Psychological interventions Flashcards
what are psychological interventions?
actions put in place to influence the way we think and behave
what are examples of where psychological interventions can be used?
- commercial advertising - marketing products - these shape our buying habits e.g fruit and veg are placed at the front to attract you as they are bright and we feel virtuous buying healthy food
- politics and social control - provision of information/misinformation, monitoring and surveillance, social cohesion, establishing and maintaining social norms and values (support for NHS, preventative population behaviours COVID-19)
- Health behaviours - positive and negative
what are the goals of a psychological intervention? give examples
to bring about some form of change in beliefs, behaviour and mood
examples:
- “beating the blues” is an online programme designed to help people with moderate depression
- “overcoming bulimia” is an online package containing 8 different sessions of CBT for bulimia sufferers
- “sleepio” is a successful online CBT intervention for insomnia
How are psychological interventions used in medical settings?
- to increase the perception of control and predictability
- to reduce pre/post operative anxiety, reduce pain and analgesia requirements
- health promotion and risk reduction to modify established habits - smoking, diet, exercise, alcohol and increase adherence to treatment
- managing adherence, coping and adjustment issues e.g chronic illness, changes in family dynamics, disability, body image, bereavement
- managing problems related to mood - depression, anxiety, anger, stress
- stress management - coping, anxiety, behavioural and emotional disturbance, PTSD, phobias, pre/post operative anxiety, crisis management, improving sleep
- used as an alternative/adjunct to drugs - this reduces over-medication
- managing symptoms and side effects of difficult to manage conditions e.g. chronic pain, chemotherapy
what are the different types of interventions ?
- cognitive interventions
- behavioural interventions
- combined interventions
what does the cognitive model describe?
It describes how our perceptions and spontaneous thoughts about situations influence our emotional behaviour and sometimes our physiological reactions.
It suggests that there is a relationship between what we think, how we feel and what we do
list the assumptions of the cognitive model
our interactions with the world are through the interpretations and evaluations we make about our environment
it’s not the situation itself but rather the thoughts, beliefs and meanings we attach to the event that produces our emotional and behavioural response
results of cognitive processes are accessible via thoughts therefore they have the potential to change
What are the 3 levels of thinking (cognitive model)?
- automatic thoughts
- underlying rules and assumptions (intermediate beliefs)
- core beliefs (cognitive schemata)
what are automatic thoughts?
Automatic thoughts - fleeting thoughts that pop into your mind unbidden. They can be positive or negative. They are involuntary and situation-specific. E.g you are told to prepare a presentation to present to the cohort in 10 minutes’ time.
what are underlying thoughts and assumptions (intermediate beliefs)
Underlying rules and assumptions - Guide behaviour, set standards, and provide the ‘rules’ by which we live our lives. Healthy vs unhealthy. Often unarticulated - Assumptions can often be identified by their ‘if……then’ construction. Rules are usually expressed as ‘expressed as ‘must’’ & ‘‘should’’ statements.
what are core beliefs?
Give rise to our rules and assumptions, and thoughts (NATS)
Develop in early life and childhood
Enduring ideas and philosophies we hold very deeply - centre of our beliefs
Global, absolute, rigid
Focus on self, others, world
Can be positive and/or negative
They are usually over-generalised, unconditional and rigid
E.g.If I grow up to believe that I will only be worthy of love and acceptance if/when I achieve, I may believe that I am unlovable if I do not achieve goals as I believe I “achieve goals as I believe I “should”.
Arbitrary Inference
Drawing conclusions on the basis of insufficient irrelevant evidence
Catastrophising
assume worst possible case scenario
Negative predictions
expecting not to enjoy a party, expecting to feel too tired to exercise, expecting that others will not like your ideas
Selective abstraction
Focusing on a detail taken out of context and ignoring other important features of the situation.
Magnification and minimisation
Errors and distortions in the way an event is perceived. Magnify weaknesses and minimise strengths.
Personalisation
Relating an event to oneself when there is no basis for making such a connection.
Absolutistic, dichotomous thinking
Tendency to place one’s experience in one of two opposite categories (splitting)
Fait accompli” thinking
(‘What the hell effect’) “I didn’t mean to eat that piece of pie. There goes my diet, may as well finish the whole pie!”
Aims of cognitive interventions
- To identify maladaptive thoughts/beliefs
(cognitions), challenge them & change them to
become more adaptive (cognitive restructuring). - Develop effective coping strategies
- Help the patient to gain some insight into their
cognitive and emotional functioning - Requires some understanding of the relationship between thoughts/feelings/behaviour
what is the purpose of self-monitoring?
to identify and increase attention/awareness of the thought, and subsequent emotion and behaviour
what is self-monitoring?
increasing awareness by recording thoughts, emotions and behaviour. It should be quick and simple to make the record e.g. thoughts, emotional response, rate intensity, resulting behaviour
what is a thought diary?
its where you track your thoughts and emotions and then challenge that pattern of thought
e.g if I failed an exam that means I’m stupid but I challenge that thought by remembering my academic attainment proves otherwise
what is cognitive restructuring?
learning to question automatic thoughts and beliefs, assumptions and predictions that often lead to negative emotions
replacing negative thinking with more realistic and positive beliefs
what is cognitive restructuring?
learning to question automatic thoughts and beliefs, assumptions and predictions that often lead to negative emotions
replacing negative thinking with more realistic and positive beliefs
what is socratic questioning?
is the thought based on emotion or facts?
what evidence is there that this thought is accurate?
how could I test this belief?
what other ways could this information be interpreted?
how do you consider using decisional balance intervention for making lifestyle changes
think about the costs and benefits of changing and not changing a specific behaviour
determining what is involved in the decision to change current habits
change is difficult - are the costs worth it?
e.g. make a table of benefits and costs for the desired behaviour and current behaviour and weigh it up
what is the goal motivational interviewing?
to guide individuals to explore their own conflicting beliefs and attitudes towards a decision regarding particular behaviour - helps to reduce ambivalence
it is effective in reducing smoking, alcohol/drugs misuse, addictions, improving adherence to lifestyle changes
what is cognitive dissonance?
holding opposing beliefs, this causes psychological discomfort
what are the key characteristics of motivational interviewing?
non-confrontational
roll with resistance
increase motivation
supports patient autonomy
what are distraction techniques?
they are a cognitive technique which involved deliberately focussing attention away from whatever is causing distress
effective in reducing moderate to acute stress
short term
e.g colouring, puzzles, talking to a nurse, watching tv
what are the assumptions of behavioural interventions?
- maladaptive behaviour is a learned response
- can be substituted for a more adaptive response
- focus on a specific behaviour/treat specific symptoms
- insight of the theory is not required
what are the aims of behavioural interventions?
to substitute maladaptive behaviours for adaptive ones
to relieve symptoms
e.g conditioning, reward and reinforcement
what is modelling?
learning behaviour by observing and imitating others
most effective when model is perceived as being of a higher status
most effective when results in reward
can be symbolic e.g. film clips
models can be observed performing stressful tasks without adverse effects
useful in treating anxieties, specific phobias etc
what is positive reinforcement?
If a behaviour is followed by some form of reward this increases the likelihood that the behaviour will be repeated.
If it is not rewarded or it is followed by an unpleasant outcome, the behaviour will occur less frequently or be extinguished. (Skinner, 1953)
what is negative reinforcement?
If a behaviour results in a (usually unpleasant) stimulus being removed it increases the likelihood the behaviour will be repeated.
Example: child cries so medication not given.
what is selective reinforcement?
rewarding desired behaviour and ignoring undesirable behaviour. Useful in modifying behaviours, improving adherence etc. Examples: Star charts, Token rewards - shopping vouchers for breastfeeding, student prizes, Loyalty cards etc.
what is relaxation training?
1) Learn to relax & practice regularly
2) Self-monitoring of tension in daily
life
3) Use relaxation at times of high
stress
what is progressive muscle relaxation (PMR)
Most widely used relaxation technique in clinics
Systematic technique for reducing muscle tension in clinic/everyday use.
Focusing on 16 specific muscle groups in sequence combined with abdominal breathing
Involves tensing (7-12 secs) and then relaxing (15 secs) muscle groups - 2 to 3 repetitions per muscle group
Daily practice should take about 20 minutes
Pros of relaxation techniques
Easy to learn
Can be used virtually anywhere
Once learned relaxation is rapid
Easily combined with other techniques
No special equipment required
Choice of techniques
Cons of relaxation techniques
Daily practice required
Not suitable for all clinical populations (caution: psychosis, schizophrenia)
Can take time to learn (PMR/meditation)
Does not address underlying cognitive processes
what are systematic desensitisation/graduated exposure interventions?
A method of eliminating fears by substituting
a response that is incompatible with anxiety
such as relaxation.
Based on principles of classical & operant
conditioning
Gradual controlled increased exposure
(imagined or real) to the feared subject
whilst maintaining a relaxed state until fear
is extinguished.
what is flooding?
Inescapable continuous exposure to the
feared subject, either real, virtual or
imagined, until anxiety subsides (extinction).
Useful in treating phobias, Obsessive Compulsive Disorder, Post Traumatic
Stress Disorder etc
what is biofeedback?
identifying and recording the physiological stress response
may involve using a mechanical device to monitor heart rate, resp rate, bp, muscle tension and temperature
Patient learns relaxation/breathing techniques to reduce the
physiological readings.
Positive reinforcement -patient can feel/ see immediate response.
Increases confidence and self efficacy
Ability to use techniques without mechanical support.
what are the benefits of biofeedback?
Increased awareness and confidence in relaxation skills
Control over “involuntary” functions
May be useful in ‘difficult to treat’ conditions:
recurrent migraine headache
Tension headaches
Hypertension
Treatment of Raynaud’s disease
Urinary incontinence
Labour pain in childbirth
However:
Few controlled trials
Placebo effect
aims of CBT
Identify and modify maladaptive beliefs & strategies
Teach positive strategies for coping and managingTeach positive strategies for coping and managing
Empower patient to become own therapist
features of CBT
*Education - process and goals of CBT
*Collaboration between client & therapist – therapeutic alliance
*Identifying maladaptive beliefs & behaviours
*Guided discovery & Socratic questioning
*Cognitive re-structuring
*Goal setting with self-reinforcement
*Homework - Self monitoring, thought records, diaries
behavioural experiments
*Relapse prevention
*Empowering the patient to be their own therapist
advantages of CBT
Can be used in a wide range of disorders
e.g. Depression, Generalised Anxiety Disorder, Bipolar disorder, Panic Disorder,
Agoraphobia, Social Phobia, OCD, PTSD, Eating Disorders, Self-harm,
Psychosis, Schizophrenia and more …
Can be used for children and adults
Self help versions available – written manuals, online
programmes, facilitated groups
Good evidence base for use for mild/moderate cases but
can also be useful in more severe cases used alongside
medication (Butler et al, 2006)
Brief and time limited – 5 to 20 sessions
list some recommendations and research evidence for CBT
NICE recommends CBT for the treatment of anxiety disorders (including panic
attacks and PTSD), depression, OCD, schizophrenia and psychosis, bipolar attacks and PTSD), depression, OCD, schizophrenia and psychosis, bipolar disorder. There is also good evidence that it is helpful for treatment of chronic disorder. There is also good evidence that it is helpful for treatment of chronic
fatigue, behavioural difficulties in children, chronic pain, sleep disorders, anger
management.
DOH recommends CBT treatment of Depression, PTSD, anxiety disorders, eating
disorders, chronic fatigue, chronic pain.
Large review of the efficacy of CBT for a range of mental health conditions
including anxiety, depression, eating disorders, schizophrenia etc. Hofmann, S.G. et
al (2013)
CBT for General Anxiety Disorder is as effective as pharmacological treatment in CBT for General Anxiety Disorder is as effective as pharmacological treatment in
reducing anxiety, depression and increasing quality of life.
RCTs show positive effects of CBT for a range of illnesses from rheumatoid
arthritis, cancer, chronic fatigue, tinitis, traumatic brain injury, sleep problems tasthma.
