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Clinical Psychology > Lecture 1 - History of Clinical Psychology > Flashcards

Lecture 1 - History of Clinical Psychology Flashcards

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1
Q

Describe ‘madness’ and the changing attitudes to madness

A

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

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2
Q

What was the great confinement?

A

Throughout Europe around 1960s

Part of wider social group/social deviancy

Organised into workhouses if able to work, asylums if not

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3
Q

County Asylums Act (1808)

A

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

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4
Q

Gloucester County Lunatic Asylum

When did it open?
What was significant about it?

A

1823

Was open to the public and for a penny you could walk around and see the lunatics in their cells (public display)

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5
Q

What were lunatic asylums/what were they made for?

A

places of safety for the mad and poor

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5
Q

The Lunacy Act (1845)

What did this change?
What was it built on?

A

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

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6
Q

By 1850s, psychiatric conditions were separated into…

A

Neuroses and psychoses

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7
Q

Neuroses

A

disorders which affected mood and self-esteem - associated with fear, anxiety and panic (these days anxiety, depression, OCD, panic disorders etc)

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8
Q

psychoses

A

disorders which affect reason and individual’s grasp of reality - associated with delusions and hallucinations

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9
Q

What did classifying mental illness in 1850 do for madness?

A

Madness no longer a class of social deviancy but a medical disorder

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10
Q

Who was Emile Kraepelin and what did he do?

A

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

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11
Q

Classification before Kraepelin’s taxonomy

A

symptom clusters were not organised like they are today

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12
Q

Kraepelin’s taxonomy (1889-)

A

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

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13
Q

What did the Kraepelinian Dichtomy change about psychoses?

A

divided the psychoses into dementia praecox and manic-depressive illness

subsequently reformulated (but using essentially the same syndromes) as schizophrenia and bipolar disorder

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14
Q

neuroses in the Kraepelin scheme

A

OCD
impulse control disorder
anxiety disorder
phobias
hysteria and conversion hysteria

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15
Q

DSM-3 (1980)
What is it?
What does it adopt?
What did it do for psychology?

A

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

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16
Q

Psychiatric treatments for psychoses up until 1950

A

Hospitalisation and restraint

Coma (insulin shock therapy), fever, ECT-induced convulsions

Sedative drugs

Psychosurgery

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17
Q

Psychiatric treatments for neuroses up until 1950

A

Psychodynamic theory
Hypnosis
Surgery
ECT

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18
Q

When was the pharmacological revolution and what was it?

A

1945-1965

introduction of effective drug treatments

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19
Q

4 common effective drugs developed in the pharmacological revolution

A

Lithium
Phenothiazines
Tricyclic antidepressants
Benzodiazepines

20
Q

Problems with the pharmacological revolution

A

Phenothiazines: physical and psychological side effects

Benzodiazepines: addition, withdrawal problems, behavioural and cognitive impact, massive overprescribing

21
Q

psychology and mental health, when did the relationship come about?

A

after 1945

contributions to assessment and psychometrics, the understanding of neuroses ad anxiety, and therapy

22
Q

What is the Boulder model?

A

Provided the research aspect to the psychologist

23
Q

What did the APA Boulder model (1949) emphasise the 3 roles for clinical psychologists were?

A

diagnosis
research
therapy

24
Q

Progressive muscle relaxation

A

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

25
Q

The revolution of talking therapies

A

popularised by Freud

26
Q

Psychoanalysis and studies on hysteria

A

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’

27
Q

Cognitive and behavioural talking therapies

A

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

28
Q

Who came up with REBT

A

Ellis 1959

29
Q

What is the basis of REBT

A
  • 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
30
Q

REBT emphasises what?

A

the A-B-C model of distress

31
Q

the A-B-C model

A

o A - adversity/adverse circumstances
o B - beliefs about these circumstances
o C - consequences/emotional distress when B is negative

32
Q

what does REBT help do?

A

helps client challenge and dispute the A-B-C relationship through argument and ‘testing’ evidence

33
Q

Who came up with systematic desensitisation?

A

Wolf 1960s

34
Q

reciprocal inhibition

A

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.

35
Q

what is systematic desensitisation

A

Practise the new response at each level of a graded exposure to the phobic stimulus

36
Q

who came up with cognitive therapy?

A

Beck

37
Q

what is cognitive therapy? Beck

A
  • 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’
38
Q

How does cognitive therapy address cognitive errors?

A
  • Directly - cognitive restructuring
    o Challenge negative schema & replace with positive/realistic alternatives
  • Indirectly
    o Distraction or blocking strategies which prevent negative schema formulating
39
Q

similarities between cognitive and behavioural therapies

A
  • 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
40
Q

CBT

A

the pragmatic combination of cognitive and behaviour therapies

1980-2000

41
Q

Mental health act 2007 changes from 1983

A
  • 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.
42
Q

roles in psychology then and now

A

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

43
Q

what is evidence based practice?

A

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.

44
Q

Evidence based practice in psychotherapies:

A
  • 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
45
Q

NICE

A
  • The National Institute for Health and Care Excellence (NICE) was founded in 1999 as an arm of the Department of Health
46
Q

NICE and evidence-based practice

A
  • 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
47
Q

NICE and clinical psychology

A
  • 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.

Clinical Psychology (28 decks)

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