Prevention, Consultation, and Psychotherapy Research Flashcards
(78 cards)
1
Q
Who developed the most frequently cited models of prevention?
A
Gerald Caplan and Robert Gordon
2
Q
What are the 3 types of prevention in Caplan’s Model?
A
- primary
- secondary
- tertiary
3
Q
According to Caplan’s Model, what is the goal of primary prevention?
A
to reduce the occurrence of new cases of a mental or physical disorder
4
Q
According to Caplan’s Model, who are primary preventions aimed at?
A
an entire population or group of individuals rwho may or may not be at elevated risk for the disorder
5
Q
According to Caplan’s Model, what is the goal of secondary prevention?
A
to reduce the prevalence of a mental or physical disorder in the population through early detection and intervention
6
Q
According to Caplan’s Model, who are secondary preventions aimed at?
A
specific individuals who have been identified as being at elevated risk for the disorder
7
Q
According to Caplan’s Model, what is the goal of tertiary prevention?
A
to reduce the severity and duration of a mental or physical disorder
8
Q
According to Caplan’s Model, who are tertiary preventions aimed at?
A
people who have already received a diagnosis of a mental or physical disorder and include relapse prevention and rehabilitation programs
9
Q
What are the 3 types of prevention according to Gordon’s Model?
A
- universal
- selective
- indicated
10
Q
According to Gordon’s Model, what are universal preventions?
A
aimed at entire populations or groups that are not restricted to individuals who are at risk for a disorder
11
Q
According to Gordon’s Model, what are selective preventions?
A
aimed at individuals who have been identified as being at increased risk for a disorder due to their biological, psychological, or social characteristics
12
Q
According to Gordon’s Model, what are indicated preventions?
A
for individuals who are known to be at high-risk because they have early or minimal signs of a disorder
13
Q
What is the Institute of Medicine’s expended version of Gordon’s Model?
A
- prevention (universal, selective, indicated)
- treatment
- maintenance
14
Q
According the Institute of Medicine’s expended version of Gordon’s Model, who is targeted by prevention?
A
people who have not received a diagnosis of a mental or physical disorder
15
Q
According the Institute of Medicine’s expended version of Gordon’s Model, who is targeted by treatment?
A
people who have received a diagnosis
16
Q
According the Institute of Medicine’s expended version of Gordon’s Model, who is targeted by maintenance?
A
people who have received treatment for a disorder and the focus is on preventing chronicity or relapse and/or providing rehabilitation
17
Q
According to Caplan’s mental health consultation, who is in the triad?
A
- consultant
- consultee (therapist/program administrator)
- client or program
18
Q
According to Caplan, what are the four types of mental health consultation?
A
- Client-centered case consultation
- Consultee-centered case consultation
- Program-centered administrative consultation
- Consultee-centered administrative consultation
19
Q
What is client-centered case consultation?
A
- focuses on a particular client of the consultee who is having trouble identifying the appropriate treatment
- the consultant provides the consultee with a plan what will benefit the client
20
Q
What is consultee-centered case consultation?
A
- focuses on the consultee and improving their ability to work effectively with a specific group/type of clients
- the goal is to improve the consultee’s knowledge, skills, confidence, and/or objectivity
21
Q
What is program-centered administrative consultation?
A
- working with program administrators to help them clarify and resolve problems they’re having with an existing mental health program
- provide administrators with recommendations for dealing with the problems they’ve encountered in developing, administering, and/or evaluating the program
22
Q
What is consultee-centered administrative consultation?
A
focuses on improving the professional functioning of program administrators so they’re better able to develop, administer, and evaluate mental health programs in the future
23
Q
How does mental health consultation differ from collaboration?
A
- consultant has little or no direct contact with a consultee’s client
- consultant is not responsible for the client’s outcomes
24
Q
What are efficacy research studies?
A
maximize internal validity (the ability to draw conclusions about the cause-effect relationship between therapy and outcomes) by maximizing experimental control (aka clinical trials)
25
What are effectiveness research studies?
maximize external validity (the ability to generalize the conclusions drawn from the study to other people and conditions) by providing therapy in naturalistic clinical settings
26
Describe Eysenck's (1952) psychotherapy outcomes research.
- reviewed 24 empirical studies reporting treatment outcomes for neurotic patients receiving anychoanalytic or eclectic psychotherapy
- no control groups, so used other research to estimate spontaneous remission rates
- concluded that psychotherapy is ineffective and may be detrimental based on the following improvement rates: spontaneous remission = 72%, psychoanalytic psychotherapy = 44%, eclectic psychotherapy = 64%
27
What were the 2 main methodological flaws of Eysenck's (1952) psychotherapy outcomes research?
- no random assignment to intervention and control groups so initial differences between groups could explain results
- criteria used to determine recovery were questionable and using different criteria significantly changes results (83% recovery for therapy; 30% recovery for control)
28
Describe Smith, Glass & Miller's (1980) psychotherapy outcomes research.
- first meta-analysis to compare outcomes of therapy versus control
- included 475 studies that produced a mean effect size of .85
- means the average patient who got therapy was better off than 80% of people who did not get therapy
29
Describe Howard et al.'s (1986, 1996) psychotherapy outcomes research.
- investigated the relationship between the duration of psychotherapy and its outcomes
- developed two models based on this research: the dosage model and the phase model
30
According to Howard et al., what is the dosage model?
- there's a predictable relationship between number of therapy sessions and probability of clinically significant symptom improvement
- 50% of clients see improvement by 6-8 sessions, 75% by 26 sessions, and 85% by 52 sessions
31
According to Howard et al., what is the phase model?
- psychotherapy outcomes can be described in terms of three phases: initial remoralization, remediation, and rehabilitation
- initial remoralization: occurs during the first few sessions and is characterized by an increase in hopefulness
- remediation: occurs during the next 16 sessions and involves a reduction in symptoms
- rehabilitation: unlearning troublesome, maladaptive, habitual behaviors and establishing new ways of dealing with various aspects of life
- says different outcome measures should be used in different phases
32
What are the common factors in psychotherapy?
- says that different psychotherapy approaches hav similar beneficial effects
- the elements are: patient contributions (30% of variability), therapeutic relationship (12% of variability), treatment method (8% of variability), other factors (3% of variability), unexplained variance (40%)
33
According to Ralph Greenson (1967), what are the three components of the therapeutic relationship?
1. working alliance
2. real relationship
3. transference-countertransference
34
According to Ralph Greenson, what is the working alliance?
the relatively non-neurotic, rational relationship between patient and analyst which makes it possible for the patient to work purposely in the analytic situation
35
The effects of client-therapist matching based on race/ethnicity vary depending on what factors?
- race and ethnicity
| - outcome measure
36
What did Cabral & Smith's meta-analysis show about client-therapist matching?
- effect size of .32 for the impact of matching on clients’ perceptions of their therapists
- an effect size of only .09 on measures of therapy outcome
37
What factors may be more important than race for client-therapist matching?
- clinician's cultural competence
- compassion
- worldview
38
What factors determine mental health service utilizatoin rates?
- gender: more women than men (adults)
- age: more adults age 26-49 followed by 50+ then finally 18-25
- sexual orientation: 2-4x more likely if sexual minority (LGBT+) than majority (heterosexual), even for common issues like addiction and depression
- race/ethnicity: outpatient is highest for belonging to 2+ racial groups and lowest for Asians; inpatient is highest for Indigenous, lowest for Asian
39
What has the APA concluded about the impact of psychotherapy on medical utilization and expense?
it reduces it
40
Describe the meta-analysis by Chiles, Lambert and Hatch (1999) on medical cost offset.
- participation in psychological interventions by patients undergoing surgery, patients with a history of medical overutilization, and patients receiving treatment for substance misuse of other psychological disorder
- 90% of studues reported medical cost offset
- average cost savings attributable to a psychological intervention was 20%
41
What are 3 methods of economic evaluation?
1. cost-benefit analysis
2. cost-effectiveness analysis
3. cost-utility analysis
42
What is cost-benefit analysis?
- compare the costs and benefits of one or multiple interventions
- costs and benefits are both expressed in monetary term
43
What is cost-effectiveness analysis?
compare the costs and benefits of two or more interventions when benefits cannot be expressed as monetary values
44
What is cost-utility analysis?
compare the costs of two or more interventions on quality-adjusted life-years (QALYs), which combines measures of gain in the health-related quality and the quantity (duration) of life
45
What is the effect of age, gender, and socioeconomic status on psychotherapy outcomes?
- no consistent results
- best conclusions indicate there is little or no impact
- differences are actually due to other factors
46
What is alpha bias?
the tendency to exaggerate differences between men and women and can reinforce gender stereotypes and justify discriminatory practices
47
What is beta bias?
the tendency to ignore or minimize differences between men and women which can lead to the erroneous conclusion that the results of research that included only male participants also apply to females, and vice versa
48
What is androcentrism?
means “male-centered” and occurs when male behaviors and traits are considered to be the norm while female behaviors and traits are viewed as deviations from the norm and often as abnormal or inferior
49
Explain the WEIRD bias.
- WEIRD is an acronym for western, educated, industrialized, rich, and democratic cultures
- studies published in the world’s top journals have over-relied on samples drawn from WEIRD cultures and, consequently, their results may have limited generalizability
50
What is routine outcome monitoring?
- aka feedback-informed treatment or measurement-based care
- transtheoretical and transdiagnostic evidence-based practice
- consists of four components:
1. a routinely administered symptom, outcome, or process measure, ideally before each clinical encounter
2. practitioner review of data
3. patient review of data
4. collaborative reevaluation of the treatment plan informed by the data
- most often uses standardized patient self-report measures but may involve clinician rating scales
51
What are the benefits of routine outcome monitoring?
- more effective than less frequent feedback
- increased rates of clinically significant improvement
- significant reductions in client deterioration during therapy
- significant reductions in premature termination
- most effective for clients at risk for treatment failure
52
What are client (2) and clinician (5) barriers to using routine outcome monitoring?
ROM is underutilized
- Client barriers:
- - concerns about confidentiality
- - time needed to complete the measures
- Clinician barriers:
- - the belief that information provided by ROM is not more accurate than clinical judgment
- - a lack of training in the use of ROM
- - unease about the potential effects of ROM on the therapeutic relationship
- - concerns about the time it takes to administer, score, and interpret measures, create a report, and provide feedback to clients
- - concerns about how results of ROM will be used by employers and insurance companies
53
What are transdiagnostic treatments?
designed to address a range of diagnoses that share symptoms as well as the biological, psychological, and environmental mechanisms that increase the risk for and maintain those symptoms
54
What are the benefits of transdiagnostic treatments?
- reduce cost and time of psychologist training
| - equally effective (e.g. anxiety) or superior (e.g. depression) to comparable treatments
55
What is Cognitive Behavioral Therapy-Enhanced?
- designed as transdiagnostic intervention for eating disorders
- based on the assumption that they share the same core psychopathology of overvaluation of body shape and weight
56
What is the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders?
- an emotion-focused, cognitive-behavioral intervention for anxiety, depression, and related disorders (transdiagnostic treatment)
- views neuroticism as the core characteristic shared by these disorders and focuses on mechanisms associated with neuroticism, including deficits in emotion regulation and avoidance of intense emotional experiences
57
What is Emotion-Focused Therapy-Transdiagnostic?
- developed as a treatment for depression, anxiety, and related disorders and targets the chronic painful emotions of loneliness/sadness, shame, and fear/terror that underlie these disorders
- transdiagnostic treatment
58
Explain how ACT is transdiagnostic.
- is a cognitive-behavioral intervention for a wide range of mental health and medical conditions
- based on the assumption that pain, grief, disappointment, illness, and anxiety are inevitable features of human life and its goal is helping individuals adapt to these types of challenges by developing greater psychological flexibility
59
What is Parent-Child Interaction Therapy?
- originally developed as a treatment for disruptive behavior disorders but also used for anxiety, mood, and trauma-related disorders and child maltreatment
- based on the premise that emotion dysregulation is a factor in early-onset psychopathology symptoms
- primary goal is improving a child’s emotion regulation
60
Wat are the benefits of telepsychology over in-person therapy?
- decreases patients’ and providers’ costs (e.g., travel and transportation)
- increases access to psychotherapy for individuals who have no or limited access (e.g. rural and underserved populations)
- reduces the stigma and embarrassment that some individuals experience when receiving psychotherapy at treatment facilities
61
How do client outcomes of telepsychology compare to in person therapy?
roughly equivalent outcomes for members of diverse populations and a variety of disorders
62
What is the evidence for telepsychology with anxiety disorders?
- effective for treating anxiety disorders and comorbid anxiety and mood disorders
- similar effectiveness to in person therapy
63
What is the evidence for telepsychology with PTSD?
- comparable effectiveness compared to in-person therapy
- compared to in-person the drop out rates, client satisfaction, and therapist fidelity to treatment protocols was similar
- one study by Turgoose, Ashwick and Murphy (2018) found that some therapists reported barriers to developing a therapeutic alliance (e.g. harder to see nonverbal communication)
64
What is the evidence for telepsychology with Major Depressive Disorder?
- in their systematic review Berryhill et al (2019) found statistically significant decreases in symptoms and no statistical differences between telepsychology versus in person
- useful for insomnia and chronic pain that often accompany depression
- effect on attrition rate depends on mode, population, and type of intervention
65
What is the evidence for telepsychology with bulimia nervosa?
- beneficial effects but is not necessarily as effective as in-person treatments
- in-person has higher rates of abstinence form binging and purging (not statistically significant)
- in person has greater reductions in eating disordered cognitions and depression
- Zerwas and colleagues (2017) found that an in person group had better outomes than a Internet chat group at the end of group therapy but the gap narrowed at the 12-month follow-up indicating that pace of recovery is slower for online therapy
66
What is stepped care?
A model of healthcare delivery with two fundamental features:
1. the recommended treatment should be the least restrictive of those currently available, but still likely to provide significant health gain
2. self-correcting, which means that the results of treatments and decisions are monitored systematically and changes are made (‘stepping up’) if current treatments are not achieving significant health gain
67
What are the 2 primary goals of stepped care.
1. increase the efficiency of health care services
| 2. increase the accessibility of effective treatments through better allocation of scarce mental health resources
68
What are the 4 steps in the stepped care models for depression, similar to those described by Broten, Naugle, Kalata, and Gaynor (2011)?
1. Assessment and Monitoring
2. Interventions Requiring Minimal Practitioner Involvement
3. Interventions Requiring More Intensive Care and Specialized Training
4. Most Restrictive and Intensive Forms of Care
69
What happens in the Assessment and Monitoring step of the stepped care model?
This step includes evaluating the patient’s symptoms and “watchful waiting” which is appropriate for patients with minor depressive symptoms and involves monitoring their symptoms.
70
What happens in the Interventions Requiring Minimal Practitioner Involvement step of the stepped care model?
interventions include:
- psychoeducation about the symptoms, course of depression, treatment options, and signs of relapse
- bibliotherapy
- computer-based symptom tracking
- using multimedia with interactive components designed to help patients cope with depression and anxiety
71
What happens in the Interventions Requiring More Intensive Care and Specialized Training step of the stepped care model?
- group therapy
- individual psychotherapy
- medication
72
What happens in the Most Restrictive and Intensive Forms of Care step of the stepped care model?
voluntary or mandated inpatient care for patients with severe depressive symptoms
73
How does the Americans with Disabilities Act define a person with a disability?
- physical or mental impairment that substantially limits a major life activity
- has a record of such impairment OR
- is regarded as having such an impairment because of an actual or perceived physical or mental impairment
74
What are the four scientific models of disability?
1. biomedical
2. social
3. functional
4. forensic
75
What is the biomedical model of disability?
- aka the medical model
- views disabilities as medical conditions that deviate from the norm and disrupt a person’s physical and/or cognitive functioning
- a disability is intrinsic to the individual
- focus of intervention is identifying and providing treatments that will manage, alter, or cure the medical condition causing the disability
76
What is the social model of disability?
- views a disability as a difference rather than an abnormality or deficiency
- disability is due primarily to aspects of society that create barriers for people with disabilities (e.g., negative attitudes, discrimination, exclusion, architectural barriers)
- interventions on making societal and environmental changes
77
What is the functional model of disability?
- views a disability as the cause of a person’s inability to perform his or her function or role at work or elsewhere
- recognizes a person’s medical condition but focuses on identifying what accommodations, modifications, or assistive technology devices are needed to improve the person’s functioning
78
What is the forensic model of disability?
- focuses on legal concepts
- requires objective proof of impairment and disability and determination of the honesty and motivation of individuals seeking recognition, benefits, or compensation for disability
- the primary focus is on distinguishing between honest and dishonest people (e.g., malingerers) in order to identify the appropriate interventions or consequences
