NURS 661 EXAM 1 KEY POINTS/ Weeks 1-5 1. The PMHNP as a Therapy Provider 2. Assessment, Co, Exams of Nursing

Download NURS 661 EXAM 1 KEY POINTS/ Weeks 1-5 1. The PMHNP as a Therapy Provider 2. Assessment, Co and more Exams Nursing in PDF only on Docsity! NURS 661 EXAM 1 KEY POINTS/ Weeks 1-5 1. The PMHNP as a Therapy Provider 2. Assessment, Countertransference, Cultural Competency; Supportive and Psychodynamic Therapy 3. EMDR and Motivational Interviewing 4. Cognitive Behavioral Therapy 5. Interpersonal, Humanistic-Existential, & Solution-Focused Psychotherapy/ with Definitive Solutions/ 2024. Socratic Dialogue - Answer: Hallmark of CBT. Non-directive. A technique described as "mutual discovery in which the therapist guides the patient through a series of questions and answers to elicit automatic thoughts and assumptions, and examine the logic and evidence that relates to them" Diathesis-Stress Model - Answer: Serves to explore how biological or genetic traits diathesis interact with environmental influences, stressors to produce disorders such as depression, anxiety, or schizophrenia 1 | P a g e Hypothalamic-pituitary-adrenal (HPA) axis - Answer: Regulates cortisol, a potent hormone that inhibits growth, immune responses, and inflammatory responses. In severe and prolonged stress, this feedback to the pituitary gland is impaired and the hypothalamus does not decrease its activity, thus continuing to pump too much cortisol Cortisol - Answer: This potent stress hormone mobilizes energy stores, stimulates the release of glucose, potentiates the release of adrenaline, increases cardiovascular tone, and inhibits growth, immune, and inflammatory responses How PTSD affects cortisol production - Answer: For those with PTSD, it is hypothesized that the brain may become hypersensitive to the effects of cortisol. The person has a consequent loss of stimulus discrimination, and even minor triggers may cause the person to overact. Risk Factors for Eating Disorders - Answer: · Body image distortion · Dissatisfaction · Perfectionism · History of anxiety Erikson's Stages of Development Infancy (birth to 18 months) - Answer: Trust vs. mistrust Pathological Outcome: Psychosis, addictions, depression 2 | P a g e Freud's Psychosexual Stages Phallic/Oedipal (3 to 6 years) - Answer: Task: identification with same sex parent; development of sexual identity Problematic Traits: sexual identity issues; castration in males; penis envy in females; excessive guilt Freud's Psychosexual Stages Latency (6 to 12 years) - Answer: Task: sexuality sublimated; emphasis on same sex peers Problematic Traits: inability to sublimate energies to learn; excessive inner control; obsessive traits Freud's Psychosexual Stages Genital (13 to 20 years) - Answer: Task: establishment of separation from parents and mature non-incestuous relationships with others Problematic Traits: reworking all the previous developmental issues; establishing a life not dependent on parents Hippocampus following a traumatic event - Answer: For those who have been significantly traumatized, it is much harder to process any new experience if there are not enough cells in the hippocampus 5 | P a g e Decreased functioning of the hippocampus is caused by increased levels of cortisol combined with other substances, such as glutamate, which damages dendrites in the hippocampus and eventually causes cell death. Glucocorticoids secreted during a traumatic experience shut down the hippocampus and make it impossible for memory to be adaptively linked. These hormonal changes result in behavioral disinhibition and an inability to learn from experience. Amygdala following a traumatic event - Answer: 2 types of reactions to traumatic events: 1) emotional under modulation with intrusive symptoms leading to hyperactivity of the medial prefrontal cortex and inhibition of the amygdala, 2) hypoarousal of the prefrontal cortex and activation of the amygdala When the amygdala is overactivated and irritable, kindling occurs. Kindling refers to lowering of the excitability threshold of neurons, rendering the person increasingly likely to develop certain symptoms. With repeated stress, kindling is thought to sensitize limbic neurons, so the reactions are set off by stimuli that were previously subthreshold Hypothalamus following a traumatic event - Answer: Regulates BP, body temperature, sleep, appetite, glucose levels, and the autonomic nervous system. During stress, a cascade of physiological responses occurs, with the limbic- hypothalamic system modulating and coordinating the biochemical activity of the autonomic, endocrine, and immune systems Thalamus following a traumatic event - Answer: Mediates the interaction between attention and arousal and is therefore relevant to the phenomenology of trauma. 6 | P a g e Can result in significant memory problems, and the person may be unable to integrate memories into the present and personal memory into identity. These memories are isolated from consciousness and thought to underlie the experiences of flashbacks, nightmares, avoidances, and dissociation Attunement - Answer: The capacity to read signals (often nonverbal) that indicate the need for engagement or disengagement Egocentrism - Answer: Having or regarding the self or the individual as the center of all things Piaget's Stages of Cognitive Development: 2-6/7-year-olds are this Someone's inability to understand that another person's view or opinion may be different than their own Minimizing - Answer: Cognitive distortion consisting of a tendency to present events to oneself or others as insignificant or unimportant Neuroplasticity - Answer: Refers to areas that are responsive to the environment and that can change. The lower brain structures such as the brainstem are more fixed than the higher brain functions of the cortex, which continue to develop throughout life. The cortex is the most "plastic" area of the brain Growth and reorganization Nurturing - Answer: Care for and encourage the growth or development of 7 | P a g e Acetylcholine (ACh) - Answer: Occurs in cholinergic tracts extending from the limbic structures to the cortex, and a decrease in concentration is associated with memory and cognitive impairments. Also regulates mood, mania, and sexual aggression. An increase is associated with depression Decrease is associated with memory, cognitive impairments, Parkinsonism Cortisol - Answer: Mobilizes energy stores, stimulates the release of glucose, potentiates the release of adrenaline, increase cardiovascular tone, and inhibits growth, immune, and inflammatory responses Dopamine - Answer: Produced in the substantia nigra and other areas in the brainstem; it is a key NT for motor action, integration of emotions and thoughts, and decision-making; it stimulates the HPA axis to release hormones; and acts as the reward system. Elevated levels may change mood, increase motor behavior, and disturb frontal lobe functioning, resulting in depression, memory impairment, and apathy. Parkinson's disease and depression have been linked with decreased levels of dopamine and an increase is linked with schizophrenia and mania Gamma-aminobutyric acid (GABA) - Answer: This inhibitory NT is found in most neurons in the CNS. It is involved in postsynaptic inhibition when benzodiazepines are given for anxiety, which further decreases the firing of the neurons. It plays a role in inhibition; reduces aggression, excitation, and anxiety; has anticonvulsant and muscle relaxing properties; impairs cognition and psychomotor functioning. A decrease is associated with anxiety disorders, schizophrenia, and mania 10 | P a g e Glutamate - Answer: Is found in all cells, and its major receptor, N-methyl-d- aspartate (NMDA), helps to regulate brain development. Too much is toxic to neurons Acting out (immature) - Answer: Avoiding conscious experience of the emotion through impulsive action (e.g., instead of feeling sad, a person gets drunk) Denial (immature) - Answer: Avoiding the reality of painful reality by ignoring or refusing to acknowledge reality (e.g., a man with schizophrenia denies that he is ill and does not take his medication) Involves blocking external events from awareness. If some situation is just too much to handle, the person just refuses to experience it. Ex: Smokers may refuse to admit to themselves that smoking is bad for their health Hypochondria (immature) - Answer: Exaggerating an illness arising from unacceptable feelings (e.g., anger and hostility are transformed into pain and somatic complaints) Somatization (immature) - Answer: Converting emotion into bodily symptoms (e.g., instead of getting angry, the person gets a headache) Projection (immature) - Answer: Perceiving and reacting to unacceptable feelings and impulses as if they were outside the self (e.g., instead of the person feeling 11 | P a g e anger, anger is experienced as coming from others toward the person who is doing this, as during paranoid delusions) To disown certain unacceptable aspects of self by ascribing them to other people or the environment. Ex: blaming others for problems within the self or believing others do not like you when you actually have strong negative feelings toward them Introjection (immature) - Answer: Internalizing the qualities of the other (e.g., identification with the aggressor through which the person becomes aggressive to gain control) To uncritically accept others' beliefs and standard without discriminating and assimilating what belongs to self and eliminating what does not. Ex: "be a good girl," "don't be angry," and "boys don't cry" Splitting (immature) - Answer: Inability to integrate positive with negative aspects of oneself and then projecting this onto other people or situations (e.g., a woman tells her husband she loves him one day and hates him the next day, even though nothing has changed to warrant this) Regression (immature) - Answer: Avoiding emotional pain through returning to an earlier level of development (e.g., a child begins wetting the bed after a sibling is born) A movement back in psychological time when one is faced with stress Ex: a child may begin to suck their thumb again or wet the bed when they need to spend time in the hospital 12 | P a g e thoughts and feelings, with the result that the unwelcome thought is rarely activated Closed-ended question - Answer: Elicit the specific details - such as symptom type, severity, frequency, duration, and the context in which a symptom occurs - that are necessary to thoroughly assess a content region or establish a diagnosis Ex: "How many drinks did you have?" "How often do you feel that way?" Empathetic statement - Answer: Ex: "You must have been so hurt by that." "That is very frustrating." "It is hard to lose someone you love." Gentle command - Answer: Ex: "tell me about your family situation," "try to describe how you felt when...," "share with me what you think a good outcome would be." Open-ended question - Answer: Invite exploration in new content regions, reveal what is uppermost in the patient's mind, and may yield important information about the patient's capacities, defenses, or degree of resistance to engaging in psychotherapy Ex: "what brings you in today?" "How can I help you?" "How would you describe your relationship with ...?" Qualitative question - Answer: Ex: "How have you been sleeping?" "How is school going?" "How have you been getting along with your mom?" 15 | P a g e Swing question - Answer: Client can say "no" or client can elaborate Ex: "Can you describe the depressive symptoms?" "Can you tell me anything more about that?" "Can you tell me what you're thinking right now?" Domineering - Answer: I try to change other people too much Intrusive - Answer: It is hard for me to stay out of other people's business Overly nurturing - Answer: I put other people's needs before my own too much Vindictive - Answer: I fight with other people too much Classical Psychodynamic Therapist role - Answer: Objective Classical Psychodynamic Perspective - Answer: One-person psychology Classical Psychodynamic Motivation - Answer: Drives; sex and/or aggression Classical Psychodynamic Focus of exploration - Answer: Then and there; genetic roots of the problem (how a person's transference reaction is linked to feelings belonging to a person from the past) 16 | P a g e Classical Psychodynamic Aim - Answer: Make the unconscious conscious Classical Psychodynamic Change agent - Answer: Insight Classical Psychodynamic Symptom - Answer: Psychopathology Classical Psychodynamic Transference - Answer: Interprets in light of the past Classical Psychodynamic Countertransference - Answer: Caused by the patient; less disclosure by therapist Classical Psychodynamic Resistance - Answer: Intrapsychic event that involves a defense working against change Classical Psychodynamic Interpretation - Answer: Of wish/defense conflicts Relational Psychodynamic Therapist role - Answer: Participant-observer 17 | P a g e When to Refer to Psychoanalytic Therapy - Answer: The unconscious supports the patient's status If the person wants to understand himself or herself deeply and significantly change When to Refer to Supportive Therapy - Answer: Increasing self-esteem and dealing with life stressors Often most useful for people who need clarification and help in sorting out issues that they would be able to sort out under other circumstances Focuses on safety, education, and assisting with enhancing coping skills Restore emotional equilibrium as quickly as possible When to Refer to Trauma-Focused Cognitive Behavioral Therapy - Answer: Processing and coping with negative effects of trauma Mindfulness - Answer: A state of open, nonjudgmental awareness of current experience Internal and having external awareness in abundance while dissociation is the deficiency of internal and external awareness. Projective Identification - Answer: A specific type of countertransference that deepens the therapist's understanding of the patient It essentially involves a patient behaving in such a way that subtle, interpersonal pressure is placed on the therapist to take on dimensions of the patient's experience or unconsciously identify with facets of him- or herself 20 | P a g e This out-of-the-blue feeling may reflect the patient's own fear being projected onto the therapist, which the therapist experiences in place of the patient. Not only fear can be projected, but also anger, boredom, intrusiveness, passivity, and other feelings. Transference - Answer: The patient's thoughts, feelings, and behaviors that are associated with early important relationships with caretakers and significant others and that are felt toward the therapist EMDR procedures - Answer: Activates both sides of the brain. Involves the past, present, and future. The therapist guides the patient in processing affective, cognitive, and somatic material with procedures and protocols that include some form of bilateral stimulation (BLS) during a session. The BLS may take form of eyes moving horizontally back and forth, sounds alternating in each ear, or alternate tapping on each hand or knee. The goal is to bring the trauma to an adaptive resolution. Research indicates that trauma involves right-brain processing and most psychotherapy is a left-brain endeavor, so there may be areas that talk therapy does not reach. Processing in EMDR therapy seems to rapidly connect left-brain ways of processing information with emotional right-brain information. 4 signs that EMDR is helping - Answer: 1. emotional regulation 2. positive self-relief 21 | P a g e 3. better sleep 4. improving self-esteem EMDR S/E - Answer: Vivid dreams Nightmares Emotionally stressful 8-Phase Protocol for EMDR - Answer: 1. Patient History and Treatment Planning 2. Preparation 3. Assessment 4. Desensitization 5. Installation 6. Body scan 7. Closure 8. Reevaluation Theoretical framework behind motivational interviewing (MI) - Answer: TRANSTHEORETICAL MODEL This is an evidence-based person-centered approach that started in addiction counseling coupled with the transtheoretical model of change: precontemplation, contemplation, preparation, action, and maintenance MI Phases of the Change Process - Answer: Engagement Focusing 22 | P a g e Deep breathing exercises, muscle relaxation Meditation - Answer: Behavioral technique aimed at reduction of autonomic nervous system responses to anxiety Support stress reduction, control emotions, and sense of well-being Motivational Interviewing (MI) - Answer: Facilitates the patient's inherent motivation to change. It is not a therapy but a method of communication that partners with patients through accepting their autonomy and respecting that they have within themselves the knowledge of how to change Shame Attacking Exercises - Answer: In this type of therapy, the therapist engages the individual in exercises that emphasize their concern for what others think of them. For example: a person who is afraid of drinking soup in public may be assigned the task of going to a restaurant with a friend, ordering soup, and drinking it loudly while the fried makes note of how many people are really interested in what they are doing. The friend would then share the notes on the actual responses of the other diners as a way to disarm the person's irrational belief that others are looking at him or her eat, slurp, etc. Social Skills Training - Answer: Review and instruct on behaviors that will improve the potential for successful social interactions. 25 | P a g e For example, a therapist may notice that the patient looks at the floor or the ceiling during conversation or when introducing herself. The APPN may make use of this information by role-playing skills such as maintaining eye contact during an interview, shaking hands assertively, developing techniques for self-expression, and conveying opinions as well as overt changes such as appropriate language in public. Avoidant Personality Disorder - Answer: CBT is the best therapy for this PD Cluster C ("Anxious") Self-statement: "I'm really afraid of what people will think of me, so I avoid making new friends to prevent rejection." Behavioral clues: the patient may appear shy and nervous with a poignant eagerness to make contact. He may begin the interview reluctant to open up and will typically become quite self-revealing once rapport has been established Avoidant PD Mnemonic - Answer: Mnemonic: CRINGES (4 of these 7) Certainty of being liked required before willing to risk involvement Rejection possibility preoccupies his thoughts Intimate relationships avoided New relationships avoided Gets around occupational activities that involve interpersonal contact Embarrassment potential prevents new activities 26 | P a g e Borderline Personality Disorder - Answer: DBT is the best therapy for this PD Cluster B ("Dramatic") Self-statement: "I need people desperately, and when people reject me, I fall apart completely. I hate them, and I get suicidal." Behavioral clues: may alternately idealize and devalue you over the course of the interview; may be unusually emotionally liable Borderline Personality Disorder Mnemonic - Answer: Mnemonic: I DESPAIRR Identity disturbance Disordered, unstable affect owing to a marked reactivity of mood chronic feelings of Emptiness recurrent Suicidal behavior, gestures, or threats, or self-mutilating behavior transient, stress-related Paranoid ideation or severe dissociative symptoms frantic efforts to avoid real or imagined Abandonment Impulsivity in at least two areas that is potentially self-damaging inappropriate, intense Rage or difficulty controlling anger a pattern of unstable and intense interpersonal Relationships characterized by alternating extremes of idealization and devaluation Dependent Personality Disorder - Answer: Psychotherapy/CBT is the best therapy for this PD 27 | P a g e