CLP EXAM 4
Explain when MI is used with clients in clinical settings
"A collaborative conversation style for strengthening a person's own motivation and commitment to change" Now used in all situations in therapy where changed behavior is desired by the client but there is some ambivalence about making the change
Determine whether DBT is an empirically supported treatment & for what
"Well-established" treatment for Borderline Personality Disorder
Describe the 4 areas of BPD symptoms
(1) Identity disturbance and dissociation Unstable self image Chronic feeling of emptiness Shifting goals and values Nonnormative (drastic shifts) Perceptual disturbances (Dissociation or Delusions, Things around you do not seem real) (2) Interpersonal chaos Intense and unstable relationships Lots of trouble maintaining relationships (Devaluation of someone) Frantic attempts to avoid abandonment (Behaviors involved with that) (3) Emotion dysregulation (Shame, guilt, sadness and anger) Frequent negative emotions Problems with anger (4) Impulsivity Impulsive behaviors with outcomes
Describe the structure of behavioral activation & explain how each component of the treatment targets the maintaining factors identified in Learning Objective 3
(1) Orient to treatment (2) Develop treatment goals (3) Individualized targets (4) Applying and troubleshooting (5) Reviewing and consolidating Core components: (1) Activity Monitoring: fills out a form everyday - Looks for ratio of importance to enjoyment - How many important things are you doing, how many enjoyment periods - How rewarding or accomplished do you feel - These target factors in BA by forcing individuals to see what areas they need to work on (2)Areas,Values, Activities: - Values of the specific client - Where the ideographic part comes to plays - Reduce isolation and increase engagement
Describe the cognitive theory of PTSD & how CPT uses this theory to identify treatment targets
- Based on cognitive theory - Individuals organize information into schemas - Traumatic events can disrupt these schemas - PTSD occurs when disruption leads to maladaptive/inaccurate beliefs - Avoidance also plays a key role! - Primary treatment goal: develop balanced beliefs
Describe the origins and evolution of CPT as a treatment
- Based on principles of 2nd wave (Beckian) CBT... - Originally developed for civilian, female survivors of sexual assault and rape.... - Now widely used for all trauma types - Translated and available in 12 languages - Available in individual and group formats - 12 + sessions
Name who developed DBT and who it was developed for
- Developed by Marsha Linehan, Ph.D. - Developed to treat suicidal behavior and self-injury and became a treatment for Borderline Personality Disorder (BPD)
How does BA assume depressive symptoms arise and are maintained?
- Focuses on behavioral conceptualization - Important to understand context and activity KEY QUESTIONS: -- What in a person's life context may have triggered depressive symptoms? -- What patterns of behavior maintain this depression? MAINTAINED: (1) Changes in life context lead to: low positive reinforcement and high aversive control (2) Individual reacts by disrupting basic routines and pulling away (avoidance) (3) Results in more depressed mood and difficulty solving problems CAUSES: -- Prevention of problem solving and connecting with things that increase mood.
Explain the goals of DBT
- To learn how to change behaviors, emotions, & thoughts that cause problems, misery, & distress - To create a life worth living SO: we must... (1) solve the problem (2) feel better about the problem (3) tolerate the problem (4) OR stay miserable
Explain the goals of behavioral activation.
-- Increased Activation -- Decreased Escape/Avoidance -- Functional Analysis: -- What maintains depression -- What is getting in the way of engaging in, enjoying life -- What behaviors are good candidates for max changes How to explain behavioral activation We want to first explain the facts: so events in your life and how you respond to events affects how you feel Example: Life is providing you too many problems and not enough rewards When life is more stressful than rewarding, we want to pull away But, this gives us less of an opportunity to solve these problems and get rewarded We want to become more involved again and solves those problems It has to be tailored to the individual which adds in that idiographic approach.
Discuss empirical support for CPT as a treatment for PTSD
--> APA "Strong" strength of research support for the treatment of PTSD --> Shown to affective individually, group, and in-person, telehealth
Describe the conceptualization of psychological symptoms from a Family Therapy perspective and explain the goals of Family Therapy
--> Conceptualizes psychological symptoms as arising from the family system --> Failure of communication --> NOT focused on the individual --> Goals: Improve communication, Deemphasize problems of an individual, Treat the problems of the family as a whole
Provide examples of life areas, values, and activities
5 life areas that are targeted in BA: You come up w values for each of those areas - Relationships (caring friend → come up with activities that fit in that value) - Education/Career - Recreation or interests - Mind/body/spirituality - Daily Responsibilities
Describe the common features that promote positive outcomes across different treatments
Alliance Cohesion Empathy• Collecting client feedback Adapting Reactance Preferences Culture ******* Probably Effective• Goal consensus• Collaboration• Positive regard• Adapting to: • Stage of change• Coping style
Discuss the efficacy of ESTs for eating disorders
Anorexia nervosa - No intervention has shown clear evidence of superiority - CBT appears to produce benefit for some - Family-based therapy effective for adolescents, but not adults (Maudsley model) Bulimia nervosa - Individual CBT most effective for achieving remission for adults - Family-based therapy most effective for adolescents Binge-eating disorder - Interpersonal psychotherapy (IPT) and CBT have been shown to be effective
Define and provide examples of assimilated stuck points and over-accommodation stuck points
Assimilated stuck points are thoughts that are looking back on the past (e.g., the should have, could have, if only, it's my fault, etc). Over-accommodated stuck points are present and future oriented. (If I let other people get close to me, I'll get hurt again. Expressing any emotion means I will lose control of myself.) The goal is accommodation --> modification of existing beliefs to help resolve the discrepant trauma, which promotes recover
Describe the considerations & definitions of recovery for eating disorders
Before evaluating efficacy, need to determine what a "good outcome" is Varying definitions of recovery Physical: Maintaining a "healthy" body weight Return of menses Bone health Cognitive: Adaptive thoughts about weight and shape (vs. overvaluation) Behavioral: Reductions/cessation in bingeing and purging Reductions in body-checking Still no universally accepted operationalization of recovery
Describe the techniques of (Cognitive) Behavioral Marital Therapy and the assumptions/goals involved in (C)BMT for alcohol use disorders
Cognitive Behavioral Marital Therapy techniques: - contingency contracting - support understanding - problem solving Assumptions and goals: (1) Intimate partner behaviors and couple interactions can be triggers for drinking and the goal is to decrease partner's behaviors that cue or reinforce the client's drinking (2) Intimate partners can reward abstinence and the goal is to strengthen the partner's support of the client's efforts to change (3) A positive intimate relationship is a key source of motivation and the goal is to increase positive couple interactions (4) Reducing relationship distress lessens risk for relapse and improve the client's coping skills and relapse prevention techniques
Identify techniques that the therapist uses to challenge stuck points
Cognitive Restructuring --> Socratic questioning --> Collaborative empiricism --> Behavioral Experiments Impact statement --> Originally a core part of CPT --> Now most versions just use the impact statement twice --> Initial impact statement --> Revised impact statement --> CPT plus written accounts (CPT + A)
Describe the three fundamentals of DBT & Compare/contrast DBT and traditional CBT
CBT: - Skills Training (tracking and learning behaviors, role playing) - Exposure Therapy (exposure to uncomfortable thoughts) - Cognitive Therapy (change bad thinking) - Contingency Management (learn how behaviors are rewarded and punished) Validation: - be respectful - assume emotion makes sense - treat individual as equal but do not agree with bad behaviors Dialectics: - The idea that two contradictory things can be true - We replace the "but" with the "and" - "I accept myself for who I am, and I can make changes to become better"
Determine whether BA is an empirically supported treatment & what for
It is empirically supported for MDD and a strong form of treatment compared to placebo and medication
Identify the different PTSD treatment options
Components of Treatment --> Exposure is Imaginal & In-Vivo and is paired with Cognitive Restructuring Treatments --> CPT, Prolonged Exposure (PE), & More
Determine when Family Therapy is usually conducted & whether it is an efficacious treatment
Conducted adolescent, family crisis, conflicts over values Efficacious for --> Schizophrenia --> Adolescent Anorexia & Bulimia --> Bipolar Disorder (depression) --> Youth antisocial behavior --> Youth substance use
Identify features that predict worse therapy outcomes for individuals
Confrontation Being confrontational Assumptions Assuming things Rigidity Being rigid with the therapy Flexibility without fidelity Flexibility without sticking to what we know works No structure to the treatment
Define and describe Multisystemic Therapy (MST) including why it was developed and therapists' responsibilities
Developed as an intervention for juvenile offenders and their families - Assumes that clinical problems are determined by multiple systems: -- Individual -- Family -- School environment -- Neighborhood Responsibilities: - Deliver treatment in home, school, other community locations - Are available 24/7 - Work on a team (to help with continuity) - Have intentionally low caseloads
Describe the theory and principles underlying motivational interviewing
Draws heavily on client-centered care modality... aka Growth Potential. It needs to use empathy, positive regards, validations, clarify feelings... People make their own decisions; we cannot revoke their choices regarding their own behaviors. People trust their own ideas more than those of others. Causing someone to verbalize one side of an issue tends to move the person's opinion in that direction.
Identify barriers to care for eating disorders
Financial cost Physical distance Stigma Clinician bias Weight bias (against individuals in larger bodies) Minoritized groups Men
Describe each of the four modules of DBT skills & explain how these modules connect to BPD symptoms and maintaining factors
Identity Disturbance & Dissociation --> Core Mindfulness -- Core mindfulness: Use mindfulness Learning to be in control of your mind instead of letting your mind be in control of you Reasonable mind → rationally and logically Emotion mind → your mind is controlled by your emotions Wise mind → complete understanding of everything Integrate the two! Observing & describing emotions Practicing controlling mind, attention, behavior, body, emotions to fully experience the moment Non-judgmental stance Interpersonal Chaos --> Interpersonal Effectiveness Help client become more aware of how behavior affects relationships to make positive changes Objective Effectiveness: Get your objective, What is your main priority? Relationship Effectiveness: Maintain and improve your relationships Self-Respect Effectiveness: Maintain good values for yourself Emotion Dysregulation --> Emotion regulation Understanding one's emotions Reducing emotional vulnerability Engaging in these behaviors to reduce the likelihood to be vulnerable to the emotion mind Treat PhysicaL Illness Balance Eating Avoid mood-Altering drugs Balance Sleep Get Exercise Decreasing emotional suffering Emotion Dysregulation --> Emotion Regulation Learning to tolerate being distressed! Crisis survival strategies Live through a bad situation without resorting to behaviors that will make it worse Distract with other sensations Focus on the attention on something strong, other than the problem Self-soothe Pet my cat Improve the moment Relaxation, prayer, encouragement
Define the "idiographic approach" to therapy & explain why BA is considered an idiographic treatment
Idiographic approach: Psychologists who take an idiographic approach focus on the individual and emphasize the unique personal experience of human nature. BA is considered an idiographic treatment because there is no specific treatment manual and is tailored to the individual
Identify the curative factors of group therapy
Imparting information Instilling hope Universality Altruism Interpersonal learning Imitative behavior Catharsis Group cohesiveness Do i need to know all of these??????????***
Describe the structural components of DBT
Individual Therapy - ONE SESSION per week with an individual therapist - Chain analysis occurs → functional analysis where you take the behavior and piece what happens (what started the events).... What skills could you have used and when for future situations Group Therapy - Skills training (4 modules) Phone Coaching - Therapist can help the client escalate the issue - With their individual therapist Consultation - The support system on the therapist end to help provide the best
Name what MI was developed to treat & describe how it contrasted with treatment as usual at the time
MI was originally developed to treat substance use disorders Observed that Empathy was key to good outcomes!
Describe how therapists use common factors in clinical settings & integrate them into treatment
Nonspecific Factors Expectations that will promote better mental health e.g., faith, hope, expectations "Placebo Effect" Expert Role The notion that the therapist has the training, knowledge, and experience to help resolve problems COMPETENCE Keeping the collaboration but demonstrating there is a knowledge base Relationship/Therapeutic Alliance Nature of the relationship between therapist and client (e.g., empathetic, accepting, non-judgmental) Research supports that this is associated with treatment outcomes Affective bonds Consensus about goals Sense of partnership Building Competence/Mastery Goal is to make client more competent and effective Increase self-confidence in ability to accomplish goals (e.g., problem-solving, how to find a job, how to regulate sleep) Increase in mastery → Increase in feeling good
List and give examples of the elements of an MI-based conversation style
Not directing the individual and not following the individual, but rather GUIDING... Promote: Elicit change talk Understanding client's own motivation Listening with empathy Empowering the client Avoid: Sustain talk (drinking makes me feel really good) Righting Reflex (automatically correct someone when they are wrong) Directional conversation patterns Confrontation
Explain what OARS stands for, how it guides MI-based conversations, and give examples of each of these types of statements
OARS: Open ended questions- It allows for the therapist to learn more about what they care about I understand you have concerns about your drinking, can you tell them about me? Make affirmations- Compliment or statement of appreciation Builds rapport and validates and supports the patient during the process of change Most effective if the patient wants to change Reflections- Rephrase what the patient says and add something digitally Summarize- You point out discrepancies Demonstrate listening to the patient's perspective
Describe the differences between open & closed groups
Open groups are those in which new members can join at any time. Closed groups are those in which all members begin the group at the same time.
Discuss & describe the various treatment settings for eating disorders
Outpatient/intensive outpatient -- Patient can function in normal settings (school, work, etc.) and does not need daily monitoring -- Patient is medically stable -- Outpatient: Weekly (-ish) appointments with therapist, nutritionist, and/or psychiatrist -- Intensive outpatient: 3-5 hours per day, 3-5 days per week, Typically involves therapist, nutritionist, and psychiatrist, Group component - Partial hospital Medically stable but requires daily assessment Eating disorder impairs functioning, but no immediate risk Between residential and intensive outpatient Structure: 5 days per week, 5+ hours per day, Individual therapist and psychiatrist appointments, group, nutritionist - Residential Patient is medically stable Patient is experiencing significant distress and impairment that cannot be addressed at an IOP or partial program 24-hour treatment environment Groups, community meetings, individual therapy Supervised activities and outings - Inpatient Patient is medically unstable or experiencing acute health risk Patient is experiencing severe psychiatric distress (e.g., suicidality) Psychological treatment of eating disorder (psychotherapy and psychiatry), discharge planning Treatment team includes therapist, nutritionist, psychiatrist, medical providers, nurses, etc. Group therapy component Supervised meals and snacks
List and define the components of the MI spirit
Partnership - MI is done with you, for you - Done in practice Evocation - Pulls from a strength based perspective - You have what you need and together we are going to find that within you and help you apply it Acceptance - Effort to see through these individuals eyes and see where they are coming from - Empathy and acceptance Compassion -You want to have a commitment to pursue that person's best welfare
Define and describe the three types of group therapy that we discussed in class including whether they are considered efficacious treatment
Psychoanalytic Group therapy --> Free association --> transference --> interpretations --> working through process --> Sometimes involves other group members Structure: 8 - 10 people, 90-minute sessions, 3x/week Goal: Individual psychoanalysis is still main goal, group dynamics are secondary Established --> NOT well-established but IPT deemed strongly supported for depression and eating disorders Psychodrama Group Therapy --> By J.L. Moreno --> Role-playing --> Act out roles as if in a play --> Past or future events --> Goal: emotional relief and increased self-understanding --> Established: somewhat, needs more research though CBT Group Therapy --> CBT group setting which includes exposure, behavioral rehearsal, modeling, rational restructuring --> Developed for efficiency, rather than a focus on group dynamics --> Comprised of clients with similar problems --> Therapist plays an active and didactic role --> Predetermined time limit (e.g., 1x/week for 12 weeks) --> Established: Well established for social anxiety disorder, GAD, panic disorder, specific phobia, depression, binge eating disorder, bulimia and it is the treatment of choice
Identify techniques used across multiple empirically-supported treatments
Relaxation: Techniques that lead to reduced arousal (i.e., relaxation) Common across several interventions CBT DBT Progressive muscle relaxation An exercise that relaxes your mind and body by progressively tensing and relaxation muscle groups throughout your entire body Mindfulness : 1) Mindfulness in ACT Defusion A skill or technique that is primarily used to detach, separate, or get some distance from our thoughts Looking at thoughts Noticing rather than getting caught up in thoughts Practice exercise: leaves on a stream You're watching the leaf float by and letting it continue on 2) Mindfulness in DBT "What" is mindfulness in DBT? Observe Describe Participate The three "what" skills are "what" you do when you are being mindful You can only do one at a time What you are doing when you are being mindful "How" to be mindful in DBT One-Mindfully Effectively Non-judgmentally The three "how" skills are "how" to be mindful You can do all three at the same time Sleep hygiene Otherwise known as "good sleep habits" Habits to improve sleep health Interventions: Behavioral activation Social rhythms tracking DBT "PLEASE" skills to aid in emotion regulation CBT-I CBT for insomnia Can be incorporated into almost any treatment! From the American Academy of Sleep Medicine: Maintain a consistent sleep schedule Set a regular bedtime Use bed only for sleep and sex Avoid consuming caffeine in the afternoon or evening Limit use of electronics or other stimulating media before bed
Identify the 5 common "themes" addressed in CPT
Safety --> The world is not a safe place Trust --> no one is trustworthy Power and Control --> I am powerless Esteem --> I am permanently damaged, people are cruel and not caring Intimacy --> If I get close to someone they might hurt me
Determine whether Couples Therapy is an efficacious treatment
Well-Established" for Alcohol Use Disorders and there is some evidence that it may be superior to individual CBT Although it is probably efficacious for depression and health-related behaviors
Identify the key features of PTSD
Traumatic Stressors --> exposure to actual death, serious injury, sexual violence.... could be through direct exposure, witnessing, and learning about details Re-experiencing Symptoms --> intrusive thoughts or memories, nightmares, flashbacks, emotional reactions to reminders, physical reactions to reminders Avoidance --> avoidance of external cues (people, places, situations) and internal cues (memories, thoughts, feelings) Negative alterations in cognition and mood --> inability to recall key features of the trauma, Overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, Negative affect, Decreased interest in activities, Feeling isolated Alterations in arousal and reactivity --> • Irritability or aggression, Risky or destructive behavior, Hypervigilance, Heightened startle reaction, Difficulty concentrating, Difficulty sleeping Duration --> needs to be at least one month Distress and impairment --> in relationships, work or school, daily living, symptoms
Describe Couples Therapy including who and what is it intended to treat
Treats married, unmarried, and same sex Treats relationship or psychological problem
Name the different types of depressive disorders & describe the core features of major depressive disorder
Types of depressive disorders: - Disruptive Mood Dysregulation Disorder - Major Depressive Disorder - Persistent Depressive Disorder (Dysthymia) - Premenstrual Dysphoric Disorder - Substance/Medication-Induced - Depressive Disorder due to AMC - Other specified Depressive Disorder - Unspecified Depressive Disorder Major Depressive Disorder core features: - 5+ symptoms present during 2-week period, representing a change from previous functioning - Depressed mood* (ou have to at LEAST have one of these) - Markedly diminished interest or pleasure* (you have to at LEAST have one of these) - Significant increase or decrease in weight and/or appetite - Insomnia or hypersomnia - Psychomotor agitation or retardation - Fatigue or loss of energy - Feelings of worthlessness; excessive guilt - Diminished ability to think or concentrate; indecisiveness - Recurrent thoughts of death; suicide ideation / plan / attempt
Describe the Stages of Change model
Used to predict if a person is ready to consider or make a change within their life. The belief that each change occurs in the following stages-- - Pre-contemplation: not ready for change - Contemplation: getting ready for change - Preparation-Action: ready for change - Maintenance: sticking to it - Relapse: learning (normal within MI) used to maintain longer behavior change
