Psychotherapies

Question 1

What mental health conditions can psychotherapies be used for?

Answer 1

Psychotherapies can be used for a variety of psychiatric illnesses, including mild to moderate depressive illness, bipolar affective disorder, neurotic illness, schizophrenia, eating disorders and personality disorders

Question 2

What is the most common psychotherapy?

Answer 2

The most commonly used forms of psychotherapy are cognitive behavioural therapy (CBT) and psychodynamic psychotherapy . There are many other psychotherapies derived from these.

Question 3

What are the principles of psychotherapy?

Question 4

What is improving access to psychological therapies (IAPT)?

Answer 4

Improving access to psychological therapies (IAPT) is a UK initiative developed in 2006. The aim of the project was to increase the provision of evidence-based treatments (recommended by NICE) for anxiety and depression, by primary care organisations.

Question 5

What are the indications of cognitive behavioural therapy (CBT)?

Answer 5

Mild– moderate depressive illness, eating disorders, anxiety disorders, BPAD, substance misuse disorders, schizophrenia and other psychotic disorders as an adjunct to pharmacotherapy, as well as chronic medical conditions (such as fibromyalgia, chronic fatigue syndrome) or chronic pain.

Question 6

Briefly describe the rationale of CBT

Answer 6

Treatment is based on the idea that the disorder is not caused by life events, but by the way the patient views these events. It is a short-term, collaborative therapy, focused on the ‘here and now’, the goals of which are symptom relief and the development of new skills to sustain recovery. Some people hold unhelpful core beliefs or ‘silent assumptions’ that they learn from early, traumatic life experiences. These people are more vulnerable to depression. When exposed to stress at a later date, these core beliefs are activated and they have negative automatic thoughts or cognitive distortions

Question 7

What is the aim of CBT?

Answer 7

The aim of CBT is initially to help individuals to identify and challenge their automatic negative thoughts and then to modify any abnormal underlying core beliefs. The latter is important in reducing risk of relapse

Question 8

What is the mode of delivery for CBT?

Answer 8

CBT can be delivered on an individual basis, in groups , or as self-help via books or computer programmes (including online). It is usually fairly brief (6– 20 sessions).

Question 9

Briefly describe the rationale of behavioural therapies

Answer 9

Behavioural therapies are based on the learning theory , and particularly operant conditioning. Operant conditioning states that behaviour is reinforced if it has positive consequences for the individua and it prevents any negative consequences.

Question 10

Give examples of behavioural therapies

Answer 10

• Relaxation training
• Systemic desensitisation
• Flooding
• Exposure and response prevention (ERP)
• Behavioural activation

Question 11

Briefly describe relaxation training

Answer 11

This is particularly useful for those with stress-related and anxiety disorders. Here, the patient is asked to use techniques causing muscle relaxation during times of stress or anxiety. The patient also learns to put themselves in situations that they find relaxing, such as walking in the fields.

Question 12

Briefly describe systemic desensitisation

Answer 12

This is often used for phobic anxiety disorders. In this therapy, an individual is gradually exposed to a hierarchy of anxiety-producing situations

Question 13

Briefly describe flooding

Answer 13

Unlike systemic desensitization, flooding therapy involves the patient rapidly being exposed to the phobic object without any attempt to reduce anxiety beforehand. They are required to continue exposure until the associated anxiety diminishes. It is not a technique commonly used.

Question 14

Briefly describe exposure and response prevention (ERP)

Answer 14

This therapy can be used for a variety of anxiety disorders but is particularly useful for OCD and phobias. Patients are repeatedly exposed to the situation which causes them anxiety (e.g. exposure to dirt) and are prevented from performing the compulsive actions which lessens that anxiety (e.g. washing their hands). After initial anxiety on exposure, the levels of anxiety gradually habituate and decline.

Question 15

Briefly describe behavioural activation

Answer 15

This therapy is used for depressive illness. The rationale behind it is that patients avoid doing certain things as they feel they will not enjoy them or fear failure in completing them. Behavioural activation involves making realistic and achievable plans to carry out activities and then gradually increasing the amount of activity.

Question 16

What are the indications of psychodynamic therapy?

Answer 16

Dissociative disorders, somatoform disorders, psychosexual disorders, certain personality disorders, chronic dysthymia and recurrent depression.

Question 17

Briefly describe the rationale of psychodynamic therapy

Answer 17

It is based upon the idea that childhood experiences, past unresolved conflicts and previous relationships significantly influence an individual’s current situation. It is based on psychoanalytic principles.

Question 18

What are the aims of psychodynamic therapy?

Answer 18

The unconscious is explored using free association (the client says whatever comes to their mind) and the therapist then interprets these statements. Conflicts and defence mechanisms (e.g. denial, projection) are explored and the client subsequently develops insight in order to change their maladaptive behaviour.

Question 19

What are the 2 key therapeutic tools used in psychodynamic therapy?

Answer 19

Key therapeutic tools:

1. Transference: the patient re-experiences the strong emotions from early important relationships, in their relationship with the therapist. When the current emotions are positive it is said to be positive transference and vice versa for negative emotions.
2. Counter-transference: the therapist is affected by powerful emotions felt by the patient during therapy and reflects what the patient is feeling.

Question 20

What is the mode of delivery of psychodynamic therapy?

Answer 20

Psychoanalysis is an intense therapy that usually involves between one and five 50-minute sessions per week, possibly for a number of years. This is a much longer duration than in CBT.

Question 21

Give examples of psychotherapies

Answer 21

• Simple forms of psychotherpy
  
  • Psychoeducation
  • Counselling
  • Supportive psychotherpy
  • Problem-solving therapy
• Relatively new psychotherapies
  
  • Interpersonal therapy (IPT)
  • Eye movement desensitization and reprocessing (EMDR)
  • Dialectical behavioural therapy (DBT)
  • Cognitive analytic therapy (CAT)

Question 22

Briefly describe psychoeducation

Answer 22

Psychoeducation (PE) is the delivery of information to people in order to help them understand and cope with their mental illness.

It is usual to inform the patient of:

1. The name and nature of their illness;
2. Likely causes of the illness, in their particular case;
3. What the health services can do to help them;
4. What they can do to help themselves (self-help).

PE may take place individually or in groups, and will usually take the person’s own strengths and coping strategies into account.

Question 23

Briefly describe counselling

Answer 23

Counselling is a form of relieving distress and is undertaken by means of active dialogue between the counsellor and the client. It is less technically complicated than other forms of psychotherapy and can range from sympathetic listening to active advice on problem solving.

Question 24

What are the indications of counselling?

Answer 24

Adjustment disorder; mild depressive illness; normal and pathological grief; childhood sexual abuse; other forms of trauma (e.g. rape, postnatal depression, pregnancy loss and stillbirth); substance misuse; chronic medical conditions; and prior to decision making, e.g. genetic testing or HIV testing.

Question 25

What is the aim of counselling?

Answer 25

To help the client or patient find their own solutions to problems, while being supported to do so and being guided by appropriate advice.

Question 26

Briefly describe the rationale of counselling

Answer 26

Behaviour and emotional life are shaped by previous experience, the current environment, and the relationships that individuals have. People have the tendency towards positive change and fulfilment which can be halted by ‘life problems’. A collaborative relationship with a counsellor is one method of addressing these issues.

Question 27

Briefly describe supportive psychotherapy

Answer 27

Is used to describe the psychological support given by mental health professionals to patients with chronic and disabling mental illnesses.

It does not aim to produce change, but rather to help people cope with adversity or unsolved problems over a sustained period.

Key elements include active listening, providing reassurance, providing explanation of the patient’s illness, providing guidance and possible solutions to difficulties they are faced with, as well as enabling the patient to express themselves in a safe environment.

Question 28

Briefly describe problem solving psychotherapy

Answer 28

Consists of a structured combination of counselling and CBT. It facilitates individuals to learn to deal actively with their life problems by selecting an option for tackling each one, trialling out solutions and reviewing their effect.

Indications are mild anxiety and depressive disorders.

Question 29

Briefly describe interpersonal therapy (IPT)

Answer 29

IPT is used to treat depression and eating disorders.

The focus is on an interpersonal problem such as a complicated bereavement, relationship difficulties or interpersonal deficit, adopting techniques from different psychotherapies. The therapy focuses on the difficulties that arise in relationships and the impact on the individual.

It has some overlap with CBT and psychodynamic therapy and deals with four interpersonal problems (grief at the loss of relationships , role disputes within relationships , managing changes in relationships and interpersonal deficits) which may be causing difficulty in initiating or maintaining relationships.

Question 30

Briefly describe eye movement desensitization and reprocessing (EMDR)

Answer 30

EMDR is a psychotherapy treatment that aims to help patients access and process traumatic memories with the goal of emotionally resolving them.

It is an effective treatment for PTSD.

It involves the client recalling emotonially traumatic material while focusing on an external stimulus. The stimulus invovles the therapist directing the patient’s lateral eye movements by asking them to look one way and then another or follow their finger.

Question 31

Briefly describe dialectical behavioural therapy (DBT)

Answer 31

DBT is used for individuals with borderline PD.

The therapy adopts components of CBT and also provides group skills training to provide the individual with alternative coping strategies (rather than deliberate self-harm) when faced with emotional instability.

Question 32

Briefly describe cognitive analytic therapy (CAT)

Answer 32

Combines cognitive theories and psychoanalytic approaches into an integrated therapy.

It is based on various areas of analysis including analysing problems and difficulties, how they began and how they affect everyday life as well as analysing the reasons behind symptoms. Can be used for a range of psychiatric problems such as eating and personality disorders.

Question 33

What is the role of couples therapy?

Answer 33

Allows both partners to overcome relationship difficulties with the aid of the therapist. Specific issues may be addressed such as sexual relations and parenting. It is also a valuable adjuvant therapy for psychiatric disorders such as depression and substance misuse. Usually used when relationship problems are maintaining a psychiatric disorder.

Question 34

What is the role of family therapy?

Answer 34

Family therapy attempts to correct impaired communication and dysfunctional relationships as a means of helping the entire family including the patient with the disorder. It is particularly useful for schizophrenia , depression , bipolar affective disorder and conduct disorder.

Question 35

What is the role of group therapy?

Answer 35

Group therapy offers supportive networks for individuals who suffer from similar difficulties. Group therapy can involve cognitive, psychodynamic and supportive therapies. It is often used for bereavement, substance misuse and chronic conditions.