Unit 2 Theory and Therapies Chapter 2

Question 1

Which one of these philosophers? Recognized that majority of mental disorders stem from problems from childhood

A. Erikson
B. Peppau
C. Freud
D. Bank

Answer 1

C. Freud

Freud came to believe that the vast majority of mental disorders resulted from unresolved issues that originated in childhood.

Question 2

What are the 3 levels of awareness according to Freud?

Answer 2

Conscious:
It contains all the material a person is aware of at any one time, including perceptions, memories, thoughts, fantasies, and feelings.

Preconscious:
Just below the surface of awareness is the preconscious, which contains material that can be retrieved rather easily through conscious effort.

Unconscious.:
Unconscious. The unconscious includes all repressed memories, passions, and unacceptable urges lying deep below the surface.

Question 3

What does the Personality Structure According to Freud Consist of ? Elect all that apply

A. Id
B. Unconscoius
C. Interpersonal
D. Ego
E. Superego

Answer 3

According to Freud you are born with a personality structure that consist of …

A. Id
D. Ego
E. Superego

Question 4

Id (Freud)

Answer 4

ID - primal instincts, natural desires, congenital reflexes

Id. At birth, we are all id. The id is totally unconscious and impulsive. It is the source of all drives, instincts, reflexes, and needs. The id cannot tolerate frustration and seeks to discharge tension and return to a more comfortable level of energy. The id lacks the ability to problem solve and is illogical.

id is too powerful, the person will lack control over impulses.

Example
-A hungry, screaming infant is the perfect example of id.

Question 5

Ego (Freud)

Answer 5

Ego:
Problem solving and critical thing, the ability to control oneself and to delay gratification. Logically thinking. REALITY TESTER

The ego resides in the conscious, preconscious, and unconscious levels of awareness. The problem solver and reality tester, the ego attempts to navigate the outside world. It is able to differentiate subjective experiences, memory images, and objective reality.

EXAMPLE

For example, a hungry man feels tension arising from the id that wants to be fed. His ego allows him not only to think about his hunger but also to plan where he can eat and to seek that destination. This process is known as reality testing because the individual is factoring in reality to implement a plan to decrease tension.

Question 6

Superego

Answer 6

A balance or mix between Id and Ego
The ability to have a natural instruct while thinking logically and testing reality. (SHOULD’S & SHOULD NOTS)

The superego consists of the conscience (all the “should nots” internalized from parents and society) and the ego ideal (all the “shoulds” internalized from parents and society). When behavior falls short of ideal, the superego may induce guilt. Likewise, when behavior is ideal, the superego may allow a sense of pride.

Question 7

Anxiety according to freud

Answer 7

Freud (1969) believed that anxiety is an inevitable part of living.

Question 8

Psychodynamic Therapy

Answer 8

The therapy is oriented toward the here and now and makes less of an attempt to reconstruct the developmental origins of conflicts.

Question 9

Who is Psychodynamic therapy more geared dtowards?

Answer 9

The best candidates for psychodynamic therapy are relatively healthy and well-functioning individuals, sometimes referred to as the “worried well” who have a clear area of difficulty and are intelligent, psychologically minded, and well-motivated for change.

Patients with psychosis, severe depression, borderline personality disorders, and severe personality disorders are not appropriate candidates for this type of treatment.

Question 10

Defense Mechanism Freud

Answer 10

. The ego develops defenses, or defense mechanisms, to ward off anx- iety by preventing conscious awareness of threatening feelings.

Defense mechanisms share two common features: (1) they all (except suppression) operate on an unconscious level and (2) they deny, falsify, or distort reality to make it less threatening. Although we cannot survive without defense mechanisms, it is possible for our defense mechanisms to distort reality to such a degree that we experience difficulty with healthy adjustment and personal growth

Question 11

(Interpersonal Therapy)Psychoanalytic Therapy Purpose

Answer 11

• identify unconscious conflicts(digs deep to the unsconsious)

Free association—Analysts actively encourage patients to
freely share whatever thoughts or words come to mind to
access the unconscious.

Dream analysis—Patients are encouraged to share the con-
tent of dreams, which the therapist analyzes for symbolic meanings (e.g., “I was falling” could be interpreted as the patient feels unable to control situations).

Defense mechanism recognition—The analyst assists the patient in recognizing and subsequently changing the over- use of maladaptive defense mechanisms, such as denial, pro- jection, and rationalization (see Chapter 15 for a discussion of defense mechanisms).

(LONG TERM , 3 TO 5 TIMES A WEEK FOR YEARS )

Question 12

Harry Stack Sullivan Interpersonal theory beliefs

Answer 12

believed that human beings are driven by the need for interac- tion. Indeed, he viewed loneliness as the most painful human condition. He emphasized the early relationship with the primary parenting figure, or significant other (a term he coined), as crucial for personality development.

Question 13

Is interpersonal therapy long term or short term?

A. long
B. short

Answer 13

B. short

Interpersonal therapy is an effective short-term therapy. The assumption is that psychiatric disorders are influenced by interpersonal interactions and the social context.

Question 14

The goal of Interpersonal therapy

Answer 14

The goal of inter-personal therapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships.

TX for
-depression

1. Grief and loss: Complicated bereavement after death,
   divorce, or other loss
2. Interpersonal disputes: Conflicts with a significant other
3. Role transition: Problematic change in life status or social or
   vocational role

Question 15

Peplau’s Theory - interpersonal relation between nurse and patient

Answer 15

Her theory is mainly concerned with the processes by which the nurse helps patients to make positive changes in their healthcare status and well-being.

Preorientation
Orientation
Working phase
Termination

Shift from what nurses “do to” patients - “do with” patients

Question 16

What is the purpose of Behavioral Therapy?

Answer 16

To alter(CHANGE( a perosons dysfunctional behavior

Question 17

Classical Conditioning (Ivan Pavlov

Answer 17

Pavlov (1928) found that when a neutral stimulus (a bell) was repeatedly paired with another stimulus (food that triggered salivation), even- tually the sound of the bell alone could elicit salivation in the dogs.

involuntary

Question 18

Behavioral Theory (John Watson

Answer 18

Behaviorism – personality traits and responses are socially learned through classical conditioning (maladaptive and adaptive)

Question 19

Operant Conditioning Theory

Answer 19

Operant Conditioning Theory (B.F. Skinner)
* Method of learning through rewards and punishment
* Positive reinforcement or negative reinforcemen

Question 20

Example of Operant behavior

Answer 20

Other techniques can cause behaviors to occur less frequently. One technique is an unpleasant consequence, or punishment. Driving too fast may result in a speeding ticket, which—in mature and healthy individuals—decreases the chances that speeding will occur.

Question 21

Positive reinforcement example

Answer 21

To cause behavior more frequently, Skinner used two methods. When a hungry rat pressed the lever, it would receive a food pellet. He learned to go straight to the lever for food. This is positive reinforcement of the behavior.

,, you do the right thing you get a treat

Question 22

Negative reinforcement

Answer 22

Another rat was placed in the cage with an electrical charge on the grid under his feet. If he accidentally pressed the lever, the charge would turn off. He learned to go straight to the lever to eliminate the shock. This removal of an objectionable or averse stimulus is negative reinforcement.

you do the wrong thing there’s consequences

Question 23

Effects of Absence of reinforcement,

Answer 23

Absence of reinforcement, or extinction, also decreases behavior by withholding a reward that has become habitual. For example, if a person tells a joke and no one laughs, the person is less apt to tell jokes because his joke-telling behavior is not being reinforced. Teachers use this strategy in the classroom when they ignore acting-out behavior that had previously been rewarded by more attention.

Question 24

Modeling therapy

Answer 24

In modeling, the therapist provides a role model for specific identified behaviors, and the patient learns through imita- tion. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose.

Patient learns through imitation

Question 25

Operant condition therapy

Answer 25

Positive reinforcement to increase desired behaviors

Question 26

Systemic Desensitization(Exposure therapy)

Answer 26

Exposure therapy is used for people who experience anxiety due to fears, phobias, or traumatic memories

Therapy occurs in steps ( 1 step at a time)
Form of behavior modification
* 4 steps – Breaking down fear, exposure (little by little), hierarchy of fears, practice

Question 27

Goal of Exposure therapy

Answer 27

In exposure therapy, patients are encouraged to face their fears and emotionally process them in a safe environment. The goal of this therapy is the elimination, or extinction, of these responses.

Patients To manage or elimi- nate this anxiety, they avoid anything that reminds them of the feared object, activities, or situation.

Question 28

Tools used in Exposure therapy

Answer 28

• Imaginal exposure: In this type of therapy, patients are encouraged to imagine and confront the fear or situation. For example, a person with arachnophobia (fear of spiders) is asked to recall responses to spiders and describe associated thoughts and feelings.
• In vivo exposure: Patients actually confront their fears in a real-world setting. For example, a patient with fear of flying may go to an airport and begin by simply watching planes take off and then discuss his or her feeling.
• Virtual reality exposure: This therapy is a combination of imaginal and in vivo exposure. A patient with a fear of elevators may use virtual reality goggles and audio that provides the sights and sounds of elevators (Fig. 2.4). Gradually the patient can explore approaching and then entering the virtual elevator in safety.

Question 29

Aversion therapy

Answer 29

Aversion therapy is used to treat conditions and behaviors such as alcohol use disorder, paraphilic disorders, shoplifting, aggressive behavior, and self-mutilation. Aversion therapy is pairing a target behavior with a negative stimulus, to extin- guish undesirable behavior. This treatment may be used when other less drastic measures have failed to produce the desired effects.

Question 30

Example of aversion therapy

Answer 30

A simple example of aversion therapy is applying bitter sub- stances on the fingernails of nail biters or the thumbs of thumb suckers. Other examples of aversive stimuli are chemicals that induce nausea and vomiting, unpleasant odors, unpleasant ver- bal stimuli (e.g., descriptions of disturbing scenes), costs or fines in a token economy, and denial of positive reinforcement (e.g., isolation).

Question 31

Cognitive Behavioral therapy (Negative thinkers) Aron Beck

Answer 31

Goal to correct though process

challenge native thinkers to think positively

Negative thinking pt’s benefit from this therapy

Cognitive-Behavioral Therapy
* Aaron Beck – identified that patients with depression thought
differently than those w/o
* Negative thinking
* Self-Critical thinking

• CBT – challenges those negative thoughts ( Identify and
  replace/reframe)
• Connections – Life events, Negative thought, Negative self-perception, Negative
  response

Question 32

A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!”
2.
Which psychosocial crisis is evident?
a. Trust versus mistrust
b. Initiative versus guilt
c. Industry versus inferiority
d. Autonomy versus shame and doubt

Answer 32

d. Autonomy versus shame and doubt

4.
The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.

Question 33

A 4-year-old grabs toys from other children and says, “I want that now!” From a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious

Answer 33

a. Id

ANS: A
The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother’s wrath. The superego would oppose the impulsive behavior as “not nice.” The preconscious is a level of awareness rather than an aspect of personality.

Question 34

The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. These qualities are likely to be internalized and become part of which system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious

Answer 34

c. Superego

ANS: C
The superego contains the “shoulds,” or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality-testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort. This item relates to an audience response question.

Question 35

16.
Operant conditioning is part of the treatment plan to encourage speech in a child who is
nearly mute. Which technique applies?
a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques.

Answer 35

c. Give the child a small treat for speaking.

ANS: C
Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and reinforce speech through positive reinforcement.

Question 36

A client participated in psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the client understand conflicts and foster change. What is the term that applies to this method?
a. Rational-emotive behavior therapy
b. Psychodynamic psychotherapy
c. Cognitive-behavioral therapy
d. Operant conditioning

Answer 36

b. Psychodynamic psychotherap

ANS: B
The techniques are aspects of psychodynamic psychotherapy. The distracters use other techniques.

Question 37

Consider this comment from a therapist: “The client is homosexual but has kept this preference secret. Severe anxiety and depression occur when the client anticipates family reactions to this sexual orientation.” Which perspective is evident in the speaker?
a. Theory of interpersonal relationships
b. Classical conditioning theory
c. Psychosexual theory
d. Behaviorism theory

Answer 37

a. Theory of interpersonal relationships

ANS: A
The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material that relates to the client problem.

Question 38

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consistent with psychoanalytic psychotherapy?
a. Identifying the client’s strengths and assets
b. Praising the client for describing feelings of isolation
c. Focusing on feelings developed by the client toward the therapist
d. Providing psychoeducation and emphasizing medication adherence

Answer 38

c. Focusing on feelings developed by the client toward the therapist

Positive or negative feelings of the client toward the therapist indicate transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common “homework” assignment used in cognitive therapy.

Question 39

A person says, “I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and I’m better now.” Which type of therapy was used?
a. Systematic desensitization
b. Psychoanalysis
c. Behavior modification
d. Interpersonal psychotherapy

Answer 39

ANS: D
Interpersonal psychotherapy returned the client to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the client understand what is going on in his life.

Question 40

Which technique is most applicable to aversion therapy?
a. Punishment
b. Desensitization
c. Role modeling
d. Positive reinforcement

Answer 40

ANS: A
Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a noxious stimulus, punishment, and avoidance training.

Question 41

A client says to the nurse, “My father has been dead for over 10 years but talking to you is almost as comforting as the talks he and I had when I was a child.” Which term applies to the client’s comment?

a. Superego
b. Transference
c. Reality testing
d. Countertransference

Answer 41

ANS: B
Transference refers to feelings a client has toward the health care workers that were originally held toward significant others in his or her life. Countertransference refers to unconscious feelings that the health care worker has toward the client. The superego represents the moral component of personality; it seeks perfection.

Question 42

A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this client?
a. Psychoanalysis
b. Aversion therapy
c. Systematic desensitization
d. Short-term dynamic therapy

Answer 42

ANS: C
Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Aversion therapy involves use of a noxious stimulus, punishment, and avoidance.

Question 43

A client repeatedly stated, “I’m stupid.” Which statement by that client would show progress
resulting from cognitive-behavioral therapy?
a. “Sometimes I do stupid things.”
b. “Things always go wrong for me.”
c. “I always fail when I try new things.”
d. “I’m disappointed in my lack of ability.”

Answer 43

ANS: A
“I’m stupid” is a cognitive distortion. A more rational thought is “Sometimes I do stupid things.” The latter thinking promotes emotional self-control. The distracters reflect irrational or distorted thinking. This item relates to an audience response question.

Question 44

A client says, “All my life I’ve been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent.” This client is experiencing what type of reaction?
a. self-esteem deficit.
b. cognitive distortion.
c. deficit in motivation.
d. deficit in love and belonging.

Answer 44

ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. See related audience response question.

Question 45

A client is fearful of riding on elevators. The therapist first rides an escalator with the client. The therapist and client then stand in an elevator with the door open for 5 minutes and later with the elevator door closed for 5 minutes. Which technique has the therapist used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rational emotive therapy
d. Biofeedback

Answer 45

ANS: B
Systematic desensitization is a form of behavior modification therapy that involves the development of behavior tasks customized to the client’s specific fears. These tasks are presented to the client while using learned relaxation techniques. The client is incrementally exposed to the fear.

Question 46

A client says, “I always feel good when I wear a size 2 petite.” Which type of cognitive
distortion is evident?
a. Disqualifying the positive
b. Overgeneralization
c. Catastrophizing
d. Personalization

Answer 46

ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. The stem offers an example of overgeneralization. See related audience response question.

Question 47

Which comment best indicates a client is self-actualized?
a. “I have succeeded despite a world filled with evil.”
b. “I have a plan for my life. If I follow it, everything will be fine.”
c. “I’m successful because I work hard. No one has ever given me anything.”
d. “My favorite leisure is walking on the beach, hearing soft sounds of rolling
waves.”

Answer 47

d. “My favorite leisure is walking on the beach, hearing soft sounds of rolling
waves.”

ANS: D
The self-actualized personality is associated with high productivity and enjoyment of life. Self-actualized persons experience pleasure in being alone and an ability to reflect on events.

Question 48

9. Linda is terrified of spiders and cannot explain why. Because she lives in a wooded area, she would like to overcome this over- whelming fear. Her nurse practitioner suggests which therapy? a. Behavioral
   b. Biofeedback
   c. Aversion
   d. Exposure and response prevention therapy

Answer 48

d. Exposure and response prevention therapy

Question 49

8. In an outpatient psychiatric clinic, a nurse notices that a newly admitted young male patient smiles when he sees her. One day the young man tells the nurse, “You are pretty like my mother.” The nurse recognizes that the male is exhibiting:
   a. Transference
   b. Id expression
   c. Countertransference
   d. A cognitive distortion

Answer 49

a. Transference

Question 50

. Which question should the nurse ask when assessing for what Sullivan’s Interpersonal Theory identifies as the most
painful human condition?
a. “Is self-esteem important to you?”
b. “Do you think of yourself as being lonely?”
c. “What do you do to manage your anxiety?”
d. “Have you ever been diagnosed with depression?”

Answer 50

b. “Do you think of yourself as being lonely?”

Question 51

Which action reflects therapeutic practices associated with operant conditioning?
a. Encouraging a parent to read to their children to foster a
love for learning
b. Encouraging a patient to make daily journal entries
describing their feelings
c. Suggesting to a new mother that she spend time cud-
dling her newborn often during the day
d. Acknowledging a patient who is often verbally aggres-
sive for complimenting a picture another patient drew

Answer 51

d. Acknowledging a patient who is often verbally aggres-
sive for complimenting a picture another patient drew

Question 52

6. A nurse is assessing a patient who graduated at the top of his class but now obsesses about being incompetent in his new job. The nurse recognizes that this patient may benefit
   from the following type of psychotherapy: a. Interpersonal
   b. Operant conditioning
   c. Behavioral
   d. Cognitive behavioral

Answer 52

d. Cognitive behavioral

Question 53

According to Maslow’s hierarchy of needs, the most basic
needs category for nurses to address is:
a. Physiological
b. Safety
c. Love and belonging
d. Self-actualization

Answer 53

a. Physiological

Question 54

You notice that your adolescent patient has begone smoking because of his peers . Which type of theory is the patient exhibiting?
A. Classical conditioning
B.Modeling
C.Operant conditioning
D. Interpersonal theory

Answer 54

B.Modeling

Question 55

Your preschool patient has the same bubbly personality as theirs mother, and often uses the same reactions as her

Answer 55

Behaviorism – personality traits and responses are socially learned through classical conditioning (maladaptive and adaptive)

Question 56

j