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MRCPsych Part B > Psychotherapy 1.2 > Flashcards

Psychotherapy 1.2 Flashcards

1
Q

When were group methods developed?

A

Early 20th century

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2
Q

What led to the development of group methods?

A

Observations of beneficial group effects in TB patients

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3
Q

Who was the first major proponent to observe beneficial effect of groups?

A

JH Pratt

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4
Q

Who developed group methods?

A

T Burrow in the 1920s

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5
Q

What is the premise of group processes?

A

Behaviour and dynamics of the group cannot be derived from the individuals.

Once formed, groups develop their own way of existing.

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6
Q

What is group alliance?

A

Quality of relationships that develop between each member and the therapist.

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7
Q

What is group cohesion?

A

Group working together towards a common goal.

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8
Q

What is group coherence?

A

Group goes beyond cohesion and becomes self-evolving and able to work through conflicts.

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9
Q

What is positive identification?

A

Unconscious group mechanism in which a person incorporates the characteristics and qualities of the group.

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10
Q

What is catharsis?

A

Expression of ideas and conflicts is accompanied by an emotional response which produces a sense of relief.

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11
Q

How can group therapies be divided

A

According to degree of leadership
According to membership
According to mode of therapy

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12
Q

Which group therapies have high level of leader input and are highly specific

A

Structured groups for drug and alcohol misuse
Activity groups like OT

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13
Q

Which group therapies are highly specific but have low level of therapist activity

A

Problem-solving therapy
Psychoeducational groups

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14
Q

Which groups have low leadership level and low specificity of treatment goals

A

Support groups
Art therapy
Interpersonal therapy like Tavistock model analytic groups

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15
Q

What can groups be divided into according to mode of therapy?

A

Activity
Support
Problem-focused
Psychodynamic
Behavioural

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16
Q

What do analytic/dynamic groups involve?

A

Examination of the conscious and unconscious processes in the group including resistance, transference and countertransference

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17
Q

What did Bion describe?

A

Three basic states that a group goes into when it gets derailed

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18
Q

What are the three states described by Bion?

A

Dependency
Pairing
Fight-flight

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19
Q

What are the three states described by Bion known as?

A

Basic assumption

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20
Q

What is the 4th basic assumption introduced by Hopper?

A

Massification/aggregation

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21
Q

What happens in dependency?

A

Group members become dependent on one another

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22
Q

What happens in pairing?

A

Formation of a partnership in the group might bring forth new resolution

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23
Q

What is massification/aggregation?

A

Regid fusion of identities leads to loss of individuality or extensive withdrawal leads to loss of mutual dependence

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24
Q

What did Foulkes describe?

A

Group matrix; web of communications and relationships within a group

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25
Q

What did Foulkes divide the group matrix into?

A

Foundation matrix
Dynamic matrix

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26
Q

What is the foundation matrix?

A

Commonalities existing between strangers attributable to characteristics of human species

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27
Q

What is the foundation matrix a precondition of?

A

Later evolving dynamic of group matrix

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28
Q

What is the dynamic matrix?

A

Ever developing exchanges that occur between group members

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29
Q

Factors that influence a group matrix

A

Mirroring
Exchange
Free floating discussion
Resonance
Translation

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30
Q

What did Yalom cite?

A

11 curative factors responsible for change in groups

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31
Q

What are the 11 curative factors according to Yalom?

A

Instillation of hope
Universality
Imparting information
Altruism
Corrective recapitulation
Socialisation techniques
Imitative behaviour
Interpersonal learning
Group cohesiveness
Catharsis
Existential factors

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32
Q

Name some expressive therapies

A

Psychodrama
Art therapy
Music therapy
Support groups

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33
Q

Who created psychodrama?

A

Moreno

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34
Q

What happens in psychodrama?

A

Therapist acts as the director
Patient as protagonist
Another group member as someone significant in the patients life (auxiliary ego)
Soliloquey as a recital of thoughts and feelings

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35
Q

What is role reversal in psychodrama?

A

Exchange of patients role for role of significant person

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36
Q

What is ‘double’ in psychodrama?

A

Auxiliary ego acting as the patient

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37
Q

What is ‘multiple double’ in psychodrama?

A

Several egos acting as the patient

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38
Q

What is ‘mirror technique’ in psychodrama?

A

Auxiliary ego imitating the patient and speaking in the proxy

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39
Q

Most important component of music therapy?

A

Therapeutic alliance

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40
Q

Important aspects of cognitive behavioural groups?

A

Group cohesiveness
Task focus

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41
Q

Principles of therapeutic communities is based on what?

A

Henderson hospital model

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42
Q

Major components of therapeutic communities?

A

Communalism
Permissiveness
Democratisation
Reality confrontation

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43
Q

What is communalism?

A

Staff not separated from patients
Mutual helping and learning

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44
Q

What is permissiveness?

A

Tolerating each other and realising unpredictable behaviour can happen in the community

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45
Q

What is democratisation?

A

Shared decision making and joint running of the unit

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46
Q

What is reality confrontation?

A

Self-deception or distortions from reality are dealt with honestly and openly by all members

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47
Q

Who created interpersonal therapy?

A

Klerman & Weissman

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48
Q

Aim of interpersonal therapy?

A

Improvement of interpersonal functioning

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49
Q

How many sessions are involved in interpersonal therapy?

A

12-16

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50
Q

What is the patient seen as in interpersonal therapy?

A

The sick role

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51
Q

What is interpersonal therapy based on?

A

The idea that emotional problems are best understood by studying the interpersonal context in which they arise.

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52
Q

Focus of interpersonal therapy?

A

Current interpersonal relationships and their relationship to development of illness

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53
Q

Therapists stance in IPT

A

Advocate for patient

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54
Q

Areas of focus in IPT

A

Role transitions
Interpersonal disputes
Grief
Interpersonal deficits

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55
Q

Which disorders is IPT indicated for?

A

Mild to moderate depression
Bulimia

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56
Q

Who created DBT?

A

Marsha Linehan

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57
Q

Aim of DBT

A

Reduce self-harm in BPD

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58
Q

How does DBT address problems of patients with BPD?

A

Uses hierarchical fashion starting from self-harming behaviours, then therapy interfering behaviours and later behaviours reducing QoL.

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59
Q

Modes of DBT?

A

Group skills training
Individual therapy
Phone consultations
Consultation team

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60
Q

Key techniques of DBT

A

Distress tolerance
Interpersonal effectiveness
Core mindfulness
Emotion regulation skills

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61
Q

What happens in distress tolerance?

A

Accepting, finding meaning for and tolerating distress.

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62
Q

What is interpersonal effectiveness training?

A

Assertiveness and problem solving training

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63
Q

What is core mindfulness training?

A

Learning to monitor internal mental states

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64
Q

What is another approach used in DBT>

A

Validation - recognising distress and behaviours as legitimate and understandable but ultimately harmful

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65
Q

Who created cognitive analytic therapy?

A

Anthony Ryle

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66
Q

Which psychiatric disorders can CAT be used for?

A

Depression
Anxiety
PDs

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67
Q

Central concepts of CAT?

A

Procedural sequence model
Role-repertoires

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68
Q

What is procedural sequence model?

A

Attempt to understand aim-directed action.

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69
Q

What do aim-directed actions consist of?

A

Aim generation
Environmental evaluation
Plan formation
action
Evaluation
Procedural revision

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70
Q

What patterns are seen in patients under the procedural sequence model?

A

Traps
Dilemmas
Snags

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71
Q

What are traps?

A

Negative assumptions that produce consequences which in turn reinforce assumptions.

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72
Q

What are dilemmas?

A

A person acts as though available actions are limited or polarised.

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73
Q

What are snags?

A

Appropriate roles or goals abandoned because others would oppose them or thought to be forbidden

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74
Q

What is restricted role repertoire?

A

Undue restriction in number/variety of procedural sequences may occur due to impoverished environment, childhood abuse etc.
These lead to neurotic difficulties.

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75
Q

Duration of CAT

A

16-24 sessions in three phases

76
Q

What are the phases of CAT

A

Initial
Middle
Finding

77
Q

What happens in the initial phase of CAT?

A

Exploration of traps, dilemmas, snags
Therapist writes formulation letter

78
Q

What happens in middle phase of CAT?

A

Working through problems with diagrams exploring target problem procedures

79
Q

What happens in final phase of CAT?

A

Therapist and patient write goodbye letters

80
Q

Difficulties in using CAT for BPD

A

Those with BPD have a small number of highly maladaptive reciprocal roles.
Patients with BPD are oversensitive to stimuli resulting in unwarranted changes
Capacity for conscious self-reflection and control is impaired in BPD.

81
Q

What is the reciprocal role in CAT?

A

When subject assumes one pole the opponent is pressurized to take up the opposite pole to interact

82
Q

Who created transactional analysis?

A

Eric Berne

83
Q

What does transactional analysis do?

A

Examines interactions between people

84
Q

Key ideas of transactional analysis?

A

There are three main ego states:
Parent
Adult
Child

85
Q

What is the parent ego state?

A

Criticising or nurturing parental style

86
Q

What is the adult ego state?

A

Examples include making an objective appraisal of reality or behaving in a rational way towards others

87
Q

What is the child ego state?

A

Source of emotions, spontaneity, creativity.
Impulsive behaviour

88
Q

How was humanistic psychotherapy originally promoted as?

A

Third force in psychotherapy

89
Q

What do humanistic therapists believe?

A

Each person has a the responsibility for finding meaning in our own lives.
Therapy is a way to help people make their own life choices.

90
Q

What do humanistic therapists strive for in therapy?

A

To increase emotional awareness

91
Q

What is seen as the treatment in humanistic psychotherapy?

A

The therapeutic relationship

92
Q

Who created client-centred therapy?

A

Carl Rogers

93
Q

What is the central aspect of client-centred therapy?

A

Every individual as the motivation and ability to change and they are the best person to decide on the direction of that change.

94
Q

How do clients resolve their difficulties according to Carl Rogers?

A

By experiencing and accepting themselves

95
Q

What does it mean that client-centred therapy is nondirective?

A

Client is encouraged to focus on current subjective understanding.

96
Q

How is the patient viewed in client centred therapy?

A

The patient has vast resources to understand and help themselves and the therapists goal is to facilitate this

97
Q

What is the notion of self concept emphasised in client centred therapy?

A

The organised, consistent set of perceptions and beliefs about onself

98
Q

What three things are emphasised in client centred therapy?

A

Therapeutic attributes of genuineness
Unconditional positive regard
Accurate empathy

99
Q

What is unconditional positive regard?

A

Valuing clients for who they are and refraining from judgement

100
Q

What developed from client centred therapy?

A

Q-sort technique

101
Q

Who created Getalt therapy?

A

Perls and Goodman

102
Q

What does Gestalt therapy focus on?

A

Patients experience in the present and emphasises personal responsibility

103
Q

Central aspects of Gestalt therapy

A

Phenomenological method
Field-theoretical strategies
Experiental freedom

104
Q

What is the phenomenological method?

A

Aims to increase awareness through repeated observation and inquiry

105
Q

What is the dialogical relationship?

A

Therapist attends to their own presence and creates a space for the client to do likewise. This is described as inclusion; supporting the presence of the client

106
Q

What are field-theoretical strategies?

A

Focus on both physical/environmental realities of the client and those related to the clients mental processes and character structure

107
Q

What is experiental freedom?

A

A move towards action

108
Q

Who created Mentalization based therapy?

A

Bateman and Fonagy

109
Q

What is Mentalization based therapy derived from?

A

Attachment theory

110
Q

Central concepts of Mentalization based therapy

A

Maintaing a curious stance
Understanding the patients subjective experience through empathy
Validating the patients experience

111
Q

What is the goal of mentalization based therapy?

A

To increase the patients mentalizing capacities

112
Q

How did mentalization based treatment start off?

A

As treatment for BPD in a psychoanalytically oriented partial hospitalisation programme

113
Q

Key features of MBT

A

Therapist focuses on patients current mental state to build up representations of internal states.
Therapy creates a transitional area of relatedness

114
Q

What is the transitional area of relatedness?

A

Where thoughts and emotions can be trained

115
Q

How are enactments during treatment perceived in MBT?

A

As terms of the situation and emotions immediately before the enactment

116
Q

In what ways is MBT a derivation from psychodynamic therapy?

A

De-emphasis of hidden unconscious concerns in favour of conscious content
Less focus on the past, more on present
Therapist avoids describing complex mental states

117
Q

Who created EMDR?

A

Shapiro

118
Q

What is the premise behind EMDR?

A

When trauma occurs it gets locked in the nervous system with original pictures, sounds, images, thoughts and feelings. This material can combine fact with fantasy and ‘images that stand for actual emotions.’
Eye movements in EMDR unlock the nervous system and allow the brain to correctly process the experience

119
Q

What is the hypothesis behind the EMDR theory

A

REM sleep helps in processing unconscious material and reproducing eye movements in REM can induce similar process while awake.

120
Q

When was EMDR originally used?

A

With Vietnamese war veterans suffering from PTSD

121
Q

Who created the Transtheoretical model?

A

Prochaska and DiClemente

122
Q

What was the transtheoretical model developed in response to?

A

Increasing divergence in the practice of psychotherapy

123
Q

What common processes did the transtheoretical model identify amongst 18 models?

A

Consciousness raising
Choose
Catharsis
Conditional stimuli
Contingency control

124
Q

What is consciousness raising?

A

Helping the patient gather information and self and the problem

125
Q

What is choosing?

A

Increasing awareness of healthy alternatives

126
Q

What is catharsis in transtheoretical model?

A

Emotional expression of problem behaviour and process of change

127
Q

What is conditional stimuli?

A

Stimulus control and counterconditioning

128
Q

What is stimulus control

A

Avoidance of stimuli associated with problem behaviour

129
Q

What is counterconditioning in transtheoretical model

A

Training an alternative, healthier response to stimuli

130
Q

What is contingency control?

A

Positive reinforcement and self appraisal, improving self-efficacy by self-reinforcement

131
Q

What are the six stages of change in the transtheoreticalmodel?

A

Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse

132
Q

What happens in the precontemplation stage?

A

Person is not considering changing their behaviour
Do not see behaviour as a problem
Minimise and deny risks
Avoid information to the contrary

133
Q

What happens in contemplation stage?

A

Person is aware of why the behaviour is a problem but is ambivalent about changing
Sees equal or more benefits than costs from behaviour

134
Q

What happens during preparation stage?

A

Person has made a decision to change and is planning a strategy for change but has not yet taken action

135
Q

What happens in maintenance?

A

Person is able to sustain change and avoid reverting to problem behaviour for significant period of time

136
Q

Who created Motivational Interviewing?

A

Miller and Rollnick

137
Q

What is Motivational Interviewing used with?

A

TTM
Stages of change

138
Q

How did Miller and Rollnick develop motivational interviewing?

A

In line with client centred therapy
Work with substance-abusing patients

139
Q

Major principles of motivational interviewing?

A

More effective to work collaboratively with patients than to challenge their behaviour
Resolving ambivalence towards changing can increase motivation to change
Change from the patient is more powerful than that prescribed by a therapist

140
Q

Aim of motivational interviewing

A

Increase in intrinsic motivation to change

141
Q

General principles of motivational interviewing

A

Express empathy
Develop discrepancy
Avoid argumentation
Roll with resistance
Support self-efficacy

142
Q

What is behavioural couples therapy used for?

A

Alcoholism

143
Q

What does behavioural couples therapy work to do?

A

Increase relationship factors, which is conducive to abstinence

144
Q

Structure of behavioural couples therapy

A

Patient and spouse are seen together for 15-20 sessions for 5-6 months

145
Q

What happens in BCT?

A

Therapist arranges a daily sobriety contract and spouse expresses support

146
Q

What can BCT lead to?

A

Increase in positive feelings and constructive communication

147
Q

What is acceptance and commitment therapy part of?

A

Third-wave CBT

148
Q

What does acceptance and commitment therapy draw upon?

A

Basic account of language

149
Q

What does acceptance and commitment therapy emphasise?

A

The way people relate to their thinking and feeling

150
Q

Theoretical underpinnings of acceptance and commitment therapy

A

Cogitive fusion
Experiental avoidance

151
Q

Give an e.g. of cognitive fusion

A

I think I am useless, this belief influences my behaviour, therefore reinforcing my belief

152
Q

Give an e.g. of experiential avoidance

A

I feel anxious, instead of staying with the anxiety I do everything to avoid it

153
Q

Strategies of acceptance and commitment therapy

A

Acceptance
Cognitive Defusion
Contact with the present
Self-as-context
Values
Committed action

154
Q

What happens in acceptance?

A

Taking position of non-judgemental awareness towards feelings, thoughts and sensations

155
Q

What happens in cognitive defusion?

A

Stepping back and observing ones thoughts

156
Q

What happens in contact with the present?

A

Mindfulness to experience the present moment

157
Q

What happens in self-as-context?

A

Persons identity is caught up in a particular thought ‘I am useless’

158
Q

What happens in values?

A

Patients are encouraged to explore their values, sense of purpose and meaning.
Choice and freedom are main focus

159
Q

What happens in committed action?

A

Learning to move in a valued direction while in the presence of unwanted thoughts and feelings

160
Q

Therapeutic stance in acceptance and commitment therapy

A

Clinician uses metaphors, paradoxes and experiental exercises

161
Q

Which psychiatric disorders is acceptance and commitment therapy effective for?

A

Depression
Work stress
Psychosis
Substance abuse
Chronic pain
BPD

162
Q

Who developed mindfulness based cognitive therapy?

A

Segal and Teasdale

163
Q

Who is mindfulness based cognitive therapy aimed at?

A

People vulnerable to repeated episodes of depression

164
Q

Structure of mindfulness based cognitive therapy

A

8 weeks of mindfulness classes
Education classes
Exercises from cognitive therapy

165
Q

What happens in education classes in mindfulness based cognitive therapy?

A

Learning about depression

166
Q

What do exercises from cognitive therapy help with?

A

Demonstrate links between thoughts, emotions and bodily sensations

167
Q

Evidence of impact of mindfulness based cognitive therapy on depression?

A

44% reduction in depressive relapse risk

168
Q

Who does NICE recommend mindfulness based cognitive therapy for?

A

People who are well but who have experienced 3 or more past depressive episodes

169
Q

Which factors make psychotherapy easy to measure?

A

Fixed duration
Standardised by use of manuals
Random assignment
Patients have a single specifically-selected problem
Outcome is measured in symptom counts

170
Q

What are variations in outcome of psychotherapy thought to be due to?

A

Severity of disorder
Clinician and context-related factors

171
Q

What is considered one of the most important factors in the effectiveness of psychotherapy?

A

The therapeutic alliance

172
Q

Who does NICE recommend CBT for?

A

Psychosis
Depression
Anxiety
ED
PTSD

173
Q

Who does NICE recommend interpersonal therapy for?

A

Depression
ED

174
Q

Who does NICE recommend Mentalisation Behavioural Therapy for?

A

PD

175
Q

Who does NICE recommend CAT for?

A

Depression
Anxiety
OD

176
Q

Who does NICE recommend psychodynamic psychothapy for?

A

Depression
Anxiety
PTSD
PD

177
Q

Who does NICE recommend behavioural psychotherapy for?

A

Addiction disorders

178
Q

Who does NICE recommend family/systemic therapy for?

A

ED
Psychosis

179
Q

Best predictor of outcome of any psychotherapy?

A

Degree of therapeutic alliance

180
Q

Who conducted a meta-analysis of psychotherapies and pharmacotherapies?

A

Huhn et al 2014

181
Q

For which psychiatric disorders has combination therapy found to be effective (therapy and medication)?

A

Depression
Social phobia
Panic Disorder
Bulimia

182
Q

Which psychiatric disorders were found to have greater efficacy with medication treatment?

A

Schizophrenia
Dysthymia

183
Q

Benefits of combined psycho-pharmacotherapy

A

Improved recovery rates
Faster responses
Decreased rate of relapse
Improved long-term social functioning
Improved medication compliance
Greater reported satisfaction
Lower long-term service costs

184
Q

Challenges in offering combined therapies

A

Higher administration costs
Lack of reliable evidence base
Practical difficulties in co-administration

185
Q

Difficulties in comparing trials of psychotherapy with pharmacotherapy

A

General psychotherapy trials have small sizes and larger effect sizes with compared to controls
Individual pharmacotherapy trials have large sample sizes
Psychotherapy trials have lower drop out rates and better quality of follow-up data
Researcher allegiance
Psychotherapy research do not often report authors conflict of interest

186
Q

What is researcher allegiance?

A

Testing of psychotherapy by its inventors often positively influences the effect size

MRCPsych Part B (64 decks)

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