Interventions PDF

**Interventions** **Cognitive & Behavioural approaches** - How we think (cognition), how we feel (emotion) and how we act (behaviour) all interact together. Specifically, our thoughts determine our feelings and our behaviour - Negative and unrealistic thoughts can cause us distress an...

**Interventions** **Cognitive & Behavioural approaches** - How we think (cognition), how we feel (emotion) and how we act (behaviour) all interact together. Specifically, our thoughts determine our feelings and our behaviour - Negative and unrealistic thoughts can cause us distress and result in problems **Cognitive Therapy (CT)** - How we think about things affects how we feel emotionally **Behavioural Therapy (BT)** - Identifying and changing potentially self-destructive or unhealthy behaviours - All behaviours are learned and that unhealthy behaviours can be changed **Acceptance and Commitment Therapy (ACT)** - Encourages value-guided action - Encouraging one to take action that is based upon their own values and in ways that will ultimately enrich their lives - Does not focus on symptom reduction -- believes that people can live fulfilling and enriched lives regardless of symptoms **Mindfulness-Based Cognitive Therapy (MBCT)** - Like CBT but incorporates mindfulness practices such as medication and breathing exercises **Dialectical Behaviour Therapy (DBT)** - Emphasise the psychosocial aspects of treatment - Some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships **Motivational Interviewing (MI)** - Attempts to move an individual away from a state of indecision or uncertainty and towards finding motivation to making positive decisions and accomplishing established goals **Schema Therapy (ST)** - Combines the best aspects of CBT, experiential, IPT and Psychoanalytic therapies into one unified model - Schemas -- enduring and self-defeating patterns that typically begin in early life **[Used]** - Anxiety - Anxiety disorders such as social phobia, obsessive-compulsive disorder or post-traumatic stress disorder - Depression - Low self-esteem - Irrational fears - Hypochondria - Substance misuse, such as smoking, drinking or another drug use - Problem gambling - Eating disorders - Insomnia - Marriage or relationship problems - Certain emotional or behavioural problems in children or teenagers. **[Typical Application]** - **Assessment** -- this may include filling out questionnaires to help you describe your particular problem and pinpoint distressing symptoms. You will be asked to complete forms from time to time so that you and your therapist can plot your progress and identify problems or symptoms that need extra attention - **Personal** **education** -- your therapist provides written materials (such as brochures or books) to help you learn more about your particular problem. The saying 'knowledge is power' is a cornerstone of CBT. A good understanding of your particular psychological problem will help you to dismiss unfounded fears, which will help to ease your anxiety and other negative feelings - **Goal** **setting** -- your therapist helps you to draw up a list of goals you wish to achieve from therapy (for example, you may want to overcome your shyness in social settings). You and your therapist work out practical strategies to help fulfil these goals - Practise of strategies -- you practise your new strategies with the therapist. For example, you may role-play difficult social situations or realistic self-talk (how you talk to yourself in your head) to replace unhealthy or negative self-talk - **Homework** -- you will be expected to actively participate in your own therapy. You are encouraged to use the practical strategies you have practised during the course of your daily life and report the results to the therapist. For example, the therapist may ask you to keep a diary. **[Key Terms/Components:]** **Rational Emotive Behaviour Therapy (ABCDEF)** - Clients are helped to identify and challenge irrational beliefs by looking at Activating Events, Beliefs, and the Consequences - Are then assisted in Disputing the thoughts and check the Effect of the changed thinking and the new set of Feelings **Behavioural Experiments** - Experiential, often homework, activity undertaken by a client designed to gather information which tests the validity of a certain belief - E.g. clients will often discuss trying to "not" think of something, which actually increases one's focus on the item - Try to not think of a pink polka-dotted elephant balancing on a beach ball - Can also be planned to explore individualised cognitions for specific clients - Get them to go out and record how many times their belief actually happens **Motivational Interviewing** - Designed to move clients toward greater levels of readiness to change - Motivation is seen as a state that is open to influence and change by identifying and resolving ambivalence - Connected other model of change - Techniques: giving advice, removing barriers, providing choice, decreasing desirability and providing feedback - Main focus: collaboration, evocation and autonomy - The therapist helps the client find their own motivation for change vs provides the client with motivation - Often used in addressing addiction and the management of physical health conditions such as diabetes, heart disease and asthma - Used for people who are angry or hostile -- can help them through the emotional stages of change necessary to find their motivation - At the start of any therapy to prepare them **Psychoeducation** - Educating the client about their psychological illness and second the mastery of techniques which can be used to control symptoms and manage psychological conditions **Socratic Questioning** - Exploring and examining evidence for and against each cognitive distortion **Behaviour Modification** - Behaviour is controlled by antecedents and consequences - Both appropriate and inappropriate behaviour is learned - Changing antecedents and consequences will increase or decrease the associated behaviour **Schedules of reinforcement** - Continuous: reinforces every single production of a target behaviour - Intermittent: will deliver a reinforcement after a specific number of behavioural occurrences are delivered **Exposure Therapy** - Designed to modify a pathological fear structure by providing corrective information that is incompatible with the fear - In vivo: systematic and gradual confrontation with actual/real-life objects and situations that trigger fear and avoidance - Imaginal exposure: Can assist the client to process the traumatic experience and produce habituation (the process of diminishing anxiety) of distress when thinking about the trauma - 4 main steps: preparation, creation of an exposure hierarchy, initial exposure and repeated exposure - Hierarchy: SUDS - Interoceptive exposure: helping the clients experience feared physical sensations associated with panic e.g. hyperventilating in session **Behavioural Activation** - Aka activity scheduling or reward planning - Most commonly used in the treatment of depression - Goal is to increase behaviours that are likely to result in a client being rewarded either internally (sense of accomplishment) or externally (social attention) - Increases client mood by decreasing rumination - Starts with monitoring current activities and then moves to developing a list of possibly rewarding activities - Graded tasks assignment: the therapist assists the client to break a task into smaller tasks if they are too anxious or depressed to begin engaging **Skills training** - Focus on problem solving, anger management, emotional self-regulation, social interactions, stress management, parenting ability, and basic self-care, etc. - Often an overt and integral part of a number of evidence-based therapies - DBT group training skills consist of training in mindfulness, interpersonal effectiveness, emotional regulation and distress to address instability of BPD - Social anxiety, ASD and psychotic disorders within CBT - Relaxation training in CBT to reduce state of physical tension in depression, anxiety and pain management - Anger management programs routinely used skills training to teach relaxation, emotional awareness and alternative coping strategies - Addiction treatment: problem solving skills, emotion regulation and mindfulness skills **Relaxation Strategies** - Provide the client with a rapid, reliable and easy-to-apply for coping with and moderating anxiety - *[Progressive Muscle Relaxation (PMR):]* helping the client notice the difference between tension and relaxation by having them tense and then relax various muscle groups - *[Breathing restraining:]* used for clients who hyperventilate when anxious. Clients are taught to 're-breathe' the air they have already exhaled by cupping their hands over their mouths and breathe into their hands or a paper bag. **Psychodynamic Therapy** - Aka: insight-oriented therapy - Focuses on unconscious process as they are manifested in a person's present behaviour - Goals are client's self-awareness and understanding of the influence of the past on present behaviour - Used to treat a wide range of disorders, mainly depression -- those that have lost meaning in their lives and have difficulty forming or maintaining personal relationships **[Application]** - Therapist adopts an active role and initially aims to uncover focal interpersonal problems - Throughout therapy, therapist aims to interpret the subconscious motivations underpinning the client's behaviour and expressions of thoughts and feelings - Therapist is there to interpret the client's underlying motivations and conflicts whist the client directs the topic of dialogue *[Primary Goal:]* to uncover and process internal conflicts which represent the root cause of disturbances in mental health - Client is encouraged to express their full range of emotions *[Mechanisms:]* goal setting, reality testing, confrontation and empathic validation **Interpersonal Psychotherapy (ITP)** - Main goal is to improve the quality of a client's interpersonal relationships and social functioning to help reduce their distress - Interpersonal deficits -- social isolation or involvement in unfulfilling relationships - Unresolved grief -- if the onset of distress is linked to the death of a loved one, either recent of past - Difficult life transitions -- retirement, divorce or moving to another city - Dealing with interpersonal disputes that emerge from conflicting expectations between partners, family members, close friends or co-workers - Examines current rather than past relationships and recognises but does not focus on internal conflicts - Differs from CBT because it addresses maladaptive thoughts and behaviours only as they apply to interpersonal relationships **[Use]** - MDD - Eating disorders - Perinatal depression - Drug and alcohol - Dysthymia - Bipolar **[Application]** *3 Phases:* 1. Therapist evaluates the client's psychosocial environment and identifies focal interpersonal problems or conflicts, as well as assigning a "sick" role to the client to alleviate a potential sense of personal responsibility for their problem 2. Therapist strives to identify problematic relationships and interactions and equip the client with strategies to manage these (grief about loss of an individual or pet, interpersonal disputes and disagreements, role transitions/change, interpersonal deficits or inability to create or sustain relationships) 3. Collaborative termination of therapy, including a forward plan **Solution Focused Brief Therapy (SFBT)** - Places focused on a person's present and future circumstances and goals rather than past experiences. - Goal oriented therapy - Symptoms or issues bringing a person to therapy are typically not targeted - Client is considered the expert - Therapist encourages the individual to envision their solution or what change would look like and then outline the steps necessary to solve problems and achieve goals **Techniques** - Coping questions -- help demonstrate the client's resiliency and the number of ways in which they are capable of coping with challenges in their lives - Miracle questions -- help the client envision a future in which the problem is absent - Scaling questions -- use to assess present circumstances, progress or how one is viewed by others **Use** - Individual therapy - Families - Couples **Family Systems** - Family as an emotional unit - Individuals are inseparable from their network of relationships - Each family member works together with the others to better understand their group dynamic and how their individual actions affect each other and the family unit as a whole - What happens to one member of the family happens to everyone in the family **Use** - Depression - Bipolar - Anxiety - Personality disorders - Addiction - Food-related disorders **Ecotherapy/ Ecological Intervention/ Nature Therapy** - People are part of the web of life and that our psyches are not isolated or separate from our environment - Informed by systems theory and provides individuals with an opportunity to explore their relationship with nature - Connection with earth: the core of ecotherapy - The earth has a self-righting capacity which operates through complex systems of integrated balance and that if people can harmonise with these systems, they may experience improved mental health **Techniques** - Nature meditation - Horticulture therapy - Animal-assisted therapy - Physical exercise in a natural environment - Involvement in conservation activities **Humanistic** - Emphasises the importance of being your true self in order to lead the most fulfilling life - Everyone has their own unique way of looking at the world - This view can impact your choices and actions - Core belief that people are good at heart and capable of making the right choices for themselves **Narrative Therapy** - Our perceptions of reality and self-concept are organised through personal narratives - Working with these narratives in a therapy context is useful for exploring and healing the client's psychological state - Individuals create self-defining memories about their experiences which converge to form a life story or narrative identity which become increasingly complex - Asking the client to share, the therapist can identify which aspects of the experience the client is focusing on and which one they are omitting and identify avenues or opportunities for growth and healing **[Multi-cultural applications]** - Indigenous Australians -- aligned with the practice of "yarning" which is a significant cultural method of sharing and handing down information - Many indigenous have experienced oppression or discrimination and internalise feelings o resentment or hate - Narrative therapy is useful as it facilitates the externalisation of problems which redirects negative feelings