Psychotherapy

Question 1

What are six different theoretical orientations mentioned?

Answer 1

1. Psychoanalytic/Psychodynamic
2. Interpersonal
3. Family
4. BEHAVIORAL
5. COGNITIVE
6. COGNITIVE BEHAVIORAL

Question 2

Some common factors among the different theoretical orientations?

Answer 2

1. Expectation (by seeking help, one will CHANGE)
2. Hawthorne effect (improve due to receiving attention)
3. Therapeutic RELATIONSHIP/alliance (important, but relative importance varies according to theory, e.g. BEHAVIORISM < cognitive < CBT < psychoanalytic)

HER

Question 3

For psychoanalysis/psychodynamic: what is this based on, aims, techniques, therapy types, Treatment for;

Answer 3

1. Notion that UNCONSCIOUS conflicts are REPRESSED and can cause difficulty (INSIGHT-oriented)
2. Aims: help make the unconscious conscious; understand the conflicts/behaviors
3. Techniques: free association (think someone on a couch and talks to therapist, while therapist mostly listens, interprets, offers insight), analysis of transference (how does patient react to you, vs COUNTERTRANSFERENCE which is how I would then react to patient), analysis of resistance (understand how patient might respond to you), dream interpretation (FAAD)
4. Analysis is LONG-TERM therapy (multiple meetings/week, usually over several years), while shorter, TIME-LIMITED DYNAMIC therapy focuses on the present
5. Treat: depression, anxiety, some personality disorders (PAD)

Question 4

Interpersonal theory is based on….; aim; what problems are you dealing with? what is therapy like? Treats what?

Answer 4

idea that problematic ATTACHMENTS EARLY IN LIFE will predispose one to develop disorders that are expressed through troubled interpersonal relationships in the present ;

Aim: correct INTERPERSONAL difficulties;

Interpersonal problems: loss and grief, role disputes, role transitions (graduate, move onto residency), interpersonal deficits (no social skills);

Think SHORT TERM (12-16 sessions) and focus on CURRENT relationships;

Treat: depression, eating disorders

Question 5

Family systems theory is based on…; aim; techniques; treats what?

Answer 5

notion tthat identified patient reflects dysfunction in WHOLE FAMILY SYSTEM;

help improve family’s relational health; treating WHOLE FAMILY;

normalizing boundaries (parent lives vicariously through child) and redefining blame (not just child’s fault, but whole family) think TIGER and MEG Griffin;

Treats children with ID’d behavior problems, families dealing with conflict, and teenagers with eating disorders or substance abuse

Think GTA V scene!!

Question 6

Group therapies: treats, based on, what else?

Answer 6

1. Used to treat people with common experiences, a particular disorder, or interpersonal difficulties (
2. Allows members to learn skills, discuss own feelings, as well as provide feedback and support to others (10 people in a group vs. 10 separate sessions)
3. Therapist usually FACILITATOR, usually around 8 people and meet weekly, often TIME-LIMITED

Question 7

Behavioral: based on, aim, techniques, used to treat what?

Answer 7

1. Learning theory
2. Relieve symptoms by unlearning maladaptive behaviors
3. Based on classical and operant conditioning (systematic desens, aversive conditioning, flooding/implosion, token economy, so think BIG BANG THEORY) SF plays at AT&t park!!
4. Phobias (systematic desens, flooding); depression (behavioral activation); autism spectrum disorders (applied behavior analysis/token economy); psychotic disorder (token economy)

Question 8

List phase 1, 2, and 3 of classical conditioning

Answer 8

1. before conditioning has occurred (UCS, or meat powder leads to UCR, or salivation; also present neutral stimulus, a tone, leading to ORIENTING response)
2. Process of conditioning (neutral stimulus comes FIRST, then UCS, or meat powder; followed by UCR with salivation)
3. After conditioning has occurred (CONDITIONED stimulus, the TONE, followed by the CONDITIONED response, or salivation)

Question 9

Describe the graph of change over time in the strength of the conditioned response:

Answer 9

Trials (time) on x axis, and strength of conditioned response on y axis (acquisition first with CS and UCS paired); then extinction is when UCS is withheld and you see strength of CR go down;
with TIME DELAY, you can get a CR that has less strength than peak of acquisition, but if you withhold the UCS and just have CS, there would be the SPONTANEOUS RECOVERY but eventually extinction

Question 10

What is stimulus generalization?

Answer 10

Person generalizes response to things that are SIMILAR to the original TONE, but not the EXACT tone (phobia could potentially become AGORAphobia)

Question 11

Stimulus discrimination is

Answer 11

learning to differentiate among different stimuli (complements stimulus generalization)

Question 12

What are some applications of classical conditioning?

Answer 12

With stimulus generalization, can have development of intense, irrational fears of objects or situations, ie phobias;

SYSTEMIC DESENS uses classical conditioning to treat fears (ie HABITUATION, where you become accustomed to something and respond less to it, and systematic means we go step-wise, like seeing a picture of a clown, then a more aggressive clown, go to circus, then watch actual movie of clown)
ADDICTIONS treatment (think Ant abuse, where you condition alcoholic to think alcohol is NAUSEOUS)

Question 13

Basic of operant conditioning, and examples

Answer 13

Reinforcer: a stimulus event that increases probability that operant behavior will occur again:

1. positive: stimulus that STRENGTHENS the response if it follows that response (put coins into slot machine, get some money, keep putting coins into slot machine)
2. negative: an UNPLEASANT stimulus that, if REMOVED, would strengthen the response that removes the stimulus (in middle of boring date, you say you have headache, date ends early, use same tactic in future!!)

Question 14

A couple facts on delay and size of reinforcement:

Answer 14

1. Effect of a reinforcer is STRONGER when it comes soon after a response occurs (give kid high-five right away for doing good deed)
2. Generally, the LARGER the reinforcer, the more VIGOROUS the behavior (if more money, you will study harder for exam)

Question 15

List the schedules of reinforcement:

Answer 15

1. Continuous reinforcement schedule: reinforcer is delivered every time a particular response occurs (unrealistic)
2. Partial or Intermittent Reinforcement Schedule (reinforcement is given only SOME of the time)
   a. Fixed ratio (fixed number of responses needed for reinforcement, like meeting a quota!!)
   b. Variable ratio (number of responses required for reinforcement varies, so think CASINOS where you could win on third try or 19th try, but every 10 tries on average there will be reinforcement)
   c. Fixed Interval (fixed set of time must elapse before next opportunity for reinforcement, like PAYCHECK)
   d. Variable interval (time interval that must elapse before next opportunity for reinforcement varies)

Question 16

For schedules for reinforcement, what interval schedules will keep people “responding?”

Answer 16

Fixed/variable interval schedules (keep you going across time)

Question 17

Punishment definition and how it differs from neg reinforcement: give examples of punishment

Answer 17

Punishment is presentation of AVERSIVE stimulus or the REMOVAL of a PLEASANT one following some behavior (results in decrease in frequency of a response);
negative reinforcement STRENGTHENS behavior, punishment WEAKENS;
Positive punishment is presentation of an unpleasant stimulus and frequency of behavior DECREASES, vs. negative punishment where you have removal of a pleasant stimulus like ice cream dropping on the ground, leading to frequency of behavior DECREASING

Question 18

Drawbacks of punishment (4)

Answer 18

1. Does not “erase” an undesirable habit, but SUPPRESSES it (could lead to unwanted SE’s)
2. Often ineffective unless given IMMEDIATELY after the response and EACH TIME the response is made (hypothetical way of dealing with speeders and taking out money)
3. Can become aggression, even abuse, if given in anger (Adrian Peterson)
4. Signals what is INAPPROPRIATE behavior, but does not specify correct alternative behavior (shouldn’t do this bad thing, but what’s the alternative)

Question 19

List clinical applications of learning theory:

Answer 19

Behaviors can be changed; try to understand the learning principles maintaining the undesired behaviors and learn NEW RESPONSES to those situations;

1. Systematic desens (patient visualizes a series of anxiety-provoking stimuli but remains RELAXED)
2. Flooding/implosion (direct exposure without possibility of avoidance/escape; aka go straight to Chucky to break the cycle of negative reinforcement without buildup!!)
3. Positive reinforcement (use to alter PROBLEMATIC behavior and teach new skills: think token economy)
4. Aversive condition (classical conditioning principles used to associate physical or psychological discomfort with undesired behaviors)
5. Self monitoring (patient should maintain detailed record of daily activities; used to establish antecedents/consequences based on e.g. patient recording what they’re recording)
6. Stimulus control: modification of environmental cues that maintain or elicit behaviors (e.g. smoke only in certain locations0

Question 20

Cognitive therapy: treatment aims, therapist role, based on…, aim, techniques, treatment type, used to treat

Answer 20

1. Replace presumed distorted appraisals (driven by schemas) with more ADAPTIVE appraisals
2. Therapist will help clients MONITOR thoughts; recognize relations among cognition, behavior, and affect; test validity of automatic thoughts; substitute more REALISTIC cognitions; ID and later alter schemas that predispose people to think in NEGATIVE ways
3. idea that problems develop as a result of errors in THINKING
4. Correct errors in logic (cognitive distortions): think catastrophizing (me in med school), overgeneralization, dichotomous thinking (do all of this project…or none of it)
5. Techniques (psychoeducation and cognitive restructuring, with latter getting people to question thinking)
6. Short-term (12-18 sessions)
7. Depression, anxiety, eating disorders

Question 21

Cognitive behavioral therapy shares; three major classes?

Answer 21

3 fundamental propositions:

1. cognitive activity affects behavior (mediational model)
2. can monitor and alter cognitive activity
3. desired behavior change could be EFFECTED through cognitive change;
4. coping skills therapies (focus on developing repertoire of skills to manage stressors)
5. cognitive restructuring methods (assume emotional distress is consequence of maladaptive thoughts)
6. problem solving therapies (combo of OTHER TWO)

Question 22

For CBT, in addition to mediational nature of CBT, all CBTs share in common; what is the structural framework for CBT?

Answer 22

1. Emphasizes “homework” and outside of session activities
2. direction of session activity (50:50 talking)
3. Teaching skills to COPE with symptoms
4. Focus on patient’s FUTURE experiences
5. Providing patient with INFO about his/her treatment, disorder, or symptoms
6. Focus on patient’s COGNITIVE/INTRAPERSONAL experience (specifically the illogical or irrational thoughts and beliefs)

50 minutes: 10-30-10
First 10: check-in, bridge from last session, brief discussion of week, what’s on agenda
Middle 30: do therapeutic work to help client change and achieve goals
Last 10: summary, “homework” discussion and feedback

Question 23

4 elements to CBT case fomulation? elements of the case-level formulation?

Answer 23

1. Assessment (diagnosis yields info that is helpful; go from NOMOTHETIC to IDIOGRAPHIC, with latter more about patient)
2. Treatment planning (what psychological mechs must change in order to attain goals?)
3. Treatment: usually MANUAL driven (fidelity with flexibility)
4. Continuous monitoring and hypothesis testing (collect data VERY OFTEN and test formulation and monitor progress)

Disorders and problems (symptoms and impairments, NOT just symptoms);
Mech’s: what is causing and maintaining the problems and symptoms;
Precipitants: diathesis-stress model;
Origins: how patient acquired mechs that cause the problems