Cognitive, Humanistic and psychobiologic theory

							Basis for Psychopathology


    Cognitive, Humanistic, and
    Psychobiology approach
Cognitive Approach

   Focus
       Cognitive process include expectations, beliefs,
        memory and thinking pattern
       Thinking influences behavior
   Basic Concepts
       Cognitive process can be altered or restructured
       Appraisal are the automatic thoughts a person
        used to evaluate his or her present situation
       Attribution refers to a person’s conception of why
        an event is happening: They may be:
           External arising from outside the self
           Internal arising from within the self
       Belief are long-held ideas that shape thoughts,
        feelings, and behavior
Cognitive Theory

   The foundation of cognitive theory involves
    the mental process, such as thinking,
    remembering, attending, planning, wishing,
    and fantasizing in relation to self, others, and
    the future
   Person’s perception and interpretations
    influence subsequent biologic and behavioral
    responses.
Some of the cognitive theory


   Jean Piaget’s Theory of Cognitive
    Development
Piaget’s Theory of Cognitive Development

   Explored how intelligence and cognitive
    function develop in children
   He believed that human intelligence
    progresses through a series of stages based
    on their age
   Biologic changes and maturation were
    responsible for cognitive development
                                             AGE                                     DESCRIPTION
             PHASE

a. Sensorimotor                       Birth to 2 yrs     Sensory organs & muscles become more functional
Stage 1: Use of reflexes              Birth to 1 month   Movements are primarily reflexive
Stage 2: Primary circular reaction    1-4 months         Perceptions center around one’s body.
                                                         Objects are perceived as extensions of the self.

Stage 3: Secondary circular           4-8 months         Becomes aware of external environment.
reaction                                                 Initiates acts to change the movement.

Stage 4: Coordination of              8-12 months        Differentiates goals and goal-directed activities.
secondary schemata

Stage 5: Tertiary circular reaction   12-18 months       Experiments with methods to reach goals.
                                                         Develops rituals that become significant.

Stage 6: Invention of new means       18-24 months       Uses mental imagery to understand the environment.
                                                         Uses fantasy.

b. Pre-operational                    2-7 years          Emerging ability to think

Pre-conceptual stage                  2-4 year           Thinking tends to be egocentric.
                                                         Exhibits use of symbolism.

Intuitive stage                       4-7 years          Unable to break down a whole into separate parts.
                                                         Able to classify objects according to one trait.

c. Concrete Operations                7-11 years         Learns to reason about events in the here-and-now.
d. Formal Operations                  11+ years          Able to see relationships and to reason in the abstract.

  Piaget’s Phases of Cognitive Development
View on Mental Illness

   Applicable to depression but also useful in
    addressing other mental illness
   Distorted thinking leads to distorted behavior
Nursing Application

   Nurses assess patient thought (cognitive
    pattern)
   Nurses participate in cognitive restructuring
    as part of a team approach
Humanistic Approach

   Focus: Conscious Human experience from
    here and now
       Human being have the potential to grow
       Human being can exercise freedom of choice
       Freedom to choose among alternatives gives
        meaning to a person’s life
       Human being are responsible for their own
        behavior
   Basic Concepts
       Human existence is a search for meaning,
        authenticity and realization of potential
       Human needs are organized in a hierarchy
        ranging from biologic needs to self-actualization
       As a person’s basic needs are gratified, higher-
        level needs emerge
       When basic needs are met, a person becomes
        growth oriented
Humanistic Theory

   Humanism focuses on a person’s positive
    qualities, his or her capacity to change
    (human potential) and to promote self-esteem
   Humanist consider the person’s past
    experiences, but they direct more attention
    toward the present and future
Some of the Humanistic theory

   Maslow’s Hierarchy needs
   Carl Roger: Client Centered Therapy
Maslow’s Hierarchy of needs

   He used a pyramid to arrange and illustrate
    the basic drive or needs that motivate people
   He used the term “Self-actualization” to
    described the person who has achieved all
    the needs of the hierarchy and has
    developed his or her fullest potential in life
   This theory helps nurses understand how
    client’s motivations and behaviors change
    during life crises.
Carl Rogers: Client Centered Therapy

   Focused on the therapeutic relationship and
    developed a new method of client-centered
    therapy
   Client Centered Therapy- focuses on the role
    of the client, rather than the therapist, as the
    key to the healing process
Client-Centered Therapy

   Three central concepts to promote the client’s
    self-esteem:
       Unconditional Positive Regard
       Genuine
       Emphatic Understanding
View of Mental Illness

   Alienation from self that hinders freedom of
    choice, responsibility and growth
   Lack of self-awareness and unmet needs
    interfere with relationship and with feeling of
    security
   Recovery involves heightened awareness of
    choice and of potential for growth, love and
    fulfillment
Nursing Application

   Basic nurse-patient interaction are based on
    humanistic principles such as:
       positive regard
      empathy
      respect
   Nurse-patient interaction are client-centered
       Patient is encouraged to initiate topics of concern
       Nurse listen carefully to the patient
       Nurse uses reflective listening approach to help patient
        gain self-understanding
       Nurse helps patient examine alternative choice
Psychobiology

   Focus
       Identification of syndrome
       Establishment of diagnoses
       Search for etiologies
Basic Concepts

   a disease
   results from abnormalities in brain structure
    and chemistry
   Genetic factors major contribution
   Physiological, social, or environmental factors
   can be classified and treated
   Evidence supporting the biomedical approach to
    mental illness includes:
       Eradication of general paresis (tertiary syphilis)
        through the discovery of causative bacteria
       Presence of genetic transmission patterns in
        schizophrenia and effective disorders
       Reduction of symptoms through the use of
        pharmaceutical agents
Brain

   the control center for
    movement, sleep, hunger,
    thirst, and virtually every
    other vital activity necessary
    to survival.
   It also receives and
    interprets the countless
    signals that are sent to it
    from other parts of the body
    and from the external
    environment.
Parts of the brain

   Cerebrum- Many motor and sensory
    functions have been “mapped” to specific
    areas of the cerebral cortex, some of which
    are indicated here.
   Cerebellum- coordinates voluntary
    movements by fine-tuning commands from
    the motor cortex in the cerebrum. also
    maintains posture and balance by controlling
    muscle tone and sensing the position of the
    limbs.
Parts of the brain

   Brain stem- evolutionarily the most primitive
    part of the brain and is responsible for
    sustaining the basic functions of life, such as
    breathing and blood pressure
Limbic System

   An area of the brain located above the brain
    stem that includes the thalamus,
    hypothalamus, hippocampus, and amygdala
   Disturbances in the limbic system have been
    implicated in a variety of mental illness
   It is associated with behavior, physiologic
    changes, and emotional tone or feelings.
Parts of the limbic system

   Thalamus- regulates activity, sensation and
    emotion
   Hypothalamus- temperature regulation,
    appetite control, endocrine function, sexual
    drive and impulsive behavior associated with
    feeling of anger, rage or excitement.
   Hippocampus and amydala- emotional
    arousal and memory
Neurotransmitter
   Chemical substances manufactured in the neuron that aid in the
    transmission of information throughout the body
   Excite or stimulate (excitatory) or inhibit or stop (inhibitory) the action
   Released, transported back (reuptake) or metabolized and
    inactivated by enzymes, primarily monoamine oxidase (MAO)
   Necessary in just the right proportions to relay messages across
    the synapses
   Studies show that people with mental disorders have different
    amounts of neurotransmitters compared to people without mental
    disorders
Neurotransmitters

   Dopamine- controls complex movements, motivation
   Norepinephrine- changes in attention, learning, and
    memory
   Serotonin- controls food intake, sleep and
    wakefulness, temperature regulation, pain control
    and sexual behavior
   Acetylcholine- controls wake and sleep cycle,
    signals the muscle to become alert
   GABA- signals to modulate other neurotransmitters
Neurotransmitter

   Dopamine – implicated in psychoses
   Norepinephrine – most prevalent neurotransmitter;
    excess has been implicated in several anxiety
    disorders; deficits may contribute to withdrawal and
    depression
   Serotonin – anxiety, mood disorders, schizophrenia
   Acetylcholine – decreased in Alzheimer’s disease
   Glutamate – high levels have neurotoxic effects
   Gamma-Aminobutyric Acid (GABA)- low level may
    indicate anxiety disorder
Other Etiologies


   environmental toxin,
   heredity
   brain damage
   prenatal exposure to alcohol and tobacco
   malnutrition
View on Mental Illness

   Disorder of the body
   Classified in the DSM-IV
Nursing Application

   Nurses work in biomedically approach
   Nurses observe and assess patient behavior as well
    as facilitate physical well-being
   Nurses administer treatments and foster patient
    compliance
   Nurses teach patient about their illness
       Recognition of symptom
       Management of illness
       Prevention of Relapse
   Nurse coordinate diverse aspect of care