employed in CBT. This specifically trains the individual based on their needs. Cognitive-behavioral techniques are useful with most psychiatric conditions and mental health states to improve mental flexibility and resilience, moving the person towards health on the health-illness continuum. Helping the patient to identify beliefs (true or false) about situations enables the patient to challenge the beliefs that are detrimental to recovery (McKay et al., 2015). Psychiatric nurses of all levels can utilize the basic skills of CBT in teaching their patients how to reframe distorted thoughts that lead to emotional turmoil and erratic behaviors. is complex, and master’s or doctorate-level clinicians should be utilized for this type of intense treatment. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) offers specialized accreditation to marriage and family therapy programs; this encourages programs to continue monitoring and maintaining their rigor and development and demonstrates that programs are meeting industry standards and their own objectives (COAMFTE, n.d.) Treating the family via emotional or cognitive methods allows problems to be addressed within the family dynamic; treating the patient apart from his or her family alone will not correct these systemic problems, and relapse is likely (Sexton & Alexander, 2015). Cognitive awareness (as in CBT) helps individuals and families recognize the cyclic nature of thoughts creating feelings, which create behaviors, which reinforce thoughts, and which continue circularly. Addressing this from a systems nature allows all members of the family unit to explore their role within this continuum and work toward healthier interactions simultaneously. affected by mental illness. Established in 1979, NAMI is a powerful lobbying force in Washington, DC, with affiliates in every state and more than 1,100 communities across the country. NAMI focuses on fighting against the stigma associated with mental illness and provides support for families and patients with psychiatric illnesses. Self-Assessment Quiz Question #5 Which of the following is considered a support group? a. Cognitive behavioral therapy. b. Alcoholics Anonymous. c. Family therapy. d. Medication education. The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots support organization for families and persons
Exposure is a CBT technique that provokes the patient’s anxiety over a feared idea or object in a controlled, supportive environment (Boyd, 2018). A person afraid of heights might be asked to work toward standing on a footstool for a minute or two in the clinician’s office. Gradual exposure to the situation allows the patient to systematically desensitize to the stressor with tools to manage thoughts and feelings that arise when confronted with the feared stimulus. Flooding exposes the patient to the stressful object or idea all at once; although this technique can be used, trained clinicians should judiciously use it as it may produce panic symptoms. Skills training may also be Family therapy (Social theory) Individuals with psychiatric, mental health, or behavioral problems often live in a family environment. Children and adolescents are still part of the family unit although the nature of “family” may differ in situations concerning foster care or residential treatment centers. Adults may live alone or with others, be married or single, and live with or without children of their own. Even adults who live alone often have significant family relationships with parents, children, or others. The concept of “family” is identified by the patient but usually involves other persons with whom the patient interacts on a frequent basis and in whom the patient has significant emotional investment. Family therapy is based within the understanding that, although there is an identified patient, problems may arise out of dysfunctions within the system because the family is a unit and problems are relational to each other (Friedman, Bowden, & Jones, 2003; Sexton & Alexander, 2015). Family therapies focus on strengths of the individual patient and the family as a basis for treatment. Understanding how the family functions and relates to one another helps contribute information that is helpful in the development of a plan of care. Family therapy Community support groups (Social theory) Many community support groups exist to help individuals who are experiencing specific mental health problems. Groups exist for gambling addiction, rape and sexual abuse support, bipolar disorder, depression, grief and bereavement, suicide, attention deficit disorder, PTSD, substance abuse, and many more. Support groups differ from therapy groups in several important ways. Support groups are a network of members with similar traits or characteristics; support groups are leaderless – they may have a nominated leader, but that person is also a victim or patient and a group member; support groups are not managed by a healthcare professional; support groups are free or have minimal cost; support groups may meet less frequently than therapy groups but for a longer period of time (years to indefinitely); and support groups are usually self-sustaining. If members lose interest, the group can’t find a place to meet, or membership wanes, then the group may end (https://www. frontiersin.org/articles/10.3389/fpsyt.2021.714181/full).
BRAIN ANATOMY AND PHYSIOLOGY
and coordination. The temporal lobe is involved with memory, smells, sounds, and language. The hypothalamus regulates body temperature and metabolism, and research suggests that it plays a role in emotions. The pituitary gland regulates hormones, and the brainstem controls basic vital functions such as respiratory rate, heart rate, reflexes, and movement (Norris, 2019). The limbic system, which is involved in emotions, has a central role in psychiatric-mental health disorders. The limbic system contains the amygdala, which regulates mood and emotions such as anger; the hippocampus, which regulates memory; and the anterior cingulate, which regulates sensations (Norris, 2019; Stahl, 2020). These areas all work together to compose emotions and the body’s responses to emotions. There are millions of connections among these areas. These connections, or pathways of electrical impulses, allow parts of the brain to communicate with one another and respond to stimuli.
Within the brain, several areas influence behaviors and are related to psychiatric-mental health disorders, such as the areas involved in mood, anger, and thoughts. Therefore, it is important for nurses to understand how the brain regulates mood and behaviors. The cortex, the outer surface of the brain, is associated with rational thinking (Halter, 2018). The orbitofrontal cortex, which is in the forehead, regulates sympathetic and parasympathetic signals and houses the executive functions (Norris, 2019). Examples of executive functions include decision making, organizing, and determining right from wrong. Additionally, the cortex is adjacent to other areas of the brain, connecting rational thought to mood. Several other areas of the brain also have a role in psychiatric- mental health disorders. The frontal lobe, for example, is heavily involved in decision making. The parietal lobe integrates sensory and motor information. The occipital cortex is the vision center. The cerebellum works to create muscle tone, posture,
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