Brain imaging studies in adolescents with bipolar disorder point to abnormalities in parts
of the brain that _______
! =regulate emotion p.282 ➔ amigdala
not plan exec funtionc
not control memory
not regulate sleep patterns
In general, LITHIUM is the ﬁrst choice in the treatments of bipolar disorder
For exam, Check out
Test Anxiety Protocol
Behavioral activation manual- please read ﬁgures 2-10 for examples of how homework
sheets meet SMART goals
single most important
*On OWL, beside each link in “resources” is a icon “i” which tells you what you must
know (or only have for interest)
Treatments for depression
By the end of 2 hours tonight you shoud be able to:
• understand factors leading to CHANGE BEHAVIOURS (not behavior change)
• describe the process of a tyical youth therapy session
• understand how attributions impact cognitive bias
• describe some CBT strategies that are proven to aid child and youth clinets
• discuss some of the literature on tx effectiveness
• know how to access free self-help and prevention resources
Look at textbook for biological and cultural reasons why teenage girls experience 2:1
rates of anxiety and depression
psychotherapy is not actually paid friendship (duh)
• due to the power differential in the therapeutic alliance, NO dual relationships are
allowed (ﬁnancial, sexual, personal)
• Dy deﬁnition, clear rules must be set to ensure no boundaries are violated. Regulated
health professions in Ontario are deﬁned by legislation, known as the Regulated
Health Professions Act (RHPA). A new College being formed will regulate
psychotherapy in Ontario
http//www.collegeofpsychotherapists.on.ca/pages/Home (soon the term “psychotherapy” will be regulated and “not anyone can call themselves a
➔ for profs clinic, the time between treating them as a pt. and having a dual relationship
is 2 years (some ppl argue it should be forever)
Effective psychotherapy does NOT actually have to explore childhood memories, to ﬁnd
out where a problem started and “get it out” through catharsis
• best evidence for treating mood and anxiety disorders (EBT) indicates that a focus on
the present and on the future is needed, ➔ learning skills, facing fears, changing
thoughts and practicing new behaviours daily
➔ exception PTSD - must talk about memory and get it to become just a memory again
(no longer reliving the event sensorily)
• Let’s look at one way a psychologist can quickly know treatments have empirical
evidence to support efﬁcacy
(provided websites available online)
How does therapy work?
• Need a client motivated to change ➔ what if their parents drags them to see me?
• need a good therapeutic relationship
• need clearly deﬁned goals that are agreed upon by all
• need to monitor goal attainment
• need to do homework outside of the session to meet those goals through
• Need to follow the Evidence Based Treatment literature➔ just chatting about feelings
does not change behavior!
People think that there is an age to leaving therapy, but there isn’t!
➔ ➔ As long as you have the capacity to understand risks and beneﬁts of staying in Trx,
you have the right to chose to leave Trx
Dodo bird Verdict
given Treatment A vs Treatment B, there was not a big difference and both were much
better than no Trx.
conclusion of study: general or non-speciﬁc factors are more important than
! Factors such as therapist-client alliance and therapist certainty that the therapy
will help (alligiance), clear goal setting, gains in knowledge, missed one
What if you are not ready for change?
The Stages of Change model
Self help version is “Changing for Good”
Precontemplation- not thinking about change
contemplation-thining about change
Preparation-making small changes
Action- behavior chnage
Maintenance- maintaining behavior change
Relaspe- reverting to old habits
What if parents want change but youth does not?
discuss what the true problem is for parents/child
! “If i meet with someone who truly believes there is nothing wrong in their life (my
binge drinking is OK) then he tries to sublty show them that maybe things in life aren’t
quite adding up as much as they believe”
Therapeutic Relationship Factors
Nonspeciﬁc therapy factors account for AT LEAST 30% OF BENIFITS SEEN IN
THERAPY (MAYBE HIGHER)
Nonspecifc therapy factors that anyone can learn and use in any therapeutic orientation
account for at least 30% of the beneﬁts of therapy
➔ Active listening- offers empathy and builds therapeutic alliance
-ensures client is heard and directs goal setting
-client centered care is complex in children’s mental health ➔ who is the client? -youth?
parent? both? relationship?
“People don’t care how much you know, until they know how much you care”
for kids, active listening is replaced by “play” whatever the child wants to play not what
the adults decides they should play
speciﬁc, measurable, attainable, relevant, time-bound
Within a session format
Steps -look online to see the owl post about charting 1. check in: informed consent, reveiw of goals, personal updates, review of last weeks
homework sheets - on owl you can see a self help article describing the charting of
behaviour- must look at this !
2. Psychoeducation teaching (EBT!), what are the obstacles that are preventing you
from reaching weekly goals? anticipate obstacles
3. In session modeling, practice and guided rehearsal
4. New homework discussed and practiced in sessions
5. Check out: Homework sheets given- practicalities and obstacles? Formal check of
therapeutic alliance- still on track, goal attainment? Hearing you?
For a child this is now play time that was agreed upon “when we do some work, then we
will do some play”
Looking forward➔ how many sessions left, where are we headed?
! (don’t lose track of SMART goals)
Talk is insufﬁcient. Homework is key behavior to change:
Begin to act the part of the person you would like to become as soon as possible
and at every opportunity
➔ many people have offered this idea
“Fake it to you make it”
See Treatment and Prevention of Anxiety in Chapter 7 slides
! ➔ trx includes distorted information processing “false alarms”
let’s look at Cognitive Behaviour Therapy
• Congnitive activity affects behavior
Cognitive activity may be monitored and altered
• Desired behaviour change may be altered through cognitive change
➔ This term emcompasses treatments that attempt to change overt behaviors by
altering thought, interpretations, assumptions, and strategies of responding ➔ do it yourself CBT for child and adult anxiety disorders can be found at
The fundamental error of attribution.
➔ The fundamental attribution error describes the tendency to over value dispositional
or personalit-based explanations for behavior while under-valuing situational
explanations. The fundamental attributtion error is most visible when people explain the
behavior of others.
Cultural differences in attribution errors?
➔ there is some evidence that people from individualist cultures are more inclined to
make fundamental- attribution error than people from collective-ist cultures. Indivdualist
cultures tend to attribute a person’s behavior to his internal factors whereas collectivist
cultures tend to attribut a person’s behavior to his external factors.
“when you walk into a store and the cashier is grumpy, you think ‘what a rude person’.
but we don’t think about external attributions- maybe they had their co worker call in sick
and they are overworked and exhausted?”
Self-serving bias error of attribution - (when not depressed!)
➔ attributing dispositional and internal factor for success and external, uncontrollable
if we fail a test “I didn’t study anyways”, if we