Treatments Flashcards
What are the effective treatments for DBD?
- Parent Management Training (PMT)
- Problem-Solving Skills Training (PSST)
- Multisystemic Training (MST)
Describe Problem-Solving Skills Training (PSST) for DBD
- Works on microsystem of child
- Work with the child to reduce behavior problems
- Targeting cognitive processes upstream
- Underlying theory: Social-information
processing - Encoding (attention)
- Interpretation (Hostile attribution bias)
- Response Search (generation)
- Response Selection (Evaluation along different dimensions)
- STEPS for solving problems
- Includes anger coping program
What’s the goal of the anger coping program?
To inhibit early angry and aggressive reactions
Describe time outs
- Time out involves removal of positive reinforcement – toys, electronics, positive social interaction – for a brief period of time
- 1 minute for every year of age
- It is one of the only discipline strategies recommended by the American
Academy of Pediatrics - Use of time outs has been shown to decrease behavior problems in youth
- Alarmist claims in popular media that time outs are hurting children
- Studies showing long-term increases in well-being with time outs
- Time outs are not harmful to child’s development
Describe Littel et al. (2021) systematic review + meta-analysis of Multisystemic Therapy for youth (10-17)
- 23 studies reviewed
- Mixed evidence for increased efficacy of MST versus other treatments
- Ex: 1-year reduction in child out-of-home placements only for trials in US but not in other countries
- Reduced self-reported delinquency and increases in family functioning but not other important outcomes (ex: peer relations, academics)
- Family functioning is mediating mechanism shown to drive effects of MST
- Is MST better than other studies? -> we don’t know
Describe Multisystemic Therapy for DBD
- Exosystem and Mesosystem
- Serious clinical problems result from the interplay of multiple factors
- Caregivers are key to positive long-term outcomes for youth
- Integration of evidence-based practice
(ex: Problem solving skills training, Parent management training, Change global reinforcement context (association with deviant peers)) - Intensive services that overcome barriers to service access
Ex: Therapist available 24/7, services in home and directly other settings, typically 4 months of treatment
Describe Parent Management Training (PMT) for DBD
- Mesosystem
- Behavioural Parent Training -> working with parents
- Operant conditioning -> use positive reinforcement
- Education -> learning reasonable expectations for child’s behavior and that behavior will get worse before it gets better
- Communication -> digestible instructions, tell child what to do and not what not to do, communicate expectations and what will happen if these aren’t met
Describe Developmental Social Pragmatic Models (DSP) for ASD
- Core feature of ASD is difficulty engaging in activities jointly with another person
- Aim to promote social communication and interaction by being responsive to the child
- More naturalistic interaction
- Build on the child’s communication
What are 2 well-established treatments for ASD?
- Individual, Comprehensive ABA (intensive)
- Teacher-Implemented, Focused ABA + DSP
What’s the controversy around ABA for ASD
- Many advocates in the autism community don’t think ABA should be used with children with autism
Common complaints:
1) Historical use of harsh punishment (electric shock) to reduce unwanted stimming behaviors (ex: handflapping)
^ neurodiversity argument is that these behaviors may be ‘atypical’ but are largely harmless and should be accepted, not shaped away (whether punishment or extinction is used)
2) Dosage of intervention way too much
up to 40 hours a week in some cases historically
3) People in the Autism community not being sufficiently consulted around implementation of ABA
^ are treatment goals aligned with what people want for themselves?
who advocates for children and chooses what behaviors should and shouldn’t be reinforced vs extinguished?
What’s the maintenance model of OCD?
Obsession -> appraisal (importance) -> anxiety/disgust -> neutralization (compulsion) -> distress goes down momentarily -> strengthens appraisal -> increases obsessions
Describe Social Information Processing & Anxiety Disorders
- Encoding: attention to threat -> attention to threat varies contextually among people high in anxiety as well
- Threat intensity, personal relevance of threat information, and current mood moderates people with anxiety’s attention to threat
- Interpretation -> strong association between social anxiety and negative interpretation bias (interpreting ambiguous social events negatively and catastrophizing even mildly negative social events) + negative interpretational bias = significant maintenance factor for anxiety in general
Treatment Anxiety
- SSRIs for OCD, GAD, SAD, social phobia
- CBT
- For youth, cognitive-behavioral approaches usually recommended first
- Medication doesn’t cure anxiety -> suppresses symptoms
What are some core components of effective interventions for anxiety?
1) Reduce cognitive biases (self-talk, attention re-training)
2) Reduce bodily tension (diaphragmatic breathing, progressive muscle relaxation, guided imagery)
3) Exposure and habituation (usually graded, key technique in CBT for anxiety)
What’s the extinction paradigm?
- US: Danger
- UR: Fear
- CS: Dog
- CR: Fear
- CS- : CS presented in the absence of the US
- Repeated exposure to CS- will extinguish the relationship between CS and CR
