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Psychology Degree > Psychological Approach To Therapy > Flashcards

Psychological Approach To Therapy Flashcards

1
Q

What is psychotherapy?

A

a talking therapy that helps you deal with emotional problems and mental health disorders, (patient-led) and longer term than counselling
- 2019 BACP found 33% of people had counselling or psychopathology (gender split of 32% of females to 23% of males)

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2
Q

What is mental health?

A

A state of well-being where the individual realises their own potential, can cope with normal stresses and work productivity
- Dual continuum model (Diagnosis or no diagnosis on your mental wellbeing)
- Estimated 792 million people affected (10.7%)

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3
Q

How do you diagnose a mental health disorder?

A
  • Diagnostic and statistical manual of mental disorders (DSM-5)
  • International statistical classification of diseases and related health problems (ICD-10)
    1. Deviance – Statistically less common
    1. Dysfunction – Issue interferes in individuals life in a major way
    1. Distress – How much distress does it cause
    1. Danger – Danger to self and others
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4
Q

What is prevalence? 3 types

A

Proportion of the population who have a specific disorder at a given time
- Point (Time)
- Period (Time period)
- Lifetime (Some point in life up to the time of assessment)

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5
Q

Facts about depression

A
  • 4-10% of people will experience depression in their lifetime
  • Persistent low mood, loss of interest in activities, irritability, changes in sleep or appetite
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6
Q

Facts about anxiety disorders

A
  • 8.2 million cases in 2013
  • prevalence of 1-7% in Europe
  • Excessive worrying, cause distress, persists beyond an appropriate period
  • Types of anxiety (Generalised, social and phobias)
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7
Q

Facts about obsessive compulsive disorder

A
  • Recurrent distressing thoughts
  • Repetitive behaviours aimed to minimise distress
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8
Q

Facts about bipolar disorder

A
  • Nearly 4 million cases in 2013
  • Cyclical mood disorder (Mania/ hypomania)
  • Increased risk taking
  • Type 1 (Alternating mania and depression) & Type 2 (episodes and hypomania)
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9
Q

Facts about schizophrenia

A
  • 220,000 people in England & Wales (1% of population)
  • Positive, negative and cognitive
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10
Q

Facts about eating disorders

A
  • Could affect up to 1.6 million people in the UK
  • Anorexia nervosa (Body perception, fear of gaining weight, lack insight)
  • Bulimia nervosa (Binge eating, body perception, inappropriate compensatory behaviour, have insight)
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11
Q

Facts about personality disorders

A
  • One in 20 people in UK
  • Cluster A (Paranoid, schizoid)
  • Cluster B (Antisocial, borderline)
  • Cluster C (Avoidant, Dependent)
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12
Q

Facts about PTSD

A
  • 1 in 20 reported PTSD in the adult psychiatric morbidity survey
  • Flashbacks, intrusive thoughts, nightmares
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13
Q

What is aetiology?

A

the origin or cause of a disorder

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13
Q

Prehistory of treating disorders: the four humours

A
  • Hippocrates (‘father’ of modern western medicine) – concept of the 4 humours and saw mental health disorders as any other disease of the body
  • Galen (Hippocratic-Galenic approach) – humoural theory of disorders
    The four humours:
    1. Blood
    2. Phlegm
    3. Black bile
    4. Yellow bile
    Treatments: regulate environment to restore balance (e.g. change in diet and bloodletting)
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14
Q

Treating disorders: Middle Ages

A
  • Continuation of 4 humours but recognised the role of environmental factors (grief, injury.) Treatments: bleeding, purging and whipping
  • Influence of the church (evidence of witchcraft or sin.) Treatments: exorcism, fasting and prayer
  • First asylums appear to house the mentally ill
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15
Q

Treating disorders: Renaissance

A
  • Humanism – worldwide emphasising human welfare and decline of supernatural explanations
  • Asylums were commonly used but patients were treated almost as ‘inmates’ and very harsh conditions and public show for visitors
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16
Q

Renaissance reforme movements: Moral treatments by 3 people

A
  • Pinel (1745-1826) – unchained the patients and advocated moral guidance and humane techniques
  • William Tuke (1732-1822) – established the York retreat in England, County Asylums Act of 1845
  • Dorothea Dix (1802-1887) – Mental Hygiene Movement which improved conditions and challenged the idea that mental illness couldn’t be helped or cured
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17
Q

Emergence of modern views for treating disorders

A
  • Richard Von Krafft Ebing – link between general paresis and syphilis
  • Emil Kraepelin – system for classifying symptoms into discrete disorders and measured effects of drugs on disorders behaviour
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18
Q

The medical model

A
  • Behaviour affected by changes in brain/nervous system and mental illness problems viewed in the same way as physical illness
  • Diagnosis treated not individual
  • Therapies (Drug therapy, psychosurgery, electroconvulsive therapy)
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19
Q

Diagnosis & Classification

A
  • Symptoms usually co-occurring leading to syndrome (DSM-5)
  • Same diagnosis, treatment and research across world
  • Issues: boundaries between disorders can be unclear (reliability: consistency of judgements) e.g. links between anxiety and depression
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20
Q

The role of culture in different disorders: 2 examples

A
  • ‘Culturally bound syndromes’ are specific to a certain place/culture/group
  • ‘Ataque de Nervios’ in Latino descent (symptoms include crying, trembling and aggression)
  • ‘Taijin Kyofusho’ in Japan (Symptoms include anxiety about and avoidance of social situations due to fear that one’s actions and appearance will offend others)
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21
Q

Pros of diagnosis

A
  • Some people find it helpful to have a diagnosis to explain what they are experiencing
  • Can reduce feelings of blame and guilt
  • Guides decision about treatment plans
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22
Q

Cons of diagnosis: 3 factors

A
  1. Labelling
    Rosenhan (1973) – 8 individuals presented themselves to psychiatric hospital as they experienced auditory hallucinations. Majority admitted with diagnosis of schizophrenia but once it hospital, they stopped hearing voices. Hospitalisation from 7-52 days. Labels are ‘sticky’
  2. Stigma & Self-Fulfilling Prophecy
    Harris et al (1992) – pairs of boys aged 6-12 years. The perceivers were typically developing boys (TD) and targets were boys with ADHD or TD. Questionnaire data (How well do you think your partner did?) and behavioural data (Time spent talking)
  3. Implications
    Social and psychological factors are critical and not just biological factors
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23
Q

Alternatives to medical model

A
  • Make no dichotomy between ‘normal’ and ‘disordered’ states
  • Dimensional approach as mental disorders exist on a spectrum
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24
Q

What is psychological formulation? key factors

A

provides an alternate to diagnosis. Guided by theoretical viewpoint/approach
- Co-constructing hypothesis – about origins of a person’s difficulties
- Diagnostic label has little impact on type of treatment given
- Aims to identify processes that led to and maintain problems faced by the individual
- Hypothesis: guide the therapist and establish criteria to evaluate intervention
- Influenced by context (time, place and character of originator)

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25
Q

Freud’s psychoanalysis

A
  • Psychodynamic approach (deterministic, early life experiences, conflict, internal causes and dynamic unconscious)
    Sigmund Freud (1856-1939)
  • scientific study of humans as no different than other animals and biological ‘instincts’ (sexual drives)
  • Published ‘The Interpretation of Dreams’ (1899) from self-analysis
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26
Q

Anna O study (patient of Josef Breuer)

A
  • Symptoms including physical weakness, paralysis, deafness
  • Under hypnosis, spoke of past traumas and expressed strong emotions (symptoms ‘cured’ = catharsis)
  • Freud took these implications from these case:
    1. Behaviour influenced by unconscious mental processes
    2. Physical symptoms could be removed by ‘talk therapy’
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27
Q

What are the 3 levels of consciousness?

A
  1. Conscious – thoughts that we are aware of
  2. Preconscious – memories that we are unaware of but can easily be brought into awareness
  3. Unconscious – ‘inadmissable’ material that we are unaware of
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28
Q

Freud’s model of personality: 3 factors

A
  1. Id – present at birth, consists of everything inherited. Ruled by the pleasure principle
  2. Superego – made up of conscience and ego ideal. Can become too harsh and restrictive. Social and moral standards as inhibits id impulses and persuades ego to swap realistic for moralistic goals
  3. Ego – develops around 6 months, mediatory between Id and reality. Ruled by the reality principle and confronts reality through secondary process thinking
    (When forces are balanced = psychological wellbeing/ health)
    - A state of tension which must be reduced or leads to anxiety
  4. Realistic – fear of real dangers in the external world
  5. Moral – fear of conscience
  6. Neurotic – fear of strength of id’s instinctual impulses
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29
Q

Psychic energy & the instincts

A
  • Helmholtz – conservation of energy: cannot be created or destroyed, only transferred
  • Brucke – all living things are energy systems
  • Freud – psychic energy
  • Instincts are the source of energy in behaviour, and make up the dynamics of personality (Eros – preservation of self and species, sexual drive = libido, Thanatos – self-destruction, aggressive drive = destructive energy)
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30
Q

What are the Freudian stages of development? 5 stages

A
  1. Oral (0-2 yrs) – Sucking
  2. Anal (2-3 yrs) – Retention of faeces
  3. Phallic (3-6 yrs) – Self-manipulation of genitals
  4. Latency (6-12 yrs) – Sexual inhibitions
  5. Genital (12+ yrs) – Development of adult sexuality
    (Conflicts at each stage must be resolved to move on successfully, failure to resolve leads to fixations which have an impact on personality)
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31
Q

Difference between oedipus and electra

A

Oedipus – Mother as love object for male child and identification with father
Electra – Female child’s striving for father’s love and approval and identification with mother

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32
Q

What are the ego-defence mechanisms?

A
  • Develop in childhood to relieve anxiety and operate unconsciously (Repression, Denial, Projection, Sublimation and Displacement)
  • Repression – keeping unacceptable impulses unconscious and can also give rise to neuroses (menta disorder)
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33
Q

What is Freudian psychotherapy?

A
  • Neuroses: originate in childhood, symptoms may be later
  • Triggered by stress or crisis (usually sexual)
  • Neuroses perpetuate because repressions are unconscious (ego doesn’t have access, so conflict cannot be resolved)
    Examples:
  • OCD – fixation at anal stage as ‘battle’ between explicit thoughts and actions
  • Depression – regression to oral stage as introjection of negative feelings
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34
Q

What are the 3 main goals of therapy? and some key factors

A

(Neuroses are acquired at childhood, but are maintained because they have been repressed)
1. Make unconscious conscious
2. Strengthen ego
3. Make superego more humane

  • According to Freud, psychoanalysis is suitable for; not individuals with psychosis, not individuals ‘near or above the age of 50’ and reasonable degree of education
  • At least 4 sessions per week; at least 45 mins each
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35
Q

What are 5 Freudian therapeutic techniques?

A
  1. Free association – allow the mind to wander and report everything that comes to mind even if its unpleasant to lift repressions by making the unconscious conscious
  2. Resistance – anything that works against the process of therapy, ego protects itself from repressed id
  3. Transference – clients perceive analysts as ‘reincarnations’ of key figures from life and transfer onto them emotions associated with past relationships
  4. Interpretation – repressed unconscious material becomes conscious and helps clients gain insight into defence mechanisms and resistances
  5. Dream analysis – disguised hallucinatory fulfilments of repressed sexual infantile wishes. Manifest vs latent content. Dream work: complex mental process of disguise involving condensation, displacement, symbolism
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36
Q

Case Histories: The wolf man: treated by Freud (1910-1914)

A
  • Presented with dramatic symptoms: depression, animal phobia, panic attacks
  • Had a dream of wolves in a walnut tree the night before his 4th birthday, so the current symptoms were due to unconscious repressed material
  • Dreams give insight into repressed desires based on a previous experience
  • At age 1.5, he had witnessed his parents having sexual intercourse so desires the same gratification but fears castration
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37
Q

Evaluation of Freud’s psychoanalysis

A
  • Changed how we think about human nature
  • Paved the way for an understanding and treatment of mental disorder based on a psychogenic approach
  • Some of his ideas not well suited to testing with traditional ‘scientific method’
  • Very limited sample
  • Not falsifiable
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38
Q

Jung’s analytical psychology

A

Two of Freud’s key assumptions were unacceptable to him
1. That human motivation is exclusively sexual
2. That the unconscious mind is entirely personal and peculiar to an individual
Levels of consciousness:
- Consciousness – known and available to the individual, ego at its centre
- Personal unconscious – memories that have been forgotten or repressed
- Collective unconscious – inherited from our ancestors. Made up of archetypes (Persona, Anima, Animus, Shadow and Self)

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39
Q

Jungian Psychodynamics: 3 factors

A
  • Psychic energy: Libido (spiritual) and other motivating forces
  • Compensation: Balance or adjust energy distributed through the psyche
  • Transcendent function: Synthesising process which can remove some of the separation between conscious and unconscious
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40
Q

The stages of life: 4 stages

A
  1. Childhood
  2. Youth
  3. Middle age
  4. Extreme old age
    (Integration of unconscious and conscious into whole self, ‘Self-actualisation.’ Key time: Middle age)
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41
Q

What are Jung’s psychological types?

A
  • 2 attitude types based on habitual direction of an individuals interests (extraversion & introversion)
  • 4 function types based on an individual predisposed mode of mental processing (thinking, feeling, sensation & intuition)
  • Everybody has all functions, but 2 are well-developed and the other 2 are mostly unconscious in the shadow
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42
Q

Jung: What is the difference between extraversion and introversion?

A
  • Extraversion: external objects and open/ sociable
  • Introversion: inner world and reflective/ reserved
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43
Q

Jung: What are the rational function types? 2 types

A
  • Thinking: reflective thinking “I make decisions with my head and want to be fair”
  • Feeling: values arising from feelings “I make decisions with my heart and want to be compassionate”
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44
Q

Jung: What are the irrational function types? 2 types

A
  • Sensing: function of the senses “I solve problems by working through facts until I understand the problem”
  • Intuiting: hunches and insights I solve problems by leaping between different ideas and possibilities”
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45
Q

What is Jungian therapy? and what was the goals of therapy?

A
  • Not consistent with medical model ‘problem is always the whole person, never the system alone’
  • Hysteria and schizophrenia – extreme persistent expressions of two basic attitudes: Extraversion for hysteria & introversion for schizophrenia
  • Attain specific goals and strengthen consciousness
  • Understand own inner being and meaning of lives (all stages of life)
  • Self-actualization, new balance
46
Q

What was Jung’s view on neuroses?

A
  • Mental health – balance or imbalance between the needs of the individual and demands of collective
  • Neuroses: homeostatic imbalance between conscious and unconscious
  • Symptoms are a form of adaptation ‘created’ as part of individuation
47
Q

What was the difference between Freud and Jung’s view on mental health? 2 differences

A

Freud:
- Early childhood
- Backward-looking, reductive

Jung:
- Any stage in life cycle
- Forward-looking, adaptive

48
Q

What was Jung’s therapeutic process? 4 stages

A
  • Individual, eye-to-eye, 2/3 sessions a week, break after 10 weeks
  • Not a ‘cure’, better able to deal with life’s challenges
  • Focus on expression of emotion, avoidance od distressing thoughts, discussion of past experience, focus on therapeutic relationship
    Stage 1: Confession – share secrets
    Stage 2: Elucidation – therapist ‘interprets’
    Stage 3: Education – new and adaptive habits
    Stage 4: Transformation – individuation, acceptance of self
49
Q

What was Jung’s therapeutic techniques? 3 factors

A
  1. Analysis of transference – understand projection that take place from client to therapist
  2. Active imagination – get in touch with unconscious material
  3. Dream analysis – (Amplification: elaboration and clarification of dream images to establish context, Interpretation: keep record of dreams and interpretations, Assimilation: client and therapist make conscious sense of dreams)
50
Q

Does psychodynamic therapy work? and for specific mental health problems?

A
  • Eysenck (1952) 72% treated by GPs
  • Average person receiving treatment is better off than 75% of untreated individuals (Smith & Glass 1977)
  • Randomised Controlled Trials to increase internal validity
  • Evidence for psychodynamic therapies is limited
  • Psychodynamic therapy effective when specific (Fonagy et all 2005)
  • Approx 33% no longer met DSM criteria compared with 5% routine
  • No difference between CBT and STPP
51
Q

What are the challenges for psychotherapy?

A

Freud worked with a very narrow section of society – not representative.

Evidence that rates of mental distress/disorder differ based on factors such as ethnicity and cultural background.

Other factors such as age (children or older adults), and level of income may also affect how accessible and how effective psychotherapy can be.

52
Q

What are the features of Humanistic-Existential Approaches?

A
  • Free will
  • Conscious thoughts
  • Present
  • Responsibility
  • Phenomenology
53
Q

Who is Abraham Maslow?

A
  • Viewed humanism as a ‘Third Force’ in psychology
  • 2 types of motivation: deficiency and growth
  • Described a hierarchy of human needs
54
Q

Rogers’ Person-centred approach: Carl Rogers (1902-1987)

A
  • 1951 ‘Client-centred therapy’ and viewed himself as a scientist
  • Rogers said ‘we are experts of ourselves’
  • Flexibility of self-concept – shaped by socialisation (ideal self, values attached to characteristics, relationship perceived between self and others)
  • Conditions of worth – need for positive regard (unconditional = valued for who you are, Conditional = valued for doing what others want you to do)
  • Children can then rely on conditional regard and introject conditions of worth (lose touch with organismic valuing = secondary valuing process, or develop conditional positive self-regard = overlaps with Freud’s super-ego)
55
Q

Difference between Freud and Rogers: 2 differences

A

Freud:
- Pessimistic view
- Sexual drives lead to aggression, selfishness, incest

Rogers
- Humans basically good
- Actualising tendency leads to productive life

56
Q

What is actualising tendency and organismic valuing?

A

Actualising tendency: Single basic motivative drive and present in all living things. Includes maintenance (e.g. food, water, etc) as well as growth and fulfilment

Organismic valuing: Central to notion of ‘true’ or unique self. ‘Weighing’ of experiences and placing value on ability to satisfy organism. Based on the individuals subjective experience

57
Q

Maintaining maladjustment: How can experiences be?

A
  1. Accurately perceived & assimilated – congruent with self-concept
  2. Ignored – unimportant
  3. Distorted & denied – incongruent with self-concept (defence against conflict)
58
Q

What are the goals of person-centred therapy?

A
  • Goals of therapy: Rejects medical model, not set by therapist (client responsible for own purpose and goals, therapy trusts in actualising tendency), assist client in growth process and allow them to become increasingly actualised (internal locus of evaluation)
  • Therapeutic process: no specific techniques, provide conditions required to allow change, the change will be positive as its actualising tendency
59
Q

What are the core attitudinal conditions for person-centred therapy?

A
  • Congruence (openness, genuineness and authenticity)
  • Unconditional positive regard
  • Empathy – understand client’s feelings & experiences
  • Internal frame of references
  • Listening, resonating, discriminating, communicating and checking
60
Q

Evaluation Person-Centred Therapy

A

Con’s
- Actualising tendency cannot be directly observed
- Overlay optimistic view of human nature
- Vague concepts and unsuitable for scientific testing
- Issues from a diversity perspective
Pro’s
- Emphasis on research
- Importance of empathy
- Importance of self-concept in guiding behaviour
- Benefits from a diversity perspective

61
Q

Do humanistic Psychotherapies (HPs) work?

A
  • Rogers ‘Father of psychotherapy research’
  • Humanistic psychotherapies lack evidence
  • Rosenzweig (1936) common rather than specific factors (Dodo bird conjecture)
  • Many meta-analyses: all therapies lead to comparable effect sizes
  • ‘Common’ factors more frequently studies: accurate empathy, positive regard, congruence and genuineness
  • Problem: preference for ‘gold-standard’ evidence for therapies to be classed as evidence-based treatments
62
Q

Humanistic Psychotherapies for depression

A
  • Growing support for HPs
  • King et al (2000) RCT for mild to moderate depression
  • PCT & CBT equally effective in reducing depression symptoms at 4 months, better than GP care
  • However, no difference between 3 groups at 12 months
  • Patients in PCT were more satisfied with treatment at 12 months
63
Q

Person-centered therapy: Gibbard & Hanley (2008)

A
  • PCT in primary care was effective for anxiety and depression for over 5 years
  • Not limited to mild as it was effective for moderate and severe depression
  • Counselling included as option of first-line treatment for new episodes of depression but is considered as less-well supported
64
Q

NICE - HP across different client groups

A
  • McArthur et al (2013) for school-base humanistic counselling (SBHC) vs waiting list control. Assumes the distress brought about by acting in accordance with extrinsic demands rather than intrinsic authentic needs. Promotes self-awareness, self-acceptance and actualisation
  • 13-16yrs experience moderate to high psychological distress at 6&12 weeks
  • SBHC may be effective in reducing psychological distress in young people, but it was a small sample, lacking diversity
  • Pearce et al (2007) supported McArthur in more ethnically diverse sample where short-term effectiveness only demonstrated
  • Freire et all (2005) in Brazil found ‘observable improvements’ in relationships with peers and family at 6 months. Not a randomised controlled trial
65
Q

Multicultural considerations in Psychotherapy and its importance

A
  • Ethical obligation for psychotherapists to develop cultural sensitivity
  • Minority groups can experience prejudice, marginalisation = poor mental health
  • Dominant ‘mainstream’ psychotherapists = while, male, Western roots
  • Support monocultural worldview and can lead to ethnocentrism
  • Minority groups many not be offered appropriate help
66
Q

Worldviews and values:
(Laungani 1999)

A

Core values distinguishing Western from Eastern cultures:
1. Individualism -collectivism
2. Cognitivism – Emotionalism
3. Free Will – Determinism
4. Materialism - Spiritualism

67
Q

Therapeutic approaches: 3 factors to be more universal

A
  1. More engagement with non-Western approaches
  2. Adapt existing mainstream therapies to be more culturally sensitive
  3. Therapists developing multicultural competencies
68
Q

Non-Western therapies

A
  • Meditation – mindfulness of breathing and awareness. Roots in Hinduism, Taoism and Buddhism. Evidence indicates reduction of psychological stress
  • Naikan therapy – Japanese Buddhism. Find meaning, feel & show gratitude. Some evidence to indicate that gratitude interventions relate to improving wellbeing
  • Adapt to mainstream therapy – expand to cultural empathy and listen carefully to culturally-relevant cues. Check the accuracy of therapist’s cultural understanding and ask clients to help them with this
  • Potential barriers – therapists as ‘experts’ to give direction and clients reluctant to talk about problems outside family
69
Q

Cultural competence: Sue et al (1998)

A
  • statement of multicultural counselling competencies and 3 main components:
    1. Awareness of own assumptions, values and biases (practice cultural humility)
    1. Understanding worldview of culturally different clients
    1. Developing appropriate techniques
70
Q

Multicultural therapist: difference between monocultural and multicultural

A

Monocultural
*Neglect multicultural worldviews.
*Fail to consider historical & sociopolitical contexts – ignore role of power & privilege.
*Resist change as preserve status quo.

Multicultural
*Embrace diversity.
*Examine own and clients’ worldviews.
*Consider power differences based on intersecting diversity characteristics.
*Embrace change by promoting empowerment and social justice.

70
Q

Who is Derald Sue

A

Professor of Counselling Psychology.
Pioneer of Multicultural Counselling & Therapy (MCT).
Well known for work on microaggressions and implicit racial bias.
Mainstream White male culture biased against minority groups.
Traditional Eurocentric therapeutic approaches can be harmful to culturally diverse groups – cultural oppression

71
Q

What is the behavioural approach?

A
  • Origins from 1950/60s
  • Behavioural principles can be applied to clinical problems
  • Symptoms are learned patterns of behaviour
  • Three generations of behavioural therapy:
    1. Traditional/Radical Behavioural Therapy
    2. Cognitive Behavioural Therapy
    3. ‘Third wave’ Behavioural Therapy
72
Q

Behavioural approach: Ivan Pavlov (1849-1936)

A
  • Classical conditioning – learning through association
  • Instincts and reflexes: inevitable responses of organism to internal/external stimuli
  • Based on salivary reflex behaviour in dogs (Unconditioned stimulus, Unconditioned response, Conditioned stimulus, Conditioned response
73
Q

Behavioural approach: John B. Watson (1878-1958)

A
  • Emphasis on external behaviours rather than internal processes
  • Some stimuli are responses are unconditioned and many are conditioned
  • New psychology (objective and behaviourism)
  • Conditioning emotion with ‘Littler Albert’ and associating the loud noise to the rat and now to any furry animal
74
Q

Behavioural approach: B. F. Skinner (1904-1990)

A
  • The consequences of our behaviour are important for learning
  • Operant conditioning: learning though reinforcement and punishments and the probability of behaviour depends on consequence of previous behaviours
  • Reinforcement increases likelihood of a behaviour
75
Q

Maintenance of phobias

A
  • Classical conditioning gives you the phobia (learned fear responses to previously neutral item)
  • Reinforcement helps explain the maintenance of phobia
  • Avoidance learning: avoidance of the CS leads to prevention of fear/anxiety (negative reinforcement)
  • E.g. OCD: In a fearful situation, a particular behaviour coincidentally occurs
  • When the threat subsids, behaviour linked to fear reduction, so behaviour becomes negatively reinforced, leading to compulsions
  • Lack of opportunity for unlearning
76
Q

Behaviourist approach: Albert Bandura (1925-2021)

A
  • Social learning or social cognitive theory
  • E.g. people who observe others handling snakes were less avoidant than those who had just used systematic desensitisation (importance of human agency, observational learning and perceived self-efficacy)
77
Q

Behavioural therapy: goals and types of intervention

A
  • Goals of therapy (change observable and current behaviours, symptoms are the target of treatment, goals need to be specific and measurable)
  • Characteristics of therapy (time-limited, less intensive than psychoanalysis, clients are actively involved from the outset)
  • Types of intervention: classical conditioning (systematic desensitisation, exposure therapy and aversion therapy), operant conditioning, reinforcement interventions (token economy) and social learning theory (modelling)
78
Q

Systematic desensitisation and study supporting it

A

Joseph Wolpe (1915-1997)
1. Relaxation training (muscle relaxation)
2. Constructing a hierarchy (Rate subjective fear)
3. Gradual exposure using relaxation techniques
Egara & Mosimege (2024)
- 120 pp’s who scored >51 on maths anxiety scale (58 in SD & 62 in control group)
- Compared scores before and after the SD programme
- Results: Treatment group had significantly lower post-intervention maths anxiety than control group. Treatment group had significantly higher post-intervention maths achievement than control group

79
Q

What is flooding?

A
  • Direct or imaginal
  • Intense and prolonged exposure.
  • Requires high client motivation.
  • Stressful for patient & therapist (Schumacher et al., 2015)
80
Q

What is graded exposure?

A
  • In vivo - real life contact with the feared stimulus until fear response habituates.
  • Can be self-managed or with therapist help.
  • Goes through a hierarchical structure.
  • Emmelkamp et al (2001) had 33 pp’s exposed to three environments (4 story mall, 50-foot fire escape, 65-foot-high roof garden) Exposure was gradual in both conditions and both groups improved on measure of anxiety and avoidance
81
Q

What is modelling?

A
  • Learning behaviours though others/role models (e.g. learning by imitation, the Bobo Doll experiment by Bandura 1969)
  • Therapists can model appropriate behaviours to help reduce anxiety and this requires high self-efficacy from the client
82
Q

What is aversion therapy?

A
  • Simultaneous pairing of target stimulus with aversive stimulus
  • E.g. alcoholism and electric shock (Kantorovich, 1930)
  • This is different from operant conditioning
  • Evidence: Controversial approach - Relies on patient experiencing aversive and potentially harmful stimuli. Used to “cure” homosexuality or “sexual deviancy” in the mid 20th century. Anecdotal evidence around certain weight loss pills – eating high fat foods -> unpleasant side effects = avoid those foods & lose weight
  • More recent evidence focuses on treating substance use
  • Shown to be effective in reducing cravings for crack cocaine (Bordnick et al., 2004)
  • Ineffective at reducing smoking (Saeed et al., 2024)
83
Q

Reinforcement interventions & Token economies

A
  • Use positive reinforcement to increase the frequency of desire behaviour and reduce undesired behaviour.
  • Allyon and Azrin (1968)- Token economies
  • Practical example- giving out stickers in school, merit systems
84
Q

Evaluation of behaviour therapy

A

Pros
- Emphasis on research into techniques and assessment of outcomes
- Much success in helping people with anxiety disorders and OCD

Cons
- Less useful in understanding some other disorders, e.g. depression
- Pure behavioural approach – under-emphasises role of internal cognitive processes

85
Q

Background on Ellis

A
  • Ellis had social phobia (fear of public speaking) and forced himself to overcome these issues
  • Trained in psychoanalysis but found its methods unscientific
86
Q

Difference between rational and irrational living

A

Rational Living
- Helps to achieve goals
- Self-preservation & actualisation

Irrational Living
- Prevents from achieving goals
- Self-destruction and perfectionism

87
Q

Ellis’ ABC theory of personality

A
  • People create their own emotional disturbances
  • A - activating event
  • B – belief (Rational = healthy, productive & Irrational = dogmatic, unhealthy)
  • C - consequences (emotional & behavioural)
  • Primary demanding belief is ‘musturbation’ (e.g. I MUST do well)
  • Secondary demanding belief (e.g. miserable about misery C TO A)
88
Q

What does Ellis group neurosis into? 2 groups

A
  • Ellis (1988) grouped neurosis into 2 main categories
    1. Ego disturbance – I must be perfect
    1. Low frustration tolerance – OTHERS must treat me well
  • Acquisition: biological tendencies, social learning, choosing irrational cognitions
  • Maintenance: Biological tendencies, reinforcing consequences, insufficient scientific thinking, emphasising one’s ‘godawful’ past
89
Q

Ellis’ REBT

A
  • Inelegant change goals: new philosophy focused on specific issues
  • Elegant change goals: new philosophy for life, anti-musturbatory thinking, life acceptance
90
Q

REBT: therapeutic process

A
  • Active-direct structured therapy with focus on specific issues
  • Therapist as teacher and homework tasks
  • Relationship: unconditionally accepting, genuine, empathetic
  • Therapists detect irrational beliefs and then dispute (challenge and question it)
91
Q

REBT: cognitive techniques

A
  • Scientific questioning:
  • D ‘Why must I always do well?’
  • E ‘I’d prefer to have passed, but there’s no proof I must have’
  • Rational coping statement
  • Cognitive homework (e.g. reminder cards, visualizing, self-help forms)
92
Q

REBT:Emotive techniques

A
  • Rational Emotive Imagery:
  • Role playing rehearse behaviours, work through irrational beliefs
  • Humour: put life in perspective, take things less seriously, laugh at self-defeating ways of thinking
93
Q

REBT: Behavioural Techniques

A
  • Shame-attacking: emotional distress (shame, guilt, humiliation)
  • Assignments that challenge demandingness: repeatedly do ‘feared’ behaviour, while convincing yourself it’s not awful (do this floodingly)
  • Reinforcement: rewards and penalties
94
Q

Does REBT work?

A
  • Studies show that REBT can be effective across a wide range of patients & contexts:
    1. REBT informed group therapy for veterans with PTSD reduced depression and PTSD symptoms (USA, 88.3% male sample; Grove et al., 2021).
    2. REBT reduced irrational beliefs & distress and increased self-acceptance for women at risk of exercise addiction (UK; Knapp et al., 2023).
    3. REBT reduced exam anxiety in school students (Indonesia; Misdeni et al., 2019).
    4. REBT increased self control and reduced impulsivity in male prisoners (Iran; Ahmadabadi et al., 2024)
  • But these studies have small samples sizes and no control condition
95
Q

David et al (2017) Systematic review & meta-analysis on REBT

A
  • Systematic review = uses a detailed, comprehensive strategy to search for and synthesise all existing relevant literature on a topic.
  • Meta-analysis = uses statistics to synthesise the data from multiple studies and give an effect size.
  • Reviewed 84 studies which included an REBT intervention and found a medium effect size on most outcomes (e.g. anxiety, depression, behavioural outcomes, quality of life) and irrational beliefs
  • Conclusion = REBT is a sound intervention
96
Q

Evaluating REBT

A
  • Evidence shows that it is effective across a range of outcomes
  • Focus on education supports longer term effectiveness for client without the need for ongoing appointments
  • Focus on beliefs, thoughts and behaviours more accessible than requiring client to go back into past memories and experiences
  • Ellis took quite a direct, confrontational approach (e.g. would interrupt clients) and used humour often
  • Confronting irrational beliefs may not be suitable for everyone (e.g. those who have experienced abuse/trauma/invalidation in the past)
  • Focus on irrational beliefs could be simplistic – role of past experiences (e.g. during childhood)
97
Q

Background on Beck

A
  • Began his research into depression in the 1950s
  • Professor of the Beck Institute for Cognitive therapy and Research
  • Developed important tests used throughout Clinical Psychology, including Beck Depression Inventory (BDI)
98
Q

Basic principles of CBT

A
  • Information processing critical for survival
  • How we feel and behave is based on hoe we perceive and structure our experiences
  • Schemas (develop early in life through experiences, fundamental beliefs about self and others, can be adaptive or maladaptive, selection of incoming info)
99
Q

Psychological distress

A
  • Biological, environmental & developmental factor all contribute to potential for psychological distress
  • Because of our schemas, we all have a set of unique cognitive vulnerabilities which predispose us to distress
  • Systematic bias – shift to rigid, absolutist thinking
  • Characterised by ‘logical errors’ – cognitive distortions
100
Q

What are automatic thoughts?

A
  • Involuntary, recurring words or images that occur rapidly at the edge of awareness
  • Reflect out schema content
  • Negative automatic thoughts (NATs) (e.g. “I’m useless. I’ll never get out of this mess”
  • Generally, plausible, but unrealist and an become frequent & severe
  • Systematic bias towards negative information in the cognitive triad (self, world, future)
  • As depressions worsens, depressive schema more activated and leading to an increase in cognitive distortions
101
Q

Beck’s cognitive therapy

A
  • Correct faulty information-processing
  • Treat beliefs and automatic thoughts as testable hypotheses
  • Learn to become own therapist
  • Process: in-depth initial session and get client to draw up a ‘problem list’. 5-16 weekly sessions that include homework. Takes a Rogerian therapeutic style
  • Collaborative empiricism and help client challenge their thoughts themselves and guide them on their discovery
102
Q

CBT: Cognitive interventions

A
  • Replace distorted NATs and beliefs with more realistic information-processing
    1. Elicit & Identify NATs: providing reasons and encourage engagement
    1. Reality-test & Correct NATs: Socratic dialogues “Is this thought helpful or true?” and forming adaptive responses (e.g. what should you replace this thought with?)
    1. Identify & Alter beliefs: hypothesis testing and re-fashioning beliefs
103
Q

CBT: behavioural interventions

A
  • Lay foundation for cognitive interventions
  • Assist in reality-testing and engaging in activities
  • Rating mastery, rehearsing behaviour, hypothesis-testing (do the thing you’re afraid about and see how it went) & assigning graded tasks (gradual process)
104
Q

3rd wave approaches to CBT

A
  • These approaches complement and extent CBT (more holistic and less symptom focused – promoting wellbeing)
  • CBT – content of thoughts, 3rd wave – context & relationship with thoughts
  • Many 3rd wave concepts ae now widely used, evidenced and considered part of CBT
105
Q

3rd wave examples:
Dialectical Behaviour Therapy (DBT)

A
  • Dialectal = two opposite things can be true
  • Designed for treating borderline personality disorder
  • DBT has a focus on self-acceptance, accepting and regulating strong emotions
  • Systematic reviews suggest it is effective for eating disorders (Bankoff et al., 2012), BPD and reducing suicide attempts, but not for depression (Panos et al., 2014)
106
Q

3rd wave examples: Mindfulness Based Cognitive therapy (MBCT)

A
  • Uses mindfulness techniques alongside CBT
  • Mindfulness can help us learn to observe and recogniser our thoughts without reacting to them
  • NICE recommended for prevention of relapse in current depression
  • Systematic review = effective at preventing relapse with a medium effect size (Fjorback et al, 2011)
107
Q

3rd wave examples: Acceptance and Commitment Therapy (ACT)

A
  • Learning to accept and live with our thoughts/ feelings rather than fighting them
  • A focus on learning our individua values and then setting goas that align with these values to ensure the goals are meaningful to the client
  • Used for managing physical and mental health issues
  • Systematic reviews suggest effective for chronic pain (Ost, 2014), depression (Zhenggang et al., 2020) and anxiety (Swain et al., 2013)
108
Q

Do cognitive behavioural therapies work?

A
  • In 2008, government allocated £300 million investment into Improving Access to Psychological Therapies (IAPT)
  • DeRubeis et al (2005) – Severe mdd
  • Placebo vs anti-depressant medication vs CBT
  • CBT as effective as anti-depressant medication than placebo control
  • Follow up: CBT has enduring effects and protects against symptom return. CT patients learn something that reduces subsequent risk
109
Q

CBT for phobia & Anxiety

A
  • Kani et al (2015). CBT for dental phobia. Following an average of 5 CBT sessions (79% patients had dental treatment without sedation)
  • Kendall et al (1994). ‘Coping cat’ CBT program for 9-13 yrs. Improvement in self and parent reported anxiety scores
110
Q

Does CBT work for everyone?

A
  • Gender: Suggested these may occur due to differences in emotional intelligence.
  • No apparent gender differences in CBT efficacy for depression (Cuijpers et al., 2014)
  • Culture/Ethnicity: All developed from similar US perspective, may not map across to other cultures (e.g. individualist vs collectivist)
  • Tang et al (2017) compared White and Asian Americans pre- and post- week long intensive CBT course and found no difference in symptom reduction or depression
  • Naeem et al (2015) adapted CBT for use in Pakistan (more involvement of family members and homework tasks)
111
Q

Evaluating CBT

A

Pros
- CBT approaches supported by the greatest weights of evidence
- Diversity perspective
- Some research with little difference in effectiveness across approaches
Cons
- CT assumes that correcting faulty thinking is what brings about clinical improvement
- Some researchers question whether research finding din CBT generalise to real clinical practice
- ‘Therapist drift; may lead to decreased effectiveness

Psychology Degree (8 decks)

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