Final exam review– chapters 11, 12,

Chapter 11: intervention overview

Key terms

• Short-term psychodynamic therapy: emphasis on awareness to unconscious processes, helping client understand and alter these processes especially in interpersonal relationships
• Interpretive interventions: promotion of clients insight into wishes, emotions and defense mechanisms
• Supportive intervention: emphasis on development of therapeutic alliance, setting goals, and/or strengthening psychosocial resources
• Transference: unconscious application of expectations and emotional experiences based on important early relationships
• Countertransference: therapists emotional reaction to the client
• Interpersonal psychotherapy: emphasis on interpersonal elements in developing, maintaining and altering psychological problems
• Process-experiential therapy: emphasis on awareness of emotions and expressing them, and transforming maladaptive behaviors
• Cognitive behavioral therapy: emphasis on thoughts/behaviors in psychological problems and focus on altering beliefs, expectations and behaviors
• Self-efficacy: sense of competence to learn/perform new tasks, often found to be the best predictor of behaviour
• Collaborative empiricism: client and therapist develop strategies to concretely test clients dysfunctional beliefs
• Self-administered treatments: treatment that client engages in with no or minimal contact w mental health professional
• Telehealth: delivery of healthcare services online (phone, video)
• Stepped care: approach where lower-cost interventions are offered first, and then upped if its not working

Ethics of intervention

• There is research evidence relevant to almost all psychological problems
• Evidence-based practice doesn't require highly controlled treatments, internal validity, replicated studies. Just base treatment based on best available evidence
• Corners with neuro Linguistic programming, rebirthing, DARE, scared straight
• Humanistic therapy worsens behaviour of people who often violate the rights of others.
• What if there is no evidence-based treatment that matches the client's needs exactly? Adopt, adapt, abandon

Short-term psychodynamic therapy (Freud)

• Emphasized importance of biological drives that we must control to adapt
• Lester Luborsky’s supportive-expressive therapy
• Hans Strupp’s time-limited dynamic therapy
  • Conflicts between id and ego
  • Id impulses are suppressed
• Treatment options vary along a interpretive-supportive continuum
• Face-to-face sessions, 1-2x/week, 16-30 sessions

Interpersonal psychotherapy for depression (IPT)

• Brief, weekly, for 3-4 moths
• Therapist explains how interpersonal issues and maintain depression
• The average person who receives treatment is better off than 80% of those who do not
• Tailored to themes of grief, role disputes, role transitions and interpersonal deficits
• Sullivan says psychiatric issues were related to communication & dysfunctional relationships
• IPT-LL is for needs of adults in later life, ITP-A for adolescents
• Strong evidence for efficacy in adult depression, same with bipolar (w other things)
• Initial sessions 1-3 for assessment and case formulation, present formulation with client, Intermediate 4-12, address interpersonal themes: grief, role disputes and transitions, interpersonal deficits, then termination 13-16: Acknowledge feelings about termination, practice skills, anticipate challenges

Process-experiential therapies

• Origins as alternatives to psychodynamic and behavioral psychology
• Combines client-centered and gestalt approaches into an emotion-focused approach
• Includes: increase clients awareness of emotion, enhancing emotional regulation, reflection and emotions, transforming maladaptive emotions
• Evidence in treating depression, couples distress, survivors of childhood abuse. Mixed on anxiety
• 12-20 sessions

CBT

• Earliest approach used operant and classical conditioning
• Focus on present functioning
• Steps: 1. define problem, 2. generate alternative solutions, 3. decide on best solution to implement, and implementing and evaluating the solution
• Ellis's rational emotive therapy, Beck’s cognitive therapy– based on person's perception of events, rather than the event itself
• Emphasizes use of psychopathology
• 8-30 sessions
• Effective in: mood disorders, anxiety, sleep, eating, somatoform, and substance abuse disorders, marital distress, anger and stress related problems

Seeking treatment

• Increase in use of medications rather than psychological treatment
• Those meeting criteria for major depression, ~40% reported using antidepressant medication, only ~14% reported receiving some form of counseling or psychotherapy
• series of 4 decisions: realizing that there is a problem, deciding that therapy might be of value, actually deciding to seek therapy, and then contacting a therapist or a clinic.

Duration and impact of treatment

• Most attend less than 10 sessions
  • ⅓ attend only 1, median number of 3
• Data from outcome questionnaire 45: 8.2% of patients deteriorated during treatment, 56.8% experienced no change, and 35.0% improved or recovered
• 29% of patients were seen as improved or recovered
• Average of 12.7 sessions
• Those who received psychotherapy, 50% had improved or recovered following therapy; of those receiving psychotherapy and medication, 56% had improved or recovered

Alternative modes of service delivery

• Marital therapies are now couples therapies
• Couples therapy is joint sessions and separate
• Self help books have evidence for usefulness; for several disorders, depression, panic disorder, social anxiety, binge eating and chronic fatigue
• At one end- entirely self-administered or mostly self-administered
  • Other end- traditional, predominantly therapist-administered treatments, self-help materials can be used as an adjunct to treatment.
• Self-administered treatments, can be clinically effective in treating depression, anxiety disorders, OCD, psychosis, and substance abuse disorders in adults

Chapter 12: intervention for adults and couples

Key terms

• Randomized control trial (RCT): participants are randomly assigned to 2 or more treatment conditions
• Meta-analysis: set of statistical procedures for quantitatively summarizing results of a research domain
• Effect size: allows for the results of research studies to be combined and analyzed (in SD units or correlations)
• Publication bias: tendency for journalists to selectively publish research w statistically significant results
• Gray literature: unpublished research
• Clinical practice guidelines: based on best available research, common way in which empirical evidence is used to assist in making assessment and treatment decisions
• Empirically supported treatment (EST): psychotherapy that has been found in a series of RCTs or single-participant designs, effective in treatment of specific conditions
• Open trials: initial exploratory treatment study where no control group is used
• Benchmarking strategy: use of data from empirical studies to provide a comparison against which the effectiveness of a clinical service can be gauged

Meta-analysis and psychotherapy research

• Family member inclusion for OCD helps
• You can be excluded from an RCT bc a comorbid diagnosis
• Psychotherapy helps with psychological disorders, and diseases seen in primary care medical practices but are hard to medically manage
• Eyesnck says psychotherapy is useless
• Uses r (correlation coefficient)
• Cohen’s d stands for standardized mean differences (SMD). d = (Mean of treatment group-mean of control group)/Standard deviation of pooled samples
• Strongest effects by therapeutic approach in order: Cognitive therapy, CBT, Behavioral therapy, Psychodynamic therapy, Humanistic therapy

Evidence-based treatments: initiatives and controversies

• Evidence-based is broader/more inclusive than EST (empirically supported treatments)
• CBT, Interpersonal therapy, Psychodynamic therapy → Depression
• Prolonged Exposure CBT → PTSD; also Cognitive Processing therapy for CBT
• DBT → Borderline personality disorder
• Process-experiential → Emotionally focused couples therapy for couple distress
• types of clinical trials: 1) high-quality RCTs, type 2) imperfect RCTs, type 3) open trials, 4) meta analyses, 5) qualitative literature reviews, and 6) statements not based on research evidence

CBT for depression

• Attention to relationships and social functioning, ltering behaviors, negative automatic thoughts and dysfunctional beliefs
• Initial sessions focus on behavioral activation tasks

Prolonged exposure for CBT and PTSD

• Importance of initial assessment, collaborative relationship, homework, monitoring, prevention
• Begins w assessment of the patient’s condition and the provision of psychoeducational information about the nature of PTSD and the nature of the CBT approach.
  • Use of relaxation skills, imaginal exposure and in vivo exposure

EFT (emotionally focused couples therapy)

• Made by Sue Johnson and Les Greenberg
• Focus is on the attachment bond
• Main goals
  • Modify emotional responses & constricted, rigid interactional patterns
  • Foster the establishment or enhancement of a secure emotional bond

Effectiveness trials

• Many efficacious treatments can be transported into routine clinical practice without much loss of treatment impact
  • Best transportability for a specific adult disorder is for CBT for depression.
• Increasing use of a benchmarking strategy

Adoption of evidence-based treatments

• Psychological interventions, unlike pharmaceutical interventions, cannot be patented.
• Ethical codes prevent advertising
• Systems-level factors (organizational support for learning/providing cutting-edge interventions) and individual-level factors (motivation, knowledge, skill)

Chapter 13: intervention children and adults

Key terms

• Oppositional defiant disorder (ODD): pattern of persistent negativistic/hostile behavior evident before age 8
• Conduct disorder (CD): pattern of serious violation of rights of others (aggression, destructiveness and deceitfulness)
• Coercive exchanges: parent-child interactions where the parent interactions where the parents unintentionally rewards the child for whining or aggression (withdrawing command or giving attention) and rewarding by giving into the complaints (ceasing the aversive behaviour)
• Positive reinforcement: consequence that increases the likelihood of a behavior being repeated
• Potential monitoring: parents awareness and tracking of kids activities
• Multisystemic therapy (MST): approach to treat disturbed delinquent teens by intervening in an integrated way in the multiple systems which they are involved in
• Ecological theory: theory that examines a young person's functioning in the multiple contexts which he/she lives (family, school, etc)
• Mood monitoring: tracking mood on a regular basis with a chart
• Psychoeducation: teaching psychological concepts to clients in an accessible manner

Who is the client in psychological services for children and teens?

• Parent-therapist alliance is important for less cancellations
• Youth-therapist alliance is related to improvements
• Early child psychotherapy was related to intrapsychic factors, now interpersonal

Meta-analyses on therapy outcomes for children and teens

• Humanistic approaches were more effective than non-humanistic ones, using parents in play therapy resulted in the biggest changes

Disruptive behaviour disorders

• ODD often precedes CD
• Kids with ODD have problems in school
• Young kids with ODD and CD are at higher risk of ADHD, learning disorders, depression and substance abuse
• Can be improved by modifying their environment

Parenting programs

• Use of manual, 4-8 weeks, or 12-25 for kids with CD
• 5 parenting practices associated with development of prosocial behavior: skill encouragement, discipline, monitoring, problem solving and positive involvement
• Patterson’s approach offers mild punishment as effective response to misbehavior
  • Punishment involves the withdrawal of reinforcers
• Parents agree on a few rules that will be imposed consistently

Multisystemic therapy- (Parenting Programs (MST)) → not much improvement w it

• Working in teams of 3-5 with caseload of 4-5 families lasting for 3-5 months
• Therapist is available 24/7
• Offered in home, school, and neighborhood
• Using behavioral approach
• Evaluated continuously by youth, parents, educators, health practitioners, & justice system
• Phase one is explanation and assessment of risk factors, strengths and goal setting

Psychosocial approaches for ADHD treatment

• Stimulant treatment is ineffective in 25% of children.

Adolescent depression

• Twofold increase from 13- and 14-year-olds to 17- and 18-year-olds
• Therapists should consider treating parental psychopathology at the same time
• Antidepressants should not be given for mild depression. Monitoring, non-directive supportive therapy, or group CBT is recommended
• CBT, IPT, short-term family therapy, or psychodynamic psychotherapy
• Coping with Depression in Adolescence (CWDA) is a program developed by Clarke and his colleagues
  • Adaptation of Coping with Depression course
  • 6-10 teens (ages 13-18) take part in each group
  • 16 two hour sessions over 8 weeks, with homework and quizzes

Chapter 14: identifying key elements of change

Key terms

• Process research: examines patterns, using therapists and/or client data that is evident within/across therapy sessions
• Process-outcome research: examines relation between variables related to the process of providing psychotherapy and outcome of therapy
• Common factors: therapeutic elements that occur in all or most treatments and believed to be critical for successful client outcomes
• Reactance: tendency to react against attempts to directly influence one's behaviour
• Integrative treatment models: theoretical models that explicitly incorporate aspects of multiple theoretical approaches, and frequently common factors
• Therapeutic alliance: concept that encompasses quality and strength of collaborative relationship between client and therapist

Psychological reactance

• Low reactant: do best in directive treatments, High: do best in less directive treatments
• Therapist variables account for 3% of variability of outcome in efficacy trials and 7% in effectiveness trials

Psychotherapy process and process-outcome research

• Treatment outcome- which intervention is most effective, process-outcome asks how
• Strategies for studying what transpires in therapy (process research) and how it is related to client change (process-outcome research)

Examining treatment factors

• Interpretation
  • Explanation for clients problems and labeling unconscious processes
• Directiveness
  • Low reactive clients are open to therapists being directive, vise versa
• Insight vs symptom reduction
  • Enhance self-awareness
  • Nest for patients who are introspective or introverted
  • Patients who are impulsive or under-controlled or who have an externalizing style respond best to a focus on symptom alleviation.

Common factors is psychotherapy

• 2 broad propositions about psychotherapy (argued it applied to all health care)
  • 1- all therapies share common therapeutic elements responsible for client improvement
  • 2- bc of this, all therapies will be equivalent in outcome

Evidence-Based Psychotherapy Relationship APA Task Force Listing of General Elements of the Therapy Relationship that have Demonstrated Effectiveness

• Alliance, cohesion, empathy, collecting feedback
• Probably effective: goal consensus, collaboration, positive regard

Empirically based principles of therapeutic change (Castonguay & Beutler)

• Relationship, therapist behaviour
• Client variables that reduce change: greater impairment, personality disorders, financial difficulties, significant interpersonal problems in childhood, unfavorable to treatment
• Therapist behaviors that do not work: confrontation, assumptions, rigidity, flexibility

Transtheoretical model of change

• Precontemplation: not concerned about issues
• Contemplation: starting to consider change
• Preparation: aware of issue becoming more weighted toward negative
• Action: making change
• Maintenance: changes are made, less struggle
• Relapse and lapse: slip up; opportunity to change

Chapter 15: clinical health psych, clinical neuropsych, forensic psych

Key terms

• Disability: impairment, limitation, and participation restriction
• Biopsychosocial model: take biological, individual and social factors into account
• Contextual factors: individual characteristics, characteristics external to the individual, and legal and social structures
• Health psychologist: careers focus on research and teaching related to health. clinical health psychologist are those who are also health service providers
• Acute pain: short-term sensation that is unpleasant, but a useful function.
• Chronic pain: persists for more than 6 months
• Sleep hygiene: engaging in good sleep habits
• Neuropsychology: study of the brain and behavior relationships
• Clinical neuropsychology: application of knowledge in the assessment and remediation of neurological injury or illness
• Functional model: Idea that different areas of the brain interact to produce behaviour
• Neuroanatomy: normal brain function
• Neuropathology: ways injuries and diseases affect the brain
• Pharmacology: ways environmental toxins, chemo, and drugs affect brain functioning
• Capacity assessment: made to balance need for autonomy w need for protection. Needs understanding of ways in functioning can be impaired by injury/degenerative processes
• Forensic psychology: practice by any psychologist within the subdiscipline of psych when applying scientific, technical or specialized knowledge of psychology to the law in assisting legal, contractual and admin matters
• Risk assessment: predictions of likelihood of reoffending
• Risk principle: match level of service to the offenders risk to reoffend
• Need principle: assess criminogenic needs and target them in treatment
• Responsivity principle: maximize offenders ability to learn from rehabilitative intervention by providing CBT and tailoring intervention to motivation, abilities and strengths of the offender

Clinical health psychology

Definitions of health psych

• 1980, WHO developed international classification of functioning, disability and health (ICF) to provide a standard (based on biopsychosocial model)
• Functioning or disability is determined by the interaction between health and contexts
• Data from Canadian Disability survey (2012) 14% disability rate
  • Ages 15-24 → 4%, 75+ → 43%

Activities of clinical health psychologists

• For health promotion and some engage in intervention or assessment

Assessment and intervention related to pain

• Patrick McGrath et al. made strategies to measure pain in those who are incapable of expressing pain verbally
  • asking about pain, observing their behaviour, and watching facial expressions
• 22% of CAD 18+ experience chronic pain
• Protective factors: psychoeducational groups, education on differences of acute and chronic pain, relaxation training, education on problem solving, contingency management aims to rehabilitate person with pain rather than take it away

Vaccination for infectious disease and relevance to health psych

• Polio, measles, and mumps, vaccines are over 99% effective
• Vaccination helps prevent spreading, and lessens severity
• Chicken pox is a form of herpes
  • Times of high stress or low immunity, virus can worsen causing shingles

Covid and the brain

• Effects of covid are similar to those of chemo on the brain
• Response to respiratory infection causes inflammatory response in brain through cytokines and chemokines in the CNS that cause inflammation in brain cells

Spanish flu

• Identifies in 1918, unknown origin
• 1/3 people were infected, Center for disease control says 50 million deaths worldwide
• Masks and lockdowns. Lasted about 8 years

Psychological treatment for insomnia (CBT-I)

• Sleep hygiene, stimulus control, sleep restrictions, cognitions about sleep

Clinical neuropsychology

• Knowledge requirements: neuroanatomy, physiology, pharmacology, human neuropsych and neuropathology, neurological assessment, clinical neuropsych intervention techniques, neuropsych and developmental psych

Activities of clinical neuropsychologists

• Training can be obtained in generalist training in clinical psych, in small number of specialist clinical neuropsychology doctoral programs, or in postdoc training
• Assessment of memory, abstract reasoning, problem solving, and emotional consequences brain dysfunction
• Toolkit: psychometric tests such as the Wechsler Adult Intelligence Scale-4 (WAIS-IV), Wechsler Memory Scale-4, and Wechsler Individual Achievement Test-3

Fetal alcohol spectrum disorders (FSAD)

• Combines FAS, alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD)
• Most severe case on the spectrum
• CNS issues, facial features (flat nasal bridge and midface, thin upper lip and small head) Can have problems with learning, attention, memory, hearing and communication

Alcohol related neurodevelopmental disorder

• Difficulty with behaviour regulation, poor school performance, difficulties in cognitive processes (attention, memory, impulse control)
• High rate of incarceration- problems with frontal lobe development (~50%)

Alcohol-related birth defects (ARBD)

• Have problems with kidney or heart function, hearing difficulties and abnormalities in their bone structure and health

Potential role of fathers in FASD in their offspring

• Parental alcohol use is associated w lower intelligence and cognitive ability
  • These parents exhibit lower levels of academic performance, lower cognitive abilities and increase levels of learning disabilities

Forensic psychology

• Client is typically the justice system, court, or insurance agency
• Normally see a client for a couple sessions in a highly structured, evaluative context
• Psychiatrists also offer forensic services
• Natural of their work in correctional facilities is affected by high incarceration rates, overcrowding and limited resources
• Treatment of victims, perps and workers in legal field, consult witnesses, victims and offenders, lie detection, expert witness, workplace safety, custody, professional malpractice
• Almost 50% of repeat offenders have been diagnosed with a substance abuse disorder
• Confidentiality cannot be assured
• Prediction of dangerousness is not overly accurate
• Try to predict who will become dangerous (true positive) and who will not become dangerous (true negative).

Assessment methods used

• Psychopathy checklist-revised (PCL-R) most used forensic test
• Static-99 for predicting risk of reoffending
• MMPI-2
• WAIS is used in 50% of assessments of adolescents on trial
• Projective tests are rarely used when predicting risk of continuing violence or competency to stand trial

HARE psychopathy checklist revised (PCL-R) and psychopathy

• Predicts recidivism, violence, and response to therapy
• 20 item scale, max score of 40
• 1% incidence in the general population (half as many women as men), 15-25% of those in prison meet the criteria for Psychopathy.

Diminished capacity defenses

• Physician gave medication that interfered with ability to know right from wrong
• Wrong-doing due to intoxication – no longer a defense in Canada
• Disease of the mind or mental condition that interferes with ability to understand the nature and consequences of actions

Lie detection (polygraph)

• Sympathetic nervous system activity is triggered when lying
• Multiple channels to assess NS activity
• Not legal in in courts, police use it though
• Guilty knowledge test
  • Police hold back critical information on the crime, then give MC question to person

Treatment: risk-need responsivity (RNR) model

• Most effective model of treating model
• First emerged in Canada in 1980s, goal is to reduce rate of recidivism