Maladaptive Docu

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A. ELECTROCONVULSIVE AND OTHER SOMATIC THERAPIES

Electroconvulsive thera! "ECT#

Electroconvulsive therapy, also known as ECT and electroshock therapy, was

developed in the 1930s when various observations led physicians to conclude that

epileptic seizures might prevent or relieve the symptoms o schi$ohrenia! "ter

e#periments with insulin and other potentially seizure$inducing drugs, %talian physicians

pioneered the use o an electric current to create seizures in schizophrenic patients!

ECT was routinely used to treat schizophrenia, %eression, and, in some

cases, &ania! %t eventually became a source o controversy due to misuse and negative

side eects! ECT was used indiscriminately and was oten prescribed or treatingdisorders on which it had no real eect, such as alcohol dependence, and was used or

punitive reasons! &atients typically e#perienced conusion and loss o &e&or!ater

treatments, and even those whose condition improved eventually relapsed! 'ther side

eects o ECT include speech deects, physical in(ury rom the orce o the convulsions,

and cardiac arrest! )se o electroconvulsive therapy declined ater 19*0 with the

introduction o antidepressant and antipsychotic drugs!

ECT is still used today but with less re+uency and with modiications that have

made the procedure saer and less unpleasant! "naesthetics and muscle rela#ants are

usually administered to prevent bone ractures or other in(uries rom muscle spasms!

&atients receive appro#imately to 10 treatments administered over a period o about

two weeks! Conusion and memory loss are minimized by the common practice o

applying the current only to the non$dominant 'rainhemisphere, usually the ri(ht)'rain

he&ishere! -evertheless, some memory loss still occurs. anterograde memory

/the a'ilit!to learn new material returns relatively rapidly ollowing treatment, butretrograde memory /the ability to remember past events is more strongly aected!

There is a marked memory deicit one week ater treatment which gradually improves

over the ne#t si# or seven months! %n many cases, however, subtle memory losses

persist even beyond this point, and can be serious and debilitating or some patients!


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ECT can only be administered with the inormed consent o the patient and is

used primarily or severely depressed patients who have not responded to

antidepressant medications or whose suicidal impulses make it dangerous to wait until

such medications can take eect! ECT is also administered to patients with 'iolar

%isor%er! Contrary to the theories o those who irst pioneered its use, ECT is not an

eective treatment or schizophrenia unless the patient is also suering rom

depression! The rate o relapse ater administration o ECT can be greatly diminished

when it is accompanied by other orms o treatment!

esearchers are still not sure e#actly how electro$convulsive therapy works,

although it is known that the seizures rather than the electric current itsel are the basis

or the treatment2s eects, and that seizures can aect the unctioning oneurotransmitters in the brain, including nor epinephrine and serotonin, which are

associated with depression! They also increase the release o pituitary hor&ones!

ecause o its possible side eects, as well as the public2s level o discomort with both

electrical shock and the idea o inducing seizures, ECT remains a controversial

treatment method! %n 1945, the city o erkeley, Caliornia, passed a reerendum making

the administration o ECT a misdemeanor punishable by ines o up to 6700 and si#

months in prison, but the law was later overturned!

%n the 190s there were ew treatments available or mental illnesses! 'ne

regimen, called shock therapy, involved the use o drugs or electricity to treat severe

mental disorders by inducing coma or convulsions! Early shock treatments used such

chemicals as insulin, camphor, or metrazol! %n(ections o increasing levels o insulin

deo#ygenated the blood and induced a deep coma! 8etrazol was used to produce

convulsions! The therapeutic beneit o the drug shock therapies seemed to be greatest

with schizophrenics! %n 1934 )go Cerletti o %taly irst developed an electric shock

therapy techni+ue! %t proved to be less dangerous, more controlled, and less e#pensive

than the drug treatments! %t rapidly became the primary medical treatment or the

mentally ill, since there was little else available! "t a meeting o the -ew ork "cademy

o 8edicine in :ebruary 19, physicians concluded that the beneits o

electroconvulsive therapy ar outweighed the dangers involved! &hysicians considered
http://www.encyclopedia.com/topic/California.aspxhttp://www.encyclopedia.com/topic/California.aspx


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electric$shock therapy especially beneicial in cases o severe depression or

;melancholia,; as an alternative to months or years in a mental hospital! %n these cases

treatments were used about three times a week or two to eight weeks or more! %n

cases o e#treme psychosis psychiatrists gave as many as three treatments a day over

a period o several weeks!

De*inition

Electroconvulsive therapy /ECT is a medical treatment or severe mental illness

in which a small, careully controlled amount o electricity is introduced into the brain!

This electrical stimulation, used in con(unction with anesthesia and muscle rela#ant

medications, produces a mild generalized seizure or convulsion!


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consent orm! This orm gives the doctor and the hospital legal permission to administer

the treatment!

"ter the orm has been signed, the doctor perorms a complete physical

e#amination and orders a number o tests that can help identiy any potential problem!These tests may include a chest # ray. an electrocardiogram /E=>. a CT scan. a

urinalysis. a spinal # ray. a brain wave tracing /EE>. and a complete blood count

/CC!

?ome medications, such as lithium and a class o antidepressants known as

monoamine o#idase inhibitors /8"'%s, should be discontinued or some time beore

ECT administration! &atients are instructed not to eat or drink or at least eight hours

prior to the procedure in order to reduce the possibility o vomiting and choking! @uringthe procedure itsel, the members o the health care team closely monitor the patient2s

vital signs, including blood pressure, heart rate and o#ygen content!

A*tercare

The patient is moved to a recovery area ater an ECT treatment! Aital signs are

recorded every ive minutes until the patient is ully awake, which may take 17B30

minutes! The patient may e#perience some initial conusion, but this eeling usually

disappears in a matter o minutes! The patient may complain o headache, muscle pain,or back pain, which can be +uickly relieved by aspirin or another mild medication!

:ollowing successul ECT treatments, patients with bipolar disorder may be given

maintenance doses o lithium! ?imilarly, patients with depression may be given

antidepressant drugs! These medications are intended to reduce the chance o relapse

or the recurrence o symptoms! ?ome studies have estimated that appro#imately one$

third to one$hal o patients treated with ECT relapse within 15 months o treatment!

"ter three years, this igure may increase to two$thirds! :ollow$up care with

medications or bipolar disorder or depression can reduce the relapse rate in the year

ollowing ECT treatment rom 70 to 50! ?ome patients might relapse because they

do not respond well to the medications they take ater their ECT sessions are

completed! %n some cases, patients who relapse may suer rom severe orms o

depression that are especially diicult to treat by any method!


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Ris,s

ecent advances in medical technology have substantially reduced the

complications associated with ECT! These include memory loss and conusion! &ersons

at high risk o having complications ollowing ECT include those with a recent heart

attack, uncontrolled high blood pressure, brain tumors, and previous spinal in(uries!

'ne o the most common side eects o electroconvulsive therapy is memory loss!

&atients may be unable to recall events that occurred beore and ater treatment!

Elderly patients, or e#ample, may become increasingly conused and orgetul as the

treatments continue! %n a minority o individuals, memory loss may last or months! :or

the ma(ority o patients, however, recent memories return in a ew days or weeks!

Elderly patients receiving ECT may e#perience disturbances in heart rhythm. slowheartbeat /bradycardia. or rapid heartbeat /tachycardia. and an increased number o

alls! "s many as one$third o elderly patients may e#perience such complications

ollowing the procedure!

Nor&al results

ECT oten produces dramatic improvement in the signs and symptoms o ma(or

depression, especially in elderly patients! ?ometimes the beneits are evident even

during the irst week o treatment!

" remarkable 90 o patients who receive ECT or depression respond

positively! y contrast, only D0 respond as well when treated with antidepressant

medications alone!


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" ew patients are placed on maintenance ECT! This term means that they must

return to the hospital every one to two months as needed or an additional treatment!

These persons are thus able to keep their illness under control and lead normal and

productive lives!

A'nor&al results

% an ECT$induced seizure lasts too long /more than two minutes during the

procedure, physicians will control it with an intravenous inusion o an anticonvulsant

drug, usually %ia$ea&/Aalium!

'verall, ECT is a very sae procedure! The complications encountered are no dierent

rom those that may occur with the administration o anesthesia without ECT! There is

no convincing evidence o long$term harmul eects rom ECT! esearchers are

continuing to e#plore its potential in treating other disorders!

SOMATIC THERAPIES

So&atic s!cholo(!is an interdisciplinaryield involving the study o the body,

somatic e#perience, and the embodied sel, including therapeutic

and holisticapproaches to body! The word somatic comes rom the ancient >reek root

FGHI$ somat$ /body! The word psychology comes rom the ancient

>reek psyche/breath, soul hence mind and $logia /study! &sychotherapies a generalbranch o this sub(ect, whilst ?omatherapy, Eco$somatics and @ance therapy, or

e#ample, are speciic branches o the sub(ect! ?omatic psychology is a ield o study

that bridges the 8ind$body dichotomy!


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subse+uent developments and other inluences /reN entry on ody &sychotherapyand

?omatic &sychology is o particular interest in trauma work!

There is increasing use o body$oriented therapeutic techni+ues within

mainstream psychology /like E8@and 8indulnesspractice and psychoanalysis hasrecognized the use o somatic resonance, embodied trauma, and similar concepts, or

many years!

Oistorically, there are early practitioners, or e#ample, the &ersian

physician"vicenna/940 to 103D CE who perormed psychotherapy only by observing

the movement o the patient2s pulse as he listened to their anguish! This is reminiscent

o both traditional Tibetan medicineand current energytherapies that employ tapping

points on a meridian! "s a contrast to the


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potency drugs achieve eicacy at lower dosages! Oal lie is the time it takes or a hal o

the drug to be removed rom the bloodstream! lood with a shorter hal$lie may need to

be given 3 or times a day, but drugs with a longer hal$lie may be given once a day!

The time that the drugs need to leave the body completely ater it has been

discontinued is about 7 times its hal lie!

&rinciples that >uide &harmacologic Treatment

The ollowing are several principles that guide the use o medications to treat psychiatric

disorderN

" medication is selected based on its eect on the clients target symptoms such

as delusional thinking, panic attacks, or hallucinations! The medications

eectiveness is evaluated largely by its ability to diminish or eliminate the target

symptoms! 8any psychotropic drugs must be given in ade+uate dosages or some time

beore their ull eect is realized! :or e#ample, tricyclic antidepressants can

re+uire to * weeks beore the client e#periences optimal therapeutic beneit! The dosage o medication oten is ad(usted to the lowest eective dosage or the

client! ?ometimes client may need higher dosages to stabilize his or her target

symptoms, whereas lower dosages can be used to sustain those eects

overtime! "s a rule, older adults re+uire lower dosages o medications than do younger

clients to e#perience therapeutic eects! %t also may take longer or a drug to

achieve its ull therapeutic eect in older adults! &sychotropic medications oten are decreased gradually /tapering rather than

abruptly! This is because o potential problem with rebound /temporary return o

symptoms, recurrence o the original symptoms, or withdrawal /new symptoms

resulting rom discontinuation o the drug!

:ollow up care is essential to ensure compliance with the medication regimen, to

make needed ad(ustments in dosage, and no mange side eects! Compliance with the medication regimen oten is enhanced when the regimen is

as simple as possible in terms o both the number o medications prescribed and

the number o daily doses!


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Qists o medications such asN

"ntipsychotic @rugs

"ntidepressant @rugs "ntian#iety @rugs /"n#iolytics

@isuliram /"ntabuse

SUPPORTIVE PSCHOTHERAP

$%s a psychotherapeutic approach that integrates psychodynamic, cognitive$

behavioral, and interpersonalconceptual models and techni+ues!

$%s used primarily to reinorce a patientRs ability to cope with stressors through anumber o key activities, including attentively listening and encouraging

e#pression o thoughts and eelings. assisting the individual to gain a greater

understanding o their situation and alternatives. helping to buttress the

individualRs sel$esteem and resilience. and working to instill a sense o hope!

$%s a type o psychological therapy that aims to help the client to unction better

by providing personal support

$%n general, the therapist does not ask the client to change. rather they act as a

support person, allowing the client to relect on their lie situation in an

environment where they are accepted!

$%t is a common orm o therapy that may be provided over the short or long term,

depending on the individual and the speciic set o circumstances!

$The ob(ective o the therapistis to reinorce the patient2s healthy and adaptivepatterns o thought behaviors in order to reduce the intrapsychic conlicts that

produce symptoms o mental disorders!

$)nlike in psychoanalysis, in which the analyst works to maintain a neutral

demeanor as a ;blank canvas; or transerence, in supportive therapy the
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therapist engages in a ully emotional, encouraging, and supportive relationship

with the patient as a method o urthering healthy deense mechanisms,

especially in the conte#t o interpersonal relationships!

$This therapy has been used or patients suering rom severe cases o addiction

as well as ulimia -ervosa, stress and other mental illnesses! Trust is very

important between patients and the doctors to help patients get better treatment

eect!

$%n this orm o therapy, a trusting relationship between the patient and the

therapist is integral to the patientRs healing or progress! %t is important that the

individual has conidence that the therapist can understand their eelings o

despair or anger, yet still maintain a belie in their ability to recover! They must

also help the patient to understand the dierence between recovering and

gaining back what has been lost! %n many cases, re$establishing the past or prior

patterns o lie is not possible, and the patient will need to come to terms with the

changes that need to be made!

A. NURSE)PATIENT RELATIONSHIP THERAP

Oildegard &eplauN Therapeutic nurse$ patient elationship&eplau studied and wrote about the interpersonal processes and the phases o

the nurse$ client relationship or 37 years! Oer work provides the nursing proession with

a model that can be use to understand and document progress with interpersonal

interactions! &eplauRs model has three phasesN orientation, working, and resolution

phase or termination!

Orientation hase$ begins when the nurse and client meet and ends when the client

begins to identiy problems to e#amine!

0or,in( Phase$ o the nurse client relationship is usually divided into two sub phasesN

@uring problem identiication, the client identiies the issues or concerns causing

problems! @uring e#ploitation, the nurse guides the client to e#amine eelings and

responses and to develop better coping skills and a more positive sel image
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Ter&ination or resolution hase$ is the inal stage in the nurse client relationship! %t

begins when the problems are resolved and it ends when the relationship is ended

De*inition o* /rous

is a number o persons who gather in a ace to ace setting to accomplish tasks

that re+uire cooperation, collaboration, or working together!

%s a collection o individuals whose association is ounded on commonalties o

interest, norms and valuesS

/rou Conte1t

eers to what is said in the conte#t o the group, including educational material,

eelings and emotions, or discussions o the pro(ect to be completed!

/rou Process

eers to the behavior o the group and its individual members, including seating

arrangement, tone voice, who speaks to who, who is +uiet, and so orth!

Sta(es o* /rou Develo&ent

Pre(rou Sta(es

8embers are selected, the purpose or work o the group is identiied, and group

structure is addressed!

Initial2'e(innin( Sta(es

8embers introduce themselves, a leader can be selected, group purpose is

discussed, and rules and e#pectation or group participation are reviewed!

0or,in( Sta(es

egins as members begin to ocus their attention on the purpose or task the

group is trying to accomplish! &hase in which several group characteristics maybe seen like cohesiveness and

competition or rivalry!


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3inal2Ter&ination Sta(e

'ccur beore the group disbands!

roups oten have an identiied or ormal leader$ someone designated to lead

the group! %n therapy and education groups, a ormal leader is usually identiied based

on hisPher education, +ualiications, and e#perience! ?upport and sel groups usually do

not have identiied ormal leaders. all members are seen as e+ual! Eective group,leaders ocus on group process as well as on group content! OisPher tasks include

giving eedback and suggestions. encouraging participation rom all members. clariying

thoughts, eelings, and ideas. summarizing progress and accomplishments. and

acilitating progress through the stages o group development!

/ROUP ROLES

oles are the parts that members play within the group! ?ome roles acilitate the

work o the group, whereas others can negatively aect the process or outcome o the

group! >rowth$producing roles include the inormation seeker, opinion seeker,

inormation giver, energizer, coordinator, harmonizer, encourager, and elaborator!

>rowth$%nhibiting roles include monopolize, aggressor, dominator, critic, recognition

seeker, and passive ollower!

-./ROUP THERAP

Clients participate in sessions with a group o people! " type o psychiatric care in which several patients meet one or more

therapists at the same time! The group therapy model is particularly

appropriate or psychiatric illnesses that are support$intensive, such as

an#iety disorders, but is not well suited or treatment o some other

psychiatric disorders!


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%s a orm o psychosocial treatment where a small group o patients meet

regularly to talk, interact, and discuss problems with each other and the

group leader /therapist!

The therapeutic results o group therapy includes gaining new inormation, or

learning. gaining inspiration or hope, interacting with others. eeling o

acceptance and belonging. becoming aware that one is not alone and that others

share the same problems. gaining insight into ones problems and behaviors and

how they aect others. giving o onesel or the beneit o others/altruism!

PSCHOTERAPH /ROUPS

The goal o psychotherapy group is or members to learn about their behavior

and to make positive changes in their behavior by interacting and communicating with

others as a member o a group! &sychotherapy groups are oten ormal in structure with

one or two therapists as the group leader or the entire group is to establish the rules or

the group!

There are two types o groupsN open groups and closed groups! Oen (rous

are ongoing and run indeinitely, allowing members to (oin or leave the group as they

need to while the Close% (rous are structured to keep the same members in thegroup or a speciied number o sessions!

C.3AMIL THERAP

:amily Therapy is a orm o group therapy in which the client and his or her

amily members participate! The goals include understanding how amily dynamics

contribute to the clients psychopathology, mobilizing the amilys inherent strengths and

unctional resources, restructuring maladaptive amily behavioral styles, and

strengthening amily$problem solving behaviors! %t can be used both to asses and to

treat various psychiatric disorders!


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EDUCATION /ROUPS

The goal o the group is to provide inormation to members to a speciic issue$or

instance, stress management, medication management, or assertive training! %t is

usually scheduled or a speciic number o sessions and retains the same members orthe duration o the group!

SUPPORT /ROUPS

%t is organized to help members who share a common problem to cope with it!

?upport groups oten provide a sae place or group members to e#press their eelings

o rustration, boredom, or unhappiness and also to discuss common problems and

potential solutions!

COUNSELLIN/

$'ne o the oles or :unction o a -urse

$ is the process o helping a client to recognize and cope with stressul psycologic

and stressul problems, to develop improved interpersonal relationships, and to promote

personal growth! %t involves providing emotional, intellectual and psychological support!

$The nurse counsel primarily healthy individuals with normal ad(ustment

diiculties and ocuses on helping the person develop new attitudes, eeling and

behaviour by encouraging the client to look at alternative behaviours, recognize

choices, and develop sense o control!

Airginia ?atir$ e#plained how important the clientRs participation is to inding eective

and meaningul solutions to the problem!

MENTAL HEALTH TEACHIN/2 CLIENT EDUCATION

$Teaching$ coaching is one o the standards o care or the &sychiatric$8ental

Oealth -urse! "ccording to this standard, the &8O nurse Uattempts to understand the

lie e#perience o the client and uses this understanding to support and promote

learning related to health and personal developmentV!


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$ased on principles o teaching, health teaching involves collaborating with the

client to determine learning needs and transmitting new inormation, while considering

the conte#t o the clientRs lie e#periencesN

The nurse considersN

1! eadiness$ eadiness may include readiness or change, readiness to

engage in a speciic program or with a speciic helper and readiness to

continue the ongoing process o rehabilitation!5! Culture$


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$is a type o motivation that works to make people eel good about themselves

and to maintain sel$esteem! This motive becomes especially prominent in situations o

threat, ailure or blows to one2s sel$esteem

Levels o* Sel*)Enhance&ent4

O'serve% E**ect$ ?el$enhancement at the level o an observed eect describes

the product o the motive! :or e#ample, sel$enhancement can produce inlated

sel$ratings /positive illusions! ?uch ratings would be sel$enhancement

maniested as an observed eect! %t is an observable instance o the motive! On(oin( Process) ?el$enhancement at the level o an ongoing process

describes the actual operation o the motive! :or e#ample, sel$enhancement can

result in attributing avorable outcomes to the sel and unavorable outcomes toothers /sel$serving attribution bias! The actual act o attributing such ratings

would be sel$enhancement maniested as an ongoing process! %t is the motive in

operation! Personalit! Trait)?el$enhancement at the level o a personality trait describes

habitual or inadvertent sel$enhancement! :or e#ample, sel$enhancement can

cause situations to be created to ease the pain o ailure /sel$handicapping! The

abrication o such situations or e#cuses re+uently and without awareness would

be sel$enhancement maniested as a personality trait! %t is the repetitive

inclination to demonstrate the motive! Un%erl!in( Motive) ?el$enhancement at the level o an underlying motive

describes the conscious desire to sel$enhance! :or e#ample, sel$enhancement

can cause the comparison o the sel to a worse other, making the sel seem

greater in comparison /strategic social comparisons! The act o comparing

intentionally to achieve superiority would be sel$enhancement maniested as an

underlying motive! %t is the genuine desire to see the sel as superior! (The four

levels of self-enhancement manifestation as defined by Sedikides & Gregg

(2008)

Di&ensions4


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Sel*)A%vance&ent vs. Sel*)Protection) ?el$enhancement can occur by either

sel$advancing or sel$protecting that is either by enhancing the positivity o one2s

sel$concept, or by reducing the negativity o one2s sel$concept! ?el$protection

appears to be the stronger o the two motives, given that avoiding negativity is o

greater importance than encouraging positivity! Pu'lic vs. Private)?elBenhancement can occur in private or in public! &ublic

sel$enhancement is obvious positive sel$presentation, whereas private sel

enhancement is unnoticeable e#cept to the individual Central vs. Periheral)&otential areas o sel$enhancement dier in terms how

important, or central, they are to a person! ?el$enhancement tends to occur

more in the domains that are the most important to a person, and less in more

peripheral, less important domains! Can%i% vs. Tactical$ ?el$enhancement can occur either candidly or tactically!

Candid sel$enhancement serves the purpose o immediate gratiication whereas

tactical sel$enhancement can result in potentially larger beneits rom delayed

gratiication! Tactical sel$enhancement is oten preerred over candid sel$

enhancement as overt sel$enhancement is socially displeasing or those around

it!

T!es4

Sel*)servin( attri'ution 'ias$ &eople have a tendency to e#hibit a sel$serving

attribution bias, that is to attribute positive outcomes to one2s internal disposition

but negative outcomes to actors beyond one2s control e!g! others, chance or

circumstance! Selective &e&or!) &eople sometimes sel$enhance by selectively remembering

their strengths rather than weaknesses! This pattern o selective orgetting has

been described as mnemic neglect! 8nemic neglect may relect biases in the

processing o inormation at encoding, retrieval or retention! ?elective acceptance M reutation$ ?elective acceptance involves taking as act

sel$lattering or ego$enhancing inormation with little regard or its validity!

?elective reutation involves searching or plausible theories that enable criticism

to be discredited!


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?trategic ?ocial Comparisons$ The social nature o the world we live in means

that sel$evaluation cannot take place in an absolute nature $ comparison to other

social beings is inevitable! 8any social comparisons occur automatically as a

conse+uence o circumstance, or e#ample within an e#am sitting social

comparisons o intellect may occur to those sitting the same e#am!

)pward ?ocial Comparisons$ involves comparing onesel to an individual

perceived to be superior to or better than one! @ownward ?ocial Comparisons$ involve comparing onesel to an

individual perceived to be inerior to or less skilled than the sel!

@ownwards social comparisons serve as a orm o ego$deense whereby

the ego is inlated due to the sense o superiority gained rom such

downwards social comparisons! Qateral ?ocial Comparisons$ comparisons against those perceived as

e+ual to the sel can also be sel$enhancing!

ASSERTIVE TRAININ/

$it helps the person take control over lie situations

$ :orm o behaviour therapy designed to help people stand up or themselvesWto

empower themselves, in more contemporary terms!

$it works best when the speaker is calm, speciic, actual statements and ocuses

on U%V statements!

Purose

$ To teach persons appropriate strategies or identiying and acting on their

desires, needs, and opinions while remaining respectul o others

$ )seul in variety o situations, such as resolving conlicts, solving problems and

e#pressing eelings or thoughts

3our t!es o* resonses

1! "ggressive $ a style in which individuals e#press their eelings and opinions and

advocate or their needs in a way that violates the rights o others! Thus,

aggressive communicators are verbally andPor physically abusive! "ggressive

communication is born o low sel$esteem /oten caused by past physical andPor

emotional abuse, unhealed emotional wounds, and eelings o powerlessness!


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5! &assive$aggressive $ a style in which individuals appear passive on the surace

but are really acting out anger in a subtle, indirect, or behind$the$scenes way!

&risoners o


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Eat well$balanced meals!

Qimit intake o caeine and alcohol!

>et enough rest and sleep!

?et realistic goals and e#pectations!

Qearn stress management techni+ues such as rela#ation, guided imagery,

and meditation. practice them as part o your daily routine!

-EHAVIOR MODI3ICATION

ehavior 8odiication is a therapeutic techni+ue based on the work o!:!

?kinner, a amous psychologist who is known as the ;:ather o ehaviorism!; ?kinner

developed a theory o operant conditioning, which states that all behavior is governed

by reinorcing and punishing stimuli! ehavior modiication uses a scheduled approach

that rewards desired behavior and ;punishes; undesirable behavior! This techni+ue

continues to be used in therapy and issued in many psychological settings!

ehavior modiication is a term used in behavioural therapies to denote methods

or conditioning behavior! %t has its roots in classical conditioning, which involves the

pairing o a behavior with reinorcement! The main idea is to reward the person i they

implement a desired behavior or i they stop undesired behavior! ehavior modiication

can also involve incurring an unpleasant conse+uence or undesired behavior! ehavior

modiication is used in a variety o situations, ranging rom the behaviors o a child in the

classroom and at home to the behavior o adult prison inmates! This conditioning may

be implemented by an authority igure, or it may be used in sel$help e#ercises!

ehavior 8odiication is a method o attempting to strengthen a desired behavior

or response by reinorcement, either positive! :or e#ample, i the desired behavior is

assertiveness, wherever the client uses assertiveness skills in a communication group,

the group &'?%T%AE E%-:'CE8E-T is by giving the client attention and positive

eedback! -E>"T%AE E%-:'CE8E-T involves removing a stimulus immediately

ater a behavior occurs so that the behavior is more likely to occur again! :or e#ample,i a client becomes an#ious when waiting to talk in a group, he or she may volunteer to

speak irst to avoid an#iety!

The &urpose o ehavior modiication is used to treat a variety o problems in

both adults and children! ehavior modiication has been successully used to treat


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'bsessive$Compulsive@isorder /'C@, "ttention$@eicitPOyperactivity @isorder /"@O@,

&hobias and Enuresis /bed$wetting!

CO/NITIVE RESTRUCTURIN/

Qearning how to think dierently to change Uaulty thinkingV to a more

realistic, rational, positive thinking!

"lso reerred to as cognitive reraming which is a behavior techni+ue

associated with cognitive therapy!

eing able to recognize when thoughts are irrational and learn to replace

them with rational thoughts!

Cognitive restructuring is most beneicial or those who suer rom an#iety,

depression, social phobia, eating disorders, etcY "llows people to ace their daily lives with conidence because they have

learned to control their thinking and change irrational thoughts into rational

thoughts!

Co(nitive)'ehavioral Thera! "C-T#

%t ocuses on immediate thought processingB how a person

perceives or interprets hisPher e#perience and determines how

hePshe eels and behaves!

%t involves learning how to think dierently, to change undamental

Zaulty thinking,R and replace it with more rational, realistic, and

perhaps positive thinking!

%t ocuses on helping its users understand the negative thought

processes that can cause problems, and on restructuring these so

that they are air and balanced!

Dr. Aaron T. -ec,

&ioneered CT in the 19*0Rs while he was a psychiatrist at the )niversity o

&ennsylvania

@r! eck designed and carried out e#periments to test psychoanalytic concepts

o depression


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Oe ound that depressed patients e#perienced streams o negative thoughts and

named these cognitions Uautomatic thoughtsV

[ "utomatic thoughts

Critical thoughts that re+uently think and say to yoursel!

Thoughts which sabotage success M happiness

Thoughts which makes eel sad or an#ious

Can occur consciously or without any awareness that youRre

thinking them!

5. Rational E&otive Thera! "RET#

" cognitive therapy using conrontation o Uirrational beliesV that

prevent the individual rom accepting responsibility or sel and

behavior!

%t emphasizes that thoughts aect human emotion as well as

behavior and irrational belies are mainly responsible or a wide

range o disorders!

)ses "C techni+ue to help people identiy these automatic

thoughts!

"N "ctivating "gentP "dversity

N elieve

CN Conse+uences

E#ampleN

"Nour employer alsely accuses you o taking money rom

her purse and threatens to ire you!

Nou believe, U?he has no right to accuse me! ?heRs a

bitch\V

CNou eel angry!

% you had held a dierent belie, the emotional

response would have been dierent!

"Nour employer alsely accuses you o taking money rom

her purse and threatens to ire you!


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Nou believe, U% must not lose my (ob! That would be

unbearable!V

CNou eel an#ious!

"C model shows that " does not cause C! %t is

that causes C!

Al'ert Ellis

[ "lbert Ellis ounded ational Emotive Therapy /ET!

[ Oe identiied Uirrational beliesV that people use to make their selves unhappy!

[ Oe believes that people have Uautomatic thoughtsV that cause them unhappiness

in certain situations!

6. Lo(othera! %t means 2therapy through meaning2!

" therapy designed to help individuals assume personal

responsibility /the search or meaning in lie is a central theme

Third Aiennese ?chool o &sychology, ollowing :reud and "dler

"ccording to Qogotherapy, we can discover our meaning in lie

in three dierent waysN

1! by creating a work or doing a deed5! by e#periencing something /goodness, truth, beauty,

nature and culture or encountering someone /by

e#periencing another human being in his very

uni+ueness. by loving him

3! by the attitude we take toward unavoidable suering!

Vi,tor E&il 3ran,l

[ Oe is a &roessor o -eurology and &sychiatry[ :ounder o Qogotherapy and E#istential "nalysis

[ "uthored the book an!s Search for eaning$ belongs to ;the ten most

inluential books in "merica!;

7. /estalt Thera!


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" therapy ocusing on the identiication o eelings in the here and

now, which leads to sel$acceptance!

%t is used to increase clientRs sel$awareness by having them write

and read letters, keep (ournals, and perorm other activities

designed to put the past to rest and ocus on the present!

3re%eric, S. Perls- Oe believed that sel$awareness leads to sel$acceptance and

responsibility or oneRs own thoughts and eelings!

8. Realit! Thera!

Therapeutic ocus is need or identity through responsible behavior!

%ndividuals are challenged to e#amine ways in which their behavior

thwarts their attempts to achieve lie goals!

0illia& /lasser

[ @evised an approach called eality Therapy!

[ Oe developed this approach while working with persons with delin+uent behavior,

unsuccessul school perormance, and emotional problems!

[ Oe believed that persons who were unsuccessul oten blamed their problems on

other people, the system, or the society!

[ Oe believed they needed to ind their own identities through responsible

behavior!

MILIEU THERAP

8ilieu therapy involves clientsR interaction with one another, that is, practicing

interpersonal relationship skills, giving one another eedback about behavior and

working cooperatively as a group to solve day$to$day problems! ?ullivan coined the term

Particiant O'server or the therapist role, meaning that the therapist both participates


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and observes the progress o the relationship! %n the concept o therapeutic community

or milieu, the interaction among the client is seen as beneicial and treatment

emphasizes the role o the client$to$client interaction! %t was believe that the interaction

between the client and the psychiatrist was the one essential component to the clientRs

treatment!

'b(ectives o 8ilieu Therapy

To promote a undamental respect or individuals /both clients and sta!

To use opportunities or communication between client and sta or ma#imum

therapeutic beneit!

To encourage clients to act at a level e+ual to their ability and to enhance their

sel esteem/ autonomy is reinorced &rovide saety and protection or all clients and promote social interaction

&ositive &eer pressure is utilized to reinorce rules and regulations!

"dvantagesN

1! 8ilieu therapy creates a dierent type o attitude and behaviour in the patient

because the environment is like home!

5! The patient learns to make decisions which improve his sel conidence!

3! " therapeutic milieu is a sae space, a non punitive atmosphere, which minimize

the environmental stress and provides a chance or rest and nurturance o sel, a

time to ocus on the developments o strengths, and an opportunity to learn to

identiy alternatives or solutions to problems!

! &atient develops harmonious relationships with other members o the community!

@isadvantagesN

1! ole blurring between sta and patient!

5! 8ilieu therapy is limited to only hospitalized patients!


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3! Conlict resolution is needed as part o the staRs skills!

! Qow client$ to$ sta ratio!

7! e+uires continuous open communication among all sta and clients!PLA THERAP

$is also known as TOE"&E)T%C &Q", play techni+ues are used to understand

the childRs thoughts and eelings and to promote communication! %t is used by

&sychiatrists!

@"8"T%C &Q"

$ %s acting out an an#iety$ producing situation such as allowing the child to be a

doctor or use a stethoscope or other e+uipment to take care o a patient /a doll! &lay

techni+ues to release energy could include pounding pegs, running, or working with

modeling clay!

CE"T%AE &Q"

$ %t is a techni+ue that can help children to e#press themselves, or e#ample, by

drawing pictures o themselves, their amily and peers! These techni+ues are especially

useul when children are unable or unwilling to e#press themselves verbally!

PSCHOSOCIAL SUPPORT INTERVENTIONS

Ps!chosocial Interventions$ -ursing activities that enhance the clientRs social and

psychological unctioning and improve social skills, interpersonal relationships, and

communication! -urses oten use psychosocial interventions to help meet clientsR needs

and achieve outcomes in all practice settings!

:or e#ample, a medical$surgical nurse might need to use interventions that incorporate

behavioral principles such as setting limits with manipulative behavior or getting positive

eedback! E#ampleN " client with @8 &atientN U% promise to have (ust one bite o cake!

&lease\ %tRs my grandsonRs birthday cake!V -urseN U% canRt give you permission to eat the


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cake! our blood glucose level will go up i you do, and your insulin canRt be ad(usted

properly!V

PSCHO SPIRITUAL INTERVENTIONS

&sychotherapy can help patients with religious and spiritual problems to shape

their e#perience into a coherent narrative, to see the ;message; contained in their

e#periences, and to create a lie$airming personal mythology that integrates their

spiritual problem! &sycho$spiritual interventions can be essential to acilitating recovery

and change! "t times these could includeN

$Educating the patient about the spiritual emergence process that is part o a

spiritual (ourney with a potentially positive outcome!

$Encouraging the patient2s involvement with a spiritual path or religious

community that is consistent with their e#periences and values!

$Encouraging the patient to seek support and guidance rom a credible and

appropriate religious or spiritual leader!

$Encouraging the patient to engage in religious and spiritual practices consistent

with their belies /e!g!, prayer, meditation, reading spiritual books, acts o worship, ritual,

orgiveness and service

$8odeling hisPher own spirituality /when appropriate, including a sense ospiritual purpose and meaning, hope, and aith in something transcendent

COMPLEMENTAR AND ALTERNATIVE THERAPIES

National Center *or Co&le&entar! an% Alternative Me%icine/-CC"8

The National Center *or Co&le&entar! an% Alternative Me%icine /-CC"8 is a

ederal government agency or scientiic research on complementary and alternative

medicine /C"8! This agency is a part o -ational %nstitutes o health in the @epartment

o Oealth and Ouman ?ervices! This )nited ?tates government agency is ormerly

known as O**ice o* Alternative Me%icine/OAM that investigates in dierent healing

practices in the conte#t o rigorous science, in training complementary and alternative

medicine researchers, and in disseminating authoritative inormation to the public and

proessionals!

NCCAM9s ro(ra&s an% or(ani$ation incororate 7 lon()ran(e (oals4


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"dvance the science and practice o symptom management!

@evelop eective, practical, personalized strategies or promoting health and

well$being! Enable better evidence$based decision making regarding C"8 use and its

integration into health care and health promotion!

3ive &a:or o':ectives serve the (oals4

"dvance research on mind and body interventions, practices, and disciplines!

"dvance research on C"8 natural products!

%ncrease understanding o ;real world; patterns and outcomes o C"8 use and

its integration into health care and health promotion! %mprove the capacity o the ield to carry out rigorous research!

@evelop and disseminate ob(ective, evidence$based inormation on C"8

interventions!Co&le&entar! Me%icine includes therapies used "ith conventional medicine

practices /the medical model!#onventional edicine $ractices are treatments

prescribed by the 8edical @octors /8!@!. this is the UregularV and UstandardV medicine!

Conducting research on the use o chiropratic massage and antidepressant medications

to treat depression is an e#ample o complementary medicine research!

Alternative Me%icineincludes therapies used in %laceo conventional treatment!

-CC"8 conducts clinical research to help determine the saety and eicacy o these

practices! ?tudying the use o ?t! JohnRs worth to treat depression /instead o using

antidepressant medication would be an e#ample o researching alternative medicine!

Conducting research on the use o chiropratic massage and antidepressant medications

to treat depression is an e#ample o complementary medicine research!

Inte(rative Me%icinecombines conventional medical therapy and C"8 therapies that

have scientiic evidence supporting their saety and eectiveness!

-CC"8 studies a wide variety o complementary and alternative therapiesN

lternative medical systems include homeopathic medicine and naturopathic

medicine in


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'iologically based thera%iesuse substances ound in nature such as herbs, ood

and vitamins! @ietary supplements, herbal products, herbal teas, aromatherapy,

and a variety o diets are included! ani%ulative and body-based thera%iesare based on manipulation or movement

o one or more parts o the body, such as therapeutic massage and chiropathic or

osteopathic manipulation!

nergy thera%ies include t"o ty%es of thera%y 'io*iel% theraies, intended to

aect energy ields that are believed to surround and penetrate the body such as

therapeutic touch, +i gong, and eiki, and 'ioelectrical)'ase% theraies

involving the unconventional use o electromagnetic ields, such as pulsed ields,

magnetic ields, and "C or @C ields! ]i gong is a part o Chinese medicine that

combines movement, meditation, and regulated breathing to enhance the low o

vital energy and promote healing! eiki /which in Japanese means universal lie

energy is based on the belie that when spiritual energy is channelled through a

eiki practitioner, the patientRs spirit and body are healed!

Client may be reluctant to tell the psychiatrist or primary care provider about the use o

C"8! Thereore, it is important that the nurse ask clients speciically about use o herbs,

vitamins, or other health practices in a non$(udgemental way!

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