Prevention, Consultation, and Psychotherapy Research Flashcards
What are the three types of prevention according to Caplan’s Model?
Primary, Secondary, Tertiary
Caplan (1964) distinguished these types based on their goals and target populations.
What is the goal of primary prevention?
To reduce the occurrence of new cases of a mental or physical disorder
Examples include public education programs and prenatal care.
What is an example of primary prevention?
Public education program about depression and suicide
Other examples include school-based programs and prenatal care for low-income mothers.
What is the goal of secondary prevention?
To reduce the prevalence of a mental or physical disorder through early detection and intervention
Secondary preventions target individuals at elevated risk.
What is an example of secondary prevention?
Providing tutoring to students with academic difficulties
This also includes screening tests for at-risk individuals.
What is the goal of tertiary prevention?
To reduce the severity and duration of a mental or physical disorder
Tertiary preventions target individuals who have already received a diagnosis.
What is an example of tertiary prevention?
Social skills training for patients with schizophrenia
Other examples include halfway houses and Alcoholics Anonymous.
What are the three types of prevention in Gordon’s Model?
Universal, Selective, Indicated
Gordon (1983) distinguished these types based on the target population.
What is universal prevention?
Aimed at entire populations not restricted to individuals at risk
Example: Drug abuse prevention programs for all high school students.
What is selective prevention?
Aimed at individuals identified as being at increased risk for a disorder
Example: Programs for adolescents with parents who have substance use disorders.
What is indicated prevention?
For individuals known to be at high-risk due to early signs of a disorder
Example: Programs for adolescents who have experimented with drugs.
What did the Institute of Medicine expand upon in Gordon’s Model?
Created a continuum of care model including prevention, treatment, and maintenance
This model emphasizes strategies based on diagnosis status.
What is client-centered case consultation?
Focuses on a particular client of the consultee who is having difficulty providing effective services
The consultant aims to provide a plan that will benefit the client.
What is consultee-centered case consultation?
Focuses on improving the consultee’s ability to work effectively with similar clients
It aims to enhance the consultee’s knowledge, skills, and confidence.
What is program-centered administrative consultation?
Involves working with program administrators to resolve problems with existing mental health programs
The consultant provides recommendations for program development and evaluation.
What is consultee-centered administrative consultation?
Focuses on improving the professional functioning of program administrators
Aims to enhance their capability in developing and evaluating mental health programs.
How does mental health consultation differ from collaboration?
Consultants have little or no direct contact with clients and are not responsible for outcomes
Collaborators usually have direct contact and share responsibility for outcomes.
What is interprofessional collaboration (IPC)?
A partnership between a team of health providers and a client for shared decision making
IPC aims to address health and social issues collaboratively.
What are the three primary functions of IPC in primary care settings?
- Improvement of patient care
- Improvement of health outcomes
- Decreased healthcare costs
IPC serves to enhance the overall healthcare experience.
What are the mixed results of IPC according to research?
Positive effects on clinical outcomes, process of care, and patient satisfaction, but inconsistent results on quality of life
Research shows variability in effects on physical, emotional, and social functioning.
Why is IPC considered useful for older patients?
Addresses the multiple and complex healthcare needs of older patients
Often referred to as integrated care in related research.
What are the benefits of integrated care for older patients?
- Improved access to care
- Increased patient satisfaction
- Fewer emergency visits and hospitalizations
Research shows positive outcomes related to integrated care for older patients.
What are the two main categories of research evaluating psychotherapy outcomes?
Efficacy research and effectiveness research
Efficacy research focuses on internal validity, while effectiveness research emphasizes external validity.
What is efficacy research primarily known as?
Clinical trials
Efficacy research maximizes internal validity by controlling experimental conditions.
What is the focus of effectiveness research?
Maximizing external validity
Effectiveness research assesses generalizability in natural clinical settings.
What is a recommended strategy for evaluating treatment outcomes?
Conduct an efficacy study followed by an effectiveness study
This approach helps determine effectiveness in controlled conditions and generalizability in real-world settings.
Who is Hans Eysenck?
A psychologist known for his conclusions about intelligence, personality, and psychotherapy effectiveness
Eysenck proposed that intelligence is largely hereditary and made controversial claims about psychotherapy.
What did Eysenck conclude about the effectiveness of psychotherapy?
That psychotherapy may be ineffective or even detrimental
He based this on recovery rates of patients who did and did not receive psychotherapy.
What were the spontaneous remission rates for patients not receiving psychotherapy according to Eysenck?
72% experienced improvement
This was higher than the recovery rates for those who participated in psychotherapy.
What methodological flaw did Luborsky identify in Eysenck’s study?
Patients were not randomly assigned to groups
This could have influenced recovery rate differences.
What recovery rates did Bergin find for patients participating in psychoanalytic psychotherapy?
83%
This was significantly higher than Eysenck’s findings.
What is meta-analysis?
A statistical method to combine results from multiple studies
Smith, Glass, and Miller were the first to apply this to psychotherapy outcome studies.
What was the mean effect size found by Smith, Glass, and Miller?
.85
This indicates that the average patient receiving psychotherapy was better off than 80% of those not receiving therapy.
What does an effect size of .85 signify?
The mean outcome score for psychotherapy patients was .85 standard deviation above non-therapy patients
This reflects significant effectiveness of psychotherapy.
What two models did Howard and colleagues develop regarding psychotherapy?
The dosage model and the phase model
These models describe the relationship between therapy duration and outcomes.
What does the dosage model predict?
A predictable relationship between number of therapy sessions and improvement probability
For example, 50% of clients may show significant improvement by 6-8 sessions.
What are the three phases of psychotherapy according to the phase model?
Initial remoralization, remediation, and rehabilitation
Each phase has distinct characteristics and outcome measures.
What occurs during the initial remoralization phase?
An increase in hopefulness
This phase occurs in the first few therapy sessions.
What is the focus of the remediation phase?
Reduction in symptoms
This phase typically occurs during the next 16 sessions.
What is the goal of the rehabilitation phase?
Unlearning maladaptive behaviors and establishing new coping strategies
This phase involves addressing problematic patterns in life.
What type of outcome measures should be used during the remoralization phase?
Measures of subjective well-being
Different measures are recommended for each phase of therapy.
True or False: Eysenck’s conclusions were widely accepted without criticism.
False
His methodology faced significant criticism from advocates of psychotherapy.
What percentage of variability in psychotherapy outcomes is attributed to patient contributions according to Norcross and Lambert (2011)?
30%
What are the three components of the therapeutic relationship as described by Ralph Greenson?
- Working alliance
- Real relationship
- Transference-countertransference
What is the working alliance in psychotherapy?
The relatively non-neurotic, rational relationship between patient and analyst
According to Fluckiger et al. (2018), what is the relationship between the working alliance and psychotherapy outcomes?
A strong working alliance is a significant predictor of successful psychotherapy outcomes
What effect size did Cabral and Smith (2011) find for the impact of client-therapist matching on clients’ perceptions of their therapists?
.32
True or False: Matching in terms of race and ethnicity is the most important factor for therapy outcomes.
False
What did Comas-Diaz (2012) conclude about the importance of client-therapist matching?
Clinicians’ cultural competence, compassion, and worldview were more important than ethnic matching
What was found regarding client-therapist personality similarity by Taber et al. (2011)?
Personality congruence positively impacted clients’ perceptions of the alliance but did not affect therapy outcomes
What demographic factors affect the utilization rates of mental health care services?
- Gender
- Age
- Sexual orientation
- Race/ethnicity
According to the 2020 NHIS, who was more likely to have received counseling or therapy in the past 12 months?
Women
What are attitudinal barriers to seeking mental health services as noted by Ebert et al. (2019)?
- Preferring to handle the problem alone
- Preferring to talk to friends and family
- Being embarrassed
What impact does stigma have on seeking mental health treatment?
Higher levels of stigma are associated with lower willingness to seek treatment and dropping out of treatment
True or False: Sexual minority individuals utilize mental health care services at lower rates than heterosexual individuals.
False
What did the 2021 National Survey of Drug Use and Health reveal about outpatient mental health services usage among racial groups?
Highest for respondents belonging to two or more racial groups, followed by White, and lowest for Asian
What conclusion did the American Psychological Association reach about psychotherapy and medical costs?
Psychotherapy reduces overall medical utilization and expenses
What does cost-benefit analysis (CBA) compare?
The costs and benefits of one or multiple interventions expressed in monetary terms
In economic evaluations, what does cost-effectiveness analysis (CEA) focus on?
Comparing costs and benefits when benefits cannot be expressed as monetary values
What is cost-utility analysis (CUA) used to compare?
Costs of interventions on quality-adjusted life-years (QALYs)
What overall conclusion has research drawn about the effects of age, gender, and socioeconomic status on psychotherapy outcomes?
They have little or no impact on outcomes
What did Nordberg et al. (2014) find regarding client age and psychotherapy outcomes?
Client age explained essentially none of the variance in outcomes when initial severity of symptoms was controlled
What are biases in psychological research?
Biases can include gender biases and WEIRD sampling bias
Gender biases can affect research results by being nonrepresentative of actual experiences and behaviors.
What is alpha bias?
The tendency to exaggerate differences between men and women
Alpha bias can reinforce gender stereotypes and justify discriminatory practices.
What is beta bias?
The tendency to ignore or minimize differences between men and women
Beta bias can lead to erroneous conclusions about the applicability of research results.
What does androcentrism mean?
It means ‘male-centered’ and considers male behaviors as the norm
Female behaviors may be viewed as deviations from the norm.
What does WEIRD stand for?
Western, Educated, Industrialized, Rich, and Democratic cultures
WEIRD samples may limit the generalizability of research findings.
What is Routine Outcome Monitoring (ROM)?
Also known as feedback-informed treatment and measurement-based care
ROM is considered a transtheoretical and transdiagnostic evidence-based practice.
What are the four components of Routine Outcome Monitoring?
- Routinely administered measure
- Practitioner review of data
- Patient review of data
- Collaborative reevaluation of the treatment plan
These components help inform treatment decisions.
What is the Partners for Change Outcome Management System (PCOMS)?
A standardized patient self-report measure used in ROM
It assesses a client’s progress and the quality of the therapeutic relationship.
What benefits are associated with Routine Outcome Monitoring?
Increased rates of clinically significant improvement and reduced client deterioration
Clients at risk for treatment failure benefit the most from ROM.
What are common barriers to the utilization of Routine Outcome Monitoring?
Client concerns about confidentiality and clinician beliefs about accuracy
Other barriers include lack of training and concerns about time and use of results.
What are transdiagnostic treatments?
Treatments designed to address a range of diagnoses sharing common mechanisms
They target commonalities across disorders rather than focusing solely on specific diagnoses.
What is the core premise of transdiagnostic treatments?
Commonalities across disorders outweigh the differences
This approach may offer benefits compared to diagnosis-specific treatments.
What is Cognitive Behavioral Therapy-Enhanced (CBT-E)?
An intervention designed for anorexia nervosa, bulimia nervosa, and other eating disorders
It targets the shared core psychopathology of overvaluation of body shape and weight.
What is the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP)?
An emotion-focused, cognitive-behavioral intervention for anxiety and depression
It focuses on deficits in emotion regulation and avoidance of intense emotional experiences.
What is Acceptance and Commitment Therapy (ACT)?
A cognitive-behavioral intervention for various mental health conditions
ACT helps individuals develop greater psychological flexibility in facing life’s challenges.
What is Telepsychology?
Provision of psychological services using telecommunication technologies
It includes methods like videoconferencing, email, and mobile devices.
What are some benefits of telepsychology over in-person therapy?
Decreased costs, increased access, and reduced stigma
Telepsychology can be especially beneficial for underserved populations.
What challenges do psychologists face when providing telepsychology?
Internet access issues, technical difficulties, and diminished therapeutic alliance
These challenges can affect the delivery of care.
True or False: Telepsychology is always preferred over in-person therapy.
False
Many psychologists find telehealth more challenging than in-person therapy.
What is the effectiveness of telepsychology for treating anxiety disorders?
Psychotherapy via telepsychology is effective for treating individual anxiety disorders and comorbid anxiety and mood disorders.
Studies indicate significant improvement in anxiety symptoms with no significant differences between videoconferencing and in-person therapy.
Which types of anxiety disorders have been evaluated for treatment via telepsychology?
- Panic Disorder with Agoraphobia
- Generalized Anxiety Disorder
- Social Anxiety Disorder
These disorders were specifically evaluated in a systematic review by Berryhill et al. (2019b).
What did Stubbings et al. (2013) find when comparing videoconferencing-delivered CBT to in-person CBT?
Both were similarly effective for reducing comorbid anxiety and depression and improving quality of life.
This indicates that telepsychology can be as effective as traditional therapy.
What is the general effectiveness of telepsychology for treating PTSD?
Telepsychology for PTSD is comparable to face-to-face interventions.
Turgoose et al. (2018) found similar outcomes in symptom reduction, attendance, and satisfaction.
What challenges did therapists face in developing a therapeutic alliance during telepsychology for PTSD?
Some therapists reported barriers such as the inability to detect nonverbal communications.
This indicates potential limitations in building rapport through telehealth.
What has research shown about the effectiveness of telepsychology for major depressive disorder?
Telepsychology is effective for treating major depressive disorder, with significant decreases in depressive symptoms.
Berryhill et al. (2019a) reported no statistical differences between videoconferencing and in-person therapy.
What are some benefits of telepsychology for individuals with chronic pain and insomnia?
Telepsychology can alleviate insomnia and chronic pain often associated with depression.
This highlights its broader applicability beyond just mood disorders.
What differences were found in treatment outcomes for bulimia nervosa between telepsychology and in-person therapy?
In-person CBT had higher rates of abstinence from binge eating and purging and greater reductions in eating disordered cognitions and depression.
This was noted in studies comparing videoconference and in-person treatments.
What is ‘stepped care’ in mental health treatment?
A model of healthcare delivery that recommends the least restrictive treatment likely to provide health gain and is self-correcting.
It aims to improve healthcare efficiency and accessibility.
List the steps in a commonly cited model of stepped care for depression.
- Step 1 - Assessment and Monitoring
- Step 2 - Interventions Requiring Minimal Practitioner Involvement
- Step 3 - Interventions Requiring More Intensive Care
- Step 4 - Most Restrictive and Intensive Forms of Care
These steps help guide the treatment process based on patient needs.
What is treatment fidelity?
The degree to which a treatment is delivered as intended, influenced by therapist adherence and competence.
High fidelity is crucial for evaluating treatment effectiveness.
What are Digital Mental Health Interventions (DMHIs)?
DMHIs use online and/or mobile formats to deliver psychological strategies and interventions, ranging from self-guided tools to complex therapies.
They include interventions like CBT for depression.
What does research indicate about the implementation of DMHIs in healthcare settings?
Implementation research shows less supportive results due to inconsistent use by patients and uncertainty among providers.
This highlights a gap between research efficacy and practical effectiveness.
What is the medical model of disability?
Views disabilities as medical conditions that deviate from the norm, focusing on treatment to manage or cure the condition.
This model emphasizes intrinsic factors related to the individual.
How does the social model of disability differ from the medical model?
It views disability as a difference caused by societal barriers, focusing on environmental and societal changes.
This model emphasizes addressing discrimination and exclusion.
What is the functional model of disability?
Focuses on a person’s inability to perform roles due to their disability and emphasizes accommodations and assistive technology.
It recognizes medical conditions while prioritizing functional improvements.
What is the forensic model of disability?
Requires objective proof of impairment and focuses on distinguishing between honest and dishonest claims of disability.
This model is concerned with legal implications of disability.
