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Best Practice
100
What is the definition of evidence based practice?
What is conscientious, explicit, and judicious use of best evidence in making decisions regarding practice. It is researched and found to be reliable by 2 random clinical trials.
100
CBT
Psychotherapeutic approach that addresses maladaptive behavior and cognitive processes through goal-oriented and systematic procedures
100
What's the best practice for eating disorders?
• Eating disorders o Anorexia: No single treatment. Combination of hospitalization and refeeding, behavior therapy, CBT, family therapy, IPT o Bulimia: CBT, then IPT • Psychopharmacology (co-occurring): SSRI, tricyclic antidepressant o Binge Eating: CBT->DBT o Psychopharmacology is only to treat symptoms of co-occuring disorders-there is no pill that directly deals with an eating disorder
100
What is psychodynamic treatment?
o Based on the belief that behavior is controlled by internal forces and motivations • Everything a person thinks, feels, or does has a psychological motive so internal psychological processes are seen as the primary concern • Childhood experiences are critical to adult experiences • Mind/personality has a structure-rational and moral forces, unconscious motivations, and defenses
100
Schizophrenia and Mood Disorders
• Schizophrenia o No cure, highly treatable o Pharmacotherapy • Medication, while effective, is not enough • Antipsychotic • Atypical • Typical o Psychosocial and/or psychotherapeutic • Care Coordination • Assertive community treatment • Intensive case management • Supported employment • Family psychoeducation and interventions (Multiple family group treatment) • Social Skills Training • Behavior Modification • Mood disorders (bipolar disorder) o Bipolar • CBT/BT (Family, couple, psychoed) • Interpersonal Therapy • Support/Family focused therapy • Psychoeducation • Psychopharmacology • Mood stabilizers, antidepressants, antipsychotics o Antidepressants MUST be used in conjunction with mood stabilizers to avoid onset of mania o Depression • CBT • IPT • Behavior therapy • Pharmacology: MAOI’s (monoamine oxidase inhibitors-earlier class), SSRI’s, mood stabilizers, tricyclic antidepressants, atypical antidepressants ***ONLY EVIDENCE BASED IS SSRI?!?!*** • ECT (electroconvulsive therapy)
200
How do we determine the best EBP and evidence?
Through client characteristics and the 6 levels of evidence.
200
DBT
A cognitive-behavioral approach that emphasizes collaboration, support, and cognitive techniques, recognizing the person is trying their best
200
What is the best practice for alzheimers?
• Alzheimer’s Disease (and treatment of elderly) o CBT o Memory focused therapies o IPT (early stages) o Validation techniques o Family therapy o Reminiscence and life review o Empowerment o Integrative therapies (music therapy) o Medication (Aricept)
200
What is family systems treatment?
o Helping families believe in themselves, providing families with a new perspective, educating families to increase their own skills, recognizing and building strengths and resources, helping families realize alternatives and options, designing interventions that support families cultural and ethnic backgrounds o Family assessment, see families together for some reasons and individually for others
200
What are the pros and cons of EBP?
o Pros • Shows it is an effective treatment • Clinician can protect themselves against litigation • Cost-effective because it is faster than trying other treatments out • Honest • Fueled by accrediting bodies, professional organizations, third party payers • Potential to improve quality, reduce variations in care • Provides a way to keep pace with advances o Cons • Sometimes culturally incompetent • Rigidity of practitioner (Having a patient with depression and jumping to use CBT because CBT is used for depression) • If social workers completely embrace EBP, do we lose the uniqueness of social work compared to other helping professions? • Disregards the unique emphasis of understanding people in context What is
300
What are validity and reliability?
Validity is whether a test measures what it is intended to measure. Reliability is the consistency and dependability of a measure.
300
IPT
A time-limited treatment that encourages the client to regain control of their mood and interpersonal functioning
300
What is the best practice for substance abuse?
• Substance abuse o Psychopharmacological • Alcohol: Disulfiram • Tobacco: Bupropion • Opiods: Naltrexone, Methodone, Buprenorphine o Behavioral • CBT • Community reinforcement (12-step) • Motivational therapy (decisional balancing) • Behavior therapy (recognition of cues) o Inpatient
300
Adult relationship and borderline EBP's
• Adult relationship problems o No EBP, but the following are effective: • Behavioral couples therapy • Emotionally focused couples therapy • Insight oriented approach • Group marital therapy programs • Solution focused therapy • Integrated behavioral couples therapy o Lacking research on issues of ethnicity and gay/lesbian populations • Personality disorders (borderline) o DBT o Transference focused psychotherapy: SSRI’s when indicated, antipsychotic and mood stabilizers (Mitchell)
300
Tell me about couple and family therapy treatment
o What does the data show us? o There’s no evidence based practice, but we do know there are best practices o What is lacking: little to no research on ethnicity, little to no research on gay/lesbian population o Adult relationship therapy – effective in resolving couple and marital difficulties – multimodal therapy for depression, anxiety, and substance abuse o Behavioral couples therapy – emphasizes skill development o Emotionally focused couples therapies – attention paid to attachment patterns that underlie conflict o Insight oriented approach – emphasis on individual paired with problem solving o Group marital therapy programs o Solution focused therapy – emerging as evidenced base What is
400
2 forms of validity
Construct Validity Face Validity
400
EMDR
Psychotherapy that emphasizes disturbing memories as the cause of the psychopathology. Helps process distressing memories and reduces the effects to allow clients to develop coping mechanisms
400
What is the best practice for traumatic brain injury?
• Traumatic brain injury o No EBP yet, but treatment should include: • Rehabilitation • Psychoeducation • Enhancing self-esteem, coping skills • Case management/community referrals • Family therapy/support • Pharmacotherapy PRN for symptoms
400
Anxiety Disorders BP
o Panic Disorder • Relaxation techniques • Moderate-severe agoraphobia: in vivo exposure • No agoraphobia: CBT • Pharmacological: Benzodiazepenes, anxiolytics – fast acting, SSRI’s-less addicting but take longer to work o GAD • Relaxation techniques and CBT combined • Pharmacological: SSRI’s, Buspirone o OCD • Behavioral therapy • Cognitive therapy and CBT • Exposure • Pharmacological: SSRI’s o Phobias • CBT with gradual exposure • Systematic desensitization • Pharmacotherapy is not really useful o Social anxiety • Multi-component CBT: social skills training, relaxation techniques, exposure based therapies • Pharmacotherapy: Benzodiazepines, SSRI’s What is
400
Adult attachment style and it's impact on pathology
o Attachment patterns have a lasting impact. If attachment is the issue, then an emotional focused therapy is best o No one develops in vacuum o 4 attachment styles – secure is a protective factor and the others are more risk factors than secure o Attachment helps you develop empathy and altruism o Sense of trust in adult relationships o Impact of trauma o Attachment style can always change depending on your life pattern o The more stable in the world you are can be related to resiliency
500
2 forms of Reliability
test retest reliability scorer reliability
500
BT
o Rewards, consequences
500
What are the 6 levels of evidence?
• Type 1 studies • Most rigorous – classic, scientific method • Blind assessment-clients don’t know what group they are in and neither does the assessor (double blind) o Ex: Placebo vs. medication • Type 2 studies • Still very dependable and clean • Ex: unethical to turn away but unethical to take him off of medication – explain ends of bellcurve • Type 3 studies • Focus groups – “Are you 18-21 and wake more than 2 hours a night?” • Type 4 studies • Reviewing someone elses data • Type 5 studies • Essentially a literature review – no data • Type 6 studies • Purely qualitative – opinion papers, etc.
500
PTSD
o PTSD • Past focused therapies • CPT (cognitive processing therapy) • Exposures – imaginal • EMDR • Present focused therapies • CT, TF-CBT • Exposure – in vivo • Stress Innoculation training • Seeking safety therapy • Pharmacotherapy: SSRI’s, atypical antipsychotics if flashbacks are intrusive and persistent
500
Sexual abuse history and it's impact on future pathology
o Judged to be a traumatic event and is a huge risk factor o Might disrupt adult sexual functioning which can result in relationship issues o Can cause fear, nightmares, cruelty, delinquency, regressive behavior, running away, poor self-esteem, general behavior problems, sexually inappropriate behavior o Anxiety, acute stress disorder, bipolar, depression, dissociative identity disorder, personality disorders, PTSD, and substance abuse, major depression o Increased odds of MDD & suicide attempts o Lifetime prevalence for MDD in women is 3-5 and up for those with history of child sexual abuse