Non pharma therapy Flashcards
What does CBT involve?
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
What parts does CBT break the problem into?
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)
How can CBT format be applied to anxiety?
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)
What is ECT?
Electroconvulsive therapy
Generalised tonic-clonic seizure is induced by electron pulses between 2 electrodes (0.5-1ms long)
Bitemporal electrodes
How does ECT work?
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)
When is ECT licensed to be used?
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
Is ECT safe in elderly? pregnancy?
Yes ECT is safe in elderly, medically ill and in pregnancy
What non-mood /psychotic disorder can ECT be used for?
Parkinson’s as an adjuvant for motor and affective symptoms
In pts with severe disability despite medical treatment
What are you expected to see in the seizure in ECT?
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)
What are the adverse effects of ECT?
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
What is WRAP?
Wellness recovery action plan
Personal management of mental health challenges
What are the 5 fundamentals of WRAP?
Hope Personal responsibility Education Self advocacy Support
What are the 7 parts of a WRAP?
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)
How can CBT be helpful in schizophrenia?
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
What non pharma therapy is offered to people with schizophrenia?
CBT
Family therapy
Art therapy for -ve symptoms
Self help (Hearing Voices groups)
What non pharma therapy is good for mild depression?
Self help groups
Structured physical activity groups
Computerised CBT
What treatment is given in PTSD?
Trauma focused CBT
EMDR (eye movement desensitisation and reprocessing therapy)
Antidepressants (2nd line)
Treatment of agoraphobia
CBT
Graded exposure to avoided situations
SSRIs
Treatment of OCD
Psychoeducation
CBT (exposure, response prevention)
SSRIs
What is DBT?
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
2 types of family therapy
Systemic
Behavioural
Describe IPT
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
Describe EMDR
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
Name 4 contraindications to ECT
No absolute contraindications Raised ICP Recent stroke Recent MI Crescendo angina
Describe the procedure for ECT
Patient fasts for 4 hrs Short acting anaesthetic, muscle relaxant and preoxygenation Bitemporal electrodes-> seizure Monitor EEG and movement Recovery
What is CAT?
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
What are the 5 principles of motivational interviewing?
- Expressempathy
- Developdiscrepancy
- Rollwithresistance
- Supportself efficacy
- Avoidargumentation(anddirectconfrontation)
Describe the basis of psychodynamic therapy
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.
How does psychodynamic theory describe mental health difficulties?
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
Describe classic conditioning
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!)
Describe operant conditioning
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)
Define psychological attachment
A deep enduring bond connecting to another person
What 4 characteristics are needed for attachment development?
Proximity maintenance
Safe haven
Separation distress
Secure base
Name the 4 categories attachment can be classified into
Secure
3 types of insecure (anxious-preoccupied, dismissive-avoidant and fearful-avoidant)
Describe how the 4 types of attachment would deal with a difficult situation at work
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’)
What are the 3 main concepts of family and systemic theory?
“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
