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Psychiatric Nursing
Ch. 29 Cognitive and Behavior Change Interventions
76
Nursing
Undergraduate 4
07/09/2011

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Term
Behavior Change Interventions
Definition
  • All change is self-change
  • Self-efficacy is critical
  • Knowledge does not equal change
  • A therapeutic alliance helps patients initiate and maintain change
  • Hope is essential
Term
Motivational readiness
Definition
readiness to change is tied to a person's motivation
Term
Stages of change
Definition
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Termination
Term
Precontemplation
Definition
patient does not think he or she has a problem; thus they are not likely to seek help or participate in treatment
Term
Contemplation
Definition
Notion of "yes, but"; often recognizes that a change is needed, but unsure and indecisive about whether it is worth the time, effort, and energy to achieve it
Term
Preparation
Definition
Has made a decision to change and is assessing how that decision feels
Term
Action
Definition
now has a firm commitment to change and has identified a plan for future
Term
Maintenance
Definition
Change continues and focus is placed on what the patient needs to do to maintain or consolidate gains; relapses should be seen as part of the change process and not as a failure
Term
Termination
Definition
Based on notion that one will not engage in old behavior under any circumstances; may be more of an ideal than an achievable stage
Term
Motivation to change is an ____ process
Definition
intrinsic 
Term
Motivational interviewing
Definition
a patient-centered, directive counseling method for enhancing a person's internal motivation to change by identifying, exploring, and resolving ambivalence 
Term
4 Key elements of motivational interviewing
Definition
  1. Express empathy
  2. Identify discrepancy
  3. Roll with resistance
  4. Support self-efficacy 
Term
Behavior
Definition
any observable, recordable, and measurable act, movement, or response; must be accurately described before it can be measured; not subject to interpretation
Term
Classical Conditioning
Definition
the process by which involuntary behavior is learned; Pavlov
Term
Operant conditioning
Definition
Concerned with the relationship btw voluntary behavior and the environment; behaviors are influenced by their consequences and operant behaviors are cued by environmental stimuli; B.F. Skinner
Term
Operant Behaviors
Definition
those that are influenced by the consequences of an action, and they are regarded as a more complex form of learning
Term
Difference between classical conditioning and operant conditioning
Definition
Operant conditioning is strengthened rather than weakened by inconsistent pairings of behaviors and consequences
Term
Behavior Modification
Definition
Based on assumption that a high-frequency, preferred activity can be used to reinforce a low-frequency, nonpreferred activity
Term
Reinforcers
Definition
anything that increases frequency of a behavior
Term
Positive Reinforcement
Definition
A rewarding stimuli
Term
Negative Reinforcement
Definition
Reinforces the power of the behavior to control an aversive, rather than rewarding, stimulus; it removes or subtracts something from the environment, resulting in an increase in the desired behavior
Term
3 techniques used to reduce frequency of behavior
Definition
  1. Punishment
  2. Response cost
  3. Extinction 
Term
Punishment
Definition
an aversive stimulus that occurs after the behavior and decreases its future occurrence
Term
Response Cost
Definition
Decreases behavior through experience of a loss or penalty following a behavior
Term
Extinction
Definition
The process of eliminating a behavior by ignoring it or not rewarding it
Term
Overgeneralization
Definition
draws conclusions about a wide variety of things on the basis of a single event
Term
Personalization
Definition
Relates external events to oneself when it is not justified
Term
Dichotomous thinking
Definition
Thinking in extremes-that things are either all good or all bad
Term
Catastrophizing
Definition
thinking the worst about people and events
Term
Selective abstraction
Definition
Focusing on details but not on other relevant information
Term
Arbitrary inference
Definition
Drawing a negative conclusion without supporting evidence 
Term
Mind reading
Definition
Believing that one knows the thoughts of another without validation
Term
Magnification/minimization
Definition
Exaggerating or trivializing the importance of events
Term
Perfectionism
Definition
Needing to do everything perfectly to feel good about oneself
Term
Externalization of self-worth
Definition
Determining one's value based on the approval of others
Term
Cognition
Definition
the act or process of knowing
Term
Cognitive Therapy
Definition
proposes that it is not the events themselves that cause anxiety and maladaptive responses but rather people's expectations, appraisals, and interpretations of these events
Term
Cognitive therapists believe that maladaptive responses arise from ______
Definition
cognitive distortions
Term
Cognitive behavioral Therapy
Definition
Views the individual as primary decision maker regarding goals and issues to e dealt with during treatment; problem focused, goal oriented, and deals with here-and-now issues
Term
Goal of cognitive behavioral therapy
Definition
To change irrational beliefs, faulty reasoning, and negative self-statements that underlie behavioral problems 
Term
Characteristics of Cognitive Therapy
Definition
  • Empirically Based
  • Goal Oriented
  • Practical
  • Collaborative
  • Open
  • Homework
  • Measurements
  • Active
  • Short term
Term
Behavioral Analysis
Definition
  1. Antecedent
  2. Behavior
  3. Consequence
Term
Antecedent
Definition
the stimulus or cue that occurs before the behavior and leads to its manifestation
Term
Behavior
Definition
What the person does or does not say or do
Term
Consequence
Definition
what type of effect the person thinks results from the behavior
Term
ABCs of Treatment
Definition
  1. Affective
  2. Behavioral
  3. Cognitive
Term
The most heavily researched form of psychotherapy and has a strong evidence base to support its efficacy in the treatment of a wide variety of clinical problems
Definition
Cognitive Behavioral Therapy
Term
Aim of cognitive behavioral treatment strategies
Definition
  • Increase activity
  • Reduce unwanted behavior
  • Increase pleasure
  • enhance social skills
Term
Relaxation Training
Definition
Muscle tension is related to anxiety. If tense muscles can be made to relax, anxiety will be reduced
Term
All relaxation procedures involve:
Definition
  • rhythmic breathing
  • reduced muscle tension
  • altered state of consciousness 
Term
Systematic relaxation training
Definition
involves tensing and relaxing voluntary muscles in an orderly sequence until the body, as a whole, is relaxed
Term
Meditation components
Definition
  • quite environment
  • passive attitude
  • comfortable position
  • word or scene to focus on
Term
Visualization
Definition
the process in which the patient selects a cue word or scene with pleasant connotations
Term
Biofeedback
Definition
the use of a machine to reduce anxiety and modify behavioral responses; pleasant sights and sounds stop when patient stops relaxing, and they resume when patient again achieves relaxed state
Term
Systematic desensitization
Definition
helps patient change the response to a threatening stimulus by combining deep muscle relaxation with imagined scenes of situations that cause anxiety
Term
In vitro/imagined, desensitization
Definition
patient proceeds with imagined pairing of hierarchy items with the relaxed state, progressing from least anxiety-provoking item to most anxiety-provoking item
Term
In vivo desensitization
Definition
exposes patient to real-life situations rather than imagined
Term
In vivo exposure
Definition
treatment of choice for simple and social phobias and for OCD
Term
Interoceptive exposure
Definition
a technique used to desensitize a patient to catastrophic interpretations of internal body cues by asking patient to do things that cause symptoms in a gradually increasing, repetitive manner in order to become desensitized to these cues
Term
Flooding
Definition
form of exposure therapy in which patient is immediately exposed to most anxiety-provoking stimulus instead of being exposed gradually or systematically to a hierarchy of feared stimuli
Term
Implosion
Definition
form of exposure therapy in which the technique uses an imaginary event instead of a real-life event (flooding)
Term
Vestibular desensitization
Definition
training is an exposure therapy for patients whose panic attacks are provoked by environmental cues that cause them to have symptoms of motion sickness 
Term
Response prevention
Definition
patient is encouraged to face particular fear or stimulation without engaging in accompanying behavior; leads to anxiety reduction because feared consequence does not occur
Term
Eye movement desensitization and reprocessing (EMDR)
Definition
Principle behind treatment is that brain lays down biological memory tracks during early traumatic experiences; memory tracks are provoked later during seemingly unrelated events, causing anxiety and perhaps depression
Term
Steps of cognitive restructuring
Definition
  1. monitor thoughts and feelings (daily record of dysfunctional thoughts form)
  2. questioning evidence
  3. examin alternatives
  4. Decatastrophizing
  5. Reframing
  6. Thought stopping
Term
Decatastrophizing ("what if" technique)
Definition
helps patient to see that consequences of life's actions are generally not "all or nothing" and thus are less catastrophic 
Term
Reframing
Definition
strategy that changes a patient's perception of a situation or behavior; involves focusing on other aspects of problem or encouraging patient to see issue from different perspective
Term
Modeling
Definition
strategy used to form new behavior patterns, increase existing skills, or reduce avoidance behavior
Term
Shaping
Definition
Induces new behaviors by reinforcing those that approximate desired behavior
Term
Process of learning new behaviors
Definition
  • Modeling
  • Shaping
  • Token Economy
  • Role Playing
  • Social skills Training
  • Aversion Therapy
  • Contingency Contracting
Term
3 basic roles of nurse involved in cognitive behavioral therapy
Definition
  1. Providing direct patient care
  2. Planning treatment programs
  3. Teaching others use of cognitive behavioral techniques
Term
Principles of social skills training
Definition
  • Guidance
  • Demonstration
  • Practice
  • Feedback 
Term
4 strategies of social skills treatment
Definition
  1. Describing new behavior to be learned
  2. Learning new behavior through use of guidance and demonstration
  3. Practicing new behavior with feedback
  4. Transferring new behavior to natural environment
Term
Aversion Therapy
Definition
applies an aversive or noxious stimulus when a maladaptive behavior occurs 
Term
Covert sensitization
Definition
an aversive technique in which patients imagine scenes that pair undesired behavior with an unpleasant consequence
Term
Contingency Contracting
Definition
involves a formal contract between patient and therapist, defining what behaviors are to be changes and what consequences (+ and -) follow performance of these behaviors
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