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twenty-first century ethical challenges for psychology
- ethical obligations to society at large
- demise of psychiatry, don't want to follow similar path
competence issues of telepsychology (koocher, 2007)
- misuse of sessions (record them, alter them, youtube, stupidvideos.com)
- misrepresentation of services
- limited ability to respond to crisis, suicide attempt when client is hundreds of miles away
- cannot always assume that web-based versions of assessments are the same
- help the real problem if not really interacting face to face?
oktelepsychology issues with confidentiality
- koocher, 2007
- lie beyond control of psychologists
- many snooping systems used by government to scan phone calls and emails
- must state which jurisdiction's laws apply (inter, intrastate)
- caution against vulnerabilities of using electronic methods
bpd suicidal behavior rate
69-80% linehan 1996
suicide rate of bpd
- up to 9%
- linehan et al. 2000
Study to cite for unique effects of DBT
- Linehan et al. 2006
- control condition: community treatment by experts to rule out factors commonly believed to be effective across a variety of disorders. designed to maximize internal validity by controlling for availability of tx, assistance finding and getting to first appointment, hours of indiv therapy, therapist sex, training, clinical experience, expertise, availability of group clinical consultation, alledgiance to treatment approach, prestige of institution, general factors associated with tx.
Description of DPT
- a CBT program developed to treat suicidal clients meeting criteria for BPD.
- Directly targets: suicidal behavior, behaviors that interfere with treatment delivery, and other dangerous, sever, or destabilizing behaviors.
- Standard DBT addresses 5 functions:
- 1. increasing behavioral capabilities
- 2. improving motivation for skillful behavior (through contingency management and reduction of interfering emotions and cognitions)
- 3. assuring generalizations of gains to the natural environment
- 4. structuring the treatment envi so that it reinforces functional rather than dusfunctional behaviors
- 5. enhancing therapis capabilities and motivation to treat patients effectively.
4 modes of service delivery in DBT:
- 1. weekly individual psychotherapy
- 2. group skills training
- 3. telephone consultation as needed to ensure generalization
- 4. weekly therapist consulation team meetings
linehan 1996 study found
- significantly fewer suicide attempts in dbt group than treatment by community experts both during treatment and one year follow-up
- also dbt used crises services significantly less than other group, but that makes you wonder if the therapist replaced other services
- fewer dbt group people went to emergency room for any condition including drug and alcohol problems
- fewer dbt admitted to hospital for any reason
- BOTH GROUPS SIGNIFICANT REDUCTIONS IS SCORES ON HAMILTON RADING SCALE FOR DEPRESSION. SLOPE DEFFERENCE BETWEEN GROUPS NOT SIGNIFICANT
- no difference in frequency or incidence of nonsuicidal self-injury
possible mechanisms of change in dbt?
- targeting and chain analysis
mechanisms of change in dbt can be distilled to what processes?
- reduction of ineffective action tendencies linked with dysregulated emotions
- ex: mindfulness=active, nonjudgmental participation in one's emotional experience instead of trying to suppress, using "wise mind" which is the combination of rational and emotional
- Suggested that this results in exposure to feared internal simuli (uncomfortable physio, and emotional feelings), ala craske, barlow and meadows, 2000 and may result in learning of new CS-US pairings, Robbins, 1990.
- Since Bouton, 1993 suggested that context is important in extinction, suggested that the person becomes the context and extinction is maintained thus.