psychological therapies COPY Flashcards
3 common mental health problems - categories
- affective/anxiety disorders
- substance misuse disorders
- disorders of reaction to psychological stress
which affective and anxiety disorders are amenable to psychological therapies
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
availability of psychological therapies
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
evidence based therapy - psychological therapies
useful guidelines for treatment - NICE, SIGN, matrix
details evidence based therapeutic approaches for a range of severities for lots of conditions
what is CBT
what does it focus on
types of CBT
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
what conditions is CBT useful for
particularly good for depression, anxiety, phobias, OCD, PTSD
over what time frame is CBT effective
evidence for it to be effective as a short term therapy
e.g. over 12 wks
CBT example of how thoughts affect feelings and behaviours
what does the therapist help the client with in CBT
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
CBT ‘homework’
client engages in homework which challenges the unrealistic or unhelpful thoughts
- graded exposure
- response prevention
what is behavioural activation effective for
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
behavioural activation - 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 thinking
examples of avoidance in depression
- 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
goals of behavioural activation
collaborative/empathic/non judgemental
structured agenda - review progress
small changes - build to long term goals
what is IPT
what can it be used to treat
interpersonal therapy
treatment for depression/anxiety - as good as CBT for depression
focuses on the present
time for IPT
time limited
12-16wks
theory behind IPT
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
what is an interpersonal deficit
difficulty relating to others
interpersonal therapy in practice
‘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
goal of IPT for depression
reduce depressive symptoms
improve interpersonal functioning
strengths of IPT
strong evidence for treating depression
no formal homework - may be preferable
client can continue to practice skills beyond the sessions ending
limitations of IPT
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
what is motivational interviewing
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
principles of MI
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
stages of change
pre-contemplation stage
not thinking about changing their behaviour
don’t think there is a problem
let them know you are there is they ever need help
contemplation stage
beginning to think they might have a problem
can last mths-lifetime
provide information, screen for risks, discuss pros and cons
planning/determination stage
accept they have a problem and want to change
build their confidence and motivation and help them turn this into action
action stage
actually doing something to change their behaviour
work with health professional
prevent relapse, coping strategies, strategies to maintain goals, encouragement in failures
maintenance stage
coping strategies
identify weak points
emergencies and slip back protocols
