PSYCHOTHERAPY

INTRODUCTION

• As human beings, most people experience various kinds of emotional difficulties at some
time or other in their lives.
• These emotional problems are frequently related to several kinds of undesirable life
experiences. Problems related to family, work, education, finance, health, marriage,
relationships with other people
• At times these problems may become so severe and so unbearable that unpleasant
symptoms of anxiety and depression may result in interference with normal functioning.

• A method of treatment based on the development of intimate (therapeutic) relationship

between client & therapist for the purpose of exploring & modifying the client behavior in a
satisfying direction.”

• A process in which a person who wishes to relieve symptoms or resolve problems in living
or seeking personal growth enters in implicit or explicit contract to interact in a prescribed
way with a psychotherapist.”

• Treatment methods most effective in these situations involve the principles of

psychotherapy and counselling. The focus of treatment is to communicate with the individual
in distress, understand the source of problem, and utilize specific psychological remedies to
deal with the problems effectively.

• In 1853, Walter Cooper Dendy introduced the term “Psychotherapeia” regarding how
physician might influence the mental states of suffers and their bodily ailments.

• In late 1800s, Sigmund Freud (now known as the father of Psychotherapy) developed
psychoanalysis, an early form of Psychotherapy.

• Psychotherapy is an English word derived from Ancient Greek Psyche (meaning “breath,
spirit, soul) and therapia (healing, medical treatment).

• The treatment of disease by ‘Psychi’ (i.e. hypnotic) methods.

• The term “Psychological” means to cover a number of techniques which are mediated by
verbal interaction (listening and talking).

DEFINITION

Psychotherapy also called as Talk Therapy has been defined in various ways. Briefly it can
be defined as “the treatment of emotional and/or related bodily problems by psychological
means”.
OR
Psychotherapy is the treatment of disorders of the mind or personality by psychological or
psycho-physiological methods. According to Frederik Van Eeden, 1892

OR
Psychotherapy as the relief of distress or disability in one person by another, using an
approach based on a particular theory or paradigm, and a requirement that the agent
performing the therapy had some form of training in delivering this. According to Jerome
Frank

GOALS OF PSYCHOTHERAPIES

•To improve an individual’s well-being and mental health.

• To resolve troublesome behaviors, beliefs, compulsions, thoughts, or emotions.
• To improve relationships and social skills of an individual.
• To enhance insight and adaptive coping skills.
• To improve problems solving skills, facilitate reframing of cognitions and changes in
behavior.

TYPES OF PSYCHOTHERAPY

1. INDIVIDUAL PSYCHOTHERAPY

•Psychoanalysis
•Hypnosis
•Abreaction
•Reality therapy
•Uncovering

2. BEHAVIORAL PSYCHOTHERAPY

•Behavior Modification
•Systematic Desensitization
•Aversion therapy
•Assertiveness training Other Psycho-social
•Cognitive behavior therapy therapy
•Implosive (flooding) therapy
•Therapeutic community
•Positive reinforcement
-Response shaping
-Modelling
-Token economy

3. INTERPERSONAL PSYCHOTHERAPY

•Marital therapy
•Family therapy
•Transactional therapy

4. GROUP PSYCHOTHERAPY
5. OTHER PSYCHOSOCIAL THERAPY

•Milieu therapy
•Occupational therapy
•Play therapy
•Recreational therapy
•Music therapy
•Dance therapy
•Therapeutic Community
• Attitude Therapy

PSYCHOSOCIAL THERAPY
INTRODUCTION - In treatment modalities of psychiatric patients the approaches used
are; psychopharmacology, psychotherapies or psychological treatments and physical
treatment. Psychotherapy is the treatment used for a patient with emotional and personality
problems. The basic principle in psychotherapy is the therapist-patient relationship. Use
psychotherapy by nursing personnel is an independent role where nurse use an appropriate
psychotherapy approach to help her patient.

DEFINITION - Wolberg define psychotherapy as, “a form of treatment for problems of

an emotional nature in which a traines person deliberately establishes a professional
relationship with the objective of removing, modifying or retarding existing symptoms, of
mediating disturbed patterns of behavior and of promoting positive personality growth and
development.

Lego S. defines psychotherapy as, “A method of treatment based on the development of

intimate relationship between patient and therapies for the purpose of exploring and
modifying the patient behavior in a satisfying direction.

GOAL OF PSYCHOSOCIAL THERAPY

• Changing maladaptive behavior pattern.

• Reducing of elimination environmental conditions that may be causing such a behavior.
• Improving interpersonal & other competencies i.e communication skill
• Helping the patient to resolve inner conflict & overcome feelings of handicap
• Modifying an individual’s accurate assessment of himself & the world around him
• Helping him to develop a sense of self-identity.

TYPES OF PSYCHOSOCIAL THERAPIES

[Link] PSYCHOTHERAPY
 Psychoanalysis
 Hypnosis
 Abreaction
 Reality therapy
 Uncovering
  Supportive therapy

[Link] THERAPY

 Behaviour modification
 Systematic decentralization
 Aversion therapy
 Assertiveness training
 Cognitive Behaviour Therapy
 Cognitive Behaviour Therapy
 Positive Reinforcement

[Link] PSYCHO THERAPY

 Marital Therapy
 Family therapy
 Transactional Therapy

[Link] PSYCHOTHERAPY

5. OTHERS PSYCHOSOCIAL THERAPY

 Therapeutic Community
 Milieu Therapy
 Attitude Therapy
 Occupational Therapy
 Recreational Therapy
 Play Therapy
 Music Therapy
 Light Therapy
 Colour Therapy
 Aroma Therapy
 1. INDIVIDUAL THERAPY

INTRODUCTION
Individual therapy is a psychotherapy implemented by a trained professional, usually a
therapist or psychologist, to help a client work through a problem. The ways that individual
therapy is implemented varies widely depending upon the psychological problem experienced
by the client, the personal beliefs and practices of the therapist, and the individual needs of
the client.

MEANING

Individual therapy is a joint process between a therapist and a person in therapy. Common
goals of therapy can be to inspire change or improve quality of life. Individual therapy is also
called psychotherapy, psychosocial therapy, talk therapy, and counselling. This therapy can
help people overcome obstacles to their well-being. It can increase positive feelings, like self-
esteem. People in therapy can learn skills for handling difficult situations, making healthy
decisions, and reaching goals.

DEFINITION

Individual psychotherapy is based on the development of therapeutic relationship with the

client to modify client behaviour by exploring his or her feelings, attitude & thinking. It is a
process of assisting a person in dealing with symptoms or problems a person is having
individual therapy. It is conducted on a one to one basis i.e. the therapist deals with one
client at a time • By this therapist helps the patient to come to a greater understanding of
himself & to find a way of dealing with his problem.

INDIVIDUAL THERAPY DURATION: 7-8 sessions depending upon the client’s

progress. Follow up session after 1 month, 6 months and 12 months
INDICATIONS

• Stress-related problems
• Anxiety- disorder
• Depression
• Alcohol & drug dependence
• Grief and loss
• Adjustment disorders
• Relationship issues
• Sexual disorder & marital disharmony
• Personal growth & exploration

GOALS OF INDIVIDUAL THERAPY

• Remove or modify existing symptoms.

• Mediate disturbed patterns of behaviour.
• Promote positive personality growth and development.

PURPOSE OF INDIVIDUAL THERAPY

• Changing maladaptive behaviour pattern.
• Improving interpersonal skills and other competence like communication skills.
• Helps the client to resolve inner conflicts
• Helps the client to develop a sense of self- worth and self -identity.

COMPONENTS OF INDIVIDUAL THERAPY

• Psychoanalysis
• Hypnosis
• Abreaction
• Reality therapy
• Uncovering
• Supportive therapy

PSYCHOANALYSIS - Psychoanalysis focuses on the influence of unconscious forces such

as repressed impulses & memories, internal conflicts & childhood trauma on mental
functioning and adjustment of the individual.

AIM - The aim of therapy is to bring all repressed material to unconscious awareness so that
the patient can work towards a healthy resolution of his problems, which are causing the
symptoms.

HYPNOSIS - Hypnosis is a heightened state of awareness (trance), focussed attention, and

intense concentration that is achieved by guided relaxation.
• Hypnosis is also known as hypnotherapy or hypnotic suggestion.
• The client becomes highly suggestible, submissive & abandons control & responds to
therapist influence.

Hypnotic experience involves three factors:

1. Absorption
2. Dissociation
3. Suggestibility/Analysis

ABREACTION THERAPY- Abreaction is a process by which repressed material,

particularly a painful experience or conflict is brought back to consciousness. The person not
only recalls but also relieves the situation, which is accompanied by the appropriate
emotional response.

REALITY THERAPY- Reality therapy focus on improving present relationships &

circumstances, without discussing the past events. It is based on the assumption that
psychological symptoms occur because of choosing wrong behaviours to fulfil their needs
The goal of reality therapy is to help people in improving their lives by learning to make
better choices.
 UNCOVERING- Uncovering or Insight Psychotherapy is a technique used to bring the
patient’s repressed conflict & traumatic experience to the surface. It helps the patient in
gaining an insight. The patient explores different methods to cope with problem, once he
gains an insight into his conflict or problem.

SUPPORTIVE PSYCHOTHERAPY- The therapist helps the patient to relieve emotional

distress & symptoms without probing in to past or attempting to change or alter the basic
personality of the individual. The therapist reinforces the existing defences used by the client.
ADVANTAGES

• Can be set up quickly.

• Patient with a trained professional to talk to.
• Helps define the problems the client is having.
• Improves communication skills.
• Teaches better ways to cope.

DISADVANTAGES

• Client can talk but not make any real changes.

• Some clients don’t have interest in talking about their problems.
• May not provide enough help for the severity of problems.

ROLE OF NURSE

• Reinforce positive behaviour.

• Co-ordinate with other team members.
• Allow patient to take decision.
• Explain about the treatment.
• Develop a trusting relationship.
• Set limits on unacceptable behaviour
 2. BEHAVIOURAL THERAPY

INTRODUCTION

Behavioural therapy is an umbrella term for types of therapy that treat mental health
disorders. Behavioural therapy can vary substantially from disorder to disorder. This form of
therapy seeks to identify and help change potentially self-destructive or unhealthy
behaviours. It is also called as behaviour modification.

The principles of behaviours therapy as we know it today are based on the early studies of
Classical Conditioning by Pavlov (1927) and Operant Conditioning by Skinner (1938).

Behavioural therapies for children and adolescents vary widely, but they all focus primarily
on how some problematic thoughts or negative behaviours may unknowingly or
unintentionally get “rewarded” within a young person’s environment.

DEFINITION

THERAPY: Therapy (Psychotherapy) is the process of working with licensed therapist to

develop positive thinking and coping skills and treat mental health issues such as mental
illness and trauma.

BEHAVIORAL THERAPY: It is a form of Psychotherapy, the goal of which is to modify

maladaptive behaviours patterns by reinforcing more adaptive behaviour.

OR
Behaviour therapy is a type of psychotherapy which is based on theories of learning, and
aims at modifying maladaptive behaviour and substituting it with adaptive behaviour.
 Behaviour therapy is a form of treatment that tries to change someone’s behaviour rather
than treat the cause of it.

OR
Behaviour therapy is the attempt to alter human behaviour and emotions in a beneficial way
according to the laws of modern learning theory.
ACCORDING TO EYSENCK’S

PRINCIPLES OF BEHAVIORAL THERAPY

The principles of behavioural Therapy are based on the early studies of classical conditioning
and Operant conditioning.
PRINCIPLES OF BEHAVIORAL THERAPY
1. CLASSICAL CONDITIONING
2. OPERANT CONDITIONING

1. THEORY OF CLASSICAL CONDITIONING: Classical conditioning is a process of

learning and was introduced by the Russian Psychologist Pavlov. It is a term used to describe
learning which has been acquired through experience.

Theory of Classical Conditioning involves learning by association and is usually the cause of
most phobias. During his experiments, Pavlov hoped to learn more about the digestive
process, he inadvertently discovered that organisms can learn to respond in specific ways if
they are conditioned to do so. It refers to a learning procedure in which a biologically potent
stimulus (e.g. food) is paired with a previously neutral stimulus.

2. OPERANT CONDITIONING: The focus of operant conditioning differs from that of

classical conditioning.  It was introduced by Skinner. It involves learning by reinforcement
 It is based on the idea that an individual will choose his behaviour based on past experience
of consequences of that behaviour.

INDICATION OF BEHAVIOURAL THERAPY

Obsessive-compulsive- disorder (OCD)

Post-traumatic stress disorder (PTSD)
Depression
Social phobia
Substance abuse
Bipolar disorder
Personality disorder
Eating disorder
Schizophrenia
Autism

MAJOR ASSUMPTIONS OF BEHAVIOR THERAPY

 All behaviours are learned (adaptive and maladaptive).

 Human beings are passive organisms that can be conditioned or shaped to do

anything if correct responses are rewarded or reinforced.

 Maladaptive behaviour can be unlearned and replaced by adaptive behaviour if the

person receives exposure to specific stimuli and reinforcement for the desired
adaptive behaviour.
 Behavioural assessment is focused more on current behaviour rather than on
historical antecedents.

 Treatment strategies are individually tailored.

 Behaviours therapy is a short duration therapy, therapists are easy to train and is cost-
effective. The total duration of therapy is usually 6-8 weeks. Initial sessions are given
daily, but the later sessions are spaced out.

TECHNIQUES

1. SHAPING: In shaping the components of a particular skill, the behaviours is reinforced

step by step. The therapist starts shaping by reinforcing, the existing behaviour. Once it
is established, therapist reinforces the responses which are closest to the desired
behaviour and ignores the other responses. Instead of rewarding only the desired
behaviour, therapist reward successive approximations of desired behaviour.

e.g. In eliciting speech from autistic child, the teacher may first reward the child for:
(a) watching the teacher’s lips, then for
(b) making any sound in imitation of the teacher, then for
 (c) Forming sounds similar to the word uttered by the teacher.

2. MODELING: Modelling refers to the learning of new behaviours by imitating the

behaviours in others. Modelling is a method of teaching by demonstration, wherein therapist
shows how a specific behaviour is to be performed. Modelling occurs in various ways:
• Children imitate the behaviours of their parents, teachers and friends.
• In practice setting, client may imitate the behaviours of practitioners who are charged with
their care.

3. PREMACK PRINCIPLE: The Premack principle is a principle of reinforcement which

states that an opportunity to engage in more probable behaviours (or activities) will reinforce
fewer probable behaviours (or activities).

e.g. If a child enjoys playing computer games (more probable) and avoids completing math
problems (less probable), we might follow child to play the computer after (contingent upon)
completing maths problem.
 4. EXTINCTION/IGNORING: It is gradual decrease in frequency or disappearance of
response when the positive reinforcement is withheld.

e.g. Temper tantrum Child The tantrum behaviours continue as long as the parent gives
attention to them but decrease and often disappear when the parent simply leaves the child
alone in the room.

5. CONTINGENCY CONTRACTING: It is a type of intervention that is used to increase

desirable behaviours or decrease undesirable ones. A contingency contract may be entered
into by a teacher and student, a parent and child, or a therapist and client

e.g. A parent and child enter into a contingency contract to get the child finish his homework
before dinner time, after which he earns some TV time. Every time he satisfactorily finishes
his homework before dinner time, he gets to watch an hour of TV after dinner. If he fails to
finish his homework satisfactorily, then instead of enjoying some TV time, he has to use that
time to finish his homework.
6. TOKEN ECONOMY: It is a form of behaviour modification designed to increase
desirable behaviour and decrease undesirable behaviour with the use of tokens. Individuals
receive tokens immediately after displaying desirable behaviour.

7. TIME OUT: Time out is a popular technique based on principle of negative

reinforcement. Timeout method includes removing the patient from the reward or the reward
from the patient for a particular period of time following a problem behaviours. This is often
used in the treatment of childhood disorders.

8. RECIPROCAL INHIBITION: Also called as counterconditioning, reciprocal inhibition

decreases or eliminates a behaviour by introducing a more adaptive behaviour, but one that is
incompatible with the unacceptable behaviour

e.g. Introduction of relaxation exercises to an individual who is phobic. Relaxation is

practiced in the presence of anxiety so that in the time the individual is able to manage the
anxiety in the presence of phobic stimulus by engaging in relaxation exercises. Relaxation
and anxiety are incompatible behaviours
 9. OVERT SENSITIZATION/AVERSION THERAPY: It is a type of aversion therapy
that produces unpleasant consequences for undesirable behaviour. Thought stopping
techniques are used to abolish obsessional thoughts.

e.g. Disulfiram (Antabuse) is a drug that is given to individuals who wish to stop drinking
alcohol. If an individual consumes alcohol while on anta-abuse therapy, symptoms of nausea
& vomiting, dyspnoea, palpitation and headache will occur.

10. COVERT SENSITIZATION: It relies on the individual’s imagination, rather than on

medication, to produce unpleasant symptoms. The technique is under client’s control and can
be used whenever and wherever is required. It is form of behaviour therapy in which an
undesirable behaviour is paired with an unpleasant image in order to eliminate that behaviour.
 11. SYSTEMATIC DESENSITIZATION: It is also known as “Graduated exposure
therapy”. It is a technique for assisting individuals to overcome their fear of phobic stimulus.
It was developed by Joseph Wolpe. This therapy aims to remove the fear response of phobia.
In this patient attain a state of complete relaxation and are then often exposed to stimulus that
elicits the anxiety response.
The process of systematic desensitization occurs in three steps:

RELAXATION TRAINING: There are many methods which can be used to induce
relaxation. Some of them are Jacobson’s progressive muscle relaxation, Hypnosis, Meditation
or Yoga, Mental Imagery and Biofeedback

HIERARCHY CONSTRUCTION: Here the patient is asked to list all the conditions which
provoke anxiety. Then he is asked to list them in a descending order of anxiety provocation.

THE STIMULUS: This can either be done in reality or through imagination. At first, the
lowest item in hierarchy is confronted. The patient is advised to signal whenever anxiety is
produced. With each signal he is asked to relax. After a few trials individual is able to control
anxiety gradually.

12. FLOODING: Also known as Exposure and Implosion therapy. The patient is directly
exposed to the phobic stimulus, but escape is made impossible. Prolonged contact with the
phobic stimulus, the therapist’s guidance and encouragement and his modelling behaviour
reduce anxiety. Flooding is believed to produce results faster than systematic desensitization;
however, some therapists report more lasting behavioural changes with systematic
desensitization.

13. CHAINING: Chaining is used when a person fails to perform a task. The complex task
is broken into a number of small steps and each step is taught to the patient.
* In forward Chaining, one starts with the first step, goes on to the second step, then to third
and so on.

* In backward Chaining, one starts with the last step and goes on to the next step in a
backward fashion. Backward chaining is found to be more effective in training the mentally
disabled.

14. RESTITUTION (OVERCORRECTION): Restitution means restoring the disturbed

situation to a state that is much better than what it was before the occurrence of the problem
behaviour.
E.g.: If a patient passes urine in the ward, he would be required to not only clean the dirty
area but also mop the entire/larger area of the floor in the ward.
15. BEHAVIOURAL HOMEWORK ASSIGNMENTS: The therapist often requests that
the patient complete homework assignment between therapy sessions. These may consist of
real-life behavioural experiments where patients after encouraged to try new responses to
situations discussed in therapy sessions.
ROLE OF NURSE

[Link]
2. OBSERVER
3. TEACHER
4. SUPPORTER
5. GUIDE AND FRIEND
6. WARDEN

[Link] THERAPY

INTRODUCTION:

Relaxation produces physiological effects opposite those of anxiety: slow heart rate,
increased peripheral blood flow and neuro- muscular stability.

A relaxation technique (also known as relaxation training) is any method, process,

procedure, or activity that helps a person to relax; to attain a state of increased calmness; or
otherwise reduce levels of pain, anxiety, stress or anger.
 Relaxation techniques are often employed as one element of a wider stress management
program and can decrease muscle tension, lower the blood pressure and slow heart and
breathe rates, among other health benefits.

Relaxation is a technique often used by sports performers to calm themselves-thereby

decreasing anxiety and controlling arousal. It can increase the sense of control, reduce
anxiety, and help the performer to feel calm and comfortable.
Involves a decrease in:
• Breathing rate.
• Heart rate.
• Muscle activity.
• Oxygen consumption.

DEFINATION

Relaxation therapy is a broad term used to describe a number of techniques that promote
stress reduction, the elimination of tension throughout the body, and a calm and peaceful state
of mind.
The aim of relaxation therapy is to quiet the mind; to allow thoughts to flow in a smooth,
level rhythm, and induce the relaxation response. This mental quiet allows for rest and
rejuvenation that does not always occur, even during sleep.

PURPOSE

The goal of relaxation therapy is to calm the brain or brain, to permit thinking process to
stream in an even, smooth pace, and trigger the relaxation reaction.
• To improve the circulation.
• To relive muscle fatigue
• To improve the physical and mental health.
• To improve the physiological function.
This mental silence facilitates for relax and transformation that may even cannot be
achieved during sleep, since throughout the sleep, the mind can stay energetic, even if the
pace is slower than that of the mind when it is conscious.

BENEFITS OF RELAXATION THERAPY

Increase in self-confidence to manage the problems

• Suppress tension and anger.
• Increase in blood flow to primary muscles.
• Regularize the heartbeat.
• Lower the blood pressure.
• Increase concentration and memory.
• Reduce sleep deprivation.
• Increase in energy.
• Reduction of frequency and severity of panic attacks, Increase in ability to focus .
Reduction of insomnia and fatigue
PSYCHOLOGICAL EFFECTS:

• Respiratory rate slows 4 to 6 breath per minute.

• Heart rate to as low as 24 beats per minute.
• Blood pressure decreases.
• Metabolic rate slows down.

COGNITIVE AND BEHAVIOUR EFFECTS

 Mental alertness.
 Active thinking
 Increases the creative and memory
 Increases the ability to concentrate
 Improvement in adoptive functioning
 It focuses on specific problems
 It is goal oriented
 Recognize to those whose ideas affect their mood, behaviour, and physical condition.

ELEMENTS OF RELAXATION THERAPY

Quiet environment.
Mental devices. (A word, phrase, object, or process used to help a person relax. Two
commonly used mental devices are the mantra and the process of taking deep breaths and
exhaling slowly.)

Passive attitude. (A passive attitude means that you aren't taking any action. For example,
if you have a passive attitude about exercising, you aren't exercising.)

Comfortable position.

METHODES OF RELAXATION THERAPY:

A. Jacobson progressive muscle relaxation.

B. Mental imagery
C. Meditation.
D. Yoga.
E. Biofeedback.
F. Physical exercises.
G. Deep breathing exercise.

A. JACOBSON PROGRESSIVE MUSCLE RELAXATION.

• It is the most often used relaxation training, developed by the psychiatrist Edmund
Jacobson. • In this the client must learn to relax through deep muscle relaxation training.
• Excellent results has been observed with this method in the treatment of muscular tension,
anxiety, insomnia, depression, fatigue, irritable bowel, muscles spasms, neck and back pain,
high blood pressure, mild phobias, etc.
PROCEDURE:

 Make the patients in a comfortable position.

 Provide light or soft music / pleasant visual cues.
 Give a brief explanation about the progressive muscles’ relaxation.
 Instruct the client to tense each muscles group approximately for 10 second.
 Explain the tension of the muscles and uncomfortable the body parts feel.
 Ask the client to relax each muscle.

B. MENTAL IMAGERY: It is a relaxation method in which patients are instructed to

imagine themselves in a place associated with pleasant relaxed memories. Such images allow
patients to enter a relaxed state or experience a feeling of calmness and tranquility.
 • Some might select a scene at the seashore, some might choose a mountain atmosphere, and
some might choose floating through the air.
• The choices are as limitless as one's imagination.
• Nurses can assist patients with imagery during a painful or stressful event. The nurse's
certificate program in Imagery is endorsed by the American Holistic Nurse's Association
(AHNA).

C. MEDITATION: Meditation involves focusing the mind upon a sound, phrase, prayer,
object, visualized image, the breath, or consciousness in order to increase awareness of the
present moments, promote relaxation, reduce stress, and also enhance the spiritual growth.
PURPOSE:

1. Promote well-being n healthy people.

[Link] regularly experience less anxiety and depression.
[Link] more enjoyment and appreciation of the life.
4. Facilitates a greater sense of calmness, empathy, and acceptance to self and others.
5. Based on the clinical evidence, meditation is seen as an appropriate therapy for panic
disorder, anxiety disorder, substance abuse. It may improve function or reduce symptoms of
patients with neurotic disorder that is Parkinson’s diseases, epilepsy, etc.

TYPES OF METITATION:

I. CONCENTRATION MEDITATION: It involves focusing once attention on the

breath, an imagined or real image, sound, or word, or phrase that is repeated silently.

II. MINDFUL MEDITATION: It involves becoming aware of the entire filed of attention.
There is an awareness of all thought, feelings, perceptions or sensation as they arise from
moment to moment
.
D. YOGA: Yoga is an ancient system of breathing practice, physical exercise, and
postures and meditation intended to integrate the practitioner’s body, mind, and spirit.
• Yoga uses combination of physical postures (asanas), breathing techniques (pranayamas)
and meditation to promote relaxation and enhance the flow of vital energy called prana.
• It is essential for a nurse to have baseline information and awareness of yoga which is
purely Indian in origin
 This is brought about by the following eight steps:
[Link]-control (Yama), obtained by such devices as chastity, non-stealing, non-violence,
truthfulness, and avoidance of greed.
[Link] observance (Niyama), through chanting of the Vedic hymns, austerity, purity and
contentment.
[Link] of certain positions (Aasana).
4. Regulation of the breath (Pranayama), with controlled rhythmic exhalation, inhalation, and
temporary suspension of breathing.
5. Restraint of the senses (Pratyahara).
[Link] of the mind (Dharana), through fixation on some part of the body, such as the
nose or navel.
[Link] (Dhyana), on the true object of knowledge, the supreme spirit, to the exclusion
of other things in life.
8. Profound contemplation (Samadhi), with such complete absorption and detachment that
there is insensitivity to heat and cold, pain and pleasure.

E. BIO-FEEDBACK: It is the technique that is used monitoring instrument to measure

and feedback information about the muscle tension, heart rate, Sweat responses, and skin
temperature or brain activity.
• The term associated with biofeedback include applied psychophysiology or behavioural
physiology.
• It is also viewed as a mind-body therapy use as an alternative medicine.
• Biofeedback is an important part of understanding the relationship between physical state
and thought, feeling and behaviour.

PURPOSES: The purpose of the biofeedback is to enhance an individual awareness of the

physical reaction to physical, emotional or psychological stress and their ability to influence
their own physiological response.
INDICATIONS:

• High blood pressure.

• Eating disorder.
• Anxiety disorder.
• Substance abuse.
• Attention deficit disorder.
• Depression.
• Sleep disorder.
• Migraine headache.

EQUIPMENTS USE IN BIOFEEDBACK:

 Electronic instruments used to obtain immediate feedback to the patients regarding his
physiological activities.
 (ECG, EEG, Pulse, BP, GSP(Galvanic Skin Response)

F. PHYSICAL EXERCISE

 Regular exercise is the most effective method of reliving stress.

 Physical exertion provides a natural outlet for the tension produced by the body in its state
of aerosol for “fight or flight”.
• Aerobic exercise strengthens the cardio vascular system. Following exercise physiological
equilibrium is restored, resulting in a feeling of relaxation.
DEEP BREATHING EXERCISES: Tension is released when the lungs are allowed to breath in as
much oxygen as possible. Breathing exercise has been found to be effective in reducing
anxiety, depression, irritability, fatigue and muscular tension.
TECHNIQUES:

1. Sit or lie down in a comfortably, inhale slowly through the nose and exhale through the
mouth.
[Link] inhaling place one hand below the ribs, allow the hand to expand outward when
inhaled.
3. Let hand fall back to its original position when exhaled. 4. Exhalation should take twice as
long as inhalation.

ROLE OF NURSE

1. Help the individual to recognize the source of stress.

[Link] to identify the method of coping.
[Link] identify the individual adaptation to stress.
[Link] assess the individual to achieve their highest potential for wellbeing.
[Link] evaluate the effectiveness of the therapy.
[Link] plan alternative / modification.
[Link] main is documentation.
[Link] role while the therapy.

CONCLUSION: Relaxation produces physiological effects opposite those of anxiety:

slow heart rate, increased peripheral blood flow and neuro- muscular stability.
• A relaxation technique (also known as relaxation training) is any method, process,
procedure, or activity that helps a person to relax; to attain a state of increased calmness;
There are many types of relaxation therapy, such as;
• Jacobson progressive muscle relaxation.
• Mental imagery
• Meditation.
• Yoga.
• Biofeedback.
• Physical exercises.
• Deep breathing exercise.
 4. COGNITIVE THERAPY

INTRODUCTION

A type of psychotherapy and short-term structured therapy Developed by American

psychiatrist Aaron T. Beck Uses active collaboration between the patient and the therapist to
achieve the therapeutic goals. Concentrates on unconscious processes and past events.

DEFINITION

A type of psychotherapy in which negative patterns of thought about the self and the world
are challenged in order to alter unwanted behaviour patterns or treat mood disorders such as
depression. Attempts to change problematic feelings and behaviours by changing the way a
client thinks about significant life.

FUNDAMENTAL ASSUMPTION
•
It is based on how a person thinks/perceives an event rather than the event itself.
• It is time limited.
• Therapeutic changes can be effected through an alteration of idiosyncratic, dysfunctional
mode of thinking leading to cognitive change.
• Based on patient’s thoughts and behaviour.
• Aims at altering the cognitions for effecting a change in behaviour.

Basis Change may begin by targeting:

1. Thoughts (to change emotion and behavior).

[Link] (to change feelings and thoughts). Cognitive therapy takes a skill-building
approach, where the therapist helps the person to learn and practice these skills
independently, eventually "becoming his or her own therapist"

CLASSIFICATION

1. Techniques to interrupt cognitions

2. Techniques used to counterbalance emotional effects of cognitions
3. Techniques intended to alter cognitions
4. Problem solving techniques

1. Techniques to interrupt cognitions - Distraction- In distraction, patient forcefully

attends to something other than the intrusive thoughts. Direct attention to another mental act.
• Thought stopping

2. Techniques used to counterbalance emotional effects of cognitions - A

suitably chosen statement, produced by a conscious effort to balance the intrusive thought.
3. Techniques intended to alter cognitions By Beck and consists of three
stages: -
• To Identify maladaptive cognitions
• Identify logical ‘errors’ allowing maladaptive cognitions
• Persist and to challenge the underlying assumptions which generate maladaptive
cognitions in the first place.

4. Problem Solving Techniques

• Define the problem

• Divide it into manageable parts
• Think of alternate solutions.
• Select the best solution
• Carry it out, and
• Examine the result

5. Additional Techniques

1. Smart goals (specific, measurable, achievable, realistic, and time-limited)

2. Journaling (to jot down negative beliefs that come up during the week and the positive
ones you can replace them with)
3. Self- talk (In order to replace negative or critical self-talk with compassionate, constructive
self-talk).
4. Others (Thought recording, Positive activities, Situation exposure)

INDICATIONS

• Obsessive Compulsive Disorder (OCD)

• Major Depression
• Anxiety Disorder
• Eating Disorder
• Schizophrenia
• Phobias
• Panic Disorders
• Post-Traumatic Stress Disorder (PTSD)
• Suicidal Behaviour

Other Indications Cognitive therapies have also been used in the treatment-

• Dissociative (and conversion) disorders

• Paranoid disorders
• Solving real life problems
• Including marital problems
• Substance abuse
• Stress disorders

Limitations Cognitive therapy is contraindicated-

• Patients with poor reality testing (e.g. With psychotic features),
• Impaired reasoning and retention abilities, and
• Borderline or other severe personality disorders.
 5. COGNITIVE BEHAVIOUR THERAPY
COGNITIONS - Cognition are the higher order mental process that help us to gather and
process the information. Cognitive functions include thinking, remembering, judgement,
decision making and problem solving.

COGNITIVE TRIAD- Behaviour and actions of a person depends upon cognitive triad.

People’s beliefs about themselves

People’s beliefs about their personal world (including the people in their lives)
People’s beliefs about their future

How your thoughts affect your behaviour??

A person who thinks himself as unworthy of love or respect may feel withdrawn in social
situations and behave as a shy person. He may also lack social skills like communication or
interactions.

COGNITIVE BEHAVIOR THERAPY

Cognitive behaviour therapy is based on the concept that our thoughts, emotions, physical
sensations, and behaviours are interconnected. Negative or faulty cognitions can result into
maladaptive patterns of behaviour. The gaol is to modify the thinking patterns that is
contributing to the patient’s problem.

DEFINITION

Cognitive behaviour therapy is a type of talk therapy (psychotherapy) that is focussed on

modifying the distorted cognitions and maladaptive behaviours.

AIMS OF CBT

• to identify the distorted cognitions.

• to change or modify the distorted thinking pattern.
• to substitute more realistic cognitions.

ASSUMPTIONS OF CBT

• How we behave in a situation depends on our thoughts and perception.

• Distorted cognitions leads to maladaptive behaviours.
• Thoughts can be controlled and modified.
• Therapeutic change can be produced by altering the distorted thinking patterns in an
individual.

INDICATIONS

• Depression
• Eating disorders
• PTSD • Personality disorders
• Sleep disorders
• OCD
• Anxiety disorder (Panic & generalized anxiety disorders, social anxiety) Phobias
• Bipolar disorder
• Anger issues
• Schizophrenia
• Substance abuse
• Sexual disorders

DURATION OF THERAPY - Cognitive behaviour therapy is a structured and short

term therapy , usually lasting for 12-25 weeks. Sessions: once a week meeting.

BASIC CONCEPTS OF CBT

1. Automatic thoughts (cognitive errors/ cognitive distortions)

2. Schemas (Core Beliefs)
[Link] thoughts (cognitive errors/ cognitive distortions)- These are the
rapidly occurring thoughts (usually negative ) in response to a situation without rational
analysis.
e.g. “people with laugh at me when they see how badly I bowl” is an automatic thought that
occurs in someone who has been asked to go for bowling and responds negatively.

[Link] (core beliefs)- These are the pattern or framework of thoughts that help us
organize and interpret the information. Core beliefs produce the automated thoughts. These
may be adaptive or maladaptive. (positive or negative)

e.g. Schemas associated with failure No matter what I do, I will fail (maladaptive) If I try
and very hard, I will succeed (adaptive) Schemas associated with lovability I am stupid. No
one would love me. (maladaptive) People love me for who I am (adaptive)

TECHNIQUES OF CBT

1. Identifying the troubling situation.

2. Recognizing the automatic thoughts and schemas
3. Modifying the automatic thoughts and schemas
4. Behavioural interventions

[Link] the troubling situation- These may include stress full situations or
other issues such as medical condition, divorce, grief or symptoms of mental illness.

[Link] the automatic thoughts and schemas - Identify the thought

distortions by using guided questions or through thought recording. Client is asked to keep a
record of situations that caused stress and the automatic thoughts that were elicited by the
situation. The patient is helped to identify “maladaptive cognitions” and their “logical
errors”.
[Link] automatic thoughts and schemas - Counterbalancing intruding
cognitions and the emotions with another thought.
eg. When an anxious patient with chest pain becomes apprehensive thinking that he has a
heart problem; he may be trained to think it is only muscular pain and does not relate to the
heart.

[Link] interventions
• Defining the problem more clearly.
• Dividing it into small sub-problem which can be better managed.
• Finding out alternate methods of solving each problems.

ADVANTAGES

• Teach the clients rational self- counselling skills.

• Emphasize getting better, rather than feeling better.
• CBT creates long-term results since the cause of the problem is corrected.
• Focus on the client's goals, rather than attempting to impose the therapist's goals on the
client.

DISADVANTAGES

• A therapist is like a personal trainer that advises and encourages but cannot 'do' it for the
client.
• Ineffective if client lacks concentration and motivation.
• Time consuming
• Due to the structured nature, not suitable for people with more complex mental health needs
or learning difficulties.
 6. GROUP THERAPY

INTRODUCTION
Group psychotherapy is a treatment of psychological problem in which two or more
patients/client interact with each other on both an emotional & cognitive levels in the
presences of one or more psychotherapists who serve as catalysts (the person who can be
related to or who can understand the other’s point of view), facilitators or interpreters.

DEFINITION

Group psychotherapy or group therapy is a form of psychotherapy in which one or more

therapists treat a small group of clients together as a group

History Of Group Therapy

 Originally found successful in treating patients with TB in the early 1900’s

 Jacob L. Moreno introduced group therapy in counselling in 1920.
 Later used during WW II for treating those with emotional reactions
 In 1946 “T-groups” emerged, to enhances interpersonal relationship. It was the
beginning of modern group work.
 Encounter group- intended for “Normal Functioning” who wanted to grow.
 Marathon group- break-down barriers that individuals use.
 The 1960 human potential movement “Founded on the belief that the most people
only use a small percentage of their capability but that within a group experiences,
they can recognize their full potential”

GOALS OF GROUP THERAPY

• Help Individuals Identify Maladaptive behaviour
• Help with Emotional Difficulties through Feedback
• Offer a Supportive Environment

TYPES OF GROUP THERAPY

1. Psychoeducational/ Guidance group

2. Counselling/Interpersonal Problem- Solving Groups
3. Psychotherapy Groups
4. Task/work Groups

1. Psychoeducational/ Guidance group - The purpose is to teach group participant

how to deal with a potential threat (catching the flu), developmental life events (growing
older) or immediate life crisis (death of love one) • Used in educational setting but frequently
used in hospital, mental health centre, or social service agencies.

2. Counselling/Interpersonal Problem- Solving Groups These groups help

participants resolve problems of living through interpersonal support and problem solving.

3. Psychotherapy Groups - These groups focus on personality reconstruction or

remediation of deep-seated psychological problems.

4. Task/work Groups - A group that comes together to perform a task that has a
concrete goal (e.g. community organizations, committees, planning groups, task force).

Stages of group development

Forming
Storming
Norming
Performing
Adjourning

Guidelines for group therapy

• Maintain Confidentiality
• Commitment to Attendance.
• Socializing with Group Members
• Putting Feelings into Words Not Actions.
• Role of Leader and Members

. Yalom’s Therapeutic Factors •

Yalom (1995) defined therapeutic factors as "the actual mechanisms of effecting change in
the patient “.
• Yalom identified 11 factors that influence the processes of change and recovery among
group therapy clients.
 Therapeutic Factors
1) universality- feeling of having problems similar to others, not alone
2) Altruism - helping and supporting others
3) Instillation of hope - encouragement that recovery is possible
4) Guidance - nurturing support & assistance
5) Imparting information - teaching about problem and recovery
6) Developing social skills - learning new ways to talk about feelings, observations and
concerns
7) Interpersonal learning - finding out about themselves & others from the group
8) Cohesion - feeling of belonging to the group, valuing the group
9) Catharsis – release of emotional tension
10) Existential factors – life & death are realities
11) Imitative behaviour – modelling another’s manners & recovery skills

Group Composition-

Homogenous groups Group - composed of patients of the same age, race, sex,
socioeconomic level and similar of illness.

Heterogeneous groups Group- vary on different clients age, race, sex, socioeconomic
level and different category of illness.

Concerns in Group Work

Group Size - Group counselling and psychotherapy generally work best with 6-8 members.
If group run as long as 6 months 10 people can be included.

Length and Duration of Sessions- Group sessions range from 1-2 hours.

Group structure
• Open (allows members to enter and leave the group as needed)
• closed (only the group members who started at the beginning are in the group at the end).

Purposes of therapist intervention

• To help build an atmosphere of trust and safety.
• To enforce rules and norms.
• To provide feedback.
• To get a member’s input, reaction or feedback.
• To draw connections between members or point out themes.
• To correct irrational or faulty thinking.
• To empower participants.
• To offer support when needed.
• To reinforce helpful contributions.
• To encourage constructive risk taking.
Functions of group therapy
• Sharing experiences
• Support to & from group member
• Socialization
• Imitation
• International learning

Sharing experiences
help the client to realize that they are not isolated & that other also have similar experience &
problem
• Hearing from other client that they shared experiences is often more convincing & helpful
then reassurance from the therapist.

Support to & from group member

• The sharing action of being mutually supportive is an aspect of the group cohesiveness that
can provide a sense of belonging for client feeling who feel isolated in their everyday lives.

Socialization
It is acquisition of social skill (E.g. maintaining eye contact) with in a group through
comments that member about one another deficiencies in social skills.
• This process can be helped by trying out new ways of interacting within the safety of the
group.

Imitation
• It is learning from observing & adopting the behaviours of other group members. • If
the group is run well, client imitate the adaptive behaviours of other group members.

International learning
It refers to learning about difficulties in relationships by examining the interaction of
individuals with the other members of group.

Roles of Therapist

• An advisor
• An advocate
• A facilitator
• A social policeman
• A technician
• An enabler

Techniques of group therapy

Cognitive therapy
Focus on irrational thoughts and beliefs of members and restructuring perceptions and beliefs
by substitution of new effective thoughts and beliefs.

Behavioural therapy
Behaviour is learned so ineffective behaviour can be unlearned and replaced by effective
behaviour.

Role plays
One member of the group can portray someone in another group member's life to
give the other member a chance at practicing how to communicate effectively.

Story Writing and Sharing

Members write a story about themselves and their lives and then read it aloud for the
group to hear and discuss.

Task oriented groups

•To develop social skills, interacting in a group home.
• Therapeutic activity groups Wide array of art, music, dance, psychodrama and many other
techniques having a defined therapeutic goal.

Areas That May Particularly Benefit from A Group Therapy

• Addiction
• Anxiety
• Depression
• Obsessive Compulsive Disorder

ADVANTAGES

• You realize you’re not alone.

• Facilitates giving and receiving support.
• Helps you find your “voice.”
• Helps you relate to others (and yourself) in healthier ways.
• Social Skills
• Learn From Others Mistakes
• Diversity of Opinions
• It costs less

DISADVANTAGES

Personality Clashing
• Loss of trust
• It strikes fear into some patients.
• It doesn’t guarantee confidentiality.
• Social Anxiety
• Mourning A Loss
CONCLUSION

• Group therapy plays a major role in rehabilitation of mentally ill client.

• It gives an opportunity for immediate feedback.
• It facilitates chance for therapist to observe the clients emotional and behavioural response
towards variety of people.
• Enhances clients communication, decision making and assertive skill.
 7. FAMILY THERAPY

INTRODUCTION

Family therapy is the branch of psychiatry which sees an individual’s psychiatric symptoms
as inseparably related to the family in which he/she lives, thus the focus of treatment is not on
the individual, but the family as whole. Family therapy is essentially about changing
relationship through changing interaction among people who make up the family. The basic
principle of family therapy evaluates the complex web of relationship pattern of transaction
taking place within a family system.

DEFINITION

“A psychotherapeutic approach that focuses on interaction between a couple within a nuclear

family or its members in extended family or between the family and other interpersonal
systems with the goal of alleviating problems initially presented by individual family
members, family subsystem, the family as a whole or other referral sources.”

AIMS/GOALS

• To reduce dysfunctional behaviour of individual family members.

• To reduce conflicts in family relations.
• To improve family communication skills.
• To heighten awareness and sensitivity to other family members to meet their needs.
• To strengthen family’s ability to cope with major life stressors and traumatic events.
• To improve integration of family system into social system.
• To improve autonomy for each member.
• To reduce distress in the patient.
INDICATION

1. Problem in relationship within the family

2. Interdependence of symptoms
3. Failure of individual therapy
4. Psychosis
5. Schizophrenia
6. Childhood psychiatric disorder
7. Anxiety- disorder
8. Bipolar -disorder

CONTRAINDICATION

1. Family in the process of breaking up.

2. Family in which tense, dysfunctional equilibrium is present.
3. Families staying apart.
4. Non-availability of key family members.
5. Families in which members are unwilling to take therapy.

FUNCTIONS OF FAMILY THERAPY

1. MANAGEMENT FUNCTIONS: Decision-making, rule-making, provision of financial

support. In a healthy family, usually adults take these decisions and they see that children
learn decision making skills as they mature and prefer to make choices on their own lives.

2. BOUNDARY FUNCTIONS: Boundary maintain distinction between individuals in

family, they may be
• Clear Boundaries: are usually well understand by all members, helps define their roles
in family.
• Diffuse Boundaries: refers to blending together of roles, thoughts and feelings. Clear
distinctions may fail to emerge.
• Rigid Boundaries: in families where this predominates, isolation may be marked. The
family can often get cut-off from community.

3. COMMUNICATION FUNCTION: Extremely important in family life, encourages

members to express their feelings and prevent conflicts.

4. EMOTIONAL-SUPPORTIVE FUNCTION: Healthy family is concerned with each

other’s need and provide emotional support to the family members at the time of crisis. Gives
freedom to grow, explore new roles within family members.

5. SOCIALISATION FUNCTION: It is within the family that each member learns

socialisation skills, learn how to interact, negotiate and plan. They also adopt coping skills.
Promotes safety, security and lays emphasis on kinship patterns. Decreases the chances of
social tension and conflicts with society.
TYPES OF FAMILY THERAPY

1. INDIVIDUAL FAMILY THERAPY: In individual family therapy, each family member

has a single therapist. The whole family may meet occasionally with one or two of the
therapists to see how the member’s are relating to one another and work out specific issues
that have been defined by the individual members.

2. CONJOINED FAMILY THERAPY: The most common type of family therapy is the
single-family or nuclear family therapy. The family is seen, and the issues and problems
raised by the family are addressed by the therapist. The way in which the family interacts is
observed and becomes the focus of therapy. The therapist helps the family deal more
effectively with problems as defined.
 3. MULTIPLE FAMILY GROUP THERAPY: In this therapy, four or five families meet
weekly to confront and deal with the problems or issues they have in common. Ability or
inability to function well in the home and community fearing of talking to or relating to
others, abuse, anger, neglect, the development of social skills, and responsibility for oneself
are some of the issues on which these group focus and become the support for all the
families.

4. MULTIPLE IMPACT THERAPY: Several therapists come together with families in a

community setting. They live together and deal with pertinent issues for each family member
within the context of the group. Multiple impact therapy is similar to multiple family group
therapy except that it is more intense and time limited. Like multiple family group therapy, it
focuses on developing skills or working together as a family and with other families.
5. NETWORK THERAPY: It is conducted in people’s homes. All individuals interested or
invested in a problem or crisis that particular person or persons in a family are experiencing
take part in therapy. This gathering includes family, friends, neighbours, professional groups
or persons. People who form the network generally know each other and interact on a regular
basis in each other’s lives. Thus a network may include as many as 40 to 60 people.

6. MARITAL/COUPLE THERAPY: Couples are often seen by the therapist together. The
couple may be experiencing difficulties in their marriage, and in therapy, they are helped to
work together to seek a resolution for their problems, family patterns, interaction and the
communication styles, each partner’s goals, hopes and expectations are examined in therapy.
This examination enables the couple to find a common ground for resolving conflicts by
recognizing and respecting each other’s similarities and differences.
OBJECTIVE OF MARITAL THERAPY

• A support of marriage/couple in identifying sources of conflict.

• A help to each partner in determining their participation in conflicts.
• A help in deciding whether to continue the relationship or not.
• An improvement in natural verbal communication and non-verbal communication.

INDICATIONS OF MARITAL THERAPY

• Overprotection of one partner co-existing with emotional dependence of others.

• Jealousy combined with controlled suspicion and restriction.
• Dominance of one partner with lowering self esteem of other.
• Mutual antagonism blaming an emotional interdependence.

CONTRAINDICATIONS OF MARITAL THERAPY

• Physical violence between partners.

• Mental illness or addiction problem of one or both partners.
• Staying of partners in other relationship and lack of motivation to give up on them.
• Undertaking the decision of divorce.

NURSING RESPONSIBILITIES

1. Create a therapeutic environment that foster trust and make member fully safe and
comfortable.
2. Promote effective communication by seeking clarification or vague statements.
3. Identifying patterns of interaction that interfere with successful problem solving.
4. Help the family to identify problems that demand change.
5. Encourage all members to express honest feeling without judgement.
6. Avoid being triangled in family’s emotional system. Remain natural and objective.
7. Reframe problems into their resolutions.
8. Discuss present coping strategies encourage each member to describe how they cope with
stress.
9. Identify community resources that may assist members to adapt coping mechanisms.
[Link] family members in planning leisure time activities together and encourage ‘we-
feeling’.
8. MILIEU THERAPY OR THERAPEUTIC COMMUNITY

INTRODUCTION

‘Milieu’ is a French word, means ‘Middle’ and ‘Surrounding or Environment’. The therapy
which involves the ‘milieu’ or environment is called as ‘Milieu therapy or Therapeutic
Community or Therapeutic Environment’. The concept of ‘Therapeutic Community’ was
first developed by Maxwell Jones in 1953.

DEFINITION

‘The Psychiatric Mental Health Nurse structures, provides and maintains a therapeutic
environment with the client and other health care clinicians. – ANA, 2000 ‘A special kind of
Milieu therapy in which the total social structure of the treatment unit is involved as a part of
helping process. – Kraft

GOALS

• Changes maladaptive behaviour into adaptive behaviour

• Promotes early recovery.
• Minimizes prolongation of hospital stay.
•To resocialise the client.
• To promote self- confidence

OBJECTIVES

• To use patients’ social environment to provide a therapeutic experience for him.

• To enable the patient to be active participant in his own care and become involved in daily
activities of his community.
• To help patients solve problems, plan activities and develop the necessary rules and
regulation for the community.

ELEMENTS

FREE COMMUNI -CATION

SHARED RESPONSI -BILITY
ACTIVE PARTICIP- ATION
DECISION MAKING
UNDERST -ANDING ROLES & RESPONS -BILITY

INDICATION
  Neurosis
 Drug addiction and abuse
 Personality disorder
 Schizophrenia

CONTRAINDICATION
  Depression
 Mania
 Paranoid personality disorder

COMPONENTS

DAILY COMMUNITY MEETINGS

PATIENT GOVERNMENT OR WARD COUNCIL
STAFF MEETINGS OR REVIEWS
LIVING BAND LEARNING OPPORTUNITIES

DAILY COMMUNITY MEETINGS

•Meetings are composed of 60-90 patients

• Held regularly for 60 mint.
• Patient’s feelings and behaviours are examined by other members.
• Frank discussion are encouraged
PATIENT GOVERNMENT OR WARD COUNCIL

•Patient government is to deal with practical unit details such as housekeeping functions,
activity planning and privileges.
•All decision should be feedback to the community through the community meetings.
STAFF MEETINGS OR REVIEWS - Staff meeting should be held following each
community meeting (patients are excluded and only staff are present). In this meeting the
staff would examine their own responses, expectations, and prejudice’s.
 LIVING BAND LEARNING OPPORTUNITIES- Learning opportunities are to be
provided within the social milieu, which should provide realistic learning experiences for the
patients.

ADVANTAGES

• Patients develop harmonious relationships with other members of the community.

• Gains self-confidence.
• Develops leadership skills.
• Learns to understand and solve problems of self and others.
• Becomes socio-centric.
• To improve self-esteem.
• It creates positive attitude.

DISADVANTAGES

• Role blurring between staff and patient.

• Group responsibility can easily become nobody’s responsibility.
• Individuals needs and concern may not be met.
• Client may find the transition and difficulty to survive within the community.

TEAM IN MAINTENANCE OF THERAPEUTIC COMMUNITY

• Psychiatrist
• Clinical psychologist
• Psychiatric clinical nurse specialist
• Mental health technician
• Psychiatric social worker
• Occupational therapist
• Recreational therapist
• Music therapist
• Art therapist
• Psycho dramatist
• Dietician
• Chaplain

PROGRAMS WITHIN THE MILIEU

KEY PARAMETERS IN SETTING UP

• Size of the unit -The residents in a therapeutic community are 20-30. It allows the
group members to experience a number of group situations and membership and everyone
will know each other.
• Duration of Treatment- 9-18 months, it may be divided into different phases. In acute
settings, shorter period and longer period for people with enduring mental illness.

• Relation with the Parents Organization and wider Community It is vital task for the long-
term survival and integrity of a therapeutic community.

ROLE OF NURSE

• Providing and maintaining a safe and conflict free environment through role modeling and
group leadership.
• Sharing of responsibilities with patients.
• Encouraging patients to participate in decision making functions.
• Giving feedback.
• Carrying out supervisory function.
• Nurse ensures that clients’ needs are met.

9. OCCUPATIONAL THERAPY
INTRODUCTION- Occupational Therapy (OT) can be described as the art and science
of challenging an individual’s effort in specially selected activities that have been designed to
restore and enhance his performance.

OCCUPATION-.“Any activity, which engages a person’s resources of time and energy and
is composed of skills and values”

DEFINITION

Occupational Therapy is the application of goal – oriented and, purposeful activity in the
assessment and treatment of individuals with psychological, physical or developmental
disabilities.

GOALS

 Promotion of recovery
 Mobilization of total assets of the patient
 Prevention of hospitalization
 Creation of good habits of work and leisure
 Enhance the patient to regain self – confidence

PRINCIPLES

 Select the activities based on interest IQ levels strengths and abilities of the client.
 Utilizes the client’s available resources.
 Select short duration activities to foster a sense of accomplishment and enhance self-
confidence.
 Provide good reinforcement for even small achievements.
 Plan and selected activities that gives new experience for the client to meet the day to day
activities.

INDICATION
 Depression
 Chronic schizophrenia
 Anxiety -disorder,
 Manic disorder,
 Paranoid schizophrenias
 Catatonic schizophrenia
 Antisocial Personality dementia
 Substance abuse
 Childhood Psychiatric disorders
SETTINGS

 OT is provided to children, adolescents, adults and elderly patients.

 Psychiatric Hospitals
 Nursing Homes
 Rehabilitation Centres
 Special Schools
 Community Mental Health Centres
 Halfway Homes and De – addiction Centres

SERVICES

 Independent living skills: Self – care or Self Maintenance.

 Crafts, Socialization, Leisure activity and Education.
 Employment and Academic preparation, Homes making, child care or parenting.
 Design fabrication and application of orthotic devices.
 Therapeutic exercise
 Patient or family education / Counselling.

OT ACTIVITIES

 Assertiveness Training
 Daily Activities Living
 Music, Art and Clay Work.
 Poetry and Drama.
 Craft Work
 Wood Work
 Weaving
 Painting
 Social Skills Training
 Industrial Works
 Sewing
 Leather Work
 Ceramics

CLASSIFICATION

OT are classified as follows,

 Diversional – E.g. Organized games.
 Remedial – E.g. Physiotherapy for particular muscle groups. (Basket making, Weaving,
Carpentry, Candle Making, Baking, Tailoring, Gardening, Embroidery) Physiotherapy also
includes (Heat massage, Electrotherapy)

SUGGESTED OT ACTIVITIES

Anxiety Disorder: Simple concrete tasks with not more than 3 or 4 steps. (Sweeping,
Washing, Weeding -garden)

Depressive Disorder: Simple concrete tasks which are achievable. (Craft Works)

Manic Disorder: Non-competitive activities that allows the use of energy and expression
of feelings. (Raking Grass)

Schizophrenia (Paranoid): Non-competitive solitary meaningful tasks that require

some degree of concentration (Puzzles)

Catatonic Schizophrenia: Simple concrete tasks in which patients involves actively.

(Metal work, Moulding clay)

Anti-Social Personality: Activities that enhance self – esteem and expressive and
creative. (Leather Work, Painting)

Dementia: Group activities to increase feeling of belonging and self-worth. (Cover

making, packing goods)

Substance Abuse: Group activities in which patient uses his talents. (Involve patient in
planning social activities)

Childhood and Adolescent disorders:

 Children – Playing, Story- telling, Painting, Poetry Music etc.

 Adolescents – Leather work drawing, painting etc.
 MR – Cover making, candle making and packing goods.

ADVANTAGES

 OT helps to build a more healthy and integrated ego.

 OT helps to express and deal with needs and feelings.
 Assists in the gratification of basic needs.
 Strengthens Ego defence.
 Reverses Psychopathology
 Facilitates personality development.
 Develops Self Esteem and Good Self – Concept.

POINT TO BE KEPT IN MIND

 Involve patients to select activity
 Activity should utilizes patients strength and abilities.
 The activity should be of short duration to foster feeling of accomplishments.
 The selected activity should provide new experience for the patient.

ROLE OF NURSE IN OT

 Coordinates with other therapeutic team members in diagnosing the abilities, strengths, and
talents, interests IQ levels of the client and in selecting the activity for a specific client.

 Provides a series of graded experiences to the client, e.g. observing the demonstration of
any activity to more direct and active experiences

 Educates the client to develop specific new skills

 Encourages socialization and exhibits positive interest to the client

 Guides the client in formulation of new hobbies by strengthening the abilities of the client
 Appreciates if the client performs any approved behaviour.

 Offers tokens for each accomplishment of the work, based on the principle of positive
reinforcement.

 Helps the client to develop independent living skills.

 Approaches community agencies for job placement of the clients in approved social
activities.

 Assists in developing good social interaction and relationship.

 Never citizens the client, when he is performing any activity.

 It is well clear that occupational therapy plays an important role for treating and
rehabilitating mentally – ill clients.

10. RECREATIONAL THERAPY

INTRODUCTION
Recreational programmes will be developed by therapeutic team specifically by
recreational therapist with the help of community resources to encourage the clients by
participating in socializing activities.
DEFINITION

“It is a form of activity therapy, where an individual enjoys pleasurably, the leisure time
through recreating and renewing the body and mind by relieving emotional tensions or
internal conflicts and there by releases monotonous life of mentally sick or ill persons”.

AIMS

 To stimulate interest
 To improve respiration
 To improve the circulation
 To improve the appetite
 To strengthen the tone of the muscles
 To develop a good posture
 To stimulate or recreate self – confidence
INDICATION

 Organic brain syndrome

 Obsessive compulsive disorder
 Substance abuse
 Depression
 Anxiety disorder
 Schizophrenia
 Excitement

PURPOSE

 To relieve from stress, anxiety, boredom, tension, emotional internal conflicts, loneliness.
 To assist the client for self- expression of their thoughts, feelings freely and openly.
 Identifies own creative ability
 Increases self- esteem
 To develop and enhance social skills
 To promote the clients to engage in healthy and competitive interaction.

 Modifies lifestyle  Enhances interest

 To create self- confidence

 Improves appetite, circulation, respiration and muscle tone .

 Promotes growth and development of an individual

FORMS OF RECREATIONAL ACTIVITIES

Motor forms: These can be further divided into fundamental and accessory.

 fundamental forms are such games as hockey and football

 accessory forms are exemplified by play activity and dancing.
 Sensory forms: These can be either visual, e.g. looking at motion pictures, play, etc., or
auditory such as listening to a concert.

Intellectual forms: These include reading, debating and so on.

TYPES OF RECREATIONAL ACTIVITIES

1). Indoor Activities: For example, Ludo, weight lifting, cards, chess, puppet shows, carom
board, singing, dances, painting, gardening, table tennis.

2). Outdoor Activities: For example, picnic trips, visits, shopping and swimming.

3). Activities for Intellectual Expression: For example, Readings books, magazines,
newspapers of their interest, painting, drawing, participating in debates, competitions.
 4). Activities for Psychosexual Expression: For example: singing, dancing, painting,
drawing etc.

5). Activities for Expression of Love and Tenderness: For example - taking care of kids
with play material; pets, gardening etc.

6). Activities for Expression of Muscular Strength: For example: Sports and game.
7). Activities for Increasing Sensory Power: For example: visual, e.g. watching pictures
Auditory form, e.g. listening to slow, sound music, radio.

Suggested Recreational Activities for Psychiatric Disorders

Anxiety disorders - Aerobic activities like walking, jogging, etc.

Depressive disorder - Non-competitive sports, which provide outlet for anger, like
jogging, walking, running, etc.
 Manic disorder- One-to-one basis individual games like badminton, ball.

Schizophrenia (paranoid) - Concentrative activities like chess, puzzles.

Schizophrenia (catatonic)- Social activities to give client contact with reality, like
dancing, athletics.
Dementia- Concrete, repetitious crafts and projects that breed familiarization and comfort.
It is better to work with the child on a one-to-one basis and give him a feeling of importance.
Some activities include playing, story-telling, and painting.
Adolescents fare better in groups; provide gross motor activities like sports and games to
use up excess energy.

Mental retardation: Activities should be according to the client's level of functioning such
as walking, dancing, swimming, ball playing, etc.

ROLE OF NURSE

 Plan the recreational activities based on

 Abilities / Strengthens
 Talents
 Needs
 Age, sex
 Illness  encourage the client to participate in recreational activities actively

 Teaches the necessary skills for each activity  Avoid competitive games in the
beginning, e.g. depressive client if they fail to perform effectively, they will go further
depression
 Encourage the client to express self.  Supervise the activities and note the behavioural
changes e.g. Take imitativeness, decision making, interest in games, enjoys the activity,
depression, communicate with others.

 In today class we had discussed about

 Introduction of Recreational therapy.
 Aims of recreational therapy.
 Indication and purposes of Recreational therapy.
 Types of Recreational therapy.  Role of nurse in Recreational therapy.

 Recreation therapy work with clients to develop a tailored approach to help them
increase their mental, physical, and emotional well- being through interventions that may
include physical activity. Recreational therapy is one of the essential treatment areas
within the health care team.
 11. PLAY THERAPY

INTRODUCTION

Play therapy refers to a method of psychotherapy with children in which a therapist uses a
child's fantasies and the symbolic meanings of his or her play as a medium for understanding
and communication with the child  To resolve psychological difficulties and achieve
optimal growth and development. (Association for Play Therapy Board, March 1997)

DEFINITION

Play therapy is the systematic use of a theoretical model to establish an interpersonal process
wherein trained play therapist use the therapeutic powers of play to help clients prevent or
resolve psychological difficulties and achieve optimal growth and development. (Association
for Play Therapy Board, March 1997)

INDICATIONS

 Children dealing with parental conflict, separation or divorce.

 Traumatized children (sexual, physical or emotional abuse)
 Children who have been adopted or are in foster care
 (ADD/ADHD)
 Children who have experienced serious accidents or disasters.
 dealing with issues of loss
 Children who have been hospitalized
 Children who have witnessed domestic violence
 Children diagnosed with attention deficit disorder

IMPORTANCE

 Play is generally employed with children aged 3 through 11

 It provides a way for them to express their experiences and feelings through a natural, self-
guided, self-healing process.
 Children’s experiences and knowledge are often communicated through play,
 It becomes an important vehicle for them to know and accept themselves and others.

GOAL

 Develop a more positive self-concept

 Assume greater self-responsibility
 Become more self-accepting
 Become more self-directing
 Become more self-reliant
 Become more trusting of self
 Experience a feeling of control
 Become sensitive to the process of coping
 Develop an internal source of evaluation
 Engage in self-determined decision making

PUPOSES

 Reduces anxiety about traumatic events in the child life

 Facilitates a child expression of feelings
 Promotes self-confidence and a sense of competence
 Develops a sense of trust in self and others
 Defines healthy boundaries
 Creates or enhances healthy bonding in relationships
 Enhances creativity and playfulness
 Promotes appropriate behaviour.

TYPES

Play therapy can be divided into two basic types:

1. Non-directive
2. Directive

NON- DIRECTIVE PLAY THERAPY  non-directive play therapy is a non-intrusive

method in which children are encouraged to work toward their own solutions to problems
through play. It is typically classified as a psychodynamic therapy.

DIRECTIVE PLAY THERAPY  Directive play therapy is a method that includes more
structure and guidance by the therapist as children work through emotional and behavioural
difficulties through play.

PROCEDURE OF PLAY THERAPY

THE PLAY ROOM  The necessary elements within the play room are: the child, the
therapist, the relationship formed by the child and therapist, the play therapy room and the
play room contents.

The play therapy space is usually a designated room, set up in a particular and predictable
way.

 Within the room, there are a wide range of expressive tool and toys.
 toys including craft materials, dress-ups and masks, musical instruments, puppets, toy
animals, toy weapons and military characters, superheroes, books, vehicles, building blocks,
a dollhouse and dolls, balloons and balls and table.

 Therapy room as needing to contain something to represent everything in the child’s world.

 Gurney (2001) outlined that a range of toys allow a child to understand that a range of
behaviours are permitted in the playroom.

 Toys that support issues of aggression, regression, independence and mastery are as
important as toys that foster nurturing, acceptance and contentment. Therapeutic Stages in
Play Therapy There are several stages in play therapy. First stage is Intake interview first
meeting with your child’s play therapist, during which questions about your child’s early
development, current functioning and presenting problem will asked. It is very important to
be as open and honest as possible.

 This intake interview foundation of the play therapist’s understanding of both your child’s
difficulties and the treatment plan. pre-treatment assessment: Depending on the presenting
complaints the therapist may conduct an assessment. This can be as simple as having you
complete some rating scales and/or your child completing questionnaires and drawings. the
assessment process provides the play therapist additional information about your child’s
difficulties and best ways to treat them.

 The first few sessions are referred to as the Introduction phase. During this phase your
child will be getting used to the play therapist, the playroom, and the play therapy process.
The more shy or anxious your child is, the more difficult this period may be. Tentative
Acceptance: This stage begins after one to several sessions and is the period when you or
your child feels eager to go to counselling. You are noticing some positive changes. Your
child is excited about interacting with his or her counsellor and looks forward to entering the
room.

 As play therapy begins some changes occur. these changes are necessary, and may not be
easy. Initially, change makes all of us uncomfortable. We are trying to behave in ways we are
not used to and we attempt to engage in healthy new behaviours or attempts to retreat to
older, more comfortable patterns. This is called the Negative Reaction phase. Some children
pass through this phase with virtually no problems. Growth This is the most important and,
usually the longest, part of the play therapy process

 During this phase your child will come to better understand his or her difficulties, how to
best resolve those difficulties and how to live a much happier and playful life. Surprisingly,
this phase can be a bit difficult for parents. Termination phase. The final stage of therapy
begins when you and the therapist are confident that behavioural and emotional functioning
are stable enough to maintain what you and/or your child has accomplished
 This can be both an exciting and difficult time. the end of therapy is a sign of success, it is
also the ending of the therapeutic relationship.

PLAY THERAPY MATERIALS

 Aggressive Toys
 Clients use these to express anger and aggression and explore power and control
 Guns, play knives, hammer and nails, toy soldiers, handcuffs, punching bag
 Expressive Toys

 Clients use these to explore relationships, express feelings, explore problem/ solution,
communicate
 Crayons, paper, scissors, paint, craft items, telephones, mirror, soft ball
 Pretend/Fantasy Toys
 Clients can use these to explore different roles, hidden feelings, and alternative behaviours.
 Masks, hats, doctor’s kit, zoo and farm animals, building materials, dress-up clothing,
jewellery.
 Mastery Toys.
 Clients can use these to explore sense of confidence, competence, self-esteem.
 Blocks, chalk board, school supplies, puzzles, books.
ADVANTAGES

 Helps overcome resistance to therapy

 Increases communication and socialization
 Strengthens quality attachments, enhance relationships
 Gives a child confidence, and dealing with fears
 Enhance relationship with family

DISADVNTAGES

1. Requires long-term commitment

2. Children might not like it
3. Children with disorders respond in an aggressive way
4. Can cause stress and anxiety

CONCLUSION

Play therapy can be a beneficial approach for children, adolescents, and families. It allows
children to enjoy counselling in a way they can understand, free from stress and the pressure
to understand adult conversation. Counsellors who choose to use this form of therapy must be
properly trained in play therapy. Counsellors who are not trained in this form of therapy
should make referrals to best benefit the child and the family.
 12. MUSIC THERAPY

INTRODUCTION

Music therapy is the use of music and its elements with a patient or a group of people in a
process destinated to make communication, learning or expression easier and also to promote
it.

DEFINITION

Music Therapy is the clinical and evidence- based use of music interventions to accomplish
individualized goals within a therapeutic relationship by a credentialed professional who has
completed an approved music therapy program.” -American Music Therapy Association,
2005

An interpersonal process in which the therapist uses music to help clients to improve or
maintain their health.
 Used with individuals of all ages and with a variety of conditions.
 To help patients make changes in their lives so as to adjust better to or overcome obstacles

MUSIC THERAPY IN THE HISTORY

Egyptians: Music like something curative.

Greeks: used music to prevent and cure different illnesses.

Now a days: Music therapy is the use of music to improve physical, psychological,
intellectual or social functioning of people with health or educational problems.

INDICATIONS

 People with illness

 Reduces symptoms of distress
 Parkinson’s disease and cancer

 Workers in high stress jobs

 Less stress in the newsroom

 Prisoners
 Less stress, more relaxation

 The elderly
 Alzheimer’s Disease
 Less agitated behaviors

 Pregnant women and new mothers

 Increased relaxation in childbirth

 Athletes
 Mood regulation

GOALS
♪ Promote wellness
♪ Manage stress
♪ Alleviate pain
♪ Express feelings
♪ Enhance memory
♪ Improve communication
♪ Promote physical rehabilitation

SETTINGS

 Medical and Psychiatric Hospitals

 Rehabilitative Facilities
 Out patients’ clinics
 Day Care Centres
 Agencies serving developmentally disabled persons
 Community mental health centres
 Drug and Alcohol Programs
 Long Term Care Facilities
 Correctional Facilities
 Halfway Houses
 Schools
 Hospice Programs

BENEFITS OF MUSIC THERAPY IN MENTAL HEALTH

 Can be used in a wide range of treatment programs due to its flexibility

 Increases concentration
 Increases relaxation
 Increases socialization and awareness of others
 Creates a diversion from neurotic concerns or obsessions
 Music allows us to become more aware and connected to ourselves and our environment
 Problem solving skills develop
 Creates an uplifting mood experience
 It can increase motivation to cope with life situations
 Appropriate use of leisure time

MUSIC THERAPY TECHNIQUES

 Singing - involves having the participants sing along or learn songs.

 Toning -the individual is required to make sounds based on vowels and consonants. It
involves making sounds of distinct pitch, quality, and duration.

 Listening - involves receptive listening to music; the type of music that is used is varied
and can range from classical to rap.  Imagery - is a process of music psychotherapy in which
music experiences are used to bring about therapeutic change. It involves the client listening
to specifically programmed music in a deeply relaxed state. The client may experience visual
imagery, feeling states and/or body responses as evoked by the music. The therapist engages
the client in a dialogue to enhance the experience of the imagery. This process facilitates the
client to explore and to resolve major life issues in a supportive manner

 Playing instruments - involves actually playing a musical instrument with the guidance of
the therapist.

 Lyric Writing - is the writing of original lyrics for a composition. It acts as a catharsis and
helps bring to the fore issues that have been kept at bay.

 Improvisation - is defined as a process whereby client and therapist relate to one another
in which the client makes up music while singing or playing, extemporaneously creating a
melody, rhythm, song or instrumental piece.
TYPES OF THERAPIES

There are two types of music therapy: adaptive and palliative.

1. Adaptive music therapy: Used to help people adapt to their handicaps.

2. Palliative music therapy: Used to treat the symptoms of patients with physical, mental
and emotional disturbances.

MUSIC THERAPY IS USED WITH

 Children
 Adults
 Séniors citizens
 People who are not ill.

THIS KIND OF THERAPY ALLOW PEOPLE

 To explore their feelings.

 To make positive changes in mood and in their emotional state.
 To develop a sense of control over their lives.
 To learn or implement skills to solve problems.
 To improve socialization.

WHY IS MUSIC ABLE TO CURE

 MUSIC AND BREATHING: An average low, deep breathe helps calm and control
emotions and build a better body metabolism.

 MUSIC AND BLOOD PRESSURE: Frequency, time, volume and slow rhythms create less
tension and stress, keeping the body calm and relaxed.

 MUSIC AND MUSCLE COORDINATION: the tone and the flexibility of the muscular
system are powerfully influenced by tone, sound and vibration.

 MUSIC AND TEMPERATURE: High or noisy music can elevate body temperature while
soft music can decrease it.

INDICATION

 Psychiatric disorders
 medical problems
 physical handicaps
 sensory impairments
 developmental disabilities
 substance abuse
 communication disorders
 interpersonal problems
 aging.

FUNCTION

 They regain a sense of control over lives.

 Music therapy strengthens memories.
 It improves overall mood and emotional well-being.
 It helps manage pain without the use of drugs.
 It helps increase their social interactions with others.
 Music encourages verbal as well as nonverbal communication and promotes social
interaction and relatedness.
 Promote positive changes in the wellbeing of an individual.
 Stimulates relaxation response which can therefore lead to physiological changes in the
body.  Processed in both hemispheres of the brain and this stimulation has been shown to
help in development of language and speech functions.

MUSIC CAN HELP TO REDUCE STRESS

 Music can drastically change and improve your mood. Some experts say the rhythm of the
music produces a soothing effect on a subconscious level.
 Choose your music wisely

KINDS OF MUSIC AND THEIR EFFECT

Studies have shown that a variety of music can aid in relieving symptoms of stress. Some
such types of music are:
 Classical
 Celtic
 Native American
 Sounds of nature can be extremely calming

TIPS FOR EFFECTIVE MUSIC THERAPY

Sit or lie in a comfortable position Choose music of your choice Go for walking before or
after MT

GENERAL GUIDELINES TO MAXIMISZE THE EFFECTIVENESS

 Sound bath followed by music

 Choose music with slow rhythm
 For stimulation go for a faster music
 When going gets tough, go for a music you are familiar with
 Take walks with your favourite music playing on the Walkman. Inhale and exhale in tune
with the music.

THE BENEFIT IN DIFFERENT AGES

CHILDREN:

 Learning disabilities  Conduct

problems
 Deep developmental disorders: autism
 Children with mental deficiency
 Difficulties in socialization
 Low self – esteem
 With degenerative and/or chronical medical conditions.

ADULTS

 Degenerative diseases due to age (Alzheimer…).

 Problems of drug and substance abuse.
 Brain damage due to illnesses or injuries.

IN GENERAL

 Reduce stress

CONCLUSION

Listening to music together with whatever treatment you are receiving can have a strong
healing effect on your body. It is considered a creative art therapy. With all these benefits that
music can carry, it's no surprise that music therapy is growing in popularity.

13. DANCE THERAPY

INTRODUCTION- Dance therapy is a psychotherapeutic use of movement, which

furthers the emotional and physical integration of the individual. Dancing is a good way to
express non-verbal communication and make contact with the others. Dance therapy makes
the personality the centre, and leads it through experimental learning, and dance therapy
focuses on connecting the self, the other, and the community, and the space to each other.

DANCE THERAPY shows every little motif of our everyday life, and offers a discovery of
soul and body unit. It measures where we are open and where we close ourself and how our
body reacts on everything that happens to us. We can gain self-knowledge through dance,
and moving. It makes us to find the first step in the road of healing

The cerebral cortex and cells - Perceiving, learning and the memory, the plans of our
activities, the making process, the creativity and other cognitive processes are linked to the
cerebral cortex, which is the centre of the highest standard nerve function.

DEFINITION

Dance therapy is the psychotherapeutic use of movement to further the social, cognitive,
emotional, and physical development of the individual (American Dance Therapy
Association, 2007).

INDICATIONS

 Autism
 Learning Disabilities
BENEFITS

 Improving Gross Motor Skills

 Improving Health

 Increasing Flexibility

 Growing Confidence and Social Skills

person to increase his/her self-awareness, self-esteem and personal autonomy.

It may help to acknowledge the links between thought, feelings and actions. It can help to
increase and rehearse adaptive coping behaviors.

 Dancing is one way for expressing and managing overwhelming feelings or thoughts.

It can be used as a tool to help person to communicate and be interactive with other persons.

 It may be used as a relieving therapy for anyone experiencing difficulties or concerns with
emotional problems, conflict or distress.

 It can be useful tool for people who want to enhance their personal communication skills,
self-exploration or self-understanding.
 Dance therapy may be seen as a way of alternative communication method for people who
may find some feelings or experiences too overwhelming or too difficult to communicate by
words alone.
 It can help people who have problems bound up in bodily form; in distortions or concerns
about their body image, in actual movement difficulties such as tension or blocked areas of
the body, impaired movements or in anxieties about proximity, physical contact or trust.

 Dance therapy allows people with impairment or trauma may to acknowledge and
understand personal areas of strength and weakness.

TECHNIQUES

 Body Movements – The basic technique used in dance/movement therapy, are movement
and manipulation of the various body parts.
 This can be done by isolating each body part or by using combinations of body parts.
 This is done through awareness of the body and control of breath.
 Movements are carried out in a rhythmic pattern so as to make the participant aware of the
functions, flexibility and capabilities of the various parts of the body.

 Props - Various objects or props are used in dance therapy, as they provide a medium of
expression of feelings and emotions.
 Props are used as aids to motivate and energize people.

 Imagery and Movement - Using imagery the therapist talks the participants through
various situations, in which they have to imagine they are the object and behave as the object
would. For example, imagining melting of ice-creams.

 Space Awareness and Memory Movements - Here movements are employed in such a
way that the individual is made aware of the space around him/her and is taught how to best
use it.
 For memory movements a certain sequence of movements is practiced or certain
movements are to be done on specific cues. This helps or checks the memory of the
individual. These movement techniques take into account the cognitive aspect of the
individual as well.

 Group Co-ordination - Here two or more participants work together and perform
movements in synchronization with each other. It provides a medium for interacting with
others and gives an insight into how the individual relates to people and the surroundings.

ADVANTAGES - Helps to develop body awareness

 Facilitates expression of feelings

 Improves interaction and communication
 Fosters integration of physical, emotional and social experiences that result in a sense of
increased self-confidence and contentment
 Exercise through body movement maintains good circulation and muscle tone

What are the Focuses in Dance Therapy

 • exercise-centered
• experience-centered
• Self-recognition centered

Verbal and Non-verbal skills development

• Dance therapy combines verbal and nonverbal practices and can also help to develop
language skills.
• Language builds on the development of other skills in dealing with the environment, such as
the opportunity of preverbal communication, perception and imitation.
• Dance therapy can take this up and create situations in which these is encouraged by
movement, dance, voice and sound.

Dance Is a Communication Tool

• Proximity and distance as design elements of contact, encounter or relationship can be

tested and experienced.
• The use of different materials such as ropes, ribbons, balloons, scarves or masks may make
indirect contacts easier or may give the opportunity to hide and cover oneself.

Self-expression

• Through improvisation, role playing, the dancing of little stories and small design tasks the
possibilities of immediate self-expression are expanded.

• Secondly, the repertoire of expression can be extended in a way that emotions, feelings and
ideas are expressed in movement and dance.

• Dance Movement Psychotherapy may be recommended as a primary service or as a

complement to other forms of on-going treatment, rehabilitation or education. The therapy
can be short or long term and is available for adults and children.

14. LIGHT THERAPY

INTRODUCTION

 Light therapy refers to two different categories of treatment, one used in mainstream
medical practice and the other in alternative/ complementary medicine.

 Mainstream light therapy (also called phototherapy) includes the use of ultraviolet light to
treat psoriasis and other skin disorders, and the use of full-spectrum or bright light to treat
seasonal affective disorder (SAD). Light therapy for SAD was first introduced in the 1980s
and is now a widely approved form of treatment for the disorder.

 Light therapy is also called heliotherapy.

HISTORY

Light therapy may be as ancient as human kind.
 This was first used in ancient Greece, ancient Egypt, ancient Rome.
 The Inca, Assyrian, and early German settlers worshipped the sun as the deity bringing in
health.
 The Indian literature of 1500 BC describes treatment with the use of herbs and natural
sunlight for the treatment of nonpigmented skin areas.
 The Buddhist literature from AD 200 and the 10th century Chinese also document the same.

DEFINITION

Light therapy is defined as a therapy which involves the use of light for the purposes of
treatment. This may in the form of exposure to daylight or to specific wavelengths of light for
a prescribed amount of time, using lasers , light –emitting diodes (LEDs), fluorescent lamps ,
dichroic lamps , or very bright, full spectrum light , usually controlled with various devices.

INDICATIONS AND USES

 Psoriasis
 Wound healing
 Mood and sleep disorders
 Neonatal jaundice
 Parkinson’s disease.

IN PSYCHIATRY

 Seasonal depression.
 Establishment of normal sleep.
 Alleviating symptoms of unipolar and bipolar depression.
 Increasing daytime alertness.
 Reducing slumping in the afternoon and evening.
 Improving cognitive function, mood and affect.
 Improving sleep in adults with ADHD.
 It works effectively in combination with antidepressants and mood stabilizers.

ADMINISTRATION OF LIGHT THERAPY

 Light therapy for seasonal affective disorder and other forms of depression can be self-
administered at home or in a private room in the workplace. The patient sits in front of a light
box mounted on or near a desk or table for a period of time each day ranging from 15 minutes
to several hours, depending on the severity of the SAD symptoms.
 patients may have two or three sessions of light therapy each day. Treatment typically
begins in the fall, when the days grow noticeably shorter, and ends in the spring.

 The light box itself may be equipped with full-spectrum bulbs, which do emit UV rays as
well as visible light; or it may use bulbs that filter out the UV rays and emit bright light only.

 Most light boxes emit light ranging from 2500–10,000 lux, a lux being a unit of light
measurement equivalent to 1 lumen per square meter. For purposes of comparison, average
indoor lighting is 300– 500 lux, and the sunlight outdoors on a sunny day in summer is about
100,000 lux.

 Patients are instructed to sit facing the light box but to avoid staring directly at it. They can
read or work at their desk while sitting in front of the light box. Light boxes cost between
$200 and $500, but can often be rented from medical supply companies.

 Newer forms of light therapy for SAD include the light visor, which resembles a baseball
cap with a light source attached underneath the front of the device, above the wearer's eyes.
The light visor allows the patient to walk or move about while receiving light treatment.
  Another new treatment is dawn simulation, which appears to be especially helpful for
SAD patients who have difficulty getting up in the morning. In dawn simulation, the lighting
fixture is programmed to turn gradually from dim to brighter light to simulate the sunrise.
Dawn simulation is started around 4:30 or 5 o'clock on the morning, while the patient is still
asleep.

PREPARATION

 Patients should consult their health care provider before mainstream phototherapy, in order
to determine possible sensitivity to bright light and adjust medication dosages if necessary.

Although you don't need a prescription to buy a light therapy box, it's best to ask your
doctor or mental health provider if light therapy is a good option for you. Ask whether you
need to take any special precautions. Also discuss which type of light therapy box would best
meet your needs, so you get the most benefit and minimize possible side effects.

SIDE EFFECTS

 Light therapy is generally safe. If side effects occur, they're usually mild and short lasting.
They may include:
[Link]
[Link]
 Nausea
 Irritability or agitation
 Mania, euphoria, hyperactivity or agitation associated with bipolar disorder.

When side effects do occur, they may go away on their own within a few days of starting
light therapy. You also may be able to manage side effects by reducing treatment time,
moving farther from your light box, taking breaks during long sessions or changing the time
of day you use light therapy. Talk to your doctor for advice if side effects are a problem.

Caution for bipolar disorder Light therapy may trigger mania in some people with
bipolar disorder, so get advice from your doctor before starting light therapy. If you have any
concerns about how light therapy may be affecting your mood or thoughts, seek help right
away.

What you can expect Starting light therapy?

 Generally, most people with seasonal affective disorder begin treatment with light therapy
in the early fall, when it typically becomes cloudy in many regions of the country. Treatment
usually continues until spring, when outdoor light alone is sufficient to sustain a good mood
and higher levels of energy.

If you typically have fall and winter depression, you may notice symptoms during
prolonged periods of cloudy or rainy weather during other seasons.

You and your doctor can adjust your light treatment based on the timing and duration of
your symptoms.

If you want to try light therapy for non seasonal depression or another condition, talk to
your doctor about how light therapy can be most effective.

During light therapy

During li
ght therapy sessions, you sit or work near a light box. To be effective, light from the light box
must enter your eyes indirectly. You can't get the same effect merely by exposing your skin to
the light.

While your eyes must be open, don't look directly at the light box, because the bright light
can damage your eyes. Be sure to follow your doctor's recommendations and the
manufacturer's directions.

Light therapy requires time and consistency. You can set your light box on a table or desk in
your home or office. That way you can read, use a computer, write, watch TV, talk on the
phone or eat while having light therapy. Stick to your therapy schedule and don't overdo it.
Three key elements for effectiveness

 Light therapy is most effective when you have the proper combination of light intensity,
duration and timing.

[Link]. The intensity of the light box is recorded in lux, which is a measure of the
amount of light you receive. For SAD, the typical recommendation is to use a 10,000- lux
light box at a distance of about 16 to 24 inches (41 to 61 centimetres) from your face.

[Link]. With a 10,000-lux light box, light therapy typically involves daily sessions of
about 20 to 30 minutes. But a lower- intensity light box, such as 2,500 lux, may require
longer sessions. Check the manufacturer's guidelines and follow your doctor's instructions.
He or she may suggest you start with shorter sessions and gradually increase the time.

[Link]. For most people, light therapy is most effective when it's done early in the
morning, after you first wake up. Your doctor can help you determine the light therapy
schedule that works best.

ROLE OF NURSE

 Assess need of patient for doing any activity.

 Ask what he want to do.
 Assess the mood or activity level.
 Activity should be like that it should improve the condition.
 Encourage the client to participate in activities.
 Teaches about how to do that activity which he wishes to do.

CONCLUSION

Light therapy probably won't cure seasonal affective disorder, non-seasonal depression or
other conditions. But it may ease symptoms, increase your energy levels, and help you feel
better about yourself and life.

15. COLOUR THERAPY

INTRODUCTION
Colour therapy, also known as chromotherapy, incorporates colour into treatment, whether
through coloured lights, specific daily colour choices (i.e., clothing, paint colours, etc.), or
coloured imagery. Colour therapy is rooted in Ayurvedic medicine and is practiced globally,
particularly in Japan, India, and Egypt.

Meaning of Colour Therapy

C- Calm
O- Optimism
L- Love
U- Unique
R- Relax

DEFINITION

1. It has been known for ages of time that colour plays a major role in setting up a particular
mood or state of mind. Colour does affect one's feelings, moods, and emotions.

History of Colour Therapy

The history of colour therapy dates back to ancient Egypt, Greece, India, and China. These
cultures focused on tapping into Ayurvedic medicine and understanding the healing
properties of colours. For example, many temples were built to reflect light in certain ways,
and houses were painted to induce different energies and moods. In Indian culture, it is
believed that colours are linked to one’s chakra. Thus, using colours in treatment can help
align and fix a person’s chakras.1

By the end of the 19th century the therapeutic properties of UV light were discovered 
And later international scientists proved that each colour spectrum affects the human body in
a different way  which gave birth to a science called `colour therapy`.

Colour therapy became more widely used during the 20th century. When Swiss
psychologist Dr Max Lüscher developed the Lüscher-Colour-Diagnostic test. During the
test, the recipient is asked to select eight coloured bottles in order of preference The results
are said to reveal your worries and their solution.

TYPES OF COLOURS

Yellow
Orange
Red
Purple
Green
Blue
Brown
Violet
Black
White

Colour therapy can be helpful in the treatment of:

 Anxiety disorders
 Depression
 Seasonal affective disorder
 Sleep disorders
 Attention deficit hyperactivity disorder (ADHD)
 Post-traumatic stress disorder (PTSD)
 Postpartum depression

ROLE OF COLOUR THERAPY

Rapidly gaining popularity

 Mental relaxation and treat various psychological and physical diseases
 Have positive stimulating effects
 Main chakras or energy centers - of the body
 Colour puncture

EFFECT OF COLOUR THERAPY

 Languages of the soul

 Mood and emotions
 Impact on our sense
 Way of self-expression
 Effect on our of perception
 Symbolic meaning
 About biological attraction

Types of Colour Therapy

Including colour therapy in your life does not need to be complicated. Think about it–we see
colours everywhere, all of the time. Wearing particular clothes, looking at specific images,
and coloured light bulbs can make a difference in your mood and disposition throughout the
day. Colour therapists argue that each colour elicits particular changes, therefore adjusting
colours used throughout treatment to enact different results.

The types of colour therapy include:

Red: Red is a powerful colour that increases energy by stimulating the lymphatic system.
However, red may also trigger stress as it is often used to notate the end of something or alert
someone of danger.

Orange: This colour is often associated with one’s mind-body connection. Using this color in
therapy may help heal one’s relationship with food.

Yellow: Yellow brings warmth, yielding its association with happiness. When exposed to
yellow, a person feels safe; when they are safe, they are happy.

Green: Green is a natural colour commonly associated with grass, trees, and other
vegetation. Thoughts of nature can help a person feel calmer and more relaxed.

Blue: Blue light wavelengths are shorter, thus increasing one’s sense of alertness. Blue light
therapy can be used to help a person feel more focused.

PSYCHOLOGICAL PROPERTIES OF COLOURS

There are four psychological primary colours - red, blue, yellow and green.
They relate respectively to the body, the mind, the emotions and the essential balance
between these three.
 The psychological properties of the four basic colours are as follows

RED
Positive: Physical courage, strength, warmth, energy, basic survival, 'fight or flight',
stimulation, masculinity, excitement.

Negative: Defiance, aggression, visual impact, strain.

BLUE
Positive: Intelligence, communication, trust, efficiency, serenity, duty, logic, coolness,
reflection, calm.

Negative: Coldness, aloofness, lack of emotion, unfriendliness.

YELLOW
Positive: Optimism, confidence, self- esteem, extraversion, emotional strength, friendliness,
creativity.

Negative: Irrationality, fear, emotional fragility, depression, anxiety, suicide.

GREEN.
Positive: Harmony, balance, refreshment, universal love, rest, restoration,
reassurance, environmental awareness, equilibrium, peace.

Negative: Boredom, stagnation, blandness, enervation.

Colour Therapy Techniques

Colour therapy can be introduced via one’s sense of touch and sight. This is because natural
light wavelengths directly influence these two senses within the brain.

Colour therapy may be administered via:

Eyesight: This may be done by exposing a person to specific colours throughout the day,
such as the paint colours in their home, the clothes they wear, or the colour of light bulbs in
their workplace.
Skin contact: Colour therapy may be introduced as face masks, sleeping bags, or other
products that utilize coloured LED lights. These amplify the appropriate colours in treatment
depending on the desired outcome.

Benefits of Colour Therapy

Colour therapy has many benefits, especially in treating symptoms of anxiety, depression,
and other conditions. Furthermore, when we feel less anxious or sad, we may have more
opportunities to improve other aspects of our lives.

Here are six possible benefits of colour therapy:

1. Stress Management
Stress management can be tough. We are constantly dealing with life struggles, which can
ultimately negatively affect both our minds and bodies. Colour therapy helps you decrease
the impacts of this stress through mood-boosting properties. You can adopt colour therapy
practices as a stress management skill by simply changing the colours in your surroundings.

2. Decreased Seasonal Affective Disorder Symptoms

When addressing seasonal affective disorder (SAD), colour therapists focus on using colours
to elevate dopamine levels that may be depleted during the winter season. During this period,
days are typically shorter and darker. By changing the [Link] surrounding a person, whether
by wearing brighter colours or introducing coloured lights, an individual can bring warmth
and comfort back into their home despite the changing seasons.

3. Improved Sleep
Insomnia can greatly impact a person. Chromotherapy can help individuals identify certain
colours that make them feel more relaxed at night, thus positively impacting their sleep
patterns. For example, limiting blue light before bed is beneficial.

4. Energy Rejuvenation
Happy, bright colours can help a person feel more rejuvenated because these increase mental
brain activity. Therefore, individuals are more energized and ready to go about their days.
This can be helpful when dealing with the low-energy levels associated with depression.
5. Reduced Anger
Colour therapy creates environments that elicit calm and happiness rather than aggression,
helping to reduce anger. Try including pops of bright colours like yellow or orange in your
home or daily attire.

6. Improved Relationships
Communication with others may not be the greatest when dealing with excessive stress or
sadness. Because colour therapy is believed to help replace such emotions with positive ones,
a person may be more open to socialization. Therefore, they can further develop their current
relationships or seek new ones.
 16. AROMA YHERAPY

INTRODUCTION

“Aroma” “Therapy” “Fragrant smell or Scent” “Treatment” “The use of essential oils in
holistic healing to improve health and emotional well- being and in restoring balance to the
body is known as aromatherapy.” Used to alter one’s: Mood Cognitive Psychological
well-being.

HISTORY

Tittle aromatherapy was first coined by French Chemist Rene-Maurice Gattefosse in 1928,
when he accidentally used lavender oil for his burned Hand French Army Surgeon, Jean
Volnet pioneered the use of aromatherapy. He applied it cure the wounds of soldiers during
World War II The use of aroma oil is known to be as old as 6000 years In 4500 B.C.,
Egyptians used cedar wood oil to preserve the dead bodies Hippocrates recommended
regular aromatherapy bath for health improvement Romans utilized essential oils for
pleasure and to cure pain.

DEFINITION

Aromatherapy is a practice based on the use of aromatic materials, including essential oils
and other aroma compounds, with claims for improving psychological well-being. It is used
as a complementary therapy or as a form of alternative medicine, and typically is used via
inhalation and not by ingestion.
MODE OF APPLICATION

Inhalation

• Inhaled through lungs via nose

. Simplest and effective method
• Beneficial for respiratory problems, sinus congestion, flu, cough, colds, catarrh and sore
throat

• May be done through:

. Facial Steam
. Atomizers
Vaporizers (Aroma Burner)
Nebulizers
Direct Inhalation

Topical Application

• Essential oils are applied over the skin

• Due to lipophilic nature, they penetrate through the skin surface
• Absorbed into lymph and then circulatory system
• May be done through:
Bath
Foot Bath
Compresses
Massage

Clinical Aromatherapy VIA SKIN

• Due to lipophilic nature of essential oils, they easily penetrate the skin surface and absorbed
into blood via lymph Essential oil Skin (Superficial Layer) Sub-Cutaneous Layer Sub-
Cutaneous Layer Lymph Lymph Vessels Lymph Vessels Vein Systemic Circulation

Clinical Aromatherapy VIA NOSE Aroma

Nose Cilia Receptors in Cilia Impulse Impulses Olfactory lobe Limbic system Generate
response
• Limbic system controls mood, emotions, memory or learning capabilities
• The action impulse generated by aroma acts on limbic system and limbic system in response
alter the mood, emotion or learning capabilities.

Examples of Essential Oils for Aromatherapy

• Lavender Oil --- It is used to treat burns and it has a sedative effect thus also used for
relaxation
• Cedar Wood Oil --- It is used as antiseptic and anti-bacterial to prevent infection
• Aphrodisiac Oil --- It is used to induce romantic feelings • Chamomile Oil --- It is used as
anti-inflammatory
• Lemon Oil --- It is used as anti-depressant
• Eucalyptus Oil --- It is used to relieve pain
• Spearmint Oil --- It is used to relieve headache
• Wintergreen Oil --- It is used to relieve backache
• Peppermint Oil --- It is used to treat stomach upset
• Rosemary Oil --- It is used to boost mental activity and stimulate hair growth

Safety Concerns

They should never be used directly because some oils may irritate sensitive skin or cause
photosensitivity
They should be blended in adequate proportion with the carrier oils
They should be stored in a cool place in darkened bottles to avoid photo-oxidation of
components
Take out a patch test before applying
Must not be taken orally as they irritate mucous membrane
Due to concentrated and potency of pure essential oils, dilution in a carrier oil is
recommended

Practical Safety Concerns

• While taking bath, take 7-8 drops of essential oil in 30ml of carrier oil and add water and
mix it well before use.

• While massage, add 15-22 drops of essential oils to a 30ml of carrier oil for a full body
massage. Always massage in an upward motion and toward the heart for the best effect.

• While taking facial steams, add 2-3 drops of oil into a bowl of boiled water. Drape a towel
over your head and lean over the bowl to inhale the steam while keeping eyes shut. Breathe
through mouth for throat problems and through nose for sinus congestion.

Carrier Oils

0 These are vegetable oils or base oils

O Used to retain properties of the aroma oil
O They do not mask its aroma
O For Example, soya oil and wheat germ oil.

CONCLUSION

Some studies show aromatherapy is effective in certain situations, like managing anxiety or
insomnia. Other studies conclude aromatherapy doesn't help with certain symptoms. For
example, a study published in 2022 finds aromatherapy doesn't reduce symptoms of
depression in people with cancer.

17. ELECTROCONVULSIVE THERAPY

INTRODUCTION

Electroconvulsive therapy (ECT), also known as is a well-established, albeit is a well-

established, albeit controversial psychiatric treatment in which seizures are electrically
induced in anesthetized patients for therapeutic effects.

ECT was first introduced by Italian psychiatrist Ugo Carlette and Lucio Bini in April 1938.
Insulin coma therapy and pharmacoconvulsive therapy were replaced by ECT. Insulin coma
therapy was introduced by the German psychiatrist Manfred Sakel in [Link]
psychiatrist Manfred Sakel in 1933. Pharmacoconvulsive therapy was introduced in Budapest
in 1934 by Ladislas Meduna. In 1974, the APA’s council on research and development
appointed a task force on ECT. The APA task force on ECT, in 1976, gave its report which
provided clear guidelines for use of ECT.

DEFINITION

1.“ Artificial induction of a grand mal seizure (tonic phase 10-15 sec, clonic phase 30-60 sec)
through the application of electrical current to the brain, the stimulus is applied through
electrodes which are placed either bilaterally in pronto-temporal region or placed either
bilaterally in pronto-temporal region or unilaterally on the non-dominant side.”
or
[Link] is a physical/somatic therapy in which the help of two electrodes, current is passed
through the temporal region in between the two hemispheres of the brain, to produce a grand
mal type of seizure.

PARAMETERS
: 70-120 volts (The usual amount of current passed in ECT is 200-1600mA) passed in ECT is
200-1600mA)
: 0.7-1.5 sec

BENEFIT S OF ECT

ECT relief very severe depressive illnesses when other treatments have failed. ECT has
saved patient’s live because 15% of people with severe depression will kills people with
severe depression will kill themselves. ECT works faster than all antidepressants’ drugs.

INDICATION OF ECT

 Major Depression w/ or w/o psychotic features.

 Bipolar disorder - manic or depressed phase.
 Acute or Catatonic Schizophrenia.
 Some studies have shown efficacy in treating Some studies have shown efficacy in
treating OCD, Delirium, Chronic pain syndromes, and intractable seizure disorders.

CONTRAINDICATION
Absolute – Increased ICP

Relative

1. cardiovascular problems - Coronary artery disease, HTN, Aneurysms, Coronary artery

disease, HTN, Aneurysms, Arrhythmias

2. Cerebrovascular effects - Recent strokes, Space occupying lesions, Aneurysms

3. Severe pulmonary disease - TB, Pneumonia, Asthma.

MECHANISM OF ACTION

The exact mechanism of action is not known.

One hypothesis state that ECT possibly affects the catecholamine pathways between the
diencephalon (from where seizure generalization occurs) and limbic systems (which may be
responsible for mood disorders), also involving the hypothalamus.

TYPES OF ECT

DIRECT ECT - In this, ECT is given in the absence of anaesthesia and muscular relaxation.
This is not a commonly used method now.

MODIFIED ECT

Electrodes are placed on the side of a patient’s head just above the temples. The patient is
given anaesthetic injections and a muscle relaxant to stop muscles and a muscle relaxant to
stop muscle contractions that can lead to broken bones. A small electric current is passed
through the brain.
ELETRODE PLACEMENT

Bilateral - Most common, most effective and most cognitive dysfunction. Each electrode
placed 2.5 – 4 cm (1-1.5 inches) on the midpoint on a line joining the tragus of the ear and the
lateral canthus of the eye.

Unilateral - less cognitive effect, may be clinically less effective. Electrodes are placed
only on one side of head usually non dominant side.
COURSE OF ECT

ECT is usually given 3 times a week, reduced to twice a week or once a week once
symptoms begin to respond. This limits cognitive problems. Treatment of depression usually
consists of 6-12 treatments. Psychosis and mania up to (or sometimes more than) 20
treatments. Catatonia usually resolves in 3-5 treatments.

ECT TEAM

Psychiatrist
Anaesthetist
Trained Nurses
Nursing aids
ECT assistant

MEDICATIONS USED IN ECT

Inj. Atropine (0.6mg to 1mg)

Inj. Succinyl choline (1mg/kg/b. wt.)
Inj. Sodium thiopental (3-5mg/kg/b. wt.)
 A pretreatment medication such as atropine sulphate, glycopyrrolate is administered
IM 30 min before treatment, (to decrease secretion and counteract the effect of vagal
stimulation induced by ECT).
 A short acting anaesthesia (the patient should be a short acting anaesthesia (the patient
should be unconscious when the ECT is given).
 Muscle relaxant (to prevent muscle contraction during the seizure reduction of
possibility of fracture or dislocated bone).
 Pure oxygen before and after treatment

TREATMENT FACILITIES

3 rooms
1. Waiting room
 2. ECT room2.
3. Recovery room

ARTICLES NEEDED FOR ECT

-Articles For Anaesthesia

-Suction apparatus
-Face mask
-Oxygen cylinder
-Tongue depressor
-Mouth gag
-Resuscitation apparatus
-Full set of emergency drugs,
-ECT drugs Defibrillator

CONCENT

 Description of the procedure.

 Explain why the procedure is recommended.
 Alternative treatments
 Benefits may be transient
 Behavioural restrictions
 Voluntary treatment
 Implies consent for emergency treatment
 Risks major and minor

PROCEDURE

Time 10-15mit (or more time preparation and recovery)

Intravenous (IV) catheter
Oxygen mask may be given Oxygen mask may be given
Electrodes are placed on the head either unilateral or bilateral
Anaesthetic is injected into IV
Unconscious and unaware of procedure
Muscle relaxant is injected into IV
Prevent violent convulsions
BP cuff placed around forearm or ankle. To Prevents muscle relaxant from
paralyzing, so doctor can confirm seizure with movement of hand/foot.
Electric current is sent through electrodes to [Link] brain. Seizure lasts 30-60
seconds.
Few min later, anaesthetic and muscle relaxant wear off.

ROLE OF NURSE IN ECT

• Pre ECT care

• Intra procedure care
• Post procedure care

PRE ECT-CARE

Informed consent
Fully explain the risks and benefits of procedure and answer questions from patients
or relatives.
Information sheets.
Reduce patients’ anxiety and help establish good relationship (nurse-patient, doctor-
patient).

Administration of drugs.
Check patient record.
Explain procedure
on NPO 6-8 hours before ECT.
Discourage smoking just before ECT.
Remove artificial dentures and articles.
Vital signs.
Ensure emergency articles are accessible.
Emotional support.
 Transfer patient to ECT room with necessary records.

ECT ROOM

Checks patients’ identity.

Checks patient is NPO and has emptied their bowels and bladder prior to coming to
treatment room.

Check patient is not wearing restrictive clothing and jewellery/dentures have been
removed. jewellery/dentures have been removed.
Consult ECT record of previous treatments (including anaesthetic problems).
Ensure consent form is signed appropriately.
Check no medication that might increase or reduce seizure threshold has been
recently given.
Check ECT machine is functioning correctly.

DURING ECT

Reassurance & support.

Place patient in supine position.
Necessary drug administration.
Mouth gag.
Apply upward pressure to mandible.
Oxygen administration.
Clean the scalp with normal saline.
Prevent fall, fracture, dislocation
Remove the mouth gag after seizure occurred
 Suck the oral secretion & apply O2 mask

POST ECT CARE

Shift client post – procedure room.

Check vital signs every 15 min.
Administer drugs if patient is aggressive / violated / confused.

If respiratory difficulty continue oxygen.

Provide side rails. Be with the patient.
 Documentation.
Reorient the client after recovery.

RISK AND SIDE EFFECTS

Impairment of cognition

-Period of confusion immediately after ECT

-May not know where you are or why you are there
-Generally, lasts few minutes to several hours

Memory loss

-May forget weeks/months before treatment, during treatment or after treatment has stopped
-Usually improves within couple of months
-Permanent in relatively rare cases

Medical complication

-Heart problems
-Small risk of death
Physical symptoms

-Nausea
-Vomiting
-Headache
-Muscle ache
-Jaw pain

ETHICS IN ECT

 People with serious mental illness who are at risk of self-harm or are thought to be
risk to other people can be sectioned under the mental health act.
 This means they can be taken to a place of safety, usually a secure psychiatric unit,
and given treatment against their will.
 They may not consent to the treatment they are given and may be held against their
will.

18. ACCUPRESSURE AND ACCUPUNCTURE

INTRODUCTION - Acupressure and Acupuncture are two therapies based in the
practice of traditional Chinese medicine. Acupressure and acupuncture can do a world of
wonders for broadly problems pain. Acupuncture & acupressure are similar in a lot of way.

Both are considered integrative forms of medical therapy when used on their own to treat
medical condition. It is based on the thought that the body’s vital energy flows through
meridian points on the body that connect various organs, carry energy and contribute to
overall health

DEFINITION

Acupressure is the application of digital pressure on parts of the body in a therapeutic way to
relive pain or to reduce muscular tension.

PRINCIPLE

• The principle behind the use of acupressure treatment is to increase the circulation and
functioning of Qi (Takapuna, 2005)

USES

 prevention and as a treatment for many health conditions

 reduces stress, stimulates the immune system.
 improves circulation
 Acupressure is used for treating a variety of disorders.
 It stimulates a healthy digestive function
 soothes chronic pain
 improves energy levels and concentration

TECHNIQUES USED

• Acupressure technique involves pressure application, rubbing, stretching, rolling, kneading,

wiping, grasping and exercises.
• Intensity of pressure varies
• different approaches for applying pressure:
– Constant Pressure
– Intermittent Pressure

INSTRUMENTS USED
ACUPRESSURE POINTS

BENEFITS

•It works to set the whole body in balance so that it works to function better as a whole.
•Regular treatments result in an improvement in overall physical and mental health.
• Unlike acupuncture which requires a visit to a professional, acupressure can be performed
by a layperson.
• Acupressure techniques are fairly easy to learn, and have been used to provide quick, cost-
free, and effective relief from many symptoms.
A recent study published in the British Medical Journal has shown that Acupressure is
effective for treating back pain in terms of reducing disability and pain scores and increasing
functional status.
The study, which compared Acupressure and Physical Therapy, showed that overall
Acupressure was more effective in these areas both immediately after the treatments and at
the 6 month follow up (Chen, 2006).

ACCUPUNCTURE
DEFINITION

According to Merriam Webster dictionary;

“it is a method of relieving pain or curing illness by placing needles into a
person’s skin at particular points on the body”

USES

Acupuncture is used mainly to relieve discomfort associated with a variety of diseases and co
nditions • Acupuncture is known to treat a wide range of disorders

TECHNIQUES USED

 The most common method used tostimulate acupoints is the insertion of fine, sterile needl
es into the skin. Pressure, heat, or electrical stimulation may further enhance the effects. !
Other acupoint
stimulation techniques include: manual massage, moxibustion or heat therapy, cupping, and
the application of topical herbal medicines.

ACUPOINTS

TREATMENT PROCESS

•The initial evaluation may take up to 60 minutes. Subsequent appointments usually take abo
ut a half-hour.
•A common treatment plan for a single complaint would typically involve one or two treatme
nts a week
•Number of treatments will depend on the
condition being treated and its severity, but six to eight treatments are common.
 •For complex or longstanding chronic conditions, one to two treatments per w
eek for several months may be recommended.
• For acute problems, usually fewer visits are required, usually eight to ten visits in total.

CONDITIONS COMMONLY TREATED BY ACUPUNCTURE

It successfully treats conditions ranging from musculoskeletal problems (back pain, neck pain
, and others) to nausea, migraine headache, anxiety, depression, insomnia, and infertility.

BENEFITS

provides drug-free pain relief

effectively treats a wide range of acute and chronic ailments
treats the underlying cause of disease and illness as well as the symptoms
assists in the prevention against disease and illness as well as the maintenance of general
well-being Studies have found promising results for the use of acupuncture to treat nausea
and vomiting related to pregnancy, chemotherapy, and post-surgery pain.

RISK

•soreness,
•minor bleeding or bruising at the needle sites
•Organ injury
•Infections

CONTRAINDICATION

 Bleeding disorders
 Having a pacemaker
 Being pregnant

19. PETS THERAPY

INTRODUCTION

“A pet is an island of sanity in what appears to be an insane world. Friendship retains its
traditional value and securities in one’s relationship with one pet. Whether a dog, cat , bird,
fish, turtle or what have you once can rely upon the fact that one’s pet will always remain a
faithful, intimate, non-competitive friend – regardless of the good or ill fortune life bring to
us” -- Dr Boris Levinson, child psychologist

ANIMAL ASSISTED THERAPY

• Animal-assisted therapy (AAT), also known as pet therapy, utilizes trained animals and
handlers to achieve specific physical, social, cognitive, and emotional goals with patients. •
Animal assisted activities provide opportunities for motivation, education or recreation to
enhance quality of life.
• Provides opportunities for motivational, educational and or recreational benefits to enhance
quality of life.
• Is goal directed intervention in which an animal meeting specific criteria is an integral part
of the treatment process.
• Promote improvement in human physical, social, emotional, cognitive functioning.
• Provided in variety of settings & may be group or individual

COMMON TREATMENT GOALS AAT

• Reduction – physio, psycho pain

• Improved self-care, self-esteem
• Greater sense of personal control, purpose
• Enhancement positive sensations – affection, pleasure
• Reduction in feelings of agitation, fear, anxiety
• Encouraging cooperation, empathy, problem solving
• Lessening boredom, isolation, loneliness
• Facilitating greater compliance to medical treatment
• Increased optimism, feelings of empowerment
• Greater levels of concentration, attention

Goals: -
• improving motor skills and joint movement
• improving assisted or independent movement
• increasing self-esteem
• increasing verbal communication
• developing social skills
• increasing willingness to join in activities
• improving interactions with others
• motivating willingness to exercise

 Other benefits of pet therapy include:

• making you happier, lessening depression, and improving your outlook on life
• decreasing loneliness and isolation by giving you a companion
• reducing boredom
• reducing anxiety because of its calming effects
• helping children learn empathic and nurturing skills
• improving the relationship between you and your healthcare provider

WHY ANIMAL

• Less lonely
• Less depressed
• Change from routine
• Renewal of old friendships
• Entertaining
• Petting encourages use of hands, arms, stretching and turning
• Stroking a dog or cat reduce BP

CONDITIONS WHICH BENEFIT FROM AAT (animal assisted therapy)

• Cancer – improve depression, oxygen saturation

• Dementia – improved eating habit, calming effect, improved self-esteem, communication
skills
• Heart health – lower BP, stress hormone level
• Mental health- children with pervasive development disorder becomes playful and social
after therapy, autistic children
• Psychiatric disorder- schizophrenia, anxiety - improve ability of independent self-care,
experience pleasure
• Reduce anxiety
• Pain –
• It’s well-known (and scientifically proven) that interaction with a gentle, friendly pet
has significant benefits. Physical Health:
• lowers blood pressure
• improves cardiovascular health
• releases endorphins (oxytocin) that have a calming effect
• diminishes overall physical pain
• the act of petting produces an automatic relaxation response, reducing the amount of
medication some folks need
Mental Health:

• lifts spirits and lessens depression

• decreases feelings of isolation and alienation
• encourages communication
• provides comfort
• increases socialization
• reduces boredom
• lowers anxiety
• helps children overcome speech and emotional disorders
• creates motivation for the client to recover faster
• reduces loneliness
Reading: (PAWS for Reading)
• helps children focus better
• improves literacy skills
• provides non-stressful, non-judgmental environment
• increases self-confidence, reduces self-consciousness

In Physical Therapy
 • increases joint movement and improves recovery time
• maintains or increases motor skills
• provides motivation to move more, stretch farther, exercise longer

Children with special needs

• Child improves reading skills
• Mental stimulation • E.g. child recovering from traumatic brain injury experiences
considerable difficulty dressing and grooming due to loss of function in one arm.

• The therapist may ask the child to reach out with the weak arm to a pet, brush or even feed
the dog
• A wrist wit may be added to weak arm to develop strength. Child becomes motivated,
excited to participate

What kind of animals participate

Domestic animals

• Cats, dogs, birds,

• Hippo
• Calf
• Lamb
• Caged rodent
• Farm animals
• Horses
• fish

How does it work

• Animals socialize
• Reinforce rehabilitative behaviours in patients- throwing a ball, walking, verbal response
• Hippo therapy – improve posture, balance, coordination.

Concerns related to AAT

•Lowers self-esteem if animal rejects

• Death of animal – grief, guilt
• Human injury if animals are selected inappropriately
• Zoonotic disease – if lack of sound sanitation, veterinary supervision

Key to successful AAT

• Interdisciplinary cooperation – physicians, veterinarians, nursing staff, activity directors,

therapists, volunteers
• Planning – realistic goals, expectations, anticipating problems and development of
solutions prior
• Supervisions
• Animal selection – type, breed, size, age, sex, medical & behavioural history, natural
behaviour.
• Animal training – positive reinforcement

Pet therapy and mental health

• A wide range of mental health conditions are now treated through pet-therapy programs.
• Interactions with animals are considered to offer benefits to patients suffering from post-
traumatic stress disorder, autism, and challenging psychiatric disorders.

Animal therapy is also used extensively to treat depression. Petting an animal is believed to
cause the release of endorphins (feel-good neurotransmitters) which can have an extremely
positive impact in patients dealing with depressive disorders
• Dogs and other animals have taken part in visiting programs to assisted living centres for
elderly people for many years.

• Although this type of interaction can certainly lift the spirits of those living in such centres,
Alzheimer’s experts felt more could be gained through structured animal-assisted
intervention programs.

• Therapy animals have also been successfully used within treatment programs for
individuals with substance abuse issues.

• The presence of an animal can in itself help calm the patient down and prepare them to face
their demons.

• Addicts often focus almost exclusively on themselves.

• Engaging with an animal can encourage them to think about the needs of others.

• Delivered in a group setting, addicts are also more likely to interact socially with others if
an animal is involved.
• Doctors observing how the addict deals with the animal also get a greater insight into the
patient’s self-esteem issues, helping them identify specific coping mechanisms and healthier
new behaviours

Role of Nurses
• Often integrated into counselling programs,
• animal therapy can help learn more about teamwork,
• communication,
• trust, and
• self-expression
• A study done in psychiatric centre – 250 patients referred for therapeutic recreation sessions
on AAT reduces anxiety levels of psychiatric patients
• Pre and post treatment cross over study design was used. Result – statistically significant
reductions in anxiety scores were found – psychotic disorders, mood disorder
• Studies prove- long survival rate of MI patients with Pets than with no pets
CONCLUSION

• psychotherapy is a collaborative treatment based on the relationship between an individual

and psychologist. Grounded in dialogue, it provides a supportive environment that allows you
to talk openly with someone who’s objective, neutral and nonjudgmental. You and your
psychologist work together to identify and change the thought and behavior pattern that are
keeping you from feeling your best.

• Psychotherapy is also called as talk therapy, therapy or counselling … is a process focused

on helping you heal and learn more constructive way to deal with the problems or issues
within your life.

THANK YOU