Psychological Therapies Flashcards
What was the first wave of psychological therapy?
Behavioural psychotherapy
Who was the primary influencer of the US tradition?
Skinner
What was the main methods used by the US tradition?
Operant conditioning - using positive and negative reinforcers
What was the main target of the US tradition?
Behaviour modification - reducing unwanted behaviours and encouraging desired ones
In what setting were the US behavioural approaches typically used?
Psychiatric and other long-stay institutions
What is the key model in operant and behavioural modification approaches?
The ABC model
What are the three parts of the ABC model?
Antecedent stimulus (stimulus)
Behaviour (response)
Consequence (reinforcer)
What is functional analysis / applied behavioural analysis?
A technique used to examine the purpose of a behaviour to better understand what caused the behaviour, the behaviour itself, and the possible consequences
What are the two broad categories of behaviour types?
- To obtain or access something positive
- To avoid or escape something negative
What are the four main purposes of challenging behaviour?
- Sensory stimulation/distraction
- Escape/avoid situations or tasks
- Attention
- Tangible reward
(SEAT)
What tools can be used to assess situations, behaviours and reinforcers?
Functional Assessment Screen Tool or ABC charts
Give an example of an antecedent based approach to modifying behaviour.
Reducing an individual’s exposure to a distressing stimulus
What is the main goal of a behaviour based approach to modifying behaviour?
To provide an individual with new skills that can be used to achieve the purpose of the behaviour in a better way (e.g. non-verbal communication aids)
What is the main target of a consequence based approach to modifying behaviour?
To identify what reinforcement is maintaining to problem behaviour and how we can break this link
Give an example of a consequence based approach to behaviour modification.
Extinction (ignoring the behaviour)
What is the fastest approach to extinction?
A continuous reinforcement schedule - immediate and consistent reinforcement for a period of time followed by the complete removal of reinforcement
How is the extinction approach usually applied in practice?
Non-contingent reinforcement - ongoing, minimal reinforcement, increased when the behaviour is not occurring to reinforce the positive behaviour
What is TREA?
Treatment Routes for Exploring Agitation - a behavioural intervention for agitation in dementia that uses an ABC assessment to determine individualised treatment
What are primary (tangible) reinforcers?
Rewards that satisfy basic, biological needs such as water, food, or sleep.
What are secondary reinforcers?
Rewards with no intrinsic value that have been conditioned/learned in association with a primary reinforcer (e.g. money, tokens, praise)
What are the advantages of using token economies as reinforcers?
▪️Easier to control and manage at the time of behaviour
▪️Scalable (can be something someone can ‘save up’)
▪️Resistant to satiety effects
▪️Can also have a ‘response cost’ (loss tokens in response to problem behaviour)
What is contingency management?
A behaviour modification intervention that reinforces positive behaviours through incentives (secondary reinforcers) (e.g. star charts)
What five components are necessary for an effective token system?
- Token value is explicit and understood
- Accurate and transparent token recording
- Association with valued tangible reinforcers
- Clear rules for earning and losing tokens
- Consistent implementation
What disorders most commonly incorporate contingency management and token economies in their therapeutic regime?
▪️Learning disability
▪️Neurodevelopmental disorders
▪️Substance misuse
In 2003, LePage et al studied the use of a token economy on an acute psychiatric unit. What were their main findings?
▪️Reduction in total injuries on the ward, particularly between patients
▪️Reduction in the severity of staff injuries
How have behavioural modification approaches evolved?
Focus has shifted from the behaviour to the person, aiming to change behaviours for the person’s own benefit (e.g. improve QoL or reduce harm)
Who were the main influencer of the British tradition of behavioural psychotherapy?
Watson, Pavlov, Hull, and Cover-Jones
What were the main methods used in the British tradition?
Classical conditioning, de-conditioning, and extinction to address emotions rather than behaviours
What were the main targets of British tradition behavioural therapy?
‘Neuroses’, anxiety, and fear (emotions!)
Which psychotherapy tradition focused on behaviours more so than emotions?
US
Which psychotherapy tradition focused on emotions more so than behaviours?
British
In what settings were the British approaches to psychotherapy typically used?
Acute psychiatric settings and outpatient care
What was Watson and Rayners influential study?
Little Albert - using Pavlovian conditioning to study fear acquisition in a child
What is a generalised conditioned response?
When a response conditioned to one stimulus is evoked by other similar stimuli (transferred fear)
What were Cover-Jones’ key experiments?
▪️Reducing Peters fear through exposure
▪️Changing Peters conditioned response to rabbits by presenting positive stimuli at the same time (biscuits)
▪️Measured blood pressure as a sign of physiological arousal
What is Joseph Wolpe known for?
Developing behaviour therapy by applying early research to the treatment of Neuroses - Systematic Desensitisation
What is reciprocal inhibition?
Wolpes theory that anxiety or fear is inhibited by a feeling or behaviour that is incompatibke with these emotions (impossible to have both) (e.g. relaxation, eating)
What are stimulus hierarchies?
A graded list created by the patient of situations from easy to difficult with steps in between to systematically expose them to a feared situation
What is response prevention?
Inhibition of fear reduction behaviours, such as closing eyes. The idea is to experience the anxiety and learn that it decreases on its own.
What did Wolpe use to measure anxiety during exposure and response prevention?
Subject Units of Distress or Discomfort (subjective scale from 1-100, has to be sufficiently low to move onto the next exposure)
What is relaxation training?
Patients taught skills to reduce anxiety, subjectively and physically, for before and during exposure (thought to enable counter-conditioning)
What behavioural treatment approach is Wolpe known for and what are the main components?
Systematic Desensitisation
▪️Stimulus hierarchies
▪️Exposure and response prevention
▪️Relaxation training
What is Social Learning Theory?
We learn important behaviours by observing the behaviours and consequences of others (learning without reinforcement)
What was the seminal research for social learning theory?
Bandura’s bobo doll experiments
What were Bandura’s main observations in the bobo doll experiments?
Children who observed aggressive play were more likely to imitate the aggression
What is systematic desensitisation now most commonly used for?
Common phobias
What are the two types of avoidance?
Active and passive
What is active avoidance?
An action to prevent an aversive event that would happen if we did nothing (e.g. finding ourselves Iong grass and leaving immediately)
What is passive avoidance?
Avoidance of a situation in which the danger could happen (e.g. avoiding long grass)
What type of response distances us from an ongoing aversive event?
Escape
What type of response distances us from an future aversive event?
Avoidance
What is maladaptive avoidance behaviour?
Avoidance of a relatively safe stimulus due to excessive anxiety or fear of a future aversive event, which often perpetuates the anxiety leading to disorder
What was the second wave of psychological therapy?
Cognitive therapy, considering the role of cognition and not just the behaviour itself
What are the three main strands of cognitive therapy/CBT?
▪️ Coping skills (instead of maladaptive responses)
▪️ Problem solving
▪️ Restructuring (identify and change maladaptive thinking patterns
What are the core premises of Beck and Ellis’s approach to cognitive therapy?
▪️ Emotional state is not a direct consequence of our situation, but is mediated by thoughts
▪️ These thoughts are often illogical or irrational
Primary aim to reduce emotional distress!
What was Beck’s cognitive triad?
Thinking in depression is characterised by schema based on pervasive negative beliefs of:
▪️ Self
▪️ World
▪️ Future
What are NATs?
Negative Automatic Thoughts - emerge without effort, common in response to particular situations or triggers
What are the key characteristics of NATS?
▪️ Negative
▪️ Feel bad
▪️ Uninvited
▪️ Unhelpful
▪️ Believable
How might NATs link to depression?
▪️ Repeated tendency to think negative as a mechanism by which low mood may be maintained
▪️ Low mood is more likely to result in negative thought compared to positive
What are the main cognitive distortions/unhelpful thinking patterns seen with increased negative thought?
▪️ ‘All or nothing’ thinking
▪️ Mental filtering/selective abstraction - paying more attention to things that support out negative views (confirmatory bias)
▪️ Magnification and minimisation - disqualifying the positive?
▪️ Catastrophising (illogical leaps)
▪️ Personalising (assume personal responsibility for things)
▪️ Overgeneralisation (always, never)
▪️ Emotional reasoning (equating feeling for reality)
What is the hot-cross bun model of cognitive therapy?
Triggering events leads to dynamic system and vicious circles of:
▪️ Thoughts
▪️ Feelings
▪️ Behaviour
▪️ Physical sensations
