Psychotherapy w1-2

mental disorder

persisting or recurrent feelings, thoughts, behaviour tendencies, or bodily sensations as a problem: unwanted, intolerable, abnormal, uncontrollable, absurd

what is the goal of PT?

change unwanted patterns of subjective experiences/ reduce agreed upon symptoms

7 mechanisms of change

1. change by reasoning, arguments and explanations

2. discover who you are while in therapy

3. change dominant schemas (holistic representations) distanting dominant schema representations (autobiographical memories) by building up new salient experiences

4. systematic exercise for changing associative representations (belangrijk in directive pt)

5. high quality therapeutic alliance

6. patient needs to be active and involved

7. rearrange environment and social interactions

propositional representations

logische argumenten (propositioneel) hebben weinig grip op diepgewortelde holistische overtuigingen (schematisch). Therapeutische verandering vereist daarom ervaringen die deze schematische netwerken direct aanspreken

non-directive

focus op inzicht en zelfkennis:

1. psychoanalyse en psychodynamische therapie

2. client centered humanistic

3. existentiele therapie

directive

oefenprocedures en methodieken

1. behavioral (gebaseerd op leerprocessen om ongewenste gedragspatronen en gevoelens te veranderen via systematische oefening)

2. cognitive (bewustmaken en vervangen automatische aannames)

3. CGT

Behavioral therapy

• Psychopathology bases on S-R associations (interactions person-environment)

• symptom-oriented

• observation and self-monitoring are part of treatment and planning/evaluation

5 steps in BT process

1. problem inventory

2. position in holistic theory (integratie problemen geheel)

3. problem selection, measurement and functional analysis (Classical conditioning starts)

4. treatment plan and treatment execution

5. evaluation

betekenissen S

+S = occurs while expected -S= doesn’t occur

S+ = pleasant S- = unpleasant

Positive reinforcement

+S+, R increases

adding rewarding stimulus after behavior

Negative reinforcement

-S-, R increases

-S- = dissapearance of a unpleasant Sr, for example, a child is allowed to quit his homework assignments and play outside)

sequential conditioning

or by avoiding a situation in which something unpleasant is expected (~S-), such as avoiding visiting malls because one expects (sequential conditioning)

Positive punishment

+S-, R decreases

adding unpleasant stimulus after unwanted behavior

Negative punishment

-S+, R decreases

expecting something positive to occur but it doesn’t so behavior reduces

treatment techniques BT

1. encourage willingness to change

2. increase awareness and direct attentional processes

3. train alternative S-R associations

• exposure, self-control procedures, contingency management, behavioral activation

evaluation BT

decrease of symptoms + confidence to reach further along lines of treatment

goal of behavioral therapy

increase/reduce/change overt or covert behavior in accordance with mutally agreed-upon goals and a treatment plan

BT treatment techniques

• exposure

• self-control procedures

• contingency management

• behavior activation (most effective)

BT mechanisms of change

• aanpassen omgevingscontingenties

• inhibitie leren

• vergroten tolerantie interne ervaringen

geschiedenis BT

reactie op psychoanalyse in jaren 50-60

persoonlijkheid wordt gezien als reflectie van leergeschiedenis individu. Gedrag niet (on)gezond. maar (mal)adaptief binnen specifieke sociaalculturele context

vormen van exposure

• in vivo (confrontatie)

• imaginair

• introceptief (= bloodstelling gevreesde lichamelijke sensaties)

• virtual reality