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MRCPsych Part B > Psychotherapy > Flashcards

Psychotherapy Flashcards

1
Q

What is repression?

A

Unacceptable ideas, memories and thoughts pushed into the unconscious

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2
Q

What are paraprexes?

A

Return of repressed materials that slips out as words during conversation

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3
Q

What gives us clue to the unconscious?

A

Paraprexes
Dreams
Free association

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4
Q

What are dreams made up of?

A

Unconscious mental matter
Residues from the day
Stimuli experienced during sleep

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5
Q

What does dream work do?

A

Turns latent content into manifest content

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6
Q

Processes of dream work

A

Condensation
Diffusion/Irradiation
Displacement
Symbolic representation

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7
Q

What happens in condensation

A

Two or more unconscious impulses are combined into a single image.

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8
Q

What happens in diffusion?

A

One unconscious impulse is represented by several images

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9
Q

What happens in displacement in dream work?

A

Energy invested in one object or idea gets transferred to another

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10
Q

What happens in symbolic representation?

A

Innocent or less highly charged image is used in place of something that is potentially overwhelming

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11
Q

According to Freud, why did the mind develop?

A

To manage our instincts

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12
Q

What leads to anxiety according to Freud?

A

Pressure that arises from our two instincts pressing to be fulfilled

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13
Q

What does the Topographical model consist of?

A

Unconscious
Preconscious
Conscious

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14
Q

What does the unconscious contain?

A

Repressed memories, sensations, impulses

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15
Q

What governs the unconscious?

A

Pleasure principle

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16
Q

What characterises the thinking in the unconscious?

A

Primary process thinking
Defies logic
Not restricted to reality

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17
Q

What characterises the conscious?

A

Secondary process thinking
Bound by time and space

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18
Q

What does the preconscious do?

A

Maintains a repressive barrier than censors unacceptable wishes and desires

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19
Q

What are the aspects of the structural model of the mind?

A

Id
Ego
Superego

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20
Q

What is the Id?

A

Full of the instinctual aspects of the individual, unconscious

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21
Q

What is the ego?

A

Executive organ of the mind, linked with reality

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22
Q

What is the superego?

A

Internalised morals and values

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23
Q

Psychosexual stages of development

A

Oral
Anal
Phallic/Oedipal
Genital

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24
Q

What age does the oral stage occur?

A

0-18 months

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25
Q

What age does the anal stage occur?

A

18 months - 3 years

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26
Q

What age does the Oedipal stage occur?

A

3-5 years

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27
Q

What is the focus of the infant in the oral stage?

A

Mouth and sucking

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28
Q

What can fixation on oral phase lead to later in life?

A

Alcoholism
Excessive eating

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29
Q

What happens in the anal phase?

A

Infant becomes able to control the function of the anal sphincter.

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30
Q

What does the term anally retentive mean?

A

Sense of power and control

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31
Q

What happens if fixation on the anal phase continues into adulthood?

A

OCD

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32
Q

What becomes of interest in the oedipal stage?

A

Genitals

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33
Q

What occurs once the oedipus complex is resolved?

A

Formation of the superego with introjection of parental values

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34
Q

Name some Neo Freudians

A

Melanie Klein
Carl Jung
Winnicott
Fairbairn

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35
Q

What did Melanie Klein propose?

A

Aggressive and destructive forces were central components of early development

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36
Q

What positions did Melanie Klein introduce?

A

Paranoid-schizoid
Depressive

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37
Q

What happens in the paranoid-schizoid position?

A

World is split into good/bad
Infant has destructive feelings and thoughts about a bad mother and fear that the bad mother will punish the infant (paranoid).
One way for the infant to deal with this is by retreating and cutting off (schizoid)

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38
Q

What happens in the depressive position?

A

Once an infant is able to integrate good and bad and see the mother as having both qualities, the infant may feel guilt

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39
Q

Who founded the school of Analytic Psychology?

A

Carl Jung

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40
Q

What are archetypes part of?

A

Collective Unconscious

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41
Q

What are archetypes?

A

Representational images of universal symbolic meaning

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42
Q

What does the personal unconscious consist of?

A

Complexes

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43
Q

What are complexes?

A

Sets of ideas and feelings triggered by interpersonal interactions

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44
Q

What is anima?

A

Unconscious feminine aspect of a man

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45
Q

What is animus?

A

Unconscious masculine aspect of a woman

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46
Q

What did Winnicott suggest?

A

Child’s psychological development occurs in the transitional zone - between reality and fantasy.

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47
Q

What is Winnicott’s theory of multiple self organisations?

A

Parental control and impositions can lead to development of a false self different from the real self

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48
Q

What is the transitional object?

A

AN object invested with special meaning given to an important person (mum) but which is under the childs control

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49
Q

What is a good enough mother?

A

A mother who adequately fulfils her caring role but who allows for gradual disillusionment, helping the child develop independence

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50
Q

What is holding according to Winnicott?

A

The affective disposition of the therapist which helps in restraining oneself from retaliating in negative transferences

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51
Q

Who created the concept of containing?

A

Bion

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52
Q

What ic containing?

A

Cognitive capacity of the therapist to maintain objectivity and focus on selected facts during discourse

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53
Q

What did Fairbairn propose?

A

Libidinal, antilibidinal and ideal parts of an object, extended to the ideal self

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54
Q

What is psychic determinism?

A

The idea that developmental psychopathology is the source of adult life difficulties.

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55
Q

What do psychodynamic therapies emphasize?

A

Idiosyncrasy
Uniqueness of an individual

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56
Q

What are the three parts of the therapeutic relationship?

A

Therapeutic alliance
Transference
Countertransference

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57
Q

What is the therapeutic alliance?

A

Unwritten implicit contract between doctor and patient

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58
Q

What types of issues may occur in the process of psychotherapy and establishment of therapeutic alliance?

A

Continuity
Acting in
Acting out

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59
Q

What is continuity?

A

Not immediate threat of termination but may affect progress

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60
Q

What is acting in?

A

Enactment within a session

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61
Q

What is acting out?

A

Enactment outside the session

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62
Q

Examples of continuity

A

Absence
Lateness
Breaks
Impasse

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63
Q

Examples of acting in

A

Physical contact
Persistent questions
Presents/gifts
Silence

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64
Q

Examples of acting out

A

Suicide
Self injury
Alcohol and drug abuse

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65
Q

What is interpretation?

A

Expression of therapists understanding of the meaning of feelings, attitudes, defense mechanisms and behaviours exhibited during therapy.

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66
Q

Importance of interpretation

A

Sheds light on an unconscious process in the patient, making it accessible to the conscious mind

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67
Q

What is transference>

A

Feelings, thoughts and attitudes given to a person in the present (e.g. therapist) that do not befit the person but originate from a person in the patients past

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68
Q

What does it mean that transference is bidimensional?

A

Includes replaying past experiences and seeking new relationship with the therapist

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69
Q

Is transference conscious?

A

No

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70
Q

Importance of transference

A

Can be considered a communication of a patients needs than cannot be expressed verbally

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71
Q

Factors that increase transference reactions

A

Vulnerable personality e.g. BPD features
Patients appraisal of being in a needy and vulnerable position
Frequent contact with therapist

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72
Q

What did Kohut divide transference into?

A

Mirroring
Idealizing
Twinship

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73
Q

What is mirroring transference?

A

Due to significant mirroring failures from parental figures. Child feels inadequate and compensates by being perfect.

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74
Q

How does mirroring transference occur in therapy?

A

Patient is in constant need of a therapist to assure their self-esteem

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75
Q

What is idealizing transference?

A

Poor self-esteem is not troublesome as long as the individual can be attached to a person with power.
Through the idealization of and identification with external objects, preservation of self-esteem is maintained

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76
Q

What is twinship transference?

A

Patient feels comfortable only when the self-object has the same thoughts, values and appearance.

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77
Q

What is countertransference?

A

The therapists’ spontaneous feelings and emotions that are evoked when they tune into the patients unconscious communication.

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78
Q

Importance of countertransference

A

Analysing countertransference can provide insight into a patients psychic state

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79
Q

What is resistance?

A

The means by which aspects of reality are rejected by the patient and are kept unconscious

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80
Q

What is repression resistance?

A

Patients difficulty in gaining access to certain ideas and emotions

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81
Q

What is transference resistance?

A

Patients unconscious wish to keep therapeutic relationship similar to past relationships.

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82
Q

What are termination reactions?

A

Temporary setbacks that occur when sessions enter termination phase due to dependence of patient on the therapist

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83
Q

What is negative therapeutic reaction?

A

When a step in the right direction may be followed by a backward step

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84
Q

What did Freud consider the negative therapeutic reaction was due to?

A

Thanatos and aggressive impulses

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85
Q

What is acting out in therapy?

A

Performing an action to express unconscious emotional conflicts via actions rather than words.

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86
Q

What is repetition compulsion?

A

When a person repeats a traumatic event.

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87
Q

What did Freud suggest repetition compulsion was a result of?

A

Id vs superego conflicts where Id overrides the superego and presents itself

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88
Q

What is working through?

A

Process of unlearning prior misconceptions and learning new constructions

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89
Q

Who suggested the term corrective emotional experience?

A

Franz Alexander

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90
Q

What is corrective emotional experience?

A

Processes that take place during therapy which give the patient an opportunity to reflect on past experiences and make necessary behavioural, cognitive or emotional changes to reduce ones difficulties

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91
Q

What is regression in psychotherapy?

A

Activation of parts of the persons personality which are usually hidden may occur.

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92
Q

What can trigger the use of a defence mechanism?

A

Anxiety about internal conflict over a wish or impulse

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93
Q

What do defence mechanisms help with?

A

Help manage interface between unconscious wishes/impulses and external reality

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94
Q

Who divided defence mechanisms into three groups?

A

Vaillant 1977

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95
Q

What are the three types of defence mechanisms?

A

Immature
Neurotic
Mature

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96
Q

What are the immature defence mechanisms

A

Acting out
Regression
Denial
Splitting
Idealisation and Denigration
Projection
Projective Identification

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97
Q

Why are immature defence mechanisms so named?

A

Frequently employed in infancy

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98
Q

What happens in acting out?

A

Unconscious wish or impulse is expressed

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99
Q

Who described the Psychotic defence mechanisms?

A

Melanie Klein

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100
Q

What are the psychotic defence mechanisms

A

Splitting
Idealisation and Denigration
Projection
Projective Identification

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101
Q

What happens in Idealisation and Denigration?

A

When splitting occurs, one side is idealised and the other denigrated

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102
Q

What is projection?

A

An unwanted aspect of oneself is located to the other

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103
Q

What is projective identification?

A

Projection is received and taken in by the other person to whom it is directed and they act as if it were their own quality.

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104
Q

What are the neurotic defence mechanisms?

A

Repression
Intellectualisation
Rationalisation
Reaction Formation
Undoing and magical thinking
Displacement

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105
Q

What happens in repression?

A

Unwanted aspects of internal reality are kept out of consciousness but patient may experience some emotions of the repressed memory

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106
Q

What happens in intellectualisation?

A

Focus on abstract, theoretical concepts and distancing from emotions

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107
Q

What happens in rationalisation?

A

Justification is made to explain away a thought or feeling which would rather be kept out of awareness

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108
Q

What happens in reaction formation?

A

Feelings/thoughts expressed are the opposite of what is really thought or felt, but has to be kept out of conscious awareness and might be difficult to handle.

109
Q

What happens in undoing or magical thinking?

A

Patient may believe that doing a certain action may prevent a tragedy from occurring.

110
Q

What happens during displacement?

A

Instead of directing thoughts and feelings towards one person, they are directed towards somewhere less threatening

111
Q

What are the mature defence mechanisms?

A

Humour
Altruism
Sublimation

112
Q

What is the conflict in altruism?

A

Conflict about attending to ones own needs

113
Q

What happens in sublimation?

A

Energy from an unacceptable impulse is directed in a socially-acceptable way

114
Q

Indications for brief psychotherapy

A

Problem is well demarcated in the context of a difficulty of short duration
Other aspects of patients life are functioning well

115
Q

Indications for long-term psychotherapy

A

More complex difficulties, long-standing that affect multiple aspects of a persons functioning and involve the persons personality or character

116
Q

Indications for supportive psychotherapy

A

Periods of transition and adaptation when deeper working through problems is not required

117
Q

Contraindications for psychotherapy

A

Poor impulse control
Poor frustration tolerance
Low motivation
Antisocial PD
Absence of psychological mindedness
Being in the midst of a major life crisis
Poor ego strength
Sever active psychosis
Poor ability to form and sustain relationships

118
Q

Who identified the characteristics of brief psychodynamic psychotherapy?

A

Franz Alexander and Thomas French, 1946

119
Q

What are the characteristics of brief psychodynamic psychotherapy?

A

Time-limited
Focused on the here and now
Transference identified early
Circumscribed focus and termination date formed in advance

120
Q

Methods employed in brief psychodynamic psychotherapy

A

Goal setting and explicit identification of anxiety and defenses to be tackled
Focus choosing; identification of active problem.
Active interpretation: therapist may guide therapy by use of interpretation at an early point
Creating heightened emotional contexts conducive to change

121
Q

What factors predict good outcomes of brief psychodynamic psychotherapy?

A

Circumscribed problem
Strong motivation
Able to express feelings
Psychological mindedness
At least one good relationship
Evidence of achievement
Not actively suicidal, chronically obsessed or phobic
Not grossly destructive or self-destructive nor actively abusing illicit drugs

122
Q

What is supportive psychotherapy?

A

Counselling and supportive techniques used when offering psychiatric follow-up

123
Q

Aims of supportive psychotherapy?

A

To offer practical and emotional support
Opportunity for ventilation of emotions
Guided problem solving discussion
Support reality testing
Provide ego support
Reestablish usual level of functioning

124
Q

Which group of patients is supportive psychotherapy aimed towards?

A

Healthy patients with overwhelming ongoing crises and those with ego deficits

125
Q

Main tools of supportive therapy?

A

Problem solving
Advice
Reinforcement
Reassurance

126
Q

Aim of analytical psychotherapy

A

Exploring cause of sx

127
Q

What do sessions of analytical psychotherapy work on?

A

Childhood trauma
Developmental difficulties

128
Q

Key figure for general systems theory

A

Ludwig von Bertalanffy (biologist)

129
Q

Key idea of general systems theory

A

A system is a set of interconnected components that forms a whole
Components show properties of the whole
Cycles of feedback between different components continuously create and re-create a basis for interaction

130
Q

Models of Family Therapy

A

Dynamic
Structural
Family Systems Approach
Strategic
Psychoeducational
Behavioural

131
Q

Theme of dynamic family therapy

A

To bring to light forces at play that influence the way a family functions.
Emphasises individual maturation

132
Q

What theory is dynamic family therapy based on?

A

Unconscious processes which when noticed and worked through, can bring relief to the family’s conflictual experiences

133
Q

Activities involved in dynamic family therapy

A

Makes interpretations
Notices formation of alliances between members
Family sculpting

134
Q

What is family sculpting?

A

Family members physically arranging themselves in a scene depicting individual view of relationships

135
Q

Relationship of therapist in dynamic family therapy

A

Therapist aims to establish intimate bond with each family member

136
Q

Who created structural family therapy?

A

Minuchin

137
Q

Theme of structural family therapy?

A

Challenges patterns of behaviours or interactions that disrupt family structure

138
Q

What is the theory behind structural family therapy?

A

A well-functioning family has a structure; hierarchy, boundaries, well-defined rules.
When disrupted, problems occur.

139
Q

Activities involved in structural family therapy

A

Therapist challenges interactions between generations.
Individual and family sessions used.

140
Q

Who created the family systems approach?

A

Bowen

141
Q

Theme underlying family systems approach?

A

Emphasis on ones ability to retain individual self in the face of family tension

142
Q

Theory behind family systems approach?

A

An emotional triangle is a three-party system where closeness of two members excludes a third. This triangle leads to symptom formation

143
Q

Activities involved in family systems approach

A

Degree of enmeshment is analysed.
Therapist maintains minimal emotional contact.
Genogram

144
Q

What is genogram?

A

A tool to analyse history of families across generations

145
Q

Who created strategic family therapy?

A

Haley

146
Q

Theme underlying strategic family therapy?

A

Aims to find the positives in a system and builds on them

147
Q

Theory behind strategic family therapy

A

Problems within families are maintained by over-emphasising them

148
Q

Activities involved in strategic family therapy

A

Positive reframing
Domino effect; if one problem is addressed, it leads to reduction of other problems

149
Q

Theme of psychoeducational family therapy

A

Objective is to enhance family support and reduce stress

150
Q

Theory behind psychoeducational family therapy

A

Risk of relapse when family interactions are overinvolved, emotionally charged and critical.
Course of MI will be affected by these stress levels

151
Q

Activities involved in psychoeducational family therapy

A

Focuses on helping families understand factors that affect stress levels
Helps facilitate communication
Encourages problem-solving strategies

152
Q

Theme underlying behavioural family therapy

A

Aim is to closely observe and evaluate behaviours in the family to identify problems and make interventions

153
Q

Theory behind behavioural family therapy

A

Behaviour is maintained in a linear model.
Symptoms viewed as learned responses that reinforce dysfunctional patterns of relating.

154
Q

Activities involved in behavioural family therapy

A

Treatment is symptom-focused and time-limited.

155
Q

What is the Milan systemic approach?

A

Greater emphasis on circular and reflexive questioning.

156
Q

Who created the milan systemic approach?

A

Palazzoli

157
Q

Who created paradoxical therapy?

A

Gregory Bateson

158
Q

What happens in paradoxical therapy?

A

Therapist makes the patient intentionally engage in unwanted behaviour (paradoxical injunction)
This can provide new insights for the patient

159
Q

What happens in covert reinforcement?

A

Reinforcer is the imagination of something present

160
Q

What is covert sensitisation?

A

Something unpleasant is imagined

161
Q

What is shaping?

A

Desirable behaviour pattern is learned by the successive reinforcement of behaviours that get progressively closer to the desired one

162
Q

What is chaining?

A

Reinforcing individual responses occurring in a seqence.

163
Q

What is incubation?

A

Emotional response increases in strength if brief, repeated exposure to stimulus is present.

164
Q

What can increase anxiety via incubation?

A

Rumination

165
Q

Who created the term learned helplessness?

A

Seligman

166
Q

What is stimulus control?

A

The control a discriminatory stimulus has on the probability of a behaviour because of reinforcement in the past.

167
Q

What is stimulus control in therapy?

A

Controlling the stimuli that leads to problem behaviour

168
Q

What is habituation?

A

Repeated stimulation leads to reduction in response over time

169
Q

What is sensitisation?

A

Increase in response to a stimulus as a function of repeated presentations of that stimulus.

170
Q

Therapies based on conditioning

A

Systematic desensitisation
Flooding
Massed Negative Practice
Habit reversal training
Modelling
Biofeedback
Social skills training

171
Q

Who created systematic desensitization?

A

Wolpe

172
Q

What is systematic desensitization based on?

A

Counterconditioning: gradual approach of feared situation in a state that inhibits anxiety leads to reduction of anxiety response
Reciprocal inhibition

173
Q

What are the steps of systematic desensitization?

A

Relaxation training
Constructing a hierarchy of anxieties
Desensitization of the stimulus

174
Q

What happens in systematic desensitization?

A

Patient is exposed to a graded hierarchy of anxiety-provoking situations in stepwise fashion

175
Q

Who created the term progressive relaxation?

A

Jacobson

176
Q

What is progressive relaxation?

A

Patients relax muscle groups in fixed order

177
Q

Difference between systematic desensitization and graded exposure therapy?

A

In graded exposure relation training is not involved
Treatment carried out in real-life context

178
Q

What is autogenic training?

A

Self-suggestion where subject directs their attention of specific body areas while carrying out relaxation exercises

179
Q

What is applied tension?

A

Opposite of relaxation, used to counteract fainting response

180
Q

What is flooding?

A

Real life exposure occurs without any hierarchy.

181
Q

What is targeted in flooding?

A

Avoidance conditioning

182
Q

What does success of flooding depend on?

A

Exposing patients for reasonable duration until mastery and calm composure is gained

183
Q

What is flooding in imagination called?

A

Implosion

184
Q

Who is flooding contraindicated in?

A

Poor stress tolerance
Cardiac morbidity that may cause ischaemia

185
Q

What disorders is massed negative practice used in?

A

Tic disorder

186
Q

What happens in massed negative practice?

A

Patient is asked to deliberately perform tic movement for specified period of time interspersed with periods of rest

187
Q

What disorder is habit reversal training helpful for?

A

OCD
Tic disorders

188
Q

What is involved in habit reversal training

A

Awareness training
Competing response training
Contingency management
Relaxation training
Generalisation training

189
Q

What happens in awareness training?

A

Becoming aware of stimuli that provoke behaviour

190
Q

What happens in competing response training?

A

Teaching responses that counteract behaviour

191
Q

What happens in contingency management?

A

Positive reinforcement of desirable behaviour

192
Q

What happens in generalisation training?

A

Once one component has been mastered, this is generalised to other problem behaviours

193
Q

Who is modelling helpful for?

A

Phobic children

194
Q

What happens in behaviour reversal?

A

Real-life problems are acted out under a therapists observation or direction

195
Q

Who created biofeedback therapy?

A

Miller

196
Q

What happens in biofeedback?

A

Involuntary autonomic nervous system can be conditioned by the use of appropriate feedback

197
Q

Which conditions can be treated using biofeedback?

A

Migraines
Asthma
HTN
Angina

198
Q

What framework is used for social skills training?

A

Bellack and Mueser

199
Q

What are the three forms of social skills training?

A

Basic model
Social problem-solving model
Cognitive remediation model

200
Q

What happens in the basic model of social skills training?

A

Complex social repertoires are broken down and subjected to corrective learning, practiced through role plays

201
Q

What happens in the social problem solving model of social skills training?

A

Focus is on improving impairments in information processing that are assumed to be the cause of social skills deficit.
Model targets needing changes including medication and sx management, recreation, basic conversation and self-care.

202
Q

What happens in the cognitive remediation model of social skills training?

A

Corrective learning process begins by targeting cognitive impairments.
Assumption is that if underlying cognitive impairment can be improved, this learning will be transferred to support more complex cognitive processes

203
Q

What is important for behavioural therapy?

A

Identifying the function of a behaviour in order to manipulate it

204
Q

What does behavioural analysis consist of

A

Identifying motivating operations
Identifying triggers for behaviour
Identifying behaviour that has been operationalized
Identifying consequences of behaviour and what reinforces it

205
Q

What is another name for behavioural analysis?

A

Antecedents-behaviour-consequences approach of functional assessment

206
Q

What happens after behavioural analysis

A

Functional analysis

207
Q

What happens in functional analysis?

A

Antecedents and consequences are manipulated in therapy setting to find their separate effects on the behaviour

208
Q

What is a behavioural treatment plan?

A

Identifies the problems/sx, sets short-term and long-term goals and objectives, defines specific interventions and decides how outcomes will be measured

209
Q

What dimensions of behaviour can be measured

A

Repeatability
Temporal extent
Temporal locus
Response latency
Inter-response time

210
Q

What is repeatability?

A

Frequency of behaviour

211
Q

What is temporal extent?

A

Duration of each instance of behaviour

212
Q

What is temporal locus?

A

Refers to time point at which each instance of behaviour occurs

213
Q

What is response latency?

A

Measured time interval between onset of stimulus and initiation of response

214
Q

What is inter-response time?

A

Amount of time between two consecetive responses

215
Q

Who is the major proponent of cognitive therapy?

A

Aaron Beck

216
Q

What is the view of cognitive therapy?

A

That ones cognition determines affective and physical changes

217
Q

What are the three cognitive dysfunctions recognised in cognitive therapy?

A

Negative automatic thoughts
Conditional assumptions
Core beliefs (schemas)

218
Q

What are negative automatic thoughts?

A

Cognitive distortions - cognitions that automatically arise in certain situations as a reflex

219
Q

What are conditional assumptions?

A

Rules for life such as I must/I should

220
Q

What are core beliefs?

A

Ones appraisal of oneself

221
Q

Name some cognitive distortions

A

Minimisation/Magnification
Over-generalising
Selective abstraction
Personalisation
Arbitrary inference
Dichotomous thinking
Catastrophization

222
Q

Give an example of selective abstraction

A

You fail one exam and focus on this rather than considering the exams you passed

223
Q

Example of personalisation

A

A team is made redundant and you think ‘its because of me’

224
Q

Example of arbitrary inference

A

‘I did my exam on the last day of autumn and failed, the same will happen this year’

225
Q

Cognitive assumptions used in depression

A

Negative view of self/past (worthlessness), world/present (hopelessness), future (hopelessness)

226
Q

Cognitive assumptions in panic disorder

A

Catastrophic misinterpretation of physiological experiences

227
Q

Cognitive assumptions in paranoid PD

A

Negative global external attribution bias

228
Q

Cognitive assumptions in OCD

A

Thought omnipotence
Alternative action can undo or compensate for another thought/action

229
Q

What is thought omnipotence?

A

Thoughts are as powerful as actinos

230
Q

Cognitive assumptions in suicidal behaviour

A

Hopelessness and cognitive constriction (one-way exit)

231
Q

Cognitive assumptions in PTSD

A

Guilt
Self-blame
Feelings of loss of control

232
Q

How is anxiety maintained by cognitive assumptions?

A

Situational avoidance
In-situation safety behaviours
Attentional deployment
Rumination

233
Q

Who created the term in-situation safety behaviour?

A

Salkovskis

234
Q

What are in-situation safety behaviours?

A

Variety of behaviours/internal mental processes that patients engage in whilst in a fearful situation, intended to prevent fearful outcome. This makes one believe that this behaviour is the reason one survived an ‘attack.’

235
Q

What is attentional deployment?

A

Patients with panic or hypochondriasis fear certain bodily sensations, catastrophically elaborating them. Thus they pay more selective attention to such body parts and become aware of benign sensations that others do not notice.

236
Q

Dysfunctions caused by safety behavioirs

A

Generating new symptoms
Worsening existing symptoms
Escalating undesirable social responses
Maintaining existing symptoms

237
Q

Techniques employed in CBT

A

Guided discovery
Questioning identified beliefs
Testing predictions

238
Q

What happens in guided discovery?

A

Sensitive questioning allows patients to reach new interpretations of their cognitions independently

239
Q

Stages of guided discovery

A

Ask informal q’s
Listen
Summarise
Synthesizing questions

240
Q

What happens in Stage 1 of guided discovery?

A

Delineate patients concerns

241
Q

What happens in Stage 2 of guided discovery?

A

Be clear about exact issues

242
Q

What happens in Stage 3 of guided discovery?

A

Demonstrate understanding and to revise

243
Q

What happens in stage 4 of guided discovery?

A

‘How does all the information discussed fit with your idea that you are a failure?’

244
Q

CBT approaches for anxiety

A

Behavioural experiments
Imagery modification
Cognitive restructuring
Dropping safety-seeking behaviours

245
Q

What happens in behavioural experiments?

A

Construction of hypothesis about symptoms is tested through homework of patient conducting experiment and reporting the event in the next session

246
Q

What do behavioural experiments help with?

A

Establish that feared catastrophe will not happen
Discover importance of maintaining factors and negative thinking
Find out whether alternative strategy will be of value
Generate evidence of non disease based explanation

247
Q

What happens in dropping safety-seeking behaviours?

A

Safety behaviours maintain health anxiety.
Patients can test out effects of these behaviours by conducting alternating treatment experiments.

248
Q

What happens in treatment experiments in dropping safety-seeking behaviours?

A

Increasing target behaviour for a day and monitoring anxiety and strength of belief and regular intervals.
Next day, patient bans completely carrying out target behaviour and again monitoring anxiety sx at regular intervals.
This data is reviewed at the next session.

249
Q

CBT techniques for OCD

A

Thought stopping
Thought postponement
Exposure and response prevention

250
Q

What happens in thought stopping?

A

Patient shouts ‘stop’ or applies aversive stimulus to counteract obsessional preoccupation.

251
Q

What happens in thought postponement?

A

Postponing thought until specified time and not to delay it until then to gain control

252
Q

What happens in exposure and response prevention?

A

Hierarchy of obsession provoking situations is created and exposed to while preventing any compulsions or responses being carried out

253
Q

CBT techniques for health anxiety

A

Self-monitoring via thoughts diary
Inverted pyramid
Selective physical attention experiments

254
Q

What happens in the inverted pyramid technique?

A

Patient is asked to estimate current number of people with a particular sx, number for whom it persists, number who consult their doctor, number who are told they need test, number who are told the problem is serious and number not successfully treated.

255
Q

Aim of inverted pyramid technique?

A

Addresses overperception of risk

256
Q

What happens in selective physical attention experiments?

A

Patient focuses on specific body part for several minutes after which they are asked to describe any body sensation they notice.

257
Q

What is the aim of selective physical attention experiments?

A

Demonstrates effects of symptom monitoring and bodily checking

258
Q

Models for CBT for psychosis

A

Stress-vulnerability model
Continuum model

259
Q

What is the focus of the stress-vulnerability model?

A

Stressors capable of triggering or exacerbating sx.

260
Q

Primary tool in stress-vulnerability model

A

Coping strategy enhancement; affective, behavioural and cognitive

261
Q

Aim of stress-vulnerability model

A

Relapse prevention
Functional recovery

262
Q

What is the emphasis in the continuum model?

A

Similarity between normal beliefs and delusional beliefs

263
Q

Aim of continuum model?

A

Symptom relief

264
Q

How does continuum model work?

A

Encourages individual to weigh evidence that contradicts a delusion

265
Q

What did Birchwood say was the target of CBT for psychosis?

A

Emotional dysfunction that accompanies psychotic experiences

266
Q

What did Turkington describe were the following elements for CBT in psychosis?

A

Therapeutic alliance
Improving medication adherence
Providing alternate explanations to unusual experiences
Decreasing impact of positive sx
Graded reality testing

267
Q

What is therapeutic alliance in CBT for psychosis?

A

Not colluding with delusions but validation

268
Q

How is graded reality testing used in CBT for psychosis?

A

Peripheral questioning
Inference chaining

MRCPsych Part B (64 decks)

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