Talking Therapies/Placebo Flashcards
List some commonly encountered Mental Health Problems.
- Mood disorders; depression, bipolar disorder
- Anxiety disorders; OCD, agoraphobia (fear of things/situations that may cause panic etc), panic disorder
- Psychoses; schizophrenia
- Substance misuse/addictions; drugs, alcohol, gambling
- Personality disorders
- Neurodevelopmental disorders; ADHD, Aspergers
- Others; dementia, somatoform disorders
What is the approach to treating Mental Health Problems?
- Holistic approach (patient as a whole)
- Biopsychosocial model
- Biomedical; medication, ECT (in severe life-threatening depression)
- Psychological; talking therapies
- Social; occupational therapy, social inclusion and wellbeing
What are the psychological therapeutic talking interactions that a patient may undergo?
- Self help groups
- GP consultation
- Everyday social networks
- Friends and Family
- Formal psychotherapy w/trained therapist
- ‘Self Help’; internet, books
- ‘Counselling’
What are talking therapies?
AKA psychotherapies, psychological therapies, counselling:
- Use of language/verbal interaction
- May involve face to face interaction with therapist, some self-help
- May be 1:1, group work, couples, families
- Aim; offer support to improve an identified difficulty or distress
- Explore; thoughts, feelings (moods), behaviour. Look for patterns
- Reflect, understand, evaluate, move forward
What are the general principles of talking therapies?
- Formalised structure: time, venue, no. of sessions, ‘ground rules and boundaries’
- Patient understands and agrees to work with model, motivated to participate
- Often, motivation to work outside the therapy session
- Requires patient to be an ACTIVE PARTICIPANT; rather than a passive recipient of care
- More than ‘just talking’
- Facilitate patient ultimately to be their own therapist
- Trusting therapeutic relationship very important
Who are Talking Therapies for?
Problems helped by TT:
- Bereavement
- Anxiety disorders
- Chronic pain
- Smoking cessation
- Depression
- Substance misuse
- Personality disorder
Types of TT: • CBT (cognitive behavioural therapy) • Psychodynamic psychotherapy • Supportive psychotherapy • MBCT (mindfulness based cognitive therapy) • Motivational interviewing • DBT (dialectical behaviour therapy)
Why must caution be practiced in selection of who a talking therapy may benefit?
- Some types of therapy are not indicated for some conditions; insufficient evidence base, may be harmful
- Careful assessment of patient suitability essential before comitting to therapy
What is CBT? What is its aim?
Cognitive Behavioural Therapy:
- Views of self, world, future
- How behaviour, thoughts, physical feelings and mood affect each other
- Aim: identify unhelpful cycles of thought, behaviour, mood, physical feelings, and consider how these cycles can be broken.
What is CBT indicated for? How is it delivered?
Indicated for: • Depression • Anxiety disorders (phobias, panic, OCD) • Psychoses (some e.g. schizophrenia) • Anger management • Bulimia • Low self-esteem • Chronic physical health problems
> > > Delivery; time limited face-to-face sessions, self-help.
What is the Five Areas Approach that demonstrates how something may impact a person e.g. negative things said about a patient?
- Situation/practical problem/relationships:
• Altered thinking (e.g. negative ‘I am no good’)
• Altered physical symptoms (e.g. emotions; feeling down, upset)
• Altered behaviour; physical sensations, feeling sick in your stomach etc
• Altered feelings; behaviour, stop going out etc.
»> All bullets interconnected, with altered thinking bridging to the life situation
Describe the structure of CBT sessions.
- Explain model
- Agree time (frequency, time, length of session; 50 mins, how many sessions; 18-20 recommended by NHS, irl 6-10)
- Boundaries (who to contact if unwell between appointments, issues re. confidentiality)
- Identify difficulty, goals
- Begin to identify unhelpful vicious cycles and triggers
- ‘Homework’
- On return; review Homework
- Encourage patient to find own solutions and devise ‘experiments’
- Regular review of progress
- Patient may keep notes/workbook for future reference
- Speed of progress will depend on individual patient
What is MBCT?
Mindfulness Based Cognitive Therapy:
- Mindfulness; meditation, based on traditional Eastern philosophies ‘East meets West’
- Mindfulness/cognitive therapy exercises combine to help manage problems with depression and stress
- Increased awareness of ‘here and now’
- Being aware of, but neither engaging with nor actively dismissing the thoughts that arise (looking at your thoughts from an outside perspective)
- Other ways of experiencing consciousness than just thought
- ‘Present’ more of the time
- Enable to notice and disengage from negative thoughts
- More kindness to self
What have Jon Kabat Zinn (1990) and Williams et al (2007) described mindfulness as?
“Paying attention on purpose, in the present moment, and non-judgmentally, to things as they are”
“Mindfulness is not paying more attention, but paying attention differently and more wisely-with the whole mind and heart, using the full resources of the body and its senses”
Which patients benefit from MBCT (mindfulness)?
- Vulnerable to recurrent depression
- Longstanding depression symptoms
- Stress
- Offered to reduce stress, better clarity of mind, problem solving, mood regulation
What is the availability of MBCT? What does NICE recommend?
- Mostly group sessions (secondary care)
- Other sources availible
- Books and internet sites
- NICE; recommended for recurrent depression
