PSYC 528: Evidence Based Practise Flashcards
Adjunct Treatment
What: A secondary or additional treatment used to compliment a primary therapy. Common types are medication, group therapy, and couples/family therapy.
Why: This can maximize treatment effectiveness and is tailored to the individual client.
Ex: A client comes to therapy with symptoms of PTSD from a trauma she experienced as a child. The client discusses that she has tried yoga in the past to help manage some of her symptoms. Knowing this, your treatment plan includes CPT to treat her symptoms of PTSD and you add an adjunct therapy of deep breathing 3x/week.
ADDRESSING Model
What: An acronym of cultural influence and client factors that can help with case conceptualization and treatment. These factors can be often overlooked.
Why: The goal is to help therapists understand the client fully and develop effective and culturally sensitive treatment plans (holistic care).
A: Age
D: Disability at birth
D: Disability acquired
R: Religon
E: Ethnicity
S: Socioeconomic status (SES)
S: Sexual orientation
I: Indigenous heritage
N: Nation of origin
G: Gender identity/pronouns
Ex: In order to assess a client’s friends, neighbors, & acquaintances as well as their extended family and partner & children spheres of influence, you might ask things like “How is your social support?” “What would your family say is your biggest struggle?” “Tell me about your work life.” All of these questions are working to uncover how each sphere of influence is affecting the client and the presenting problem.Sam is a new client who identifies as a cisgender, Jewish female. She is 68 years old. As her therapist does the initial interview, the therapist will want to gather information about how her Jewish heritage/faith and age are influencing her presenting problems, if at all.
Case Conceptualization
What: The process of collecting information about a client and organizing it to develop an effective treatment plan. Produced from a combination of the clinicians preferred theoretical framework, best evidence available, and client factors. The conceptualization contains client symptoms, diagnosis, problems, hypotheses of mechanism causing and maintaining diagnosis/problems, recent precipitants of current issue, and origins of mechanisms.
Why: Can guide treatment, enhance therapeutic alliance, and help everyone measure if treatment is progressing towards therapeutic goals.
Ex: Jane presents with symptoms of depression including lethargy, anhedonia, weight gain, and frequent crying spells. Her clinician uses a biopsychosocial model to help with the process of case conceptualization. She finds that Jane’s family has a history of depression, that Jane recently moved and has not developed strong friendships in her new home, and often experiences self-shaming thoughts. All of these factors will help guide the clinician’s choices about how to best treat Jane’s symptoms.
Client Factors
What: Aspects that are unique to each client and can influence their presenting problem(s) and presentation. This can include multicultural factors (ADDRESSING Model), experiences/expectations in therapy, readiness to change, values, temperament, assets, etc.
Why: Gathering this information can help a clinician learn about client interpersonal belief systems. This can influence all aspects of the therapeutic process (i.e. alliance, planning, conceptualization, etc.). It is important in helping tailor a personalized treatment plan for clients (individual factors are taken into consideration).
Ex: A client, Linda, communicated in her intake interview that she is highly motivated to confront and improve her major depression while also utilizing her social support system including family. She says she prefers a holistic approach and does not have any prior experience with mental health care. She is low SES and does not have medical coverage so she is concerned about paying for therapeutic services. These are just a few of Linda’s client factors that her therapist will take into consideration when tailoring an effective and individualized treatment plan.
Common Factors
Who: Influences all therapeutic approaches. Produced by Jerome Frank.
What: Traits that are necessary characteristics to be an effective therapist and impact the effectiveness of the therapeutic process. This can include warmth, empathy, genuineness, accurate identification of emotion, credibility of therapist, and strong therapeutic alliance.
Why: This contrasts with the perspective that effective psychotherapy is best explained by specific unique factors (particular methods or procedures) meant to treat specific problems.
Ex: Felicia, Gayle and Abigail are all three therapists in a group practice. They all practice from different theoretical backgrounds, however, they all possess characteristics of warmth, empathy and genuineness. They are able to foster strong therapeutic relationships with their clients. Though they may use different therapeutic interventions with their clients, these necessary common factors are present in all three therapists, which allows them all to be effective clinicians.
Efficacy v. Effectiveness Research
What: Efficacy research is explanatory and determines whether or not an intervention produces the expected change (i.e. does the treatment work). Effectiveness research refers to the degree of how beneficial the treatment effect is in “real world” clinical settings (i.e. does the treatment work in practice and not just in controlled research settings).
Why: Can help clinicians figure out if a treatment is a viable option for clinical application or not.
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Evidence Based Practice (EBP)
What: Based on the medical model. Integrates best available empirical research results, clinical expertise, client preferences/culture/characteristics, and values.
Why: Meant to provide effective psychological services that are responsive to clients unique needs while incorporating aspects of effective treatment that don’t lend themselves to empirical research (based on current knowledge of specific treatments proven to work for specific disorders).
Failure to Respond
What: This occurs when a client does not react to treatment. If the client repeatedly does not meet their goals for therapy/respond the therapist has an ethical obligation to refer the client to another provider.
Why: This is relevant to progress monitoring where a clinician can help identify failure and discuss course-correcting treatment with a client. This can include changing, discounting treatment, or a referral out. Clinicians can utilize peer consultation in clinical decision making for this concern.
Informed Consent for Treatment
What: an essential part of clinical practice. Consent by a client to participate in medical or psychotherapeutic procedure or participation in research. Clinicians are legally required to obtain this (verbal and written) before proceeding. This is supported by the right of the individual (inpatient and outpatient) to have and exercise freedom, autonomy, and human dignity. This right can not be denied based on mental health status of conduit of client. The informed consent process includes understanding of: relevant facts, risks/benefits, available alternatives, and legal aspects of informed consent (comprehension, capacity, and voluntary).
ASK ABOUT THIS! (Ericas stuff)
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Practice Guidelines
What: Refers to criteria and strategies designed to assist mental health providers in the recognition and treatment of specific disorders as indicated by the best available research findings. Alternatively this can also refer to the code of ethics by which all clinicians ought to abide by.
Why: This can help with clinical decision making by presenting systematically developed treatment strategies in a standardized format.
Ex: The APA released guidelines for working with schizophrenic adult clients, including the most up to date information on what is considered to be the best, most effective, ethical treatments and approaches.
Precipitants of the Problem
What: In the diathesis stress model of psychopathology this is the stressor (proximal activating event) that activates the underlying mechanisms making the client susceptible to psychopathologies (worsens/intensifies or maintain the problem). Can be internal, external, biological, psychological or all of the above. Precipitants are not always immediately evident and are expired by asking the “why now” question regarding why the client has started therapy at this time.
Why: This is a key part of cognitive behavioral case conceptualization. Allows the therapist to test hypothesis regarding underlying mechanisms of problems and understand them.
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Primary v. Secondary Evidence
What: Primary evidence is data from the source or the research, whereas secondary is someone analyzing and writing about someone else’s research without doing a study themselves.
Why: Both primary and secondary evidence are used in evidence based practice to support the use of methods or treatments.
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Problem List
What: Part of pretreatment and assessment this is a comprehensive priority ordered list produced to name client issues and link tot treatment goals. The list tends to be 5-8 items to keep it manageable and can include behavioral, occupational, interpersonal/social, biological, psychological, legal, financial, and housing problems. The severity of each issue can be included and can be built from multiple sources such as clinical interview, assessment measure, other providers, family, structured interview protocols etc.
Why: Creating this list can help a clinician prioritize what to treat, see how issues coincide, and see what issues can be simultaneously addressed by certain treatments.
Ex: A client named Brad, 39 years of age, is pursuing therapy to attend to this interpersonal concerns. The clinician produces a problem list to highlight his presenting issues in a priority ordered list. The list goes as follows: 1. generalize anxiety disorder 2. major depressive disorder 3. substance abuse of alcohol 4. stress management problems and inability to emotionally cope 5. self esteem and body image concerns. This list will be used to help the client and clinician produce treatment goals and a plan moving forward.
Mechanisms of Action
What: Describes the reason certain interventions work and why. If an intervention works it means that it is targeting the maintaining mechanism. These can be cognitive or behavioral.
Why: Clinicians should understand the mechanisms of action in order to explain the reasons behind treatment.
Ex: behavioral activation works because it targets avoidance which is the maintaining mechanism that is seen in anxiety and depression.
Non-adherence
What: This occurs when a client does not abide b the proposed therapeutic regimen. The client and the therapist can be at fault for this. Can occur because:
- client resistance
- physical/cognitive limitations that prevent the client from following recommendations
- poor communication between clinician and client
- clinician fails to carryout behavior that is agreed to or expected
Why: This can lead to slowing down or failure of therapy.
Ex: A clinician does not check in on their client’s homework for completion during session or either party is repeatedly late to sessions.
