Clinical Psychology and Behavior Change

Final Exam

Define transference

When a person unconsciously redirects feelings, desires, and attitudes from part significant relationships onto a new person. Typically onto a therapist

Define countertransference

When a therapist projects their own unresolved feelings, experiences, or biases onto a client, often as a reaction to the client

Define resistance

Natural, often unconscious, opposition to change, insight, or exploring painful thoughts, acting as a self-protective mechanism to avoid anxiety or threat

Describe ID

Entirely unconscious, fundamental drive. Present from birth. The instinctual part of the mind that contains basic drives and desires, operating on the pleasure principle (to seek immediate gratification)

Describe Ego

Partly conscious. The goal is to mediate between the other two portions. Reality principle: Seeks to gratify our primal impulses in realistic ways that will bring long-term pleasure

Describe Superego

Partly conscious. Goal: act, think and feel the way we should according to social rules. Contains our conscience (punishes us with guilt for something morally wrong) and our ego ideal, or how we would ideally like tor be (rewards us with pride when we do something morally right

Defense mechanism

Unconscious mental strategies designed to keep anxiety provoking material from reaching consciousness. Overuse can be harmful. The ego uses defense mechanisms to cope with neurotic anxiety.

Types of defense mechanisms

Know general.

What are 3 main features that differentiate psychodynamics from psychoanalysis

Psychodynamics:

1. Focus on the ego and its adaptive functions. De-emphasizes role of sexual and aggressive id impulses as the main drives of personality development.

2. Emphasizes the role of our closest early relationships

3. Highlights the healing aspects of the therapeutic relationship

Tends to be shorter-term and less fre

Psychodynamic therapies: Adlerian

Striving for superiority. Inferiority complexes. Treatment focused on altering “maladaptive lifestyles”. Modeling homework. and social relationships.

Psychodynamic therapies: Jungian/Analytical

Emphasized role of ego. Unconscious material used to create meaning. Collective unconscious: cultural universal symbols

Psychodynamic therapies: Ego psychology

Saw the ego as a force for learning and creativity. Focuses on the present to boost :ego strengths”. Solving current problems. Therapeutic relationship is a source of support

Psychodynamic therapies: Object therapies

Definition is a person of emotional significance. Early emotional attachment of caregiver is particularly important. Ego supper, acceptance, and psychologically “holding” damaged self

Psychodynamic therapies: Relational Therapy

Also emphasizes early relationships (objective and subjective components). Use interpersonal patterns to give insight into client’s “problems of living”. Basis for IPT (Interpersonal psychotherapy)

3 essential therapeutic attitudes of person-centered therapy

Unconditional positive regard: Therapist attitude that expresses caring for and acceptance of the client as a value based person.

Empathy: Therapist’s attempt to appreciate how the world look from the clients point of view

Congruence (Authenticity): Consistency between the way therapists feel and the way they act towards clients

Classic conditioning

Theorized by Ivan Pavlov: Conditioned stimulus makes a conditioned response without an unconditioned stimulus

Operant conditioning

Behaviors increase or decrease in frequency depending on whether they are reinforced or punished (Positive and negative reinforcement/punishment)

Positive Punishment

Adding something unpleasant. Ex: Your student is disruptive in class and you give them a detention

Negative Punishment

Removing something pleasant. Ex: Your child is home after their curfew and you confiscate their phone

Positive Reinforcement

Adding something pleasant. Ex: Your dog sits when told and you give them a treat.

Negative reinforcement

Removing something unpleasant. Ex: Your car keeps beeping and you put your seatbelt on

ABC’s of behaviorism

Antecedent —> Behavior —> Consequence

What comes before, the action, and what happens after

Differentiate between the following types of exposure treatments: In vivo, imaginal. and interoceptive

In vivo: Real life (this is preferred)

Imaginal: Imagined or using virtual reality

Interoceptive: Involves internal physical sensations

Differentiate between flooding and systematic desensitization. Know which is generally preferred in exposure treatment

Flooding: Start with the most fear-prokoving situation, generally not recommended

Systematic desensitization: Gradual exposure to feared stimuli or environment to reduce fear response over time

What is a schema

Organized knowledge that influences how we anticipate, perceive, interpret, and recall information

What is a core belief

Ex: I am worthless

What is an intermediate belief

Ex: I must prove my worth to others

Automatic Negative Thought

Ex: “I can’t do anything right”

Describe and differentiate between types of cognitive distortions (the one on the slides)

Six pivots of Acceptance and Commitment Therapy

Being present: Sensory experiences in the present moment

Acceptance: Practicing non-judgmental awareness to internal and external events

Values: Defining what is most important

Defusion: Learning to notice the process or thought

Self-As-Context: Contacting the observing self

Committed Action: Taking steps towards valued goals

Identify the condition for which Dialectical Behavior Therapy was developed

An integrated cognitive behavior and acceptance-based approach for individuals with borderline personality disorder

Define the mental health treatment gap

The disparity between the number os people who need mental health services and the availability of and access to those services

Identify the four factors influencing the mental health treatment gap identified by Qin & Hsieh (2020)

1. High stigma

2. High out-of-pocket payments due to insufficient public funding

3. Low availability of mental health resources

4. Low expected treatment benefits due to slow diffusion of new technologic and practices

Define dissemination and implementation science

Finding ways to more effectively, sustainably, and widely distribute evidence-based interventions in forms that will be integrated and applies in different settings

Challenges to treatment implementation science

Develop a new treatment

Educate clinicians on benefits of new treatment

Prepare and deliver training to clinicians to become competent in new treatment

Monitor treatment delivery to prevent protocol “drift”

Dedicate whether treatment needs cultural adaptations

Measure treatment outcomes and monitor long-term impacts

Therapeutic factors of group therapy

Feedback from therapist and group members. Mutual hope and encouragement. Reduces stigma. Altruism and self-worth. Interpersonal learning. Group cohesiveness

Identify which theoretical orientation is most commonly used in group therapy

Cognitive Behavioral Therapy is used most often. Emphasizes psychoeducation, skill building, and therapist/group member feedback. Applied to a wide verity of psychological concerns

Couples Therapy

Focus on relationship between two partners. Can be used to enhance individual treatment for specific problem. Important to prevent triangulation

Family Therapy

Addresses relationships between at least two generations. Identifies problematic interaction patters that may perpetuate psychological distress in 1+ family members.

Define the three levels of prevention and identify examples of each

Primary: Prevention

Secondary: Screening

Tertiary: Treatment

Define primary level of prevention with examples

Efforts to modify environments or strengthen individuals’ resilience so they are less susceptible to developing mental health problems

Ex: Sex education, drug prevention programs, mental health literacy programs

Define secondary level of prevention with examples

Efforts to intervene with people who are at risk for developing a disorder

Ex: Screening instruments during primary care visits

Define tertiary level of prevention

Efforts to lessen the severity of disorders and reduce their short and long term consequences

Ex: Psychological rehabilitation for psychosis

Piaget’s theory of cognitive development

Children progress through four distinct universal stages, each characterized by unique ways of thinking, understanding, and interacting with the world.

Piaget’s theory of cognitive development: Sensorimotor

Birth - 2 years. Goal: Object permanence. Children learn through senses and motor actions. developing an understanding of cause-and-effect

Piaget’s theory of cognitive development: Pre-operational

2 years - 7 years. Goal: Symbolic thought. Children develop symbolic thought. language, and pretend play.

Piaget’s theory of cognitive development: Concrete Operational

7 years - 12 years. Goal: Concrete operational. Children begin to think logically about concrete events and objects

Piaget’s theory of cognitive development: Formal Operational

12 years and on. Goal: Scientific reasoning. Adolescents develop abstract thought. hypothetical reasoning. and scientific thinking

Role of parents/family in the treatment and prevention of childhood psychopathology

Assessments are comprehensive because of the influence different environments have on child behavior. Parents are better at reporting external behaviors while kids are better at internal. Must gather family history and information about the quality of familial relationships

Types of Assessment Data: Behavior Rating Scales

Standard in most assessment batteries. Ex: CBCL, BASC-3, Conners 3

Types of Assessment Data: Clinical Interviews

Can be structures or unstructured, often convicted with parent present. Ex: MINI KID, SCID

Types of Assessment Data: Intelligence and Achievement

Most referrals for assessment involve school problems. Ex: WISC-V, WJ-IV

Types of Assessment Data: Projective Tests

Generally not recommended given psychometric properties

Types of Assessment Data: Behavioral Observation

Crucial for child assessment!

Explain the importance of a developmental approach to clinical psychology

Children and their behaviors change rapidly.

Define deviancy training

Children in group treatment reward one another’s problematic behavior

What special considerations a psychologist needs to take into account the treatment of older adults

Memory impairment, effects of medical conditions on psychological symptoms and vice vera, internalized stigma and ageism, more grief work, and cohort effects on stigma/openness

What special considerations a psychologist needs to take into account the assessment of older adults

Physical limitations and differentiating chronic health conditions/drug interactions from mental disorders

Define agism

Prejudice or discrimination against a particular age-group and especially the elderly

How to combat common myths related to aging (e.g. inevitability of physical and mental decline)

Focus on proactive healthy habits: regular exercise, balanced nutrition, and continuous mental challenges (puzzles, learning) to maintain physical/cognitive function, alongside staying socially connected to fight loneliness, and emphasizing realistic, positive narratives about aging rather than stereotypes

What is stress?

The negative emotional and physiological process associated with people’s efforts to deal with circumstances that disrupt, or threaten to disrupt their lives.

Describe how we currently understand how stress develops

Stress results from interactions between people and their environments. Perceptions of events as stressful and ability to cope are important

How stress impacts the body, e.g. the immune system (very generally)

Triggers a “fight or flight” response, flooding your system with hormones like cortisol and adrenaline. Leads to mental health issues like anxiety and depression, cognitive problems such as poor focus, and physical symptoms like headaches, digestive issues, and a weakened immune system

Define allostatic load

The cumulative “wear and tear” on your body from chronic or traumatic stress, representing the physiological cost of constantly adapting to challenges, leading to increased risk of illness by disrupting systems like cardiovascular, metabolic, immune, and endocrine functions

Define coping

Cognitive, emotional, and behavioral efforts at modifying, tolerating, or eliminating stressors

Differentiate between the two main types of coping

Problem focused: Confronting, seeking social support. playful problem-solving

Emotion focused: Self-controlling, distancing, positive reappraisal, accepting responsibility, escape/avoidance

Social support types: Appraisal support

Helps person identify resources and coping abilities, expresses confidence in their success

Social support types: Emotional support

Empathic listening and understanding

Social support types: Informational support

Provides information/suggestions

Social support types: Instrumental support

Provides tangible assistance

Three primary ways psychologists can work to increase client adherence

Education, modifying treatment plan, and behavior modification

Identify the four lobes of the brain (on a diagram)

Frontal lobe, parietal lobe, occipital lobe, and temporal lobe

Frontal lobe function

Planning, movement, and personality

Parietal lobe function

Processes sensory information like touch, temperature, and spatial awareness

Temporal lobe function

Deals with hearing, memory, and language comprehension

Occipital lobe function

Interprets visual information, like shapes and colors

Define executive functioning

The brains management system, a set of high-level cognitive skills like planning, organizing, working memory, attention control, and self control that help you set and achieve goals, manage tasks, and adapt to new situations by directing your thoughts and behaviors

Localization view

Discrete brain areas contra; different functions, with no overlap

Globalism view

No one area of the brain is more important than any other area

Define lateralization of function

Discrete brain areas control different functions, no overlap

Left hemisphere function

Language, especially if right handed

Right hemisphere function

Unspoken communication. Ex: Tone of voice, emotional expression, and body language

General Neuropsychological Conditions

Know the chart

Broca's aphasia

Expressive. Involves difficulty producing speech, leading to short, effortful sentences but relatively intact comprehension

Wernicke’s aphasia

Receptive. Causes fluent but often meaningless speech, “word salad” with severe comprehension problems, often with little awareness of errors

Describe the “split-brain” procedure for patients who have severe epilepsy and the effects of such procedure

Corpus callosotomy. Surgically surfing the corpus callosum, or the nerve fiber bundle connecting the brain’s hemispheres. This stops seizures from spreading. Has effect like isolating the hemispheres, allowing study of their independent functions but leading to disconnected awareness, where one hemisphere might "see" something the other doesn't report, though severe, immediate side effects often resolve, leaving potential for subtle cognitive differences

Standardized test battery approach

Administers the exact same set of tests to every patient

Individualized test battery approach

Selects tests based on the specific patient’s needs and the referral questions