Psychology Y3 - P2 - Google Docs PDF

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cognitive psychology and interviewing methods...

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L9 Cognitive Psychology  -

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At the very heart of cognitive psychology is the idea of information processing The mind works in a way similar to a computer: inputting, Storing, retrieving data.  We make sense of the world by forming concepts: We like to think in grouping Mental grouping for similar objects, people, ideas or events Which simplify thinking process Forming concepts speed up cognition, but also boxes it → Prejudice if something does not fit our prototype, e.g. woman and mechanics, doctor, president It is important to keep the mind open for new evolving concepts  Cognitive psychologists build up cognitive models of the information processing that goes on inside people’s minds, including perception, attention, language, memory, thinking, and consciousness.

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The behaviorists approach only studies external observable (S>>R) behavior Because can be objectively measured. Internal behavior cannot be studied because we cannot see what happens in a person’s mind and therefore cannot objectively measure it

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 The cognitive approach believes that internal mental behavior can be scientifically studied using experiments. Assumes that a mediational process occurs between stimulus/input and response/output. The mediational event could be memory, perception, attention or problem solving, etc.

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Cognition ( the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses ) helps us to solve problems eciently Problem solving can be approached dierently By looking at eciency, By looking at speed 3 Strategies (E.g. searching for a sauce in the supermarket): Trial and error Slow process It involves trying a number of dierent solutions and ruling out those that did not work. good option if you have a very limited number of options available. Algorithm Slow process Logical, methodical, step-by-step procedure guarantees an eventual solution The solution can appear as a sudden insight. Heuristics (mental shortcuts) Simple strategy Employs a practical method, based on intuition which indeed does not guarantee to be optimal, perfect, logical, or rational, but instead sucient for reaching an immediate goal 

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How smart people make dumb decisions The Need to Assess Probabilities People need to make decisions constantly, during diagnosis/therapy People need to assess probabilities to predict various values, such as the probability of a disease given a set of symptoms Eg. DDx during consultation can be biased by our believes Cognitive biases hamper critical thinking and, as a result, the validity of our decisions. We see what we want to see filtered through our inherent biases, and then we make decisions based on those biases.  Three Major Human Probability - Assessment Heuristics/Biases Representativeness The more object X is similar to class Y, the more likely we think X belongs to Y "If it looks like a duck and walks like a duck and quacks like a duck" Making judgements based on the similarity of an object or person to an “existing persona”  Availability The easier it is to consider instances of class Y, the more frequent we think it is Tendency to overestimate the likelihood of events with greater “availability” in memory, which can be over-optimistic, overestimating favorable and pleasing outcomes.  People remember vivid events like plane crashes and lottery wins > some of us to overestimate the likelihood that our plane will crash or, more optimistically -- but equally erroneously -- that we will win the lottery. In these cases, the availability bias leads  some people to avoid flying And others to rely on a big lottery win as a retirement plan.  What is availability? Two possibilities: 1. Number – amount of information generated 2. Ease – the ease with which information can be generated  Anchoring Initial estimated values aect the final estimates, even after considerable adjustments Tendency to rely too heavily, or “anchor,” on one trait or piece of information when making decisions.  Probability of conjunctive events overestimated Probability of disjunctive events underestimated  College students were asked the following questions in sequence: How happy are you? How often are you dating? The two answers showed a low correlation (0.11)  Then the question sequence was reversed: How often are you dating? How happy are you? The two answers showed a high correlation (0.62) The answer to the dating question (objective and easily determined) acted as an anchor to the happiness question

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Cognitive bias  Confirmation bias The tendency to look for and favour evidence that confirms our ideas, while avoiding or ignoring evidence to the contrary Contribute to → Overconfidence in personal beliefs → Belief perseverance the tendency for people to hold their beliefs as true, even when there is ample evidence to discredit the belief → Functionally fixed unable to see dierent perspectives you might view a thumbtack as something that can only be used to hold paper to a corkboard. → Approach tasks with the same mental set (as worked in the past)  Framing bias How an issue is posed or presented Framing can significantly aect decisions and judgements  E.g. Message is the same but framing matters: You have got a 95% chance of survival versus 5 out of 100 people die doing this activity  Learn the common errors that people make in our uncertain world They rely too much on aect, availability and representativeness They’re overconfident in their decisions Take a skeptical mindset even when you like an initial judgment Don’t be an “assumer” Invoke an audience to which you need to justify your thinking

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Take away in practise Ease of retrieval can aect answer! Sequencing of questions can aect answer! By anchoring By base rate neglect Framing can aect response!

L10 Models of behaviour change/ Motivational Interviewing  Glossary Arm – To validate, confirm, or state positively the patient’s interests or eorts. Change talk – The patient’s expressions of desire, reason, ability or need to make a change in oral health behaviours. Collaborative – The clinician and patient working jointly to identify and achieve behaviour change. Develop discrepancy – The clinician uncovers any perceived inconsistencies among the patient’s health status, behaviours and values, to create an internal tension and provide a rationale for change. Elicit-provide-elicit – An approach the clinician uses to ask, listen and inform that encourages patients to talk about and hear their intrinsic motivation for change. Express empathy – The clinician asks questions and actively listens to patient’s responses to indicate understanding and sensitivity to patient’s desires and feelings. Open-ended questions – Questions requiring more than a yes/no or short-answer response. Patient-centered – An approach that focuses on the patient’s needs, desires and internal motivations rather than the clinician’s goals. Reflective listening – The clinician reflects back what he/she perceives the patient has communicated. Rolling with resistance – The clinician acknowledges the patient’s resistance to change rather than continuing to push forward. Self-ecacy/autonomy – The patient’s self-directing ownership of behaviour change. Summarize – The clinician recaps what the patient has said.  Patient education Carl Roger Believed that in order for a client's condition to improve therapists should be warm, genuine and understanding. Client-centered approach  Similarly  “Student-centered learning theory” “In a student-centered class, students don’t depend on their teacher all the time; waiting for instructions, words of approval, correction, advice, or praise,”  Respect for client’s experience and trust in clients ability to change Believe in freedom, choice, values, personal responsibility, autonomy Client takes an active role in his or her treatment with the therapist being non directive and supportive, determining the course and direction of treatment while the therapist clarifies the client's responses to promote self-understanding.  The goals are increased self-esteem openness to experience, leading full lives of self-understanding, reduction in defensiveness, guilt, and insecurity more positive and comfortable relationships with others increased capacity to experience and express their feelings.      

The Role of the Therapist Client-centered therapy operates according to three basic principles that reflect the attitude of the therapist to the client: The therapist is congruent with the client. Congruence—genuineness, one’s behavior congruent with emotions The therapist provides the client with unconditional positive regard. Unconditional Positive Regard—acceptance, caring The therapist shows empathetic understanding to the client Empathy—accurate ability to view the world from client’s perspective  Tips for Client-Centred Sessions The client knows best. The client is the expert on his/her own diculties. It’s better to let the client explain what is wrong. Don’t fall into the trap of telling them what their problem is or how they should solve it. Act as a sounding board. One useful technique is to listen carefully to what the client is saying and then try to explain to him/her what you think he/she is telling you in your own words. This can not only help you clarify the client’s point of view, it can also help the client understand his/her feelings better and begin to look for a constructive way forward. Don’t be judgmental. Some clients may feel that their personal problems mean that they fall short of the ‘ideal’. They may need to feel reassured that they will be accepted for the person that they are and not face rejection or disapproval. Concentrate on what they are really saying. Sometimes this will not be clear at the outset. Often a client will not tell you what is really bothering him/her until he/she feels sure of you. Listen carefully – the problem you are initially presented with may not be the real problem at all. Be genuine. If you simply present yourself in your ocial role the client is unlikely to want to reveal personal details about themselves. This may mean disclosing things about yourself – not necessarily facts, but feelings as well. Don’t be afraid to do this – bearing in mind that you are under no obligation to disclose anything you do not want to. Accept negative emotions. Some clients may have negative feelings about themselves, their family or even you. Try to work through their aggression without taking oence, but do not put up with personal abuse. How you speak can be more important than what you say. It is possible to convey a great deal through your tone of voice. Often it will be found helpful to slow down the pace of conversation. Short pauses where the client (and you) have time to reflect on the direction of the session can also be useful. I may not be the best person to help. Knowing yourself and your own limitations can be just as important as understanding the client’s point of view. No person centred counsellor succeeds all the time. Sometimes you will be able to help but you will never know.

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Remember the purpose of a counselling session is not to make you feel good about yourself.

 Why study behaviour and behaviour change? Because people change, and so their health behaviour Causes of death in 2010 are dierent from causes of death of the 40’  Traditional Patient Education -

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Traditionally been clinician-centered and prescriptive in nature. Clinicians provide educational messages and direct advice using a unidirectional form of communication that attempts to persuade patients to comply with professional recommendations. This puts the patient in the position of either passively accepting or, alternatively resisting the often unsolicited advice. Patients may perceive the advice as judgmental and intrusive, setting up resistance to change.

 Knowledge If I tell them that their oral condition might aect their heart health, they will change. Insight If I show them that they have chronic inflammation, they will change. Skill If I teach them how to do the exercise, they will change. Threats If I make them feel bad or afraid, they will change  Health Behaviour Models Transtheoretical model (TM)/ Stages of change: Describes stages and processes of behavioural change Motivational interviewing Based on the Stages of Change model  Health Belief Model (HBM): Identifies barriers to health behaviour change and threat as the driving factor for motivation  General Principles of MI Resisting the righting reflex. Avoid a prescriptive provider centered style of solving patient’s problems for them. Guide them in eliciting their own solutions. Understanding your patient’s motivation between current behaviour and important goals or values. Listening to your patient through acceptance, armation, open-ended questions and reflective listening. Empower your patient by support, self-ecacy and optimism.  Keys for communication AROSE Armations Reflective listening Open-ended questions Summarizing Elicit change talk 

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Stages Precontemplation Contemplation Preparation / planning Action Maintenance  Precontemplation -

Discuss patient’s feelings and experiences Don’t assume patient is ready to change Educate regarding benefits Start small

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Contemplation Talk about benefits and barriers to change Identify patient’s personal reasons for wanting to make change Have patient identify his/her own motivation Encourage short term, achievable goal setting

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Preparation / planning Be Supportive Reinforce all positive progress Help patient build self confidence Help patient monitor gains and decrease barriers  Action Provide continued encouragement Discuss ways to slowly increase frequency, intensity and time (FIT) Help patient to plan ahead for changes in routine (vacations, illness, so that they can stay on track)  Maintenance Praise and feedback still important In case of relapse, have suggestions/ a plan for getting back in action Remind them that lapses are temporary and can be viewed as a learning situation rather than a failure 

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The eective clinician     

 Patient-practitioner interaction Practitioners attitudes Patients attitudes Behaviour change Patient resistance to change Communication skills Transference/ Countertransference (more on this in 2nd term)

Goal Setting Short term Long term goals  S.M.A.R.T. Goals Specific Measurable Achievable Realistic Time-bound  Signs of Readiness to Change -

Less resistance Fewer questions about the problem Self-motivational statements More questions about change Looking ahead Experimenting with change

 Tools to elevate motivation for change Decisional Balance (Pros/ Cons) ‘How Important’ Ruler Ask patient: “How important is this change for you?” “Why not lower?” Goal Planning Action Plans (plus Plan B)  Use of Rulers/ Scales A common way of assessing as well as cultivating confidence or importance is the use of scales. They help the patient to verbalise and process their ambivalence further. “On a scale of 1 to 10, how important do you think it is for you to start planning better ahead?” (Patient says 9 out of 10) “On a scale of 1 to 10, how confident are you that you will actually do this?” (Patient says 4 out of 10)  Principles Armations: recognizing patient’s strengths and countering a defeatist attitude “Why did you give yourself a 4 instead of a 2?” “I think you have done a great job in trying to prepare this meal ahead” Reflecting the pros and cons “So, it is important for you to cook your own meals, but you also…” Look for patient-driven strengths “What would make you go up to a 6 or 7?”          

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