Seminar 10 - Treatment of mental health phobias Flashcards
(11 cards)
Evidence-based psychological research
Empirically supported treatments have been defined as “clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population” (Chambless & Hollow, 1998)
Common approached to treating mental health conditions
Psychological therapies
- cognitive behavioural therapy (CBT)
- interpersonal psychotherapy (IPT)
- dialectical behavioural therapy (DBT)
Medications
- antidepressants
- mood stabilsiers
- anti-psychotics
Combination of psychopharmacological and psychological invention
Depression: antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
- fluoxetine (prozac)
- sertraline (zoloft)
- paroxetine (Paxil, pexeva)
- citalopram (celesta)
Tricyclics (TCAS)
- imipramine (tofranil)
- amitriptyline
- doxepin
- desipramine
Monoamine oxidase inhibitors (MAOIs)
- phenelzine (nardil)
- isocarboxazid (marplan)
- selegiline (emsam)
- tranylcypromine (partite)
Anxiety: medication
Antidepressants including SSRI’s, selective norepinephrine reuptake inhibitors (SNRIs, e.g. Venlafaxine) and TCAs used in treatment of anxiety disorders
SSRIs most commonly prescribed in treatment of anxiety disorders
Beta-blockers (e.g. propranolol) commonly prescribed for social/performance anxiety
Benzodiazepines (e.g. lorazepam, alprazolam, clonazepam)
- previously commonly prescribed, now typically short-term and predicted after other inventions have been trialled
- clinical guidelines recommend only short-term use due to potential of addiction and dependency
Psychological therapies
Schacter et al (20219) highlight that psychological therapies broadly:
- help patients to develop an understanding of their difficulties, including factors which contributed to developing difficulties and processes maintaining difficulties in here and now
- identify and address dysfunctional ways of thinking that contribute to psychological distress/mental disorder
- identify and modify behaviour patterns that contribute to psychological
Different models/schools of psychological therapies involve:
- establishing therapeutic alliance
- providing rationale that provides plausible framework for understanding symptoms and procedure for resolving them
- active participation of both client and therapist, believed by both to be means of restoring health
Cognitive behavioural therapy (CBT)
Evidence-based CBT interventions exist for a variety of psychological difficulties e.g. depression, anxiety disorders, OCD, PTSD, eating disorders, BPD
CBT has a brand evidence-baee and is recommended as first-line treatment in NICE clinical guidelines for variety of difficulties
Time-limited, structured therapy
Aims to understand and processes which contribute to maintenance of difficulties
Treatment driven by patient goals and a joint understanding of difficulties (formulation)
Treatment is action oriented and involved actively addressing processes of maintenance
Cognitive and behavioural components crucial (with emphasis on behaviour change)
(thought->emotion-> behaviour loop)
Behavioural therapy:
- clinical applications of behavioural principles/learning theory to mental health difficulties
- assumed that disordered behaviour is learned and symptom relief is achieved through changing overt maladaptive behaviours into more constructive behaviour
- involved understanding context of distress and behaviour
~ role of shaping behaviour in maintenance emphasised (particularly through removal aversive stimuli)
- behavioural theory/therapy shapes evidence-based intervention and part of CBT interventions e.g. graded exposure/exposure and response prevention
CBT uses a thought, behaviour and emotion loop
- helps us recognise the relationship between thoughts, behaviours and emotions in our lived, aiming changes to thoughts and behaviours to enhance emotional experiences/ symptoms
- thoughts, behaviours and emotions can be reciprocally deterministic
Psychoeducation
Identifying thoughts (including images), feelings and behaviours
Identifying triggers for specific behaviours/thought/feeling
Evaluating function and consequences of behaviours/strategies central
Through “cognitive restructuring” - clients monist and learn to challenge/re-evaluate negative thoughts and beliefs
- e.g. developing alternative interpretation and anxiety symptoms
Identifying and addressing processes of maintenance e.g.
- mental imagery
- memory
- selective attention/attentional processes
Commonly used CBT strategies
Cognitive restructuring - identifying and challenging unhelpful/irrational thoughts (e.g. appraisal of symptoms/feared outcomes/personal meaning), remedying cognitive distortions
Though record - identifying and challenging negative automatic thoughts
- emotion
- thoughts
- evidence that supports the thought
- evidence that does not support the thought
- alternative/balances thoughts
- rate moods now
Behavioural activation - supports individuals to increase participation in activities that will be intrinsically rewarding (i.e. those that provide enjoyment and/or sense of achievement)
(feeling depressed (trigger/life event) -> withdrawal from activity -> temporary relief -> reduction of positive rewards -> (back to start))
Behavioural experiments - pragmatically testing beliefs/predictions/perceived function and/or consequences of behaviour
(fear of something bad happening -> safety behaviour (i.e. behaviour designed to prevent or minimise feared outcome) -> failure to discomfort fear (non-occurrence of feared outcome attributed to safety behaviour) -> back to start)
CBT as an evidence-based treatment
CBT argued to be the gold standard of psychotherapy field
- most researched form of psychotherapy
- no other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences, they typically favour CBT
- CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of human mind and behaviour
CBT (overall) effective for many people in treatment of variety of disorders - evidence clearly more effective than no treatment for MDD, anxiety disorders, eating disorder
Some meta-analyses suggest CBT somewhat more effective than medication alone for MDD and anxiety disorders, some suggest broadly equivalent
Limited evidence to determine who is most likely to benefit from a given evidence-based intervention
Do all therapists take a specific theoretical approach?
Therapists may be trained in an utilise 2/3 different therapeutic models/modalities
Some therapists use a much wider range of strategies - known as eclectic in their approach
Eclectic approached may involve clinicians choosing strategies based upon clinician judgement rather than a specific theoretical model/protocol
Evidence-based practise involved delivering empirically sup[proted treatments - something current training models emphasise
Dialectical behavioural therapy (DBT)
Closely allied to CBT (sometimes classified as a form of CBT or a 3rd wave behaviour therapy)
Developed to help individuals experiencing intense emotions and difficulties consistent with personality disorder, particularly BPD but may be helpful for individuals who have difficulties regulating emotions
Benefits individuals with mood interlace, emotion dysregulation, self-harm, destructive, interpersonal relationships
Incorporates and promotes:
- mindfulness
- distress tolerance
- emotion recognition and acceptance
- understanding causes and consequences of feeling
- interpersonal effectiveness
Interpersonal psychotherapy (IPT)
IPT conceptualises psychological problems understood as being maintained through interpersonal difficulties and aims to address symptoms by improving interpersonal functioning
Attachment-focussed intervention initially designed for tx of depression
Time-limited (12-16 sessions)
Focus on attachment, fried, role transitions, interpersonal dispute and deficits
Aims to improve interpersonal functioning, well-being and through helping individuals effectively communicate, resolve interpersonal crises, help patients effectively utilise social support
