MENTAL HEALTH NURSING-PSYCHOLOGICAL THERAPIES

PSYCHOLOGICAL
THERAPIES
PREPARED BY
MRS.AKILA. A., M.Sc (N),M.Sc (PSY)
ASSOCIATE PROFESSOR

INTRODUCTION
Psychotherapy has been referred to as
a systemic treatment primarily employing
verbal communication as the means of
treatment aimed at relieving the patient’s
symptoms and helping him to understand
and modify his conduct so as to lead a
well adjusted life.

• The term psychotherapy is derived
from Ancient Greek word
psyche (meaning "breath; spirit; soul")
and therapeia ("healing; medical
treatment").
• The Oxford English Dictionary defines it
now as "The treatment of disorders of the
mind or personality by psychological
methods.",

DEFINITION
Psychotherapy, or talk therapy, is a way
to help people with a broad variety of
mental illnesses and emotional difficulties.
Psychotherapy can help eliminate or
control troubling symptoms. so a person
can function better and can increase well-
being and healing- APA

TYPES OF PSYCHOTHERAPY
DIMENSION TYPES

STAGES OF PSYCHOTHERAPY:
Introductory stage :-
• In this stage, the client & therapist meet &
begin to work together.
• involves taking a history of the client’s life,
including any medical problems & current
medications.
• If the client is a referral, the therapist may
already have the information.
• Many physical illnesses resemble emotional
problems or the reverse. Referrals or
consultation may be indicated at this to
understand the problem better.

• The exploration of the patient’s background &
problems will include any precipitating factors or
events that led the client in seeking help. Clients
are asked to discuss their perceptions of their
challenges or problems, needs or expectations of
their challenges or problems, needs or
expectations & the desired outcome of their
therapy sessions.
• During the introductory stage, the therapist forms
some preliminary ideas about the client’s needs.
• Together, client & therapist discuss issues such as
the length of time, therapy will require, meeting
dates, location, fees & so forth.

Working stage :-
• In the working stage of the therapy the client is able
to become more trusting, to disclose & to begin
exploring with the therapist, the thoughts, feelings
& behaviours that lead to the pain or problems.
• Again in the past, this exploration may have taken
months or years to complete.
• Today, the whole process may be completed in 20
sessions.
• Increased trust allows the client to experience
greater recall &insight & to express previously
repressed feeling.
• As the client understands& functions more
effectively, the last stage of working through is
reached.

Termination stage :-
• In the final stage of therapy, the working through
stage , the client achieves a higher level of
understanding or the self & relationships with
others & begins to try out new ways of perceiving,
thinking, feeling & behaving.
• As the client interact with others & sees newly
acquired coping skills, changes are reflected in
external behaviours in interactions with others.
• The client may need a great deal of support &
encouragement during this stage & may rework
emotional material more than one time.
• Although clients do become more autonomous &
ready to live their own lives, termination of the
therapy is viewed as a kind of separation & loss &
the client may experience grief.

INDIVIDUAL PSYCHO
THERAPY
• Individual Psychotherapy is a method of bringing
about change in a person by exploring his or her
feelings, attitudes, thinking and behaviour.
• Therapy is conducted on a one to one basis, that
is the therapist treats one patient at a time.
• Patient generally seek this kind of therapy based
on their desire. Such therapy helps to:
- Understand themselves and their behaviour
- Make personal changes
- Improve interpersonal relationships
- Get relief from emotional pain or un happiness

INDICATIONS
• Stress related disorders
• Alcohol and drug dependence
• Sexual disorders
• Marital disharmony

Therapy process
• The patient is encouraged to discover for
himself the reasons for his behaviour.
• The therapist listens to the patient and offers
explanation and advice when necessary. By
this he helps the patient to come to a great
degree of understanding of self and to find a
way of dealing with his problems.
• The relationship between the therapist and
the patient proceeds through stages similar to
those of the nurse patient relationship.

APPROACHES
• Psychodynamic therapy/ Psychoanalytical
therapy
• Humanistic therapy
• Behaviour therapy
• Cognitive therapy
• Supportive Psycho therapy

HUMANISTIC THERAPY
• This therapy centers on the patients view of
the world and his or her problems.
• The goal is to help patients to realize their full
potential through the therapist’s genuineness,
unconditional positive regard, which fosters the
patient’s sense of self-worth and empathetic
understanding of the patient’s point of view.
• This therapy is nondirective, but focuses on
helping the patient to explore and clarify his or
her own feelings and choices.

PSYCHOANALYTIC
THERAPY
• Psychoanalytic Therapy looks at how
the unconscious mind influences thoughts
and behaviors.
• Psychoanalysis frequently involves
looking childhood experiences in order to
discover how these events might have
shaped the individual and how they
contribute to current actions.

• Psycho analytical Psychotherapy was first
developed by Sigmund Freud at the end of
the 19th century.
• According to Freud, our behaviour is
determined by irrational forces,
unconscious motivation, biological and
instinctual drives as these evolve through
key psychosexual stages.

INSTINCTS
• Life Instincts: It serves as the purpose of
the survival of the individual and the
human race; they were oriented toward
growth, development and creativity.
• Death Instinct: It accounts for the
aggressive drive. At times, people
manifest through their behavior an
unconscious wish to die or to hurt
themselves or others.

According to Psychoanalytic view
The Personality consists of three systems:
 The ID is the Biological component
 The EGO is the Psychological component
 The SUPEREGO is the Social component
STRUCTURE OF THE MIND:
- Conscious
- Pre/sub conscious
- Unconsciousness

• Clinical evidence for postulating the
unconscious includes the following:
1. Dreams- which are symbolic representations
of unconscious needs and, wishes and
conflicts.
2. Slips of the tongue and forgetting(ex. familiar
name)
3. Posthypnotic suggestions
4. Material derived from free association
techniques
5. Material drive from Projective Technique
6. Symbolic Content of psychotic symptoms

The most important indication:
- Presence of Longstanding Mental conflicts,
which may be unconscious, but produce
symptoms.
• In Psychoanalysis, the focus is on the cause
of the problem, which is buried somewhere in
the unconsciousness.
• The therapist tries to take the patient into
past in an effort to determine where the
problem began

Aim of the Psychoanalytical
Psychotherapy:
- To bring all repressed material to conscious
awareness , so that the patient can work
towards a healthy resolution of his
problems, which are causing the
symptoms.

THERAPY PROCESS
• It is typical for the psychoanalyst to be
positioned at the head of the patient and
slightly behind, so that the patient cannot see
the therapist.
• This decreases any kind of non verbal
communication between the two people.
• The patient is typically on the couch, relaxed,
ready to focus on the therapist’s instruction,
which facilitates the free association.

• The roles of the patient and Psychologist are
explicitly defined by Freud.
• The patient is an active participant , freely
revealing all thoughts exactly as they occur and
describing all dreams.
• A psychologist is a shadow person. He reveals
nothing personal, nor does he gives any directions
to the patient.
• His verbal responses are for the most part brief
and also non committal, so as not to interfere with
the associative flow.
• He departs from this style of communication when
an interpretation of behaviour is made to the
patient.

Some of the techniques used in the Psycho
analysis are:
- Free association
- Dream analysis
- Hypnosis
- Catharsis
- Abreaction

FREE ASSOCIATION
• In free association, the Patient is allowed to say
whatever comes to his mind, in response to a
word , that is given by the therapist.
• For example, the therapist might say ‘
mother’ or ‘ blue’ and the patient would give a
response, also typically one word, to each of the
words the therapist says.
• Then the therapist looks for a theme or pattern to
the patient’s responses.
• The theme may give the therapist an idea of the
cause of the patient’s emotional disturbance.

DREAM ANALYSIS:
Dream analysis is a therapeutic technique
best known for its used in psychoanalysis.
• Sigmund Freud viewed dreams as “the
royal road” to the unconscious and developed
dream analysis, or dream interpretation, as a
way of tapping into this unconscious material.
• Dream analysis is the investigation of
repressed feelings that can be expressed in
our dreams. Psychoanalytic theory believes
repressed feelings often manifest themselves
in our dreams. This happens because our
defenses are lowered when we sleep. Dream
analysis helps uncover this unconscious
material.

Dreams have two levels of content:
• Latent content, or hidden motives, wishes,
or fears
• Manifest content: This refers to the dream
as it actually appears
• Dream analysis takes place as the therapist
uncovers the disguised, latent content within
the actual, manifest content of the dream.
Usually this involves identifying symbolic
meaning in the dream. Sometimes, free
association with different dream elements is
used in the process.

• This Process is complicated through the
occurences of transference reactions.
• May be strong Positive or Negative
feelings.
• Psychoanalytical therapy is a longterm
proposition.
• The Patient is seen frequently, usually five
times a week., it is therefore time
consuming and expensive.

HYPNOSIS
• Hypnosis is an artificially induced state in
which the person is relaxed and usually
suggestible.
• The relaxation is guided by the therapist.
• Hypnosis means for entering an altered
state of consciousness and suggestion to
bring about desired changes in behaviour
and thinking.

• Hypnosis can be induced in many ways such as
by using a fixed point for attention, rhythmic
monotonous instructions, etc.
• In hypnotherapy, relaxation is guided by the
therapist who has been trained in techniques of
trance formation and who then asks certain
questions of the patient or uses guided imagery to
help picture the situation in an effort to find the
cause of the problem.
• At the end of the session, the therapist leaves
some helpful hints for the patients. These are
called posthypnotic suggestions and typically
include positive, affirming statements for the
patient to think about as well as instructions to
help the person accomplish self-hypnosis.

CATHARSIS
• The term itself comes from the Greek word,
katharsis meaning "purification" or "cleansing.“
• A catharsis is an emotional release. According
to psychoanalytic theory, this emotional release is
linked to a need to relieve unconscious conflicts.
For example, experiencing stress over a work-
related situation may cause feelings of frustration
and tension.
• Rather than vent these feelings inappropriately,
the individual may instead release these feelings
in another way, such as through physical activity
or another stress-relieving activity.

• Catharsis takes place in a one to one
basis between the patient and the
therapist.
• The nurse can be helpful in the treatment
in the treatment process by allowing the
patient to talk about the experiences in
therapy and by carefully documenting the
responses of the patient.

Examples:
Catharsis can take place during the course of therapy, but it
can also occur during other moments as well. Some examples
of how catharsis might take place include:
• Talking with a friend: A discussion with a friend about a
problem you are facing might spark a moment of insight in
which you are able to see how an event from earlier in your
life might be contributing to your current patterns of behavior.
This emotional release may help you feel better able to face
your current dilemma.
• Listening to a song: Music can be motivational, but it can
also often spark moments of great insight. Music can allow
you to release emotions in a way that often leaves you feeling
restored.
• Creating or viewing art: A powerful artwork can stir deep
emotions. Creating art can also be a form of release.
• Exercise. The physical demands of exercise can be a great
way to work through strong emotions and release them in a
constructive manner.

ABREACTION
• Abreaction Therapy focuses on reliving a traumatic
event and going through the emotions associated with
them to heal and move forward.
• Originally created by Sigmund Freud the method gives
patients a way to release their unconscious pain and
escape from the memories and feelings that have kept
them from moving forward.
• Therapists who work as Abreaction counselors use
catharsis or the cleansing of emotions to get rid of the
spirit and thoughts associated with the experience.
• As a process that brings out difficult emotions the
client will go through an emotional removal that takes
away the burden of the traumatic event after
treatment.

Goals of Abreaction Therapy
• The goal of Abreaction Therapy is to cleanse the
patient's body by going through their trauma yet again
and letting go of painful thoughts and emotions.
• When the client has completed their treatment they
should be able to speak openly about the event
without feeling uncomfortable or unable to cope.
• Therapy clears up what has happened and heals the
individual so that they can move forward and prevent
the trauma from ruining their personal lives and
relationships.
• As a traditional and direct form of therapy this is an
awareness tool that helps clear up the conscious
tension which can be extremely dramatic when it is
associated with heavy emotions and painful memories.

METHOD
• Abreaction can be brought about by strong
encouragement to relieve the stressful events.
• The procedure is begun with neutral topics at first,
and gradually approaches areas of conflict.
• Although abreaction can be done with or without
the use of medication , the procedure can be
facilitated through sedative drug by IV.
• A safe method is the use of thiopentone
sodium,500mg dissolved in 10cc of normal saline .
• It is infused at a rate no faster than 1cc/ minute to
prevent sleep as well as respiratory depression.

COGNITIVE THERAPY
• Cognitive therapy is a type of psychotherapy developed by
American psychiatrist Aaron T. Beck.
• It is one of the therapeutic approaches within the larger group
of cognitive behavioural therapies and was first expounded by
Beck in the 1960s.
• Cognitive therapy is based on the cognitive model which
states that thoughts, feelings and behaviour are all connected,
and that individuals can move toward overcoming difficulties
and meeting their goals by identifying and changing unhelpful
or inaccurate thinking, problematic behaviour, and distressing
emotional responses.
• This involves the individual working collaboratively with the
therapist to develop skills for testing and modifying beliefs,
identifying distorted thinking, relating to others in different
ways, and changing behaviours.

Fundamental Assumptions
• Based on the premise that way a person perceives an event, rather
than the event itself, determines its relevance and the emotional
response to it.
• It is time limited, attempting to cause change rapidly and often within
an established time frame.
• Therapeutic change can be effected through an alteration of
idiosyncratic, dysfunctional modes of thinking, leading to cognitive
changes.
• Based on the belief that patients are the architects of their own
misfortune and have control over their thoughts and actions.
• This therapy helps the patient learn something about the process of
therapy and develop therapeutic skills applicable to other problems.
• It aims at altering the cognitions for effecting a change in behaviour.
• It implies that all psychiatric disorders have some amount of
cognition impairment and an improvement in this enhances the
patient’s recovery.

Techniques of cognitive
therapy
• Techniques of stopping intrusive
cognitions.
• Techniques to counterbalance faulty
cognitions.
• Techniques for altering cognitions.
• Techniques to resolve problems directly.

(i)Techniques of stopping intrusive
cognitions:
Aim: Stopping intruding thoughts through
distraction.
• Attention is directed to another mental act
like doing mental arithmetic or copying a
figure.
• The method of ‘ thought stopping’, as done
in obsessional ruminations is also tried.

(ii) Techniques to counterbalance faulty
cognitions.
• This involves counterbalancing intruding
cognitions and the emotions provoked by
them, with another thought.
Example:
When an anxious patient with chest pain
becomes apprehensive thinking that he
has a ‘ heart problem’, he may be trained
to think that it is only a muscular pain and
relate to the heart.

(iii)Techniques for altering cognitions:
• These are aimed at changing the nature of
cognitions. The patient is helped to identify
‘maladaptive cognitions’ and their ‘logical
errors’.
• Some errors which are not mutually exclusive
and which occur in depression are given
below:
- Faulty inference
- Overgeneralization
- Magnification or Minimization
- Unrealistic assumptions

(iv)Techniques to resolve problems
directly:
- Defining the Problem more clearly
- Dividing it into small sub problem which
can be better managed.
- Finding out alternate methods of solving
each sub problem.
- Considering the merits and demerits of
each method.
- Selecting one method which is most
advantageous at that instance.

Indications
• Anxiety disorders
• Personality disorders
• Suicidal thoughts or attempts
• Sexual disorders

Therapy Process
• Therapy is result oriented and defines goals so
that progress towards them can be monitored.
• The therapist is a coach and teacher for the
patients learning new skills. Therapist may help
the patient identify situations in which undesired
thoughts and actions occur and then assist with
the development of alternatives.
• The overall goal is to increase self-efficacy or
proficiency and sense of control over life.
• Patient must participate actively and be committed
to the decision for change.
• The patient-therapist interaction is a goal oriented
collaborative partnership with a beginning, middle
and an end.

• Cognitive therapy helps people examine
these beliefs, learn how they influence
feelings and behaviours and alter
dysfunctional beliefs that predispose them
to distort their experiences.
• By understanding the idiosyncratic ways
the people perceive themselves, their
experiences the world and the future,
therapist can help the patient to alter the
negative emotions, change their view of
life experiences and behave more
adaptivley.

Supportive psychotherapy
• In this, the therapist helps the patient to relieve
emotional distress and symptoms without probing
into the past and changing the personality.
Techniques:
- Ventilation
- Environmental modification
- Persuasion
- Re-education
- Reassurance
- Explanation
- Guidance

Phases of Therapy
(i) Initial Phase focuses on assessment
and relationship formation.
• Assessment encompasses full physical
and psychiatric evaluation including level
of motivation, the patient’s strengths and
weaknesses.
• The therapist should be able to
empathize with the patient in order to
understand him better.

(ii) Working Phase involves intense
therapeutic activity and there is a further
exploration of the patient’s problems and
life situations.
The various therapeutic techniques are
applied and attempts are made to give the
patient an insight into his problems.
(iii) The terminal Phase is intended to
strengthen the patient’s improvement and
to prepare him to end his treatment.

FAMILY AND MARITAL THERAPY
• Family therapy is that branch of psychiatry
which sees an individual’s psychiatric
symptoms as inseparably related to the
family in which he lives.
• Thus, the focus of treatment is not the
individual, but the family.
• Today, most family theorists identify the
individual’s problems as a symptom of
trouble within the family.

Aims of Family therapy
• Helping the family members clarify and
express their feeling towards one another.
• To remove transitional – generational gap.
• To establish good communication pattern.
• To develop greater mutual understanding.

Purposes of family therapy
• Improving communication
• Facilitating autonomy and individuation of
member
• Increasing empathy
• Fasting flexible leadership
• Improving role agreement and enactment
• Reducing conflicts
• Facilitating symptomatic improvement
• Enhancing individual task performance.

Indications for Family therapy
• Problems in the relationship within a family
or marital unit which is Common in
- Psychoses,
- reactive depression,
- Anxiety disorders
- Psychosomatic disorders
- Substance abuse
- Childhood psychiatric Problems.

Components of therapy
• Assessment of family structure, roles,
boundaries, resources, Communication
Patterns and problem solving skills.
• Teaching communication skills
• Teaching problem –solving skills
• Writing a behavioural marital contract
• Homework assignments

Patient Selection
• Families may be referred for treatment by, private physicians
and agencies such as the school system, welfare board,
parole officers and judges.
• Some families are referred for therapy from emergency room
psychiatric services after a visit caused by a crisis in the
family, such as overdose.
• On discharge from a psychiatric hospital, a patient and his
family may be referred for family therapy, as part of follow –up
services.
• Family therapy is the treatment of choice when there is a
marital problem or sibling conflict; family therapy may also be
indicated when problems are caused by using one child as
the scapegoat.
• Situational crises such as the sudden death of a family
member, and maturational crises such as birth of the first child
may cause sufficient stress to warrant family therapy.

TYPES OF FAMILY THERAPY
• INDIVIDUAL FAMILY THERAPY
• CONJOINT FAMILY THERAPY
• COUPLES THERAPY
• MULTIPLE FAMILY GROUP THERAPY
• MUTIPLE IMPACT THERAPY
• NETWORK THERAPY

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 members are relating to one
another and work out specific issues that
have been defined bu individual members.

CONJOINT FAMILY
THERAPY
• Common type of family therapy.
• The nuclear family is seen, and the issues
and problems raised by the family are the
ones addressed by the therapist.
• The way in which the family interacts is
observed and it becomes the focus of the
therapy.
• The therapist helps the family deal more
effectively with problems as they arise and
are defined.

COUPLES THERAPY
• Couples are often seen by the therapist.
• 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 communication
styles, and 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
recognising and respecting each other’s
similarities and differences.

MULTIPLE FAMILY GROUP
THERAPY
• In this group therapy, four or five families meet weekly
to confront and deal with problems or issues they have
in common.
• Ability or inability to function well in the home and
community, fear 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 groups focus.
• The multiple family group becomes the support for all
the families.
• The network also encourages each person to reach
out and form new relationships outside the group.

MULTIPLE IMPACT
THERAPY
• Several therapists come together with the
families in a community setting.
• They live together and deal with pertinent
issues for each family member within the
context of the group.
• It is also similar to multiple family group
therapy, but it is intensive and time limited.
• It helps to focus on developing skills or
working together as a family and with other
families.

NETWORK THERAPY
• It is conducted in people’s homes.
• All individuals interested or invested in a problem
or crisis that a particular person or persons in a
family are experiencing take part.
• This gathering includes family, friends, neighbours,
professional groups or persons, and anyone in the
community who has an investment in the outcome
of the current crisis.
• 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.

• The rewards are great when all the people
involved mobilize energy for management of
the problem.
• The Power is in the network itself.
• The answers to each problem come from the
network and how people in the network
decide to manage each issue as it arises.
• The therapists serve as a guide to clarify
issues, reinforce the importance of and need
for the network towards its members
collectively and individually , and assist in the
development and effective management in
the evolution of the problem resolution.

GROUP THERAPY
Group psychotherapy is a treatment in
which carefully selected people who are
emotionally ill meet in a group guided by a
trained therapist and help one another
effect personality change.

SELECTION:
• Homogeneous groups
• Adolescents and patients with personality
disorders.
• Families and couples where the system
needs change.
CONTRAINDICATIONS:
1.Antisocial patients
2.Actively suicidal or severely depressed
patients.
3.Patients who are delusional and who may
incorporate the group into their delusional
system.

GROUP SIZE:
• 8 TO 10 members.
FREQUENCY AND LENGTH OF
SESSIONS:
- once in a week
- Each session lasts for 45 minutes to 1
hour.

APPROACHES TO GROUP
THERAPY
• Therapist’s role is primarily that of a facilitator, he
should provide a safe, comfortable atmosphere for self
closure.
• Focus on the ‘here and now’.
• Use any transference situations to develop insight into
their problems.
• Protect members from verbal abuse or from
scapegoating.
• Provide positive reinforcement.
• Protect patient’s self esteem and set limits on patient’s
behaviour.
• Develop ability to recognise when a group member is
‘fragile’; he should be approached in a gentle,
supportive and non threatening manner.

• Use silence effectively
• Laughter and a moderate amount of joking
can act as a safety valve and at times can
contribute to group cohesiveness.
• Role playing may help a member develop
insight into ways in which he relates to
others.

Types Of Psychotherapy Groups
1. Traditional Groups
2. Encounter Group or T. Group
3. Homogeneous or heterogeneous groups
4. Open or close groups
5. Groups for psychosis or neurosis

1. Traditional Groups:
• Traditional groups includes mainly the patients
with mental illness & are from the hospital
inpatient department.
• In this group therapy, lecture is given to the patient
along with some filmshow, like in the case of
excessive drinking or use of drugs.
• Psychodrama is a technique of psychotherapy in
which a patient acts out his feelings in front of a
group of patients. The therapist guides & directs
the patient & interprets the actions of the patient.
This type of acting out provides an insight into the
patient about his faulty patterns of learning which
he can eliminate

2. Encounter Group or T. Group:
• Encounter group is a form of small group in which
an individual learns how his feelings & behaviour
affect him & others. This group is not necessarily a
group of people with mental illness.
• The individual may have some coping difficulty
which he would like to resolve at the right time.
• For Example:
- a suspicious feeling gradually being developed
about his wife or any other illusions.
- Theses groups are based on sensitivity training
or T-groups.

3. Homogeneous or heterogeneous
groups:
• Homogeneous groups are composed of
patients of the same age, race, sex,
socioeconomic level & similar category of
illness.
• Heterogeneous groups vary on all these
aspects.

4. Open Groups & Closed Groups:
• In open groups members may join & leave
the group at anytime.
• Closed groups have a specific number of
people, specific time to start & close the
group sessions; the duration is three to
four weeks. Inpatients & outpatients both
are included in this group.
• Open & closed groups are used
extensively in the hospital.

5. Group According to Mental Illness:
• Neurotic group or patient suffering from
psychotic illnesses come under this category.

Therapeutic Factors
• Sharing experience
• Support to and form group members.
• Socialization
• Imitation
• Interpersonal learning

1. Sharing Experience:
• This helps the patients to realize that they
are not isolated & that others also have
similar experience & problems .
• Hearing from other patients that they have
shared experiences is often more
convincing & helpful than reassurance
from the therapist.

2. Support to and from group members:
• Receiving help from other group members
can be supportive to the person helped.
• The sharing action of being mutually
supportive is an aspect of the group
cohesiveness that can provide a sense of
belonging for patients who feel isolated in
their everyday lives.

3. socialization:
• It is acquisition of social skills (for
example, maintaining eye contact) within a
group through comments that members
provide about one another’s deficiencies in
social skills.
• This process can be helped by trying out
new ways of interacting within the safety of
the group.

4. Imitation:
• It is learning from observing & adopting
the behaviors of other group members.
• If the group is run well, patients imitate
the adaptive behaviors of other group
members.

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

STEPS OF GROUP THERAPY
1. Selecting group Members
2. Developing contact
3. Selection of group leaders

1. Selecting group Members:
• It is very important function of a group
therapist.
• She has to decide based on the condition
of the patient who all can be included in
the group.
• A very depressed patient may lead to
withdrawal of other members of the group,
whereas too many excited patients
included in the group may lead to
unsuccessful group therapy.

2. Developing Contact:
• The purpose should be made clear to all the
members in the group.
• Time, length & place of the meeting should be
announced.
• Starting & ending time & how frequently the group
sessions will be conducted.
• Attendance of members.
• Confidentiality to be maintained within the group.
Role of the members is;
• to report punctually, maintain confidentiality &
interact freely.

3. Selection of Group Leaders:
• Role of the therapist – the therapist acts as a
facilitator & helper.
I. To provide information to the group.
II. Allow emotional catharsis.
III. Share members’ perception.
IV. Share feelings of fear, loneliness & frustration.
V. Improve communication skills
VI. Provide a role model.
VII. Help to know what is reality.
VIII. Set limits for some patients.
IX. Make observation of all the non-verbal
techniques being used by the patient.

TECHNIQUES
• Reflecting or rewarding comments of group
members.
• Asking for group reaction to one member’s
statement.
• Asking for individual reaction to one
member’s statement.
• Pointing out any shared feelings within the
group.
• Summarizing various points at the end of
session.

BEHAVIOUR THERAPY
• It is a form of treatment for problem in
which a trained person deliberately
establishes a professional relationship with
the patient,with the objective of removing
or modifying existing symptoms and
promoting positive personality, growth and
development.

MAJOR ASSUMPTIONS OF BEHAVIOUR
THERAPY:
The following are the assumptions of behaviour
therapy.
• All behaviour is 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.

• Behaviour assessment is focused more on
the current behaviour rather than on
historical antecedents.
• Treatment strategies are individually
tailored.

BEHAVIOUR TECHNIQUES
• Systemic desensitization It was developed
by Joseph wolpe, based on the
behavioural principle of counter
conditioning.
• In this, patient attain a state of complete
relaxation and are then exposed to the
stimulus that elicits the anxiety response.
• The negative reaction of anxiety is
inhibited by the relaxed state, a process
called reciprocal inhibition.

It consists of three main steps:
• Relaxation training
• Hierachy construction
• Desensitization of the stimulus

a)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
• biofeedback

b)Hierachy 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.
c)Desensitization of the stimulus:
• This can either be done in reality or though
imagination.
• At first, the lowest item in hierarchy is
confronted.
• The patient is advised to signal whenever
anxiety is produced. After a few trails, patient
is able to control his anxiety gradually.

INDICATIONS:
• Phobias
• Obessions
• Compulsions
• Certain sexual disorders

FLOODING
• The patient is directly exposed to the
phobic stimulus, but escape is made
impossible.
• By prolonged contact with the phobic
stimulus, the therapist guidance and
encouragement and his modeling behavior
reduce anxiety.
• Indication: specific phobias

AVERSION THERAPY:
• Pairing of the pleasant with an unpleasant
response, so that even in absence of the
unpleasant response the pleasant stimulus
becomes unpleasant .
• Unpleasant response is produced by
electric stimulus, drugs,social disapproval
or even fantasy.

INDICATIONS:
• Alcohol abuse
• Paraphilias
• Homosexuality
• Transvestism

OPERANT CONDITIONING PROCEDURE FOR
INCREASING ADAPTIVE BEHAVIOUR :
a)Positive reinforcement :
When a behavioural response is followed
by a generally rewarding event such as food,
praise or gifts, it tends to be strengthened
and occur more frequently than before
reward. This techniques is used to increase
desired behaviour.
b)Token economy :This program involves
giving token rewards for appropriate or
desired target behaviours performed by the
patient.

• OPERANT CONDITIONING PROCEDURE TO
TEACH NEW BEHAVIOUR
a)Modeling:
• Modeling is a method of teaching by
demonstration where the therapist shows
how a specific behaviour is to be performed.
• In modeling, the patient observes other
patient indulging in target behaviours and
getting rewards for those behaviours.
• This will make the patient repeat the same
behaviour and earn rewards in the same
manner.

b)Shaping:
In shaping the components of a particular skill, the
behaviour is reinforced step by step. The therapist
starts shaping by reinforcing, the existing behaviour.
C)Chaining:
• Chaining is used when a person fails to perform a
complex task.
• The complex task is broken in to a number of small
step and each step is taught to the patient. In forward
chaining one start with the first steps, goes on to the
second step, then to the third and so on.
• In backward chaining, one starts with the last step
and goes on to the next step in a backward fashion.

OPERANT CONDITIONING PROCEDURES
FOR DECREASING MALADAPTIVE
BEHAVIOR
a)Extinction/Ignoring:
• Extinction mean removal of attention rewards
permanently, following a problem behavior.
• This includes actions like not looking at the
patient, not talking to the patient, or having no
physical contact with the patient.
• This is used when patients exhibit odd
behaviour.

b)Punishment :
• The punishment procedure should be
administered immediately and consistently
following the undesirable behaviour with
clear explanation.
• Desirable punishment should always be
added when a punishment is being used
for decreasing an undesirable behaviour.

c)Time out :
• Timeout method includes removing the
patient from the reward or the reward from
the patient for a particular period of time
following a problem behaviour.
• This is often used in the treatment of
childhood disorders.
• Example: the child is not allowed to go
out of the ward to play if he fails to
complete the given work.

d)Restitution (over correction)
• Restitution means restoring the disturbed
situation to a state that is much better than
what it was before the occurrence of the
problem behaviour.
• Example: if a patient passes urine in the
ward,he would be required to not only
clean the dirty area, but also map the
entire area of the floor in the ward.

e. Response cost:
This Procedure is used with individuals
who are on token programs for teaching
adaptive behaviour.
When understandable behaviour occurs,
a fixed number of tokens or points are
deducted from what the individual has
already learned.

ASSERTIVENESS AND SOCIAL SKILL TRAINING
• Assertive training is a behaviour therapy technique
in which the patient is given training to bring about
change in emotional and other behavioural pattern
by being assertive.
• Patient is encouraged not to be afraid of showing
an appropriate response, negative or positive, to
an idea or suggestion.
• Assertive behaviour training is given by the
therapist, first by role play and then by practice in
a real life situation.
• Social skills training helps to improve social
manners like encouraging eye contact, speaking
appropriately, observing simple etiquette and
relating to people.

PLAY THERAPY
• Play is a natural mode of growth and
development in children. Through play a
child learns to express his emotions and it
serve as a tool in the development of the
child.

• Play therapy is a form of counselling or
psychotherapy. That uses play to
communicate with and help people,
especially children, to prevent or resolve
psychosocial challenges.
• Play is a child's natural medium to learn,
communicate and explore their world.
• Play Therapy allows children to explore
feelings and make sense of and recover from
difficult life experiences in a safe and trusting
environment

• It is a primarily non-verbal approach.
• Age range of mostly children's are 2 to 12
But it vary for example cognitive or
developmental delay may participate in
play therapy at an older chronological age.
• Time of session 30 to 50 minute but it
vary:
- Mild issues may improve in 6 to 12
session,
- Complex issues may require up to 40 to
80 sessions.

Goals of play therapy :
1) Develop a more positive self-concept
2) Assume greater self-responsibility
3) Become more self-accepting
4) Become more self-directing
5) Become more self-reliant
6) Become more trusting of self
7) Experience a feeling of control
8) Become sensitive to the process of coping
9) Develop an internal source of evaluation
10)Engage in self-determined decision making

HISTORY OF PLAY THERAPY
• Early 1900s, Melanie Klein and Anna Freud
included play in their psychoanalytic treatment of
children
• Klein (1961, 1987) stipulated that a child’s
spontaneous play was a substitute for the free
association used within adult psychoanalysis.
• In the 1940’s, Carl Rogers established a new
model of psychotherapy – client centered therapy
• Relationship between therapist and client based
upon genuineness, acceptance and trust.
• Axline (1971) developed a new therapeutic
approach for working with children – non directive
Play Therapy

Theoretical Basis of Play Therapy
Play Therapy is based upon three critical
theoretical principles:
• Actualization: Humans are motivated by an
innate tendency to develop constructive and
healthy capacities.
• The Need for Positive Regard: All people
require warmth, respect and acceptance from
others, especially from ‘significant others’.
• Play as Communication : Children use play
as their primary medium of communication.
Play is a format for transmitting children’s
emotions, thoughts, values and perceptions.

PURPOSES OF PLAY THERAPY
• Psychosocial issues: shyness, anxiety, stress,
poor communication, grief and loss.
• Behavioral problems : aggression, poor motor
co-ordination, self-harming, and attention deficit
hyperactivity disorder;
• Responses to family and relationship
problems: Family violence, parental separation,
attachment disorders, trauma and abuse;
• Educational issues : Poor organizational skills,
poor planning and execution of tasks, poor story
comprehension.
• Disabilities: autism, psychosis, sensory
impairment and intellectual impairment.

FUNCTIONS OF PLAY THERAPY
CURATIVE FUNCTIONS:
1. It releases tension and pent-up emotions
2. It allows compensation for loss and failures.
3. It improves emotional growth through his
relationship with other children.
4. It provides an opportunity to the child to act
out his fantasies and conflicts, to get rid of
aggression and to learn positive qualities
from other children.

DIAGNOSTIC FUNCTIONS:
1. Play therapy gives the therapist a chance
to explore family relationships of the child
and discover what difficulties are
contributing to the child’s problems.
2. Play therapy allows to study the child’s
hidden aspects of personality.
3. It helps to obtain a intelligence level of
the child.
4. Through play inter-sibling relationship can
be adequately studied.

TYPES OF PLAY THERAPY
a) INDIVIDUAL VS GROUP PLAY:
In individual play therapy, child is allowed
play by themselves and the therapist’s
attention on this one child alone. In group
play therapy, other children are involved.
b) FREE PLAY VS CONTROLLED PLAY:
In free play, the child is given freedom in
deciding what toys he wants to play, in
controlled play, the child is introduced into a
scene where the situation or setting is
already established.

c)STRUCTURED VS UNSTRUCTURED
PLAY:
Structured play involves organising the
situation in such a way so as to obtain more
information . In unstructured play therapy no
situation is set and no plans are followed.
d) DIRECTIVE VS NON-DIRECTIVE PLAY
In directive play therapy, the therapist totally
sets the directions, whereas in non –directive
play therapy, the child receives no directions.

AXLINE'S BASIC PRINCIPLES OF NON-
DIRECTIVE PLAY THERAPY
The therapist:
 Must develop a warm and friendly relationship with the child.
 Accepts the child as she or he is
 Establishes a feeling of permission in the relationship is alert to recognize
the feelings the child is expressing and reflects these feelings back in such
a manner that the child gains insight into his/her behaviour.
 Maintains a deep respect for the child’s ability to solve his/her problems and
gives the child the opportunity to do so.
 Does not attempt to direct the child’s actions or conversations in any
manner.
 Does not hurry the therapy along.
 Only establishes those limitations necessary to anchor the therapy to the
world of reality and to make the child aware of his/her responsibility in the
relationship.

• 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

PSYCHODRAMA
• Psychodrama is an action method, often
used as a psychotherapy, in which clients use
spontaneous dramatization, role playing, and
dramatic self-presentation to investigate and
gain insight into their lives.
• Developed by Jacob L. Moreno,
psychodrama includes elements of theater,
often conducted on a stage, or a space that
serves as a stage area, where props can be
used.

DEFINITION:
Psychodrama is a specialised type of
group therapy that employs a dramatic
approach in which patients become actors
in life –situation scenarios.
GOAL:
• To resolve interpersonal conflicts in a less
threatening atmosphere than the real –life
situation would present.

• A psychodrama therapy: A group, under
the direction of a licensed psycho
dramatist, re-enacts real-life, past
situations (or inner mental processes),
acting them out in present time.
Participants then have the opportunity to
evaluate their behaviour, reflect on how
the past incident is getting played out in
the present and more deeply understand
particular situations in their lives.

PSYCHODRAMA PROCESS:
• A psychodrama is best conducted and
produced by a person trained in the method,
called a psychodrama director.
• In a session of psychodrama, one client of
the group becomes the protagonist, and
focuses on a particular, personal, emotionally
problematic situation to enact on stage.
• A variety of scenes may be enacted,
depicting, for example, memories of specific
happenings in the client's past, unfinished
situations, inner dramas, fantasies, dreams,
preparations for future risk-taking situations,
or unrehearsed expressions of mental states
in the here and now.

• These scenes either approximate real-life
situations or are externalizations of inner
mental processes.
• Other members of the group may become
auxiliaries and support the protagonist by
playing other significant roles in the scene
or they may step in as a "double" who
plays the role of the protagonist.

Core Psycho Dramatic
Techniques
• Mirroring: The protagonist is first asked to
act out an experience. After this, the client
steps out of the scene and watches as
another actor steps into their role and
portrays them in the scene.

• Doubling: The job of the “double” is to make
conscious any thoughts or feelings that another
person is unable to express whether it is because
of shyness, guilt, inhibition, politeness, fear, anger,
etc.
In many cases the person is unaware of these
thoughts or at least is unable to form the words to
express how they are feeling.
Therefore, the “Double” attempts to make
conscious and give form to the unconscious
and/or under expressed material. The person
being doubled has the full right to disown any of
the “Double’s” statements and to correct them as
necessary. In this way, doubling itself can never be
wrong.

• Role playing: The client portrays a person or
object that is problematic to him or her.
• Soliloquy: The client speaks his or her
thoughts aloud in order to build self-
knowledge.
• Role reversal:
- The client is asked to portray another
person while a second actor portrays the
client in the particular scene.
- This not only prompts the client to think as
the other person, but also has some of the
benefits of mirroring, as the client sees him-
or herself as portrayed by the second actor.

USES OF PSYCHODRAMA
• Psychodrama can be used in both non-
clinical and clinical arenas.
In the non-clinical field, psychodrama is
used in business, education, and
professional training. In the clinical field,
psychodrama may be used to alleviate the
effects of emotional trauma and PTSD.

In clinical situations,
- It is used for people suffering from
dysfunctional attachments.
- For this reason, it is often utilized in the
treatment of children who have
suffered emotional trauma and abuse.
- Using role-play and story telling children
may be able to express themselves
emotionally and reveal truths about their
experience they are not able to openly
discuss with their therapist, and rehearse
new ways of behaviour.

Moreno's theory of child development offers further
insight into psychodrama and children.
Moreno suggested that child development is divided
into four stages:
• Finding personal identity (the double),
• Recognizing oneself (the mirror stage,
• The auxiliary ego (finding the need to fit in), and
• Recognizing the other person (the role-
reversal stage).
Mirroring, role-playing and other psycho dramatic
techniques are based on these stages.
Moreno believed that psychodrama could be used to
help individuals continue their emotional
development through the use of these techniques.

DANCE THERAPY
• Dance/movement therapy, usually
referred to simply as dance therapy or
DMT, is a type of therapy that uses
movement to help individuals achieve
emotional, cognitive, physical, and social
integration

BENEFITS OF DANCE
THERAPY
• Beneficial for both physical and mental health,
dance therapy can be used for stress reduction,
disease prevention, and mood management.
• Physical component offers increased muscular
strength, coordination, mobility, and decreased
muscular tension.
• Dance/movement therapy can be used with all
populations and with individuals, couples, families,
or groups.
• In general, dance therapy promotes self-
awareness, self-esteem, and a safe space for the
expression of feelings.

The creative expression of dance therapy can bolster
communication skills and inspire dynamic relationships.
It is commonly used to treat physical, psychological, cognitive,
and social issues such as:
Physical Issues:
• Chronic pain
• Childhood obesity
• Cancer
• Arthritis
• Hypertension
• Cardiovascular disease
Mental Health Issues:
• Anxiety
• Depression
• Disordered eating
• Poor self-esteem
• Posttraumatic stress

Cognitive Issues:
• Dementia
• Communication issues
Social Issues:
• Autism
• Aggression/violence
• Domestic violence trauma
• Social interaction
• Family conflict

Key Principles:
• Body and mind are interconnected, so that a
change in one impacts the other.
• Movement can express aspects of
the personality
• Part of the therapeutic relationship is
communicated through non-verbal means.
• Movements can be symbolic and can
represent unconscious material/processes.
• Movement improvisation/experimentation can
bring about new ways of being.

Advantages of dance
therapy
• 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.

MUSIC THERAPY
• Music transcends time and is present in all
communities throughout the world. Given the
universal nature of music, music therapy is
uniquely able to reach individuals across all
backgrounds and ages.
• It does not require any previous knowledge
for individuals to meet their goals and be
successful.
• Music therapy provides individualized
treatments to help treat individuals with
disabilities, injuries, illnesses or to improve
their well being.

The overall goal of music therapy is to achieve the objectives
that meet the needs of the individual .
• This may include, for example, improving motor function,
social skills, emotions, coordination, self-expression and
personal growth.
Common goals in music therapy:
• Communication skills (using vocal/verbal sounds and
gestures)
• Social skills (making eye contact, turn-taking, initiating
interaction, and self-esteem)
• Sensory skills (through touch, listening, and levels of
awareness)
• Physical skills (fine and gross motor control and movement)
• Cognitive skills (concentration and attention, imitation, and
sequencing)
• Emotional skills (expression of feelings non-verbally)

Benefits of Music Therapy
Jillian Levy (2017) shares the six major health
benefits of music therapy:
• Music therapy reduces anxiety and physical
effects of stress
• It improves healing
• It can help manage Parkinson’s and Alzheimer’s
disease
• Music therapy reduces depression and other
symptoms in the elderly
• It helps to reduce symptoms of psychological
disorders including schizophrenia
• Music therapy improves self-expression and
communication

MUSIC THERAPY IN
CHILDREN
• Music therapy can be a useful way to meet
the various psychosocial needs of
children, through engagement in song-
writing and improvisation. It can provide
children with opportunities for self-
expression and communication. Music
therapy can also give children the
opportunity to identify their strengths,
providing a way for them to maintain a
sense of self-esteem.

• For infants and children, a music therapist can use
live, familiar music in conjunction with physical, social
and cognitive activities to stimulate development.
• This also promotes interaction and encourages
participation and motivation in young children.
• In order to reduce irritability, pain or anxiety, the music
therapist can use soothing music.
• This also encourages child and family bonding.
• To help develop creative self-expression in infants and
young children, the music therapist and child can
make music together and write songs.
• Adolescents can play a more active role in coming up
with their own music therapy program.
• With a therapist, adolescents can explore a range of
musical activities and select what feels right to them.

EFFECTS OF MUSIC
THERAPY
• Music can affect a client’s attention, emotion,
cognition, behaviour, and communication.
• It can also help bring
about relaxation and pleasure.
• Music also affects perception
• Training in music promotes an individual’s
skills in the decoding of acoustic features,
such as pitch height and frequency
modulation

• Music has various effects on the activity of
a large range of brain structures.
• Functional neuro imaging studies have
shown that listening to music can have
effects on the core structures of emotional
processing (the Limbic and Para limbic
structures).

Types of music therapy
There are two fundamental types of music
therapy:
(i) Receptive music therapy
(ii) Active music therapy (also known as
expressive music therapy).

(i)Receptive:
• Receptive music therapy involves listening to
recorded or live music selected by a
therapist. It can improve mood, decrease
stress, decrease pain, enhance relaxation,
and decrease anxiety. Although it doesn't
affect disease, it can help with coping skills.
(ii) Active:
• In active music therapy, patients engage in
some form of music-making, either by singing
or by playing instruments.

ADVANTAGES OF MUSIC
THERAPY
1. Facilitates emotional expressions.
2. Improves cognitive skills like learning,
listening and attention span.
3. Social interaction is stimulated.

RECREATIONAL THERAPY
• Recreation is a form of activity therapy
used in most psychiatric settings. It is a
planned therapeutic activity that enables
people with limitations to engage in
recreational experiences.
• Recreation: A form of voluntary activities
that is carried on in the leisure time,
usually for pleasure but also to satisfy
other personal needs and drives.

DEFINITION OF
RECREATIONAL THERAPY
• Recreational therapy also known as
therapeutic recreation, is a systematic
process that utilizes recreation and other
activity-based interventions to address the
assessed needs of individuals with
illnesses and/or disabling conditions, as a
means to psychological and physical
health, recovery and well-being.

AIMS OF RECREATIONAL
THERAPY
• To encourage social interaction.
• To decrease withdrawal tendencies.
• To provide outlet for feelings.
• To promote socially acceptable behaviour.
• To develop skills, talents and abilities.
• To increase physical confidence and a
feeling of self- worth.

Points to be Kept in Mind
• Provide a non-threatening and non-
demanding environment.
• Provide activities that are relaxing and
without rigid guidelines and time-frames.
• Provide activities that are enjoyable and
self- satisfying.

USES OF RECREATIONAL
THERAPY
Recreational Therapists may work with a wide
range of individuals requiring health services
including :
• Geriatric mental illness
• Addiction rehabilitation
• Developmental disabilities
• Paediatric clients

STEPS OF RECREATIONAL
THERAPY
• Assessment: working with clients to identify health
status, needs and strengths to provide data for
interventions.
• Planning: priorities are set; goals are formulated;
objectives are developed; programmes, strategies,
and approaches are specified; and means of
evaluation are determined.
• Intervention: the action phase of the TR process.
Involves the actual execution of the programme plan
by the TR specialist and client.
• Evaluation: The goals and objectives are appraised.
The primary question: How did the client respond to
the planned intervention?

TYPES OF RECREATION
1. Active Recreation: involves playing
fields and team participation such as
baseball, soccer etc.
2. Passive Recreation: Recreation without
fields, more generally trial based hiking,
mountain biking, hoarse riding, wild life
viewing etc.

TYPES OF RECREATIONAL
ACTIVITIES
1.Indoor recreational activities: These
activities are carried out inside a room or a
place.
Example: Reading, writing, computer and
vedio games, playing cards, dance , music,
indoor games.
2. Outdoor Recreational Activities: Those
activities which you enjoy outside from your
place.
Example: Hiking, Camping, Boating,
Swimming ,etc

Forms of Recreational
Activities
• Motor forms: These can be further divided
into fundamental and accessory.
Fundamental forms are such games as
hockey and football ,while the 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

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.
• Childhood and adolescent disorders 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.

• Recreation therapists 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.
• Recreation therapy is one of the essential
treatment areas within the health care
team.

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

• 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.

DEFINITION
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.

AIMS OF RELAXATION
THERAPY
• 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.
• 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.

PURPOSES OF RELAXATION
THERAPY
• 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

EFFECTS OF RELAXATION
THERAPY
1.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.
2.COGNITIVE AND BEHAVIOUR EFFECTS :
Mental alertness
Active thinking.
Increases the creative and memory.
Increases the ability to concentrate.
Improvement in adoptive functioning

ELEMENTS OF RELAXATION
TEHRAPY
• 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.

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.

INDICATIONS OF JPMR
• Muscular tension,
• Anxiety,
• Insomnia,
• Depression,
• Fatigue,
• Irritable bowel, muscles spasms,
• Neck and back pain,
• High blood pressure,
• Mild phobias, etc.

PROCEDURE OF JPMR
• 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 feels.
• Ask the client to relax each muscle.

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 tranquillity.
• 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).

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.

• Meditation was used routinely in ancient
Syria, India, Japan and the Monasteries of
Europe.
• Meditation is a kind of self discipline that
helps one achieve inner peace and
harmony by focusing uncritically on one
thing at a time.

PURPOSES OF MEDITATION:
1.Promote well-being in healthy people.
2.Meditate regularly experience less anxiety
and depression.
3.Gives more enjoyment and appreciation
of the life.
4. Facilitates a greater sense of calmness,
empathy, and acceptance to self and
others.

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 MEDITATION
1.CONCENTRATION MEDITATION:
• It involves focusing once attention on the
breath, an imagined or real image, sound, or
word, or phrase that is repeated silently.
2.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.

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

EIGHT STEPS OF YOGA
1.Self-control (Yama), obtained by such devices as
chastity, non-stealing, non-violence, truthfulness,
and avoidance of greed.
2.Religious observance (Niyama), through
chanting of the Vedic hymns, austerity, purity and
contentment.
3. Assumption 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).

6.Studying of the mind (Dharana), through
fixation on some part of the body, such as
the nose or navel.
7.Meditation (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.

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 OF
BIOFEED BACK
• 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 OF
BIO FEED BACK
• 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.

PHYSICAL EXERCISES
• Regular exercise is the most effective method
of relieving 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 and increases the body’s
ability to use oxygen more effectively.
• Following exercise physiological equilibrium
is restored, resulting in a feeling of relaxation.

• Studies revealed that Physical exercise can
be effective in reducing anxiety and
depression.
• Vigorous exercises increases the levels of
serotonin and beta endorphins ; both helps in
mood regulation.
• Decreased serotonin seen in people with
depression.
• Endorphins are natural narcotics and mood
elevators.

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 OF DEEP
BREATHING EXERCISES
1.Sit or lie down in a comfortably, inhale slowly
through the nose and exhale through the
mouth.
2.While 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.

PSYCHO EDUCATION
• It is an evidence based psychotherapeutic
intervention.
• In this intervention, education about the
nature of illness, its treatment, coping and
management strategies and skills needed
to avoid relapse is provided to mentally ill
patients and their condition in an optimal
manner.

• It can be given to the patient in a one to
one discussion or in a group by qualified
health educators, such as nurses, social
workers, psychologists, psychiatrists,
occupational therapists..

ROLE OF NURSE IN
PSYCHOLOGICAL THERAPIES
• Close co-ordination between the therapist
and nurse is essential.
• By engaging in these activities, the nurse
not only has an opportunity to support the
therapeutic efforts of the therapist, but also
has an invaluable opportunity to observe
the patient in different settings.

• Through her observations of the patient’s
behaviour during these activities, the nurse gains
valuable information that she can subsequently
utilize to therapeutic advantage in the working
phase of the nurse patient relationship. .
• Help the individual to recognize the source of
stress.
• Help to identify the method of coping.
• To identify the individual adaptation to stress.
• To assess the individual to achieve their highest
potential for wellbeing.
• To evaluate the effectiveness of the therapy.
• To plan alternative / modification.
• document the behavioural changes.
• Supportive role while the therapy.

MENTAL HEALTH NURSING-PSYCHOLOGICAL THERAPIES

MENTAL HEALTH NURSING-PSYCHOLOGICAL THERAPIES

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