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Psychological Therapies - Coggle Diagram

- - - - therapists preferred change oriented techniques, patients preferred relaxation
        
        Explore why! for some patients relaxation over change may be avoidance
      - anxious therapists avoided exposure or behavioural experiments
- - - - Clark and Wells (1995)
        
        symptoms of anxiety + mechanisms used to cope with the anxiety -> vicious cycle maintains the disorder
        
        self-focused attention -> use of internally generated info to see selves as social objects
        
        "felt sense" believes others see their distorted self. "Felt a geek"
        
        'observer perspective' maintains disorder from loss of attention to external environment to disconfirm beliefs
      - Spurr and Stopa (2002)
        
        safety behaviours may prevent disconfirming negative beliefs and belief in inability to cope if ppl saw physical symptoms fx
        
        reduction in self-focused attiention -> improvements in social phobia
      - Ingram (1990) self-awareness -> an awareness of self-referent, internally generated information
    - - Low intensity CBT for mild-moderate anxiety (NICE)
      - Low intensity CBT efficacious for reducing anxiety, depression and worry in GAD patients (comp against passive control)
        
        however, Morris (2011) says bc self-selected! patient should be afforded choice for effectiveness
      - fewer therapeutic comp. shorter in duro, non specialist can deliver
    - - effectiveness of guided self-help CBT for anxiety and depression (review)
        
        Lovell et al (2008) GSH = ‘involving a CBT-based self-help resource and limited support from a healthcare professional’
      - Part of Stepped Care and NICE recs. HOWEVER: GSH rec based on self-selected samples who may benefit more than clinical samples
    - - CBT for anxiety as effective in routine clinical care as efficacy studies
    - - GAD
        
        CBT (GAD specific) if no response to self-help or psychoeducation
        
        possible harms not systematically researched
  - - - CBT likely superior to ACT for depression (post treatment and follow-up)
    - - component studies for depression: behavioural activation alone as effective as combos
    - - depression underpinned by negative cognitive triad
      - socratic questioning found to improve depression
    - - depression = lack of response-contingent positive reinforcement
    - - CBT produces a 12- to 14-point mean reduction in Beck Depression Inventory scores
    - - best established CBT for depression model (Barton and Armstrong, 2019)
      - negative cognitive triad
- - - - Use imagery: what did you see in mind's eye?
      - HW: collect evidence against thought for balance
      - how are safety behaviours involved in the maintenance cycle?
      - obstacles: low motivation, missing appts. no HW
        
        frame as avoidance
  - - - especially adapted materials
  - - - CBT rec
      - exposure most effective
- - - - formulation made some "sad and worried"
        
        MacNeil (2012) counters that they did not consider protective factors and strengths
- - - - only study supporting emotion regulation added to CBT had enough statistical power
- - - - eliciting info and discussion of derived formulation helps person to evaluate less threatening explanation and beliefs driving distress
  - - - formulation provides a hypothesis about person's difficulties, which draws from psychological theory
- - - - PDT poss. alternative
- - - - evaluate maladaptive thinking
        
        socratic questioning
      - modify maladaptive thinking
        
        thought records with response to thought and adaptive response
        
        behavioural experiments
      - identify maladaptive thinking
        
        automatic thought records
        
        downward arrow technique
    - - Lewinsohn and Clarke (1999)
        
        depression = lack of response-contingent positive reinforcement
      - activity monitoring (including mastery) and scheduling (rate mastery)
      - Contemporary uses FUNCTIONAL ANALYSIS A-B-C that reinforce depression say
      - very effective!!
    - - fear hierarchy (try in session)
      - discourage safety behaviour like reassurance
      - in vivo or imagined if necessary
        
        interoceptive exposure if fear of anxiety symptoms
      - good for anxiety and OCD
    - - 4 toolkits
        
        distress tolerance (relaxation)
        
        cognitive modification
        
        planful problem solving
        
        problem definition
        
        brainstorm solutions
        
        pros and cons to each solution
        
        managing overwhelm (externalisation, visualisation)
      - skills training (boundaries fx)
- - - - cognitive restructuring
      - imagery training
    - - stimulus control
      - sleep restriction
    - - case conceptualisation -> personalised selection of CBT components