Psychotherapy Flashcards
Cognitive Distortions
What are they: Tendencies or patterns of thinking or believing, false or inaccurate, have the potential to cause psychological damage.
(ABCDMMS)
- Arbitrary Inference: Use very poor-quality / unrelated evidence to reach conclusions
- Black-and-White Thinking: see things in terms of extremes
- Catastrophising: Assuming the worst possible outcome is going to be true
- Discounting the Positive: acknowledges positive experiences but rejects them instead of embracing them
- Minimisation: Downplaying anything good you have done
- Maximisation: Exaggerating the impact of anything bad you have done
- Selective Abstraction: Jumping to negative conclusions based on small pieces of evidence without considering contradictory evidence
Systematic Desensitisatation
What is it
- Main additional feature to graded exposure is the use of a counter-conditional stimulus – a relaxing stimulus.
- The idea is that it is hard to feel both relaxed and anxious simultaneously.
- Usually, the therapist will work with the patient to find something relaxing (e.g. relaxation exercises) and then pair this up with tolerable levels of anxiety-provoking stimuli.
- The brain then learns to associate the stimulus with relaxation, so less anxiety is generated.
Graded Exposure Therapy
What it is
- Treatment introduces a progressive increase in exposure level to the fear/anxiety-provoking stimulus.
- In agoraphobia, this might involve thinking about leaving the house, walking to the door, holding the door handle, opening the door but not leaving, spending a few minutes outside, and so on.
- The idea is to explain that anxiety usually follows a pattern of building and then gradually dissipates by itself in less than an hour.
How it works
- It is explained that each time this happens (in the absence of avoidance or escape behaviours), anxiety naturally completely goes away (extinction).
- Each time extinction is achieved in relation to one anxiety-provoking stimulus, the brain learns that it survives and the anxiety was not needed. Hence, the maximum anxiety level is reduced a little the next time. This is called habituation.
- Gradually, the stimulus is stepped up until the patient’s anxiety is manageable despite the stimulus.
CBT Explanation
What is it:
- Talking therapy
- Helps you to learn more helpful ways of thinking and reacting in everyday situations
- Focuses on your current challenges rather than on your past experiences.
- Aims to improve your state of mind by teaching you to spot the links between your thoughts, actions and feelings.
Who can it help:
- depression, anxiety, panic and phobias, eating disorders, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder, and psychosis (including schizophrenia).
How does it work
- C stands for ‘cognitive’ (what you think) – In CBT, you learn to notice when you are thinking negatively. You work to challenge negative or unhelpful thoughts
- B stands for ‘behaviour’ (what you do) – Your behaviour is what you do and how you act. CBT can help you to deal with things you have been avoiding or have fears around.
How long is the therapy
- Usually weekly for 16-20 sessions
What happens in the sessions
- Staying well plan
- Background history (1-4)
- Goal setting
- Behavioural Experiments
- Homework: Questionnaire, worksheet, diary, testing beliefs
How Effective is it:
- NICE first line Rx for: anxiety, depression, phobias and OCD
IPT Explanation
What is it:
- Structured therapy that takes place over 12–16 weeks and includes homework.
- Conceptualises depression in terms of interpersonal roles and relationships.
4 Domains:
1. Role transitions (life changes
2. Losses/grief
3. Disputes/conflicts
4. Starting and maintaining relationships
Structure
- Similarly to CBT, IPT typically starts with a few assessment sessions, looking to map out depressive symptoms, social history, and close relationships.
- Once this is completed, a dynamic, targeted treatment can begin.
- Staying well plan
Contraindications:
- Absolute: Active self harm / suicidal acts
- Relative: substance/ alcohol misuse or thought disorder/psychosis
Family Therapy
Communication
- Useful to see child in the wider context of family
- Support different members
- Actions and behaviours impact everyone else’s, people may be unaware of this
Two main types
- Structural: Useful when usual family structure has been lost
- Systemic: Wider team of therapists, two way mirror, external perspective is provided. Views family as a ‘system’ that behaves as a whole, and tests its function, its strengths, and its areas for improvement. It therefore also assumes that rather than people behaving alone or in isolation, all of the system is involved and contributes.
Length of treatment
- 3-6 months, roughly fortnightly
Psychoanalytic Psychotherapy
What is it
- A large part of our mind that is out of conscious awareness which influences our way of relating to ourselves and others. This is called the Unconscious.
- We develop unconscious templates of how we see the world and how we think the world sees us.
- These can make us unhappy and lead to repeated patterns of difficulty.
- Therefore, psychoanalytic psychotherapy offers a reliable setting to explore memory, dreams and fantasies in order to gain better access to the unconscious mind.
Aims
- Therapy aims to identify each person’s unique unconscious patterns of relating as they emerge in relation to the therapist, a process referred to as “transference”.
- Particular attention is paid to the “transference” by the therapist because it is seen as the key to understanding repeated patterns and therefore may offer a beginning to resolve long standing difficulties.
- Psychoanalytic psychotherapy tries to create a space where all aspects of the person’s emotional life can be explored and thought about.
