Class 10 - Intervention Overview

Intervention

When a clinician acting in a professional capacity attempts to change a client’s behavior, thoughts, social circumstances, or everyday function.

What is the most common intervention?

Psychotherapy

Name 3 other interventions that are adjuncts to psychotherapy.

1. Psychoeducation

2. Biofeedback

3. Cognitive Training

Psychotherapy

Psychological techniques administered by trained professionals to help clients address psychological problems

How many “brand name” psychotherapies are there?

at least 600

Are all “brand name” psychotherapies scientific?

No, there are many that lack a scientific basis and consist of pseudoscience.

What are the six categories that psychotherapies can fit under based on evidence?

1. Psychodynamic

2. Humanistic

3. Cognitive, Behavioral, Cognitive-Behavioral

4. Mindfulness/Acceptance-based

5. Social Systems

6. Transdiagnostic

Base Rates

How common a given condition is in the population

What are the most commonly diagnosed disorders

• Anxiety (19.1% - US 2023 Data)

• Depression (8.3% - US 2023 Data)

What is the prevalence of disorders throughout the lifespan?

Prevalence of disorders peak in early adulthood and declines over time

When do most disorders first emerge?

During adolescence and young adulthood

What age range to most people receive their first mental disorder diagnosis?

11 to 15 (~30%)

True or False: Emergence time varies by disorder/

True

When do anxiety symptoms tend to appear?

Early on in life (childhood)

When do OCD symptoms tend to appear?

mid-adolescence

When do Mood Disorder symptoms tend to appear?

late-adolescence

When do Personality Disorders and Schizophrenia symptoms tend to appear?

Adulthood

What is the pattern of prevalence rates of mental illness by race?

Prevalence of disorders varies slightly by race & ethnicity (likely due to a conbo of stress and vulnerability differences from culture, discrimination, etc.)

What is the number one reason for people to not seek therapy?

Access: cost, coverage, and logistics

What is the second reason for people to not seek therapy?

Stigma

What is the third reason for people to not seek therapy?

Negative Beliefs about Therapy

Who benefits most from therapy?

Mixed findings on demographics (sex, gender, race/ethnicity, social class); there is no type of person that would benefit more than another

Better therapy outcomes appear with clients who have more:

• Motivation

• Confidence that therapy can work

• Willingness to experience unpleasant thoughts, emotions, and sensations

• Autonomy to choose from various treatment options

Which therapists are most effective (in general)?

• more training and experience = better outcomes

• better interpersonal skills = better outcomes

  • communicators, relationship builders, self-monitors

What are factors common to all therapies?

• Common v. Specific Factors

• Psychoeducation

• Homework/Practice

• Therapy Interfering Behaviors

• General Therapy Stages

Common v. Specific Factors

When a treatment works- Is it the treatment’s special ingredients or is it just common factors that benefit everyone?

example: EMDR - effective for trauma and anxiety disorders b/c you tell someone abt trauma, not because of the use of eye movement

What contributes most to treatment success?

Client variables and extra-therapeutic events (40%)

What other factors contribute to treatment success?

• Therapeutic relationship (30%)

• Expectancy and Placebo Effects (15%)

• Technique and Model Factors (15%)

What does Common Factors Therapy focus on?

1. The therapeutic relationship

2. Motivation (to learn or change)

3. Corrective experiencing (learning)

4. Insight (understanding)

5. Self-efficacy (doing)

House of Common Factor Therapy

1. Support - things you need before anything else happens (Therapeutic Relationship & Motivation)

2. Learning - Teaching (Corrective Experiencing & Insight)

3. Actualization - what should stick after therapy; applying what they learned (Self-Efficacy)

Therapeutic Relationship/Alliance

• Emotional bond built on trust, empathy, and collaboration to promote client well-being

• shared understanding of therapy tasks and goals

• changes over time; build slowly and can weaken/strengthen

• Most treatment models view this as necessary, but not sufficient for success

Who are the therapists that view the therapeutic relationship as the active ingredient in treatment?

Humanistic Therapists

True or False: Therapeutic alliance is consistently predictive of treatment success.

True

Do we know why therapeutic alliance is consistently predictive of treatment success?

• No, we aren’t sure why.

• Reverse causation is sometimes possible

• Early treatment success can strengthen the alliance

Insight

A client’s understanding of themselves and their problems

Psychoeducation

The process of providing knowledge, information, and resources about a specific mental health condition, concern, or treatment

• all the therapies have this to a degree

• usually early on in a treatment

Homework/Practice

Specific tasks or exercises assigned by a therapist to a client to be completed between treatment sessions

• extension of the work down during session

• “medicine dose”

• more common in 2nd and 3rd wave treatments

Therapy Interfering Behaviors

Any actions that disrupt the therapeutic process

• can be intentional or unintentional (i.e. cancelling, leaving early, not participating, not doing homework)

General Model of Treatment

1. Initial Assessment

2. Collaborate to Develop Treatment Plan

3. Follow treatment plan and learn skill

4. Apply skills outside of therapy

5. Monitor progress and make adjustments

6. Meet goals and terminate therapy

Stages of Change

1. Precontemplation = not ready to change

2. Contemplation = acknowledging there is a problem but not yet ready or sure they want to change

3. Preparation = getting ready to change

4. Action = taking active steps to cahnge

5. Maintenance = maintain the new status quo

6. Relapse = resumption of old behaviors

• comes from motivational interviewing (substance abuse concerns)

• we are always in a stage of change regarding whatever behavior we think of

• if you have a problem to solve, figure out where you are on this wheel!

What does DBT stand for?

Dialectical Behavior Therapy

Dialectical Behavior Therapy

• Designed for the most disordered, reactive, and high-risk patients

• Goals for therapy depend on the stage the client is in

Stages of DBT

1. Severe Behavioral Dyscontrol - Getting in Control: of behaviors that are life-threatening; threats to treatment; major threat to quality of life with commitment, skills, and contingencies

2. Quiet Desperation - Getting in Touch: Exposure (PTSD Work); Cognitive Restructuring Working to reduce suffering

3. Problems in Living - Getting a Life: Identifying & working towards life goals & increasing self-respect

4. Incompleteness - Peak Experiences: spiritual fulfillment; expanded awareness; capacity of sustained joy

Termination (Graduation!)

• End treatment with empathy and optimism

• Reinforce learning, skill acquisition, and insight

• Generate relapse prevention plan if necessary

• Identify signals of when to return for “booster” therapy

Good Relapse Prevention Plans include:

• Known triggers, stressors, or high-risk events

• Tools and technique for coping with stress and triggers

• A maintenance plan for important activity of daily life

• Communication ideas for family and love ones

• Flags for knowing when to return for more treatment

What are the ethical considerations in intervention guided by?

APA Ethical Principles of Psychologists and Code of Conduct

• 5 General Principles

• 10 Ethical Standards

• 151 Rules

Key Ethical Concerns for Therapists

• Confidentiality - must maintain client’s privacy

• Competence - must practice only within area of expertise

• Informed Consent - client must know what they are signing up for

• Conflict of Interest - must maintain therapeutic boundaries

• Nonmaleficence - must avoid or minimize harm to others