Intro to Theory and Therapies

DSM-5

Current official guidebook for categorizing and diagnosing mental health disorders in the US

What are the therapeutic models?

1. Behavioral

2. Systematic desensitization

3. Aversion therapy

4. Biofeedback

Behavioral Therapy

• Behavior is learned through conditioning

• Addresses maladaptive behaviors by rewarding adaptive behavior

Behavioral

Through which therapy are personality traits and maladaptive behaviors are learned?

Systematic desensitization

Classical conditioning; learned responses can be reversed by starting with relaxation and gradually face stimulus (ex. phobias)

Aversion therapy

Therapy that works by eradicating unwanted habits by associating unpleasant consequences with the maladaptive behavior

Biofeedback therapy

Individual learns to control RR, HR, BP, temp; brain waves by relaxation techniques (ex. slow deep breaths)

Cognitive and behavioral theory and seeks to modify negative thoughts

What is cognitive and behavioral therapy based on and seek to modify?

• Identify negative thought patterns

• Replace with rational thoughts

What is the goal of cognitive and behavioral therapy?

A: Activating Event

B: Belief

C: Consequence

R: Reframing

What are the ABC(R)S of irrational beliefs?

• Behavior learned through conditioning

• Personality and maladaptive behaviors are learned

• Modification addresses maladaptive behaviors by rewarding adaptive behaviors

What are the concepts of behavioral therapy?

Cognitive

What therapy suggests that negative and self-critical thinking causes depression?

Identifying negative thought patterns and replacing them with rational ones

What do CBT therapists assist in, in cognitive therapy?

1. Autocratic

2. Laissez-faire

3. Democratic

What are the leadership styles?

Support and therapy

What are the two types of groups?

Autocratic

Exerts control over group and doesn’t encourage much interaction among group members

Laissez-faire

Allows group members to behave in any way they choose, hands off management

Democratic

Supports extensive group interaction in the process of problem solving

1. Altruism

2. Cohesiveness

3. Interpersonal learning

4. Guidance

5. Catharsis

6. Identification

7. Family reenactment

8. Self-understanding

9. Instillation of hope

10. Universality

11. Existential factors

What are Yalom’s curative factors?

Altruism

Giving appropriate help to other members

Cohesiveness

Feeling connected to other members and belonging to the group

Interpersonal learning

Learning from other members

Guidance

Receiving help and advice from others

Catharsis

Releasing feelings and emotions

Identification

Modeling (or taking characteristics) after member or leader

Family reenactment

Testing new behaviors in a safe environment

Self-understanding

Gaining personal insights

Instillation of hope

Feeling hopeful about one’s life

Universality

Feeling that one is not alone

Existential factors

Coming to understand what life is about

• Medical education

• Dual-diagnosis

• Symptom management

• Stress management

• Self-care

What are the role of nurses in therapeutic groups?

Milieu

Environment in which treatment occurs

• Socialization

• Safety (Unit rules and limit setting)

• Activities

• Therapeutic communication

• Opportunity to participate in goal setting

• Opportunity for clients to be involved

• A system of positive and negative reinforcement

What are the elements of the therapeutic milieu?

• Me (nurse-pt. relationship)

• Meds (Medication skills)

• Milieu (create safe therapeutic environment)

What are the three M's nurse’s role?

The setting that provides the necessary care while allowing the greatest personal freedom

What does “least restrictive environment” in setting mean?

Provides a structure in which patient eats meals, receive meds (if needed), attend activities, and participate in individual and group therapies on a schedule

What does an inpatient care setting provide for the mental health patient?

Plan of care and right to refuse treatment as long as they are declared competent

What are patient’s an active participant of in an inpatient care setting?

Elopement

Leaving before discharged aka “AWOL” (away without leave)

Anyone that is directly involved in patient care

• RN/nurse manager

• Family

• Psychiatrists

• Pharmacists

• Psychologists

• Dietitian

• Clinical social worker

• Music therapists

• Recreation/activity aid

• Psy. technicians

Who are the members of the treatment team?

• Structured short or long term 24hr living environment in which individuals are provided with varying levels of supervision and support

• Psycho education is provided for symptom management and meds

• Residents learn to access community support as an alternative to hospitalization and are encouraged to maximal independence

What is a residential treatment program?

• Treated with dignity

• Involved in care

• Refuse treatment

• Request to leave

What are typical items included in patient’s rights?