Non pharma therapy

Question 1

What does CBT involve?

Answer 1

Talking therapy that can help you manage your problems by changing the way you think and behave.
CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.
Thought->feeling->behaviour

Question 2

What parts does CBT break the problem into?

Answer 2

Situation
Thoughts and images (what went through my mind at that time?)
Mood/emotions
Behaviours/what I did or didn’t do (what helped me cope, what did I avoid? Automatic reactions?)
Body/physical sensations (feelings/notice about body)

Question 3

How can CBT format be applied to anxiety?

Answer 3

Thought record sheets

• Situation/trigger
• Feelings/emotions
• Unhelpful thoughts/images
• Facts that supported unhelpful thought
• Facts that provide evidence against unhelpful thought
• Alternative, more realistic and balanced perspective
• Outcome (re-rate emotion)

Question 4

What is ECT?

Answer 4

Electroconvulsive therapy
Generalised tonic-clonic seizure is induced by electron pulses between 2 electrodes (0.5-1ms long)
Bitemporal electrodes

Question 5

How does ECT work?

Answer 5

The seizure threshold is progressively decreased by electrical pulses until it becomes low enough for enough neurons to initiate a seizure
Modulated mono-amine systems in brain (serotonergic and noradrenergic and dopamine)

Question 6

When is ECT licensed to be used?

Answer 6

To achieve rapid and short-term improvement of sever symptoms after an adequate trial of other treatment options has proven ineffective or when condition is considered life-threatening

• Severe depressive illness
• Catatonia where lorazepam is ineffective
• Prolonged/severe manic episode
• Schizophrenia as 4th line when clozapine ineffective/intolerable

Question 7

Is ECT safe in elderly? pregnancy?

Answer 7

Yes ECT is safe in elderly, medically ill and in pregnancy

Question 8

What non-mood /psychotic disorder can ECT be used for?

Answer 8

Parkinson’s as an adjuvant for motor and affective symptoms

In pts with severe disability despite medical treatment

Question 9

What are you expected to see in the seizure in ECT?

Answer 9

Tonic contraction of muscles
Rhythmic clonic relaxation/contraction of bilateral limbs
EEG shows widespread high frequency spike waves followed by slower spike and wave complexes (3 cycles a second)

Question 10

What are the adverse effects of ECT?

Answer 10

After seizure, tachycardia and hypertension occur
Seizures lasting more than 2 mins should be terminated using IV diazepam
Seizures lasting more than 5 mins lead to increased confusion and memory impairment
Headaches, muscle aches, drowsiness, weakness, nausea and anorexia

Question 11

What is WRAP?

Answer 11

Wellness recovery action plan

Personal management of mental health challenges

Question 12

What are the 5 fundamentals of WRAP?

Answer 12

Hope
Personal responsibility
Education
Self advocacy
Support

Question 13

What are the 7 parts of a WRAP?

Answer 13

Wellness toolbox (routines, mood lifting activities)
Daily maintenance plan (what you really need to do)
Triggers and action plan if event occurs
Early warning signs
When things break down and action plan
Crisis plan (contact numbers, pets fed)
Post crisis plan (thank you, sorry)

Question 14

How can CBT be helpful in schizophrenia?

Answer 14

Can help patients cope with persistent delusions and hallucinations
Alleviates distress and disability rather than eliminating symptoms
eg not being frightened of a voice, using distraction tools, challenging delusions

Question 15

What non pharma therapy is offered to people with schizophrenia?

Answer 15

CBT
Family therapy
Art therapy for -ve symptoms
Self help (Hearing Voices groups)

Question 16

What non pharma therapy is good for mild depression?

Answer 16

Self help groups
Structured physical activity groups
Computerised CBT

Question 17

What treatment is given in PTSD?

Answer 17

Trauma focused CBT
EMDR (eye movement desensitisation and reprocessing therapy)
Antidepressants (2nd line)

Question 18

Treatment of agoraphobia

Answer 18

CBT
Graded exposure to avoided situations
SSRIs

Question 19

Treatment of OCD

Answer 19

Psychoeducation
CBT (exposure, response prevention)
SSRIs

Question 20

What is DBT?

Answer 20

Dialectical behaviour therapy
For EUPD
Lasts about a year
Group and individual sessions
Addresses repeated self harm behaviour
Equips pts with alternative coping strategies & mindfulness

Question 21

2 types of family therapy

Answer 21

Systemic

Behavioural

Question 22

Describe IPT

Answer 22

Interpersonal therapy
For depression and eating disorders
All close relationships are carefully discussed
Problems are seen as ‘difficulties on role transitions’, interpersonal disputes, deficits in nº or quality of relationships or grief

Question 23

Describe EMDR

Answer 23

Eye movement desensitisation and reprocessing
For PTSD
Pts access and process traumatic memories with goal to emotionally resolve them
Recall emotionally disturbing material while simultaneously focussing on external stimlulus

Question 24

Name 4 contraindications to ECT

Answer 24

No absolute contraindications 
Raised ICP
Recent stroke
Recent MI
Crescendo angina

Question 25

Describe the procedure for ECT

Answer 25

Patient fasts for 4 hrs
Short acting anaesthetic, muscle relaxant and preoxygenation
Bitemporal electrodes-> seizure
Monitor EEG and movement
Recovery

Question 26

What is CAT?

Answer 26

The CAT practitioner aims to work with the patient to identify procedural sequences; chains of events, thoughts, emotions and motivations that explain how a target problem (for example self-harm) is established and maintained.
Reciprocal roles (RRs) identify problems as occurring between people and not within the patient

Question 27

What are the 5 principles of motivational interviewing?

Answer 27

1. Expressempathy
2. Developdiscrepancy
3. Rollwithresistance
4. Supportself ­efficacy
5. Avoidargumentation(anddirectconfrontation)

Question 28

Describe the basis of psychodynamic therapy

Answer 28

All internal experiences and feelings stem from childhood experience and this in turn develops our view of self, others and the world.
Personality made up of Id, Ego & Superego
- The Id is primitive and instinctive. It demands immediate satisfaction. When this happens we experience pleasure. When it doesn’t, we experience pain. It is not affected by reality or logic.
- The Ego manages the difference between the unrealistic Id and the real world. It uses reason to solve problems and dilemmas in a practical, realistic way.
- The Superego incorporates the learned morals of society. It develops around age 3 – 5 and consists of two aspects: conscience and the ideal self. It controls the Id’s impulses, especially those which society forbids (e.g. sex or aggression). It also tries to make the Ego focus on moralistic goals and to strive for perfection.

Question 29

How does psychodynamic theory describe mental health difficulties?

Answer 29

Imbalance between Id, Ego and Superego
Id – We are driven by primitive drives which get in the way of our long-term goals.
Ego - Unconsciously we draw on ‘defence mechanisms’ to protect ourselves but these can often be problematic (Short Term gain, Long Term pain)
Superego – we become fixated on being a ‘perfect’ person in our society which is impossible and leaves us constantly striving for the unrealistic

Question 30

Describe classic conditioning

Answer 30

A learning process in which an ‘automatic’ response (or association) is produced after repeated contact with a specific experience.
For example, a dog hears bell before being fed eventually starts to salivate when they hear bell (because they expect food!)

Question 31

Describe operant conditioning

Answer 31

A learning process in which behaviour is affected or controlled by its consequences-simply put an action produces a response that in turn leads to behavioural change
Consequences can be added in or taken away. This is described as positive (added in) or negative (taken away) in the table below.
Consequences can also be rewarding (something a person wants) or punishing (something a person doesn’t like)

Question 32

Define psychological attachment

Answer 32

A deep enduring bond connecting to another person

Question 33

What 4 characteristics are needed for attachment development?

Answer 33

Proximity maintenance
Safe haven
Separation distress
Secure base

Question 34

Name the 4 categories attachment can be classified into

Answer 34

Secure

3 types of insecure (anxious-preoccupied, dismissive-avoidant and fearful-avoidant)

Question 35

Describe how the 4 types of attachment would deal with a difficult situation at work

Answer 35

Secure (able to overcome by discussing/reflecting with close friend)
Anxious-preoccupied (feels unable to tolerate situation without the direct support of close friend/partner)
Dismissive-avoidant (purposely tolerating a difficult situation at work alone, without support to avoid feelings of inadequacy)
Fearful-avoidant (Trying to tolerate the situation without support to avoid feeling inadequate but not being able to maintain. Then drawing on others to support and ultimately allowing them to take over when it becomes ‘too much’)

Question 36

What are the 3 main concepts of family and systemic theory?

Answer 36

“My experience and behaviour influences your experience and your reaction (behaviour) influences my experience”
Difficulties exist in systems (not in individuals) – They can be found in the relationships we have
Power impacts on what social stories are ‘privileged’ and which are ‘prejudiced’ against – therefore ‘truth’ is just what is most commonly decided upon