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Introduction
•  Psychological theories help us to explain behavior
•  Psychological therapies are treatments based on these theories
•  An overview of theories and therapies and their relevance to
nursing and psychiatric mental health nursing are described in
this chapter
CHAPTER 2
RelevantTheoriesand
TherapiesforNursing
Practice
•  Remember – the etiology of all psychiatric illness are twofold
•  1)
•  2)
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Freud’s Psychoanalytic Theory
PSYCHOANALYTIC
THEORIES
• Levels of awareness
• Conscious
• Preconscious
• Unconscious
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Freud’s Psychoanalytic Theory (Cont.)
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The Mind is an Iceberg
• Personality structure
• Id
• Ego
• Superego
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Freud’s Psychoanalytic Theory (Cont.)
Freudian Theory and Nursing
• Defense mechanisms and anxiety
• Operate on unconscious level
• Deny, falsify, or distort reality to make it less
threatening
• Formation of personality
• Experiences during the early stages of life
determine
• Individual’s lifetime adjustment patterns
• Personality traits
• Transference
• Conscious and unconscious influences
• Importance of individual talk sessions
• Attentive listening
• Countertransference
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Therapeutic Approaches
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Case Study
•  A patient is admitted to your unit who has an uncanny
resemblance to your older sister. As a child, your older sister
bossed you around and criticized you constantly. You realize that
you are responding negatively to this patient.
•  What is going on?
• Classical psychoanalysis
• Uncover unconscious material
•  What should the nurse do?
• Transference/Countertransference
• Defense mechanisms
• Psychodynamic and psychoanalytic therapy
• Short-term dynamic psychotherapy
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Erikson’s Theory and Nursing
Erikson’s Ego Theory
• This developmental model is an
• Eight stages of development
important part of nursing assessment
Personality continues to develop through old age
Failures at one stage can be rectified at another
stage
• Helps determine what types
of interventions are
Stage
Trustvs.mistrust
Age Stage
0-1.5 Identityvs.roleconfusion
Age
12-20
Autonomyvs.shamedoubt
Initiativevs.guilt
1.5-3 Intimacyvs.isolation
20-35
3-6
35-65
Industryvs.inferiority
6-12
Generativityvs.selfabsorption
Integrityvs.despair
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most likely to be effective
per developmental stage
65+
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ErikErikson’sEgoTheory
Erickson Vs. Freud
• Personalitycontinuestodevelopthrougholdage.
• Failuresatonestagecanberectifiedatanotherstage.
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Erickson
• Stressedego
Freud
• Stressedid
• Psychosocialaspectsof
development
• Psychosexualaspectsof
development
• Consideredlifespan
development
• Personalitydevelopedby
age5
• Studiedhealthypeople
• Studiedneuroticpeople
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Sullivan’s Interpersonal Theory
• Purpose of all behavior is to get needs met through
interpersonal interactions and decrease or avoid anxiety
• Personality can be observed within interpersonal
relationships
INTERPERSONAL
THEORY
• Security operations (observable vs. intrapsychic process)
• Act to reduce anxiety and increase security
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Interpersonal Therapy
• Focus is on interpersonal relationships
• Problems
• Grief
• Role disputes
• Role transition
• Interpersonal deficits
NURSING
THEORIES
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Hildegard Peplau’s Theory of
Sullivan’s Theory and Nursing
Interpersonal Relationships in Nursing (1952)
• Foundation for Hildegard Peplau’s theory
Major paradigm shift in nursing
• The art of nursing
• Participant observer
•  Provide care, compassion, and advocacy
•  Enhance comfort and well-being
• Mutuality
•  Focus is on the patient
• The science of nursing
• Respect for the patient
•  Application of knowledge
• Unconditional acceptance
•  Nursing is investigative and uses theory
•  To understand a broad range of human problems and psychosocial
phenomena
• Empathy
•  To intervene in relieving patient’s suffering and promote growth
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Peplau and the
Therapeutic Relationship
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Sr. Callista Roy (1976)
• Emphasizes the role of nursing in assisting
patients to adapt in order to cope more
effectively
• Adaptive Modes
• Physiologic
• Self-concept
• Role function
• Interdependence
• Levels of anxiety
• Communication
• Aim to improve patient’s ability to think and
function
• Personal growth
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Maslow’s Hierarchy of Needs
Humanistic
Theories
• Human beings are active participants in life,
striving for self-actualization
• When lower needs are met, higher needs are able
to emerge
• Basic needs
• D-motives/deficiency needs
• Self-esteem and self-actualization
• B-motives/being needs
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Maslow’s Hierarchy of Needs
• Basicneeds
• D-motives
• Deficiencyneeds
(e.g.,air,water,food)
• Self-actualization
• B-motives
• Beingneeds
(e.g.,esteemneeds)
Human beings are active participants in life
and
Strive for Self-actualization
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Maslow’s Theory and Nursing
• Emphasis on human potential and the patient’s strengths
• Needs are fulfilled by and through other humans
BEHAVIORAL
THEORIESAND
THERAPIES
• A person does the best he/she can at the time
• Prioritizing nursing actions in the nurse-patient relationship
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Behavior Theories
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Behavior Theories
•  Pavlov’s classical conditioning theory
•  Watson’s behaviorism theory
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Behavior Theories
Behavior Therapy
• Skinner’s operant conditioning theory
• Modeling
• Implications for nursing
• Operant conditioning
• Modifying or replacing behaviors
• Systematic desensitization
• Behavior management
• Aversion therapy
• Biofeedback
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Cognitive Theory
• Dynamic interplay between individuals and the
environment
• Thoughts come before feelings and actions
COGNITIVE
THEORIESAND
THERAPIES
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• Thoughts about the world and our place in it are
based on our own unique perspectives, which may
or may not be based on reality.
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Cognitive Therapy (Beck)
Piaget’s Stages of Cognitive Development
• How people feel/behave is largely determined by the way in
which they think about the world and their place in it
• Test distorted beliefs and change way of thinking; reduce
symptoms
• Focus
• Thoughts/cognitions
• Correcting cognitive distortions
• Reality testing
• Sensorimotor
• Preoperational
• Concrete operations
• Formal operations
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Cognitive Therapy
• Rational-Emotive Behavior
Therapy (Ellis)
• Schemata – our attitudes
and assumptions based on
individual experiences
• Aims to eradicate irrational
beliefs
• Recognize thoughts that
are not accurate
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Rational-EmotiveBehavioralTherapy
BiologicalTheories
• Focuson:
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• 
Neurologic
• 
Chemical
• 
Biological
• 
Genetic
• Howdoesthebodyand
braininteracttocreate
thefollowing?
•  Emotions
•  Memories
•  Perceptualexperiences
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Biological Theories and Nursing
Milieu Therapy
• Consider other influences that play a role in the
development and treatment of mental disorders
• Social, environmental, cultural, economic
• Focus on
• Qualities of a therapeutic relationship
• Understanding patient’s perspective
• Communicating to facilitate recovery
• Application of newest biologic research in nursing
practice
• Milieu Therapy
• Use of total environment
• People, setting, structure, and emotional climate
are all important to healing
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NewerTherapies
Apps
• Mindfulness-Based Cognitive Therapy (MBCT)
• Elements of CBT
• Plus mindfulness-based stress reduction
• Goal is to train the brain to accept and observe cognitions
without judgment
• Dialectical Behavioral Therapy (DBT)
•  Gay,K.,Torous,J.,Pandya,A.Duckworth,K.(2016)Digitaltechnologyuse
amonthindividualswithschizophrenia:Resultsofanonlinesurvey.
JournalofMedicalInternetResearch3(2),e15.doi:10.2196/mental.
5379.
•  Examples:
•  NAMIAIR
• Evidence-based to decrease suicidal and self-injurious
behaviors in borderline personality disorder
•  BellyBio
• Eye Movement Desensitization and Reprocessing
Therapy (EMDR)
•  My3
•  eCBTCalm
• Used to treat post traumatic stress disorder
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•  StudyFindings–
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Audience Response Questions
Audience Response Questions
1.  AccordingtoFreud,whichaspectofthe
personalitymotivatesanindividualtoseek
perfection?
A. Id
B. Ego
C. Superego
D. Preconscious
2.  Whichtheoristmostinfluencedtheprofessional
practiceofpsychiatricnursing?
A. HarryStackSullivan
B. HildegardPeplau
C. ErikErikson
D. IvanPavlov
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Audience Response Questions
3.Schemata,automaticthoughts,andcognitive
distortionsaretermsthatrelateto
A. rational-emotivebehavioraltherapy.
B. cognitive-behavioraltherapy.
C. operantconditioningtheory.
D. biofeedback.
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