Psych 90 Final Review PDF

¼ Midterm 1 Content Requirements on who can practice as a clinical psychologist ○ Undergrad bachelors ○ Ph.D or Psy.D ○ Clinical training - internships and fellowship ○ Licensure - pass state exam Who can be considered a psychotherapist...

¼ Midterm 1 Content Requirements on who can practice as a clinical psychologist ○ Undergrad bachelors ○ Ph.D or Psy.D ○ Clinical training - internships and fellowship ○ Licensure - pass state exam Who can be considered a psychotherapist ○ psychotherapist is a broad term for professionals trained to help individuals, couples, or groups address mental health, emotional, and behavioral issues through various therapeutic techniques ○ Clinical Psychologists ○ Psychiatrists ○ Psychiatric Nurses ○ MSW, LCSW, MFCC ○ Guidance Counselors ○ Clergy ○ What are the differences and different qualifications between those History ○ Reason for historical shift in medical care 1960s Intro of psychotropic drugs, less in patients Fixing these problems at home not in asylums (defunded) Need for more people in practice because ○ In terms of institutionalization Decrease in psychiatric hospital populations. Growth of community mental health services. Increased emphasis on rehabilitation and integration into society. Training models ○ Scientist practitioner vs clinical scientist model ○ Clinical Scientist: strong scientific research background - produces graduates who can conduct high-level research and apply evidence-based treatments → trains students as researchers who also practice clinical work = PhD ○ Scientist-Practitioner = Boulder model - balances research and clinical practice, training psychologists to integrate scientific evidence into their clinical work = PhD programs follow this model Differences  ○ Model Suggested in the Berenbaum (2021) paper Know the main concept of that model Phase 1 general knowledge phase two is specialization, very flexible APA Code of Ethics - Aspirational: general principles for describing ideal level of ethical functioning or what to strive for ○ Five ethical principles 1. Beneficence and Nonmalifience: do no harm! And try to do good 2. Fidelity and responsibilities: be honest and truthful, have integrity 3. Justice: see everyone and ensure all people have access, maybe offer some pro bono services 4. Respect for people’s rights and dignity: respect multiculturalism and personal circumstances 5. Competence: licensure allows you to call you a psychologist, and these are the ethical guidelines that dictates if you are competent enough to achieve these aspirations, but it’s a self judgment ○ Limits to privacy/duty to warn the victims and police - Patient communicated serious threat of physical violence - Victim is identifiable Tarasoff case ○ Tarasoff Case: Berkeley student said I’m going to kill my ex- girlfriend and the psychologist told the campus police that Tarasoff was in danger. The campus police interviewed the patient and didn't see him as a threat so they let him go and he went to kill Tarasoff. Parents filed a lawsuit against the university. Psychologist new her name and told police, so went to court twice and second time established that threatened persons need a warning and supreme court said there’s a reasonable care to protect if there’s imminent threat and you take whatever steps necessary– no confidentiality this is a LEGAL obligation to tell victim Baker Act ○ Baker Act: you can hospitalize someone short term if you feel it’s warranted and take advantage of that— understand you’re no longer keeping their information confidential. ○ promotes safety and monitoring Research Methods  ○ What is reliability vs validity in assessing scientific findings Reliability: consistency Do people respond the same way to the test over time (test-retest)? ○ Do two or more raters agree on the meaning of a person’s responses (inter-rater)? ○ Internal consistency - whether the test measures the same variables? Validity: does it measure what it is supposed to? ○ ○ Incremental validity: extent to which a new measure or test adds to the predictive power or understanding of a concept beyond what is already provided. Purpose: if not, you’re wasting your time. justify its use economically Remember you can have reliability without validity but you can’t get validity without reliability and think of examples of each ○ Epidemiology of mental health conditions Epidemiology is study of disorders or illness in a given population and possible correlations ○ Survey and interview based ○ Identifies cases ○ can make policy decisions Incidence rates rate of new cases in a given time vs prevalence overall rate of cases (idc when) in a pop. (total cases / total pop.) point prevalence is right now or whenever ex. 1981 vs distribution Point prevalence: over amt. of time Ex. “Over the past year have you been depressed?” ○ Types of Research designs - Differences between all four and being able to define them Cross-sectional one point in time across multiple demographic groups Longitudinal design two points in time & same individuals Answers more questions Control (like clinical) trials one group gets it one does not to see if it is effective Randomly assigned to treatments ABAB design baseline period A followed by treatment B → reverse back to A (see what happens to behavior → B (see if it actually worked) Type of single-case design See direct efficacy with 1 case etc. Observational Methods Naturalistic Observation: no involvements or manipulation of anything just observing free of bias Controlled Observation: observer creates environment and observes to gain knowledge Case Study: observation of a single patient, individualized and can describe rare circumstances but CONS is non generalizable findings (THINK COUSIN LILY) Correlational Research: Examine relationship between two measures or constructs to gain insight about the association Examples: childhood vaccines and autism patient characteristics and treatment outcomes height and weight (for the first part of your life but not later) ○ Variables are measured but not manipulated ○ Correlation DOESN'T imply causation! Experimental Research: independent variables are manipulated to see effect on dependent variables ○ Participants are randomly assigned to experimental or control group ○ Shows cause and effect  ○ Develop a hypothesis ○ Measure group differences (sometimes differences emerge in 3 months or a certain threshold of time) ○ Statistical approaches vs clinical judgment Meehl 1954 - computers can do it just as well if not BETTER than clinical psychologists - human assessments are void and pointless Assessment & Interviewing ○ Clinical interviewing techniques Physical arrangements: privacy and protection and office should be neutral and not distracting Note taking and Recording: help maintain accuracy, avoid problems, obtain consent for recording, notes: can be distracting, written notes can be taken to court Don’t need test if you can get what you need from interview Interactive between 2 ppl Goals: gather info and establish relationship Derive conclusions, ○ Its role in terms of its clinicians theoretical orientation - Intake Interview: figure out why you are here and what brought you here today. Typically seeing a second opinion or help - Social History Interview: I want to learn everything about you - Medical history, infancy, adulthood relationships, includes sexual medical and religious history - ONLY use this if you have a particular orientation (psychoanalytical and you feel that all problems stem from early experience) otherwise it’s not relevant to do this! - Frued for example is like the root cause of depression are experiences early in life so if you take that orientation you're going to want to have this type of interview! - A cognitive therapist you deal with PRESENT functioning so maybe this wouldn’t apply - Mental Status Examination Interview: constrained and confined almost exclusively to medical settings (used by clinical psychologists working in medical settings) - Diagnostic Interviews: many interested parties require a diagnosis - In order to get a diagnosis, you have to meet the criteria (from DSM) so you need to know how to conduct an interview that will yield that diagnosis - Medication: Every diagnostic has a number, so you can bill insurance to reimburse you for treating that person - Unstructured: clinician interviews the client based on a loose set of goals and questions - Very free form and content varies - Lots of open end questions and allows for client to answer elaborately - Close-ended questions are yes and no - Semi-Structured: specific questions set by clinician that allow some flexibility in what a clinician can ask - Structured: takes 2 hours (for context a general practitioner takes four minutes as a check-in) specific format for asking questions and for determining follow up questions - Standard set of questions and a flow chart (cardinal systems lets you stop the interview when you need to because you can tell if a person is or isnt depressed by like 1 or 2 questions) - Increases reliability if nothing else by a LOT  - Several types like for DSM, anxiety disorders, some for children, some for schizophrenia, etc — no reason NOT to use a structured clinical IF getting diagnosis is the primary goal! - Crisis Interview: Purpose is to assist the patient and family with an immediate crisis - Focus on identifying the immediate problem and asses lethality - Assist patient in ways to cope with the problem and referral for help - It doesn't happen often but you need to be aware on how to do this– not the time for Social History Interview ¼ Midterm 2 Content Intelligence ○ Describe different theories of intelligence Spearman (1927) - Different intellectual tests correlate highly - Hypothesized one general intelligence (‘g’) factor that underlies all mental abilities - to understand need to understand other 4 - Specific intelligence factor : unique elements of a given test Thurstone (1938) - Seven ‘Primary mental abilities’ = number, word fluency, verbal meaning, perceptual speed, space, reasoning, memory Cattell (1965) - Two types of g - Fluid intelligence = ability to react to new situations , think on spot, solve problems, gain new knowledge, perceive associations : thought to be genetic based → measured on tests by doing novel things - puzzles etc - Crystallized Intelligence = factual knowledge obtained about the world , what you already know and practices : facts, meaning of words, state capitals etc → capacities that can be attributed to culture-based learning Sternberg - Triarchic theory of intelligence Emphasizes planning and monitoring of responses instead of speech and accuracy 1. Compomental component 2. Experiential component 3. Contextual component Gardner (1983) - multiple intelligences Logical mathematics etc etc continue ○ Known measurements for intelligence -> Stanford Binet - mental age: mental performance is mental age… test administered to dertermine. More you get right more questions there are IQ and Ratio IQ: mental age / chronological age x 100 = IQ Difficult with older people as their age increases but knowledge does not Deviation IQ presented compares in the chronological age group Wechsler scale is a mean of 100 and sd of 15 ○ Validity of intelligence tests You might have a bad childhood you might have a bad day, you are affected your ability to be smart, intelligence does not indicate growth and success  Diagnosis DSM ○ Explain differences between categorical and dimensional approaches to diagnosis: give examples DSM 5 Vs RDoC Categorical DSM - Diagnostic Statistical Manual - the existence of anxiety or not you have it or you don't. Dimensional is RDoc - Research Domain of Criteria. You are tested on a range or scale ○ reliability/validity of DSM for diagnosing top mental health disorders You might add more categories but is it really valid? Is it really telling you that a person has anxiety? ○ Understand what RDoC is in relation to clinical diagnosing RDoC is related and used in diagnosing, uses biological theories and biotypes to diagnose you versus descriptive categories. ○ Criteria for defining abnormal behavior Statistical Infrequency: Does not conform to societal norms ○ Definition suggests that rare behaviors are abnormal ○ Abnormal by a statistical infrequency ○ Normal curve indicates that some behaviors are common while others are rare, Common behaviors are at the middle of the curve; rare characteristic fall at the tails of the curve Think of the intelligence quotient ○ Advantages: cut offs or cut points make decisions to label abnormality easier ○ Problems: choice of cut off: there is no convection for setting them Cultural relativity: deviance for one group is NOT deviant for another group Subjective/Personal Distress: behaviors that are accompanied by distress are abnormal ○ Advantages: seems reasonable to expect that people can assess whether or not they are experiencing distress ○ Problems: not everyone who we might consider “abnormal” reports subjective distress, so how much subjective distress is needed to qualify as abnormal? Ex: hoarding– are people who hoard distressed by the hoarding? No because they aren’t distressed about it so it’s not abnormal– problem with this definition Disability/Dysfunction: argues that impairment of life function can be a component of abnormal behavior ○ Social: interpersonal relationships are affected ○ Occupational: Job is disrupted, perhaps even lost ○ Personal: day to day functioning is impaired ○ Advantages: Relatively little inference is required and often prompts people to seek treatment ○ Problems: but who sets the standards for dysfunction? In how many domains of functioning must we see problems (1-3? more?) Treatment ○ Summarize key findings from studies of efficacy and effectiveness of outcomes from psychotherapy Aspirin preventing heart attacks: the framing of the study determines the recommendation through randomized clinical studies - This means that the effect size has got to be HUGE for it to be a policy mandate - d= 0.034 Cigarettes increasing risk for lung cancer: d=0.6 9 months of instruction in reading in elementary school: 0.65 Psychotherapy: 0.85→ big deal! Weisz and Weiss - effect size in control subjects d =.62 THEN bring in effectiveness d = 0.0 NOT EFFECTIVE Benefits of psychotherapy and timing of its effectiveness Smith and Glass - effect size.85 sd - tested psychotherapy in children average treated with therapy better off than 80% of untreated Consumer reports 87% of people received therapy reported at least some improvement TIMING - The longer people stayed in therapy the more they improved, People who started out feeling the worst reported the most progress ○ Three levels of psychological interventions and approaches for them: promotion, prevention, and treatment; give examples Prevention - reduces incidence, stops problems before they occur. Ex. selected indicated universal child and adult promotion - promote positive behaviors Treatment - reduce suffering , reduced prevalence Assessments ○ Differences in approach between traditional and behavioral assessments Traditional: ○ Personality thoughts: personality reflects underlying states or traits Behavioral: ○ Personality thoughts: personality constructs mainly used to summarize specific behavior patterns, if at all Sample vs Signs In traditional assessment, test data are interpreted as signs of internal processes and underlying disorder - comes from medical model In behavioral assessment, test and interviews responses are interpreted as samples of behavior that are thought to generalize to other situations - Not a sign of some underlying problem, it IS the problem and example of the problem Approach as in how to measure specific behaviors Behavioral Assessment Methods ○ Behavioral Interviews: careful precise description of observable problem behavior, conditions that control problem behavior: antecedent conditions, resulting behaviors, and consequent events I don't care about your upbringing! Recall the different interview types, they focus on behavior NOW and what’s maintaining behavior NOW (you might lose the picture of the whole person, but if this is your method that’s okay!) he sees the downsides though They are direct, goal oriented Client is asked specific questions about behavior: situations that caused problem behavior Clinicians applies learning theory– reinforcement and punishment Limitations: time consuming, may be unreliable, interviews with other people familiar with patients add reliability, and Information from observational methods adds to interviews… ○ Behavioral Observation: provide samples of behavior in naturalistic or controlled conditions  Limitations with all forms: Reactivity: Observer may influence outcomes, threats to internal, external validity Requires high reliability and validity – can be difficult to achieve because of complexity of behaviors Recording: Define the behavior to be observed, Select observational method, and Initiate observations Interval coding: quantify the behavior ○ Occurrence of target behavior within a specific time– does the behavior occur or not? ○ Recording whether the behavior occurs in a specified time segment, need to determine specific block of time ○ Interval coding is preferred if target behavior infrequent or if starting or ending point unclear Event Coding ○ Record each/ every discreet occurrence of target behavior within a specified time ○ Optimal with target behaviors that have specific start-end points Naturalistic: Observing client in own environment without manipulating situation, home, school, hospital therapy Environment in which client spends much time Ecological validity: observations represent behaviors similar to those that occur when the individual is not being observed Home Observation: ○ Mealtime family interaction coding ○ Use of a videotaped interaction of the entire family eating together ○ Trained coders watch and rate family using rating scales ○ Task accomplishment, affect management, interpersonal involvement, behavioral control, communication, roles School observation ○ Direct Observation Form ○ Used to assess problem behaviors in school settings ○ Assessors rate frequency of 88 problem items during several observation periods in morning and afternoon ○ Helpful in forming diagnostic formulations ○ Check list in argues, defiant, cruel, disturbs other children, psychically attacks people, stares blankly, etc Hospital observation ○ More controlled environment ○ Behavior Checklists ○ Observations made at regular intervals ○ Daily behavioral profile can be constructed by compiling observations ○ High inter-observer reliability Limitations ○ Target behavior may not occur ○ Causes of behavior cannot be identified  Sources of Error ○ Response definition too vague or unclear ○ Observational situation makes observations difficult ○ Poor training of observers/raters ○ Poorly designed data sheets Controlled: situational tests that approximate real life Clinical or natural settings Environment is “designed” to elicit target behavior - Clinician exerts some degree of control (e.g., asking married couples to talk about specific topics) Trigger specific behaviors so they can be observed Situational testing Controlled Performance Technique: Similar to controlled observational methods but more structured (ex would be marshmallow test) Not real life, but may be analogous to - or heighten aspects of - real life (pressure, interpersonal challenges, presence of phobic stimuli) Difficulties: Reactivity: Observer may influence outcomes, threats to internal, external validity ○ Requires high reliability and validity – can be difficult to achieve because of complexity of behaviors Contrived Situations ○ Behavioral Avoidance Test: series of tasks requiring increasingly threatening interactions YOU JUST NEED TO QUANTIFY THEIR BEHAVIOR, it's very pragmatic Marshmallow study ○ Potential for standardization across individuals Self Monitoring: clients observe their own behaviors, thoughts and emotions, recorded behavior– you don’t care why they do it, you're concerned with quantifying the extent of the behavior! ○ Smoking, drinking, eating, studying ○ Change simply as a result of monitoring? Behavior immediately decreases when you start observing doesn't stay down though ○ Clients have to keep list of observations ○ Advantages: logs provide information about frequency, intensity, and duration of target behavior. Learned about circumstances of target behaviors ○ Disadvantages: inaccurate recording, client may resist recording or distressing to record negative behaviors, difficult amongst children Issues with Observation: More complex = Lower reliability Training observers to be clear with definitions and ratings or else you get observer drift (subtle shifts in ratings and reliability checks) Improvements: specify objective behaviors, establish explicit theoretical orientation, Standardized observational format, Awareness of potential errors, Consider reactivity, Consider representativeness of behavior ○ Experience Sampling Method (ESM): aka Ecological Momentary Assessment  Type of self-monitoring, behavioral data collected in real time in natural environment using biosensors, audio, video, GPS, Pre-programmed handheld devices, Repeated assessments over time in natural settings Example: for assessment of emotions & cognitions associated with eating habits, participants may be asked to answer questions on their smartphone each time it beeps (set randomly ~5x / day), and before and after all meals and snacks I feel very ___ right now (choice of A through D) Density of emotions in Major Depression ESM: depressed emotions travel together, but nondepressed people can be angry without being sad, or sad without being fearful, so it demonstrates clustering Advantages: less labor intensive and costly that other forms of behavioral assessment, target a lot of behaviors with very little time and free memory bias, high ecological validity Inventories and Checklists and comparisons to self monitoring Like self monitoring, client is the source of data But unlike self monitoring, because self reports are more retrospective and summative Parents, peers, self, teachers rate a list of behaviors Questionnaire format Often have multiple “factors” in checklist ○ ex: aggressive, depressed, anxious behaviors ○ When you’re in a state of depression and you say “how you’ve been over the last week” the level of depression you feel NOW affects your memory and how you recall feeling over the last week or vice versa and so it turns out that these measures are not full proof and people who are depressed reports higher scores for lifetime history and current mood affects recall of overall mood and thats less of a problem for just moment by moment ○ Cognitive Behavior Assessment: cognitions (thoughts) uncover unobservable behaviors Thoughts can be monitored and recorded systematically by the client Self-monitoring of thoughts has a reactive effect (monitoring thoughts and behaviors changes them), but this usually dissipates over time Derived from the notion that a person’s thoughts- self images and self statements- play an important role in their behavior In CBA, assessment and functional analysis of a target problem or behavior must include measuring thinking processes Activating event or situation (A) Beliefs or interpretations (B) Consequences of emotions or behavior © ○ Psychophysiological Assessment: Study of bodily changes that accompany psychological characteristics or events Electrocardiogram (EKG): Heart rate measured by electrodes placed on chest Electrodermal responding (skin conductance): Sweat-gland activity measured by electrodes placed on hand Electroencephalogram (EEG): Brain’s electrical activity measured by electrodes placed on scalp  ○ Biological Approaches to Assessment: Biofeedback: feedback about some bodily function you can’t otherwise monitor or observe (measure finger temperature) MRI: Nucleus accumbens, brain activation, blood flow– if youre spider phobic your amygdala will light up Telomeres: repetitive nucleotide sequences, cap ends of chromosomes, protect against genomic instability, chromosomal replication (more stress you perceive the shorter your telomeres) Telomere length in low risk and high risk girls for depression, high risk girls have way shorter telomeres! Personality ○ Explain differences between objective and projective personality tests Objective Tests: self reports, persons descriptions or accounts of their behaviors, attitudes, emotions, and perceptions of themselves Ex. MMPI quantitative measures of attitude and behaviors, may be reliable but not a lot of incremental reliability, what does this tell me about patient , statistical scoring, Projective Tests: responses to ambiguous stimuli, responses are open-ended and subjective. Procedures for discovering a person's characteristic modes of behavior by observing his behavior in response to situation that does not elicit or compel a particular response Ex. inkblot test, lower interrater reliability, lower validity, interpretational, clinical judgment Administration, scoring, interpretation ○ Characteristics of personality clusters ½ Final Content Psychoanalytic Approaches (ch. 14) - Whenever someone goes to a clinician, conceptualizes their behavior, assesses, and then gives treatment. Here are the treatments Psychoanalytic approaches ○ Freud’s Psychoanalytic Theory (theoretical approach) Theoretical approach that states our behavior is largely caused by our internal unconscious desires, memories, and conflicts primarily from early childhood experiences Psychic determinism: psychological event reveal unconscious beliefs and evaluated through free association Nothing happens by chance or accident. Each psychological event is determined by an event/ memory that preceded it Energy system: the mind functions to maintain ‘homeostasis’ Humans are viewed as an energy system, there is limited amount of energy which can be blocked but does NOT dissipate rather gets expressed in another alternative form Components of personality (id/ego/superego), defense mechanism Id - primitive - basic drives and instincts (devil on your shoulder) max pleasure min pain. Not conscious behavior (basic instincts like hunger and sex) Pleasure principle: humans seek pleasure avoid pain since beginning Ego - operates on reality, is aware. Constrains the ID, age 2-3 Superego - conscience, rules and morals internalized, influenced by parents, age 5, source of guilt over ID (angel on your shoulder) Defense mechanism - manage conflicts (anxiety - when ID and superego conflict about what is wanted and what will be punished by society) - “Techniques of ego to deal with unwanted thoughts and desires” - ○ Psychoanalytic therapy (treatment) Goal: make unconscious conscious Where the ID was let Ego be, resolve conflicts between the three and take away defense mechanisms - Help the person to become aware of his/her needs and desires, to recognize that these are natural, and that they can be met without losing control of them. - FREE ASSOCIATION is fundamental technique Role of the therapist: make the client relaxed, overcome the defense mechanism and lead to free association - patient does not see therapist ○ Psychodynamic psychotherapy (treatment) Therapist & client relationship ⇒ interpersonal relationship in clients life Psychodynamic model: how the unconscious is evaluated and therapeutic approaches for treatment Shorter and more focused treatments - more focus on interpersonal relationships Humanistic Approaches (Ch 14) Humanistic/ phenomenological approaches OUTCOMES: Willingness to Continue Growing, increased self acceptance. WEAKNESS: Not suitable for serious disorders or urgent situations – not all clients are able to find their own answers, not developed mush since 1960s - Focuses on the client and their perspective of the world, their own reality  ○ Client-centered therapy (Carl Rogers) - Rogerian Therapy Innate motivation of the client in relationship to patient outcomes Goal: Self actualization - release of an already existing capacity in a competent individual Ability to reach one's full potential - therapist guides client to self understanding Therapist: empathetic, unconditional positive regard - no matter what… - growth promoting environment, they are not the expert and not controlling, fully caring and accepting, genuine CLIENT - removes obstacles to promote growth The therapeutic process IS Acceptance Recognition w/o consequences Clarification It is NOT Advice and information Reassurance and persuasion Questioning and interpreting Encourage clients to express thoughts and feelings without consequences Therapy sessions held usually once a week Use reflection statements - To show they understand client’s thoughts and feelings; Give space to clients to clarify thoughts and feelings Traditional ^^ approaches Different theoretical approach than traditional Behavioral Approaches - Focuses on understanding and changing observable and measurable behaviors rather than internal psychological causes Assumptions of the Behavioral Model ○ “Change by learning” Neutral view of human nature, learning accounts for both normal and abnormal behavior, treatment is active directive and collaborative. ○ No insights into causes of the behavior; emphasis on measurable behaviors Focus on how behavior is acquired, maintained, and increased or decreased, ○ How behavioral therapists view the relationship between behavior and the environment Assessment: understanding observable behavior Uses principles of classical and operant conditioning and observational learning to change maladaptive behaviors Learning new behaviors is the core (classical conditioning) Does not deal with history of patient , clients are active should be goal oriented Classical conditioning vs Operant conditioning (treatment) ○ Classical (Pavlov) Pavlov’s approach vs Wolpe’s approach (systematic desensitization and inhibition) (define and understand) Pavlov and dog basic learning mechanisms. Metronom set up to play sound then reward dog… the dog began to salivate whenever a sound was heard. Associate  two unrelated stimuli through behavioral training. pR, NR, PP, NP, main founder of behaviorism through his research, started this, SYSTEMATIC DESENSITIZATION - a type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias by pairing a new response (relaxation) with gradual stimuli (imagine exposure) that have been causing the fear and anxiety Wolpe: you cannot be both anxious and relaxed at the same time, RECIPROCAL INHIBITION: for a more positive outcome for humans, Good with OCD and Phobias and anxiety disorders: WOLPE and s.d. and In Vivo D (gradual real-life exposure) Exposure therapy and response prevention - Differences and similarities between the two Exposure therapy: face fears - involves exposing people to fear driving objects IRL or VR environments with no relaxation (just the exposure), Eliminate anxiety through intense and prolonged exposure to anxiety-producing stimuli. “Extinction” is the mechanism of change Response prevention: target compulsive behaviors - specific within exposure. A person deliberately refrains from performing their usual compulsive behaviors after exposure to trigger ⇒ anxiety will naturally decrease around trigger Exposure + response prevention = Identify situation → increase situational anxiety → sustain exposure → tolerate → prevent avoidant response ○ Operant (Skinner) learning Rejected unconscious and phenomenology concepts Positive/ negative reinforcement (changes in stimuli and behaviors), reinforcement schedules (Skinner) Believes behaviors have consequences - -Positive reinforcement: introducing stimulus increases if a specific behavior will be repeated (dog treat after trick) -Negative reinforcement: take away stimulus decrease behavior(s that end a negative stimulus) (shock mouse until achieves right activity/ stops doing wrong one) Techniques of aversion therapy and positive punishment: give examples Aversion Therapy: reducing or eliminating undesirable behaviors by pairing or associating them with pain and discomfort. → goal: decrease behaviors Ex. shock paired with cigs or drug induced nausea with alc or bad tasting nail coating for nail biting ○ Understand client behaviors and treatment outcomes Shaping, generalization, discrimination, extinction Shaping: gradually reinforcing certain parts of a behavior to more closely guess the desired behavior (small tasks until you get to final goal ex. socializing)  Generalization: transferring the response from one type of stim to similar stim (little albert: white rat scared him with noise till he was conditioned to fear it… later feared other white things) (if you get bit by dog you will probs fear all dogs not just that one) Discrimination: responding differentially to stimuli that are similarly based on different cues or antecedent events: being able to respond differently to similar stimuli, change in behavior Ex. dog doing two tricks with two different bell tones Extinction: the process of no longer presenting a reinforcement to decrease or eliminate certain behaviors (TAKE PHONE WHEN ACTING OUT) ○ Observational learning/modeling Based on AI Bandura’s Social Learning Theory Children have skills to punch but they choose to punch or not depending on reward Prof. stressed the importance of modeling and how learning can take place just be observing others (learning and imitating) Learning through observing model behaviors Participant modeling: modeling and in vivo exposure for phobias Model : someone reinforcing to the person watching. They are ok with the snake therefore you will be ok. Model is demonstrating fearlessness and coping response when confronted with feared object or situation Very effective ○ Contingency Management: Contingency = unforeseen event Managing environmental unforeseen events that are sustaining the behavior ○ shaping, token economy Shaping: reinforcing successive approximations Token economy: “vouchers” (clearly identified) positively reinforce desirable behaviors (specified) that are exchangeable for rewards or privileges Ex. Students learning math get tokens for correct answers or good behavior and can exchange rewards for a privilege like candy or recess time (something desirable) gives more value to education (intrinsic value) more willing to try the subject more + participation. ○ Differences between treatment approaches between psychoanalysis and behavior therapists Psychoanalysis what is your past and what are your ids Behavior in the moment idc about past or history, Cognitive-Behavioral Approaches Cognitive therapies - A desired change in behavior can be accomplished by changing cognitions - have the most consistent and promising data as treatment Founders of CBT ○ Albert Ellis - people are not disturbed by things but just their view on them ○ Aaron Beck Ellis’ rational-emotive therapy try and change demandings into preferences ○ Primary goals of this behavioral approach - help people realize they can live more rational and productive lives ○ Basic types of beliefs  Rational beliefs - lead to rational emotional and or behavioral consequences Irrational and maladaptive beliefs - inaccurate perceptions of situations and events that led to adverse emotional or behavioral consequences Automatic, irrational thoughts are disputable and need empirical validation and data ○ Appraisal-judgements people make; type of automatic thought Threat appraisal vs Coping appraisal You can think it is either coping or a threat., that affected me but i can work through it and cope, or you can think it is a threat and abort it ○ Activating Event, Irrational Beliefs, Emotional Consequences A-B-C Model: When a highly charged emotional consequence (C) follows a significant activating event (A), A may seem to have caused C, but it did not. Instead, emotional consequences are created largely by B, the individual’s belief system (D and E is disputing and evaluating) ○ Dispute of irrational beliefs (discuss it then evaluate) ○ Evaluate the Effects of it on yourself Beck’s approach - same but more complicated, thoughts cause trouble ○ 4 steps in cognitive behavior therapy 1. Recognize and record automatic thoughts a. Monitor daily → evaluate reasonableness → discuss with therapist 2. Logical analysis of automatic thoughts a. Talk it through question them, 3. Generate alternative thoughts a. Talk through and solve 4. Practice alternative thoughts Downward arrow technique: ask questions “but how did that make you feel, why, why … why” to get to dysfunctional pattern ○ Cognitive distortions; give examples Overgeneralization Seeing a single negative event as a never-ending pattern Ex. “No one ever wants to be with me” Magnification and minimization You're magnifying an event “that test is an indication of my stupidity” minimize: “I cheated on bf, I ain’t no slut” Personalization My friend was mean to me today and i am going to take it personally Jumping to conclusions - making negative predictions without evidence, “my doctor wants another test so there must be something really wrong with me” ○ Effectiveness of alternative administration to in-person cognitive therapy Its the same ○ Effect size of an intervention denotes efficacy Know difference between effectiveness and efficacy ○ Disorders commonly treated in Dialectical Behavior Therapy (DBT) Targets suicidal and self injurious women with borderline personality disorder, most effective treatment Group, Family & Couples Therapy Group therapy: can be used for any form of therapy (behavioral, cognitive- behavioral, psychodynamic, dialectical, etc) Homeostasis - stable environment in relationships - stable and functional dynamic state where all party members maintain balance through trust etc. ○ General systems theory is the basis of group therapy- group needs to maintain homeostasis and focus on the unbalanced state GST comes from physics think of the solar system - System: set of units that stand in some consistent relationship to one another organized around relationships - Elements (units): interact with each other in a predictable “organized” fashion and once they are combined they form an entity (a whole that is greater than the sum of its parts) - = No element can be understood in isolation Emphasis on communication: failure to communicate causes problems ○ Directive groups: classroom-type setting; clients with similar problems; very structured Best for children - children need structure, teacher actively gives feedback ○ Non-directive groups: less structured; oriented at clients’ experience, support provision You tell me your problem, now you tell me yours even tho its not the same, interpersonal learning, you learn from others experiences ○ Curative Factors Sharing new information Sharing richer more info, might have more realization hearing others Instilling hope Hope towards the therapist, you believe they can help you Universality We all go through shit, we are not alone Altruism The belief you can help others as well as yourself Interpersonal learning You believe i can learn from you and you can learn from mine Imitative behavior I am imitating the feedback your getting , i overhearing and applying it to myself Group cohesiveness Cooperating as a group ○ Group therapy is more efficacious than no treatment but not more efficacious than other forms of treatment Probably better to get an individual therapist but still has some help. Focus on clear, efficient and satisfying communication Family and Couples Therapy: a systematic effort to produce beneficial changes in a marital or family unit by introducing changes in the pattern of family interactions Family therapy: uses techniques to address emotion expressions or inhibition  ○ Conjoint Family Therapy: All members of family are seen at one time by one therapist: therapist is relatively non-directive All present, one must understand homeostasis in order to get back to that state Behavioral Family Therapy Behavioral Family therapy: all family members seen at one time by 1 therapist Focus on reinforcement contingencies and skills training (similar to contingency contracts) Full behavioral analysis of family problems and provides correct reinforcement Similar to CBT approach ○ Concurrent Family Therapy: All family members are seen individually by one therapist ○ Collaborative Family therapy: Each family member is seen individually by a different therapist, who meet to discuss their clients and family as a whole ○ Multisystemic Therapy (MST): intervention for juvenile offenders and their families, treatment delivered at home or at school, 24/7 access to therapists Know which population MST was developed and most beneficial for Bad kids Couples therapy ○ Behavioral couples/marital therapy: focuses on couple’s present interactions and seeks to replace negative and punishing behaviors with more rewarding behaviors If your wife likes flowers, get them flowers everyday, you learn to generalize, if i get them flowers, i will do other things that also make them happy. Super low stress cases, not serious abusive problems, low distressed cases ○ Cognitive-Behavioral Couples Therapy: Change various aspects of the ays partners think about their relationships Most effective type, what is my interpretation of the bad things that are happening in our relationship, am i actually made at the way you did that or its not cause i dont like you anymore i am just upset Better for more extreme cases Thought process ○ Emotion-focused Couple Therapy: focus on improving couple attachment security, teaching emotion regulation skills VERY extreme cases There is some serious emotional impairment, working to approve attachment and bonding Reconstructing your emotions , you feel a certain way Some serious issues that is manifesting these emotions in a different way Health Psychology & Behavioral Medicine What is biofeedback - definition A produce monitoring some aspect of psychological functioning, Person can observe and modify functions in real time, Can consciously regulate responses to some degree, Treatment not therapy Stress activates the sympathetic nervous system  ○ Biological functions of epinephrine (adrenaline heart rate), norepinephrine (hormone and neurotransmitter), cortisol (stress hormones) and cytokines (immune system small proteins) - first 3 are released into the bloodstream, cytokines increase which weakens the immune system, Energy levels rise as well as heart rate respiration and blood flow. - Transactional Model of Stress: affecting hormonal, autonomic, and immune systems. Stress is not just environment but the appraisal of how it affects you and how you might react/ your ability to cope - Cortisol reactivity at age 12 predicts the onset of depression by age 18– biomarker of stress– significantly increases their chance of developing depression Closed energy system - different types of systems ○ General systems theory is the basis of group therapy- group needs to maintain homeostasis Everyone works together if someone out of place you help them individually - what does that mean for family therapy? This vs a closed system energy doesn't go away but expressed through different forms How is homeostasis tied to general systems theory - how everyone works as a unit. one out of balance cause Remember some theory terms. effect family therapy essay question? Group therapy idea is the same family therapy they interact with all their life. These people don't really have relationships. All kinds of therapy, memorize bigger types family group couples What Are some types of family therapy Imagine you you are therapist and you choose types of therapy Rogers therapy client centered therapy key traits what kind of clients is it the best for Borderline personality disorder - dialectical behavior therapy is good for it Multi systemic therapy for juveniles Group therapy more effective for Question 18: group therapy is better than no treatment Biofeedback - able to manage Couple stress related questions Know three therapies and details you can use Page 6: as long as it is flexible based of the person's career choices and as long as it. if you dont want Question 44 Behavioral contingency = your behavior is based on your environment phenomenological approach - aspect of a client centered therapy Behavioral therapy Conditioning is not a therapy Question 6 The effectiveness of CBT in general is just as effective as drugs for 60% of people. More effective in longer term because you learn it In person and the online therapy effectiveness is the exact same. Pros and cons of all types of therapy Variable schedules are in behavioral therapy and behavioral is harder to extinguish than fixed CBT vs BT : behavioral therapy in terms of early developmental disorders Cbt more broad application. Everything you’d need to know about CBT BT developmental disorders ex. Phobias fear of spiders Crash course on CBT phobias in life never gonna find love Conditioning on CBT Pavlov JOseph skinner Couples therapy : know why we do it: what's the goal: to reframe their perception of the relationship. Less about blame and more about taking accountability. Address you emotion and attachment and bonding Goal: improve relationship quality; reduce emotions of anger, sadness, disgust Emotional focused couples therapy Goals: Train spouses to treat each other in ways that allow them to feel safe, loved, and connected to one another, Expand and re-organize key emotional responses, Create a shift in partners’ interactional positions and initiate new cycles of interaction, Foster the creation of a secure bond between partners What is emotional couples therapy: train the spouse to treat each other in ways that are safe and positive: If you are Three questions related to numbers what percent of people. What is the effectiveness CBCT 60% of people respond equally to drugs as they do CBT psychotherapy was better off at the end of it than were 80% of the persons who did not receive therapy Abnormal