Mental Health Study Guide Exam 1 PDF

**[MENTAL HEALTH STUDY GUIDE EXAM 1]** **[CHAPTER 1 MENTAL HEALTH AND MENTAL ILLNESS]** **[DEFINITIONS]** Resilience---the ability and capacity for people to secure the resources they need to support their well-being. Mental Illness---Refers to all psychiatric disorders that have definable diagn...

**[MENTAL HEALTH STUDY GUIDE EXAM 1]** **[CHAPTER 1 MENTAL HEALTH AND MENTAL ILLNESS]** **[DEFINITIONS]** Resilience---the ability and capacity for people to secure the resources they need to support their well-being. Mental Illness---Refers to all psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfunctions that may be related to developmental biological or psychological disturbances' in mental function. The ability to think may be impaired as in Alzheimer's disease. Emotions may be affected as in major depressive disorders. Behavioral alterations may be apparent (schizophrenia) People experience a combination of 3 alterations. Stigma---to which people with mental illness are often subjected. Stigma is the belief that the overall person is flawed, is characterized by social shunning, disgrace and shame. Milieu Therapy---provides structures and maintains a safe and therapeutic environment in collaboration with patients, families, and other healthcare clinicians. **[ATTRIBUTES OF MENTAL HEALTH]** - Rationale thinking - Effective coping - Resiliency - Self-Control - Self-Awareness - Developmentally on task - Spiritual Satisfaction - Happiness and Joy - Self-Care - Positive self-concept - Learning and productivity - Effective communication - Meaningful relationships **[Mental Health Continuum]** In the mental health continuum a patient can experience gradual shifts back and forth. Patients have also experienced a more impaired level of mental health and they can also experience recovery. On one end of the continuum is mental health. A sense of well-being describes the general state of people in this category. Well-being is characterized by adequate to high-level functioning. Although individuals at this end of the continuum may experience stress and discomfort resulting from problems of everyday life, they experience no serious impairments in daily functioning. For example, you may spend a day or two in a gray cloud of self-doubt and recrimination over a failed exam, a sleepless night filled with worry about trivial concerns, or months of genuine sadness and mourning after the death of a loved one. During those low times, you are fully or vaguely aware that you are not functioning well. However, time, exercise, a balanced diet, rest, interaction with others, and mental reframing may alleviate these problems or concerns. At the opposite end of the continuum is mental illness. Individuals may have emotional problems or concerns and experience mild to moderate discomfort and distress. Mild impairment in functioning such as insomnia, lack of concentration, or loss of appetite may be felt. If the distress increases or persists, individuals might seek professional help. Problems in this category tend to be temporary, but individuals with mild depression, generalized anxiety disorder, and attention-deficit disorder may fit into this group. The most severely affected individuals fall into the mental illness portion of the continuum. At this point, individuals experience altered thinking, mood, and behavior. It may include relatively common disorders such as depression and anxiety, as well as major disorders such as schizophrenia. The distinguishing factor in mental illness is typically chronic or long-term impairments that range from moderate to disabling. All of us fall somewhere on the mental health--mental illness continuum and experience gradual or sudden shifts. Many people will never experience the mental illness stage. On the other hand, many people who do reach a more severe level of impairment can experience recovery that ranges from a glimmer of hope to leading a satisfying and fulfilling life. **[DSM-5]** Serves as a tool for collecting epidemiological statistics about the diagnosis of psychiatric disorders: - Neurodevelopment disorders - Schizophrenia Spectrum disorders - Bipolar and related disorders - Depressive disorders - Anxiety disorders - Obsessive Compulsive disorders - Trauma and Stressor related disorders - Dissociative disorders - Somatic Symptom disorders - Feeling and eating disorders - Elimination disorders - Sleep-Wake disorders - Sexual dysfunction - Gender Dysphoria - Disruptive, impulse control and conduct disorders - Substance related and addictive disorders - Neurocognitive disorders - Personality disorders - Paraphilia disorders - Other disorders **[NURSING LEVELS IN MENTAL HEALTH]** 1. Basic Level Registered Nurse: Complete the nursing program and qualified to work in most general or specialty area 2. Psychiatric Mental Health Nurse: Mental health registered nurse (PMH-RN): a nurse that has received diploma, associate's degree, or bachelor's degree and chooses to work in the specialty of psychiatric mental health nursing. 3. Advanced Practice: Psychiatric Clinical Nurse Specialist: (PMH-APRN) are able to provide individual therapy, group therapy, diagnostic privileges, prescriptive authority and psychotherapy. Must obtain a master's degree in science of nursing (MSN) or Doctor of Nursing (DNP) functions at various levels of autonomy depending on the state and is eligible for specialty privileges. **[ADVOCACY]** Nurses are advocates for their patients, as a patient advocate the nurse reports incidences of abuse or neglect to the appropriate authorities for immediate action. Also supporting the patient's rights to make decisions regarding treatment. **[CHAPTER 2 THERORIES AND THERAPIES]** **[DEFINITIONS]** Countertransference---unconscious feelings the healthcare worker has toward the patient. Psychodynamic therapy---uses free association and dream analysis and concepts such as transference and countertransference. Transference---refers to unconscious feelings that the patient has toward a healthcare worker. Psychodynamic therapy\--is rooted in traditional psychoanalysis and uses many of the same tools, such as free association and dream analysis, and concepts such as transference and countertransference. Interpersonal theory\-- human beings are driven by the need for interaction. Harry Stack Sullivan (1892--1949), an American-born psychiatrist, developed a model for understanding psychiatric alterations that focused on interpersonal problems. He viewed loneliness as the most painful human condition. He emphasized the early relationship with the primary parenting figure, or significant other (a term he coined), as crucial for personality development. Interpersonal therapy\-- is an effective short-term therapy. The assumption is that psychiatric disorders are influenced by interpersonal interactions and the social context. The goal of interpersonal therapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships. **[PSYCHOANALYTIC THEROIES AND THERAPIES]** Sigmund Freud--- **[Conscious]** The conscious part of the mind is the tip of the iceberg. It contains all the material a person is aware of at any one time, including perceptions, memories, thoughts, fantasies, and feelings. **[Preconscious]** Just below the surface of awareness is the preconscious, which contains material that can be retrieved rather easily through conscious effort. **[Unconscious]** The unconscious includes all repressed memories, passions, and unacceptable urges lying deep below the surface. Memories and emotions associated with trauma may be stored in the unconscious because the individual finds it too painful to deal with them. The unconscious exerts a powerful yet unseen effect on the conscious thoughts and feelings of the individual. The individual is usually unable to retrieve unconscious material without the assistance of a trained therapist. **[Personality Structure]** Freud (1960) delineated three major and distinct but interactive systems of the personality: the id, ego, and superego. **[Id]** At birth, we are all id. The id is totally unconscious and impulsive. It is the source of all drives, instincts, reflexes, and needs. The id cannot tolerate frustration and seeks to discharge tension and return to a more comfortable level of energy. The id lacks the ability to problem solve and is illogical. A hungry, screaming infant is the perfect example of id. **[Ego]** Within the first few years of life as the child begins to interact with others, the ego develops. The ego resides in the conscious, preconscious, and unconscious levels of awareness. The problem solver and reality tester, the ego attempts to navigate the outside world. It is able to differentiate subjective experiences, memory images, and objective reality. The ego follows the reality principle, which says to the id, "You have to delay gratification for right now," then sets a course of action. For example, a hungry man feels tension arising from the id that wants to be fed. His ego allows him not only to think about his hunger but also to plan where he can eat and to seek that destination. This process is known as reality testing because the individual is factoring in reality to implement a plan to decrease tension. **[Superego]** The superego, which develops between the ages of 3 and 5, represents the moral component of personality. The superego resides in the conscious, preconscious, and unconscious levels of awareness. The superego consists of the conscience (all the "should nots" internalized from parents and society) and the ego ideal (all the "shoulds" internalized from parents and society). When behavior falls short of ideal, the superego may induce guilt. Likewise, when behavior is ideal, the superego may allow a sense of pride. In a mature and well-adjusted individual, the three systems of the personality---the id, ego, and superego---work together as a team under the administrative leadership of the ego. If the id is too powerful, the person will lack control over impulses. If the superego is too powerful, the person may be self-critical and suffer from feelings of inferiority. **[Defense Mechanisms and Anxiety]** Freud (1969) believed that anxiety is an inevitable part of living. The environment in which we live presents dangers and insecurities, threats and satisfactions. It can produce pain and increase tension or produce pleasure and decrease tension. The ego develops defenses, or defense mechanisms, to ward off anxiety by preventing conscious awareness of threatening feelings. Defense mechanisms share two common features: (1) they all (except suppression) operate on an unconscious level and (2) they deny, falsify, or distort reality to make it less threatening. Although we cannot survive without defense mechanisms, it is possible for our defense mechanisms to distort reality to such a degree that we experience difficulty with healthy adjustment and personal growth. Chapter 15 provides a full list and description of defense mechanisms. **[Psychosexual Stages of Development]** Freud believed that human development proceeds through five stages from infancy to adulthood. He believed that experiences during the first 5 years determined an individual's lifetime adjustment pattern and personality traits. By the time a child enters school, subsequent growth consists of elaborating on this basic structure. Freud's psychosexual stages of development are in Table 2.1. **[Psychoanalytic Therapy]** Classical psychoanalysis, as developed by Sigmund Freud, is seldom used nowadays. Freud's premise that early intrapsychic conflict is the cause for all mental illness is no longer widely thought to be valid. Such therapy requires an unrealistically lengthy period of treatment (i.e., three to five times a week for many years), making it prohibitively expensive and uncovered by insurance. **[INTERPERSONAL THERAPY]** 1\. Grief and loss: Complicated bereavement after death, divorce, or other loss 2\. Interpersonal disputes: Conflicts with a significant other 3\. Role transition: Problematic change in life status or social or vocational role **[IMPLICATIONS OF INTERPERSONAL THERORY TO NURSING]** Hildegard Peplau (1909--1999) (Fig. 2.2), influenced by the work of Sullivan and learning theory, developed the first systematic theoretical framework for psychiatric nursing in her groundbreaking book Interpersonal Relations in Nursing (1952). Peplau not only established the foundation for the professional practice of psychiatric nursing but also continued to enrich psychiatric nursing theory and work for the advancement of nursing practice throughout her career. Peplau was the first nurse to identify psychiatric-mental health nursing both as an essential element of general nursing and as a specialty area that embraces specific governing principles. She was also the first nurse theorist to describe the nurse-patient relationship as the foundation of nursing practice. She also shifted the focus from what nurses do to patients to what nurses do with patients. Her theory is mainly concerned with the processes by which the nurse helps patients to make positive changes in their healthcare status and well-being. She believed that illness offered a unique opportunity for experiential learning, personal growth, and improved coping strategies. Psychiatric nurses play a central role in facilitating this growth. **[Selected Nursing Theorists, Their Major Contributions, and Their Impact on Psychiatric-Mental Health Nursing]** Nursing Theorist Focus of Theory Contribution to Psychiatric- Mental Health Nursing Patricia Benner Caring as foundation for nursing Benner encourages nurses to provide caring and comforting interventions. She emphasizes the importance of the nurse-patient relationship and the importance of teaching and coaching the patient and bearing witness to suffering as the patient deals with illness. --------------------- ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dorothea Orem Goal of self-care as integral to the practice of nursing Orem emphasizes the role of the nurse in promoting self-care activities of the patient; this has relevance to the seriously and persistently mentally ill patient. Sister Callista Roy Continual need for people to adapt physically, psychologically, and socially Roy emphasizes the role of nursing in assisting patients to adapt so that they can cope more effectively with changes. Betty Neuman Impact of internal and external stressors on the equilibrium of the system Neuman emphasizes the role of nursing in assisting patients to discover and use stress-reducing strategies. Joyce Travelbee Meaning in the nurse-patient relationship and the importance of communication Travelbee emphasizes the role of nursing in affirming the suffering of the patient and in being able to alleviate that suffering through communication skills used appropriately through the stages of the nurse-patient relationship. **[BEHAVORIAL THERORIES AND THERAPIES]** **[Classical conditioning theory:]** - Ivan Pavlou found that when a neutral stimulus (a bell) was repeatedly paired with another stimulus (food), that would trigger salivation and eventually just the sound of the bell triggered salivation in a dog. **[Behavioral Theory]** - John B Watson, developed the school of thought referred to as behaviorism, there was more than one objective that was measurable. That adaptive and maladaptive were socially learned through classical conditioning. **[Behavioral Therapy]** - Assumes that changes in maladaptive behavior can occur without insight into the underlying cause and works best when specific problems and goals are well defined. **[MASLOWS HIERARCHY OF NEEDS]** **[Biological Theories and Therapies]** A biological or medical model of mental illness assumes that abnormal behavior is the result of a physical problem. - Electroconvulsive Therapy (ECT)-is convulsive site (cortical); helps depression, mania, catatonia. - Repetitive Transcranial Magnetic Stimulus (rTMS)-Not convulsive, site (cortical), helps depression - Vagus Nerve Stimulation (VNS)-Not conclusive site (cervical cranial nerve); helps with depression - Deep Brain Stimulation (DBS)-Not conclusive (subcortical) treats depression, obsessive compulsive disorder. **[Theory of Psychosocial Development]** Eric Erikson, culture and society play a role in personal development personality, continues to evolve throughout life. +-------------+-------------+-------------+-------------+-------------+ | **Erikson's | | | | | | Eight | | | | | | Stages of | | | | | | Development | | | | | | ** | | | | | +=============+=============+=============+=============+=============+ | **Approxima | **Developme | **Psychosoc | **Successfu | **Unsuccess | | te | ntal | ial | l | ful | | Age** | Task** | Crisis** | Resolution | Resolution | | | | | of Crisis** | of Crisis** | +-------------+-------------+-------------+-------------+-------------+ | **Infancy | Forming | Trust | Sound basis | General | | (0--1½ | attachment | versus | for | difficultie | | years)** | to mother, | mistrust | relating to | s | | | which lays | | other | relating to | | | foundations | | people; | people | | | for later | | trust in | effectively | | | trust in | | people; | ; | | | others | | faith and | suspicion; | | | | | hope about | trust-fear | | | | | environment | conflict; | | | | | and future | fear of | | | | | | future | | | | | "If he's | | | | | | late in | "I can't | | | | | picking me | trust | | | | | up, there | anyone; no | | | | | must be a | one has | | | | | good | ever been | | | | | reason." | there when | | | | | | I needed | | | | | | them." | +-------------+-------------+-------------+-------------+-------------+ | **Early | Gaining | Autonomy | Sense of | Independenc | | childhood | some basic | versus | self-contro | e/fear | | (1½--3 | control of | shame and | l | conflict; | | years)** | self and | doubt | and | severe | | | environment | | adequacy; | feelings of | | | (e.g., | | will power | self-doubt | | | toilet | | | | | | training, | | "I'm sure | "I could | | | exploration | | that with | never lose | | | ) | | the proper | the weight | | | | | diet and | they want | | | | | exercise | me to, so | | | | | program, I | why even | | | | | can achieve | try?" | | | | | my target | | | | | | weight." | | +-------------+-------------+-------------+-------------+-------------+ | **Preschool | Becoming | Initiative | Ability to | Aggression/ | | (3--6 | purposeful | versus | initiate | fear | | years)** | and | guilt | one's own | conflict; | | | directive | | activities; | sense of | | | | | sense of | inadequacy | | | | | purpose | or guilt | | | | | | | | | | | "I like to | "I wanted | | | | | help mommy | the candy, | | | | | set the | so I took | | | | | table for | it." | | | | | dinner." | | +-------------+-------------+-------------+-------------+-------------+ | **School | Developing | Industry | Competence; | Sense of | | age (6--12 | social, | versus | ability to | inferiority | | years)** | physical, | inferiority | work | ; | | | and school | | | difficulty | | | skills | | "I'm | learning | | | | | getting | and working | | | | | really good | | | | | | at swimming | "I can't | | | | | since I've | read as | | | | | been taking | well as the | | | | | lessons." | others in | | | | | | my class; | | | | | | I'm just | | | | | | dumb." | +-------------+-------------+-------------+-------------+-------------+ | **Adolescen | Making | Identity | Sense of | Confusion | | ce | transition | versus role | personal | about who | | (12--20 | from | confusion | identity; | one is; | | years)** | childhood | | fidelity | weak sense | | | to | | | of self | | | adulthood; | | "I'm going | | | | developing | | to go to | "I belong | | | sense of | | college to | to the gang | | | identity | | be an | because | | | | | engineer; I | without | | | | | hope to get | them, I'm | | | | | married | nothing." | | | | | before I am | | | | | | 30." | | +-------------+-------------+-------------+-------------+-------------+ | **Early | Establishin | Intimacy | Ability to | Emotional | | adulthood | g | versus | love deeply | isolation; | | (20--35 | intimate | isolation | and commit | egocentrici | | years)** | bonds of | | oneself | ty | | | love and | | | | | | friendship | | "My husband | "There's no | | | | | has been my | one out | | | | | best friend | there for | | | | | for 25 | me." | | | | | years." | | +-------------+-------------+-------------+-------------+-------------+ | **Middle | Fulfilling | Generativit | Ability to | Self-absorp | | adulthood | life goals | y | give and to | tion; | | (35--65 | that | versus | care for | inability | | years)** | involve | self-absorp | others | to grow as | | | family, | tion | | a person | | | career, and | | "I'm | | | | society; | | joining the | "After I | | | developing | | political | work all | | | concerns | | action | day, I just | | | that | | committee | want to | | | embrace | | to help | watch | | | future | | people get | television | | | generations | | the | and don't | | | | | healthcare | want to be | | | | | they need." | around | | | | | | people." | +-------------+-------------+-------------+-------------+-------------+ | **Later | Looking | Integrity | Sense of | Dissatisfac | | years (65 | back over | versus | integrity | tion | | years to | one's life | despair | and | with life; | | death)** | and | | fulfillment | denial of | | | accepting | | ; | or despair | | | its meaning | | willingness | over | | | | | to face | prospect of | | | | | death; | death | | | | | wisdom | | | | | | | "What a | | | | | "I've led a | waste my | | | | | happy, | life has | | | | | productive | been; I'm | | | | | life, and I | going to | | | | | still have | die alone." | | | | | plenty to | | | | | | give." | | +-------------+-------------+-------------+-------------+-------------+ **[PRECONVENTIONAL LEVEL]** - Stage 1---**[Obedience & Punishment]**. Focuses on the rules and on listening to authority, people believe obedience is the method to avoid punishment - Stage 2---**[Individualism & Exchange]**. Becoming aware not everyone thinks the way that they do. People see rules differently. If they decide to break rules then they risk punishment. - State 3---**[Good Interpersonal Relationships.]** Children begin to view rightness and wrongness as related to motivations, personality, or the goodness or badness of the person. In general people should get along and have the same values. - Stage 4---**[Maintaining The Social Order.]** Rules are rules mindset returns. However, the reasoning behind it is not simply to avoid punishment, it is because the person has begun to adopt a broader view of society. Listening to authority maintains the social order; bureaucracies and big government agencies seem to operate with this tenant. - Stage 5\--**[Social contract and individual rights]**. People in stage 5 still believe that the social order is important, but the social order must be good. For example, if the social order is corrupt, then rules should be changed and it is a duty to protect the rights of others. - Stage 6\-- **[Universal ethical principles]**. Actions should create justice for everyone involved. We are obliged to break unjust laws. **Gilligan's Stages of Moral Development** -------------------------------------------- ------------------------------------------------------- -------------------------------------------------- **Stage** **Goal** **Action** **Preconventional** Goal is individual survival---selfishness Caring for self **Conventional** Self-sacrifice is goodness---responsibility to others Caring for others **Postconventional** Principle of nonviolence---do not hurt others or self Balancing caring for self with caring for others **[ETHICS OF CARE THEORY]** Carol Gilligan---suggests that morality of care should replace Kohlberg's "justice view" of morality. Which maintains that we should do what is right no matter the personal cost or the cost of those we love. **[CHAPTER 4 TREATMENT SETTINGS]** **[Definitions]** Stigma---a sense of responsibility or shame, being flawed associated with a disorder. **[Continuum of Care]** Primary Care Physician Specialty Care Patient Centered Medical Homes Assertive Community Treatment Intensive Outpatient Programs Partial Hospitalization Emergency Care Crisis Stabilization/ Observation Units General & Private Hospitals State Hospitals **MOST RESTRICTIVE** **[Treatment Modalities]** - **Primary Care Physician---**first choice for patients when ill. - **Specialized Psychiatric Care Providers---**they have an educational background and experience in care of psychiatric problems and mental health. - **Patient Centered Medical Homes---**were developed in response to fragmented care that resulted in some services never being delivered, while some were duplicated. This patient centered focused care provides access physical health, behavioral health, and supportive community and social services. - **Patient Centered** - **Comprehensive Care** - **Coordination of Care** - **Improved Access** - **Systems Approach** **[Community Mental Health Centers]** Provides emergency services, community home-based services and outpatient services across the lifespan. **Psychiatric Home Care** there are four elements that must be met 1. Homebound 2. Psychiatric Diagnoses 3. Need for psychiatric nurse 4. Development of a plan under orders of a physician or advanced practice registered nurse - Right to be treated with dignity - Right to be involved in treatment planning and decisions - Right to refuse treatment, including medications - Right to request to leave the hospital even against medical advice - Right to be protected against harming oneself or others - Right to a timely evaluation in the event of involuntary hospitalization - Right to legal counsel - Right to vote - Right to communicate privately by telephone and in person - Right to informed consent - Right to confidentiality regarding one's disorder and treatment - Right to choose or refuse visitors - Right to be informed of research and refuse to participate - Right to the least restrictive means of treatment - Right to send and receive mail and be present during any inspections of packages received - Right to keep personal belongings unless they are dangerous - Right to lodge a complaint through a plainly publicized procedures - Right to participate in religious worship **[Milieu]** Milieu is a word of French origin and refers to surroundings and physical environment, overall environment therapeutic context, overall environment and interactions within that environment. Peplaue referred to as the therapeutic milieu. It is an all inclusive term that recognizes the (people and staff) the setting, the structure and the emotional climate as important to the healing products. **[Behavioral Crises]** This is when a patient will be violent toward oneself or other people. Suicide or Homicide. - Risk for suicide - Risk for violence against others - Mood disequilibrium **[Purpose of emergency care]** The primary goal in emergency services is to perform tirage and stabilization. To determine the severity of the problem, and urgency of response. **[Emergency Pediatric Care Categorized]** - Comprehensive emergency services model (in hospital or medical center setting) - Hospital based consultant model uses concepts of comprehensive model by incorporating triage and stabilization - Mobile crises team model for stabilization in the field **[Multidisciplinary Treatment]** Several specialized physicians, nurses and personnel assigned to a treatment plan for a patient. - Psychiatric Mental Health Nurse - Psychiatric Mental Health Advanced Practice Registered Nurse - Psychiatrists - Psychologists - Social Workers - Counselors - Occupational, Recreational, Art, Music and Dance Therapists - Medical advanced Practice Nurses, Medical Doctors, and Physicians Assistants - Mental Health Workers (mental health specialists /psychiatric technician) - Pharmacists **[Intradisciplinary Treatment]** Where the patient is included in their care and treatment. **[Chapter 36 Integrated Treatment]** **Integrative Care**---Places patient at the center of care, focuses on prevention and wellness and attends to the patients holistic needs, including the physical, mental, and spiritual emphasis on the body's ability to heal itself. - Patient actively participates in their own healthcare and engage in holistic practices that can promote health and healing - Patient wants a therapeutic approach that carries lower risks than traditionally used medications - Positive experiences with holistic integrative CAM practitioners whose approach is supportive and inclusive **Conventional Care**---healthcare professionals such as nurses, doctors, pharmacists and therapists treat symptoms and disease with drugs, surgery and radiation. **[Certification for Holistic Nursing]** - Nurses can be certified on 2 levels - 2000 hours or 1 year of fulltime experience in holistic nursing in the past 5 years - 48 hours of continuing education every year - Holistic nurse -- Board Certified (HN-BC) - Holistic Baccalaureate Nurse---Board Certified (HNB-BC) **[Mindfulness approach-]** Meditation simply focusing on your breathing pattern and clearing your thoughts. Mindfulness approaches have been increasingly useful in conditions such as depression, anxiety, and chronic pain Homeopathy---Western alternative medicine small doses (dilutions) of specially prepared plant extracts, herbs, minerals, and other materials are used to stimulate the bodies self defense mechanisms and healing processes. Healing occurs from the inside out. Naturopathy---Emphasizes health restoration rather than disease treatment. Naturopathic physicians may combine nutrition homeopathy herbal medicine hydrotherapy light therapy therapeutic counseling and other therapies. The underlying belief is that the individual is responsible for recovery.