Week 01-Lecture 2 Clinical Perspectives in Psychology

(Week 1) Lecture #2 Clinical Perspectives in Psychology Lecture Goals What does psychology have to do with the real world? How does basic psychology inform clinical practice? Psychology and the Real World Psychology is based on ‘scientific method’ Experimental control Strict measurement These factors form the basis of understanding, measuring, and changing psychological aspects of the real world Stress Disorders After trauma, some people develop posttraumatic stress disorder (PTSD) This is a real problem after disasters, terrorism, war, accidents, etc Marked by distressing memories of the event, anxiety, and avoidance of reminders Affects about 10% of survivors Managing Stress Responses For over 30 years the common response has been to offer everyone trauma counseling Termed “psychological debriefing” Psychological Debriefing Occurs within 48 hours of trauma exposure Requires people to discuss their experience and their emotional responses Presumes that “spilling your guts” is a good thing Intended to prevent posttraumatic stress Discovered to be an ineffective treatment How Do We Know?: Measurement Assess people before treatment with standardized measures – Pyschometric Properties Need to know the ‘starting point’ of a person’s distress Properly developed measurement tools are essential How Do We Know?: Comparison Comparison condition needed We can only know that a treatment works if we compare it against something else Observed changes may be due to: Time Attention you receive Repeated assessments MUST HAVE A COMPARISON CONDITION How Do We Know?: Controlling for Bias Must avoid any sources of bias in sample Randomization To avoid biased allocation to a treatment condition How Do We Know? Assessment Bias Assessment needed after treatment This assessment must be independent – Double Blind Test “Blind” assessment means assessment not biased by knowing what treatment was given - Ignorant Assessment needed after treatment This assessment must be independent “Blind” assessment means assessment not biased by knowing what treatment was given How Do We Know? Double Blind Studies Drug trials even involve ‘double blind’ designs Patients do not know what treatment they are getting Clinicians do not know what drugs they are giving How Do We Know? Quality Checks Critical to always check that procedures followed properly Treatment ‘fidelity’ checks ensure people do what they say they are doing Audio Reports Psychological Debriefing: Findings These principles were ignored for decades As result, everyone believed debriefing worked because people said they liked it Controlled trials have now proven that debriefing does not prevent psychological disorders Scientific Method Hallmark of psychology Thanks to these studies, debriefing has been debunked Policy makers are now turning to alternatives … and TESTING them. Need for Evidence Policy makers realized that evidence needed to shape practice World Health Organization (WHO) now requires multiple trials to validate a psychological intervention Being subjected to randomized controlled trials and replication of trials Unscientific and unethical to deliver ineffective treatments Randomized Controlled Trials Random allocation to groups Independent assessments Standardized assessments – validated & standardized tools Strict protocols for interventions Checks that interventions are valid What does basic Psychology say about Trauma Response? Classical Conditioning Learning that certain environmental stimuli predict harmful events. Fear Conditioning Models Trauma = Electric Shock Fear = Rat’s fright Trauma reminders = Light Distress = Rat’s fear to the light Animal Models: These models (called “fear conditioning”) are shaping how we understand and treat traumatic stress disorders Extinction “Extinction” involves new learning when the stimuli are repeatedly presented but without a negative outcome … teaches that the stimuli is now signaling safety! Extinction Learning & Stress In a UNSW experiment, cadet firefighters were taken through fear conditioning/extinction paradigm before trauma, to predict PTSD after exposure to trauma. Four years after they had all been exposed to trauma, we assessed them for stress disorders Those who developed stress disorders were poorer in extinction learning before they became firefighters Tells us key mechanisms This highlights that basic animal models of learning are crucial to understanding how humans respond to stress Helps us to identify people who are at risk for PTSD Possibly leads to better prevention methods Treatment PTSD Treatment does not begin until 1 month after the event due to stress reactions experience immediately post event “Treating the Rat” We know that putting the rat back into chamber without the shock leads to new learning that the chamber is safe (remember this is called “extinction learning”) “Treating the Human” PTSD Treatment does not begin until 1 month after the event due to stress reactions post event We know that putting the human back to reminders in a safe way leads to new learning that the world is safer This is the major way we treat people after trauma (called Exposure Therapy) It is based on basic animal work Therefore, can Animal Neuroscience shape Clinical Practice?....................YES Neurobiological Model of PTSD 19052540* MPFC = Medial Pre-Frontal Cortex Brain Regions Predict Treatment Response The same brain regions underpinning extinction in rats predict exposure therapy for fear in humans Extending from basic animal research is helping us understand how to treat people affected by trauma Neurotransmitters and Learning Glutamate is the major excitatory neurotransmitter Animal studies tell us that glutamate is a neurotransmitter linked to emotional learning By increasing glutamate experimentally before extinction trials, we can increase extinction learning in rats Glutamate and Therapy We now can improve therapy for anxiety by increasing glutamate prior to therapy session This advance is a direct result of psychological models tested by animal research Summary Basic psychological principles & research shape major policies and practices in society This basic work is essential for developing new approaches to many disorders It is also essential for testing if what we do works or not