Chapter 7 Flashcards
(156 cards)
1
Q
What are the guiding principles for interpersonal psychotherapy?
A
 interpersonal disputes role, transitions, grief, and interpersonal deficits. Example a couple fighting or a new mom with postpartum depression and doing role-playing.
2
Q
What is Cognitive Behavioral Therapy (CBT) primarily based on?
A
Evidence-based practice
Supported by data for various psychiatric disorders and medical conditions
3
Q
List some disorders that CBT has shown effectiveness for.
A
- Major depressive disorder
- Post-traumatic stress disorder (PTSD)
- Premenstrual dysphoric disorder
- Bipolar disorder
- Generalized anxiety disorder
- Insomnia
- Obsessive compulsive disorder
- Panic disorder
- Pathologic gambling
- Schizophrenia
Evidence supports CBT for these mental health disorders
4
Q
What medical disorders show evidence for benefit from CBT?
A
- Tinnitus
- Chronic pain
- Sexual dysfunction
- Chronic insomnia
- Chronic fatigue syndrome
CBT can also help with various medical conditions
5
Q
What do psychiatric disorders result from according to CBT principles?
A
Dysfunctional thoughts about self, world, and others
These thoughts can be irrational or illogical
6
Q
How do dysfunctional thoughts impact individuals?
A
They impact behavior and emotion
Recognition of these thoughts is crucial for change
7
Q
What is a key goal of CBT?
A
Recognition of dysfunctional thinking and development of new skills and strategies for changing thinking patterns
This can significantly impact mood and coping
8
Q
What is an important aspect of the therapeutic relationship in CBT?
A
Psychoeducation
Educating patients is essential for effective therapy
9
Q
What cognitive technique involves logical sequencing of reasoning?
A
Downward arrow
This technique helps patients explore the implications of their thoughts
10
Q
What question might a psychiatric mental health nurse practitioner (PMHNP) ask to challenge a thought?
A
‘If that were true, what would happen then?’
This encourages deeper examination of thoughts
11
Q
What is meant by ‘labeling of distortions’ in CBT?
A
Identifying cognitive distortions in a patient’s thinking
Helps patients understand and correct their thought patterns
12
Q
What tool might a patient examine to identify cognitive distortions?
A
A table of cognitive distortions
This aids in recognizing faulty thinking patterns
13
Q
What is ‘All or nothing’ thinking?
A
‘Black or white’ thinking; ‘If I’m not perfect, I’m a failure.’
One mistake leads to everything being a mistake and nothing good will result.
14
Q
What is Overgeneralization?
A
The one negative aspect of a situation is singled out and dwelt upon.
15
Q
What is a Negative Mental Filter?
A
Exclusion of being able to see anything positive.
16
Q
What is Catastrophizing?
A
Exaggerating something negative.
17
Q
What are ‘Should’ Statements?
A
Adds a value statement and guilt as a motivator if actions are not done.
Directed towards others, this leads to anger, frustration, and resentment.
18
Q
What is Labeling?
A
Attaches negative and emotionally charged descriptions to people or events; extreme overgeneralization.
19
Q
What is ‘Mind-reading’?
A
A negative conclusion that is drawn before receiving any of the facts.
20
Q
What is Personalization?
A
Believing and blaming oneself for a negative outcome of an event or situation even though they were not primarily responsible.
21
Q
What is Psychodynamic Psychotherapy?
A
Evidence-based practice with data to support effectiveness with various disorders.
22
Q
What are the guiding principles of Psychodynamic Psychotherapy?
A
Psychiatric problems are caused by an internalization of conflicts related to powerful desires, wishes, and fears from earlier relationships.
23
Q
What are the goals of Psychodynamic Psychotherapy?
A
For the client to understand patterns and relationship conflicts of the past in order to change behavior and emotions in the present.
24
Q
What are some techniques used in Psychodynamic Psychotherapy?
A
‘Working backward’ while assessing current symptoms in light of past experiences.
Assess past conflicts with significant others, how conflicts were or were not resolved, and how this past relates to the current situation.
25
What is Transference in Psychodynamic Psychotherapy?
It is useful and may help explicate conflicts from the past.
26
What are Defense Mechanisms?
Unconsciously employed strategies/impulses that reduce anxiety and guilt.
27
What is the origin of Defense Mechanisms?
Freudian and psychoanalytic in origin.
28
What do Defense Mechanisms maintain?
Ego strength.
29
What is the conflict involved in Defense Mechanisms?
Id conflict with superego.
30
What do Defense Mechanisms safeguard?
The conscious mind.
31
What are Defense Mechanisms also known as?
Coping skills.
32
What is Denial? And what mechanism is this?
Refusal to admit or recognize that something has occurred or is currently occurring.
## Footnote
Example: Alcoholic who denies they have a problem in the face of job loss or divorce
33
What is Projection?
Taking one's own unacceptable qualities or feelings and attributing them to another.
34
What is Regression?
Reverting to patterns of behavior from an earlier stage of development in order to cope with stressful events.
## Footnote
Example: A child begins wetting the bed after his parents' divorce.
35
What is Passive-aggression?
Indirectly expressing anger.
## Footnote
Example: 'The pie scene' in the movie The Help: An indirect or 'passive aggression' towards another rather than confronting directly.
36
What is Reaction formation?
Taking up the opposite feeling, impulse, or behavior in order to reduce anxiety.
37
What is Intellectualization?
Focusing on the intellectual component to avoid thinking about a stressful or emotional aspect.
## Footnote
Example: A person with a terminal illness spends hours learning about the disease and treatment to distance them from reality.
38
What is Repression?
Keeps information (negative) out of conscious awareness.
## Footnote
Example: Child cannot remember abuse from parent.
39
What is Displacement?
Taking out frustrations, feelings, and impulses on people or objects less threatening.
## Footnote
Example: Angry at boss and instead of arguing with them, go home and pick a fight with spouse.
40
What is Rationalization?
Explaining an unacceptable behavior or feeling in a rational or logical manner.
## Footnote
Example: A student does poorly on a test and blames the professor for a 'bad' test.
41
What is Splitting?
Aspects of a person or self are seen only in extremes and not able to be integrated.
## Footnote
Example: A woman views her husband as either all good or all bad; she cannot integrate negative and positive.
42
What is Humor?
Pointing out funny or ironic aspects of a situation to express feelings.
## Footnote
Example: Making a joke at one's own expense.
43
What is Sublimation?
Converts unacceptable impulses into more acceptable behaviors.
## Footnote
Example: A person with extreme anger goes to the gym to box.
44
What is Suppression?
The conscious removal of unwanted information out of awareness.
## Footnote
Example: The woman decided to put aside and not think about her negative test results until after her daughter's wedding.
45
Mr. Jackson was recently diagnosed with prostate cancer prior to his next appointment. He speaks with two prostate cancer survivors joins an online chat group for patient with prostate cancer and spends at least two hours a day on the web reading about prostate cancer. His examples are an example of intellectualization. The above mentioned mechanism. Mr. Jackson is using would be example of which of the following:
A. immature
B. neurotic
C. mature
D. primitive.
Neurotic
46
Which of the following is a defense mechanism that is helpful to the patient and likely to move the patient forward in meeting their coping needs?
A. Suppression
B. Intellectualization
C. Rationalization
D. Splitting
Suppression
47
What is the defense mechanism of Denial?
Denial is a primitive or narcissistic defense mechanism.
48
What is the defense mechanism of Projection?
Projection is a primitive or narcissistic defense mechanism.
49
What is the defense mechanism of Regression?
Regression is an immature defense mechanism.
50
What is the defense mechanism of Passive-aggression?
Passive-aggression is an immature defense mechanism.
51
What is the defense mechanism of Reaction formation?
Reaction formation is a neurotic defense mechanism.
52
What is the defense mechanism of Intellectualization?
Intellectualization is a neurotic defense mechanism.
53
What is the defense mechanism of Repression?
Repression is a neurotic defense mechanism.
54
What is the defense mechanism of Displacement?
Displacement is a neurotic defense mechanism.
55
What is the defense mechanism of Rationalization?
Rationalization is a neurotic defense mechanism.
56
What is the defense mechanism of Splitting?
Splitting is a primitive or narcissistic defense mechanism.
57
What is the defense mechanism of Humor?
Humor is a mature defense mechanism.
58
What is the defense mechanism of Sublimation?
Sublimation is a mature defense mechanism.
59
What is the defense mechanism of Suppression?
Suppression is a mature defense mechanism.
60
61
56-year-old woman who is an alcoholic and in denial has which type of defense mechanism?
A. Immature
B. Neurotic
C. Mature
D. Primitive
D. Primitive
62
63
Rationalization is an example of which of the following?
A. Immature
B. Neurotic
C. Mature
D. Primitive
Neurotic
64
Labeling of distortions is a technique often used in:
Cognitive behavioral therapy
65
What type of therapy is Dialectical Behavioral Therapy (DBT)?
Evidence-based therapy for borderline personality disorder and suicide reduction
66
What are the guiding principles of DBT?
Behavioral focus, acceptance-based strategies, dialectical processes
## Footnote
Emphasis on balancing change with acceptance
67
What are the main goals of DBT?
Balance behavioral change, problem-solving, distress tolerance, interpersonal effectiveness, self-management, emotional regulation with validation, mindfulness, acceptance
68
What techniques are used in DBT?
Individual therapy, group skills training, evaluate events, homework, family involvement, telephone consultation, CBT techniques
## Footnote
Emphasis on reinforcing adaptive behaviors and balancing behavior
69
What is Solution-focused Therapy (SFT)?
Evidence-based practice with a focus on solutions rather than problems
70
What are the guiding principles of SFT?
Highly structured, manual-based, short-term therapy focused on strengths and capabilities
71
What are the goals of SFT?
Help patients resolve problems by focusing on strengths and solutions, foster client empowerment
72
What techniques are used in SFT?
Use of questions to help clients develop solutions
## Footnote
Examples include pre-session change questions, joining, miracle questions, and exception questions
73
Fill in the blank: DBT emphasizes _______ strategies.
[acceptance-based]
74
True or False: SFT is focused on dwelling on past problems.
False
75
What is the 'miracle' question in SFT?
If you woke up in the morning and the problem was solved, how would you know it had been solved?
76
What role does family involvement play in DBT?
Family involvement is part of the treatment process
77
What is emphasized in SFT regarding the client's abilities?
Focus on competence, strengths, and capabilities
78
What does DBT use to evaluate emotions after an event?
Evaluate events, actions, and triggers following emotional incidents
79
Fill in the blank: SFT is particularly used in _______.
[prisons, schools, legal system, and clinically]
80
What is congruence and what kind of Theray is it?
Genuine and authentic, openly expresses feelings with client, unconditional positive regard and accurate empathic understanding. Under HUMANISTIC THERAPY
81
What kind of statement should you ask to assess someone's readiness to change under behavior change therapy?
Have you or are you thinking about ______?
What thoughts have you had about ______?
82
What is the primary attitude a healthcare provider must maintain towards a patient regarding change?
The patient can change and achieve a given health goal
## Footnote
Change occurs dynamically and often unpredictably.
83
What framework is commonly used for understanding change in health behavior?
The transtheoretical model based on the work of Prochaska
## Footnote
It assesses an individual's readiness to act on a new healthier behavior.
84
What are the five stages of change in the Prochaska and DiClemente model?
* Precontemplation
* Contemplation
* Preparation
* Action
* Maintenance/relapse
85
What characterizes the Precontemplation stage?
The patient is not interested in change and might not be aware of the problem
## Footnote
The patient may minimize the impact of the problem.
86
What is the healthcare provider's action during the Precontemplation stage?
Help the patient to move towards thinking about changing the unhealthy behavior
## Footnote
This involves raising awareness of the problem.
87
In the Contemplation stage, what is the patient doing?
Considering change and looking at its positive and negative aspects
## Footnote
The patient often feels 'stuck' with the problem.
88
What action should a healthcare provider take during the Contemplation stage?
Help the patient to examine benefits and barriers to change
89
What does the Preparation stage involve?
The patient exhibits some change behaviors or thoughts but feels they lack the tools to proceed
## Footnote
They may express readiness but are uncertain.
90
What healthcare provider action is recommended during the Preparation stage?
Assist the patient in finding and using tools to help with change
91
What is the key characteristic of the Action stage?
The patient is ready to go forward with change and takes concrete steps, but is inconsistent
## Footnote
This stage involves active efforts to change.
92
What should a healthcare provider do during the Action stage?
Encourage the healthy behavior change and provide continued positive reinforcement
93
What does the Maintenance/relapse stage entail?
The patient learns to continue the change and adopts the healthy habit, while also managing relapse
## Footnote
Relapse is common but not insurmountable.
94
What is the healthcare provider's role in the Maintenance/relapse stage?
Work with the patient on the use of tools and acknowledge that backsliding is common
95
What does Lewin's Change Theory define behavior as?
A dynamic balance of forces working in opposing directions.
96
In what contexts is Lewin's Change Theory often used?
Management change, organizational implementation, and quality improvement.
97
What are the three major concepts in Lewin's Change Theory?
Unfreezing, change, freeze.
98
What are driving forces in Lewin's Change Theory?
Forces that move the organization towards the direction of change.
99
What are restraining forces in Lewin's Change Theory?
An opposing force to change that pushes the organization in the opposite direction.
100
What does equilibrium mean in the context of Lewin's Change Theory?
Driving force = Restraining force and no change occurs/status quo remains.
101
What is the first stage of Lewin's Change Theory?
Unfreezing.
102
What occurs during the unfreezing stage?
Identifying and assisting with letting go of an old, counterproductive pattern.
103
What happens during the change stage?
Thoughts, feelings, behavior, or all three will begin to change.
104
What is the goal of the change stage?
Become more productive with a new situation and belief that the new is better than the old.
105
What is the final stage of Lewin's Change Theory?
Refreezing.
106
What does refreezing establish?
The change as the new status quo.
107
108
109
The PMHMP is asked to consult on an inpatient unit that will be going through the process of implementing a new restraints protocol. The director reached out to the PMHNP to assist with the transition as there has been resistance to this change. The PMHNP recognizes that the unit is stagnant or not wanting to change. What concept of the lie change model is present?
EQUILIBRIUM
110
111
The PMHNP in the above scenario applied strategies consistent with Luis's change model to address this situation, which is a strategy used in the unfreezing stage?
Conduct small group sessions to address employee concerns
112
What is Motivational Interviewing (MI)?
An evidence-based approach used to support individuals with substance use disorders and chronic medical illnesses.
113
What are the guiding principles of MI?
* Partnership with patient, work on self-efficacy
* Provider doesn't have what the patient needs; the patient has what they need
* Struggles with ambivalence are expected and normal
* Support change consistent with patient's values and concerns.
114
What are the goals of MI?
Support change in a person that aligns with their own values and concerns.
115
What does the acronym OARS stand for in MI techniques?
* O = Open-ended questions
* A = Affirming statements
* R = Reflecting statements/listening
* S = Summarizing
116
What are open-ended questions in MI?
Questions that cannot be answered with a simple 'yes' or 'no', encouraging elaboration.
117
What is the purpose of affirming statements in MI?
To recognize and highlight the patient's strengths.
118
What is the function of reflecting statements in MI?
To mirror feelings or content expressed by the patient, either through simple restating or complex reflections.
119
What is summarizing in the context of MI?
A review of the session to consolidate understanding and reinforce key points.
120
What are the phases of change in MI?
* Engagement
* Focusing
* Evoking
* Planning
121
What does the engagement phase in MI involve?
Establishing a trusted and respectful relationship with the patient.
122
What is the focusing phase in MI?
Moving the interaction towards identifying a direction of change.
123
What does the evoking phase in MI entail?
Uncovering the person's motivation for change.
124
What is involved in the planning phase of MI?
Eliciting a plan that the patient will follow.
125
What are some other skills used in MI?
* Develop a discrepancy
* Roll with resistance
* Support self-efficacy
126
Fill in the blank: Change talk in MI includes exploring _______.
[pros and cons of behavior change]
127
What is an example of looking back in MI?
Asking how things were different at a previous time.
128
What does exploring values involve in MI?
Discussing what is important to the patient in the context of change.
129
What does exploring the negative side of ambivalence mean in MI?
Examining the drawbacks or challenges associated with not changing behavior.
130
What is the ask-provide-ask technique in MI?
A method of providing information by first asking what the patient knows, then providing information, and finally asking for their thoughts on it.
131
Mr. Jacob is a 65-year-old man with COPD and a 60 pack your history who is currently smoking 1.5 packs of cigarettes per day. He is reading a pamphlet in your office about smoking cessation. You ask him if he has any questions and he states I don't plan to quit smoking. My health is pretty good according to the trans theoretical model of change he is most likely in which of the following stage stages?
Pre contemplation
132
Is there a 55-year-old woman with bipolar type one and alcohol used disorder she states I just do not know where to start and trying to stop my alcohol use which of the following is the most appropriate response to that statement?
 can you tell me more about your drinking?
133
The PMHNP is working with a client who states I just want to get out of my marriage the PMHMP response if you woke up tomorrow morning in a miracle occurred and the problem was resolved. How would you know what would be different the PMHMP is using which therapy approach?
Solution focused therapy (miracle question)
134
135
Which of the following is not a technique used in motivational interviewing?
A. Ask-provide-ask
B. Summarizing
C. Silence
D. Roll with resistance
Silence
136
137
What are the phases of group formation/development?
Existential factors, Orientation or forming, Storming, Norming, Performing, Adjourning
138
What happens during the Orientation or forming phase?
Members adapt to being in the group and review boundaries and limits. Some limited sharing may occur, and anxiety may be present.
139
What characterizes the Storming phase?
Individual members find a place in the group, ideas are exchanged, differences are noticed, and the group grows.
140
What occurs during the Norming phase?
Individuals align as a group, trust develops, and members work towards common goals.
141
What is the focus during the Performing phase?
Increased sharing among group members and group ownership of the experience in the group.
142
What happens in the Adjourning phase?
Termination occurs, emotional responses are expressed, and appreciation for group members is shown.
143
What is transference in the context of psychotherapy?
Client experiences feelings or thoughts towards the NP, originally associated with other important persons in the patient's life.
144
What can transference involve regarding the client's feelings towards the NP?
It can be a preconceived idea about clinicians based on past experience.
145
What is countertransference?
NP experiences feelings or thoughts towards the client based on past experiences or bias.
146
List some ways a client may express transference.
* Resistance and strong emotion
* Hostility
* Forgetfulness
* Irrelevant chatter
147
What is an appropriate NP response to a client's transference?
* Empathy
* Active listening
* Open and receptive body language
148
What feelings might an NP experience in countertransference?
* Feelings of love
* Hostility
* Repulsion
* Anxiety
149
What behaviors may indicate countertransference by the NP?
* Extending sessions
* Forgetting sessions
* Being late to a session
* Dreams about client
150
What should an NP do in response to feelings of countertransference?
* Maintain nonjudgmental awareness of feelings
* Seek supervision and/or therapy
151
True or False: Transference is only experienced by the client towards the NP.
True
152
Fill in the blank: Countertransference occurs when the NP experiences feelings or thoughts towards the _______.
[client]
153
154
Examining the pros and cons of change is conducted during which stage of change?
Contemplation
155
Which of the following is not the goal of the maintenance stage of change?
A. Make the chsnge
B. Maintain the change
C. Build a new lifestyle to support the change
D. Avoid relapse
Make the change
156
While conducting a therapeutic session with a 24 year-old male with major depressive disorder, all of the following techniques are utilized during cognitive behavioral except:
A. Downward arrow
B. Joining statement
C. Labeling of distortions
D. Cognitive restructuring 
Joining statement
