NR605 Final Exam Questions And Answers, Exams of Nursing

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NR605 Final Exam

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 -Homework
• to help clients reinforce & build on what was learned during the therapy session motivational interviewing (MI) - -helps individuals prepare for change -person-centered, evidence-based approach to behavior change -using a collaborative, goal-oriented communication style -empowers clients to draw on their meanings & capacities to facilitate change

-Affirming

• provide encouragement, are (+) comments on a client's strengths or efforts -Reflecting
• mirror the content or feelings explicitly or implicitly stated by the client
• convey empathy, demonstrate listening, highlight emotions & beliefs, • provide opportunities for the client to elaborate on their concerns
• empower clients to take control of the conversation
• recommended to use at least two reflections for every question -Summarizing
• links together what has been stated to help the client organize their experiences MI Phases of the Change Process - -engagement
• establishment of trust & a helping relationship between the therapist & client
• uses reflections that communicate understanding -focusing
• identification of the direction or target of the change
• uses open-ended questions -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

-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 failure!"

-Catastrophizing

• "I know my relationship is in trouble. If my girlfriend leaves, I know I'll never find someone else and will be alone forever." -Filtering
• "I just read my student evaluations for the term. While they're almost all positive, one student felt that I was insensitive and never responded promptly even though I answered every email within 24 hours. I'm a terrible teacher." -Overgeneralization
• "Every single time I work the night shift at the hospital, they always give me the worst assignments! It's always a nightmare!" -Mind reading
• "I was at lunch with my friend today. She kept looking at her phone the whole time. I just know she didn't want to be there and is bored with our friendship." -Emotional reasoning
• "I started a diet on Monday and was doing well until they brought in pizza for lunch on Thursday. I feel like I'll never be able to succeed at this, so I'm giving up." Cognitive Techniques for Stabilization - -Socratic dialogue (SD) -Decatastrophizing Socratic dialogue (SD) - -hallmark of CBT -helps facilitate guided discovery

-Problem solving Socratic Question

• What would be good to do now?
• What would you like to do about this situation? Decatastrophizing - -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

"I can see that things have been difficult for you. How have you managed to carry on and preve - "What needs to happen today so that when you leave, you'll think this was a good session?" "I can see that things have been difficult for you. How have you managed to carry on and prevent things from becoming worse?" "How bad is the problem? What would it take to move one point higher?" "Between now and the next time we meet, observe what happens in your life that you want to continue." Rationale: Joining questions helps the therapist to connect with and accommodate the client's world. Coping questions help the client to identify resources that may have gone unnoticed. Scaling questions helps the client to pay attention to what they are doing and how they can take steps that lead to the changes they desire. Future-oriented questions help the client to shift their focus from problems to envisioning a better life. group therapy first appeared in the _______ - 1940s -grew out of the need to efficiently treat large groups of psychiatrically disturbed soldiers following World War II figures in group therapy - -Joseph Moreno

• psychodrama to enable veterans to participate in group dramatizations, reenact or role-play scenarios in their past and present
• learn to better manage fears and anxieties -Wilfred Bion
• identified fundamental patterns that could disrupt group work

-Samuel Slavson

• used psychoanalytic approaches in working with groups of disturbed children and adolescents psychodrama - Therapy in which clients act out personal conflicts and feelings in the presence of others who play supporting roles Stages -the warm up
• getting to know each other -the drama
• the enactment -sharing Group therapy - -form of psychotherapy -group of clients meets to discuss problems or concerns under the guidance of a therapist -one to two hours per week either online or in-person -may be designed to address a specific problem or diagnosis or may be more general -benefit, provides opportunity to expand access to care & efficiency
• therapists can provide tx to several clients at once
• more cost-effective than individual therapy 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

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 diagnosis. Which principle of group therapy is this an example of? - Existential factors Rationale: Existential factors include the ultimate concerns of the human condition—death, isolation, freedom, and meaninglessness—and may be the basis of psychiatric problems. Experiencing an existential event such as possible illness may mobilize awareness that each individual is responsible for their lives, actions, and choices. Inmates in group therapy were asked to share one thing they valued about each of the other group members. Which principle of group therapy is this an example of? - Interpersonal learning Rationale: Group members gain a deeper understanding of themselves through interacting with others and receiving feedback. Jamilla just began group therapy for an eating disorder and shared that she has overwhelming shame. Another group member, Jessamine, has been in the group for a while and talked openly about how she has overcome her body shame and shame around eating, which was encouraging to Jamilla.

• ask that clients not socialize outside of group sessions to avoid alliances that could disrupt group dynamics Types of Groups - -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