Stigma Flashcards
Public stigma
What society beliefs about people with mental illness
Self-stigma
When public stigma becomes internalized (which might lead to low self-esteem, depression, or lack of motivation)
Structural stigma
When stigmatizing beliefs and attitudes lead to unfair social institutions and policies for the stigmatized
group.
Polythetic criteria
No single criterion is absolutely required or essential to the disorder, but they are alternative definers of the disorder, with a certain critical minimum number for the diagnosis to be present (equal weight of the criteria)
Maladaptive variants of the domains of the 5-factor model of normative personality structure
- Negative affectivity
- Detachment
- Antagonism
- Disinhibition
- Psychoticism
What is PD according to AMPD
PD is defined as the combination of clinically significant problems in functioning along with ≥1 pathological trait
What is the gold standard for assessing PDs?
Structured clinical interviews
What is the risk of using self-report instruments for diagnosis?
Personality pathology by definition is ego-syntonic,
and personality-disordered individuals may thus be liable to produce biased self-portrayals
Dodo bird hypothesis
When bona fide
treatments are compared they yield roughly equal outcomes.
Overall, psychotherapy is more effective than no treatment or placebo controls
The cognitive contrast hypothesis
that CBT is superior to other non-CBT treatments.
What is the core feature of BPD according to DBT?
Emotional dysregulation
Core emotional needs:
a. The development of secure attachment to others
b. The development of autonomy, competency, and sense of identity
c. The freedom to express valid needs and emotions
d. Spontaneity and play
e. Realistic limits and self-control
Four types of early life experiences that foster the acquisition of schemata:
- Toxic frustration of needs (®deprivation)
- Traumatization (® mistrust/abuse)
- Overindulgence (®entitlement and dependence)
- Selective internalization (® subjugation)
Core aim of transeference-focused therapy
To learn to accept and tolerate conflicting feelings and images in one person – both in self and others.
Main assumption in TFT?
Important childhood conflicts will surface in the therapeutic relationships and change is achieved
through interpreting the transference and countertransference, focusing primarily on the therapeutic relationship in a here-and-now context
Stages of TFT
- Treatment contract
- Containment of suicidal and self-destructive behaviors, treatment-interfering behavior, and identification of dominant
object relational themes - Strengthening of control over self-harming and treatment-interfering behaviors
- Increasing emphasis on analysis of unfolding transference and countertransference reactions (patients learn to tolerate
and communicate their ongoing feelings more effectively as they practice these behaviors in each session)
Stages in schema focused therapy
- The bonding and emotional regulation phase: patient and therapist work towards the shared perception that the
therapeutic relationship is a safe place in which the patient is affirmed and the expression of needs, desires, and feelings
is encouraged - The schema mode phase: all the predominant modes are specifically addressed.
- The development of autonomy phase: focus on gaining independence outside sessions; core issues are working on
mutually reinforcing (give and take) relationships and solidifying a core sense of self.
4 mechanisms of healing in schema focused therapy
Four mechanisms of healing:
1. Limited parenting: while maintaining professional boundaries, the therapist tries to compensate for the deficits caused
by growing up in an emotionally depriving matrix.
- Providing safety, stability, and acceptance (preconditions for growth from functioning emotionally at childlike levels to
healthy adult functioning)
2. Emotion-focused work through imagery and dialogues produces positive change.
- Empty chair and two chair role-playing techniques, structured letter-writing (helps the patient emotionally process
childhood scenes and strengthen the more adaptive modes)
3. Cognitive restructuring and education: focus on teaching the patient what normal emotional needs are, and then
validating these needs, emotions, and longings in the patient.
4. Behavior pattern breaking: developing more adaptive ways to get the emotional needs met.
MBT is based on?
Psychodynamic theory, attachment theory, and cognitive theory.
MBT is based on?
Psychodynamic theory, attachment theory, and cognitive theory.
MBT is based on?
Psychodynamic theory, attachment theory, and cognitive theory.
What is mentalizing?
- Being attentive to our own and others’ feelings, thoughts, desires and intentions.
- Develops through having experienced oneself in the mind of another during childhood within an attachment context
(only matures adequately within secure attachment)
Why is group therapy beneficial?
Group therapy is like a mini-society, it allows us to see the true personality of a person: individuals become aware
of how they are affecting their environment and how their environment is affecting them
The client gets to analyze his/her interactions with people: past negative experiences in interactions can be “corrected” by new positive interactions
It is less costly (and it is cost-effective)
Yalom’s 11 factors that help the group be effective
instillation of hope, universality, imparting of
information, altruism, development of socializing techniques, imitative
behavior, catharsis, corrective recapitulation of primary family group,
existential factors, group cohesiveness, and interpersonal learning
Which is the most profound of all the 11 factors (Yalom)
Universality
Characteristics of a group therapist
- Having experience in group therapy yourself
- Effective therapy depends on the client as well, and the match between therapist and client
- It doesn’t matter if you are warm, cold, detached, as long as your clients leave
therapy feeling hopeful, more aware of themselves and others, capable
of sustaining positive relationships, and better able to effectively interact
with the vicissitudes and capriciousness of life.
!!! the sine qua non of creating a safe environment, is to develop a personality that is as free as possible from judging others !!!
Preparations before therapy?
- The setting:
- the physical environment has to be restful and peaceful; clients have to feel physically comfortable in order to share their feelings and thoughts
- space between the clients
- most important: stimulus from the outside world must
be reduced to a minimum, if not totally
- clean office
- no personal belongings (like photographs)
- do not answer calls in therapy - Client inclusion/exclusion:
- This success in the development of the group—whether it will be a healthy environment or an unhealthy environment for growth
to occur—is specifically related to the group leader’s skill in client selection for a particular group.
- the future is sealed before it begins due to the combination of
the members selected
Ways to develop cohesion in the group (Corey and Corey)
- Developing cohesion through group members disclosing their feelings concerning their issues on trust - feeling safe in the group
- Clearly defined goals: need to be similar to the personal goals of the members
- Encouraging participation by all group members
- Creating a here-and-now approach to group therapy. In this approach
the members relate to one another directly and take collective
responsibility for the direction that the group may take. The greater the involvement that each
member has with every other member, the greater the chance that
group cohesion will develop. - Effectively dealing with conflict. Any time a group of individuals
gets together, conflict is sure to ensue. This is part of the therapeutic process in a group. Group members should learn and seek
to understand and resolve conflictual situations. - The level of appeal of the group for the individual members. If members are attracted to the experience and to the other members in
the group cohesiveness will be reinforced. - Honesty and openness about one’s thoughts and feelings
The group contract
- important that the rules are understood and accepted by all group members
- once a group has begun we don’t change the group contract- group contract depends on the population, setting, limited or ongoing therapy and the leader
1. All members must arrive on time; notifying the leader beforehand if they’re going to be absent
2. Confidentiality
3. Any and all feelings and thoughts are permissible for expression, and disclosure is encouraged.
4. Members socializing outside group is discouraged as it initiates
the development of subgrouping and bonding at the expense of
the other group members and reinforces secrets
5. “You cannot have a
sexual relationship with anyone in group.”
6. Payment for each session - when and if they pay for cancellation as well
The life cycle of a group:
- analogous to the life cycle of a human being in a compressed form
- similar to Erikson stages: one crisis has to be resolved in order for the person to develop further; resolution is never quite complete
- involves: 1) the recapitulation of an individual’s developmental stages and 2) the developmental life cycle of the group itself
Yalom’s 3 stages of development:
- Time of orientation, disinclination to participate and a search for understanding and meaning of the experience
- Transitional phase - involves rebelliousness, conflict, and control
- Working stage - self-disclosure increases with group members developing greater cohesion and trust
Schutz - about Yalom’s 3 stages:
- Inclusion
- Control
- Affection
5 stages of the development of the group:
- Adaptation, orientation, formation, initial engagement and inclusion:
- anxiety in both group members and leader
- structure and permitted behaviors should be addressed in group contract
- group members are detached and share information that is deemed safe
- analyzing the individual differences rather than similarities
- ambivalence about the group and its development
- the leader observes defense mechanisms - Reactive phase control, differentiation, disinclination to participate, transition, conflict and confrontation resistance
- power and control with confrontation and conflict
- more comfortable, less vulnerable
- covert self-talk is given overt expression
- testing the limits and determining who is in control
- subgrouping
- confronting/attacking other members
- stress and confrontation helps develop trust
- members group together to face the shared enemy: the group leader
- common enemy –> group cohesion - Togetherness, commitment, cohesion, bonding, attraction, identification, family
- develops after the difficulty of stage 2 has been resolved
- the leader becomes less active
- the group takes more responsibility
- judgement starts to diminish, members start to notice similarities
- self-disclosure on a more intimate level
- greater trust
- the real personality - Mature work, resolution, productivity, task-oriented cooperation
- time of cooperation
- individuals are primarily interested in relationships with the other members
- the sense of emotionality begins to rise
- people are working on problems that have caused them personal stress and discomfort
- here and now focus
- greater openness
- willingness to explore feedback with minimum defensiveness
- the group has become entity - it has solidified, having a history with memories, like a family offering support and acceptance to individual members - Termination, farewell, closure, the end:
- sadness
- sense of accomplishment: in what they achieved and in having had the shared experience
- relief for some members
- rehashing of the experience
Baumeister’s escape from self model
- People contemplate suicide to get out of a painful, oppressive or unbearable self-perception.
- A dynamic between events and circumstances and a vulnerable personality
- Suicide has a long-build up process during which high expectations fuel failure
- The person blames themselves for mistakes and flaws. (negative self-image
- These negative thoughts and feelings of inadequacy grow and take up more space until they become unbearable (sense of entrapment).
- sense of entrapment, long build-up and negative self image - also present in the IMV model
William’s cry of pain model
Vulnerability for suicidal behaviour arises from a combination of three factors:
1. Susceptibility to signs of defeat: the person focuses more on signs of failure and less on signs of success
2. Inability to escape: sense of entrapment, arises from limited problem-solving skills and faulty autobiographical memory: the person is less able to recall positive experiences.
3. Feelings of hopelessness : the person sees no future
Growing sense of entrapment: vulnerability increases with each successive experience of defeat –> Even small shifts in mood can trigger suicidal ideation.
Suicide risk depends on the activation of the 3 ideas. If cognitions are activated, suicide risk will remain high even if depressive feelings ae lower.
Treatment should focus on reducing the cognitions - this will lower the person’ vulnerability
Safety plan: elements
- warning signs that the person is in distress
- protective factors
- contact details of people who can help in the event of crisis
- coping strategies and activities
- information about where someone with suicidal behavior can turn for assistance
Characteristics of suicide:
- highly individual
- serious expression of distress
- similarities in the process for different people
- tends to be characterised by both fluctuations in intesivity and a self-reinforcing effect
- stress factors and vulnerabilities also play a role
- self-reinforcing processes progressively increase the likelihood of suicidality
Integrated Motivational Volitional Model (IMV) model
- describes the process leading up to suicide in a progression of three phases
- views suicidal behavior as real behavior with a motivational and a volitional phase
- based on the theory of planned behavior
3 phases:
1. Pre-motivational:
- the person’s background: diathesis (genetics) + environment (family) + life events (abuse, poverty)
2. Motivational:
- the core of the model
- feelings and emotions that create a risk for suicide: feelings of defeat and humiliation–> makes you feel threatened and trapped
- the sense of entrapment is central to the model
- protective factors: healthy coping mechanisms and social skills
- worrying and erroneous thinking increase the risk
- moderators: linking a sense of entrapment to suicidal thoughts and plans (sense of belonging, social support or feeling like a burden)
3. Volitional phase (intention)
- the suicidal behavior
- factors that trigger thought to become actual behavior
- volitional moderators: access to means, exposure to suicide, impulsiveness, ability to visualise suicide or death, a history of self-harm and fearlessness about death (all increase the risk of suicide)
Processes during the pre-motivational phase of the IMV model:
- early childhood
- depression
- interpersonal sensitivity
- self-hatred
Processes during the motivational phase of the IMV model:
- continual worrying
- shame and guilt
- pointlessness
- painful awareness of incapacity
Factors the volitional phase of the IMV model:
- prior attempts
- fear and loss of control
- intrusions
- suicide becomes an “attractive solution” - relief and escape
- tolerance for pain and mental habituation
- protection against worse
- vortex
Severity of the suicide process:
- Mild - suicidal thoughts are under control; awareness for the consequences; the person prefers life
- Ambivalence - the person both want to die and to live; not made plans
- Severe - suicidal thoughts are all-consuming, already have plans, made preparations
- Very severe - the individual is in despair; thinks of nothing but suicide, has firm plans and means; vortex and have tolerance for paon
Interventions against suicide:
- Not effective:
- no suicide contract - Effective:
- safety plan
CASE (Chronological Assessment of Suicide Events) method
- used to evaluate suicide behavior
CASE interview;
- Current suicidal ideation occasioning the examination (entrapment): present problems; building rapport and showing interest
- Recent life events (stressor)
- Broader case history: prior episodes of suicidal behavior (long-term vulnerability)
- Future expectations and plans: drawing up a safety plan, how to prevent another crisis, naming people who can be involved
What percentage of suicide attempters meet diagnostic criteria for a PD?
55-70%
What percentage of people who die by suicide have a PD?
13%
