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149 Cards in this Set

  • Front
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? entails the extension of memory back to early childhood events, a time in the distant past when the core of neurosis was formed. The actual reconstruction of these events comes through reminiscence, associations, and autobiographical linking of developmental events
Recollection
? involves more than mere mental recall; it is an emotional replay of former interactions with significant individuals in the patient's life. The replay occurs within the special context of the analyst as projected parent, a fantasized object from the patient's past with whom the latter unwittingly reproduces forgotten, unresolved feelings and experiences from childhood.
Repetition
? is both an affective and cognitive integration of previously repressed memories that have been brought into consciousness and through which the patient is gradually set free (cured of neurosis).
working through
Patients who enter analysis must have a ?, not a
genuine wish to understand themselves

desperate hunger for symptomatic relief.
Contraindications for psychoanalysis
absence of suffering,
poor impulse control,
inability to tolerate frustration and anxiety, and
low motivation to understand
life crisis
low IQ
close relationship with analyst (i.e., as friend)
Describe 3 stages of psychoanalysis
1. Patient becomes familiar with frame, basic rules, relief through catharsis, sense of security
2. Transference neurosis emerges, gradual surfacing of unconscious conflicts, regression
3. irrtational attachment ot the analyst in the transference neurosis has subsided because it has been worked through
Goals of psychoanalysis
The patient should be better able to relinquish former regressive patterns and to develop new, more adaptive ones, particularly as he or she learns the reasons for his or her behavior
achieve mature insight/self-understanding
List 4 Patient Prerequisites for Psychoanalysis
1. High Motivation
2. Ability to form a relationship
3. Psychological-mindedness and capacity for insight
4. Ego Strength
Psychoanalytic psychotherapy, in its narrowest sense, is the use of
insight-oriented methods only
Some differences between psychoanalysis and psychoanalytic psychotherapy?
Rarely use couch,
Analysis more expressive
Indications for Psychoanalytic Psychotherapy?
i.e., what conditions might you use this for?
B PD
Narcissistic PD
The overall goals of expressive psychotherapy are to
increase the patient's self-awareness and
to improve object relations through exploration of current interpersonal events and perceptions.
Indications for supportive tx?
1) individuals in acute crisis
2) severe chronic pathology, deficient ego functioning
3) unsuitable for insight-oreinted approach
4) psychologically unmotivated
major goals of supportive tx?
sx relief
increase ability to cope
decrease vulnerability
Which one is more for expressive vs supportive?
Strong motivation to understand

Significant ego defects of a long-term nature
E: Strong motivation to understand
S: Significant ego defects of a long-term nature
Severe life crisis
Significant suffering
Severe life crisis =S
Significant suffering =E
Ability to regress in the service of the ego
Exp or Supportive?
Expressive
Tolerance for frustration
vs Poor frustration tolerance
E = Tolerance for frustration
vs S= Poor frustration tolerance
Exp/Supportive?
Ability to sustain work
Low intelligence
E: Ability to sustain work
S: Low intelligence
Brief Focal Psychotherapy
Therapists
Selection Criteria
CI?
Brief focal psychotherapy was originally developed in the 1950s by the Balint team at the Tavistock Clinic in London. Malan, a member of the team, reported the results of the therapy.

Selection: included eliminating absolute contraindications, rejecting patients for whom certain dangers seemed inevitable, clearly assessing patients' psychopathology, and determining patients' capacities to consider problems in emotional terms, face disturbing material, respond to interpretations, and endure the stress of the treatment

CI: serious suicide attempts, substance dependence, chronic alcohol abuse, incapacitating chronic obsessional symptoms, incapacitating chronic phobic symptoms, and gross destructive or self-destructive acting out
In Malan's routine, therapists should identify the ? early and interpret it and the negative ?. They should then link the ? to patients' relationships to their parents.
transference
Therapists should
formulate a circumscribed focus and

set a termination date in advance, and patients should work through

grief and anger about termination.

Max # sessions?
Type of therapy?
Brief Focal Psychotherapy (Tavistock–Malan)

40
A psychotherapeutic model of exactly ? interviews focusing on a specified central issue was developed at Boston University by James Mann and his colleagues in the early 1970s
12
Time–Limited Psychotherapy (Boston University–Mann)
Time-limited: compare to Brief Focal?
n contrast with Malan's emphasis on clear-cut selection and rejection criteria, Mann has not been as explicit about the appropriate candidates for time-limited psychotherapy.
Time Limited:
Mann considered the major emphases of his theory to be
determining a patient's central conflict reasonably correctly and exploring young persons' maturational crises with many psychological and somatic complaints
Time Limited, Malan
Rejection criteria?
Mann's exceptions, similar to his rejection criteria, include persons with major depressive disorder that interferes with the treatment agreement, those with acute psychotic states, and desperate patients who need, but cannot tolerate, object relations.
Type of therapy?


Goal Clarify the nature of the defense, the anxiety, and the impulse
Link the present, the past, and the transference
Selection criteria Patient able to think in feeling terms
High motivation
Good response to trial interpretation
Duration Up to one year
Mean, 20 sessions
Focus Internal conflict present since childhood
Termination Set definite date at beginning of treatment
Malan and the Tavistock Group: Brief Focal Psychotherapy
Malan and the Tavistock Group's Exclusion Criteria for Brief Focal Psychotherapy?
1. Patient is unavailable to therapeutic contact.
2. Therapist anticipates that prolonged work will be needed to
* generate motivation
* penetrate rigid defenses
* deal with complex or deep-seated issues
* resolve unfavorable, intense transference, dependent or other, that may develop
3. Depressive or psychotic disturbance may intensify
Type of therapy?
Goal Resolution of the present and chronically endured pain and the patient's negative self-image
Selection criteria High ego strength
Able to engage and disengage
Therapist quickly able to identify a central issue
Excludes major depressive disorder, acute psychosis, and borderline personality disorder
Duration 12 treatment hours
Focus Present and chronically endured pain
Particular image of the self
Termination Specific last session set at beginning of treatment
Termination a major focus of the therapy work
Mann: Time-Limited Psychotherapy
As conducted by ? at McGill University, short-term dynamic psychotherapy encompasses nearly all varieties of brief psychotherapy and crisis intervention
Davanloo
Patients treated in Davanloo's series are classified as those whose psychological conflicts are:
predominantly oedipal,
those whose conflicts are not oedipal, and
those whose conflicts have more than one focus.
What therapy has these selection criteria?
the establishment of a psychotherapeutic focus; the psychodynamic formulation of the patient's psychological problems; the ability to interact emotionally with evaluators; a history of give-and-take relationships with a significant person in the patient's lives; the patient's ability to experience and tolerate anxiety, guilt, and depression; the patient's motivations for change, psychological-mindness, and ability to respond to interpretation and to link evaluators with persons in the present and past.
Davanloo's selection criteria emphasize evaluating those ego functions of primary importance to psychotherapeutic work
Both Malan and Davanloo emphasized a ? as an important selection and prognostic criterion.
patient's responses to interpretation
Type of therapy?

Goal Resolution of oedipal conflict, loss focus, or multiple foci
Selection criteria Psychological-mindedness
At least one past meaningful relationship
Able to tolerate affect
Good response to trial transference interpretation
High motivation
Flexible defenses
Lack of projection, splitting, and denial
Duration 5–40 sessions, usually 5–25
Longer durations for seriously ill
Termination No specific termination date
Patient is told that treatment will be short
Davanloo: Short-Term Dynamic Psychotherapy
Type of therapy?

Goal Resolution of oedipal conflict
Selection criteria Above-average intelligence
At least one past meaningful relationship
High motivation
Specific chief complaint
Able to interact with evaluator
Able to express feelings
Flexible
Duration A few months
Focus Oedipal (triangular) conflict
Termination No specific date given
Short-Term Anxiety-Provoking Psychotherapy
Short–Term Anxiety-Provoking Psychotherapy
associated with what name?
Sifneos developed short-term anxiety-provoking psychotherapy at the Massachusetts General Hospital in Boston during the 1950s.
Type of therapy associated with the following selection criteria?
a circumscribed chief complaint (implying a patient's ability to select one of a variety of problems to be given top priority and the patient's desire to resolve the problem in treatment), one meaningful or give-and-take relationship during early childhood, the ability to interact flexibly with an evaluator and to express feelings appropriately, above-average psychological sophistication (implying not only above-average intelligence but also an ability to respond to interpretations), a specific psychodynamic formulation (usually a set of psychological conflicts underlying a patient's difficulties and centering on an oedipal focus), a contract between therapist and patient to work on the specified focus and the formulation of minimal expectations of outcome, and good to excellent motivation for change, not just for symptom relief.
Sifneous Short-Term Anxiety Provoking psychotherapy
4 phases of brief therepies?
reatment can be divided into four major phases:
1) patient–therapist encounter
2) early therapy
3) height of treatment, and
4) evidence of change and termination. Therapists use the following techniques during the four phases.
Therapy phase?
A therapist establishes a working alliance by using the patient's quick rapport with, and positive feelings for, the therapist that appear in this phase. Judicious use of open-ended and forced-choice questions enables the therapist to outline and concentrate on a therapeutic focus. The therapist specifies the minimal expectations of outcome to be achieved by the therapy.
Patient-Therapist Encounter
In transference, feelings for the therapist are clarified as soon as they appear, a technique that leads to the establishment of a true therapeutic alliance.

Phase?
Early therapy
Phase?
emphasizes active concentration on the ? conflicts that have been chosen as the therapeutic focus; repeated use of anxiety-provoking questions and confrontations;
avoidance of pregenital characterological issues, which the patient uses defensively to avoid dealing with the therapist's anxiety-provoking techniques;

avoidance at all costs of a transference neurosis;

repetitive demonstration of the patient's neurotic ways or maladaptive patterns of behavior;

concentration on the anxiety-laden material, even before the defense mechanisms have been clarified;

repeated demonstrations of parent-transference links by the use of properly timed interpretations based on material given by the patient;

establishment of a corrective emotional experience;

encouragement and support of the patient, who becomes anxious while struggling to understand the conflicts;

new learning and problem-solving patterns;

and repeated presentations and recapitulations of the patient's psychodynamics until the defense mechanisms used in dealing with oedipal conflicts are understood.
Height of Treatment
emphasizes the tangible demonstration of change in the patient's behavior outside therapy, evidence that adaptive patterns of behavior are being used, and initiation of talk about terminating the treatment
Phase?
Evidence of Change
? group therapy, which was devised by Eric Berne and emphasizes the here-and-now interactions among group members
transactional
? group therapy, which relies on conditioning techniques based on learning theory
behavioral
? group therapy, which was created from the theories of Frederick Perls, enables patients to abreact and express themselves fully
Gestalt
?group psychotherapy, which was developed by Carl Rogers and is based on the nonjudgmental expression of feelings among group members
client-centered
Those patients whose primary problem is their relationship to ? and who are extremely anxious in the presence of ? may do well in group therapy because they are more comfortable in a group and more likely will do better in a group than in a dyadic (one-to-one) setting.

Patients with a great deal of ? anxiety may be blocked, anxious, resistant, and unwilling to verbalize thoughts and feelings in an individual setting, generally for fear of the therapist's censure or disapproval.
authority
authority figures
Compare
1) Supportive Group T
2) Analytically Oreinted Group Tx
3) Psychoanalysis Group
4) Transactional Group Therapy
5) Behavioral Group Therapy
See Table 35.3-1
Antisocial patients generally do (well or poorly) in a heterogeneous group setting because ?;

if the group is composed of other antisocial patients, they may respond (well or poorly) to peers than to perceived authority figures
Poorly

they cannot adhere to group standards

well
List and describe tasks of therapist in creating group?
# Decision to establish a therapy group:
Determine setting and size of the group
Choose frequency and length of group sessions
Decide on open versus closed group
Select a cotherapist for the group
Formulate policy on group therapy with other therapeutic modalities
# Act of creating a therapy group:
Formulate appropriate goals
Select patients who can perform the group task
Prepare patients for group therapy
# Construction and maintenance of a therapeutic environment:
Build the culture of the group explicitly and implicitly identify and resolve common problems (membership turnover,
Group therapy has been successful with as few as 3 members and as many as 15, but most therapists consider ? members the optimal size.
8 to 10
? groups have a set number and composition of patients. If members leave, no new members are accepted. In ? groups, membership is more fluid, and new members are taken on whenever old members leave.
Closed

Open
A process inherent in group formation requires that patients suspend their previous ways of coping. In entering the group, they allow their ? functions—reality testing, adaptation to and mastery of the environment, and perception—to be assumed, to some degree, by the collective assessment provided by the total membership, including the leader.
executive ego
outlines 20 significant therapeutic factors that account for change in group psychotherapy
Abreaction (bring conflict to consciousness)
Acceptance
Altruism
Catharsis
Cohesion
Consensual validation (reality confirmed by others)
Contagion (affect in one stimulates others affect)
Corrective familial experience
Empathy
Identification
Imitation
Insight
Inspiration
Interaction
Interpretation
Learning
Reality testing
Transference
Universalization
Ventilation
Although opinions differ about how active or passive a group therapist should be, the consensus is that the therapist's role is primarily ?
facilitative
Common goals of inpt group tx?
to increase patients' awareness of themselves through their interactions with the other group members, who provide feedback about their behavior;

to provide patients with improved interpersonal and social skills;

to help the members adapt to an inpatient setting;

and to improve communication between patients and staff.
A distinguishing characteristic of the self-help groups is their
homogeneity
A combined therapy approach called ? group psychotherapy has a different group member as the focus of each weekly group session who is discussed in depth by the other members.
structured interactional
The hallmark of the ? is persons' differentiation from their family of origin, their ability to be their true selves in the face of familial or other pressures that threaten the loss of love or social position. Problem families are assessed on two levels:
Bowen Model or Family Systems

1) the degree of their enmeshment versus the degree of their ability to differentiate and
2) the analysis of emotional triangles in the problem for which they seek help.
Bowen Family Tx
The therapist's role is, first, ?
, second, to
stabilize or shift the “hot” triangle,the one producing the presenting symptoms—and

work with the most psychologically available family members, individually if necessary, to achieve sufficient personal differentiation so that the hot triangle does not recur.
In a ? model, families are viewed as single, interrelated systems assessed in terms of significant alliances and splits among family members,
hierarchy of power (parents in charge of children),
clarity and firmness of boundaries between the generations, and
family tolerance for each other.

The structural model uses concurrent individual and family therapy
Structural MOdel
Criteria for Family Treatment Termination?
When family members can complete transactions, check, ask

When they can interpret hostility

When they can see how others see them

When they can see how they see themselves

When one member can tell others how they manifest themselves

When one member can tell others what is hoped, feared, and expected from them

When they can disagree
When they can make choices

When they can learn through practice

When they can free themselves from the harmful effects of past models

When they can give clear message—that is, be congruent in their behavior—with a minimum of difference between feelings and communication and with a minimum of hidden messages.
Based on? theory, a ? model holds that families are systems and that every action in a family produces a reaction in one or more of its members.
general systems
Families have external boundaries and internal rules. Every member is presumed to play a role (e.g., spokesperson, persecutor, victim, rescuer, symptom bearer, nurturer), which is relatively stable, but which member fills each role may change. Some families try to scapegoat one member by blaming him or her for the family's problems (the identified patient). If the identified patient improves, another family member may become the scapegoat.

Model?
General Systems Model
?, also known as positive connotation, is a relabeling of all negatively expressed feelings or behavior as positive. When the therapist attempts to get family members to view behavior from a new frame of reference, “This child is impossible” becomes “This child is desperately trying to distract and protect you from what he or she perceives as an unhappy marriage.” ? is an important process that allows family members to view themselves in new ways that can produce change.
Reframing
Family therapy has several goals:
to resolve or reduce pathogenic conflict and anxiety within the matrix of interpersonal relationships;

to enhance the perception and fulfillment by family members of one another's emotional needs;

to promote appropriate role relationships between the sexes and generations;

to strengthen the capacity of individual members and the family as a whole to cope with destructive forces inside and outside the surrounding environment;

and to influence family identity and values so that members are oriented toward health and growth
Difference between marriage counselling and therapy?
counselling has problem solving focus
therapy: restructure
Contraindications for couples therapy include
patients with severe forms of psychosis, particularly patients with paranoid elements and those in whom the marriage's homeostatic mechanism is a protection against psychosis,

marriages in which one or both partners really want to divorce,

and marriages in which one spouse refuses to participate because of anxiety or fear.
Dialectical behavior therapy (DBT) is a type of psychotherapy that was originally developed for ?
chronically self-injurious patients with borderline personality disorder and parasuicidal behavior
As described by its originator, there are five essential “functions” in DBT treatment:
(1) to enhance and expand the patient's repertoire of SKILLFUL behavioral patterns;
(2) to improve patient MOTIVATION to change by reducing reinforcement of maladaptive behavior, including dysfunctional cognition and emotion;

(3) to ensure that new behavioral patterns GENERALIZE from the therapeutic to the natural environment;

(4) to structure the environment so that EFFECTIVE behaviors, rather than dysfunctional behaviors, are reinforced; and


(5) to enhance the motivation and capabilities of the THERAPIST so that effective treatment is rendered
DBT cycle?
Cue >
Emotion Dysregulation > Avoidance or escape > Problem Behaviour >Temporary Relief and or back to Emotion Dysregulation
The four modes of treatment in DBT are as follows:
(1) group skills training,
(2) individual therapy,
(3) phone consultations, and
(4) consultation team
Describe DBT group skills training
patients learn specific behavioral, emotional, cognitive, and interpersonal skills.idactic approach, using specific exercises taken from a skills training manual, is used, many of which are geared to control emotional dysregulation and impulsive behavior.
Describe DBT individual tx
Sessions in DBT are held weekly, generally for 50 to 60 minutes, in which skills learned during group training are reviewed and life events in the previous week examined. Particular attention is paid to episodes of pathological behavioral patterns that could have been corrected if learned skills had been put into effect. Patients are encouraged to record their thoughts, feelings, and behavior on diary cards which are analyzed in the session.
Describe DBT telphone consultation
Therapists are available for phone consultation 24 hours per day. Patients are encouraged to call when they feel themselves heading toward some crisis that might lead to injurious behavior to themselves or others. Calls are intended to be brief and usually last about 10 minutes.
Describe consultation team
Therapists meet in weekly meetings to review their work with their patients. By doing so, they provide support for one another and maintain motivation in their work. The meetings enable them to compare techniques used and to validate those that are most effective
? refers to the portion of individuals with a specific genotype who also manifest that genotype at the phenotype level.

If all individuals who carry the dominant gene show any phenotype of the gene, the gene is said to be ?
Penetrance

completely penetrant
Currently, only rare examples exist of known genes for mental disorders that demonstrate complete penetrance of symptoms in the presence of a single gene. One such example is
early-onset familial Alzheimer's disease resulting from mutations in the amyloid precursor protein (APP) located on the long arm of chromosome 21
? refers to the extent to which a genotype is ?. In the case of variable ?, the trait can vary in ? from mild to severe, but is never completely unexpressed in individuals who have the gene. The genes that result in most mental disorders are believed to regulate a wide spectrum of traits demonstrating variability of ? (spectrum disorders).
expressivity refers to the extent to which a genotype is expressed. In the case of variable expressivity, the trait can vary in expression from mild to severe, but is never completely unexpressed in individuals who have the gene. The genes that result in most mental disorders are believed to regulate a wide spectrum of traits demonstrating variability of expression (spectrum disorders).
? is the term used to identify the affected person within the family who first brought the family to medical attention.
Proband
Highest risk of disorder if have first degree relative with disorder?
phobia up to 31%
highest sibling or parental risk
OCD 25 to 35%
Risk of Sz, Bipolar ds if both parents have disorder?
Sz: 45%
Bipolar: 50 to 75%
According to the cognitive theory of depression, ? are the core of depression, and affective and physical changes and other associated features of depression are consequences of ?
cognitive dysfunctions
From a cognitive perspective, depression can be explained by the cognitive triad, which explains that
negative thoughts are about the self, the world, and the future.
Goal of Cognitive Tx?
alleviate depression and to prevent its recurrence by helping patients to

identify and test negative cognitions,

to develop alternative and more flexible schemas,

and to rehearse both new cognitive and behavioral responses.

Changing the way a person thinks can alleviate the psychiatric disorder.
CT techniques?
Collaborative empiricism

Structured and directive

Assigned readings

Homework and behavioral techniques

Identification of irrational beliefs and automatic thoughts

Identification of attitudes and assumptions underlying negatively biased thoughts
List core beliefs of people with following disorders:
MDD
Mania
Anxiety
Panic
Phobias
Paranoid PD
Conversion
OCD
Suicidal Behaviour
AN
Hypochondriasis
Depressive disorder Negative view of self, experience, and future

Hypomanic episode Inflated view of self, experience, and future

Anxiety disorders Fear of physical or psychological danger

Panic disorder Catastrophic misinterpretation of bodily and mental experiences

Phobias Danger in specific, avoidable situations

Paranoid personality disorder Negative bias, interference, and so forth by others

Conversion disorder Concept of motor or sensory abnormality

Obsessive-compulsive disorder Repeated warning or doubting about safety and repetitive acts to ward off threat

Suicidal behavior Hopelessness and deficit in problem solving

Anorexia nervosa Fear of being fat or unshapely

Hypochondriasis Attribution of serious medical disorder
Cognitive Techniques
The therapy's cognitive approach includes four processes
1) eliciting automatic thoughts,
2) testing automatic thoughts,
3) identifying maladaptive underlying assumptions, and
4) testing the validity of maladaptive assumptions.
? thoughts, also called cognitive distortions, are cognitions that intervene between external events and a person's emotional reaction to the event.
Automatic
For example, the belief that “people will laugh at me when they see how badly I bowl” is an ? thought that occurs to someone who has been asked to go bowling and responds negatively.
automatic
Describe testing automatic thoughts
Acting as a teacher, a therapist helps a patient test the validity of automatic thoughts. The goal is to encourage the patient to reject inaccurate or exaggerated automatic thoughts after careful examination. Patients often blame themselves when things that are outside their control go awry. The therapist reviews the entire situation with the patient and helps reassign the blame or cause of the unpleasant events. Generating alternative explanations for events is another way of undermining inaccurate and distorted automatic thoughts.
Identifying Maladaptive Assumptions ... describe this process
As the patient and therapist continue to identify automatic thoughts, patterns usually become apparent. The patterns represent rules or maladaptive general assumptions that guide a patient's life. Samples of such rules are “In order to be happy, I must be perfect” and “If anyone doesn't like me, I'm not lovable.” Such rules inevitably lead to disappointments and failure and, ultimately, to depression
Describe Testing the Validity of Maladaptive Assumptions
Testing the accuracy of maladaptive assumptions is similar to testing the validity of automatic thoughts. In a particularly effective test, therapists ask patients to defend the validity of their assumptions. For example, patients may state that they should always work up to their potential, and a therapist may ask, “Why is that so important to you?”
Among the behavioral techniques in cognitive therapy are
scheduling activities,
mastery and pleasure,
graded task assignments,
cognitive rehearsal,
self-reliance training,
role-playing, and
diversion techniques
In a technique called ?, therapists encourage patients to have fantasies that can be interpreted as wish fulfillments or attempts to master disturbing affects or impulses.
guided imagery
List 5 common cognitive errors
Overgeneralizing
Selective abstraction
Excessive responsibility assuming
Assuming temporal causality, predicting without sufficient evidence
Self references
Catastrophizing
Dichotomous thinkig
Everything is either one extreme or another (black or white, good or bad)

How tx and name?
Demonstrate that events may be evaluated on a continuum

Dichotomous/Black and White thinking
Always think of the worst. It's almost likely to happen to you.
Catasrophizing

Calculate real probabilities. Focus on evidence that the worst did not happen
I am the center of everyone's attention—especially my bad performances. I am the cause of misfortunes.
Self-references

Establish criteria to determine when patient is the focus of attention and also the probable facts that cause bad experiences.
If it has been true in the past, it's always going to be true.
I am responsible for all bad things, failures, etc. Disattribution technique.
Assuming temporal causality (predicting without sufficient evidence)

Expose faulty logic. Specify factors that could influence outcome other than past events.
I am responsible for all bad things, failures, etc.
Excessive responsibility (assuming personal causality)

Disattribution technique.
The only events that matter are failures, deprivation, etc. Should measure self by errors, weaknesses, etc.
Use log to identify successes patient forgot
If it's true in one case, it applies to any case that is even slightly similar.
Overgeneralizing

Exposure of faulty logic. Establish criteria of which cases are similar to what degree.
List Criteria that justify the administration of cognitive therapy alone:
Failure to respond to adequate trials of two antidepressants
Partial response to adequate dosages of antidepressants
Failure to respond or only a partial response to other psychotherapies
concentration, and memory function
Inability to tolerate medication effects or evidence that excessive risk is associated with pharmacotherapy


Diagnosis of dysthymic disorder
Mild somatoform disorders (sleep, appetite, weight, libidinal)

Variable mood reactive to environmental events
Variable mood that correlates with negative cognitions

Adequate reality testing (i.e., no hallucinations or delusions), span of concentration, and memory function
List Features that suggest cognitive therapy alone is not indicated:
Evidence of coexisting schizophrenia, dementia, substance-related disorders, mental retardation
Patient has medical illness or is taking medication that is likely to cause depression
Obvious memory impairment or poor reality testing (hallucinations, delusions)
History of manic episode (bipolar I disorder)
History of family member who responded to antidepressant
History of family member with bipolar I disorder
Absence of precipitating or exacerbating environmental stresses
Little evidence of cognitive distortions
Presence of severe somatoform disorders (e.g., pain disorder)
Indications for combined therapies (medication plus cognitive therapy):
Partial or no response to trial of cognitive therapy alone
Partial but incomplete response to adequate pharmacotherapy alone
Poor compliance with medication regimen
Historical evidence of chronic maladaptive functioning with depressive syndrome on intermittent basis
Presence of severe somatoform disorders and marked cognitive distortions (e.g., hopelessness)
Impaired memory and concentration and marked psychomotor difficulty
Major depressive disorder with suicidal danger
History of first-degree relative who responded to antidepressants
History of manic episode in relative or patient
Cognitive therapy can be used ? in the treatment of mild to moderate depressive disorders
or ? for major depressive disorder.
Cognitive therapy can be used alone in the treatment of mild to moderate depressive disorders or in conjunction with antidepressant medication for major depressive disorder.
Hypnosis is currently understood as a (abnormal or normal) activity of a (abnormal or normal) mind through which attention is more focused, critical judgment is partially suspended, and peripheral awareness is diminished.
Hypnosis is currently understood as a normal activity of a normal mind through which attention is more focused, critical judgment is partially suspended, and peripheral awareness is diminished.
? is an ability to reduce peripheral awareness that results in a greater focal attention. It can be metaphorically described as a psychological zoom lens that increases attention to the given thought or emotion to the increasing exclusion of all context, even including orientation to time and space.
Absorption
? is the separating out from consciousness elements of the patient's identity, perception, memory, or motor response as the hypnotic experience deepens. The result is that components of self-awareness, time, perception, and physical activity can occur without being known to the patient's consciousness and so may seem involuntary.
Dissociation
? is the tendency of the hypnotized patient to accept signals and information with a relative suspension of normal critical judgment; it is controversial whether critical judgment can be completely suspended. This trait will vary from an almost compulsive response to input in the highly hypnotizable to a sense of automaticity in the less hypnotizable individual.
Suggestibility
Electroencephalographic (EEG) studies have shown that hypnotized persons exhibit electrical patterns that are similar to those of fully awake and attentive persons and not like those found during sleep. Increased ? activity and ? power in the ? region has been reported in highly hypnotizable patients as compared with those who are less hypnotizable
Electroencephalographic (EEG) studies have shown that hypnotized persons exhibit electrical patterns that are similar to those of fully awake and attentive persons and not like those found during sleep. Increased alpha activity and theta power in the left frontal region has been reported in highly hypnotizable patients as compared with those who are less hypnotizable
Positron emission tomography (PET) studies that compare regional blood flow in the brain in both hypnotized and nonhypnotized subjects lend further evidence to the hypothesis that hypnosis exerts some of its effects at lower level modalities of the brain. Hypnotic suggestions to add color to a visual image result in ? blood flow to the ? and ? ?, the color vision processing centers of the brain; suggestions to remove color have the opposite effect.
Positron emission tomography (PET) studies that compare regional blood flow in the brain in both hypnotized and nonhypnotized subjects lend further evidence to the hypothesis that hypnosis exerts some of its effects at lower level modalities of the brain. Hypnotic suggestions to add color to a visual image result in increased blood flow to the lingual and fusiform gyri, the color vision processing centers of the brain; suggestions to remove color have the opposite effect.
through hypnosis.
The role of the ? brain regions, such as the ? lobes, in hypnosis has been shown physiologically by the positive correlation between ? concentrations in the cerebrospinal fluid and degree of hypnotizability.
through hypnosis.
The role of the anterior brain regions, such as the frontal lobes, in hypnosis has been shown physiologically by the positive correlation between homovanillic acid concentrations in the cerebrospinal fluid and degree of hypnotizability
The frontal cortex and basal ganglia have a large number of neurons that use ?, of which the metabolite is ?
The frontal cortex and basal ganglia have a large number of neurons that use dopamine, of which the metabolite is homovanillic acid
This may explain why pharmacological enhancement of hypnotizability, although difficult, is primarily accomplished with dopaminergic agents, such as ?
amphetamine
patients with paranoid personality disorder are ? (low or high) and patients who are histrionic (low or high) on the hypnotizability spectrum
patients with paranoid personality disorder are low and patients who are histrionic higher on the hypnotizability spectrum
Patients with ? disorder are highly hypnotizable. Patients with ? disorders are difficult to hypnotize.
Patients with dissociative identity disorder are highly hypnotizable. Patients with eating disorders are difficult to hypnotize.
Indications for hypnosis?
Smoking, overeating, phobias, anxiety, conversion symptoms, and chronic pain are all indications for hypnosis
The overall goal of ITP is to reduce or eliminate psychiatric symptoms by
improving the quality of the patient's current interpersonal relations and social functioning.
The typical course of ITP lasts ? sessions over a 4- to 5-month period. ITP moves through three defined phases:
12 to 20

(1) The initial phase is dedicated to identifying the problem area that will be the target for treatment;
(2) the intermediate phase is devoted to working on the target problem area(s); and
(3) the termination phase is focused on consolidating gains made during treatment and preparing the patients for future work on their own
Sessions 1 through ? typically constitute the ? phase of ITP
Sessions 1 through 5 typically constitute the initial phase of ITP
Describe initial phase
Dx
Assign sick role
Educate re: ITP
Interpersonal inventory
Links sx to 1/4 problem areas
Interpersonal Formulation
4 ITP problem areas
GRId (Grief, Role transition, Inpers role disputes, interperson Deficits)
Grief
Role Transition
Interpersonal role Disputes
Interpersonal Deficits
nitial phase: sessions 1–5
Give the syndrome a name; provide information about prevalence and characteristics of the disorder
Describe the rationale and nature of interpersonal psychotherapy
Conduct the interpersonal inventory to identify the current interpersonal problem area(s) associated with the onset or maintenance of the psychiatric symptoms
Review significant relationships, past and present
Identify interpersonal precipitants of episodes of psychiatric symptoms
Select and reach consensus about the interpersonal psychotherapy problem area(s) and treatment plan with patient (Formulation)
Intermediate phase: sessions 6–15
Implement strategies specific to the identified problem area(s)
Encourage and review work on goals specific to the problem area
Illuminate connections between symptoms and interpersonal events during the week
Work with the patient to identify and manage negative or painful affects associated with his or her interpersonal problem area
Relate issues about psychiatric symptoms to the interpersonal problem area
Termination phase: sessions 16–20
Discuss termination explicitly
Educate patient about the end of treatment as a potential time of grieving; encourage patient to identify associated emotions
Review progress to foster feelings of accomplishment and competence
Outline goals for remaining work; identify areas and warning signs of anticipated future difficulty
Formulate specific plans for continued work after termination of treatment
Grief:
Goals and Strategies?
Goals
1. Facilitate the mourning process
2. Help patient reestablish interest in new activities and relationships to substitute for what has been lost
Strategies:
1. Reconstruct the patient's relationship with the deceased
2. Explore associated feelings (negative and positive)
3. Consider ways of becoming reinvolved with others
Interpersonal deficits
Goals and Strategies?
Goals
1. Reduce patient's social ISOLATION
2. Enhance quality of any EXISTING relationships
3. Encourage the formation of NEW relationships
Strategies:
1. Review PAST significant relationships, including negative and positive aspects
2. Explore repetitive PATTERNS in relationships
3. Note problematic interpersonal patterns in the SESSION and relate them to similar patterns in the patient's life
Interpersonal role disputes
Goals and Strategies?
Interpersonal Role Disputes:
1. Identify the nature of the dispute
2. Explore options to resolve the dispute
3. Modify expectations and faulty communication to bring about a satisfactory resolution
4. If modification is unworkable, encourage patient to reassess the expectations for the relationship and to generate options to either resolve it or dissolve it and mourn its loss
Strategies:
1. Determine the stage of the dispute:
a) renegotiation (calm down participants to facilitate resolution); b) impasse (increase disharmony to reopen negotiation);
c) dissolution (assist mourning and adaptation)
2. Understand how nonreciprocal role expectations relate to the dispute
3. Identify available resources to bring about change in the relationship
Role transitions
Goals
Mourn and accept the loss of the old role
Recognize the positive and negative aspects of the new role and assets and liabilities of the old role
Restore self-esteem by developing a sense of mastery regarding the demands of the new role
Strategies:
1. Review positive and negative aspects of old and new roles
2 .Explore feelings about what is lost
3. Encourage development of social support system and new skills called for in new role
IPT group therapy components?
Pregroup meeting
IPT group stages?
Pre-Treatment Meeting
Engagement: sessions 1–2
Differentiation: sessions 3–5
Work: sessions 6–15
Termination: sessions 16–20
PostTreatment meeting
Engagement: sessions 1–2
Members work and Tx interventions?
Members look for structure as they grapple with the anxiety of being in a group and sharing their problems.

Tx: Establish a structure that encourages appropriate self-disclosure. Facilitate norms for effective communication
Differentiation: sessions 3–5
Members work to manage negative feelings over interpersonal differences as they emerge in the group.
Tx:Help members understand their reactions in the context of interpersonal differences in their outside social lives.
Work: sessions 6–15
Members work out differences and strive toward common goals.
Tx:Facilitate connections among members as they share their work with each other. Encourage practice of newly acquired interpersonal skills in and outside of the group.
Termination: sessions 16–20
Members struggle with how to manage the impending loss of connection with other group members
Tx:Help members to consolidate their work and to plan continued work. Assist members in grieving the loss of the group.
What are components of social skills?
Expressive behaviour
Nonverbal behaviour
Receptive skills
Processing skills
Interactive behaviours
Situation factors
social competence is based on three component skills: (
1) social perception, or receiving skills;
(2) social cognition, or processing skills; and
(3) behavioral response, or expressive skills
? is the ability to read or decode social inputs accurately. This includes accurate detection of affect cues, such as facial expressions and nuances of voice, gesture, and body posture, as well as verbal content and contextual information
Social perception
? involves effective analysis of the social stimulus, integration of current information with historical information, and planning of an effective response. This domain is also referred to as ?
Social cognition

social problem solving.
The primary modality of social skills training is?
Trainer steps?
role play of simulated conversations.
Social skills training teaching steps?
First provides instructions on how to perform the skill and then models the behavior to demonstrate how it is performed.

After identifying a relevant social situation in which the skill might be used, the patient engages in role play with the trainer.

The trainer next provides feedback and positive reinforcement, which are followed by suggestions for how the response can be improved.

The sequence of role play followed by feedback and reinforcement is repeated until the patient can perform the response adequately.
In a treatment setting, there are four major goals of social skills training:
(1) improved social skills in specific situations,
(2) moderate generalization of acquired skills to similar situations,
(3) acquisition or relearning of social and conversational skills, and
(4) decreased social anxiety.
A study at the National Institutes of Health (NIH) found that patients with schizophrenia were (able or unable) to benefit from explicit instructions and practice on the Wisconsin Card Sorting Test (WCST), a widely used test of executive functioning.

The study was linked to data demonstrating that patients had ? blood flow in ? cortex while responding to the WCST, implying that schizophrenia was marked by an unmodifiable abnormality of the dorsolateral prefrontal cortex
unable

The study was linked to data demonstrating that patients had diminished prefrontal blood flow in dorsolateral prefrontal cortex while responding to the WCST, implying that schizophrenia was marked by an unmodifiable abnormality of the dorsolateral prefrontal cortex
A major indication for using medication when conducting psychotherapy, particularly for those patients with major mental disorders such as schizophrenia or bipolar disorder is that psychotropics ?
reduce anxiety and hostility.
This improves the patient's capacity to communicate and to participate in the psychotherapeutic process.
The reduction of symptoms, especially anxiety, (does or does not decrease) the patient's motivation for psychoanalysis or other insight-oriented psychotherapy. In
DOES NOT
In practice, drug-induced symptom reduction improves communication and motivation
Clinical Situations in Which It Is Advantageous for One Psychiatrist to Provide Medication and Psychotherapy?
Patients with schizophrenia and other psychotic disorders who are not compliant with prescribed medication
Patients with bipolar I disorder who deny illness and do not cooperate with the treatment plan
Patients with serious or unstable medical conditions
Patients with severe borderline personality disorders
Impulsive and severely suicidal patients who are likely to require hospitalization
Patients with eating disorders who present complicated management problems
Patients who present a clinical picture in which the need for medication is unclear, thus requiring ongoing assessment