Psychological Interventions

Question 1

Describe the historical context surrounding Clinical Psychology?

Answer 1

• emerged as a practice in the 19th Century
• The first psychological clinic is credited to Lightner Witmer at the University of Pennsylvania (1896)
• In the U.K., the first clinical psychology clinics emerged at the Tavistock Centre in London in 1926 and the Notre Dame Centre in Glasgow in 1931
• Profession developed after World War II and with the advent of the NHS
• The first ever trainees in Clinical Psychology were trained at the Maudsley Hospital in London in 1949

Question 2

Identify what a Clinical Psychologist does (Llewelyn & Murphy (2014).

Answer 2

• 6 core competencies.
• Assessment
• then Formulation
• then intervention
• then evaluation
• then communication/consultation & service delivery
• then leadership

Question 3

Describe what is meant by the ‘reflective scientist-practitioner’.

(Scientist)

Answer 3

• Evidence-based treatments and recommendations
• Develop hypotheses (almost like a research question)
• Conduct research and evaluate outcomes

Question 4

Describe what is meant by the ‘reflective scientist-practitioner’.
(Reflective - Schon, 1983)

Answer 4

• ‘Thinking on your feet’
• Use of past experience
• Use of psychological theory

Question 5

What is the core purpose and philosophy of the profession (Clinical Psychology)?

Answer 5

• aims to reduce psychological distress
• enhances and promote psychological well-being by the systematic application of knowledge derived from psychological theory and data.
• aim to enable individual service users and carers to have the necessary skills and abilities to cope with their emotional needs and daily lives in order to maximise psychological and physical well-being

BPS, 2010

Question 6

Identify the main stages of developing, evaluating and implementing complex interventions.

Answer 6

Intervention Development
Feasibility and Piloting of the Intervention
Evaluation of the Intervention
Implementation of the Intervention

Question 7

Describe the process of developing interventions.

Answer 7

1. Identify the evidence-base (look at what research has already been done in this area)
2. Interventions should be based on theory (have an early understanding of the process of change that you expect)
3. Important to think about implementation and feasibility

These processes are relevant for researchers and clinicians when developing and delivering interventions for mental health

Question 8

Define what a Developmental Psychopathology Perspective is

Answer 8

how early child experiences influence later outcomes such as mental health in adulthood

Question 9

Why is child and adolescent mental health important?

Answer 9

Observed behaviour in childhood is a risk factor for psychopathology in later life (Caspi et al, 1996)

Intervening during childhood could improve long-term outcomes for children and young people

Question 10

Outline the prevalence rates of emotional and behavioural problems in childhood

Answer 10

Around 10% of children (aged 5-16) in the UK meet criteria for an emotional or behavioural disorder.

Anxiety (3.5%), ADHD (2.2%) and disruptive behaviour disorders (5%) are the most prevalent (Ford et al., 2017)

For 50% of children, conditions persist 3 years later

Prevalence rates of co-occurring conditions are higher for children with neurodevelopmental conditions (autism, intellectual disability)

Question 11

Outline the Challenges in Child and Adolescent Mental Health

Answer 11

It is important that children are not over-diagnosed; behaviours need to be clinically relevant

Behaviours should be considered in terms of what is appropriate for children for their age (e.g. temper outbursts at age 3 vs. age 14)

Diagnosis and assessment may be complicated by the fact that some children are unable communicate how they are feeling

However, if emotional and behavioural problems are impacting children, intervention may be needed

Interventions should be evidence-based, and based on theory. We will discuss some of the key theories in childhood anxiety and disruptive behaviour in the next videos.

Question 12

What is the meaning of Externalising Behaviours in Childhood?

Answer 12

Behaviours directed outward (e.g. aggression, non-compliance, impulsivity)

Attention Deficit Hyperactivity Disorder (ADHD)

Oppositional Defiant Disorder (ODD)

Conduct Disorder

Question 13

Outline what is Attention Deficit Hyperactivity Disorder (ADHD).

Answer 13

• Persistent pattern of inattention and/or hyperactivity/impulsivity at rates higher than would be expected for child’s developmental level
• Occurs before age 12
• Pervasive across settings (it’s everywhere)

Question 14

Outline what is Oppositional Defiant Disorder (ODD)

Answer 14

• A pattern of angry/irritable mood and argumentative/defiant behaviour
• Exhibited with at least one person who is not a sibling

Question 15

Outline what is meant by Conduct Disorder (CD)

Answer 15

An ongoing pattern of behaviour where the rights of others or social norms are infringed

Show at least three behaviours over a 12 month period

Question 16

Describe the Formulation Process

Answer 16

Presentation at Clinical Services
Assessment: What made the person vulnerable in the first place?

Treatment planning: What triggered the behaviour/problem?

Treatment implementation and monitoring overtime: What is causing the behaviour/problems to be maintained overtime? What keeps the problem going?

Question 17

Identify the Key theories to explaining externalising behaviours in childhood

Answer 17

• Parent-Child Interactions
• Executive Function Deficits
• Theory of Mind Deficits
• Media and Peer Influences
• Cognitive Factors
• Neglect
• Socio-economic factors
• Family Environment

Question 18

Explain the Parenting and the Family Environment Theory to explaining externalising behaviours in childhood

Answer 18

Adverse familial environments and parenting practices are commonly observed in families of children who show high levels of externalising behaviour problems (Johnston & Mash, 2001).

Parents are more likely to engage in hostile parenting practices, use inconsistent discipline strategies and show less warmth in interactions.

Child emotion regulation may mediate the relationship between parenting practices and Child Disruptive Behaviour (Duncombe et al., 2012)

Question 19

Describe Socioeconomic factors to explaining externalising behaviours in childhood

Answer 19

• Socio-economic factors play a role in the development of externalising child behaviour
• For children who moved out of poverty, also likely to show a reduction in behavioural problems (not emotional)
• Seems to be related to the amount of time that parents can spend with their child

Costello EJ, Compton SN, Keeler G, Angold A. Relationships between poverty and psychopathology: a natural experiment. JAMA. 2003

Question 20

Describe the cognitive factors to explaining externalising behaviours in childhood

Answer 20

Executive function deficits have been implicated in externalizing behaviour problems in children

Impulsivity, working memory and cognitive flexibility

Some children with ADHD display differences in reward processing (Seidman 2006).

Preference for smaller, immediate rewards over larger later rewards and display greater sensitivity to social rewards (Kohls et al. 2009)

Examiner leaves the room and informs child that if they wait for them to get back they have two marshmallows.
They they call the examiner back immediately, they only get one.

Question 21

Identify what is meant by internalising behaviours in childhood

Answer 21

Behaviours directed inward (e.g. withdrawal, low mood)

Childhood anxiety disorders (e.g. separation anxiety)

Childhood major depression

Question 22

General Outline of Childhood Anxiety

Answer 22

Anxiety in children will overlap with adult anxiety that you will have covered in

‘Introduction to Clinical’
Generalised Anxiety Disorder
Social Anxiety Disorder
Some manifestations of anxiety tend to more prevalent in childhood

Separation anxiety
Disproportionate distress when separated from parents
Distress about harm coming to parents
Unable to sleep alone

A combination of inherited factors and environmental stressors

Question 23

General Outline of Traumatic Life Experiences
and internalising behaviours in childhood

Answer 23

Physical Health Conditions

20% of children experience chronic physical health conditions such as asthma, epilepsy (van der Lee et al., 2007)

Children with physical health conditions experience higher levels of anxiety than children without physical health conditions (Pinquart & Shen, 2011)

Learned helplessness from unpredictability of physical health conditions (e.g. epileptic fits)

Indirect effect by impacting the family environment (Ferro & Boyle, 2014)

Internalising problems also associated with bullying/peer victimisation

Question 24

General Outline of Modelling and Exposure
and internalising behaviours in childhood

Answer 24

Children will use information from people around them to help them learn what is scary/dangerous and what is not (vicarious learning)

Askew, Kessock-Phillip & Field (2008)

Question 25

General Outline of Parenting and how it can cause anxiety in children.

Answer 25

Children whose parents have an anxiety disorder are at increased risk for having an anxiety disorder themselves (Li et al., 2008)

Question 26

Outline the most important risk factors that predict conduct disorder

Answer 26

Impulsiveness low IQ low school achievement poor parental supervision punitive or erratic parental discipline cold parental attitude child physical abuse parental conflict disrupted families antisocial parents large family size low family income antisocial peers high delinquency rate schools high crime neighbourhoods

Question 27

Explain what is meant by SNAP-IV

Answer 27

Assesses child behaviour. Completed by a parent. Items from the DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) are included for the two subsets of symptoms: Inattention (items 1–9) and Hyperactivity/Impulsivity (items 10– 18). Also, items from the DSM-IV criteria for oppositional defiant disorder (ODD) are included (items 19–26) because ODD is often present in children with ADHD.

Question 28

What is the Parenting Scale?

Answer 28

The Parenting Scale (PS) is brief measure of parenting behaviour that measures ‘mistakes’ in discipline of children (Blair Irvine et al, 1999). The PS identifies three factors: (a) Laxness, (b) Over-reactivity, and (c) Hostility The Laxness factor describes the ways in which parents give in, allow rules to go unenforced, or provide positive consequences for misbehaviour. The Over-reactivity factor reflects mistakes such as displays of anger, meanness, and irritability. The Hostility factor reflects warmth and support. The respondent indicates their position between an ineffective response versus its more effective counterpart on a 7-point scale.