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74 Cards in this Set
- Front
- Back
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Classic Psychoanalysis
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Therapeutic process of assessing unconscious thoughts and feelings, and resolving conflic thru talking to a psychoanalyst for many sessions and over months to years
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Psychoanalysis therapeutic tools include:
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Free association (spontaneous/uncensored verbalization of w/e comes to mind)
-Dream analysis + interpretation -Transference - includes feelings that PT has developed toward therapist related to similar feelings toward significant person in PTs early childhood -Use of defense mechanisms |
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Psychodynamic Psychotherapy
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Employs same tools as psychoanalysis but is more oriented to PT's present state rather than early life
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Interpersonal Therapy (IPT)
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used for PTs w/specific problems. It can improve interpersonal relationships, communication, role-relationship, and bereavement
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Cognitive Therapy
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Based on cognitive model, which focuses on individual thoughts and behaviors to solve current problems. Used to treat depression, anxiety, eating disorders, and other issues that can be improved by changing a PT's attitude toward life experiences.
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Behavioral Therapy Belief
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Belief that changing behavior is key to treating problems like anxiety and depression
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Behavioral Therapy
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Based on theory that behavior is learned and has consequences. Abnormal behavior results from an attempt to avoid painful feelings. Changing abnormal and maladaptive behavior can occur without the need for insight into the underlying cause of the behavior
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Behavioral Therapy Teaches..
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PTs ways to decrease anxiety or avoidant behaviors and gives PTs an opportunity to practice techniques
**success w/treating phobias, addictions |
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Cognitive Reframing
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Anxiety can be decreased by changing cognitive distortions. It assists PTs to ID negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk.
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Priority Restructuring
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Assists PTs to ID what should be given priority, such as devoting energy to pleasurable activites
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Journal Keeping
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Helps PTs write down stressful throughts and has a positive effect on well-being
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Assertiveness Training
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Teaches PTs to express feelings, and solve problems in a nonaggressive manner
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Monitoring Thoughts
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helps PTs be aware of negative thinking
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Types of Behavioral Therapy
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Modeling, operant conditioning, systematic desensitization, aversion therapy, (meditation, guided imagery, diaphragmatic breathing, muscle relaxation, biofeedback)
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Modeling
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Therapist/other serve as role models for PT, who learns improved behavior by imitation
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Operant Conditioning
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Positive rewards are given for positive behavior (positive reinforcement)
*tokens given to PT for good behavior, can be exchanged by PT for a privlege/item |
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Systematic Desensitization
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Planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situations, or by imagining events that cause anxiety. During exposure - the anxiety response is suppressed thru use of relaxation techniques
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Aversion therapy
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A maladaptive behavior is paired with a punishment or unpleasant stimuli to change behavior.
Team may use unpleasant stimuli/bitter taste/mild electric shock as punishment for behaviors such as alcoholism, violence, self-mutilation, and thumb sucking |
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meditation, guided imagery, diaphragmatic breathing, muscle relaxation, biofeedback
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Various techniques are used to control pain, tension, and anxiety
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Leadership styles of group therapy
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Democratic, laissez-faire, autocratic
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Democratic
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Supports group interaction and decision making to solve problems
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Laissez-faire
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Group process progresses w/out any attempt by the leader to control the direction of the group
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Autocratic
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Leader completely controls the direction and structure of the group without allowing group interaction or decision making to solve problems
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Group Norm
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The way the group behaves during session - and over time it provides structure for the group
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Hidden Agenda
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Some group members or leader may have goals different from the stated group doals that may disrupt group processes.
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Subgroup
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small # ppl w/in large group who function separately from the group
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Homogenous Group
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All members share a certain chosen characteristic - like diagnosis or gender
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Heterogenous Group
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not based on a shared personal characteristic - ex: all clients on a given unit
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Initial Phase
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Purpose and goals of the group are defined
*group leader sets tone of respect, trust, and confidentiality among members *Members become acquainted w/each other and group leader *Termination is discussed |
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Working Phase
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Prob-solving skills are promoted to facilitate behavioral changes. Power and control issues may dominate in this phase
*group leader encourages group work toward meeting goals *members take informal roles in group |
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Termination Phase
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Marks end of group session
leader summarizes work of group and individual contributions |
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Maintenance Roles
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Members of group who take on this role tend to help maintain the purpose and process of the group.
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Task Roles
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Members take on various tasks w/in group orcess. Ex: recorder - takes notes/records what occurs during each session
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Individual Roles
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Tend to prevent teamwork, b/c individuals take on roles to promote their own agenda. Ex: dominator - who tries to control other members, and the recognition seeker - boasts about personal achievements
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Scapegoating
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Member of the family w/little power is blamed for problems w/in family
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Triangulation
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A third party is drawn into the relationship w/2 members whose relationship is unstable. For example: one parent may become strongly allied w/a child leaving the other parent relatively uninvolved w/them both.
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Multigenerational Issues
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Emotional issues/themes w/in a family that continue for at least 3 generations, such as pattern of addiction when the family is under stress, dysfunction grief patterns, triangulation patterns, divorce
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Areas of functioning in Families (5)
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- Communication
-Management - Boundaries - Socialization -Emotional/supportive |
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General Adaptation Syndrome (GAS)
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body's response to an increased demand. The first stage is the initial adaptive response - "fight or flight" mechanism. If stress prolonged - maladaptive responses occur.
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Responses to stress and anxiety are affected by (5)
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age, gender, culture, life experiences, and lifestyle
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Protective factors increasing a person's resilience, or ability to resist effects of stress include:
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physical health, strong sense of self, religious/spiritual beliefs, optimism, hobbies and other outside interests, satisfying interpersonal relationships, strong social support systems, humor
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Acute Stress (Fight or Flight)
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-Apprehension
-Unhappiness/sorrow -Decreased appetite - Increased RR, HR, cardiac output, BP -Increased metab and glucose use -Depressed Immune system |
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Prolonged Stress (Maladaptive Response)
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-Chronic anxiety/panic attacks
- Depression, chronic pain, sleep disturbances - Weight gain or loss - Increased risk for myocardial infarction, stroke - Poor diabetes control, htn, fatigue, irritability, decreased ability to concentrate -increased risk for infection |
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Stress Nursing Care
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most involves teaching stress-reduction strategies
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Cognitive Reframing
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PT is helped to look at irrational cognitions (thoughts) in a more realistic light and to restructure those thoughts in a more positive way
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Relaxation Techniques
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meditation, guided imagery, breathing exercises
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Electroconvulsive Therapy (ECT)
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Alternative somatic treatment for mental health disorders. Delivers an electrical current that produces a grand mal seizure.
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How does ECT work?
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-- exact mechanism of how works still unknown.
One theory is that it may enhance the effects of neurotransmitter (serotonin, dopamine, and norepinephrine) in the brain |
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Indications for ECT
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Severe depression
-PTs who are not responsive to pharmacologic treatment PTs for the risks of other treatments outweight the risks of ECT (first trimester of pregnancy) -Actively suicidal and for whom there is a need for rapid therapeutic response |
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Acute Manic Episodes + ECT
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ECT used for PTs who have bipolar disorder w/rapid ccling ( 4 or MORE episodes of acute mania w/in1 year) and very destructive behavior. Both of these features tend to respond poorly to lithium therapy. These PTs receive ECT therapy and then regimen of lithium therapy.
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Contraindications for ECT
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No absolute contraindications for this therapy if it is deemed necessary to save PT's life. Nurse should be aware that some PTs may have medical conditions that place at higher risk if ECT used
-recent MI -Hx of cerebrovascular accident -Cerebrovascular malformation -Intracranial mass lesion |
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Ect not been found useful for
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Developmental disabilities
Chemical dependence Personality disorders Situational depression |
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Typical treatment ECT
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3 times a week for total 6 - 12 treatments
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Incompetent PT
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Guardian must give consent for ECT - some PTs who have been declared incompetent require a court order
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Anesthesia + ECT
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Some facilities require a separate informed consent for anesthesia
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What is done before ECT?
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-Hx + physical examination
-neuro exam -electrocardiogram - lab tests complete w/ CBC and other tests ordered by facility) |
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Medications + eCT
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Any meds affecting PT's seizure threshhold must be decreased or d/c several days before ECT procedure
MAOIs + lithium should be d/c 2 weeks before ECT procedure |
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Hypertension + ECT
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Severe hypertension should be controlled, since a short period of hypertension occurs immediately after ECT procedure
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30 minutes prior to beginning ECT what is administered and why?
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an IM injection of atropine sulfate or robinul (Glycopyrrolate) is given to decrease secretions and counteract any vagal stimulation
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iv LINE?
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Inserted and maintained until full recovery
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When?
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Administered early in the AM after PT has fasted for 8 - 12 hour
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Bite guard?
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Given to prevent trauma to oral cavity
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Oxygen?
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PT mechanically ventilated during procedure and receives 100% oxygen
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Anesthesia
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Short-acting anesthestic - like methohexital (brevital) via IV bolus
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Muscle Relaxant
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after anesthesia this is administered
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Why is a cuff placed on the leg or arm?
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To block the muscle relaxant so that seizure activity can be monitored in the limb distal to the cuff
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Electrical Stimulus
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Applied for 0.2 - 0.8 seconds, seizure activity monitored, and duration of seizure, (25-60 seconds) is documented
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Post Procedure Care
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Transferred to recovery area where level of consciousness, cardiac status, VS, and O2 sat monitored
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Position of PT in recovery?
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On side to facilitate drainage and prevent aspiration
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Transfer back to mental health unit when?
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PT usually awake and ready to transfer back w.in 30-60 mins after procedure
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Memory Loss and Confusion
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Short-term memory loss, confusion, and disorientation may occur immediately following the procedure. Memory loss may persist for several weeks.
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Nursing actions for memory loss
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-pROVIDE FREQUENT ORIENTATION
Provide a safe environment to prevent injurt -assist PT w/ personal hygiene as needed |
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How to assist w.memory
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Place clock in PT's room
Label PT's room location explain typically short term |
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ECG Changes
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PTs baseline HR is expected to increase by 25% during the procedure and early recovery
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