CLP4302 Exam 2 Concepts

Understand why prevention programs were first established and how that differs from why they are currently used and what professional fields are involved

Prevention programs were first established to prevent physical health problems. Clinical psychologists are now doing more and more prevention work, not just community psychologists. This is because lifestyle factors are associated with many health problems.

Be able to list the three approaches to prevention and understand how they are similar and different

Universal preventive intervention: entire population (ex: "media awareness campaign" on dangers of drinking)

Selective preventive intervention: people at elevated risk for a disorder (ex: handout given to smokers for lung cancer)

Indicated preventive intervention: people who do not meet criteria for disorder but might show signs of disorder (ex: someone who screen at risk meaning they show symptoms during a primary care exam and are given depression resources)

Know the five themes and examples for risk factors and protective factors in the development of psychopathology in children

Risk factors-

Individual Factors: impulsivity, intellectual delay, physical health problems

School Context: bullying, peer rejection

Family/Social Factors: parental isolation, criminality in family, parental psychopathology

Life Events and Situations: abuse, chronic illness of family member, poverty, witnessing trauma

Community and Cultural Factors: socioeconomic disadvantage

Protective factors-

Individual Factors: adequate nutrition, problem-solving skills, optimism

School Context: prosocial peer group, required responsibility and helpfulness, opportunities for some success

Family/Social Factors: family harmony, supportive parents

Life Events and Situations: adequate income, adequate housing

Community and Cultural Factors: attachment to networks within the community, strong cultural identity and pride

Know the steps for designing and evaluating prevention research (Exhibit 10.3)

Identifying the target: What do you want to prevent?

Determine how serious the problem is.

Review the research evidence about the problem. Risk factors?

Identify high-risk groups.

What is known about protective factors?

Design the intervention.

Design the study. How will you know the intervention works?

Generally understand the aims of the Incredible Years and Triple P programs

Incredible Years: train parents in skills so that they can effectively play with their child, provide praise for positive behaviors, and set limits on unacceptable behaviors

Triple P (Positive Parenting Program): reduce stigma by acknowledging that parenting is challenging

For prevention of internalizing disorders, know if programs for anxiety disorders/depression are effective and what types of programs are helpful.

Internalizing disorders are disorders like anxiety and depression. Greater effects were found for indicated/selected interventions than for universal programs for anxiety and depression.

Know the three elements of successful substance abuse prevention programs (Exhibit 10.4)

Skills promoted in social/problem-solving/decision making are the 3 elements of successful substance abuse prevention programs.

Understand that intervention providers are ethically expected to explain to potential patients. What types of questions might patients ask?

Hourly rate? Medication? Therapy? Different provider? Side effects? Health insurance? Length of treatment? Specialist?

What are the therapeutic tasks in short-term psychodynamic psychotherapy (Exhibit 11.2)

Phase 1: developing a positive transference relationship

Identifying themes that are important for the patient

Phase 2: analyzing the transference relationship

Exploring themes through clarification and confrontation

Phase 3: terminating therapy

Dealing with loss

Dealing with expectable challenges in life

What are the phases of interpersonal psychotherapy for depression (Exhibit 11.3)

Initial sessions (1-3): assess symptoms, diagnose, and examine patient relationships

Intermediate sessions (4-12): grief (help with loss), role disputes (modify communication), role transitions (develop skills), interpersonal deficits (build social skills)

Termination phase (13-16): encourage practice, address future challenges, acknowledge worries when ending therapy

What are the principles of process-experiential therapy (Exhibit 11.4)

Fostering a therapeutic relationship

Facilitating work on therapeutic tasks (growth and self-determination)

Experiential response mode (empathy)

Therapeutic tasks (reflection, active listening)

What are the phases of cognitive behavioral therapy (Exhibit 11.5)

Assessment phase: combine data from interview, observation, self-monitoring

Intervention phase: provide psychoeducational info about the nature of the problems, skills in session

Termination phase: review treatment goals and skills

Booster sessions: review treatment goals and skills

Know the cognitive-behavioral therapy triangle

Thoughts: "I can't do this"

Feelings: "I feel inadequate and embarrassed"

Behavior: "Acting out as a function to avoid work"

Body responses: increased HR, changes in breathing, body temps, racing thoughts, belly pain, digestion

Understand the background of the controversy of determining if psychotherapy is effective. What were the main studies that demonstrated initial ineffectiveness and why were they not ideal studies? What do we know now from future studies?

Hans Eysenck argued rates of improvement among clients receiving psychodynamic therapy were comparable or worse than clients without treatment (spontaneous recovery of 72% of patients).

CBT, behavior, psychodynamic, then humanistic approaches were most efficacious (treatment dose effect)

Understand the importance of meta-analysis and effect size in psychotherapy

Meta-analysis takes a bunch of different research studies and analyzes whether there are patterns found that show an impact.

Effect size will be determined. The relationships have a small, medium, large effect. It is now the gold standard for evaluating treatment effects.

Understand the importance of evidence-based treatments in psychotherapy

Clinical practice guidelines and empirically supported treatments support different psychotherapy treatments from research and randomized controlled trials for a specific condition.

Why are clinical practice guidelines important?

They provide recommendations based on best available evidence.

What are recommendations for determining empirically supported treatments (Exhibit 12.1)

Establish review panels, review process, review panels decisions and recommendations (standardized tools, recommendations regarding the clinical use of the treatment, issues such as treatment costs and the extent of evidence in diverse populations.

What are effectiveness trials? Understand how the benchmarking strategy is used in these trials.

Effectiveness trials address if it would work in the real world. The benchmarking strategy is used to provide a comparison of data from empirical studies vs the effectiveness of clinical trials.

Understand "who is the client in psychological services for children/adolescents."

Parents generally serve as gatekeepers for therapy. Consent procedures for youth vary according to the jurisdiction and context in which services are offered.

Know the landmark individuals involved in determining if psychological treatments for children/adolescents work, and what they contributed.

John Weisz: if a treatment uses an artificial activity (like a computer task) to train a skill (like paying attention), then it is not fair to use a score on that same computer activity as a measure of treatment outcome

Excluded these studies from meta-analyses

Found mean effect size of .79 with larger effects fond for behavioral approaches

Alan Kazdin: Treatment studies should NOT rely on volunteer samples but REAL clinical samples, treatment researchers should pay greater attention to the characteristics of child, parent, family, or therapist that might influence treatment outcome.

Bruce Chorpita: Anxiety/depression researcher part of the Hawaii Dept of Health Task Force to identify the empirical basis for services

Gerald Patterson: "Parent Management Training"

Be familiar with the core parenting skills described in Exhibit 13.2, and, overall, understand why parent management training for changing children's behavior is relevant.

Positive reinforcement: Reward the behavior you want to increase.

Understand what type of theory is involved in multisystemic treatment and be able to explain what this theory means and why it is relevant to multisystemic therapy.

Ecological theory: a theory that examines a young person's functioning within the multiple contexts in which he or she lives (family, school, neighborhood, etc)

It's relevant to multisystemic therapy because it will use multiple contexts.

Know that mood monitoring and psychoeducation are used in the treatment of adolescent depression.

Coping with depression in adolescence (using CPT) we can use mood monitoring and psychoeducation. By tracking moods on a regular basis for depressed moods. By teaching psychological concepts to clients in a way that is easy for them.

Understand why process-outcome research is important.

To learn the best ways of therapy and improve alliance between therapist and patient in order to achieve symptom reduction and a better quality of life.

The different process factors for different time frames of analysis: time frame, time scale, process focus, and outcome focus

Daily, # of days, homework assignments, change in functioning

Review how client variables influence treatment and generally understand what goes into each.

Sociodemographic:

Socioeconomic status

Ethnicity

Gender

Age

Psychological Functioning:

Symptom severity

Functional impairment

Personality

Characteristics:

Personality disorders

Ego strength

Psychological mindedness

Psychological reactance

Treatment expectations

Review how therapist variables influence treatment and generally understand what goes into each.

Sociodemographic:

Ethnicity

Gender

Age

Professional Background:

Professional discipline

Professional experience

Personality Characteristics:

Personality traits

Emotional well-being

Values, attitudes, and beliefs

Use of self-disclosure

How are Treatment Factors examined?

Interpretation

Therapists can explain client's problems or unconscious processes.

Therapist interpretations are most effective with clients that have good interpersonal skills.

Directiveness

Guiding by a therapist depends on the client's level of reactance.

Low-reactive clients are usually open to the therapist being directive

Insight vs. Symptom Reduction

Symptom-focused interventions have superior outcomes; however, patient coping style is an important moderator.

Insight driven is good for patients who are introspective, introverted, or internalizing (depression/anxiety).

Symptom driven is good for more impulsive, externalizing patients.

Between-Session Assignments

Usually more directive-driven therapy

Critical in turning hopes for improvement into actual improvement

Understand research prospective on common factors

Therapeutic Alliance

A series of meta-analyses on the relation between therapeutic alliance, typically measured in the first few sessions of treatment, and treatment outcome found the alliance to be a consistent predictor of the impact of treatment.

Psychotherapy Equivalence

Various results

What is meant by evidence-based psychotherapy relationships? What did the Task Force recommend?

Aspects of the therapeutic relationship that research has found to be associated with successful treatment.

Recommended that mental health training programs provide specific training on elements of evidence-based psychotherapy relationships.

They also encouraged mental health practitioners to use this information in their clinical work.

Encouraged clinicians to (a) routinely monitor their treatment services and (b) strive to integrate aspects of evidence-based psychotherapy relationships and evidence-based treatments adapted to clients in their clinical work in order to provide the best services possible to clients.

Be able to identify the main roles/activities of a clinical health psychologist, clinical neuropsychologist, and forensic psychologist

Clinical Health Psychologist:

Pediatric (child health), adult

Hospitals, academic institutions, sometimes seen in sports psychology

Interdisciplinary clinics

Careers focus on research and teaching related to health

Clinical Neuropsychologist:

Treatment planning and rehab

Cause of disease and application to models

Legal proceedings: evidence of brain dysfunction related to a committed crime? Extent of damage to an injured employee?

Forensic Psychologist:

Prevention- prevention programs

Court-related- Witnesses (credibility), Victims (impact of injury), Accused (evaluated of mental status at time of offense, competence to stand trial), Disputing Parties (custody cases)

Assessment- of offenders, risk of violence/sexual violence

Treatment services for offenders

Research- identify best strategies, most effective treatments

Understand methods to manage children's acute pain: Example: If I said to tell a child to "deny the pain" is that helpful or unhelpful?

Unhelpful

Know psychological and physical methods are used to manage children's acute pain and be able to give one example of each

Psychological:

Presence of a parent or other special person

Encouragement to ask questions and express feelings

Provision of simple, accurate information about a medical procedure

Provision of some control (e.g., sit on a lap or in a chair)

Distraction: talking, video games, music, books

Physical:

Deep breathing

Comforting touch: stroking, swaddling, holding, rocking, cuddling

Medication

Be able to list one intervention, strategy and goal to approach chronic pain management (Exhibit 15.5)

Education about pain, goal setting, biofeedback, relaxation, hypnotherapy, mindfulness, contingency management, exercise and fitness, cognitive restructuring, problem-solving, acceptance and commitment, generalization and maintenance

Intervention/Strategy/Goal:

Education about pain

Provide a rationale for the treatment

Patient motivation to take an active role in treatment