Talking Therapies / Placebo Effect (Dr R Shaw)

Question 1

What are some commonly encountered mental health problems?

Answer 1

Mood disorders; depression, bipolar disorder
Anxiety disorders; OCDs, agoraphobia, panic disorder
Psychoses; schizophrenia
Substance misuse/addictions; drugs alcohol gambling
Personality disorders
Neurodevelopment disorders e.g. ADHD, Aspergers
Others include dementia, somatoform disorders

Question 2

How should we treat common mental health problems?

Answer 2

Holistic approach 
Biopsychological model
Biomedical e.g. medication, ECT
Psychological e.g. 'talking therapies'
Social e.g. occupational therapy, social inclusion and wellbeing

Question 3

What kind of therapeutic talking therapies are available?

Answer 3

Self help groups 
GP consultation
Everyday social networks
Friends and family 
Formal psychotherapy with a trained therapist
Self-help books, internet etc 
'Counselling'

Question 4

What are talking therapies?

Answer 4

Psychotherapies
Counselling
Use of language / verbal communication
May involve face to face interaction, some self help
May be 1:1, group work, couples, families

Question 5

What is the aim of talking therapies?

Answer 5

Aim to offer support and improve an identified difficulty or distress
Explore thoughts, feelings, look for patterns
Reflect, understand, evaluate and move forward.

Question 6

What are the general principles of TT?

Answer 6

Formalised, structure-time, venue, no. of sessions, ‘ground rules and boundaries’.
Motivation from the patient re sessions and also outside of sessions; active participation.
Facilitation of patient helping themself

Question 7

Who are Talking Therapies particularly effective for?

Answer 7

Problems that are helped by talking therapies;

bereavement, anxiety, disorders, chronic pain, quit smoking, depression, substance misuse, personality disorder etc etc.

Question 8

What examples of different talking therapies are there?

Answer 8

Cognitive behaviour therapy (CBT)
Psychodynamic psychotherapy
Supportive psychotherapy 
Mindfulness based cognitive therapy (MBCT)
Motivational interviewing 
Dialectical behaviour therapy (DBT)

Question 9

What is it important to consider before behavioural therapy is undertaken?

Answer 9

Careful assessment of the therapy and whether it is indicated for that condition; it may be harmful to the patient. The patient’s suitability to commit to the therapy is also important.

Question 10

What is Cognitive Behavioural Therapy? (CBT)

Answer 10

Aaron Beck, 1960s
View of self, world, future
Aim is to identify unhelpful cycles of thought, mood, behaviour and consider how these cycles can be broken.
Delivered as time limited face to face sessions, self-help.

Question 11

When is CBT used?

Answer 11

Depression, anxiety disorders (phobias, panic attacks etc) some psychoses, bulimia, anger management, chronic physical health problems

Question 12

How does CBT break the cyclical habits that lead to patient problems?

Answer 12

Targets the behaviour that is the cause
Targets the feelings that result from the cause
Explores behaviour that can combat the situation

Question 13

How is a CBT session structured?

Answer 13

Explain model, outline the time, frequency, length f session
Establish boundaries
Identify difficulties and goals
‘Homework’
Review of outside work / self - help
Encourage patient participation, to find own resolutions
Patient’s may keep a notebook/record

Question 14

What is Mindfulness Based Cognitive Therapy? (MBCT)

Answer 14

Meditation, manage stress and depression
Increased awareness of ‘here and now’
Enabled to notice and disengage from negative thoughts
More kindness to self
“Not paying more attention but paying attention differently and more wisely - with the whole mind and heart.”

Question 15

Who benefits from MBCT?

Answer 15

Vulnerable patients to recurrent depression, longstanding symptoms, stress

Question 16

In what forms is MBCT available?

Answer 16

Mainly group sessions, available in secondary care. Other sources available i.e. books and internet
NICE recommended for recurrent depression

Question 17

What is Psychodynamic Psychotherapy?

Answer 17

Focusses on emotional and relationship problems
Pain from the past hidden from consciousness
Aims to reveal the buried burden - ‘depth psychology’
Gain insight and understanding of dysfunctional patterns in order to work through them

Question 18

What is the setting for Psychodynamic Psychotherapy?

Answer 18

Patient talks in a safe environment
Therapist is a blank screen. ‘Transference’ of feelings from significant person in the past onto the therapist.
Therapist offers interpretations

Question 19

When is PP unsuitable?

Answer 19

Chaotic, fragile, risk of decompensation or psychosis

Question 20

What is IAPT?

Answer 20

Increased Access to Psychological Therapies
The government aim to provide NICE compliant services for all ages
First line referral for mild to moderate depression and anxiety with or without medication
Aims to reduce long term costs
Not appropriate for severe, complex illness or high risk (suicidality).