Psychotherapy Flashcards
Numerous Theoretical Orientations
*Psychotherapy: A process in which a
professionally-trained therapist
* Systematically uses techniques derived from
psychological principles
* To relieve another person’s psychological distress
* Or promote growth
Major Schools include:
* Psychodynamic
* CBT
* Humanistic-experiential
* Integrative/eclectic
EVIDENCE-BASED TREATMENT
Establishing Efficacy, Understanding
Effectiveness
- Efficacy: treatment does what supposed to do in curing or relieving target problem, and does it for more people than doing nothing does
- Typically established through RCTs
- RCTs (Randomized control trial): large group of people with (ex:depression), randomly assigned to receive either my treatment or already established treatment. Prove better than waiting-list control (have people wait for the amount of time they would be waiting to get into therapy… aka doing nothing) or better/similar than an already established treatment
- Can tell us whether a treatment has a beneficial effect, BUT
- Issues:
– Wait-list control for people who are acutely ill? Ethical to do wait-list control for people badly ill?– Unlike a pill, different therapists may give different “doses” (may inadvertently be giving different “doses” of the therapy, which is not being measured)
– Patients are usually relatively uncomplicated cases (e.g., single
dx) (patients who are enrolled in RCT are typically the least complicated cases. Ex: people with severe suicidal idea, comorbid with substance abuse, etc. often excluded. So tests developed on “cleanest” cases. Also, very standardized treatment: in the real world doesn’t happen that way)
– Highly controlled treatments - Effectiveness? (different from efficacy): effective outside of these very controlled environments? Effective in real world context? External validity?
- Empirically supported therapy
-are the gold standard
Empirically Supported Therapies
* Gold-Standard
* Evidence-Based Practice = the integration of the
best available research and clinical expertise
within the context of patient characteristics,
culture, values, and treatment preferences
* APA and CPA require training programs to train in
evidence-based practices
Cognitive-Behavioral Therapies (CBT)
CBT is not the solution to every problem
Designed for specific psychopathologies
Three Waves of Behaviour Therapy
First Wave: Classic behaviour therapies
* Classical and operant conditioning; systematic
desensitization.
* Focus is on behaviours, not thoughts
Second Wave: Incorporation of cognitions
* Rise of mainline Cognitive-behavioral therapy
Third Wave: New Ideas and approaches
* Acceptance and Commitment Therapy
* Mindfulness-based Cognitive Therapy
* Dialectical Behavior Therapy
CBT: Exposure therapy
Exposure therapies are example of early behavioral therapy:
-Exposure: anxiety climbing
-Panic peak
-Habituation: anxiety coasting
Leads to Mastery of anxiety
Flooding= old way of doing it. Immediately expose them to biggest fear.
In Vivo Exposure = gradual. Least feared thing to most feared
* Systematic desensitization
through exposure to feared
situations or locations, in order
to produce extinction of the fear
response
Ex: pictures of birds, videos of birds, outside with birds, touching a bird…
Important that the therapist is there with the client and doing it too
* Imaginal exposure used if the
patient cannot be directly
exposed to the feared stimuli
Imaginal exposure: for things where you can’t go and be exposed (ex: fear of my children dying). Ex: write a script of the situation, record saying it and listen to it over and over until habituation
Interoceptive Exposure
* When the feared stimulus is
not EXTERNAL, but instead
INTERNAL
* Systematic exposure to feared
bodily symptoms
-What if have a panic attack?
–Great, wonderful thing to practice. Safe space for learning experience that you survive.
–Used when afraid of things that aren’t dangerous (ex: panic attack)
CBT: Exposure and
Response Prevention
- For OCD
- Focus is on exposure to feared stimuli
without engaging in safety behaviours
(i.e., compulsions)! - Operates according to the principles
of Pavlovian extinction
*Also done for PTSD in some cases
*Challenging but really effective form of treatment, esp. for OCD
*If can get to the extreme (sometimes) and concur it (ex: put hand in public toilet bowl), gives enormous sense of mastery. Established with the client though, done as a hierarchy, don’t start here!
The Cognitive Triangle
*Thoughts, behavior and feelings
-All influence each other
-Ex: thoughts: pigeons are dangerous and I need to stay inside to avoid them, behavior: stay inside, feelings: yeah inside I feel safe from the pigeons, thoughts: I feel safe so outside with pigeons is really dangerous….. etc.
*Thoughts are not facts! Just because I think pigeons are dangerous does not mean they are
Cognitive distortions:
-all or nothing thinking (black and white). Ex: I didn’t get an A in the class so I basically failed.
-disqualifying the positive (only focusing on the failures). Ex: I did so bad this semester ☹ … but you got 3 As and 2 A-
Etc. (see slide)
Cognitive restructuring (ex: CBT thought record… example with social anxious teen demo) helpful for many but not for everyyy psychopathology or reason for seeking therapy
Other treatments with CBT
Specific disorders may have add-ons/things to focus on specific to disorder
Depression:
* Often incorporates a combination of behavioural activation (adding more positive reinforcement to the person’s life… doing things that bring reward) and cognitive restructuring
through thought records
Anxiety:
*Anxiety and OCD treatment often relies on cognitive restructuring in addition to
EXPOSURE techniques
- In-vivo exposure (systematic desensitization)
- Interoceptive exposure
- Imaginal exposure
- Exposure and response prevention
Acceptance and
Commitment Therapy (ACT)
- Mainline CBT focuses on disputing
thoughts (questioning them and how factual they are)
General goals of ACT are to:
* Foster acceptance of unwanted thoughts
and feelings
-Let thoughts and feelings flow through you, not fighting
* Stimulate action that improves the
circumstances of living
-ex: values clarification exercise (what are the values that you WANT to be guiding your life)… look at in what ways behaviors intercept that… and focus on acceptance of feelings as way to get to that valued life
* Discourage experiential avoidance
- “an unwillingness to experience negatively
evaluated feelings, physical sensations, and
thoughts.”
- Hayes, 2005
Demo: write down thoughts of sugar packs, then therapist throws them a you while you try to answer their questions. When try to catch the thoughts (sugar packs), hard to answer the questions. When just let them flow, let them go, much easier to focus on answering the questions
By trying to engage rather than let them wash over us, not able to engage in the acts of daily living
*there is other stuff in the powerpoints but she didn’t go over them… maybe briefly look over but I doubt they will be tested
