Massed negative practice treatment is used in the treatment of:
A. Massed negative practice requires the individual to deliberately perform the tic accurately and with effort for a specific amount of time during the day. In theory, this is supposed to induce conditioned inhibition or conditioned fatigue of the behaviour, which results in a decrease in the tic. This is usually employed when habit reversal techniques have not been found to be useful. The evidence for the effectiveness of this treatment is not compelling, especially when compared with habit reversal training.
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Token economy programmes are based on which of the following psychological principle?
B. Token economy is based on operant conditioning theory. Their aim is to reinforce desired behaviour, while undesired behaviour is extinguished or punished. In token economy, the therapist distributes so-called tokens for occurrences of desired behaviour, e.g. brushing teeth or cleaning the room. These tokens are chips that function as secondary reinforcers. The patient can exchange the tokens for various objects (such as money or sweets) and favours (like watching television or taking a walk outside). This was widely used in the treatment of schizophrenia in the past, although most behaviour techniques are thought to be of ethical concern. Voucher-based token economy programmes are also used in substance use programmes, where ‘supermarket’ vouchers worth certain amounts are given to the patient as a reward for abstinence.
Dawn is known to have moderate learning disability. She hits her head very often with her right hand. Her therapist teaches Dawn to engage in knitting with her right hand. This gradually replaced her maladaptive behaviour. The process through which the therapist replaced a maladaptive behaviour with an adaptive constructive one is through the principles of:
A. Positive behavioural programming was developed to concentrate solely on interventions designed to increase desired behaviours with the theoretical argument that these would then replace problem behaviours. In this case there has been differential reinforcement of a more positive activity. Functional communication training is an example of positive behaviour programming. It is based on the hypothesis that problem behaviours are usually communication needs. Individuals are taught to communicate through alternative more acceptable ways.
Which of the following in the least likely outcome in a patient undergoing CBT for hypochondriasis?
E. In a 12-month follow-up randomized controlled trial of CBT vs treatment as usual, CBT was found to be better than medical care as usual. Compared with the control group, the CBT group had significantly lower levels of hypochondriacal symptoms, beliefs, and attitudes and health-related anxiety at 12 months. They also had less impairment of social role functioning and intermediate activities of daily living. However, hypochondriacal somatic symptoms did not improve significantly. The authors of the study Barsky and Ahern explained, ‘Conceptually, hypochondriacalsomatic symptoms cannot simply be stripped away with symptomatic treatment, because they exist for underlying psychological and interpersonal reasons. This suggests that a realistic goal in treating hypochondriasis is amelioration of distressing fears and beliefs and improved coping, rather than the elimination of somatic symptoms per se.’
Which of the following approaches have shown to be the most effective in bulimia nervosa?
A. Most evidence suggests that CBT specific for bulimia nervosa (CBT-BN) devised by Fairburn has a better and faster outcome than most other psychological therapies. NICE guidelines recommend a self-help programme as possible first step for treatment. CBT-BN, a specifically adapted form of CBT, is offered to adults with bulimia nervosa as an alternative. The course of treatment should be for 16–20 sessions over 4–5 months. When people with bulimia nervosa have not responded to or do not want CBT, other psychological treatments should be considered. Interpersonal psychotherapy should be considered as an alternative to CBT, but patients should be informed it takes 8–12 months to achieve results similar to CBT.
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