Psychological interventions

Question 1

what are psychological interventions?

Answer 1

actions put in place to influence the way we think and behave

Question 2

what are examples of where psychological interventions can be used?

Answer 2

1. 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
2. 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)
3. Health behaviours - positive and negative

Question 3

what are the goals of a psychological intervention? give examples

Answer 3

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

Question 4

How are psychological interventions used in medical settings?

Answer 4

• 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

Question 5

what are the different types of interventions ?

Answer 5

• cognitive interventions
• behavioural interventions
• combined interventions

Question 6

what does the cognitive model describe?

Answer 6

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

Question 7

list the assumptions of the cognitive model

Answer 7

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

Question 8

What are the 3 levels of thinking (cognitive model)?

Answer 8

1. automatic thoughts
2. underlying rules and assumptions (intermediate beliefs)
3. core beliefs (cognitive schemata)

Question 9

what are automatic thoughts?

Answer 9

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.

Question 10

what are underlying thoughts and assumptions (intermediate beliefs)

Answer 10

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.

Question 11

what are core beliefs?

Answer 11

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”.

Question 12

Arbitrary Inference

Answer 12

Drawing conclusions on the basis of insufficient irrelevant evidence

Question 13

Catastrophising

Answer 13

assume worst possible case scenario

Question 14

Negative predictions

Answer 14

expecting not to enjoy a party, expecting to feel too tired to exercise, expecting that others will not like your ideas

Question 15

Selective abstraction

Answer 15

Focusing on a detail taken out of context and ignoring other important features of the situation.

Question 16

Magnification and minimisation

Answer 16

Errors and distortions in the way an event is perceived. Magnify weaknesses and minimise strengths.

Question 17

Personalisation

Answer 17

Relating an event to oneself when there is no basis for making such a connection.

Question 18

Absolutistic, dichotomous thinking

Answer 18

Tendency to place one’s experience in one of two opposite categories (splitting)

Question 19

Fait accompli” thinking

Answer 19

(‘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!”

Question 20

Aims of cognitive interventions

Answer 20

• 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

Question 21

what is the purpose of self-monitoring?

Answer 21

to identify and increase attention/awareness of the thought, and subsequent emotion and behaviour

Question 22

what is self-monitoring?

Answer 22

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

Question 23

what is a thought diary?

Answer 23

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

Question 24

what is cognitive restructuring?

Answer 24

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

Question 25

what is cognitive restructuring?

Answer 25

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

Question 26

what is socratic questioning?

Answer 26

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?

Question 27

how do you consider using decisional balance intervention for making lifestyle changes

Answer 27

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

Question 28

what is the goal motivational interviewing?

Answer 28

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

Question 29

what is cognitive dissonance?

Answer 29

holding opposing beliefs, this causes psychological discomfort

Question 30

what are the key characteristics of motivational interviewing?

Answer 30

non-confrontational roll with resistance increase motivation supports patient autonomy

Question 31

what are distraction techniques?

Answer 31

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

Question 32

what are the assumptions of behavioural interventions?

Answer 32

- 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

Question 33

what are the aims of behavioural interventions?

Answer 33

to substitute maladaptive behaviours for adaptive ones to relieve symptoms e.g conditioning, reward and reinforcement

Question 34

what is modelling?

Answer 34

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

Question 35

what is positive reinforcement?

Answer 35

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)

Question 36

what is negative reinforcement?

Answer 36

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.

Question 37

what is selective reinforcement?

Answer 37

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.

Question 38

what is relaxation training?

Answer 38

1) Learn to relax & practice regularly 2) Self-monitoring of tension in daily life 3) Use relaxation at times of high stress

Question 39

what is progressive muscle relaxation (PMR)

Answer 39

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

Question 40

Pros of relaxation techniques

Answer 40

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

Question 41

Cons of relaxation techniques

Answer 41

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

Question 42

what are systematic desensitisation/graduated exposure interventions?

Answer 42

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.

Question 43

what is flooding?

Answer 43

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

Question 44

what is biofeedback?

Answer 44

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.

Question 45

what are the benefits of biofeedback?

Answer 45

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

Question 46

aims of CBT

Answer 46

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

Question 47

features of CBT

Answer 47

*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

Question 48

advantages of CBT

Answer 48

 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

Question 49

list some recommendations and research evidence for CBT

Answer 49

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.