Model of Care: Behavior Modification

Behavior Modification is the systematic use of principles of conditioning and learning, especially operant or instrumental conditioning, to teach certain skills or to extinguish undesirable behaviors, attitudes, or phobias. There are types of behavior modification: behavior therapy, self-control therapy, desensitization, aversion therapy, modeling therapy, and operant conditioning.

Behavior Therapy:
Behavior therapy is an approach to bring about behavioral change. It includes a group of diversified approaches for dealing with maladaptive behavior.


Self-Control Therapy:
Self control therapy is a combination of cognitive and behavioral approaches. It is useful to deal with stress. The basic of this concept is that talking to oneself can direct and control action more effectively.

Desensitization:
Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus in a weaker and milder form. The exposure is increased until the fear of the object or situation is ceased.

Aversion Therapy:
Aversion therapy is also a technique to change behavior in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations in order to stop the specific behavior.

Modeling Therapy:
In this therapy, the therapist acts as a role model for a specified behavior, and the client learns through imitation.

Operant Conditioning:
Operant conditioning is the use of consequences to modify the occurrence and form of behavior. It deals with the modification of "voluntary behavior". Reinforcement and punishment are the for this therapy.

Model of Care: Psychotherapy

Psychotherapy is treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication and interventions with the patient, in contrast to treatments utilizing chemical and physical measures. Verbal means communication. Non verbal techniques include silence, body language, facial expressions, and respect for personal space.

There are three levels of psychotherapy:

1. Supportive therapy
2. Reeducative therapy
3. Reconstructive therapy

Supportive Therapy:
In supportive therapy, the client is allowed to express feelings, explore alternatives and make decision.


Reeducative Therapy:
Reeducative therapy will include a short-term psychotherapy, reality therapy, cognitive restructuring, and behavior modification, and involves learning new ways of perceiving and behaving. Reeducative therapy requires a longer period than supportive therapy.

Reconstructive Therapy:
Reconstructive therapy includes deep psychotherapy or psychoanalysis and may require 2 to 5 years of therapy or more, focusing on all aspects of the client’s life. The positive outcomes of reconstructive therapy will be a greater understanding of self and others, more emotional freedom, and the development of potential abilities.

Anxiety Disorder Classification (part-2)

Post-Traumatic Stress Disorder (PTSD)
This stress disorder occurs after experiencing a psychologically traumatic event outside the range of usual experience such as rape, combat, bombings, kidnapping. The person with posttraumatic stress disorder re-experiences the event through recurrent dreams and flashbacks.

Person with post-traumatic stress disorder may commonly uses emotional numbness, detachment, and estrangement to defend against anxiety. Sleep disturbance, hypervigilance, guilt about surviving, poor concentration, and avoidance of activities that trigger memory of the event are the most symptom with post-traumatic stress disorder.

Phobias
Phobia is irrational fear of an object or situation that persists, although the person may recognize it as unreasonable. Sever anxiety will be occurred if the object, situation, or activity cannot be avoided



Types of Phobias include:

• Agoraphobia: Fear of being alone in open or public places where escape might be difficult; may not leave home
• Social phobia: Fear of situations in which one might be seen and embarrassed or criticized; fear of eating in public, public speaking, or performing
• Specific phobia: Fear of a single object, activity, or situation (eg, snakes, closed spaces, and flying)

Substance-induced anxiety disorder

A substance-induced anxiety disorder is sub-typed or categorized based on whether the prominent feature is generalized anxiety, panic attacks, obsessive-compulsive symptoms, or phobia symptoms. Drug use is related to this disorder.

Symptoms substance-induced anxiety disorder will develop within 1 month of substance intoxication or withdrawal and significant distress of impairment in social and occupational functional will be occurred.

Anxiety Disorder Classification (part-1)

Acute Stress Disorder

Client with acute stress disorder will develop three or more of these dissociative symptoms:

• Subjective sense of numbing
• No emotional responsiveness
• Feeling dazed
• Depersonalization
• Derealization
• Amnesia

Duration of acute stress disorder would be 2 days to 4 weeks.


Generalized Anxiety Disorder

Client with generalized anxiety disorder will develop three off the four categories:

• Autonomic hyperactivity: palpitations, sweating, cold clammy, urinary frequency, pallor or flushing, lump in throat, rapid respiration, and tachycardia.
• Motor tension: restlessness, trembling, inability to relax, fatigue.
• Apprehensiveness: dread, worry, fear, insomnia, rumination, and inconcentrate.
• Hypervigilance: felling edgy and distractibility.

These symptoms persist for at least 6 months.


Obsessive-Compulsive Disorder

Obsession is preoccupation with persistent intrusive thoughts. Compulsion is repeated perfomance of rituals designed to prevent some anxiety. Client with Obsessive-Compulsive Disorder with have obsession symptoms, compulsion symptoms, or both.

The client will be in anxiety condition if obsessions or compulsions are resisted and from feeling powerless to resist the thoughts or rituals.


Panic Disorder

Panic disorder means the recurrent unexpected anxiety attacks. It happens suddenly with intense apprehension and dread.
Client with panic disorder will develop at least four of the following symptoms:

• Dyspnea
• Dizziness
• Chest discomfort
• Hot or cold flashes
• Tingling of hands or feet
• Feeling of unreality
• Palpitation
• Syncope
• Diaphoresis
• Trembling
• Fear of losing control, going crazy or dying

Anxiety Related Disorder

Anxiety-related disorders are the most common of all psychiatric disorders. Client with these disorder will experience physiologic, cognitive, and behavioral symptoms.

Physiologic manifestations are related to the fight and flight response that result in cardiovascular, respiratory, neuromuscular, and gastrointestinal stimulation. The cognitive symptoms are apprehension, uneasiness, an uncertainty. Behavioral symptoms are irritability, restlesnes, pacing, crying, and sighing, tension and nervousness.

Classification

As defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR), anxiety-related disorders are include those listed here.


Anxiety Disorders:

• Panic disorder without agoraphobia
• Panic disorder with agoraphobia
• Agoraphobia without history of panic disorder
• Specific phobia
• Social phobia
• Obsessive-compulsive disorder (OCD)
• Posttraumatic stress disorder (PTSD)
• Acute stress disorder
• Generalized anxiety disorder
• Anxiety disorder due to a general medical condition
• Substance-induced anxiety disorder
• Anxiety disorder not otherwise specified

Dissociative Disorders

• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder
• Depersonalization disorder
• Dissociative disorder not otherwise specified

Model Of Care: Milieu Therapy

Milieu therapy is an treatment environment in which everyday events and interactions are therapeutically designed for the purpose of enhancing social skills and building confidence. It provides a safe environment adapted to the client’s needs, comport, and freedom of expression.

Milieu therapy is staffed by persons trained to provide support, and all members contribute to the planning and functioning of setting. All members are viewed as significant and valuable members of community.

Focus of milieu therapy:

• Positive physical, social and environmental manipulation to effect a positive changes.
• Group and social interaction.
• Client’s rights.
• Using community meeting, activity groups, social skills groups, and physical exercise programs.

Mental Health Admission and Client Rights

There are two types of admission and discharge in Mental Health Care :

Voluntary Admission

• Client agree to accept treatment
• Civil rights are retained fully by the client and the client is free to sign out of the hospital
• The client has the right to demand and receive release
• Any client of lawful age may apply in writing for admission to the hospital

Involuntary Admission

• Client who has legal capacity to consent to mental health treatment refuses to do so and is detained involuntarily for treatment by the state
• It is necessary when a client is mentally ill and is a danger to self or other and need of psychiatric treatment and physical care
• The client who involuntary admitted to mental health care can be categorized for evaluation and emergency care, certification for observation and treatment, or extended and indeterminate commitment.
• This client does not lose his or her right of informed consent

The client who is admitted to mental health care (voluntary or involuntary) will have “client right” to :

• Accessible health care
• Courteous and individualized health care
• Coordination and continuity of health care
• Get the information about the qualifications, names, and titles of personal giving care
• Privacy and confidentiality
• Refuse observation by those not directly involved in care
• Informed consent
• Treatment
• Information about diagnosis, prognosis, and treatment
• Information on the charges of services
• Communicate with people outside the hospital through correspondence, telephone, and personal visits
• Be employed
• Religious freedom
• Execute wills
• Retains in licenses, privileges, or permits established by law
• Treatment in the least restrictive setting
• Not to be subjected to unnecessary restraints