PSYCHOLOGICAL INTERVENTIONS Flashcards
Describe the cognotive model in psychological interventions
We interact with the world through interpretations of our environment. It isn’t situation itself but our interpretation of it that causes our emotional response. These thoughts/meanings can change and therefore, so can our emotional reaction
What are the 3 levels of thought?
- Automatic Thoughts: fleeting, involuntary thoughts. E.g. “what a dick”
- Underlying Assumptions: can be healthy or unhealthy. E.g. “talking loudly in library is a dickish thing to do”
- Core Beliefs: often unconditional, rigid beliefs that give rise to our rules/assumptions. E.g. any selfish behaviour makes you a dick
Give examples of common cognitive biases/maladaptive thinking - 7 listed
Arbitrary inference Catastrophising Selective abstraction Magnification and minimisation Personalisation Absolutistic, dichotomous thinking “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 it!”
Drawing conclusions on the basis of insufficient or irrelevant evidence is what type of maladaptive thinking?
Arbitrary Inference
Define selective abstraction
Focusing on a detail taken out of context and ignoring other important features of situation
Describe magnification and minimisation in maladaptive thinking
Errors and distortions in way an event is perceived. Magnify weaknesses and minimise strengths
What is “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 it!”
Aims of cognitive interventions
Identify maladaptive (self defeating) thoughts or beliefs (cognitions), challenge them and change them to become more adaptive (cognitive restructuring). Change the way we relate to our thought. Develop effective coping strategies
What is self monitoring?
Aims to increase awareness of thoughts and subsequent emotions by recording them (this also allows external monitoring by a health professional)
What is a desicion balance sheet?
Thinking about costs/benefits of changing/not changing a behaviour and drawing up a table
What is the goal of motivational interviewing?
Encourage individuals to explore own conflicting beliefs and attitudes towards a particular behaviour. Effective in decreasing smoking, alcohol/drugs misuse, addictions, improving adherence to lifestyle changes. Induces cognitive dissonance
Common cognitive therapies
Rational Emotive Therapy Acceptance and Commitment therapy (ACT) Integrative therapy (IT) Cognitive Analytic Therapy (CAT) Interpersonal psychotherapy (IPT) Systemic/Family therapy
Aim and principle of behavioural interventions
Aim: substitute maladaptive behaviours for adaptive ones and relieve symptoms
Principle: interventions assume that maladaptive behaviour is a learned response and can be substituted for a better one
Operant conditioning is a behavioural intervention. What are the 3 types?
Positive reinforcement
Negative reinforcement
Punishment
Describe modelling in behavioural intervention
Learning behaviour by observing and imitating others. Models are observed performing stressful tasks without adverse effects. Most effective when model is perceived to be of ‘higher status’ or a peer
Describe progressive muscle relaxation
Most widely used relaxation technique in clinics. Focusing on 16 specific muscle groups in sequence combined with abdominal breathing. Daily practice should take about 20 mins
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
Describe exposure interventions
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
Describe flooding
Inescapable continuous exposure to feared subject (real, virtual or imagined) until anxiety subsides (extinction). Useful in treating phobias, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder etc.
Aims of Combined Cognitive and Behavioural Interventions (CBT) - 3 listed
- Identify and modify maladaptive beliefs and strategies
- Teach positive coping strategies
- Empower patient to become their own therapist
Pros of CBT - 5 listed
- Can be used in a wide range of disorders e.g. Depression, Generalised Anxiety Disorder, Bipolar disorder, Panic Disorder, Agoraphobia, Social Phobia, OCD etc…
- Can be used for children and adults
- Self help versions available
- Good evidence base for use for mild/moderate cases but also in severe cases alongside drugs
- Brief, time limited - 5 to 20 sessions
What is psychotherapy?
Treatment modality (talking therapy)
By a trained person
To relieve distress/ disability in another person
Based on a particular theory/ model
Aims of psychotherapy
Relieve symptoms
Explore and change maladaptive emotional, cognitive and behavioral patterns
Encourage and facilitate self-exploration and knowledge
Enable learning of tools and skills to help oneself
Increase resilience
What is psychological resilience?
Individual ability to successfully adapt to life tasks in face of social disadvantage or highly adverse conditions. Adversity and stress can come in shape of family or relationship problems, health problems, or workplace and financial worries, among others. Resilience is ability to bounce back from a negative experience with “competent functioning”. Resilience is not a rare ability; in reality, it is found in the average individual and it can be learned and developed by virtually anyone
Who is suitable for psychotherapy?
Psychologically minded Owns difficulties Can self reflect/question Motivation to understand and change Capacity for self-containment Can have learning difficulties
Who is not suitabe for psychotherapy?
Poor impulse control Poor frustration tolerance Impaired cognitive function Substance abuse/dependency Active psychosis
Define psychologically minded
Capacity to think about oneself, reflect about one’s own cognitive processes, emotions and behaviours and verbalize them. Capacity for self containment: Being able to tolerate a degree of emotional discomfort
Types of psychotherapy - list 4
Supportive
Behavioural
Cognitive Behavioural (CBT)
Counselling
What is the stepped care approach for psychotherapy in the NHS?
- Primary Care: GP/ IAPT
- Secondary Care: Mental Health Trusts
Psychotherapy Departments
Personality Disorder Units
Liaison Departments
Community MHTs - Tertiary Care:
Specialist National Units
OCD and BDD Service (SWLStG)
Cassel Hospital (Therapeutic Communities)
Describe supportive psychotherapy
Encouraging the positive (as opposed to seeking insight)
Emotional release
Explanation and advice
Reassurance
Indication: Chronic mental and physical illnesses
Describe the 3 parts of the therapeutic relationship
- Therapeutic alliance
- Transference
- Countertransference
The therapeutic alliance is the rational (implicit) contract between doctor and patient. The contract may be straightforward with mutual cooperation. The contract may be complicated by a covert agenda: patient’s unconscious and unspoken wishes and needs (the transference)
What is transference in the therapeutic alliance?
Early relationships get transferred onto a person or situation in present. It is at least partly inappropriate (disproportionate) to present. Other person is expected to play complementary role through subtle behavioural “nudges” to take on these feelings and behaviours. Example: pt afraid that he is seriously ill may adopt a helpless child-like role and project an omnipotent parent-like quality on to doctor, who is then expected to provide a solution
What is countertransference in the therapeutic alliance?
Emotions evoked in therapist/dr. Includes feelings evoked by pt’s transference. Useful guide to pt’s expectations. Easy to identify if not congruent with dr’s expectations. Awareness of transference: countertransference relationship allows thoughtful rather than unthinking response from dr
Describe defence mechanism projection
Ascribing difficult/unacceptable bits of self to others (self doubt in oneself is seen as incompetence in others)
Describe defence mechanism regression
Retrograde step to an earlier stage of development (acceptable when ill)
Describe defence mechanism rationalisation
Externally located explanation (patients ambivalent to therapy often come late to sessions and give practical excuses)
Describe defence mechanism reaction formation
Opposite extreme (excessive cleanliness to counteract “dirty” wishes)
Describe defence mechanism displacement
Anger at your boss makes you kick your cat/argue with your wife
Purpose of psychological defense mechanisms
Employed to resist the unconscious being made conscious
