Therapies Flashcards
What is trephination?
Drilling a hole in the head! Was thought to drive out demons and evil spirits.
What are 4 advantages of getting therapy with trained professionals compared to someone who’s untrained?
○ Knowledge about specific treatments
○ Relationships with other professionals
○ Ability to detect and handle emergencies
○ Sensitivity to legal and ethical issues
What 5 ethical principles do psychologists adhere to?
○ Striving to benefit the people they work with (Benefit)
○ Establishing relationships based on trust (Trust)
○ Showing integrity to being accurate, honest, and truthful (Integrity)
○ Being vigilant about potential biases (Bias)
○ Showing respect for dignity and worth of all people (Respect)
What’s 1 advantage and 1 disadvantage of more practitioners being able to prescribe psychotropic medications?
Can be a good thing bc of high demand
Critics say if they want to prescribe biological therapies they should follow the usual educational path so that they understand potentially dangerous interactions
What are the 3 major barriers to care?
Access
Finances
Stigma
What 3 factors make someone find more value in therapy?
Those who do best have:
1) rapport with their therapist
2) a strong motivation to become well
3) a disorder that’s amenable to the type of treatment being provided
Subsyndromal disorder
do not meet DSM-V criteria but can nonetheless cause significant problems
What ethnic group is most likely to seek therapy in the US?
European Americans
What % of people in “developing” countries have access to psychological treatment?
90%
(I am not sure if this is quite as true as it appears; is it possible that treatment options are different and don’t neatly map onto western labels?)
What 3 things does a therapist have to adjust to to be culturally competent?
Client’s beliefs,
values,
and expectations for therapy
Why do people with schizophrenia have a better prognosis in India than in the US? (4)
○ Overreliance on medication at the expense of training someone to perform social roles
○ Having a supportive social network–99% of people who have schizophrenia in India live with their families compared to 15-20% in the US
○ Families wanting to distance members with schizophrenia in the US due to stigma
○ Healthcare insurance companies not wanting to pay for social programs
I would add less association with stigmatising label.
Rapport
whether person respects and trusts the provider and feels comfortable in therapy
Hysteria (now called conversion disorder) (4)
Wide catalog of symptoms including: • Blindness/deafness • Paralysis/numbness • Trembling/convulsing • Memory gaps
What are the 4 key stages of Freudian psychoanalysis?
- Free association–whatever comes to mind
- Analysis of resistance–avoiding certain ideas
- Interpretation–explaining how certain thoughts and feelings arise
- Analysis of transference–client’s tendencies to respond to therapist in ways that recreate their responses to major figures in their life
Glove anesthesia
People might have no feeling in their hand but have feeling above the wrist, which can’t be caused by a nerve injury because that would affect the nerves above the wrist too.
Free association
Patient says anything that comes to mind, no matter how trivial, embarrassing, or disagreeable. Birth of talking therapy.
What is resistance? What did it lead Freud to develop?
Freud’s patients avoided certain topics and censored what they said about people, when he thought they would mention everything that came to mind. Freud believed this resistance arose because certain memories were too painful or anxiety-provoking–so they pushed them out of their consciousness (repressed them). Because of resistance, he thought he had to develop indirect methods of analysis to uncover the ideas and memories his patients would not, or could not, reveal–i.e. psychoanalysis.
What is interpretation in Freudian psychoanalysis?
The psychoanalyst’s explanations of how a patient’s thoughts, feelings and behaviours are related to earlier experiences.
Transference
The tendency of patients to respond to the therapist in ways that recreate their responses to major figures in their lives. Freud thought it could be a powerful tool allowing analyst to show patient how they really feel about the important people in their lives. Therapist plays a neutral role and “stands in” for these people, allowing for emotional re-education
Ego psychology (4)
Psychodynamic therapy
Everyone deals with psychic conflict
Skills and adaptive abilities of the ego
Ego can be a clever strategist with intrinsic competencies
Object relations theory (2)
Form of psychodynamic therapy
Emphasises importance of individual’s real (as opposed to fantasized) important relationships with others and how these motivate behaviour
Interpersonal therapy (3)
○ Contemporary psychodynamic approach
○ Builds on the assumption that disorders are often the result of social isolation that cuts people off from the nourishment provided by healthy relationships
○ Focuses on helping people learn better ways of interacting with others, to help people learn to act the part of the roles they are now taking on
What are the fundamental concerns of the humanistic approach to therapy? (3)
- Meaning
- Self-actualization
- Willingness to take charge of their actions and their life’s trajectories.
Carl Rogers’ client-centered therapy
Therapists seek to help clients accept themselves as they are with no pretense or self-imposed limits
A therapist’s success in client-centered therapy is conditional on (3)
§ Genuineness
§ Unconditional positive regard
§ Empathic understanding
What is motivational interviewing?
What are the 3 steps?
Brief non-confrontational, person-centred intervention to change problematic behaviour by:
1) drawing out their goals,
2) reducing ambivalence, and
3) clarifying discrepancies between how they’re living and how they would like to live
What is gestalt therapy? What are the two things it works to increase?
Focuses on helping clients acknowledge and integrate previously disparate parts of the self by increasing self-awareness and self-acceptance
“Focusing” in therapy
asking clients what they’re feeling in the moment, which Perls developed as part of Gestalt therapy.
Hot seat technique
therapist directly challenges or confronts the client
Empty chair technique
client imagines being seated across from another person and tells them honestly what they feel
Experiential therapies (5)
- Modern humanist
- Person-centered + Gestalt
- Empathetic and accepting + direct challenge
- Client’s subjective experience
- Emotionally validating
What is the assumption behind behavioural therapy?
Assume disorders result from faulty learning–employ learning theories to create behavioural interventions
Exposure therapy
attempt to break association with stimulus and fear
In vivo exposure therapy
Patient is exposed to the stimulus in the real world or through interactive computer programs
Vicarious reinforcement
Patient attempts to acquire conditioned response by observing someone else have it.
Instrumental or operant conditioning
Aim to change behaviour by reinforcing relationships between acts and consequences, e.g. token economies
Classical conditioning
Reduce links between stimulus and impact on patient e.g. exposure therapy
Modelling
People learn new skills by watching and imitating other people.
What are token economies? What are two positive effects they have?
Patients earn tokens when they exhibit helpful or healthy behaviours.
1) Less apathy in wards that use them and 2) atmosphere improved.
Shaping
Slowly modifying types of reinforcement.
E.g. patient originally given tokens for getting out of bed, then they start getting out of bed every day, and instead are given tokens for getting out of bed and walking to dining hall.
Contingency management
Rewarding positive behaviours and punishing negative ones, to show someone that their actions change the way people react to them.
Observational learning principles
Using modelling to teach client to imitate another person’s thinking, decision-making process, or behaviour
What is the assumption behind cognitive therapy?
Assume that disorders involve unhelpful beliefs and maladaptive patterns of thinking
Rational-emotive behavioural therapy (ABC)
Disrupting and correcting faulty beliefs.
Action -> Belief -> Consequence.
Dispute B, then move on to D–disputing irrational beliefs -> E–substituting more effective beliefs.
Cognitive therapy
Cognitive restructuring to change maladaptive beliefs or patterns of thinking.
Uses various methods. Aim of all of them is to change both your behaviours and how you think about the world.
Negative cognitive triad
Depressed people have negative beliefs about:
themselves,
the world,
and the future
Give an example of all or nothing thinking
Now that I’ve done badly on this exam, I’ve failed at psychology
Give an example of overgeneralization
I lost my car keys, that’s just like me, I lose everything!
Give an example of disqualifying the positive
Doing well on the test was just a fluke
Give an example of emotional reasoning
I feel it, therefore it’s true
What time period does cognitive behavioural therapy focus on?
Now!
Third-wave therapies
First wave was behavioural, second wave was cognitive, third wave is cognitive-behavioural.
Third wave therapies place less emphasis on direct cognitive change and more on pursuing valued goals despite unwanted thoughts and feelings.
Acceptance and commitment therapy
Type of third wave therapy.
Help client achieve greater awareness and acceptance of thoughts and feelings.
Goal is to make it clear client can achieve goals despite unwanted thoughts and feelings.
Mindfulness-based stress reduction
Third wave therapy teaching clients to be fully present in the moment and observe thoughts, feelings and sensations without judgement
What are 5 reasons there’s an increased focus on non-traditional forms of therapy?
○ Need to focus on couple- and family-level issues
○ High cost of one-on-one therapy
○ Lack of therapists outside urban areas
○ Privacy
○ Convenience
What is family therapy? Give an example of when it works well.
Includes interventions designed to repair family dynamic. Shown people with bipolar are less likely to relapse if therapy includes family-level interventions as well as medication.
4 benefits of group therapy
○ Cheaper
○ Shows people they aren’t alone with their problems
○ Belonging in a group, shared support, encouragement
○ Group dynamic shows people what they might want to change, how to relate to people better, how their beliefs are not true
Self-help or support group (3 advantages and 2 disadvantages)
○ No therapist
○ Usually free
○ Chance to share experiences
○ Usually little attention paid to individual’s emotional problems
○ No professional present to manage difficult situations
Psychotropic medication
Drugs that control or moderate the symptoms of psychological disorders
What are typical antipsychotics and what are they good for?
Developed in 50s, effective at reducing positive symptoms but less effective in treating negative symptoms
Atypical antipsychotics
Treat both positive and negative symptoms so widely used nowadays
What’s a potential downside of the reliance on antipsychotics?
Antipsychotics are a heck of a lot cheaper than long-term, institutionalized care, which has fueled deinstitutionalization.
Lack of stable housing and support has led to a lot of people who have schizophrenia becoming homeless or being incarcerated.
What are the four major classes of antidepressants?
- MAOIs
- Tricyclics
- SSRIs
- Atypical
What neurotransmitters do MAOIs and tricyclics work on?
Increasing availability of norepinephrine and serotonin
What are atypical antidepressants?
Work variously on norepinephrine, dopamine, and serotonin. Includes Wellbutrin and Effexor.
Example: Wellbutrin seems to have little effect on serotonin. Has no sexual side-effects. Works as a stimulant for ADHD and for smoking cessation.
What are 5 issues with antidepressants?
- Usually take about a month to start working
- Unknown how much is placebo
- Trial and error approach to finding one that works
- May stop working and require repetition of trial and error to find a new one
- Side effects: most common are weight gain, loss of sexual desire, and insomnia
What percentage of people who seek treatment for depression receive antidepressant medication?
80%
What condition do mood stabilizers treat?
Bipolar
What percentage of people with bipolar does lithium work for?
60-70%
What are the 3 most commonly prescribed types of anti-anxiety medication?
- Anxiolytics e.g. benzos
- Beta blockers
- Antidepressants
How do anxiolytics work?
Increasing neurotransmission at synapses containing GABA
How do beta blockers work for anxiety?
Decreased autonomic arousal -> less spiraling due to physical anxiety symptoms
What are the 3 main limitations of psychotropic medications?
○ Need to keep taking them
○ Difficulty finding right medication and dose
○ Side effects, such as tardive dyskinesia
What did psychosurgery originally aim to do?
Alter problematic patterns of thinking, feeling, or behaving by removing brain areas or disconnecting them from each other.
What is a lobotomy? When was it popular and why did it go out of favour?
Early psychosurgery that cuts axons that connect subcortical structures to prefrontal cortex.
Hailed in 1930s but by 1950s was “proved” to have devastating side effects including memory, ability to plan and self-regulate, and death.
What is ECT? How often do people have to get it?
Applying moderately intense current, usually to right side of the brain, for about half a second to induce a 30 to 60 second seizure.
Usually involves 2-3 treatments a week for 3-6 weeks.
4/10 patients relapse within 6 months of treatment.
When is ECT used?
When all other treatment options have failed or there is a serious risk of suicide.
What is the success rate of ECT?
It works for 70 to 90% of patients who have not responded to any antidepressant medication or who can’t take it.
What are three next-generation surgical/biological treatments?
- Vagal nerve stimulation
- Deep brain stimulation
- (r)Transcranial Magnetic Stimulation
What is vagal nerve stimulation? What does it act on?
Sends electrical impulses to vagus nerve. Thought to stimulate parasympathetic nervous system and therefore facilitate mood regulation.
What is deep brain stimulation?
Stimulates subgenual cingulate cortex.
Overactivation of this region implicated in depression.
Proven effective for people with depression who haven’t responded to other treatments. Mixed results.
What is rTMS? What does the process look like?
Rapid pulses of magnetic stimulation that alter neuronal activity from coil held close to scalp.
Proven effective for medication-resistant depression.
Lasts 30-60 mins, 5 times a week for 4-6 weeks. No cognitive side effects.
Give 4 facts about physical activity and nature
- People with psychological disorders are usually less physically active
- Increasing activity levels may improve MH, but results are mixed
- Exposure to natural environments is thought to reduce stress
- Urban living associated with activation of amygdala
What are 3 issues with survey results about whether people are happy with their therapy?
- We don’t know whether respondents are representative of the wider population–those who responded to the survey may differ from those who didn’t
- Regression to the mean: maybe they would have got better anyway
- Respondents may just want to justify the time and money they spent on therapy
What is the before-and-after approach to assessing the effectiveness of treatment? What effect is it vulnerable to?
- Step in the right direction
2. Vulnerable to spontaneous improvement effects i.e. some people get better on their own
What is wait-list control? Is it any good? What is one common version called?
One group tracked as they take a medication + second group tracked as they are on waitlist.
Presents stronger evidence for effectiveness of treatment but vulnerable to placebo effects–influence of individual’s beliefs and expectations in bringing about a cure.
If participants grouped by random assignment, this is a randomized controlled trial.
What are 2 issues with double blind studies for therapy effectiveness?
Address placebo effects but hard to apply in context of psychological therapies:
1. Hard to make both therapist and patient truly blind to which they are taking. 2. Hard to make inert medication that doesn't include any common factors that help therapies work, such as rapport with therapist
Dodo bird effect
Widely different interventions are equally effective
What type of condition is behavioural therapy especially good for?
Anxiety, esp. specific phobias
What 3 conditions are cognitive therapy especially good for?
Depression
Panic
Bulimia
What are 2 conditions experiential therapies are good for and 1 that they aren’t good for?
Good for anxiety and depression
Not good for schizophrenia
What condition does interpersonal therapy seem to be helpful for?
Depression
What is eclecticism? (3 points)
- Deliberately combining different therapeutic approaches
- Widely endorsed today
- Successful new therapies like DBT often emerge from combining different approaches
Mix-and-match approach
Therapist draws on many therapeutic techniques when working with a particular client OR a particular population.
What are the advantages (1) and disadvantages (1) of the mix-and-match approach?
a. Advantage: therapy can be tailored to each client (or population), and therapist can keep using what works and back off from what doesn’t
b. Disadvantage: therapist no longer using empirically-backed method (but that method is empirically backed for a population not an individual)
What is the matched-treatment approach?
Selecting best approved therapy or combination of approved therapies for patient’s complaints, e.g. medication + CBT.
What are the advantages (1) and disadvantages (3) of the matched therapy approach?
• Advantage: Based on most approved science
• Disadvantages: ○ Therapist must keep up with best practices in broad range of therapies ○ Must refer out when necessary to someone with more expertise in type of therapy client needs ○ Combined therapy is essentially still a new therapy and the combination must be proved efficacious.
What are the six models of treatment for psychological disorder?
- Biological
- Psychodynamic
- Behavioural
- Cognitive
- Humanistic
- Systems
Etiology
The cause of disorder
What are the 2 main etiologies under the biological model?
- Structural abnormality: damage or abnormality to physical modules in the brain
- Neurotransmitter or hormone imbalance: absolute levels and imbalances in levels
Name 7 diagnostic or treatment methods in the biological school?
- fMRI
- Hormone assay
- Drugs
- Phototherapy
- ECT
- DBS
- TMS
Give an example of when fMRI can be useful
For head trauma, can help predict symptoms that might be experienced and treatment methods that might be appropriate based on location of trauma.
E.g. doctors immediately made Andrew start speaking and remembering words after damage to frontal lobe.
What 3 conditions are biological treatments most effective for and why?
- Schizophrenia**: CBT is not useful to someone who’s acutely psychotic. Medication is used to get people out of their break from reality, and then other forms of therapies are used to help people deal with symptoms.
- Bipolar**: one of the most important things is to get a salt like lithium to prevent mania. This is frontline treatment so biological model very important.
- Anxiety
What is the etiology of disorder under the psychodynamic model?
- Unconscious intrapsychic conflict presenting as conscious anxiety and distress
- Fixations in psychosexual development
What does diagnosis and treatment look like under a psychodynamic method? (6)
Have to access part of patient that even they are unaware of, because the defense mechanisms are unconscious.
* Find out what defense mechanisms they're using * Projective testing * Prolonged therapy–Freud's original method was 5 days a week for at least 3 years, changes this to 3 days a week * Raise awareness of conflict–once you know what the conflict is, it will basically resolve itself * Defuse defense mechanisms
What is psychodynamic therapy effective for?
- Some dissociative disorders–arguably
- Mild persistent anxiety/depression
- Most effective in some sexual disorders
What is the etiological of psychological disorder under the behavioural model?
- Maladaptive learned associations
* Maladaptive environmental contingencies
What does diagnosis look like under the behavioural model?
- Observation
* Self-report
What does treatment look like under the behavioural model? (3) Give an example of each.
- Exposure
- Learning new skills/behaviours: do a new habit and reward the habit
- Changing environment
What is behavioural therapy effective for? (4)
- Phobias, acute anxiety
- Addictions
- Child behaviour problems
- Andrew said autism… and developmental disorders
What is the ethology of disorder under the cognitive model? Give an example of each.
- Maladaptive cognitions
* Automatic thoughts
What does diagnosis and treatment look like in cognitive therapy? (4)
- Client self-report
- Collect automatic thoughts and maladaptive cognitions
- Generate substitute cognitions
- May even ask them to collect evidence on why maladaptive cognitions are untrue
What 4 types of disorder is cognitive therapy effective for?
- Depression
- Social anxiety
- Generalized anxiety disorder
- Eating disorders
What is the ethology of disorder under the humanistic model?
- Failure to self-actualize
* Absence of responsibility for oneself
What does diagnosis and treatment look like in humanistic therapy? (1 dx, 3 tx)
- Always based on self-report
- Unconditional positive regard
- Reflection of clients’ thoughts
- Client-directed
What is the key limitation of unconditional positive regard?
Assumes the client always knows what is wrong with them
What 2 things are humanistic therapy useful for?
- Low self-esteem
* Those with little dysfunction, but some distress
What is the etiology of disorder under a systems model?
- Maladaptive interactions within a system such as our family unit, relationship
- Often related to behavioral contingencies and/or maladaptive cognitions
What does diagnosis look like under a systems model?
Parent and child self report
Agency referral
When is systems therapy most often used?
Children who are experiencing behavioral difficulties, which have often stemmed from seeing examples of bad things in their family unit, being reinforced for bad behaviour or punished for good
What does treatment look like in systems therapy? (3)
- Restore pre-existing positive relationships
- Identify problematic interactions and/or relationships
- Publicly acknowledge challenges and solution
What is the process involved in a motivational interview? What is it used for?
Asking the client to list out all of the challenges that they’re going to face if they want to change their behaviour, all the things they’re going to have to give up to do it, and all the benefits they might get from doing it. Therapist doesn’t direct it, client does.
Hope is it will intrinsically motivate them to pursue and stick to therapy.
What is the prevalence of schizophrenia?
1%, slightly more common in men
What two factors are affected by the relative proportion of positive and negative symptoms someone with schizophrenia has?
Prognosis
Treatment effectiveness
What are the positive symptoms of schizophrenia? (4)
- Hallucinations
- Delusions of grandeur, reference, and/or persecution
- Disorganized speech–sentences make sense but loose associations between different concepts
- Psychomotor agitation–nervousness, tics, forced grasping
What are the negative symptoms of schizophrenia? (4)
- Inappropriate affect (manic or blunted)
- Impoverished speech (alogia)–absence of appropriate amount of speech, stopping in middle of thought
- Social withdrawal
- Catatonia–absence of normal movements, waxy flexibility, resistance to being moved
What’s the prognosis for acute onset schizophrenia with primarily positive symptoms?
More responsive to medications, more likely to see minimal dysfunction
What’s the prognosis for chronic onset schizophrenia with primarily of negative symptoms?
Less responsive to medications, dysfunction persists and management of symptoms is usually the goal of treatment
What’s the age of onset for schizophrenia? How does it differ in men vs women?
Usually diagnosed in adolescence or young adulthood 18-25. However some behavioural and brain differences have been shown from much earlier–as young as 2 years old.
Usually starts earlier in men compared to women.
What is acute onset schizophrenia?
Psychotic break with no previous symptoms, associated with more positive outcomes with well managed symptoms.
What is chronic onset schizophrenia?
The first “break” is preceded by a period of atypical behaviours building up over many months or years, preceding a psychotic break.
Associated with lower treatment efficacy with current treatment options.
Describe the genetic basis for schizophrenia. (4)
○ Proportion of variability in diagnosis is .80–.80 of the variance in schizophrenia is explained by the genetic component, .20 from experience.
○ Chance of having it if both parents have it 50%. ○ Identical twin of someone with schizophrenia has nearly 50% chance of developing it, lower the further away you get. ○ Related to chance of biological parents having it not adopted parents.
Name 2 environmental factors that are associated with schizophrenia.
First psychotic episode often triggered by a stressful event.
Psychedelic use.
What structural abnormalities are associated with schizophrenia? (3) What symptoms are they associated with? (1)
○ Enlargement of ventricles
○ Loss of cortical matter
○ Loss of white matter (myelin) in temporal cortex which aids communication between neurons
Appear to be most associated with negative symptoms
What is the timeline of loss of cortical matter in schizophrenia? (3 stages)
- Parietal-motor function and sense of the body
- Temporal
- Frontal
What type of symptoms are biochemical abnormalities mostly associated with in schizophrenia?
Positive symptoms
Part of why medications work so well–much easier to correct a biochemical abnormality than loss of matter/enlargement of ventricles
What three biochemical abnormalities are associated with schizophrenia? (3)
○ Over-reactivity of dopamine receptors–dopamine more easily communicated. Dopamine closely associated with hallucination as in psychedelics, e.g. meth. These worked primarily on positive symptoms but not negative symptoms.
○ Hyper-activity of serotonin–esp around start of psychotic episode. LSD primarily acts on serotonin.
○ Enhanced glutamate production associated with both positive and negative symptoms. Why atypical antipsychotics work on both. Cocaine works on glutamate.
What is the prognosis of schizophrenia? (2)
Not curable yet
Therapeutic goal is symptom management
(In other parts of the world, goal is primarily finding a useful social role)
What neurotransmitter do typical antipsychotics work on?
Work primarily on dopamine, generally v effective on stopping hallucinations and acute psychotic breaks.
Name 4 side effects of typical antipsychotics
- Lockjaw
- Tremors
- Extreme sedation
- Tardive dyskinesia
What do atypical antipsychotics do? (3)
Targeted effects on dopamine transmission and serotonin
Fewer side effects than typical antipsychotics, and no tardive dyskinesia
As, or more, effective than typical antipsychotics
What is skills training for schizophrenia? Give two examples.
Behavioural approach to managing daily life with symptoms
Token economy
Training in how to interact with people, finding income and housing, etc.
What is case management?
Assistance with navigating social services, such as paperwork, access to therapy, housing, etc.
