Treatment of Disorders 3: Intervention Therapies

What is the focus of First Wave therapy?

Behavioural therapy—replacing automatic maladaptive behaviours with adaptive ones.

What is the focus of Second Wave therapy?

Cognitive therapy—replacing automatic maladaptive thoughts (cognitive distortions such as thoughts of worthlessness in depression) with adaptive ones.

What is the focus of Third Wave therapy?

Acceptance-based therapy—emphasizes psychological flexibility, acceptance of thoughts, and aligning actions with client values.

What type of therapy is CBT (Cognitive/Behavioral Therapy) and what does it aim to change?

CBT is an intervention-based psychotherapy aiming to change automatic thoughts and behaviours that cause or worsen mental disorders.

Combination of behavioural and cognitive therapy

How effective is CBT?

When combined with medication, it is the most effective psychotherapy for most disorders.

What are some unique features of CBT?

1. Evidence-based, informed by psychology research

2. Includes psychoeducation → knowledge is passed on to client

3. Focuses on skills, not origins → goal is to teach skills and focus on current symptoms; not concerned with past and why?

4. Homework-based (practice skills outside of therapy)

5. Short-term (12 sessions over 3–6 months) → highly focused

What is classical conditioning in CBT?

Associating a stimulus with an automatic physical reaction; e.g., using Antabuse to associate alcohol with nausea.'

E.g., Pavlov’s dogs (create association to change behaviour)

What is operant conditioning in CBT?

Using rewards (and sometimes punishment) to shape behaviour; e.g., token economies (E.g., given money for desired behaviour to be exchanged for rewards) and monetary penalties (E.g., withholding a pool of money set aside by client when they engage in undesirable behaviour).

Reinforce positive behaviours and punish negative behaviours

What is exposure therapy?

Repeatedly confronting emotion-arousing stimuli to reduce emotional response.

What is response prevention?

Blocking maladaptive coping behaviours to show they are unnecessary; often paired with exposure.

What is cognitive restructuring?

Challenging and replacing negative thoughts using techniques like Socratic questioning.

• Collection of techniques → push and challenge beliefs person talks about → persuasive way that creates ‘cognitive dissonance’

  • Socratic questioning: deflates beliefs that often don’t have a basis

What are thought journals used for in CBT?

Clients record and examine automatic thoughts, identifying and challenging distortions.

What is DBT (dialectical behavioral therapy) and what does it teach?

An intervention-based psychotherapy teaching emotion regulation, mindfulness, and self-compassion.

Acceptance-based model → focused on regulating emotions (accepting rather than changing emotions)

What disorders is DBT used for?

BPD, self-harm, PTSD, depression, eating disorders.

Effectiveness is still emerging but gaining major support

What are unique features of DBT?

• Frequent sessions (up to 12 months)

• Group/class format (2h/week)

• In-vivo coaching (1h/week) → therapist is available for contact during live emergencies

What techniques are used in DBT?

• Mindfulness meditation → let thoughts and emotions flow past like a river

• Distress tolerance → let people sit with their discomfort (like exposure therapy)

• Interpersonal effectiveness → how, when? (managing emotions and knowing when to distract ourselves)

• Emotional regulation

What is the best treatment for Phobia, PTSD, and Panic Disorder?

CBT (especially exposure therapy); alternative: antidepressants.

What is the best treatment for Generalized Anxiety Disorder (GAD)?

CBT (especially cognitive restructuring); alternatives: antidepressants, Buspirone.

What is the best treatment for OCD?

CBT + antidepressants; alternative: Deep Brain Stimulation (DBS).

What is the best treatment for Mood Disorders?

CBT + antidepressants; alternatives: ECT, DBS, IPT.

What is the best treatment for Bipolar Disorder?

Mood stabilizers; alternative: antipsychotics.

What is the best treatment for Schizophrenia?

Antipsychotics; alternatives: CBT, ECT.

What is the best treatment for Borderline Personality Disorder (BPD)?

DBT; alternative: psychodynamic therapy.

What is the best treatment for other personality disorders?

Psychodynamic therapy.

What is the best treatment for ADHD?

Psychostimulants; alternative: CBT.

What is the best treatment for Autism?

No widely accepted treatment; structured behavioural intervention is used.

Exposure therapy is most similar to:

a) Stress Inoculation Therapy

b) Improvements in personal mastery

c) Implicit bias training

d) PERMA workshops

a) is correct → a form of exposure therapy; put into stressful situation to become habituated to it