PsychoTx Flashcards
Types of psychoTx
- supportive psychotherapy
- psychoeducation
- behavioural therapy
- cognitive therapy
- cognitive behaviour therapy
- interpersonal psychotherapy
- dialectic behaviour therapy
- brief psychodynamic psychotherapy, and
- long-term psychodynamic psychotherapy (e.g. psychoanalysis)
Behavioural Tx
Behavioural therapy essentially encompasses techniques where a feared object or situation is faced rather than avoided. This can be done in vivo (i.e. in real life), or imaginally (i.e. the person summonses the image into their mind): the former is usually preferred, as it is easier to do and seems more powerful.
Some people employ techniques such as emotional withdrawal, ask others for reassurance, or resort to alcohol or benzodiazepines to deal with anxiogenic situations: these can interfere with the therapeutic effect
of behavioural therapy.
Use: anxiety: “exposure and response prevention” or “flooding.” Behavioural therapy is also the primary therapeutic modality in obsessive-compulsive disorder.
Cognitive Tx
Aaron T Beck postulated that people who are prone to depression tend to see themselves, the world around them, and their future, in a negative way, and that they tend to have negative automatic thoughts in response to events in their world. He also identified a number of thinking traps people with depression tend to fall into.
Cognitive therapy involves helping individuals identify and challenge negative automatic thoughts. They are also taught to recognise their own thinking traps, and use this knowledge to assist them to face the world in a more positive manner.
Pts keep a diary of negative thoughts and rate how much they believe them. They then challenge the thoughts and rate how much the belief has been eroded. This is done in an iterative way with the therapist. A further technique is the so-called downward arrow, which seeks to explore the underlying schemas the individual holds.
Cognitive ‘thinking traps’
- dichotomous thinking: ‘black-or-white’; all-or-nothing
- overgeneralisation: concluding that if one thing goes wrong, then everything is going to go wrong
- personalisation: jumping to an immediate conclusion that an event relates (usually negatively) to oneself (‘My colleague seemed grumpy in the morning staff meeting; I must have done something to offend him’)
- arbitrary inference: jumping to conclusions without weighing the evidence (‘I will never get the hang of this therapy’)
- selective attention: the tendency to ‘filter in’ only negatives, rather than giving equal weight to all sources (e.g. ‘One person rated my lecture badly; I am a useless lecturer’).
CBT
Cognitive behaviour therapy (CBT) integrates both behavioural and cognitive therapeutic techniques, and has shown proven benefit for milder forms of depression, and many of the anxiety disorders. It has also been applied to bipolar disorder and to persistent delusions and hallucinations in people with schizophrenia.
Interpersonal Tx
Based on the notion that life events determine psychopathology, as well as attachment theory (disrupted attachment in early life creates vulnerability to psychiatric problems such as depression; early attachment experiences impact adult relationship patterns, and these can be damaging for the individual and feed psychopathology).
IPT is a ‘here and now’ therapy, and addresses issues such as grief (e.g. loss events), role transitions (e.g. retirement), role disputes (e.g. conflictual relationships) and interpersonal deficits (e.g. social isolation) on current psychopathology. The idea is that identification and resolution of interpersonal problems current at the time of onset of symptoms will lead to improved life circumstances and thus improved symptomatology.
Initially used for depression, IPT has been modified for use in a range of circumstances, including depression associated with HIV, depression in pregnancy and, in conjunction with social rhythm therapy (SRT), for bipolar disorder.
Dialectic behaviour therapy
Skills-based therapy which follows cognitive behavioural principles but with an emphasis upon acceptance of and by the person of their current maladaptive behaviours, combined with an expectation that these behaviours need to change. This combination creates a ‘dialectical tension’ with the expectation of achieving a ‘synthesis’ which is more adaptive. This therapy was originally
designed for the treatment of borderline personality disorder (cluster B), but has application in other disorders such as eating disorders and other personality disorders.
DBT aims to address four specific goals:
- reducing self-harming behaviours
- reducing therapy-sabotaging behaviours
- reducing ‘quality of life’ self-sabotaging behaviours
- developing constructive coping skills.
DBT encompasses group therapy aimed at developing ‘core mindfulness skills.’ The patient is also helped to develop ‘interpersonal effectiveness skills’ (communication/conflict), ‘emotional regulation skills,’ and ‘distress tolerance skills.’ Individual therapy is also provided to reinforce skills from group Tx with a focus upon individual needs. Intersession telephone contact focuses upon crisis intervention and the application of the above skills to coping ‘in the moment’ (tolerate the distress and address it in following session).
Psychodynamic psychoTx
Owes much to Freud and subsequent refinement/change by others. Freud’s original technique (psychoanalysis) involved ‘free-association:’ therapist sitting behind pt (rarely intervening/interpreting), and pt saying whatever came into their mind at the time. Freud also emphasised the importance of dreams (‘the royal road to the unconscious’). Emphasised transference (pt’s interaction with therapist was a recapitulation of earlier life interactions), and countertransference (therapist reacted to pt according to therapist’s own earlier relationship experiences). Therapist also explored pt’s resistance (to accepting the interpretations of the therapist).
Classical psychoanalysis is very time-consuming, entailing hourly sessions up to five times a week and conducted over months to years. Today: less frequent sessions, therapist sits facing pt and is more ‘active’ during sessions.
Generally employed to create lasting and profound change for the individual in terms of the way they see themselves. Pt needs to show psychological mindedness, commitment to attending sessions regularly and the resilience (ego strength) to tolerate the feelings evoked through exploration of unconscious issues. Not appropriate in severe depression or psychosis.
Group Tx: advantages and disadvantages
Can employ any combination of techniques. Groups can be open (members can start and exit at pretty much any stage) or closed (participants make a commitment to the group, and no further members are allowed to join).
Advantages:
• cost effectiveness
• a sense of belonging to the group
• identification with other members of the group, and a feeling of not being ‘the only one’ with a particular set of problems
• learning from other members of the group
• a sense of altruism in helping others deal with their problems, and
• the opportunity to role play within the group, and/or perform exposure tasks (e.g. giving a presentation).
Disadvantages:
- logistics of bringing people together regularly
- confidentiality issues
- the propensity for some members of the group to be (or perceive themselves as being) ostracised by the
others (the skilled therapist can use this therapeutically, but it can be very difficult for the individual concerned).
Family Tx
Draws upon systems theory, which essentially recognises a system as a separate entity to its component parts. Thus, a family is seen as an entity in itself and the members of the family are simply the components which make up the structure and organisation.
In family therapy there is no identified person who is considered to be the patient. Rather, the family addresses the problems which exist as a whole. Everyone in the family is expected to contribute and to recognise the ways in which the operations of the family lead to certain problems arising, including emotional or behavioural problems in a particular family member.
In some cases there will be an attempt to disrupt the structures which exist between individuals, and in other cases the family will be disrupted with a strategy which causes a substantial reorganisation of their approach to life activities and problems.
May employ circular questioning (asking one family member how others might view an issue, while others comment), narrative approach (looks at the ways families see themselves and their history and suggests more adaptive ‘stories’), and/or use of a one-way mirror (family and primary therapist on one side and other members of the therapy team on the other).
Couple Tx
May include behavioural, cognitive behavioural, and
psychodynamic approaches, as well as systems theory. Depends on clinical problem and what the couple bring to the session. Couple therapy can be modified for specific situations (e.g. sex therapy).
