Lecture 22: Treatment Flashcards
what is stigma for PDs
PDs= most stigmatised disorders in DSM-5
- problematic behs–> maladaptive
- try to understand how beh. in past might have been important for person to get their emotional needs met
maladaptive meaning
beh. that once served as adaptive function, but is no longer adaptive
what are stigmatising language
acting out, manipulative, self-destructive
heightened emotional arousal
- sensitivity– likely to become emotional at lower threshold
- reactivity– have stronger emotional reaction
- slow return to baseline– takes longer to return to baseline
trt. of PDs– explain levels
level 1: meta-analysis of level 2 studies– includes quantitative analysis
level 2: study of test accuracy w/: independent, blinded comparison, from people w/ clinical presentation
evidence for level 1
- dialectical behaviour therapy (DBT)
- schema therapy
- psychodynamic psychotherapy
evidence for level 2
- acceptance + commitment therapy (ACT)
- CBT
- Interpersonal therapy
- Psychoedu.
what is DBT
- developed for borderline
- CBT based intervention for chronically suicidal behs.
- dialectic= combination of opposites
- beh. reinforcement used– use rewards to increase likelihood of beh.= use this for beh change
central dialectics of DBT
acceptance + change
goals of DBT
- accept yourself + current situation– while changing behs
- enhance beh, emotional, cog responses + interpersonal interactions
DBT + evidence
- effective in reducing life-threatening beh
- reduces suicidal beh + self- harm
- improves emotional regulation?= no consistent benefits in improving emotional regulation
DBT steps
- mindfulness
- distress tolerance
- emotion regulation
- interpersonal effectiveness
- mindfulness
- live w/ awareness in present moment– be present in your life
- no judging
- notice consequences
- no attachment to moment (pay attention to each moment, don’t ignore now, don’t cling onto past)
- wise mind
- distress tolerance
- survive crisis situations w/o making them worse
- accept reality– move forward
- don’t feel like you always have to satisfy your desires, urges, intense emotions
- emotion regulation
goals:
- understand emotions that you experience
- reduce emotional vulnerability
- decrease emotional suffering
- interpersonal effectiveness
- maintaining healthy relationships
- getting somebody to do what you want
- maintaining self-respect
schema therapy + evidence
- meta-analytic findings= effective in reducing borderline PD
schema therapy for PDs
- individuals all have core emotional needs
- unmet emotional needs in childhood–> schemas rise–> strengthened throughout adulthood
- early maladaptive schemas= unconditional + problematic beliefs about yourself
conclusion for trt.
- most people w/ these diagnoses= have experienced sig. adversity when younger–> might have learnt problematic ways of coping w/ distress
- so= develop new ways to manage distress– in ways which allow them to get their emotional needs met
- trt.= effective
complex trauma
- repeated, cumulative experiences in childhood ongoing psychological effects include: - anxiety + depression - cog distortions - ptsd - identity disturbance - interpersonal problems - substance abuse - binging and purging - unsafe sex - aggression - suicidality
transactional model of Borderline PD
emotion vulnerability (sensitive, easy to react, slow return to baseline)–>
heightened emotional arousal (increased chance of emotion dysregulation)–>
inaccurate expression–>
invalidating responses from parents and others–>
prevalent history of invalidating responses–>
goes back to emotion vulnerability
dysfunctional ways of coping
- surrender
- avoid– detached, avoidant– to protect yourself
- overcompensate:
- self-aggrandiser
- attention seeker
- perfectionist overcontroller
- compensate by being paranoid
- bully, attack
- conning
