week 1 Flashcards
defense mechanism: acting out
actions/behaviours r/t emotional conflicts that are dealt with thru actions (rather than reflections/feelings)
ex: a child becoming more restless & disruptive in class after loss of parent
defense mechanism: denial
refusing to accept/acknowledge some painful aspect of reality or subjective experience that would be obvious to others
*“psychotic denial” is used when there’s ++impairment in reality.
ex: your bff moves away, but you keep telling other people you’re not sad at all
defense mechanism: displacement
transferring a feeling about (or a response to) something onto another (usually less threatening) substitute thing
ex: a child is mad at their mom for leaving for the day, but says that they’re really mad at the babysitter for feeding her food they don’t like
*lied about cause of anger
defense mechanism: dissociation
feeling disconnected from a stressful or traumatic event — or feeling that the event isn’t really happening.
*a way to block out mental trauma & protect mind from experiencing ++stress.
ex: an adult relates severe sexual abuse but does it without feeling; they claim that the experience was as if they were outside their body, watching the abuse happen.
defense mechanism: idealization
when one associates ++positive qualities to self or others.
*you put someone up on a pedestal; you look up to them & believe they can do nothing wrong
ex: you fall in love & fail to see the negative in the other person
defense mechanism: projection
falsely project one’s own unwanted feelings, impulses, or thoughts onto another person
*appear as a threat
ex: an individual is threatened by own angry feelings, then accuses another person of having those thoughts
ex: bully teases a child for crying but is quick to cry
ex: child is angry at parent, but accuses the parent of being angry
defense mechanism: rationalization
hiding the true intentions for one’s own thoughts, actions, or feelings thru self-reassurance, but make wrong explanations.
ex: a girl breaks up with her bf, but the bf explains to his friends that her leaving was best because she was socially beneath him & wouldn’t be liked by his family anyway
defense mechanism: reaction formation
a person unconsciously replaces unwanted or anxiety-provoking thoughts, feelings, or actions with its opposite (often expressed) in an exaggerated/showy way.
*usually occurs in conjunction w/ repression
ex: a boy bullies a girl because, on a subconscious level, he’s attracted to her!
ex: wife finds out about husband’s affair & tells her friends that she thinks affairs are basically appropriate (she truly doesn’t feel, on a conscious level, any hurt/anger)
defense mechanism: repression
subconsciously (unintentionally) blocking disturbing wishes, thoughts, or experiences from conscious awareness (the feeling may stay unconscious, detached from its associated ideas).
ex: a child, who faced abuse by a parent, later has no memory of the events but has trouble forming relationships.
ex: a woman who experienced painful labor, continues to have kids (& each time the level of pain is surprising).
ex: a woman doesn’t remember getting raped in her basement, but gets anxious when entering her house.
defense mechanism: splitting
failing to realize both positive & negative attributes into a whole understanding of a person or situation, resulting in all-or-none thinking; people will be seen as “perfect” or “evil” OR things “always” or “never” go according to plan
*usually associated w/ borderline personality disorder
ex: after a bad breakup, the ex-partner refuses to acknowledge that their ex had any good qualities
defense mechanism: suppression
intentionally (consciously) blocking out thoughts about disturbing issues, wishes, feelings, or experiences
ex: a woman who was abused by her husband REFUSES to think about the traumatic experience
defense mechanism: undoing
saying words or doing actions/behaviours that cancel out or remove unhealthy, destructive, or threatening thoughts/actions by doing the opposite; trying to make up for what you feel are inappropriate thoughts/actions
ex: a man has sexual fantasies about his wife’s sister…so he took his wife away for a romantic weekend/vacation LOL
defense mechanism: transference
the client’s emotional reaction to the therapist; a client’s subconscious feeling toward nurse/therapist that were once held towards a significant other in their life.
*this occurs w/in psychotherapy in which memories of old feelings, attitudes, desires, or fantasies that someone displaces are subconsciously projected onto the current person they’re interacting with.
ex: you observe characteristics of your father towards your new boss & attribute fatherly feelings; can be good or bad feelings.
defense mechanism: counter-transference
the therapist’s emotional reaction to the client; the health care worker’s [usually] unconscious personal response to the pt.
*occurs when a health care worker lets their own feelings determine the way they interact with or react to their client in therapy (biased)
ex: therapists could be overly protective of a pt. (who reminds them of their own child)
ex: therapists could become angry at a pt. who has an alcohol addiction (because they personally had a parent who was an alcoholic)
what is resilience?
a mental health trait that helps ppl recognize stressors & negative emotions, deal w/ them, & learn from the experience
*occurs when ppl are able to withstand, toughen, & recover quickly from personal struggles.
what does “comorbid condition” mean?
when a pt. has more than 1 disease or mental disorder occurring at the same time (chronic or long-term conditions)
what is milieu therapy?
safe structured & group treatment method for those w/ mental health issues
*involves using everyday activities & a conditioned environment to help psychiatric pts. w/ interaction in community settings; flexible treatment intervention that may work together w/ other treatment methods.
what are “defense mechanisms”?
automatic reaction to cope & prevent conscious awareness of threatening feelings or of denying/distorting reality to rid of anxiety.
Positive reinforcement vs. Negative reinforcement
Positive reinforcement: giving a reward right after a certain behaviour, to strengthen the likelihood of making that behaviour occur again in the future.
Negative reinforcement: not the same as punishment; strengthens the likelihood of removing a particular behaviour/response by removing an undesirable consequence of a behaviour.
CBT (Cognitive Behavior Therapy) vs. DBT (Dialectical Behavior Therapy)
CBT: mainly about learning to change negative thoughts & behaviours; used to treat psychiatric disorders (pain issues, depression, phobias, anxiety)
DBT: helps people accept their thoughts, feelings, & behaviours, & focuses on methods to help change them; used to treat chronically suicidal people w/ borderline personality disorder
what are cognitive distortions (automatic thoughts)?
thoughts that pop up automatically in response to a trigger that increases misery, causes anxiety, & make us feel bad about ourselves (usually unintentionally induce feelings of guilt or shame)
*prevalent in many forms of mental illness; when associated w/ mental illness, these thoughts are often irrational & harmful.
ex: “I must lose weight to be more attractive”
ex: “I should’ve came to class earlier”
what is the brief therapy approach?
a systematic, focused process that relies on assessment, client engagement, & quick implementation of change strategies.
*brief therapy providers can affect important changes in client behavior w/in a short period of time
what is recovery?
the ability of a client to work, live, & participate in the community after an illness.
what is mental health?
[WHO] a state of well-being where a person realizes their own abilities, can cope w/ normal stresses of life, can work ++productively, & is able to make a contribution to their community
[WRHA] the capacity to feel, think, & act in ways that improve our ability to enjoy life & deal with the challenges we face; ties in w/ the definition of recovery
*Adaptability is CRITICAL; we’ll face ++challenges in life, but we have to learn how to cope w/ them & move on!
what are the differences between: mental health problem, mental illness, & serious mental illness?
Mental Health Problem: reduced capacities – whether cognitive, emotional, interpersonal, etc. that interfere w/ a person’s enjoyment of life
- most never get admitted to a facility d/t the acuity of the illness
- pt. could be experiencing stress & doesn’t have to be admitted to a psych ward
- have traits of a mental illness but don’t actually have a mental illness (temporary)
Mental Illness
All diagnosable mental disorders (text, p. 19)
- health conditions characterized by major/significant changes in thinking, mood, behavior
- associated w/ distress &/or impaired functioning
- people only come to the hospital when they’re experiencing an exacerbation of the symptoms of their medical illness (heart disease, diabetes, nephrotic syndrome)
Serious Mental Illness
- chronic
- causes illnesses w/ potential to be more incapacitating
- ex: schizophrenia (pts. experience auditory hallucinations); this is lifelong & will impact them to some degree *not 24/7 tho
What might be significant to consider around diagnosis?
- how long has the mental disorder been present? what are their triggers?
- remember: homosexuality used to be considered a mental disorder.
- be careful with “labelling” a pt. with their condition; pts. want to know ABOUT their diagnosis, NOT to be defined as their diagnosis.
*one’s perception may differ from one another.
what does “there’s no health w/o mental health” mean?
mental health is most significant to one’s emotional well-being & ultimately, quality of life; therefore, even if a person has good physical health, nothing matters if they’re depressed.
true or false: everyone has the potential to be mentally healthy
true
differentiate between optimal mental health (without mental illness), optimal mental health (with mental illness), poor mental health (without mental illness), poor mental health (with mental illness).
*need to know what pt. is thinking & feeling & how long it’s been happening (before starting to diagnose)
optimal mental health (without mental illness)
- this is healthy [no issues]; desired
optimal mental health (with mental illness)
- has a formalized diagnosis of a mental illness; usually managed w/ meds
poor mental health (without mental illness)
- no formalized diagnosis of a mental illness; overall feeling down & sad (struggling w/ life)
poor mental health (with mental illness)
- has a formalized diagnosis of a mental illness; overall unable to enjoy life & personal achieve goals
- usually admitted into hospital to deal w/ exacerbations of the mental illness
what’s the importance of understanding the history of mental illness?
it helps us to better understand trauma or one’s perceptions/preconceived ideas of mental health
- it eventually lead to the development of the concept of Recovery & Recovery Oriented Practice.
Examples of the historical perspectives of mental health care & mental illness?
- Evil spirits, demonic possessions, brain disturbances
- Individuals were killed, left to die/abandoned, trephined (drilled hole in the back of head to “release” evil spirits)
- People w/ mental illness were banished outside the “city walls”
- Belief that people are affected by the moon
- Churches sometimes looked after those with mental illness
true or false: in the late 1700s, people believed that the insane were ill, needed treatment, & should be under the care of physicians (rather than custodial treatment/care)
true
who is the father of psychiatry? what did he believe in?
Philippe Pinel
- was against the idea of mental illness being “demonic”; believed in moral treatment for the mentally ill (this provided a more comfy place to stay & be treated; restraints were no longer used regularly at this point)
who is Dorthea Dix?
a social reformer who lobbied for state & laws to fund asylums; followed pinel’s steps (to move ppl out of jails bc they’re not criminals, they’re just mentally sick)
explain the asylum era (era of institutionalization)
- pts. were confined in asylums & cut off from society; led to overcrowding d/t no effective treatments (so nobody left the asylum)
- custodial care was implemented & ADLs were attended to, but some abuse occurred d/t no formalized training (so abuse was prevalent bc staff thought they were doing the right thing for the mentally ill pts.)
- treatments included: hydrotherapy (meds in ice baths), insulin shock (inducing seizures), lobotomy (severing parts of the brain)
*confinement-insanity act was established
mental health act vs. confinement-insanity act
mental health act
- an act to protect pt. rights
confinement-insanity act
- an act to protect society’s rights
when were anti-psychotic meds introduced?
1950s
*fun fact: during this time, lithium was made to address issues for for bipolar disorder!
what theories influence mental health?
- Psychoanalytical/dynamic Theory (Freud & Erickson)
- Humanistic Therapy (Maslow & Rogers)
- Behavioral Theory (Pavlov, Skinner, Watson)
- Cognitive Theory (Beck [CBT] & Ellis [REBT])
- Biological Theory
who is the mother of psychiatric nursing?
Hildegard Peplau
- Introduced change in publishing her nursing theory in Interpersonal Relations for Nursing (1952) – describing phases of the therapeutic nurse-client relationship
- before her work, nurses only provided custodial care & physicians were the ones physically looking after their pts.
explain the era of deinstitutionalization (70s; shift to community care)
Community Mental Health Care – availability & equal access to all levels of mental health prevention, treatment & services were available to each of those experiencing mental health problems.
what is stigma? what are the aspects of stigma?
the negative, discriminatory, & rejecting attitudes & behaviour toward a certain circumstance, quality, person, or element displayed by an individual or group
*often, the stigma of mental illness has a greater negative impact on an individual than the illness itself (wide ranging impact)
aspects of stigma:
- public or social stigma (ex: stereotyping)
- labelling (ex: schizophrenic)
- avoidance of seeking care
- separating “them” from “us”
- stigma by health care professionals
- self-stigma
- discrimination (ex: from employment/housing)
- cultural variations (ex: religion, etc.)
- research funding
what is the psychoanalytical/dynamic theory? give an example.
Psychoanalytical/dynamic theory
- Freud & Erickson; believed that childhood experiences & unconscious desires shape our behaviour
*assumes that defense mechanisms prevent unconscious, unpleasant thoughts & feelings from becoming conscious
ex: john lost his keys & was late for work; he lost his keys bc in his subconscious mind, he didn’t want to work that day & actually wanted to quit his job
what is the humanistic theory? give an example.
Humanistic theory
- Maslow & Rogers; hierarchy of needs (SDoH); believed that humans are not only the product of their environment, but also, our behaviour is linked to self-image/actualization (holistic approach)
*focuses on helping ppl reach their full potential by exploring their own uniqueness with free will; helps nurse prioritize actions (ex: meet stable VS & pain relief first)
ex: JC wants to become a nurse; he always feels like he could help others & should try everything possible to become a better person (when he becomes a nurse, he plans to fulfill his dream of working w/ underprivileged ppl. *JC is working towards self-actualization & achieving his full potential.
what is the behavioral theory? give an example.
Behavioural Theory
- Pavlov, Skinner, Watson; believed in behaviourism: all behaviours are learned through conditioned interactions w/ the environment
*idea of rewards playing a motivational role/factor
ex: positive & negative reinforcement
- positive: a child gets money for doing chores
- negative: students work very hard in class, so the teacher removed the homework assignment
what is the cognitive theory? give an example.
Cognitive Theory
- Beck (CBT) & Ellis (REBT); believed that thoughts could guide one’s actions; focuses on the idea that how & what ppl think leads to certain actions/behaviours
*CBT works hard to interrupt/change negative thoughts; DBT helps people accept own thoughts & focuses on ways to change them
ex: one’s motivation to learn helps determine how often their mind wanders during class; those who felt more motivated to learn experienced less mind wandering compared to those who felt less motivated
ex: cognitive distortions
ex: all-or-nothing mindset
what is the biological theory? give an example.
Biological Theory
- focuses on chemical, genetic, neurological, & biological issues; believes that a mental illness is caused by a physical condition (abnormal behaviour occurs as part of a disease process)
ex: labs could be done to explore “abnormal” behaviour
