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Understanding Individuality And Abnormality > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What is cognitive behavioural therapy?

A

Behavioural therapy focuses on increasing adaptive actions and behavioural responses.

Change tends to be at a physiological/behavioural response level

Cognitive behavioural extends on this and incorporates cognitive response to a greater level

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2
Q

What’re the three cognitive behavioural therapy assumptions?

A
  1. Cognitions can be identified and measured
  2. Cognitions underpin high adaptive and maladaptive psychological function
  3. Through therapy and practice, maladaptive thought processes and behaviours can be changed into adaptive processes
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3
Q

What is rational emotive therapy in cognitive behavioural therapy?

A

RET; rational emotive therapy - Albert Ellis (AKA REBT)

Emotional reactions are caused by internal sentences that people repeat to themselves. RET is designed to eliminate the incorrect (irrational) beliefs of a disturbed person through a process of rational examination of those beliefs.

Key element of RET is the A-B-C theory of psychopathology. Ellis later added D & E.

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4
Q

Becks cognitive therapy - cognitive behavioural therapy

A

Becks version of cognitive therapy was devised specifically for the treatment of depression.

Beck believed that depression in particular is caused by the negative patterns in which individuals think about themselves, the world, and the future.

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5
Q

What is an example of a behavioural exercise in cognitive behavioural therapy?

A

Behavioural activation

  • aim is to increase engagement by scheduling pleasant activities
  • it also helps the client re engage in activities they have been avoiding
  • it is important to set tasks that are achievable
  • the first step is to get client to recognise the connection between inactivity and low mood
  • this involves the client monitoring what they do during the day and also noting their more at that time (0=low mood, 10=excellent mood)
  • gradually the client is asked to start implementing pleasant events by scheduling activities
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6
Q

Criticisms of behavioural and cognitive behavioural therapies

A

Some therapies require a moderate high level of motivation by client

Negative thoughts can be realistic

The relationship between changing thoughts and changing behaviour may be exaggerated (eg change in thought but still engage in maladaptive behaviour)

Insufficient consideration of personal relationships

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7
Q

Biological treatments

A

Premise behind the biological approaches is that psychological disorders are the result of an organic pathology in the brain. This pathology can be structural (eg neuronal) or chemical (neurotransmitter imbalance). The belief here is that treating the organic dysfunction cures the psychological dysfunction.

The notions of organic pathology does not preclude environmental triggers for mental illness. It would be argued that the environmental trigger (stressor) resulted in an organic change in brain function (cf plasticity), consequently a mental illness arises.

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8
Q

Pharmacotherapy

A

Psychotropic medication/pharmacotherapy

Drugs that act on specific brain functions. Broadly included any pharmaceutical agent that is able to cross the blood brain barrier and exert a direct influence on CNS cellular function.

1950’s

  • Thorazine found to be effective for treating psychosis
  • lithium used in bipolar disorder

Now

  • medications for psychological disorders are the most commonly prescribed of all medications
  • 170 + different medications
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9
Q

Pharmacotherapy-how do they work

A
  1. Decreases neural transmission by “locking up” reception sites
    Neurotransmitter released, drug binds with receptors to prevent them from being activated by the neurotransmitters in the synapse.
  2. Increases neural transmission by blocking reuptake
    Drug blocks neurotransmitters from being taken back into the presynaptic membrane, leaving the neurotransmitters in the synapse longer
  3. Increase neural transmission by blocking breakdown of neurotransmitters in synaptic vesicles
    Drug prevents the neurotransmitter returning from the synapse from being broken down for storage, which keeps it available at the synapse
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10
Q

Anti anxiety medications (anxiolytics)

A

Broadly derived from a class of benzodiazepines which appeared in the 1960s and replaced the use of barbiturates (highly addictive).

Examples of potential side effects: drowsiness, dizziness, low BP. Some are addictive.

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11
Q

Mood stabilisers

A

Used primarily to treat bipolar and related disorders, and the mood dysfunction that can occur with schizophrenia.

Examples of potential side effects:
Weight gain, tremors, fatigue, digestive problems.

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12
Q

Antipsychotic medications

A

Also referred to as neuroleptics or major tranquillisers

A class of drugs used to treat schizophrenia as well as other disorders involving episodes of psychoses.

Examples of potential side effects:
Drowsiness, rapid heart beat, weight gain. Older drugs caused tremors, tardive dyskinesia.

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13
Q

Psychostimulants

A

Used to treat attentional disorders, such as ADHD, and disorders such as narcolepsy. Most work by increasing dopamine.

Examples of potential side effects:
Decreased appetite, sleep disturbances, and headache. Some have risk of addiction.

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14
Q

Pharmacotherapy- cautions

A

Misconceptions regarding need for drugs, efficiency and appropriateness:

  • not always necessary to treat a biological disorder with drugs. Non pharmaceutical therapies can alter neurobiology.
  • not a ‘cure all’ - eg some drugs may work in some age groups and not others, and may need to also use non pharmaceutical in conjunction with pharma for best outcomes (eg. MDD - start with antidepressant but also use CBT or similar)

Often have side effects - some at commencement of treatment, others if taken for a long period of time.

Individual differences - people vary greatly in response to drugs (including susceptibility to addiction), depending on various factors such as weight, age etc.

Overprescription and polytherapy

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15
Q

Surgical treatments for mental illness - psychosurgery

A

Involves the neurosurgical destruction of brain tissue to “cure” mental illness.

Lobotomies (especially frontal lobotomies) were carried out rather extensively in the 1920-1960’s. The procedure disappeared with the advent of affective psychotropic medications.

Dr. Walter Freeman - trans-orbital (aka ‘ice pick’) lobotomies.

Psychosurgery is now rare, involves highly selective lesions to specific brain structures, and only performed in extreme cases.

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16
Q 
Surgical treatments (psychosurgery) 
Capsulotomy
A

Specific lesions to reduce the symptoms of severe medication-resistant OCD.

Ruck et al (2008) - long term outcomes (approx 10 years after surgery) in 25 patients

Approx 50% had very good recovery

However, also some side effects

  • weight gain
  • sos executive/short term memory dysfunction
  • severe disinhibition (less common)
17
Q

ECT (electroconvulsive therapy)

A

Involves the application of a brief electrical current to the head of a person. The duration and intensity of the current are sufficient to induce a seizure in the individual. Used in intractable MDD.

Despite its inappropriate and indiscriminate use in the 1920’s-1970’s: research has led to the appropriate use of ECT.

ECT is currently used in cases of very severe depression that are unresponsive to other therapies, as well as severe depression with psychotic features.

18
Q

rTMS - repetitive trans magnetic stimulation

A

Similar to ECT, except that a magnetic pulse is used instead of electrical charge.

Non- invasive - a magnetic coil is placed on the skill and delivers pulses to specific regions

Patient remains conscious, no need for pain relief or prolonged recovery period

Found to be effective for people with medication resistant MDD

19
Q

Deep brain stimulation (DBS)

A

An alternative to psychosurgery

Similar to pacemaker, but provides electrical pulses to specific areas of the brain via implanted electrode

Initially used in Parkinson’s Disease, now also used to intractable OCD and MDD.

20
Q

Surgical treatments - cautions

A

Can have serious side effects, some of which may be life long

Mechanisms of action remain unclear for ECT, DBS and rTMS.

Only appropriate where other measures have failed and they person is continuing to experience significant and distressing levels of impairment.

21
Q

Evaluating the efficacy of treatments for psychological disorders (psychodynamic theory)

A

Outcome studies have found that:
-There is no clear evidence to show that the outcome of psychoanalysis is any better than would be achieved by doing nothing, or by seeing another professional (eg the family doctor)

  • the more education a patients has the better he/she does in analysis
  • patients with severe psychopathology (eg schizophrenia) do not do as well as those with anxiety disorders
  • some evidence to suggest that approx 5-10% become worse off
22
Q

Evaluating the efficiency of CBT

A

Paul (1969) reported that of 210 clients, 92% were successfully tested by desensitisation- ie where successful treatment mean a reduction in the intensity of the original problem by at least 80%.

Experimental studies demonstrate that systematic desensitisation results in behaviour change, especially for anxiety disorders and PTSD.

Operant conditioning and token economies have a wealth of research evidence supporting their use in long term behaviour change

23
Q

Evaluating the efficiency of cognitive therapy therapy

A

Outcome studies in RET (Ellis) report:
- reduces general anxiety, speech anxiety, and test anxiety.

  • reduces social anxiety, but systematic desensitisation is more effective
  • behaviour therapy techniques are more effective for agoraphobia, simple phobias
  • useful in the treatment of excessive anger, depression, anti social behaviour, and as part of a comprehensive behavioural program for treating sexual dysfunction
  • virtually useless in cases of severe psychopathology (eg. Schizophrenia)
24
Q

Why do we believe in ineffective therapies?

A

Ineffective therapies often appear to work due to a number of factors:

  1. spontaneous remission - many disorders fluctuate or are cyclical
  2. the placebo effect - just talking about problem may lead to improvement
  3. self serving bias - clients may want the therapy to work and so many may exaggerate improvement of downplay continuing issues
  4. regression to the mean - often extreme behaviours will naturally become closer to ‘normal’ over time
  5. Re-writing the past - clients may recall being much worse then they actually were -thus see improvement as being greater than it really is
25
Q

What elements of therapy are important in cognitive behavioural therapy?

A

We often measure CBT outcomes, rather than how CBT processes contributes to change

So could there be something else underpinning CBT?

Technique vs relationship (the therapeutic alliance)

26
Q

Ethics in clinical practice

A
  • ethics can be defined as beliefs about what is right conduct
  • ethics are moral principles adopted by a group or individual to provide rules for right conduct
  • ethics represents the ideal standards set by a profession
  • they are enforced by professional associations and government boards that regulate them
  • the professional association for psychologists in Australia is Australian Psychological Society (APS)
  • the regulatory body for psychologists is Australian Health Practitioner Regulation Agency (AHPRA): psychology board of Australia (PsyBA)
27
Q

What is the cognitive behavioural model?

A

Unhelpful maladaptive thoughts-> emotion -> unhelpful maladaptive behaviours -> trigger -> unhelpful maladaptive thoughts

And so on

27
Q

Biology in mental illness

A

Neurons transmit messages through the release of neurotransmitters

Too much or too little of a neurotransmitter may lead to psychological or physiological dysfunction m

Neurotransmitters are inactivated by:

  1. Reuptake
  2. Inactivation
  3. Drifting away
28
Q

Antidepressants

A

Antidepressants first emerged in the 1950’s with the SSRI’s (selective serotonin re-uptake inhibitors) appearing in the late 1980’s. SSRI’s now the dominant antidepressant - lower risk of side effects and safer to use than MAOI’s (monoamine oxidase inhibitors). SNRIs are now also gaining popularity

Example of potential side effects:
Nausea, headaches, increased appetite, sexual dysfunction, drowsiness.

29
Q

Evaluating the efficacy of treatments for psychological in Becks cognitive therapy

A

Outcome studies into Becks cognitive therapy report:

  • is at least effective as the use of anti-depressant medication in the treatment of Acute phases of depression
  • highly effective in reducing risk of relapse from depression
30
Q

Evaluating the efficacy of pharmacotherapy

A

Well established for certain disorders:

  • approx. 60% of patients with Schizophrenia who are treated with antipsychotic medication show a complete remission of symptoms within 6 weeks (only 20% do with a placebo)
  • anti-depressants are effective in alleviating the acute symptoms of depression, however, relapse following cessation of medication is a significant risk
  • anxiolytics are also effective in alleviating the acute symptoms of anxiety - however with cessation of medication there is a high rate of relapse
31
Q

Combining psychotherapy and pharmacotherapy

A

Combining approaches can lead to increased efficacy:

  • Becks cognitive therapy and anti- depressant medication when used alone are equally effective in treating acute phases of depression
  • combining the two approaches reduces risk of relapse from depression following cessation of medication
  • similar findings exist for the treatment of anxiety disorders with a combination of medication and CBT

Eclectic psychotherapy - involves combining techniques from different therapeutic approaches to fit a specific clients needs

32
Q

Evaluating the efficacy of treatments for psychological disorders

A

Evidence suggests that effective therapy depends on:
The appropriateness of the therapy for the condition in question.

Ability of the therapist:

  • well trained
  • up to date with techniques
  • emphatic and able to establish rapport

Client traits:

  • some anxiety can facilitate willingness to change
  • level of self awareness
  • willingness to take responsibility
  • willingness to take action
33
Q

Ethics in clinical practise with boards

A

The professional association for psychologists in Australia is Australian Psychological Society (APS)
-the role of the APS is to support, protect and provide resources for its psychologist members

The regulatory body for psychologists is Australian Health Practitioner Regulation Agency (AHPRA): Psychology Board of Australia (PsyBA)
-the role of the board is to protect the community and consumers (or clients) of psychologists

34
Q

Principles of good practise

A

Good standards of practise require:

  • professional competence, (keeping up to date with research/treatment approaches)
  • good and appropriate relationships with clients and colleagues (having appropriate supervision, not having dual roles)
  • observance of professional ethics (adhering to the code of ethics in your area)
35
Q

Ethics in clinical psychology

A

Three general principles of the APS code of ethics

  • respect for the rights and dignity of people and people’s
  • propriety
  • integrity
36
Q

Ethics in clinical psychology

A

In addition to each general principle there are ethical standards that guide behaviour.
Why do we need to have such strict standards to guide behaviour?

  • protect client
  • protect clinician
  • protect profession

Understanding Individuality And Abnormality (11 decks)

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