NURS 340 - Psychobiology & Psychological Theories

psychoanalytic theory

psychological theory: attempts to explain personality, motivation, and mental disorders by focusing on unconscious determinants of behavior

psychoanalytic theory

psychological theory: emphasizes the importance of childhood experiences on personality development

id, ego, superego

Sigmund Freud delineated three major and distinct but interactive systems of the personality, including:

id

system of the personality: totally unconscious and impulsive, lacks the ability to problem solve and is illogical

ego

system of the personality: attempts to navigate the outside world; able to differentiate subjective experiences, memory images, and objective reality

superego

system of the personality: represents the moral component of personality, consists of the conscience

superego

when behavior falls short of ideal, the _____ may induce guilt

superego

when behavior is ideal, the _____ may allow a sense of pride

impulsive

too much id is _____

self-critical

too much superego is _____

defense mechanisms

the ego develops _____ to help lessen anxiety by preventing conscious awareness of threatening feelings

defense mechanisms

unconscious ways that we try to distort or deal with reality

- they all (except suppression) operate on an unconscious level

- they deny, falsify, or distort reality to make is less threatening

defense mechanisms share two common features:

to uncover unconscious conflicts

what is the purpose of classical psychoanalytic sessions?

free association, dream analysis, defense mechanism recognition

specific tools of psychoanalytic therapy include:

transference, countertransference

two important concepts from classical psychoanalysis are:

transference

unconscious feelings that the patient has toward a healthcare worker (nurse, psychiatrist, other provider) that were originally felt in childhood for a significant other

countertransference

unconscious feelings that the healthcare worker has toward the patient

psychoanalytic therapy

psychological therapy: focuses on the event that occurred in early childhood that has caused the current unconscious thoughts

psychodynamic therapy

psychological therapy: focuses on the actual issue and the patient's current state, rather than on their early life

- consider conscious and unconscious influences to identify and begin to think about the root causes of patient suffering

- conduct individual talk sessions characterized by attentive listening with a focus on underlying themes as an important tool of healing in psychiatric care

nursing implications of psychoanalytic and psychodynamic therapy:

interpersonal theory

psychological theory: human beings are driven by the need for interaction, loneliness as the most painful human condition

interpersonal theory

psychological theory: early relationship with the primary parenting figure, or significant other, is crucial for personality development

to reduce or eliminate psychiatric symptoms by improving interpersonal functioning and satisfaction with social relationships

what is the goal of interpersonal therapy?

- grief and loss (complicated bereavement after death, divorce, or other loss)

- interpersonal disputes (conflicts with significant other)

- role transition (change in life status or social or vocational role)

what three types of problems in particular respond well to interpersonal therapy?

interpersonal therapy

psychological therapy: mental health disorders are influenced by unhealthy relationships, developing healthy relationships are the treatment

Hildegard Peplau

developed the first systematic theoretical framework for psychiatric nursing in her book Interpersonal Relations in Nursing

Hildegard Peplau

the first nurse to identify psychiatric-mental health nursing both as an essential element of general nursing and as a specialty area that embraces specific governing principles

Hildegard Peplau

the first nurse theorist to describe the nurse-patient relationship as the foundation of nursing practice

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

Hildegard Peplau

described the effects of different levels of anxiety (mild, moderate, severe, and panic) on perception and learning

promoted interventions to lower anxiety with the aim of improving patients' abilities to think and function at more satisfactory levels

- be a participant and observer in therapeutic conversations–observe the behavior not only of the patient but also of yourself

- have self-awareness to keep personal needs and information out of the nurse-patient conversation

nursing implications of interpersonal therapy:

behavioral theory

psychological theory: personality simply consists of learned behavior

behavioral theory

psychological theory: behavior can be influenced through conditioning (pairing a behavior with a condition that reinforces or diminishes the behavior's occurrence)

classical conditioning

*it is important to recognize that classical conditioned responses are involuntary—not under conscious personal control—and are not spontaneous choices

when a neutral stimulus (a bell) is repeatedly paired with another stimulus (food that triggered salivation), eventually the sound of the bell alone will elicit salivation in the dogs. what is this an example of?

operant conditioning

a method of learning that occurs through rewards and punishment for voluntary behavior

behavioral responses are elicited through reinforcement, which causes a behavior to occur more frequently

positive reinforcement

a stimulus that causes a behavior to occur more frequently

positive reinforcement

when a hungry rat pressed the lever, it would receive a food pellet. he learned to go straight to the lever for food. what type of reinforcement is this an example of?

negative reinforcement

removal of objectionable or adverse stimulus, causing the behavior to occur less frequently

negative reinforcement

a 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. what type of reinforcement is this an example of?

extinction

the absence of reinforcement in which decreases behavior by withholding a reward that has become habitual (ex. teachers ignore acting-out behavior that had previously been rewarded by more attention)

behavioral therapy

psychological therapy: assumes that changes in maladaptive behavior can occur without insight into the underlying cause

modeling

type of behavioral therapy: the therapist provides a role model for specific identified behaviors, and the patient learns through imitation

operant conditioning

type of behavioral therapy: uses positive reinforcement to increase desired behaviors

exposure therapy

type of behavioral therapy: patients are encouraged to face their fears and emotionally process them in a safe environment

exposure therapy

type of behavioral therapy: used for people who experience anxiety due to fears, phobias, or traumatic memories

systematic desensitization

type of behavioral therapy: incorporates incremental exposure along with relaxation techniques such as slow, deep breathing

flooding

type of behavioral therapy: extreme confrontation-relies upon confronting the most feared object, situation, or event and then managing and processing it

aversion therapy

type of behavioral therapy: pairing a target behavior with a negative stimulus, to extinguish undesirable behavior

aversion therapy

type of behavioral therapy: applying bitter substances on the fingernails of nail biters or the thumbs of thumb sucker

biofeedback

type of behavioral therapy: uses physical data to promote techniques to reduce the stress response

biofeedback

type of behavioral therapy: apple watch notifies you that it is time to deep breathe

rational-emotive therapy

psychological therapy: the aim is to remove core irrational beliefs by helping people to recognize thoughts that are not accurate, sensible, or useful

- activating event (i went for a job interview and didn't get the job)

- beliefs about the event (how terrible to get rejected! i'm worthless! i'll never get a job)

- emotional consequences as a result of the event (i feel hopeless. i am making myself so anxious that i will do poorly on other job interviews)

describe the negative thinking process:

rational-emotive therapy

psychological therapy: perception influences all thoughts, which, in turn, influence our behaviors

rational-emotive therapy

psychological therapy: person engages in certain self-statements based on distorted thoughts-these thoughts tend to take the form of shoulds, oughts, and musts. these distorted self-statements then contribute to maladaptive behaviors

cognitive-behavioral therapy

psychological therapy: therapeutic techniques are designed to identify, reality test, and correct distorted thoughts and the dysfunctional beliefs underlying them. patients are taught to challenge their own negative thinking and substitute it with positive, rational thoughts

cognitive-behavioral therapy

psychological therapy: the patient's feelings and thoughts about an event is influencing their behavior-the key to recovery is correcting their distorted thinking

all-or-nothing thinking

cognitive distortion: thinking in black and white, reducing complex outcomes into absolutes

all-or-nothing thinking

cognitive distortion: although Lindsey earned the second highest score in the state's cheerleading competition, she consistently referred to herself as "a loser."

overgeneralization

cognitive distortion: using a bad outcome (or a few bad outcomes) as evidence that nothing will ever go right again

overgeneralization

cognitive distortion: Andrew had a minor traffic accident. he is reluctant to drive and says, "I shouldn't be allowed on the road."

labeling

cognitive distortion: a form of generalization in which a characteristic or event becomes definitive and results in an overly harsh label for self or others

labeling

cognitive distortion: "because I failed the advanced statistics exam, I am a failure. I might as well give up. I may as well quit and look for an easier major."

mental filter

cognitive distortion: focusing on a negative detail or bad event and allowing it to taint everything else

mental filter

cognitive distortion: Anne's boss evaluated her work as exemplary and gave her a few suggestions for improvement. she obsessed about the suggestions and ignored the rest.

disqualifying the positive

cognitive distortion: maintaining a negative view by rejecting information that supports a positive view as being irrelevant, inaccurate, or accidental

disqualifying the positive

cognitive distortion: "I've just been offered the job I thought I always wanted. there must have been no other applicants."

jumping to conclusions

cognitive distortion: making a negative interpretation despite the fact that there is little or no supporting evidence

jumping to conclusions

cognitive distortion: "my fiancé, Juan, didn't call me for 3 hours, which just proves he doesn't love me anymore."

fortune-telling error

cognitive distortion: anticipating that things will turn out badly as an established fact

fortune-telling error

cognitive distortion: "I'll ask her out, but I know she won't have a good time."

mind-reading

cognitive distortion: inferring negative thoughts, responses, and motives of others

mind-reading

cognitive distortion: Isabel is giving a presentation and a man in the audience is sleeping. she panics, "I must be boring."

magnification

cognitive distortion: exaggerating the importance of something (e.g., a personal success or the failure of others)

minimization

cognitive distortion: reducing the importance of something (e.g., a personal success or the failure of others)

catastrophizing

cognitive distortion: an extreme form of magnification in which the very worst is assumed to be a probable outcome

catastrophizing

cognitive distortion: "if I don't make a good impression on the boss at the company picnic, she will fire me."

emotional reasoning

cognitive distortion: drawing a conclusion based on an emotional state

emotional reasoning

cognitive distortion: "I'm nervous about the exam. I must not be prepared. If I were, I wouldn't be afraid."

"should" and "must" statements

cognitive distortion: rigid self-directives that presume an unrealistic amount of control over external events

"should" and "must" statements

cognitive distortion: Renee believes that a patient with diabetes has high blood sugar today because she's not a very good nurse and that her patients should always get better.

personalization

cognitive distortion: assuming responsibility for an external event or situation that was likely outside personal control

personalization

cognitive distortion: "I'm sorry your party wasn't more fun. It's probably because I was there."

cognitive trauma-focused behavioral therapy

psychological therapy: developed to address sexual abuse trauma in children, and expanded to address the needs of individuals who are impacted by any severe trauma and abuse

dialectic

an integration of opposites

dialogue between people holding different points of view about a subject, but wishing to arrive at the truth through reasoned argumentation

dialectical behavioral therapy

psychological therapy: developed for individuals with intractable behavioral disorders involving emotional dysregulation (e.g., chronically suicidal and self-injuring women with borderline personality disorder)

mindfulness, distress tolerance, interpersonal effectiveness, emotional regulation

strategies of dialectical behavioral therapy:

human motivation theory

psychological theory: focuses on human potential and free will to choose life patterns that support personal growth

human motivation theory

psychological theory: the patient's basic needs being met is the focus-the key to recovery is addressing basic needs to foster growth

human motivation theory

psychological theory: helps to establish what is most important in the sequencing of nursing actions

biological theory

psychological theory: locates the illness or disease in the body—usually in the limbic system of the brain and the synapse receptor sites of the central nervous system—and targets the site of the illness using physical interventions such as drugs, diet, or surgery

biological theory

psychological theory: recognizes that psychiatric illnesses are physical in origin

biological theory

psychological theory: the key to recovery is medications and treatment to alter the way in which the body functions

psychopharmacotherapy, brain stimulation therapies

types of biological therapies:

theory of cognitive development

psychological theory: our mental representations of the world depend on the cognitive stage we have reached (sensorimotor stage, preoperational stage, concrete operational stage, formal operational stage)

theory of psychosocial development

psychological theory: development occurs in eight predetermined and consecutive life stages (psychosocial crises), each of which results in a positive or negative outcome

theory of object relations

psychological theory: how a dependent infant transitions to an independent toddler

theory of moral development

psychological theory: provides a framework for understanding how people progressively develop a sense of morality

the patient

what is the nurse's primary source of data?

consider developmental levels

*one of the hallmarks of psychiatric disorders in children is the tendency to regress, or return to a previous level of development

what should a nurse consider in the evaluation of children?