Lesson 10 - Treating psychopathology

Question 1

What are the goals of treatment?

Answer 1

1. 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.

Question 2

What are the 3 theoretical approaches to treatment?

Answer 2

Psychodynamic/psychoanalytic approach
Behaviour Therapy
Cognitive Behavioural Therapy
cog therapy cont

Question 3

What is the psychoanalytic/ psychodynamic approach?

Answer 3

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

Question 4

What are some techniques used in the psychodynamic/ psychoanalytic approach?

Answer 4

free association (a trigger word is given and the patient tells the therapist what they’re thinking ab) , dream analysis.

Question 5

What is behaviour therapy?

Answer 5

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.

Question 6

What are 4 techniques used in behaviour therapy?

Answer 6

Flooding
Systematic desensitisation
Contingency Management
Response shaping
Aversion therapy

Question 7

What is contingency management?

Answer 7

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.

Question 8

What is aversion therapy?

Answer 8

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

Question 9

What is response shaping?

Answer 9

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.

Question 10

What is the function of techniques in therapy?

Answer 10

–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’

Question 11

What does cognitive behaviour therapy split off into?

Answer 11

Mindfulness-based cognitive therapy (MCBT) and Acceptance and Commitment therapy (ACT)

Question 12

What is the aim of humanistic therapies?

Answer 12

Aims: Encourage the client to find their own solutions to enable them to move from one (usually negative) ‘state’ to another.

Question 13

What are the techniques of humanistic therapies?

Answer 13

–‘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)

Question 14

What are the assumptions of family and systematic therapies?

Answer 14

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.

Question 15

What disorder are benzodiazepines associated with? (GABA)

Answer 15

Anxiety/Depression

Question 16

What are selective serotonin reuptake inhibitors (SSRIs) (serotonin) associated w disorder wise?

Answer 16

Anxiety/ Depression

Question 17

What are antipsychotics/ neuroleptics (Dopamine) associated w disorder wise?

Answer 17

SZ, bipolar disorder

Question 18

What are the limitations of drug treatments?

Answer 18

Side effects
overprescription medicalising every day living problems
for ppl w mild symptoms drugs can be ineffective

Question 19

How is treatment delivered?

Answer 19

One-to-one

Group therapy

Computerized (C-CBT)

E-therapy (E-CBT)

Mobile apps (‘mhealth’, ‘mtherapy’)

Telephone / videoconferencing

Question 20

What is a case study?

Answer 20

Detailed report of treatment provided to an individual patient, and their outcome (improvement, remission….or deterioration).

Question 21

What is a case series?

Answer 21

Descriptive report of treatment and patient outcomes in groups of patients who have received different types of treatment

Question 22

What are both case studys and case series vulnerable to?

Answer 22

Selection bias and a number of other biases

Question 23

What is spontaneous remission?

Answer 23

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’

Question 24

What is structured social support?

Answer 24

• most kinds of therapy offer unstructured attention, understanding and caring, which may be an effective treatment in itself.
• Some overlap with placebo effects

Question 25

Control comparisons are needed?
What are advantages and disadvantages of control comparisons?

Answer 25

• Waitlist control

–Spontaneous remission✔

–placebo effectsX

–structured social supportX

–Ethical issues involved in withholding treatment

Question 26

What is befriending?

Answer 26

Providing social support

Question 27

What are 2 advantages of befriending and 1 limitation?

Answer 27

Spontaneous remission✔

–structured social support✔

–placebo effectsX

Question 28

Why are comparisons with other treatments needed?

Answer 28

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

Question 29

What is RCT/Randomised Control trial?

Answer 29

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

Question 30

What are some limitations of randomised control trials?

Answer 30

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

Question 31

How do we combine evidence across studies?

Answer 31

Narrative summaries

–Prone to bias

–Cannot quantify the effect size

Question 32

What do meta-analysis enable with RCTs?

Answer 32

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

Question 33

What is Therapeutic alliance?

Answer 33

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).

Question 34

What is involved in therapeutic alliance

Answer 34

–Empathy and active listening

–Hope and expectation

• goal setting and collaboration
• Psychoeducation
• feedback and monitoring
• Emotional expression and catharsis -