Psychotherapy

Question 1

indications/CI

Answer 1

85% effective (all types equal)

dep/anx/OCD, ED, PD, schizophrenia

active substance abuse/SI/psychosis (Control)
poor self-observation (improve), poor tolerance, engagement/relations issues

Question 2

theories

Answer 2

interactions between genetics and experiences
current personality/MH influenced by past experiences
dev psych, cog neuroscience, attachment
affect-behaviour-cognition interactions

Question 3

PDT - principles

Answer 3

unconscious thought and past relationships influence present ABC
focus on emotion and avoidance
awareness of UC, changing patterns of emotions/UC
T (feeling from patient) and CT (response to T, own T)

triangles: conflict (UC feeling, feeling, defence/response); person (past, present, therapist relations); therapy (trauma, Sx, defence)

Question 4

PDT - course

Answer 4

regular sessions: same time/place/therapist; fixed duration
individual or group, brief or long-term
link past and present; interpretation, confrontation
boundaries important

Question 5

PDT - indications

Answer 5

depression, anxiety, PD
complex multilayered problems

assessment: psychologically minded; distress tolerance (vs. risk), motivation, focus/target

Question 6

CBT - principles

fix thoughts to change behaviours/Sx

Answer 6

current influences; ‘problem solving’; thoughts drive feelings
cross-sectional concept: thoughts, physio, emotion, behaviour interact
longitudinal concept: events activate beliefs and assumptions
-assumption (good at job = successful),
-core beliefs (I’m worthless); downward arrowing (Deeper schema), resistance to change

Question 7

CBT - course

Answer 7

6-20 sessions (axis 1);set agenda/plan, and homework
-rapport, baselines, goals/expectations; motivation and commitment (?MI)

same time, place, therapist; 1 on 1
focus on present, and problem-solving; relapse prevention
-feedback, guided discovery, measuring progress
Sx-focused, behavioural re-attribution

Question 8

MI - principles

Answer 8

reduce ambivalence, increase internal motivation
-focus on personal goals and values

express empathy, non-judge, support self-efficacy
develop discrepancy, roll with resistance

patient centred, reflection (repeat, rephrase, paraphrase, reflect feeling)
elicit change talk (desire, ability, need, reasons)
guidance with permission

Question 9

stages of change

Answer 9

pre-contemplation: unaware
contemplation: ambivalent, no intention
preparation: considering change
action: planning; learning and using skills to change
maintenance (or relapse): consolidate, continue;

Question 10

MI - 5 steps/process

Answer 10

I: rapport and narrative; avoid resistance (rushing, authority, confronting)
II: priorities and agenda; 
-"most important/concerning to you?"
III: change talk; importance/confidence
-"why did you give that score"
IV: advice with permission
V: plan; summarise, plan together, f/u;
-patient in control

Question 11

behavioural therapies

Answer 11

flooding; 'straight to 10'
exposure and response: prevent response and decrease behaviour/association
aversion therapy
graded exposure
learned helplessness (Seligman)

Question 12

other therapies

Answer 12

systemic psychotherapy/FIT: schizo, ED (high EE)
DBT: BPD, ED, substances, DSH/SI, relationships
Interpersonal therapy: relations
couples therapy; group therapy
mindfulness

Question 13

therapy features

Answer 13

involves empathy, listening, support, narrative/vent, reflection, alternative persepective

relationship, explanation/education, positive expectations, patient factors, advice/guidance/support, belief in efficacy, boundaries

Question 14

therapy classification

Answer 14

theory: psychoanalytic, behav, cog, systemic, humanistic
technique: expressive, supportive
mode and setting
timing: brief, limited, long, open-ended
level: self-help, counselling, non-specialist, supportive, specialist

Question 15

stepped care

Answer 15

I (subclinical; 1o): self-help, screen, promote health
II (mild/mod): guided self-help, cCBT, telehealth
III (mod): brief PT (CBT, PDT)
IV (complex, high risk): specialist PT
V (severe, high risk): therapeutic community

Question 16

CBT - indications

Answer 16

mono: anxiety, unipolar depression, BN
adjunct: psychoses, addiction, AN, PD

Question 17

CBT - process/mechanism

Answer 17

assess suitability: engagement etc.
identify ANT, core beliefs/rules, key triggers/experiences

manage ANT: homework, thoughr records, behavioural experiments
-thought records: event, feeling, thoughts, alternatives, behaviour

observe change and response over time
prepare for self-reliance

Question 18

ANT - automatic negative thoughts

Answer 18

all-or-nothing, overgeneralising, jumping to conclusions
mental filter, discounting positive (mind-reading/fortune-telling)
magnification/minimisation
emotional reasoning, ‘mustibation’, labelling
personalisation

Question 19

Defence mechanisms

Answer 19

repression, fantasy, withdrawal, projection and introjection (blame), rationalisation, educations, substances, denial, somatisation, avoidance, mania/depression

Question 20

PDT - process/mechanism

Answer 20

assessment of suitability
identify problem: symptoms and trauma
-free association, narrative/explore, dream analysis
identify and fix maladaptive coping
-talking, creativity, altruism

goals: awareness of UC, understand defences, reduced repetition, ‘ok with self’

Question 21

DBT: based on CBT

change unhelpful thoughts/behaviours
accept emotions

Answer 21

acceptance: understand behaviours, emotions, coping
change: encourage/motivate, alternative coping mechanisms

individual, group skills, telehealth, consult group r/v

3 stages of individual therapy; duration approx. 1 year
‘here and now’ practical (barriers, QOL); understanding and changing; maintenance (goals, self-Mx)