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Lecture 1

Treatment for depression: mood disorders.pdf

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Psychology 2320A/B
Tom Haffie

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 Psych 2042 *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 Mythbuster #1: 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// (soon the term “psychotherapy” will be regulated and “not anyone can call themselves a therapist”) ➔ 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) Mythbuster #2 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 specific techniques. ! 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 Motivational interviewing ! “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 -reflect content -refelct feelings -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 SMART GOALS 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) Between Sessions 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” CBT 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 Attribution bias? 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 factors if we fail a test “I didn’t study anyways”, if we
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