psych theories Flashcards
Psychotherapy - purpose (psychotherapy is insightful)
purpose is to effect improvement through insight.
Psychoanalysis
unconscious - free association and dreams (the psychoanalyst interprets dreams)
psychoanalysis - Basic orientation - (freud was meaningful)
all behavior is psychologically meaningful, and is influenced by unconscious impulses and conflicts
psychoanalysis - methods (dreams are the method)
Methods - analyst interprets pt’s free associations and dreams
psychoanalysis - concepts - And what age is important?
id, ego, super ego. 1st 5 years of life is most important.
psychoanalysis - 3 stages
oral, anal, phalic
psycholanlysis - goal (the ego gets the goal)
Goal – uncover unconscious conflict and empower the ego to deal with it.
Freudian Psychoanalysis - transference and counter
Freudian Psychoanalysis - Transference (pt has feelings towards therapist. May view therapist as mom and have good feelings about it. it is considered an important part of therapy) and Countertransference (therapist has feelings for patient. could be good or bad) These are normal, but be aware of them.
Client-centered/Humanism - Basic orientation
(humans are trying to integrate to get better)
human beings move toward construction change and integration. they are trying to get better.
Client-centered/Humanism - methods (humans need empathy and unconditional love)
unconditional positive regard and empathic active listening- the pt will feel safe and vulnerable.
Client-centered/Humanism concepts (to be human is to have relationships)
interpersonal relationships are the basis for mental health. focus is on improving interpersonal relationships - communication.
Client-centered/Humanism goal (the goal of humans is to be aware)
bring aspects of self into awareness and acceptance. nurse needs to put themselves in client’s shoes. nurse should be genuine.
Cognitive Development (Piaget)
children developing through cognitive stages.
Cognitive development from reflex to logic. Provides a framework for understanding negative self view.
Cognitive Development (Piaget) - stages - and ages
Sensorimotor (0-2 yr), preoperational
(2-7), Concrete Operational (7-11 yr) Formal Operational (11+)
Rational Emotive Therapy (Ellis) a hybrid of what? (rational hybrid)
a hybrid of psychotherapy and behavior modification
Rational Emotive Therapy basic orientation (choose to accept that you are not rational)
Individuals can choose thoughts and behaviors that promote or limit self-acceptance.
Rational Emotive Therapy (Ellis) - methods - Cognitive
(rational reasoning)
reasoning
Rational Emotive Therapy (Ellis) - concepts - ABCs (the ABCs are a rational cycle)
ABCs of intrapsychic conflict: Activating event, irrational Belief. Consequence, Dispute
Rational Emotive Therapy (Ellis) - goals (the goal of science is to rationally challenge)
provide skills to scientifically challenge irrational premises and change behavior
Cognitive Behavioral Therapy (Reframe the CBT)
- questioning beliefs and reframing their beliefs.
CBT - basic orientation - mood and behavior are determined by what? (it’s in the name - cognitive)
mood & behavior are determined by client’s organization of the world through thoughts; assumptions
CBT - methods
Cognitive: questioning and reframing. Behavioral: journaling, cognitive rehearsal, activity plan
CBT - concepts/what is the chain of events
(CBD automatically schemes, and it’s a faulty catastrophe)
dysfunctional automatic thoughts, schemas (irrational thoughts), faulty information processing. automatic reaction and catastrophizing.
CBT - goal (CBD keeps you balanced and rational)
develop balanced (rational) cognitions and self-statements
Dialectical Behavior Therapy (Linehan) (Diablo validates the east)
(uses eastern medicine) (validates pt and encourages change)
Dialectical Behavior Therapy (Linehan) - behaviors result from what?
(Diablo is emotional)
emotional dysregulation
Dialectical Behavior Therapy (Linehan) - methods (Diablo meditates on the chain)
meditation, chain-of-events analysis (something that didn’t go well),
Dialectical Behavior Therapy (Linehan) - concepts
Dialectical Behavior Therapy (Linehan) -
Dialectical Behavior Therapy (Linehan) - goals (diablo’s goal is here and now)
accurate labeling of emotions, here-and-now awareness, monitoring and regulating behaviors
Dialectical Behavior Therapy (Linehan) -Differs from traditional CBT in its emphasis on
validation— the therapist and the patient work on “accepting” uncomfortable thoughts, feelings and behaviors.
behavior modification - who created it- and what is not needed?
Behavior modification (Watson and Skinner)– unlike psychotherapy, insight is not necessary for improvement (though it can help!). You don’t need to understand why you do it, you just need to change it.
common uses of behavior modification - systematic desensitization
systematic desensitization (form of behavior modification - used with anxiety disorders) – associates relaxation with aversive stimuli to decrease the aversive feeling (e.g., anxiety or fear). Used for anxiety disorders, esp. phobias and OCD.
behavior modification - aversion therapy ex. (the alchys need aversion)
aversion therapy, e.g., disulfiram with alcoholics. Associates aversive feeling with unwanted behavior.
behavior modification - limit setting
limit setting – an informal type of behavior modification. telling someone something is not allowed.
behavior modification - modeling
used frequently by RNs on inpatient units - showing what should be done.
family therapy - what role do nurses play?
a ‘family’ can take many shapes!
a virtual necessity when a dependent client is involved
Nurses usually play a peripheral role, giving input to the team treating clients.
play therapy - what age (don’t play after 12)
<12 years old – sand tray, toys, etc. with individual therapist (kids don’t usually have the verbal ability to state what’s going on with them)
group therapy - and what age?
> 12 years old – constructive use of peer pressure to effect behavioral changes
biological theory - biology is new and organic
This is the predominant model used today, especially for mood disorders and psychotic disorders. The premise is that mental illness has organic or physical causes, such as genetic abnormalities and/or biochemical imbalances, and will therefore respond to biological treatment
inpatient care
is what nursing students mostly experience, but there are also many community mental health options and facilities. RNs need to be familiar with these because they assist SW with discharge planning.
crisis stabilization - what is the main priority
e.g. Psychiatric Emergency Services (PES) and Willow Rock; the priority for both inpatient care and crisis stabilization is SAFETY. coping mechanisms fail. unsafe behavior. when they first come in to mental health.
community based resources - what is the main priority?
can save both money and quality of life. Facilities may include day treatment programs, ADUs, B&Cs , L (locked)-facilities, etc. Specifics of care provided can differ greatly within categories of facilities. The priority is to prevent hospitalization.
case managers
Case management needs to be in place before discharge from an inpatient setting. Social workers and others may plan this, but the RN needs to ensure it is in place before discharge. provide updates to prescribers.
assertive community treatment (ACT) (act intense)
Intensive Case Management (24/7) focusing on community living needs of patients with CHRONIC severe illness.
Partial Hospitalization Program (PHP) (you’re partial) - and how long does it last?
day program. an average of 5-6 hours/day of group therapy, focusing on sx mgmt, med education, coping skills; client goes home at end of day; typically lasts 1-2 weeks (e.g. Langley Porter Partial Hospitalization Program (PHP) ;
Intensive Outpatient Program (IOP) (Kaiser is not intense)
(e.g. Kaiser) - not all day, on 2-3 hours.
Locked Facility (L-fac) - who is it for?
Locked Facility (L-fac) - Usually reserved for patients who are on conservatorship, chronically GD (e.g. Crestwood Vallejo) (nurses, LVNs)
Mobile Crisis Units –
Mobile Crisis Units – usually includes an MD or Psych NP to be able to prescribe meds in the field, plus support staff, who respond to 911 calls related to mental illness; a helpful alternative to police always being first responders. give maybe an IM injection.
home care - what are the 4 requirements (psycho at home needs a professional plan)
client must be homebound for third-party payment. The four requirements for Medicare to cover home health care for mentally ill pts are:
homebound status
psych diagnosis
need for professional psych RN
development of plan of care under MD
id
id (primitive)
ego
defense mechanisms - balances the id and superego
super ego
moral censor
oral stage
oral (0-1 1/2 yrs old) - id is hungry. can you trust your environment for reliable food?)
anal stage
anal (1 1/2 to 3 yrs) pee and poop - but superego says don’t do that in your pants. if needs aren’t met, you might have shame and anal fixation - anal retentive. very methodical, clean.
phalic stage
phalic stage age 3-5 (little boys fall in love w/ moms) can’t bc dad wis bigger, will do opposite and be like the dad.
who is psychoanalysis not appropriate for?
This is NOT appropriate for the BPD, psychotic, severely depressed patient - ex. ppl who can’t reason well.
sensorimotor and age?
(sense the sucking)
Sensorimotor (0-2 yr) - explore through sucking
concrete operational - (and age) (Concrete logic)
, Concrete Operational (7-11 yr) - less egocentric, more aware, more logical
formal operational (and age) (the adolescent is formal)
Formal Operational (11+) adolescent, able to problem solve using multiple steps, use logic, think abstractly.
preoperational (and age) (premie at 27is imaginary)
Preoperational (2-7 yr) - imaginary play, not logical, egocentric
A
Activating event (major or minor - lost a job or spilled a cup of coffee - something makes them feel like a loser)
B
irrational Belief (I shouldn’t have spilled that), negative emotional
C (cc)
consequence - usually some type of catastrophizing
D (dispute your beliefs)
dispute. therapist helps patient dispute the irrational belief
dialetical - used for who?
designed for use with BPD clients. . most important therapy for BPD***.
dialetical - used for what disorders
(diablo loves drugs)
used for anxiety, substance use, eating disorders, depression.
tolerance, how to manage distress, and mindfulness. Help clients label emotions.
dialetical
(diablo wants validation and change)
The term “dialectic” refers to the therapist’s goal of establishing a balance between acceptance (validation) + change (coping in more healthy ways)
dialetical - what techniques (and ex.)
(Diablo has a contract not to harm)
Uses standard CBT techniques, ex. use contracts to not self harm while therapist is on vacation.
behavior modification - all behavior is….
learned. good to use with kids.
behavior modification - relies on what?
Relies on effectiveness of contingencies, which need to be measurable. It’s usually best for clients to have contingencies in writing (a contract)
biological theory - treatments
(e.g. psychotropics, ECT (electroconvulsive therapy), TCS (transcutanal stimulation), VNS (vagus nerve stimulation), etc.)
ADUs - how long? (adu 2 weeks)
(acute diversional units - designed to last about 2 weeks - coming out of inpatient unit, like a step down unit)
B&Cs - how long? (boarding a long time)
(board and care - residential - long term. don’t have intensive group programs, don’t need to go to locked facility, but need help)
assertive community treatment - drawbacks
Drawbacks: this service only serves the sickest of clients. Those who are functioning poorly, yet otherwise maintaining, cannot access ACT. it’s expensive. ppl in and out of hospital.
assertive community treatment requires…(drawback)
Coordination between: homes, agencies, hospitals, clinics.
24 hours a day, on call.
SW, RNs, MDs, PSYCHs. Often the RN serves as case manager.
rational emotive therapy - therapist will challenge what?
therapist will challenge faulty beliefs
CBT is a hybrid of what?
- another hybrid of psychotherapy & behavior modification
dialectical: how to treat behavior
(Contract with Diablo for a period of time)
contract with therapist that may include telephone support, NHC and agreement to work together for a stated period of time (usually one year).
rational emotive therapy - who started it
Ellis
rational emotive therapy - precursor to what?
precursor to CBT
who created client-centered/humanism?
(Rogers and Maslow)
rational emotive therapy - methods - Behavioral: (R for role playing)
role-playing, progressive tasks
biological theory treats what disorder?
(depression is biological)
used for severe depression***
who started cognitive behavior therapy (beckham is not cognitive)
beck
neurotransmitter associated w/ anxiety
not enough gaba
neurotransmitters associated w/ depression
deficiency of norepinephrine, serotonin, dopamine, or a combination
dialetical - what types of exercises? (diablo needs skills, homework, and a rating scale)
such as skills training, homework assignments, symptom rating scales, and behavioral analysis to develop coping skills.
dialetical - an evolution of what?
- a further evolution of RET/CBT
CBT is usually used for what?
depression. some eating disorders and anxiety.
automatic thoughts
CBT
who usually identifies the thought distortion with CBT?
the therapist - are you really a loser?
most common type of thinking with depression and CBT
dichotomous thinking
filtering
seeing only the negative aspects of a situation - focusing on one mistake
self-acceptance
DBT
tranference and countertranference is
a natural part of therapy
main issue with BPD
self-injury - cutting, etc.
main goal of dialectical
validation and change of behavior
big fear with BPD
fear of abandonment
label emotions?
Dialectical - Borderline
main thing with behavior modification
you don’t need to understand why, and all behavior is learned
contingencies?
behavior modification
desensitization is what therapy
behavior modification
limit setting and modeling - type of therapy
behavior modification
ECT is what type of therapy
biological
active suicidal ideation
thoughts of suicide plus a plan
grandiose
better than others
floridity
flamboyance, severe delusion, hallucinations
disorganized thinking and speech, more profound negative symptoms like withdrawal symptoms- flat affect, alogia
