Behavioral Health Exam 2
Advantages of Therapeutic Groups: 1) Treat multiple patients at once
2) Learn from others' perspectives
3) Safe place to practice skills
4) Promotes cohesion/support
Disadvantages of Therapeutic Groups: 1) Privacy concerns (must sign a consent)
2) Disruptions
3) Group norms may limit expression (time limits can also hurt this)
4) Not beneficial for all patients
5) Large groups can limit individual participation
Therapeutic Factors of Group Experience (factors 1) Instillation of hope ("If that person can get better then maybe I can too")
common to all groups): 2) Universality (not alone)
3) Altruism (selflessness - sponsors in the AA group)
4) Cohesion (support system)
5) Imparting information (speaker comes to share wisdom)
6) Interpersonal learning (learn from each other)
7) Development of social skills
Concepts Common to All Groups: Group content: what is said
Group process: everything else that is not group content (expressions,
nonverbals)
Group work: recognizing what happens on the surface and what is going on
underneath
Group norms: established expectations of acceptable behaviors
Ethical Issues in Group Therapy: 1) Informed consent
2) Confidentiality (need to address confidentiality as a group norm but cannot
guarantee it)
3) Rules about leaving or socializing outside of the group (could lead to 2 people
talking about another, could effect group dynamic if 2 people get too close)
4) Member removal considerations (aggression, violation of norms)
5) Proper training/credentialing
6) Follow ANA scope of practice
7) Follow evidence based practice (stay current)
Psychoanalytic Theory Core Idea: Human behavior is driven by unconscious thoughts, conflicts, and early
childhood experiences. We can get rid of anxiety by preventing conscious
awareness of unconscious feelings
Levels of Awareness: Conscious → what you are aware of now
Preconscious → memories easily retrieved through conscious effort
Unconscious → repressed memories, urges, or trauma
Personality Structure: Id: Resides in the unconscious level of awareness. Instincts, impulses, and the
pleasure principle ("I want it now")
Ego: Resides in the conscious, preconscious, and unconscious levels of
awareness. Reality based problem solver
Superego: Resides in the conscious, preconscious, and unconscious levels of
awareness. This is the moral component of personality ("should/shouldn't")
Defense Mechanisms: These protect a person from anxiety by distorting reality. Types are denial,
projection, repression
Therapy Focus in Psychoanalytic Therapy: Gain insight into unconscious conflicts. Patient talks freely to uncover root
causes
Interpersonal Theory Core Idea: Behavior exists to meet needs through relationships. Mental illness develops
when relationships are disrupted
Interpersonal Therapy is most effective in treating what?: 1) Grief/loss
2) Relationship conflicts (short term in length so good for this)
3) Role transitions
, Behavioral Health Exam 2
Peplau's Contribution (Implications of Interpersonal 1) Shifted focus from what nurses do to patients to what nurses do with patients
Theory in Nursing Practice): 2) Foundation for psych-mental health nursing
3) The nurse-patient relationship is foundational
4) Lowering the patient's anxiety improves their ability to think and function
5) Self-awareness helps keep the focus on the patient
Behavioral Therapy Core Idea: Behavior is learned, therefore it can be changed. Changing behaviors leads to
changing a personality
Behavioral Therapy - Operant Conditioning: The idea that learning occurs through rewards and punishment for voluntary
behavior
Types of Operant Conditioning: Positive Reinforcement: a positive stimulus reinforces behavior (child gets a
piece of candy when they get an A)
Negative Reinforcement: a negative stimulus reinforces behaviors (dog collar
shocks the dog if they cross the line)
Punishment: an unpleasant consequence that diminishes behaviors (child gets
put in timeout)
Other types of behavioral therapies: 1) Modeling: therapist role plays the desired behavior and the patient learns
through imitation (ex: patient needs to have a hard convo so they practice it and
play roles)
2) Exposure Therapy: addresses fears, phobias, and traumatic memories in a
safe environment (ex: therapist talks about or shows pictures of their fear)
3) Aversion Therapy: undesired behavior is extinguished through a negative
stimulus (ex: a medication that gives the person a bad response when taken with
alcohol is used for alcoholics)
4) Biofeedback: body's physiological response is controlled to manage anxiety
Implications of Behavioral Theory in Nursing Practice Focuses on helping the patient manage behaviors that impact thier health
(example: smoking cessation group)
Cognitive Therapy Core Idea: Thoughts create emotions, which then create a behavior
Cognitive Therapy Example: Event: Failed test
Thought: "I'm stupid"
Emotion: Depression
Behavior: Withdrawal
If the thought is changed, the outcome could be changed.
Cognitive Behavioral Therapy (CBT): Most common cognitive therapy. Challenges negative thinking and replaces it
with positive, rational thoughts. Homework (like journaling) aids in identifying
events, related feelings, automatic thought, and create a challenge to the thought
Examples of Cognitive Distortions: All-or-nothing thinking ("I'm an awful test taker")
Overgeneralizing (using always or never)
Mind reading ("they think that i'm fat")
Catastrophizing ("I got a 65 on my exam so they're going to kick me out of the
program")
Emotional reasoning ("im super nervous. that must mean that i'm not be ready to
take this exam")
Labeling ("i'm stupid")
Mental filtering ("i burnt the chicken. that means the party was horrible for
everyone")
Personalization (person is the cause of something even though their is no
evidence of that being true)
Advantages of Therapeutic Groups: 1) Treat multiple patients at once
2) Learn from others' perspectives
3) Safe place to practice skills
4) Promotes cohesion/support
Disadvantages of Therapeutic Groups: 1) Privacy concerns (must sign a consent)
2) Disruptions
3) Group norms may limit expression (time limits can also hurt this)
4) Not beneficial for all patients
5) Large groups can limit individual participation
Therapeutic Factors of Group Experience (factors 1) Instillation of hope ("If that person can get better then maybe I can too")
common to all groups): 2) Universality (not alone)
3) Altruism (selflessness - sponsors in the AA group)
4) Cohesion (support system)
5) Imparting information (speaker comes to share wisdom)
6) Interpersonal learning (learn from each other)
7) Development of social skills
Concepts Common to All Groups: Group content: what is said
Group process: everything else that is not group content (expressions,
nonverbals)
Group work: recognizing what happens on the surface and what is going on
underneath
Group norms: established expectations of acceptable behaviors
Ethical Issues in Group Therapy: 1) Informed consent
2) Confidentiality (need to address confidentiality as a group norm but cannot
guarantee it)
3) Rules about leaving or socializing outside of the group (could lead to 2 people
talking about another, could effect group dynamic if 2 people get too close)
4) Member removal considerations (aggression, violation of norms)
5) Proper training/credentialing
6) Follow ANA scope of practice
7) Follow evidence based practice (stay current)
Psychoanalytic Theory Core Idea: Human behavior is driven by unconscious thoughts, conflicts, and early
childhood experiences. We can get rid of anxiety by preventing conscious
awareness of unconscious feelings
Levels of Awareness: Conscious → what you are aware of now
Preconscious → memories easily retrieved through conscious effort
Unconscious → repressed memories, urges, or trauma
Personality Structure: Id: Resides in the unconscious level of awareness. Instincts, impulses, and the
pleasure principle ("I want it now")
Ego: Resides in the conscious, preconscious, and unconscious levels of
awareness. Reality based problem solver
Superego: Resides in the conscious, preconscious, and unconscious levels of
awareness. This is the moral component of personality ("should/shouldn't")
Defense Mechanisms: These protect a person from anxiety by distorting reality. Types are denial,
projection, repression
Therapy Focus in Psychoanalytic Therapy: Gain insight into unconscious conflicts. Patient talks freely to uncover root
causes
Interpersonal Theory Core Idea: Behavior exists to meet needs through relationships. Mental illness develops
when relationships are disrupted
Interpersonal Therapy is most effective in treating what?: 1) Grief/loss
2) Relationship conflicts (short term in length so good for this)
3) Role transitions
, Behavioral Health Exam 2
Peplau's Contribution (Implications of Interpersonal 1) Shifted focus from what nurses do to patients to what nurses do with patients
Theory in Nursing Practice): 2) Foundation for psych-mental health nursing
3) The nurse-patient relationship is foundational
4) Lowering the patient's anxiety improves their ability to think and function
5) Self-awareness helps keep the focus on the patient
Behavioral Therapy Core Idea: Behavior is learned, therefore it can be changed. Changing behaviors leads to
changing a personality
Behavioral Therapy - Operant Conditioning: The idea that learning occurs through rewards and punishment for voluntary
behavior
Types of Operant Conditioning: Positive Reinforcement: a positive stimulus reinforces behavior (child gets a
piece of candy when they get an A)
Negative Reinforcement: a negative stimulus reinforces behaviors (dog collar
shocks the dog if they cross the line)
Punishment: an unpleasant consequence that diminishes behaviors (child gets
put in timeout)
Other types of behavioral therapies: 1) Modeling: therapist role plays the desired behavior and the patient learns
through imitation (ex: patient needs to have a hard convo so they practice it and
play roles)
2) Exposure Therapy: addresses fears, phobias, and traumatic memories in a
safe environment (ex: therapist talks about or shows pictures of their fear)
3) Aversion Therapy: undesired behavior is extinguished through a negative
stimulus (ex: a medication that gives the person a bad response when taken with
alcohol is used for alcoholics)
4) Biofeedback: body's physiological response is controlled to manage anxiety
Implications of Behavioral Theory in Nursing Practice Focuses on helping the patient manage behaviors that impact thier health
(example: smoking cessation group)
Cognitive Therapy Core Idea: Thoughts create emotions, which then create a behavior
Cognitive Therapy Example: Event: Failed test
Thought: "I'm stupid"
Emotion: Depression
Behavior: Withdrawal
If the thought is changed, the outcome could be changed.
Cognitive Behavioral Therapy (CBT): Most common cognitive therapy. Challenges negative thinking and replaces it
with positive, rational thoughts. Homework (like journaling) aids in identifying
events, related feelings, automatic thought, and create a challenge to the thought
Examples of Cognitive Distortions: All-or-nothing thinking ("I'm an awful test taker")
Overgeneralizing (using always or never)
Mind reading ("they think that i'm fat")
Catastrophizing ("I got a 65 on my exam so they're going to kick me out of the
program")
Emotional reasoning ("im super nervous. that must mean that i'm not be ready to
take this exam")
Labeling ("i'm stupid")
Mental filtering ("i burnt the chicken. that means the party was horrible for
everyone")
Personalization (person is the cause of something even though their is no
evidence of that being true)
