NR605 Final Exam 100% VERIFIED ANSWERS 2024/2025 CORRECT, Exams of Nursing

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NR605 Final Exam 100% VERIFIED ANSWERS 2024/2025 CORRECT cognitive-behavioral therapy -focus on how well individuals can adapt cognitively and functionally to their environments -short-term, structured, goal-oriented form of psychotherapy -stresses necessity of challenging maladaptive thoughts that lead to behavioral problems -first emerged in 1955 -most widely practiced psychotherapy -help clients recognize and address cognitive distortions • by Albert Ellis, widely known as the grandfather of cognitive behavior therapy -Beck • originally trained in psychoanalysis, pioneered cognitive therapy in the 1960s, through his research on depression • also developed the popular Depression Inventory instrument CBT Relationship to Nursing Theory -Orem's self-care deficit nursing theory • provides a framework to view CBT as a supportive intervention • fosters effective self-care behaviors -Roy's Adaptation Theory • premise that individuals use coping mechanisms to adapt to stimuli, both internal and external • share underpinnings with CBT. Indications for CBT -treatment of a wide range of diagnoses • depression • anxiety disorders • substance use disorders • eating disorders • severe mental illness • PTSD Principles of CBT include: -way an ind cognitively structures thoughts about self & the world determines how the ind feels & behaves -Dysfunctional thoughts are rooted in irrational assumptions -Dysfunctional thinking and learned patterns of maladaptive behavior contribute to psychological problems -Ind's can learn more adaptive behaviors which can relieve symptoms & improve quality of life -CBT is (+) & stresses collaboration & active participation -CBT includes action plans in the form of therapy homework Role of the Psychotherapist in CBT -using a structured, collaborative approach to help clients recognize and reevaluate cognitive distortions -help clients: • better understand the behaviors of others • develop improved coping skills -Psychoeducation -evoking • identifying the client's motivation for change and evoking hope • uses reflections and summaries -planning • creating a plan for change acceptance and commitment therapy (ACT) -helps individuals accept life's challenges while focusing on their values and goals • learning how to relate to thoughts & feelings which impact life rather than changing those thoughts & feelings -referred to as a "third wave" CBT therapy -Accepting reactions and being present -Choosing a valued direction -Taking action -Used for: • depression, anxiety, substance use, chronic pain, transdiagnostic combinations of conditions solution-focused therapy (SFT) -future-oriented approach -helps client ID problems & construct solutions that will result in change -postmodern thinking • reality is shaped by multiple and conflicting "truths" & constructed through human interaction • there are as many stories of meaning as there are people involved -fourth force of psychotherapy • transpersonal, going beyond the ideas of humanness, identity, and self-actualization -client is considered to be the expert of their lives -focus from the problem to the solution -grew out of the work at the Brief Family Therapy Center in Milwaukee in the 1970s • influenced by many psychotherapists, work at the Mental Research Institute in California, and the philosophies of Buddhism and Taoism solution-focused therapy Key Concepts and the Role of the Psychotherapist -Solutions talk • Shift talk from problems to solutions -Positive orientation • Shift focus from problems to new possibilities -Looking for what is working • Focus on the exceptions within problem patterns Indications for SFT -used for individual or group therapy across settings • marriage, family, and child therapies • trauma • postpartum depression • depression • eating disorders • severe mental illness how SFT is used to alleviate anxiety 4-Step Approach for Overcoming Anxiety -Identify the meaningful parts of life that the anxiety is blocking. -Shift the focus away from the anxiety itself toward the meaningful goal. -Create a list of positive messages that would motivate you toward that goal. -Be gentle with yourself - you're not alone. Many of the people you meet may be working through something similar. Behavioral theory -Personality is a result of the interaction between an ind. and their environment. -focus on observable and measurable behavior -Skinner • associated with the concept of operant conditioning, using rewards and punishments to increase or decrease a behavior -Pavlov • Russian Physiologist, father of behaviorism, associated with classical conditioning, Pavlov dog, Cognitive theory -Study of mental processes and complex behaviors -Albert Bandura combines concepts of observing, thinking, and behaving. -Tying external behaviors in with internal mental processes that facilitate them • learning, memory, language development, mental problem solving. Cognitive Distortions -faulty, exaggerated, or irrational thinking patterns • cause ind's to inaccurately perceive reality • lead to (-) emotions & psychopathological states, including depression & anxiety common cognitive distortions -Should statement • "I shouldn't yell at my kids. I should always be able to keep my temper. I'm the adult here." -All-or-nothing thinking • "I got an A- on the biology exam! I never get below an A. I am such a complete -Catastrophic thinking • common for clients with anxiety • focusing on most (-) outcome of a situation -Decatastrophizing • cognitive restructuring technique • used to explore fears • help challenge catastrophic thinking -examining the outcome the client considers to be the "worst possible" • developing a plan of action to address that outcome to decrease anxiety Valerie is a 34-year-old who presents for therapy with symptoms of anxiety and depressive disorder. She has been in a relationship with her partner for the past 12 years. She feels like her partner makes all the decisions in the relationship, and when Valerie's opinions differ, she does not feel comfortable sharing her thoughts. She states, "If my partner can't figure out what my needs are after so many years, I don't know how we can save this relationship." What can you use to assist the client? Assertiveness training Bibliotherapy Contingency management Behavioral rehearsal Assertiveness training Rationale: Assertiveness training can assist clients who are experiencing symptoms of depression, anxiety, and low self-worth. It may help clients learn how to express their point of view in a respectful manner. The client and therapist may use role-play to practice verbal and nonverbal behaviors and improve assertiveness. Dustin is a 24-year-old who presents for therapy with symptoms of anxiety. He has a remote position with a large company and rarely meets with colleagues or clients in person. When he does have an in-person meeting, he states "I feel like an idiot whenever I open my mouth. I'm always tripping over my words, and I feel so awkward." What can you use to assist the client? Assertiveness training Bibliotherapy Contingency management Behavioral rehearsal Behavioral rehearsal Rationale: Behavioral rehearsal can assist clients who experience anxiety with social skills or interactions with others. Rehearsal may be conducted using guided imagery where the client pictures themselves responding appropriately, or the client and therapist may choose to explore a behavioral rehearsal using role-play. Corinne is a 46-year-old who presents for therapy with symptoms of depression. The therapist recommends that Corinne read Cognitive Behavioral Therapy in 7 Weeks by Dr. Seth J. Gillihan between sessions. What can you use to assist the client? Assertiveness training Bibliotherapy Contingency management Behavioral rehearsal Bibliotherapy Rationale: CBT therapists may prescribe specific readings or self-help books related to the client's condition as an adjunct to in-session work. Tina is a 52-year-old who presents with depression and obesity. She has struggled with her weight for the last several years. The therapist implements a series of rewards when Tina adheres to treatment goals. What can you use to assist the client? Assertiveness training Bibliotherapy Contingency management Behavioral rehearsal Contingency management Rationale: Contingency management reinforces or rewards positive behavioral changes. The client and therapist can work together to identify appropriate rewards; for instance, Tina may choose to reward herself for maintaining an exercise regimen by scheduling a relaxation massage. Amina is a 40-year-old who presents for therapy. She reports that she has felt "depressed" most of her life but never sought mental health services. She discloses that she was a victim of childhood incest and neither reported the abuse nor discussed it with anyone before this time. She feels that the time is right to do therapy. The psychiatric mental health nurse practitioner (PMHNP) selects solution-focused therapy (SFT) to create a warm and supportive climate in which the client can identify her resources to create a shift from the past to the present, integrate her memories, and empower herself beyond her victimization. Which of the following provider statements or question prompts are congruent with SFT? Select all that apply. "What needs to happen today so that when you leave, you'll think this was a good Mindfulness- and cognitive-based group therapy has shown efficacy for ____________________________ schizophrenia spectrum disorders Group therapy has also shown efficacy in helping clients with physical diagnoses such as ____________________________________ neurological conditions, chronic pain, and cancer Principles of Group Therapy Existential psychoanalyst Irvin Yalom identified eleven principles that underpin group therapy: 1. Instillation of hope 2. Universality 3. Imparting information 4. Altruism 5. Corrective recapitulation of the primary family group 6. Development of socializing techniques 7. Imitative behavior 8. Interpersonal learning 9. Group cohesiveness 10. Catharsis 11. Existential factors catharsis the process of releasing, and thereby providing relief from, strong or repressed emotions. Altruism unselfish regard for the welfare of others Nikki typically pouted through group meetings. When asked about her silence, she said she felt other members were favored and that she wanted to quit the group and do therapy on her own. Over time, she saw that her feelings stemmed from her jealousy of her sister and was able to address her feelings. Which principle of group therapy is this an example of? Corrective recapitulation of the primary family group Rationale: Corrective recapitulation of the primary family group helps group members work through unresolved family issues, such as sibling rivalry. Group therapy helps members process unresolved family conflicts. Kesha told the group that the most important aspect of therapy was just having a group of people she could talk to, that wouldn't walk out on her. Which principle of group therapy is this an example of? Group cohesiveness Rationale: Group cohesiveness occurs when members feel they belong and are unconditionally accepted by the other members. Group cohesion correlates with positive outcomes. At home, Tuan used communication strategies he observed in group therapy to try to improve his relationship with his daughter. Which principle of group therapy is this an example of? Imitative behavior Rationale: Learning from the therapy of others helps members experiment or try on new behaviors. Van recently joined group therapy for sexual abuse survivors and listened to others talk about their feelings of shame, guilt, rage, and uncleanliness which mirror his feelings. Which principle of group therapy is this an example of? Universality Rationale: Being part of a group of people who have the same experiences helps members feel that they are not alone and what they are going through is universal. A feeling of universality is a fundamental step in healing for clients burdened by shame, stigma, and self-blame. Stasia joined group therapy following the recent death of her child. Group members helped her to anticipate feelings associated with significant days in her first year of bereavement, such as birthdays, anniversaries, and holidays. Which principle of group therapy is this an example of? Imparting information Rationale: Group members help one another by sharing information. Information about the natural cycle of bereavement can help Stasia realize there is a sequence of pain and a lessening of distress as the stages are experienced. Madison told the group how she shoplifts clothes, makeup, and other items when life feels out of control. She noticed that she felt better after sharing. Which principle of group therapy is this an example of? Catharsis Rationale: Sharing feelings and experiences with group members can help relieve pain, guilt, or stress. Group members may benefit from witnessing a peer in emotional catharsis. Sindhu is typically withdrawn in group therapy. She developed a large axillary lymph node and underwent a biopsy. She arrived at the next meeting animated and wanted to plunge into her feelings of fear about the implications of her -Psychoeducational Groups -Support Groups -Self-Help Groups -Acute Inpatient Therapy Group Psychoeducational Groups -most common types of therapeutic groups -provide education to clients & families about a variety of psychiatric & mental health topics -may provide info about a pt dx as well as encouragement to remain committed to a tx plan -may include info about addiction, medication, self-care, and recovery -may teach pts how to avoid maladaptive behaviors • how to engage in (+) behavioral change -less focused on developing relationships between group members -role of the therapist • educator • support client engagement, incorporating diff learning styles Support Groups -focus on providing members with an opportunity to interact and share personal experiences, feelings, or coping strategies with others who may be going through similar circumstances • serious illness, grief, or loss -formal or informal -may be led by professional or nonprofessional leaders Self-Help Groups -typically comprised of participants experiencing a common issue or concern • provide a venue for members to share struggles and successes and to help members feel less alone -not considered a form of psychotherapy though they often help support members' efforts to change -substance-centered Twelve Step groups • Alcoholics Anonymous • Narcotics Anonymous • Al-Anon -Other focuses • bipolar disorder, substance use disorder, or cancer • Grief -members may participate for months to years -do not have a professional formal leader Acute Inpatient Therapy Group -not an independent, freestanding entity • group has a complex relationship with the inpatient ward -challenges: • client turnover • variety of psychiatric diagnoses and concerns • therapist's time with clients is limited • Boundaries blurred, clients spending much time outside group together -Opportunities: • engaging pts in therapeutic process • helping pts see that engagement can be helpful • assisting pts in problem identification • decreasing isolation • allowing pts to help others • reducing ward-based anxiety or tension who identified the five phases of group development? Tuckman (1965) -Phases of group formation are useful in documentation and in assessing the group's productivity. Phases of Group Formation -Forming -Storming -Norming -Performing -Adjourning Forming -getting acquainted and orientation to the group process. -Most interactions are social as members get to know each other. Storming -phase is one of transition and is often marked by conflict, anxiety, and ambiguity as members define themselves by testing or acting out behaviors and define group norms. Norming -marked by group cohesion and the formation of the therapeutic alliance. -The group develops standards of behavior. Performing -Encompasses individual and group growth. -Members experiment with new ideas or behaviors. -Conflict may emerge but is dealt with constructively. Adjourning Leonard expresses how much he appreciates the other members of the group and how much he will miss meeting with them. What phase of group development? Forming Adjourning Performing Storming Norming Adjourning Rationale: The adjourning phase involves closure for the group or an individual that left. In this phase, achievements are reviewed and feelings are explored about what worked (and what didn't), and any feelings of loss. Contraindications for Group Therapy -paranoid -significant brain injury -acutely psychotic -Delusional clients • may incorporate the group into their delusions -aggressive clients • may pose a threat to others indications for couples, and family therapies presence of relational difficulty is the primary indication Family Therapy -type of therapy that seeks to improve the functioning of a family as a unit -Types of families: • traditional nuclear family • single-parent • blended • extended • alternative • institutional family • family by choice or chosen family (provides love and support but may not be recognized by the legal system) Family Therapy: Underlying Assumptions -Individuals are best understood within the context of the family system. -The whole family is viewed as the client. -The behavior of one family member influences all family members and the behavior of the family influences each member. -Symptoms are viewed as an expression of family dysfunction. -Problematic behaviors may serve a purpose for the family and may be unintentionally maintained. -Attempts at change are best accomplished by working with the family as a whole. Approaches to Family Therapy -Systemic -Structural -Strategic -Emotionally Focused Systemic Approach to Family Therapy -multigenerational framework • family is a complex, self-regulating unit that seeks to maintain homeostasis -change in functioning of one member affects functioning of other members -Family systems therapy seeks to change systemic factors that produce dysfunction in the family using a psychodynamic approach • goal, help members increase their self-differentiation, reduce emotional turmoil applications for systemic family therapy -attachment problems -child abuse -childhood disruptive behavior disorders -psychosexual problems -intimate partner violence -substance use disorders -mood and anxiety disorders -adjustment to illness or disability systemic family therapy Therapeutic techniques -promoting self-statements -transforming dysfunctional generational patterns -decreasing anxiety and interrupting conflict -detriangulating family members -reestablishing connections between family members Couples Therapy -designed to improve the interactions between two individuals who are in conflict with one another • conflicts: emotional, sexual, economic, or social elements -therapist helps the couple: • ID & address maladaptive behavior or communication patterns • finds shared resources for problem-solving • encourages personality growth & development -goal of therapy: alleviate emotional distress & promote well-being of the partners both together and individually -physical, sexual, and emotional abuse -childhood neglect -living with someone with mental health or substance use disorders -a sudden separation from a loved one (death, divorce, separation) -poverty -racism, discrimination, and oppression -violence in the community, war, or terrorism -disasters, natural and man-made -serious, invasive, distressing medical illness and procedures Neurobiology of a Traumatic Event: disrupts the limbic system, amygdala, orbitofrontal cortex, and anterior cingulate gyrus -amygdala or "fear center" of the brain stores the physical impact of negative emotions. • interferes with the hippocampus, which is involved with the recall of memory • causes the prefrontal cortex to function less effectively, and the brain goes into survival mode What happens in the brain during a potentially traumatic event -brain stem directly connected with the retina • retina sends visual info to the brain stem before higher levels of brain are aware of threat. -predator moves closer, periaqueductal gray initiates a fight or flight response • activates the sympathetic nervous system • Heart rate goes up. Blood flow to muscles increases. Blood pressure increases. Pupils dilate -person may enter the freeze response, or feigned death • periaqueductal gray activates the parasympathetic nervous system as well • Muscles get tight and freeze. Both gaze and breath may freeze, not a cognitive choice -predator doesn't move away, the person may shutdown completely • Heart rate drops. Respiratory rate drops. Some people stop breathing. Muscles become limp. Metabolism shuts down. Endorphins released. • state of "no pain". They are no longer aware of their surroundings • During inescapable trauma differences between the freeze and shutdown trauma responses -Freeze • The client is HYPERaroused. • The muscles are tense and full of energy, but can't release it. • In this stage, there are similar levels of sympathetic and parasympathetic activation. • Increased heart rate/blood pressure. • The client might say, "I feel stuck," "I can't move," or "I feel like I am encased in cement." • Eyes widen. • The body is ready to return to fight/ flight as soon as the threat passes. -Shutdown/Collapse • The client is HYPOaroused. • The muscles are flaccid and loose. • The parasympathic nervous system is dominant. • Decreased heart rate/blood pressure/temperature. • The client may not be able to speak at all. • Blank stare. • Sensory info stops at the thalamus. It doesn't reach the cortex (so it's not integrated). The client is less aware of their internal and external world. • Endorphins release to numb pain. Dynorphins release, which can make the client feel detached from their body. • Can result in fainting. impact of trauma on Semantic Memory -What it is: The memory of general knowledge and facts. -Example: You remember what a bicycle is. -How trauma can affect it: Trauma can prevent information (like words, images, sounds, etc.) from different parts of the brain from combining to make a semantic memory. -Related brain area: The temporal lobe and inferior parietal cortex collect information from different brain areas to create semantic memory. impact of trauma on memory -Explicit Memory • Semantic Memory • Episodic Memory -Implicit Memory • Emotional Memory • Procedural Memory impact of trauma on Episodic Memory -What it is: The autobiographical memory of an event of experience - including the who, what, and where. -Example: You remember who was there and what street you were on when you fell off your bicycle in front of a crowd. -How trauma can affect it: Trauma can shutdown episodic memory and fragment the sequence of events. -Related brain area: The hippocampus is responsible for creating and recalling episodic memory. impact of trauma on Emotional Memory -What it is: The memory of the emotion you felt during an experience. -Example: When a wave of shame or anxiety grabs you the next time you see your bicycle after the big fall. -How trauma can affect it: After trauma, a person may get triggered and experience painful emotions, often without context. -Related brain area: The amygdala plays a key role in supporting memory for emotionally charged experiences. 1. Compliance / Obedience 2. Treatment-Resistant Depression 3. Interpersonal Conflict 4. Social Avoidance / Desire to Isolate Compliance / Obedience: -might be simply going through the motions of life on autopilot. -may feel detached from bodily experiences • feelings no longer guide their actions -Ex: domestic violence pt may no longer be aware of fear, which keeps the person in the situation Treatment-Resistant Depression: -Experiencing ongoing, inescapable traumatic stress can lead to treatment-resistant depression -defining feature of this kind of depression is learned helplessness. -important to consider the client's history (for example, did they experience chronic, inescapable stress?). Interpersonal Conflict: A patient in collapse/submit might have difficulty engaging with others and/or setting boundaries. Social Avoidance / Desire to Isolate: -Collapse/submit can make it difficult for a patient to engage in basic daily activities • making meals or personal hygiene. • may withdraw socially activated responses: ________ or _________ fight or flight avoiding responses: ___________/___________ shutdown/collapse Kahara cannot sit still in class and constantly fidgets in her seat. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Activated response (fight or flight) Connie loudly over shares personal information in public settings. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Activated response (fight or flight) Genevieve is chronically late or misses meetings. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Avoiding response (shutdown/collapse) Eunjee is very directive and controlling of how things should be done. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Activated response (fight or flight) Marshawn hides his belongings and tends to sneak things. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Avoiding response (shutdown/collapse) Norland often sleeps through class or appears zoned out. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Avoiding response (shutdown/collapse) Rhye talks about violence or intense events without emotions. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Avoiding response (shutdown/collapse) Leon is easily defensive or reactive at meetings. activated responses (fight or flight) or avoiding responses (shutdown/collapse). Activated response (fight or flight) Circuits in the lower brain, responsible for: emotional reactions and the defense system • Grounding • Shift and StaY "What are you aware of now? Is this sensation pleasant, unpleasant, or neutral?" What CRM skill? • Tracking • Gesturing • Titration • Resourcing & Resource Intensification • Help Now! • Pendulation • Grounding • Shift and Stay Tracking Rationale: Tracking skills help the client to pay attention to sensations, name them, and distinguish sensations of distress from those of well-being. "What is it about you that helped you get through that?" What CRM skill? • Tracking • Gesturing • Titration • Resourcing & Resource Intensification • Help Now! • Pendulation • Grounding • Shift and Stay Resourcing and Resource Intensification Rationale: Resource questions can be used to shift from thoughts or feelings of stress or trauma to resilience. "Place this weighted pillow in your lap and bring your attention to your body sitting in the chair." What CRM skill? • Tracking • Gesturing • Titration • Resourcing & Resource Intensification • Help Now! • Pendulation • Grounding • Shift and Stay Grounding Rationale: Grounding provides a felt sense of contact in the present moment to provide a sense of safety, security, and control. "Let's perform this movement together." What CRM skill? • Tracking • Gesturing • Titration • Resourcing & Resource Intensification • Help Now! • Pendulation • Grounding • Shift and Stay Gesturing Rationale: Soothing gestures can be used as a form of self-regulation. "Count backward as you walk around the room." What CRM skill? • Tracking • Gesturing • Titration • Resourcing & Resource Intensification • Help Now! • Pendulation • Grounding • Shift and Stay Help Now! Rationale: Help Now! strategies decrease or increase activation within the nervous system when a person is hyper- or hypoaroused. "Shift your awareness by imagining your dog for at least 15 seconds." What CRM skill? • Tracking • Gesturing • Titration • Resourcing & Resource Intensification • Help Now! • Pendulation strategies 3. Assessment -ID aspects of the target or an image to process that best represents the traumatic injury. 4. Desensitization -Create bilateral stimulation with eye movements, sound, and/or tapping. 5. Installing & Strengthening (+) Cognition -Use (+) cognition with repeated eye movements when the distress has been reduced. 6. Body Scan -ensure all aspects of the traumatic injury have been processed. 7. Closure -self-calming strategies to end session with the pt feeling safe, psychoeducation about journaling feelings that come up after session is over. 8. Re-evaluation -Determine if (+) results maintained & ID new targets that need processing. "window of tolerance" resilient zone (RZ) or therapeutic window -When you are in your Window of Tolerance, you feel like you can deal with whatever's happening in your life -You might feel stress or pressure, but it doesn't bother you too much -ideal place to be -Working with a practitioner can help expand window of tolerance • more able to cope with challenges How Trauma can Affect Your Window of Tolerance When stress & trauma shrink your window of tolerance, it doesn't take much to throw you off balance. Hyperarousal -Anxious, Angry, Out of Control, Overwhelmed • body wants to fight or run away Hypoarousal -Spacy, Zoned Out, Numb, Frozen • body wants to shut down Areas of brain r/t traumatic experiences Amygdala -alarm system for stressful events Hippocampus -assists with learning • including memories about safety & danger Prefrontal Cortex -controls behavior & emotion Elisabeth is a 30-year-old who presents for psychotherapy. Elisabeth's eight- month-old daughter died suddenly in the night two years ago. The coroner determined the death was sudden infant death syndrome (SIDS). Elisabeth is a critical care nurse and is having difficulty understanding how her baby died so suddenly and without warning. She feels like she should have detected some symptoms of distress and feels guilty that her attempts at cardiopulmonary resuscitation (CPR) did not revive her baby. She also has disturbing memories of finding her baby dead in the crib. The psychiatric mental health nurse practitioner (PMHNP) selects EMDR as a psychotherapeutic approach. Which of the following responses are congruent with EMDR? Select all that apply. "Identify the 10 most disturbing experiences in your life?" "Imagine yourself in a safe train that is speeding by upsetting scenery." "Choose a preferred statement, such "Identify the 10 most disturbing experiences in your life?" "Imagine yourself in a safe train that is speeding by upsetting scenery." "Choose a preferred statement, such as I did the best I could to counter your statement that the death is your fault." "As you think about the death, how do the words I did my best feel now?" "Can a mother be guilty of her child's death when there are no symptoms of distress?" Rationale: A client's history of disturbing events that might be related to the trauma might also be targeted for processing (client history and treatment planning). Clients are taught ways to relax and calm themselves to cope with distressing arousal. A safe train speeding by distressing scenery may help the client feel safe during EMDR (preparation). Having the client identify a negative belief associated with the event and a preferred statement helps support positive cognition (assessment). Repeating positive cognition after distress strengthens positive cognition (installing and strengthening positive cognition). When processing is stuck, the therapist may pose a question to simulate the connection to a positive cognition (installing and strengthening positive cognition). Trying one thing different between sessions is congruent with Gestalt therapy, not EMDR. patterns and enhance her functioning. In the early phase of DBT, the PMHNP helps Sasha build skills in mindfulness to enhance her awareness and self-observation. Which of the following are the most appropriate exercises to enhance mindfulness skills? Select all that apply. abdominal breathing wise mind judgment diffusion assertive listening negotiating relaxation abdominal breathing wise mind judgment diffusion Rationale: Mindful abdominal breathing, wise mind, and judgment diffusion are common mindfulness exercises. Assertive listening and negotiating are exercises to build interpersonal effectiveness and relaxation exercises are used to build distress tolerance skills. Sasha also has low distress tolerance. The PMHNP helps her build distress tolerance skills as a healthier alternative than self-medicating with her boyfriend's pain medications. Which of the following are the most appropriate exercises to enhance distress tolerance? Select all that apply. reducing vulnerabilities relaxation recognizing emotions making a request self-soothing radical acceptance relaxation self-soothing radical acceptance Rationale: Radical acceptance, relaxation, and self-soothing exercises build skills in distress tolerance. Recognizing emotions and reducing vulnerabilities exercises build skills in emotional regulation. Making a request is an exercise to build interpersonal effectiveness. In the next phase of DBT, Sasha reports that she wants to be able to feel again since her emotions have been "numbed out" due to her substance abuse. The PMHNP uses skills in emotional regulation to help Sasha learn to control her feelings rather than being controlled by them. Which of the following are the most appropriate exercises to enhance emotional regulation? Select all that apply. problem-solving realistic goal setting passive versus aggressive behavior radical acceptance opposite action to emotion opposite action to emotion problem-solving Rationale: Opposite action to emotion and problem-solving exercises build skills in emotional regulation. Realistic goal setting is an exercise to enhance self-management. Radical acceptance builds skills in distress tolerance, whereas exercises in passive versus aggressive behavior build skills in interpersonal effectiveness. Psychotherapy with older adults considerations -higher prevalence of dementia •raises need for neuropsychological screening -higher prevalence of medical disorders • req careful consideration of physical causes of symptoms & effects of meds Child Development: -Physical Development • by three months, infants can lift their heads and clasp their hands • by six months, they may roll over, sit with support, and reach for objects and transfer them from hand to hand • by one year, infants can stand and start to take steps • by one year, birth weight triples and height increases by 50% -Cognitive and Language Development • by two months, infants start to coo • by six months, infants begin to babble • by nine months, infants imitate sounds and know their name • by one year, infants begin to say words and can follow one-step commands -Psychosocial Development • by four months, infants socially smile • by six months, infants enjoy their reflection in a mirror. • by nine months, infants enjoy peekaboo and often develop stranger anxiety -Health History • obtain information from the parent or caregiver observation and report of infant behavior and activity -Physical Exam • perform as much of the exam with the infant in parent or caregiver's lap as possible • keep familiar toys or blankets with infant • feed hungry infants before examining them • parents or caregivers of children younger than 11 should stay in the room -Health Promotion • administer immunizations per the recommended schedule • discuss experience at school, with peers, and social activities • healthy habits: nutrition, exercise, reading, sleep, screen time5 Child Development: Adolescents (11 years to adult) -Physical Development • age of onset and duration of puberty vary widely; however, the stages follow the same sequence • puberty typically occurs for girls around age 10 through 14 years • puberty typically occurs for boys around age 11 through 16 years -Cognitive Development • progress from concrete to formal operational thinking • can reason logically and abstractly to consider the future implications of actions -Psychosocial Development • the transition from primarily family influences to more autonomy and influence by friends • challenges related to identity, independence, and intimacy • establishing a supportive and nonjudgmental relationship may all lesbian, gay, bisexual, transgender, or queer youths to openly discuss sexual identity and/or concerns -Health History • utilize a comfortable and confidential environment • informally discuss friends, school, and activities using specific questions to build trust and rapport, then transition to more open-ended questions • a valuable technique to elicit questions about important or sensitive topics is to say, "other kids your age often have questions about..." • use the mnemonic HEADSSS to recall parts of a psychosocial assessment: ‣ Home environment ‣ Education, employment, eating ‣ Activities ‣ Drugs ‣ Sexuality, Suicide/depression, Safety -Physical Exam • unique to adolescents is puberty and growth • maintain modesty • ask adolescents about their preferences for exams to be alone or with a parent or caregiver in the room -Health Promotion • administer immunizations per the recommended schedule • healthy habits and behaviors: seat belts, drunk driving, obesity prevention, physical activity, screen time • sexuality: confidentiality, safer sex, contraception if needed • high-risk behaviors: preven Freud's Stages of Psychosexual Development -Oral stage (Stage I): Birth to 1 year • Mouth -Anal stage (Stage II): 1 to 3 years • Bowel and bladder control -Phallic stage (Stage III): 3 to 6 years • Genitals -Latent stage (Stage IV): 6 years to puberty • Libido inactive -Genital stage (Stage V): Puberty to death • Maturing sexual interests Freud's early developmental theory on psychosexual development -personality is shaped in childhood • maturation into a well-functioning adult requires sequential progression through each psychosexual stage -instinct or libidinal drives repressed or unmet • fixation occurs & the personality is affected Anquiette smokes, drinks, and bites her nails nonstop. match the psychosexual stage with the corresponding fixated behaviors: -Stage I: 0-1 year, oral, mouth -Stage II: 1-3 years old, anal, bowel, and bladder -Stage III: 3-6 years old, phallic, genitalia -Stage IV: 6-12 years old, latency, dormant sexual feelings -Stage V: Puberty to death, genital, mature sexual feelings -Stage I: 0-1 year, oral, mouth Rationale: Oral desire is the pleasure center for the infant. When oral needs are unmet, libidinal energy fixates, resulting in latent aggressive or passive tendencies, such as smoking, nail-biting, thumb-sucking, excessive drinking. Quinn is very possessive of his mother and stomped out of the room when his father hugged and kissed her. match the psychosexual stage with the corresponding fixated behaviors: -Stage I: 0-1 year, oral, mouth -Stage II: 1-3 years old, anal, bowel, and bladder -Stage III: 3-6 years old, phallic, genitalia -Stage IV: 6-12 years old, latency, dormant sexual feelings -Stage V: Puberty to death, genital, mature sexual feelings -Stage 6: Young adulthood period - Intimacy vs isolation -Stage 7: Adulthood period - Generativity vs stagnation/self-absorption -Stage 8: Old age period - Integrity vs despair *each stage, ind must resolve two conflicting ideas to become a well-functioning adult Piaget's Stages of Cognitive Development -Sensorimotor stage: Birth to 2 years -Preoperational stage: 2 to 7 years -Concrete operational stage: 7 to 11 years -Formal operational stage: 12 years & up Margarita scolded her brother who ran down the hallway at the hotel where they were staying. She told him that even though they were allowed to run at home, they can't run in a hotel. match the cognitive stage with the corresponding developmental behaviors: -Sensorimotor -Preoperational -Concrete operational -Formal operational Formal operational Rationale: In the formal operational stage, adolescents learn to apply logical rules to abstract concepts, moving beyond facts (what is) to problem-solving (what is possible). Essential skills developed in this stage include hypothetical-deductive thought, propositional thought, isolating variables, and examining combinations. Nile pulls down the pillow to look for a hidden toy. match the cognitive stage with the corresponding developmental behaviors: -Sensorimotor -Preoperational -Concrete operational -Formal operational Sensorimotor Rationale: During the sensorimotor stage, a child experiences the world through sensation and movement. This stage is marked by the child's understanding of object permanence: the ability to understand that objects exist independent of their interaction with them. Ibrahim understands that 10 cookies are constant in number whether stacked into a tower or spread out on the table. match the cognitive stage with the corresponding developmental behaviors: -Sensorimotor -Preoperational -Concrete operational -Formal operational Concrete operational Rationale: During the concrete operational stage, a child learns to apply logical rules to concrete or tangible objects and mentally transform what is seen or heard. The concept of conservation is an essential skill during this stage, where values remain unchanged during visual transformation. Nithin uses a box as a boat to "sail out to sea." match the cognitive stage with the corresponding developmental behaviors: -Sensorimotor -Preoperational -Concrete operational -Formal operational Preoperational Rationale: In the preoperational stage, representational thought through signs and symbols occurs. Children mimic behaviors and use their imagination to project an idea onto an object, symbolically. Mastery of this stage indicates that a child can think and assimilate knowledge rather than simply act on present objects. Psychotherapy with Children and Adolescents may involve: an individual child or adolescent, a group, a family, or multiple families Psychotherapy with Children and Adolescents: Development considerations -developmental level will impact how they: • reason • approach relationships • regulate emotion and behavior • communicate -Developmental considerations • inform the diagnostic process • guide tx planning Psychotherapy with Children and Adolescents: Family involvement -Family involvement in tx & decision-making • a norm in child and adolescent psychotherapy -invite parents to share the hx of the child or adolescent's chief complaint & prior tx, Children and Adolescents: Psychodynamic -primary modality in the treatment of younger children & complex cases -Psychodynamic techniques • allow pt to express emotions and experiences nonverbally through activities such as: ‣ free play ‣ dolls ‣ expressive art supplies ‣ sand trays ‣ movement Children and Adolescents: Motivational Interviewing -often used as a brief intervention for adolescents at risk for SUD -Substance Abuse and Mental Health Services Administration (SAMHSA, 2021) endorses the use of the SBIRT • Screening • Brief Intervention • Referral • Treatment ‣ model to ensure that adolescents are screened for risk of substance use ‣ 1-4 session intervention used to increase the adolescent's motivation to decrease substance use Children and Adolescents: Parent Training -The Oregon Model (PMTO) • training program for parents and other primary caregivers with children between the ages of 2-18 years who have disruptive behaviors: ‣ conduct disorder ‣ oppositional defiant disorder ‣ anti-social behaviors • uses a behavioral family systems approach • Parents taught: ‣ positive reinforcement methods ‣ limit setting ‣ how to model socially appropriate behaviors ‣ problem-solving skills Children and Adolescents: Problem-Solving Skills Training -focuses on cognitive processes -effective for doing individual work with children -Solutions-focused therapy can be used to develop new skills while building confidence and strengthening relationships Children and Adolescents: Cognitive Behavioral Therapy (CBT) -most commonly recommended therapy with children over the age of 8 & adolescents -helps clients with: • cognitive restructuring • changing behavior • problem-solving -techniques adjusted to level of cognitive development Children and Adolescents: Eye Movement Desensitization and Reprocessing (EMDR) -used successfully in the tx of children & adolescents with: • PTSD & other trauma • depression • anxiety • phobias -Parents /caregivers often included in sessions to promote nurturing & sense of safety -PMHNP adapt the eight phases of EMDR to accommodate the pt's developmental state Children and Adolescents: Group Therapy -may be used to help children learn strategies to improve: • emotional function and self-regulation • stress tolerance • social skills Children and Adolescents Ethical & Legal Consideration: Confidentiality -ind's in psychotherapy under age 18 do not have a blanket right to confidentiality from parents -Minors' rights to confidentiality • governed by a complex network of federal and state laws, professional ethics, & court interpretations of law -parents: • can req medical record, including symptoms, dx, tx plan • do not have the right to view psychotherapy notes without a court order • may not have the right to information in special situations ‣ signed a confidentiality agreement ‣ lost or given up parental rights ‣ court order prohibits access ‣ youth is emancipated Psychotherapy with Older Adults -Although mental illness is not a normal part of aging • 14.5% over the age of 50 have some type of mental health concern ‣ 3.4% have a serious mental illness -PMHNP must assess cognitive, affective, & physical function as well as social & family dynamics older adults: Common Approaches to Treatment -cognitive-behavioral therapy (CBT) -interpersonal psychotherapy (ITP) -problem-solving therapy for executive dysfunction (PST-ED) -cognitive behavioral therapy for mild dementia (CBT-MD) • for pts with cognitive impairment -ecosystem-focused therapy (EFT) • for pts with post-stroke depression older adults: Mindfulness-Based Interventions -Mindfulness-based stress reduction (MBSR) • typically provided over eight weeks • shown some efficacy for novice and regular meditating adults • reduce stress and mood disturbances older adults: Reminiscence Therapy and Life Review -Reminiscence therapy (RT) and life review therapy (LRT) • approaches used to help older adults recall life events • promote reflection • help clients understand who they are as individuals • help clients achieve ego integrity -RT can help improve psychosocial outcomes, cognition, communication, and quality of life for clients with dementia Legal and Ethical Considerations: Elder Abuse -PMHNPs must be alert for signs of elder abuse in their clients -Worldwide • 15% over age 60 experience abuse • abuse rates in community & LTC settings increased during COVID pandemic -Psychological abuse more prevalent than physical abuse -neglect & self-neglect also occur Types of Elder Abuse -Emotional abuse -Sexual abuse -Financial exploitation -Neglect -Abandonment -Physical abuse Which of the following are factors that contribute to elder abuse? Select all that apply. -cognitive impairment -aggressive behaviors -lower household income -psychological distress -need for activities of daily living assistance -shared living environment -sharing expenses with other members living in the household -participation in household chores -cognitive impairment -aggressive behaviors -lower household income -psychological distress -need for activities of daily living assistance -shared living environment Elder abuse: Almost ___% of abusers are caregivers, and __/__ of perpetrators are adult children or spouses 60%, 2/3 These offenders are well-intentioned. They become a caregiver expecting to provide adequate care but are beleaguered by the amount of care and lash out verbally or physically. Match the type of offender with the description: -Narcissistic offenders -Sadistic offenders -Overwhelmed offenders -Domineering or bullying offenders -Impaired offenders Overwhelmed offenders These offenders are well-intentioned but have personal problems that render them unqualified to provide care. This includes caregivers who are of advanced age, have physical or mental limitations, or have developmental disabilities. Match the type of offender with the description: -Narcissistic offenders -Sadistic offenders -Overwhelmed offenders -Domineering or bullying offenders -Impaired offenders Impaired offenders These offenders are motivated by anticipated personal gain and not the desire to help others. They tend to be socially sophisticated and gain a position of trust over the elder. Maltreatment most often occurs in the form of neglect and financial exploitation.