Chapter 16 Therapy Prevention and Assessment Types of Psychotherapy Evaluation of Psychotherapy Prevention and Assessment Types of Prevention o Universal mental health prevention Massive coverage limited ethnicity E g wear sunscreen o Selective mental health prevention More focused prevention E g diabetes o Indicated prevention interventions Stop kids problems from getting worse E g Families and Schools Together FAST Program kids with conduct issues are treated for 10 years Justification P 684 685 The earlier you treat the better Mushrooming of dysfunction Personal and societal costs The Importance of Assessment Foundational to diagnosis and treatment Broad vs Narrow focus during assessment o Broad initial assessment new focus on treatment o Narrow assessment of treatment efficiency continuous o Not just one point in time o E g OCD treatment reassessments Types of Psychotherapy P 666 How to know if therapy is needed and what type Successful transition Psychodynamic approaches Focus on deeper conflicts Family of origin and insight Subjectivity and research support o Less directive o Insight orientated Client centered approaches humanism unlocks potential Focus on support and acceptance Rogers and unconditional positive regard Non specific therapy effects o Be yourself o Warmth genuineness o What is really helping Therapist with lens vs good listener and warm person to talk to Behavioral Approaches Focus on behavior modification o Small steps of exposure Influence of Watson and Skinner o E g contingencies of reinforcement Greatly influenced behavioral parent training Training o Defiant children Barkley 1997 Durability and symptom substitutions o AKA Parent Child Interaction Therapy and Parent Management o What happens when reinforcement stops Do symptoms reappear o Teach patient how to internally reinforce Bobby Revisited AD HD and ODD Oppositional Defined Disorder 80 of kids aged 7 9 show reduced symptoms of AD HD when on medication that is well controlled these kids also tend to have conduct academic social skills and anxiety issues Treat using therapy and maybe medication Prevention and assessment needed before treatment MTA Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study Comparison of behavioral training vs medication vs combination Medications most effective in reducing core AD HD symptoms o This applies to 80 of kids o Durability Evaluated at age 8 How bad is it Compliance or non compliance what percentage of the time o 10 compliance 90 non compliance o Increasing compliance is the best way to make long term changes not putting out fires in the short term Firmness and warmth is balance is effective parenting Behavioral Parent Training 3 broad parenting skills 10 12 sessions o Attends paying attention catching your child being good and offering clear and specific praise ignoring mild displays of non compliance Ensures consistent practice Reinforcement of good behavior is necessary clear effective and developmentally appropriate o Commands commands followed by attends compliance with request o Discipline calm consistent immediate minimal emotionality and Delayed obedience is non compliance More specific components o Psycho education why children misbehave o Token economies Attends Chips and charts for compliance e g stars o The use of time out o Anticipating problems e g Toys R Us behavior o Home school communication Report card to send home should be simple positive and safety nets Does not need to be perfect to earn reward Perfection fosters anxiety and non compliance Types of Psychotherapy Cognitive behavioral approaches o Focus on thoughts behaviors and feelings o Like behavioral active and collaborative o TBF pyramid revisited Cognitive behavioral techniques o Psychoeducation o Somatic management or relaxation techniques o Challenging automatic thoughts o Situational exposure Jamey anger outbursts depressed mood social isolation first treatment contact at age 9 16 yr old male no major medical problems primary diagnosis of OCD with obsessions revolving around fear of contamination Treatment Procedure o Exposure with response prevention Exposure anxiety activate obsessive thoughts and resultant Response prevention information and habituate to anxiety confront fear access corrective o Develop fear and avoidance hierarchy and implement in context of broader CBT intervention Evaluation of Psychotherapy Does it work For whom what o Example of facilitated communication o Example of EMDR p 671 Empirically supported therapies o Consumer reports p 667 vs Outcome studies o Randomized clinical trials and meta analysis research on effectiveness of all treatment o Well established vs probably efficacious o Abundant support for behavioral and cognitive behavioral approaches
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