c/a interventions Flashcards
Risk Factor
A risk factor is believed to predispose children and adults to mental disorder. To qualify as a risk factor, a variable must pre-date the disorder and increase the chances that a person will develop the disorder.
Can be:
Biological or psychosocial
individual-, family-, community-, or institution-level
Protective Factor
is believed to “protect” individuals against the association between a risk factor and a negative mental health outcome. In other words, protective factors modify, ameliorate, or otherwise change a person’s response to a known risk factor.
Can be:
Biological or psychosocial
Individual-, family-, community-, or institution-level
Efficacy
refers to evidence that a treatment works under tightly controlled, experimental conditions (maximizes internal validity)
Effectiveness
refers to evidence that a treatment works in a real-world setting under real-world conditions, such as in clinics or schools (maximizes external validity)
Treatment Mediator
is a factor that explains the relationship between the treatment and an outcome of interest, and therefore can be said to be a mechanism of change in the treatment
Treatment Moderator
is a factor that changes the nature of the relationship between the treatment and the outcome of interest, thereby demonstrating that the treatment is more effective or less effective for specific groups of participants.
What three TYPES of measures are used to assess treatment outcomes?
Broad-Band Mental Health Measure
Measure Specific to Disorder(s)
Weekly/Bi-Weekly Monitoring
Overall Measures
CBCL
BASC
Anxiety Measures
MASC (& RC-RASC-2)
Beck Anxiety Inventory – Youth
SUDS (weekly anxiety)
Feeling thermometer (weekly)
Depression
Beck Inventories (Depression, Anxiety, Anger, Disruptive Bx, Self-Concept)
Feelings thermometer
SUDS
ADHD/ODD
Conner’s 3
Counting Plan (weekly)
Delinquency & Substance Use
Conner’s 3
Personal Experience Screening Questionnaire
Problem Oriented Screening Instrument for Teenagers (POSIT)
Trauma
Trauma Symptom Checklist for Children (TSCC)
Trauma Symptom Checklist for Young Children (TSCYC)
Trauma narrative chapters (weekly)
FEAR cycle and reinforcement
Anticipation of negative consequences →
increased physio arousal →
avoidance of the feared situation →
reduced physiological arousal →
reinforcement via reduced physio arousal and avoidance of feared consequences
How avoidance is reinforced? ‘Double dose’ of reward
reducing physiological arousal when you avoid a feared thing.
prevents exposure to any feared consequences,‘
Be able to name the FEAR Steps and to describe what happens at each step.
Be able to apply the FEAR Steps to a vignette, describing what strategy you would use under each step and an example of how you might apply it to the vignette.
F- Feeling frightened?
E- Expecting bad things to happen?
A- Attitudes and actions that will help
R- Results and rewards
Feeling Frightened?
youths must learn to identify situations that make them fearful and read own body for signs of anxious arousal and signal that it is time to start coping
each child will have a person-specific pattern of physiological arousal (not all children get anxious in the same way)
this component is aimed at teaching children to recognize their own distinctive pattern
prompted by therapist who models self-disclosure by discussing some of his/her own anxiety triggers, and distinctive bodily responses that signal anxious arousal for him and her
once anxiety/cues and bodily arousal is identified, introduce relaxation training (PMR)
Expecting bad things to happen?
Focus shifts to cognitions and their role in either heightening or reducing anxiety
could use thought bubbles to generate thoughts or self-talk, and then connecting them to events
ideally child reaches a point at which he or she is generating both anxious thoughts and thoughts that might reduce anxiety and promote good coping
turn child to effective critic of fearful thinking- “Is my scary thought realistic?”
turning anxious self-talk into coping self-talk
Attitudes and Actions That Will Help
moving from describing fears → to figuring out ways to cope with them.
distinctive arousal pattern signaling anxiety can be used to put relaxation skills into play
idea is to challenge irrational ideas, reconceptualize the situation as less risky and less frightening
with cognitive reframing accomplished and fear-provoking attitudes altered, child’s next task is to find ways of reducing the stressfulness of anxiety provoking situations, by altering the situations
working w/ examples of everyday stressors, therapist and child practice problem solving, and the solution-generation skills are gradually extended to more frightening situations
child begins to learn that stressful situations need not be intractable but that they may be made less stressful through planning and problem solving
Results and Reward
Puts the child in charge of evaluating his or her own efforts to cope with frightening situations.
Children use feelings barometer to rate how they feel about their performance
Learn to allocate rewards to themselves based on their barometer ratings
Homework: STIC
“Show That I Can” tasks
assignments in which child’s job is to practice skills taught in the therapy sessions
toward the end of each treatment session, the child and therapist agree to a STIC task that involves application of skills from that session to a situation tailored to fit the child.
effective tailoring on therapist part is necessary
aim is that STIC tasks are sufficiently challenging to promote growth, but sufficiently realistic to make success very likely
experiences of success (not perfection) are rewarded
key task for the therapist is to help the child frame experiences in a positive way so that motivation and self-confidence remain high throughout
goal is for the child to learn that it is possible to go into the geared situation without having the feared outcome happen
Best established practices in research for feared situations?
Best: participant modeling and reinforced exposure
‘probably efficacious’: live modeling, video modeling, systematic desensitization, self-talk
Modeling Treatments types and pitfalls
Exposing fearful youths to a model who violates the assumptions underlying the fear → interrupt sequence of fear
Model engages in the feared behavior→ demonstrating that it can be done and showing how + model does not experience adverse consequences that the child has feared
Types:
live modeling: in-person observation of models’ non fearful behavior
symbolic modeling: video or other representations of models showing non fearful behavior
participant modeling: fearful child is paired with a model who encourages shared involvement in feared activity
Participant approach appears to be the most potent b/c it
combines power of observational learning
with added security of competent partner
and added impetus of persuasion to try the exposure
Pitfalls:
Low credibility of the model
the model used is not believable enough to the youth to inspire emulation (ex. model is not enough like the child) or, credibility may be low because the model does the behavior so easily that the child thinks, “I could never do that.”
Solution: may need a coping modeling approach in which the model shows initial fear but overcomes it.
Failure to repeat the model’s behavior:
even if model seems credible, fearful child can’t work up the nerve to try the model’s behavior
Solution: could adjust by downgrading the intensity of modeled behavior, add incentives, strengthen the physical connection between youth and model during the activity
Excessive dependence on the model
children can be too connected to their model (ex. some children won’t repeat the target behavior except in the presence of the model)
therapists can address the problem through fading
other children can be overly connected in that they can only perform the model’s exact behavior
therapist will need to be clear about the goal
Systematic Desensitization steps and pitfalls
(specific fears of objects or situations in kids age 6-15)
Builds on the notion that fears develop through classical conditioning
→ follows that fears may be undone through counterconditioning or reciprocal inhibition
Fear-inducing stimuli are presented together with other stimuli that provoke responses that are not-compatible with fear (relaxation)
Steps:
Assess fear level in kid
Establish fear hierarchy from least to most anxiety-provoking
Train kid to relax
Expose child to items on hierarchy, from least to most anx. provoking
Whenever kid signals uncomfortable anxiety, revert to items lower on the hierarchy and/or restate relaxation instructions
When kid remains relaxed through full hierarchy, repeat the process in one or more review sessions
Pitfalls:
Therapist difficulty in conveying a vivid image for imaginal exposure: description doesn’t generate real fear during the imaginal exposure
work on generating a more vivid image
Youth difficulty in imagining and in mental elaboration: some youths seem to lack skill in holding an image in mind and elaborating it
can sharpen skill through guiding child from pleasant imagery at first, and then moving to unpleasant details
therapists can probe for details
Reinforced Exposure steps and pitfalls
(specific fears in kids age 3-12)
Focuses on consequences that follow behavior
Viewed as a form of contingency management, altering behavior by changing its consequences
Treatment benefit is explained partly by reference to venerable law of effect
Steps:
ID feared object/situations + arrange a way for gradual exposure to occur
Present child with situation and response options, noting reward for increased exposures
Upon exposure, give child feedback (ie: on duration) and reward and praise increments
Continue until child reaches preestablished criterion for success
Pitfalls:
exposure task is too easy or too hard
therapist to work on better calibration
rewards not rewarding enough
Self-Talk steps and pitfalls
(specific fears in kids age 5-13)
Teach children to make self-statements that embody either constructive coping, positive self-evaluation, or a positive reframing of feared situations
Steps:
ID feared situations and assess baseline fear levels
ID thoughts child has that make the situations frightening
Teach kid alternative thoughts in the form of coping self-statements (ie: “I am a brave person, I can take care of myself in the dark”) and when to use them (ie: in target fear situation)
Observe and record child’s degree of tolerance of feared situations when self-talk is being used (or parents can do this)
Give child feedback on progress and reward success
Continue until child reaches preestablished criterion for success
Altering cognitions can change behavior b/c bx is guided by cognitions
Challenge is to identify those specific cognitive adjustments that can actually lead to more adaptive behavior
Pitfalls:
“I don’t know” problem: some children can’t identify thoughts that go through their mind when they feel frightened
can help to make the task concrete by using cartoons bubbles on a worksheet, and writing thoughts within the bubbles. Works best to begin with pleasant thoughts, then move to more negative ones
Confusing thoughts with feelings: makes it difficult to identify or modify cognitions
might help to focus children on the concept of guessing (“thoughts are guesses”), can have children guess what characters are thinking, then transition to discussing their own thoughts
Failure to self-talk to generalize: can learn coping self-talk with therapist but then fail to use talk at other times
therapist could assign homework
Coping Cat pitfalls
(GAD, Separation Anxiety Disorder, and Social Phobia)
Pitfalls:
in-vivos and STIC tasks are too easy:
tasks need to be challenging enough to promote real growth and change in clients
(esp if therapist is in protector/comforter role)
therapist must be willing to let the kid become anxious
children who resist exposures:
begin with imaginary exposures
may break task into components w/ child identifying what is troubling about each of the component steps
anxious cognitions are the only ones the child can think of, or are more believable than the non anxious ones
when treatment focuses on cognitions that make feared situations scary (or child finds non-anxious thoughts less believable)
have children identify one of their heroes (that seems to have mastered fear and coped successfully)
children are then asked to identify thoughts that their hero might have about the situation the child finds frightening, to think aloud about how it would feel to walk around with those thoughts, and then to act (in the exposure tasks) as if the hero’s thoughts were really true.
Rigid manual adherence that fails to adapt to child characteristics and contexts. need to adapt to child
The Family Anxiety Management program steps and pitfalls
Targets conflict or disharmony between parents
Name the six things that parents are taught to do when a problem occurs
Remain calm and speak in a calm voice
Try not to either interfere or come to the rescue when your partner is dealing with the child. The parent who gives instructions should be the one who follows through.
Help your partner if you see he or she needs it – for example, if your partner is attending to one child and others begin to misbehave, tend to the others.
Back each other up; do not give contradictory instructions to the child.
Do not comment on each other’s behavior until the problem is resolved, and you are more relaxed. Do not blame or criticize each other.
After the problem is over, discuss it together if necessary; arrange a problem-solving discussion.
It also suggests setting time aside for a problem-solving discussion when parents disagree. What instructions guide these problem-solving sessions?
AGREE on a mutual time and place to discuss the problem, a time and place in which both parents will be calm and will not be interrupted by children.
IDENTIFY the problem in the child’s behavior as specifically as possible. Deal with only one problem at a time. Make sure both parents agree on what needs to change.
BRAINSTORM together, writing down as many possible solutions as you can think of.
DISCUSS each possible solution, weighing its pros and cons, its likelihood of success, whether it is practical to use, and any problems that may arise.
CHOOSE the best solution by mutual agreement.
PLAN a strategy for using the solution. Make this very specific, noting exactly what each parent will say and do when the problem arises.
REVIEW how the solution is working; arrange another meeting to discuss this.
Pitfalls:
Parents’ wariness at being “targeted” in treatment.
Parental reluctance to grant independence to the child
Interparent conflict that undermines child progress
Parents can’t/won’t model exposure for their child
What is emotional avoidance and why is it viewed as problematic?
Emotional avoidance in youth is when they try to ignore or suppress their feelings, particularly negative ones.
It’s viewed as problematic because it can lead to increased emotional distress, hinder problem-solving, strain relationships, and contribute to mental health issues.
What intervention strategies are recommended to help youth tolerate, rather than avoid, difficult feelings?
Recommended intervention strategies to help youth tolerate difficult feelings include
teaching emotional regulation skills
encouraging open expression
identifying and labeling emotions
using cognitive-behavioral therapy
practicing exposure therapy
promoting self-compassion
fostering supportive relationships
engaging in creative outlets like art and music
What is interoceptive exposure and when is it used?
Interoceptive exposure in youth is a therapeutic technique that involves safely experiencing physical sensations (like a racing heart) associated with anxiety or panic.
It’s used to treat conditions like panic disorder, social anxiety, and specific phobias by helping individuals confront and desensitize to the bodily sensations that trigger anxiety.
