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- Presentation, CARP BC 2004, February 18, 2004
- Drs. Buch, Garrett & Bannerman
- Behavioural Health Care
- www.behaviouralhealthcare.com
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3
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4
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- To identify 3 characteristics of an excellent assessment.
- To become acquainted with 3 treatment approaches.
- To generate a list of strengths & weaknesses of these 3 treatments
to expedite case management & work return.
- To familiarize yourself with the outcome literature on 3 psychological
disorders.
- To explore 3 future treatment trends.
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5
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6
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7
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8
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9
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10
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- Assess first!
- Assessment as story
- Assessment as therapy
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11
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- Psycho-Legal
- 1 - 2 visits only
- Comprehensive, costly
- Lots of testing
- Diagnostic focus
- Atheoretical
- Intake
- First of many visits
- Narrow, less costly
- A few, brief tests
- Treatment focus
- Follows theory
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12
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- Appropriate Scope
- Clear Opinion
- Scientist/Practitioner Expertise
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13
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14
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- Origin of psychiatric symptoms
- Treatment objectives
- Empathy
- Transference & Countertransference
- Corrective emotional experience
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15
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- Let her tell her story
- Safety, security & understanding through empathy
- How she interprets & understands her world
- Attention to transference
- Interpretation of transference/emotions to validate
- Deepen insight & self-awareness
- Working through inner conflicts & motivations to build a more
coherent and integrated self
- Enlist the help of corrective emotional experiences
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16
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17
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- Present-oriented, active, strategic, time-limited, and structured
- Psychoeducational, focused on skill acquisition
- Goal is to replace maladaptive perceptions with adaptive beliefs
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- Develop & share case formulation & treatment rationale
- Behavioural strategies (cBt)
- behavioural activation
- increase pleasant, mastery & social activities
- relaxation training: a self-calming tool to manage anxiety
- systematic desensitization
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19
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- Systematic Desensitization
- Create a hierarchy or fear ladder
- CAP Principle: Challenge (don’t overwhelm); Apply anxiety management
techniques to reduce distress of challenge (never escape); Practice
- Exposure can begin in imagination (covert desensitization) then in real
life trials (in vivo desensitization)
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- Cognitive Strategies (Cbt)
- mood monitoring
- identify automatic thoughts & cognitive distortions
- rational responding; formulating adaptive alternatives
- address underlying assumptions and maladaptive schema
- the consistent way in which the self or others are viewed
- core beliefs can increase our vulnerability to emotional distress
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- Relapse prevention
- normalize recurrence of some symptoms; attentional control
- anticipate triggers and stressors
- develop social supports
- review & rehearse adaptive coping strategies
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22
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- Treatment method
- Treatment rationale
- Treatment phases (8)
- EMDR distinctives
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- Client History
- Preparation
- Assessment
- Desensitization
- Installation
- Body Scan
- Closure
- Re-evaluation
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- Bilateral activation
- Less talk
- Re-exposure to trauma important
- Client centred
- Somatic focus
- Change may be unpredictable
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27
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28
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29
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- On a conceptual level
- On a technical level
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30
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- Explanation of etiology
- Maintaining factors
- Mechanism of clinical change
- role of insight
- role of language & cognition vs. experiential interventions
- nature & role of therapeutic alliance
- Emphasis upon here-&-now vs. developmental or historical factors
- Emphasis on environment vs. internal processes
- Emphasis placed on genetic or biological vulnerability
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- Importance of identifying & pursuing specific treatment goals
- Importance of objective diagnosis & assessment of symptom severity
- Importance of obtaining specific information from patients & family
members
- Identification of patient characteristics that are predictive of
clinical improvement
- Role of case formulation in guiding selection of specific interventions
- Emphasis placed on therapeutic structure (problem focus) & directive
intervention vs. unstructured & non-directive
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32
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33
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- A typology is useful to classify & weigh research contributions
- Factors common across therapies account for a significant proportion of
what is therapeutic
- Characteristics of patient, therapist & their relationship are
important
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- BT, CBT & IPT
- Type 1 (RCT) studies
- Meta-analytic reviews
- Combined psychosocial & medication
- Strongly supported by at least one major study
- SSRIs & several new compounds
- Support from Type 1 RCTs w/ placebo controls
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- Exposure, Anxiety Management
- EMDR
- One Type 1 study & several Type 2 studies of civilian trauma vs
controls
- Antidepressants
- Type 1 RCTs with placebo controls
- BT, SSRIs & EMDR
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- CBT Individual or Group
- Reduces pain-related distress & disability (not pain)
- Several Type 2 RCTs
- Cognitive Therapy, Behavioural Therapy
- At least three Type 4 studies & several more Type 5 studies
- Antidepressants
- Reduce pain intensity
- Large number of Type 1 & Type 2 placebo-controlled RCTs
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37
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38
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- Interdisciplinary Treatment
- Getting more per investment dollar?
- Individualization vs Generic Tx
- Modularized CBT: CbT vs. cBT
- Eclectic need not be a dirty word
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39
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- Neuroplasticity & the changing brain.
- How many new connections did you make today?
- Brain/Mind/Body in action
- Implications for treatmnet
- The neurobiology of posychotherapy
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40
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- Biofeedback
- traditional biofeedback, neurofeedback, hemoencephalography
- Digitized Psychology
- Self-help web sites & list-serves
- Web-based appointments, assessment & counselling
- The digital psychologist
- Virtual Reality
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41
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Notes
