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*Medicine: Psychiatry > Psychological interventions > Flashcards

Psychological interventions Flashcards

1
Q

BBM

What is the goal of psychological interventions?

A

Bring about form of change in:

  • Beliefs
  • Behaviour
  • Mood
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2
Q

When are psychological interventions used in medical settings?

A
  • Reduce pre/post op anxiety, pain + reduce analgesia requirements
  • Health promotion + risk reduction - smoking, diet, exercise, alcohol, drugs
  • Manage adjustment issues - chronic illness, family changes, disability, loss
  • Stress management - coping, anxiety, behavioural/emo disturbance, PTSD, phobias
  • Managing mood problems - depression, anxiety, anger
  • Alternative/adjunct to drugs - reduces over-medication
  • Managing symptoms/side-effects of difficult to manage conditions - chronic pain, chemo
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3
Q

What are the (3) main types of interventions?

A
  • Cognitive
  • Behavioural
  • Combined
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4
Q

What does the cognitive model state?

A

Thoughts, behaviours, feelings

States that all link together and affect one another.

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5
Q

What are the assumptions of the cognitive model?

A
  • We interact with the world through interpretations and evaluations that we make about our environment
  • It is not the situation itself that causes psychological disturbance. It’s the thoughts, beliefs and meanings we attach to the event that produce our emotional and behavioural responses.
  • Results of cognitive processes are accessible via thoughts and images, and therefore have potential to change.
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6
Q

What are the 3 levels of thinking targetted by cognitive interventions?

A
  1. Automatic thinking (highest level)
  2. Underlying rules and assumptions (intermediate beliefs)
  3. Core beliefs (cognitive schemata)
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7
Q

What are automatic thoughts?

A

Fleeting thoughts that pop into your mind unbidden, situation specific and involuntary.

Feeling results in the thought (negative automatic thoughts):

Eg. I feel anxious - I can’t cope, I’ll make a fool of myself
I feel pain - I am going to die
I feel incompetent - I’ll make a fool of myself, everyone will see…

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8
Q

What is meant by underlying rules and assumptions?

A

Guide our behaviour, set standards that we live by - can be healthy or unhealthy.

Examples of unhealthy assumptions:

  • ‘If I am to be successful, people must like me’
  • ‘I must get over 80% in my exams in order to be successful’
  • ‘No one should be disrespectful to me or treat me poorly’

They provide a way to avoid facing a negative core belief.

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9
Q

What are core beliefs?

A

They give rise to our rules and assumptions and thoughts (NATS). Developed in early life/childhood, the centre of our beliefs. Usually global, absolute and focus on ourselves, the world. Can be positive or negative.

Activated by life events (trauma, bereavement, rejection)

Negative core beliefs usually:

  • Over-generalised
  • Unconditional
  • Rigid
  • Eg. ‘I’m unlovable’ ‘I can’t trust anyone’ ‘I am bad’
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10
Q

Cognitive biases refer to maladaptive thinking, logical errors or cognitive distortions. What are some examples?

A
  • Arbitary inference
  • Catastrophising
  • Selective abstraction
  • Magnification and minimisation
  • Personalisation
  • Absolutistic, dichotomous thinking
  • Fait accompli thinking
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11
Q

Briefly describe Beck’s cognitive theory of depression

A
  • Negative triad - pessimistic beliefs about self, world + future
  • Negative schemas or beliefs triggered by negative life events
  • Cognitive biases

This is all said to associate/cause depression.

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12
Q

What do cognitive interventions focus on?

A
  • Identifying maladaptive thoughts or beliefs, challenging them and changing them to become more adaptive - cognitive restructuring.
  • Changing the way we relate to our thoughts
  • Developing effective coping strategies

For depression, anxiety, panic disorders etc.

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13
Q

An example of a cognitive intervention is ‘self-monitoring’. What is the purpose of this and how is it helpful?

A
  • PURPOSE: To identify and increase attention of thoughts, emotion, behaviour (+ allows external monitoring by HCP)
  • Monitoring process: inc awareness by recording thoughts, emotions + behaviour. Should be quick and simple to make record.
  • Timing of record keeping: ASAP after emotion/behavioour has occurred.
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14
Q

A ‘thought diary’ is an effective way of self-monitoring, in terms of cognitive intervention. What things does a thought diary take into account?

A
  • Event/trigger
  • Thoughts/beliefs
  • Emotional response
  • Consequences + actions
  • Thinking error
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15
Q

What is decisional balance intervention?

A
  • Thinking about costs/benefits (pros/cons) of changing and not changing a specific behaviour.
  • Determining what is involved in decision to change current habits
  • Change is difficult - are costs worth it?

So look at costs/benefits of changing behaviour and then of maintaing behaviour - eg. taking regular exercise.

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16
Q

What is motivational interviewing?

A
  • Goal - to encourage individuals to explore their own conflicting beliefs towards particular behaviour or change.
  • Effective in decreasing smoking, alcohol/drug misuse, addictions, improving adherence to lifestyle changes etc.
  • Cognitive dissonance - psychological discomfort of two opposing views, so consultant will try to help patient explore these feelings and increase levels of motivation.
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17
Q

What is Rational Emotive Therapy (Ellis, 1960s)

A

Usually requires a trained counsellor

  • A - identify Activating event (trigger)
  • B - identify Beliefs, assumptions + thoughts in response to A
  • C - identify the emotional and behavioural Consequences of B
  • D - Dispute irrational beliefs
  • E - develop an Effective new rational outlook by restructuing belief system in order to acknowledge rational beliefs + discard irrational ones
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18
Q

Can you name any other types of cognitive therapies that involve a trained counsellor?

A
  • Acceptance and comitment therapy (ACT)
  • Integrative therapy (IT)
  • Cognitive Analytic Therapy (CAT)
  • Interpersonal psychotherapy (IPT)
  • Systemic/family therapy
19
Q

What are distraction techniques? How are they useful?

A
  • Cognitive technique involves deliberately focussing attention away from whatever is causing distress
  • Effective in reducing moderate-acute pain/distress
  • Short term - lasts as long as person remains distracted
  • Eg. counting, colouring, puzzle, talking, crosswords, TV, music etc.

Cartoon distraction alleviated anxiety in children during anaesthesia.

20
Q

What are assumptions of behavioural interventions?

A
  • Maladaptive behaviour is a learned response
  • Can be substituted for a more adaptive response
  • Focus on a specific behaviour/treat specific symptoms
  • Insight and/or understanding of theory is not a requirement
21
Q

What are aims of behavioural interventions?

A
  • Substitute maladaptive behaviours for adaptive ones
  • Relieve symptoms
22
Q

What is modelling?

A

Learning a behaviour by observing and imitating others.

  • Models are observed performing gradually more stressful tasks without adverse effects
  • Useful in treating anxieties concerning hospital procedures, specific phobias, social phobia + new skills.
  • Behavioural rehearsal (medical training) - role play, cardiac resus procedures, simulations, history taking, breaking bad news.
23
Q

Reward and Reinforcement: What is meant by positive reinforcement?

A

If a behaviour followed by reward, this increases likelihood of behaviour being repeated. If it is not rewarded or is followed by an unpleasant outcome then the behaviour will occur less frequently.

24
Q

What is negative reinforcement?

A

If a behaviour results in (usually unpleasant) stimulus being removed, it increases the likelihood of behaviour being repeated.

25
Q

What is punishment?

A

Process by which a consequence immediately follows a behaviour which decreases the future frequency of that behaviour.

26
Q

What is selective reinforcement?

A
  • Rewarding desired behaviour and ignoring undesirable behaviour.
  • Useful in modifying behaviours, improving adherence etc.
  • You get more of the behaviour you pay attention to
27
Q

What is relaxation training? Name a few examples

A
  1. Learn to relax and practice
  2. Self monitoring of tension in daily life
  3. Use relaxation at times of high stress

Eg. progressive muscle relaxation, meditation, guided visualisation, autogenic training etc.

28
Q

What is progressive muscle relaxation (PMR)?

A
  • Most widely used relaxation technique in clinics
  • Systematic technique for reducing muscle tension in clinic/everyday
  • Focusing on 16 specific muscle groups in sequence combined with abdominal breathing
  • Involved tensing and then relaxing muscle groups
  • Daily practice should take about 20 mins
29
Q

What are the pros and cons of relaxation techniques?

A
  • PROS: easy to learn, can be used virtually anywhere, once learned relaxation is rapid, easily combined with other techs, no special equip needed, choice of techniques
  • CONS: daily practice required, not suitible for all clin populations (psychosis, schizo), can take time to learn, does not address underlying cognitive processes
30
Q

Name two types of exposure interventions

A
  • Systemic desensitisation/graduated exposure
  • Flooding
31
Q

What is systematic desensitization?

A
  • Method of eliminating fears by substituting a response that is incompatible with anxiety such as relaxation.
  • Based on principles of classical conditioning
  • Gradual controlled increased exposure (imagined or real) to the feared subject whilst maintaining a relaxed state until fear is extinguished.
32
Q

What is flooding?

A

Inescapable continuous exposure to the feared subject, either real or virtual or imagined until anxiety subsides.

33
Q

Biofeedback is another example of behavioural intervention. What is the aim of this?

A

To achieve voluntary control over certain automatic physiological processes we are usually unaware of.

34
Q

How does biofeedback work?

A
  • Identify + record physiological stress response. Involve using mechanical device to monitor HR, RR, BP, mucle tension or peripheral temp.
  • Patient learns relaxation/breathing techniques to reduce physiological readings.
35
Q

What are the advantages and disadvantages of biofeedback?

A
  • Results in positive reinforcement + increases confidence and self-efficacy. There is ability to use techniques without mechanical support.
  • However, few controlled trials + placebo effect.
36
Q

What conditions is biofeedback useful in treating?

A
  • Recurrent migraine headache
  • Tension headaches
  • Hypertension
  • Treatment of Raynaud’s disease
  • Urinary incontinence
  • Labout pain in childbirth
37
Q

What is cognitive behavioural therapy (CBT) + its aims?

A

A popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behaviour therapy (changing maladaptive behaviour).

AIMS:

  • Identify and modify maladaptive beliefs + strategies
  • Teach positive strategies for coping and managing
  • Empower patient to be come own therapist
38
Q

Describe the features of CBT

A
  • Education - process + goals of CBT
  • Collaboration between client + therapist
  • Identifying maladptive beliefs + behaviours
  • Homework - self monitoring, records, diaries
  • Guided discovery + Socratic questioning
  • Cognitive re-structuring
  • Goal setting with self-reinforcement
  • Relapse prevention
  • Empowering the patient to be their own therapist
39
Q

What are advantages of CBT?

A
  • Can be used in wide range of disorders (depression, GAD, bipolar, panic, agoraphobia, social phobia, OCD, PTSD, eating, self-harm, psychosis, schizo..)
  • Can be used for children and adults
  • Self-help versions available - online programmes eg. Silvercloud
  • Good evidence base for use for mild/moderate cases but can also be useful in more severe cases used alongside medication
  • Brief + time limited - 5 to 20 sessions
40
Q

What are disadvantages of CBT?

A
  • Not a magical answer and will not suit all patients
  • Requires ‘psychological mind set’, willingness to engage + not passive
41
Q

Stress management is aimed at adequately functioning individuals who may be facing difficult circumstances in their work or social settings, patients with chronic illness finding it difficuly to cope. What are advantages of this?

A
  • Educational focus rather than psychotherepeautic
  • Short duration with fixed number of sessions
  • Often delivered to a group rather than an individual
  • The ‘facilitator’ does not usually form a therapeutic relationship with participants
  • Rarely followed up
42
Q

What are the four stages of a stress management programme?

A
  1. Recognise stress is a problem
  2. Understand the causes of stress
  3. Develop appropriate behaviours/skills to cope
  4. Develop appropriate attitudes and beliefs
43
Q

What are four targets of change in stress management?

A
  • Changing the external causes of stress
  • Changing the individual’s rsponse to stress
  • Providing solutions (short or long term as appropriate)
  • Preventive or palliative solutions

*Medicine: Psychiatry (12 decks)

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