Please enable JavaScript.
Coggle requires JavaScript to display documents.
Introduction to Psychological Therapies (Psychological therapy evidence…
Introduction to Psychological Therapies
Waves of Therapy
Psychodynamic
1890s +
Focus: the unconscious
Principles: conflict, free association, hypnosis, transference, counter-transference, dream analysis, projection tests, defence mechanisms Therapies:
Sigmund Freud (1856-1939). ID, Ego, Superego. Life and death drives.
Melanie Klein. Object relations: paranoid schizoid position (early in life) and depressive position (later on in life)
Anna Freud (continued frueds work, with a focus on children)
Winnicot (relationships)
Bion (containment)
Behaviour therapy (1st wave)
1940s
Focus: environmental factors
Principles: operant conditioning, classical conditioning (Pavlov), social skills, relaxation
Cognitive revolution (2nd wave)
1960s
Focus: cognitions > environment
Principles: cognitions cause consequences (Perception precedes emotion audio clip:
https://soundcloud.com/beck-institute
) – there being no emotional reaction to an event if this is not first perceived
Therapies
rational-emotive behaviour therapy (REBT; Ellis, 1974)
cognitive therapy (CT; Beck et al, 1979)
http://www.beckinstitute.org/
cognitive behaviour therapy (CBT)
Cognitive Therapy (CT)
Basic cognitive theory
To understand the nature of an emotion disturbance it is essential to focus on the cognitive content of an individual’s reaction to an external event or stream of thoughts (internal event)
Goal of CT
To change the way clients think by using their automatic thoughts to reach the core schemata/ beliefs and begin to introduce the idea of schema restructuring by encouraging the client to gather and weigh evidence in support of their belief.
.
The thoughts we have impacting our emotions and feelings … changing the way of thinking, might change the way we feel
.there being different levels of thought (some bing unconscious … which can be made conscious by exploration)
Helping people to develop the skills to deal with problems that migh arise from inappropriate thoughts
Simplified CT Model (ABC)
Antecedent - Belif - Consequences
How you think about an event, determines your feelings and behaviours
Cognitive biased/unhelpful thinking
look at slides
Emotionally focused therapy for couples (systemic)
1980s
Focus: attachment bond between the couple
Principles: (pursue-withdraw) cycle, experientially target primary emotions and attachment needs, enactments
Therapies
Sue Johnson
.
.Not only looking at distress within the individual, but within relationships
.often find partners with whom we can “play out” roles that we know from childhood
Looking at primary and not secondary emotions… e.g. if someone is angry, are they really angry or are they manybe hurt but express anger instread because that is more comfortable (more easy for partner to respond to primary emotions – more vunerable, than the more protective secondary emotions)
Applied behaviour analysis (3rd wave)
1990s
Focus: context and function; flexibility
Principles: acceptance, mindfulness, cognitive defusion, dialectics, spirituality, values
Therapies:
meta-cognitive therapy (Wells, 1999)
mindfulness based cognitive therapy (MBCT; Segal, Williams & Teasdale, 2002)
acceptance and commitment therapy (ACT; Hayes, Strosahl& Wilson, 1999)
**
Cognitive analytic therapy (integrative therapy)**
Focus: relationships, traps, dilemmas and snags
Principles: early relationships influence adult relationships; coping strategies can
become unhelpful; collaboration (psychotherapy file, maps, letters)
Therapies:
Anthony Ryle
Steve Potter
Acceptance and Commitment Therapy (ACT)
Based on Relational Frame Theory
Research program examining how the human mind works
Cognitive psychology, animal models
Focus on language (loud or to our selves)
The dark side (can be mean and disruptive to ourselves or others)
Suffering as common to the human experience
Not indicative of abnormal processes (. That negative feelings belong to human life.. and are natural--- but should accept them)
Based on precedence of psychological symptoms & disorders
ACT questions
look at slides
Commonalities and differences between Therapies
Strong Therapeutic Relationship
Empathy - Validating the Patients' Experiences
Genuiness - Being Authentic
Positive Regard - Respect
.
Need a strong therapeutic relationship - otherways not worth doing the theraps (one side of the argument)
Commonalities between Therapies
Mind and behaviour
Early experiences and formation of beliefs/ internal relationships
Trauma and aversive experiences have a potentially unhelpful impact
Different techniques with different names?
Therapeutic alliance
Differences between Therapies
Aims
Location of distress
General model vs. ‘disorder’ specific
Conscious vs unconscious
Past, present, future
Understanding vs change
Language
Look at slides for grid !!
Psychological therapy evidence base, debates and developments
Scientist practitioner/ applied scientist model
Ideas change across time/ perspective
Mid 20th century +
SP = researcher + practitioner
AS = research < practitioner
Apply findings of psychology to mental health
Scientifically validated methods of assessment
Clinical work informed by hypotheses, data gathering, evaluation
What is research?
A search/ investigation directed to the discovery of some fact by careful consideration of study; a course of critical scientific enquiry
Qualitative (bottom-up)
Depth/ detail
Complex issues
Unexpected findings
Generate hypotheses/ theory
E.g., focus groups asking men about sex post prostate cancer
Quantitative (top-down)
Precision
Theory of reliability/ validity
Statistics
Easy comparison
E.g., HADS across services to measure change in mood
Design
Independent variable vs. Dependent variable
Non randomised (NR)
1 group post or pre-post
NR groups post or pre-post
Randomised
Random allocation to 2 or more groups
Intervention vs control arm
- Small N design (behavioural)
Naturalistic case studies
Narrative
Systematic
Meta analysis
Statistical study of studies
Research developments
Practice based evidence (e.g., EFTC) – now much more – research more based on clinical work, not so much on theory
Grant applications require service user involvement
Data collation
Self report
Open ended
Closed ended questionnaires questionnaires
Interviews/ focus gps
Check lists/inventories
Observation
Participants/ text
Systematic counting/ timing of specified behaviours
Evaluation
Does it work?
Efficacy (in research)
Statistical significance
Effect size
Clinical significance
Effectiveness (in services)
Ecological validity
Is it acceptable to people?
Friends and family test
Is it affordable?
Health economists
Ethics
Informed consent
Capacity to consent
Privacy
Confidentiality
Ethics committee
Outcomes
Effect sizes generally medium to large, but wide variation.
Frequently similar to medication.
Range of evidence of a range of therapies across a range of psychological presenting problems.
CBT has most evidence, followed by ACT.
EFTC has most evidence for couple therapies.
Lack of evidence does not mean that a therapy does not work.
Critique the evidence
Quality of research
RCT gold standard, but…
Replicability
Statistics
Low ‘power’ missing possible effects
Data ‘fishing’ increasing chance of type 1 error
NB. Confidence intervals
Publication bias
Experimental hypothesis > null hypothesis
IAPT evidence base
• Thrive
https://www.youtube.com/watch?v=a9eHyZmcLCk
Effectiveness of IAPT (Increasing Access to Psychological Therapies)
Cost benefit
Training and development (CYP IAPT, LTC, SEMH)
Challenges
Application of psychological therapies in different environments
Settings
Mental health services
Primary care (IAPT)
Secondary care
Specialist services (IAPT SEMH)
Physical health services
IAPT LTC (long term conditions)
Psychology services
Community settings
NGOs
Community or critical psychology
Private practice
Growing sector
Limited use of outcome measures
In reality
Evidence based health care/ quality assurance
set of standards, e.g., NICE
Gap between what the ‘evidence’ says is best practice and what happens
Service vs individual offerings
Integrated vs pure delivery
Formulation
Clinical formulation: critique
Allows for consideration of client’s own view of problem and solution
Broadens the definition of “insight”
May help to explain engagement or disengagement with treatment
Many ways of doing it as there are theories
Low agreement levels between clinicians
How to evaluate?
Truth versus usefulness
Useful to whom?
Psychological therapies in 21st century multicultural Britain
Socio-political causes of distress
Economic recession, foodbanks, civil war…
Non-psychology interventions that have psychological benefits
.Possibly differences in risk and protective factors
Stepping out of mainstream delivery
How adapt ‘Western’ psychology models
Working with interpreters/ advocates
Gender and sexual minorities
Psychology and faith/ religion