Psychological interventions Flashcards
BBM
What is the goal of psychological interventions?
Bring about form of change in:
- Beliefs
- Behaviour
- Mood
When are psychological interventions used in medical settings?
- Reduce pre/post op anxiety, pain + reduce analgesia requirements
- Health promotion + risk reduction - smoking, diet, exercise, alcohol, drugs
- Manage adjustment issues - chronic illness, family changes, disability, loss
- Stress management - coping, anxiety, behavioural/emo disturbance, PTSD, phobias
- Managing mood problems - depression, anxiety, anger
- Alternative/adjunct to drugs - reduces over-medication
- Managing symptoms/side-effects of difficult to manage conditions - chronic pain, chemo
What are the (3) main types of interventions?
- Cognitive
- Behavioural
- Combined
What does the cognitive model state?
Thoughts, behaviours, feelings
States that all link together and affect one another.
What are the assumptions of the cognitive model?
- We interact with the world through interpretations and evaluations that we make about our environment
- It is not the situation itself that causes psychological disturbance. It’s the thoughts, beliefs and meanings we attach to the event that produce our emotional and behavioural responses.
- Results of cognitive processes are accessible via thoughts and images, and therefore have potential to change.
What are the 3 levels of thinking targetted by cognitive interventions?
- Automatic thinking (highest level)
- Underlying rules and assumptions (intermediate beliefs)
- Core beliefs (cognitive schemata)
What are automatic thoughts?
Fleeting thoughts that pop into your mind unbidden, situation specific and involuntary.
Feeling results in the thought (negative automatic thoughts):
Eg. I feel anxious - I can’t cope, I’ll make a fool of myself
I feel pain - I am going to die
I feel incompetent - I’ll make a fool of myself, everyone will see…
What is meant by underlying rules and assumptions?
Guide our behaviour, set standards that we live by - can be healthy or unhealthy.
Examples of unhealthy assumptions:
- ‘If I am to be successful, people must like me’
- ‘I must get over 80% in my exams in order to be successful’
- ‘No one should be disrespectful to me or treat me poorly’
They provide a way to avoid facing a negative core belief.
What are core beliefs?
They give rise to our rules and assumptions and thoughts (NATS). Developed in early life/childhood, the centre of our beliefs. Usually global, absolute and focus on ourselves, the world. Can be positive or negative.
Activated by life events (trauma, bereavement, rejection)
Negative core beliefs usually:
- Over-generalised
- Unconditional
- Rigid
- Eg. ‘I’m unlovable’ ‘I can’t trust anyone’ ‘I am bad’
Cognitive biases refer to maladaptive thinking, logical errors or cognitive distortions. What are some examples?
- Arbitary inference
- Catastrophising
- Selective abstraction
- Magnification and minimisation
- Personalisation
- Absolutistic, dichotomous thinking
- Fait accompli thinking
Briefly describe Beck’s cognitive theory of depression
- Negative triad - pessimistic beliefs about self, world + future
- Negative schemas or beliefs triggered by negative life events
- Cognitive biases
This is all said to associate/cause depression.
What do cognitive interventions focus on?
- Identifying maladaptive thoughts or beliefs, challenging them and changing them to become more adaptive - cognitive restructuring.
- Changing the way we relate to our thoughts
- Developing effective coping strategies
For depression, anxiety, panic disorders etc.
An example of a cognitive intervention is ‘self-monitoring’. What is the purpose of this and how is it helpful?
- PURPOSE: To identify and increase attention of thoughts, emotion, behaviour (+ allows external monitoring by HCP)
- Monitoring process: inc awareness by recording thoughts, emotions + behaviour. Should be quick and simple to make record.
- Timing of record keeping: ASAP after emotion/behavioour has occurred.
A ‘thought diary’ is an effective way of self-monitoring, in terms of cognitive intervention. What things does a thought diary take into account?
- Event/trigger
- Thoughts/beliefs
- Emotional response
- Consequences + actions
- Thinking error
What is decisional balance intervention?
- Thinking about costs/benefits (pros/cons) of changing and not changing a specific behaviour.
- Determining what is involved in decision to change current habits
- Change is difficult - are costs worth it?
So look at costs/benefits of changing behaviour and then of maintaing behaviour - eg. taking regular exercise.
What is motivational interviewing?
- Goal - to encourage individuals to explore their own conflicting beliefs towards particular behaviour or change.
- Effective in decreasing smoking, alcohol/drug misuse, addictions, improving adherence to lifestyle changes etc.
- Cognitive dissonance - psychological discomfort of two opposing views, so consultant will try to help patient explore these feelings and increase levels of motivation.
What is Rational Emotive Therapy (Ellis, 1960s)
Usually requires a trained counsellor
- A - identify Activating event (trigger)
- B - identify Beliefs, assumptions + thoughts in response to A
- C - identify the emotional and behavioural Consequences of B
- D - Dispute irrational beliefs
- E - develop an Effective new rational outlook by restructuing belief system in order to acknowledge rational beliefs + discard irrational ones
Can you name any other types of cognitive therapies that involve a trained counsellor?
- Acceptance and comitment therapy (ACT)
- Integrative therapy (IT)
- Cognitive Analytic Therapy (CAT)
- Interpersonal psychotherapy (IPT)
- Systemic/family therapy
What are distraction techniques? How are they useful?
- Cognitive technique involves deliberately focussing attention away from whatever is causing distress
- Effective in reducing moderate-acute pain/distress
- Short term - lasts as long as person remains distracted
- Eg. counting, colouring, puzzle, talking, crosswords, TV, music etc.
Cartoon distraction alleviated anxiety in children during anaesthesia.
What are 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 and/or understanding of theory is not a requirement
What are aims of behavioural interventions?
- Substitute maladaptive behaviours for adaptive ones
- Relieve symptoms
What is modelling?
Learning a behaviour by observing and imitating others.
- Models are observed performing gradually more stressful tasks without adverse effects
- Useful in treating anxieties concerning hospital procedures, specific phobias, social phobia + new skills.
- Behavioural rehearsal (medical training) - role play, cardiac resus procedures, simulations, history taking, breaking bad news.
Reward and Reinforcement: What is meant by positive reinforcement?
If a behaviour followed by reward, this increases likelihood of behaviour being repeated. If it is not rewarded or is followed by an unpleasant outcome then the behaviour will occur less frequently.
What is negative reinforcement?
If a behaviour results in (usually unpleasant) stimulus being removed, it increases the likelihood of behaviour being repeated.
