A
- Idea that psych phenomena is influenced by a range of systems
- Focusing on individual factors
- Timeframe: longitudinal factors are considers inc. attachment, childhood development and neuro development and adverse events = 5Ps go from past to present
- Focus on systemic factors
14
Q
What are limitations of the 5Ps?
A
- Not linked to a specific evidenced based model
- Unclear how diff levels of Ps interact
- No obvious blue-print for treatment
- Have to build arrows self
- Requires more clinical things to figure treatment out
HOWEVER
- Useful way to structure information from a person
- Highly person centred
- Does not constrain clinician’s thinking to a specific disorder = facilitates that and creates structured info that clinician can create hypothesis from
15
Q
What is treatment fidelity?
A
- Do clinicians do what they are supposed to? (Perform the therapy in the right way)
- Vital when evaluating interventions as need to know effect of intervention
- Formulation is individualised so must use empirically supported techniques - evidence based techniques that address specific issues and used flexibly, based on care formulation
16
Q
Are formulations reliable? (study)
A
- Systematic literature review
- Studies assess inter-rater or test-retest reliability of case formulations
- Huge range of reliability found only 6/18 had substantial reliability
- Differed by therapy modality: psychodynamic appears more reliable than CBT BUT may be to do with clinician experience as psychodynamic therapy had more experienced clinicians but not in the CBT condition
17
Q
How does this extend to Long-Term Health Conditions?
A
- Long-term health conditions are a global issue
- Depression is more common for people with long-term conditions = links to higher levels of health needs globally
18
Q
What are Long-Term health conditions?
A
- Conditions for which there is no cure, managed with drugs and other treatment e.g diabetes
- Very common: 1 in 3 have at least one in the UK
- Multimorbidity: 1 in 4 adults in UK = government strategic policy = very expensive to NHS
19
Q
What are the psychological impacts of long-term health conditions?
A
- UK: Depression is 2-3x more common in a range of cardiovascular diseases
- In low-middle income countries: Pooled prevalence of mental disorders in patients with chronic physical diseases was 36.6%
20
Q
How to adjust to long-term conditions?
A
- Adjustment = returning to an equilibrium
- Key process and major factor considering someone’s psych health
- Active process: coping behaviours, cog/social adjustment, denial/avoidance
- Response shift: People must reconceptualise, recalibrate, reprioritise
21
Q
What are the background factors for adjustment?
A
- Acro-issues: impact of gender, socioeconomic status
- Pre-existing intra-personal context e.g personality
- Social context: social support
- Disease context: prognosis, severity, treatment and side effects
22
Q
What are psychology’s three main levels of analysis?
A
- Bio
- Socio-cultural
- Psych: learned fears/emotional responses/cog processing
23
Q
What is the equilibrium disturbed by in the intra-person sector?
A
- Acute critical events e.g onset of illness
- Ongoing illness stressors
- LEADS TO: cog factors and behavioural factors
- Determine illness management and drive adjustment = health outcomes
24
Q
What is fatigue in long-term conditions?
A
- Common symptoms
- Does not mean person is sleeping more/enough
- Symptom of physical illness - also symptom of depression
- Fatigue can lead to difficulties with cognitive processes, so important to formulation
STUDY: - Fatigue reduces executive functioning (and depression)
- But found depression was not independently associated with executive functioning when fatigue was taken into account
25
Q
What did Carrol do?
A
- Created transdiagnostic method for formulation: covers processes that occurs across diff presentations/condition
- Shows range of diff factors at play and how they interact across different levels
- Shows within-individual processes: cog, behavioural, social, bio
- Understanding the processes of what people need
26
Q
Why does formulation matter in Long-Term conditions?
A
- Can guide effective treatment by clinical psychologists: case studies suggest approach is useful
- Can write treatment manual and develop the intervention further
- Randomised controlled trial of intervention
- Leads to better health outcomes: reduced mortality in men following cardiac event, reduced depression in people with COPD, reduced disability associated with chronic pain (Williams)
