Psychotherapy - BB

Question 1

What is CBT?

Answer 1

• Type of talking therapy
• Helps understand that thoughts, feelings, actions and body sensations are all connected
• By changing one you can change the others
• Eg when we are sad/worried we sometimes think and act in ways that makes us feel worse, CBT helps notice these things and change unhelpful thoughts and actions

Question 2

What can CBT be used to treat?

Answer 2

• Depression
• Anxiety disorders (inc panic attacks)
• Obsessive compulsive disorder
• PTSD
• Psychosis and Schizophrenia
• Bipolar
• Eating disorder
• Tinnitus
• Insomnia

Question 3

What conditions can CBT be used for to manage the symptoms?

Answer 3

• Chronic fatigue syndrome
• Irritable bowel syndrome
• Fibromyalgia
• Chronic pain

Question 4

How can CBT be delivered?

Answer 4

• Group or one to one
• Ranges from 5-20 sessions
• Each lasts about 1hr

Question 5

CBT vs antidepressants

Answer 5

• Work best when used together - superior than individual use alone

Question 6

Fundamental principle of CBT

Answer 6

• What people think affects how they feel emotionally and physically and also alters what they do
• In anxiety and depression, changes occur in thinking an behaviour (cognition and behvaiour)

Question 7

C component of CBT

Answer 7

• When people are anxious or depressed often think about things in extreme and unhelpful ways
• = unhelpful thinking stypes
• They reflect habitual, repetitive and consistent thought patterns that occur during times of anxiety or depression
• = everyday situations misinterpreted
• = own strengths downplayed, problems are focused on and blown out of proportion

Question 8

B component of CBT

Answer 8

• Reduced acitivity/avoidance - when anxious people avoid situations which then causes people to feel more depressed/anxious due to viscious circle
• Unhelpful behaviours - altered behaviour to try and improve mood eg alcohol/drugs, excessive reassurance, self harm, retail therapy

Question 9

5 areas assessment prior to CBT

Answer 9

• Life situation, relationships and practical problems
• Altered thinking
• Altered emotions - also called mood/feelings
• Altered behaviour or activity levels

Question 10

What is psychoanalysis therapy?

Answer 10

• Rarely provided via NHS - can go private
• Investigates mind and human behaviour
• Allows unconscious patterns to be brought into awareness with a view of changing them
• Freudian analysis = verbalise thoughts via free association (anything that comes to mind), fantasy and dreams
• Patients relationship with analyst is important

Question 11

What is psychodynamic therapy?

Answer 11

• Allows regular time to think and talk about feelings you have about yourself and other people - especially family that you are close to
• Discuss life at the moment, what has happened in the past, how the past can affect your feelings, thoughts and behaviours currently
• Allows connections to be made between past and present - show how some thoughts are driven by unconscious feelings from past
• Allows you to take control and act based on current feelings rather than past ones
• Unstructured sessions - free expression of what patient wants to discuss
• Therapist will have had their own therapy

Question 12

Define psychotherapy

Answer 12

• Systematic use of a relationship between patient and therapist as apposed to physical and social methods
• To produce feelings, cognition and behaviour

Question 13

Common characteristics of all psychotherapies

Answer 13

• Intense confiding relationship with helpful person
• Rationale containing an explanation of patients distress
• Provision of new information about nature and origins of patients problems and ways of dealing with them
• Development of hope in the patient that they will be helped
• Opportunities to experience success during treatment, enabling increased sense of mastery
• Facilitate emotional arousal

Question 14

Types of psychotherapy

Answer 14

• Psychodynamic psychotherapy
• Cognitive behavioural therapy
• Interpersonal therapy
• Family/systemic therapy

Question 15

When is psychodynamic therapy often used?

Answer 15

• Recurrent and chronic relationship issues
• Psychological conflict or alienation
• Allows understanding of current problem by exploring past experiences and how this affects dynamics of internal world
• Can be used for personality disorders, depression, eating disorders and some anxiety

Question 16

What is interpersonal therapy?

Answer 16

• Link between depressive symptoms and current interpersonal problems as focus for treatment
• Does not dwell on personality or cause but addresses current relationships
• Used for depression and eating disorders

Question 17

What is involved in family/systemic therapies?

Answer 17

• Target system that generates problematic behaviour - eg family unit
• Bring about change in family system
• Used often for children but can be used in eating disorders and adjunct in schizophrenia

Question 18

In what settings can psychotherapy be delivered?

Answer 18

• Psychodynamic and CBT - individual or groups (eg 8 and 1 or 2 therapists)
• Patient couple (marital or psychosexual work)
• Systemic therapies - whole family unit
• Can be in day cenres, hospitals and sometimes residential settings

Question 19

Psychotherapy vs counselling

Answer 19

• Very similar
• Counselling offers non-judgemental support and encourages person to clarify and prioritise current problems and find solutions, does not usually explore therapeutic relationships
• Helps people overcome immediate crisis
• Psychotherapy helps more long standing problem, requires long and specialised training and get regularly supervised

Question 20

Who is suitable for psychotherapy?

Answer 20

• If patient is able to verbalise problems and psychologically minded (able to see that psychological processes could contribute to problem)
• Some degree of responsibility for resolution of difficulties (motivated)
• Need to be mindful of doing harm - stirring up difficult issues and not being able to manage them
• Psychotic patients and those with serious dependence on illegal drugs not usually suitable
• People with strong suicidal ideation often benefit

Question 21

What is Dialectical Behavioural therapy?

Answer 21

• Skills based therapy - derived as CBT appraoches were less effective for those with emotional dysregulation and chronic suicidality in personality disorders
• Combination of individual and group sessions for 6-12 months
• Clear structure

Question 22

Modules of dialectical behaviorual therapy

Answer 22

• Distress tolerance
• Emotional regulation
• Interpersonal effectivness
• Mindfulness work interspersed

Question 23

What does distress tolerance focus on in DBT?

Answer 23

• Increase capacity to bear periods of intense emotional activation without use of unskilful behaviour (eg self harm, substance use, binge eating to distract from emotional pain)

Question 24

How does emotional regulation work as part of DBT?

Answer 24

• Address emotion in neutral way
• Focus on naming distinct emotional experiences rather than catergorising them as good or bad
• Encourages relfection rather than reactive
• Challenges approach that emotions need to be frightening/overwhelming
• = sense of control

Question 25

How does interpersonal effectivness work in DBT?

Answer 25

• Considers how people might enrich their lives by developing rewarding relationships
• Develop skills in assertiveness and negotiation
• Allows balance for own needs whilst validating needs of othrs
• = healthy boundaries

Question 26

Defence mechanisms of psychoanalysis/psychodynamic therapy

Answer 26

• Compensation - strengthen one to hide another
• Denial
• Displacement - take out on someone/something else
• Identification - attach to something positive
• Projection - see your faults in others
• Reaction formation - pretend you are different
• Regression - act younger to feel better
• Repression - put things into dark
• Ritual - hide thoughts with habit
• Sublimation - divert negaitve into socially acceptable (eg anger into sport)