Podcast
Questions and Answers
Which of the following actions may indicate a patient’s attempt to avoid therapy progress?
Which of the following actions may indicate a patient’s attempt to avoid therapy progress?
What is a significant focus in understanding a patient's interpersonal experiences?
What is a significant focus in understanding a patient's interpersonal experiences?
What is a common method used to identify patterns in a patient's actions and experiences?
What is a common method used to identify patterns in a patient's actions and experiences?
Which of the following statements about the focus of therapy is accurate?
Which of the following statements about the focus of therapy is accurate?
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What role does the therapeutic relationship play in therapy?
What role does the therapeutic relationship play in therapy?
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What is the primary focus of process-based therapy?
What is the primary focus of process-based therapy?
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What does personalizing psychotherapy involve?
What does personalizing psychotherapy involve?
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What is the emphasis of mediation in psychological studies?
What is the emphasis of mediation in psychological studies?
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Why is it important to target mechanisms in therapy?
Why is it important to target mechanisms in therapy?
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What is a key drawback of traditionally focusing treatment on symptom reduction?
What is a key drawback of traditionally focusing treatment on symptom reduction?
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Which method is effective for determining the effectiveness of behavioural activation?
Which method is effective for determining the effectiveness of behavioural activation?
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What does moderation in psychological research typically assess?
What does moderation in psychological research typically assess?
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What were the primary improvements observed with the UP intervention in patients with principal anxiety disorders?
What were the primary improvements observed with the UP intervention in patients with principal anxiety disorders?
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What is one limitation mentioned regarding the UP intervention?
What is one limitation mentioned regarding the UP intervention?
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What does excessive co-occurrence among psychological disorders indicate?
What does excessive co-occurrence among psychological disorders indicate?
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In the SMART design study, what was compared to the full treatment?
In the SMART design study, what was compared to the full treatment?
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How many patients with emotional disorders were involved in the study by Sauer-Zavala et al.?
How many patients with emotional disorders were involved in the study by Sauer-Zavala et al.?
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What does the compensation condition refer to in the context of personalized psychotherapy?
What does the compensation condition refer to in the context of personalized psychotherapy?
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What was the average number of concurrent disorders reported among the 70 patients in the study?
What was the average number of concurrent disorders reported among the 70 patients in the study?
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During the study, after how many sessions were the patients randomized to continue or discontinue treatment?
During the study, after how many sessions were the patients randomized to continue or discontinue treatment?
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What aspect of future psychotherapy research is suggested by the information provided?
What aspect of future psychotherapy research is suggested by the information provided?
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What does mediation in the context of therapy research refer to?
What does mediation in the context of therapy research refer to?
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Which of the following is NOT a requirement for establishing a mechanism in therapy research?
Which of the following is NOT a requirement for establishing a mechanism in therapy research?
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What constitutes a moderator in the context of therapy effectiveness?
What constitutes a moderator in the context of therapy effectiveness?
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What is one of the key shifts in research focus regarding therapy as mentioned?
What is one of the key shifts in research focus regarding therapy as mentioned?
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What is the importance of establishing that a mechanism is malleable in therapy research?
What is the importance of establishing that a mechanism is malleable in therapy research?
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What question does process-based therapy emphasize regarding behavior change?
What question does process-based therapy emphasize regarding behavior change?
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What approach is being contrasted with process-based therapy in the content?
What approach is being contrasted with process-based therapy in the content?
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What is the primary goal of Transdiagnostic formulation in treating eating disorders?
What is the primary goal of Transdiagnostic formulation in treating eating disorders?
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Which of the following is NOT a component of the 'Starting Well' phase in CBT for eating disorders?
Which of the following is NOT a component of the 'Starting Well' phase in CBT for eating disorders?
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How many sessions of CBT-E are recommended for patients with a BMI less than 17.5?
How many sessions of CBT-E are recommended for patients with a BMI less than 17.5?
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What is a key feature of CBT-Enhanced for Eating Disorders?
What is a key feature of CBT-Enhanced for Eating Disorders?
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What is the purpose of self-monitoring in the treatment of eating disorders?
What is the purpose of self-monitoring in the treatment of eating disorders?
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What is the recommended maximum time between meals and snacks to establish regular eating habits?
What is the recommended maximum time between meals and snacks to establish regular eating habits?
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Which of the following describes a significant finding from the meta-analysis of IPT for depression?
Which of the following describes a significant finding from the meta-analysis of IPT for depression?
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Which statement best describes the relationship between CBT and IPT for treating bulimia nervosa?
Which statement best describes the relationship between CBT and IPT for treating bulimia nervosa?
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Why is it important to avoid weighing patients at home initially during treatment?
Why is it important to avoid weighing patients at home initially during treatment?
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What is a common misconception regarding the implications of a single weight reading?
What is a common misconception regarding the implications of a single weight reading?
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In the context of regular eating patterns, how should meals be scheduled?
In the context of regular eating patterns, how should meals be scheduled?
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How should weight trends be examined according to the 'Weekly Weighing' procedure?
How should weight trends be examined according to the 'Weekly Weighing' procedure?
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What is emphasized during the treatment process initially regarding eating habits?
What is emphasized during the treatment process initially regarding eating habits?
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Which of the following is NOT one of Kabat-Zinn's seven attitudinal foundations of mindfulness?
Which of the following is NOT one of Kabat-Zinn's seven attitudinal foundations of mindfulness?
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What distinguishes Mindfulness-Based Cognitive Therapy (MBCT) from traditional Cognitive Behavioral Therapy (CBT)?
What distinguishes Mindfulness-Based Cognitive Therapy (MBCT) from traditional Cognitive Behavioral Therapy (CBT)?
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Which aspect of Acceptance and Commitment Therapy (ACT) is primarily concerned with flexible psychological functioning?
Which aspect of Acceptance and Commitment Therapy (ACT) is primarily concerned with flexible psychological functioning?
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In ACT, what is meant by 'cognitive fusion'?
In ACT, what is meant by 'cognitive fusion'?
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The primary goal of Mindfulness-Based Stress Reduction (MBSR) is to:
The primary goal of Mindfulness-Based Stress Reduction (MBSR) is to:
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What does the term 'defusion' refer to in ACT?
What does the term 'defusion' refer to in ACT?
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Which type of meditation is included in formal mindfulness practices?
Which type of meditation is included in formal mindfulness practices?
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What is one of the focuses of the ACT model regarding personal values?
What is one of the focuses of the ACT model regarding personal values?
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Which of the following describes the term 'experiential avoidance' in ACT?
Which of the following describes the term 'experiential avoidance' in ACT?
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Which of the following statements about mindfulness is true?
Which of the following statements about mindfulness is true?
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What is a common metaphor used in ACT to illustrate the concept of 'creative hopelessness'?
What is a common metaphor used in ACT to illustrate the concept of 'creative hopelessness'?
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What is the primary focus of research on ACT?
What is the primary focus of research on ACT?
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In terms of the practice of mindfulness, informal practice can be described as:
In terms of the practice of mindfulness, informal practice can be described as:
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Study Notes
Psychotherapy and the Brain
- Lecture 18, 2024-11-18
- Topics covered: notable brain areas, cognitive models of anxiety/depression, neurocognitive correlates of change in CBT.
The Brain
- Higher cognitive hierarchy: Prefrontal Cortex, Anterior Cingulate Cortex
- Lower cognitive hierarchy: Hippocampus, Amygdala
Definitions
- Top-down processing: Slow, deliberate, explicit processing using rule-based knowledge; mediated by prefrontal cortex; main target in CBT.
- Bottom-up processing: Automatic, effortless, implicit, and pre-conscious processing based on salient features or stimulus and situational cues; mediated by lower-order brain structures.
Psychotherapy and the Brain (Linden)
- Cognitive restructuring increases top-down control over negative emotion; medication decreases bottom-up reactivity.
- CBT primarily reduces symptoms by impacting higher-order executive functions (e.g., problem-solving, cognitive reappraisal, self-referential thinking).
Depression
- CBT alters activity in dorsolateral, ventrolateral, and medial prefrontal cortices, and anterior and posterior cingulate cortices.
- Mostly higher-order areas.
- Modulates encoding, retrieval of negative associative memories (rumination), and overprocessing of irrelevant information.
Anxiety
- CBT alters activity in the same higher-order regions as well as the amygdala, hippocampus, and anterior and medial temporal cortices.
- More modulation of bottom-up structures in CBT for anxiety.
- PTSD: Increased activity in anterior cingulate cortex and decreased activity in amygdala after exposure plus restructuring
- Social anxiety: Decreased activity in amygdala-hippocampal region after CBT or medication treatment
- OCD decreases activation in orbitofrontal cortex, dorsolateral prefrontal cortex, and anterior cingulate cortex with CBT or medication.
Basic Mechanism: Cognitive Control of Emotion
- Higher-order cortical regions are involved in cognitive control of emotion.
- Cognitive reappraisal involves increased activation of dorsolateral and ventrolateral prefrontal cortex and anterior cingulate cortex, decreased activity of amygdala
- Using strategies to regulate emotions activates top-down processes consistent with CBT.
More recently...
- Neuroscience research has examined functional connectivity changes in relevant brain regions after therapy.
- Shou et al. (2017): CBT increased resting-state connectivity between amygdala and fronto-parietal network in patients with MDD and PTSD.
- Young et al. (2017): Symptom improvement in CBT or ACT for SAD correlated with increased amygdala-vm/vl-PFC connectivity during emotion regulation tasks.
- Mason et al. (2016): CBT for psychosis associated with greater connectivity between amygdala and dlPFC in social threat tasks.
- Gotnik et al. (2016): Systematic review of 11 studies examining brain changes after 8-week MBSR program showed increases in volume, activity, and connectivity of prefrontal cortex, cingulate cortex, insula, and hippocampus, and decrease in amygdala activity and increased connectivity with prefrontal cortex.
Other "Brain" Interventions
- Psychopharmacology: Selective serotonin reuptake inhibitors (SSRIs) are first-line treatment for depression; have a milder side effect profile compared to previous generations. They benefit most with severe depression; most people stop taking them within 3 months.
- Deep-brain stimulation: Neurostimulator implanted in brain sends electrical impulses to specific subcortical regions affecting subgenual cingulate. Mayberg (2005) showed a sustained response or remission for 4 out of 6 people with treatment-resistant depression using DBS for 6 months. Being used for OCD and anorexia.
- Psychedelics: Reiff et al. (2020): scoping review of 161 studies on clinical application of psilocybin, LSD, ayahuasca, and MDMA for psychiatric disorders. Psychedelics-assisted therapy includes preparatory therapy, psychedelic session(s), integrative therapy. Dworkin (2023) examined combination of psychedelics and psychotherapy to explore synergistic effects.
- Narratives about Psychotherapy and the Brain: Perricone et al. (2024): Study to look at beliefs about psychotherapy; tested 3 conditions – brain-level psychotherapy explanation, mind-level explanation and inactive control.
Scaling Up Psychotherapy for Greater Reach
- Kazdin (2017): Survey research showing a treatment gap in mental health care
- Novel models of delivery for mental health services include task-shifting, best-buy interventions, disruptive innovations (e.g., tele-medicine), and interventions in everyday settings.
- Use of technology: psychoeducation, digital treatments, digital assessment, digital training.
- Important to make programs cost-effective, feasible, and appropriate to implement in various settings to increase reach of psychotherapeutic services.
- Schleider et al. (2022): Nation-wide RCT of online single-session interventions for adolescent depression.
Process-Based Therapy: Personalizing Therapy
- Goal is to personalize treatment to target patient mechanisms of change (e.g., cognitive restructuring, or mindfulness in therapy).
- Research has gone toward process-based psychotherapy and not on what does the therapy work for average patients.
- Stumpp & Sauer-Zavala (2021): Explored dimensions of diagnosis, symptoms, psychological processes, personality, and response to, and changes during the treatments.
- Unified Protocol for Emotional Disorders: Farchione et al., (2012) demonstrated effectiveness of UP; but with limitations in comparison groups.
- Sauer-Zavala et al. (2022): Examined a SMART design (sequential multiple assignment randomized trial) in a cohort of patients with emotional disorders and treatment conditions focused on capitalization, compensation, and standard care.
Dialectical Behavior Therapy (DBT)
- Background: Designed to treat chronic suicidality and parasuicidality not responding to other treatments.
- Most patients with chronic suicidal behaviours have borderline personality disorder (BPD).
- Based on Linehan's Biosocial theory of borderline personality disorder.
- The central dilemma in DBT is to accommodate patients' emotional experience while helping change problematic behaviours.
- Therapy involves weekly individual sessions, a weekly skills group session, telephone contact, and therapist consultation team meetings.
- There are several facets of enhancement in capabilities (e.g., enhancing life skills in their groups sessions) to generalize skills outside sessions.
Mindfulness-Based Therapies and Acceptance and Commitment Therapy
- Aims to increase client's awareness of their thoughts, emotions, and physical sensations, accepting them rather than fighting them.
- Mindfulness-based interventions are offered within the framework of Acceptance and Commitment Therapy (ACT). CBT interventions are used as a complementary tool, rather than replacing the existing therapies.
- Hoffman et al., (2010) and Khoury et al., (2015) used both standardized treatment methodologies and large group practices when conducting their research.
Contemporary Psychodynamic and Humanistic Therapies
- Short-term psychodynamic therapy:Focuses on the current emotional state of the patients; aims to help the client understand their personal issues and develop coping strategies with limited treatment sessions.
- Emotion-focused therapy: Targets the emotional experiences and reactions of patients to elicit an emotional response with the ultimate goal to improve interpersonal and behavioral patterns.
- Interpersonal Psychotherapy: Focuses on improving interpersonal relationships and coping in order to improve the client's mental health and wellness.
- Evidence shows effectiveness of different types of psychotherapy for different types of disorders.
CBT for Eating Disorders
- Transdiagnostic approach: Addresses common characteristics across eating disorders. CBT-E uses several modules to address symptoms and external factors.
- "Starting well" involves collaborative formulation, psychoeducation about treatment, self-monitoring, and regular eating.
- Transdiagnostic formulation involves assessing over-evaluation of shape and weight, behaviours, and their impact.
- Self-monitoring, weekly weighing, and regular eating are encouraged.
Behavioural Activation for Depression
- Behavioural models of depression focus on the interaction between the environment and behaviour to promote a particular effect.
- Behavioural activation is a treatment model that aims to increase the client's engagement in positive reinforcement, activities, and goals to improve mood and reduce avoidance behaviours involved in depression.
- Dimidjian et al. (2017) demonstrated effectiveness of BA for pregnant women.
- Ekers et al. (2014) studied effectiveness compared to other treatments for moderate-severe depression.
Exposure Therapy for Anxiety Disorders
- Brief history of exposure therapy, including the work of Joseph Wolpe.
- Proposed mechanisms of change – habituation, extinction, and learning of corrective information.
- Various types of exposure therapies (e.g., graded, systematic, prolonged) and modes of delivery (e.g., in vivo, imaginal, virtual reality).
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Description
This quiz explores key concepts and techniques in psychotherapy, including therapeutic relationships, process-based therapy, and behavioral activation. Test your understanding of patient behaviors and the effectiveness of various therapeutic approaches.