psuchological interventions

Question 1

epidemiology of mental health

Answer 1

25% british adults experience at least 1 MH problem in a yr - 1 in 6 at any time

mixed anxiety and depression is the commonest disorder

Question 2

what is a panic attack

Answer 2

A discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feeling of impending doom

Question 3

what are the symptoms of a panic attack

Answer 3

shortness of breath,

palpitations, - activation of the CNS

chest pain or discomfort,

choking or smothering sensations,

and fear of “going crazy” or losing control - social risk

Question 4

what is agoraphobia

Answer 4

Develops as a complication of panic attacks

Agoraphobia may arise by the fear of having a panic attack in a setting from which escape is difficult (or embarrassing) eg in shop - have to leave shopping

Question 5

what is the consequence of agoraphobia

Answer 5

sufferers of agoraphobia avoid public and/or unfamiliar places, especially large, open, spaces where there are few ‘places to hide‘ or prevent easy escape

Question 6

what is the biomedical model of MH disorders

Answer 6

classify mental health disorders on objective markers

claims markers can clarify the aetiology of psychiatric disorders, confirm a dignosis and identify pts that are at risk - therefore determine the severity and predict the course of the disorder

The clinical utility, sensitivity, specificity, and the predictive value of biomarkers for panic disorder is still questionable.

Question 7

what is psychotherapy

Answer 7

Goal of all psychotherapy is to help people change maladaptive thoughts, feelings, and behavior patterns

Major schools:

• Psychodynamic
• Behavioural
• cognitive

Question 8

describe the psychodynamic theory

Answer 8

in panic attack - only see the tip of the iceburg

because of inyteraction between 3 things - superego (moral sense of how someone should behave), Id (primary drivers and instincts), ego

to resolve the MH problem - need to resolve the conflict

Question 9

describe teh principle of behavioural therapies

Answer 9

Maladaptive behaviours are not merely symptoms of underlying problems - The behaviours are the problem

problem behaviours are learned in the same ways normal behaviours are

therefore we need to treat the behavioural problem rather than seeing it as a deep routed problem

Question 10

describe how classical conditioning relates to phobia development

Answer 10

before conditioning raised HR = no fear or anxiety

during the conditioning raised HR (conditioned stim), and traumatic incident (unconditioned stim) = fear and anxiety (unconditioned response)

after conditioning - the raised HR (CS) = high fear and anxiety (CR) - we are conditioned to associate the high HR with traumatic experience so now just increased HR = fear

Question 11

describe the 2 factor theory of maintenance of conditioned associations

Answer 11

during conditioning CS and US = UR

cause you to avoid the stressers and things that cause an increase in HR (intraceptive sensations) = reduction in fear (ie reduced UR) = tendancy to avoid things that cause an increase in HR

Question 12

describe the mechanism of behavioural therapies

Answer 12

treat phobias through exposure to CS (eg car after car crash) in absence of US (ie crash)

response prevention is used to stop the operant avoidant response from occuring - this is highly effective for reducing anxiety responses

use systematic desensitisation - make each exposure more and more like the time when the crash happened

Question 13

describe cognitive therapy

Answer 13

critism of behavioural therapy

suggests between stimulus and response there is a learning process, this is associative learning ie your appraisal determines the response both emotionally and behaviourally

Question 14

describe the cognitive theory of panic

Answer 14

the appraisal of the bodily sensations is the problem - not just the response to the sensation (the sensation can be benign)

individuals who panic interpret symptoms in catastrophic fashion - sensations involved in normal anxiety responses are considered to be a sign of impending disaster

1. there is an internal/external trigger
2. this is perceived as a threat
3. causes anxiety
4. causes increase in physical/cognitive syptoms
5. these are further misinterpreted as signs of disaster
6. increasing anxiety - influence behaviour and emotions eg go to a and e

Question 15

what is cognitive behavioural therapy composed of (CBT)

Answer 15

psychoeducation - share idea of how the cognitive theory operates so people understand the signs

relaxation techniques - reduce the SNS response

cognitive restructuring - reverse idea that the perceived outcome will always be the outcome

behavioural experiments - test appraisal - cause increase in HR to level you can tolerate, then increase exposure in other situations

graded exposure

relapse prevention - what people should do if the problems happen again

Question 16

describe how background effects your appraisal of risk

Answer 16

if you were diagnosed when previously healthy - might feel like the disease is out of your control = more likely to percieve threat as high risk

if have premorbid personality (free floating anxiety) - more likely to perceive signs as threat

Question 17

what are the core features of behavioural therapy

Answer 17

it focuses on the problematic beliefs and behaviours that maintain the disorders - targets the here and now, rather than the original causes

goal orientated - specific and measurable goals

collaborative relationship between therapist and patient

‘scientific’ approach - find the hypothesis of why having the panic disorders and what behavioural tasks can we do to test this

Question 18

what is depression

Answer 18

a period of almost daily depressed mood or/and diminished interest in activities lasting at least two weeks

ie a feeling of pervasive sadness

Question 19

symptoms of depression

Answer 19

there is individual variability in these symptoms

• difficulty concentrating,
• feelings of worthlessness
• excessive or inappropriate guilt,
• hopelessness,
• recurrent thoughts of death or suicide,
• changes in appetite or sleep,
• psychomotor agitation or retardation,
• reduced energy or fatigue.

Question 20

is psychotherapy effective

Answer 20

majority of studies have shown a significant effect on outcomes

strongest evidence for CBT - although arguably this has been studied the most - anxiety disorder lends itself to this therapy, less so for depression

comparative studies between psychotherapies show difference on effects is small

Question 21

when is CBT recommended as 1st line - NICE

Answer 21

• Mild to moderate depression
• Social anxiety
• PTSD
• Generalised anxiety disorder
• OCD
• Bulimia
• Panic disorder and specific phobia
• Schizophrenia

Question 22

how do NICE recommend that you recognise depression

Answer 22

be alert to possibility - especially in people with a PMH of depression, or chronic physical health problem with associated functional impairment - they’re more vulnerable to depression

ask:

1. During the last month, have you often been bothered by feeling down, depressed or hopeless?
2. During the last month, have you often been bothered by having little interest or pleasure in doing things?

Question 23

describe NICE’s position on drug use for depression

Answer 23

dont use for persistant subthreshold symptoms or for mild depression - the risk-benefit ratio is poor

should use for mod-severe

consider for people with

• a past history of moderate or severe depression
• subthreshold depressive symptoms present for a long time
• subthreshold depressive symptoms or mild depression that persist(s) after other interventions.

Question 24

describe use of placebo for antidepressants

Answer 24

difference between antidepressants and placebo were not clinically significant - according to criteria by NICE
the more severe the depression = the bigger difference between placebo and active drug - therefore drugs are appropriate for the severe end of depression

however antidepressants are more likely to work than placebos

people are just as likely to stop taking the placebo as the drug

Question 25

what psychological interventions should be given to people who are at significant risk of relapse

Answer 25

individual CBT

• for people who have relapsed despite antidepressant medication
• for people with a significant history of depression and residual symptoms despite treatment

mindfulness based cognitive therapy

• for people currently well but have experienced 3 or more previous episodes of depression - give when not depressed to safeguard against future episodes

Question 26

describe mindfulness therapy

Answer 26

paying attention in a particular way on purpose in the present moment and non-judgementally - recognising the thoughts as thoughts not as ‘you’ or reality

cortisol levels decrease following participation in a mindfulness program - useful in a stress management program in people who are vulnerable

Question 27

describe acceptance and commitment therapy

Answer 27

made of several features

• being present - focus on there here and now
• values - discover what is truely important to you
• commitment - take action to persue the important things in your life
• self as context - see yourself as unchanged by time and experience
• defusion - observing your thoughts w/o being ruled by them
• acceptance - be willing to experience difficult thoughts

Question 28

what are the vicious circles of pain

Answer 28

pain leads to activity avoidance = progressive deconditioning = pain with decreasing activity (low levels of activity begin presenting with pain) = further activity avoidance

pain = anger, anxiety, fear and distress = lower mood = depression = increased perception of pain

Question 29

describe how the acceptance and commitment therapy fits in with chronic pain

Answer 29

instead of the factors in ACT you feel the following

• being present - fear of future health and finance. loss of past health and function
• values - pain focus, lose sight of values, pain determines your decisions
• commitment - efforts to control pain dominate at expende of valued actipn
• self as context - i am a pain sufferer
• defusion - strong belief in negative at catastrophising thoughts
• acceptance - pain avoidance and struggle for control

in therapy need to focus on getting back the different mindsets

Question 30

evidence for CBT and ACT for chronic pain

Answer 30

CBT for chronic pain can have positive effects on factors such as disability, negative mood and pain self-efficacy (ability to manage pain) when compared with treatment as usual/waiting list, with some evidence that it is maintained at six months post intervention.

ACT is efficacious particularly for enhancing general, mostly physical functioning, and for decreasing distress, in comparison to inactive treatment comparisons

Question 31

treatment for depression

Answer 31

over half show improvement after anti-depressant

some show improvement with placebo

60% improvement after psychotherapy

40% after care as usual

over half with untreated depression show improvement after 12 months - however might have other ways of managing eg exercise/social support

a lot of people dont benefit from treatment - we dont know why some people do and some dont, or what the active part of each treatment is