psychotherapy exam 4

Motivational interviewing

Interview style to create constructive conversation

Promote empathy and growth

Identify values and aspirations

Collaborative, confrontational, directive

Key concepts in MI

Readiness to change, ambivalence, resistance

MI principles

Rolling with resistance, expressing empathy, supporting self efficacy, developing discrepancy

MI method

Responding to resistance

Open ended questions, affirmations, reflections, summaries

Increasing change talk

Explore internal conflict

Explore discomfort

Intention behavior relationship

Self reported intention is the biggest predictor of behavior change

Theory of planned behavior

A person’s belief about behavior influence intention, which determines if the person will enact the behavior

Belief - intention- behavior

3 components that influence intention

Attitudes, subjective norms, perceived behavioral control

Theory of planned behavior

If the three components are shifted towards quitting a behavior then you are more likely to quit and vice versa

Continuum of control

How much of this behavior is under the person’s control

No control to volitional control

Modifying perceived behavioral control

Increase confidence, improving outcome expectations

Comparison of psychotherapies

Most have a small to tiny effect size difference, besides CBT over behavioral (0.22) and psychotherapy over pharmacotherapy (0.2)

Average heterogeneity between psychotherapies

36%

Evidence based approach effectiveness

Improve outcomes among people experiencing psychological problems

Don’t show much difference for improving outcomes btwn each other

Therapeutic techniques

Specific skills or activities used in psychotherapy

Treatment mechanisms

Factors changed by treatment that improve outcomes

Specific effects

Treatment effects brought about by that specific form of psychotherapy

Common factors

Treatment effects that occur due to factors common in all psychotherapies

All therapies involve

Relationship btwn client and therapist

Credible and effective treatment

Structured procedures and rituals

A healing context

Contribution to effectiveness of common factors

50%

Component testing

Removing one part of a therapy and testing to see if it improves or worsens the efficacy

Ways to individualize therapy

Match to disorder

Match to kind of person

Client resistance and reactance

Due to an ambivalence towards behavior change

High resistance leads to worse therapy outcomes

How to combat resistance and reactiveness

Clinician directiveness- increase or reduce

Asking about their preferences in clinical role, treatment, etc

Culturally adapted therapy

Tailoring an ebt around a specific ethnic culture

Environment on behavior

Behaviors highly influenced by social factors

Social factors can determine health

Can increase harmful behaviors

Lower social position contributes to

Increased vulnerability to risk factors

Decreased access to key resources

Marginalization

Exclusion of minorities from mainstream resources and positions of power

Allostatic load

Chronic stress that causes slow wear and tear to the body and contributes worse mental and psychological health outcomes

Addressing environmental barriers

Bring psych services to under serviced communities

Indemnifying and appreciating environmental barriers that prevent change

Developing treatment plans that work around this

Increasing cultural competency

Cycle of avoidance

Addressing procrastination

Increase congruence btwn selves

Challenging negative self talk

Engaging in mindfulness to promote self reg7

Shifting

Switching between tasks or response rules

Inhibition

Suppression of an automatic response to make a more task specific response

Updating

Replacing old information with new relevant information

Working memory

Actively maintaining and manipulating information across a short delay

Domain interaction

Diversity, unity, top down processing

Executive function impairments

In psychopathology

Difficulties maintaining focus on goals and top down processing and self regulation

Improving executive functioning

Real world strategies

Stimulant medication

Goal management training

Therapy with fewer executive functioning demands

Is behavior change sustainable

Psychotherapy effects diminish over time

Maintenance is required to prevent relapse

5 areas that contribute to maintenance

Motivation, self regulation, habit, resources, environment and social factors

Predictors of maintenance motivation

Desire to continue

Gratification or enjoyment from the new behavior

Satisfaction with outcomes

Identity and value congruence

Intrinsic motivation

Self regulation vs habit

Self regulation is needed in the beginning to become habit

Psychotherapy termination

Mutual termination is the goal

Should be clear when and how

Collaborative and checked in on