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64 Cards in this Set

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What are Clinical Interventions?
- anything that will lower pathology
- present distress and increased risk and functional impairment
Treatment
– intervention to lower or eliminate symptoms/ signs associated with mental disorder
Ex: talk therapy
Prevention
-intention to avoid (or prevent) onset of a mental disorder (keep from coming)
Prevention
Universal
-prevent occurs in gen. population to stop problems before they start (targeted prevent- increased risk population)
ex: school assembly
Prevention
Targeted
prevent occurs in group selected because of increased risk

ex: body image for girls with high body dissatisfaction
How do you know if clinical interventions work?

Controlled studies
compare outcome between people who receive intervention vs. people who do NOT receive intervention
How do you know if clinical
interventions work?

Controlled Studies:
Random Assignment
-important to use RAMDOM ASSIGNMENT to condition ( intervention vs. no intervention)
How do you know if clinical interventions work?

Controlled Studies:
Waitlist control
-compare people who receive intervention to people placed on a wait list for treatment
How do you know if clinical interventions work?

Controlled Studies:
Alternative treatment control
- compare people who receive intervention to people given a diff. kind of intervention
Empirically Supported Interventions
- Interventions that produce superior outcomes compared to control condition

- demonstrated through scientific means to be supported

(waitlist vs. alternative treatement)
What is Non-Directive Therapy?
Therapy which:
- therapist does not structure course of therapy

- patient determines content of sessions (silence/ no ?) (true humanist and )psychodynamic

- therapist do not make directive suggestions to patient (don’t tell to do things differently)
Psychoanalytic Theory

-Structure of the mind
Draw in
Psychoanalytic Theory
ID
(born with it)
*pleasure = creative (sex) and destructive (kill) tell what want to do/ don’t know what ID tell you
Psychoanalytic Theory
Ego
(second)
*mediate reality between real world and ID/ choose behaviors engage in
Psychoanalytic Theory
Superego
(third)
*whats moral/ allowed (internalized) ex: good angel on shoulder
Fundamental Assumptions of Psychodynamic Therapy

Insight
complete understanding of unconscious cause of problematic feelings, thoughts, and behaviors (able to work through them)
Fundamental Assumptions of Psychodynamic Therapy

Psychosexual development
problems emerge between mental structures (ID, ego, superego) because of traumatic experiences during psychosexual development
Fundamental Assumptions of Psychodynamic Therapy

Transference
therapy is designed to elicit and resolve the types of conflicts that emerge from the traumatic (psychosexual development) experiences by facilitating transference into therapy session

Transference: patient reacts to therapist as if the therapist represented important person from patients childhood (therapist is neutral not pretend someone not)
Fundamental Assumptions of Psychodynamic Therapy

Counter-transference
therapist reacts to patient as if patient represented important person from therapist’s childhood- sees patient as self centered and bring in attitudes of own siblings from their own childhood
Fundamental Assumptions of Psychodynamic Therapy

Interpretation
Interpretation is required to facilitate insight
- make them conscious

-method for revealing the underlying motivations for thoughts, feelings, and behaviors

- traditional: psychoanalysis, therapist makes interps

- modern: psychodynamic- orientated therapies, process of interpretation viewed as a collaboration or a mutual discovery of underlying reasons
Fundamental Assumptions of Psychodynamic Therapy

Resistance
- everything is fair game

-dreams

- topics patients chooses to discuss in therapy

- actions toward therapist or impacting therapy (what said when/ show up drunk)

- progress in treatment
What is Efficacy of Psychodynamic Therapy?
- superior to no treatment (wait list) control

- on average inferior to directive, manual- based treatments
Drawbacks of Psychodynamic Therapy
- insight into problems does not necessarily lead to change in problems

-therapy not designed to assess observable improvements in problems (talk about past) NO FOLLOW UP ?’s

- length of treatment makes it cost prohibitive for most individuals
Modern Modifications
- brief psychodynamic therapies – time limited 20 sessions

- manual- based treatments (interpersonal therapy where focus on present more)

- both modification improve efficacy of psychodynamically oriented therapies AND they make the therapies more directive
Humanistic Therapy
origins in Rogers’ client-centered therapy

Client-centered therapy
(client = expert)
Fundamental Assumptions of Humanist Therapy

Phenomenal Field
Behavior determined by everything experienced by person at given time

- the client best source of info concerning his/ her experience : client = expert

- client makes choices

- focus on Present not past
Fundamental Assumptions of Humanist Therapy

Self-actualization
basic human tendency is this

- self-maintenance and self-enhancement

- Be all that you can be!

- tendency to maintain self

- each person holds power for SA, therapy simply creates environment that permits this process to occur

- not in psychodynamic therapy! (think system is broken 1st place)
Fundamental Assumptions of Humanist Therapy

Accurate, empathic understanding
*(correct) understanding, intellectually and emotionally (both) the clients pt of view (through their eyes)

- Reflection and Mirroring affects

Ex: client: Cant understand it when my boss criticizes my work

Therapist: You feel upset when your boss criticizes you

Reflection: say back what they just said (same thing)

Mirroring affects: tap into feeling when went along with that statement (reflect)
Fundamental Assumptions of Humanist Therapy

Unconditional positive regard
acceptance client as worth while human being regardless of what they do, say, or feel

- get into human part of this therapy

- UPR for client not same as UPR for everything a person does

- maintain stance client is worth wild human being

- disapprove of behavior not the person (not like everything they do)
Fundamental Assumptions of Humanist Therapy

Genuineness or congruence
Genuine in behaviors feelings or attitudes

- say what mean and mean what you say

- Ex: tell you concerned how did on exam

- open posture and non verbal behavior show care

- not congruent: turn away/ check email when said really cared

- actions speak louder than words
What is Efficacy of Humanist Therapy?
- Superior to no treatment (waitlist) control

- aver. inferior to directive, manual based treatments

(same as psychodynamic therapy)
Drawbacks of Humanist Therapy
- an attempt to be (client expert) avoids use of assessment and diagnosis (no diff. every client)

- therapy not designs to assess observable improvements in problems (get better? Unless they say)

- (BIG) relies on client being responsibly intelligent, perceptive, verbal and high functioning

- Ex: college student (good)
Bad: poor insight (delusions)

- go on what person tells you – could be lying
Behavioral Therapy
- origins in behavioral learning theory
Systematic Desensitization
Classical conditioning
NS + US „³ UR

CS „³ CR

- CT + Incompatible Response „³ changed response

- cant be both same time
Systematic Desensitization

Progressive Muscle Relaxation
- technique for training patients to become relaxed

- can be used as incompatible response to combat anxiety

- pair relaxation with thoughts about anxiety provoking stimuli

- use increasing anxiety- provoking stimuli according to hierarchy described by patient

* start with least period anxiety- imagine in this pd. Right now practice pd. anxiety with muscle relaxation

* Then next step 2 weeks before finals

* Then weekend before final week – fell anxious and practice (1) when not feeling anxious
Systematic Desensitization
Operant Conditioning
- behavior --> consequences
- Behavior --> reinforcement
Exposure Response Prevention
- expose patient to anxiety – provoking stimulus and prevent them from engaging in anxiety reducing responses


ex: OCD – women with rat poison
“contamination” --> Hand Washing --> lower anxiety

“contamination” --> no Hand Washing--> no lower anxiety

Then “contamination” --> anxiety

Then “contamination” --> nothing else bad happens

…Anxiety about contamination extinguishes
Cognitive Therapy
- origins in cog. explanations for psychopathology from Ellis and Beck

-rather than view behavior as center of psychopathology view beliefs/ thinking
(Write in ABC Model)
Cognitive Restructuring
- examine beliefs (done together)

- provide info (psychoeducation)

- evidence for and against beliefs

- consequences
(write in ABC example)
Cognitive-Behavioral Therapy
- combine cog and behave. Techniques to achieve lower in symptoms/ signs (put it all together)
Efficacious CBT
- superior to doing no treatment (waitlist) controls

- superior to alternative therapies for

- panic disorder (w or w/o agoraphobia), specific phobia, OCD, MDD, bulimia nervosa, martial problems, bed wetting, smoking, pain disorder
Advantages of CBT
- short term approach produces significant improvements

-constantly evaluating whether improvements are occurring throughout treatment

-rationale for approach is explained to patient

- although therapist is expert patient can learn from therapist and gain expertise to form collaborative approach to resolving problems. Patient can become expert (as with humanist therapy)

ex: has to understand rationale behind homework to do it!
Dialectical Behavior Therapy
To basic components:

- indiv. CBT therapy
- skills training group
Borderline Personality Disorder
- a pervasive pattern of instability in
1. interpersonal relationships
2. self-image
3. affect (emotions)
4. behavior (marked impulsivity)

1. frantic efforts to avoid real or imagined abandonment
- pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

2. identify disturbance: marked and persistently unstable sense of self
- chronic feellings of emptiness

3. affective instability due to marked relativity of mood
- inappropriate, intense anger or difficulty controlling anger
- transient (passing come and go), stress- related paranoid ideation or severe dissociative symptoms

4. impulsivity at least 2 self damaging areas
- spending, sex, substance abuse, reckless driving, binge eating, recurrent suicidal behavior, gestures, or threats or self mutilating behavior
Dialectical Behavior Therapy

Individual Sessions
- patients keep daily log of symptoms (cut/drug use)

- focus on behaviors in a hierarchy of risk they pose to patient

- suicidal behavior/ thoughts

- substance abuse

- unstable relationships

~Positive reinforcements eliminates thoughts cause talk about something else if they talk about something they don’t want to
Dialectical Behavior Therapy

Skills Training Groups
Mindfulness
- self image, nonjudgemental observe and describe emotions, thoughts, and urges to act in the moment
Dialectical Behavior Therapy

Skills Training Groups
Distress Tolerance
- impulsive and suicidal behavior

- adaptive methods for coping with the inevitable stresses in life (change = accept)

- acceptance of reality – not free stress pr pain but encounter difficulties
Dialectical Behavior Therapy

Skills Training Groups
Interpersonal Effectiveness
- maintain relationship

- maintain self- respect – reflect back to us who we are

- get what want out of relationships
Dialectical Behavior Therapy

Skills Training Groups
Emotional Regulation
- understand emotions

- lower vulnerability to negative emotions

- higher positive emotions (not just things happen have power to change how you are feeling)
Dialectical Behavior Therapy

Efficacy
- compared to patients who received alternative (Standard) care, randomly assigned DBT

- less inpatient treatment

- less frequent parasuicidal behavior

- less severe parasuicidal behavior

- no difference in depression, hopelessness, suicidal ideation, or reasons for living
Clinical Health Psychology Names
Clinical Behavioral Medicine
Medical Psychology
Psychosomatic Medicine
Clinical Psychology in Medical Settings
Pediatric Psychology
Rehabilitation Psychology
Neuropsychology
Clinical Health Psychology
Definition
“the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, and the identification of etiologic and diagnostic correlates of health, illness, and related dysfunctions” (Matarazzo, 1980)
Contributions reach and apply that to health
- assess candidates for penile prosthesis surgery, back surgery
- desensitize fears medical and dental treatments
- enhance coping with pain
- interventions control symptoms
- support groups chronic illness
- train overcome physical handicaps or cogs. trauma etc.
- behavior change programs (ex: smoking)
- consult patient compliance
- Dev. psychosocial services oncology patients
- neuropsychological assessments
Growth Health Psychology
- longevity of life
- shift chronic diseases from infectious diseases
- influence behavior and lifestyle in development of disease *social support*
- higher cost health care and search for alternatives
- failure biomedical model explain health and illness
- people with same disease have diff experiences
Clinical Health Psychology
The Biomedical Model
- disease best understood as caused by an underlying pathogen, removal of which will result in alleviation of symptom

- etiology or pathogen is often unknown

- symptoms not explained by etiology or pathogen

- mind and body are separate

- disease – focused- remove illness not promote health
Clinical Health Psychology
The Biopsychosocial Model
- health and illness are a consequence of interactions among biological, psychosocial and socio-environmental factors (social and cultural norms)
Treatment and Assessment Techniques in Clinical Health Psychology

Assessment and Treatment Targets
-Biological/physical – health history if follow it

- Affective - current emotional state

- Cognitive - changes in mental status (do mental status exam- neuropsych assess)
- understanding of own medical program?

- Behavioral – what current activities are/ health behaviors are

- Personality – testing MMPI/ interact with client/ info family members
- not treatment target but important factor
Treatment and Assessment Techniques in Clinical Health Psychology

Assessment Techniques
- Diagnostic interviewing – with patient and family members

- Behavioral assessments – self- monitoring (ex: record diet log)

- Neuropsychological assessment

- Psychometric testing – personality or depression inventories
Treatment and Assessment Techniques in Clinical Health Psychology

Intervention Techniques
- Individual psychotherapy – personal problems, etc.

- Behavioral therapies – exposure therapy for anxiety/ target health behaviors

- Relaxation, hypnosis, and biofeedback – cope with stressful medical procedures

- Family, marital, and group therapies – support groups

- Psycho educational counseling groups

- Public education – public health campaigns
Examples and Illustrations

Compliance with Renal Dialysis Treatment
- Medical Noncompliance
- preventive regimes:50 – 80%
- chronic regimes: 30 – 60%
- acute regimes: 20 – 50%
Examples and Illustrations Clinical Health Psychology

Health Belief Model
Draw Diagram
Clinical Health Psychology

Improving Compliance
1. Self Monitoring
- time (when)
- type & amount of fluid
- situation / activity (place/ doing/ think or feel)
- consequences

2. set goals – very specific in terms of behavior

3. self- reinforcement
- rewards for reaching goal
- positive self talk
Clinical Health Psychology

Improving Compliance Others
- Stimulus control – drink out one container

- cuing/ reminders – on fridge

- chaining – link to brush teeth before go to bed

- coping skills – suck on ice cube/ chew gum instead
Clincal Health Psychology

Ex. Anticipatory Nausea
US: Chemo --> UR: Nausea and vomit

CS: Stimuli assoc. with Chemo -->
CR: Nausea and vomit

Ways to help this:
- relaxation training – sense of control
- systematic desensitization – relax exercise neutral setting
- distraction
- more efficacious earlier in treatment better