Lecture 2: Patient Rights and Legal Issues PDF

Lecture #2: Patient Rights and Legal Issues 2 groups of people are guaranteed healthcare in the US: 1. Criminals 2. Native Americans Self-Determinism: Empowerment or having free will to make moral judgments  Ability and motivation to make choices based on personal goals  Key values: 1....

Lecture #2: Patient Rights and Legal Issues 2 groups of people are guaranteed healthcare in the US: 1. Criminals 2. Native Americans Self-Determinism: Empowerment or having free will to make moral judgments  Ability and motivation to make choices based on personal goals  Key values: 1. Personal autonomy  2. Avoidance of dependence on others Considered a basic and fundamental psychological need Foundation Of Self-Determinism: Veracity → be truthful  Beneficence → act in patient’s best interest  Autonomy → make own choices  Justice → fairness  Non-maleficence → avoidance or minimization of harm Protection of Patient’s Rights Patient Self-Determination Act (1990):  1. Requires providers to inform all adult patients about their rights to accept or refuse medical treatment  2. Protects a patient’s right to self-determination in health care decision-making.  3. Information about advance care documents/directives Advance care directives in mental health: 1. Psychiatric advance directives: Living will  Durable power of attorney Protection Of Patient Rights → Bill of Rights for mental health patients: Right to the least restrictive treatment alternative  Right to informed consent  Right to confidentiality  1. Use patient ID codes Right to retain personal items  Right to refuse treatment 1. Professionals can override a patient’s refusal for the safety of the patient, other patients, and staff members NOTE: RIGHTS ARE LIMITED DEPENDING ON PATIENT SAFETY! 1. EX: A nurse might deem a patient a danger to him/herself and force them to take a medication COMPETENCY → Degree to which patient can understand the information given during the consent process  Cognitive ability to process information at a specific time  Different from rationality  Not clearly defined across the states ​​INFORMED CONSENT → Legal procedure to ensure patient knows the benefits and costs of treatment  Mandate of state laws  Complicated in mental health treatment 1. Competency necessary to give consent  2. Decision-making ability often compromised in mental illness LEAST RESTRICTIVE ENVIRONMENT → Larger concept underlying patient’s right to refuse treatment Active SI or HI allows nurses to override patient choice A person cannot be restricted to an institution when he or she can be successfully treated in the community  Medication Cannot Be Given Unnecessarily: 1. Threat To Others, Threat To Self Are Considered Necessary → YOU HAVE TO DOCUMENT  2. Behavioral Restraints vs. Medical Restraints  Behavioral Restraints → Used to prevent harm due to violent or aggressive behavior that poses an immediate threat Medical Restraints → Used to prevent interference with medical care  1. 4 hours for adults 18 years of age or older (4 HOURS IS THE MAXIMUM TIME!) 2. 2 hours for children and adolescents (Ages 9 to 17) 3. 1 hour for children under 9 years of age 4. NOTE: Orders may be renewed according to the time limits for a maximum of 24 consecutive hours.  In-person evaluation, conducted within one hour of the initiation Use of restraints or locked room only if all other “less restrictive” interventions have been tried first TYPES OF TREATMENT: Voluntary or involuntary admission: 1. Voluntary Admission → Patient is admitted with their consent! 2. Involuntary Admission → Patient is admitted without their consent! Court ordered or in process of becoming court ordered Involves the Department of Mental Health (if custody is remanded to DMH) Often temporary and meant for initial evaluation 1. Commitment → Court Orders A Person To Receive Treatment In A Mental Health Facility Or Through Outpatient Services Typically longer-term 1. Person retains full civil rights  2. Is the patient free to leave at any time, even against medical advice? Involuntary admission vs. commitment: court ordered; without the person’s consent  Three Common Elements: 1. Mentally disordered  2. Dangerous to self or others  3. Unable to provide for basic needs Right to receive or refuse treatment Provisions for emergency short-term → hospitalization of 48 to 72 hours is common, but a state issue COURT ORDERED TREATMENT OPTIONS Commitment hearing is scheduled within 10 business days of admission  Occurs after a hearing with the probate judge in the patient's county of residence  Commitment options: 1. Commitment to the ADMH (Bryce Hospital for 150 days)  2. Continuance at present facility (typically 2 weeks)  3. Outpatient commitment  4. Petition dropped (no legal right to hold the patient) These are not all inclusive, but are the outcomes for a high percentage of the patients Involuntary hold →  A short-term detention (usually 24-72 hours) where a person is kept in a hospital or facility because they are a danger to themselves or others. This is done for evaluation and safety. Involuntary admission → placed in a psychiatric facility without their consent because they are unable to care for themselves or are a threat to themselves/others. This usually requires a doctor's and/or court order. Commitment → A legal process where a court decides that a person must stay in psychiatric treatment for a longer period (beyond the initial hold). This can be temporary or long-term, depending on their mental health needs. ALABAMA LAW: Involuntary admission and commitment: 1. the Patient is mentally ill; and: 2. because of the mental illness the person poses a real and present threat of substantial harm to himself or to others; and  3. respondent will continue to experience mental distress and deterioration of ability to function independently if not treated; and  4. respondent is unable to make a competent decision regarding treatment.  5. treatment is available for the person’s mental illness or confinement is necessary to prevent the person from causing substantial harm to oneself or to others; and  6. commitment is the least restrictive alternative available.  7. No timeframe: must file petition in the probate court of the respective county ALABAMA HOUSE BILL 70: Allows LEO to transport persons deemed to be incapable of self care, IE, not meeting their basic needs  1. No longer must meet the requirement of a danger to self or others.  2. “Be unable to satisfy his or her need for nourishment, medical care, shelter, or self-protection so that there is a substantial likelihood of death, serious bodily harm, serious physical debilitation, serious mental debilitation, or life-threatening disease. Goal: commitment to outpatient treatment PRIVACY AND CONFIDENTIALITY: Privacy → part of person’s life not governed by society’s laws and government intrusion  Confidentiality → ethical duty of nondisclosure (provider has information about patient and should not disclose it)  1. Remember patient ID numbers Breach of confidentiality → release of patient information without the patient’s consent in the absence of legal compulsion or authorization Challenging when attempting to obtain information during off hours MANDATES TO INFORM: A legal obligation to breach confidentiality   “Duty to warn”: 1. Judgment that the patient has harmed someone or is about to injure someone  MANDATORY REPORTING → REPORT WHEN: 1. Suspected child abuse/endangerment  2. Vulnerable adults ACCOUNTABILITY: Legal liability in psychiatric nursing practice  1. Assault → Threatening to harm someone 2. Battery → Physically Harming someone without their permission 3. Medical battery → Giving medical treatment without patient consent 4. False imprisonment → Restraining or holding someone against their will without legal reason 5. Negligence → Not doing something a reasonable person would do, leading to harm (EX: Forgetfulness) 6. Malpractice → Not following proper standards, causing harm to a patient Common areas for lawsuits → patients who are suicidal or violent  1. A positive working relationship with a patient minimizes lawsuits PERSONAL INJURY: Patients may threaten to sue individuals involved in treatment.  1. Best defense = professional and positive working relationship! DOCUMENTATION EHR must contain the rationale for nursing intervention   Common for all disciplines to record on one progress note → problem focused  Patients have access to their records  REQUIRED NURSING DOCUMENTATION → DOCUMENT: 1. Observations of the patient’s subjective and objective physical, psychological, and social responses  2. Interventions implemented and patient's response  3. Observations of medications’ therapeutic and side effects  4. Evaluation of outcomes of interventions DOCUMENTATION: Patient record: primary documentation of patient’s problems; verifies behavior and describes care provided  Entry is clear and without jargon  Meaningful, accurate, objective descriptions; no general or stereotypic statements  Electronic records held to same standards as non-electronic records 1. Handwritten documentation NURSE MENTAL HEALTH What issues are encountered by nurse mental health?  1. Could this be negligence, malpractice, or just a failure to remember? What action(s) would have provided a base of support for nurse mental health?  1. Effective communication with the patient/establishment of a viable relationship  2. Accurate and complete documentation  3. Know and meet the standard of care THE BIOPSYCHOSOCIAL MODEL IN PSYCHIATRIC–MENTAL HEALTH NURSING: Biologic domain → physical and biological aspects of a person’s health. Psychological domain → person’s thoughts, emotions, and behaviors Social domain → how a person interacts with their environment and relationships CHALLENGES OF PSYCHIATRIC NURSING Knowledge development, dissemination, and application  Overcoming stigma  Health care delivery system challenges-parity  Impact of technology and electronic health records  Red flag laws MILIEU: Structured programming is intended to affect behavioral changes and to improve the psychological health and functioning of the individual 1. ​​Some patients will decompensate when outside of a structured environment Patient Is Expected To Learn Coping, Interaction, And Relationship Skills, That Can Be Generalized To Other Aspects Of Their Life   Encourages independence and Self-Reliance ASSUMPTIONS OF MILIEU THERAPY: The health in each individual is to be realized and encouraged to grow.  Every interaction is an opportunity for therapeutic intervention.  The individual owns his or her own environment.  Each individual owns his or her own behavior.  Peer pressure is a useful and powerful tool Inappropriate behaviors are dealt with as they occur: 1. Calm demeanor 2. Explain consequences of behavior  3. Set limits on the patient's behavior Restrictions and punishment are to be avoided CONDITIONS THAT PROMOTE A THERAPEUTIC COMMUNITY: Containment-locked unit  Structure-TV, phone, activities  Involvement-group rooms, common areas, out of room activities  Support-staff and other patients within the milieu  Validation-affirmation of patient, active listening, gaining an understanding of patients concerns Nurses are also responsible for:  1. Medication administration  2. Development of a one-to-one relationship  3. Setting limits on unacceptable behavior  4. Client education ROLE OF THE NURSE IN MILIEU THERAPY: Through Use Of The Nursing Process, Nurses Manage The Therapeutic Environment On A 24-Hour Basis.  Nurses Have The Responsibility For Ensuring That The Client’s Physiological And Psychological Needs Are Met Aggression → A Cluster Of Characteristics That Include: Pacing; restlessness  Verbal/physical threats  Threats of homicide or suicide  Loud voice; argumentative  Destruction of property  Suspiciousness and defensive posturing ANGER MANAGEMENT: Anger → Secondary emotion  1. may be a response to underlying issues such as grief, depression, fear, or anxiety.  Anger can be manifested in the following ways:  1. Clenched fists  2. Low-pitched verbalizations forced through clenched teeth  3. Yelling and shouting  4. Intense eye contact or avoidance of eye contact  5. Hypersensitivity, easily offended  6. Defensive response to criticism MEDICATION INTERVENTION: Frequently used PRN medication → Called a cocktail  3 types of meds: antipsychotic, benzodiazepine (sedative), anti-cholinergic or anti-histamine  Haldol 5mg or ativan 1mg or cogentin 1mg  Geodon 20 mg or ativan 1mg  Severe agitation → Haldol 10mg or Ativan 2mg or Benadryl 50mg CRISIS MANAGEMENT: Focus on psychiatric crisis  1. Crisis situation in which general functioning has been severely impaired and the individual has limited control of emotions and actions Inpatient  1. “Acting out”  2. Anger  3. Physical altercation  4. Yelling or screaming  5. Acute manic episode  6. Suicide attempt CRISIS IN THE INPATIENT UNIT: ANGER OR AGGRESSION: Prevention is the key issue in management of aggressive or violent behavior.  Risk factors include in identifying the extent of risks: 1. History of violence or aggression  2. Client diagnosis, poor coping skills, and/or limited support system  3. Current behaviors, limit testing within the milieu Redirect and remove patient from the milieu 1. Just walking and talking with the patient can be effective THE ROLE OF THE NURSE IN CRISIS INTERVENTION: NOTE: THE KEY IS PREVENTION!! Phase 1 → Assessment  1. Information is gathered regarding the precipitating stressor and the resulting crisis that prompted the individual to seek professional help.  2. Will often observe defensiveness, facial grimacing, and agitation Phase 2 → Planning of therapeutic intervention 1. From the assessment data, the nurse selects appropriate nursing interventions that reflect the immediacy of the crisis. Focus on safety  2. Desired outcome criteria are established. Focus on safety  3. Appropriate nursing actions are selected, taking into consideration the type of crisis.  4. A display of violence requires distancing from other patient’s and possible PRN meds Phase 3 → Intervention  1. The actions identified in the planning phase are implemented.  2. Either restraint or seclusion is implemented  3. A reality-oriented approach is used.  4. Includes limited setting on aggressive behavior  5. Explanation of options  6. Rapid implementation of the intervention is initiated.  7. Goal is to prevent injury to the patient and the staff during the restraint/seclusion.  8. Patient is immediately placed on 1:1 status Phase 4. Evaluation of crisis resolution and anticipatory planning  1. A reassessment is conducted to determine stressors or triggers within the milieu (includes staff)  2. Debrief the patient (as soon as possible) Discuss the incident  Identify misconceptions (listen to patients POV) Discuss prevention of further episodes  Support the patient’s return to the milieu A plan of action is developed for the individual to deal with the stressor should it recur. 1. DOCUMENTATION: Objective description of events  Staff redirection  Patient’s response to redirection  Implementation of intervention  1. Restraint/seclusion/prn meds  Follow-up intervention (includes debriefing) BEREAVEMENT → Grief Response Grief → Loss Of Someone Or Something Of Importance Examples of loss include:  1. A significant other (person or pet)  2. Illness or debilitating conditions  3. Developmental/maturational changes  4. Decrease in self-esteem  5. Personal possessions ADDITIONAL ASSISTANCE: HOSPICE: Provides palliative and supportive care to meet the special needs of people who are dying and their families  Provides physical, psychological, spiritual, and social care for the person for whom aggressive treatment is no longer appropriate LENGTH OF THE GRIEVING PROCESS: Acute grief → 6 to 8 weeks; longer in older adults  The grief process: 1. Is very individual  2. May last for many years The grief response is more difficult if: 1. The bereaved person was strongly dependent.  2. The relationship was an ambivalent one.  3. The individual has experienced a number of recent losses.  4. The loss is that of a young person.  5. The bereaved person’s health is unstable.  6. The bereaved person perceives some responsibility for the loss.  7. The loss is secondary to suicide or is a traumatic death MALADAPTIVE RESPONSES TO LOSS: 1. Categorized in the DSM-5TR as Prolonged Grief  2. Delayed, inhibited, or complicated grief The absence of grief when it ordinarily would be expected  Potentially pathological because the person is not dealing with the reality of the loss  Remains fixed in the denial stage of the grief process.  Goal is to acknowledge the loss  May remain in the anger stage of grief causing intense emotional pain  Grief may be triggered much later in response to a subsequent loss CONCEPTS OF DEATH: DEVELOPMENTAL ISSUES Children: 1. Birth to age 2 → Unable to understand death but can experience the feelings of loss and separation  2. Ages 3 to 5 → Have some understanding about death but have difficulty distinguishing between fantasy and reality; believe death is reversible  3. School age → Beginning to understand the finality of death; difficult to perceive their own death;  normal grief reactions include: 1. regressive and aggressive behaviors.  2. Understand that death is final and eventually affects everyone 3. feelings of anger, guilt, and depression are common  4. peer relations and school performance may be disrupted Adolescents: 1. Usually able to view death on an adult level  2. Have difficulty perceiving their own death  3. May or may not cry; may withdraw from social circle  4. May exhibit acting-out behaviors, such as aggression and defiance of authority Elderly adults 1. A time in life of the convergence of many losses  2. May lead to “bereavement overload”  3. Bereavement overload may result in depression INTERVENTIONS: Be aware grieving takes time and is individualized  Utilize therapeutic communication to explore feelings  Giving false reassurance or advice, changing the subject, or using clichés are non-supportive and do not promote the grieving process Do not be afraid of discussing the reality of the loss 1. Explore new relationships  2. Encourage interaction with family and friends 3. Educate the patient regarding support group availability Lecture #3: Behavioral Health Functionality CULTURAL AWARENESS Culture → Shared beliefs, feelings, and knowledge  1. Used to guide a group’s conduct  2. Passed down from generation to generation SPIRITUALITY → Exists within everyone regardless of belief system   Gives meaning and purpose to an individual’s existence   Connects us to others, the environment, & a higher power   Religion → beliefs, values, rites, and rituals adopted by a group  NOTE: Nurses Must consider cultural, spiritual, and religious needs Mental Health Vs. Mental Illness: Mental Health → Successful adaptation to stressors   1. Thoughts, feelings, and behaviors → CONGRUENT with social norms!  2. Cultural relativity Mental Illness → Maladaptive responses to stressors   1. Interferes with functioning (social, occupational, physical)   2. Thoughts, feelings, and behaviors → INCONGRUENT with social norms! 3. Cultural incomprehensibility MASLOW’S HIERARCHY OF NEEDS → FROM TOP TO BOTTOM (WILL BE ON TEST!) Physiological Needs → Basic survival needs 1. Food, water, air, sleep, and shelter, etc.  Safety Needs → Feeling secure and safe 1. Financial stability, health, protection from danger, etc. Love and Belonging → Emotional connections  1. friendships, family, romantic relationships, etc Esteem → Feeling respected, recognized, and having self-confidence.  Self-Actualization → Becoming the best version of yourself, achieving personal growth, and fulfilling your potential GENERAL ADAPTATION SYNDROME (GAS) → How the body responds to stress! Alarm Stage → FIGHT OR FLIGHT RESPONSE 1. Adrenaline increases, heart rate rises, and energy surges to handle the threat. Resistance Stage → Body tries to adapt to ongoing stress. Remains alert but starts using stored energy, which can lead to fatigue if stress continues too long. Exhaustion Stage → If stress persists too long, the body’s resources get depleted. This can lead to burnout, illness, or other health issues. 1. Can lead to Insulin resistance, chronic anxiety and depression, irritability, concentration and sleep issues, HTN, T2DM Types of Fight or Flight Responses Fight → facing the stressor or situation 1. Anger, aggression, stomping, kicking, punching, stomach in knots, N&V Flight → Fleeing the stressor or situation  1. Anxious, feeling trapped, tense, wide eyes, restless (pacing or fidgeting) Faint → physically fainting (syncope) → Limits exposure to stress 1. Vision changes, feeling lightheaded, blacking out falling Freeze → Inability to respond or react to the stressor or situation  1. Dread, HR racing/pounding, pale, breath holding Fawn → Attempting to please or give in to the stressor or situation 1. Anger turned inward, boundaryless, people-pleasing, ignoring personal goals/desires, lack of personal identity TYPES OF STRESS Acute stress → Stress response for a short period of time → a temporary stressor  Chronic stress → Prolonged exposure to stressful stimuli 1. EFFECTS OF CHRONIC STRESS: Increased risk of disease and death due to chronically elevated Cortisol and Inflammation Impaired immune response → Increased infections  Cardiovascular disease, Obesity, Diabetes  Autoimmune disorders (fibromyalgia and lupus)  Gastrointestinal disorders (IBS, Crohn’s)  Reproductive or sexual dysfunction  Neurocognitive disorders, delayed development, regression  Chronic Depression, anxiety, insomnia, irritability, sadness, worry  Eating disorders, Substance use disorders, Addictive behaviors (gambling, shopping, sex) Toxic Stress → Prolonged activation of the stress → DUE TO CHRONIC NEGLECT, VIOLENCE, OR BULLYING IMMUNE RESPONSE TO STRESS Stress activates the immune response   1. Increased cytokines   2. Increased cortisol  3. Increased corticosteroids  Impact on the immune system  1. Inflammation → inhibits immune response   2. Damage and Disease Increase  Chronic Exposure to stress hormones WEAKENS the immune system MEDIATORS OF THE STRESS RESPONSE: Risk Factors: 1. Hopelessness   2. Racism and discrimination   3. Poverty   4. Genetics   5. Previous or repeated exposure to trauma (ACEs)   6. Feeling a lack of control   7. negative self-talk   8. internalizing/externalizing problems/situations   9. Reduced social interaction or negative interactions   10. Substance use Protective Factors: 1. Perception of control   2. Healthy lifestyle   3. Positive-secure relationships   4. Cultural connections   5. Beliefs and spiritual practices 6. Hardiness   7. Realistic expectations   8. Positive- safe-secure work   9. Home and school environment   10. Parental bonding   TRAUMA INFORMED CARE Safety  Compassion and trustworthiness  Support and collaboration  Empowerment  Consider issues of: 1. Culture   2. History   3. Gender Client Centered EUSTRESS VS DISTRESS: Eustress → Positive Forms of Stress Distress → Negative Forms of Stress STANDARDIZED STRESS SCREENERS: Holmes and Rahe Stress Scale → assigns "stress points" to life events 1. Higher Score → Higher Your Risk Of Stress-Related Illness Perceived Stress Scale → measures how stressed you feel Lazarus’s Cognitive Appraisal → explains how we mentally evaluate stress 1. Primary appraisal → Deciding if a situation is a threat, challenge, or harmless. 2. Secondary appraisal → Assessing if we have the resources to cope NOTE: Healing Isn’t Linear! SAMHSA: GUIDING PRINCIPLES OF RECOVERY Emerges from hope  Person-driven  Many pathways  Addresses Trauma  Supported by social network  Culturally based & influenced  Holistic  Based on respect and acceptance of the client Resilience → Process Of Adapting Well In The Face Of Adversity Factors: 1. Physical health  2. Spiritual/Religious beliefs  3. Optimism  4. Good personal relationships  5. Strong social support  6. Humor  7. Hobbies/interests  8. Strong self-concept TEACH CLIENTS STRESS REDUCTION METHODS: Cognitive reframing  Behavioral methods  Journal  Writing  Individual stress reduction methods  Priority restructuring  Biofeedback  Mindfulness  Assertiveness training GRIEF & ANXIETY  Grief → a normal response to the loss of a valued entity 1. Kubler Ross’ Stages of Grief:  Denial Anger Bargaining Depression Acceptance  1. Resolution → good and bad aspects of the lost entity are reconciled  2. Maladaptive grief → exaggerated, distorted, leads to depression and impaired functioning Anxiety → discomfort and worry due to fear of impending danger 1. Low levels are adaptive and enhance motivation to survive   2. May include uncertainty and helplessness   3. Impairs functioning when increased or prolonged LEVELS OF ANXIETY: Normal → motivates action (healthy survival trait)  1. ex. moving away from a fight Acute → a sudden loss or change, seen as a threat to personal security  1. ex. death of spouse, child, parent Chronic → sustained, may start in childhood, debilitating  1. ex. chronic migraines or fatigue due to abuse Anxiety Assessment: Mild Anxiety → first exposed to stressor 1. Perceptual field: an increase of awareness of the environment with possible hypervigilance  2. Ability to problem-solve: Peak functioning  3. Characteristics: nail-biting, foot-tapping, or fidgeting Moderate Anxiety → Unable to resolve the stress or initial response to the stressor is pronounced 1. Perceptual field: and concentration are more limited than before the stress was introduced  2. Ability to problem-solve: intact but may have limited ability to learn new skills  3. Characteristics: Increased vital signs due to sympathetic nervous system activation Severe Anxiety → perceives the stressor to be threatening  1. Perceptual field: distorted, unable to focus on more than one detail at a time  2. Ability to problem-solve: severely limited, displays ineffective reasoning  3. Characteristics: impending doom, withdrawal, loud speech, and nausea Panic Anxiety - unable to process the environment  1. Perceptual field: symptoms of dissociation are common  2. Ability to problem-solve: not intact, may be disorganized or irrational  3. Characteristics: extremely fearful; may freeze, run, scream, or fight; may exhibit hallucinations and delusions (psychosis) Anxiety Nursing Interventions → MILD AND MODERATE ANXIETY Remain calm, use simple and clear directions   Actively listen and recognize the client’s distress  Discuss and evaluate the client’s coping skills   Explore solutions   Encourage physical activity Anxiety Nursing Interventions → SEVERE AND PANIC ANXIETY Safe environment, stay with patient, be calm  Quiet atmosphere with minimal stimulation  Encourage exercise to release tension  Set firm limits; give brief, simple directions  Speak slowly in a low tone, repeat directions  Have client focus on surroundings and reality DEFENSE MECHANISMS → Used by everyone, a conscious and unconscious process used to respond to stress   Used for self-protection and survival in difficult situations   Reduces pain, stress, or anxiety   Can be adaptive or maladaptive Adaptive use → helps the individual to resolve feelings or thoughts about a stressor so they can respond appropriately Maladaptive use → prolongs, avoids, or complicates feelings or thoughts about the stressor TYPES OF DEFENSE MECHANISMS! Altruism → When you help others selflessly, without expecting anything in return 1. concern for the welfare of others, transforming feelings and emotions by helping others going through similar experiences Sublimation → expressing difficult feelings in acceptable ways  1. EX: Working out to deal with anger and stress Repression → Unconsciously pushing away painful or uncomfortable thoughts and memories.  1. EX: Forgetting a traumatic event Suppression → Consciously choosing to avoid thinking about something upsetting.  1. EX: Ignoring worries about an upcoming exam to stay focused Denial → Refusing to accept reality because it’s too painful. 1. EX: A person with a serious illness insisting they are completely healthy Introjection → Adopting someone else’s beliefs, attitudes, or behaviors as your own.  1. EX: A child taking on a parent’s strict moral views Identification → Boosting self-esteem by associating with a person or group.  1. EX: Dressing like a celebrity to feel more confident Compensation → Making up for a weakness by excelling in another area.  1. EX: A student struggling academically focusing on being a great athlete Intellectualization/Isolation → Avoiding emotions by focusing only on logic and facts.  1. EX: Discussing a tragic event in a detached, analytical way Conversion → Turning psychological stress into physical symptoms.  1. EX: Anxiety leading to sudden blindness or paralysis without a medical cause Splitting – Viewing people or situations as entirely good or entirely bad, with no in-between. 1. EX: Thinking a friend is perfect one day and terrible the next Projection – Attributing your own unwanted thoughts, feelings, or behaviors to someone else. 1. EX: Accusing someone of being angry when you are the one feeling angry Regression → Reverting to childish behaviors when stressed.  1. EX: An adult throwing a tantrum or sucking their thumb under pressure. Displacement → Redirecting emotions from the real source to a safer target.  1. Taking out frustration from work by yelling at a family member Reaction Formation → Acting in the opposite way of how you really feel.  1. Treating someone you dislike overly kindly Undoing – Trying to "cancel out" a bad action or thought by doing something good 1. Being overly nice after saying something hurtful Rationalization – Justifying bad behavior or failures with logical but false explanations.  1. EX: Saying you failed a test because the teacher was unfair, not because you didn’t study Dissociation – Mentally disconnecting from reality or emotions to avoid stress. 1. EX: Zoning out or feeling detached during a traumatic event CLASSIC PSYCHOANALYSIS → SIGMUND FREUD Psychoanalysis: 1. Examines unconscious motives to resolve conflicts with a Psychoanalyst 2. Therapy lasts months to years (not cost effective)  3. All internal conflicts are the result of early childhood  4. Past relationships are a common focus in therapy Id → used for instant gratification of desires and physical needs  Ego → the conscious and unconscious reasons why you behave a certain way Superego → morals and rules (your conscience) culturally influenced  Unconscious → desires, impulses, memories, and emotional conflicts (influences behavior, below awareness)  Conscious → self- awareness made up of acknowledged feelings, thoughts, and perceptions Erik Erikson’s Stages of Psychosocial Development Trust vs. Mistrust (0-1 year) → Learning to trust caregivers when needs are met.  1. EX: A baby feels secure when fed and comforted Autonomy vs. Shame and Doubt (1-3 years) → Developing independence and confidence.  1. EX: A toddler learns to say “no” and tries to do things on their own Initiative vs. Guilt (3-6 years) → Learning to take initiative and make decisions. 1. A child starts planning activities and asking lots of questions Industry vs. Inferiority (6-12 years) → Developing a sense of competence through school and activities.  1. EX: A child feels proud of doing well in class or sports Identity vs. Role Confusion (12-18 years) – Figuring out personal identity and values.  1. EX: A teenager explores different beliefs, careers, and social roles Intimacy vs. Isolation (Young adulthood, 18-40 years) → Forming deep relationships with others.  1. EX: A young adult builds close friendships or romantic relationships Generativity vs. Stagnation (Middle adulthood, 40-65 years) → Contributing to society and helping the next generation.  1. EX: A person focuses on career, family, or mentoring others Integrity vs. Despair (Late adulthood, 65+ years) → Reflecting on life with a sense of fulfillment or regret.  1. EX: An elderly person feels proud of their life or regrets missed opportunities Behavioral vs. Cognitive Therapy: Behavioral Therapy → Changing Behaviors  1. Behavior is learned and has consequences   2. Behavior can change without exploring underlying causes   3. Tools (relaxation, modeling) used to decrease anxiety/avoidance Cognitive Therapy → Changing Thoughts 1. Problems may stem from the past but are guided and maintained by current events 2. Addressing current crises or problematic situations causing negative thought processes 3. Distorted thought patterns cause negative emotions and lead to maladaptive behaviors 4. The therapist identifies the client’s thoughts that enhance or contribute to anxiety COGNITIVE THERAPY TOOLS Cognitive Reframing → Changing the way you think about a situation to see it in a more positive or helpful way.  Priority Restructuring → Adjusting what you focus on to better align with your goals and well-being.  Assertiveness Training → Learning to express thoughts, needs, and boundaries confidently and respectfully.  Monitoring Thoughts → Keeping track of negative or unhelpful thoughts to recognize patterns and make changes.  Response Prevention → Stopping yourself from engaging in a habitual or harmful response to stress or anxiety.  Thought Stopping → Interrupting negative or intrusive thoughts with a mental or physical cue.  Validation Therapy → A therapeutic approach that acknowledges and respects a person’s feelings and experiences, often used for those with dementia.  BEHAVIORAL THERAPY TOOLS: Systematic Desensitization → Gradually exposing a person to a feared object or situation while teaching relaxation techniques to reduce anxiety.  Flooding → Exposing a person to their feared object or situation all at once to overwhelm their fear Aversion Therapy → Associating an unwanted behavior with an unpleasant stimulus to reduce it. Operant Conditioning – Learning through rewards and punishments Meditation – Focusing the mind and calming the body to reduce stress and improve well-being Modeling – Learning by observing and imitating others TYPES OF COGNITIVE & BEHAVIORAL THERAPY: Cognitive Behavioral Therapy → A mix of cognitive and behavioral approaches to treat anxiety   1. Treats: anxiety, depression, eating disorders, and substance use  2. Considers the client’s perceptions about what motivates their actions   Dialectical Behavioral Therapy → Used for clients with personality disorders and self-harm behaviors   1. Treats suicidal and other self-destructive behaviors 2. Focuses on gradual change   3. Accepts and validates the client   EMDR Therapy (Eye Movement Desensitization and Reprocessing) → Helps people process and heal from traumatic memories by using guided eye movements or other forms of bilateral stimulation (like tapping) 1. Goal: To decrease the emotional charge tied to trauma and replace negative beliefs with healthier ones. GROUP THERAPY: Intensive treatment involving open therapeutic communication between members 1. Group Therapy Types: Individual Group Family  1. Leadership Types:   Democratic → leader involves the team in decision-making, encourages collaboration, and values everyone's inpu Laissez-faire → leader gives the team a lot of freedom to make decisions and work independently, with minimal supervision. Autocratic → leader makes decisions alone. THERAPY TERMS & PROCESSES: Group process  Group norm  Hidden agenda  Subgroup  Dynamics  Homogeneous group  Heterogeneous group Purpose: 1. Open, clear, respectful communication   2. Therapist provides support, encouragement, acceptance, education   3. Cohesive and subject to guidelines   4. Goal-directed Group Therapy Phases: Orientation Phase → The group gets to know each other, establish trust, and understand the goals and rules of therapy. Working Phase → The group works through issues more openly, provides support, shares personal insights, and explores deeper emotions Termination Phase → The group prepares to end therapy, reflecting on progress, and saying goodbye. Members discuss how to maintain their growth outside of the group NOTE: LOCATION DETERMINES GROUP FEATURES Acute Unit: 1. Members may change daily, focus is relief  2. Unit activities affect the group  3. Highly structured Outpatient: 1. Membership consistent and focused on growth  2. External interruptions limited  3. Members have more input in group progress GROUP ROLES: Maintenance roles → helps keep the group on track Task Roles → responsible for tasks necessary to group function Individual Roles- promote an individual’s agenda TYPES OF GROUPS: Task Groups  Teaching Groups  Supportive-Therapeutic Groups  Self-help Groups GROUP FUNCTIONS: Socialization  Governance  Support  Camaraderie  Task completion  Information sharing  Normative influence  Empowerment THERAPEUTIC GROUP FACTORS Installation of hope  Imitative Behavior  Universality Imparting of Information  Altruism  Interpersonal  Group cohesiveness  Corrective recapitulation  Catharsis Existential Factors  Developing social skills FAMILY FUNCTIONING: Communication  Management  Boundaries  Socialization  Emotional/Supportive  Discipline  Family therapy NERVOUS SYSTEM: Central Nervous System (CNS) 1. Brain and Spinal cord Peripheral Nervous System (PNS) → nerves outside of CNS 1. Somatic Nervous System   2. Autonomic Nervous System: Sympathetic (fight/flight)  Parasympathetic (rest/digest) Note: The Brain Has Lobes That Are Responsible For Different Activities! Frontal Lobe – Decision-making, problem-solving, planning, and controlling movements Parietal Lobe – Processes sensory information like touch, temperature, and spatial awareness Temporal Lobe – Processing auditory information (hearing) and Memory Occipital Lobe – Processes visual information NERVOUS SYSTEM COMPOSITION: Neurons → nerve cells send and receive messages throughout body  Neurotransmitters → chemical messengers stored in vesicles  Reuptake → storage process for neurotransmitter reuse NEUROTRANSMITTERS: Acetylcholine → Memory, learning, and muscle movement 1. Too Much → Depression 2. Too Little → Alzheimers, Huntingtons, Parkinsons Norepinephrine → Alertness, focus, and mood regulation 1. Too Much → Mania, Anxiety, Schizophrenia 2. Too Little → Depression Dopamine → Involved in pleasure, reward, and movement control 1. Too Much → Schizophrenia, Mania, Addiction 2. Too Little → Parkinsons, Depression, Tourettes, ADHD Serotonin → Regulates mood, sleep, and appetite 1. Too Much → Anxiety 2. Too Little → Depression, Anxiety Histamine → immune response, digestion, and wakefulness 1. Too Much → Sleep Disorders, Anxiety, Alzheimer’s, Psychosis 2. Too Little → Depression NEUROPEPTIDES: 1. Opioid peptides → endorphins and enkephalins → modulate pain 2. Substance P → regulates pain 3. Somatostatin → stimulates or inhibits NTs AMINO ACIDS: 1. GABA → hinders excitatory impulses  (benzodiazepines and alcohol)  1. Glycine → inhibits motor neurons 2. D-serine → mediates NMDA receptor activity, synaptic plasticity, neurotoxicity 3. Glutamate And Aspartate → Relay Sensory Info, Regulate Reflexes  Plays a Role In Learning And Memory! HORMONES: Thyroid stimulating hormone: 1. Too Much → Fatigue, Depression 2. Too Little → Insomnia, Anxiety Antidiuretic Hormone → Helps the body hold onto water by reducing urine output.  1. Altered amounts → Polydipsia (THIRST)  2. Altered Pain Response 3. Modified sleep pattern 4. STOPS PEE Oxytocin  1. Altered amounts → Stimulates ACTH Growth hormone 1. Altered amounts → Anorexia Nervosa! Adrenocorticotropic hormone (ACTH) 1. Increased Levels → Mood Disorders, Psychosis 2. Decreased Levels → Depression, Apathy, Fatigue Prolactin 1. Increased Levels → Depression, Anxiety, Fatigue, Decreased Libido, Irritability Gonadotropic Hormones  1. Increased Testosterone → Increased Aggression and Sexual Behavior 2. Decreased levels → Depression and Anorexia Nervosa Melanocyte Stimulating Hormone 1. Increased levels → Depression Sleep: Abnormal Circadian Rhythms are associated with: 1. Depression  2. Seasonal affective disorder (SAD)  3. Bipolar Poor sleep increases symptoms of anxiety and ADHD! ​​BIOLOGY AND MENTAL HEALTH Psychobiology - studies the biological foundations of cognitive, emotional, and behavioral processes  Neuroendocrinology - study of the interaction between the nervous system and the endocrine system  Psychoneuroimmunology - studies the effects of social and psychological factors on immune system function