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PSYC 3170
Jennifer S Mills

1 Lecture 2: January 18 Missed Lecture  one of the more purely clinical psychology topics  put it in beginning of course because ideas of theories and interventions around health compromising behaviors is important  what do clinical psychologists do when client comes to them and are engaging in unhealthy behaviors ex. smoking, substance abuse, under/over eating  there are some important and well researched theories that can help give us a framework  any assessment that we're going to imagine taking place - were gonna follow with the biopsychosocial model  this refers to the multidimensional framework or model for understanding behaviors we want to consider biological psychological and social factors not individually but in intreaction with eachother --- last week  review from last week - what are some examples of psychological factors in behavior  emotions, feelings, thoughts, attitudes  fears and anxieties - (under emotional states)  cognitions -- are synonomous with thoughts and beliefs  behaviors - remember that behaviors are going to be considered a psychological factor  biological factors - hormones, genetics, neurotransmitters like serotonin - physiology in general like anatomical structures and physiology in body  social factors - broad category - encompasses entire enviornment outside individual but related to individual - occupation, social role, relationships, culture, religion or geographic area  social factors arent so much in realm of psychology - more in sociology  an assessment is going to include all three factors, psycho, bio, social Assessment of Health-Related Problem Behaviors  Biopsychosocial model o psychological factors o biological factors o social factors  an assessment going to include all three factors The Case of Julie  to illustrate this going to describe case of Julie- hybrid of real clients prof has seen  Julie is third year undergraduate student taking biology, she lives at home with parents and younger brother and younger sister - parents both work and have successful careers (insurance business) Julie doing well in study , getting B's and A's working part time in dentist office, helps to look after younger siblings  Julie also suffers from cripling migraines- she suffers from what physicians would call a classical migraine headache - gets them once a month, when she gets a migraine headache she is debilitated by the headache, cant go to school, cant study - all she can do is go to bedroom and lie down and sleep it off  sometimes she will be bed-ridden for 12-24 hours  parents relationship - busy not having time with her - they rely on her to do a lot for herself- they have high expectations of her, expect her to get As in school and get a good job  parents pushing her to apply for graduate or medical school even though she dosnt know if she has good enough grades to get in or if she even wants it 2  she gets extrmeely anxious around exam times, when she sees she has exams to study for, especially when they all cluster around eachother, same week and hard for her to know whether pattern to migraine but thinks they happen in months in year shes busy  busier she is more frequent and severe the headaches  doctor has given her migraine medication but its not working, she'd like to worry less about the migraine, found not only she is dealing with migraine headaches themselves but shes getting anticipatory anxiety - what if I get a migraine how will I cope if I cant study or get to school  Julie - might be familiar, but this is a typical case Clinical psychologist might see  propose cognitive behavioral assessment  there are different kinds of assessments psychologists can do, kind of assessment you do informed by theories you ascribe to - cognitive behavioral theories have good research evidence to support them  also nice way to organize a persons problem  now going to do a cognitive behavioral assessment using a biopsychosocial model  and these are the kinds of things were going to do: Cognitiive-Behavioral Assessment  1) Identify the problem(s) - what brings julie to treatment - migraine headaches, 2 worry about headaches  2) Prioritize the problem(s) - if client presents more than one problem, prioritize them - this is common when see people in some kind of health related - usually stress anxiety difficulties sleeping eating etc - important to prioritize the problems so helps focus - want to do this collaboratively with client - out of all these things I think we should focus on eating -- don’t want to do that* don’t pose own view on client - you want to foster self dependence, you have the power decide to what is important, things that are most important to client is what they will be most motivated to work on - motivation is key* choose things important to client -- you want to get into psychology of whats important - sometiems disagreement with what patient wants to work on, and psychologist - especially in anorexia nervosa - see low levels of motivation for treatment, person sees no problem they like being thin, everyone elses problem - have to try to come together to work on compriimse or agreement - like we'll not talk abou tthis but we should touch base - --- so priotizie in view point of client**  3) Select the target problem (s) - might work on one thing at a time, more than one thing - work on migraine and the worry about the migraine - worry about migraine might make migraine worse - anxiety can exaserbate migraines, make them worse - once selected target problems, want to do a detailed analysis of those problems  4) Meausre and analyze the problem(s) -- hall mark of cognitive behavioral assessment* this is what most sets it apart from other kinds of assessments - emphasis on measurement and quantifying prolem  THEN go to  5) Develop treatment goals  6) Match treatment to client  7) Assess ongoing therapy Meausre and Analyze the Problem… (step 4)  when doing cognitive behavioral assessment there are two ways to get information first is a clinical interview- where a person doing assessment talks to client and asks lots of questions - from a clinical interview can get lots of useful information using clients own words  Clinical Interview:  Nature and dimensions of problem 3 o describe what these migraines feel like, what kinds of symptoms do you get? she'll say beginning with throbbing pain in one side of head then that pain spreads to both sides of head - she also feels nausea, so bad that she vomits, feels confused- Julie got aura's before migraine - visual symptom that preceeds a migraine attack - people describe these aura's as being as if people are far away - distorts depth perceptions, other people have distortions in peripheral field - a lot of people who experience these aura's that’s their early warning sign your going to get a headache- this aura's happen in 10-15% of patients o how long the migraines last 12-24 hours- how often you get them, once a month, sometimes 2 in one month - get detailed description of problem  Relevent historical events o Julie mother also suffers from migraine headaches - her mother's migraine headaches started when she was pregnant and ended when she reached menopause - mother had migraine headaches from 25-50 o Julie's started earlier than moms but similar pattern and type of headache o history with client - has their ever been a time where didn't have headache - Julie started 16 where had them 4-5 years o right after high school first months of univeristy didn’t have migraine headaches - she was feeling happy, good place, good relationship where she was happy o stress levels were a lot lower - university ramped up, migraines came back  Current situational determinants o important - what are the triggers o this is a lot harder than it sounds - when ask people what are the triggers of migraine headaches, even with people who have stomach problems, binge eating, people are terrible at knowing what their triggers are o 80 percent of time people say just out of the blue - not to say that always out of blue but a lot of time people unaware because don’t pay close attention because busy and feels like coming out of blue o sometimes necessary to give them homework and track occurences of this health related problem o Julie gave her a headache diary - length of homework assignement depends on how frequent behavior is - if someone gets headache every 3-4 weeks have to wait to get information, but easier if its something like eating that people do everyday o Julie diary keeps track of any or all symptoms - kinds of things important for her headaches, aura's type of pain intensity of pain o what was happening immediately before hand - keep track of things that are potentially relevant to behavior o have to do it ahead of actual event - prospective o this is where guided by research, talk to client and see if she has hypotheses and then you track them over time o consulting with research helpful get an idea of what commonly triggers migraines o caffeine, menstrual cycle, hormone related events, foods, o things on there that not so intuitive - MSG common trigger for people, foods high in tyrosine, avacados, mayonnaise - odd list but common triggers o after she did headache diary - what we noticed was time stress was a big one for her - just as she had predicted, migraines more common times where had a lot of things do - those weeks where have 2 midterms and 2 assignments all due at once 4 o when felt things piling up, described being overwhelmed with work, social responsibilities, never enough time to get it all done o possible biological triggers, foods and psychologicial determinants stress  Consequences of the problem in the client's life o best way to do this is to ask client - what do you do when you get your headache o Julie -when she gets headache, goes upstairs, turns off light, sometimes even put in earplugs and she sleeps - sometimes for 12 hours o sleep is something that adaptive as being good for headache- but psychologically was this was a big escape o what better way to escape feelings of stress and anxiety buy sleeping, when sleeping not able to worry or feel stress o important distinction - not that she was faking headaches and using them as excuse to fall asleep and check out - but that inadvertently that behavior is reinforcing, something rewarding of being able to crawl into bed andnot deal with anything o mom and dad were understanding at those times - knew they couldn’t ask her to do much - tey were reinforcing that behavior o distinguish between indirect reinforcing behavior and someone faking to get out - julie wasn't faking to get out o more negative consequences included the pain of the headache - once she did recoop she felt guilt about missing things and class, anxiety built up o now I have to catch up, even more work to do o delayed anxiety about catching up and getting back on track - missing work shifts and not getting payed  all of this detail about the problem of the client can get from clinical interview The clinical interview is aided by:  structured self-report questionnaires o so many available - questionnaire for migraine that looks at impact on persons life o pain questionnaires - quantify persons pain o benefits to questionnaires - you have basis for comparison - on scale from mild, moderate, severe compared to 1000 other people this individual is in moderate range o now make conclusions about how severe it is  direct observation o some problems lend themselves - migraine don’t lend themselves, there not predictable, not frequent - chancing of person comign to office and having migraine in front of you not likely o other things you can observe -- health related problem you can directly observe - you can observe anxiety, techniques use to ellicit anxiety or ask to use imagine situation writing exam and don’t know answer - o phobias - if want to see just how anxious someone looks and feels, for ex. someone in front of a spider o tool box of phobic items - fake spiders, videos of spiders etc - o field trips - for ex. pigeon phobia go down toronto - she had full blown panic attack -set up scenerios where directly observe anxiety o colleague shows up a little late to see whether get really angry or bothered - measure aggression o smoking - patient addicted to cigarettes - watch them smoke, how often take drag, how deeply they inhale - other behavioral observations, twitchy, calm o look at body posture - if look anxious relaxed etc. 5 o eating - if someone reports eating quickly or slowly, tricky because people self - conscious - very fact watching them means not eating same as eating alone o reactions to certain kinds of foods - behavioral exposure to certain foods o someone phobic of eating big mac - eat one along with her - do first hand behavioral exposures together - hybrid of treatment and assessment - watch person eat big mac and expose s
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