Ch. 13 Cognitive Interventions in Psychiatric Nursing

Which statement made by the client identifies a misconception of the goal of cognitive behavioral therapy (CBT) that the nurse should address initially?

"Concentrating on past mistakes will help me make better decisions in the future In CBT, goals are developed in partnership and supply a forward-looking focus for what "can be" in the future as opposed to "what happened" in the past. All the remaining options either focus on the future or express an desire to change past perceptions.

A psychiatric-mental health nurse is reading a journal article about general and preferential rational emotive behavior therapy. The nurse demonstrates understanding of the information, identifying that the preferential rational emotive behavior therapy includes general rational emotive behavior therapy as well as an emphasis on which concept?

A profound philosophic change Preferential rational emotive behavior therapy includes general rational emotive behavior therapy but also emphasizes a profound philosophic change. It teaches clients how to dispute irrational ideas and unhealthy behaviors and to become more creative, scientific, and skeptical thinkers. Solution-focused brief therapy focuses on solutions rather than problems. In cognitive behavioral therapy, the relationships among thoughts, feelings, and behavior are emphasized. The cognitive triad includes thoughts about oneself, the world, and the future.

Who developed cognitive therapy for persons with depression?

Aaron beck Beginning in the 1960s, other cognitively based theories and therapeutic approaches were developed, the most prominent being cognitive behavioral therapy by Aaron Beck. It was not developed by Albert Ellis, Sigmund Freud, or Jean Piaget.

A psychiatric-mental health nurse is working with a client who is receiving rational emotive behavior therapy. While reviewing the clients history, the nurse identifies statements that reflect common themes associated with irrational beliefs. Which theme would the nurse most identify in these beliefs?

Absolute thinking There are five themes common in irrational beliefs: a demand, such that "This must happen"; absolute thinking, for example, "All or nothing at all"; catastrophizing, that is, exaggerating negative consequences of an event; low frustration tolerance (i.e., everything should be easy); and global evaluations of human worth, such that "People can be rated and some are better than others."

Rational beliefs accept that human beings are fallible and reject absolutes such as what?

Always And Never Rational beliefs accept that human beings are fallible and reject absolutes such as "always" and "never." Rationale emotive therapy is based on this premise. This form of therapy also includes the belief that people use identified specific beliefs called irrational beliefs to make themselves unhappy.

Cognitive techniques focus on the clients patterns of which type of thinking?

Automatic Cognitive techniques focus on the client's patterns of automatic thinking, first identifying what he or she is examining of recurrent patterns in everyday life and then testing the validity of these automatic thoughts. Cognitive techniques do not focus on delayed, delusional, or magical thinking.

Which question asked by the nurse demonstrates an attempt to implement cognitive behavioral therapy (CBT) with a client who has stated " I'm worthless"?

Can you identify one quality you admire in yourself? The goal of CBT is to restructure how a person perceives events in his or her life to facilitate behavioral and emotional change. By asking the client to identify an admirable quality, the nurse is attempting to help the client substitute a negative perception of self with a positive one. While the other options are possibly appropriate questions, they are not associated with the goals of CBT.

What is an assumption of solution-focused behavior therapy?

Change is most likely to occur when the focus is on what is changeable According to solution-focused behavior therapy, change is most likely to occur when the focus is on what is changeable. It isn't necessary to know a lot about the report and its origin or functions in order to resolve it. Even long-standing issues can be resolved in a relatively short period of time. There is not a right or wrong way to see things.

A nursing student has heard that material on the next test is difficult to master and many students have failed this particular test over the last few years. The student chooses to go skiing for the weekend instead of studying for the test and ultimately fails. The student then blames the test, not the lack of attention to study. This is an example of which cognitive process?

Cognitive distortion The student who believed that he or she would fail the test no matter what is using "twisted thinking" or cognitive distortion. Cognitive distortions are generated by organizing distorted information or inaccurate interpretations of a situation.

A nursing student does not prepare for a test on the respiratory system because she believes that the material on the test will be too difficult and that she will fail the test regardless. What cognitive process is the student exhibiting?

Cognitive distortions The student's belief is not supported by empirical evidence but is generated automatically in response to a given situation. These automatic thoughts are called cognitive distortions.

A psychiatric-mental health nurse clinical specialist is conducting an in-service program for a group of psychiatric-mental health nurses about the different types of interventions used for patients with psychiatric-mental disorders. After teaching the group about cognitive interventions, the nurse determines that the teaching was successful based on which statement?

Cognitive interventions are appropriate for use by any discipline Cognitive interventions had their beginnings in the long-term inpatient environment, but today they are a mainstay of psychiatric care in all settings and are used by all disciplines and at all levels of practice. Evidence from several studies, and reinforced by meta-analysis of groups in the past decade, supports the use of cognitive therapies with a wide variety of psychological and psychiatric conditions, and it has been shown to be effective with diverse individuals in diverse settings. Cognitive interventions aim to change or reframe an individual's automatic thought patterns that have developed over time and which interfere with the individual's ability to function optimally. The skills and techniques that were developed on the basis of cognitive theory result in a new view of self and the environment.

A nurse working on the psychiatric unit is helping clients to understand how individual perceptions determine a persons response or behavior in stressful situations. Which therapeutic approach is the nurse employing?

Cognitive therapy Cognitive therapy is a psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative and inaccurate thoughts.

A client with depression is receiving cognitive behavioral therapy (CBT). When focusing on the cause of a clients depression, the nurse helps the client identify triggers involving cognitive processes. Which area would most likely be involved?

Cognitive triad Cognitive distortions Schema Three cognitive processes are involved in the development of common mental disorders such as depression. These processes include the cognitive triad, cognitive distortions, and schema. Cognitive limitations and sociality may be triggers for other mental health issues, but they are not directly associated with the development of depression or cognitive behavioral therapy

Which response by a client involved in a solution focused brief therapy demonstrates an understanding of the fundamental principles of this form of therapy

Finding ways to manage my anger will allow my relationships to be so much more fulfilling Solution-focused brief therapy focuses on solutions rather than problems. This approach does not challenge the existence of problems but proposes that problems are best understood in relation to their solutions. While accurate statements, none of the other options focus on the guidelines principles of solution-focused brief therapy.

Which technique reinforces the clients successes and the strengths to achieve those successes?

Giving compliments Compliments are affirmations of the client; they reinforce the client's successes and the strengths needed to achieve those successes. Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. Scaling questions ask the client to rate the issue or problem on a scale of 1 to 10, with 1 being the worst, or greatest intensity, and 10 being the complete absence of the issue. Relationship questions ask clients to consider the points of view of significant others in their lives. Exception questions are rooted in the belief that nothing is constantly present at the same level of intensity; these questions are designed to elicit times the client does not experience "the problem."

From the stand point of cognitive therapy, the term cognition refers to what?

How clients think about themselves and their world Cognitive therapy focuses on how clients think about themselves and their world. Addressing cognitions, cognitive therapy posits that how a person perceives an event, rather than the event itself, determines its relevance and the emotional response to it. Cognitive therapy helps clients recognize the process and results of their thinking.

Which question asked of a client being treated with solution-focused behavioral therapy is an example of a miracle question?

How would your life be different if you woke up tomorrow without anxiety? In miracle questions, the patient is asked to think carefully and to use their imagination in crafting the response to very specific question like how would life be different without anxiety. An exception question focuses on what was different when the problem is less severe or even nonexistent. Scaling questions ask the client to rate their problem on a scale of 1-10. Asking how others are affected by the problem is considered a relationship question.

Which statement demonstrates a clients cognitive distortion about success in a course the client is enrolled in?

I didn't make an A on that test; I'm never going to pass this course Cognitive distortions are generated by organizing distorted information and/or inaccurate interpretation of a situation. Cognitive distortions or "twisted thinking" occur in the statement about the effects of the grade on the future.

Which statement made by a client engaged in solution-focused behavioral therapy (SFBT) demonstrates an understanding of a fundamental assumption of this form of therapy?

I'm trying to find ways to change how i function when im faced with a frustrating situation. SFBT assumes that change is most likely to occur when the focus is on what is changeable. None of the other statements are expressing the need to focus on change in order to manage the problem. Triggers are associated with rational emotive behavior therapy.

The client asks the nurse to explain the role ones schema plays in determining mental health. Which statement describes the concept of schema?

Its the rules you've created about how you will see yourself and your world Schema are the individual's life rules that act as a sieve or filter. They allow only information compatible with the internal picture of self and the world to be brought to the person's awareness. None of the other statements accurately identify one's schema as the rules that filter the information upon which the view of self and of the world is based.

A psychiatric-mental health nurse is reading a journal article about cognitive behavioral therapy. The article is about the effectiveness of this type of therapy in the psychiatric client population. Which information would the nurse most likely find as being cited as the major limitation?

Lack of focus on the therapeutic relationship Chief among the limitations identified is the concern that the therapeutic relationship, long believed to be the main factor in patient improvement, may be forgotten in the rigid adherence to specific techniques. Others believe that change is dependent on the client developing a clear understanding of their belief system and the origin of that system; thus, CBT is not effective with persons who have thought disorders and other issues that interfere with the ability to do so. One of the strengths of CBT lies in the body of empirical evidence supporting the effectiveness of these interventions with many studies showing positive, sustained improvement in people treated with this form of intervention.

An instructor is teaching a class about the use of cognitive therapies in psychiatric nursing. Which statement made by a student identifies a need for further instruction?

Lengths of stay for clients in inpatient settings are becoming longer each year The lengths of stay for clients in inpatient settings are becoming shorter each year, not longer. All the other statements are true and thus do not indicate a need for further instruction.

A psychiatric-mental health nurse is teaching a client about cognitive behavioral therapy. which client statement demonstrates an understanding of the fundamental framework of this therapy?

My distorted beliefs about how i look are responsible for my distorted thoughts It is important to realize that the thoughts a person has about a problem are not beliefs. CBT helps the patient identify the underlying belief, and then they then go on to explore the evidence that supports or refutes the belief about the event; identify alternative explanations for the event; and examine the real implications if the belief is true. It is believed that one's schema or rule of life are formed in early childhood and fixed by middle childhood. The focus of CBT is not "what happened" but rather what "can be." It is rational emotive behavior therapy that is based on the assumptions that people are born with the potential to be rational (self-constructive) and irrational (self-defeating).

A psychiatric-mental health nurse is interviewing a client who has come to the community mental health center fir an evaluation of anger issues. Which statement would the nurse interpret as an irrational belief?

Nobody understands the enormous stress I'm under so what's the use Irrational beliefs promote dysfunctional negative emotions that in turn lead to psychic pain and discomfort. Behaviors directed at relief of this pain tend to be self-defeating: "I can't fight the system; I will never succeed." The statement that nobody understands reflects this type of belief. Rational beliefs are flexible and lead to reasonable evaluations of negative activating events. Rational beliefs accept that human beings are fallible and reject absolutes such as always and never. The statements about needing to work on controlling my temper, not liking but being willing to try to learn, and needing to get help reflect rational beliefs.

A psychiatric-mental health nurse is working with a client. Which statement made by the client involved in solution-focused behavior therapy demonstrates effective use of a scaling question?

Now that i understand what triggers my fear of flying, it feels more like a 7 than a 5 Scaling questions are useful in making the patient's problem or issue more specific, in quantifying the exceptions noted in intensity, and in tracking change over time. A client is asked to rate the problem on a scale of 1 to 10, with 1 being the worst, or greatest intensity, and 10 being the complete absence of the issue. Any change on the scale toward 10 is discussed, and the client is asked to talk about what was done to make that happen. The other options do not rate the severity of the client's issue on a scale of 1 to 10.

A psychiatric-mental health nurse is assessing a client and evaluation a clients beliefs. The nurse determines that the clients beliefs are rational because the belief:

Reflects flexibility Rational beliefs are flexible and lead to reasonable evaluations of negative activating events. Rational beliefs accept that human beings are fallible and reject absolutes such as always and never.

When clients are asked to consider the points of view of significant others in their lives, the nurse is asking which type of question?

Relationship When relationship questions are used, clients are asked to consider the points of view of significant others in their lives. Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. Exception questions are rooted in the belief that nothing is constantly present at the same level of intensity—that there are fluctuations on how the client experiences "the problem." Compliments are affirmations of the client; they reinforce the client's success and the strengths needed to achieve those successes.

A nurse working in a psychiatric facility identifies the goals of cognitive therapy (CT) to be what?

Restructure how a person perceives events The goal of CT is to restructure how a person perceives events in his or her life to facilitate behavioral and emotional change.

Dysfunctional consequences follow which type of belief?

Rigid Whereas dysfunctional consequences of the interaction between A (activating event) and B (belief system) follow from absolute, rigid, irrational beliefs, functional consequences follow from flexible, rational beliefs.

An individuals life rules that act as a filter for cognitive distortions are known as what?

Schema Schema is an individual's life rules that act as a sieve or filter. They allow only information compatible with the internal picture of the self and the world to be brought to the person's awareness. The activating event may be either external or internal; it is not necessarily an actual event but may be an emotion, thought, or expectation. Engagement is the first step in CBT. A demand is something that must happen.

A client with depression goes through three processes. The first is the cognitive triad, which includes thoughts about which of the following?

Self, The world, and The future The cognitive triad includes thoughts about oneself, the world, and the future.

A client states that she is anxious about separating from her emotionally abusive husband because she hasn't worked in many years. Using becks cognitive triad, the nurse understands that the client is concerned primarily about what?

Threats about her future All issues and problems can be subsumed under one or a combination of Beck's cognitive triad. One client may be more concerned about self ("Can I do this?"). This client is concerned about the future ("Will there be a job for me?").

Which statement by the psychiatric nurse identifies the goal of rational emotive behavior therapy (REBT)?

We will work at helping you develop rational beliefs about eating and how you look The focus of REBT and its interventions during the therapy sessions is on developing rational beliefs to replace those that are irrational and interfere with the patient's quality of life. None of the other options focus on the client's belief system.

The nurse provides care for a client who is participating in rational emotive behavioral therapy (REBT). Which client response indicates an accurate understanding of the primary emphasis of REBT?

We will work on changing my irrational beliefs into reasonable thoughts Rational emotive behavior therapy (REBT) is a psychotherapeutic approach that proposes that unrealistic and irrational beliefs cause many emotional problems. Medication adherence is not the primary focus for REBT. Irrational thinking is exacerbated by cultural groups and family. An activating event may be perceived and not be an actual event.

A client reports anxiety over "sounding stupid" when talking to strangers. As part of the cognitive behavioral therapy, the client is expected to speak to a stranger on the bus ride home and to journal about the experience. What information will be evaluated to determine the effect the activity has on the clients irrational belief about "sounding stupid"

What actually happened compared to what the client feared would happen The information concerning what really happened during the conversation compared to what the client feared would happen will be evaluated to determine the refuting of the irrational belief at the root of the client's fears. None of the other options are focused on the belief but rather the client's response to, preparation for, and memory of the conversation

A psychiatric-mental health nurse is working as a part of the interdisciplinary team to develop the plan of care for a client who is to receive solution-focused behavior therapy. Which question would the nurse identify as being most appropriate to ask during the clients initial session?

What brought you here today? In SFBT, the therapist takes a position of curiosity in learning about the client, as opposed to an expert to whom the person has come to be helped. This curiosity is manifested in the questions and techniques that are integral to this approach and enable the development of realistic goals at each session. Questions used in eliciting the "problem" (frequently referred to as the "issue(s)" to avoid focusing on the "problem") seek very specific information. A question such as "What brought you here today?" is open-ended and focuses on the issue, not the problem. Asking about symptoms, diagnosis, or problems would not be used to elicit information with solution-focused behavior therapy.

A psychiatric-mental health nurse is describing solution-focused behavior therapy. which statement reflects an assumption upon which solution-focused behavior therapy is based?

You have strengths and abilities that will help you manage this problem There is no right or wrong way to view your situation Change is most likely to occur when the focus is on that which can be changed Solution-focused behavior therapy assumptions include: people have the strengths and resources needed to solve their problems; even long-standing issues can be resolved in a relatively short period of time; there is no right or wrong way to see things; change is most likely to occur when the focus is on what is changeable; it isn't necessary to know a lot about the complaint and its origins or functions in order to resolve it.