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***PSYCH 335- Clinical Psychology > Week 7 - Intervention & Prevention Overview > Flashcards

Week 7 - Intervention & Prevention Overview Flashcards

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1
Q

What is a universal preventative intervention?

A

Applied to an ENTIRE. POP

EX) include immunization programs, “body break,” public education programs

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2
Q

What is a selective preventative intervention?

A

Targets ppl who are at elevated RISK of developing a particular disorder or problem.

EX) using screen tests to identify 1st graders reading disabilities

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3
Q

What is an indicated preventative intervention?

A

Targets ppl who do NOT meet the criteria for a disorder, but have elevated RISK & may show detectable, subclinical SIGNS of the disorder

EX) quarantines, youth at high risk for acting out behaviour

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4
Q

What factors does the risk model contain?

What is the risk reduction model?

A

Risk: THREAT/HAZARD incompletely understood

Risk factors: a characteristic, event etc… PRECEDES the occurance of a hazard (may make it worse)

Protective factors: help to MITIGATE the risk/occurance from happening
—————————————————————————————-
Risk reduction model: an approach that REDUCES risks and PROMOTES protective factors

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5
Q

What are some examples of risk factors?

5 examples…

A
  1. Individual
    Poor nutrition, intellectual disabilities,
    attachment problems
  2. School
    Bullying, rejection, poor behaviour
    management
  3. Family
    Harsh or inconsistent discipline, inadequate
    supervision and monitoring
  4. Life
    Trauma, poverty, poor housing
  5. Community/Cultural
    Socioeconomic disadvantage, social or
    cultural discrimination, exposure to
    community violence or crime
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6
Q

What are some examples of protective factors?

5 examples…

A
  1. Individual
    Easy temperament, adequate nutrition,
    school achievement, positive attachment
  2. School
    Prosocial peer group, school norms against
    violence
  3. Family
    authoritative parenting, family harmony,
    attachments with other role models
  4. Life
    Adequate income, adequate housing
  5. Community/Cultural
    participation in church or other community
    group, strong cultural identity and ethnic
    pride, access to support services
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7
Q

What are 3 ways to evaluate a prevention program?

A
  1. Incidence rates:
    - the # of NEW cases of a specific problem
  2. # needed to treat:
    • # of people who NEED to receive the intervention (in order to prevent)
  3. Effectiveness:
    - the extent to which a prevention program achieves DESIRED OUTCOMES when used in an APPLIED setting
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8
Q

How was evidence-based parenting promoted?

A
  1. Home visiting programs (services low-income teenagers single mothers = improved quality of life)
  2. Incredible years (train parents in skills)
  3. Triple P positive parenting program (designed to enhance knowledge, kills and confidence of parents)
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9
Q

What are 2 programs designed for the prevention of violence?

A
  1. Anti-bullying programs
  2. Fast-track program
    - designed to decrease conduct disorder, 10-yr program
    - child and parent component
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10
Q

How effective are anxiety prevention programs?

A

Meta-analysis of 65 outcome trials found SMALL but SIGNIFICANT effects in reduction of both symptoms and diagnosis of anxiety

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11
Q

How effective are depression intervention programs?

A

Horowitz and Garber examined a wide range of programs designed to prevent depressive systems in children and adolescents

Found LITTLE meta-analytic evidence that universal programs are effective in preventing depression, but observed SMALL, yet SIGNIFICANT effects for indicated/selective intervention

Preventative intervention reduce incidence of depressive episodes by 22%

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12
Q

What is used in the prevention of substance abuse?

A

Skills development

Youth, peer groups, school, home and community

Programs should be SENSITIVE to developmental stage and include adequate training and support

Use of interactive programs is crucial for success

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13
Q

What is used in the prevention of problems w/ those exposed to loss & trauma?

A

Be cautious about well-intended programs & assumptions

Cognitive-behavioural interventions (individual/group), can have (+) impact
- provide knowledge about trauma
- emphasize skills
- develop skills

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14
Q

What are 4 things that determine if someone seeks out psychotherapy?

Are people more likely to seek psychotherapy VS medication?

Why does the typical demographic look like who seek therapy?

A
  1. Realizing that there IS a problem
  2. Deciding that therapy might be of VALUE
  3. Actually deciding to SEEK therapy
  4. Contacting a THERAPIST/CLINIC
    —————————————————————————————
    People are 3x more likely to seek psychological treatment than medication
    —————————————————————————————
    Two thirds of clients are female, half have college/university degree, half are married, and the majority of young -middle aged adults
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15
Q

What are two (main) ethical considerations in therapy?

A

5.1 A psychologist shall provide only
supportable professional services; a
supportable professional service refers
to a service based upon the client’s
needs and relevant issues and which is
in accordance with reasonable and
generally accepted common practice
and/or a theoretical and scientific
knowledge base of the discipline

5.2 A psychologist shall not provide a
professional service when there are
reasonable grounds to believe that the
treatment may lead to harm and no
demonstrable evidence of benefit exists,
even if the client has consented to the
treatment and/or intervention

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16
Q

What does evidence-based practice consist of?

A

Best research evidence

Clinical expertise

Patient preferences and values

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17
Q

What is there is no evidence-based treatment that matches your client needs exactly?

A

Adopt the one that’s CLOSEST

ADAPT if necessary

ABADON evidence that does NOT fit and REPLACE w/ another EBP

18
Q

What is a randomized controlled trial (RCT)?

A

An experiment in which research participants are randomly assigned to one of TWO/MORE treatment conditions

19
Q

What is effect size?

A

A STANDARDIZED metric, typically expressed in standard deviation units or correlations, that ALLOWS the results of research studies to be combined & analyzed

Typically expressed in standard deviation units and are called d or standardized mean difference (SMD)
• d = .4 indicates that 66% of patients in treated group score below the mean of
untreated participants

When correlational analyses are used to determine the strength of association between variables (e.g., r or R), the effect size is expressed as an r statistic

20
Q

Majority of people in therapy attend for “________” than “___” sessions

A

Fewer; 10

21
Q

“___%” of clients end treatment prematurely

A

20%

22
Q

Up to “___%” of people fail to follow up on a referral for psychotherapy

A

50%

23
Q

One-third of painters attended only a single session of psychotherapy, w/ the median # being “______”

A

Three

24
Q

Some studies show only “___%” of clients “________” following therapy

A

30%; improved

***MOST PAITENTS ATTENDED TOO FEW SESSIONS AND MOST THERAPISTS DID NOT PROVIDE EVIDENCE-BASED TREATMENTS

25
Q

What are some strategies to increase attendance of therapy?

A

ALLOWING clients to choose a therapist & appointment
times

Using motivational interviewing techniques to explore
CLIENTS REASONS for seeking treatment

Preparing clients for what will be REQUIRED of them in therapy

Using appointment REMINDERS

IMPLEMENTING a case management service for severely
distressed clients

26
Q

What did Hansen et al find in evidence-based treatment?

A

Examined RCTs of evidence-based treatments:
◦ Across 28 studies and more than 2,100 patients, the average dose of therapy was 12.7 sessions
◦ 57.6% of patients met criteria for recovery (and 67.2% meeting criteria for improvement or recovery)
◦ Concluded that w/ EBT = success rate of psychotherapy IMPROVES substantially compared with treatment as usual.
◦ Evidence-based psychological treatments are AT LEAST as efficacious as psychotropic medication in the treatment of depression and anxiety disorders
◦ A meta-analysis of 32 studies comparing evidence-based treatments with usual clinical care found that evidence-based care consistently OUTPERFORMED usual clinical care for children and adolescents

27
Q

What did Smith & Glass find in evidence-based treatment?

A

• Review of 475 controlled studies
• d = .85
• Average person receiving treatment was BETTER OFF at the END of treatment than 80% of those who did not receive
treatment
• Largest effect sizes (d values of 1.31 and 1.24, respectively) for cognitive and cognitive-behavioural treatments, followed by behavioural (.91), psychodynamic (.78), and humanistic treatments (.63)

28
Q

What did Weisz et al find in evidence-based treatment?

A

Examined effect of therapy for children and adolescents:
• Reported a mean effect size of .79, with LARGER effects found for BEHAVIOUR APPROACHES than for non-behavioural
approaches
• Weisz et al. (2013) conducted a meta-analysis of 52 randomized trials that directly compared an evidence-based treatment for children and adolescents to usual care.

The effect size for the difference in outcome between evidence-
based psychotherapy and usual care was d = 0.29

On average, youth receiving EBT would have a better outcome than 60% of youth receiving usual care

29
Q

What is clinical practice guidelines?

A

A summary of SCIENTIFIC RESEARCH (dealing with the diagnosis, assessment, and/or treatment of a disorder) designed to provide GUIDANCE to clinicians providing services to patients with the disorder

30
Q

What is empirically supported treatment?

Is this more stringent than “evidence-based”?

A

A psychotherapy that has been found, in a series of RANDOMIZED CONTROLLED TRIALS or single-participant designs, to be efficacious in the treatment of a SPECIFIC condition

MORE stringent criteria than “evidence-based”

31
Q

What is Norman & Gorman’s review for research in practice?

Compare evidence found with adults VS children…

A

ADULTS:
- there are evidence-based therapies for almost ALL commonly encountered mental disorders for adults
- strength of the evidence supporting the use of CBT
treatment (cognitive-behavioural
interventions have been found to be efficacious in
many independent replications)
- increasing number of process-experiential, interpersonal,
and psychodynamic therapies that have been demonstrated to be efficacious in the treatment of SOME clinical conditions
—————————————————————————————
CHILDREN:
- many of the efficacious treatments for children
involve parents LEARNING STRATEGIES to respond to their
children’s behaviour
- most effective treatments of childhood disorders fall
under the umbrella of behavioural, cognitive-behavioural,
and interpersonal approaches

32
Q

What are treatment factors influencing clinicians treatment selection decisions?

A

◦ Treatment FLEXIBILITY
◦ RESEARCH support in an EFFECTIVENESS study
◦ RECOMMENDED by trusted colleague(s)
◦ PAST SUCCESS with the treatment in own
practice
◦ Easy to LEARN/IMPLEMENT
◦ Easily ACCESSIBLE TRAINING and supervision in
the treatment
◦ RESEARCH support in an EFFICACY study
◦ A focus on the THERAPEUTIC RELATIONSHIP
◦ REIMBURSEMENT for treatment by insurance
company
◦ SHORT treatment duration

33
Q

What must informed consent and intervention contain?

A

◦ PURPOSE/NATURE of the activity
◦ MUTUAL responsibilities
◦ CONFIDENTIALITY protections and limitations
including how information will be stored and who may have access
◦ HOW confidential information can be ACCESSED
◦ HOW communication will HAPPEN between the
psychologist and client(s), guardian(s) or third- parties
◦ likely BENEFITS/RISKS
◦ ALTERNATIVE modalities of assessment/treatment
◦ likely consequences of NON-ACTION
◦ option to REFUSE/WITHDRAWAL at any time, without prejudice by the psychologist
◦ TIME PERIOD covered by the consent
◦ HOW to RESCIND consent, if a decision to rescind consent is made
◦ FEES/FINANCIAL arrangement

34
Q

What must consent and minors contain?

A

A Patient UNDER the age of 18 is presumed to be a Minor Patient without Capacity UNLESS they have been deemed to be a Mature Minor

The Psychologist must be INFORMED of
consent laws specific to:
◦ Education services
◦ Health services
◦ Child protection
◦ Separated or divorced parents
◦ Mature minors
The Psychologist must CLARIFY from the outset of services the circumstances under which confidentiality will be maintained and what information will be SHARED with parents

35
Q

What are some good ways to start of therapy w/ the client?

A

Attend to therapy ENVIRO

Attend to your PRESENTATION

Attend to SUBTLE ASPECTS that may reinforce POWER differences

In comparison to assessment, the first session of therapy is often the FIRST OF MANY sessions

May be more assumptions and stigma attached to therapy

Have to balance INFORMING the client with COLLABERATION

Discuss what therapy IS and what clients can EXPECT and/or process any prior experiences or misconceptions

Discuss EXPECTATIONS of therapy – both for client and clinician

Focus is all on building rapport and developing a THERAPEUTIC RELATIONSHIP

36
Q

Engaged clients are more likely to what?

A

◦ BOND with therapists and counselors
◦ ENDORSE treatment goals
◦ PARTICIPATE to a greater degree
◦ REMAIN in treatment LONGER
◦ report HIGHER levels of satisfaction

37
Q

What are some effective elements of the therapeutic relationship?

Compare this with the different types of therapy…

A

EMPATHY

COLLECTING client feedback

ADAPTING to client reactance/resistance level, client treatment preferences, client culture & client religion/spirituality
—————————————————————————————
***ALLIANCE in individual adult psychotherapy, youth psychotherapy & couples/family therapy

***COHESION in group therapy

38
Q

What are 3 aspects of a therapeutic alliance?

A
  1. Understanding & empathy:
    - communicate empathy- check for accuracy & sense of being understood
  2. Acceptance & prizing:
    - attitude of consistent, genuine, noncritical interest and tolerance for all aspects of the clients life
  3. Presence & genuineness:
    - being authentic, transparent and in emotional contact
39
Q

What are 4 main therapy skills?

A
  1. Empathy:
    - ACCURATE PERCEPTION of and communication about another’s experience
    • empathic exploration – asking tentative questions to promote client self-exploration
    • empathic attunement – resonate with client’s experiences; focus on what seems to be central
  2. Active listening:
    - ATTENDING to the CONTENT/PROCESS of what the client is saying and demonstrating an understanding of the same
    - demonstrate listening through nonverbals – open body posture, nodding, leaning forward, eye contact, facial expressions, mirroring, hmms, mmms, and uh huhs
    • paraphrasing – reflecting the content of what the client is saying
  3. Clear communication:
    - CLEAR, CONCISE & THOUGHTFUL in communicating
    - avoid mumbling, side thoughts, tangents
    - use language that is easily understood
    - explain jargon that is necessary to use
    ***ASK if you are making sense and take responsibility if you don’t
  4. Interpretation:
    - PROVIDING ALTERNATIVE meanings, explanations, or hypotheses for client experiences
    - present them as tentative and questioning
    - point out themes or patterns that seem apparent
    - provide meaning to nonverbal or process information
    - use research and/or clinical experience
40
Q

What are some general therapy skills?

A

Thoughtful curiosity
Socratic questioning
Silence
Avoid the “but”
Avoid advice and judgement
Attend to ruptures
Acknowledge mistakes and apologize
***?Self-disclosure? = tricky

41
Q

Why is authenticity so important in therapy?

A

Finding your identity as a therapist is one of the greatest CHALLENGES for early clinicians

Transition from mimicking supervisors to testing out approaches to finding your AUTHENTIC SELF

Comfort and ease come with time and experience

ACKNOWLEDGE your faults or deficits when clinically relevant

Yet, always continue to have SELF-REFLECTION as authenticity does not guarantee a connection with your client

42
Q

What is corrective emotional experience?

A

You’re NOT just representing your OWN practice, but MENTAL HEALTH as a CONCEPT

***PSYCH 335- Clinical Psychology (10 decks)

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