Treatment / Interventions Flashcards
counterconditioning
- based on the principle of reciprocal inhibition (two incompatible responses cannot be experienced at the same time - the stronger response will inhibit the weaker)
example - fear will inhibit pleasure
extinction
in vivo exposure - presenting the conditioned stimulus (example - a spider) without the unconditioned stimulus (example - a screaming mother) to eliminate the unwanted responses (fear)
- studies show that high anxiety arousal is not necessary for successful treatment with in vivo exposure.
exposure in imagination - type of therapy called implosive therapy, client is exposed to a feared object in their imagination and the therapist interprets possible psychosexual themes
systematic desensitization
- first, train the client in relaxation techniques
- second, construct an anxiety hierarchy
- third, expose the client slowly using the anxiety hierarchy while they use their relaxation techniques (can be in vivo or in imagination)
- the process continues until the situation that originally provoked the anxiety only elicits relaxation
- counterconditioning
aversive counterconditioning
- used to eliminate “bad” or “deviant” behaviours
- the conditioned stimulus is paired with a new and stronger stimulus that elicits a strong negative response
example: smoking a cigarette is paired with an electric shock, OR, the drug Antabuse (for those trying to quit drinking)
*when aversive counterconditioning is done in imagination, it is called covert sensitization
primary reinforcers
those that reinforce everyone at all ages and in all cultures (example - food)
secondary reinforcers
acquire their reinforcing value through training or experience (example - praise)
generalized reinforcers
not inherently reinforcing but end up taking on a reinforcing value because they give people access to other reinforcers (example - money to buy food)
self-monitoring
(self-control procedure)
keeping a detailed record of what you do (example - monitoring everything you eat)
stimulus control
(self-control procedure)
narrowing a range of stimulus that elicits a particular behaviour and developing incompatible responses (example - going for a walk instead of snacking)
escape learning
once the stimulus has started, it can be stopped by emitting a certain behaviour (example - an animal is shocked and they can make the shock stop by pressing a lever)
avoidance learning
you can entirely avoid the aversive stimulus by emitting the desired behaviour in time (example - a red light flashes, and if the animal presses the lever in time, they avoid being shocked)
symbolic modeling (or filmed modeling)
observing a film in which a model (often someone similar to the viewer) enjoys progressively more interaction with a feared object or anxiety-producing situation
live (in vivo) modeling
having the person observe a live model engage in graduated interactions with a feared object or anxiety-producing situation
participant modeling
live models + contact with the model… the model gradually guides the person in activities that involve either physically interacting with a feared object or dealing with the anxiety-producing situation
*particularly appropriate for children with phobias
Kohler vs. Tolman
Wolfgang Kohler studied behavioural interactions of chimps (insight learning)
Edward Tolman studied behaviour interactions with rats (keyword: latent learning)
cognitive triad of depression
(Beck)
- negative view of the self
- negative view of the world
- negative view of the future
self-instructional training
- a set of procedures that combines modeling and graduated practice (with elements of REBT) that help children or adults who have problems with task completion
- 5 step procedure: therapist modeling, therapist verbalization, patient verbalization, patient silently talks through task, independent performance
stress inoculation
- a set of guidelines for treating stressed individuals
- 3 phase interventions: education and cognitive preparation, coping skills acquisition, application of skills in imagination and in vivo
protocol analysis
- similar but not the same as self-instructional training
- procedure used when a person is learning a task and is asked to describe aloud the steps being taken to solve the task (helps therapist gain insight into people’s problem-solving strategies
Rehm’s self-control theory of depression
- views depression as a result of negative self-evaluations, lack of self-reinforcement, and high rates of self-punishment
pleasure principle
the desire for immediate gratification = ID in Freud’s psychoanalytic therapy
reality principle
the way people learn to consider the consequences of their actions
(ego in Freud operates under this pronciple)
vs ID= pleasure principle , super ego= morality/moral principle
primary process
dreams and hallucinations
secondary process
thinking and speaking
repression
- forcing disturbing impulses out of consciousness
- most basic and commonly used
- also known as “motivated forgetting”
regression
retreating to behaviours of an earlier, less demanding, and safer stage of development (borderline)
projection
seeing one’s unconscious in another person (examples - suspicion or paranoia)
displacement
transference of emotions from the original object to some substitute or symbolic representation
reaction formation
engaging in behaviours that are opposite of the id’s real urges
*think= react in opposite of ID or “forma” = form against ID
intellectualization
distancing oneself from one’s feelings (schizoid)
rationalization
coming up with self-satisfying yet incorrect reasons for one’s behaviour (narcissism)
sublimation
- finding socially acceptable ways to discharge energy from subconscious forbidden desires
- considered desirable
*think s= socially acceptable/desirable ways
alloplastic
allo = aloe/environment
- trying to change the external environment or blaming the external environment
autoplastic
auto = oneself
- trying to change oneself or blaming oneself
transference and countertransference
(analytic work)
both seen as a form of resistance that must be worked through
ego psychologists
Heinz Hartmann
Anna Freud
Erik Erickson
neo-Freudians
- focused on the impact of social and cultural factors in determining personality
- believed that psychological disturbances result from faulty learning and maladaptive style of interacting with the environment
Adlerian psychology (or Individual Psychology)
- humans are motivated by social urges (rather than sexual according to Freud)
- happiness is largely related to social connectedness
keywords: feelings of inferiority and superiority, birth order, mistaken goals, faulty assumptions, teleological view of a behaviour
STEP program
(Adlerian psychology)
- systematic training in effective parenting
- democratic approach, values and respects children’s contribution
- recommends using natural and logical consequences of behaviour as the basis of discipline
- encourages parents to understand their child’s misbehaviour as reflecting one of 4 mistaken goals (attention, power, revenge, giving up)
Jungian psychology (or analytic psychology)
- the psyche includes the conscious ego, the personal unconscious, and the collective conscious
- neurosis represents the struggle of people to free themselves from the interference of the archetypes
- neurosis is seen as striving towards psychological maturity (individuation)
*think I in jungian= individuation
keywords: collective unconscious, archetypes - persona (social mask), shadow (one’s hidden aspects), anima (female aspect), animus (male aspect), individuation* (primary goal; bring unconscious—> conscious)
Jung vs. Freud
Jung = much more focused on the process of adult development
Freud = much more focused on infantile development
phenomenological perspective
- approach used by humanists and existentialists
- emphasizes the client’s subjective experiences, requires the therapist to entire the client’s subjective world
Roger’s person centered therapy
- problems are based on incongruence between the self (true feelings) and experience (ability to be aware of these feelings and express them to others)
- incongruence: reacts defensively by = denying or distorting their experiences (DD)
keywords: incongruence, empathy, unconditional positive regard, genuineness
introjection
people take in information in whole (can result in being overly gullible or overly compliant)
*think “in”= as in take in everything without question
projection
people project their feelings onto others (can result in paraoia)
retroflection
people turn back onto themselves what they would like to do to others (can result in self-destructive behaviour)
deflection
people distance themselves from their feelings through distraction, humor, generalization, or asking questions rather than answering
confluence
involves a lack of awareness of a differentiation between the self and others in an attempt to avoid conflicts
reality therapy
- focuses on clarifying a clients values and then helping the client evaluate their current behaviour and plans in relation to these values
- goal is to get client to accept responsibility
hypnosis
- treatment for chronic pain, asthma, conversion symptoms, substance use
- not good candidates = paranoid individuals, people with OCD
- often results in false memories
thermal biofeedback
- measures peripheral skin temperature and is commonly used to treat migraines and Reynaud’s disease
- goal is to increase peripheral temperature
electromyography (EMG)
- measure surface muscle tension
- used to treat tension headaches, TMJ, back pain
- commonly prescribed with progressive muscle relaxation training
electroencephalography (EEG)
- measures brain waves
- used to treat people suffering from hyperactivity or seizure disorders
electrodermal response (EDR)
- measures skin conductivity or sweat
- used to treat anxiety
biofeedback
- focus on decreased arousal of the sympathetic nervous system
feminist therapy
- focuses on independence and autonomy
- focus on socio-political climate
- strive for an egalitarian relationship with their clients (serve as a role model for their clients)
negative feedback loop
“maintaining the status quo”
example: thermostat (minimizes changes in temperature, tries to keep things the SAME)
positive feedback loop
represents change
object relational family therapy
- focuses on transference and projections between couples or family members
- family members project unwanted elements of themselves onto others in the family, results in dissatisfaction and trying to change one another
- therapist meets with family-of-origin of one spouse, then family-of-origin of another spouse
- goal is to help family become aware of what is being projected and then address the unwanted elements in each person
boundaries
(structural family therapy)
- ideally they are firm and clear, yet flexible enough to allow for autonomy, independence, individual growth
- problems stem from boundaries that are too rigid or from a malfunctioning hierarchical arrangement
- 3 chronic boundary problems: triangulation, detouring, stable coalitions
- Minuchin
triangulation
(structural family therapy)
the child is caught in the middle of parents conflict, and each parent tries to get the child to side with them (often results in the child becoming “paralyzed”
Also known as unstable
detouring
(structural family therapy)
when parents express their distress through one child, this serves to create a false sense of harmony between the two (either they blame the child as the source of the family’s problems, or they unite to protect the child from something… thus ignoring their own problems)
Detour attack vs detour support
stable coalition
(structural family therapy)
one parent unites with the child against the other parent
joining
(structural family therapy)
the therapist joins the family and attempts to understand the dynamics by adopting it’s style of interaction
disengaged
(structural family therapy)
rigid boundaries result in disengaged or emotionally distant relationships
enmeshed
(structural family therapy)
the boundaries are too permeable and there becomes a sacrificing of autonomy in order to maintain the greater sense of belonging to the family system
double bind communication
(communications family therapy)
3 elements:
- an injunction telling the person that if they do or don’t do something they will be punished
- a secondary injunction that is typically nonverbal and conflicting with the first
- a third injunction that prohibits the victim from escaping (example - not allowing the victim to point out this inconsistency)
paradoxical interventions
(communications family therapy; Satir)
prescribing the symptom, ordeal
multigenerational transmission process
(Bowen’s family systems therapy)
the emotional dysfunction of an individual results from emotional processes that have lasted in the family over several generations
differentiation
(Bowen’s family systems therapy)
the ability to be one’s true self in the face of familial / other pressures that threaten the loss of love or social position
emotional triangle
(Bowen’s family systems therapy)
a three party system arranged so that they closeness of two members tends to exclude a third
3 most effective components of groups
- cohesiveness
- catharsis (expressing emotions)
- self-understanding
crisis intervention vs. brief therapy
- most important aspect is rapid treatment
- goal is to resolve the crisis and avoid developing chronic symptoms
- different from brief therapy… focuses ONLY on the crisis itself and restoring the client to pre-crisis level of functioning
efficacy research
- involves tight experimental control
- internal validity is maximized
effectiveness research
- studies something as it is actually practiced in the real world
- external validity is maximized
client-centered consultation
consultant helps the consultee support an individual client
consultee-centered consultation
the consultant helps the consultee with difficulties they are having in their job (could be a result of lack of experience/skills, or lack of objectivity, etc.)
consultee-centered administrative consultation
the consultant focuses on the consultees difficulties that are limiting their effectiveness in instituting program change
program-centered administrative consultation
the consultant focuses on developing, expanding, or modifying a program
primary prevention
attempts to prevent the onset or occurrence of a a disease or a disorder in hopes that the number of new cases will be reduced/limited
example: alcohol/drug education, vaccinations
secondary prevention
focuses on early identification and prompt treatment of an illness or disorder that already exists… goal is to stop relatively mild problems from becoming more serious / prolonged
example: mammograms, screening children for learning disabilities, hotlines
tertiary prevention
focuses on reducing the residual effects of a chronic disability or minimizing further negative consequences of an already established serious disorder
example: AA meetings, rehab centers
effects of divorce
- children tend to have more social, academic, and behavioural problems
- sometimes become more aggressive, withdrawn, or less interested in schoolwork / socializing
- age plays a role - younger children are worst in short term but adapt more quickly and have less bad memories… older children tend to feel guilt/fault and are more critical and hurt by parents
- girls have worst outcomes long term due to internalization
- typically takes about 3-5 years for children to recover from divorce
Smith, Glass, & Miller research
- found an average effect size of .85 in comparing treated vs. untreated individuals (in other words - the average treated person is better off than 80% of untreated people)
drop out rates of minorities in treatment
- 23% of clients starting therapy dropped out after the first session
- 70% dropped out before the 10th session
- individuals of lower social class and less education drop out earlier and more frequently than individuals of higher SES / more education - due to transport issues though, not therapy.
psychodynamic family therapy
- focuses on freeing family from unconscious patterns of anxiety and projection rooted in the past
keywords: marital schism, marital skew
structural family therapy
- the family is viewed as a single, interrelated system
keywords: hierarchy of power, boundaries, subsystems, disengaged, enmeshed, triangulation, detouring, stable coalition
systemic family therapy
- associated with the Milan group
- involves elements of general systems theory and cybernetics
- primary goal: disrupt destructive family games (dirty games) that involve deceit and power struggles and lead to and maintain problems
keywords: circular questioning, prescription of rituals
Bowen’s family systems therapy
- the emotional dysfunction of an individual results from emotional processes that have lasted in the family over several generations
keywords: differentiation, emotional triangulation (recruit a third family member to alleviate tension and increase stability), multigenerational transmission process
marital behaviour therapy
- combines operant learning principles with social learning theory
- daily and weekly exchanges between spouses lead to satisfaction or dissatisfaction
- caring days = one day of the week a spouse deliberately performs behaviours that have been requested by the other spouse
countertransference
- emotions and thoughts stirred up in a therapist by an encounter with a patient
- can be beneficial because it provides patients with feedback about the kinds of reactions they elicit from others
free association
- the fundamental rule of psychoanalysis
- patients are instructed to tell the analyst everything that comes to their mind, no matter how trivial or how embarassing
triangulation (unstable coalition) vs. stable coalition (structural) vs. Detouring (attack/support) coalition
(a) Stable Coalition:
- Definition: Parent-child alliance against the other parent.
- Example: Parent A and Child align against Parent B.
- Impact: Can create a stable but rigid family dynamic.
(b) Unstable Coalition (Triangulation):
- Definition: Each parent vies for the child’s alliance.
- Example: Parent A seeks child’s support against Parent B.
- Impact: Tension, confusion, and instability in family relationships.
(c) Detouring-Attack Coalition:
- Definition: Parents blame the child, avoiding their own conflict.
- Example: Parents blame the child for marital issues.
- Impact: Child becomes a scapegoat, masking parental conflicts.
(d) Detouring-Support Coalition:
- Definition: Parents overprotect the child to evade their own conflict.
- Example: Parents shield the child from their relationship problems.
- Impact: Child becomes a focal point, masking underlying issues.
Note: Minuchin identified these as boundary problems hindering healthy family dynamics.
NAVIGATE
Multimodal early intervention for schizophrenia (included CBTp) and teaches skills to manage illness
CBT: selective abstraction vs arbitrary inference
Selective abstraction: based on a single detail taken out of context. Ex> employee feels worthless due to one criticism, ignoring positive performance review
Arbitrary inference: conclusion drawn without any supporting evidence. Ex> employee assumed he won’t be promoted without considering any evidence.
First line treatment for female orgasmic disorder
Behavioural and CBT techniques.
Directed masturbation is most supported (1st line)
Structural family therapist methods to facilitate joining (tracking, mimesis and maintenance)
1st stage of counselling
Tracking: adopt content of family communication
Mimesis: adoption of families communication, affective and behavioural style
Maintenance: providing family with support
Studies on effectiveness of treatment for OCD (meds, therapy, combo)
ERP alone and AD alone have similar effects.
Combo is best.
Erikson described which of his stages of development as a period of psychosocial moratorium (re: Marcia)
Identity vs role confusion
*marcia was influenced by erikson
Smoking cessation treatment effectiveness (meds, counselling, combo)
Combo is most effective.
Meds and counselling are effective on their own.
Strategy in pre-contemplation and contemplation
Consciousness raising
Strategies in action or maintenance stage
Stimulus control and counterconditioning
Strategy for preparation stage
Self liberation
ECT on severe depression treatment
Good. Has the fastest time to remission of symptoms
Evidence based treatement for bipolar disorder
Psychoeducational, interpersonal and social rhythm therapy, CBT, family focused therapy.
Meds: lithium (most effective for classic) and anticonvulsants (most effective for atypical)
Evidence based treatment for depression (children, teens, adults and OAs)
Children: insufficient evidence.
Teens: CBT or IPT-A, fluoxetine (first line)
Adults: combined treatment more effective (drugs: SSRI/SNRI). CBT, mindfulness based cognitive therapy, IPT, behavioural therapy, psychodynamic and supportive therapy. Combined CBT or IPT with AD is best for chronic/treatment resistant.
OAs: group CBT, combination of IPT with SNRI. Not enough support for bibliotherapy or life review.
Other treatments for depression (St John, ketamine, ECT, rTMS or telepsych)
St John: similar effects to SSRI for mild/moderate depression. Caution with seratonin drug mixing
Ketamine: effective for treatment resistant depression+suicidal ideation. Form: nasal spray + oral AD. Admin under supervisor of Dr.
ECT: high success for severe depression. Faster response/remission rates vs therapy and other drugs. Side effects: anterograde & retrograde amnesia.
rTMS: non invasive for treatment resistant depression. Lower response/remission rates than ECT but no sedation or memory loss.
Telepsych: similar to face to face
Treatment for agoraphobia
First line: in vivo, & ERP. Graded (hierarchy) commonly used. Intense exposure better for longer term effects. Research: combining exposure with relaxation/cognitive techniques may not improve outcomes
Mowrer’s Two Factor Theory (how does it explain development of phobias)
Combine classical and operant conditioning.
Classical: pairs neutral object with anxiety
Operant: avoidance as negative reinforcement*
Treatment for paraphillic disorders
CBT, group therapy, marital therapy and drugs.
Cognitive/behavioural strategies: cognitive restructuring, empathy training, covert sensitization, orgasmic reconditioning
What do the 3 conditions of worth in person centered therapy help with?
Move beyond internalized conditions of worth and progress from a state of incongruence to a state of congruence
Select whatever answer includes the word worth** or incongruence/congruence**
Satir identified 4 dysfunctional (incongruent) communication styles that contribute to family problems these are:
Blaming= assign responsibility/fault to others (contributes to conflict/defensiveness)
Placating= seeking approval/avoiding conflict (suppression)
Distracting (irrelevant)= families avoid talking about important issues by changing the subject or pretending to misunderstand (hinders problem solving)
Computing (super-reasonable)= lack of emotional connection
Unstable coalition (structural family)
Both parents DEMAND kid sides with them, to go against other parent
Think: U* side with me
Also known as triangulation
Steeped care model (Broten): 4 steps
Step 1: consists of virtually no work from the psych. (Assessment, monitoring and watchful waiting)
Step 2: consists of minimal work from the psych (psychoeducational, bibliotherapy, computer aided CBT)
Step 3: interventions that require more care from psych and specialized training (group therapy, individual therapy and medication)
Step 4: most involved psych level, most restrictive and intense form of care (voluntary/involuntary inpatient care)
CRAFT
Type of unilateral family therapy in which therapists work directly with a CSO (significant other) rather than an IP (addict) to achieve 3 primary goals:
1) help CSO influence IP to seek treatment
2) teach CSO procedures to help reduce the IP’s substance abuse
3) help CSO make positive life changes that improve their quality of life
Characteristic of Al-anon for CSO
Encourage CSO to adopt a position of loving detachment is a characteristic of Al-Anon
MATCH (matching alcoholism treatment for client heterogeneity)
Compared effects of motivational enhancement therapy, CBT, 12 step for individuals with alcohol dependence.
Results= 3 treatments produced similar outcomes** and there was SOME support for matching hypothesis.
Treatment voucher based reinforcement therapy(VRBT) and CBT for treating cocaine use disorder
VRBT is effective for promoting initial abstinence
CBT most effective for preventing relapse
Systems theory (open, closed systems)
Open systems are adaptable and free to change
Closed systems have few exchanges with outside environment are disorganized and tend toward entropy. The more closed off a family is the more entropic/disorganized.
Diathesis-stress model
Describe illness as result of combination of vulnerability (diathesis) and stress, with the nature of vulnerability depending on theory.
- In beck’s cognitive diathesis stress model, it proposes that certain people have depressogenic SCHEMAS.
- in hopelessness model of depression= faulty attributions
