psychological therapies

Question 1

3 common mental health problems - categories

Answer 1

1. affective/anxiety disorders
2. substance misuse disorders
3. disorders of reaction to psychological stress

Question 2

which affective and anxiety disorders are amenable to psychological therapies

Answer 2

major depressive disorder (MDD)
generalised anxiety disorder (GAD)
panic disorder and phobic anxiety disorders
obsessive compulse disorder (OCD)

substance misuse disorders - alcohol, tobacco, opioids, benzodiazepines, stimulants etc

PTSD

Question 3

availability of psychological therapies

Answer 3

limited availability
- long waiting times

reality of long waiting times means lots of people are seen in 1y care and prescribed medication until they are able to start therapy

Question 4

evidence based therapy - psychological therapies

Answer 4

useful guidelines for treatment - NICE, SIGN, matrix

details evidence based therapeutic approaches for a range of severities for lots of conditions

Question 5

what is CBT

what does it focus on

types of CBT

Answer 5

cognitive behavioural therapy

how our thoughts relate to our feelings and behaviour

focus on here and now

problem focussed, goal oriented

individual, group, self-help book or computer programme

Question 6

what conditions is CBT useful for

Answer 6

particularly good for depression, anxiety, phobias, OCD, PTSD

Question 7

over what time frame is CBT effective

Answer 7

evidence for it to be effective as a short term therapy

e.g. over 12 wks

Question 8

CBT example of how thoughts affect feelings and behaviours

Answer 8

Question 9

what does the therapist help the client with in CBT

Answer 9

identify thoughts, feelings and behaviours
assess whether thoughts are unrealistic/unhelpful (thinking errors)
- automatic -ve thoughts
- unrealistic beliefs
- cognitive distortions
- catastrophising
- black and white/all or nothing thinking
- perfectionism

identify what can change

Question 10

CBT ‘homework’

Answer 10

client engages in homework which challenges the unrealistic or unhelpful thoughts

• graded exposure
• response prevention

Question 11

what is behavioural activation effective for

Answer 11

evidence base of efficacy, specifically for depression

depression - activities function as avoidance and escape from aversive thoughts, feelings and external situations

Randomised control trial - activity scheduling alone for depression as effective as CBT for depression

Question 12

behavioural activation - theory and rationale

Answer 12

focus on avoided activities:

• as a guide for activity scheduling
• for a functional analysis of cognitive processes that involve avoidance

focus on what predicts and maintains an unhelpful response by various reinforcers

client taught to analyse unintended consequences of their way of thinking

Question 13

examples of avoidance in depression

Answer 13

• social withdrawal - not answering the phone, avoiding friends
• non-social avoidance - not taking on challenging tasks, sitting around the house, spending excessive time in bed
• cognitive avoidance - not thinking about relationship problems, not making decisions about the future, not taking opportunities, not being serious about work/studies
• avoidance by distraction - watching TV, computer games, gambling, comfort eating, excessive exercise
• emotional avoidance - use of alcohol and other substances

Question 14

goals of behavioural activation

Answer 14

collaborative/empathic/non judgemental
structured agenda - review progress
small changes - build to long term goals

Question 15

what is IPT

what can it be used to treat

Answer 15

interpersonal therapy

treatment for depression/anxiety - as good as CBT for depression

focuses on the present

Question 16

time for IPT

Answer 16

time limited

12-16wks

Question 17

theory behind IPT

Answer 17

our affect is linked with interpersonal events in our life

e. g. depression often follows a disturbing change in or contingents w/ significant interpersonal event
e. g. complicated bereavement, dispute, role transition, interpersonal deficit

Question 18

what is an interpersonal deficit

Answer 18

difficulty relating to others

Question 19

interpersonal therapy in practice

Answer 19

‘sick role’ given to the client - permission to acknowledge they are struggling

construct an interpersonal map - identify the interpersonal context (look at all the key people and relationships in their life and identify areas of difficulty)

identify ‘focus area’ that might be maintaining depressive symptoms

weekly goals to work on

Question 20

goal of IPT for depression

Answer 20

reduce depressive symptoms

improve interpersonal functioning

Question 21

strengths of IPT

Answer 21

strong evidence for treating depression

no formal homework - may be preferable

client can continue to practice skills beyond the sessions ending

Question 22

limitations of IPT

Answer 22

requires degree of ability to reflect - may be difficult for some

where poor social networks - limited interpersonal support
- in this case the focus would be on the relationship between the client and the therapist

Question 23

what is motivational interviewing

Answer 23

promotes behaviour change in a wide range of healthcare settings

more effective than advice giving

used where behaviour change is being considered - when patient may be unmotivated or ambivalent to change

Question 24

principles of MI

Answer 24

express empathy - understand person’s predicament

avoid argument - if challenging the patient’s position they may become defensive

support self-efficacy - patient sets agenda, generates what they might consider challenging

Question 25

stages of change

Answer 25

Question 26

pre-contemplation stage

Answer 26

not thinking about changing their behaviour
don’t think there is a problem

let them know you are there is they ever need help

Question 27

contemplation stage

Answer 27

beginning to think they might have a problem

can last mths-lifetime

provide information, screen for risks, discuss pros and cons

Question 28

planning/determination stage

Answer 28

accept they have a problem and want to change

build their confidence and motivation and help them turn this into action

Question 29

action stage

Answer 29

actually doing something to change their behaviour

work with health professional

prevent relapse, coping strategies, strategies to maintain goals, encouragement in failures

Question 30

maintenance stage

Answer 30

coping strategies

identify weak points

emergencies and slip back protocols