Mental Health Chapter 13 Individual Therapies and Nursing Interventions
Which statement made by the client identifies a misconception of the goal of cognitive behavioral therapy (CBT) that the nurse should address initially? a) "My future isn't dictated by my past." b) "Concentrating on past mistakes will help me make better decisions in the future." c) "I want to change the way I perceive my experiences as usually being negative and hopeless." d) "I've got to stop thinking of myself as a loser."
"Concentrating on past mistakes will help me make better decisions in the future." Explanation: 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 therapist is using solution-focused behavior therapy (SFBT). A nursing student is observing the session and asks afterward why the therapist did not mention the client's problems. What is the best response by the therapist? a) "In SFBT, it is best to focus on strengths and successes as opposed to a diagnosis." b) "This patient is unlikely to ever change, so it makes no sense to dwell on the problems." c) "It makes more sense to me to do it this way." d) "This patient cannot expect to solve the problem, so why spend time dwelling on it?
"In SFBT, it is best to focus on strengths and successes as opposed to a diagnosis." Explanation: The best response by the therapist about SFBT is to explain to the student that it is sometimes best to focus on the client's strengths and successes instead of the problems. Emphasizing the uniqueness of the patient and his or her capacity to make changes will help more.
Which of the following individuals is most likely to benefit from brief cognitive therapy? a) A woman with major depression who is scheduled to begin electroconvulsive therapy b) A college freshman who is experiencing intense anxiety in the days before his final exams c) A male hospital patient who has a diagnosis of schizophrenia, paranoid type d) A female student who has been diagnosed with anorexia nervosa
A college freshman who is experiencing intense anxiety in the days before his final exams Explanation: Candidates for brief cognitive therapy are described as educated, verbal, and psychologically minded. Individuals with severe symptoms or protracted mental health problems are less likely to benefit from this mode of treatment.
Which form of questioning typically used as part of solution-focused behavioral therapy (SFBT) shown be avoided for clients diagnosed with thought disorders? a) Scaling b) Exception c) Relationship d) Miracle
Miracle Explanation: A research study asked the question if SFBT could be used with persons diagnosed with thought disorders. Findings indicated that clients respond well to all forms of traditional questioning except miracle questions.
Based on the theory of transference, if a client's childhood experiences teach him to mistrust authority figures, he will do which of the following as an adult? a) Develop paranoid tendencies toward all of the unit's staff b) Freely discusses his experiences with people with power and authority c) Resist advice given by the mental health care professionals d) Strive to be a truthful authority figure to his family and friends.
Resist advice given by the mental health care professionals Explanation: It is believed that our relationships with other people are patterned by early infant and childhood relationships with significant people in our environment. These patterns of relationships are repeated later in our lives and may interfere with client-therapist relationships because of transference, or the client's unconscious assignment to the therapist of feelings and attitudes originally associated with important figures in his or her early life. Based on these ideas, if a client's childhood experiences teach him to mistrust authority figures, as an adult he will resist advice given by the mental health care professionals.
An individual's life rules that act as a filter for cognitive distortions are known as what? a) Schema b) Engagement c) Demand d) Activating event
Schema Explanation: 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
Considering that cognitive behavioral therapy (CBT) requires a clear understanding of one's own belief system, which client is not a candidate for effective cognitive behavioral therapy (CBT)? a) The client diagnosed with schizophrenia two years ago b) The client diagnosed with post traumatic stress disorder after being sexually assaulted. c) The client grieving the death of an infant child d) The client express an intense fear of closed in spaces
The client diagnosed with schizophrenia two years ago Explanation: Chief among the limitations identified associated with CBY is the concern that success is dependent on the patient 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. Schizophrenia is a thought disorder while the other options are all mood disorders such as depression and anxiety.
The education provided to a client receiving cognitive behavioral therapy provides the client with information on the nature and course of the disorder and ... a) identifies client weaknesses. b) empowers clients to engage in a collaborative approach to their care. c) examines the pros and cons of receiving cognitive behavior therapy. d) promotes the relationship with therapist for indefinite period of time.
empowers clients to engage in a collaborative approach to their care. Explanation: Providing clients information on the nature and course of their disorder not only helps them to understand their current struggles, but also empowers clients to engage in a collaborative approach to their care.
Three cognitive processes are involved in the development of common mental disorders such as depression. Which of the following are included in the cognitive triad? Select all that apply. a) Oneself b) Future c) Present d) World e) Nurse
• Oneself • World • Future Explanation: The cognitive triad includes thoughts about oneself, the world, and the future.
Which of the following is the key common element in the various psychotherapeutic approaches? a) An effective client-therapist relationship b) The underlying origin of the clients' issues c) The clients' history of therapeutic success in the past d) The therapist's ability to manage the clients' symptoms
An effective client-therapist relationship Explanation: The key common element in the various psychotherapeutic approaches is an effective client-therapist relationship. The nurse-client relationship is critical to the success of the use of any therapeutic modality because the client is unlikely to engage authentically if trust in the relationship is lacking.
Which of the following is the key common element in the various psychotherapeutic approaches? a) The therapist's ability to manage the clients' symptoms b) The clients' history of therapeutic success in the past c) The underlying origin of the clients' issues d) An effective client-therapist relationship
An effective client-therapist relationship Explanation: The key common element in the various psychotherapeutic approaches is an effective client-therapist relationship. The nurse-client relationship is critical to the success of the use of any therapeutic modality because the client is unlikely to engage authentically if trust in the relationship is lacking.
Cognitive techniques focus on the client's patterns of which type of thinking? a) Magical b) Delusional c) Delayed d) Automatic
Automatic Correct Explanation: 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.
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? a) Cognitive triad b) Cognitive distortion c) Schema d) All of the above
Cognitive distortion Explanation: 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 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? a) Cognitive triad b) Cognitive distortion c) Schema d) All of the above
Cognitive distortion Explanation: 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.
Which of the following types of questions reinforces the client's successes and the strengths needed to achieve those successes? a) Relationship b) Exception c) Scaling d) Compliments
Compliments Explanation: Compliments are affirmations of the client; they reinforce the client's success 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, that there are fluctuations on how the client experiences "the problem."
When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to help her achieve which goal? a) Help regain confidence in her pervious ability to cope with the stress of being a single parent b) Help her identify reliable, affordable help with her childcare needs c) Rely more on her extended family's offer to act as a support system d) Comply with her prescribed therapies including the use of an antidepressant.
Help regain confidence in her pervious ability to cope with the stress of being a single parent Explanation: The psychiatric nurse uses counseling interventions to assist clients in improving or regaining their previous coping abilities since the primary goal of crisis therapy is to regain precrisis levels of function. When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to help her regain confidence in her pervious ability to cope with the stress of being a single parent.
In which of the following environments did cognitive interventions have their beginning? a) Skilled care b) Community health clinics c) Emergency care centers d) Long-term inpatient settings
Long-term inpatient settings Explanation: 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, at all levels of practice.
A nurse working in a psychiatric facility identifies the goal of cognitive therapy (CT) to be which of the following? a) Restructure how a person perceives events. b) Help the person maintain all thoughts and behaviors. c) Redirect all events in a person's life. d) Change events in a person's life.
Restructure how a person perceives events. Explanation: The goal of CT is to restructure how a person perceives events in his or her life to facilitate behavioral and emotional change.
Which statement guides the work of the cognitive behavior therapist especially when evaluating the client's progress towards treatment goals? a) The inflexibility of the scheduled sessions is vital to the client's progress b) Setbacks in treatment are both normal and expected. c) Evaluation is done periodically so as to allow for incidences of failed progress d) Treatment goals are regularly altered to support continuous progress
Setbacks in treatment are both normal and expected. Explanation: The patient's progress toward treatment goals is continually evaluated, and the patient is urged to become more self-reliant and independent. As progress is never a continuous upward process, therapists prepare the patient for setbacks by acknowledging that setbacks are normal and expected and crafting ways in which the patient can deal with them. Treatment goals aren't altered but rather activities are crafted to address progress. It is not uncommon for the time between sessions to lengthen as the final session approaches
The significant of the use of praise in the therapeutic relationship between the psychiatric nurse and the school aged client is particularly important for which of the following reasons? a) The child client needs to relate to the nurse as a surrogate parent b) A child's ability to express themselves is limited by their stage of development c) The child's takes pleasure in his own accomplishments and develops confidence d) The nurse is subject to developing countertransference issues with the child
The child's takes pleasure in his own accomplishments and develops confidence Explanation: The relationship that develops between the therapist and client is very important. In accordance with Erikson's stages of Psychosocial Development, a school aged child is in a stage of industry vs. inferiority with a need to fulfill the virtue of competence. The nurse can establish and maintain the therapeutic relationship by recognizing and validating successes through praise.
Which question asked of a client being treated with solution-focused behavioral therapy (SFBT) is an example of a miracle question? a) "Are you still rating your anxiety as a 3 today?" b) "What do you think is different about the times when you aren't feeling anxious." c) "How does your anxiety affect your children's lives?" d) "How would your life be different if you woke up tomorrow without any anxiety?"
"How would your life be different if you woke up tomorrow without any anxiety?" Explanation: 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 if you sudden wasn't anxious any more. An exception question focuses on what was different when the problem is less severe or even non-existent. 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 client's cognitive distortion about success in a course they are enrolled in? a) "Tests just aren't the best way to evaluate my knowledge of the subject." b) "Everyone says the course is hard but I really like the subject so I'll do well." c) "I didn't make an A on that test; I'm never going to pass this course." d) "I wish the test wasn't on Tuesday; I do better on tests scheduled on Mondays."
"I didn't make an A on that test; I'm never going to pass this course." Explanation: Cognitive distortions and 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
An "all or nothing at all" thought process is an example of which theme associated with irrational beliefs? a) Absolute thinking b) A demand c) Low frustration tolerance d) Catastrophizing
Absolute thinking Explanation: An "all or nothing at all" thought process is an example of absolute thinking. An irrational belief that everything should be easy is an example of low frustration tolerance. Catastrophizing is exaggerating negative consequences of an event. A demand is an irrational belief that something "must happen.
A nurse working on a psychiatric unit is helping clients to understand how individual perceptions determine a person's response or behavior in stressful situations.Which of the following therapeutic approaches is the nurse employing? a) Cognitive therapy b) Group therapy c) Humanistic therapy d) Psychoanalytic therapy
Cognitive therapy Explanation: Cognitive therapy is a psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative and inaccurate thoughts.
A nurse working on a psychiatric unit is helping clients to understand how individual perceptions determine a person's response or behavior in stressful situations.Which of the following therapeutic approaches is the nurse employing? a) Humanistic therapy b) Psychoanalytic therapy c) Group therapy d) Cognitive therapy
Cognitive therapy Explanation: Cognitive therapy is a psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative and inaccurate thoughts.
An outline of the developmental issues that contribute to and continue to reinforce the problem refers to a) Intermediate beliefs b) Cognitive-behavioral formulation c) Cognitive schema d) Behavioral treatment technique
Cognitive-behavioral formulation Explanation: A cognitive-behavioral formulation also outlines the developmental issues that contributed to and continue to reinforce the current problem.
Which of the following therapies was developed by Linehan for the chronically suicidal client with borderline personality disorder? a) E-therapy b) Brief cognitive therapy c) Split-treatment psychotherapy d) Dialectic behavioral therapy (DBT)
Dialectic behavioral therapy (DBT) Explanation: Linehan developed DBT for suicidal clients with a diagnosis of borderline personality disorder. This therapy blends behavior therapy with treatment strategies that focus on acceptance and validation. E-therapy is online psychotherapy. Brief cognitive therapy encompasses the therapist assuming an active role while working with individuals to solve present-day problems by identifying distorted thinking that causes emotional discomfort, exploring alternate behaviors, and creating change. Split-treatment psychotherapy involves a protocol between a nurse-therapist who provides psychotherapy and a psychiatrist or nurse practitioner who provides pharmacotherapy for the client
The nurse is aware of the changing demographics and growth of ethnic subcultures of the community and is trying to ensure that residents' needs for psychotherapy are effectively met. How should the nurse best work toward this goal? a) Perform teaching for clients about the different cultures represented in the United States. b) Foster cultural competency among those caregivers who perform psychotherapy and counseling. c) Ensure that therapists and clients always share the same ethnic background. d) Enlist the assistance of counselors in clients' home countries using e-therapy.
Foster cultural competency among those caregivers who perform psychotherapy and counseling. Explanation: While e-therapy and client education may have some utility, the primary factor needed in order to provide transcultural care is cultural competence on the part of practitioners. It is not always feasible to match care providers and clients based on ethnicity.
A client is undergoing individual psychotherapy. He is yelling at the therapist because of a fight with his wife about their children several years ago. In this instance, the client is exhibiting which response? a) Resistance b) Countertransference c) Parataxis d) Transference
Transference Explanation: Transference is the client's unconscious assignment of feelings and attitudes originally associated with important figures in his or her early life to the therapist. Countertransference is the emotional reaction to the client based on the therapist's unconscious needs and conflicts. Resistance is defined as the conscious or unconscious psychological defense against bringing repressed thoughts into conscious awareness. Parataxis is the presence of distorted perception or judgment exhibited by the client during therapy
A client reports anxiety over "sounding stupid" when talking to strangers. As a part of 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 client's irrational belief about 'sounding stupid'? a) What the stranger said during the conversation b) What actually happened compared to what the client feared would happen c) What physical manifestations the client felt during the conversation d) What self-talk the client employed to prepare for the conversation.
What actually happened compared to what the client feared would happen Explanation: 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.
The cognitive model is described as the interconnection between behaviors, emotions and a) understandings. b) perceptions. c) feelings. d) thoughts.
thoughts. Explanation: The cognitive model is described as the interconnection between behaviors, emotions and thoughts.
Rational beliefs accept that human beings are fallible and reject absolutes such as which of the following? Select all that apply. a) "Maybe" b) "Never" c) "Once in a while" d) "Sometimes" e) "Always"
• "Always" • "Never" Explanation: 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.