PSYC 391 Lecture 11 PDF

PSYC 391 Lecture 11 July 19, 2024 Outline 1. Elements of Change 2. Some Disciplines of CP Health Psychology Clinical Neuropsychology Clinical Forensic Psychology Quiz #3 next week July 26 After quiz, guest lecture on private versus public work...

PSYC 391 Lecture 11 July 19, 2024 Outline 1. Elements of Change 2. Some Disciplines of CP Health Psychology Clinical Neuropsychology Clinical Forensic Psychology Quiz #3 next week July 26 After quiz, guest lecture on private versus public work 2 Elements of Change 3 Intervention: Elements of Change A Focus on Process In addition to studying therapy outcomes, research has examined client, therapist, and process variables that influence outcomes Process research Examine patterns evident within and across therapy sessions Understand therapeutic process, what is going on in therapy Process-outcome research Examine how therapeutic process variables affect outcome Understand how an intervention works Level of analysis varies 4 Intervention: Elements of Change Client Factors Client characteristics other than diagnosis are relevant to treatment outcomes If you know the impact of these characteristics, you can tailor your approach to be optimal for your client Relevant factors: Socioeconomic status Ethnicity Gender Age 5 Intervention: Elements of Change Client Factors Relevant factors continued: Symptom severity Functional impairment Personality disorders Psychological mindedness Psychological reactance Treatment expectations Use knowledge of client characteristics to adjust approach Likely most relevant to decision to seek and engage in therapy After therapy starts, relationship/process more relevant 6 Intervention: Elements of Change Therapist Factors Look at impact of therapist on client’s response to treatment Relevant factors: Better outcomes if trained in a mental health discipline Therapist experience (to a limited extent) Therapist emotional well-being Self-disclosure Sum of a therapist’s personal qualities is more relevant Clients of effective therapists feel more understood See variability in client outcomes due to therapist factors More variability with more severe problems 7  Intervention: Elements of Change Treatment Factors Look at whether some aspects of therapy are especially important to achieving change Relevant factors: Interpretation Average effect low, higher if client has good interpersonal skills Directiveness More effective if clients are low in psychological reactance Insight vs. symptom reduction Insight helps if introspective, introverted, or internalizing Symptom reduction if impulsive, under-controlled, externalizing Between-session assignments Helps if assign, helps more if client does the assignment 8 Intervention: Elements of Change Cautions in Research Different studies assess these variables in different ways Harder to synthesize the findings Research is generally correlational Can’t make causal inferences Can’t conclude that a therapy process variable is actually important or critical Effects may vary depending on how well a technique is matched to a client 9 Intervention: Elements of Change Common Factors in Psychotherapy David Barlow The Unified Protocol is a transdiagnostic treatment Help patients learn new ways of responding to uncomfortable emotions Many argue for the importance of common factors in therapy Contributed to focus on integrative treatment models Focus on common factors, incorporate aspects of multiple approaches Most therapists rely primarily on one conceptual framework and complement this approach with techniques from other frameworks 10 Intervention: Elements of Change Factors (Support, Learning, Action) Support Reducing isolation Providing reassurance Therapeutic alliance Therapist expertise Therapist respect, empathy Exploration of assumptions, beliefs, expectations 11 Intervention: Elements of Change Factors (Support, Learning, Action) Learning Advice Cognitive learning Emotional experiencing Insight Feedback Development of mastery Behavioral regulation 12 Intervention: Elements of Change Factors (Support, Learning, Action) Action Practice Modelling Reality testing Facing fears Working through issues of acceptance, warmth Catharsis Releasing tension 13  Intervention: Elements of Change Evidence-Based Psychotherapy Relationships Aspects of the therapeutic relationship that are associated with treatment success APA task force Identify elements of effective therapy relationships Determine methods of tailoring therapy to individual client characteristics Considered both experimental and correlational research Categorized treatment elements according to research support 14 Intervention: Elements of Change Demonstrably Effective Elements Alliance Cohesion in group therapy Empathy Collecting client feedback Adapting to client reactance/resistance level Adapting to client treatment preferences Adapting to client culture/religion/spirituality 15 Intervention: Elements of Change Probably Effective Elements Goal consensus Collaboration Positive regard Adapting to client stage of change Adapting to client coping style 16 Intervention: Elements of Change Task Force Recommendations For practice Create relationship characterized by these elements Adapt relationship to specific client characteristics Monitor client responses to the relationship and ongoing treatment Use evidence-based therapy relationships and evidence-based treatments adapted to the client For training Train in these elements and methods for adapting therapy Provide continuing education in the same Develop relevant accreditation and certification criteria 17 Intervention Disciplines for this Class Health Psychology Clinical Neuropsychology Clinical Forensic Psychology 18 Health Psychology 19 Intervention Health Psychology Lifestyle factors have replaced germs as the major threat to a person’s health Individual behaviors Moods Stress People with serious illnesses have increased life expectancy Psychology can play an important role in health promotion, the treatment of disease, and rehabilitation 20 Intervention Disability Impairment, activity limitation, and participation restriction Medical model Disability is a characteristic of a person To correct, must treat the person Social model Disability is a function of the physical and social environment Biopsychosocial model Takes into account biological, individual, and social factors associated with participation in various activities Disability determined by interaction between health condition and contextual factors 21 Intervention Clinical Health Psychology Apply psychological research and principles to promote and maintain health, prevent and treat illness, help people adjust to health problems, and improve the health care system Reduce disability, increase positive aspects of functioning Research, teaching, and practice related to health Require additional knowledge/training in: Normal lifespan development Behavioral medicine and psychological issues related to health If working with kids: Behavioral medicine and psychological issues related to the health of children Developmental psychology 22 Intervention Prevention and Health Promotion Promote a healthy lifestyle Prevent the development of health problems Targets: Smoking Drinking Obesity Exercise 23 Intervention Assessment Work with patients dealing with any type of health problem Need to know about disorder, risk factors, diagnostic and treatment procedures Consider mental health, personality, coping style Consider understanding of condition, how it is likely to affect them Consider quality of relationships, social support, relationships with caregivers Consider nature of healthcare system, barriers 24 Intervention Intervention Identify strategies to help people cope with, adjust to, and alleviate health conditions Methods: Respondent methods Extinction, systematic desensitization Operant methods Train others to reinforce more desirable behavior, contingency contracting Cognitive-Behavioral Techniques Self monitoring, cognitive restructuring, behavioral analysis Biofeedback Learn to modify or control physiological processes 25 Intervention Intervention Individual or group Examples: Pain management Treatment of sleep disorders Coping with medical examinations and procedures Preparation for surgery Compliance with treatment regimens May be limited to a few sessions 26 Intervention Pain Management Exercise and fitness Education about pain Cognitive restructuring Goal setting Problem solving Biofeedback Acceptance and commitment Relaxation Generalization and Hypnotherapy maintenance Mindfulness Contingency management 27 Intervention Training Most train as clinical psychologists first Health psychology often an “add on” to standard programs Are some clinical health psychology programs Up to 1/3 of programs offer some training in this concentration A few programs offer formal training in child clinical health psychology Can become board certified 28 Intervention Challenges Role still largely undefined Issues of status May have competing goals Need to document effectiveness of approach Data on health psychology largely unknown by physicians Overemphasis on biological origins of health problems in medical settings Patients may be resistant to psychological interventions and explanations Role of ethnicity and other factors unclear 29 Clinical Neuropsychology 30 Clinical Neuropsychology Apply knowledge of brain-behaviour relationships in the assessment and remediation of neurological injury/illness Address the affects of neurological problems on functioning Non-invasive method of describing brain functioning based on performance on standardized tests Tests shown to be accurate and sensitive indicators of brain- behavior relationships 31 Clinical Neuropsychology Additional Knowledge/ Training Required Neuroanatomy, physiology, pharmacology Human neuropsychology and neuropathology Neuropsychological assessment Adaptations Clinical and neuropsychological intervention Lifespan development If working with kids: Developmental psychology Relevant assessment and intervention strategies 32 Clinical Neuropsychology Role of Neuropsychologists Often called on by neurologists or other physicians to help establish or rule out particular diagnoses Can often make predictions regarding prognosis for recovery Role in intervention and rehabilitation Assessment findings have implications for treatment Results may provide guidance regarding which domains of functioning to target May evaluate clients with mental disorders to predict course of illness and tailor treatment strategies to client’s strengths and weaknesses 33 Clinical Neuropsychology Assessment Historically diagnostic, aid in localization of lesions Determine if there is an organic basis for problems, identify precise area affected Assess cognitive functioning, emotional, behavioral, and psychosocial difficulties, functional status 34 Clinical Neuropsychology Purpose of assessment varies: Diagnosis: Is problem neurological/psychological? What is the nature/extent of the problem? Is the damage focal or diffuse? Prognosis: predict future functioning, is the damage permanent? Treatment planning and rehabilitation: identify interventions that may be of benefit Legal proceedings: capacity assessment, disability, criminal responsibility 35 Clinical Neuropsychology Interpreting Assessment Results May interpret in context of normative data May look at difference scores between two tests Note and interpret pathognomonic signs of brain damage (e.g., failing to draw the left half of a picture) May do a pattern analysis of scores Certain patterns have been reliably associated with specific neurological injuries or impairments Statistical formulas that weight test scores differentially are available for certain diagnostic decisions May get best results using normative data Helpful to also consider qualitative data 36 Clinical Neuropsychology Variables that May Affect Performance Test scores differ according to sex, age, education Use appropriate norms Influenced by handedness, premorbid ability, chronicity of neurological condition, presence of other physical conditions Need to consider motivational variables Arousal, level of cooperation, medication Malingering 37 Clinical Neuropsychology Intervention Identify strategies that will help remediate effects of neurological problems Coordinate cognitive and behavioral treatment Targets: Help clients “relearn” lost skills Overcome impairment by teaching new strategies Target impaired skill Adjust difficulty Provide feedback Base on collaborative goal setting 38 Clinical Neuropsychology Intervention Targets: Compensate for impairments by modifying the environment or by using aids so that the patient is capable of carrying out an activity Incorporate external cues, technology Address social, psychological, and physical barriers to participation Research evidence is limited Modest improvement in attention, visuospatial, and language deficits Support cognitive and behavioural interventions for children with acquired brain injury Need to focus more on prediction and rehabilitation 39 Clinical Neuropsychology Training to be a Neuropsychologist Specialty training is required Recognized as a specialty by the CPA May start with generalist training in clinical psychology Need to supplement with specific coursework and practicum experience relevant to brain-behavior relationships Is an integrated training model for neuropsychologists Small number of specialist doctoral programs Can learn through postdoctoral training Can become board certified in neuropsychology American Board of Clinical Neuropsychology 40 Clinical Forensic Psychology Intervention 41 Clinical Forensic Psychology Typically aim to reduce likelihood to reoffend May focus on restoring person to state of mental competence Often focus on personality problems, sexual behaviour, and aggressiveness While incarcerated or outpatient Individual and group, range of techniques, Problem solving, social skills training, cognitive restructuring, impulse control May be required to legally testify in court Interests of court, attorney, client and clinician may be at conflict Clinical Forensic Psychology Typically court ordered by judge or probation officer Consequences for not attending and participating Introduces a different power dynamic between therapist and offender The client is actually the government because you are providing services to reduce the likelihood of the individual to re-offend Different limits to confidentiality Good Lives Model of Offender Treatment Strength based approach equipping clients with the resources and skills necessary to have a ‘good life’ that is meaningful to them, while also being socially acceptable 2 main goals enhancement of offenders' well-being reduction of their risk of further offending Good Lives Model: Theoretical Assumptions Offending is a flawed attempt at achieving a primary good 4 main obstacles to obtaining the goods: (1) lack of appropriate means (i.e., use of inappropriate means) (2) lack of scope (i.e., focusing on some primary goods, to the neglect of others); (3) lack of coherence (i.e., conflict in the way primary goods are ordered or related to one another) (4) lack of capacity (i.e., difficulties in internal skills or external conditions necessary for attaining primary goods). GLM: 2 primary routes to offending: Direct: attempt to achieve a good through their behaviour. For example, an individual lacking the competencies to satisfy the good of intimacy with an adult might instead attempt to meet this good through sexual offending against a child. Another example would be someone who has difficulty obtaining and holding down a job, and they resort to stealing/fraud/robbery in order to generate an income 46 GLM: 2 primary routes to offending: Indirect: through the pursuit of one or more goods, something goes awry, creating a ripple or cascading effect leading to the commission of a criminal offence. For example, conflict between the goods of intimacy and autonomy might lead to the break up of a relationship, and subsequent feelings of loneliness and distress. Maladaptive coping strategies such as the use of alcohol to alleviate distress might, in specific circumstances, lead to a loss of control and culminate in sexual offending. 47 Good Lives Model: 11 Primary Goods (1) Life (healthy living) (7) Relatedness (intimate, romantic (2) Knowledge (being informed and familial relationships) about matters important to (8) Community (feeling of themselves) connection to a wider social group) (3) Excellence in Play (hobbies and (9) Spirituality (having meaning and having fun) purpose in life) (4) Excellence in Work (mastery (10) Pleasure (happiness, feeling experiences, including high skill good) levels) (11) Creativity (ability to express (5) Agency (independence, oneself through alternative means) autonomy and power) (6) Inner Peace (freedom from stress and emotional turmoil) RNR Model of Offender Treatment Risk: intervention tailored to risk level of individual (low risk = low levels, high risk = high levels) Possible iatrogenic effect of intervention with low risk individuals Resource allocation Needs: intervention tailored to address empirically supported risk factors (i.e., substance abuse, attitudes condoning violence) Responsivity: intervention tailored to individual needs (i.e., low IQ, comorbid mental health conditions) RNR Model of Offender Treatment Empirically supported risk factors for offending “Central 8” Antisocial attitudes (i.e., it’s okay to be violent) Substance abuse Antisocial affiliates (criminally involved friends/family members) Antisocial personality (i.e., traits like impulsivity, lack of empathy) Poor use of leisure/recreation time (too much free time) Work/school (unemployment, dropping out of school) Poor family relationships/support Past criminal history Motivational Interviewing Counselling approached invented by psychologists Miller and Rollnick it is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence Therapists attempt to influence clients to consider change originally invented to help alcoholics, but most commonly used in health psych settings (like quitting smoking, weight lose) and forensic settings 51 Motivational Interviewing Help clients in developing discrepancies between the current self and what they want to be like in the future after a change has taken place. increase the client’s awareness that there are consequences to their current behaviors Empathy, and positive regard -> no judgment or pressure to change On a scale from 0 – 10, how ready are you to change? You said a 5, why are you not a 3? Decisional balance matrix: Pros of changing, cons of changing, pros of staying the same, cons of staying the same 52 CBT techniques commonly used 1.Cognitive Restructuring 1. Identifying and challenging distorted thinking patterns that justify or rationalize violent behavior. 2. Teaching offenders to recognize triggers for their violent actions and to reframe their thoughts in a more positive and realistic manner. 2.Behavioral Interventions 1. Techniques to help offenders manage anger and reduce aggressive responses. 2. Role-playing and practice of non-violent problem-solving skills. 3. Encouraging the development of pro-social behaviors and responses. CBT techniques commonly used 3. Skill Development 1. Enhancing emotional regulation skills to better manage intense emotions like anger and frustration. 2. Improving communication skills to resolve conflicts without resorting to violence. 3. Teaching coping strategies to deal with stress and adverse situations constructively. 4. Relapse Prevention 1. Identifying high-risk situations that may lead to violent behavior. 2. Developing a personalized plan to avoid or handle these situations. 3. Ongoing support and maintenance strategies to prevent recidivism. Offence Cycles Treatment of Sex Offending Psychoeducation around puberty/anatomy, consent, “groinal response” Education about healthy relationships Cognitive distortions (misogynistic beliefs i.e., women owe sex to men, if you start having sex you cannot stop, if you’ve consented to sex before, you automatically have consent onwards) Social skills training Empathy development: helping offenders understand the impact of their actions on victims. Other treatments/methods out there: Medication to suppress sex drive Penile Plethysmograph Aversion therapy 56 Treatment of Psychopathy Many studies demonstrate therapy can cause a reduction in antisocial behaviour Studies demonstrating a reduction in psychopathic traits are scarce Field used to think that therapy makes psychopaths worse and teaches them how to manipulate better General conclusion is therapy doesn’t work that well for psychopathy, but doesn’t make anyone worse Treatment of Psychopathy Compassion Focused Therapy (roots in CBT and MI) Compassion can be conceptualized as a motivation to be sensitive to the suffering of the self and others, allied with the wisdom, strength, and commitment to prevent and/or alleviate that same suffering PSYCHOPATHY.COMP Diana Ribeiro Da Silva psychopathic traits probably act as a mask of invulnerability that hides deep suffering and a shameful nucleus Overdeveloped “threat system” (rather be safe than sorry) that is serving survival principles Emotion dysregulation, specific to shame Shame is externalized by avoidance (CU traits) 58 Treatment of Psychopathy Target shame via teaching self compassion Target negative behaviors via teaching other compassion The Efficacy of a Compassion-Focused Therapy–Based Intervention in Reducing Psychopathic Traits and Disruptive Behavior: A Clinical Case Study With a Juvenile Detainee https://journals.sagepub.com/doi/10.1177/1534650119849491