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PMHNP > 8007 Test 2 week 4-7 > Flashcards

8007 Test 2 week 4-7 Flashcards

1
Q

Goals of tx for addiction

A
  1. Decrease frequency/intensity of use
  2. Sustain periods of remission
  3. Optimize functioning during remission
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2
Q

Addiction tx considerations

A
  • Multidimensional
  • Culture
  • Gender
  • Age
  • Trauma history
  • Co‐morbidity
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3
Q

Pros of AA

A
  • Evidence for efficacy
  • Cost‐effective
  • Easily accessible
  • Provides social support
  • Increases self‐efficacy
  • Instills hope
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4
Q

Barriers to 12 step

A
  • Fluctuations in readiness and commitment to change
  • High degree of spirituality or perceived religiosity, especially for individuals who are atheist or agnostic
  • The need to surrender
  • The sense of powerlessness
  • Lack of compatibility between personal and treatment belief systems and philosophies
  • Lack of comfort or perceived support in the group, due to membership in a special population (e.g., women, ethnic minorities, youth, dual disorders, sexual orientation)
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5
Q

Other self help groups for addiction

A
  • Self‐Management and Recovery Training (SMART) Recovery.
  • Women for Sobriety
  • Secular Organizations for Sobriety (S.O.S.)
  • Moderation Management
  • Double Trouble in Recovery (DTR)
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6
Q

Self‐Management and Recovery Training (SMART) Recovery

A

CBT approach

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7
Q

Women for Sobriety

A

1st secular self help group

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8
Q
  • Double Trouble in Recovery (DTR)
A
  • Dual diagnosis
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9
Q

Psychotherapy models for addiction

A
  • Motivational Interviewing
  • CBT
  • Integrated Family Therapy
  • Many others…
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10
Q

Therapeutic framework considerations for addiction

A
  • Be on lookout for transference/countertransference
  • Make clear and reinforce expectations (pp. 587‐588)
  • Can experience secondary trauma/burnout
  • Use supervision/peer support
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11
Q

Contingency Management (CM)

A
  • Successful treatment for range of substances/behaviors especially STIMULANTS
  • Uses operant conditioning principles (SKINNER) in that they get an immediate reward for clean UA or staying clean etc (CHECK OFTEN 2-3x/WEEK)
  • Stand‐alone or incorporated into other therapies (USUALLY 8-12 WEEKS)
  • Not everyone is a fan…
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12
Q

EYE MOVEMENT DESENSITIZATION and REPROCESSING (EMDR)

A

 An eight‐phase psychotherapy based on earlier life experience, present day stressor, thoughts for future
 Can be part of treatment plan with other types of therapy

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13
Q

EMDR number of phases

A

8

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14
Q

Only evidence‐based modality that includes a somatic component for therapists to access all dimensions of memory

A

EMDR

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15
Q

EMDR used to tx conditions such as…

A

 PTSD
 Anxiety and panic attacks
 Depression
 Phobias
 Sleep problems

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16
Q

Goal of EMDR according to wheeler

A

“…link dysfunctional memory networks with a larger, more adaptive network.”

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17
Q

How does EMDR work

A

Bilateral stimulation which is a rhythmic alternation of stimulation between the left and right hemisphere

the traumatic memory is isolated on one part of the brain and other parts cant access

tx triggers integration of affect with cognition, sensations, and emotions

Dual attention stimulation facilitates interhemispheric connection

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18
Q

8 phases of EMDR

A

History and Treatment Planning
Preparation
Assessment
Desensitization
Installation
Body Scan
Closure
Re‐evaluation

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19
Q

EMDR Phase 1 History and treatment planning

A

how it works, selection of therapy, how might best be used, getting to know each other

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20
Q

EMDR Phase 2 Preparation

A

explain more about the process and terms and sets expectations and client can ask questions and express concerns. Together work on coping strategies client can use if difficult emotions come up. How can they soothe themselves

some need a lot of time in phase 1-2

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21
Q

EMDR Phase 3 assessment

A

target identified

client asked to think about what those images are and the body sensations. Dont dwell on it but identify it. set baseline measurements.

subjective units of disturbance: scale of severity. goal to get to 1 (1-10)

validity of cognition scale: positive thoughts about the event, “I can get through this”. Do they have any of those starting out?

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22
Q

EMDR Phase 4 desensitization

A

when they focus on the traumatic event and continues until SUD reduces to 1 (neutral)

new images might come up but goal is neutrality

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23
Q

EMDR Phase 5 installation

A

when they associate or strengthen positive beliefs associated with the event.

there is hope for me

do that until they feel like its true

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24
Q

EMDR Phase 6 body scan

A

hold in mind target event and positive belief and scan head to toe looking for discomfort in the body

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25
Q

EMDR Phase 7 closure

A

how you close every one of the reprocessing sessions

how you return the person to a state of calm

cant just let them go, they may still be upset

deep breathing/meditation

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26
Q

EMDR Phase 8 re-evaluation

A

how you begin each new session after you have gone through reprocessing successfully

are they still having positive feelings about the future

tx is continuing in the right direction

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27
Q

Motivational Interviewing

A

“Motivational Interviewing is a clinical approach that helps people with mental health and substance use disorders and other chronic conditions such as diabetes, cardiovascular conditions, and asthma make positive behavioral changes to support better health.” (SAMHSA)

“…a collaborative conversation style for strengthening a person’s own motivation and commitment to change.” (Miller & Rollnick, 2013)

its about ambivalence toward change

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28
Q

MI conversation styles

A

Directing

Guiding

Following

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29
Q

MI core skills

A

O: open ended questions
A: affirmations
R: Reflective listening
S: Summarizing

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30
Q

DBT has been studied for many thing including

A

Suicide attempts
self harm
SUD
PTSD
mood do
eating do
anxiety

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31
Q

Stages of change

A
  • Pre‐contemplation (get hx and values)
  • Contemplation (get pros and cons)
  • Preparation (make a plan, anticipate, ask about confidence)
  • Action (support/barriers)
  • Maintenance (check ins/triggers)
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31
Q

Dialectical Behavior Therapy (DBT)

developed by?
1st line tx for?

A

Marsha Linehan in the 70s

1st line for BPD (borderline personality disorder)

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32
Q

DBT theoretically based on…

A

dialectics

which is a synthesis of simultaneous yet opposing truths (and not but) (balance acceptance and change)

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33
Q

DBT tx strategies are a combo of

A

CBT
humanism
Zen Buddhism

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34
Q

Goal of DBT

A

life is worth living

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35
Q

standard DBT structure

A

1 yr+
pre tx + 4 stages

Modes: Individual, group, inter session contact, peer consultation team meeting

therapist available 24 hrs

note sometimes modified

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36
Q

individual DBT

A

weekly, one hour

homework–diary card on skill develpment/mood etc

Behavioral chain analysis (CBT principles: precipitating event, thought about it, resulting emotions, and behaviors)

targets (according to a heirarchy)

formal assessments

37
Q

group skills training DBT

A

weekly 1.5-2.5 hrs

psychoeducation groups

4 modules:
2 acceptance skills: Mindfulness and distress tolerance
2 change skills: Interpersonal effectiveness and emotional regulation

38
Q

intersession contact DBT

A

any communication outside therapy session

dont have to be in crisis

39
Q

peer consultation team meetings DBT

A

weekly
case supervision
peer support
learn about self
discuss and apply DBT

40
Q

pretreatment DBT

A

2-3 sessions

compatibility
terms of therapy
commit to 1 yr
no suicide or self injury

41
Q

Stages and targets of DBT

A

4 and non linear

Heirarchy of behaviors to target:
1.Life threatening
2. Therapy interfering
3. Quality of life interfering
4. Skills acquisition

42
Q

Stage 1 of DBT

A

most clients start here

control severe behavior dysfunction

target: life threat, life interfere, quality of life interfere

43
Q

Stage 2 DBT

A

process trauma

behaviors like emotional avoidance, numbness, sx of PTSD

must have stage 1 issues under control

Need high level DBT skill development

Goal is to go from quiet desperation to emotional experiencing”

44
Q

Stage 3 and 4 of DBT

A

most research is on stage 1 and 2

3: move from problems in everyday living to ordinary happiness and unhappiness. Work on individual goals

4: move from incompleteness to capacity for sustained joy. Deeper meaning in life including spirituality and transcendence

45
Q

Trauma elements

A

Stressful event/situation

Overwhelms ability to cope

Highjacks neural pathways linked to memory processing

Sympathetic/parasympathetic response

46
Q

Trauma vs PTSD prevalence

A
  • ~6 of every 10 men and ~ 5 of every 10 women experience at least one trauma in their lives.
  • ~ 6 out of every 100 people (6%) will have PTSD at some point in their lives.
  • ~ 15 million adults have PTSD during a given year.
  • Twice as many women (8%) develop PTSD sometime in their lives as men (4%).
47
Q

Dx reaction to trauma

A
  • PTSD
  • Acute Stress Disorder
  • Psychosomatic Disorders
  • Dissociative Disorders
  • Complex PTSD
48
Q

Dissociation

A

a disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is

49
Q

Dissociation as disorder

A
  • Depersonalization/derealization d/o
  • Dissociative amnesia/fugue
  • Dissociative identity d/o
50
Q

Goals of tx for PTSD/Trauma

A
  • Reduce symptoms
  • Prevent/treat comorbidities
  • Improve adaptive functioning
  • Decrease chances of relapse
  • Increase sense of security and safety
51
Q

Evidenced‐based therapies for PTSD

A
  • CBT
    Including Prolonged exposure therapy (PE) and Cognitive processing therapy (CPT)
  • EMDR
52
Q

Stage 1 Trauma tx: Symptom Stabilization and safety

A
  • Safety first
  • Identify strengths and support systems
  • Address physical needs and environment
  • Building trust
  • Self‐soothing strategies
  • Psychoeducation
52
Q

Framework for tx of trauma in 3 stages

A
  • Stage 1: Symptom stabilization and safety
  • Stage 2: Memory processing
  • Stage 3: Continued growth, rehabilitation, reintegration
53
Q

Prolonged exposure therapy for trauma CI

A

DID
Complex PTSD

54
Q

Process trauma with patients only after the patient is ___

A

stabilized

also note i must have the expertise.

Be aware of secondary trauma

Takes months or years

55
Q

Humanistic Existential therapy is based on these 3 philosophies

A

Humanism
Existentialism
Phenomenology

56
Q

Humanistic Existentialism

A
  • Movement started in mid-20th century by psychologists Carl Rogers, Abraham Maslow, Rollo May, and others
  • “Third-force” of psychotherapy
  • Diverse approaches grounded in philosophies of humanism, existentialism, phenomenology
57
Q

Person Centered Therapy believes

A
  • People are inherently good
  • Remove impediments to growth through therapeutic relationship
58
Q

Person Centered Therapy was started by

A

Carl Rodgers

59
Q

Person Centered Therapy has 3 pillars

A
  • Unconditional positive regard
  • Genuineness
  • Empathetic understanding
60
Q

Person Centered Therapy techniques

A
  • Congruence
  • Nondirectivenss
  • Reflecting feelings
  • Open questions
61
Q

Gestalt

A
  • “…a physical, biological, or symbolic configuration or pattern of element so unified as a whole that its properties cannot be identified from a simple summation of its parts.”
62
Q

Gestalt Therapy goal

A

the only goal is awareness… Awareness takes place now. Prior events may be the object of present awareness, but the awareness process [e.g., remembering] is now

63
Q

Other aspects of Gestalt Therapy

A
  • I-Thou Relationship (Buber) (based on reciprocity and mutuality)`
  • Creative experimentation

therapist is active participant

patients learn how they are seen and how awareness is limited by the relationship

64
Q

Examples of gestalt experiments

A
  • Staying with the Feeling
  • I Take Responsibility For. . .
  • Empty Chair Technique
  • The Exaggeration Experiment
65
Q

Existential therapy

A

roots in 1950s

Frankl (Man search for meaning)

Wide range of methods depending on client

more of a mindset and can be woven in with other types

goal of authenticity

66
Q

Givens of Human existence by Yalom

A
  • Death
  • Freedom
  • Isolation
  • Meaning
67
Q

What does the therapist do in existential therapy

A

not one of seeking to impose a directive change or to ameliorate the lived inter-relational world of the client, but, rather, to attempt to clarify it

explicitly remind their clients that, ultimately, the task remains up to them – the clients – to find their own meanings and truths, and, hence, to realize their role and responsibility in the choices they have made and will continue to make throughout their lives

The most gratifying task of the existential counsellor is to assist people in their struggle to live such a worthwhile life…both counsellor and client will constantly be reminded that earth is a place somewhere between heaven and hell, where much pain and much joy is to be had and where some degree of wisdom can make all the difference

68
Q

Solution Focused Therapy

A
  • SFT or SFBT (B=brief)
  • Developed in early 1980’s
  • Postmodern therapy

deconstruct problems and construct solutions

69
Q

SFT techniques

A

Goal Goal-setting

Look Look for previous solutions

Look Look for exceptions

Do Do more of what is working

Compliments
Miracle question
Scaling questions
Coping questions

70
Q

Older adults and mental health in stats

A
  • 15% of older adults impacted by a behavioral health problem
  • 4.8% have SMI
    • .2% bipolar disorder
    • .2‐.8% schizophrenia
    • 3‐4.5% depression
  • Account for 17.9% of suicide deaths
71
Q

Factors to consider in tx of older adults

A
  • Cohort
  • Changes in metabolism
  • Many losses experienced
  • Acute and chronic medical conditions
  • Cognitive impairments
  • Functional and sensory impairments
  • Less likely to seek treatment
  • More likely to seek religious support over treatment
  • Growing ethnic/racial diversity
72
Q

Individual psychotherapy models for older adults

A

CBT
Interpersonal Therapy
Reminiscence
Life Review Therapy
others in lit

73
Q

CBT for older adults

A
  • Most commonly studied for depression and anxiety
  • Middle phase/working can be most difficult
  • Family involvement may be helpful
74
Q

Interpersonal Therapy for older adults

A
  • For depression and anxiety
  • Opportunity for reflecting and resolving relationship transitions
  • Not suitable for every patient
  • Better suited for therapists experienced treating older adults
75
Q

Reminiscence for older adults

A
  • Less structured
  • May be done in group or individual
  • Focus on past event, pleasurable memory
  • Cognitively intact to moderately impaired
76
Q

Life Review Therapy for older adults

A
  • Structured
  • 1:1
  • Over course of life, good and bad events
  • Analytical, evaluative
  • Cognitively intact to mildly impaired
77
Q

Mental health stats for youth

A
  • 1 in 5 ages 13‐18
  • ADHD, behavior problems, anxiety disorders, depression most prevalent
  • 9.4% (6.1 million) ages 2‐17 have ADHD diagnosis
  • 7.4% (4.5 million) ages 3‐17 have behavior problem diagnosis
  • 7.1% (4.4 million) ages 3‐17 have anxiety diagnosis
  • 3.2% (1.9 million) ages 3‐17 have depression diagnosis
  • Suicide 2nd leading cause of death for ages 10‐14
78
Q

Underlying assumptions of child therapy

A
  • Developmental considerations (Erikson, Piaget)
  • Family involvement (Involve family even if seeing child for individual therapy)
  • Systems involvement (family, school, community)
  • Resiliency (Strength‐based, promoting protective factors)
79
Q

Therapy with younger children

A

play therapy
* Have variety of toys, games, art supplies across age groups
* Structured or unstructured
* Therapist maintains calm; gives words to behaviors and expression of emotions
* Family involvement

80
Q

therapy with adolescents

A
  • Art supplies, blocks/Legos, games
  • Establish trust
  • Treat with respect, equal
  • Follow their lead
  • Structured session and rationale
81
Q

Trauma‐Focused CBT (TF‐CBT) for kids Goals

A

Goals:
1. Enhanced sense of safety
2. Re‐regulate “domains of impact,” e.g., affect, behavioral, biological, social

82
Q

Trauma‐Focused CBT (TF‐CBT) for kids Components

A
  • Components (PRACTICE) and phases (stabilization, trauma narrative, and integrative/consolidation)
83
Q

Trauma‐Focused CBT (TF‐CBT) for kids consideration and length of tx

A
  • Parents/caregivers must be part of therapy, individual sessions and conjoint
  • 12‐15 sessions; longer for complex
84
Q

Common elements therapy for kids

A
  • Transdiagnostic
  • Discrete clinical interventions (e.g., relaxation, exposure)
  • Typically modular, can be delivered independently
  • Flexible
  • Allows for co‐morbidity

Examples
* CBT+: CBT and parent management training (PMT)
* FIRST

85
Q

Other evidenced based tx for kids

A

PMT
MI
IPT
CBT
EMDR

86
Q

CBT for kids

A

8+ but maybe variable

Guided by Piaget level of cognitive developement
-concrete operational (7-11) (can imagine what will happen using logic or reasoning)
-Formal operational (12+)

Catch it, check it, change it– basic structure

COPE: Creating Opportunities for Personal Empowerment

87
Q

EMDR for kids

A

CI is risk for dissociation

8 phases like adult

may need parent/caregiver present and that caregiver may be trauamatized

88
Q

Telemental health for kids: considerations

A

Setting ‐Room
* Accommodate child and 2‐3 adults
* Child can move freely but not too freely (hyperactive child)
* Child can play on floor while conversing with parent

Privacy
* Who can be present and who cannot

Establish ground rules
* Discuss with parent and youth at outset, may have to remind periodically
* “Proper” attire and body language
* No distractions (TV, cell phones)

89
Q

Telemental health for kids: The session

A

Establish routine to start and end session
* Starting out: turning off phones, devices, getting comfortable in therapy chair
* Ending: doing a pleasurable activity between youth and provider, i.e., relaxation exercise, coloring

Take frequent breaks, such as with PowerPoint games or YouTube videos

Utilize physical things in child’s environment: Use dolls and toys that the patient has or mail items such as stress balls or fidget toys that child can use.

Tailor activities to each child’s interests to enhance engagement

Adapt worksheets and activities for digital use

Picture in picture
* Older children and adolescents love seeing themselves
* May distract younger children and children with developmental disabilities so better not to use with them

Written materials for younger children should have minimal text (that is displayed in large font) and medium‐to‐large images

Incorporate a combination of worksheets and experiential exercises for adolescents and older children

90
Q

Engaging adolescents

A
  • Engage in online site like YouTube or Facebook
  • Aren’t always comfortable “just talking,” so they may be more engaged sharing favorite art pieces, poetry, journal writings, or music
  • If reluctant to verbalize, use chat feature
  • Apps – be sure to vet them

PMHNP (26 decks)

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