Lesson 10 - Treating psychopathology Flashcards
What are the goals of treatment?
- relief from distress.
2.Increase self-awareness and insight into problems.
3.Teach coping skills to manage symptoms / distress.
4.Identify and resolve the ‘root causes’ of the disorder.
Priority and coverage of these goals may differ by type of treatment.
What are the 3 theoretical approaches to treatment?
Psychodynamic/psychoanalytic approach
Behaviour Therapy
Cognitive Behavioural Therapy
cog therapy cont
What is the psychoanalytic/ psychodynamic approach?
associated w Freud
Assumptions: mental health problems are caused by unconscious conflicts originate from early life experience, evoke ‘defense mechanisms’ (e.g. repression, denial, displacement), which then cause observable symptoms.
Aim: identify these unconscious conflicts, bring them into conscious awareness (thereby increasinginsight),and then help the client to develop strategies to resolve those conflicts.
Psychoanalysis is one form of psychodynamic therapy (but there are many others).
Identify these unconscious conflicts and bring them into awareness
3-5 sessions per week over many years
What are some techniques used in the psychodynamic/ psychoanalytic approach?
free association (a trigger word is given and the patient tells the therapist what they’re thinking ab) , dream analysis.
What is behaviour therapy?
Assumptions: Many psychological disorders arise from ‘faulty learning’, involving both classical (Pavlovian) and operant (instrumental) conditioning.
Classical conditioning, learning association between 2 stimuli in environment. E.g Pavlov dogs smelling food, salivating, can teach food to associate smell of food w ring of bell. When bell presented independently, can condition and cause dog to salivate.
Operant - strengthen or weaken a voluntary response. E.g skinner boxes
Can unlearn or relearn associations w mental health
Aim: Use associative learning principles, particularly extinction, to ‘unlearn’ or ’relearn’ those associations.
What are 4 techniques used in behaviour therapy?
Flooding
Systematic desensitisation
Contingency Management
Response shaping
Aversion therapy
What is contingency management?
helps w addiction - offer a payment if people don’t use the drug by testing their urine for example. So they get paid when they have not used a drug and they’ve been tested for it.
What is aversion therapy?
Show a video to associate something with another. Can be used in addiction or sexual offending. Not really used now but it was used in an era when behaviour was dominant? In psychology
What is response shaping?
reinforce behaviours that get closer to the target behaviour that you want. Give them small rewards for sitting still and maybe another reward for sitting still and being quiet, then another small reward for sitting still, being quiet and listening.
What is the function of techniques in therapy?
–Challenging dysfunctional beliefs (what is the evidence for them?)
Show the, how their beliefs are distorted. Test hypothesis based on their distorted beliefs.
–Replacing these with more rational (and healthy) beliefs
Homework important here to replace and change these thoughts.
–Testing out these new beliefs during ‘homework’
What does cognitive behaviour therapy split off into?
Mindfulness-based cognitive therapy (MCBT) and Acceptance and Commitment therapy (ACT)
What is the aim of humanistic therapies?
Aims: Encourage the client to find their own solutions to enable them to move from one (usually negative) ‘state’ to another.
What are the techniques of humanistic therapies?
–‘Unconditional positive regard’ (non-judgmental, or to tell people they’re thinking wrong , that their cognitions or perceptions are incorrect)
–Non-directive (active listening and providing advice when asked, rather than ’teaching’). Rather than being the expert therapist attempting them to guide them to think differently
Client-centred therapy (Rogers)
What are the assumptions of family and systematic therapies?
Family and systemic therapies
Assumptions: Many psychological disorders arise from dysfunctional relationships with and communication between close family members.
Anorexia uses this as a form of treatment (family therapy) - discussion w family members and patients
Aims and techniques: Therapist leads discussion with the patient and their close family members. The therapist’s theoretical orientation is important.
What disorder are benzodiazepines associated with? (GABA)
Anxiety/Depression
What are selective serotonin reuptake inhibitors (SSRIs) (serotonin) associated w disorder wise?
Anxiety/ Depression
What are antipsychotics/ neuroleptics (Dopamine) associated w disorder wise?
SZ, bipolar disorder
What are the limitations of drug treatments?
Side effects
overprescription medicalising every day living problems
for ppl w mild symptoms drugs can be ineffective
How is treatment delivered?
One-to-one
Group therapy
Computerized (C-CBT)
E-therapy (E-CBT)
Mobile apps (‘mhealth’, ‘mtherapy’)
Telephone / videoconferencing
What is a case study?
Detailed report of treatment provided to an individual patient, and their outcome (improvement, remission….or deterioration).
What is a case series?
Descriptive report of treatment and patient outcomes in groups of patients who have received different types of treatment
What are both case studys and case series vulnerable to?
Selection bias and a number of other biases
What is spontaneous remission?
About 30% of people with anxiety or depression will get better with no formal treatment.
–Similar for recovery from addiction (last week)–‘Regression to the mean’
What is structured social support?
- most kinds of therapy offer unstructured attention, understanding and caring, which may be an effective treatment in itself.
- Some overlap with placebo effects
Control comparisons are needed?
What are advantages and disadvantages of control comparisons?
- Waitlist control
–Spontaneous remission✔
–placebo effectsX
–structured social supportX
–Ethical issues involved in withholding treatment
What is befriending?
Providing social support
What are 2 advantages of befriending and 1 limitation?
Spontaneous remission✔
–structured social support✔
–placebo effectsX
Why are comparisons with other treatments needed?
To see if
1.If both treatments are better than doing nothing at all (waitlist).
2.If both treatments offer something over and above a placebo effect / structured social
What is RCT/Randomised Control trial?
These patients are randomised to receive either the active treatment or a control, and their symptoms are measured. The act of randomisation overcomes selection bias. You’re not choosing the patients based on their symptoms and what they want. The extent to which you see a better outcome
What are some limitations of randomised control trials?
Dropout rates can be very high, particularly from ’control’ groups
-expensive
Does not (and cannot) take account of patients’ preferred therapy
–Randomized patient preference trials
Often focused onstatisticalrather thanclinical significance
Findings may not generalize to ‘typical’ settings or populations
- biases
- publication bias, investigator/researcher allegiance bias, commercial interests
How do we combine evidence across studies?
Narrative summaries
–Prone to bias
–Cannot quantify the effect size
What do meta-analysis enable with RCTs?
synthesis of findings from many different RCTs, even if they used different controls, different measurements, different sample sizes….
–Can quantify the effect size, the extent of publication bias, and moderators of the effect size
Each study provides a data point , combine studies together and calc a numeric average for the effect size of antidepressant medication for example. Run statistical tests to establish whether CBT might produce a bigger effect on depressive symptoms compared to antidepressants for example.
Meta-meta analysis and ‘umbrella reviews’
- a meta- analysis of meta-analyses
What is Therapeutic alliance?
the relationship between therapist and client. In one study, 7% of variability in treatment outcome could be attributed to therapeutic alliance, versus 1% that could be attributed to therapy-specific principles or therapeutic techniques (Wampoldet al., 2002).
What is involved in therapeutic alliance
–Empathy and active listening
–Hope and expectation
- goal setting and collaboration
- Psychoeducation
- feedback and monitoring
- Emotional expression and catharsis -
