Psychotherapies Flashcards
CBT (explanation)
Therpay works on negative ways we think, how we reinforce them with our behaviurs, how this influences our emotions.
‘Here and now’ - change our thinking and behaviours and in turn how we feel
Principles of therapy: hot cross bun
Thoughts
emotions
bodily sensations
behaviour
Structure of therapy (12-16 sessions weekly, agree goals, homework, therapist trained in CBT).
Will explore past - but not focus - how impact present.
Questions and leaflet
CBT (assess cognitive distortions)
Clarify HPC
Explore minimization (downplay good) and magnification (exaggerate bad) errors
Explore personalisation (negative things specifically you) and labelling (i.e as failure)
Explore selective abstraction (jump to conclusons), arbitrary inference (using poor evidence). dichotomous (black and white) thinking
Explore catastrophising (thinking worst possible outcome will be true)
CBT (psychosis)
Formulate: Predisposing, precipitating, perpetuating
Link to symptoms
Aim to improve relapse awarness, functioing, reduce stress, coping strategies.
Desensitization for agoraphobia (explanation)
Explain psychological treatment (SD)
Extinction: If stay with anxiety, it will go
Habituation: Ovrer time this will reduce initial anxiety
Involves graded exposure: hierachy of situations - link to pt Hx
Combined with relaxation techniques - counter conditioning
‘difficult to feel anxious and relaxed at same time
Explain structure of treatment (12-16 sessions, homework, relaxation/exposure)
Questions and leaflet
ERP for OCD (explanation)
Works by - Extinction: If don’t respond to anxiety - it will go away.
Exposure: To provoke anxiety
Response provention: stopping safety behaviours
Heirachy of situtations
‘Behavioural expirements’
Supported by therapy
Explain structure of treament (12-16 sessions, hour-long, homework)
Questions and leaflet
Panic disorder (explanation)
Explain diagnosis (symptoms)
Explain pharmacological treatment
Explain psycholotical treatment (relaxation, CBT)
Questions and leaflet
Interpersonal therapy (assess suitability)
Clarify HPC (including severity)
Identify recent grief
Identify interpersonal disputes
Identify role transitions
Identify interpersonal role deficits (confidants, relationships with family/friends)
Explain structure of IPT (16-20 sessions, use of role-play, recognize IP needs and think about communication with others)
No friends
Arguements
Changes
Grief
Request to discontinue therapy
Explore patient factors for discontinuation (symptoms, life changes, time, money)
Explore therapist factors (competence, rapport)
Identify core problems
Explanation of transference
Address other concerns (advise to speak to therapist, effect on future relationships)
Cognitive Analytic therapy
Structured Tx for depression + others
Reciprocal role procedures - Maladaptive patterns how we relate to ourselves + others
16-24 sessions
Assessment stage –> Formultation letter –> treatment and attempt to change patterns –> reformulation letter
3 issues:
Traps: act according to belief reinforcing consequences
Dilemmas: False binary chocies
Snags: Pessimism about outcomes prevents trying
Mentalisation based therapy
Tx for EUPD
‘Thinking about thinking’ understanding mentals tates and motivations of ourselves and others
Groups and 1:1 work.
Structured programme 18 months
Pre mentalisation states:
Psychic equvalence: equating internal states with reality, what I think is real“I am sure she disapproved of me – I could just see it in her eyes”.
Pretend mode: thoughts and feelings are decoupled from the real world
Teleological thinking: difficulties solved by doing/end goals - e.g anger resolved by smashing up things or someone must come see me now when crisis as ‘proves’ love/devotion
During mentalisation-based therapy sessions you focus on difficulties in your current life situation to improve your understanding of yourself and others. You focus on what is going on in your mind and think about what might be going on in other peoples’ minds, particularly in situations which may cause a strong emotional reaction and problematic behaviours.
When you focus on understanding your own and other people’s thoughts and feelings, MBT can help you to better understand and control your impulses, emotions and behaviours. This can improve your relationships with other people.
Family Therapy
Type of therapy that understands that problems patients have are influenced by the wider family system and in turn will impact on other members of the family as well.
Not blaming family - supporting them to help patient
Fortnightly for 3-6 months
As many family members as possible.
Can have multiple therapists in room.
If schizophrenia - high expressed emotion - explain this: can be negative, critique, can be positive - overbearing - can lead to relapse, good evidence.
Can help with psychoeducation, relapse indicators, stress management.
Structural - Hierarchy - ‘Devil’s advocate’ / taking sides - look at the loss of function or harmful function
Systemic - observe family as a whole (the unit acts and contributes as one thing) - 1 x therapist in the room - observing 2 therapists watching to provide an external perspective - observation, hypothesizing, testing evidence - circular questioning (not just to those involved, but to those in the wider circle)
Dialectical Behavioural Therapy
May come up
Talking therapy - evidence based for EUPD. Similarities to CBT
Dialectic - the idea that two seemingly contradictory things can be true at once, here that we can accept we ‘are’ but can also change our behaviours.
Aim: Understand and accept feelings, learn skills to manage and subsequently make changes.
Pretreamtent phase: learn about DBT
Individual sessions: 1:1, weekly, same therapist, element of homework. Hierachy: Safety –> reduced behaviour interference –> Goals/QoL –> Skills.
Group sessions: involve skills: distress tolerance, interpersonal effectiveness, midfulness, emotional regulation
Telephone coaching: inbetween sessions, coaching in skill used, Clear boundaries set
Mix of group + 1:1. 6-12 months. Homework.
Importance of group work - not necessary to disclose personal trauma/hx
Different to CBT as; addition of the idea of acceptance.
Interpersonal therapy (explanation)
Here and now therapy for depression
IP thinks about how roles and relationships affect how we feel
12-16 sessions, weekly, 3 phases: diagnostic, treatment (active role of therapist), assessment of progress
4 key areas - link to patient Hx.
Grief
Interpersonal disputes (conflict)
Role chanages (parent, illness, divorce)
Interpersonal deficits (few attachments, social isolation, few relationships)
Therapy Suitability (general
Severity of illness - containable in OP setting?
Previous/current mania or psychosis
Substance misuse/dependency
Risk primarily to self
Motivation - put question back to them
Previous experience with therapy/engagement
Pyschodynamic therapy - transference
Explore issue and past issues - Is this similar to any other experience youve had previously?
Explain concept: When a strong emotional response to someone in our life, such as a parent, gets transferred onto someone else and produces similar reactions in this relationship.
For examle: Feel therapist doesn’t care about you - evoking the experience you had with mum.
Put to patient: What do you think?
Psychodynamic therapy (explaining)
Long term - weekly, same therapist and location, roughly one year.
Therapist largely non-active stance
Requires lots of participation from patient.
General points:
Unconscious: kind of therapy that thinks about past experiences, especially in childhood, how contribute to unconscious motivations which impact what we do + how we feel.
Transference/CT: The relationshop with the therapist to inform about patterns in how you form relationships with other people and how this is linked to relationships in the past.
Change: Bringing awareness to these unconscious processes - help understand our actions and feelings to make change.
EMDR
Typically for PTSD/trauma
Information gathering/assessment to guide treatment and develop plan.
Setting a safe place (emotional sancuary)
To demonstrate move from distrssed to calm - imagined or otherwise
Processing memories: most vivid visual image ralated to trauma. Therapist will introduce gentle rhythmic eye movements to follow with eyes. Guide to shift to pleasant thoughts. (awake/no trance state/no suggestions).
Do this in sets of few minutes + break. During break guided to notice what comesi nto mind after each set.
May involve journaling.
3-6 for single trauma, longer for multi/complex trauma 8-12. (1-2x per week) Avg 6-12 sessions
