PSYCH 1XX3 Chapter Notes - Chapter 11: Unconditional Positive Regard, Progressive Muscle Relaxation, Randomized Controlled Trial

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26 Mar 2015
Chapter 11: Psychological Treatment
Diversity of Treatment Consumers
-Potential consumers of mental health services are not limited to those who are diagnosed
Tailoring Treatment to the Disorder
-Treatments span over a broad range
-Accurate conceptualization of the disorder is imperative before choosing the treatment
-Ego syntonic disorders: symptoms of the disorder perceived by the individual with the
disorder as valued
-Ego dystonic disorders: symptoms that are perceived by the individual as undesirable
Tailoring Treatment to the Individual
-Treatment should account for the individual, family, social, circumstantial and cultural context
-Stages of Change: stepwise progression of thoughts and actions that characterize effective
change of problematic thoughts or behaviours
1. Precontemplation: inability to acknowledge the existence of the problem
2. Contemplation: acknowledges the existence of the problem but unsure how to change
the problem
3. Preparation: recognizes the problem and the preparation for change
4. Action: takes steps to change their behaviour
5. Maintenance: continuation of healthy habits formed at the action stage; watches out for
potential stressors that can trigger their relapse
Diversity of Treatment Providers
Range of Provider Backgrounds and Licensure
-Licensed psychologists: psychologists with specific training in clinical psychology
-Psychiatrists: doctors who have advanced training in the practice of psychiatry
-Other occupations that offer treatment: social workers, counselors, mental health workers…
Art and Science of Psychological Treatment
-There must be a therapeutic relationship between therapist and patient for the treatment to be
1. Alliance: in individual therapy
Cohesion: in group therapy
2. Empathy: understanding the patient’s emotions and thoughts
3. Feedback: therapist collects and responds to the patient
4. Positive regard: therapist views the patients as a good person
5. Goal consensus
6. Collaboration
Diversity of Treatment Options
Treatment is broke up into two categories: Psychological and biomedical treatments
-Often, both treatments are practiced simultaneously
-Evidence-based practice
oPatient care is enhanced with up-to-date technology
oGap between advances in knowledge and individual clinicians’ abilities to keep up with
these advances
oSummaries of evidence presented by experts that will bridge the gap
-Concerns: restriction of treatments, potential for malpractice, efficiency and effectiveness
Efficiency and Effectiveness
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Efficiency: ability of a treatment to produce a desired effect in highly controlled settings
-Efficacy studies: evaluate the utility of a treatment for an ‘idea;’ patient in a highly controlled
treatment settings
oRequires a Randomized controlled trial
Participants with the condition are randomly placed in treatment or controlled
Single blind: participants don’t know what group they’re in
Double blind: participants and researcher don’t know the groups
oIssues: identifying a patient with solely that condition, operationalizing the new
treatment, choosing appropriate placebos, which blinding test and evaluating the
treatment outcome
oFail to differentiate between statistical and clinical significance
Effectiveness: ability of a treatment to produce a desire effect in real-world settings
-Effectiveness studies: gauge the utility of a treatment for a real patient in an ordinary
treatment setting
oWeaknesses: Sample of population may seek and persist with treatment of
psychological disorders but may not represent the entire population
oAbsence of a control group: unable to differentiate the effects of psychotherapy from
social contact
Behavioural Therapy
-Ignore the patient’s unobservable internal state and focuses on their observable behaviours
-Build on the principles of classical and instrumental conditioning
Conceptualization of Psychological Maladjustment
-Maladaptive learning histories give rise to problematic behaviours
-Behaviorists try to modify the patient’s present day behavioral patterns and replace them with
adaptive, and positive alternatives
Therapeutic Techniques
-Try to reduce fear and anxiety
-Systematic desensitization: use classical conditioning to decouple a fear stimulus-response
association by taking steps to counter-condition the fear stimulus with an adaptive response
oStage 1: Relaxation training
Client learns progressive muscle relaxation and abdominal breathing
oStage 2: Anxiety hierarchy
Feared situations are listed out in order from least worst, and each fear responses is
slowly extinguished with technique called exposure.
Patient undergoes deep relaxation and slowly the therapist goes up the next step
-Operant conditioning and behaviour modification: analysis of consequences of specific
behaviours is undertaken to understand how certain contingencies increase/decrease the
likelihood of recurrence of the behaviours
-Effective for reducing symptoms of depression, OCD and substance-related disorders
-Skills learned in therapy do not easily translate to real world settings
-Ethics: people need to provide informed consent and it’s seen as unethical to change the
behaviour of another
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