Lecture 1 - History of Clinical Psychology Flashcards
Describe ‘madness’ and the changing attitudes to madness
Attitudes towards “free range” social deviants and the ‘insane’ changed with the Enlightenment (mid 1700s)
Mad = poor/unable or unwilling to work
Tied to economic changes/viability
Beginning of the Great confinement
What was the great confinement?
Throughout Europe around 1960s
Part of wider social group/social deviancy
Organised into workhouses if able to work, asylums if not
County Asylums Act (1808)
First mental health legislation in the UK
Meant authorities allowed confinement into asylums – workhouses for lunatics
The mad were removed from workhouses and prisons and put into asylums
No treatment available, no medicine existed
Required county authorities to provide for the care of ‘pauper lunatics’ so that they could be removed from workhouses and prisons
Gloucester County Lunatic Asylum
When did it open?
What was significant about it?
1823
Was open to the public and for a penny you could walk around and see the lunatics in their cells (public display)
What were lunatic asylums/what were they made for?
places of safety for the mad and poor
The Lunacy Act (1845)
What did this change?
What was it built on?
changed status of mentally ill from ‘inmates’ to ‘patients’ - growing assumption that madness was a treatable disease
Built on what was going on in the workhouses and prisons
Status of patients changed the way these people were looked at
Gave doctors opportunity to intervene as a new group needed treatment
Increasing attention on madness
Taxonomy of madness created - increased interest in classifying madness/Increasing attention paid to types of madness
By 1850s, psychiatric conditions were separated into…
Neuroses and psychoses
Neuroses
disorders which affected mood and self-esteem - associated with fear, anxiety and panic (these days anxiety, depression, OCD, panic disorders etc)
psychoses
disorders which affect reason and individual’s grasp of reality - associated with delusions and hallucinations
What did classifying mental illness in 1850 do for madness?
Madness no longer a class of social deviancy but a medical disorder
Who was Emile Kraepelin and what did he do?
German psychiatrist
Began medical studies at Leipzig in 1874
Studied experimental psychology with Wilhelm Wundt
Revolutionised the taxonomy of ‘madness’
Renewed classification of disorders to diagnose them - Still made no difference to treatment
Classification before Kraepelin’s taxonomy
symptom clusters were not organised like they are today
Kraepelin’s taxonomy (1889-)
Emphasised syndrome (symptom patterns) rather than single symptoms in the classification of mental illnesses
Produced an enduring taxonomy of conditions
Influenced the style of all subsequent psychiatric nosologies - DSM is defined and refined from this work
What did the Kraepelinian Dichtomy change about psychoses?
divided the psychoses into dementia praecox and manic-depressive illness
subsequently reformulated (but using essentially the same syndromes) as schizophrenia and bipolar disorder
neuroses in the Kraepelin scheme
OCD
impulse control disorder
anxiety disorder
phobias
hysteria and conversion hysteria
DSM-3 (1980)
What is it?
What does it adopt?
What did it do for psychology?
First scientific classification of mental health disorders
Lists conditions regarded as mental disorders and criteria required to diagnose those mental disorders
Adopts Kraepelinian schema in terms of dichotomy of disorders
Forced scientific attention to the conditions themselves
Moved to the treatments of these conditions as people realised that if these conditions are different, maybe they need to be treated differently
Psychiatric treatments for psychoses up until 1950
Hospitalisation and restraint
Coma (insulin shock therapy), fever, ECT-induced convulsions
Sedative drugs
Psychosurgery
Psychiatric treatments for neuroses up until 1950
Psychodynamic theory
Hypnosis
Surgery
ECT
When was the pharmacological revolution and what was it?
1945-1965
introduction of effective drug treatments
4 common effective drugs developed in the pharmacological revolution
Lithium
Phenothiazines
Tricyclic antidepressants
Benzodiazepines
Problems with the pharmacological revolution
Phenothiazines: physical and psychological side effects
Benzodiazepines: addition, withdrawal problems, behavioural and cognitive impact, massive overprescribing
psychology and mental health, when did the relationship come about?
after 1945
contributions to assessment and psychometrics, the understanding of neuroses ad anxiety, and therapy
What is the Boulder model?
Provided the research aspect to the psychologist
What did the APA Boulder model (1949) emphasise the 3 roles for clinical psychologists were?
diagnosis
research
therapy
Progressive muscle relaxation
Jacobson 1929
Based on research into muscle tension in mental (anxiety) states
Amplifies the experience of relaxation, modifies the experience of anxiety
Physical relaxation maps onto mental relaxation
The revolution of talking therapies
popularised by Freud
Psychoanalysis and studies on hysteria
Freud impressed by the success of Josef Breuer’s approach to the treatment of ‘Anna O’ - encouraging Anna to talk about her experiences
The patient (Bertha Pappenheim) later described the approach as her ‘talking cure’
“Studies on Hysteria” published 1895
Freud eventually developed the approach as ‘Psychoanalysis’ - ‘talking cure’
Cognitive and behavioural talking therapies
Eysenck regarded Freudian therapy as ‘unscientific’ – and resisted its introduction into UK clinical psychology
BUT – he became a champion for the newer psycho-therapies based on psychological theory & evidence
Who came up with REBT
Ellis 1959
What is the basis of REBT
- Human distress doesn’t arise because of ‘unfortunate’ events and circumstances …it arises from irrational and dysfunctional thoughts, feelings and beliefs attributed to those events and circumstances
REBT emphasises what?
the A-B-C model of distress
the A-B-C model
o A - adversity/adverse circumstances
o B - beliefs about these circumstances
o C - consequences/emotional distress when B is negative
what does REBT help do?
helps client challenge and dispute the A-B-C relationship through argument and ‘testing’ evidence
Who came up with systematic desensitisation?
Wolf 1960s
reciprocal inhibition
learn a new response to the phobic stimulus which inhibits (i.e. is incompatible with) with anxiety: e.g. Learn to RELAX in the presence of phobic stimuli.
what is systematic desensitisation
Practise the new response at each level of a graded exposure to the phobic stimulus
who came up with cognitive therapy?
Beck
what is cognitive therapy? Beck
- How we think about a situation determines how we subsequently feel about it.
- Typical patterns of thinking = ‘cognitive schemas’
- Cognitive schemas can be realistic and adaptive, or ‘negative’
- Negative (maladaptive) schemas can become ‘automatic’, producing habitual negative emotions.
- Negative schemas are characterised by cognitive bias – cognitive ‘errors’ or ‘distortions’
How does cognitive therapy address cognitive errors?
- Directly - cognitive restructuring
o Challenge negative schema & replace with positive/realistic alternatives - Indirectly
o Distraction or blocking strategies which prevent negative schema formulating
similarities between cognitive and behavioural therapies
- Both ‘symptomatic’ psychotherapies (non- exploratory)
- Both suited to ‘brief intervention’ models (4-8 clinical sessions)
- Both effective in the treatment of mental AND physical health problems
o Interactive and bidirectional relationship between the two - Both enthusiastically adopted by clinical psychology in the 1980s
CBT
the pragmatic combination of cognitive and behaviour therapies
1980-2000
Mental health act 2007 changes from 1983
- Those in charge of patient treatment changed from ‘responsible medical officer’ (RMO) to ‘responsible clinician’ (RC).
- The RC does not need to be a consultant psychiatrist, but must be an approved clinician (AC).
- With appropriate training, clinical psychologists are eligible for AC/RC roles.
roles in psychology then and now
1980s - clinical psychology had 3 distinct roles of assessment, therapy and research
now there is the science-practitioner role supported by the development of evidence based practice
what is evidence based practice?
Using the best available evidence in deciding whether a given treatment works, and for whom it works.
Using the best available evidence to decide which of 2 (or more) treatment options is most effective and affordable.
Evidence based practice in psychotherapies:
- Commits clinical psychology to an ongoing programme of controlled outcome assessment
- Makes psychological therapies a continuing ‘work in progress’
- Roth & Fonagy’s (2004) “What works for whom?” provides a landmark in evidence synthesis
NICE
- The National Institute for Health and Care Excellence (NICE) was founded in 1999 as an arm of the Department of Health
NICE and evidence-based practice
- Using methods of systematic review and evidence appraisal, NICE aims to improving health and social care through evidence-based guidance
- These authoritative outputs are often referred to as “NICE Guidelines”
- Decide what treatments should be approved to who and where the funding should go in terms of treatments
NICE and clinical psychology
- NICE guidance has become very influential in determining which therapies are appropriate (and which therapies should be commissioned) within the NHS
- As a scientist-practitioner enterprise, clinical psychology both generates evidence and adjusts clinical practice in line with results.
