Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that uses mindfulness and behavioral activation to increase psychological flexibility. ACT has been shown to effectively treat a broad range of mental health issues by focusing on six core processes: acceptance, defusion, presence, self-awareness, values identification, and committed action. ACT reduces dysfunctional thoughts and behaviors while increasing effective action and alleviating distress. Studies have found ACT reduces OCD and depression symptoms, prevents psychosis rehospitalization, and improves general mental health and workplace stress coping. ACT is delivered flexibly in individual sessions, groups, or self-help formats.
Achieving Clinical Excellence HandoutsScott Miller
This document discusses achieving clinical excellence in psychotherapy. It provides three steps to superior performance: 1) determining your baseline effectiveness rate, 2) obtaining and using feedback to improve retention and outcomes, and 3) designing optimal practice environments and activities. It also announces the first annual "Achieving Clinical Excellence Conference" in October 2010 in Kansas City.
Therapeutic Interaction: A Perception of Therapist towards Patients with Anxi...iosrjce
The present research was conducted (a) to describe the socio-demographic information of
psychotherapist providing therapy to patients of anxiety disorder (b) to examine the therapeutic interaction on
various variables of therapeutic participation, resistance and dysphoric concern (related to patient’s
responses), and directive support for the patients (variable related to his/herself). It was hypothesized that
therapist would rate significantly high on therapeutic interaction (therapeutic participation, directive support,
resistance and dysphoric concerns) with anxiety patient. Sample comprised of thirty five psychotherapist
providing therapy to diagnosed anxiety patients in OPD (Outdoor patient department). Psychotherapy Process
Inventory was administered to assess perception of therapeutic interaction of psychotherapist. Descriptive
statistics and one sample t test were calculated for the analysis of data. Results revealed that most of the
therapists, possessed MS degree in Clinical Psychology. Results indicate that there is a significant high rating
on therapeutic interaction, therapeutic participation, directive support, resistance and dysphoric concern of the
psychotherapist who are providing therapy to the anxiety patients. Therapeutic interaction is perceived by the
therapist as supportive, whereas participation, resistance and dysphoric concerns of the patients were also
perceived high by the therapist in initial sessions. Findings will be helpful for psychologist and other
professionals to plan the therapeutic interventions for anxiety patients
1. Researchers evaluate the effectiveness of therapies through methods like meta-analyses of existing studies to identify the most effective treatments for issues like depression. Common factors like the therapeutic relationship contribute to positive outcomes.
2. While therapies like CBT are supported as effective, researchers still do not fully understand why they work. Prevention strategies aim to reduce mental illness at the primary, secondary, and tertiary levels through skills training, early identification and treatment, and relapse prevention.
3. Evaluating therapeutic effectiveness and identifying common success factors helps improve treatments, while prevention research works to reduce mental illness occurrence and severity.
1. Interpersonal Psychotherapy (IPT) is based on attachment theory and posits that psychological distress arises from an interaction between acute interpersonal stressors, biological and psychological vulnerabilities, and social context.
2. IPT targets interpersonal relationships and social support as the primary mechanisms of change, with the goal of improving communication and social networks. While IPT acknowledges biological factors, it does not directly target them.
3. Over time, IPT has become more rigidly defined in research settings, focusing on symptom change for specific diagnoses. This has limited creativity and innovation in the approach based on clinical experience. A new model is needed that better integrates clinical practice and research.
Research on Psychotherapy: A Presentation at the 2013 Evolution of Psychother...Scott Miller
A summary of the findings from research on psychotherapy presented on a panel discussion with David Barlow and Steven Hayes at the 2013 Evolution of Psychotherapy conference in Anaheim, California
This the introductory presentation on the theory that underpins the consultation between doctor and patient. I would value any comments on these presentations: my hope is that your interest will lead to deeper insight into the process of consulting and to a sense of driving the quality of the interaction forward for the benefit of all parties.
Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that uses mindfulness and behavioral activation to increase psychological flexibility. ACT has been shown to effectively treat a broad range of mental health issues by focusing on six core processes: acceptance, defusion, presence, self-awareness, values identification, and committed action. ACT reduces dysfunctional thoughts and behaviors while increasing effective action and alleviating distress. Studies have found ACT reduces OCD and depression symptoms, prevents psychosis rehospitalization, and improves general mental health and workplace stress coping. ACT is delivered flexibly in individual sessions, groups, or self-help formats.
Achieving Clinical Excellence HandoutsScott Miller
This document discusses achieving clinical excellence in psychotherapy. It provides three steps to superior performance: 1) determining your baseline effectiveness rate, 2) obtaining and using feedback to improve retention and outcomes, and 3) designing optimal practice environments and activities. It also announces the first annual "Achieving Clinical Excellence Conference" in October 2010 in Kansas City.
Therapeutic Interaction: A Perception of Therapist towards Patients with Anxi...iosrjce
The present research was conducted (a) to describe the socio-demographic information of
psychotherapist providing therapy to patients of anxiety disorder (b) to examine the therapeutic interaction on
various variables of therapeutic participation, resistance and dysphoric concern (related to patient’s
responses), and directive support for the patients (variable related to his/herself). It was hypothesized that
therapist would rate significantly high on therapeutic interaction (therapeutic participation, directive support,
resistance and dysphoric concerns) with anxiety patient. Sample comprised of thirty five psychotherapist
providing therapy to diagnosed anxiety patients in OPD (Outdoor patient department). Psychotherapy Process
Inventory was administered to assess perception of therapeutic interaction of psychotherapist. Descriptive
statistics and one sample t test were calculated for the analysis of data. Results revealed that most of the
therapists, possessed MS degree in Clinical Psychology. Results indicate that there is a significant high rating
on therapeutic interaction, therapeutic participation, directive support, resistance and dysphoric concern of the
psychotherapist who are providing therapy to the anxiety patients. Therapeutic interaction is perceived by the
therapist as supportive, whereas participation, resistance and dysphoric concerns of the patients were also
perceived high by the therapist in initial sessions. Findings will be helpful for psychologist and other
professionals to plan the therapeutic interventions for anxiety patients
1. Researchers evaluate the effectiveness of therapies through methods like meta-analyses of existing studies to identify the most effective treatments for issues like depression. Common factors like the therapeutic relationship contribute to positive outcomes.
2. While therapies like CBT are supported as effective, researchers still do not fully understand why they work. Prevention strategies aim to reduce mental illness at the primary, secondary, and tertiary levels through skills training, early identification and treatment, and relapse prevention.
3. Evaluating therapeutic effectiveness and identifying common success factors helps improve treatments, while prevention research works to reduce mental illness occurrence and severity.
1. Interpersonal Psychotherapy (IPT) is based on attachment theory and posits that psychological distress arises from an interaction between acute interpersonal stressors, biological and psychological vulnerabilities, and social context.
2. IPT targets interpersonal relationships and social support as the primary mechanisms of change, with the goal of improving communication and social networks. While IPT acknowledges biological factors, it does not directly target them.
3. Over time, IPT has become more rigidly defined in research settings, focusing on symptom change for specific diagnoses. This has limited creativity and innovation in the approach based on clinical experience. A new model is needed that better integrates clinical practice and research.
Research on Psychotherapy: A Presentation at the 2013 Evolution of Psychother...Scott Miller
A summary of the findings from research on psychotherapy presented on a panel discussion with David Barlow and Steven Hayes at the 2013 Evolution of Psychotherapy conference in Anaheim, California
This the introductory presentation on the theory that underpins the consultation between doctor and patient. I would value any comments on these presentations: my hope is that your interest will lead to deeper insight into the process of consulting and to a sense of driving the quality of the interaction forward for the benefit of all parties.
A study by researchers at the Canadian Network for Mood and Anxiety Treatments (CANMAT) comparing the relative effectiveness of two psychosocial interventions in bipolar disorder has recently been published in the Journal of Clinical Psychiatry.
Bipolar disorder is insufficiently controlled by medication, so several supplementary psychosocial interventions have been tested, all of which are lengthy, expensive, and difficult to disseminate. CREST.BD members Dr. Sagar Parikh and Vytas V. Velyvis co-authored a recent paper along with their collegues at CANMAT, which relates the findings of the recent study that compared psychoeducation (PE) and cognitive behavioural therapy (CBT) in bipolar disorder in bipolar disorder. CBT is a longer, more costly, individualized treatment while PE is less expensive to provide and requires less clinician training to deliver successfully. To date, only a few studies have compared these psychosocial treatments. In this presentation, Dr. Parikh and colleagues compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive, and longer individual cognitive-behavioural therapy intervention (CBT) with a sample of 204 individuals who live with bipolar disorder. They measured long-term outcomes in mood burden of the participants in both treatments. Findings indicate that, despite its longer treatment duration and cost, CBT did not show significantly greater clinical benefit compared to group psychoeducation. The implications of these findings for psychosocial interventions in the condition are provided.
The Importance of Multiple Perspectives in Psychiatry | Crimson PublishersCrimsonpublishersPPrs
This document discusses the importance of considering multiple perspectives in psychiatry when formulating a patient's case. It outlines several perspectives to consider, including the medical model focusing on symptoms, pathologies and treatments; biological perspectives involving neurotransmitters; phenomenological perspectives articulating a patient's subjective experience; psychodynamic perspectives providing a dynamic understanding of a patient's psyche; interpersonal perspectives considering social and cultural influences as well as relationships; behavioral perspectives related to reinforcement and conditioning; and cognitive perspectives related to thoughts and associations. Considering multiple dimensions can provide a more comprehensive understanding of a patient to optimize treatment.
The Life Science Addiction Treatment Center is a private residential facility that offers short, moderate, and long-term inpatient treatment for adults struggling with alcohol and/or drug addiction. Its mission is to provide evidence-based treatment in a professional and affordable manner using a personalized approach. The treatment program utilizes principles from cognitive behavioral therapy and other therapeutic models. It offers a variety of group and individual therapy sessions, educational workshops, recreational activities, and medical and psychiatric support to help clients develop coping skills and achieve rehabilitation and wellness goals. The facility is located in a serene natural setting near Montreal, Quebec and employs a multidisciplinary clinical team.
Amputation is the removal of a limb or part of a limb by a surgical procedure in order to save the life of a person. Amputation is a triple threat. It involves loss of function, loss of sensation, and loss of body image.
This document discusses cognitive rehabilitation therapy (CRT). It began in the 1920s to help veterans with brain injuries relearn cognitive skills. CRT aims to restore lost cognitive functions or teach compensatory strategies. An interdisciplinary team may provide CRT to help those with conditions like stroke, dementia, TBI regain independence. Occupational therapists play a key role in CRT by helping clients relearn skills through functional activities to improve daily living. Strong evidence shows CRT's effectiveness, especially when provided through interdisciplinary collaboration.
What are the Core Tasks of Psychotherapy? A Presentation for the 2013 Evoluti...Scott Miller
The document summarizes research on the evolution of psychotherapy over the past 50 years. It finds that while the number of treatment approaches has grown significantly, outcomes are largely due to common or "nonspecific" factors like the therapeutic alliance rather than specific treatment techniques. Over 190 studies with over 2630 patients found strong effect sizes for factors like the alliance, empathy, and collaboration between therapist and patient. In contrast, differences between treatment approaches and adherence to treatment protocols showed weak effect sizes. The core task of psychotherapy appears to be developing a strong therapeutic relationship through engagement, understanding, affirmation, genuineness, and collaboration.
Snatching Victory From The Jaws Of Defeat (Handouts)Scott Miller
This document discusses improving the effectiveness of psychotherapy, especially for challenging cases. It provides both good and bad news about therapy outcomes. On average, treated clients do better than 80% of untreated clients. However, dropout rates are around 47% and some therapists fail to identify clients who are not progressing. The document recommends formalizing client feedback through measures of outcome and alliance administered at each session. Integrating this feedback into care through collaborative teams can help therapists "fail successfully" by changing course when needed to improve outcomes.
This meta-analysis examined the efficacy of Acceptance and Commitment Therapy (ACT) for children. It analyzed 14 randomized controlled trials involving 1189 children. The analysis found that ACT significantly improved symptoms of anxiety and depression compared to treatment as usual or waitlist control. However, ACT was not significantly more effective than traditional cognitive behavioral therapy. ACT had similar effects to other treatments on secondary outcomes like quality of life, but produced greater improvements than no treatment. The findings indicate ACT is effective for treating child mental health issues, though not necessarily superior to CBT. More high-quality research is still needed.
Summary of current research on routine outcome measurement, feedback, the validity, reliability, and effectiveness of the ORS and SRS (or PCOMS Outcome Management System)
1. Freud developed psychoanalytic therapy to transform patients' misery into common unhappiness by helping them work through unconscious causes of their issues using techniques like free association and interpretation of transference. 2. Klein and subsequent theorists focused on transference and countertransference in the here-and-now. 3. Recent approaches like mentalization therapy aim to enhance patients' ability to think about mental states in relationships to improve symptoms like those seen in borderline personality disorder.
Escobar Self-rumination mediation mental health Ayahuasca-presentation_14th F...Arturo Escobar
This document summarizes a study on the relationship between ayahuasca use, self-rumination, and mental health. The study found that members of three ayahuasca-using religious groups had low scores on measures of stress, anxiety, depression, and other psychopathologies. Higher self-rumination was associated with more hopelessness, while higher self-reflection was not. Structural analysis revealed that ayahuasca groups fell into the facet of good mental health, while self-rumination related more to disorders. The study concludes that ayahuasca use does not seem to promote mental health issues when used ritually, and may even have protective effects, though more research is needed.
Clinical supervision its influence on client-rated working alliance and clie...Daryl Chow
This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. Therapists were randomly assigned to receive either alliance skill-focused or alliance process-focused supervision, or to receive no supervision. Both supervision conditions had a significant positive effect on working alliance, symptom reduction, and treatment retention compared to the no supervision condition. However, there was no significant difference found between the two supervision conditions. The findings provide preliminary evidence that clinical supervision can improve client outcomes, but more research is still needed to separate the effects of different supervision approaches.
This document describes a study that used interpretative phenomenological analysis to examine the experiences of 3 participants in a Positive Mindfulness Programme (PMP). 5 themes emerged from interviews with the participants: 1) The program challenged participants' sense of identity and led them to question their purpose and who they are at their core. 2) Participants discovered positive emotions and traits within themselves that they had forgotten or not fully accessed previously. 3) The program improved participants' relationships and sense of connection with others. 4) While beneficial, the program also presented emotional and practical challenges in embedding the knowledge and skills learned. 5) Future research could examine these programs' impacts in broader contexts and use grounded theory to develop theoretical explanations.
How to Improve Quality of Services by Integrating Common Factors into Treatme...Scott Miller
Presentation by Dr. Bruce Wampold about how the outcome and quality of psychotherapy can be improved by adding common factors to the treatment. Wampold documents the lack of difference in outcome between competing treatment methods AND the relatively large contribution made by common factors to outcome.
This document outlines the five phases of nursing care according to the American Nurses Association standards: assessing, diagnosing, planning, implementing, and evaluating. The first phase, assessing, involves collecting client data through various methods such as interviews, observations, and examinations. The second phase, diagnosing, analyzes the collected data to identify client health problems, risks, and strengths to form nursing diagnoses. The third phase, planning, prioritizes problems and formulates goals and interventions. The fourth phase, implementing, carries out the planned nursing interventions. The fifth and final phase, evaluating, determines if goals were met and problems resolved.
The Role of Health Services Research in a Learning Healthcare SystemAcademyHealth
Dr. David Atkins, U.S. Department of Veterans Affairs, presented at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality."
London iCAAD 2019 - Prof Marcantonio Spada - DESIRE THINKING: A NEW TREATMENT...iCAADEvents
This workshop will illustrate and explore the concept of desire thinking and its relevance to addictive behaviours. Examples of key treatment interventions for interrupting desire thinking will be introduced.
Pre-workshop Reading
Caselli, G. & Spada, M. M. (2016). Desire thinking: A new target for treatment of addictive behaviors? International Journal of Cognitive Therapy, 9(4), 344-355.
Workshop Learning Objectives
1. To conceptualise desire thinking.
2. To understand the application of basic treatment interventions aimed at interrupting desire thinking.
This document provides a guide for assessing risk of harm for students and interns. It discusses cognitive behavioral therapy and how CBT can be used to assess risk of self-harm or harm to others. The guide includes information on negative core beliefs and behaviors, how CBT is applied to depression and anxiety, cultural considerations in risk assessment, and tools for assessing suicide and violence risk. Forms and guides are also included to help students conduct risk assessments in a structured manner.
Three key points:
1. There are three emerging capability areas for cognitive computing: engagement, decision making, and discovery. Engagement systems change human-computer interaction, decision systems make evidence-based decisions, and discovery systems find new insights.
2. Case studies show how cognitive computing is being used by organizations like USAA, WellPoint, and Baylor College of Medicine to improve customer service, clinical decision making, and medical research.
3. The future evolution of cognitive computing will be influenced by six forces: technology advances, societal acceptance, information growth, perceptions, skills availability, and policies. Balancing these forces will impact adoption rates.
Sports psychology seeks to understand psychological factors that affect sports performance and apply them to enhance performance. It focuses on techniques for athletes to maintain control, concentration, confidence, and commitment. Strategies used include relaxation techniques, imagery, monitoring training, and preventing overtraining. Overtraining occurs from an imbalance between training and recovery and can result in moodiness, fatigue, injury, and other physiological and psychological symptoms.
A study by researchers at the Canadian Network for Mood and Anxiety Treatments (CANMAT) comparing the relative effectiveness of two psychosocial interventions in bipolar disorder has recently been published in the Journal of Clinical Psychiatry.
Bipolar disorder is insufficiently controlled by medication, so several supplementary psychosocial interventions have been tested, all of which are lengthy, expensive, and difficult to disseminate. CREST.BD members Dr. Sagar Parikh and Vytas V. Velyvis co-authored a recent paper along with their collegues at CANMAT, which relates the findings of the recent study that compared psychoeducation (PE) and cognitive behavioural therapy (CBT) in bipolar disorder in bipolar disorder. CBT is a longer, more costly, individualized treatment while PE is less expensive to provide and requires less clinician training to deliver successfully. To date, only a few studies have compared these psychosocial treatments. In this presentation, Dr. Parikh and colleagues compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive, and longer individual cognitive-behavioural therapy intervention (CBT) with a sample of 204 individuals who live with bipolar disorder. They measured long-term outcomes in mood burden of the participants in both treatments. Findings indicate that, despite its longer treatment duration and cost, CBT did not show significantly greater clinical benefit compared to group psychoeducation. The implications of these findings for psychosocial interventions in the condition are provided.
The Importance of Multiple Perspectives in Psychiatry | Crimson PublishersCrimsonpublishersPPrs
This document discusses the importance of considering multiple perspectives in psychiatry when formulating a patient's case. It outlines several perspectives to consider, including the medical model focusing on symptoms, pathologies and treatments; biological perspectives involving neurotransmitters; phenomenological perspectives articulating a patient's subjective experience; psychodynamic perspectives providing a dynamic understanding of a patient's psyche; interpersonal perspectives considering social and cultural influences as well as relationships; behavioral perspectives related to reinforcement and conditioning; and cognitive perspectives related to thoughts and associations. Considering multiple dimensions can provide a more comprehensive understanding of a patient to optimize treatment.
The Life Science Addiction Treatment Center is a private residential facility that offers short, moderate, and long-term inpatient treatment for adults struggling with alcohol and/or drug addiction. Its mission is to provide evidence-based treatment in a professional and affordable manner using a personalized approach. The treatment program utilizes principles from cognitive behavioral therapy and other therapeutic models. It offers a variety of group and individual therapy sessions, educational workshops, recreational activities, and medical and psychiatric support to help clients develop coping skills and achieve rehabilitation and wellness goals. The facility is located in a serene natural setting near Montreal, Quebec and employs a multidisciplinary clinical team.
Amputation is the removal of a limb or part of a limb by a surgical procedure in order to save the life of a person. Amputation is a triple threat. It involves loss of function, loss of sensation, and loss of body image.
This document discusses cognitive rehabilitation therapy (CRT). It began in the 1920s to help veterans with brain injuries relearn cognitive skills. CRT aims to restore lost cognitive functions or teach compensatory strategies. An interdisciplinary team may provide CRT to help those with conditions like stroke, dementia, TBI regain independence. Occupational therapists play a key role in CRT by helping clients relearn skills through functional activities to improve daily living. Strong evidence shows CRT's effectiveness, especially when provided through interdisciplinary collaboration.
What are the Core Tasks of Psychotherapy? A Presentation for the 2013 Evoluti...Scott Miller
The document summarizes research on the evolution of psychotherapy over the past 50 years. It finds that while the number of treatment approaches has grown significantly, outcomes are largely due to common or "nonspecific" factors like the therapeutic alliance rather than specific treatment techniques. Over 190 studies with over 2630 patients found strong effect sizes for factors like the alliance, empathy, and collaboration between therapist and patient. In contrast, differences between treatment approaches and adherence to treatment protocols showed weak effect sizes. The core task of psychotherapy appears to be developing a strong therapeutic relationship through engagement, understanding, affirmation, genuineness, and collaboration.
Snatching Victory From The Jaws Of Defeat (Handouts)Scott Miller
This document discusses improving the effectiveness of psychotherapy, especially for challenging cases. It provides both good and bad news about therapy outcomes. On average, treated clients do better than 80% of untreated clients. However, dropout rates are around 47% and some therapists fail to identify clients who are not progressing. The document recommends formalizing client feedback through measures of outcome and alliance administered at each session. Integrating this feedback into care through collaborative teams can help therapists "fail successfully" by changing course when needed to improve outcomes.
This meta-analysis examined the efficacy of Acceptance and Commitment Therapy (ACT) for children. It analyzed 14 randomized controlled trials involving 1189 children. The analysis found that ACT significantly improved symptoms of anxiety and depression compared to treatment as usual or waitlist control. However, ACT was not significantly more effective than traditional cognitive behavioral therapy. ACT had similar effects to other treatments on secondary outcomes like quality of life, but produced greater improvements than no treatment. The findings indicate ACT is effective for treating child mental health issues, though not necessarily superior to CBT. More high-quality research is still needed.
Summary of current research on routine outcome measurement, feedback, the validity, reliability, and effectiveness of the ORS and SRS (or PCOMS Outcome Management System)
1. Freud developed psychoanalytic therapy to transform patients' misery into common unhappiness by helping them work through unconscious causes of their issues using techniques like free association and interpretation of transference. 2. Klein and subsequent theorists focused on transference and countertransference in the here-and-now. 3. Recent approaches like mentalization therapy aim to enhance patients' ability to think about mental states in relationships to improve symptoms like those seen in borderline personality disorder.
Escobar Self-rumination mediation mental health Ayahuasca-presentation_14th F...Arturo Escobar
This document summarizes a study on the relationship between ayahuasca use, self-rumination, and mental health. The study found that members of three ayahuasca-using religious groups had low scores on measures of stress, anxiety, depression, and other psychopathologies. Higher self-rumination was associated with more hopelessness, while higher self-reflection was not. Structural analysis revealed that ayahuasca groups fell into the facet of good mental health, while self-rumination related more to disorders. The study concludes that ayahuasca use does not seem to promote mental health issues when used ritually, and may even have protective effects, though more research is needed.
Clinical supervision its influence on client-rated working alliance and clie...Daryl Chow
This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. Therapists were randomly assigned to receive either alliance skill-focused or alliance process-focused supervision, or to receive no supervision. Both supervision conditions had a significant positive effect on working alliance, symptom reduction, and treatment retention compared to the no supervision condition. However, there was no significant difference found between the two supervision conditions. The findings provide preliminary evidence that clinical supervision can improve client outcomes, but more research is still needed to separate the effects of different supervision approaches.
This document describes a study that used interpretative phenomenological analysis to examine the experiences of 3 participants in a Positive Mindfulness Programme (PMP). 5 themes emerged from interviews with the participants: 1) The program challenged participants' sense of identity and led them to question their purpose and who they are at their core. 2) Participants discovered positive emotions and traits within themselves that they had forgotten or not fully accessed previously. 3) The program improved participants' relationships and sense of connection with others. 4) While beneficial, the program also presented emotional and practical challenges in embedding the knowledge and skills learned. 5) Future research could examine these programs' impacts in broader contexts and use grounded theory to develop theoretical explanations.
How to Improve Quality of Services by Integrating Common Factors into Treatme...Scott Miller
Presentation by Dr. Bruce Wampold about how the outcome and quality of psychotherapy can be improved by adding common factors to the treatment. Wampold documents the lack of difference in outcome between competing treatment methods AND the relatively large contribution made by common factors to outcome.
This document outlines the five phases of nursing care according to the American Nurses Association standards: assessing, diagnosing, planning, implementing, and evaluating. The first phase, assessing, involves collecting client data through various methods such as interviews, observations, and examinations. The second phase, diagnosing, analyzes the collected data to identify client health problems, risks, and strengths to form nursing diagnoses. The third phase, planning, prioritizes problems and formulates goals and interventions. The fourth phase, implementing, carries out the planned nursing interventions. The fifth and final phase, evaluating, determines if goals were met and problems resolved.
The Role of Health Services Research in a Learning Healthcare SystemAcademyHealth
Dr. David Atkins, U.S. Department of Veterans Affairs, presented at AcademyHealth's 2012 Capitol Hill briefing entitled "Health and the Deficit: Using Health Services Research to Reduce Costs and Improve Quality."
London iCAAD 2019 - Prof Marcantonio Spada - DESIRE THINKING: A NEW TREATMENT...iCAADEvents
This workshop will illustrate and explore the concept of desire thinking and its relevance to addictive behaviours. Examples of key treatment interventions for interrupting desire thinking will be introduced.
Pre-workshop Reading
Caselli, G. & Spada, M. M. (2016). Desire thinking: A new target for treatment of addictive behaviors? International Journal of Cognitive Therapy, 9(4), 344-355.
Workshop Learning Objectives
1. To conceptualise desire thinking.
2. To understand the application of basic treatment interventions aimed at interrupting desire thinking.
This document provides a guide for assessing risk of harm for students and interns. It discusses cognitive behavioral therapy and how CBT can be used to assess risk of self-harm or harm to others. The guide includes information on negative core beliefs and behaviors, how CBT is applied to depression and anxiety, cultural considerations in risk assessment, and tools for assessing suicide and violence risk. Forms and guides are also included to help students conduct risk assessments in a structured manner.
Three key points:
1. There are three emerging capability areas for cognitive computing: engagement, decision making, and discovery. Engagement systems change human-computer interaction, decision systems make evidence-based decisions, and discovery systems find new insights.
2. Case studies show how cognitive computing is being used by organizations like USAA, WellPoint, and Baylor College of Medicine to improve customer service, clinical decision making, and medical research.
3. The future evolution of cognitive computing will be influenced by six forces: technology advances, societal acceptance, information growth, perceptions, skills availability, and policies. Balancing these forces will impact adoption rates.
Sports psychology seeks to understand psychological factors that affect sports performance and apply them to enhance performance. It focuses on techniques for athletes to maintain control, concentration, confidence, and commitment. Strategies used include relaxation techniques, imagery, monitoring training, and preventing overtraining. Overtraining occurs from an imbalance between training and recovery and can result in moodiness, fatigue, injury, and other physiological and psychological symptoms.
This document compares the cognitive changes in mild cognitive impairment (MCI), Alzheimer's disease, and Parkinson's disease. MCI involves mild memory loss that does not interfere with daily life. Parkinson's disease causes tremors and movement difficulties due to dopamine loss. Alzheimer's disease is the most common dementia in older adults and involves severe memory loss and cognitive decline. While there are no cures for these conditions, treatments can help manage symptoms for a time. All three diseases have significant effects on patients and their families.
The document discusses mental health and cognitive decline issues. It notes that WHO predicts dementia cases will double every 20 years, affecting 75% of the elderly population by 2025. Mild cognitive impairment affects memory, thinking, and reasoning and is a transition stage with cognitive complaints but no dementia. Ayurveda approaches cognitive decline prevention and treatment through lifestyle changes (achara rasayana), nootropic herbs (medhya rasayana), and practices like yoga/meditation. The document recommends interventions like medhya rasayana, brain exercises, panchakarma procedures, and behavioral changes to manage mild cognitive impairment and promote mental wellness.
Mild cognitive impairment (MCI) refers to slight declines in cognitive abilities that are greater than normal aging but do not significantly interfere with daily life. The document discusses the criteria for diagnosing MCI, controversies around the definition, prevalence increasing with age from 1-34%, and high risk of progression to dementia at a rate of 10-15% per year. While no treatments have proven effective, lifestyle factors like exercise, diet, and cognitive stimulation may help prevent further decline.
This document discusses psychological intervention for non-epileptic attack disorder (NEAD). It notes that specialized services for NEAD are available in Durham but not in Newcastle, Northumberland, or Tyneside. People with NEAD have higher rates of adverse childhood experiences and commonly experience PTSD, anxiety, dissociative disorders, depression, and borderline personality disorder. Treatment challenges include emotional lability, avoidance behaviors, poor motivation, and the fact that NEAD is "orphaned" between neurology and psychiatry with heterogeneous presentations. Effective treatment requires specialized therapists experienced in both neurology and trauma treatment over a variable duration, with good outcomes including reduced seizures and trauma processing.
This document provides information on various psychological tests used to measure mental abilities and traits. It discusses the history of psychometrics from ancient Chinese civil service exams to the development of standardized testing in the late 19th century. Key intelligence tests summarized include the Stanford-Binet Intelligence Scales, Wechsler Adult Intelligence Scale (WAIS), and Raven's Progressive Matrices. The document also reviews prominent personality tests like the Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI). Projective tests such as the Rorschach inkblots and Thematic Apperception Test (TAT) are also summarized.
Suzanne Rotondo and Gretchen Schmelzer
Master coach faculty members for Teleos’ flagship coach development and certification program
In the first of a three-part series on coaching, Suzanne and Gretchen will discuss, “What Neuropsychology Tells Us About the Positive Impact of Coaching with Compassion.”
René Hernandez Cardenaché's curriculum vitae outlines his educational background and clinical experience. He received his doctorate in clinical psychology from Pepperdine University and is currently an Assistant Professor of Psychiatry and Clinical Neuropsychology at the University of Miami. The CV details his research, teaching, clinical consultation work, and roles directing fellowship programs and serving on dissertation committees.
Test de matrices progresivas (tres versiones1)Dario Ruiz
El documento describe el Test de Matrices Progresivas de Raven, un test de inteligencia no verbal que mide la capacidad de razonamiento y educción. Consiste en una serie de patrones con una pieza faltante que el sujeto debe completar analizando las relaciones. Existen versiones para diferentes edades y niveles. El puntaje obtenido se compara con normas para determinar el percentil y rango intelectual del sujeto.
The Progressive Movement occurred between 1890-1920 in response to social, economic, political, and environmental problems caused by the rapid industrialization of American cities. Progressives aimed to address issues like poverty, poor working conditions, and the unchecked power of large corporations. They worked to raise awareness of these issues and achieve reforms through journalists, activists, politicians and others. Some of their successes included regulations on child labor, women's suffrage, and the advancement of racial equality.
Cognitive Neuropsychology and Functional Brain Imaging: Implications for func...Dimitris Agorastos
The document discusses how cognitive neuropsychology uses functional brain imaging techniques and data from patients with brain lesions to inform models of normal cognition and its neural underpinnings. Functional imaging allows more precise localization of brain areas involved in cognitive tasks compared to other neuropsychological methods. While early models linked specific cognitive functions to brain regions based on patient data, modern approaches recognize interactive and distributed neural systems and acknowledge limitations of making inferences from single cases or accidental brain lesions.
Neuro-rehabilitation is a complex medical process that aims to aid recovery from nervous system injuries and minimize functional alterations. It involves a multidisciplinary team addressing issues like activities of daily living, speech, counseling, bladder/bowel control, exercise, cognition, education, and goal setting to promote the highest level of independence possible after brain or spinal cord damage and encourage rebuilding self-esteem.
All hospitals should be disability friendly, to ensure easy movement of disable patients. The presentation arrives at a solution to the all above disability issues to serve as a guide line.
A synopsis of the book "Collaborative Therapeutic Neuropsychological Assessment". See website http://www.amazon.com/Collaborative-Therapeutic-Neuropsychological-Assessment-Gorske/dp/0387754253
This document summarizes key aspects of psychotherapy. It discusses that psychotherapy can involve a few sessions or last for months/years. Therapists can be psychologists, social workers, counselors, nurses, or psychiatrists. Psychotherapy involves a trusting relationship between client and therapist and works through changing beliefs, attitudes, and encouraging new behaviors. Research shows psychotherapy is effective both in controlled settings and realistic settings, improving outcomes and reducing medical costs. While approaches differ, common factors like the therapeutic relationship and instilling hope are important. The future of psychotherapy may involve more cognitive-behavioral, culturally sensitive, and eclectic/integrative approaches.
This document provides an introduction to psychology and its importance for nursing. It defines psychology as the scientific study of mind and behavior. The document outlines several key perspectives in psychology including biological, psychological, and sociological approaches. It also discusses various fields within psychology such as psychiatry, psychotherapy, and psychoanalysis. Finally, the document explains how psychology is important for nursing as it provides insights into patient attitudes, behaviors, and responses to illness that can help nurses provide better care.
UCSF Osher Center Grand Rounds - 12/17David Becker
This document summarizes a presentation on incorporating mind-body medicine techniques into clinical care for children and adolescents. It describes several techniques, including mindfulness, hypnosis, guided imagery and biofeedback. It reviews evidence that these techniques can help with conditions like irritable bowel syndrome, recurrent abdominal pain, asthma and chronic pain. It also discusses important "common factors" for effective use of these techniques, such as developing rapport, managing expectations, cultural adaptation, clinician effects, and using language strategically to create focused states and facilitate changes.
Mindfulness training can benefit healthcare professionals and their patients. It reduces stress and improves quality of life for professionals. Mindfulness increases attention, emotional regulation, and a friendly attitude. It is associated with changes in brain regions involved in these processes. For patients, mindfulness reduces rumination, anxiety, and improves coping. Studies show professionals who received mindfulness training had patients who rated them higher and had better health outcomes. Mindfulness supports healing relationships and should be considered a characteristic of good clinical practice.
There are two broad categories of therapy - somatic therapy which treats psychological disorders by treating the body, and psychotherapy which treats problems through psychological techniques. Researchers have found psychotherapy to be consistently more effective than placebo treatment through studies using double-blind techniques. While there are many different types of therapy, researchers contend that most psychotherapies are equally effective, suggesting there is a common underlying component that makes them successful.
This document describes collaborative therapeutic neuropsychological assessment (CTNA), a method for providing client-centered feedback on neuropsychological test results. CTNA was developed based on therapeutic assessment and individualized assessment approaches. It uses a framework based on motivational interviewing principles. The basic CTNA process involves an initial interview, neuropsychological testing, and a feedback session where test results are discussed collaboratively. Interpersonal skills like empathy, open-ended questions, affirmations and summaries are emphasized. Outcome studies have looked at the psychological and clinical benefits of CTNA feedback. The document discusses applications of CTNA and lessons learned from using this approach in clinical practice.
Cognitive therapy outcome for the treatment of schizophreniaJohn G. Kuna, PsyD
This document discusses cognitive therapy for the treatment of schizophrenia. It begins by defining schizophrenia and its symptoms according to the DSM-5. It then outlines the diagnostic criteria. The document focuses on treatment, describing cognitive behavioral therapy techniques used, including normalization, developing alternative explanations, guided discovery, and behavioral experiments to challenge delusions. Key aspects of CBT for schizophrenia discussed are a strong therapeutic alliance, problem-focused and time-limited therapy, and collaborative empiricism.
This document summarizes a presentation on cognitive remediation for schizophrenia. Cognitive remediation aims to improve cognitive processes like attention, memory, and executive function through behavioral training interventions. It relies on neuroplasticity to strengthen connections in the brain. Exercises target basic sensory skills, discrete cognitive abilities, and more complex skills. Studies find cognitive remediation improves cognition, functioning, and motivation, especially when treatment is more intensive, motivational factors are incorporated, and exercises are personalized. Typical programs involve cognitive assessment, goal setting, group sessions 2+ times per week for 3-4 months using drill and strategy practice, and bridging to real-world skills.
Assessment strategies, Neuropsychological Assessment for inpatient and outpatient department, measurement of psychological status, psychological issues faced in rehabilitation settings, and its intervention
Clinical psychologists apply principles and procedures to understand, predict, and alleviate intellectual, emotional, psychological, and behavioral problems. They have skills in intervention and therapy, assessment and diagnosis, teaching, clinical supervision, research, consultation, program development, and administration. Some of their main activities include conducting psychotherapy and other therapies to help people overcome mental illnesses; assessing individuals' development, behavior, and functioning through methods like testing and interviews to inform diagnoses; and teaching courses on topics like psychopathology and psychological testing at academic institutions.
What are the major Types of Clinical Psychology.pdfAssignment Help
In summary, a review of the main subfields in clinical psychology reveals a complex and diverse landscape of approaches, each tailored to address certain aspects of mental health and general well-being. A variety of interventions are used in this field, such as cognitive-behavioural therapy, which highlights the relationship between ideas, emotions, and behaviours. Majors in clinical psychology must seek guidance and assistance with their dissertations because of the intricate challenges they face. The importance of assistance is highlighted by the intricacy of the subject matter as well as limitations like time constraints and limited resource availability. Students who ask for help are more likely to learn more, get insight into the subtleties of clinical psychology, and eventually achieve academic success.
RXP International Presents an Overview of Prescribing PsychologistsRXP International
This presentation was developed by Dr. Elaine Levine the first prescribing psychologist in New Mexico. In it, she described the Psychobiosocial Model of care which is a holistic model referenced in The Integration of Psychopharmacology and Psychotherapy in PTSD Treatment Biopsychosocial model of care, In E. Carll Ed., Trauma Psychology: Issues in Violence,
Disaster, Health and Illness. It also includes an overview of the requirements and responsibilities of prescribing psychologists in New Mexico.
'Non-pharmacological management in dementia' is really nice article published in British Journal of Psychiatry Advances. It gives basic idea about non pharmacological management in all forms of dementia for Behavioral and psychological symptoms of dementia.
Internship Progress in Clinical Mental Health CounselingJacob Stotler
An internship in neurofeedback treatment of trauma involved several components over 100 hours. The intern established a brain training pamphlet and parent support group. Reviews and internship goals were completed. Research on brain training treatments was compiled. Training in a brainwave software program was undertaken. Records and other documentation like a procedures and intake manual were established. The lab space was also organized. The internship utilized an integrative approach including neurofeedback, counseling, psychoeducation and skills training to address trauma's effects on cognition, behavior and physiology from a multimodal perspective.
To Chart a Course: How to Improve Our Adventure Therapy Practice Will Dobud
Presented at the 8th International International Adventure Therapy Conference in Sydney 2018.
In the most comprehensive adventure therapy study published to date, Bowen and Neill (2013) argued that “a small percentage of adventure therapy programs undergo empirical program evaluation” (p. 41), that being less than 1%. With about three decades of research supporting the efficacy of adventure therapy, though we still have questions about dose-effect and for who adventure therapy is most effective (Gass, Gillis, & Russell, 2012; Gillis & Speelman, 2008; Norton et al., 2014) and adventure therapy performing on par with other therapeutic modalities (Dobud & Harper, 2018), there is little question that adventure therapy stands as a bonafide option as a therapeutic treatment. That is the good news.
With the publication of the first meta-analysis of psychotherapy outcomes, Smith and Glass (1977) found that participants engaging in some type of therapy were bever off than 70-80% of those that received no therapy at all. These encouraging effect sizes were on par with or outperformed many common medical treatments, such as taking an ibuprofen for a headache (Miller, Hubble, Chow, & Seidel, 2013). The psychotherapy clinical trials were conducted with research participants randomly receiving either some type of therapeutic interventions or no treatment at all (Smith & Glass, 1977). The researchers further acknowledged that when participants were randomly selected to receive one of
two different therapies, such as Cogni`ve-Behavioural or Psychodynamic Therapy, no difference in outcomes could be
found despite the theoretical differences of the two. Despite the limited publications and dissertations where adventure therapy was compared to a therapeutic intervention containing no adventurous components, we have a similar issue that adventure therapy tends to perform on par, no greater and no worse, than its counterparts (Dobud & Harper, 2018; Harper, 2010). The specific differences that suggest certain therapies are unique hold little to no variance in outcomes (Ahn & Wampold, 2001). Since Smith and Glass' (1977) pinnacle study, outcomes across psychotherapy have flatlined. Despite a ballooning of new diagnostic criteria and mushrooming of empirically supported treatments, there has been no improvement in outcomes (Asay & Lambert, 1999; Miller et al., 2013; Wampold, 2001). This presentation will attempt to untangle some of the factors put forward by researchers over the last two decades to illustrate those factors most likely to lead to improved therapeutic outcomes, such as establishing goal consensus with clients, improving the therapeutic relationship, and monitoring outcomes (Lambert, 2010; Wampold, 2001). Though this workshop will present some of these important findings, the presentation will stage my experiential journey in reaching out to coaches, researchers, and supervisors in trying to improve my outcomes as a therapist, one client at a time.
Research review of Treatments for Autism in patients residing in psychiatric ...Jacob Stotler
Review of Evidence-based practice and research conducted on effective treatments with patients with Autism Spectrum Disorder (ASD) in patients residing in psychiatric facilities.
The document discusses various psychological therapies including psychoanalysis, humanistic therapies, behavior therapies, cognitive therapies, group/family therapies, and biomedical therapies. It provides details on different approaches like psychoanalysis, person-centered therapy, cognitive-behavioral therapy, and evaluates the effectiveness of psychotherapy.
1. Collaborative Therapeutic
Neuropsychological Assessment
November 22, 2012 – 9:00a – 12:30p
Tad Gorske, Ph.D.
Clinical Assistant Professor
Director, Outpatient Neuropsychology
Division of Neuropsychology and Rehabilitation Psychology
University of Pittsburgh School of Medicine, Pittsburgh Pennsylvania, USA
2. “The presentation of brain facts about
specific damages is meaningless to
patients unless they can begin to
understand how the changes in their
brains are lived out in everyday
experiences and situations”
(Varela, 1991 as stated in McInerney
and Walker, 2002)
3.
4.
5.
6.
7. What is Collaborative
Neuropsychology?
• What is traditional neuropsychology?
– Typically follows a medically based/information
gathering model.
– Outsider viewing a passive “object”
– Reductionist
– Categories, diagnoses, constructs used to explain a
client.
– Focus on pathology
– Tester as detached observer
– Sense of secrecy
– Specific focus on the brain-behavior relationship
8. What is Collaborative
Neuropsychology?
– Emanates from “Third Force” Psychology
– Relational encounter
– Client as “co-evaluator”
– Open sharing of results
– Client viewed in context
– Constructs serve to understand the client holistically.
– Focus on strengths and weaknesses
– Test scores, categories, and classifications help
patients develop an understanding of their
experience, not to define it (Fischer, 1970/1994)
– Blending art and science into a “human science
neuro-psychology” (Fischer, 2003; italics mine).
9. Holistic Neuropsychology
Yehuda Ben-Yashay and Leonard
Diller
• Roots in Kurt Goldstein’s holistic views.
– A holistic theory of the organism based
Gestalt Theory
– “We have said that life confronts us in living
organisms. But as soon as we attempt to grasp them
scientifically, we must take them apart, and this taking
apart nets us a multitude of isolated facts which offer
no direct clue to that which we experience directly in
the living organism.” Kurt Goldstein, The Organism, p.
7
10. Holistic Neuropsychological
Principles
• Empower patients and families to take an active
role in the treatment process;
• Believe people with neurological disabilities are
more like people without neurological disabilities
(ie. Go beyond the brain) ;
• Convey honesty and caring in personal
interactions to form a foundation for a strong
therapeutic relationship;
• Develop practical plans for rehabilitation; explain
rehabilitation techniques in understandable
language;
11. Holistic Neuropsychological Principles
• Help patients and families understand
neurobehavioral sequelae of brain injury and
recovery;
• Recognize change is inevitable and help families
cope with change;
• Every patient is important, treat with respect;
• Remember that patients and families have
different perspectives regarding treatment
approaches.
12. Why do we need collaborative
models?
An identity crisis in
neuropsychology
(and psychology in
general)?
13.
14. Harvard creates cyborg flesh that’s half man,
half machine
By Sebastian Anthony on August 29, 2012
21. • Neuropsychology is failing to distinguish
itself due to:
– Over-reliance on diagnosing brain behavior
relationships
– Narrow focus on psychometric approach
– Uncertainty of roles in areas such as
rehabilitation.
– Lack of translation of test results into patient
care
– Lack of assessment advocacy
(Gass and Brown, 1992; Nelson and Adams,
1997; Goldstein, S. Personal Communication)
22. Rise of Forensic
Neuropsychology
• There is a greater presence of forensic
neuropsychology topics in peer reviewed
journals and neuropsychology meeting programs
(Sweet, et al., 2002).
• Consequently there is a greater proportion of
topics related to legal proceedings and
malingering.
• Increasing emphasis on Symptom Validity
Testing.
23. Seeking a Balance
Forensic
Malingering
Patient Care
Rehabilitation
Methods
24. Possibilities
• Focus on the utility of neuropsychological
assessment
– Ensuring relevance by tailoring assessment to
treatment/rehabilitative needs and outcomes
– Focus on the needs of the client/consumer
– Closely link assessment – feedback – intervention.
– Integrate treatment planning, monitoring progress,
and outcomes
(Groth-Marnat, G. (1999)).
26. Importance of Working Alliance
• There are strong links between patient-
therapist collaboration and goal
consensus in psychotherapy outcomes
(Shick Tryon and Winograd, 2011).
• Working alliance and collaboration in
rehabilitation is viewed as important but
less well studied.
27. Working Alliance in
Rehabilitation
• A positive relationship between working
alliance and outcomes has been found.
Working alliance defined as
• (a) the agreement between client and therapist
on goals,
• (b) their agreement on how to achieve these
goals (common work on tasks) and
• (c) the development of a personal bond between
client and therapist. (Shönberger et al. 2006).
28. Working Alliance in
Rehabilitation
• A good working alliance can be created with
both clients who experience many problems and
clients who experience comparatively few
problems, as long as they are aware of the
consequences of their brain injury.
• Therapist’s experience of a good working
alliance was influenced by the client’s
experience of success. (Shönberger, et al.,
2006).
29. Working Alliance in
Rehabilitation
• Clients’ and therapists’ overall success ratings at
program end were related to their emotional
bond at program end.
• Early-therapy compliance and the average
amount of compliance are predictive of
subjective improvement. (Shönberger, et al.,
2006).
30. Working Alliance: Some
evidence
• Bieman-Copelan and Dywan (2000). Brain and Cognition, 44, 1-5.
• Behavioral therapy in context of a
supportive/collaborative therapeutic alliance for
anosognosia.
• Collaborative negotiation and trusting
therapeutic relationship for behavioral goal
setting.
• Results indicated a significant reduction in
problematic behaviors despite no increase in
insight or awareness of injury.
31. Pegg et al., 2005
• Evaluated the role of interpersonal relationship factors
on patient outcomes with 28 patients with moderate to
sever TBI admitted to an inpatient unit at a VAMC.
• Personalized information-provision intervention.
• Results:
– Patients exerted greater effort in therapies
– Patients increased satisfaction with rehabilitation
treatment.
– Significantly more improvement in cognitive FIM
scores.
32. Interdisciplinary team working
alliance (Evans, et al., 2008).
• Importance of therapeutic alliance in post acute brain
injury rehabilitation (PABIR).
• Sherer et al., 2007 - poor working alliance was
associated with high levels of family discord, greater
discrepancy between family and clinician ratings of client
functioning, and poor client participation in therapies.
• Treatment team members attended in-services that
emphasized motivational interviewing philosophy and
techniques, building rapport, reflective listening, dealing
with patient resistance, making behavioral changes,
stages of change, dealing with challenging clients, and
assessment and treatment issues with depressed and/or
suicidal patients (pg. 332).
33. Interdisciplinary team working
alliance (Evans, et al., 2008).
• Treatment group had higher functional status and were
more productive and had less dropouts, although the
differences were not statistically significant.
34. Lane-Brown and Tate, 2010.
• Single case study that evaluated an
intervention utilizing external
compensation and motivational
interviewing to initiate and sustain goal
directed activity with a TBI patient.
• Demonstrated that treating specific and
operationally defined goals through
external compensation and motivational
interviewing successfully decreased
apathy.
35. Enhancing our patient care skills can create
a ripple effect with consumers, providers,
and public perception
36. Neuropsychology has the potential to be a lead
discipline in understanding human beings from a
holistic mind/body perspective
38. Comprehensive Recovery Challenges
Rehabilitation
• Physical Therapy • Knowledge of deficits
• Occupational Therapy • Adapting to deficits
• Speech Therapy • Grieving and Coping
(Denial, anger,
• Medical Management bargaining, depression,
• Psychological/Neuropsyc acceptance).
hological • Learning and re-learning
• Emotional/Psychiatric • Integrating knowledge
Management as into the self
appropriate • Re-discovering meaning
• Family Support and a sense of purpose
• Case Management
39. Existential Issues in
Neuropsychological Conditions
• Awareness of change;
• Emotions;
• Struggle of acceptance;
• Struggle to make sense and find meaning;
• Struggle to reclaim/find a sense of self
40. “…But be that as it may, those of us who did make it
have an obligation to build again. To teach to others what
we know, and to try with what's left of our lives to find a
goodness and a meaning to this life.”
(Quote from the movie “Platoon”, 1986)
41. How traditional neuropsychological
assessment addresses these challenges
1. Knowledge of deficits 1. Provides information on
2. Adapting to deficits cognitive functioning.
2. Presents potential
3. Grieving and Coping ameliorative strategies.
(Denial, anger,
3. Does not directly
bargaining, depression, address.
acceptance).
4. Cognitive rehabilitation
4. Learning and re-learning and remediation.
5. Integrating knowledge 5. Presents one aspect of
into the self the person (cognition).
6. Re-discovering meaning 6. Does not directly
address.
42. How collaborative neuropsychological
assessment addresses these challenges
1. Knowledge of deficits 1. Provides information on cognitive
functioning and seeks individual
2. Adapting to deficits application.
2. Presents potential ameliorative
3. Grieving and Coping strategies and seeks out the
(Denial, anger, individuals own resources for
change.
bargaining, depression, 3. Address a person’s experience
acceptance). and reactions to information
provided; balances education and
4. Learning and re-learning the I-Thou interaction.
5. Integrating knowledge 4. Cognitive rehabilitation and
remediation and works to
into the self motivate internalization.
6. Re-discovering meaning 5. Presents one aspect of the
person (cognition) and considers
it within the context of the whole
person.
6. Looks toward the future and what
46. Luria’s Neuropsychological
Investigation (LNI)
• Loose conceptual basis, not an actual precursor.
• A qualitative and flexible interviewing method for diagnosing brain
lesions.
• The value of LNI:
– Provides a thorough individualized neuropsychological assessment
in which the cognitive functions and psychological responses of the
individual can be ascertained.
– Provides the opportunity to identify strengths and deficits.
– LNI principles can be implemented throughout the rehabilitation
process which include
• Hypothesis testing
• A collaborative working relationship with the patient’
• Feedback to enhance awareness.
Christensen, Anne-Lise (1975); Christensen, A.L. and
Caetano, C. (1999)
47. Neuropsychological Test
Feedback Research
• No empirical studies but some recommendations
• Neuropsychological test feedback provides
useful information about cognitive strengths and
weaknesses,
• Clients find the information useful,
• Results apply to clients everyday life and
concerns
• Facilitates the development of useful and
applicable interventions
(Gass & Brown, 1992; Pope, 1992; Crosson, 2000; Bennet-Levy et al.,
1994).
48. Recommended method for
providing information (Gass & Brown, 1992)
1. Review the purpose of testing in plain,
simple language
2. Tests are “behavior samples” of
functional domains
3. Explain in terms of behavioral functioning
4. Summarize strengths and weaknesses
5. Address diagnostic issues
6. Make recommendations
49. Limited empirical evidence
• Case Studies (Malla et al., 1997; Rose,
1998)
• Conceptual articles (Allen et al., 1986)
• Provision of medical information which
included neuropsychological tests (Pegg,
Auerbach, Seel, Buenaver, Kiesler, and
Plybon, 2005).
52. Collaborative Individualized
Assessment (Fischer, 1994)
• Based on phenomenological psychology.
• Assessor works collaboratively to
understand a client’s unique worldview
• Tests, scores, categories, and
classifications serve to develop a
hermeneutic understanding of the person.
• Reflects a “human-science psychology”.
53. Therapeutic Assessment (Finn,
1992; 1997)
• Psychological assessment as a therapeutic
intervention,
• Tester is an active participant
• Rooted in humanistic psychology
• Influenced by collaborative assessment
55. Motivational Interviewing Principles
(Miller and Rollnick, 2002)
• A method of dialogue designed to
enhance client’s intrinsic motivation to
make changes in behavior.
• Heavily rooted in Roger’s Client Centered
Therapy.
• Originally developed with alcoholics but
expanded to drug addiction and health
behavior change.
56. • Strongly based on the Rogerian approach
• Non-directive/directive intervention
• Empathy and unconditional regard are the
crux of MI
• Exploring and resolving ambivalence
about making changes is a key goal
• Works to develop a discrepancy between
real and ideal self (values and behavior;
who a client is versus who they want to
be).
• Associated with the stages of change.
57. MI Method for Giving Feedback
• Elicit – Provide – Elicit
• Using OARS
– Open ended questions
– Affirmations
– Reflections
– Summarizations
• Goal is to help clients work through and
resolve ambivalence in order to move
through the stages of change.
58. The NAFI
• Origins
– Neuropsychological Testing
– Personal Feedback Report (Project MATCH,
Dual Diagnosis Adherence Strategies, WPIC)
– Anecdotal Observations
• Pilot Study
• Development of the Feedback Report
• NIDA funded study 2004 – 2008.
60. Pilot Study Results
Adherence Rates
p = .042, cohen's d = .78 (.02-1.55)
NAFI (n = 14); TAU (n = 14)
100
90
80 71%
70
60
50 48%
40
30
20
10
0
S1
NAFI
TAU
61. Pilot Study Results: D&A Use
NAFI = 6; TAU = 5
30 Day Alcohol Use
10
9
8
7 7.13
6
5.46 NAFI
5
TAU
4
3.4
3
2
1
0 0
Baseline 30 Day
62. Pilot Study Results: D&A Use
30 Day Drug Use
7
6
5
4.73
4 NAFI
3.43
3 TAU
2
1
0.66
0.40
0
Baseline 30 Day
63. Pilot Study Results: Depression
NAFI = 6; TAU = 5
30 Day Depression
HRSD-25
25
22.2
20 21.2 20.21
15 NAFI
TAU
11.4
10
5
0
Baseline 30 Day
64. Patient Responses
• “The assessment was helpful to me. I learned a lot about myself…I
would have done it without being paid.”
• “Allowed me to see why I may be reluctant to participate in groups.”
• “Helped me narrow in on specific steps I need to take with my
therapist re: depression and addiction. Identified couple things we
can work on.”
• “I am so pleased that I participated in the study. It was right on. M-
allowed me to share during the process, which really assisted with
my overall understanding of the feedback.”
65. • First presentation at The Society for
Personality Assessment, Spring 2006.
– Diane Engelman, Ph.D.
– Steven R. Smith, Ph.D.
– Tad Gorske, Ph.D.
67. Methods of Collaborative
Neuropsychology
• Demystify the neuropsychological
assessment process: Provide feedback report;
explain session purpose; facilitate collaboration and
empathic understanding
• Answer what the individual wants to know
(If you can).
• Explain how strengths and weaknesses
are determined.
• Ensure an understanding of the
information provided.
68. Methods of Collaborative
Neuropsychology
• Ensure the information relates to the
persons experience;
Or if it doesn’t
• Explore the discrepancy.
• Summarize what has been discussed.
• Make suggestions
• Look to the future.
69. CTNA
• The spirit of the CTNA lies in Collaborative
and Therapeutic Assessment Models
– Open sharing; explore results contextually;
use results to facilitate empathic
understanding
• The framework for conducting the CTNA is
drawn from MI.
• The CTNA adopts and adapts the MI
Personalized Feedback Report
70. CTNA Feedback Session
Two primary components
1. Provide information from
neuropsychological test results
2. Interact with clients in a collaborative
manner consistent with TA and MI.
71. CTNA Personalized Feedback
1. Introduction
• Provide feedback report; explain session purpose;
facilitate collaboration and empathic understanding
1. Develop Questions
• Develop 2 or 3 well defined questions the client
hopes the results can answer
1. Explain how strengths and weaknesses are
determined
• Percentiles, determine criteria for strength or
weakness
72. CTNA Personalized Feedback
4. Feedback about strengths and
weaknesses
• Elicit: What skills did the client
use to complete the test.
• Provide: Therapist provides
information on the cognitive skill
test(s) examine.
• Elicit: Therapist elicits reactions
from the clients and applies results
to their real life.
73. CTNA Personalized Feedback
5. Summarize results and provide
recommendations
Summary and key question
Ask permission to provide recommendations
Make recommendations
75. Future Implications
• Clinical: A high degree of utility for consultation,
initiating therapy, working with “sticking points” in
therapy, rehabilitation planning.
• Teaching: Developing students into
“human-science” practitioners, researchers, and
teachers.
• Research: Learn outcomes, factors
influencing effectiveness, manual development.
77. Case #1: Multiple Concussions
• Caucasian female, early 20’s;
• Recent very mild hit to the head;
• Increase in PCS: headache, mental fogginess, dizziness,
nausea, balance problems, fatigue, drowsiness, sensitivity to light and
noise, mood changes, feeling slowed down, difficulty concentrating, difficulty
remembering, and visual problems
• Hx of two prior concussions over 5 year
span since her teen years.
• Doctor told her she had a “catastrophic
reaction.”
78. Case #1: Multiple Concussions
• No significant medical issues
• Extensive psychiatric hx:
• Mental Status
– MMSE = 30
– Clock drawing was normal
– BDI = 22
– BAI = 26
79. Vocabulary 13 84
Matrix Reasoning 15 95
Digits Forward 12 75
Digits Backward 13 84
Letter Number
Sequencing 12 75
Trailmaking A 15 sec., 0 errors 95
Digit Symbol – 12 75
Coding
81. COWA FAS = 55 82
Animal = 28 79
Boston Naming 57/60 58
Test
Trailmaking B 41 sec., 1 error 87
Stroop C/W Test Word = 100 45
Color = 81 58
Color Word = 52 79
Interference = 7 77
WCST-64 Categories = 5 Average
Total Errors = 6 94
Perseverative Errors = 5 47
Trials to first category = Average
10
82. Main themes in CTNA session
• Discrepancy between how she felt vs
objective evidence;
• Negative thoughts and beliefs about
herself and her capabilities;
• Underlying perfectionism;
• After session became more open to
considering psychological/emotional vs
brain injury as causing her distress.
83. • My thanks to all the participants, Dr. Fiona
Bardenhagen and the Australian
Psychological Society for inviting me to your
conference.
My contact information
Tad T. Gorske, Ph.D
Clinical Assistant Professor
Division of Neuropsychology and Rehabilitation Psychology
UPMC Mercy
1400 Locust Street, Suite G138
Pittsburgh, PA USA 15219
Gorskett@upmc. edu