Mental Health Case Study
I I I
Case IStudy, IMohr: ICHAPTER I1, IIntroduction Ito IPsychiatric–Mental IHealth INursing I
1. Karen Iis Ia I25-year-old Iwhite Iwoman Iwho Ilives Ialone Iin Ian Iapartment Iwith Iher Idog. IKaren
Ihas Ibeen Idivorced Ifor I2 Iyears Iand Iis Itaking IProzac Iprescribed Iby Iher Ipsychiatrist Ifor
Idepression. I IKaren Iand Iher Iboyfriend Ihad Ibeen Idiscussing Imarriage Iuntil Ihe Itold Iher Ithat
Ihe Iwanted Ito Iend Itheir Irelationship. I IKaren Ibecame Ieven Imore Idepressed Iand Icould Inot
Iwork Ifor Ia Iweek. I IKaren Ireturned Ito Iwork, Irefusing Ito Idiscuss Iher Iissues Iwith Ifamily,
Ifriends, Ior Icoworkers. IShe Idid, Ihowever, Imake Ian Iappointment Ito Isee Ia Ipsychiatric Inurse
Ipractitioner. I IKaren Itold Ithe Inurse Ithat Ishe Iwas Imaking Isome Ichanges Iin Iher Ilife. I IKaren
Isaid Ithat Ishe Iand Ia Igirlfriend Iwere Ijoining Ia Igym Iprogram Ifor Iworkouts Iand Ia Isocial Igroup
Ifor Iyoung Imen Iand Iwomen. I IKaren Istated Ithat Ishe Irealizes Ithat Iher Iformer Iboyfriend Ihad
Inot Ibeen Icommitted Ito Iher, Iand Ishe Ianticipates Imeeting Iand Idating Iother Iyoung Imen Ifrom
Ithe Iadult Isocial Igroup. I IKaren Ialso Isaid Ithat Ishe Ithinks Ithat Ithe Igym Iexercise Iwill Ibe
Ibeneficial Ito Iher Imentally Iand Iphysically. I(Learning IObjectives: I1, I4)
A-How Iwill Ithe Ipsychiatric Inurse Iassess Iif IKaren Ihas Imade Iprogress Itoward Iself-
realization? I
➢ Karen Ihad Isuffered Ifrom Idepression Iwhich Iis Ia Iform Iof Imental Idisorder Ibecause Iof
Idivorce Iand Ia Ibroken Irelationship Iwith Iher Iboyfriend. IThis Isituation Iaccording Ito
IHypocritical Iin I15th Icentury IBC, Iupholds Ithe Ibrain Ias Ithe Iorgan Iof Iconsciousness;
Ithis Ioccurs Iwhen Iboth Inormal Iand Iabnormal Ibehavior Iarise Ifrom Ithe Ibrain. I
➢ The Ipsychiatric Inurse Ican Iassess Iif IKaren Ihas Imade Iprogress Itowards Iself-
realization Iby Icommitting Ito Idiagnosing Iand Itreating Iher Iresponses Ito Ithe
Iproblems Ithat Icaused Iher Ipsychiatric Idisorder. IIn-addition, Ithe Inurse Ican Imake
Iassessment Ibased Ion IKaren’s Ipsychoanalytical Idisposition Isuch Ias: Itransference,
Idefense Imechanism, Icountertransference, Iacting Iout, Idenial Iof Ithe Ireality Ibefallen
Iher Iand Iprojection. I
B-Identify Istrengths Ithat IKaren Ihas Ifor Iprogress Iin Ipersonal Igrowth. IThe Istrengths IKaren
Ihas Ifor Iprogress Iin Ipersonal Igrowth Iinclude Ithe Ifollowings:
➢ Her Icognitive Ibehavioral Iresponses Ishowed Ioptimism Itowards Ia Ibetter Ilife Ias Iwell
Ias Ifighting Iagainst Iher Idepressed Istate. IHence, Iher Iwillingness Ito Idate Iyounger
Imen.
➢ Karen Isought Iimmediate Imedical Iattention Iwhere Ishe Iwas Iadministered Iwith
IProzac Ito Ihelp Imitigate Iher Idepression Istate.
➢ Ability Ito Imake Iuse Iof Isocial Isupport, Ithat Iis, Ishe Ivisited Ia Ipsychiatric Inurse, Isocial
Igroup Iand Iregistered Iin Ia Igym.
, ➢ She Iwas Irealistic Iabout Iher Isituation, Itherefore Imade Iherself Iready Ito Iface Ithe
Ireality Ibefore Iher.
C-Karen Ihas Ibeen Iseeking Itreatment Ifor Iher Idepression. IAnalyze Ithe Ifactors Ithat Imight
Icontribute Ito IKaren’s Ireluctance Ito Idiscuss Iher Idepression Iwith Iothers.
➢ Karen’s Ireluctance Ito Idiscuss Iher Idepression Iwith Iothers Ihinges Ion Ithe Ifact Ithat Iher
Idepression Iwas Ia Ikind Icalled Isocial Idepression. ISocial Idepression Iis Ia
Ipsychological Idisorder Icaused Iby Iseveral Ifactors Isuch Ias: Iinterpersonal
Irelationship Iwhich Iinvolves Ithe Irelationship Ibetween Ia Iperson Iand Ithe Iinteractions
Iof Iemotions Iof Ieveryone Iexpressed Idirectly Iand Idiscreetly Ito Ieach Iother. I
➢ Another Iis Ia ICommon Iinterpersonal Irelationship, Ithis Iincludes: IFamily, Isocial
Ienvironment I(work Iplace), Iand Iinteraction Iamong Iage Igroups Iand Igenders.
IBecause IKaren Ihad Idivorce Iand Ibroken Irelationship, Ishe Ididn’t Ifeel Isafe Iin Iherself
Idiscussing Iher Idepression Iwith Ifamily Iand Ifriends Ibut Ito Iseek Ia Iprofessional
Iwhose Ijob Iis Ito Iattend Ito Iher Idepressed Icase. IHence, Iher Ineuroticism Iwas Icalm Iand
Istrong Iwilled.
Case IStudy, IMohr: I ICHAPTER I2, INeuroscience: IBiology Iand IBehavior
1. IMichael Iis Ia I22-year-old Icollege Isenior Iwhose IGPA Ihas Ideclined Iwith Ithis Isemester’s
Igrades. I IMichael Iplans Ito Iapply Ito Imedical Ischool Iand Ithinks Ithat Ithe Ilower IGPA Imay Iprevent
Ihis Iacceptance Ito Imedical Ischool. I IFor Ithe Ilast I2 Iweeks, IMichael Ihas Iskipped Imost Iclasses
Ibecause Ihe Ihas Iinsomnia Iand Ifatigue. I IMichael Iis Inow Ivery Idepressed Iand Ihas Ibeen Ithinking
Iof Isuicide. I IHe Itook Ia Iloaded Igun Ifrom Ihis Ifather’s Igun Icabinet Iand Ithen Iwrote Ia Isuicide Inote
Ito Ihis Ifamily. I IAt Ithe Ilast Imoment, Ihe Itelephoned I911 Iand Itold Ithem Iof Ihis Isuicide Iplan. I IThe
Ipolice Icame, Itook Ithe Igun Iaway, Iand Ithen Itook IMichael Ito Ithe Icity Ihospital Ito Ibe Iadmitted Ifor
Ipsychiatric Itreatment. I I IIn Ithe Iadmission Iinterview Iwith Ithe Ipsychiatric Inurse, IMichael Isaid
Ithat Ihis Ipastor Ithought Ithat Ionly Iweak-willed Ipeople Iexperienced Idepression Iand Ithat Iit Iwas Ia
Ipunishment Ifor Ipersonal Isins Iand Ithe Isins Iof Ione’s Iancestors. I IMichael Itold Ithe Inurse Ithat Ihe
Imust Ibe Iweak-willed Iand Iwill Inever Ibe Iable Ito Iaccomplish Ianything. I IThe Ipsychiatric Inurse
Iexplained Ithat Imultiple Ifactors Iare Ithe Icause Iof Idepression. I IThe Inurse Itold IMichael Ithat Ione
Itheory Iholds Ithat Ian Iimbalance Iof Ineurotransmitters, Ior Ichemical Imessengers Iof Ithe Ibrain,
Ioccurs Iin Idepression. I INeurotransmitters Iinfluence Ithe Iindividual’s Iemotions, Ithoughts, Iand
Isubsequent Ibehavior. I IRecent Iresearch Iimplies Ithat Ineurobiology, Iheredity, Ias Iwell Ias
IPsychological Iand Ienvironmental Ifactors Imay Ibe Iinvolved Iin Ithe Idevelopment Iand
Iprogression Iof Idepression. I I(Learning IObjectives: I5, I6)
A-Will IMichael Ithink Ithat Ithe Ipsychiatric Inurse’s Iexplanation Ifor Ithe Icause Iof Idepression
Iis Imore Icorrect Ithan Ithat Iof Ihis Ipastor?
➢ No. IIt Iis Iindeed Idifficult Ifor IMichael Ito Iaccept Ithe Idoctor’s Iopinion Isince Ibefore Ihe
Ifell Isick, Ihe Ihad Iinformation Ifrom Ithe Ipastor Ion Idepression Ion Iwhich Ihe Isolely
Ibelieved Iand Inow Ihe Iis Ia Iliving Iprove.
B-Michael Iasks Ithe Inurse Iwhy Ihe Ihas Ito Ihave Ipsychotherapy. IHe Istates Ithat Ihe Ionly Ineeds
Ito Itake Ia Icouple Iof Ipills Ito Iget Ibetter. IHow Ishould Ithe Inurse Irespond Ito IMichael’s Iquestion
Iand Icomment?
, ➢ The Inurse Ihas Ito Iexplain Ito IMichael Iwhy Ihe Ishould Iconsider Ipsychotherapy.
IBecause Iof Ithe Imany Imisconceptions Iabout Ipsychotherapy, Iyou Imay Ibe Ireluctant
Ito Itry Iit Iout. IEven Iif Iyou Iknow Ithe Irealities Iinstead Iof Ithe Imyths, Iyou Imay Ifeel
Inervous Iabout Itrying Iit Iyourself. I
➢ Overcoming Ithat Inervousness Iis Iworth Iit. IThat’s Ibecause Iany Itime Iyour Iquality Iof
Ilife Iisn’t Iwhat Iyou Iwant Iit Ito Ibe, Ipsychotherapy Ican Ihelp. ITaking Ionly Ipills Iwill
Inot Ihelp Ibut Iincrease Ithe Ieffects Ibecause Imost Iof Ithese Imedications Ihave Iside
Ieffects Iwhich Iwould Ihave Ibeen Iavoided Iby Ipsychotherapy.
C-Develop Ian Iassessment Iquestion Ifor Ieach Iof Ithe Ifollowing Ipossible Icauses Iof IMichael’s I
I I Idevelopment Iof Idepression: I IGenetic, IEnvironment Iand IStress.
➢ From Ithe IGeriatric IDepression IScale: I“Do Iyou Iprefer Ito Istay Iat Ihome Irather Ithan
Igoing Iout Iand Idoing Inew Ithings?” IThis Iquestion Iasks Ifor Ia Iyes Ior Ino Ianswer Iand
Irecognizes Ithat Iisolation Iand Iwithdrawal Iare Icommon Isigns Iof Idepression I—
Iespecially Iin Ithe Ielderly.
➢ From Ithe IMADRS: I“How Iis Iyour Isleep?” IAnswers Iinclude: ISleeping Ias Iusual,
Islight Idifficulty, Isleep Ireduced Iby Iat Ileast Itwo Ihours, Ior Igetting Iless Ithan Ithree
Ihours Iof Isleep Iat Inight. IGreater Isleep Idisturbance Isignals Ia Igreater Irisk Ifor
Idepression. I
➢ From Ithe IBeck IDepression IInventory: I“How Iis Iyour Ienergy?” IDeclines Iin Ienergy
Ilevel Iare Ia Icommon Isign Iof Idepression Ithe Imore Isignificant Iyour Ilack Iof Ienergy,
Ithe Ihigher Iyour Idepression Irisk Irating. IPossible Ianswers Ito Ithis Iquestion Iinclude:
IAs Imuch Ienergy Ias Iever, Iless Ienergy Ithan Ibefore, Inot Ienough Ito Ido Imuch, Ior Inot
Ienough Ito Ido Ianything
Case IStudy, IMohr: ICHAPTER I3, IConceptual IFrameworks Iand ITheories:
1. The Istudent Inurse Ihas Ibeen Iassigned Ia I37-year-old Iwoman Iadmitted Ito Ithe Ipsychiatric
Ihospital Iwith Ian Ianxiety Idisorder. I IThis Imorning, Ithe Istudent Inotices Ithat Ithe Iclient Ihas Ia
Itense Ifacial Iexpression Iand Iis Iwalking Iconstantly Iaround Ithe Igroup Iroom. I I IThe Istudent
Iwalked Iover Ito Ithe Iclient Iand Iused Ireflective Icommunication Iby Istating, I“I Isee Ithat Iyou
Ihave Ia Itense Iexpression Iand Iare Iwalking Iaround Ialmost Iall Iof Ithe Itime. I IIs Ithere Isomething
Ithat Iwe Icould Idiscuss?” I IThe Iclient Ireplied Ithat Ishe Ihas Italked Ion Ithe Itelephone Ito Iher
Imother Iwho Iwas Ikeeping Iher Ichildren Iwhile Ishe Iwas Iin Ithe Ihospital. I IThe Iclient Isaid Ithat
Iher Imother Ihad Itold Iher Ithat Ishe Iwas Inot Ia Igood Imother, Iand Ithen Isaid, I“I Iguess II Iam Ia
Ibad Imother, Ibut II Icould Inever Imeasure Iup Ito Imy Imother’s Iexpectations.” I IThe Istudent Ihas
Ilearned Ithat Inegative Iself-talk Ican Igreatly Iaggravate Ianxiety Iand Ilead Ito Idepression. I IThe
Istudent Idecided Ito Iuse Ia Ibehavioral Iintervention Iwith Ithe Iclient Iand Iasked Ithe Iclient Iwho
Iis Ia Igood Iartist Iand Iwhy Ithe Iclient Iliked Ithe Iartist’s Iworks. IThe Istudent Iand Ithe Iclient Ithen
Imade Ia Ilist Iof Iactivities Ithat Ithe Iclient Iliked. IThe Istudent Itaught Ithe Iclient Ito Iengage Iin Ione
Iof Ithese Iactivities Iwhen Ian Iunpleasant Iexperience Ievoked Inegative Ithoughts. I IThe
Ifollowing Iday, Ithe Istudent Idecided Ithat Ithe Iclient Ineeded Isome Icognitive Irestructuring Ifor
Iher Irelationship Iwith Iher Imother. I IThe Istudent Itaught Ithe Iclient Ithat Iduring Idiscussions
Iwith Iher Imother, Ifeelings Iof Iincompetence Imight Ibe Iexperienced Iwhen Ithe Imother Imade
Inegative Icomments. I IThe Iclient Iwas Iinstructed Ithat Iif Iher Imother Imade Inegative
, Icomments Iabout Iparenting, Ishe Iwas Ito Iimmediately Itell Iher Imother Ithat Ishe Iwas Ia Igood
Iparent Ito Iher Ichildren Iand Iterminate Ithe Iconversation Iat Ithe Ifirst Iopportunity. I(Learning
IObjective: I3)
A-Will Ithe Iclient Ibe Iable Ito Ilearn Icognitive Irestructuring Iin Iher Irelationship Iwith Iher
Imother?
➢ Yes, Ishe Iwill Ilearn Ibecause Iby Ikeeping Ipositive Ithought, Iher Icognitive Irestructure
Iwill Idevelop Ito Ithe Ipositive. IBased Ion Ithe Iabove Ifacts Iand Ibehavioral Iintervention
Imade Ibetween Iclient Iand Ithe Istudent Inurse Iit Iis Ipossible Ito Iestablish Ia Igood Iand
Icollaborative Irelationship Iwith Iher Imother. IBesides, Iclient Ican Ialso Ibe Iable Ito Igain
Iof Icognition Ito Imaintain Ia Ifruitful Irelationship Iwith Iher Imother. I I
➢ Anxiety Iis Ia Inormal Ireaction Ito Icertain Isituations. IA Ismall Ilevel Iof Ianxiety Iis
Inormal, Ibut Isevere Ianxiety Ican Ibe Ia Iserious Iproblem. IAcademic Ianxiety Ican
Ibecome Imore Idetrimental Iover Itime Ithan Icommunity-based Ianxiety. IMuch
Ievidence Isupports Ithe Inotion Ithat Isocial Ianxiety Icauses Iimpairment Iin Imany
Idomains Iof Ilife, Isuch Ias Iromantic Irelationships, Ifriendships, Iwork, Iand Iphysical
Ihealth. I
B-How Iwill Iengaging Iin Iactivities Ihelp Ithe Iclient Iwith Iher Ianxiety?
➢ Based Ion Ithe Ieveryday Ibehavior Iof Iclient Ithe Ipatient Inurse Idecided Ia Iplan Ithat Ihow
Ito Isolve Ithis Iproblem. IThen Ithe Istudent Inurse Iasks Iclient Iwhat Ihappened? IFrom
Ithis Inurse Ilearn Ithat Isome Iphone Icall Ireceived Ifrom Ihome Irelative Ito Inegative
Ithought. IThe Istudent Ihas Ilearned Ithat Inegative Iself-talk Ican Igreatly Iaggravate
Ianxiety Iand Ilead Ito Idepression. IThat Iis Iwhy Inurse Idecided Isome Iplan Iand Iasked Ito
Ieach Iclient Iwho Igreat Iartist Itheir Ifavorite Iitems Ior Iactivities Iare. I
➢ Then, Iaccording Ito Ithat Inurse Ican Iable Ito Iengage Ithe Iclient Iinto Iher Ifavorite
Ihobbies, Iwhen Ian Iunpleasant Iexperience Ievoked Inegative Ithought. IThe Inext Iday,
Ithe Istudent Idecided Ithat Ithe Iclient Ihas Ibeen Igaining Isome Icognitive Irestructuring
Ifor Iher Irelationship Iwith Iher Imother. I
➢ Finally, Ithe Istudent Inurse Ihad Iadvice Ito Ithe Iclient Ithat Iin Ifuture Iwhen Iher Imother
Imade Isome Inegative Ithought Ior Inarration Iregarding Iparenting Ishe Ishould
Iimmediately Iand Iconfidently Itell Iher Imother Ithat Ishe Iwas Ia Igood Iparent Ito Iher
Ichildren Iand Iclosed Ithis Iconversation Iimmediately Iand Iif Ipossible Idivert Ithe Itopic
Ito Isome Iextent. ISo, Ithat Imental Ithought Ican Ibe Idiversified Ito Isome Iextent Icould Ibe
Iable Ito Ihelp Ito Iprevent Ianxiety. I I
Case IStudy, IMohr: ICHAPTER I4, IEvidence-Based IPractice I
1. Jessica, Ia I17-year-old Igirl Iwho Icame Iwith Iher Ifamily Ifrom IRomania Ito Ithe IUnited IStates
I10 Iyears Iago, Iis Ibrought Ito Ithe Imental Ihealth Iclinic Iby Iher Imother. I IAt Ithe Iadmission
Ipsychiatric Iinterview, Ithe Imother Istated Ithat IJessica Ihas Ibeen Isaying Ifor I6 Imonths Ithat
Ialiens Ihave Ibeen Iconducting Iexperiments Ion Iher Iand Iwill Isoon Itake Iher Iin Ia Ispaceship Ito
Itheir Iplanet. I IJessica Iis Ioften Iawake Iat Inight Iand Iroams Ithe Ihouse Iwith Ia Ihammer Iand
Isharp Iknife, Isearching Ifor Ialiens. IJessica’s Imother Isays Ithat Ishe Ifears Ithat Isome Inight
IJessica Iwill Iharm Ia Ifamily Imember Iwhom Ishe Ibelieves Ito Ibe Ian Ialien. I IThe Imother Ithen
I I I
Case IStudy, IMohr: ICHAPTER I1, IIntroduction Ito IPsychiatric–Mental IHealth INursing I
1. Karen Iis Ia I25-year-old Iwhite Iwoman Iwho Ilives Ialone Iin Ian Iapartment Iwith Iher Idog. IKaren
Ihas Ibeen Idivorced Ifor I2 Iyears Iand Iis Itaking IProzac Iprescribed Iby Iher Ipsychiatrist Ifor
Idepression. I IKaren Iand Iher Iboyfriend Ihad Ibeen Idiscussing Imarriage Iuntil Ihe Itold Iher Ithat
Ihe Iwanted Ito Iend Itheir Irelationship. I IKaren Ibecame Ieven Imore Idepressed Iand Icould Inot
Iwork Ifor Ia Iweek. I IKaren Ireturned Ito Iwork, Irefusing Ito Idiscuss Iher Iissues Iwith Ifamily,
Ifriends, Ior Icoworkers. IShe Idid, Ihowever, Imake Ian Iappointment Ito Isee Ia Ipsychiatric Inurse
Ipractitioner. I IKaren Itold Ithe Inurse Ithat Ishe Iwas Imaking Isome Ichanges Iin Iher Ilife. I IKaren
Isaid Ithat Ishe Iand Ia Igirlfriend Iwere Ijoining Ia Igym Iprogram Ifor Iworkouts Iand Ia Isocial Igroup
Ifor Iyoung Imen Iand Iwomen. I IKaren Istated Ithat Ishe Irealizes Ithat Iher Iformer Iboyfriend Ihad
Inot Ibeen Icommitted Ito Iher, Iand Ishe Ianticipates Imeeting Iand Idating Iother Iyoung Imen Ifrom
Ithe Iadult Isocial Igroup. I IKaren Ialso Isaid Ithat Ishe Ithinks Ithat Ithe Igym Iexercise Iwill Ibe
Ibeneficial Ito Iher Imentally Iand Iphysically. I(Learning IObjectives: I1, I4)
A-How Iwill Ithe Ipsychiatric Inurse Iassess Iif IKaren Ihas Imade Iprogress Itoward Iself-
realization? I
➢ Karen Ihad Isuffered Ifrom Idepression Iwhich Iis Ia Iform Iof Imental Idisorder Ibecause Iof
Idivorce Iand Ia Ibroken Irelationship Iwith Iher Iboyfriend. IThis Isituation Iaccording Ito
IHypocritical Iin I15th Icentury IBC, Iupholds Ithe Ibrain Ias Ithe Iorgan Iof Iconsciousness;
Ithis Ioccurs Iwhen Iboth Inormal Iand Iabnormal Ibehavior Iarise Ifrom Ithe Ibrain. I
➢ The Ipsychiatric Inurse Ican Iassess Iif IKaren Ihas Imade Iprogress Itowards Iself-
realization Iby Icommitting Ito Idiagnosing Iand Itreating Iher Iresponses Ito Ithe
Iproblems Ithat Icaused Iher Ipsychiatric Idisorder. IIn-addition, Ithe Inurse Ican Imake
Iassessment Ibased Ion IKaren’s Ipsychoanalytical Idisposition Isuch Ias: Itransference,
Idefense Imechanism, Icountertransference, Iacting Iout, Idenial Iof Ithe Ireality Ibefallen
Iher Iand Iprojection. I
B-Identify Istrengths Ithat IKaren Ihas Ifor Iprogress Iin Ipersonal Igrowth. IThe Istrengths IKaren
Ihas Ifor Iprogress Iin Ipersonal Igrowth Iinclude Ithe Ifollowings:
➢ Her Icognitive Ibehavioral Iresponses Ishowed Ioptimism Itowards Ia Ibetter Ilife Ias Iwell
Ias Ifighting Iagainst Iher Idepressed Istate. IHence, Iher Iwillingness Ito Idate Iyounger
Imen.
➢ Karen Isought Iimmediate Imedical Iattention Iwhere Ishe Iwas Iadministered Iwith
IProzac Ito Ihelp Imitigate Iher Idepression Istate.
➢ Ability Ito Imake Iuse Iof Isocial Isupport, Ithat Iis, Ishe Ivisited Ia Ipsychiatric Inurse, Isocial
Igroup Iand Iregistered Iin Ia Igym.
, ➢ She Iwas Irealistic Iabout Iher Isituation, Itherefore Imade Iherself Iready Ito Iface Ithe
Ireality Ibefore Iher.
C-Karen Ihas Ibeen Iseeking Itreatment Ifor Iher Idepression. IAnalyze Ithe Ifactors Ithat Imight
Icontribute Ito IKaren’s Ireluctance Ito Idiscuss Iher Idepression Iwith Iothers.
➢ Karen’s Ireluctance Ito Idiscuss Iher Idepression Iwith Iothers Ihinges Ion Ithe Ifact Ithat Iher
Idepression Iwas Ia Ikind Icalled Isocial Idepression. ISocial Idepression Iis Ia
Ipsychological Idisorder Icaused Iby Iseveral Ifactors Isuch Ias: Iinterpersonal
Irelationship Iwhich Iinvolves Ithe Irelationship Ibetween Ia Iperson Iand Ithe Iinteractions
Iof Iemotions Iof Ieveryone Iexpressed Idirectly Iand Idiscreetly Ito Ieach Iother. I
➢ Another Iis Ia ICommon Iinterpersonal Irelationship, Ithis Iincludes: IFamily, Isocial
Ienvironment I(work Iplace), Iand Iinteraction Iamong Iage Igroups Iand Igenders.
IBecause IKaren Ihad Idivorce Iand Ibroken Irelationship, Ishe Ididn’t Ifeel Isafe Iin Iherself
Idiscussing Iher Idepression Iwith Ifamily Iand Ifriends Ibut Ito Iseek Ia Iprofessional
Iwhose Ijob Iis Ito Iattend Ito Iher Idepressed Icase. IHence, Iher Ineuroticism Iwas Icalm Iand
Istrong Iwilled.
Case IStudy, IMohr: I ICHAPTER I2, INeuroscience: IBiology Iand IBehavior
1. IMichael Iis Ia I22-year-old Icollege Isenior Iwhose IGPA Ihas Ideclined Iwith Ithis Isemester’s
Igrades. I IMichael Iplans Ito Iapply Ito Imedical Ischool Iand Ithinks Ithat Ithe Ilower IGPA Imay Iprevent
Ihis Iacceptance Ito Imedical Ischool. I IFor Ithe Ilast I2 Iweeks, IMichael Ihas Iskipped Imost Iclasses
Ibecause Ihe Ihas Iinsomnia Iand Ifatigue. I IMichael Iis Inow Ivery Idepressed Iand Ihas Ibeen Ithinking
Iof Isuicide. I IHe Itook Ia Iloaded Igun Ifrom Ihis Ifather’s Igun Icabinet Iand Ithen Iwrote Ia Isuicide Inote
Ito Ihis Ifamily. I IAt Ithe Ilast Imoment, Ihe Itelephoned I911 Iand Itold Ithem Iof Ihis Isuicide Iplan. I IThe
Ipolice Icame, Itook Ithe Igun Iaway, Iand Ithen Itook IMichael Ito Ithe Icity Ihospital Ito Ibe Iadmitted Ifor
Ipsychiatric Itreatment. I I IIn Ithe Iadmission Iinterview Iwith Ithe Ipsychiatric Inurse, IMichael Isaid
Ithat Ihis Ipastor Ithought Ithat Ionly Iweak-willed Ipeople Iexperienced Idepression Iand Ithat Iit Iwas Ia
Ipunishment Ifor Ipersonal Isins Iand Ithe Isins Iof Ione’s Iancestors. I IMichael Itold Ithe Inurse Ithat Ihe
Imust Ibe Iweak-willed Iand Iwill Inever Ibe Iable Ito Iaccomplish Ianything. I IThe Ipsychiatric Inurse
Iexplained Ithat Imultiple Ifactors Iare Ithe Icause Iof Idepression. I IThe Inurse Itold IMichael Ithat Ione
Itheory Iholds Ithat Ian Iimbalance Iof Ineurotransmitters, Ior Ichemical Imessengers Iof Ithe Ibrain,
Ioccurs Iin Idepression. I INeurotransmitters Iinfluence Ithe Iindividual’s Iemotions, Ithoughts, Iand
Isubsequent Ibehavior. I IRecent Iresearch Iimplies Ithat Ineurobiology, Iheredity, Ias Iwell Ias
IPsychological Iand Ienvironmental Ifactors Imay Ibe Iinvolved Iin Ithe Idevelopment Iand
Iprogression Iof Idepression. I I(Learning IObjectives: I5, I6)
A-Will IMichael Ithink Ithat Ithe Ipsychiatric Inurse’s Iexplanation Ifor Ithe Icause Iof Idepression
Iis Imore Icorrect Ithan Ithat Iof Ihis Ipastor?
➢ No. IIt Iis Iindeed Idifficult Ifor IMichael Ito Iaccept Ithe Idoctor’s Iopinion Isince Ibefore Ihe
Ifell Isick, Ihe Ihad Iinformation Ifrom Ithe Ipastor Ion Idepression Ion Iwhich Ihe Isolely
Ibelieved Iand Inow Ihe Iis Ia Iliving Iprove.
B-Michael Iasks Ithe Inurse Iwhy Ihe Ihas Ito Ihave Ipsychotherapy. IHe Istates Ithat Ihe Ionly Ineeds
Ito Itake Ia Icouple Iof Ipills Ito Iget Ibetter. IHow Ishould Ithe Inurse Irespond Ito IMichael’s Iquestion
Iand Icomment?
, ➢ The Inurse Ihas Ito Iexplain Ito IMichael Iwhy Ihe Ishould Iconsider Ipsychotherapy.
IBecause Iof Ithe Imany Imisconceptions Iabout Ipsychotherapy, Iyou Imay Ibe Ireluctant
Ito Itry Iit Iout. IEven Iif Iyou Iknow Ithe Irealities Iinstead Iof Ithe Imyths, Iyou Imay Ifeel
Inervous Iabout Itrying Iit Iyourself. I
➢ Overcoming Ithat Inervousness Iis Iworth Iit. IThat’s Ibecause Iany Itime Iyour Iquality Iof
Ilife Iisn’t Iwhat Iyou Iwant Iit Ito Ibe, Ipsychotherapy Ican Ihelp. ITaking Ionly Ipills Iwill
Inot Ihelp Ibut Iincrease Ithe Ieffects Ibecause Imost Iof Ithese Imedications Ihave Iside
Ieffects Iwhich Iwould Ihave Ibeen Iavoided Iby Ipsychotherapy.
C-Develop Ian Iassessment Iquestion Ifor Ieach Iof Ithe Ifollowing Ipossible Icauses Iof IMichael’s I
I I Idevelopment Iof Idepression: I IGenetic, IEnvironment Iand IStress.
➢ From Ithe IGeriatric IDepression IScale: I“Do Iyou Iprefer Ito Istay Iat Ihome Irather Ithan
Igoing Iout Iand Idoing Inew Ithings?” IThis Iquestion Iasks Ifor Ia Iyes Ior Ino Ianswer Iand
Irecognizes Ithat Iisolation Iand Iwithdrawal Iare Icommon Isigns Iof Idepression I—
Iespecially Iin Ithe Ielderly.
➢ From Ithe IMADRS: I“How Iis Iyour Isleep?” IAnswers Iinclude: ISleeping Ias Iusual,
Islight Idifficulty, Isleep Ireduced Iby Iat Ileast Itwo Ihours, Ior Igetting Iless Ithan Ithree
Ihours Iof Isleep Iat Inight. IGreater Isleep Idisturbance Isignals Ia Igreater Irisk Ifor
Idepression. I
➢ From Ithe IBeck IDepression IInventory: I“How Iis Iyour Ienergy?” IDeclines Iin Ienergy
Ilevel Iare Ia Icommon Isign Iof Idepression Ithe Imore Isignificant Iyour Ilack Iof Ienergy,
Ithe Ihigher Iyour Idepression Irisk Irating. IPossible Ianswers Ito Ithis Iquestion Iinclude:
IAs Imuch Ienergy Ias Iever, Iless Ienergy Ithan Ibefore, Inot Ienough Ito Ido Imuch, Ior Inot
Ienough Ito Ido Ianything
Case IStudy, IMohr: ICHAPTER I3, IConceptual IFrameworks Iand ITheories:
1. The Istudent Inurse Ihas Ibeen Iassigned Ia I37-year-old Iwoman Iadmitted Ito Ithe Ipsychiatric
Ihospital Iwith Ian Ianxiety Idisorder. I IThis Imorning, Ithe Istudent Inotices Ithat Ithe Iclient Ihas Ia
Itense Ifacial Iexpression Iand Iis Iwalking Iconstantly Iaround Ithe Igroup Iroom. I I IThe Istudent
Iwalked Iover Ito Ithe Iclient Iand Iused Ireflective Icommunication Iby Istating, I“I Isee Ithat Iyou
Ihave Ia Itense Iexpression Iand Iare Iwalking Iaround Ialmost Iall Iof Ithe Itime. I IIs Ithere Isomething
Ithat Iwe Icould Idiscuss?” I IThe Iclient Ireplied Ithat Ishe Ihas Italked Ion Ithe Itelephone Ito Iher
Imother Iwho Iwas Ikeeping Iher Ichildren Iwhile Ishe Iwas Iin Ithe Ihospital. I IThe Iclient Isaid Ithat
Iher Imother Ihad Itold Iher Ithat Ishe Iwas Inot Ia Igood Imother, Iand Ithen Isaid, I“I Iguess II Iam Ia
Ibad Imother, Ibut II Icould Inever Imeasure Iup Ito Imy Imother’s Iexpectations.” I IThe Istudent Ihas
Ilearned Ithat Inegative Iself-talk Ican Igreatly Iaggravate Ianxiety Iand Ilead Ito Idepression. I IThe
Istudent Idecided Ito Iuse Ia Ibehavioral Iintervention Iwith Ithe Iclient Iand Iasked Ithe Iclient Iwho
Iis Ia Igood Iartist Iand Iwhy Ithe Iclient Iliked Ithe Iartist’s Iworks. IThe Istudent Iand Ithe Iclient Ithen
Imade Ia Ilist Iof Iactivities Ithat Ithe Iclient Iliked. IThe Istudent Itaught Ithe Iclient Ito Iengage Iin Ione
Iof Ithese Iactivities Iwhen Ian Iunpleasant Iexperience Ievoked Inegative Ithoughts. I IThe
Ifollowing Iday, Ithe Istudent Idecided Ithat Ithe Iclient Ineeded Isome Icognitive Irestructuring Ifor
Iher Irelationship Iwith Iher Imother. I IThe Istudent Itaught Ithe Iclient Ithat Iduring Idiscussions
Iwith Iher Imother, Ifeelings Iof Iincompetence Imight Ibe Iexperienced Iwhen Ithe Imother Imade
Inegative Icomments. I IThe Iclient Iwas Iinstructed Ithat Iif Iher Imother Imade Inegative
, Icomments Iabout Iparenting, Ishe Iwas Ito Iimmediately Itell Iher Imother Ithat Ishe Iwas Ia Igood
Iparent Ito Iher Ichildren Iand Iterminate Ithe Iconversation Iat Ithe Ifirst Iopportunity. I(Learning
IObjective: I3)
A-Will Ithe Iclient Ibe Iable Ito Ilearn Icognitive Irestructuring Iin Iher Irelationship Iwith Iher
Imother?
➢ Yes, Ishe Iwill Ilearn Ibecause Iby Ikeeping Ipositive Ithought, Iher Icognitive Irestructure
Iwill Idevelop Ito Ithe Ipositive. IBased Ion Ithe Iabove Ifacts Iand Ibehavioral Iintervention
Imade Ibetween Iclient Iand Ithe Istudent Inurse Iit Iis Ipossible Ito Iestablish Ia Igood Iand
Icollaborative Irelationship Iwith Iher Imother. IBesides, Iclient Ican Ialso Ibe Iable Ito Igain
Iof Icognition Ito Imaintain Ia Ifruitful Irelationship Iwith Iher Imother. I I
➢ Anxiety Iis Ia Inormal Ireaction Ito Icertain Isituations. IA Ismall Ilevel Iof Ianxiety Iis
Inormal, Ibut Isevere Ianxiety Ican Ibe Ia Iserious Iproblem. IAcademic Ianxiety Ican
Ibecome Imore Idetrimental Iover Itime Ithan Icommunity-based Ianxiety. IMuch
Ievidence Isupports Ithe Inotion Ithat Isocial Ianxiety Icauses Iimpairment Iin Imany
Idomains Iof Ilife, Isuch Ias Iromantic Irelationships, Ifriendships, Iwork, Iand Iphysical
Ihealth. I
B-How Iwill Iengaging Iin Iactivities Ihelp Ithe Iclient Iwith Iher Ianxiety?
➢ Based Ion Ithe Ieveryday Ibehavior Iof Iclient Ithe Ipatient Inurse Idecided Ia Iplan Ithat Ihow
Ito Isolve Ithis Iproblem. IThen Ithe Istudent Inurse Iasks Iclient Iwhat Ihappened? IFrom
Ithis Inurse Ilearn Ithat Isome Iphone Icall Ireceived Ifrom Ihome Irelative Ito Inegative
Ithought. IThe Istudent Ihas Ilearned Ithat Inegative Iself-talk Ican Igreatly Iaggravate
Ianxiety Iand Ilead Ito Idepression. IThat Iis Iwhy Inurse Idecided Isome Iplan Iand Iasked Ito
Ieach Iclient Iwho Igreat Iartist Itheir Ifavorite Iitems Ior Iactivities Iare. I
➢ Then, Iaccording Ito Ithat Inurse Ican Iable Ito Iengage Ithe Iclient Iinto Iher Ifavorite
Ihobbies, Iwhen Ian Iunpleasant Iexperience Ievoked Inegative Ithought. IThe Inext Iday,
Ithe Istudent Idecided Ithat Ithe Iclient Ihas Ibeen Igaining Isome Icognitive Irestructuring
Ifor Iher Irelationship Iwith Iher Imother. I
➢ Finally, Ithe Istudent Inurse Ihad Iadvice Ito Ithe Iclient Ithat Iin Ifuture Iwhen Iher Imother
Imade Isome Inegative Ithought Ior Inarration Iregarding Iparenting Ishe Ishould
Iimmediately Iand Iconfidently Itell Iher Imother Ithat Ishe Iwas Ia Igood Iparent Ito Iher
Ichildren Iand Iclosed Ithis Iconversation Iimmediately Iand Iif Ipossible Idivert Ithe Itopic
Ito Isome Iextent. ISo, Ithat Imental Ithought Ican Ibe Idiversified Ito Isome Iextent Icould Ibe
Iable Ito Ihelp Ito Iprevent Ianxiety. I I
Case IStudy, IMohr: ICHAPTER I4, IEvidence-Based IPractice I
1. Jessica, Ia I17-year-old Igirl Iwho Icame Iwith Iher Ifamily Ifrom IRomania Ito Ithe IUnited IStates
I10 Iyears Iago, Iis Ibrought Ito Ithe Imental Ihealth Iclinic Iby Iher Imother. I IAt Ithe Iadmission
Ipsychiatric Iinterview, Ithe Imother Istated Ithat IJessica Ihas Ibeen Isaying Ifor I6 Imonths Ithat
Ialiens Ihave Ibeen Iconducting Iexperiments Ion Iher Iand Iwill Isoon Itake Iher Iin Ia Ispaceship Ito
Itheir Iplanet. I IJessica Iis Ioften Iawake Iat Inight Iand Iroams Ithe Ihouse Iwith Ia Ihammer Iand
Isharp Iknife, Isearching Ifor Ialiens. IJessica’s Imother Isays Ithat Ishe Ifears Ithat Isome Inight
IJessica Iwill Iharm Ia Ifamily Imember Iwhom Ishe Ibelieves Ito Ibe Ian Ialien. I IThe Imother Ithen
