Somatic Therapy
A form of body-centered therapy, focusing on the connection of body and mind. Utilization of psychotherapy and physical therapies are used for holistic healing. It may be used by individuals and by groups.
- For stress, anxiety, depression, grief, addiction, relationship problem, sexual dysfunction, trauma, and abuse.
- For chronic physical pain unmitigated by traditional medicine, digestive disorders, and other medical issues.
Electroconvulsive Therapy (ECT)
This involves the introduction of electrical current to the brain through an electrode attached to the temporal region. It is among the fastest and most effective ways to relieve symptoms in severely depressed or suicidal people
- For severe depression, actively suicidal individuals, mania, and sometimes for other mental illnesses such as schizophrenia.
- It may also be used for clients who do not respond to antidepressant therapy and those who experience intolerable side effects of antidepressants, as well as for prevention of depressive relapse.
- It may not be used for patients who have cardiovascular, pulmonary, or febrile diseases, or fractures and glaucoma.
- Produces grand mal seizures
- 6 to 15 treatments three times a week, maximum benefits being found from 12 to 15 treatments.
| Form | Result |
|---|---|
| Unilateral | An electrode is attached to either temple. Less conducive to memory loss but may require a larger volume of treatment |
| Bilateral | Electrodes are attached to both temples, resulting in more rapid improvement but with increased short term memory loss |
Preparation
- Inform the client
- Secure consent
- Complete physical exam
- Cardiopulmonary exam
- Dental records
Nursing Responsibilities
- Before ECT
- NPO 6 to 8 hours post-midnight
- VS
- Remove dentures, nail polish, jewelries
- Empty bladder, move bowel
- Dry client, loosen clothing
- Positioning: supine on firm mattress
- Pre-medication: muscle relaxant, short-acting anesthesia
- During ECT: stay with the client, provide support, and assess for any complications.
- After ECT:
- Positioning: lateral
- Assess for injuries
- VS
- Orient client (confusion and short-term memory impairment may occur)
- Offer food when gag reflex returns.
Deep Brain Stimulation (DBS)
Implantation of a device that sends electrical signals (similar to a pacemaker) as a neurostimulator to regular brain activity. It acts on brain areas that are responsible for body movement.
Supportive Therapy
Individual Therapy
A method of bringing about change in a person by exploring their feelings, attitudes, thinking, and behavior. It involves a one-on-one relationship between the therapist and the client. Divided into phases: an introduction phase, a working phase, and termination phase.
- For insight on the self and one’s behavior.
- To make personal changes
- To improve interpersonal relationships
- To get relief from emotional pain or unhappiness
Family Therapy
Group therapy involving the client and his family members. It discusses the clinical treatment and knowledge required to cope more effectively, and emphasis on emotional understanding and healing.
- To understand family-psychopathology dynamics
- To mobilize the family’s strengths and resources
- Restructuring maladaptive family behaviors
- Strengthening family problem-solving behaviors
- Can be used for schizophrenia, bipolar disorder, clinical depression, panic disorder, and OCD, among others.
Group Therapy
Multiple persons gather to accomplish shared purposes through cooperation, and collaboration.
- Results in acceptance, belonging, awareness of shared experiences, learning, inspiration, hope, insight, altruism, and social interactivity.
Psychoeducation Group
Groups for education to provide information to members on issues such as stress management, medication management, assertiveness training, conflict resolution, anger management, problem solving, etc. This may also include family education.
Self-Help Group
Concerned about coping with a specific problem or life crisis where all members share a common experience. The group has no formal or structured group, and no formally identified leader.
- Alcoholic anonymous: alcoholics
- Al-Anon: partners of alcoholics
- Ala-teen: children of alcoholics
- Overeaters Anonymous
- One Day at a Time (grief group)
Support Group
A safe place for members who share a common problem to express feelings of frustration, boredom, or unhappiness. They discuss common problems and potential solutions.
- Cancer Patients, Stroke Victims
- AIDS
- Family members of suicide victims
- Mothers Against Drunk Driving (MADD)
- Role Reversion
Psychotherapy Groups
Based on various theories (Cognitive, Behavioral, Psychoanalytic, Psychosocial), management of the individuals’ emotional problems. Cognitive Behavioral Therapy is used to change a person’s perception of the self or the events in their life in order to facilitate behavioral and emotional change. Positive feedback, behavioral modification, and a token economy is used for changing behaviors.
- Cognitive Restructuring is used to monitor automatic thoughts, then to recognize the connections between thoughts, emotional responses, and behavior.
- Thought stopping for patients with obsessional thoughts (obsession, borderline, panic, aggression). The use of cue cards may aid in restructuring thought patterns
- Thought reframing changes negative to positive thoughts
Milieu Therapy
The utilization of the environment (“therapeutic environment”) to enhance mental health:
- Unit Structure: activities of daily living; activity groups, social skills groups, physical exercise programs, community meetings, psychoeducational programs
- Unit Norms: unit rules and policies concerning dressing, appearance, group meetings, medications, visitation, telephone use, etc.
- Limit Setting: clearly identifying acceptable and unacceptable behaviors. This involves self-destructive acts, physical aggressions, noncompliance, sexual behaviors, etc.
- Balance: practice of independency even in dependent situations; judgment is required for what the patient is capable of.
- Unit Modification: purposeful arrangement of the environment e.g. the furniture to address safety issues and orientation strategies.
Components of a Therapeutic Environment
- Support
- Validation
- Involvement: regular activities that encourage socialization. When necessary, therapists can help patients learn new methods to reciprocate and develop relationships.
- Validation:
-
Adjunct Therapies
Remotivation Technique
Founded by Dorothy Hoskins Smith, this technique can be used in a ward situation regardless of duration of hospitalization, nature of illness, and age. It attempts to reach the unwounded areas of a patient’s personality to allow patients to move back into reality.
Objectives
- Develop communication ability, share ideas and experiences with others
- Stimulate the patient to think about something and talk about himself
- Stimulate the patient to be a fellow explorer of the real world
- Enhance feelings of recognition and acceptance to increase self-respect and self-esteem
- Stimulate the patient’s interest in reality situations
- Take the patient out of the dullness of the ward and from the “vegetative state”
- Develop group harmony
Implementation
Done for 45 to 60 minutes, in 12 sessions spread over one or two times per week. Subjects to consider include nature, sports, literature, industry, science, geography, history, and hobbies. Avoid family problems, religion, sex, politics, and topics of love.
- Climate of Acceptance
- Open discussions by greeting the group in general, and expressing gratitude for the group’s attendance.
- The leader introduces themself, followed by the other members. Afterwards, the leader can provide a positive comment about the environment or the members’ appearance, etc.
- Bridge to Reality (15m)
- Stimulate patients into getting interested in a reality-oriented topic. Continue with bouncing questions that are easy to answer. Poems related to the topic may be brought up, and reading stanzas may be a bridge to reality.
- Sharing the World We Live In (15m)
- Stimulate questions leading to the topic. Try to explore the topic under discussion.
- Appreciation of the Works of the World (15m)
- A continuation of step 3, the leader relates with the patient so the patient can put themselves in the situation of the leader.
- Climate of Appreciation (15m)
- Leaders should attempt to summarize the discussion, attempt to discover what should be discussed in the next session, and express appreciation to the patient for coming to the sessions and participating.
Music and Art Therapy
Musical therapy uses music to help patients overcome physical, emotional, intellectual, and social challenges.
Objectives
It is used to promote participation, social interaction, improve reality orientation, coping skills, reduce stress, and express feelings. Art can also be used to increase self-awareness, cope with stress and traumatic experiences, enhance cognitive abilities, promote self-esteem, self-discovery, and personal fulfillment.
Implementation
- Select appropriate music based on objectives. Prepare materials and gather clients in a U-shape, seated at a bench with a table.
- Greet the clients, and express gratitude for attendance. The leader introduces their self and have the members follow suit.
- Introduce the activity to be done. This may be accomplished by asking questions related to the activity. Explain the procedure to be followed.
- Play music, the same one until all clients are done with their drawing.
- Ask them to comment and explain their drawings, and attempt to analyze the explanations of the clients.
- Collect the drawings and end the activity by thanking the participants and give a brief explanation for what should be expected for the next activity.
Occupational Therapy
The promotion of healthy by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition to develop, recover, or maintain the clients’ activities of daily living. Motor functions and reasonable abilities, as well as compensation for permanent loss of function are worked on.
Objectives
- Develop the ability to grasp realities through ADLs
- Provide opportunities of creativity and productivity from the patient’s own thinking and imagination.
- Promote self-confidence and personal achievements.
- Prepare for discharge from the institution.
Implementation
Occupational therapy may be done in various ways for various settings, including inpatient, outpatient, and community-based care.
- Identify occupational performance issues
- Assess factors contributing the identified occupational performance issues
- Consider the strengths and resources of both client and therapist.
- Negotiate targeted outcomes and develop an action plan.
- Implement the plan through occupation.
- Evaluate outcomes.
Recreational Therapy
“Therapeutic recreation” is a treatment service that provides treatment and recreation activities to patients. This may include arts, crafts, animals, sports, games, dance and movement, music, and community outings.
Dance/Movement Therapy
“Dance Therapy” or DMT uses movement to help individuals achieve emotional, cognitive, physical, and social integration. It is beneficial for both physical and mental health, involving stress reduction, disease prevention, and mood management. It may improve muscle strength, coordination, mobility, decreased muscular tension, self-awareness, self-esteem, and expression. This may then lead to bolstered communication skills and inspire dynamic relationships.
- For chronic pain, childhood obesity, cancer, arthritis, hypertension, cardiovascular disease, anxiety, depression, eating disorders, poor self-esteem, post-traumatic stress, dementia, communication issues, autism, aggression, violence, domestic violence trauma, social interaction, family conflict, and many others.
Attitudes in Psychiatric Nursing
- Active Friendliness: displayed interest in the immediate wellbeing of the patient, despite any attitude the patient may be presenting. Used for isolated, withdrawn, and apathetic patients.
- Passive Friendliness: interest in the patient’s welfare, but without requiring reassuring the patient of it. The nurse is friendly and interested when approached, but allows the patient to make the initial overtures. It is used for patients who may be frightened by active friendliness or paranoid.
- Indulgence and Permissiveness: normally unacceptable behavior may require to be accepted in some cases. Minor infarctions of ward rules should not be punished, or even instigated, when deemed appropriate e.g. allowing patients to read by the nursing station after the lights-out schedule.
- Watchfulness: used for suicidal patients. The personnel should be aware of many tools of daily hospital life that could be used in a dangerous manner. Frequent inspection of the patients’ belongings and environments should be done.
- Matter-of-Fact Attitude: used for patients who are often nagging, complaining, or bidding for sympathy. These should be ignored with friendliness and firmness. Arguing should not be done, and a calm implication of “this is the way it is” is in made in carrying out daily routines.
- Kind Firmness: self-punitive behavior e.g. in suicidal persons do not accept overt friendliness, due to feelings of unworthiness, guilt, or fear. Being actively or passively friendly may only result in heavier emotional burdens for the patient. A “near sternness” in the care of such patient should be used, but should avoid showing hostility through sternness.