Psychological interventions

Bring about form of change in: • Beliefs • Behaviour • Mood

• Reduce pre/post op anxiety, pain + reduce analgesia requirements • Health promotion + risk reduction - smoking, diet, exercise, alcohol, drugs • Manage adjustment issues - chronic illness, family changes, disability, loss • Stress management - coping, anxiety, behavioural/emo disturbance, PTSD, phobias • Managing mood problems - depression, anxiety, anger • Alternative/adjunct to drugs - reduces over-medication • Managing symptoms/side-effects of difficult to manage conditions - chronic pain, chemo

• Cognitive • Behavioural • Combined

Thoughts, behaviours, feelings States that all link together and affect one another.

• We interact with the world through interpretations and evaluations that we make about our environment • It is not the situation itself that causes psychological disturbance. It’s the thoughts, beliefs and meanings we attach to the event that produce our emotional and behavioural responses. • Results of cognitive processes are accessible via thoughts and images, and therefore have potential to change.

• Automatic thinking (highest level) • Underlying rules and assumptions (intermediate beliefs) • Core beliefs (cognitive schemata)

Fleeting thoughts that pop into your mind unbidden, situation specific and involuntary. Feeling results in the thought (negative automatic thoughts): Eg. I feel anxious - I can’t cope, I’ll make a fool of myself I feel pain - I am going to die I feel incompetent - I’ll make a fool of myself, everyone will see…

Guide our behaviour, set standards that we live by - can be healthy or unhealthy. Examples of unhealthy assumptions: • ‘If I am to be successful, people must like me’ • ‘I must get over 80% in my exams in order to be successful’ • ‘No one should be disrespectful to me or treat me poorly’ They provide a way to avoid facing a negative core belief.

They give rise to our rules and assumptions and thoughts (NATS). Developed in early life/childhood, the centre of our beliefs. Usually global, absolute and focus on ourselves, the world. Can be positive or negative. Activated by life events (trauma, bereavement, rejection) Negative core beliefs usually: • Over-generalised • Unconditional • Rigid • Eg. ‘I’m unlovable’ ‘I can’t trust anyone’ ‘I am bad’

• Arbitary inference • Catastrophising • Selective abstraction • Magnification and minimisation • Personalisation • Absolutistic, dichotomous thinking • Fait accompli thinking

• Negative triad - pessimistic beliefs about self, world + future • Negative schemas or beliefs triggered by negative life events • Cognitive biases This is all said to associate/cause depression.

• Identifying maladaptive thoughts or beliefs, challenging them and changing them to become more adaptive - cognitive restructuring. • Changing the way we relate to our thoughts • Developing effective coping strategies For depression, anxiety, panic disorders etc.

• PURPOSE: To identify and increase attention of thoughts, emotion, behaviour (+ allows external monitoring by HCP) • Monitoring process: inc awareness by recording thoughts, emotions + behaviour. Should be quick and simple to make record. • Timing of record keeping: ASAP after emotion/behavioour has occurred.

• Event/trigger • Thoughts/beliefs • Emotional response • Consequences + actions • Thinking error

• Thinking about costs/benefits (pros/cons) of changing and not changing a specific behaviour. • Determining what is involved in decision to change current habits • Change is difficult - are costs worth it? So look at costs/benefits of changing behaviour and then of maintaing behaviour - eg. taking regular exercise.

• Goal - to encourage individuals to explore their own conflicting beliefs towards particular behaviour or change. • Effective in decreasing smoking, alcohol/drug misuse, addictions, improving adherence to lifestyle changes etc. • Cognitive dissonance - psychological discomfort of two opposing views, so consultant will try to help patient explore these feelings and increase levels of motivation.

Usually requires a trained counsellor • A - identify Activating event (trigger) • B - identify Beliefs, assumptions + thoughts in response to A • C - identify the emotional and behavioural Consequences of B • D - Dispute irrational beliefs • E - develop an Effective new rational outlook by restructuing belief system in order to acknowledge rational beliefs + discard irrational ones

• Acceptance and comitment therapy (ACT) • Integrative therapy (IT) • Cognitive Analytic Therapy (CAT) • Interpersonal psychotherapy (IPT) • Systemic/family therapy

• Cognitive technique involves deliberately focussing attention away from whatever is causing distress • Effective in reducing moderate-acute pain/distress • Short term - lasts as long as person remains distracted • Eg. counting, colouring, puzzle, talking, crosswords, TV, music etc. Cartoon distraction alleviated anxiety in children during anaesthesia.

• Maladaptive behaviour is a learned response • Can be substituted for a more adaptive response • Focus on a specific behaviour/treat specific symptoms • Insight and/or understanding of theory is not a requirement

• Substitute maladaptive behaviours for adaptive ones • Relieve symptoms

Learning a behaviour by observing and imitating others. • Models are observed performing gradually more stressful tasks without adverse effects • Useful in treating anxieties concerning hospital procedures, specific phobias, social phobia + new skills. • Behavioural rehearsal (medical training) - role play, cardiac resus procedures, simulations, history taking, breaking bad news.

If a behaviour followed by reward, this increases likelihood of behaviour being repeated. If it is not rewarded or is followed by an unpleasant outcome then the behaviour will occur less frequently.

If a behaviour results in (usually unpleasant) stimulus being removed, it increases the likelihood of behaviour being repeated.