Psychiatric Mental Health - Therapies, part 1: Relaxation, Milieu, Group, and Behavioral
by Cathy Parkes August 04, 2021 Updated: December 29, 2021 6 min read
In this article, we cover relaxation techniques, milieu therapy, group therapy, and different types of behavioral therapy.
This series follows along with our Psychiatric Mental Health Nursing Flashcards which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Relaxation techniques promote relaxation for the patient, and can include progressive relaxation, biofeedback, guided imagery, meditation, and others.
Progressive relaxation is the tightening and relaxing of muscle groups in a systematic order to relieve stress and tension.
Biofeedback uses a device to monitor the patient's body vital signs with a goal of obtaining voluntary control over them.
Guided imagery is a relaxation technique involving visualizing detailed images to promote relaxation.
Meditation is a relaxation technique involving mind and body practice where an individual focuses on a word or sensation (like breathing) to improve health and well-being.
Other relaxation techniques include deep breathing, self-hypnosis, yoga, tai chi, and others.
The milieu in milieu therapy refers to the environment. Milieu therapy aims to structure the physical environment to bring about beneficial changes to a person's mental health and behavior.
The goal of milieu therapy is to maintain a therapeutic environment. This type of therapy teaches patients beneficial coping, relationship, and interactive skills that can be applied to their daily lives. The idea is to promote and maintain client autonomy.
The key concepts of milieu therapy are containment, validation, structured interaction, and open communication.
Containment in milieu therapy is providing for the safety and security of the patient, along with providing privacy where possible.
Validation in milieu therapy places emphasis on a patient's worth and dignity.
Structured interaction in milieu therapy allows clients to interact with others in a meaningful way.
Milieu therapy's open communication encourages purposeful self-disclosure by the patient with the staff.
Group therapy is therapy that is carried out in a group setting that provides members with socialization, support, and/or education.
The phases of group therapy include orientation, working, and termination.
The orientation phase of group therapy helps to facilitate introductions, define the purpose of the group, and discuss rules and confidentiality.
The working phase of group therapy is the phase during which most of the work of therapy is accomplished. The leader refocuses the group as needed and helps to resolve conflict.
The termination phase of group therapy is the end of group therapy. To the patient, this may be viewed as a loss and can bring about feelings of grief.
There are several member roles to be aware of in group therapy, including task roles, maintenance roles, and individual roles.
When a patient is assuming a task role in group therapy, they contribute directly to the group’s completion of a task or defined goal (e.g., a group therapy coordinator).
When a patient takes a maintenance role in group therapy, they help to maintain social cohesiveness of the group — they are someone who harmonizes the group.
A patient's individual role in group therapy satisfies their needs as an individual member, but may interfere with effectiveness of the group. For example, if someone is dominating the group, they may feel that their needs have been met, but this may harm group effectiveness.
Behavioral therapy includes operant conditioning, modeling, aversion therapy, systematic desensitization, and flooding.
Operant conditioning uses positive reinforcement of desired behaviors.
In modeling therapy, a patient learns new behaviors by imitating others. The therapist uses role-play to demonstrate appropriate behavior for the patient, then asks the patient to imitate that behavior.
In aversion therapy, a negative stimulus is paired with an unwanted behavior to create a repulsion to that behavior. One example of this is disulfiram, a maintenance medication for alcohol abuse, makes the patient feel very sick if they ingest alcohol. To learn more about this and other alcohol abuse medications, check out our Pharmacology Flashcards.
During systematic desensitization, a patient is gradually exposed to a phobia while engaging in learned relaxation techniques.
During flooding therapy, a patient is exposed to their feared stimuli at full intensity for a prolonged period until it no longer causes anxiety.
Hi, I'm Cathy with Level Up RN. In this video, I'm going to begin my coverage of therapies used to treat mental health disorders. We'll start with the less invasive therapies, such as relaxation techniques, milieu therapy, group therapy, as well as behavioral therapy, and then we'll work our way to more invasive therapies. At the end of this video, I'm going to give you guys a little quiz, make sure you've been paying attention. It's not going to be a complex nursing-style quiz, like select all that apply or a case study. It's going to be a very just simple quiz just to test your knowledge.
So let's first talk about relaxation techniques. Relaxation techniques can include progressive relaxation, which is where you tighten and relax muscles in order to relieve stress and tension. Then we have something called biofeedback. With biofeedback, you use a device to monitor your vital signs, and the goal of biofeedback is for you to get voluntary control over those vital signs. So you'd change your thoughts, behavior, or emotions to try to bring those vital signs down. Then we have guided imagery. Guided imagery is where you visualize detailed images to promote relaxation. Meditation is a mind and body practice where an individual focuses on a word or on their breathing in order to improve their health and well-being. And then there's other relaxation techniques such as deep breathing, self-hypnosis, yoga, and tai chi.
Next, let's talk about milieu therapy and group therapy. So milieu is basically a fancy word for environment. And when we're caring for patients in a mental health setting, we really just want to make sure we have a therapeutic environment, that we're providing for the safety and security of our patients, and we are allowing patients to interact with each other in a meaningful way. The purpose of group therapy is to provide socialization, support, or education. And if you recall, when we talked about the nurse-client relationship and the phases of that relationship, those included preorientation, orientation, working, and termination. Here, we have similar phases. We have orientation, working, and termination. During the orientation phase of group therapy, we're going to facilitate introductions, we're going to define the purpose of the group, and we're going to discuss the rules and confidentiality as well. Then, during the working phase, that's really where the work of therapy is accomplished. So that can include education, sharing among members, etc. And then termination of group therapy can be viewed as a loss with some members, just like when we have the termination phase of the nurse-client relationship that may also be seen as a loss.
Next, let's talk about behavioral therapy. Behavioral therapy includes interventions that are aimed at decreasing or eliminating maladaptive behavior. So one example is operant conditioning. This is where we give positive reinforcement for a desired behavior. So this could mean a token or a reward, or it could just be a compliment. Next, we have modeling. This is where the patient learns behaviors by imitating others. So the therapist can set up a role-play type of situation where he or she demonstrates appropriate behavior and then asks the patient to imitate that behavior.
Then we have aversion therapy. This is where a negative stimuli is paired with an unwanted behavior to try to create a repulsion to that behavior. So an example is a medication called disulfiram, and disulfiram is given to patients with alcohol abuse disorder. And while they're taking disulfiram, if they drink alcohol, they feel horrible, really, really sick. And we'll talk more about disulfiram in a future video when we go over medications. But disulfiram will be an example of aversion therapy. Then we have systematic desensitization. And this is where a patient is gradually exposed to a phobia while engaging in learned relaxation techniques. This is differentiated from flooding, which is where the patient is exposed to a feared stimuli at full intensity for a prolonged amount of time until it no longer causes the patient anxiety. So again, systematic desensitization is the gradual exposure to that phobia versus flooding is like, here it is at full intensity. All right. Those are the key behavioral therapies that I think you should know. And next up, we have our quiz.
Okay. Quiz time, I have three questions for you guys, pretty much like fill-in-the-blank questions. First question, what technique uses a device to monitor vital signs with the goal of obtaining voluntary control over those vital signs? The answer is biofeedback.
Question number two, what behavioral therapy includes positive reinforcement of desired behaviors? If you said operant conditioning, you are correct.
Question number three, what behavioral therapy gradually exposes a patient to a phobia while they engage in relaxation techniques? The answer is systematic desensitization.
So hopefully, you did good on that quiz. If not, you can go back and watch the video or review our flashcard. So take care, and I'll see you on another video soon.
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