EBT-midterm – Flashcards
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What is clinical case formulation?
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The psychologist's hypothesis about the nature of the psychological mechanisms underlying the client's difficulties.
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What are overt difficulties?
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The actual problems in living that clietns seek help for (e.g., depression, relationship, difficulties, anger)
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What are underlying mechanisms?
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the underlying (central) psychological mechanisms that produce and maintain the overt difficulties (e.g., dysfunctional attitudes, cognitive schemas, coping pattern, interpersonal style, lack of secure attachment or unconditional regard, etc.) SHOULD BE CONSISTENT W/Theoretical model
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What are some things you should think about when identifying problems for a cultural formulation?
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big question: how did the problem develop? -what made me vulnerable in the first place? - triggers for the most recent episode - the problem - things that keep the problem going
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What is the difference between case formulations and treatment plan?
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CF: why a problem exists TP: what to do about the problem (informed by CF)
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Name 4 theoretical orientations?
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- Cognitive Behavioral (CBT) - Psychodynamic - Emotion-Focused therapy - Interpersonal Therapy
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How does a cognitive orientation explain psychological problems?
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Distorted cognitions
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What is the focus for cognitive orientation?
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Present, here and now
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What are treatment goals for cognitive orientation?
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Reduction of symptoms
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What are the strategies of cognitive orientation?
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changing cognitions
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Does a cognitive approach require homework?
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Yes
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How does a behavioral approach explain psychological problems?
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Classical and operant conditioning, social learning
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What is the focus for therapy using a behavioral approach?
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Present, here and now
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What are treatment goals for behavioral approach?
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Reduction of symptoms
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What are the strategies for a behavioral approach?
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Modifying behaviors
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Is there a homework component with a behavioral approach?
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yes
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What are examples of therapies that are based on the behavioral approach?
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DBT, ACT
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How does a psychodynamic approach explain psychological issues?
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Historical relationships and trauma
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What is the focus of a psychodynamic approach?
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Past, developmental
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What are tx goals for psychodynamic approach?
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insight, changing long-standing patterns
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What are strategies for psychodynamic?
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using transference and countertransference, interpretation, confrontation of defenses
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Is there a homework component for psychodynamic?
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No
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How does emotion-focused therapy explain psychological problems?
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Interpersonal relationships
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What is the focus of emotion-focused therapy?
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Present, interpersonal relationships
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What are tx goals for emotion-focused therapy?
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STRENGTHEN SELF, REGULATE AFFECT, CREATE NEW MEANING
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What are the strategies used for emotion-focused therapy?
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Using therapeutic relationship and in-session experimental exercises
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Does emotion-focused therapy have a homework component?
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No
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How does interpersonal therapy explain psychological problems?
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Interpersonal relationship
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What is the focus of interpersonal?
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Present, interpersonal relationships
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What are the tx goals for interpersonal?
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Address grief, interpersonal disputes, role transitions, interpersonal deficits
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What are strategies for interpersonal?
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Exploration, encouragement of affect, use of the therapeutic relationship, communication analysis.
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Is there a hw component in interpersonal?
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No
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What does the APA task force recommendations for empirically validated treatments?
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two RCTs w/no-tx or placebo comparison
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What are some controversies about ESTs?
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- EST biased towards favored brief, manualized tx - lost focus on common factors that help clients across d/o-focus on specific d/o and specific techniques - Concern about applicability to diverse population
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What is clinical judgement?
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includes judgment, decision-making, interpersonal skill, self-reflection, ability to evaluate the research evidence, ability to evaluate the research evidence, ability to understand individual and cultural differences, willingness to consult and seek additional information, having a clearly articulated rationale for tx approach
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what is ebpp?
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Evidence-based practice in psychology is the integration of the best available research w/clinical expertise in the context of patient characteristics, culture, and preferences
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What are three components that make up EBP (evidence-based practice)?
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- Best research evidence - clinical expertise - patient values and preference
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What are the 4 ways you can know that tx is effective?
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- faith: belief in your theory - hope: belief that your good will, goose sense, and experience will win out - charity: belief that your work will be beneficial even if things seem to be going south at times - experiment: measured outcomes
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What is efficacy?
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treatment effects compared to minimal treatment or waitlist control
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What is effectiveness?
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the comparative effects of treatments; generalizability across setting
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What is efficiency?
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who benefits from what treatment?
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What are some threats to validity of empirical tx research?
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- internal validity: did the tx make a change? - external validity: can it be generalized? - statistical conclusion validity: appropriate stats tests? - construct validity: proper operationalized definitions
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What are some examples of internal validity?
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- temporal precedence - selection - history - maturation - regression to the mean - attrition - testing and instrumentation
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How can you correct temporal precedence?
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exclude participants w/prior tx experience
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How can you correct selection?
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random assignment, stat analysis of systematic pre-existing difference
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How can you correct for history?
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random assignment, stat analysis if event occurs
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how can you correct for maturation?
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careful participant selection, random assignment, add control/contrast group
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How can you correct for regression to the mean?
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Ensure all DVs have strong test-retest reliability, include control group, use multiple measures
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How can you correct for attrition?
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Foster motivation, make sure control group has adequate attention, avoid "no treatment" control group
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How can you correct for testing and instrumentation?
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Choose testing protocols that have minimal impact on performance, include quality checks on measures, add good control groups
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What are some threats to external validity?
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- sample characteristics - setting characteristics - testing effects
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How can you correct for sample characteristics?
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recruit a sample that is representative of population of interest
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How can you correct for setting characteristics?
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make sure settings reflect typical treatment conditions
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How can you correct for testing effects?
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use measures in addition to self-reports, use unobtrusive measures, schedule time of assessment in a clinically relevant way
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How can you correct for construct validity?
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avoid jargon and ambiguous terms, make sure operational definitions clearly represent the construct
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What are examples of threats to construct validity?
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- inadequate specification of construct - confounding - singular definitions - participant reactivity - experimenter expectancies - treatment diffusion
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How can you correct for confounding threat?
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be clear w/conceptual categories
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How can you correct for singular definitions?
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use multiple therapists and multiple measures
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How can you correct for participant reactivity?
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choose control/contrast groups that minimize the treat (adding good attention/placebo contrast)
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How can you correct for experimenter expectancies?
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blind research personnel, include treatment integrity and fidelity checks
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How can you correct for treatment diffusion?
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use different therapists to implement different conditions, blind research personnel to hypotheses
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What are examples of threats to statistical conclusion validity?
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- low stats. power (increase n, vary alpha, use 1-tailed, reduce variability) - family wise error rates (use conservative stat) - unreliable of measures (use measures w/ strong reliability metrics) - unreliable tx implementation (standardized training - heterogeneity of subjects (clear and stringent i/e criteria)
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What are common research for evaluating tx efficacy?
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- no tx comparison design - wait list comparison - attention placebo - relative efficacy (tx vs TAU)
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What are the dialectics (inquiry) of research and practice?
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- concerns of the academic research/outcome researcher - concerns for clinicians
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What are ways of tolerating dialectics?
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- accept and tolerate the necessary tension - avoid absolutistic, all or none thinking
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What are patient-level considerations for tx?
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= how do patients view treatment - what type of tx do they want
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What are clinician-level considerations for tx?
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- sees pt. as end users rather than co-developers who can make good decisions and are potentially creative - tx are "specifically designed to occur within interpersonal relationships"
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What are some considerations for psychotherapy in the real world?
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- psychotherapy is messy and often unscripted - trainees must balance the patients' best interest and faithfulness to the approach in rapidly changing real time contexts - emphasizes fidelity to the conceptual paradigm and flexibility within intervention
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How do clinicians differ from technicians?
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- learn general principles not specific techniques - a theory is a good things to have - read a lot - personlize psychotherapeutic approaches - avoid procrustean bed (obsessing over individual differences or situational approaches) - treat people not dx - one size never fits all
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What are some common characteristics of anxiety d/o?
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- personal perfectionism - emotional perfectionism - strong desire to please others - fear of failure - focus on predictability, permanence, order, and routine - impressionistic cognitive style
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What are some forms of emotional avoidance in anxiety d/o?
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- avoiding eye contact (behavioral) - procrastination (behavioral) - avoiding exercise/physiological arousal (behavioral) - reassurance (cognitive) - trying to think positive (cognitive) - thought suppression (cognitive) - charging talisman, good luck charm (safety signal) - overuse of sunglasses (safety signal)
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What is cognitive content-specificity?
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- central concept to theory and practice - different mood states associated w/distinct cognitive context - enables clinicians to identify "hot cognitions"
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What are therapeutic stance variables that cut across what the clinician does?
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- collaborative empiricism - guided discovery
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What is collaborative empiricism?
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- clinician and patient work as partners
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What is guided discovery?
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- clinician is coach who shephards patient through data collection using empathy, questioning, and behavioral experimentation
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How do you increase coping skills using CBT?
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- relaxation - stress management - assertiveness
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How do you change unhelpful thinking w/CBT?
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- cognitive restructuring - rational analysis
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How do you decrease avoidance and increase self-efficacy?
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- exposure - experiments
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What is a structure of a treatment?
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components of session, relationship, assessment measures; homework assignment, exposure trials, social skills practice
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What is the content of a treatment?
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- the WHAT - material produced from structure elements (feelings, thoughts, and behaviors)
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WHat is the process of a treatment?
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- the HOW - the way the patient reacts to the structure and content (avoidance, irritation, smugness)
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What is self-monitoring?
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- part of CBT - keystone of self-directed change - objective measures - idiographic (scientific) measures
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What are SUDs?
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- Subjective Units of Distress in CBT - making emotional quantifiable - can be 1-100 or 1-10 - scaling device which titrates level of distress
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What is climbing the ladder?
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- part of CBT - adaptation of hierarchy - climbing is a nice active way to communicate progress through the hierarchy
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What are thought diaries?
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- part of CBT - analysis of thoughts, situation, and feelings. Situation is the objective description of what is going on; feeling: emotional label; thought: what is going on through their mind?
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What are examples of behavioral interventions?
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Relaxation - deep controlled breathing - progressive muscle relaxation
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What is important to note about relaxation techniques?
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- you can induce anxiety - related to fears of loss of control - fear that focusing on the sensation is dangerous
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What are examples of some cognitive interventions?
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- cognitive restructing (changing self-talk) - advantages and disadvantages - problem solving - decatastrophizing - reattribution -test of evidence
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What is cognitive restructuring?
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- focuses on changing habits of thought - refocusing attention - direct adaptive behaviors - facilitate accurate appraisals
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What are some advantages and disadvantages of cognitive restructuring?
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- very basic intervention - clients look at costs/benefits of a behavior - clients see what they lose and gain by holding onto specific behaviors - what are the advantages and disadvantages of avoiding a feared stimulus
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What is problem solving?
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- basic staple of cbt - RIBEEYE R: learn to relax in in face of stressor I: Identify stressor B: brainstorm E: evaluate each solution Y: saying yes to the best solution E: encouraging self for active problem solving
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What is the socratic method?
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Curious and inquisitive, gentle questioning
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What is decatastrophizing?
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- tests predictions of doom - adds perspective to narrow beliefs - works to modify the overestimations of the magnitude and probabilty of dangers
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What is reattribution?
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-teaching clients to view experiences from different angles - does not focus on the facts but on the explanation of facts
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How do you test evidence?
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- evaluate whether conclusions are factually based and logically sound - need to take a deliberate and mindful approach - patience is key
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What is a common technique in CBT and BT approaches?
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- exposure: - the experiential approach exposes the patient to experiences that are in themselves powerful enough to change misconceptions
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What does exposure do?
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- true experiential approach - designed to help pts face the situations they fear - pt. remain in control and engaged - pt. learn to habituate reinterpret and often extinguish the fear - promote genuine sense of self efficacy
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What are the advantages of exposures and experiments?
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- present-oriented - increased perceived sense of control
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How can the therapeutic alliance help with exposure?
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- data shows decrease in alliance rating after exposure - allign w/ pt vs. distress - no one wants to do it (avoidance high)
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What should you do before attempting exposures or experiences?
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- psychoeducation (family and pt) - is it useful - needs to be gradual - any medical issues? - pts' feels about tx - make as realistic as possible use props
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What is the key feature of social anxiety?
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- fear of negative evluation - catastrophic predictions of what may happen - common mental equation: disapproval = disaster
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What cognitive interventions could be used for social anxiety?
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- test of evidence - reattribution - decatastrophizing
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What is a cognitive formulation for obsessions?
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Rituals and compulsions are directed at reducing doubt and inceasing certainty.
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What is the paradox of mental control?
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When sense of control is threatened or thwarted high levels of arousal emerge. Client then tries to control the thought without success
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What treatment approach should you use for OCD?
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CBT
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What are the first steps of initiating treatment w/patient w/OCD?
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-psychoeducation - begin self-monitoring
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What is the overall plan tx for OCD?
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- use facilitative strategies - establish exposure hierarchy - in session graduated exposure - out session HW exposure - identify and modify underlying assumptions and core beliefs - ritual prevention
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What is thought and action fusion?
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When Clients believe that thinking something is the same as acting on it.
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What is response prevention?
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- AKA ritual prevention - Exposure is not enough -REsponse must be prevented by client, not situation
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How can you stop performance of rituals?
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- complete stopping (cold turkey) is recommended - thought some clients may need more gradual approach
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What are some facilitative strategies for ocd?
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- challenge rigid thinking: make rules conditional rather than absolute - break rules of ocd (delay, shorten ritual or do it differently)
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What can you do to minimize counting compulsions?
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- gradually reduce the number of times an action is performed - change the way the counting is done - substitute something else for the counting - count to the wrong number
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What therapy do you use for Panic?
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CBT
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How would you treat physical and mental changes and what is the underlying process?
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psycholeducation/preoccupation - hypervigilance
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How would you treat overarousal of autonomic nervous system?
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relaxation/emotional activiation
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How would you treat attention "glued" to subjective physiological feeliings?
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refocusing/attentional focus
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How would you treat attributoin to danger?
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cognitive restructuring/catastrophizing-overgeneralization
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How would you treat overwhelming escape behavior?
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graduated exposure/avoidance
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What intervention would you use with high level of physical arousal?
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attention refocus (early in tx) exposure (later in tx)
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What intervetion would you use with moderate level of arousal?
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cognitive restructuring
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What intervention would you use the low level of arousal?
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psychoeducation relaxation training environmental clean up
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What are forms of self-monitoring?
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- mood diaries - panic diaries - SUDs rating and hierarchies - daily thought records - self-report, clincian rater
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What is the benefit of refocusing techniques?
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- Can ease anxiety - count change in pocket - do different math pockets
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What are behavioral interventions?
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-relaxation - deep breathing - breathing control - environmental clean up - time mgt
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What are some examples of cognitive restructuring for panic d/o?
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- panic sxs are frightening, they are not dangerous - anxiety is like a wave - it will pass - stay in the present - pay attention to breathing
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What is interoceptive exposure?
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- disrupt or weaken associations between specific body cues and panic reactions, decrease the hyperventilation response, and the fear avoidance response -engage in physcal activities to generate sensations similar to what would be experienced in a panic attack
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What are contradincations for panic inductoin?
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- medical/phyiscal hx - pregnancy - epilepsy - hypertension
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What are four main clusters of PTSD sxs?
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- instrusion - avoidance - negative alterations in cognition and mood - alterations in arousal and reactivity
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What are treatment strategies for PTSD?
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- exposure (imaginal/in vivo) - cognitive restructuring (change unrealistic thinking about self, world, future) - coping skills
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What are types of exposure for PTSD?
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- imaginal (narrative) - in session - virtual reality
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What type of treatment is used for PTSD?
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- exposure therapy -cognitive processing therapy - CBT
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What are common goals of CBT for PTSD?
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- remember and accept what happened by not avoiding memories and accompanying emotions - allow self to feel natural emotions and let them runt heir courses so the memory can be put away w/o strong feelings attached - balance belief that had been disrupted or reinforced
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What are 4 approaches to treating depression?
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- Interpersonal therapy - cognitive behavioral therapy - emotion-focused therapy - psychodynamic therapy
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What is the more efficacious treatment for depression?
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- all equally efficacious - IPT bit more...supportive a bit less
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What is Beck's negative cognitive triad?
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pessimistic thoughts about: - self - others/world - future
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What are the 9 components of cbt case formulation?
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CHIP TROPP Chief complaint Hypothesize mechanism Identifying information Problem List Treatment plan Relation of mechanism to problems Origins of central problem Precipitants of current problems Predicted obstacles to tx
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What are the core tenants of cbt?
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- time limited, goal-oriented - pt. is active collaborator - goal is independent functioning - cognitive conceptualization model - model of emotion
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What are structured sessions of CBT?
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- update, mood check, summary of last session, review pt. goals -review homework - set session agenda - discuss agenda -assign new homework -summary/feedback
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What are characteristics of core beliefs and schemas?
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- develop early - deeper level of cognition - rigid - predict & shape automatic thoughts
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What are automatic thoughts?
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- maladaptive automatic thoughts block goals and increase emotional pain - alt. thoughts may help reach goals, decrease emotional pain
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What are list of maladaptive thought patterns?
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- catastrophizing - filtering - personalizing - (over)generalizing - polarizing - emotionalizing COPE FC
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What are behavioral interventions for depression?
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- track behaviors/activities - introduce activity scheduling - increase mastery experiences - role play - relaxation
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What are components of the treatment termination stage?
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- review treatment - assessment of goals - anticipate obstacles - create a plan for obstacles - booster sessions
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What are some basic goals for EFT?
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- strengthen the self - regulate affect - create new meaning
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What are the basics of EFT?
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- role of emotion in psychotherapeutic change - therapeutic relationship is essential for change
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What do you promote for the client in EFT?
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= awareness - acceptance -expression - utilization - regulation - transformation
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What are the core emotionals in depression according to EFT?
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fear and shame
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according to eft what are some underlying problems of depression?
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- maladaptive emotion schemes - self-organizations
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What are goals for depression when using EFT?
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- restore the self - access and utilize the existing resources of the personality -transform the depressive self-organization
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What is an overview of EFT for depression?
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- access core emotional experiences & memories - develop alternative emotional response - using emotion to change emotion
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What are some techniques in EFT to use for depression?
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- empty chair: grief - two chair: self-criticism - Empathic affirmation: process intense feelings
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In what populations is short-term dynamic psychotherapy useful for?
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- depression in outpatient popuolation
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What is the framework for psychodynamic therapy?
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- therapeutic relationship as a vehicle for change - neutral, genuine interaction - developmental context - transference/counter-transference - interpretations
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What is the greenburg video?
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- EFT - woman has conflicts w/sister - mother was sick - focused on therapy
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What are the 4 components of case formulation?
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- origins of intrapsychic and interpersonal conflict - defense mechanisms - transference/ count-transference - treatment goals
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What are effective treatments for BP D/o?
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- CBT - Family-focused - group psychoeducation -interpersonal in combo w/psychopharmocotherpy sig. reduction in mood sxs
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What are the componants for self-management for BP D/O?
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- maintaining wellness - mania - depression - suicidality - family and work
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What is meant by maintaining wellness for bp d/o?
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- known risk factors and protective factors
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How do you treatment manic sxs for BP?
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- controlling severity and limiting damage
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How do you treat depressive sxs for bp?
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- awareness of signs and sxs - cognitive restructuring
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How do you treat suicidal thoughts for bp?
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- risk factor - decrease access and increase support systems - reasons for living inventory - prevention plan
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How do you evaluate family and work in BP tx?
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- possible problems (negative emotional reactions) - possible soluations (education) - Work advantages or disadvantages of disclosing illness - accommodation
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How do you bridge the efficacy/effectiveness gap?
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Translational framework w/several stages - developing interventions - piloting/ feasibility-testing - evaluation - implementation
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What are core elements of FIMM?
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Facilitated Integrated Mood Management - education - mood/ sleep monitoring - prodromal signs - medication adherence - substance use 5- session tx -electronic mood monitoring
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What do we learn from the Milkowitz video?
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- treating woman w/BP d/o - have woman exercise (manic safety plan) - wearing glasses (need to wear glasses)
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What are the 7 features that distinguish psychodynamic therapy?
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- focus on affect and expression of emotion - exploration of attempts to avoid distressing thoughts and feelings - identification of recurring themes and patterns - discussion of past experience - focus on interpersonal relations - focus on therapy relationship -exploration of fantasy life
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Does psychodynamic tx for bp work?
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-efficacy demonstrated for depresson - reduction of relapse -reduction of medication greater self-acceptance
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What can we learn from the striker video?
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- widow/grief - transitioning psychotherapy
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Which symptom is specifically targeted in Cognitive Processing Therapy (CPT) for rape victims?
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depression
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Which response is likely to be most adaptive for rape victims, according to Cognitive Processing Therapy (CPT)?
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accommodation
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Which of the following victims of trauma are least likely to be involved in Cognitive Processing Therapy (CPT) as their only form of therapy?
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Survivors of incest sexual abuse
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Which of the following is not a common therapist consideration for therapists performing Cognitive Processing Therapy (CPT) for rape victims?
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CPT certification
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Cognitive Processing Therapy (CPT) for rape victims emphasizes the importance of working through a stuck point. A stuck point is _________________.
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a conflict in beliefs/thoughts that interferes with accepting an event
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What are two components that IPT works on for depression?
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- attachment (threat of loss) - bereavement/grief
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What is an interpersonal inventory?
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In IPT a systemic review of patient's current and past interpersonal relationships
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What is a treatment contract?
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In IPT it covers the goals and expected worst outcome, length and frequency of tx.
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What is the focus for IPT?
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the interpersonal relationships (crucial for therapy) reduce patient's social isolatuion or interpersonal diffulties
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What are stages of interpersonal role disputes?
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- renegotiation - impasse - dissolution
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What is more effective for depression IPT or CBT?
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equally effective IPT combo w/psychopharm is promising
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What are techniques in IPT?
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- exploratory: let pt. discuss what is going on - encouragement of affect: use affect to bring about interpersonal change - clarification - communication analysis: used to examine communication failures - use of therapeutic relationship: model interpersonal relationship - behavior change techniques: modeling, directive, role playing
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How does IPT differ from regular psychodynamic therapy?
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- therapist takes an active role not passive - similar in that transference and countertransference used therapeutically
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What is the best treatment for depressed latinos?
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CBT and IPT integrated therapy
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How do you treat bipolar disorder?
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Cognitive-behavioral approach
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What is the focus of CBT for BP d/o?
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- addressing depression stage and relapse prevention
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What is the structure of CBT sessions for BP d/o?
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- mood charts review - hw review - agenda setting - session summary - homework assignments Recording the session good resource for patients
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What does a tx contract for BP d/o include?
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- early action if signs of dpression or maina - contact list for suicidal thoughts - outlined steps for friend/family to take when in manic or depressive state
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What characteristic of BP d/o might make CBT less effective?
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history of multiple episodes (more than 12)
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What are some considerations for treating patients with BP d/o?
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- medications are usually prescribed so compliance should be addressed in therapy - pts that are noncompliant are at greater risk for relapse
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What are some disadvantages of using CBT for BP pts?
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-pts do not want family involved - focus is depression not mania - hw is time consuming - more sessions may be needed
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What are some cultural considerations for CBT?
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- CBT emphasizes assertiveness, personal independence, verbal ability, rationality, cognition, and behavioral change.
