clinical Psychology Exam 3 Study Guide
clinical Psychology Exam 3 Study Guide 031:013
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This 25 page Study Guide was uploaded by Allysa Yi on Sunday January 11, 2015. The Study Guide belongs to 031:013 at University of Iowa taught by Teresa Treat in Fall2014. Since its upload, it has received 236 views. For similar materials see Introduction to Clinical Psychology in Psychlogy at University of Iowa.
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Date Created: 01/11/15
Clinical Psych Lecture 13 Major Approaches to Intervention Major Approaches to Intervention Shortterm Psychodynamic Therapy 0 Interpersonal Therapy 0 ProcessExperiential Therapy 0 CognitiveBehavioral Therapy Intervention What is Intervention 0 Method of producing changes in behavior thoughts or feelings in context of professional relationship 0 People who end up in intervention is bc they seek it their guardian seek it or court ordered 0 Course of Intervention 0 Initial Contact 0 Assessment amp Case Formulation 0 Implementation and Monitoring of Treatment 0 Termination Evaluation and FollowUp 9 Basically you have to tell them the basics like fees time duration confidentiality everything is secret except for child or elder abuse killing oneself or killing another etc ShortTerm Psychodynamic Therapy 0 Tenets o Unconscious motives conflicts and memories cause maladaptive behavior Typical kind is when something happened during childhood and it39s unresolved 0 Defense mechanisms protect from painful contents of unconscious Denial refusing to admit or recognize problem Repression unconscious exclusion of painful memories impulses fears from conscious awareness 0 Central unconscious conflicts play out in relationship with therapist transference 0 Aims to make unconscious conscious 0 So basically find out what39s the unconscious memoryies that isare causing problems now Bring it to light Far briefer than extended dynamic or analytical approaches It39s SHORT TERM 20 sessions not years like the other ones 0 Techniques 0 Transference patient reacts to therapist as if therapist were important figure in patient39s past Clinical Psych InsighT orienTed Therapy Therapy is supposed To give The paTienT The reason why problems are occurring Bring abouT insighT Aka Talk Therapy 0 Tackling ResisTance idenTifying and undersTanding defense mechanisms such as denial and repression o InTerpreTaTion ClarificaTion and ConfronTaTion TherapisT commenTs on defense mechanisms Transference unconscious conflicTs I All in The inTeresT in making The unconscious become conscious InTerpersonal Therapy IPT TeneTs 0 Clinical problems caused and mainTained by inTerpersonal difficulTies I Problems ThaT could be mainTained due To problems wiTh inTeracTions wiTh oTher people 0 IniTially creaTed To help depression 0 Social funcTioning problems concepTualized as falling inTo one or more of These areas Themes I 1 Gref bereavemenT people who can39T move on afTer someone died process complicaTed by delay and or excess I 2 Role DispuTes diverging percepTions of conflicT wiTh significanT oTher producing significanT disTress I 3 Role TransiTions difficulTy adapTing To change in life circumsTances I 4 InTerpersonal DeficiTs few highqualiTy relaTionships So for This difficulTy you39d Try To help Them sTarT making inTerpersonal relaTionships improve socially 0 Aims To resolve inTerpersonal problems Focus on hereandnow problems raTher Than childhood or developmenTal issues 0 Typically lasTs 1216 weeks 0 Role TransiTion Example 0 EvaluaTe old and new roles I Example STay aT home mom divorced and back To working force 0 IdenTify sources of difficulTies in new role I Example Taking on more responsibiliTies missing more ouT on kids life missing Talking To adulTs which was her husband lonely 0 Develop soluTions for difficulTies I Example build inTerpersonal relaTionship TreaTmenT Phases 1ST phase I DiagnosTic InTerview I InTerpersonal InvenTory review of The paTienT39s paTTerns in relaTionships capaciTy for inTimacy and evaluaTion of currenT relaTionships I PaTienT educaTion Tell Them There39s a link bn mood amp inTerpersonal rlTnships I Clinical formulaTion of paTienT39s difficulTies O O 0 Clinical Psych 2nd phase I Specific sTraTegies and goals vary depending on Theme 0 Role DispuTes Example 0 IdenTify dispuTe o FormulaTe plan for resoluTion of dispuTe 0 Modify communicaTion and or change The expecTaTions To resolve The dispuTe 3quotd phase I Progress and masTery experiences reinforced and consolidaTed I MeThods of dealing wiTh recurrence of clinical sympToms discussed 0 Relapse PrevenTion 0 Techniques 0 00000 Role playing such as if you need To Talk To your boss The TherapisT may preTend To be The boss and They39d pracTice CommunicaTion Analysis EncouragemenT of AffecT ExploraTion of OpTions and Decision Analysis ClarificaTion SupporTive LisTening ProcessExperienTial or EmoTionFocused Therapy EllioTTGreenberg TeneTs o DeficienT emoTional processing is cenTral To human dysfuncTion 0 Principles of emoTional change I Increase EmoTion Awareness I Express EmoTion express and experience previously avoided feelings I Enhance EmoTion RegulaTion develop emoTionregulaTion and disTress Tolerance skills Ex is coping on emoTions somehow I ReflecT on EmoTion view emoTion as source of informaTion I Transform EmoTion acTivaTe more adapTive emoTion along wiTh or in response To maladapTive emoTion 0 Aims To access and explore painful emoTions wiThin The conTexT of a secure TherapeuTic relaTionship TechniquesGoals OOOOO EnTer and Track clienT39s immediaTe and evolving experiences Express empaThy and genuine accepTance and presence wiTh clienT FaciliTaTe muTual involvemenT in goals and Therapy FaciliTaTe opTimal clienT experienTial processing FosTer clienT39s growTh and selfdeTerminaTion FaciliTaTe clienT compleTion of key TherapeuTic Tasks Think of ThaT one of The example was using ice buckeT To chill Them ouT when They39re Trying To bring abouT angry for example feelings again Clinical Psych CogniTiveBehavioral Therapy CBT TeneTs 0 BT Behavioral Therapy Problem behaviors are learned buT iT can be reversed Through applicaTion of learning principles classical and operanT condiTioning 0 CT CogniTive Therapy cogniTions mediaTe bn environmenTal evenTs and behavioremoTion I Remember mediaTional one variable aT leasT parTially accounTs for relaTionship bn Two oTher variables moderaTional one variable influences relaTionship bn Two oTher variables MediaTe is like a circle whereas moderaTe is like 2 Things poinTing To one I Ex inviTed To a parTy where There will be loTs of sTrangers evenT 9 cogniTion 9 emoTion response Goal 0 Aims To modify maladapTive behavioral and cogniTive paTTerns I EiTher unlearn problem or relearn I Ex if someone is scared of parTies bc of social problems Try To relearn iT39s noT scary To Talk To people 0 Focus on presenT funcTioning raTher Than childhood hisTory TreaTmenT Typically lasTs 1216 weeks Behavioral Techniques 0 Behavioral AcTivaTion scheduling acTiviTies To counTeracT relaTive inacTiviTy increasing raTes of pleasurable acTiviTies Open up The person39s world again To help Them socially OfTen used wiTh depression 0 RelaxaTion Training breaThing reTraining progressive muscle relaxaTion mindfulness Techniques 0 Exposure Therapy gradual exposure To feared or avoided sTimulisiTuaTionsexperiences AnoTher way To puT iT is gradual approach Towards anxieTy provoking or disTressing experiences I OfTen used wiTh anxieTy disorders 0 Problem Solving define problem generaTe soluTions selecT besT soluTion implemenTevaluaTe soluTion 0 Social Skills Training rehearsal of increasingly complex behavioral skills asserTiveness Training eTc o ConTingency ManagemenT sTraTegies To decrease undesirable behaviors and increase desirable behaviors CogniTive Techniques 0 IdenTify DisTorTed CogniTions as in whaT39s The disTorTed ThoughTs I AuTomaTic ThoughTs inTermediaTe beliefs core beliefs I Examples I39m a loser I39m sTill going To fail I won39T be able To funcTion eTc o IdenTify The why I MaladapTive aTTribuTions so like whaT caused iT Clinical Psych Good event Bad event unStable Will it persist over time Stable speci c Will it occur in different situations global external Is it because of something about you internal For a depressed person So bad events would be like he ignored me His reasoning is going to be stable global and internal Good events would be like getting an A on an exam His reasoning is going to be unstable specific and external 0 Challenge and replace irrational cognitions I Examine accuracy of probability estimates Decatastrophizing I Develop adaptive cognitive responses So teach people to question their thoughts So if Marcus is thinking that way ask him what evidence do you have In a nutshell Approach Cause of Psychopathology AimsGoals Psychodynamic Unconscious motives Make the unconscious con icts and memories conscious insight oriented cause maladaptive behavior therapy Interpersonal Interpersonal difficulties Resolve interpersonal problems ProcessExperiential Problems in emotional Help people process more processing adaptiver CognitiveBehavioral Maladaptive cognitions and Develop more adaptive behaviors cognitions and behavioral strategies Lecture 14 GET for Panic Disorder Goals 0 To understand the nature of panic attacks panic disorder and agoraphobia 0 To learn about factors that cause panic disorder 0 To learn about this program for overcoming panic and agoraphobia Clinical Psych 0 To deTermine wheTher or noT This program is righT for you Learning To Record Panic and AnxieTy BenefiTs of ongoing recording 0 Help Them feel more in conTrol o IdenTify The ways in which you experience anxieTy physical feelings ThoughTs and behaviors o Able To judge level of anxieTy and panic more accuraTely o EvaluaTe The success of your aTTemst To change There39s usually a panic aTTack record daily mood record and a progress record So you39ll be like This is when I had iT This is whaT happened To my body This is whaT was happening before iT where you were and whaT Things you were Thinking of Triggers are anTecedenTs before If unexpecTed iT means iT is uncued EducaTe Tell clienT ThaT panic aTTacks are noT harmful Tell Them whaT physical changes are acTually for such as increased hearT raTe and sTrengTh of hearTbeaT39s purpose is To speed up deliver of oxygen and removal of carbon dioxide 0 You wanT The paTienT To realize ThaT iT39s a naTural condiTion for your body They need To know iT39s jusT a miss fire bc no acTual danger was presenT of The fighTflighT response BreaThing Skills EducaTion abouT AnxieTyBreaThing Link Panic Disorder is associaTed wiTh chronic hypervenTilaTion or overbreaThing OverbreaThing 0 Chronic hypervenTilaTion IndicaTors Feeling shorT of breaTh Feeling like suffocaTing ChesT pain or pressure FrequenT yawning sighing or air gulping BreaThing quickly and shallowly when frighTened 0 Response To hypervenTilaTion exercise EffecTs 0 Increased oxygen in blood noT Tissue o Decreased carbon dioxide 0 UpshoT less oxygen To brain and body 0 Balance is noT proper OfTen Times people will breaTh ouT of Their chesT buT you wanT Them To breaTh from Their diaphragm o Diaphragm BreaThing I Normal amounT of air SmooTh breaThing I MediTaTive componenT OOOO Clinical Psych CounT as breaTh in quotRelaxquot as breaTh ouT Focus on breaTh PracTice Twice a day for 10 minuTes in relaxing siTuaTions as well as quieT places 0 These will also be recorded Thinking Skills 0 IdenTifying ThoughTs o WhaT am I afraid of And if ThaT were To happen Then whaT And if ThaT were To happen whaT would ThaT mean EvaluaTe Odds of NegaTive ThoughTs 0 Ex Have you acTualy passed ouT before Is iT likely 0 Challenge Your PerspecTive Exposure Facing Physical SympToms o RaTionale I Face sympToms direchy in order To learn ThaT iT39s noT harmful and iT can indeed be ToleraTed o SympTom AssessmenT I IdenTify which exercises produce sympToms similar To Those in panic aTTacks o CreaTe Hierarchy So mosT similar To leasT similar To The physical sympToms you would experience if you were To have a panic aTTack I Rank similar exercises according To anxieTy level 0 010 0 noT similar 5 moderaTely similar 10 exachy The same 0 PracTice I Work your way up The hierarchy 0 Example could be like spinning in a chair Exposure Therapy facing agoraphobia siTuaTions example sTarT wiTh someThing small like someone who has a spider phobia sTarT wiTh an image Then video Then look aT a real spider far away Facing feared acTiviTies are like I wanT To go sky diving so you sTarT wiTh small like imagining iT waTching videos jumping raising hearT beaT so you don39T panic when The same Thing happens eTc Planning for The FuTure MedicaTions can be helpful buT in The fuTure you39d wanT To Try To geT off The medicaTions You wanT To prevenT iT in The fuTure so you look aT your accomplishmenTs deTermine how you39re going To mainTain iT and whaT would you do if you relapse o CreaTe sTraTegies Clinical Psych Lecture 15 Evaluation of Interventions Evaluation of Interventions Key Questions Does a treatment work 0 Statistical significance the reliability of the affect 0 Practical significance the magnitude of the affect How does treatment work 0 Analysis of potential mediators Under what conditions does treatment work 0 Analysis of potential moderators Client characteristics Therapist characteristics Treatmentcontext characteristics Randomized Controlled Trials RCTs 0 Random assignment to treatment and control 0 Purpose to see if treatment actually works 0 Control group possibilities o Waitlist control group I Ex 2 people come in for same reason One gets randomly assigned to for treatments for x amount of weeks and the other just waits control group o Attentiononly control group when therapist provides just support so like heshe just listens to client but doesn39t try to teach the client new skills 0 Treatment as usual 0 Bestavailable treatment Multiple time points of assessment 0 Pre during postfollowup Careful selection of homogenous similar people 0 Clients are similar in diagnoses severity and often don39t have comorbid conditions 0 Careful selection of outcome measures 0 Standardized reliable valid and useful Psychometrically strong 0 Treatment highy standardized o Lengthy manual on what the session is going to be of 0 There may be a video recording of them to make sure that they are adhering or following to protocol Extensive training and supervision of therapists RCTs commonly HIGH in INTERNAL VALIDITY RCTs commonly LOW in EXTERNAL VALIDITY Efficacy vs Effectiveness Studies Clinical Psych Efficacy sTudies RCTs o PrioriTize INTERNAL VALIDITY o ConTrol Types of clienTs in sTudy sTandardized TreaTmenTs randomly assignmenT paTienTs To TreaTmenT and conTrol Effectiveness sTudies o PrioriTize EXTERNAL VALIDITY 0 Seek represenfafiveness of clienTs TherapisTs TreaTmenT conTexT eTc 0 May noT include conTrol groups or random assignmenT 0 Benchmarking sTraTegyquot of evaluaTion compare resulTs To ThaT of RCTs in liT MeTaAnalyTic STudies InTegraTecombine ouTcomes of large number of carefully selecTed sTudies 0 Each sTudy conTribuTes aT leasT one effecT size 0 Average effecT size gives overall magniTude of effecT for parTicular TreaTmenT SubsTanTial variabiliTy in effecT sizes allows examinaTion of moderaTors of effecT 0 Does efficacy of TreaTmenT depend on clienT TherapisT andor conTexT characTerisTics Empirically SupporTed TreaTmenTs ESTs InTervenTions found To be effecTive for one or more psychological condiTions CriTeria developed for ESTs in 1993 by Task force appoinTed by SocieTy for Science of Clinical Psychology SSCP 0 Comparison of TreaTmenT wiTh noTreaTmenT conTrol group alTernaTive TreaTmenT group or placebo in RCT o TreaTmenT musT be superior To comparison groups OR equivalenT To Tx of esTablished efficacy Research musT have power To deTecT moderaTe effecTs Research musT have been conducTed wiTh TreaTmenT manual PopulaTion TreaTed for wellspecified specific problems Reliable and valid ouTcome measures AppropriaTe daTa analyses Chambless amp Ollendick 2001 0 6090 on EST lisT are cogniTivebehavioral 0 Depression can be TreaTed effecTively by number of differenT approaches 0 ESTs Tend To focus on skill building for a specific problem and for brief period of Time no more Than 16 weeks for ESTs o For children and adolescenTs ESTs for exTernalizing problems Tend To include parenTfamily componenTs ReservaTionsConcerns abouT ESTs o Randomized conTrolled Trials RCTs on which The EST lisT is based are fallible imperfecT and no more informaTive Than oTher sources of evidence 0 The EST lisT is biased againsT psychodynamic Therapies Clinical Psych 0 Because some TreaTmenTs ThaT haven39T yeT been sTudied may Turn ouT To be efficacious The EST lisT is unfair o The EST lisT is unnecessary because research shows ThaT all psychoTherapies work equally well Some of The sTudies on which The EST lisT is based are flawed ESTs are noT generalizable To The real world Because ESTs are manualized They consTrain clinical creaTiviTy The EST lisT is fixed and cannoT change in response To new evidence OOOO FuTure Di recTions Consider developing lisT of empirically supporTed principle of changequot InvesTigaTe mediaTors and moderaTors of TreaTmenT EvaluaTe effecTiveness of TreaTmenTs in real worldquot InvesTigaTe efficacy of oTher TreaTmenT approaches Develop lisT of poTenTially harmful TreaTmenTs ConTinue To wresTle wiTh disseminaTion problemquot So basically figure ouT Truly how effecTive The TreaTmenTs are and in whaT condiTions do They work beTTer LecTure 16 Influences on TreaTmenT OuTcome Influences on TreaTmenT OuTcome Common FacTors 0 Shared feaTures of mosT Therapy approaches associaTed wiTh posiTive TreaTmenT ouTcomes o LamberT amp Ogles 2004 Model SupporT facTors lay groundwork for change in clienTs39 beliefs and aTTiTudes learning facTors which lead To behavioral change acTion facTors Ciem CharacTerisTics Problem severiTy number of sympToms impairmenT o More sympToms more impairmenT worse ouTcome Presence of personaliTy disorder 0 Worse ouTcome Lower inTelligence psychological mindedness 0 Less posiTive ouTcome TreaT wiTh behavioral over cogniTive PosiTive TreaTmenT expecTaTions o BeTTer ouTcome Age amp Gender 0 UnrelaTed To TreaTmenT ouTcome Race EThniciTy and Social Class 0 No adequaTe daTa ThaT says There39s a relaTion bn ThaT and TreaTmenT ouTcome PresenTing problem Clinical Psych 0 Example TreaTmenT ouTcome is worse wiTh schizophrenia Than wiTh anxieTy disorder or anorexia is worse Than bulimia TherapisT CharacTerisTics 0 Age amp Gender amp EThniciTy o UnrelaTed To TreaTmenT ouTcome EmpaThy warmTh genuineness o BeTTer ouTcome EmoTional wellbeing o BeTTer wellbeing Then average says ouTcome is also beTTer Experience years menTalhealTh profession o More years of experience do NOT on average show beTTer ouTcome TreaTmenT CharacTerisTics TherapeuTic Alliance 0 QualiTy and sTrengTh of collaboraTive relaTionship Homework bn sessions 0 BesT ouTcome if TherapisT gives homework and if clienT does iT Remember ThaT CBT is The mosT likely To give homework 0 Research evidence for approach for disorder 0 Ranges of approaches effecTive for some disorders I Depression ShorTTerm Psychodynamic Therapy IPT ProcessExperienTial Therapy CBT 0 Specific approach more effecTive for some disorders AnxieTy CBT parTicularly The exposure parT you can drop The cogniTive parT and The educaTion I EaTing IPT CBT Alcohol problems college CBT EducaTion w MI LecTure 17 The DisseminaTion Problem Dissemination problem Broader HealTh Care ConTexT MenTal healTh care cosTs have escalaTed dramaTically over pasT 30 years 0 Increasingly diverTed To ThirdparTy payers which are insurance and governmenT Providers and consumers are losing conTrol over healThcare decisions 0 Decisionmakers healThcare adminisTraTors purchasers of healTh plans insurers CosT pressure and new pharmacoTherapies have changed face of menTal healTh care 0 PercenTage of populaTion receiving care doubled in The lasT 20 years 0 FronTline providers changed To social workers now 0 Increasing focus on cosTeffecTiveness and accounTabiliTy issues DisseminaTion problem SciencePracTice Gap Good News MulTiple psychosocial inTervenTions for specific problems show efficacy effecTiveness and cosTeffecTiveness Clinical Psych Bad News 0 Many wiTh menTalhealTh problems are noT receiving services I 20 of Those wiTh psychiaTric disorder obTained TreaTmenT in lasT year I 40 of Those wiTh lifeTime disorder ever receive TreaTmenT 9 LownoT a loT of people are able To geT TreaTmenT bc of COST 0 MosT received services are noT evidence based Dissemination problem AnxieTy and Depression Gaps in accessing TreaTmenT for anxieTy and depression Collins eT al 2004 Giel eT al 1990 0 Few seek TreaTmenT o 30 of adulTs wiTh mood disorder 0 11 of adulTs wiTh anxieTy disorder 0 lt 20 of children wiTh mood or anxieTy disorder Few obTain evidencebased TreaTmenT o 12 20 receive CBT for panic disorder MosT receive pharmacoTherapy raTher Than psychoTherapy eiTher one works Though PoTenTial barriers Giel eT al 1990 0 Individual facTors such as culTure or readiness for change 0 Provider facTors such as lack of knowledge of menTal healTh problem like General docTors who Think They know all ThaT o SysTemic facTors such as primary care guidelines emphasizing pharmacoTherapy or lack of Training in evidence based care among menTal healTh Training programs DisseminaTion problem Barriers To EBT Evidence Based TreaTmenT AdopTion PracTiTioner Concerns Addis and colleagues 0 TherapeuTic relaTionship will be compromised or ineffecTive I Ie Impossible To develop effecTive TherapeuTic relaTionship while using TreaTmenT manual I Evidence indicaTes ThaT manualized Therapy associaTed wiTh sTrong working alliance bTw TherapisT and clienT o ClienT needs may be unmeT I Ie Manualized TreaTmenTs ignores individual clienT differences I Ie Manualized TreaTmenTs cannoT meeT needs of mulTiproblem clienTs I Ie Manualized TreaTmenTs ignores clienT emoTions I Evidence To The conTrary o Concerns abouT compeTence and job saTisfacTion when using manualized approaches I Ie I don39T have TimeabiliTy To do This I Ie manualized TreaTmenT is uncreaTive consTraining boring unfulfilling I Evidence limiTed buT anecdoTal reporTs posiTive and indicaTes saTisfacTion from faciliTaTing greaTer clienT improvemenT I Concerns abouT TimeabiliTy consTrainTs legiT 0 Lack of moTivaTion To learn manualized TreaTmenTs I Ie My services are already effecTive I Ie Research is noT relevanT To TreaTmenTs of individual clienTs Clinical Psych I Evidence indicaTes percepTions of own effecTiveness can be biased and effecTiveness sTudies indicaTe relevance of research To real clienTs o ResTricTion of clinical innovaTion I Ie ThoughTful and creaTive pracTiTioners will be replaced by Technicians or compuTers I Ie Manualized approaches slow developmenT of new Theories and alTernaTive TreaTmenTs I NoTe ThaT manuals do noT eliminaTe need for highly skilled and innovaTive TherapisTs buT may be legiT role for Trained paraprofessionals or Tech supporTed TreaTmenT sTraTegies o Manualized TreaTmenT is noT feasible reasonable I Ie Trainingsupervision unavailable Too expensive Too Timeconsuming I Ie ImplemenTaTion Too expensive or Too Timeconsuming I Ie ClienTs won39T accepT manualized TreaTmenT I FirsT Two concerns legiT limiTed evidence on laTTer concern EBT Training InadequaTe Weissman eT al 2006 0 Goals To deTermine The amounT of EBT TaughT in accrediTed Training programs in psychiaTry psychology PhD and PsyD social work 0 STudy Design A survey of a represenTaTive sample of all accrediTed Training programs in psychiaTry psychology and social work in The US I ResulTs Few programs required boTh a didacTic course and clinical supervision in EBTs and mosT required Training was nonEBT 0 Two disciplines wiTh largesT sTudenTs and biggesT emphasis on clinical Training have largesT of programs noT requiring courses and clinical supervision in any EBT I Conclusion A considerable gap bn research evidence for psychoTherapy and clinical Training presumably is conTribuTing To The gap bn research evidence and clinical pracTice 0 SO BASICALLY IT WAS leT39s see how many acTually even use EBT Turns ouT iT39s barely used and even mosT didn39T require a loT of supervision when using EBT Conclusions 0 Increasing emphasis on delivery of EBTs buT role of EBT in clinical pracTice highly conTroversial and can be Time and cosT expensive Views of pracTiTioners researchers adminisTraTors clienTs ThirdparTy payers direcTors of Training programs and public are all criTical UrgenT need for furTher research To idenTify amp address barriers To disseminaTion of EBT LecTure 18 InTervenTion ConTroversies CriTical IncidenT STress Debriefing Clinical Psych MosT rouTinely administered inTervenTion immediaTer afTer TraumaTic evenTs Designed To prevenT developmenT of PTSD in wake of disasTer or oTher criTical incidenTquot ConducTed by menTalhealTh provide in groups Typically wiThin 2472 hours of evenT for 23 hours Procedure includes disclosure of ThoughTs and feelings specificaTion of possible sympToms educaTion abouT consequences of Trauma Large Teams of pracTiTioners Typically senT To disasTer scenes To do CISD Seven Phases MiTchell amp Everly 1996 1 InTroducTion STage i Previewsay whaT39s going To happen in meeTing 2 FacT STage i DeTailed descripTion of incidenT 3 ThoughT STage i Think of effecTsaffecTs 4 ReacTion STage i EmoTional 5 SympToms STage i Typical sTress reacTions 6 Teaching STage i STraTegies for managing sTress 7 ReenTry STage i Wrap up discussion and give referrals if needed NOT clear supporT for effecTiveness of CISD CISD may make sympToms worse reason could be reTraumaTizing people especially To Those who have been TraumaTized before CISD may inTerrupT The naTural process of reaching ouT To Those They love and are loved 0 Large majoriTy of survivors go To exisTing supporT neTworks To recover and adapT o IniTial disTress and impairmenT noT necessarily abnormal EvidenceInformed Psychological FirsT Aidquot There39s a manual for iT Goals 0 Help children adolescenTs adulTs and families in immediaTe afTermaTh of disasTer and Terrorism 0 Reduce iniTial disTress caused by TraumaTic evenTs and fosTer shorT and longTerm adapTive funcTioning and coping Basic ObjecTives EsTablish a human connecTion in a noninTrusive compassionaTe manner Enhance immediaTe and ongoing safeTy and provide physical and emoTional comforT Calm and orienT emoTionally overwhelmed or disTraughT survivors Help survivors To Tell you specifically whaT Their immediaTe needs and concerns are 000 Clinical Psych 0 Offer pracfical assisfance and informafion To help survivors fulfill fheir immediafe needs and concerns 0 Connecf survivors as soon as possible To social supporf nefworks including family members friends neighbors and communi ry helping resources 0 Supporf adapfive coping acknowledge coping efforfs and sfrengfhs and empower survivors encourage adulfs children and families To Take an acfive role in Their recovery 0 Provide informafion fhaf may help survivors cope effecfively wifh The psychological impac r of disas rers 0 Be clear abouf your availabilify and when appropriafe link The survivor fo anofher member of a disasfer response Team or To local recovery sysfems menfal healfh services publicsecfor services and organizafions 0 Things To avoid 0 Do nof make assumpfions abouf whaf survivors are experiencing or whaf They have been fhrough Do nof assume fhaf everyone exposed To a disasfer will be fraumafized Do nof pafhologize Mosf acufe reacfions are undersfandable and expecfable given whaf people exposed To The disasfer have experienced Do nof label reacfions as sympfoms or speak in Terms of diagnoses condifions pafhologies or disorders Eye Movemenf Desensifizafion and Reprocessing EMDR Designed To freaf anxiefy parficularly PTSD Componen rs o Educa rion o Desensifizafion Consfrucfion and mainfenance of imaginable represenfafion of memory as well as physical sensafions associafed wifh frauma o Reprocessing Clienf fracks fherapisf moving finger sidefoside during desensifizafion and generafes posifive reappraisals of Trauma or reacfions Shor rferm frea rmen r now on EST lis r and used by VA 0 RCTs o Reprocessing doesn39f provide added benefif o Effecfiveness affribufable fo exposure Confroversial Approaches To Subsfance Abuse 0 Confrolled Drinking Approach To Alcoholism 0 Aims Es rablish confrol or modera rion in drinking Avoid legal social and physical problems 0 Research conducfed by Sobells in 1970s described favorable oufcomes of confrolled drinking programs Treafmenf goals were inconsisfenf wifh ideology of Alcoholic39s Anonymous Clinical Psych I Enormous efforf fo discredif findings I Opposi rion confinues on ideological grounds al rhough da ra now demons rra re clearly fhaf modera rion is a reasonable freafmenf goal for some drinkers o Curren r research focuses on I Clien r characferis rics associa red with successful con rrolled drinking Being employed female and younger all have be r rer response I Iden rifica rion of me rhods fha r bes r facili ra re con rrolled drinking 0 Projecf DARE Drug Abuse and Resisfance Educafion 0 Used by approximafely 50 of school disfricfs 0 Program I Led by police officers in 5J l 6Jrh grade classes for 17 weeks I Focuses on nega rive aspec rs of subs rance abuse amp emphasizes posi rive aspecfs of healfhy lifesfyle o Infui rively appealing 0 Popular wi rh paren rs and adminis rra rors 0 PROGRAM DOES NOTWORK I RCTs DARE has no effecf on preven rion of subs rance abuse I Research evidence insfead supporfs alfernafe prevenfion programs fhaf are no r used widely New Age Therapies Examples 0 Recovered Memory Therapy 0 Psychological dis rress affribu red ro repression of childhood Trauma and resul ring mul riple personali ry disorder 0 Therapy affemp rs To recover losf memoriesquot using hypno ric induc rion fru rh serumquot guided fanfasies Therapis r suggesfion Pasf Lives Therapy 0 Psychological problems due fo having unfinished businessquot from pasf lives invading one39s curren r lives Safanic Ri rual Abuse Therapy 0 Problems resul r from moles ra rion by sa ranic cul r members 0 Rebir rhing and Reparen ring Therapy 0 Clien r no r properly bornquot and Therapy gives clien r oppor runi ry To be reborn and re parenfedquot NO RESEARCH supporf for These approaches and people who use fhem fend fo ignore fhe esfablished approaches in dealing wifh psychological disfress Numerous lawsui rs and e rhical complainfs Concern abou r ex ren r To which Therapy is harmful Clinical Psych LecTure 19 Science amp Pseudoscience in Clinical Psychology CharacTerisTics of ScienTific Clinical Psychology 0 Claims can be TesTed empirically ValidiTy and reliabiIiTy Findings can be replicaTed independenle evidence converges across sTudies and meThods are good 0 PoTenTiaI alTernaTive explanaTions for findings are specified STeps Taken To guard againsT undue influence of personal beliefs and biases on research STrengTh of claims reflecT sTrengTh of evidence CharacTerisTics of PseudoscienTific Clinical Psychology 0 ResisTance To rigorous evaluaTion of claims 0 Claims can39T be evaluaTed adequaTer using sTandard scienTific meThodsquot 0 Focus on whaT39s perceived To be True by advocaTes of claim raTher Than on whaT39s shown To be True by rigorous empirical invesTigaTion o Evasion of peer review of claims 0 Overreliance on TesTimoniaI and anecdoTaI evidence 0 This TreaTmenT worked for person x because person x showed subsTanTial improvemenT afTer TreaTmenTquot Such evidence can be quiTe useful in early sTages of scienTific invesTigaTion Necessary buT noT sufficienT evidence bc many aITernaTive explanaTions oTher Than one claimed 0 OversTaTemenT of evidence for claims Emphasis on confirmaTion raTher Than refuTaTion of claims 0 AlmosT always can find aT leasT some supporTive evidence 0 ScienTific approaches puT ideas aT risk of being proven wrong 0 AITernaTive explanaTions noT specified or evaluaTed 0 Use of obscure impressive sounding or highly Technical jargon To provide superficial connecTions To psychological science Challenges Facing ScienTific Clinical Psychology 0 Clinical pseudoscience far more prevalenT Than clinical science 0 UndersTanding of psychopaThology o MeThods of assessmenT o TreaTmenT sTraTegies Empirical evidence frequenle discarded or dismissed as irrelevanT in face of clinical experience 0 OversTaTemenT of undersTanding of clinical phenomena precision of assessmenTs accuracy of predicTions and effecTiveness of TreaTmenTs Clinical Psych Potential Remedies 0 Asking two questions to avoid being duped trickedfooled o Whaf do you mean 0 How do you know Formal training in critical Thinking skills 0 Accuracy and evaluation of clinical judgment and prediction 0 Distinction bn science and pseudoscience 0 Research methods for evaluation of assessments and interventions 0 Identifying and publishing both empirically supported and empirically unsupported assessments and treatments Education stakeholders about science vs pseudoscience in clinical psychology Working on dissemination distribution problem 0 Promoting science in professional organizations Accreditation of training programs 0 Continuing Educationquot of clinicians o Combafting inaccurate claims 0 Potential sanctions for ethics violationsquot Clinical psych disc 1114 Motivational interviewing focuses on collaboration with clients and addresses motivation to change Key features of MI approach 0 Use a nonjudgmental nonconfrontational stance 0 Attempts to increase awareness of potential problems consequences and risks associated with an individual39s current pattern of alcohol use 0 Presents objective yet personalized feedback based on the information that individuals provide about their alcohol use 0 Acknowledges that each individual might be at a different level of willingnessreadiness to change alcohol consumption patterns including No recognition of an alcohol problem Realization that alcohol consumption is a problem but not yet engaging in action to change Actively addressing the problem Maintenance of reduced alcohol consumption Main goal of MI prompt individuals to think differently about their use of alcohol and to consider the benefits that might result if changes were made 5 basic principles 1 Expressing empathy such as saying quotI can39t imagine what you39re going throughquot 2 Developing discrepancy help client see what they are doing vs what others are doing 3 Avoid argumentation don39t fight with your clients 4 Rolling with resistance so like if the client says I don39t want to do that then your like okay we can do something else 5 Supporting self efficacy belief that you are capable of doing things like changing your life in a good way Design of this study 0 Randomized experiment 0 Control group amp intervention group Clinical Psych 4 primary outcome measure 1 Number of drinks per week 2 Of drinks per month 3 Of bing drinks in the past month 4 Alcohol related problems Alcohol expectancy what do you expect to happen if you drink this amount of alcohol Results Ml worked drinking went down reduction in all categories except for the alcohol related problems Gender is NOT a moderator nor mediator and alcohol expectancies is NOT a mediator nor moderator of group assignment and reduced drinking Perceived drinking norms is a mediator to group assignment and reduced drinking Group assignment gt reduced drinking Up arrow A gender No Perceived drinking Yes Group assignment gt reduced drinking and group assignment gt perceived drinking norms gt reduced drinking Downfalls People may be biased bc they probably chose participants already willing to change whereas those who are seriously alcoholics or something like that may not want to participate because they don39t want to change and bc they may be embarrassed Another downfall is that the followup was 6 weeks and that39s relatively short Selfreport data can be lied about Small sample size Good thing very positive feedback from participants Clinical psych disc 1121 If you change physiological symptoms you can change mental possibly too Progressive muscle relaxation Heartbeat 46x292 Anxious level 2 low level As heart rate goes down relaxation increases Clinical psych disc 125 Ames used RCT randomly controlled trial 0 RCT is a gold standard to compare to two interventions to each other 0 Ames39s 3 groups is behavioral activation BA cognitive therapy CT and anti depressant medication ADM 0 Goals 0 1 Wanted to know how well each of them work 0 2 Examine whether BA or CT is a feasible treatment option for severe depression 0 Assessed people with SCID and used 2 different gold standard questionnaires BDI and Hamilton Scale 0 How it worked 0 Recruited depressed people and made sure they had depression through the use of questionnaires 0 They were randomly chosen to be in either BA or CT and half had actual medications and the other had placebo 0 Pre mid 8 weeks and post 16 weeks assessments were done Behavioral Activation BA Activating behavior There must have been something that the people enjoyed before the depression and trying to encourage them to go back to the things that they enjoyed in order for them to break from being depressed Increase contact with positive reinforcers Clinical Psych Cognitive Therapy CT 0 Changing maladaptive thinking 0 Behavioral dysfunction situation specific negative thinking and cognitive distortion and underlying cognitive beliefs Anti depressants like Xanax Prozac etc Results 0 Severely depressed people who had BA treatment and ADM got better FASTER than CT 0 Combination of BA and ADM is the single most important and best treatment for SEVERE depression 0 For mild depressed people BA CT and ADM are easily and effectively treated with ALL They all basically contribute significantly and fairly equally Symptom severity moderates the relationship between group assignment BA or CT and the decrease in depression BA Determine positive reinforces Determine availability Pursue what client wants make sure the client wants to seek it out Contingency management get a small reward for achieving a specific goal specific positive reinforcement for a specific goal Pair this with BA Clinical psych disc 1212 Short term avoidance works for those with some kind of anxiety disorder such as phobias Avoidance is NEGATIVE reinforcement because it takes away You want them to think of everything that scares them and you want them to face it you want them to be distressed as much as possible Be as engaged in the exposure in order to show the client that their feared consequences are not going to happen make sure those things won39t happen The other reason is to bc you want your client to learn a new behavior responding to the emotion wo avoiding it Third reason is the fact that you want the client to know that the client39s anxiety will lower In reading there was Kevin and Sarah Kevin engaged in a driving exposure because he was scared to drive and Sarah went to a party bc she was scared of social situations Kevin39s worst fear is crashing learned that he39s fine and didn39t get into an accident Sarah39s worst fear is that she would have people not like what she was saying learned that this didn39t happen She actually carried out a good conversation Problem emotion driven behavior occurred which diminishes the FULL exposure For Kevin he was able to drive but he would go slow and kept on checking each mirror For Sarah she didn39t start the conversation and avoided a lot of eyecontact Situational exposure therapy ex If you re scared of dogs go to a dog park Physical sensation emotion exposure therapy ex Breathing deeply and heavily in order to feel like they39re having an anxiety attack It was shown during class It s a physical thing 0 Want to avoid it being blown into a bigger thing Imaginable exposure therapy you imagine a situation or whatever they need to get over Then go through it and try to fix ithandle it Virtual reality exposure therapy a machine to able to seefeel like they are actually in the specific situation Problemlimitation a lot of money Benefits controlled eased into it Reality testing like you39re scared of fainting but how many times have you actually fainted Clinical Psych Data Analysis Statisticalsignificance 0 Probability that effect occurred by chance alone quotpvalue 0 Effect is quotstatistically significant if p lt small value 05 0 Reliability of effect strongly influenced by N sample size 0 Ex p lt 05 so conclude alcohol does influence MSI 9 Relies heavily on sample size the smaller the p the better Practicalsignificance 0 Effect size I d standardized difference bn means SML small medium large 2 5 8 I r association btw variables SML 1 3 5 Statistical is about the reliability Practical is about the magnitude Report both statistical and practical or clinical significance Effectiveness studies evaluate whether or not RCT treatment findings generalizeeffective to a quotreal world setting Efficacy studies evaluate whether or not a treatment works in a research setting 1 Consider the four major approaches to intervention that we discussed in class each of which proposes a particular reason that psychopathology develops For each intervention specify the underlying belief about the etiology of psychopathology and the main goal of the intervention Shortterm Psychodynamic Therapy assumes that psychopathology arises from unresolved unconscious con icts mostly from childhood Accordingly the main goal of this intervention is to make the unconscious conscious in order to resolve psychological distress Interpersonal Therapy posits that clinical problems result from difficulties in interpersonal relationships Therefore the main goal here is to resolve interpersonal con icts Process Experiential Therapy is based on the idea that psychological problems develop due to deficits in emotional processing So the main goal of this intervention is to help the client access and explore painful emotions so that the client may resolve psychological distress CognitiveBehavioral Therapy assumes that psychological problems develop from maladaptive cognitions and maladaptive behaviors Thus CBT has two major components a cognitive component and a behavioral component The behavioral component suggests problem behaviors are learned and thus can be unlearned via classical and operant conditioning The aim is to decrease unwanted behavior and increase desired behavior The cognitive component suggests that maladaptive cognitions contribute to psychological disorders because cognitions mediate the link between what happens in the environment and the behavioral emotional response to that environment Accordingly the cognitive component of CBT aims to identify challenge and replace distorted maladaptive cognitions 2 3 4 5 6 7 8 Clinical Psych Suppose that you were treating a client diagnosed with social phobia and focusing in particular on her marked fear and avoidance of social situations How would you use both cognitive and behavioral techniques to approach her treatment A cognitive therapist would focus initially on helping her to identify distorted or maladaptive cognitions whether automatic thoughts or cognitive errors or maladaptive attributions etc Then she would learn how to challenge and replace these cognitions by a examining the accuracy of her estimates of the probability of a negative outcome in social situations b decatastrophizing her assumptions about the unmanageability of social situations and c developing adaptive cognitive responses to social situations A behavior therapist likely would focus on implementing exposure therapy The therapist would help the client to develop a hierarchy of feared social situations and then gradually exposure herself to increasingly feared situations until she habituated to them ie until her anxiety decreased Suppose you were treating a client who was severely depressed Which behavioral therapy approach might you use to address their severe depression Behavioral activation BA would be the most appropriate treatment for this client BA aims to increase contact with diverse stable sources of positive reinforcement In other words BA helps clients begin to engage in the activities they used to enjoy For clients with severe depression concrete changes in behavior serve as a better treatment focus than changing distorted cognitions Suppose you are an IPT therapist Your newest client is a young woman who recently stopped working outside the home to take care of her firstborn child She meets criteria for depression and anxiety How would you conceptualize her case IPT focuses on 4 conceptualizations or themes grief role disputes role transitions and interpersonal difficulties This case likely would be conceptualized as re ecting difficulties with role transition Your client recently became a mother for the first time which causes enormous change in people s lives Your client is transitioning roles from a working woman without children to a new mother with a child who is no longer working outside the home Why does it require a strong therapeutic alliance b n client and therapist to conduct exposure therapy Before even suggesting the idea of an exposure therapy the relationship between therapist and client must be strong Exposure therapy is necessarily stressful and anxiety provoking for the client Therefore many clients cannot be convinced to face their fears directly unless they genuinely trust and believe that their therapist will support and help them and that their therapist would never ask them to do something that is actually dangerous Why are thinking skills taught in CBT for Panic Disorder Thinking skills are important to GET because of the relationship between thoughts emotions and behaviors According to cognitive theory how we feel and behave in response to events is mediated by our thoughts about those events Thus learning to identify and challenge maladaptive thoughts in response to events can help to reduce negative emotion and avoidance behavior Maladaptive thoughts are very common in panic disorder Clients often believe that the physical sensations that they experience are dangerous and potentially life threatening This understandably fosters avoidance of the sensations and activities or situations associated with them Learning to evaluate these thoughts more objectively can decrease fear and avoidance Explain the theory behind a panic attack Where does it come from The panic cycle starts in a person s body First the person notices an odd physical sensation eg their heart skips a beat or their palms are sweaty Second the person begins to have negative thoughts about having a heart attack going crazy or dying Third these thoughts lead to the feeling of the need to escape to seek help or get medical attention All three parts work in a cycle the need to ee leads to more physical sensations which leads to more negative thoughts which leads to a greater need to ee etc According to GET how should we challenge our negative thoughts There are several steps to challenging a negative thought First identify the specific thought about a feared event eg I am going to throw up in class Second evaluate the real oddsquot of the feared event happening eg 25 9 Clinical Psych out of 100 Third challenge your perspective on the feared event by considering whether it would be survivable and ways of coping with it Why might breathing retraining be frightening to a client with panic disorder Clients with panic disorder typically are very sensitive to their breathing patterns and to any changes in them These clients commonly engage in mild chronic hyperventilation in which too much air is taken into the body Breathing retraining aims to eliminate the chronic hyperventilation by encouraging smooth breaths of normal amounts of air from the diaphragm This change in breathing patterns commonly frightens someone with panic disorder and it often feels like they aren t getting enough air 10 All treatments on the EST list must be shown to be efficacious in at least 3 RCTs Why is this considered a conservative criterion It is necessary for all ESTs to be supported by at least 3 RCTs from 3 different labs because of the need for clear converging evidence that a treatment works This is considered a conservative requirement because conducting RCTs is time money and resourceintensive If the EST list only required 1 RCT in support of a treatment that would be considered a liberal criterionquot since that could be more easily attained 11 What are the two possible explanations for the dissemination problem The dissemination problem may be occurring for many reasons a It is too expensive to train and to supervise therapists in ESTs b Practicing therapists may not believe that using ESTs is necessary c Practicing therapists are too busy with current clients to learn ESTs d Practicing therapists often believe that all treatments work equally well for all disorders e Practicing therapists often believe that ESTs developed in research context won t work in the real worldquot of mentalhealth service provision 12 When evaluating interventions researchers ask the following questions 1 Does a treatment work 2 How does a treatment work 3 Under what conditions does treatment work Discuss how researchers answer each of these questions Does a treatment work Researchers answer this question by assessing the statistical and practical significance of an intervention If the p value is less than 05 then there would be evidence of statistical significance The magnitude of the effect is indicated by its effects size as shown by d or r Typically we expect to see at least moderatemagnitude effects for treatments that quotworkquot How does a treatment work Researchers answer this question by investigating the mechanisms by which the treatment works known as mediators Under what conditions does a treatment work Researchers answer this question by investigating the conditions under which a treatment works known as moderators 13 What are the difference b n efficacy and effectiveness studies Efficacy studies also called randomized controlled trials are much more controlled and standardized than effectiveness studies Randomized control trials include outcome measures that are standardized reliable valid and useful The treatment is highly standardized by requiring adherence to a detailed treatment manual These studies also typically select a homogenous sample without comorbidities Patients are randomly assigned to the treatment or control group Efficacy studies prioritize internal validity Effectiveness studies investigate if interventions work in a real world setting These studies use clients therapists and settings that are representative These studies may not have a control group or random assignment Effectiveness studies prioritize external validity 14 What are some potential mediators of the effects of CBT on anxiety disorder Broadly speaking the potential mediators of the effects of CBT include cognitions and behaviors as maladaptive cognitions and behaviors are assumed to maintain psychopathology and CBT focuses on modification of both maladaptive cognitions and behaviors Specifically potential mediators might be overestimation of the likelihood of a negative event catastrophic thinking chronic hyperventilation and avoidance of feared circumstances 15 Research has shown that certain characteristics of the client therapist and treatment are positively related to treatment outcome while others are unrelated or negatively related to Clinical Psych treatment outcome Why is it important to understand these in uences on treatment outcome It is important to understand the in uences of certain characteristics on treatment outcome in order to provide the most efficient and effective mental health care possible For example knowing that better outcome is associated with a stronger therapeutic alliance highlights the importance of developing and maintaining such an alliance with your clients As another example research suggests that the mentalhealth profession of a therapist has is not significantly related to treatment outcome This knowledge may reduce the cost of proper treatment as it may not be necessary for a client to receive care from a more expensive provider with a PhD as opposed to less expensive provider with an MSW This allows more people to receive affordable mental health care 16 What does the research literature indicate about whether all therapeutic techniques work equally well for all disorders The research literature indicates that some psychological problems such as depression can be treated effectively by a variety of evidencebased therapeutic techniques including IPT CBT shortterm psychodynamic therapy and processexperiential therapy This does not mean that depression can be treated effectively by all possible techniques of course just that it can be treated by several different techniques In contrast research indicates that other psychological problems are more responsive to some therapeutic techniques than others For example anxiety clearly is treated best by CBT and most importantly by exposure therapy 17 Define the term common factors and list three examples How are they related to therapeutic outcome Common factorsquot refer to the shared features of most therapy approaches all of which are associated with positive treatment outcome There are several examples of common factors including trust genuineness empathy therapist alliance etc 18 If you were a cognitivebehavioral therapist what kinds of techniques would you emphasize or deemphasize when working with a client with lower intellectual functioning Clients with lower intelligence typically respond better to more behavioral techniques than to cognitive techniques Behavioral techniques often can be presented in more concrete simple ways whereas cognitive techniques tend to demand strong analytic thinking skills 19 How do training programs play a role in the dissemination problem Part of the difficulty in making EBTs available to consumers in realworld treatment contexts is that most mental health professionals are not well trained to provide EBTs Very few training programs provide extensive training in EBTs and the training programs that produce the most mentalhealth service professionals on average provide the least training in EBTs 20 Why is the role of EBTs so controversial in clinical practice The role of EBTs is controversial in practice because not all clinicians believe it is necessary or effective to use an EBT to help their clients Many experienced therapists feel that EBTs restrain clinical creativity and make it more difficult to establish rapport Additionally many therapists do not feel that they have the time or interest to learn how to use multiple EBT manuals However other clinicians see the merit of EBTs and use them Importantly insurance companies are becoming increasingly interested in providing third party payment only for EBTs so this controversy has a direct effect on what services are available to consumers 21 Consider the framework for thinking about treatment barriers Name each category and provide some examples of the barriers each category might face Why is this framework useful The framework for thinking about treatment barriers can be separated into individual or client barriers provider barriers and systemic barriers Individuals may face these barriers desire to handle own problem on their own lack of knowledge of available treatment willingness to get treatment minimizing the severity of the problem etc Providers may face these barriers skill in assessing mental health problems level of distress in clients business amp structure of practice etc Systemic providers may face these barriers emphasis on pharmacotherapy lack of knowledge about what is evidencebased limited availability of specialized mental health providers etc This framework is incredibly helpful because it provides a hierarchy of in uences on barriers to effective Clinical Psych mental health care It highlights the need and opportunity to address this problem on multiple levels 22 Thought question Dr Treat has identified several treatments that are controversial for 23 24 25 various reasons What are some of the ways a treatment can be controversial Then identify an example from class There are many ways in which interventions can be controversial First an intervention may be controversial if research suggests that it is ineffective but it continues to be widely practiced Some may perceive this to be unethical as patients are receiving ineffective treatmentprevention Examples of this are CISD and project DARE Second an intervention may be controversial if it works for reasons that are different than what the experts claim For example EMDR is successful in reducing symptoms of PTSD however research suggests that it has nothing to do with the reprocessing of neural pathways related to memory which is a major claim of the developers of EMDR Third an intervention may be controversial on ideological grounds The Controlled Drinking approach is an example of this Historically society tells us that the ONLY way to beat addiction is to abstain However research now suggests that moderating alcohol consumption ie the Controlled Drinking approach can be an effective strategy for reducing alcoholrelated difficulties for some individuals The approach continues to be controversial because it contradicts widely held societal beliefs If EMDR does not work in the way that the EMDR experts claim then why does it work Why is it on the list of empirically supported treatments EMDR is on the list of empirically supported treatments because at least 3 RCTs from different labs suggest that it works EMDR experts believe this treatment works in part because clients move their eyes back and forth which they argue alters neural pathways associated with traumatic memories However research indicates that EMDR works because of the exposure aspect of the treatment which is called desensitization The client details their traumatic event to the therapist during EMDR It is the process of repeated exposure to the memory of the trauma that serves as a significant mechanism of change in EMDR Connect the maintenance of DARE programs in school with topics previously discussed in this class What are some of the factors that will in uence their retention in schools Think broadly about potential in uencing factors for parents and administrators DARE programs as discussed in lecture may continue to be implemented in schools due to their broad appeal to parents and administrators It seems intuitive that speaking with children about leading a drugfree life would be helpful This may be an example of how our personal beliefs in uence our views on the how effective an approach is just as we have discussed regarding astrology and lie detection Also consider how administrators and parents may react to hearing that the program is not effective this would likely be met with a great deal of resistance Due to personal beliefs about the effectiveness of the program parents and administrators may discredit evidence claiming that the program is not beneficial One of your friends approaches you and shares that she is considering engaging in treatment for what she considers to be very problematic drinking She mentions that her mental health provider is having her engage in the Controlled Drinking Approach to Alcoholism Consider factors that may be related to how your friend views this treatment how acceptable it is to her It is possible that your friend has expectations about treatment which lead her to believe that abstinence is the only way to remedy drinking problems This may affect how effective the treatment may be for her and it may potentially make her hesitant to engage in treatment Further should your friend not have serious legal or physical problems associated with drinking she may think that the treatment isn t for herquot as her problem does not quotmatchquot with one of the basic aims of this approach Additional factors may include her education about the effectiveness of this treatment as the data have shown that moderation is a reasonable goal in treatment for some drinkers
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