Topic 1: Ch 2 Psychoanalytic, Interpersonal, and Behavioral Theories and Therapies

conscious

the part of the mind that contains all the material a person is aware of at any one time, including perceptions, memories, thoughts, fantasies, and feelings

preconscious

the part of the brain that contains material that can be retrieved rather easily through conscious efforts

unconscious

The part of the brain that includes all repressed memories, passions, and unacceptable urges lying deep below the surface, like memories/emotions associated with trauma

Id

what we all are at birth → unconscious and impulsive; the source of all drives, instincts, reflexes, and needs; cannot tolerate frustration and seeks to discharge tension and return to a more comfortable level of enrgy; lack the ability to problem solve and is illogical

ie. a hungry, screaming infant

ego

develops in the first few years of life and resides in the conscious, preconscious, and unconscious levels of awareness; the ability to differentiate subjective experiences, memory images, and objective reality; reality testing or the ability to delay gratification for right now

superego

develops between the ages of 3-5 and represents the moral component of personality, residing in the conscious, preconscious, and unconscious levels of awareness; consists of the conscious (all the should nots from parents/society) and the ego (all the shoulds from parents/society); induces guilt when behavior falls short of ideal or allows pride when behavior is ideal

defense mechanisms

developed by the ego to ward off anxiety by preventing conscious awareness of threatening feelings

• they all operate on an unconscious level

• they deny, falsify, or distort reality to make it less threatening

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 content of their dreams, which the therapist analyzes for symbolic meanings

defense mechanism recognition

the analyst assists the patient in recognizing and subsequently changing the overuse of maladaptive defense mechanisms, like denial, projection, and rationalization

transference

unconscious feelings that the patient has toward a healthcare worker that were originally felt in childhood for a significant other; is a way to understand original relationships and helps patients better understand feels and behaviors

countertransference

unconscious feelings that the healthcare workers have toward the patient, such as a patient who reminds them of someone they don’t like

psychodynamic therapy

rooted in traditional psychoanalysis and uses free association, dream analysis, transference, and countertransference with increased therapist involvement and interaction oriented to the here and now, without trying to reconstruct the developmental origins of conflict

• best candidates are relatively healthy and well functioning individuals not those with severe depression, BPD, and severe panic disorders

Freudian Theory

emphasizes the importance of childhood experiences on personality development and the importance of individual talk sessions characterized by attentive listening with a focus on underlying themes as an important tool of healing in psychiatric care

Harry Stack Sullivan

An American-born psychologist who developed a model for understanding psychiatric alterations that focused on interpersonal problems and believed that human beings are driven by the need for interaction and that loneliness is the most painful human condition

interpersonal therapy

an effective short term therapy with a goal to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships; successful treatment of MDD, grief and loss, interpersonal disputes/conflicts with significant others, role transitions (life status/social/vocational)

Hildegard Peplau’s Interpersonal Relations in Nursing (1952)

established the foundation for the professional practice of psychiatric nursing and described the nurse-patient relationship as the foundation of nursing practice, shifting the focus from what nurses do to patients to what they do with patients

Patricia Benner

focus of theory: caring as a foundation for nursing

encouraged nurses to provide caring and comforting interventions, emphasizing the nurse-patient relationships and importance of teaching/coaching the patient and bearing witness to suffering as the patient deals with illness

Dorothea Orem

focus of theory: goal of self care as integral to the practice of nursing

emphasized the role of the nurse in promoting the self-care activities of the patients

Callista Roy

focus of theory: continual need for people to adapt physically, psychologically, and socially

emphasized the role of nursing in assisting patients to adapt so that they can cope for effectively with changes

Better Neuman

focus of theory: impact of internal and external stressors on the equilibrium of the system

emphasized the role of nursing in assisting patient to discover and use stress-reducing strategies

Joyce Travelbee

focus of theory: meaning in the nurse-patient relationship and the importance of communication

emphasized the role of nursing in affirming the suffering of the patient and in being able to alleviate that suffering through communication skills used appropriately through the stages of the nurse-patient relationship

conditioning

pairing a behavior with a condition that reinforces or diminishes the behavior’s occurrence

classical conditioning

theory formalized by Ivan Pavlov, responses are involuntary and not spontaneous

behaviorism

developed by the American John B. Watson, who rejected the unconscious motivation of psychoanalysis for being too subjective, believed this was more objective or measurable

Behavioral Theory

said that personality traits and responses (adaptive and maladaptive) were socially learned through classical conditioning, controlling environmental can mold behavior and anyone can be trained to be/do anything

Operant Conditioning Theroy

presented by B. F. Skinner; a method of learning that occurs through rewards and punishment for voluntary behavior; behavioral responses are elicited though reinforcement which causes a behavior to occur more frequently

positive reinforcement

adds a pleasant stimulus/reward after a desired behavior, with a goal to increase the behavior by giving a reward

adds something good

negative reinforcement

removes an unpleasant stimulus/reward after a desired behavior, with a goal to increase the behavior by taking away something unpleasant

takes away something bad

punishment

An unpleasant consequence is used to cause behaviors to occur less frequently

extinction

absence of reinforcement that decreases behavior by withholding a reward that has become habitual

behavioral therapy

assumes that changes in maladaptive behavior can occur without insight into the underlying cause, which works best when it is directed at specific problems and the goals are well defined, such as treating phobias, alcohol use disorder, and schizophrenia

types: modeling, operant conditioning, exposure and response prevention, aversion therapy, and biofeedback

modeling

behavioral therapy where the therapist provides a role model for specific identified behaviors and the patient learns through imitations, role playing

operant conditioning

The basis for behavior modification and uses positive reinforcement to increase desired behaviors; useful in improving verbal behaviors of children who are mute, autistic, or developmentally disabled and increases levels of self-care, social behavior, and group participation in those with severe and persistent mental illness

exposure therapy

behavioral therapy that is used for those who experience anxiety due to fears, phobias, or traumatic memories; patients are encouraged to face their fears and emotionally process them in a safe environment with the goal to eliminate the responses; used for phobias, panic disorder, OCD, PTSD, GAD, and social anxiety disorder

imaginal exposure therapy

patients are encouraged to imagine and confront the fear or situation and describe the associated thoughts and feelings

In vivo exposure therapy

patients actually confront their fears in a real world setting and then discusses their feelings

virtual reality exposure therapy

patient uses virtual reality to explore approaching and then experiencing their fear

graded exposure

exposure therapy that works from approaching what is least feared to was is most feared

systematic desensitization

incorporates the incremental exposure of graded exposure along with relaxation techniques like slow, deep breathing

flooding

the most extreme exposure therapy that relies upon confronting the most feared object, situation, or even, and then managing and processing it

aversion therapy

used to treat conditions and behaviors like alcohol use disorder, paraphilic disorders, shoplifting, aggressive behavior, and self-mutilation; pairing a target behavior with a negative stimulus to extinguish undesirable behavior, used when other measures have failed

biofeedback

behavioral therapy that is used for controlling the body’s physiological response to stress and anxiety, which helps people makes changes like relaxing muscles to reduce/eliminate pain; can be used to monitor brain waves, respirations, HR, muscle contraction, body temp, perspiration, and BP