Topic 11 - Interventions Flashcards
Varvogil and Darviri (2011) reviewed the following interventions:
The research conducted a littearture review to look at what stress management techniques were researched and found as effective. • Progressive muscle relaxation • Autogenic training • Relaxation response • Biofeedback • Guided imagery • Diaphragmatic breathing • Transcendental meditation • Cognitive behavioural therapy • Mindfulness-based stress reduction • Emotional freedom technique
Progressive Muscle Relaxation
- Edmund Jacobson (1920s)
- Sequential sequence of tensing and relaxing various muscle groups
Technique used to increase relaxation by altering between tensing and relaxing different muscles.
Edmunds argument: muscles tensing hold anxiety, relaxing them should help.
• Since muscle tension goes along with anxiety (when people are anxious, they feel an overall tension) –> anxiety can be reduced by this method
You often start at top or bottom, hold tension for 10 seconds, relax for 10-20 seconds - focus of tension is the focus on the DIFFERENCE (in sensations) between relaxing and tensing.
Can hinder anxiety provoking thoughts, because you have to focus on tensing/relaxing, and sensations difference = can challenge ruminative thought process + relax body.
Focusing on the difference in sensation between tensing and relaxation helps person be aware of when they are tense, and what to do to relax.
Autogenic Training
- Johannes Heinrich Schultz
- Six exercises
- Heaviness
- Warmth
- Heart
- Breathing
- Abdominal
- Head
Uses different commands to tell body to relax –> you learn how to control your body (incl eg. Breathing, body temperature, etc) - uses e.g. Imagination to control these aspects, verbal commands , visualisations, etc.
Exercises include e.g. Induced heaviness (verbal cues to suggest heaviness), verbal cues eg. Verbal statements, to induce warmth, breathing practices, abdominal practice focusing on abdominal sensations, and “cooling” of the head, heart practice = calling attention to heartbeat.
Autogenic training in collaboration with therapist/teacher
Mastering each takes approx 4-6 months - not well undertsood HOW it works, but there are measureable effects in terms of body response (e.g. Temperature)
Thought that it works in similar manner to hypnosis and biofeedback =by allowing better “communication” with body systems that are not usually in your control (e.g. Breathing you can control, but it is not something your normally actively control)
It is NOT recommended for people with severe mental disorders, or children under 5.
Relaxation Response
• Herbert Benson (1960s)
• Balancing of the stress response
• Think about sympathetic and parasympathetic nervous systems working in tandem - we have to balance these!
• Important parts
• Repetition to allow for concentration
• Repetition of e.g. Word, sound, prayer, thought, phrase or muscular movement that allow you to concentrate
• Passive return to repetition when other thoughts intrude
During relaxation response, body goes from physiological arousal to physiological relaxation
Relaxation response related to the parasympathetic nervous system, related to e.g. Meditation and yoga, activating more the “rest and digest” response. This mindful state, attention to presence, being highlighted in this approach.
Biofeedback
- Grew out of The concept of homeostasis and cybernetic theory
- Cybernetic theory:
- WERNER in 1940’s
- Feedback principles and control mechanisms -
- Idea of monitoring process through feedback process.
- Systems are controlled by monitoring results.
- Involves learning how to change the physiological activity of the body to improve health
The term biofeedback first used by chain of researchers, and was basically a step forward with regard to Werner’s feedback position/stance. They took his stance, and coined the term based on his cyberneic theory.
When someone starts biofeedback, they learn how to control physiological systems (using very precise physiological measurements, e.g. EEG, or bands around chest measuring breathing heart rate often using clip on finger measuring blood volume change, you can also use electrodes on chest - muscle contractions can be measured from electrical “trackers”/electrodes (you can measure what muscles are active based on (changes in) electrical charge - temperature can be used, e.g sensor attached to finger or feet measuring blood flow (associated because low blood flow / low temperature when under stress - measure of CO2, measuring blood flow to brain) through attending to their physiological responses
Will not be asked about which precise instruments are used in biofeedback - just know there are a lot of measurements possible, and many are often used.
We most often in psychology see EEG, heart rate, and breathing measurements.
Biofeedback training led by trained specialist.
- works with patient to explain information (on computer monitor/tablet) - person is taught techniques to change patterns they see (e.g. Learn how to do debreathing exercises) - helps if they can visually SEE what their body is doing, and how exercises induce changes.
Takes approx 6 months to really induce the changes (generally (and not just for feedback) we assume the sessions are performed once a week, in terms of how long time they take to master (so e.g. Once a week for 6 months - but if they get more sessions, they should make progress quicker - the standard across interventions is kinda like once-a-week interventions).
Question: if someone becomes good at biofeedback, are they more likely to cheat a lie detector? If they can control their breathing - answer: yeah, that would make sense, if you can control your body reactions, you would be less likely to be detected (and this highlights a problem with lie detectors in general)
Biofeedback tell you a lot about your automatic body processes.
Guided Imagery
- Not new
- Well established in
- Indigenous traditions
- Religious practices
- Traditional medicines
- Joseph Wolpe, 1960s
- Introduced more into the west by Wolpe.
“power of imagination” - introduced application of imagery to health professionals at conference.
YOU SHOULD KNOW WHAT’S ON THE SLIDE - but prof wouldn’t e.g. Ask “in what decade did Wolpe introduce guided imagery”, would more ask e.g. “briefly explain history of guided imagery and how it works”, could be answered by e.g. “it was well established for a long time, but introduced around 60s in west” - you don’t have to know details, but maybe be able to provide the gist of the details.
Guided imagery taught by trained professional - 4-8 week program
Goal of guided imagery: allow client to develop/ form own images symbolic to that person, and use those images to promote insight and healthy behavior changes
Effective guided imagery involves all/most of the senses (maybe not so much taste), also kinesthetic (muscle movement) - also involves focus on relaxation with the image (when using image, also focusing on feeling of relaxation)
Not all guided imagery has CLIENT pick a scene - depends on goal of imagery intervention. But for the most, the client chooses an image symbolic to them to promote insight and healthy behavior changes.
(but when starting out, you might use more structured practice, given them an image)
Diaphragmatic Breathing
- Aka belly breathing
- This type of breathing is not a new concept in the area of relaxation - it is well established with lot of support.
- Involves expansion of the abdomen rather than chest area when breathing
- Thought that by doing this it reset the Autonomic Nervous System
Leads to physiological response, which includes decreased oxygen consumptions, decreased HR and blood pressure, increases theta brain waves (“relaxation waves” in EEG reading, and increased parasympathetic response.
Assumed that by doing this, it “resets” ANS, by the “stretch” from belly expansion, and when this reset occurs, there are lot of inhibitory (nervous) signals started by stretch of diaphragm area, and by doing this, it inhibits stress response and turns on parasympathetic response.
Had to be practiced several times a day to be effective.
It needs to be done for a few minutes at least each time you do it, to get the benefits of doing anything - anything less will not “reset” ANS or incorporate it so you can “turn of” stress response actively, rather than being an “automatic” response.
Transcendental Meditation
- Maharishi Mahesh Yogi Introduced it to the west
- Involves practicing for 20 minutes twice daily
- Sitting with your eyes closed, repeating a mantra - goal to change state from awareness to deep rest.
- Easily learned activity
- Not identified as a religion or philosophy and taught by a certified TM teacher
- Seven step course
- Seven step course involves introductory lecture about TM program, then repetition lecture explaining mechanisms of TM (how it works, why it is easy to learn, practices and origins), another repeat lecture (more of an “interview” where TM teacher gets to know client + client can ask questions, more 1 to 1 session), 4th step is personal instruction in TM (1 to 1 client-teacher), step 5-6-7 generally done in groups/class, verify correctness of practice and give further instruction
- During TM we see reduction in mental and physical activity –> basically allows person practicing it to get a sense of their body returning to normal function (i.e. Decreased stress response)
Cognitive Behavioral Therapy
- Developed by Dr. Aaron Beck (1960s)
- There is a focus on the present and on reducing symptoms
- Connection between thoughts, feelings and behaviours
- ABC (Antecedent, Behaviour, Consequence)
- Cognitive restructuring
Behaviorism = a theory of learning - from that theory, all behaviors acquired through conditioning (skinner, classical and operant conditioning, etc)
Behavior therapy = Extinction, habituation, counter-conditioning etc –> where precursors to CBT. Operant conditioning played role in CBT development, with regards to idea of reinforcement, and better understanding of role of conditioning in behavior, and role of thoughts
Albert ellis developed rational emotive behavior therapy - aimed to help people identify irrational thought, with shift towards more rational thought process.
Aaron beck developed CBT - patients with depression had distanced and cohesive string of negative thoughts occurring in spontaneous way - he began to help patients reevaluate thoughts, and he found longer lasting changes when these thoughts were changed.
Now one of most used interventions for many disorders (especially disorders of stress and trauma)
First wave: behaviorism
Second wave: CBT
Third wave: “acceptance and commitment therapy” (ACT) - less about changing cognitions, more emphasis on ACCEPTING. (we are really just starting to take steps towards this third wave - it is a newer area of interventions)
Emphasis on collaboration between therapist and client, lots of patient responsibility and homework assignments. Structured.
Connecting thoughts, feelings and behavior (also using antecedent behavior consequence model to approach and identify interventions) - because of this, not recommended for very young children (less than 5, even less than 10 might struggle - also not recommended for people with severe mental difficulties (person needs to be able to engage in abstract thinking, which can be difficult - but depends on how much emphasis on e.g. Cognitve or behavior aspects (more cognitive = more abstract thinking = “harder”))
Focus on cognitions contributing to stress e.g. “i am not good eneough” –> challenge and restructure them. E.g. “i don’t have the skill yet, but i can learn it and perform it”
Mindfulness-Based Stress Reduction
- Developed by Dr. John Kabat-Zinn, Dr. Saki Santorelli and colleagues (1979)
- 8 week program
- With greater awareness of the present there is clearer perception and an associated decreased in negative affect and improved energy/coping
Aimed at decreasing pain, depression, stress, anxiety - can be used for other things too, but these are the big ones. MBSR can include a cognitive component, but we won’t focus on that.
Intervention assumes to work by greater awareness of present = clearer perception of present and the stressor or whatever is causing distress = better perception gives less negative affect and improved energy, and improved coping
Emotional Freedom Technique
- Gary Craig (1990s)
- Aka tapping or psychological acupressure
- By focusing on these key areas of the body you can restore balance and relieve symptoms
Technically classified as brief exposure technique, but combines cognitive and somatic aspects
“tapping” technique - (“psychological acupressure”)
Emotional trauma contributes to disease = driving force behind development of the technique
Works by having client tap on specific acupoints while saying meaningful short phrase out loud - thought is that by focusing on key areas of body, you can restore energy and relive symptoms.
• You state what problem is, acceptance and acknowledgement of problem
Eg. “even if i have this fear about this stressor, i accept this, and i am willing to accept myself” - said three times while topping at specific point.
Next, clinet is told to focus on the FEELING within the body (rating on scale from 1 to 10)
This is continued until the fear is rated as 0.
Then therapist would guide client to feel other fears that are likely to come up from the situation or emotional state - and continue the process through those fears.
• You first target MAIN FEAR, and then move on to related ones.
EFT has exposure element –> having someone acknowledge that, allows the client to feel the emotional state, experiencing that the fear/feeling diminished over time, and learn that they can cope with it.
Tapping on body helps regulate cortisol.
Also believed that through this decrease of negative affective states, it allows more positive beliefs and states to occur, giving feeling of empowerment/control over (emotional) state.
EFT is assumed to work by allowing person to experience whatever is causing them distress in a controlled way (exposure), so they learn the negative state fades over time, and that they can cope with that state.
Classifying stress management interventions
Interventions classified from focus and level of intervention.
- In the literature, common to see the following classifications
- Focus of stress management
- Primary
- aim to PREVENT stress form occuring by removing source of stress and enhancing wellbeing.
- Secondary
- aim to reduce severity or duration of stress once it has occured and prevent stress level from becoming more of an issue.
- Tertiary
- seek to rehabilitate and maximize functioning for those already experiencing or suffering from psychological or physical issues related to stress.
- Level of intervention
- Individual
- Organizational
Literature often seperate intervenitons and research on stress management into these categories.
Examples:
primary individual intervention: selection for specific types of work (put someone through some kind of assesment to determine if they are suited for a job)
Primary ORGANIZATION: Job redesign. (restructure what that job/work entails)
Secondary individual: mindfulness.
Secondary organization: conflict management
Tertiary individual: Employee assistance program
Tertiary organization: Vocational rehabilitation or retraining (training someone for a different job)
There are many stress management interventions available depending on level and focus
• They can vary in their components and intensity.
Commonalities (between interventions)
(list is not exhaustive)
Group Format
• So stress management tends to occur in group formatting -NOT trauma treatment, but group format can be very effective (for stress management) = allows people to see they are not alone in their struggles + develops e.g. Social support and interpersonal skills. + the intervention is cheaper.
• Interventions typically last 12-16 weeks
Start by discussing what stress is and personal causes of stress
• This may also include a stress model
• Includes defining stress
• Often start by talking abut WHAT stress is, biology, psychology, and usually involves poeple to do self-reflection fo what causes them stress (i think) - biology often quckly covered because they will talk about them later on.
Self-rating of stress
• E.g. Using subjective units of distress scale. SUD scales generally used to monitor feelings and progress - can also use more objective measures (stress invontories e.g.) - using of SOME KIND OF RATING SCALE is a commonality.
In depth examination of physiological aspects of stress
• Often includes what physiological symptoms of stress individual experience
• Knowing how body feels when stressed is good indivcator of WHEN you need to use your stress management tools.
• Often times we have more awareness of what our BODY feels like when we are stressed, rather than what is going on in our HEAD - so when we can attend to our body, we can know what to employ tools.
In depth examination of cognitive aspects of stress
• This is likely to involve identifying negative thoughts or irrational thinking
• And then provide skills to challenge these.
• This is kinda the “CBT” flavor in stress management.
• Trying to replace maladaptive cognitions with more adaptive ones.
• Including e.g. Cognitive structuring, thought journals, mindfulness.
• Sometimes just awraness can be enough to induce changes.
Coping skills • This is the bulk of stress management intervention • Often includes skills such as (not a comprehensive list) • Deep breathing • Meditation/mindfulness • Problem solving skills • Time management • Positive self talk
Stress management often concludes with final ratings of stress (you also collect ratings during the program) –> how stressed where people when they started vs in the end.
Also often includes review of major points covered is also a commonality.
An action / life plan also often involved
–> allows people to see and acknowledge what they have learned, and create a “manual” for how to handle stress in the future (e.g. Who do you call when you are stressed, what are their phone number - effective tool while the skills become a habit)
