Clinical - Brief + CBTs

Interpersonal psychotherapy

-based on medical model, views depression as a temporary, treatable medical illness

-primary goal = sx relief + improving interpersonal fx

-originally for depression, modified for bipolar and EDs

Three stages of IPT (initial, middle, final)

Initial: determine dx + interpersonal context of sxs, determine problem areas to focus tx on (interpersonal role transitions, role disputes, interpersonal deficits, grief)

-pts are in “sick role” (not blaming themselves for their sxs)

Middle: address the identified interpersonal problem using affect encouragement, role-plays -communication analysis, decision analysis

Final: termination, RP

Solution-focused therapy is NOT focused on

-not focused on etiology or nature of problem

-just on solutions

Solution focused therapy “Miracle Q” (Fxs)

“If a miracle happened and your problem was solved… ”

1.) establishes the focus of tx on the future (vs. past/present)

2.) identifies the tx goals

-shifts focus from analyzing past/root cause (problem-saturated thinking) to constructing vision of preferred future (identify tx goals)

-Exception Qs – identify times when their problems didn’t exist, or were less intense

e.g., “Can you think of a time in the past 2 wks when [problem didn’t occur]?

-Scaling questions:

Solution focused therapy – exception Qs

-To identify times when pt’s problems didn’t exist, or were less

Solution focused therapy – scaling Qs

Use of scales (e.g., 0-10) to evaluate status and progress towards goals

6 stages of change in Transtheoretical Model

(PC-PAM-T)

-PREcontemplation (no change intent/bx for next 6 months) + Contemplation (ambivalent, plan to change in 6 months)

-PREParation (planning to change in next month)

-Action & Maintenance – change bx maintained for 6 months

-Termination

Three variables that impact motivation to change

-decisional balance (strength of Ps/Cs; most important motivation determinant during contemplation stage)

-self-efficacy (important in contemplation → preparation → action)

-temptation (urge to engage in unwanted bx)

Motivational interviewing incorporates which therapies/theories

-goal = to enhance intrinsic motivation, through exploring + resolving ambivalence

-incorporates Rogerian/person-centered therapy, Bandura self-efficacy, Festinger’s cognitive dissonance, and transtheoretical model

MI: Change talk and sustain talk

statements that favor change

statements that favor maintaining the status quo

MI: discord

Pt statement that indicate therapist-client dissonance

“You just don’t understand what I’m going through.”

What situations indicate and don’t indicate mapping decisional balance (P/Cs)?

-NOT for: if therapist’s goal is to reduce ambivalence or change

-appropriate for: therapist has a neutral stance on change, or wants to assess pt readiness

Efficacy of MI before CBT for anxiety disorders

-MI done before CBT showed greater sx reduction than CBT alone in anxiety disorders

Brief Psychodynamic Psychotherapies (differ on)

-etiological explanations

-treatment focus (e.g., unconscious conflicts, dysfunctional interpersonal patterns)

-specific techniques

Shared characteristics of brief psychodynamic psychotherapies

-therapy can start a change process that continues on after

-therapy goals should be limited, identified, and agreed on during initial sessions

-only appropriate for certain pts (e.g., those who benefit from insight, able to form alliance)

-therapist takes active role from the start to establish alliance + ensure therapy stays focused

-emphasizes positive transference development (not negative)

-may rely more on exploration and education, not interpretation

-address loss/separation d/t fast termination

CBT with rheumatoid arthritis is effective in

-reducing dep/anx

-pain intensity, fatigue

-improves coping and self-efficacy (esp. when provided early)

Primary goal of CBT

-Correct faulty info processing

-Modify assumptions that maintain unhelpful bxs/emotions

CBT assumes problems are rooted in (3)

1.) Maladaptive cognitive schemas – CBs developed in childhood d/t experience AND biological factors/stress reactivity)

2.) ATs – come btwn event + emotional/bx reaction

3.) Cognitive distortions – systematic reasoning errors, occur when a stressful situation triggers dysfunctional schema

arbitrary inference

JTC

negative inference w/o any evidence

selective abstraction

-mental filtering

-selectively attending to a small negative aspect, ignoring all else

Got 10 good reviews, and 1 negative one

Cognitive and Behavioral techniques in CBT

Cognitive: redefine the problem, reattribute, decatastrophize

Behavioral: activity scheduling, behavioral rehearsal, exposure therapy, guided imagery

REBT views psychological problems as d/t ___, and it’s effective for

-irrational, absolute/dogmatic beliefs (must, should, ought to)

-dep/anx + anger, conduct problems

Ellis’s A-B-C-D-E model

-explains distress + process of change in REBT

Activating event → irrational Belief → Consequence (emotional/behavioral) → Dispute the belief → Effect of challenging the belief

REBT techniques

-active disputing

-rational-emotive imagery

-systematic desensitization

-skills training

Self-Instructional Training (initially developed for who, to do what?)

-initially developed by Meichenbaum to teach problem solving skills for children with high impulsivity

-five stages (from cognitive modeling → self-instruction)

Five stages of Self-Instructional Training

1.) Cognitive modeling

2.) Overt external guidance

3.) Overt self-guidance stage

4.) Faded overt guidance stage (kid performs + kid whispers)

5.) Covert self-instruction stage (kid subvocally repeats instructions while performing)

Instructions in Self-Instructional Training address what skills? (4)

(Problem solving)

1.) Identify nature of task

2.) Focus attention

3.) Provide self-reinforcement (to sustain needed bxs)

4.) Evaluate performance + correct errors

Stress-Inoculation Training (what is it for)

-developed by Meichenbaum

-to improve ability to deal with stressful situations

-via teaching coping skills

Three phases of Stress-Inoculation Training

1.) Conceptualization/education: psychoed on stress + view of stressful situations as “problems-to-be-solved”

2.) Skills acquisition and consolidation phase: acquire CB coping skills

-e.g., relaxation, self-instruction, problem-solving

3.) Application and follow-through phase: apply coping skills in imagined/role-play, then IRL

ACT assumptions and principles

-Assumption = psychological pain is universal/normal and part of what makes us human

-Main goal = increase psychological flexibility

-psychological inflexibility = rigid dominance of psychological reactions in guiding action (instead of chosen values, contingencies)

-clean vs. dirty pain (dirty pain is d/t attempts to control/resist pain)

6 core processes of ACT (what do they do, what are they)

-counter the processes contributing to psych inflexibility

1.) Experiential acceptance (active and aware acceptance of xp without unnecessary attempts to change them)

2.) Cognitive defusion

3.) Being present

4.) Self-as-context

5.) Values-based actions

6.) Committed action

MBSR vs. MBCT (uses, goal of tx)

MB Stress Reduction

• Use: coping with stress, pain, illness

• 8-session group that teaches mindfulness meditation practices

MB Cognitive Therapy (clinical version, combines MBSR + CT)

• Uses: recurrent depression, anxiety, insomnia, chronic pain

• Goal = enable clients to become self-aware, to decenter from distressing T/F/BS/Bx

Mindfulness-based interventions are effective for

-both psych + physical/med conditions

**but more effective for psychological disorders (esp. dep/anx, stress)

Evidence-based change mechanisms of MB interventions

-decreased reactivity (emotional + behavioral)

-increased mindfulness

-decreased rumination/worry

**INSUFFICIENT support for: self-compassion, psychological flexibility**

Different cognitive-behavioral therapies for suicide prevention

1.) CT-SP (Wenzel, Brown, Beck)

2.) CBT-SP (CBT for Suicide Prevention):

• Bryan’s CBT-SP

• Stanley et al.’s CBT-SP – recent-attempt adolescents

3.) Bryan and Rudd‘s Brief CBT for sp (BCBT) – CBT-SP for military

Wenzel, Brown, & Beck’s Cognitive Therapy for SP (CT-SP) (for who?, 3 phases)

-For recent-attempt adults, to prevent repeat attempt

1.) Conceptualization of suicidal mode + Safety Plan

2.) Coping skill acquisition

3.) Consolidation of skills + RP

Bryan’s CBT for suicide prevention (CBT-SP)

Focuses on:

1.) ER and 2.) cognitive flexibility

3.) RP

To Bryan, ER + cognitive flexibility = essential mechanisms for reducing suicidality

-Bryan & Rudd’s Brief CBT for sp (BCBT) – version for military; same focuses

Bryan and Rudd‘s Brief CBT for sp (for who?)

-Active-duty military members

-same focus as Bryan’s CBT-SP: emotion regulation, cognitive flexibility, RP

Stanley et al.’s CBT-SP (for who?, 2 phases)

-For recent-attempt adolescents, combines CBT/DBT

-Acute phase: chain analysis, psychoed, safety plan, reasons for living, case conceptualization

-Continuation phase: consolidation of skills, RP