LECTURE 1. INTRODUCTION
Impactful and highly distressing
Complex psychological problems are Severe + Long-lasting or recurrent (hard to treat + early development and continue in adulthood)
High comorbidity and additional problems
COMPLEX PSYCHOLOGICAL
PROBLEMS Common mental health disorders MDD - Anxiety Disorders - Specific phobias - ADHD - Sleep disorders
(Subjective => for patient
and therapist) Complex mental health disorders ersonality disorder
P - Eating disorders - Chronic/persistent depression - OCD
Psychosis (Complex) PTSD - Dissociative Identity Disorder - Bipolar Disorder
PSYCHOLOGICAL INTERVENTIONS FOR COMPLEX PROBLEMS =>Originate from previously existing therapies:
o eveloped in the late 19th century/ early 20th century
D
o Goal: bring unconscious or deeply buried thoughts + feelings to the conscious mind
SYCHOANALYTIC
P o Become aware of hidden meanings or patterns
PSYCHOTHERAPY o Examine how repressed experiences + emotions (childhood) may contribute to current experiences, actions and problems
(Sigmund Freud) o Historically: traditionally 4-5 sessions per week, 4 years at a time (long treatment)
ream analysis:Get an insight into working the unconscious mind.
D
sychoanalytic
P Free association: Emergence of emotions or thoughts that you weren't aware of => while you are talking about thoughts.
techniques Transference:Project the feeling of somebody else onto the therapist (E.g. feelings of his mother to the therapist)
Countertransference:when the practitioner project feeling of someone to the client.
o eveloped in the 1960s as cognitive therapy for depression
D
o Unvalidated thoughts and cognitive disruptions
o Impact on emotions and behaviors
o Often not needed to dive into the past (stay in the present)
COGNITIVE BEHAVIORAL o Extensively researched => effective for many psychiatric disorders, such as anxiety, OCD, PTSD, eating disorders, psychosis etc.
THERAPY
(Anton Beck)
o ysfunctional automatic thoughts=> often developed through early experience.
D
o Cognitive distortions=> Errors in logical reasoning, e.g. dichotomous thinking ‘’black or white’’.
o Core belief=> develops early on in life, also called schemas about the self, others, and world.
o Goal:Changing cognitions and behaviorto bring about change in how one feels in daily life
COGNITIVE
MODEL Means
o S tructured, goal-oriented treatment sessions
o Practical and active participation (we need active engagement) => patient is responsible own therapeutic process
o ognitive restructuring: replacing negative automatic thoughts.
C
Techniques o Exposure therapy
o Behavioral experiments: testing your expectations +Behavioral activation
, o Problem-solving skills + Relaxation
sychoanalysis => new
P
o T ransference-focused psychotherapy (TFP):more structured,borrowed aspect of CBT
development o Psychoanalysis Group Therapy(PA group):Long termtreatment, a lot of free association, limited structure
TREATMENTS FOR Schema therapy Adopts techniques from both categories
COMPLEX PSYCHOLOGICAL
PROBLEMS Dialectical Behavior Therapy Zen + mindfulness + CBT
CBT-E Eating Disorder: extended CBT
Some interventions are disorder-specific (E.g. IBA for OCD)
Some interventions => initially developed for 1 disorder => multiple disorders (Eg: DBT= autism + BPD; Schema therapy: PD => chronic depression...)
ISORDER
D
INTERVENTION OVERLAP Some disorders => effectively be treated with a diff interventions => BPD: ST, DBT, or TFP (MBT) / Chronic Depression: CBASP, ST, Psycho-dynamic.
Treatment indication? => depend on therapist + client. BUT => different scientific evidence depending on the disorders + therapy treatments.
Therapeutic alliance:the relationship between clientand therapist also impacts the treatment.
ll psychological interventions
A Attention and time investment
OMMON FACTORS
C consist ofcommon factors
VS SPECIFIC FACTORS Hope and expectation: already just knowing that theyare receiving help can be beneficial
Credible rationale:aspect that is specific for thesespecific therapeutic interventions.
Specific factors:thespecific techniquesused inthe therapy
Complex problems:long-lasting, highly debilitating,and highly comorbid
Interventions:stem from previously existing therapists=> may overlap techniques + applications.
, LECTURE 2 & 4: SCHEMA-FOCUSED THERAPY
1990s: Jeffrey Young (& colleagues) => creating a new form of treatment for complex problems by combining previous techniques (CBT not enough)
“ Schema therapy is a form of psychotherapy that helps youunderstandtheoriginsofbehavioralpatternsandchangethem.Theinfluenceof childhood
experiencesonyourbehavioralpatternsanddailylifeis explored.Youlearntochangeyourselfinsuchawaythatyoufeel betterandcantakebettercareof
yourselfandstandupforyourself.Youlearntofeelwhatyourneedsare,andyoulearntostandupfor theminahealthierway.Thischangesnotonlyyour
EVELOPMENT OF
D behavior but also your thoughts and feelings."
SCHEMA THERAPY
SFT is composed of:
o ognitive techniques: Challenging & restructuringthoughts
C
o Behavior therapy
o Experimental techniques: making a change on a deeperlevel, how you feel about things
More attention foryouth and childhood trauma(developmentof schemas/ beliefs) => most of the people with complex problems had trauma.
Use ofmodes(“ways of being”) => Develop certainschemas in early part of your life => schemas might not be appropriate => develop not healthy adult
o T herapeutic intervention is alsopart of treatmentand also helps in the success.
Therapeutic relationshipas intervention (basic needs) o Therapist => also difficult because you need to be there.
o Transference: interaction between what happens outsidewith what happens in therapy
o ttachment theory, cognitive, behavioral, Gestalt therapy, Transactional
A
Integrative psychotherapycombining theory and techniquesfrom Analyses, psychodynamic psychotherapy and psychodrama
o Group & individual sessions: combination of both is most effective
o E arly Maladaptive Schema (EMA):pervasive patternof memories, emotions, cognitions, and physical sensations, developed in childhood.
HAT IS
W Focuses on o Coping Styles:a person’s behavioral responses toschemas.
SCHEMA-FOCUSED o Mode(mood/temper): mind states that cluster schemasand coping styles into a temporary “way of being”, e.g., “vulnerable child mode”.
THERAPY
Goals
o ecognize schemas and break through these patterns of thinking, feeling and behaving.
R
o Strengthen the Healthy Adult mode andHappy Childmode
o eople with apersonality disorderdiagnosis (DSM-5)
P
Forwhom? o Longer existing, recurrent symptoms/ clinical syndromes that were (unsuccessfully)treated before
o Theclinical syndrome is treated first or does notinterfere=> also recommended to treat PTSD first(due to comorbidity with this)
atients
P
o I nsightinto theemergence of negative patterns/problems(reflective skills)
must have o Sufficientinsightintoone’s own emotions and abilityto mentalize
Impactful and highly distressing
Complex psychological problems are Severe + Long-lasting or recurrent (hard to treat + early development and continue in adulthood)
High comorbidity and additional problems
COMPLEX PSYCHOLOGICAL
PROBLEMS Common mental health disorders MDD - Anxiety Disorders - Specific phobias - ADHD - Sleep disorders
(Subjective => for patient
and therapist) Complex mental health disorders ersonality disorder
P - Eating disorders - Chronic/persistent depression - OCD
Psychosis (Complex) PTSD - Dissociative Identity Disorder - Bipolar Disorder
PSYCHOLOGICAL INTERVENTIONS FOR COMPLEX PROBLEMS =>Originate from previously existing therapies:
o eveloped in the late 19th century/ early 20th century
D
o Goal: bring unconscious or deeply buried thoughts + feelings to the conscious mind
SYCHOANALYTIC
P o Become aware of hidden meanings or patterns
PSYCHOTHERAPY o Examine how repressed experiences + emotions (childhood) may contribute to current experiences, actions and problems
(Sigmund Freud) o Historically: traditionally 4-5 sessions per week, 4 years at a time (long treatment)
ream analysis:Get an insight into working the unconscious mind.
D
sychoanalytic
P Free association: Emergence of emotions or thoughts that you weren't aware of => while you are talking about thoughts.
techniques Transference:Project the feeling of somebody else onto the therapist (E.g. feelings of his mother to the therapist)
Countertransference:when the practitioner project feeling of someone to the client.
o eveloped in the 1960s as cognitive therapy for depression
D
o Unvalidated thoughts and cognitive disruptions
o Impact on emotions and behaviors
o Often not needed to dive into the past (stay in the present)
COGNITIVE BEHAVIORAL o Extensively researched => effective for many psychiatric disorders, such as anxiety, OCD, PTSD, eating disorders, psychosis etc.
THERAPY
(Anton Beck)
o ysfunctional automatic thoughts=> often developed through early experience.
D
o Cognitive distortions=> Errors in logical reasoning, e.g. dichotomous thinking ‘’black or white’’.
o Core belief=> develops early on in life, also called schemas about the self, others, and world.
o Goal:Changing cognitions and behaviorto bring about change in how one feels in daily life
COGNITIVE
MODEL Means
o S tructured, goal-oriented treatment sessions
o Practical and active participation (we need active engagement) => patient is responsible own therapeutic process
o ognitive restructuring: replacing negative automatic thoughts.
C
Techniques o Exposure therapy
o Behavioral experiments: testing your expectations +Behavioral activation
, o Problem-solving skills + Relaxation
sychoanalysis => new
P
o T ransference-focused psychotherapy (TFP):more structured,borrowed aspect of CBT
development o Psychoanalysis Group Therapy(PA group):Long termtreatment, a lot of free association, limited structure
TREATMENTS FOR Schema therapy Adopts techniques from both categories
COMPLEX PSYCHOLOGICAL
PROBLEMS Dialectical Behavior Therapy Zen + mindfulness + CBT
CBT-E Eating Disorder: extended CBT
Some interventions are disorder-specific (E.g. IBA for OCD)
Some interventions => initially developed for 1 disorder => multiple disorders (Eg: DBT= autism + BPD; Schema therapy: PD => chronic depression...)
ISORDER
D
INTERVENTION OVERLAP Some disorders => effectively be treated with a diff interventions => BPD: ST, DBT, or TFP (MBT) / Chronic Depression: CBASP, ST, Psycho-dynamic.
Treatment indication? => depend on therapist + client. BUT => different scientific evidence depending on the disorders + therapy treatments.
Therapeutic alliance:the relationship between clientand therapist also impacts the treatment.
ll psychological interventions
A Attention and time investment
OMMON FACTORS
C consist ofcommon factors
VS SPECIFIC FACTORS Hope and expectation: already just knowing that theyare receiving help can be beneficial
Credible rationale:aspect that is specific for thesespecific therapeutic interventions.
Specific factors:thespecific techniquesused inthe therapy
Complex problems:long-lasting, highly debilitating,and highly comorbid
Interventions:stem from previously existing therapists=> may overlap techniques + applications.
, LECTURE 2 & 4: SCHEMA-FOCUSED THERAPY
1990s: Jeffrey Young (& colleagues) => creating a new form of treatment for complex problems by combining previous techniques (CBT not enough)
“ Schema therapy is a form of psychotherapy that helps youunderstandtheoriginsofbehavioralpatternsandchangethem.Theinfluenceof childhood
experiencesonyourbehavioralpatternsanddailylifeis explored.Youlearntochangeyourselfinsuchawaythatyoufeel betterandcantakebettercareof
yourselfandstandupforyourself.Youlearntofeelwhatyourneedsare,andyoulearntostandupfor theminahealthierway.Thischangesnotonlyyour
EVELOPMENT OF
D behavior but also your thoughts and feelings."
SCHEMA THERAPY
SFT is composed of:
o ognitive techniques: Challenging & restructuringthoughts
C
o Behavior therapy
o Experimental techniques: making a change on a deeperlevel, how you feel about things
More attention foryouth and childhood trauma(developmentof schemas/ beliefs) => most of the people with complex problems had trauma.
Use ofmodes(“ways of being”) => Develop certainschemas in early part of your life => schemas might not be appropriate => develop not healthy adult
o T herapeutic intervention is alsopart of treatmentand also helps in the success.
Therapeutic relationshipas intervention (basic needs) o Therapist => also difficult because you need to be there.
o Transference: interaction between what happens outsidewith what happens in therapy
o ttachment theory, cognitive, behavioral, Gestalt therapy, Transactional
A
Integrative psychotherapycombining theory and techniquesfrom Analyses, psychodynamic psychotherapy and psychodrama
o Group & individual sessions: combination of both is most effective
o E arly Maladaptive Schema (EMA):pervasive patternof memories, emotions, cognitions, and physical sensations, developed in childhood.
HAT IS
W Focuses on o Coping Styles:a person’s behavioral responses toschemas.
SCHEMA-FOCUSED o Mode(mood/temper): mind states that cluster schemasand coping styles into a temporary “way of being”, e.g., “vulnerable child mode”.
THERAPY
Goals
o ecognize schemas and break through these patterns of thinking, feeling and behaving.
R
o Strengthen the Healthy Adult mode andHappy Childmode
o eople with apersonality disorderdiagnosis (DSM-5)
P
Forwhom? o Longer existing, recurrent symptoms/ clinical syndromes that were (unsuccessfully)treated before
o Theclinical syndrome is treated first or does notinterfere=> also recommended to treat PTSD first(due to comorbidity with this)
atients
P
o I nsightinto theemergence of negative patterns/problems(reflective skills)
must have o Sufficientinsightintoone’s own emotions and abilityto mentalize
