Complex Treatments Flashcards
choice of intervention depends on?
1) Severity & complexity of illness
2) Their thoughts or feelings towards their own condition
3) Are there other things that will need to be tackled first?
4) Age
5) Clinical guidelines
6) Constraints of NHS
7) Have they used something else before that has/hasn’t worked?
non expert model what?
the person knows what’s best for them; some people may have pre-existing biases about certain therapies THUS wont wanna work with them (could give them education about it but need to work with them)
what makes a therapy complex? (7)
- Going beyond the patient (i.e. family)
- Research evidence = less extensive = NICE guidelines favours studies that can be studied with RCT, bigger population. This means that more serices offer these. Makes them more common place. Make it easier to research = cycle
- theory its based on
- cormobidity
- length
- barriers to engagement (social issues/ psychopathology)
- extensive training needed
DBT WHAT
- Underpinning: the fact that it’s hard to change things that we really want to change
- balancing acceptance and change
- individual work & group work (social skills & like minded people –> acceptance)
DBT VS CBT (3)
- DBT also helps you to change unhelpful behaviours, but it differs from CBT in that it also focuses on accepting who you are at the same time.
- DBT places particular importance on the relationship between you and your therapist, and this relationship is used to actively motivate you to change.
- ** Therapies in general = reduce problems + that’s all you do then you leave people with a bit of a gap. How do I grow & what to I change too? Why people relapse.
EG OCD if you stop people from doing compulsions then what do you fill their time with? DBT thought about this and filled gap
DBT 4 main components
1) Mindfulness - awareness of thoughts, feelings, behaviours, and behavioural urges. Knowing WHAT it is that’s going on. Allows for emotion regulation. Allows identification of negative thoughts
2) Distress tolerance = ability to sit + be ok with feeling ok with distress & anxiety; find strategies to deal with distress
3) Emotion regulation helps to cope with distress
4) Interpersonal effectiveness
individual vs group sections:
Individual:
- building trusting relationship
- reducing risks + self-destructive behaviours i.e. behaviours that cause distress
- chain analysis/work through skills incorporated in their life
Group:
- acceptance of self and recognition of emotion
- tolerance of distress strategies
- allows mutual understand of each other
- don’t feel alone
- learn social skills (interpersonal effectiveness)
- cope with own emotion in a group
DBT where used? (4)
1) BN - decreases binge/urge cycles
2) Binge eating disorder - big props stopped binge eating after follow up (why - mindfulness?)
3) OCD: CBT has a 70% relapse rate (one study found) – SO would DBT be more effective? Need research on this – research doesn’t really look at
4) substance abuse
DBT limitations
- long to complete (18+ mos) ALSO need to maintain staff for this long
- Due to the lack of research (complex treatment) authorities (clinicians) want to priorotise other treatment programs within the agency over DBT
family systems therapy
WHAT
- Systematic = looking @ the family as a whole; not just the individual
Process:
1) Therapist is in the room with a family + then there’s a group of evaluators behind a screen who are looking at the family throughout the therapy
2) Therapist then comes in and discusses with the family what they’ve seen (no interruptions)
3) therapist + family discuss what they can do to go forward
**a family therapist will offer individual sessions to supplement the family meetings - move awayfrom 1 person being the problem
- psychoeducation
FST WHERE?(4)
1) Conduct disorder = child might be modelling home behaviour, the parents might be making it worse by trying to smother them, help the parents express how they feel in a calm environment
2) Mood disorders = bipolar (calming strategies), psychoeducation for the family
3) Eating disorders = maladaptive home life = ED. NEE = ED + control. Psychoeducation
4) Substance misuse = if their family is the one that’s promoting it then it wont work to go back to it. Or, if the family doesn’t understand ti, it might push the person it relapse OR non-compliance
5) Severe psychiatric conditions such as schizophrenia. = more cost effective than inpatient programs. Reduces care givers distress (deinstitutionalisation & taking on care of SZ). How to help with isolation/social withdrawal
Challenges in the evidencing the effectiveness of family therapy? (7)
a) Every families case is very different
b) Different version of what is the deal; social desirability (parents don’t want to be seen as failures; social services often involved + don’t lose their kids)
c) Drop out big – cant get people together
d) Different structure each week; unlike CBT which is manualised
e) Whos view counts for effectiveness? Ask people in the same way?
f) Work out where youre at when using a focused based solution
theory behind EMDR
- therapist brings memory into working memory
- eye movements (like REM sleep) help the person to process this memory
is it just talking about it/ exposure to thinking about it that = the help?
IS SUPPORT FOR THE ROLE OF EMs
- bilateral eye movements aid retrieval of episodic memories???
- WM account: these traumatic mems are held in the visuospatial sketch pad + these images become less vivid as eye movements use up processing resources
- the distraction also taxes the central executive SO the focus on the traumatic event is less unpleasant
- has a visuo + spatial component –> more taxing on WM
COMPLETE WHEN HAVE THE INFO FROM THE QUESTION
Challenges/ bonuses about EMDR (4)
a) 8 clear stages
b) Is a manual
c) Hard to evaluate things that you don’t know the underpinnings of
d) Placebo effects??
stages of EMDR
8 stages of EMDR
1) History taking
2) Preparation – getting the individual safe (if we are going to unpack them we need to make sure they’re safe)
3) Assessment – exploring beliefs and strength of feelings about the trauma (brings it to mind) (manualised; rate degree of belief about incident + how distressed he felt about image)
* * many people think that its ^^^ that causes the effective outcomes** but other segmenting studies do suggest that eye movements do something)
4) Desensitisation – the eye movement bit (& after ask them what they were thinking really quickly)
5) Installation – ‘installing’ adjusted, more constructive beliefs and feelings with the memories
6) Body Scan – check for remaining tension and resolving
7) Closure
8) Re-evaluation
The Dodo bird - what + for
WHAT = claim that all psychotherapies, regardless of their specific components, produce equivalent outcomes. It’s the relationship that produces the outcomes rather than the components of therapy itself
- One explanation for the Dodo Bird effect is that virtually all types of psychotherapy share certain core features (i.e. healer/client, specific theraputic rituals, comfy offcie associated w lack of distress
if it is the relationship =
- Should look @ the therapist and see how well they are at relating to people + look @ outcome of treatment
- Sometimes liking your therapist too much — get in the way of the outcomes
