Psychological Interventions Flashcards
Describe the historical context surrounding Clinical Psychology?
- emerged as a practice in the 19th Century
- The first psychological clinic is credited to Lightner Witmer at the University of Pennsylvania (1896)
- In the U.K., the first clinical psychology clinics emerged at the Tavistock Centre in London in 1926 and the Notre Dame Centre in Glasgow in 1931
- Profession developed after World War II and with the advent of the NHS
- The first ever trainees in Clinical Psychology were trained at the Maudsley Hospital in London in 1949
Identify what a Clinical Psychologist does (Llewelyn & Murphy (2014).
- 6 core competencies.
- Assessment
- then Formulation
- then intervention
- then evaluation
- then communication/consultation & service delivery
- then leadership
Describe what is meant by the ‘reflective scientist-practitioner’.
(Scientist)
- Evidence-based treatments and recommendations
- Develop hypotheses (almost like a research question)
- Conduct research and evaluate outcomes
Describe what is meant by the ‘reflective scientist-practitioner’.
(Reflective - Schon, 1983)
- ‘Thinking on your feet’
- Use of past experience
- Use of psychological theory
What is the core purpose and philosophy of the profession (Clinical Psychology)?
- aims to reduce psychological distress
- enhances and promote psychological well-being by the systematic application of knowledge derived from psychological theory and data.
- aim to enable individual service users and carers to have the necessary skills and abilities to cope with their emotional needs and daily lives in order to maximise psychological and physical well-being
BPS, 2010
Identify the main stages of developing, evaluating and implementing complex interventions.
Intervention Development
Feasibility and Piloting of the Intervention
Evaluation of the Intervention
Implementation of the Intervention
Describe the process of developing interventions.
- Identify the evidence-base (look at what research has already been done in this area)
- Interventions should be based on theory (have an early understanding of the process of change that you expect)
- Important to think about implementation and feasibility
These processes are relevant for researchers and clinicians when developing and delivering interventions for mental health
Define what a Developmental Psychopathology Perspective is
how early child experiences influence later outcomes such as mental health in adulthood
Why is child and adolescent mental health important?
Observed behaviour in childhood is a risk factor for psychopathology in later life (Caspi et al, 1996)
Intervening during childhood could improve long-term outcomes for children and young people
Outline the prevalence rates of emotional and behavioural problems in childhood
Around 10% of children (aged 5-16) in the UK meet criteria for an emotional or behavioural disorder.
Anxiety (3.5%), ADHD (2.2%) and disruptive behaviour disorders (5%) are the most prevalent (Ford et al., 2017)
For 50% of children, conditions persist 3 years later
Prevalence rates of co-occurring conditions are higher for children with neurodevelopmental conditions (autism, intellectual disability)
Outline the Challenges in Child and Adolescent Mental Health
It is important that children are not over-diagnosed; behaviours need to be clinically relevant
Behaviours should be considered in terms of what is appropriate for children for their age (e.g. temper outbursts at age 3 vs. age 14)
Diagnosis and assessment may be complicated by the fact that some children are unable communicate how they are feeling
However, if emotional and behavioural problems are impacting children, intervention may be needed
Interventions should be evidence-based, and based on theory. We will discuss some of the key theories in childhood anxiety and disruptive behaviour in the next videos.
What is the meaning of Externalising Behaviours in Childhood?
Behaviours directed outward (e.g. aggression, non-compliance, impulsivity)
Attention Deficit Hyperactivity Disorder (ADHD)
Oppositional Defiant Disorder (ODD)
Conduct Disorder
Outline what is Attention Deficit Hyperactivity Disorder (ADHD).
- Persistent pattern of inattention and/or hyperactivity/impulsivity at rates higher than would be expected for child’s developmental level
- Occurs before age 12
- Pervasive across settings (it’s everywhere)
Outline what is Oppositional Defiant Disorder (ODD)
- A pattern of angry/irritable mood and argumentative/defiant behaviour
- Exhibited with at least one person who is not a sibling
Outline what is meant by Conduct Disorder (CD)
An ongoing pattern of behaviour where the rights of others or social norms are infringed
Show at least three behaviours over a 12 month period
Describe the Formulation Process
Presentation at Clinical Services
Assessment: What made the person vulnerable in the first place?
Treatment planning: What triggered the behaviour/problem?
Treatment implementation and monitoring overtime: What is causing the behaviour/problems to be maintained overtime? What keeps the problem going?
Identify the Key theories to explaining externalising behaviours in childhood
- Parent-Child Interactions
- Executive Function Deficits
- Theory of Mind Deficits
- Media and Peer Influences
- Cognitive Factors
- Neglect
- Socio-economic factors
- Family Environment
Explain the Parenting and the Family Environment Theory to explaining externalising behaviours in childhood
Adverse familial environments and parenting practices are commonly observed in families of children who show high levels of externalising behaviour problems (Johnston & Mash, 2001).
Parents are more likely to engage in hostile parenting practices, use inconsistent discipline strategies and show less warmth in interactions.
Child emotion regulation may mediate the relationship between parenting practices and Child Disruptive Behaviour (Duncombe et al., 2012)
Describe Socioeconomic factors to explaining externalising behaviours in childhood
- Socio-economic factors play a role in the development of externalising child behaviour
- For children who moved out of poverty, also likely to show a reduction in behavioural problems (not emotional)
- Seems to be related to the amount of time that parents can spend with their child
Costello EJ, Compton SN, Keeler G, Angold A. Relationships between poverty and psychopathology: a natural experiment. JAMA. 2003
Describe the cognitive factors to explaining externalising behaviours in childhood
Executive function deficits have been implicated in externalizing behaviour problems in children
Impulsivity, working memory and cognitive flexibility
Some children with ADHD display differences in reward processing (Seidman 2006).
Preference for smaller, immediate rewards over larger later rewards and display greater sensitivity to social rewards (Kohls et al. 2009)
Examiner leaves the room and informs child that if they wait for them to get back they have two marshmallows.
They they call the examiner back immediately, they only get one.
Identify what is meant by internalising behaviours in childhood
Behaviours directed inward (e.g. withdrawal, low mood)
Childhood anxiety disorders (e.g. separation anxiety)
Childhood major depression
General Outline of Childhood Anxiety
Anxiety in children will overlap with adult anxiety that you will have covered in
‘Introduction to Clinical’
Generalised Anxiety Disorder
Social Anxiety Disorder
Some manifestations of anxiety tend to more prevalent in childhood
Separation anxiety
Disproportionate distress when separated from parents
Distress about harm coming to parents
Unable to sleep alone
A combination of inherited factors and environmental stressors
General Outline of Traumatic Life Experiences
and internalising behaviours in childhood
Physical Health Conditions
20% of children experience chronic physical health conditions such as asthma, epilepsy (van der Lee et al., 2007)
Children with physical health conditions experience higher levels of anxiety than children without physical health conditions (Pinquart & Shen, 2011)
Learned helplessness from unpredictability of physical health conditions (e.g. epileptic fits)
Indirect effect by impacting the family environment (Ferro & Boyle, 2014)
Internalising problems also associated with bullying/peer victimisation
General Outline of Modelling and Exposure
and internalising behaviours in childhood
Children will use information from people around them to help them learn what is scary/dangerous and what is not (vicarious learning)
Askew, Kessock-Phillip & Field (2008)
