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Flashcards in Introduction to Clinical Assessment Deck (15):

In what ways can psychological assessment inform intervention and treatment planning?

  • Allowing the psychologist to identify and prioritise client needs
  • Identifing client characteristics that may help or hinder treatment outcomes
  • Considering treatment and referral options incl service matching, monitoring change
  • Predicting prognosis and treatment outcomes
  • NB: Assessment and intervention are integrated and inform each other throughout the treatment process


According the the NHMRC guidelines, what are the levels of quality of research findings?


What factors are important to consider when interpreting the APS Literature review of evidence based treatment?

  • Level, Relevance and Strength of evidence
    • Level = See table of level of evidence (RCT vs Case study etc)
    • Relevance = extent to which findings can be applied to different settings
    • Strength = Size of treatment effect
  • Some interventions are not supported due to limited research rather than ineffective findings 
  • The best practice is for psychologists to use evidence based treatments combined with situational other factors to identify treatment efficacy


What are some of the evidence findings in the APS literature review?

  • Emotional Disorders
    • Depression: Level 1; CBT, Interpersonal, Brief Psychodynamic and Self Help. Level 2; Solution based, Dialectical Behaviour, Emotion focused. 
    • Bipolar: Level 2; CBT, Interpersonal, family, mindfullness, psychoeducation
  • Anxiety Disorders
    • GAD: Level 1 CBT, Level 2 psychodynamic. Level 3 mindfullness
    • Social: Level 1 CBT, Level 2 self help and psychodynamic
  • BPD; Level 1 DBT, Level 2 Schema and psychodynamic
  • Anorexia: Level 2 family therapy and psychodynamic


What are some of the limitations of RCTs? What are the arguments against the assumption of specific effects?

  • Lack of external validity: The real world is never as controlled as the trial
  • The concept of the placebo: RCTs are based on a medical model.
    • In psychotherapy everyone knows which treatment is being delivered - there is no true placebo
  • The Assumption of Specific Effects: assumption that each therapy has unique active ingredients. 3 Arguments against this:
    • The dodo bird verdict:  all psychotherapies have very similar, robust success (dodo from Alice in Wonderland - "you are all winners")
      • has been found in many experiments
    • Component Studies: Break down therapies into components (often compounding eg full CBT or parts). Studies find no major differences.
    • Estimates regarding effect of specific techniques on outcome: most estimates are that model/technique factors account for 15% of outcome varience.
  • Bias in experiments:  unfair comparisons and loyalty


What are some alternatives to RCTs that can be used to complement them?

  • Effectiveness Studies: Evaluate treatment outcomes in naturalistic settings and provide better generalisability.
  • Process Research: breaks down the factors of a treatment to determine the why and how it is effective. This facilitates a deeper understanding of the therapy in clinical settings
    • responsive to context and complex factors of theraputic alliance
  • Single subject research: addresses threats to internal and external validity. 
    • Can be used where RCT cannot eg smaller population sizes
  • Case Studies; add richness to other data by looking at very specific contexts


What are the differences between evidence based treatment and evidence based practice?


What are the the common factors in the outcomes of psychotherapy?

There are five common factors in psychotherapy:

  • The client/extratheraputic: accounts for 87% of varience
    • The client is the agent of change
  • Therapist effects: 6-9% overall (49-69% of treatment effect) variance
    • Most of this is due to overlap with the alliance
  • The Theraputic Alliance: 5-7% (38-54% treatment) varience
  • Model Technique (delivered): belief in treatment 
    • Model alone: 1% (8% treatment effect)
    • Model delivered (including allegence and expectancy) 30% up of treatment effects
  • Feedback effect: 15-30% of treatment effects


What are the problems with manuals and diagnosis?

  • Diagnosis
    • DSM lacks internal reliability ( a lot)
    • There is no 'baseline' normal model of mental health
    • Diagnosis provides little information that effects treatment 
  • Manualisation
    • High adherance to manuals is inversely correlated with theraputic alliance and interpersonal skills
    • Manuals depend on specific effects (which are not well suported)


What is Behavioural Assessment? What are some of the core assumptions?

  • ABC model of behavioural assessment: direct investigation of problematic behaviour by examining antecedents and consequences
    • Antecedent (what happened prior) Behaviour (of concern) Consequences
  • Behaviours follow the principles of conditioning (operant and classical)
    • eg punishment, extinction, positive and negative reinforcement
  •  Behaviour can be overt (actions) or covert (thoughts) but both are:
    • directly or indirectly observable and measureable
    • influenced by behavioural modification
    • reflective of the context or environment  


How should target behaviours be identified and defined?

  • Target behaviours must be observable or measureable. Complex behaviours should be partitioned into modes (affective, motor, cognitive) 
  • Consider:
    • Will the behaviour be reinforced after treatment?
    • Is the behaviour age appropriate?
    • What might replace the behaviour? (eg self harm and distress tolerance)
    • Is the behaviour related to another problem? 
  • Use operational definitions of the behaviour; state exactly what is done
    • Be objective and unambiguous, minimise inferences and avoid labels such as "tantrum" or "being a bad sport"
  • Assess related factors - ABC Approach. Emotional cognitive physical and environmental factors and consequences. 


What six factors need to be considered when observing behavior?

  1. Topography: the specific moves involved in making the response.
    • Pictures are often useful for this eg height of arm raised. 
  2. Amount of behaviour
    • Frequency of behaviour in given time: measured using frequency or cumulative graphs (when comparing  2+ behaviours or when changes are small)
    • Relative Duration of behaviour: ie minutes in an hour 
  3. Intensity of behaviour: ususally measured with an instrument ie voice meter
  4. Stimulous Control; degree of corrolation between behaviour and response
    • eg ABLA tests response to instruction (verbal, imitation etc)
  5. Latency; time between stimulus and response 
  6. Quality of behaviour: A refinement of one or more of the above factors depending on target behaviours


What are some examples of behavioural techniques?

  • Behavioural Modification: increasing or decreasing behaviour based on learning principles (particularly operant conditioning)
    • Relies on a highly controlled environment to avoid conflicting reinforcement
    • Adapted to "behavioural self control" to preserve a collaborative relationship with the therapist
    • Differential reinforcement: a process where one behaviour is reinforced while an alternate (DRA) or incompatible (DRI) behaviour is simultaneously put on extinction
      • Used with autistic children. NB Avoid punishment
  • Systematic Desentisation: based on classical conditioning and generalisation principles, but also operative (avoidance behaviour)
    • The client is re-exposed to conditioned stimuli without the fear inducing elements. 


What is the Cognitive model in CBT?

  • Dr Beck identified common thoughts in depressed patients which when addressed helped overcome depression. 
  • The central premise of the cognitive model is that conscious thoughts, beliefs and assumptions are central to the development of of common disorders such as anxiety and depression
  • The cognitive model says responses are mediated by perception of events which are distorted when individuals are distressed
  • Situations lead to automatic thoughts which lead to emotional behavioural and physiological reactions. 


What are the central principles of CBT?

  • Case formulation: With the patient, problematic situations and feelings are understood in terms of thoughts. FActors that may have precipitated the problem are sometimes considered too
  • Non Interpretive stance: therapist does not interpret or offer alternative meanings and advice directly
  • Collaborative approach: clients offer input and ideally lead the process
  • Socratic questioning: therapist takes a curious stance rather than a challenging one
  • Empiricism: each intervention is treated as an experiment with hypothesis and new data
  • Explicit and specific: qualitative measures are used to guage process
  • Role of self practice: homework is central
  • Goal oriented and problem focused: client identifies goals to work toward
  • Structured, time-limited approach: maximise efficiency and effectiveness
  • Flexible, client centred approach: integrate other therapies if needed