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
