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MENTA L HEA LTH DEFINITIO NS

Anal p ers onality/anal retentiv e – excessive orderliness, meticulousness & often

suspicion & reserve. According to psychoanalysts, formed in early childhood a result of
efforts to control bowel movements

Ag orap hobia – anxiety disorder, fear of certain settings that may present unexpected
challenges or demands, parking lots, shopping malls, restaurants

As se rtion training – helps people stand up for themselves, empower

Av ersi ve con ditioning – exposed to unpleasant stimulus while engaging in targeted

behavior. Ex – taking nausea provoking drugs to stop smoking or drinking

Avoi dance conditionin g – leans to avoid unpleasant by leaning appropriate

anticipatory response to protect

Be havior modi fica tion – altering one’s behavior & rxns to stimuli through positive &
negative reinforcement

Be havior therapy – form of psychotherapy used to treat depression, anxiety

disorders, & phobias

Clas sical conditioning (Pav olovian o r re spon dent con ditioning) – form of
associative learning. Involves paired presentations of neutral stimulus along w/
stimulus of significance. Ex – dogs salivate when they see food, bring food and ring bell
dog will salivate, then ring bell dog will salivate

Op erant conditioning (r es pons e stimul us ) – forms association b/w behavior & a

consequence. Use of consequences to modify behavior

Co gnitive r estr ucturing – process of learning to refute cognitive distortions or

fundamental “faulty thinking” w/ goal of replacing one’s irrational, count-factual beliefs
w more accurate & beneficial ones

Fixation – person becomes obsessed w/ attachment to another human, animal, or

object

Gene ralist – broad knowledge of skills in several areas

Li bid o – energy created by survival & sexual instincts. According to Freud – the
libido is part of id and is driving force of all behavior
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Mi lie u the rapy – “group therapy” form of psychotherapy for personal growth &
behavior change may be promoted through interaction of individuals w/I therapeutic
environment

De fens e mechanism -
Psychoanalysis and psychodynamic theory have described the process by which we
protect ourselves from awareness of our undesired and feared impulses. Defense
mechanisms are our way of distancing ourselves from a full awareness of unpleasant
thoughts, feelings and desires.
In psychoanalytic theory, defense mechanisms represent an unconscious mediation by
the ego of id impulses which are in conflict with the wishes and needs of the ego and/or
superego. By altering and distorting one's awareness of the original impulse, one makes
it more tolerable.
However, while defense mechanisms are used in an attempt to protect oneself from
unpleasant emotions, they often result in equally harmful problems. Below are some of
the more common defense mechanisms.

Denial is the refusal to accept reality and to act as if a painful event, thought or feeling
did not exist. It is considered one of the most primitive of the defense mechanisms
because it is characteristic of very early childhood development

Disp lacement is the redirecting of thoughts feelings and impulses from an object that
gives rise to anxiety to a safer, more acceptable one. Being angry at the boss and
kicking the dog can be an example of displacement.

Intro jection – incorporating, w/o examination or thought the qualities or attributes of

attitudes of others. Incorporating, attitudes or qualities of an absent person of high
significance (absent mother) into oneself

Pr oj ection is the attribution of one's undesired impulses onto another. Thus, an angry
spouse accuses their partner of hostility.

Rationalization is the cognitive reframing of ones perceptions to protect the ego in

the face of changing realities. Thus, the promotion one wished fervently for and didn't
get becomes "a dead end job for brown nosers and yes men".

Reaction Fo rmation is the converting of wishes or impulses that are perceived to be

dangerous into their opposites. A woman who is furious at her child and wishes her
harm might become overly concerned and protective of the child's health.

Re gr es sion is the reversion to an earlier stage of development in the face of

unacceptable impulses. For an example an adolescent who is overwhelmed with fear,
anger and growing sexual impulses might become clinging and begin thumb sucking or
bed wetting.
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Re pr es sion is the blocking of unacceptable impulses from consciousness.

Su blimation is the channeling of unacceptable impulses into more acceptable outlets.

A person who has an obsessive need for control & order becomes a successful business
entrepreneur

Su ppr es sion – person consciously & deliberately pushed down any thoughts that lead
to feelings of anxiety. Old man has sexual feelings for teenager & quickly suppresses
thought

Symb olization – way of handling inner conflicts by turning them into distinct symbol.
Soldier explains his decision to join army as defending the flag

Healthy de fen se mechanism s

• Altu rism – sense up unconditional concern for others. Pure altruism is giving
without regard to reward or the benefits of recognition.
• Su blimation – channeling of unacceptable impulses into more acceptable outlets. A
person who has an obsessive need for control & order becomes a successful
business entrepreneur.
• Humo r
• Su ppr es sion – conscious, conceal unacceptable or painful thoughts, desires,
impulses, feelings, etc. An older man has sexual feelings towards a teenager and
quickly suppresses the thought.

Inte rme diate d ef ens es

• Re pr es sion – painful thoughts or feelings that are pushed from consciousness. A
child who is abused by a parent later has no recollection of the events, but has
trouble forming relationships.
• Disp lacement – avoiding emotional conflicts be transferring from an object that is
threatening to one less anxiety producing. A woman, rejected by her boyfriend, goes
out with another man 'on the rebound'.
• Reaction fo rmation - A common pattern in Reaction Formation is where the
person uses ‘excessive behavior’, for example using exaggerated friendliness when
the person is actually feeling unfriendly. A person who is angry with a colleague
actually ends up being particularly courteous and friendly towards them.
• Somatization - psychological problem turns into physical and subconscious
symptoms. A policeman, who has to be very restricted in his professional behavior,
develops hypertension. A worried actor develops a twitch.

Immatu re de fens es
• Passiv e-agg re ssion - A person who uses passive-aggressive method to cope
with stresses on them does this by 'attacking' others through passive means. Thus
the aggressive intent is cloaked by the passive method.
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• Acting out - 'Acting out' means literally means acting out the desires that are
forbidden by the Super ego and yet desired by the Id. We thus cope with the
pressure to do what we believe is wrong by giving in to the desire. An addict gives
in to their desire for alcohol or drugs. A person who dislikes another person seeks
to cause actual harm to them.
• Diss ocia tion - Dissociation involves separating a set of thoughts or activities from
the main area of conscious mind, in order to avoid the conflict that this would cause.
Dissociation can also appear as taking an objective, third-person perspective, where
you 'go to the balcony' and look down on the situation in order to remove emotion
from your perspective (this is sometimes called 'dissociation of affect'). A religious
person preaches kindness to all, yet is cruelly strict to children, without realizing
that there is a conflict between the two. A politician seeks legislation on
government integrity, yet also has some shady private dealings. When challenged,
they seem surprised that these are conflicting interests.
• Deval uation – find all of your negative qualities of yourself in others
• Id ealization – when you take on the traits of someone else
• Pr oj ection – individual attributes his own unacceptable traits, ideas, or impulses to
another
• Denial – emotional conflict & anxiety are avoided by refusal to acknowledge those
thoughts, feelings, desires, impulses, or facts that are consciously intolerable
• Splitting – seen in borderline personality disorders - splitting is a characteristic
cognitive error. It is characterized by the propensity to either completely idealize or
completely devalue other people, places, ideas, or objects; that is, to see them as
either all good or all bad.
• Re gr es sion - reversion to an earlier stage of development in the face of
unacceptable impulses
• Su ppr es sion - process of deliberately trying to stop thinking about certain
thoughts
• Su blimation - psychological problem turns into physical and subconscious
symptoms. A policeman, who has to be very restricted in his professional behavior,
develops hypertension. A worried actor develops a twitch.

DSM I V-TR – diagnostic & statistical manual of mental disorders

THE ID (“ It”) - functions in the irrational and emotional part of the mind. At birth a
baby’s mind is all Id - want want want. The Id is the primitive mind. It contains all the
basic needs and feelings. It is the source for libido (psychic energy). And it has only one
rule --> the “pleasure principle”: “I want it and I want it all now”. In transactional
analysis, Id equates to "Child". Id too strong = bound up in self-gratification and
uncaring to others
THE EG O - (“I”) : functions with the rational part of the mind. The Ego develops out
of growing awareness that you can’t always get what you want. The Ego relates to the
real world and operates via the “reality principle”. The Ego realizes the need for
compromise and negotiates between the Id and the Superego. The Ego's job is to get
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the Id's pleasures but to be reasonable and bear the long-term consequences in mind.
The Ego denies both instant gratification and pious delaying of gratification. The term
ego-strength is the term used to refer to how well the ego copes with these conflicting
forces. To undertake its work of planning, thinking and controlling the Id, the Ego uses
some of the Id's libidinal energy. In transactional analysis, Ego equates to "Adult".
Ego too strong = extremely rational and efficient, but cold, boring and distant
THE SUPE REGO (“Ov er- I”) : The Superego is the last part of the mind to develop. It
might be called the moral part of the mind. The Superego becomes an embodiment of
parental and societal values. It stores and enforces rules. It constantly strives for
perfection, even though this perfection ideal may be quite far from reality or possibility.
Its power to enforce rules comes from its ability to create anxiety.
The Superego has two subsystems: Ego Ideal and Conscience. The Ego Ideal provides
rules for good behavior, and standards of excellence towards which the Ego must
strive. The Ego ideal is basically what the child’s parents approve of or value. The
Conscience is the rules about what constitutes bad behavior. The Conscience is
basically all those things that the child feels mum or dad will disapprove of or punish.
Superego too strong = feels guilty all the time, may even have an insufferably saintly
personality

Mod eling n. A technique of behavior therapy in which the client or patient learns
appropriate patterns of behavior by imitating another person demonstrating the target
behavior either live or on video; often used in assertiveness training. US modeling

Multiaxial cl as sification - A procedure used in DSM-III-R for diagnosing patients

on five axes: 1) psychiatric syndrome present; 2) patient's history of personality and
developmental disorders; 3) possible nonmental medical disorders; 4) severity of
psychosocial stressors; 5) highest level of adaptive functioning in the past year.

Negative reinf orc ement is an increase in the likelihood of a behavior when the
consequence is the removal of an aversive stimulus. Turning off (or removing) a shock
when a rat presses a bar is an example of negative reinforcement (if this increases the
likelihood of the rat pressing the bar in the future).
• Avoidance conditioning is a form of negative reinforcement that occurs
when a behavior prevents an aversive stimulus from starting or being
applied.
• Escape conditioning is a form of negative reinforcement that occurs when
behavior removes an aversive stimulus that has already started.
Punishment is the opposite of reinforcement, and causes the probability of behaviors to
decrease after a punished is applied. Like reinforcement, punishment comes in two
forms:
• Po sitive p unishm ent changes the surroundings by adding an aversive stimulus
following a behavior in order to decrease the likelihood of the behavior occurring
in the future. An example is shocking an animal whenever it pressed a lever
pressing which had been previously reinforced.
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• Negative punis hment changes the surroundings by removing a stimulus that
is a reinforcer. An example is removal of a food supply contingent on undesirable
behavior.

Nerv e imp uls e - The nerve impulse is an electrical occurrence that travels down a
neuron . This electrical signal transmits commands from the brain to the motor nerves,
and carries sensory messages from sensory nerves (skin, ears, nose, eyes, taste buds)
to the brain. The transmission of nerve impulses from neuron to neuron is performed by
neurotransmitters
Neu rons are the main cells of the nervous system and there are about 100 billion of
them in the brain . Thanks to their numerous branch-like processes, they interconnect
forming a massive network of "wires" that extend throughout the entire body. By
sending messages across this network, the different parts of the human body interact
and communicate with each other.

Neu rotrans mit te rs are chemicals that are used to relay, amplify and modulate signals
between a neuron and another cell

• Acetylcholine - voluntary movement of the muscles

• Norepinephrine - wakefulness or arousal
• Dopamine - voluntary movement and motivation, "wanting"
• Serotonin - memory, emotions, wakefulness, sleep and temperature regulation
• GABA (gamma aminobutyric acid) - inhibition of motor neurons
• Glycine - spinal reflexes and motor behavior
• Neuromodulators - sensory transmission-especially pain
• Histamine is a biogenic amine involved in local immune responses as well as
regulating physiological function in the gut and acting as a neurotransmitter.

Oedip us compl ex in Freudian psychoanalysis refers to stage of psychosexual

development in childhood where children of both sexes regard their father as an
adversary and competitor for the exclusive love of their mother.

Fr eu d’ s Psycho sexual st ag es:

According to Freud, personality is mostly established by the age of five. Early
experiences play a large role in personality development and continue to influence
behavior later in life.
Freud's theory of personality development is one of the best known, but also one of the
most controversial. Freud believed that personality develops through a series of
childhood stages during which the pleasure-seeking energies of the id become focused
on certain erogenous areas. This psychosexual energy, or libido, was described as the
driving force behind behavior.
If the stages are completed successfully, the result is a healthy personality. If certain
issues are not resolved at the appropriate stage, fixation can occur.
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A fixation is a persistent focus on an earlier psychosexual stage. Until this conflict is
resolved, the individual will remain "stuck" in this stage. For example, a person who is
fixated at the oral stage may be over-dependent on others and may seek oral
stimulation through smoking, drinking, or eating.
• Oral S tag e
During the oral stage, the infant's primary source of interaction occurs through the
mouth, so the rooting and sucking reflex is especially important. The mouth is vital for
eating, and the infant derives pleasure from oral stimulation through gratifying activities
such as tasting and sucking. Because the infant is entirely dependent upon caretakers
(who are responsible for feeding the child), the infant also develops a sense of trust and
comfort through this oral stimulation.
The primary conflict at this stage is the weaning process--the child must become less
dependent upon caretakers. If fixation occurs at this stage, Freud believed the
individual would have issues with dependency or aggression. Oral fixation can result in
problems with drinking, eating, smoking, or nail biting.
• Anal Stage
During the anal stage, Freud believed that the primary focus of the libido was on
controlling bladder and bowel movements. The major conflict at this stage is toilet
training--the child has to learn to control his or her bodily needs. Developing this
control leads to a sense of accomplishment and independence.
According to Freud, success at this stage is dependent upon the way in which parents
approach toilet training. Parents who utilize praise and rewards for using the toilet at
the appropriate time encourage positive outcomes and help children feel capable and
productive. Freud believed that positive experiences during this stage served as the
basis for people to become competent, productive, and creative adults.
However, not all parents provide the support and encouragement that children need
during this stage.
• Phal lic S tage
During the phallic stage, the primary focus of the libido is on the genitals. Children also
discover the differences between males and females. Freud also believed that boys
begin to view their fathers as a rival for the mother’s affections. The Oedipus complex
describes these feelings of wanting to possess the mother and the desire to replace the
father. However, the child also fears that he will be punished by the father for these
feelings, a fear Freud termed castration anxiety.
The term Electra complex has been used to described a similar set of feelings
experienced by young girls. Freud, however, believed that girls instead experience
penis envy.
Eventually, the child realizes begins to identify with the same-sex parent as a means of
vicariously possessing the other parent.
For girls, however, Freud believed that penis envy was never fully resolved and that all
women remain somewhat fixated on this stage. Psychologists such as Karen Horney
disputed this theory, calling it both inaccurate and demeaning to women. Instead,
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Horney proposed that men experience feelings of inferiority because they cannot give
birth to children.
• Latent St ag e
During the latent period, the libido interests are suppressed. The development of the
ego and superego contribute to this period of calm. The stage begins around the time
that children enter into school and become more concerned with peer relationships,
hobbies, and other interests.
The latent period is a time of exploration in which the sexual energy is still present, but
it is directed into other areas such as intellectual pursuits and social interactions. This
stage is important in the development of social and communication skills and self-
confidence.

• Genital S tag e
During the final stage of psychosexual development, the individual develops a strong
sexual interest in the opposite sex. Where in earlier stages the focus was solely on
individual needs and, interest in the welfare of others grows during this stage. If the
other stages have been completed successfully, the individual should now be well-
balanced, warm, and caring. The goal of this stage is to establish a balance between the
various life areas.

Pri mary pr oces s - In Freud’s psychoanalytic theory of personality, the primary

process works to resolve tension created by the pleasure principle. Rather than act on
dangerous or unacceptable urges, the id forms a mental image of a desired object to
substitute for an urge in order to diffuse tension and anxiety.
In psychoanalysis, the mental process directly related to the functions of the primitive
life forces associated with the id and characteristic of unconscious mental activity;
marked by unorganized, illogical thinking and by the tendency to seek immediate
discharge and gratification of instinctual demands.

Secon dary Pr oces s - In Freud’s psychoanalytic theory of personality, the secondary

process discharges the tension between the ego and the id that is caused by unmet
urges or needs. The secondary process functions through the ego’s action of looking
for an object in the real world that matches the mental image created by the id’s
primary process.
In psychoanalysis, the mental process directly related to the learned and acquired
functions of the ego and characteristic of conscious and preconscious mental activities;
marked by logical thinking and by the tendency to delay gratification by regulation of
the discharge of instinctual demands.
Compare: primary process.

Psych oac tive dr ugs - Psychoactive drugs are substances that can alter the
consciousness, mood, and thoughts of those who use them. Examples include tobacco,
alcohol, cannabis, amphetamines, ecstasy, cocaine, and heroin
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Psych othe rapy is an interpersonal, relational intervention used by trained
psychotherapists to aid clients in problems of living. This usually includes increasing
individual sense of well-being and reducing subjective discomforting experience.
Psychotherapists employ a range of techniques based on experiential relationship
building, dialogue, communication and behavior change and that are designed to improve
the mental health of a client or patient, or to improve group relationships (such as in a
family).

Rational Emotive Behavio r The rapy (REBT ) is a comprehensive, active-directive,

philosophically and empirically based psychotherapy which focuses on resolving
cognitive, emotional and behavioral problems.

Reality p rinciple - psychoanalysis, the satisfaction of instinctual needs through

awareness of and adjustment to environmental demands

Rol e playing - developed by Jacob Moreno, a Viennese psychologist who contended

that people could gain more from acting out their problems than from talking about
them. This method requires a protagonist (the client whose problems are being acted
out); auxiliary egos (group members who assume the roles of other people in the
protagonist's life); an audience (other group members who observe and react to the
drama); and a director (the therapist). The protagonist selects an event from his or her
life and provides the information necessary for it to be reenacted.

Sche ma in general is a specific, well-documented, and consistent plan. The related

word, scheme means a loosely described plan.

Shaping - In operant conditioning, when the operant response is not in the organism's
repertoire, a procedure in which the experimenter breaks down the response into those
parts which appear most frequently, begins reinforcing them, and then slowly and
successively withholds the reinforcer until more and more of the operant is emitted.
The practi ce of shaping (also known as "successive approximation") is not, in and of
itself, a method for managing inappropriate behavior. Instead, it is a method that assists
you in setting goals for the behavior of a certain student. Shaping will provide guidance
and direction for your behavior change program, and will help you assess its
effectiveness. It can assist you in changing an aberrant behavior or creating an
appropriate behavior that is not yet in the student's repertoire.
Shaping is used when you want the student to engage in a certain desirable behavior
that is, at present, infrequently or never displayed by him/her. If you were to wait for
the student to show this behavior so that you could reward him/her, you might wait a
very long time. Shaping allows you to build this desired behavior in steps and reward
those behaviors that come progressively closer to the one you have selected as the
final goal. As the student masters each substep, you require that s/he move to the next
increment in order to receive an award or reinforcement.
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For example, John never does his math homework. You would like to have him
complete his homework on a daily basis. You realize that if you wait for him to complete
his homework before you reinforce him in some way, you may never (or infrequently)
have the opportunity to administer a positive consequence. Therefore, you decide to
break down the desired behavior into substeps that are progressively more demanding.
These steps might be:
1. John will write his name at the top of the worksheet.
2. John will complete one problem of his choice.
3. John will complete five problems of his choice.
4. John will complete either all the odd numbered problems or all the
even numbered problems.
5. John will complete all problems except one.
6. John will complete all problems.
As John masters each step, you will tell him that he must now move on to the next
objective to receive a reward. If the jump between two steps is too difficult, then you
must break down the steps even further into smaller increments.
How to use shaping:
1. Identify a desired behavior for this student. Determine the final goal.
2. Identify the student's present level of performance in displaying the desired
behavior.
3. List the steps that will eventually take the student from his/her present level of
performance to the final desired behavior. These levels of skill should be
progressively more demanding.
4. Tell the student that s/he must accomplish step 1 to receive the reward.
5. Once the student has mastered a specified behavior, require that s/he demonstrate
the next stage of behavior in order to receive a reward.

Synapse - Information from one neuron flows to another neuron across a synapse.
The synapse contains a small gap separating neurons. The synapse consists of:
1. a presynaptic ending that contains neurotransmitters, mitochondria and other cell
organelles,
2. a postsynaptic ending that contains receptor sites for neurotransmitters and,
3. a synaptic cleft or space between the presynaptic and postsynaptic endings.

Systematic de sen sitiza tion is a technique used to treat phobias and other extreme
or erroneous fears based on principles of be havior modi fica tion .

Token economy - A token economy is a system of behavior modification based on

the principles of operant conditioning. Specifically, the original proposal for such a
system emphasized reinforcing positive behavior by awarding "tokens" for meeting
positive behavioral goals.

Uncon ditional r esp onse - Unconditional response - A response to a stimulus that is

directly related to the nature of the stimulus rather than being dependent upon the
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association of that stimulus with another stimulus. In Pavlov's conditioning
experiments with dogs, salivation at the presentation of food is the unconditional
response. Compare with conditional response.

Uncon scious - The division of the mind in psychoanalytic theory containing elements
of psychic makeup, such as memories or repressed desires, that are not subject to
conscious perception or control but that often affect conscious thoughts and behavior.

CROSS SHEET CONTENT

Mental health theo ries –

1. Peplau – 1st nurse to describe nurse-patient relationship as foundation for nursing
practice. Skills include observation, interpretation, & intervention. Orientation,
working, &termination phases. Uses Sullivan'’ theory anxiety.
2. Dorotha Orem – self-care deficit theory. Self-care, self-care deficit & nursing
systems. Self-care agency, therapeutic self-care demand, nursing agency.
Emphasized role of nurse in promoting self-care activities of client.
3. Jean Watson – caring is domain of nursing. 10 curative factors involving humanistic,
altruistic system of values: instilling faith & hope; cultivation sensitivity to one’s self
& others, develop help-trust relationship, express positive & negative feelings,
interpersonal teaching – learning, environment that protects, gratification of human
needs, allow for existential phenomenological forces.

Psych obio logy of mental h ealth dis or de rs

application of the principles of biology to the study of mental processes and behavior.

• Acetylcholine - voluntary movement of the muscles

• Norepinephrine - wakefulness or arousal
• Dopamine - voluntary movement and motivation, "wanting"
• Serotonin - memory, emotions, wakefulness, sleep and temperature regulation
• GABA (gamma aminobutyric acid) - inhibition of motor neurons
• Glycine - spinal reflexes and motor behavior
• Neuromodulators - sensory transmission-especially pain
• Histamine is a biogenic amine involved in local immune responses as well as
regulating physiological function in the gut and acting as a neurotransmitter.

Mental health – successful performance of mental functions, engage in productive

activities, fulfilling relationships, & change or cope w/ adversity
Mental illness – marked by distress, disability, or risk of suffering disability or loss of
freedom.
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Mental phenomena somehow caused by array of biochemical & neuro-physical
processes that take place from moment to moment

Cu ltural ly re levant psychiatric nur sing

Culture is complex whole; knowledge, belief, art, moral, law, custom, habits. Comprises
verbal & nonverbal system. Learned, shared, & ever-changing

Nur se client relations hip

1. orientation – (assessment & diagnosis) establish trust, get to know client
2. working – (outcome identification, planning interventions) implement nursing
interventions
3. termination –(evaluation) end of relationship

Se lf care modalitie s fo r nu rse

1. Imagery – mental pics, sounds, sensations to evoke personal healing. Mental picture
or representation of something. Ex - release balloon, safe place, image of health &
wholeness
2. Relaxation through meditation – focus one’s mind. Ex - focusing on breath, learning
from body {following blood circulation}, learning from mind {focusing on thoughts,
good thoughts dwell on, bad discard}
3. Self-hypnosis – use of relaxation w/ mindful & specific imagery. Give ourselves
helpful suggestions. Ex – equivalent of one hour sleep, helping body heal itself,
letting problem solution come to you.
4. Energybalancing/ centering – we can calm the disturbed energies around us by
effecting change in out own energy fields. As if focusing out thoughts & intentions
creates vibrational pattern that emanates outward, creating higher frequency in
client’s depleted energy field through resonance. Ex- centering, sensing protecting
layers in your field, filling w/ energy from universal energy field.
5. Humor – not appropriate in some situations: severely distressing news, such as
terminal diagnosis or death of loved one, when important decision must be made,
communicating w/ culturally diverse populations or imbalanced in their psychological
orientation
6. Support groups – support from people in your field of work