Therapeutic Modalities

· Nurses station should allow for constant observation of clients. · Safety features for those with disabilities · Maintain an area free of items that could be harmful · Ensure doors lock as you enter or leave · Monitor visitors......contraband · Sexual activity among clients can occur · Rapid de-escalation · Consider personalities of clients when doing room assignments

Maintain Safety

D. Personalization

Nancy's new in-laws came to dinner for the first time. When her mother-in-law left some food on her plate, Nancy thought, "I must be a lousy cook." What automatic thought does this statement represent? A. Dichotomous thinking B. Overgeneralization C. Minimization D. Personalization

Free Time

Activities · Community Meetings: promote interaction between clients, decision making skills, feelings of self-worth, discussion of unit objectives, discussion of issues of concern, client-led with decisions made by group as a whole · Individual Therapy: is a scheduled session with a provider to address mental health concerns · Group Therapy: is a scheduled session for a group of clients to address common mental health issues · Educational Groups: are based on client's level of functioning and personal needs · Recreational Activities: include fun things, like games and community outing · ____: involves opportunities for the nurse to observe clients are they interact spontaneously within the milieu

A. Reattribution

A client tells the therapist, "I thought I would just die when my husband told me he was leaving me. If I had been a better wife, he wouldn't have fallen in love with another woman. Its all my fault." The therapist asks the client to explore what responsibilities the husband may have in the breakup. What cognitive therapy technique is the therapist using? A. Reattribution B. Role-play C. Decatastrophizing D. Thought Recording

B. Okay, you says its all your fault. Let's discuss why it might be your fault, and then we will look at why it may not be.

A client tells the therapist, "I thought I would just die when my husband told me he was leaving me. If I had been a better wife, he wouldn't have fallen in love with another woman. Its all my fault." The therapist wants to use the technique of "examining the evidence." Which of the following statements reflects this technique? A. How do you think you could have been a better wife? B. Okay, you says its all your fault. Let's discuss why it might be your fault, and then we will look at why it may not be. C. Lets talk about what would make you a happier person D. Would you have wanted him to stay if he didn't really want to?

C. Gradually expose the client to an elevator while practicing relaxation techniques

A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should the nurse implement in this form of therapy? A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior B. Advise the client to say "stop" out load every time they feel anxiety in response to an elevator C. Gradually expose the client to an elevator while practicing relaxation techniques D. Stay with the client in an elevator until the anxiety response diminishes.

A. Aversion therapy

A nurse is caring for a client who has a new prescription for disulfiram for treatment of alcohol use disorder. The nurse informs the client that this drug can cause nausea and vomiting when alcohol is consumed. Which of the following types of treatment is this? A. Aversion therapy B. Flooding C. Biofeedback D. Dialectical behavior therapy

D. When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities.

A nurse is caring for a client who states, "I am so stressed at work because of my coworker. I am expected to finish other's work because of their laziness!" when discussing effective communication, which of the following statements by the client to the coworker indicates client understanding? A. You really should complete your own work. I don't think its right to expect me to complete your responsibilities B. Why do you expect me to finish your work? You must realize that I have my own responsibilities C. It's not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor. D. When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities.

B. Depressed immune system C. Increased blood pressure E. Unhappiness

A nurse is discussing acute vs. prolonged stress with a client. Which of the following effects should the nurse identify as an acute stress response? (SATA) A. Chronic pain B. Depressed immune system C. Increased blood pressure D. Panic attacks E. Unhappiness

B. You may bring it up before the others at the community meeting, John

John tells the nurse, "I think lights out at 10pm on the weekends is stupid. We should be able to watch TV until midnight." Which of the following is the most appropriate response from the nurse on the milieu unit? A. John, you were told the rules when you were admitted B. You may bring it up before the others at the community meeting, John C. Some people want to go to bed early, John D. You are not the only person on this unit, John. You must think of others besides yourself.

1. The health in each individual is realized and encouraged to grow 2. Every Interaction is an opportunity for therapeutic intervention 3. The client owns his or her environment (make decisions related to environment to solve problems) 4. Each Client owns his or her behaviors (take responsibility for actions) 5. Peer pressure is a useful and powerful tool 6. Inappropriate behaviors are dealt with as they occur 7. Restrictions and punishment are to be avoided

7 Assumptions on which Therapeutic Community is Based:

D. I should say the first think that comes to mind

A nurse is discussing free association as a therapeutic toll with a client who has major depression. Which of the following client statements indications understanding of this technique? A. I will write own my dreams as soon as I wake up B. I might begin to associate my therapist with important people in my life C. I can learn to express myself in a nonaggressive manner D. I should say the first think that comes to mind

A. Excessive stressors cause the client to experience distress

A nurse is preparing an educational seminar on stress for other nursing staff. Which of the following information should the nurse include in the discussion? A. Excessive stressors cause the client to experience distress B. The body's initial adaptive response to stress is denial. C. Absence of stressors results in homeostasis D. Negative, rather than positive, stressors produce a biological response.

A. Priority restructuring B. Monitoring thoughts D. Journal keeping

A nurse is preparing to implement cognitive reframing techniques for a client with anxiety. Which of the following techniques should the nurse include in the plan of care? (SATA) A. Priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Journal keeping E. Meditation

B. Use assertiveness techniques

A nurse is talking with a client who reports experiencing increased stress because a new partner is "pressuring me and my kids to go live with him. I love him but I am not ready to do that." Which of the following recommendation should the nurse make to promote a change in the client's situation? A. Learn to practice mindfulness B. Use assertiveness techniques C. Exercise regularly D. Rely on the support of a close friend

A. Cognitive reframing will help me change my irrational thoughts to something positive

A nurse is teaching a client about stress-reduction techniques. Which of the following client statements indicates an understanding of teaching? A. Cognitive reframing will help me change my irrational thoughts to something positive B. Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate C. Biofeedback causes by body to release endorphins so that I feel less stress and anxiety D. Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety

B. The therapist will focus on my past relationships during sessions

A nurse is teaching a client who has an anxiety disorder and is scheduled to being classical psychoanalysis. What of the following client statements indicated an understanding of this form of therapy? A. Even if my anxiety improves, I will need to continue this therapy for 6 weeks B. The therapist will focus on my past relationships during sessions C. Psychoanalysis will help me reduce my anxiety by changing my behaviors D. This therapy will address my conscious feelings about stressful experiences.

A. Increases the probability that a behavior will recur

A positive reinforcer, and a negative reinforcer both: A. Increases the probability that a behavior will recur B. Decreases the probability that a behavior will recur C. Has nothing to do with modifying behavior D. Always results in positive behavior

Recreational Activities

Activities · Community Meetings: promote interaction between clients, decision making skills, feelings of self-worth, discussion of unit objectives, discussion of issues of concern, client-led with decisions made by group as a whole · Individual Therapy: is a scheduled session with a provider to address mental health concerns · Group Therapy: is a scheduled session for a group of clients to address common mental health issues · Educational Groups: are based on client's level of functioning and personal needs · ____: include fun things, like games and community outing

Group Therapy

Activities · Community Meetings: promote interaction between clients, decision making skills, feelings of self-worth, discussion of unit objectives, discussion of issues of concern, client-led with decisions made by group as a whole · Individual Therapy: is a scheduled session with a provider to address mental health concerns · _____: is a scheduled session for a group of clients to address common mental health issues

Individual Therapy

Activities · Community Meetings: promote interaction between clients, decision making skills, feelings of self-worth, discussion of unit objectives, discussion of issues of concern, client-led with decisions made by group as a whole · ____: is a scheduled session with a provider to address mental health concerns

Community Meetings

Activities · ____: promote interaction between clients, decision making skills, feelings of self-worth, discussion of unit objectives, discussion of issues of concern, client-led with decisions made by group as a whole

B. Decreases the probability that a behavior will recur

An aversive stimulus or punisher: A. Increases the probability that a behavior will recur B. Decreases the probability that a behavior will recur C. Has nothing to do with modifying behavior D. Always results in positive behavior

B. Magnification

Barbra burned the toast. She thinks, "I'm a totally incompetent person." What automatic thought does this represent A. Selective abstraction B. Magnification C. Minimization D. Personalization

Cognitive Therapy

Behavioral Interventions in ____: § Activity scheduling: a behavior intervention of cognitive therapy where clients are asked to keep a daily log of their activities on a hourly basis and rate the activity for pleasure and mastery. § Graded Task Assignments: a behavior intervention of cognitive therapy that is used with clients facing situations they see as overwhelming. The task is broken down to let the client do one subtask at a time (self-esteem) § Distraction: a behavior intervention of cognitive therapy where the client engages in activities that redirect the client's thinking and divert him or her from the intrusive thoughts. Miscellaneous techniques: other behavioral interventions of cognitive therapy that can include relaxation exercises, assertiveness training, role modeling, social skills, training, and contingency management contracts

· Neat and clean · Age appropriate atmosphere (children need an area, adults, older adults, etc) · Comfortable furniture · Promote social interaction and allows quiet time · Safe

Characteristics of Milieu Therapy:

D. The doctor says I have bipolar disorder. What does that really mean?

Client teaching is an important nursing function in milieu therapy. Which of the following statements by the client indicates the need for knowledge and readiness to learn? A. Get away from me with that medicine! I am not sick! B. I don't need psychiatric treatment. Its my migraine headaches that I need help with C. I've taken Valium every day of my life for the last 20 years. I'll stop when I'm good and ready! D. The doctor says I have bipolar disorder. What does that really mean?

Modifying Automatic Thoughts and Schemas

Cognitive Strategies: strategies used in cognitive therapy include: § _____: · Questioning the Evidence: a cognitive strategy where the client and therapist question the facts associated with their cognitions · Examining Options and alternatives: a cognitive strategy used to help the client see a broad range of possibilities · Decatastrophizing: a cognitive strategy where the therapist assists the client to examine the validity of a negative automatic thought. The client is assisted to examine "what is the worst thing that could happen?" and develops a plan of action. · Reattribution: a cognitive strategy that aims to reverse negative attribution of clients from self-blame or blaming others. · Daily record of Dysfunctional Thoughts: a cognitive strategy that is a tool to help clients identify and modify automatic thoughts. The client keeps a written record of situations, automatic thoughts, emotional response, rational response, and outcomes. · Cognitive Rehearsal: a cognitive strategy that uses mental imagery to uncover potential automatic thoughts. A discussion is held to identify ways to modify these dysfunctional cognitions. The client is given homework to try new learned methods in real situations.

Recognizing thoughts and schemas

Cognitive Strategies: strategies used in cognitive therapy include: § ______: · Socratic dialogue: a cognitive strategy where the therapist questions the client to elaborate the "who, what, when, where, why, and how" of their situation. Questions are mainly restatements of the client's words to stimulate insight · Guided relaxation: a cognitive strategy that is aimed at reducing the autonomic response to anxiety using deep breathing, imagery, mindfulness meditation, etc. Role play is an example where the therapist assumes a role of an individual in a situation that produces a maladaptive response in the client. · Automatic Thought Records: a cognitive strategy that is assigned as homework for the client outside of therapy. The client keeps a written record of situations that occur and the automatic thoughts elicited by the situations.

Milieu Therapy/Therapeutic Community

Conditions that Promote a ______: · Basic physiological needs are fulfilled · The physical facilities are conductive to achievement of the goals of therapy ---Sufficient privacy, interaction with others, furniture for a home-like atmosphere) · A democratic form of self-government exists ---Client participation in problem-solving and decision making through community meetings. Community meetings are attended by clients and staff to discuss problems, and democratic decisions are made (a vote is taken and staff agree to abide by expressed preference of majority) · Responsibilities are assigned according to client capabilities. (do not set client up for failure by assigning responsibility beyond capability. Appropriate responsibilities improve self-esteem with achievement.) · A structured program of social and work-related activities is schedules as part of the treatment program. (exercise groups for anger expression/ assertiveness group for the passive-aggressive clients/ stress management groups for anxiety) · Community and family are included in the program of therapy in an effort to facilitate discharge from treatment.

D. She tells Sally's parents to explain to Sally that she may watch TV only after she has practiced the piano for 1 hour.

Fourteen year-old Sally has been spending many hours after school watching TV. She has virtually stopped practicing her piano lessons. Sally's parents ask for advice about how to engage Sally to practice more. The nurse believes the Premack principle may be helpful. Which of the following does she suggest to Sally's parents? A. She tells Sally's parents to reward Sally each time she practices piano, even if it is only for 5 minutes. B. She tells Sally's parents to ignore this behavior and eventually she will start practicing on her own. C. She tells Sally's parents to draw up a contract with Sally stating what the consequences will be if she does not practice piano. D. She tells Sally's parents to explain to Sally that she may watch TV only after she has practiced the piano for 1 hour.

C. Attending to the nutritional and comfort needs of all clients

In prioritizing care within the therapeutic environment, which of the following nursing interventions would receive the highest priority? A. Ensuring that the physical facilities are conductive to achievement of the goals of therapy B. Scheduling a community meeting at 8:30 each morning C. Attending to the nutritional and comfort needs of all clients D. Establishing contacts with community resources

B. Reviewing group rules and behavioral limits that apply to all clients

In the community meeting, which of the following actions is most important for reinforcing the democratic posture of the therapy setting? A. Allowing each person a specific an equal amount of time to talk B. Reviewing group rules and behavioral limits that apply to all clients C. Reading the minutes from yesterday's meeting D. Waiting until all clients are present before initiating the meeting

C. Catastrophic thinking

Janet failure her first test in nursing school. She thinks "That's it, I'll never be a nurse!" What automatic thought does this statement represent? A. Overgeneralization B. Magnification C. Catastrophic thinking D. Personalization

1. Look at a picture of a dog 2. Look at a stuffed toy dog 3. Pet the stuffed toy dog 4. Look at a real dog 5. Walk past a real dog 6. Pet a real dog

Jill has a fear of dogs. In helping her overcome this fear, the therapist is using systematic desensitization. List the following steps in the order in which the therapist would Proceed. A. Look at a real dog B. Look at a stuffed toy dog C. Pet a real dog D. Pet the stuffed toy dog E. Walk past a real dog F. Look at a picture of a dog

A. Medication administration B. Client teaching A. Reality orientation B. Relationship development

On the milieu unit, the duties of the staff psychiatric nurse include which of the following? (SATA) A. Medication administration B. Client teaching C. Medical diagnosis D. Reality orientation E. Relationship development F. Group therapy

A. Including client input and decisions into the treatment plan

One of the goals of therapeutic community is for clients to become more independent and accept self-responsibility. Which of the following approached by staff best encourages fulfillment of this goal? A. Including client input and decisions into the treatment plan B. Insisting that each client take a turn as "president" of the community meeting C. Making decisions for the client regarding plans for treatment D. Requiring that the client be bathed, dressed, and attend breakfast on time each morning

C. Problem Solving

Opal is a 43 year old woman suffering from depression and suicidal ideation. She says, "I'm such a worthless person. I don't deserve to live." The therapist response, "I would like for you to think about what problems committing suicide would solve." The therapist is using which of the following cognitive therapy techniques A. Imagery B. Role Play C. Problem Solving D. Thought Recording

· Maintain trust; keep promises, accept the individual for who they are, respond with concrete behaviors that are understandable to the client ("If you are scared, I will stay with you") · Orient the client to the environment · Provide support (active listening) · ADPIE is used for effective treatment · Nursing plan reflects that of IDT plan · Ensure physiological needs are met · Orient client's to reality (if disoriented/confused); use large clocks with dates and boards with daily activities · Ensure client's have their written schedule of activities · Manage medication administration · Set limits on unacceptable behaviors · Ensure client learning (are they ready to learn? Teach about diagnoses, medications, stress management)

Role of the Nurse in Milieu Therapy

B. She meets him at the door, yelling that he is late, and makes him spend the night on the couch

Situation: BJ has been out with his friends. He is late getting home. He knows his wife will be angry and will yell at him for being late. He stops at the florist and buys roses for her. Which of the following behaviors represents an aversive stimulus on the part of the wife? A. She meets him at the door, accepts the roses, and says nothing further about being late B. She meets him at the door, yelling that he is late, and makes him spend the night on the couch C. She meets him at the door, expresses delight with the roses, and kisses him on the cheek D. She meets him at the door and says, "How could you? You know I'm allergic to roses!"

A. She meets him at the door, accepts the roses, and says nothing further about being late

Situation: BJ has been out with his friends. He is late getting home. He knows his wife will be angry and will yell at him for being late. He stops at the florist and buys roses for her. Which of the following behaviors represents negative reinforcement on the part of the wife? A. She meets him at the door, accepts the roses, and says nothing further about being late B. She meets him at the door, yelling that he is late, and makes him spend the night on the couch C. She meets him at the door, expresses delight with the roses, and kisses him on the cheek D. She meets him at the door and says, "How could you? You know I'm allergic to roses!"

C. She meets him at the door, expresses delight with the roses, and kisses him on the cheek

Situation: BJ has been out with his friends. He is late getting home. He knows his wife will be angry and will yell at him for being late. He stops at the florist and buys roses for her. Which of the following behaviors represents positive reinforcement on the part of the wife? A. She meets him at the door, accepts the roses, and says nothing further about being late B. She meets him at the door, yelling that he is late, and makes him spend the night on the couch C. She meets him at the door, expresses delight with the roses, and kisses him on the cheek D. She meets him at the door and says, "How could you? You know I'm allergic to roses!"

· Provide unconditional positive regard · Promote independence · Provide choices (offer activities, if they want to participate they can) · Maintain boundaries (These people are watching TV, so let's keep the noise down) · Work cooperatively · Be professional · Promote feelings of self-worth

Team Member Responsibilities in Milieu Therapy:

interdisciplinary treatment team

The Program of Therapeutic Community · The _____ coordinates client care in the therapeutic community · The client should be at the center of this team process and an active participant in decisions about the treatment plan. The essence of PCC is client involvement unless the client's thought process is harmful to themselves or others. · Team member roles: psychiatrist, clinical psychologist, psychiatric clinical nurse specialist, psychiatric nurse, mental health technician, social worker, occupational therapist, recreational therapist, music therapist, art therapist, psychodramatist, dietician, chaplain.

D. All of the above

The daily record of dysfunctional thoughts (DRDT) is used in cognitive therapy to help clients: A. Identify automatic thoughts B. Modify automatic thoughts C. Identify rational alternatives D. All of the above

C. Distraction

The therapist teaches a client that when the idea of herself as a worthless person starts to inform in her mind, she should immediately start to whist the tune of "Dixies." What cognitive therapy technique is the therapist using? A. Behavioral rehearsal B. Social skills training C. Distraction D. Generative alternatives

A. Identify automatic thoughts

The thought recoding (two-three column) cognitive therapy techniques help clients: A. Identify automatic thoughts B. Modify automatic thoughts C. Identify rational alternatives D. All of the above

· Free association, is the spontaneous, uncensored verbalization of whatever comes to a client's mind · Dream analysis and interpretation, believed by Freud to be urges and impulses of the unconscious mind that played out thought the dreams of clients. · Use of defense mechanisms

Therapeutic Tools:

A. Overgeneralization

When Jack is not accepted at the law school of his choice, he thinks, "I'm so stupid, no law school will ever accept me." What automatic thought does this statement represent? A. Overgeneralization B. Magnification C. Selective abstraction D. Minimization

A. The client owns his or her environment B. Each client owns his or her behaviors C. Peer pressure is a useful and powerful tool

Which of the following are basic assumptions of milieu therapy? (SATA) A. The client owns his or her environment B. Each client owns his or her behaviors C. Peer pressure is a useful and powerful tool D. Inappropriate behaviors are punished immediately

Dichotomous thinking

___: a cognitive error where an individual views situations in terms of all-or-nothing, black-or-white, or good-or-bad. § EX: Frank submits an article to a nursing journal, and the editor returns it and asks Frank to rewrite parts of it. Frank thinks, "I'm a bad writer, "instead of recognizing that revisions is a common part of the publication process."

Personalization

___: a cognitive error where the person takes complete responsibility for situations without considering that other circumstances may have contributed to the outcome § EX: Jack, who sells vacuum cleaners, has just given a 2 hour demonstration to Ms. W. At the end, Ms. W says she appreciates his demonstration, but she won't be purchasing a vacuum. Jack thinks, "I'm a lousy salesman." (in reality, Ms. W's husband lost his job last week and they have no extra money for a vacuum)

Selective Abstraction

____: a cognitive error that is a conclusion that is based on only a selected portion of the evidence (usually negative evidence) § EX: Jackie graduated high school with a 3.9/1.0 GPA. She won a scholarship for a university near her home. She was active in sports and had many friends. But, she is very depressed and dwells on the fact that she did not earn a scholarship to an Ivy league college.

Magnification

____: a cognitive error where the individual exaggerates the negative significance of an event. § EX: Nancy hears that her coworker is having a cocktail party over the weekend, and she is not invited. Nancy thinks, "she doesn't like me."

Minimization

____: a cognitive error where the individual undervalues the positive significance of an event § EX: Ms. M is lonely and calls her granddaughter, Amy, to come visit. Amy apologizes that she must go out of town on business and would not be able to visit at that time. While Amy is out of town, she calls Ms. M, but Ms. M feels unloved.

Overgeneralization (absolutistic thinking)

_____: a cognitive error where sweeping conclusions are made on the basis of one incident ("all or nothing" thinking) § EX: Frank submitted an article to a nursing journal, and it was rejected. Frank thinks, "No journal will ever be interested in anything I write."

Arbitrary inference

_____: a cognitive error where the individual automatically comes to a conclusion about an incident without the facts to support it or despite contradictory evidence § EX: 2 months ago, Ms. B sent a wedding gift to the daughter of an old friend. She has not received a thank you letter for the gift. Ms. B thinks, "They obviously think I have poor taste."

Catastrophic Thinking

_____: a cognitive error where the individual is always thinking that the worst will occur without considering the possibility of more likely positive outcomes. § EX: On Janet's first day of the job, her boss asked her to write a letter to another firm and put it on his desk for his signature. She did so and left for lunch. When she returned, the letter was on her desk with a typographical error circled in red with a note to redo the letter. She thinks, "This is it! I'm fired!"

Milieu Therapy/Therapeutic Community

________· : A scientific structuring of the environment in order to effect behavioral changes and improve the psychological health and functioning of the individual. · Creates a supportive and safe environment. · Began as a treatment for children. · Allows time to learn coping mechanisms · Regular treatment team meetings. (individuals meet with a therapist, psych techs, etc) · Therapeutic Nurse : Client Relationship

· Monitor negative thought · recognize connection between thoughts and behavior · examine the evidence for and against distorted thoughts · replace distorted thoughts with realistic thoughts learn to identify and alter the dysfunctional beliefs that predispose them to distort experiences

· Goals of cognitive therapy:

Cognitive Therapy

· Principles of _______: · Cognitive therapy is based on an ever-evolving formulation of the client and their problems in cognitive terms. --The therapist identifies precipitating events for distorted cognition and hypothesizes certain developmental events that may have predisposed the client to their emotional responses. · Cognitive therapy requires a sound therapeutic alliance. --A trusting relationship must exist between the client and therapist · Cognitive therapy emphasizes collaboration and active participation · Cognitive therapy is goal oriented and problem focused. · Cognitive therapy initially emphasizes the present. · Cognitive therapy is educative, aims to teach the client to be his or her own therapist, and emphasizes relapse prevention · Cognitive therapy aims to be time limited · Cognitive therapy sessions are structured · Cognitive therapy teaches clients to identify, evaluate, and response to their dysfunctional thoughts and beliefs Cognitive therapy uses a variety of techniques to change thinking, mood, and behavior.

Thought stopping

· ___: A therapy technique that involves teaching a client, when native thoughts arise, to say/shout "STOP" and substitute a positive thought. The goal is to over time use the command silently

Assertiveness Training

· ___: the client learns to communicate in a more assertive manner in order to decrease psychological stressors. One technique teaches clients to assert their feelings by describing a situation that causes stress, discussing feelings about the situation, and then making a change.

Cognitive Behavioral Therapy

· ____ Therapy uses a combination of techniques used in both cognitive and behavioral therapy to assist a client with anxiety management. It takes into account what clients think influences their feelings/behaviors -Thought stopping cognitive restructuring guided relaxation and meditation assertiveness training -behavioral rehearsal· Works for most diagnoses including insomnia and pain

Psychodynamic Therapy

· ____ employs the same tools as psychoanalysis, but is focuses more on the client's present issues rather than relationships of the past and early life

Systematic Desensitization

· ____: This is a behavioral technique for assisting individuals to overcome a phobia. It is planned, progressive, and a graduated exposure to the phobia. During the stimulus, the client uses relaxation techniques. -Example: Client has a fear of elevators. Client discusses fear with therapist. Looks at picture of elevator. Walks into a building and looks at elevator. Push the button for the elevator. Walk into elevator. Ride one floor then walk downstairs with therapist. Ride one floor then ride back down with therapist. Ride the elevator alone.

Reciprocal inhibition

· ____: This is a behavioral technique that decreases or eliminates behavior by introducing a more adaptive behavior, but one that is incompatible with the unacceptable behavior. Example: introduction of relaxation exercises in the presence of anxiety to an individual who is phobic

Aversion Therapy

· ____: This is a behavioral technique that involves pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote a change in behavior. A therapist can use unpleasant stimuli (bitter taste) as punishment for behavior (alcohol use disorder). Ongoing supervision is essential

Covert Sensitization

· ____: This is a behavioral technique that relies on the individual's imagination rather than medication to produce unpleasant symptoms. The person learns to visualize nauseating sceneries when they are about to succumb to an undesired behavior.

Contingency Contracting

· ____: This is a behavioral technique. A contract is drawn up and the desired behaviors are stated in writing. The negative consequences are also outlined.

Overt Sensitization

· ____: This is a behavioral technique. It is an aversion therapy that produces an unpleasant consequence for undesirable behavior. For example, disulfiram (Antabuse) is a drug given to individuals who wish to stop drinking alcohol. If the person drinks, symptoms of severe nausea, dyspnea, and headache occur.

Time out

· ____: This is a behavioral technique. It is an aversive stimulus/punishment during which the client is removed from the environment where the unacceptable behavior is exhibited.

Token Economy

· ____: This is a behavioral technique. This is a type of contingency contracting where reinforcers for desired behaviors are presented in the form of tokens. Tokens are awarded for desired behaviors and can be exchanged for privileges.

Premack Principle

· ____: This is a behavioral technique. This technique states that a frequently occurring response can serve as a positive reinforcement for a response. For example, 13 year old Jennie has been neglecting her homework. Being allowed to talk on the phone with her friends could be a positive reinforcement for completing her homework.

Biofeedback

· ____: a nurse trained in this method uses a sensitive mechanical device to assist the client to gain voluntary control of such autonomic functions as heart rate and BP. Exercise gadgets and smart watches give the ability to track sleep/HR.

Guided relaxation and meditation

· ____: the client is guided through a series of images to promote relaxation. Images vary on the individual. One client might image walking on a beach. Meditation can involve prayer.

Cognitive Restructuring

· ____: the client learns to prioritize differently to reduce the number of stressors affecting them. A person who is under stress due to feeling overworked might delegate some tasks to others rather than doing them all on their own.

Behavioral therapy

· _____ is a form of psychotherapy that aims to modify maladaptive behavior patterns by reinforcing more adaptive behaviors. It is designed with the belief that changing behavior was the key to treating mental health issues. The principles are based on classical conditioning (Pavlov) and operant conditioning (Skinner). The basic assumption is that problematic behaviors occur when there has been inadequate learning and therefore can be corrected through the provision of appropriate learning experiences. The therapist often "models" behaviors for the client -____ therapy is based on the theory that behavior is learned and has consequences -___ therapy teaches clients ways to decrease anxiety and gives chances to practice techniques -Behavior can be changed without addressing underlying causes -Indications for ___ therapy: Substance misuse, anxiety, phobia

Classical Conditioning

· _____ is a process of learning; individuals learn to respond in specific ways if conditioned to do so. -In Pavlov's study, dogs salivated when they began to eat food (unconditioned response). In time, the dogs responded to the sound of a bell with salivation (conditioned stimulus and response). -Unconditioned versus conditioned response

Flooding

· _____: This is a behavioral technique used to desensitize individuals to phobic stimuli. Instead of working up toward the stimulus, the individual is flooded with a continuous presentation until it no longer elicits anxiety. This practice is ethically questionable and not used for clients with intense anxiety, heart disease.

Shaping

· _____: This is a behavioral technique. In shaping the behavior of another, reinforcements are given for increasingly closer approximations to the desired response. For example, in eliciting speech from an autistic child, the teacher may first reward the child for (1) watching the teacher's lips, then (2) by making any sound in imitation of the teacher, then (3) by forming sounds similar to the word spoken by the teacher.

Extinction

· _____: This is a behavioral technique. This is the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld. An example is when a child's temper tantrum continues as long as the parent gives attention to them but decreases when a parent simply walks away and ignores the tantrum.

Modeling

· _____: This is a behavioral technique. This refers to the learning of new behaviors by imitating the behavior of others. Children imitate the behaviors of their parents, teachers, and friends. Clients may imitate behaviors of their nurses. In therapy, a client watches a model demonstrate appropriate behaviors in a role-play of the problem and the client is instructed to imitate the model's behavior (they are positively reinforced for correct imitation)

Cognitive Therapy

· _____: a type of psychotherapy based on the concept of pathological mental processing. The focus of treatment is on the modification of distorted cognitions and maladaptive behaviors It is based on the cognitive model that focuses on individual thoughts/behaviors to solve current problems. -Thoughts come before feelings and actions -Various methods are used to change client's cognitive distortions (thinking, belief systems) to bring about lasting emotional and behavioral change -Cognitive: relating to the mental process of thinking and reasoning · Indications: Depression, anxiety, anxiety disorders, social phobias, obsessive compulsive disorder, eating disorders, Schizophrenia, personality disorder, Bipolar; somatic disorders, PTSD

Operant Conditioning

· _____: this theory (Skinner) states that the connection between a stimulus and a response is strengthen or weakened by consequences of the response. -When the reinforcing stimulus increases the probability that a behavior will recur, it is a function called positive reinforcement § EX: a child gets an allowance for cleaning room -Negative reinforcement increases the probability that a behavior will occur by removal of an undesirable reinforcing stimulus. § EX: Child does not get scolded if the child cleans their room - A stimulus that follows a behavioral response and decreases the probability that the behavior will recur is called an aversive stimulus, or punisher § Child receives scolding from mother from not cleaning room. -Stimuli that precede a behavioral response and predict that a particular reinforcement will occur are called discriminative stimuli. These are under an individual's control and they can choose the reinforcement to associate with a specific stimulus. -USE IN MENTAL HEALTH NURSING: The client receives a positive reward for positive behavior. A client may receive tokens for good behavior that they can exchange for privileges

Dialectical Behavioral Therapy

· ______ Therapy is a cognitive-behavioral therapy for clients with a personality disorder and those with self-injurious behaviors. ---Approach used for chronic suicidal thoughts, personality disorders, complex trauma ---Enhances client capabilities ---Motivates client to utilize strengths ---Provides acceptance and validation for these clients · Mindfulness: the client is encouraged to be mindful of their surroundings using all of their senses (relaxing warmth of sunlight or the sound of a breeze). The client learns to restructure negative thoughts into positive ones. Instead of saying, "Its so frustrating that the elevator isn't working," the client might say, "Using the stairs is a great opportunity to burn off some extra calories." · Emotional regulation · Distress tolerance · Interpersonal effectiveness · Self-management

Interpersonal therapy

· ______ assists clients in addressing specific, current problems. It can improve interpersonal relationships, communication, role-relationship, and bereavement. It is time limited and based on current, not past relationships · Not cognitive or behavioral · Aware of personality, but not focused on it Addresses specific concerns: bereavement; communication; relationships

Cognitive Reframing

· ______ assists clients to identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk. For example, a client may say they are a "bad person" who has "never done anything good" in their life. Through therapy, this client can change their thinking to realize that they might have made some bad choices, but they are not a "bad person." · Priority restructuring: this concept of cognitive therapy assists the clients to identify what requires priority (devoting energy to pleasurable activities) · Journal Keeping: this concept of cognitive therapy helps clients write down stressful thoughts and has a positive effect on well-being. It can ease anxiety, worry, and obsessional thinking. It can increase confidence and hope. · Assertiveness Training: this concept of cognitive therapy teaches clients to express feelings, and solve problems in a nonaggressive manner Monitoring thoughts:this concept of cognitive therapy helps clients to be aware of negative thinking

Psychoanalysis

· ______ is a therapeutic process (Developed by Sigmund Freud) of assessing the unconscious thoughts and feelings, and resolving conflict by talking to a psychoanalyst. · Past relationships are a common focus to uncover conflict · Continues for months to years Not common due lengthy therapy process, cost, and insurance constraints