Psychological Therapies Flashcards
Psychological approaches to common mental
health problems = ______________ treatments
non-pharmacological
whata re the features of Common mental health disorders?
- common – prev around 15%
- significant morbidity (Stress, depression or anxiety 17.9 million work days lost)
- significant mortality (suicide the commonest cause of death men under the age of 50)
what are some Common mental health disorders?
1 AFFECTIVE / ANXIETY DISORDERS
2 SUBSTANCE MISUSE DISORDERS
3 DISORDERS OF REACTION TO PSYCHOLOGICAL STRESS
Common mental health disorders - what are examples of AFFECTIVE / ANXIETY DISORDERS
- Major Depressive Disorder (MDD)
- Generalised Anxiety Disorder (GAD)
- Panic Disorder and Phobic Anxiety Disorders
- Obsessive-Compulsive Disorder (OCD)
Common mental health disorders - what are examples of substance misuse disorders?
- due to use of ALCOHOL
- due to use of TOBACCO
- due to use of OPIOIDS/BENZOS/STIMULANTS
Common mental health disorders - what are examples of disorders of reaction to stress?
•POST TRAUMATIC STRESS DISORDER (PTSD)
wht are Psychological Therapies?
- limited availability
- HEAT target Scot– faster access - up to 18 weeks waiting time (Don’t have to wait more than 18 weeks)
- primary care with medication – reality!
- need to be evidence-based - NICE, SIGN, the MATRIX Guidelines
Example of a page from guidelines
Across the board CBT including exposure and response prevention is the key evidence based treatment with it becoming more intense and longer for more severe forms of OCD
what is Cognitive Behavioural Therapy? and hwat is it good for?
- How our thoughts relate to our feelings and behaviour
- Particularly good for depression, anxiety, phobias, OCD, PTSD
- Focus on here and now (observing what is happening at this present term)
- Short-term (over around 12 weeks)
- Problem focussed, goal oriented
- Individual, group, self-help book or computer programme
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems. Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. After working out what you can change, your therapist will ask you to practise these changes in your daily life and you’ll discuss how you got on during the next session.
Cognitive Behavioural Therapy - how dies it work?
- Therapist helps client:
- Identify thoughts, feelings and behaviours (that are unhelpful)
- Assess whether thoughts are unrealistic/unhelpful (thinking errors) - Automatic negative thoughts, Unrealistic beliefs, Cognitive distortions, Catastrophizing, Black and white/all or nothing thinking, Perfectionism
- Identify what can change
- Client engages in “homework” which challenges the unrealistic or unhelpful thoughts (thinking errors) - Graded exposure, Response prevention
can Behavioural Activation help depression?
- Depression – activities function as avoidance and escape from aversive thoughts, feelings and external situations
- RCT found activity scheduling alone for depression as effective as CBT for depression
Behavioural Activation - what is the Theory and Rationale?
•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 responding
Behavioural activation is an evidence-based treatment for depression. It is based on the idea that one way to combat low mood is to increase your activity level, especially in: pleasurable activity. tackling lists of tasks and responsibilities in a realistic and achievable way
Behavioural Activation - what may someone avoid in depression
Example of how depression and Behaviour and can lead to unintended consequences
what is required for Behavioural Activation?
- Collaborative / empathic / non judgmental
- Structured agenda – review progress
- Small changes – build to long term goals
what is interpersonal therapy?
- Treatment for depression/anxiety NICE / SIGN – ‘A’ rating as good as CBT for depression
- Time limited (12-16 weeks)
- Focused on the present
a form of psychotherapy that focuses on you and your relationships with other people. It’s based on the idea that personal relationships are at the center of psychological problems
attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery
Depression often follows a what?
- Depression often follows a disturbing change in or contingent with significant I-P event
- a complicated bereavement
- a dispute
- a role transition
- an interpersonal deficit
how does Interpersonal Therapy work in practice?
- “sick role” given
- construct an “interpersonal map” - Identify the interpersonal context
- “focus area’’ maintained – depressive symptoms linked to interpersonal events (weekly)
- GOAL!
- reduce depressive symptoms
2 improve interpersonal functioning
what are the strengths of interpersonal therapy?
- A grade evidence for treating depression
- No formal homework – may be preferable
- Client can continue to practise skills beyond the sessions ending
what are the limitations of interpersonal therapy?
- Requires degree of ability to reflect – may be difficult for some
- Where poor social networks – limited interpersonal support
Motivational Interviewing (MI) - when and why is it used?
- Promotes behaviour change in a wide range of health care settings
- More effective than - advice giving
- Used where behaviour change is being considered, when patient may be unmotivated or ambivalent to change
what are the principles of motivational interviewing?
- Express empathy - Understand person’s predicament
- Avoid argument - If challenging patient’s position – makes defensive
- Support self-efficacy - Patient sets agenda, generates what they might consider changing
what are the stages of change?
- Pre-contemplation – ‘who me?’ – ‘happy users’ – denial!! - here if you need us
- Contemplation – ambivalence – 6 months to a lifetime! – information - risk screening - pros and cons
- Planning/determination – ‘I have a problem – how can I change’ – options for change / build confidence and motivation
- Action – ‘this is what I am doing ‘– preventing relapse and coping strategies/strategies to maintain goals encouragement in failures
- Maintenance – coping strategies/weak points/emergencies/slips back protocols
