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)
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
Psychic equvalence: equating internal states with reality, resulting in unwarranted yet deeply held beliefs, such as that others think and feel in exactly the same way as the subject does; e.g., “I am sure she disapproved of me – I could just see it in her eyes”.
Pretend mode: Indications that subjectivity (my sense of what it is to be me) is completely separated from physical reality. characterised by pervasive self-deception, and the rejection of alternative realities that threaten this pretend mode.
Teleological thinking: the tendency to ascribe purpose to objects and events — is useful in some cases (encouraging explanation-seeking), but harmful in others (fueling delusions and conspiracy theories)
Family Therapy
Type of therapy that understands that prolmes 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 relapase, good evidence.
Can help with psychoeducation, relapse indicators, stress management.
Dialectical Behavioural Therapy
May come up
Talking therapy - evidence based for EUPD. Similarities to CBT
Dialectic - the idea that two seeemingly 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 therpaist, 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?
