Module 1 Chapter 3 Theories and Therapies

Freud's Psychoanalytic Theory - Id

Primitive component of personality structure that is pleasure-seeking and impulsive

Freud's Psychoanalytic Theory - Ego

Problem solver and reality tester component of personality structure

Freud's Psychoanalytic Theory - Superego

Moral component of personality structure

Freud's Levels of Awareness

Conscious, preconscious, and unconscious; experiences during early stages of life determine lifetime adjustment patterns and personality traits

Psychoanalytic Therapy

Freud's scientific method to relieve emotional disturbances; often time-consuming (3-5 times weekly for many years), expensive, emotionally painful; goal is to know and understand what is happening at unconscious level to uncover truth

Transference

Patient projects intense feelings onto therapist related to unfinished work from previous relationships; safe expression crucial to successful therapy; example: patient acts immature with therapist who reminds them of their mother

Countertransference

Unconscious emotional responses therapist has to patient; must be scrutinized to prevent damage to therapeutic relationship

Interpersonal Theory

Focus on what occurs between people rather than in the mind; developed by Herbert Stack Sullivan who believed social forces and interpersonal problems cause psychiatric alterations; purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety

Interpersonal Therapy (IPT)

Hands-on system where therapists actively guide and challenge maladaptive behaviors and distorted views; focus on here and now with emphasis on patient's life and relationships; therapist becomes participant observer

Classical Conditioning

Involuntary behavior or reflexes can be conditioned to respond to neutral stimuli; investigated by Ivan Pavlov with dogs who salivated to bell sound alone after being conditioned

John B. Watson Behavioral Theory

Rejected psychoanalysis and sought objective therapy not focusing on unconscious motivations; contended personality traits and responses (adaptive and maladaptive) are learned; concluded through behavioral techniques anyone could be trained to be anything

Operant Conditioning

Voluntary behaviors learned through consequences; investigated by B.F. Skinner using positive reinforcement, negative reinforcement, or punishment

Positive Reinforcement

Consequence that increases likelihood of behavior continuing; example: studying hard results in good grades increasing chances studying will continue

Negative Punishment

Consequence that decreases likelihood of behavior continuing; example: speeding ticket should decrease chances of future speeding

Behavioral Therapy (Behavior Modification)

Uses basic tenets from behaviorists to correct or eliminate maladaptive behaviors or responses by rewarding and reinforcing adaptive behavior

Systematic Desensitization

Based on classical conditioning; learned responses reversed by first promoting relaxation then gradually facing anxiety-provoking stimulus; successful in extinguishing phobias like agoraphobia

Aversion Therapy

Based on classical and operant conditioning; eradicates unwanted habits by associating unpleasant consequences with them; example: disulfiram (Antabuse) causes extreme illness when alcohol ingested

Biofeedback

Technique where individuals learn to control physiological responses (breathing rates, heart rates, BP, brain waves, skin temperature) by providing visual or auditory feedback then using relaxation techniques

Maslow's Hierarchy of Needs

Needs placed conceptually on pyramid with most basic and important needs on lower level; higher distinctly human needs occupy top; when lower deficiencies fulfilled, higher-level needs can emerge

Maslow's Hierarchy Levels

Bottom to top: Physiological needs, safety needs, love and belonging needs, esteem needs, self-actualization needs, self-transcendent needs

Carl Rogers' Person-Centered Therapy

Saw people as basically healthy and good with innate self-actualizing tendencies; clients in best position to explore, understand, and identify solutions to own problems; therapist as facilitator with congruence, empathy, and respect

Cognitive Theory - Aaron T. Beck

Convinced depressed people have standard patterns of negative and self-critical thinking; cognitive appraisals of events lead to emotional responses, not the event itself but one's evaluation of the event

Beck's Cognitive-Behavioral Therapy (CBT)

Based on cognitive and behavioral theory; seeks to modify negative thoughts that lead to dysfunctional emotions and actions; once maladaptive patterns identified, they can be replaced with rational thoughts

CBT - Schemata

Unique assumptions about ourselves, others, and the world around us

CBT - Automatic Thoughts

Rapid, unthinking responses based on schemata

CBT - Cognitive Distortions

Irrational thoughts because people make false assumptions and misinterpretations

Biological Model

Mental disorders believed to have physical causes

Biological Therapy Methods

Psychopharmacology, electroconvulsive therapy (ECT), other brain stimulation therapies (rTMS, MST, VNS, DBS)

Psychotherapy and Brain Changes

All mental processes derived from brain; all psychotherapeutic outcomes attributed to brain changes from medication or psychotherapy; most effective therapies for select disorders: CBT, DBT, psychodynamic psychotherapy, interpersonal psychotherapy

Kohlberg's Stages of Moral Development

Moral development progresses through three major divisions: pre-conventional, conventional, and post-conventional

Carol Gilligan's Moral Theory

Ethics of care approach to moral development

Hildegard Peplau's Contribution

Interpersonal Relations in Nursing first published 1952; based on Sullivan's interpersonal theory; emphasized nature of nurse-patient relationship strongly influenced outcome; conceptualized four levels of anxiety still used today

Peplau's Mild Anxiety

Day-to-day alertness; stimuli in environment perceived and understood; learning can easily take place

Peplau's Moderate Anxiety

Heightened sense of awareness; perceptual field narrowed; individual hears, sees, and understands less; learning can still take place but may require more direction

Peplau's Severe Anxiety

Interferes with clear thinking; perceptual field greatly diminished; nearly all behavior directed at reducing anxiety; example: response to car skidding on wet pavement

Peplau's Panic Anxiety

Overwhelming and results in either paralysis or dangerous hyperactivity; individual cannot communicate, function, or follow directions; associated with terror of panic attacks

Theories Influence on Nursing Care

Behavioral: promoting adaptive behaviors through reinforcement; Cognitive: helping patients identify negative thought patterns; Psychosocial development: providing structure for understanding critical junctures; Hierarchy of needs: prioritizing nursing care

Mental Health Recovery Model

Emphasis on adaptive living not cure; patient-centered goals and responsibility with listening and respect for patient's desires; areas of emphasis: hope, social connection, empowerment, coping strategies, and meaning in life

Group Therapy

Meeting face-to-face over time for common goal; characteristics include setting, group content and process, group development, group dynamics, group leadership style, type of group, and benefits

Common Psychoeducational Groups Led by Nurses

Medication education, dual-diagnosis, symptom management, stress management, self-care

PMH-APRN Group Therapy Role

Psychiatric-mental health advanced practice registered nurses receive specialized training in conducting therapeutic groups

Milieu Therapy

Uses total environment; people, setting, structure, and emotional climate all important to healing

Family Therapy Goals

Reduce dysfunctional behavior, resolve or reduce intrafamily conflicts, mobilize family resources, encourage adaptive family problem solving, improve family communication skills, heighten awareness of others' emotional needs, help family members meet needs, strengthen family's coping ability, improve family system integration into societal system