psuchological interventions Flashcards
epidemiology of mental health
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
what is a panic attack
A discrete period in which there is the sudden onset of intense apprehension, fearfulness, or terror, often associated with feeling of impending doom
what are the symptoms of a panic attack
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
what is agoraphobia
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
what is the consequence of agoraphobia
sufferers of agoraphobia avoid public and/or unfamiliar places, especially large, open, spaces where there are few ‘places to hide‘ or prevent easy escape
what is the biomedical model of MH disorders
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.
what is psychotherapy
Goal of all psychotherapy is to help people change maladaptive thoughts, feelings, and behavior patterns
Major schools:
- Psychodynamic
- Behavioural
- cognitive
describe the psychodynamic theory
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
describe teh principle of behavioural therapies
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
describe how classical conditioning relates to phobia development
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
describe the 2 factor theory of maintenance of conditioned associations
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
describe the mechanism of behavioural therapies
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
describe cognitive therapy
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
describe the cognitive theory of panic
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
- there is an internal/external trigger
- this is perceived as a threat
- causes anxiety
- causes increase in physical/cognitive syptoms
- these are further misinterpreted as signs of disaster
- increasing anxiety - influence behaviour and emotions eg go to a and e
what is cognitive behavioural therapy composed of (CBT)
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
describe how background effects your appraisal of risk
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
what are the core features of behavioural therapy
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
what is depression
a period of almost daily depressed mood or/and diminished interest in activities lasting at least two weeks
ie a feeling of pervasive sadness
symptoms of depression
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.
is psychotherapy effective
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
when is CBT recommended as 1st line - NICE
- Mild to moderate depression
- Social anxiety
- PTSD
- Generalised anxiety disorder
- OCD
- Bulimia
- Panic disorder and specific phobia
- Schizophrenia
how do NICE recommend that you recognise depression
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:
- During the last month, have you often been bothered by feeling down, depressed or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
describe NICE’s position on drug use for depression
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.
describe use of placebo for antidepressants
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
what psychological interventions should be given to people who are at significant risk of relapse
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
describe mindfulness therapy
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
describe acceptance and commitment therapy
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
what are the vicious circles of pain
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
describe how the acceptance and commitment therapy fits in with chronic pain
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
evidence for CBT and ACT for chronic pain
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
treatment for depression
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
