Psychological Treatment Flashcards
What is psychotherapy
It is a term covering the wide range of techniques used in an attempt to enhance psychological and emotional well-being
Psychotherapy isn’t just done by psychologist who else can administer?
Social workers Counsellors Nurses GPs Psychiatrist
What makes a good therapist
Warmth to show you care
Ability to develop a good therapeutic alliance
Focus on the key issues
Able to align treatment approach with the person
Willing to get feedback from the client
Keep up to date with research
Behave in an ethical manner
What is the scientist-practitioner model?
Scientist – practitioner psychologists embody a research orientation in their practice and a practice orientation in their research
Limitations of scientist-practitioner model?
If we focus on applying evidence based-practice, are we exploring new approaches
What is the psychodynamic theory?
Founded by Freud
Assumes that psychopathology develops when people remain unaware of their true motivations and fears.
Claims people can be restored healthy functioning only when they become conscious of what has been kept unconscious
What are the two principles of psychodynamic theory
Insight-the clients capacity to understand their own psychological processes
Therapist – client allowance-crucial in effective change to the disordered psychological processes
What are the 5 core beliefs of the psychodynamic theory?
- Behaviour is driven by unconscious wishes, impulses, drives and conflicts
- There is a meaningful explanation/cause for abnormal behavior (discovered by therapist)
- Current issues are based on childhood experiences
- Emotional expression and reliving of past emotional experiences is crucial to overcome problem
- The symptoms will resolve themselves once the client understands and had emotional insight into the unconscious material
What are the stages of psychoanalysis (psychodynamic theory)?
- Free association
- Interpretation
- Dream analysis
- Resistance
- Transference
- Working through
What is free association (psychodynamic)
Encourages free reign to thoughts and feelings whilst verbalising what comes to mind.
Thought to uncover unconscious material
What is interpretation (psychodynamic)
When unconscious material begins to surface, the therapist will point out the underlying meaning.
Need to reflect insights that the person has made themselves or on the verge of making. Can be claimed as their own
What is dream analysis (psychodynamic)
Dreams are interpreted in relation to what is occurring in life.
Tries to determine hidden meaning of dreams as dreams are thought to be the channel to the unconscious
What is resistance (psychodynamic)
Blockages in free association arise from unconscious control over sensitive areas.
Targeted by the therapist
What is transference (psychodynamic)
Client transfers feelings they have for a person with the therapist and engage in a relationship with the client that resembles a past experience.
Happens because therapy is highly intimate
What is counter-transference (psychodynamic)
Where the therapist transfers their own emotional vulnerabilities onto the client.
Negative effect on the therapeutic relationship.
What is working through (psychodynamic)
Assisting the client in processing the information and insights gained during therapy.
What are some criticisms of Freud’s theory?
Sample bias: rich, intelligent samples
Confirmation bias: selecting pieces of information that support claims and disregarding information that doesn’t
Expensive due to being long term
Lack of scientific rigour in some situations
What is humanistic-existential psychotherapy?
Requires insight
Believes that human nature is good and positive and that we all have the ability to reach our full potential.
Focus on phenomenology of the client: each person consciously experiencing the self, relationships and the world.
What is the aim of humanistic-existential psychotherapy?
Help people to get in touch with their feelings, with their true selves and with a sense of meaning in life.
Who had a large role to play in creating the humanistic-existential psychotherapy?
And why?
Abraham Maslow
Viewed psychology as being too concerned with disturbed or those who could be explained in mechanistic approaches (behaviourism).
Explain Maslows hierarchy of needs
Psychological needs Safety needs Social needs Esteem needs Self actualisation
Work your way from psychological needs to self actualisation. Need to complete one level before the next
What is person-centred therapy?
Carl Rogers - humanistic-existential
Non-directive therapy - clients can use therapy however they choose. Assumed that clients will reveal important emotional patterns. With increased awareness and heightened sense of acceptance, people come to think more realistically, become more tolerant of others and engage in more adaptive behaviour
What are the core traits of the therapist in person-centres therapy?
Must be authentic and genuine
Must express unconditional positive regard (non-judgemental)
Must relate to the client with empathetic understanding
What are the Rogerian assumptions?
Healthy people are aware of their own behaviour.
People are good and they become disturbed when faulty learning intervenes
Behaviour is purposive and goal directed
Therapists should not attempt to manipulate events for the individual - rather they should create conditions which will facilitate independent decision making from the client
What is gestalt therapy?
Humanistic-existential approach
Fritz Perls
Believe that people with psychological difficulties are incomplete gestalts because they have excluded from their awareness the experiences and aspects of personality that trigger anxiety.
Need to accept responsibility for feelings.
Dysfunction is caused by individuals suppressing experiences and traits that are anxiety inducing therefore we need to recognise and except these to become an integrated whole
What does gestalt therapy suggest about dysfunction?
Through socialisation people become overly self controlling of the thoughts, behaviour and feelings in order to conform
In this process they lose touch with the inner self and this leads to dysfunction such as anxiety and depression
What are the two techniques used in gestalt therapy?
Empty chair technique: provides opportunity to talk without risk
Two-chair technique: outlines both sides of the story as clients move from chair to chair
Basic principles of behavioural therapies?
Short term = inexpensive
Focusses on current behaviour and not on the past
Commences on a behavioural analysis
Targets problematic behaviours, cognitions and emotional responses
Exposure therapy?
Used to treat phobias.
Involves confronting the client with the stimulus they fear.
Techniques include:
- systematic desensitisation
- flooding
- virtual reality exposure
Prevented from leaving the stimulus until anxiety decreases
What happens to anxiety overtime?
Anxiety reactions decay over time due to the energy requirements for maintenance
By preventing the capacity to flee or fight the person experiences anxiety decay and is therefore reconditioned
What is systematic desensitisation
Involves pairing relaxation with imagery of anxiety provoking scenes or stimuli it is a counter conditioning process
Anxiety will level out and won’t be able to sustain it CBT gives the experience of anxiety going up and coming down again without escape
What is flooding?
Client is exposed immediately to feared experience
The therapist stops the person from engaging in their typical avoidance responses both behaviourally and cognitively
What is virtual reality?
The client views computer generated images of the feared experience
Modelling and skills training?
Learning theory (Bandura) has influenced heavily how clinical psychologists explain how disorders develop and how they’re treated
What is modeling?
Children and adults model the behaviour of others often unconsciously
Can learn both maladaptive and adaptive behaviours
Client modelling the behaviour of the therapists can be used implicitly (children learn over time) or explicitly (role play etc)
What are token economies?
Use star chart or similar to promote desired behaviour and discourage unwanted behaviour
Often used with children but can also be used in an adult setting
Aversion therapies?
Pairing of unpleasant stimuli with unwanted behaviour
Not commonly used however still useful in some situations
Example. Tablets that cause unpleasant commuting if alcohol consumption occurs in alcoholics
Criticisms of behavioural therapy?
Some therapies require a moderate-high level of motivation by client
Negative thoughts can be realistic
Advantages and disadvantages of group therapy?
Advantages: Cost effective Allows peer support Helps to normalise experience Can be done online or in person
Disadvantages:
People may be reluctant to share or may feel uncomfortable
May learn new maladaptive behaviours from others
Lack of personalised treatment
Family therapy?
Group therapy but the family members of the group. Focused on all members.
What is strategic family therapy?
Designed to improve communication between family members and to help them work together
What is structural family therapy?
The therapist interacts with and observe the family and helps to change the way they interact
What is the cognitive behavioural model?
Unhelpful behaviours (escape and avoidance)
Trigger (bodily senses eg heart rate)
Unhelpful thoughts (I’ll die, I’ll lose control)
Emotion (fear etc)
Unhelpful behaviours
What is rational emotive therapy?
Emotional reactions are caused by internal sentences that people repeat to themselves it is designed to eliminate the incorrect or irrational beliefs of a disturbed person through a process of rational examination of these beliefs
ABCDE theory
What is the ABCDE theory
A: activating conditions
B: belief systems
C: consequences
D: therapist should encourage client to identify and dispute maladaptive thought processes
E: more effective cognitions will then lead to more adaptive behaviour
What is Beck’s cognitive therapy?
Specifically designed for depression.
Believed depression is caused by the negative patterns in which individuals think about themselves, the world and the future
Biological treatments?
Psychological disorders are believed to be the result of an organic pathology in the brain.
Can be structural (neuronal) or chemical (neurotransmitter imbalance)
Pharmacotherapy?
Drugs that act on specific brain functions
Includes any pharmaceutical agent that is able to cross the blood brain barrier and exert a direct influence on the central nervous system cellular function
What are benzodiazepines?
Anti-anxiety medication
Valium, Xanax, Oscan, Ativan
Increase efficiency of GABA binding to receptor sores
What is buspirone (Buspar)?
Antianxiety medication that stabilises serotonin levels
Other uses include depressive states
What are beta blockers?
Antianxiety medication that competes with noradrenaline at receptor sites that regulate heart and muscle function
Atenolol (tenormin), propranolol (inderal)
Also can be used to regulate blood pressure and heartbeat
What are SSRIs?
Antidepressant
Selective serotonin reuptake inhibitors.
Inhibit the re-uptake of serotonin
Fluoxetine (Prozac), citalopram (cipramil), sertraline (Zoloft)
Also used for eating disorders, ocd and social phobia
What are cyclic antidepressants?
Inhibit the reuptake of noradrenaline and serotonin
Amitriptyline (endep), imipramine (tofranil), nortriptyline (allegron)
Also used for panic and other anxiety disorders as well as pain relief
What are monoamine oxidase (MAO) inhibitors?
Antidepressant
Inhibits the action of enzymes that metabolise noradrenaline and serotonin; inhibit dopamine
Also used for panic and other anxiety disorders
What are mineral salts used for?
Used as a mood stabiliser.
(Lithium carbonate)
Decreases noradrenaline
Increases serotonin
What are anticonvulsant medications?
Mood stabilisers.
Increase levels of GABA and inhibit noradrenaline re-uptake
Also used for bipolar disorder
Carbamazepine (tegretol), lamotrigine (lamictal) and sodium valproate (valpro)
What are conventional antipsychotics?
They block post synaptic dopamine receptors
Chlorpromazine (largactil), haloperidol (serenace)
Also used for Tourette’s disorder and bipolar
What are serotonin-dopamine antagonists?
Atypical antipsychotics.
Block activity of both serotonin and dopamine. Also affects noradrenaline and acetylcholine
What are psychostimulants?
For attentional problems.
Release noradrenaline, dopamine, serotonin in the frontal regions of the brain where attention and behaviour are regulated
Potential side effects for antianxiety medication?
Drowsiness, dizziness, low BP and some are addictive
Potential side effects of antidepressant medication?
Nausea, headaches, increased appetite, sexual dysfunction and drowsiness
Potential side effects of mood stabilisers?
Weight gain, tremors, fatigue and digestive problems
What are some potential side effects of antipsychotic medications?
Drowsiness, rapid heart beat, weight gain
What are some side effects of psychostimulants?
Decreases appetite, sleep disturbances and headache. Some have risk of addiction
What are some misconceptions about pharmacotherapy?
Not always necessary to treat a biological disorder with drugs. Non-pharmaceutical therapies can alter neuronbiology
Not a cure all.
What is psychosurgery?
Involves the neurosurgical destruction of brain tissue to cure mental illness.
What are labotomies?
We’re once carried out extensively to treat mental illness. Incisions in the brain
What is capsulotomy?
Specific lesions to the brain to reduce the symptoms of severe medication resistant OCD
Side effects:
Weight gain
Some executive/short term memory function
50% good recovery
What is ECT?
Electroconvulsive therapy.
Brief electrical current to patients head. They induce a seizure in the individual. Used typically for major depressive disorder that is unresponsive to other therapies.
What is rTMS?
Repetitive trans magnetic stimulation
Similar to ECT but a magnetic pulse is used. Non invasive - patient remains conscious without pin relief or a recovery period required. Used for medication resistant major depressive disorder
How successful is Becks cognitive therapy?
At least as effective as the use of anti-depressant medication in the acute phases.
Highly effective in reducing relapse
How effective is cognitive therapy?
Successful except for in the cases of severe psychopathology such as schizophrenia
What is deep brain stimulation?
Provides electrical pulses to specific areas of the brain via an implanted electrode
Initially used in Parkinson’s disease but now it is also used for OCD and MDD
What are some cautions towards surgical treatments
Can have serious side-effects
Mechanisms of action remain unclear for ECT, DBS, rTMS
Only appropriate where other measures have failed and the person is continuing to experience significant and distressing levels of impairment
How effective is psychodynamic therapy?
There is no clear evidence to show that the outcome of psychoanalysis is any better then would be achieved by doing nothing or by seeing another professional
Some evidence suggests that 5 to 10% become worse off
How effective is pharmacotherapy combines with psychotherapy?
Becks cognitive therapy and anti-depressant medication when used alone are equally effective in treating acute phases of depression
When combining the two reduces the risk of relapse following the completion of medication
What is eclectic psychotherapy?
Involves combining techniques from different therapeutic approaches to fit a specific clients needs
What factors cause us to believe ineffective therapies are working?
Spontaneous remission-many disorders fluctuate or are cyclical
The placebo affect-just talking about the problem may lead to improvement
Self-serving bias-client may want to therapy to work and so many exaggerate improvement or downplay continuing issues
Regression to the mean-often extreme behaviours will naturally become closer to normal over time
Rewriting the past-clients may recall being much worse and they actually were does see improvement has been greater than it really is
What are the three general principles the APS code of ethics
Respect for the rights and dignity of people and peoples
Propriety
Integrity
What do good standards of practice require
Professional competence
Good and appropriate relationships with clients and colleagues
Observance of professional ethics
What are the three things we need to protect according to ethics
The client, the clinician and the profession
Assertion training?
Teaching people to respond to requests in an appropriate manner - not aggressively or submissively
What is behavioural rehearsal?
Therapist uses role play to demonstrate and allow practice of behaviours
