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20 Cards in this Set
- Front
- Back
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How do clinical psychologists differ from psychiatrists?
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Clinical psychologists undergo different training than psychiatrists, and the two groups hold different degrees. Clinical psychologists hold either Ph.D. or Psy.D. degrees, whereas psychiatrists are medical doctors who have completed a residency in psychiatry. Training in clinical psychology tends to emphasize psychotherapy training, whereas psychiatrists’ training tends to emphasize somatic treatments (treatments that are directly aimed at the brain, such as medication, electrical implants, TMS, surgery), especially medication, and focuses on psychotherapy to a lesser extent.
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How does talking to a psychotherapist differ from talking to a friend?
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Although both psychotherapists and friends can listen, provide support, and make suggestions, there are important differences between the role of a psychotherapist and the role of a friend. In contrast to friendship, which is a reciprocal relationship, psychotherapy is a one-way relationship in which everything is intended for the benefit of the client. Unlike friends, psychotherapists are bound by legal and ethical rules, including confidentiality. Finally, psychotherapists, unlike friends, may be trained in specific interventions to address specific problems.
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What is critical incident stress debriefing? What does the data say about the effectiveness of this type of intervention?
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Critical incident stress debriefing is an intervention often implemented in the immediate aftermath of a large-scale trauma (school shootings, building collapses, tsunamis…). This intervention typically involves providing information about common reactions to trauma and having individuals talk in a group setting about their experiences during the trauma. Some studies have shown that critical incident stress debriefing actually increases rates of PTSD relative to no intervention. Other studies have found that critical incident stress debriefing has no effect on rates of PTSD. Thus, the data suggest that critical incident stress debriefing is at best ineffective, and at worst detrimental.
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What effect does use of psychoactive medication have on the effectiveness of psychotherapy when the two treatments are used in tandem?
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The answer to this question depends on the particular disorder being treated. In the case of severe mental illness, psychotherapy is often combined with medication, and psychotherapy has been shown to have benefits above and beyond the benefits associated with medication. Similarly, in the treatment of depression, psychotherapy and medication together may be more effective than treatment with psychotherapy alone. In contrast, adding medication to psychotherapy brings no additional benefit for disorders like obsessive-compulsive disorder, and adding medication may decrease the benefits of psychotherapy for disorders such as panic disorder.
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Define common factors and specific factors in psychotherapy. How might patient characteristics affect which type of factor is responsible for symptom decrease over the course of psychotherapy?
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Common factors are things that all good psychotherapies share. These include providing hope and an expectancy for change, providing a framework for understanding one’s problems and ways to change one’s problems, and providing a safe and supportive relationship with another individual (the therapist). Specific factors are of two sorts: there are features that are common to a general approach (e.g., cognitive behavioral therapy always involves talking about how the patient reasons about things, whereas behavior modification therapy always involves attempting to use conditioning principles), and there are features that are specific to a given disorder (what you do for OCD is different from what you do for depression, even if you’re using CBT for both). Some researchers have argued that common factors account for nearly all of the benefits provided by psychotherapy, whereas other researchers argue that specific factors matter to a great extent.
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Common factors
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-things that all good psychotherapies share
-These include providing hope and an expectancy for change, providing a framework for understanding one’s problems and ways to change one’s problems, and providing a safe and supportive relationship with another individual (the therapist). |
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Specific Factors
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-there are features that are common to a general approach (e.g., cognitive behavioral therapy always involves talking about how the patient reasons about things, whereas behavior modification therapy always involves attempting to use conditioning principles),
-there are features that are specific to a given disorder (what you do for OCD is different from what you do for depression, even if you’re using CBT for both). |
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How does a therapy work?
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It is likely that the reason why a therapy works varies depending on the severity of each patient treated. For example, a meta-analysis by Driessen et al. (2010) showed that for mildly depressed patients, effective psychotherapies (which included both common and specific factors) had only a small benefit relative to control treatments (which included only common factors). However, for severely depressed patients, effective psychotherapies provided a much larger benefit relative to control treatments. This suggests that common factors may be responsible for many of the positive effects of psychotherapy in less severe populations, but as severity increases, specific factors play a larger role in whether a treatment works.
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Psychodynamic therapy
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- involves the therapist identifying and interpreting common patterns in the client’s relationships and behavior, which may have their origins in childhood experiences.
-Freud |
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Behavior modification
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-applying the principles of operant conditioning to increase the frequency of desirable behavior and decrease the frequency of undesirable behavior
-is often focused on reducing fear and avoidance and learning new skills. |
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Interpersonal therapy
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focuses on making positive changes in the client’s relationships with others
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Cognitive Therapy
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Cognitive therapy focuses on examining maladaptive thinking patterns.
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Briefly describe prolonged exposure for PTSD. How does this differ from systematic desensitization?
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In prolonged exposure for PTSD, the client is asked to repeatedly recount the trauma memory in the therapy session until the memory is completely fleshed out and until the anxiety connected with the memory subsides. Clients are also encouraged to confront things in the world that they have been avoiding since the trauma, which often include stimuli associated with the trauma. Prolonged exposure typically involves 8-15 60-90 minute sessions. Clients often have a new perspective on the trauma after undergoing this type of therapy. Prolonged exposure differs from systematic desensitization in that the latter involves pairing gradual exposure to the feared stimulus with relaxation techniques so that the feared stimulus becomes associated with relaxation, rather than fear. In contrast, prolonged exposure involves immediate (rather than gradual) exposure to the trauma memory, and exposure is not coupled with relaxation techniques.
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Explain how prolonged exposure works in terms of the principles of classical conditioning.
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According to classical conditioning, when a neutral stimulus (the CS) is paired with a painful or scary experience (the UCS), the neutral stimulus becomes associated with pain and fear (the UR and the CR). As such, individuals begin to avoid the neutral stimulus even when it is not accompanied by pain or fear. In order for extinction to take place, the individual needs to be exposed to the CS on repeated trials in the absence of the UCS. However, because people with PTSD tend to avoid thinking about their traumatic experience or things that remind them of the trauma (the CS), extinction does not occur naturally because these individuals never confront the CS in the absence of the UCS. In prolonged exposure therapy, patients are repeatedly exposed to the trauma memory and to neutral trauma cues in a safe environment, so that extinction might occur.
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Medicines Used to Treat Schizophrenia
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Schizophrenia is typically treated with antipsychotics, most recently the “atypical antipsychotics.”
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Medicines used to treat Depression
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-Early pharmacological treatments for depression included antidepressants such as monoamine oxidase inhibitors and tricyclics
-Currently, depression is usually treated with more modern antidepressants including serotonin selective reuptake inhibitors (SSRIs) and atypical antidepressants (i.e., new drugs that are not SSRIs). |
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Medicines Used to Treat Bipolar Disorder
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-typically treated with mood stabilizers
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Medicines Used to Treat Anxiety Disorder
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-often treated with anxiolytics such as beta blockers (for autonomic arousal) and benzodiazepines.
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Drawbacks to treating psychiatric disorders with medication
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Although many psychiatric medications are quite effective, there are also drawbacks to these medications. One major concern is the side effects of medications. These side effects can be unpleasant and may interfere with medication compliance. Additionally, while medications are effective in controlling the symptoms of many disorders, they are not a cure and patients often relapse when they stop taking the medication. Another concern is that there is no way to know for sure what medication and what dosage a particular patient needs to feel better. Because of this, getting the dosage and medication right can be a long process of trial and error. Finally, there is some concern that these medications are overprescribed. This is particularly controversial when it comes to children, since less is known about the effects that these medications have on children relative to adults.
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What are the key features of a randomized controlled trial (RCT)? How do psychotherapy RCTs address the placebo effect? How do these trials ensure that patients get the same treatment at the same “dose”?
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An RCT is a way of evaluating the outcome of therapy, and it typically involves randomly assigning patients to a treatment group or a control group. The symptom severity of each group is assessed before, after, and during the course of treatment to see whether the treatment results in greater changes in symptom severity than does the control. In drug trials, the control group usually takes a placebo pill to control for the possible confound that the act of taking a pill and meeting with a friendly doctor regularly is what is accounting for any improvement seen in the treatment group. However, in psychotherapy RCTs it is more difficult to determine what the placebo or control condition should be. Because of this, psychotherapies are often compared to waiting list controls, rather than placebo psychotherapies. In RCTs for psychotherapy, the treatment and dose are standardized through the use of treatment manuals, which provide explicit instructions to study therapists about how to execute the treatment.
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