PSYH4499 - Extra bits

Unhealthy selfishness

condition where therapists prioritise others' needs over their own to detriment of their own health

Wounded healer

personal attribute refers to therapists who have overcome their own psychological struggles and now work to help others

Practical barriers faced by scientist-practitioners

time constraints and financial limitations

What is one common barrier to reporting child abuse mentioned in the lecture?

Belief that teenagers can fend for themselves

What are potential consequences for a psychologist who fails to report suspected child abuse when mandatory reporting is required?

Loss of employment and reputational damage

Risk factors for dual relationships

- Risky psychologists: lack competence, lose boundaries, seek validation, highly self-disclosing

- Risky career periods: newly qualified, mid-career disillusionment, end of career - beyond caring

- Risky work settings: individualised work setting, home office

How to manage a dual relationship

- act on the situation immediately

- identify conflict and seek to remedy it ASAP

- discuss with a senior colleague

- declare COI in documentation or reports

- refer clients on if potential issues

- should not engage in financial transactions

- discuss with client carefully and where appropriate

Handling specific dual relationship scenarios

Business Relationships:

Entering business relationships with clients (e.g., financial arrangements) is strictly prohibited as it can compromise the professional relationship.

Personal Relationships:

Avoid providing therapy to close friends, family, or employees as it increases the risk of blurred boundaries.

Immediate action should be taken if a dual relationship arises, including consulting colleagues, documenting conflicts of interest, and discussing the situation with the client where appropriate.

How to manage risk of sexual relationship with clients

• Risks of shift in relationship with client from professional to personal can be avoided by:

- Not changing appointments to last appt of day

- Not working in isolation

- Access to peer supervision

Greatest risk of sexualising relationship when psychologist has relationship problems - make sure you are self-reflecting on your own personal state of wellbeing

Three main issues to focus on in evidence-based ax

Research findings/Scientific theories, psychometric strength, and hypothesis testing

Common problem associated with the confirmation bias in the context of psychological assessment

It causes psychologists to seek evidence that only supports their initial hypothesis.

Three step process of evidence-based test interpretation

1. Psychologist synthesies/makes sense of the data

2. Test data and implications presented to the client

3. Client makes meaning of and implications in test data

Step 1: Errors in analysis

- Availability heuristic

- Anchoring

- Representativeness heuristic

These heuristics distort test interpretation

Step 2: Errors in communicating test results

Bias that affects dialogue could affect this process.

- client language ability, state of composure, environmental factors (noise, privacy etc)

- client variables in communication --> elaboration likelihood model --> encourage central route processing

Step 3: Applying test recommendations

- Actionable steps that stem directly from problems that occurred in first 2 steps

- Be clear and specific

- Provide follow-up support

- Least control over this step

3 components of evidence based assessment

1. Research findings and scientifically supported theories should guide ax process

2. Psychometrically strong measures in ax

3. Hypotheses are formulated and tested

How to judge the quality of a test?

- Test objective mesure of sample behaviour?

- Test reliable?

- Test valid?

Need to compare to client test scores

Need to understand construct of ax e.g., personality ax

Types of reliability

Test-retest reliability

Interrater reliability

Internal consistency

Types of validity

face validity, content validity, criterion-related validity, construct validity

What are the 3 components of the COM-B?

1. Capability

2. Opportunity

3. Motivation

COM-B: Capability

Individual's capacity to engage in the activity concerned

- Psychological: knowledge, skills, attributes

- Physical: strength, skills and stamina

COM-B: Opportunity

Factors that lie outside the individual and make behaviour possible or prompt it

- Social: social norms and relationships

- Environmental: external influences

COM-B: Motivation

Brain processes that energise and direct behaviour, not just goals and conscious decision-making

- Automatic: habits, drives, emotional responses

- Refective: beliefs, goals and conscious decision-making

Benefits of decision aids

- Provide info re options and outcomes

- clarify personal values

- compliment health practitioner advice

e.g., Breconda

What are behaviour change interventions?

Coordinated set of activities designed to change specified behaviour patterns in defined populations (e.g., prevalence of smoking in pregnant women)

- promote uptake and optimal use of effective clinical services and healthy lifestyles

- guide policy

Medial temporal lobe dysfunction

- Increased rate of forgetting, not helped by cues/supportive testing format

- Poor retention of novel info

- Alzheimers, temporal lobe epilepsy, anoxia, limbic encephalitis, stroke

Frontal type memory difficulties

- Executive deficits prevent encode and retrieval of info

- poor ability to immediately recall info

- better recognition than recall

- poor learning of novel info

- Depression, traumatic brain injury, tumors, Parkinsons disease, frontotemporal dementia, stroke

Frontal lobe

- Executive functioning

- Language expression

Parietal lobe

- Sensory info

- Visuospatial info

Temporal lobe

- Memory functions

- Auditory processing

- Facial recognition

Occipital lobe

- High level visual functions

Three elements of evidence-based practice

1. Research

2. Clinical expertise

3. Patient preferences

Key steps of evidence based practice

1. Ask patient centred questions/define key presenting problem

2. Identify and acquire empirical evidence

3. Critically appraise evidence

4. Apply evidence in practice

5. Assess and adjust

Key competences of evidence based practice

- assessment skills

- process skills

- communication skills

- intervention skills

Barriers to treatment

- attitudinal

- emotional

- structural

- treatment

Study elements evaluated

- long-term follow-up?

- study design and methodology

- data peer-reviewed?

Principles of exposure therapy - WD-RIM

- Work up hierarchy

- Duration

- Repetition

- Incorporation of cognitive change

- Myth of smooth progress

Steps of Problem Solving therapy

1) Identify problem

2) generate possible solutions

3) pros and cons for each solution

4) rank worst to best

5) implement

6) evaluate outcome and implement best solution

Relapse prevention - RPD - ESH

- Review progress and goals

- Plan to continue progress

- Discuss relapse prevention plan

- Early warning signs

- Self-help strategy

- Help seeking options

Case formulation

- predisposing

- precipitating

- perpetuating/maintaining

All contribute to presenting problem, perpetuating is most targeted by txt

Phoenix guidelines: STRONG interventions for adults with PTSD

- CPT

- CT

- EMDR

- PE

- Trauma focused CBT

Phoenix guidelines: early psychological intervention

Strong

- Stepped/collaborative care

Conditional

- Trauma-focused CBT

- Brief EMDR

Phoenix guidelines: Children intervention for PTSD

Trauma-focused CBT for child

How to diagnose specific learning disability - DSM V

- Clinical review of individual's developmental, medical, educational and family history, reports of test scores and teacher observations and response to academic interventions

- Persistent difficulties in reading, writing, arithmetical/mathematical reasoning skills

- Current academic skills well below average scores

- Difficulties not better explained by developmental, neurological, sensory or motor disorders and significantly interfere with academic achievement, occupational performance or activities of daily living

- Unable to perform at a level appropriate to their intelligence and age

When considering the criterion problem, which factor is said to influence ultimate (conceptual) criterion?

Deficiency

When considering the criterion problem, which factor is said to influence operational (actual) criterion?

Contamination

Advanced technologies: offer controlled and malleable environment for observation

Simulations

Advanced technologies: aid in data analysis pattern recognition and decision making, leading to more precise and personal assessment

Machine learning/AI

Advanced technologies: analyse text and speech, and extract relevant information and language patterns.

Natural language processing (NLP)

Advanced technologies: analyse facial expressions, voice, eye tracking to infer emotions, attention and cognitive functioning

Biometric measurement

Advanced technologies: assess functioning, reasoning skills, addictive behaviour, knowledge and tactic skills

Games

General structure of memory tests

- Presentation of stimuli

- Immediate recall

- Delayed recall

- Recognition memory

following a cognitive remediation program, patients...

used more strategies to support memory, achieved memory related goals, improved learning ability

Neuropsych tests measure: PIE LV

- Processing speed and attention

- Intelligence and general abilities

- Language and academic abilities

- Visuospatial and constructional skills

- Memory (learning and retention)

- Executive functioning

Conditions associated with medial temporal lobe dysfunction

Alzheimers, temporal lobe epilepsy, anoxia, limbic encephalitis, stroke

Conditions associated with frontal type memory difficulties

Depression, traumatic brain injury, stroke, tumors, frontotemporal depression, dementia, Parkinson's disease

Claiming external validity according to Cartweight & Hardie requires:

- Promote value of evidence

- Incorporate contextual variables into research

- Triangulate the range of paradigms

- Sample size considerations

- Practice-based evidence = ideal

Index score calculations by the childrens memory scale - CD VL

- Concentration

- Delayed recognition

- Visual immediate

- Learning

Characteristics of children with poor memory skills

- poor listeners

- short attention span

- struggle to get started

What are the 4 domains of the WIAT-II

Reading, Written Language, Oral Language, Mathematics

Anxiety symptoms in children

Physical symptoms, e.g., sleep issues, upset stomach, racing heart Compulsive behaviour Irritability, anger Crying or seeking comfort Avoiding situations Intrusive worrying thoughts

Depression symptoms in children

Low motivation Low mood Fatigue, sleep issues Crying yet resistant to reassurance, comfort Irritable Concentration, memory issues Poor ability to process information Angry outburst leading to guilt, misery

Contributors to stigmatisation in healthcare

- negative attitudes to mental health difficulties

- lack of awareness of own biases

- lack of skills/training

- therapeutic pessimism

To remove barriers to EBP

- Improve 4 Competence skills (PACI)

- Monitor own well-being

- Increase self-awareness

Dimensions of burnout - CEE

Cynicism, exhaustion, reduced efficacy

2 traits of perfectionism linked to burnout

1) self-sacrifice

2) unrelenting standards

Burnout and chronic workplace stress

- Younger and less experienced

- Higher workload

- Supervision and team support

Cultural competency characteristics

- cultural awareness

- cultural knowledge

- cultural skills

6 personal characteristics of effective therapists - IS A HOE

- Identity

- Self-respect

- Authentic

- Humour

- Open to change

- Empathic

6 other personal characteristics - I CLIMB

- Interest in welfare of others

- culturally sensitive/appreciative

- live in the present

- interpersonal skills

- make mistakes

- boundaries