UNIT 2- PSYCH THEORIES & THERAPIES Flashcards
What is stigma?
Negative or steriotypical view of someone with a mental illness, creates prejudice and discrimination. It is a mjaor barrier to mental health treatment and recovery. It contributes to fear, recjection and results in isoluation and reduced oppurtuinity.
What influences our mental health?
- Genetics
- Brain chemistry
- Life experiences
What is mental health?
State of well-being in which indivdual realizes potenital, copes with normal stresses, works productively, contributes to community.
Successful performance of mental and emotional functioning
What is resilience?
Ability to recover from or adjust sucsessfully to stressors, loss and trauma
What is NAMI take on mental health?
- Affects a person’s thinking, mood, and feelings
- Can make it difficult to relate to others
- May affect ability to function day to day
- Treatable
What are attributes of mental health?
- Abilit to work and be productive
- Maintain a healthy self concept and self-value
- Ability to play and laugh
- Accurate apprasial of realility
- Can navigate interpersonal conflict- know right from wrong
Review powerpoint for more
What are factors affecting mental health?
- Environmental experience
- Bullying, active shooter
- Biological hormones, genetics
- Family and friends
- neglect mental disorder, tramatic childhood in the home
- Negative influecnes, psychosocial stressors, poverty, impaired parenting
- Cultural religious differences
- Some religions are more rigid than others
- Spirituatility/religion
- Health practices & beliefs
- Personalility traits
What is the DSM5?
- Guidebook for categorizing and diagnosing psychiatric mental health disorders in the US
- Lists specific criteria for each mental disorder
- Standardizes language
- Identifies symptoms and quantifies them
- Assists in identifying underlying causes
What should we know about culture and mental illness?
- Influences how symptoms are viewed
- Influences our ability to cope with symptoms
- Health seeking behviors influenced
- Developed countries seek help from psychaiatrisis/nurse practitioners
- Indigenious cultutres see a spiritual component and may seek shaman, healers, curanderos
- Culture bound syndrome
- Running amok- SE asia, someone runs around being violent
- Pibloktoq- uncontrollable desire to remove clothing and expose onself to extreme cold
- Anorexia Nervosa- Recognized in North America, Europe, and Austrilla and unheard of in many other societies.
Sigmund Frued psychoanalytic theory claims
Psychologoical distrubances are the result of early trauma and incedents that are not often remembered or recognized.
What is the conscious mind?
Current awareness, thoughts, beliefs and feelings.
The conscious mind, the preconscious mind, and unconscious mind are part whose theory?
Sigmund Freud psychoanalytic theory
What is the preconcious mind?
Mind lies immediately below the surface. Content is not currenlty the subject of our attention but it is accessible w/conscious effort
What is the unconscious mind?
Most of our primitive feelings, drives, and memories reside esp. those that are unbarable and traumatic
What is the ID?
Primitive, pleasure seeking and impulsive part of our personalilty that lurks in the unconscious mind.
What is the ego?
Problem solver and reality tester that navigates in the outside word. It acts as an intermediary between the ID and reality by using ego defense mechanisms, such as repression, denial, rationalization.
What is the super ego?
Represents the moral component of the personaility of “our conscience” (right from wrong). Greatly influenced by parents/caregivers moral and ethical stances.
Freud believed fixation through overindulgence or frustration results in….
conditions and personaliity disorders.
What do we need to know about psychoanalytic thearpy?
Frueds anwser for a sceintific method to relieve emotional distrubances
Goal: To know and understand what is happening at the unconscious level in order to uncover the truth
Thearpy is 3-5 times a week for many years– emotionally painful proces
Free association used
What is free association and which thearpy is it seen with?
Psychoanalytic thearpy
Free association is used to search for forgotten and repressed memories.
Example: What do you think of when I say winter… pt encouraged to say what comes to mind. Which can reveal long forgotten and traumatic events…. that come to mind when pt thinks of cold weather
What do we need to know about psychodynamic therapy?
Related to psychoanalytic therapy views mind in the same way.
Shorter sessions (10-12)
Therapies take more of an active role because the therapeutic relationship is part of the healing process
Transference can occur
What is transference?
Patient projects intense feeling onto the therapist related to unfinished work from previous relationhships- crucial for succsess
Example– pt acts immature in the presence of a therapist that reminds them of a parent
What is countertransference?
Psychodynamic therapist must recognize thier unconcsious emotional response to the patient in order to prevent damage
What is repression?
Defense mechanisim: The unconscious mechanism employeed by the ego to keep distrubing or threatening thoughts from becoming concious
What is denial?
Defense mechanism: Involves blocking external events from awareness if some situation is just too much to handle. The person will refuse to to experience it.
What is projection?
Defense mechanism: This involves individuals attributing their own unacceptable thoughts, feelings and motives to another person.
What is displacement?
Defense mechanism: Satisfying an impulse with a substitue object
What is regression?
Defense mechanism: This a a movement back in psychological time when one is faced with stress
What is sublimation?
Defense mechanism: Satisfying an impuslse w/a substitute object in a socially acceptable way.
example sports instead of impulse
What is interpersonal thearpy… who created it and what should we know about it?
Herbert “Harry” stack Sullivan
1. Believed that special forces and interpersonal problems were the cause of psychiatric alterations
2. Humans are driven by the need for interaction
3. Loneliness is the most painful human experience
4. Early relationships with primary caregiver is crucial for personalility
5. Anxiety is based on approval or disapproval of significant caregiver
6. All behavior is based on avoiding anxiety and threats to self esteem
7. Focus is on the “good me”
8. Personalility can be influenced as a child and an adult
What should we know about the interpersonal therapeutic model of therapy?
- IPT (interpersonal therapeutic model)- is a hands on system in which therapisits actively guide and challange mal-adaptive behaviors and distorted views.
- If people are aware of thier dysfunctional patterns and unrealistic expectations, they can modify them.
- The foucs is on the HERE & NOW.
- Emphasis on patients life and relationship at home at work and socially
- Therapist becomes a “participant observer” and reflects the patients interpersonal behavior, including responses to the therapist.
List 3 behavioral theorists
- Ivan Pavlov
- John B. Watson
- B.F Skinner
What is Ivan Pavlov known for?
Behavioral theorist
1. Classical coniditioning
2. Pavlov dogs
What should we know about John B. Watson
He was a behavioral theorists
1. Personalility traits and responses, adaptive and maladaptive are learned
2. “little albert”- 9m old child conditioned to be afraid of the sight of white fur or hair… also considered classical conditioning.
What should we know B.F skinner?
- Operant coniditoning- voluntary behaviors are learned through consequences of postive reinforcement or negative reinforcement/punishment
What is the goal of the behavior theraputic model?
Attempt to correct or eleiminate maladaptive behavior
What is systematic desensitilization?
Part of the behavior therapeutic model
1. Based on classical coniditoning
2. Relaxation and exposure to anxiety provoking stimuli
3. Sucsessful in the treatment of extreme fears and phobias
Exposing them to a stressor slowly until they are no longer bothered
What is aversion therapy?
Part of the behavioral therapeutic model
1. Based on both classical conditioning
2. Used to eradicate unwanted habits by associating unpleasent consequences with them
3. Antabuse- for alcohol addictions
4. Biofeedback- control physiological responses such as breathing, brain wavies, temp, hr, bp, breathing, by providing auditory and visual feedback of physicological responses and then usuing relaxation techniques to chance physiological responses
What is the belief of humanistic theory?
Belief: concerned with the hman potentional for development, knowledge, attainment, motiviation, and understanding.
“Maslow hiarchy of needs”
Basic needs must be met before higher ones can be achieved
In Maslows Hiearchy of needs– starting with the basic need what are each level of the pyrimid.
- Phsyiological need: Breathing, food, water, shelter, clothing, sleep
- Safety and security: Health, employeement, property, family, social stability
- Love & Belonging: Friendship, family, intimacy, sense of connection
- Self- Esteem: Confidence, achievement, respect of others
- Self-Act: utilization, morality, creativity, acceptance.
What should we know about the humanistic therapeutic model?
Carl rogers, American psychologist, person centered care believed
1. people are basically healthy and good
2. innate self-actualizing tendencies to grow, develope and realize their full potential
3. “clients” were in the best position to explore, understand, and identify solutions to their problems
4. Focus is on SELF AWARENESS and the present
5. Therapist seeks clarification and provides encouragement
6. Therapist must be congruent, empathetic and respectful
What theorist is behind the cognitive theory and what should we know about cognitive theory?
Aaron T beck… believed…
1. Depressed people have standard patterns of negative self-critical thinking
2. Cognitive appraisals led to emotional responses, not the actual event but how one perceives the event
Goal of Cognitive behavior therapy…
- seeks to modify negative thoughts that leads to dysfunctional emotions and actions
- Schemata, unique assumptoms about ourelves, others and the world
- Automatic thoughts (cognitive distortions) are rapid unthinking responses. Common in anxiety and dperession
- Replace distortions with rational thinking
What is black and white thinking (all or nothing)
- thnkin gin black and white, reducing complex outcomes into absolutes
What is overgeneralization?
- Using a bad outcome (or a few bad outcomes) as evidence that nothing will ever go right again
What is labeling?
- A form of generalization where a characterist or event becomes definitive and results in overly harsh label for self or others
What are mental filters?
- Focusing on a negative detail or bad event and allowing it to taint everything
What is disqualfying the postive?
- Maintaining a negative view by rejecting informtion that supports a positve view as being irrelevant, inaccurate or accidental
What is jumping to conclusions?
Making a negative interpretation despite the fact there is little or no supporting evidence
What is mind reading?
- inferring negative thoughts, responses and motives of others
What is fortune-telling error?
- Anticipating that things will turn out badly as an established fact
What is magnification or minimization?
- Exaggerating the importance of something (personal failure) or reducing the important of somehting
What is catastrophing
An extreme form of magnification in which the very worst is assumed to be a probable outcome
What is should and must statemetns
rigid self directives that presume an unrealistic amount of control over external events
What is personalization?
- Assuming reponsiblity for an external event of situation that was likely out of personal control
What should we know about the biological theory?
- Mental disorders have a physical cause
- Will respond to physical tx
- in the 1950’s a surgeon noticed that surgical patients were clamed by chlorpromazine (thorazine as a preanestethic agent) which soon was used for schizophrenia which reduced the need for restraint and secultion
- Development of other drug-based treatment and the chemical imbalanced theory
Biological therapy includes?
Pychopharmacology is the primary biological treatment for mental disorders
- Antidepressants
- antipsychotics
- antianxiety
- mood stabilizers
- Psychostimulants
also
1. Correcting hormone imblances
2. Regulating deficent diets
3. Electroconculsive therapy: changes brain chemistry with generalized seizures
4. Magnetic seizure therapy (MST)- produces sizures more focal and high frequency pulces
5. Vagus nerve stimulation- stimulates the vagus nerve which improves neuro transmitters
6. Deep brain stimulation: DBS surgically implanted electrodes that stimulate certain parts of the brain
Does sleep affect mood?
Yes- mood changes, thinking correctly, can be the cause of delusions and hallucinations
What is rTMS?
Repettive transcranial magnetic stimulation- electromagnetic devices to deliver a rapidly pulsed magnetic field to the cerebral cortex to activate neurons
What is ECT
Electroconvulsive therapy- effective tx for severe depression and other psychatric conditions- uses electrical CURRENT to induce a seozire and it is thought to work by affecting neurotransmitters and neuro receptors
What is MST?
Magnetic seizure therapy- higher frequency electronic pulses instead of electricity to induce seizures
What is VNS
stimulates the vagus nerve which results in increased levels of neurotransmitters
What is DBS?
Deep brain stimulation- relies on surgically implanted electrodes stimulating a specific area of the brain
What do we need to know about Hildegard Peplau nursing model?
- Interpersonal relationships in nursing strongly influences the outcome of the patient
- mild, moderate, sever, panic anxiety
Example– sitting quietly beside a new father who has recently lost his job and attempted suicide and does not want to talk
What is the mental health recovery model in psychiatric nursing?
- Living adaptively with chronic mental illness and substance abuse
- shifts the responsibility of care from the provider to the patient
- Emphasizes hope, social connection, empowerment, coping strategies and meaning in life
basically patients with mental illness and substance abuse can live in the community with the understanding that the responsiblity shifts from the provider to the patients. Patient must manage mental well being. rather than just placing them in
What is the ideal size for group therapy?
6-10 people
Which theory is group therapy derived from?
Interpersonal theory– interaction within the group provides support
The enviroment for group therapy should be?
- Private, comfortable seating and arranged so people can see each other
What are the roles of group memebers?
Task role
1. Keep group focused
2. Attend to business at hand
Maintenance role
1. Keep group together
2. Provide interpersonal support
What is the role of the group leader?
- Defines the structure, size, composition, purpose, timing, facilitates communication
- Ensures each member summarizes accomplishments and give postive and negative feedbacks
What is an autocratic leader?
- Exerts control over the group
What is a democratic leader?
- Supports extensive group interaction in the process of problem solving
What is a laissez-fair leader?
Allows groups to behave however they want and doesnt attmpt to control the direction of the group
What is an education group?
- Requires expert leadership and careful planning
What is a task group?
- Time limited and have a common goal, team leader, facilitates team building cooperation
What is support groups
People with common concerns and may be facilitated by a supportive leader or group members
What is therapy groups?
- Led by professional group therapists. Therapists can be directive and confrontational, or a more hands off approach
What is altrusim?
Giving help to others
What is cohesiveness?
Feeling connected and belonging
What is guidance
reciving help and advise
What is catharsis?
releasing feeling and emotions
What is identification
Modeling after member or leader
What is family renactment?
Role playing- testing new behaviors in a safe environment
What is self understanding?
- gaining peronsal insight
What is instillation of hope
feeling hopeful about ones life
What is universality
Feeling that one is not alone
what is existential factors
coming to understand what life is about
What are the roles of basic nurse?
- Medication education groups
- Dual-dianosis groups (COLED)
- Symptom management groups
- Stress managment groups
- Self-care groups
- No psychotherapy
What is theraputic milieu?
- Healthy environment and social structure
- Inpatient setting or structured outpatient clinic
- safe space to test new behaviors
- increase their ability to interact adaptively with outside community
- Group meeting to set goals
- orienting new memebers
- encourage patients to participate in treatment teams
- evaluate treatment program
- nurse led
What should we know about family therapy?
Therapistis use a variety of therapeutic methods
1. Improve communication
2. Understand and manage special family situations
3. Improve functioning of th ehome enviroment
4. identify and shift dysfunction interaction and dynamics
5. Mobilize family strengths and resources
6. strengthen family problem solving behaivor
What are some outpatient care settings for psych care…
Primary care providers
1. Lessens stigma
2. Disadvantages- time constraints, lack of expertise in psychiatry
Patient-centered medical homes model (PCMH)
1. Comprehensive care
2. Patient centered
3. Coordinated care
4. Accessible
5. Quality and safety
What should we know about psychiatric home care?
- Decreases hopitalizations
- alternate to clinical settings
- Reimbursement requires patient to homebound
What should we know about IOPs and PHPs
- Intermediate steps between inpatient and outpatient care
- IOPS half days m-f
- PHPs 6 hour days M-F
- Structures activites with nursing and medical supervision, intervention and treatment
- Can be in general hospitals, psychiatric hospitals and as part of community mental health
- Multidisplianry team facilities group therapy, individual therapy and other therapy and pharmacological manaagment
- Closely monitored to determine if hospitalization is necessary
What is the goal of assertive commuity treatment?
Keep patient at optimal level of wellness, crisis intervention, decrease jail and hospitalization
What should we know about assertive community treatment (ACT)
- Case workers visit at least 2-3times/week
- RN visits at least monthly (bi-weekly if needed) depends on level of need
- Long-acting injections, set up meds for med monitoring psychosical assessments (well check), advcate as part of interdisciplinary team
- up to 12 at a time are on medication monitoring
- meds BID delivered to patient
- Usually about 60-80 patients in ACT servives
What is the goal of extended observation unit (EOC)- 23 hour
Keep patient at optimal level of wellness, decrease jail and hospitalization
What should we know about EOC (extended observation unit)
- Only 1 other 23 hours EOU in texas, all others are 48 hours
- Up to 23 hour stay
- used for acute crisis stabiliation (HI, SI, or threat to self or others r/t psychosis)
- DX: Schizo, bipolor, D/O, MDD, severe anxiety
- UMC ambulances may determine that there is no medical need and divert straight to EOU for assessment from a crisis team
- Decreasted stimulus, start on meds, observe reaction
- Leave with prescription and follow-up visit within 7 days
What should we know about inpatient care settings?
- Eat meals
- Receive medication
- attend activites
- participate in individual and group therapies
- Patients are active participatants in their paln of care
- right to refuse tx as long as not declared incompetent
What should state acute care system?
- Usually serves the most seriously ill patients- depends on the state
- Provides forensic court related care and monitoring for not guility by reason of insanity (NGRI)
