PSYCHIATRIC NURSING

SEMINAR ON

PSYCHOSOCIAL THERAPIES

COGNITIVE THERAPY
BIOFEEDBACK
PLAY THERAPY
MUSIC THERAPY
GROUP THERAPY

SUBMITTED TO SUBMITTED BY
Mrs. ANN MARY OOMMEN Ms. GOPIKA. S
PROFESSOR 1ST YEAR MSC NURSING
KIMS COLLEGE OF NURSING KIMS COLLEGE OF NURSING

SUBMITTED ON

04.08.2022

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 INDEX
SI.NO CONTENT PAGE NUMBER

1 INTRODUCTION 3

2 COGNITIVE THERAPY 3

3 BIOFEEDBACK 10

4 PLAY THERAPY 15

5 MUSIC THERAPY 18

6 GROUP THERAPY 21

7 RESEARCH ARTICLE 24

8 CONCLUSION 25

9 REFERENCE 25

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INTRODUCTION
Psychosocial treatments include different types of psychotherapy and social and
vocational training that aim to provide support, education and guidance to people with mental
health conditions and their families. They are an effective way to improve quality of life and can
lead to fewer hospitalizations and less difficulties at home, at school and at work. The term
psychosocial refers to an individual’s psychological development in and interaction with their
social environment. Psychosocial treatments (interventions) include structured counseling,
motivational enhancement, case management, care-coordination, psychotherapy and relapse
prevention.

COGNITIVE THERAPY

INTRODUCTION

Cognitive therapies have been extensively studied for the treatment of depression, and cognitive-
behavioral therapies (combining behavioral techniques and cognitive components) are useful for
many anxiety conditions. Cognitive-behavioral therapy is accumulating an evidence base for
children and teenagers with anxiety disorders, down to as young as age 7 or 8 years. Cognitive-
behavioral treatments are evidence-based for children and teens with a variety of anxiety
conditions including obsessive-compulsive disorder. Research on cognitive therapies for
depression has helped establish the long-term benefits of psychotherapy, including fewer side-
effects and better freedom from relapse than is seen with medication treatment. Cognitive
therapy also has demonstrated usefulness as an adjunct to medication for conditions like the
bipolar disorders.

DEFINITION

Cognitive therapies are designed to help people change the way that they think about their
problems. People can deal with problems by learning to change their thoughts or cognitions.

Cognitive therapy is a type of psychotherapy developed by American psychiatrist Aaron

T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies
and was first expounded by Beck in the 1960s

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HISTORICAL BACKGROUND

Cognitive therapy has its roots in the early 1960s research on depression conducted by
Aaron Beck (1963, 1964). Beck had been trained in the Freudian psychoanalytic view of
depression as “anger turned inward.” In his clinical research, he began to observe a common
theme of negative cognitive processing in the thoughts and dreams of his depressed clients (Beck
& Weishaar, 2011). A number of theorists have both taken from and expanded upon Beck’s
original concept. The common theme is the rejection of the passive listening of the
psychoanalytic method in favor of active, direct dialogues with clients (Beck & Weishaar, 2011).
The work of contemporary behavioral therapists has also influenced the evolution of cognitive
therapy. Behavioral techniques such as expectancy of reinforcement and modeling are used
within the cognitive domain.

INDICATIONS FOR COGNITIVE THERAPY

Cognitive therapy was originally developed for use with depression. Today it is used for
a broad range of emotional disorders. The proponents of cognitive therapy suggest that the
emphasis of therapy must be varied and individualized for clients according to their specific
diagnosis, symptoms, and level of functioning. In addition to depression, cognitive therapy may
be used with the following clinical conditions: panic disorder, generalized anxiety disorder,
social phobias, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders,
substance abuse, personality disorders, schizophrenia, couples’ problems, bipolar disorder,
illness anxiety disorder, and somatic symptom disorder

GOALS AND PRINCIPLES OF COGNITIVE THERAPY

Beck and associates (1987) defined the goals of cognitive therapy in the following way.

The client will:

1. Monitor his or her negative, automatic thoughts.

2. Recognize the connections between cognition, affect, and behavior.

3. Examine the evidence for and against distorted automatic thoughts.

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4. Substitute more realistic interpretations for these biased cognitions.

5. Learn to identify and alter the dysfunctional beliefs that predispose him or her to distort
experiences.

Cognitive therapy is highly structured and short term, lasting from 12 to 16 weeks suggested that
if a client does not improve within 25 weeks of therapy, a reevaluation of the diagnosis should be
made. Although therapy must be tailored to the individual, the following principles underlie
cognitive therapy for all clients.

PRINCIPLES

Principle 1. Cognitive therapy is based on an ever-evolving formulation of the client and his or
her problems in cognitive terms.

The therapist identifies the event that precipitated the distorted cognition. Current thinking
patterns that serve to maintain the problematic behaviors are reviewed. The therapist then
hypothesizes about certain developmental events and enduring patterns of cognitive appraisal
that may have predisposed the client to specific emotional and behavioral responses.

Principle 2. Cognitive therapy requires a sound therapeutic alliance.

A trusting relationship between therapist and client must exist for cognitive therapy to
succeed. The therapist must convey warmth, empathy, caring, and genuine positive regard.
Development of a working relationship between therapist and client is an individual process, and
clients with various disorders will require varying degrees of effort to achieve this therapeutic
alliance.

Principle 3. Cognitive therapy emphasizes collaboration and active participation.

Teamwork between therapist and client is emphasized. They decide together what to
work on during each session, how often they should meet, and what homework assignments
should be completed between sessions.

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Principle 4. Cognitive therapy is goal oriented and problem focused.

At the beginning of therapy, the client is encouraged to identify what he or she perceives
to be the problem or problems. With guidance from the therapist, goals are established as
outcomes of therapy. Assistance in problem solving is provided as required as the client comes to
recognize and correct distortions in thinking.

Principle 5. Cognitive therapy initially emphasizes the present.

Resolution of distressing situations that are based in the present usually lead to symptom
reduction. It is therefore of more benefit to begin with current problems and delay shifting
attention to the past until

(1) the client expresses a desire to do so

(2) the work on current problems produces little or no change,

(3) the therapist decides it is important to determine how dysfunctional ideas affecting the
client’s current thinking originated.

Principle 6. Cognitive therapy is educative, aims to teach the client to be his or her own therapist,
and emphasizes relapse prevention.

From the beginning of therapy, the client is taught about the nature and course of his or
her disorder, about the cognitive model (i.e., how thoughts influence emotions and behavior),
and about the process of cognitive therapy. The client is taught how to set goals, plan behavioral
change, and intervene on his or her own behalf.

Principle 7. Cognitive therapy aims to be time limited.

Clients often are seen weekly for a couple of months, followed by a number of biweekly
sessions, then possibly a few monthly sessions. Some clients will want periodic “booster”
sessions every few months.

Principle 8. Cognitive therapy sessions are structured.

Each session has a set structure which includes

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 (1) reviewing the client’s week,

(2) collaboratively setting the agenda for this session,

(3) reviewing the previous week’s session,

(4) reviewing the previous week’s homework,

(5) discussing this week’s agenda items,

(6) establishing homework for next week,

(7) summarizing this week’s session.

This format focuses attention on what is important and maximizes the use of therapy time.

Principle 9. Cognitive therapy teaches clients to identify, evaluate, and respond to their
dysfunctional thoughts and beliefs.

Through gentle questioning and review of data, the therapist helps the client identify his
or her dysfunctional thinking, evaluate the validity of the thoughts, and devise a plan of action.
This is done by helping the client to examine evidence that supports or contradicts the accuracy
of the thought, rather than directly challenging or confronting the belief.

Principle 10. Cognitive therapy uses a variety of techniques to change thinking, mood, and
behavior.

Techniques from various therapies may be used within the cognitive framework.
Emphasis in treatment is guided by the client’s particular disorder and directed toward
modification of the client’s dysfunctional cognitions that are contributing to the maladaptive
behavior associated with their disorder.

BASIC CONCEPTS

Wright and associates (2008) stated, “The general thrust of cognitive therapy is that
emotional responses are largely dependent upon cognitive appraisals of the significance of
environmental cues”. Basic concepts include automatic thoughts and schemas or core beliefs.

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Automatic Thoughts

Automatic thoughts are those that occur rapidly in response to a situation and without
rational analysis. These thoughts are often negative and based on erroneous logic. Beck and
associates (1987) called these thoughts cognitive errors. Following are some examples of
common cognitive errors

Arbitrary Inference

In a type of thinking error known as arbitrary inference, the individual automatically

comes to a conclusion about an incident without the facts to support it, or even sometimes
despite contradictory evidence to support it.

Overgeneralization (Absolutistic Thinking)

Sweeping conclusions are overgeneralizations made based on one incident—a type of

“all or nothing” kind of thinking.

Dichotomous Thinking

An individual who is using dichotomous thinking views situations in terms of all-or-nothing,

black-or-white, or good-or-bad.

Selective Abstraction

A selective abstraction (sometimes referred to as a “mental filter”) is a conclusion that is based

on only a selected portion of the evidence. The selected portion is usually the negative evidence
or what the individual views as a failure, rather than any successes that have occurred

TECHNIQUES OF COGNITIVE THERAPY

The three major components of cognitive therapy are didactic or educational aspects, cognitive
techniques, and behavioral interventions (Sadock & Sadock, 2007; Wright, Thase, & Beck,
2008).

Didactic (Educational) Aspects

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One of the basic principles of cognitive therapy is to prepare the client to eventually become his
or her own cognitive therapist. The therapist provides information to the client about what
cognitive therapy is, how it works, and the structure of the cognitive process. Explanation about
expectations of both client and therapist is provided. Reading assignments are given in order to
reinforce learning. Some therapists use audiotape or videotape sessions to teach clients about
cognitive therapy. A full explanation about the relationship between depression (or anxiety, or
whatever maladaptive response the client is experiencing) and distorted thinking patterns is an
essential part of cognitive therapy.

Cognitive Techniques

Strategies used in cognitive therapy include recognizing and modifying automatic thoughts
(cognitive errors) and recognizing and modifying schemas (core beliefs). The following
techniques commonly used in cognitive therapy.

Behavioral Interventions

It is believed that in cognitive therapy, an interactive relationship exists between

cognitions and behavior; that is, that cognitions affect behavior and behavior influences
cognitions. With this concept in mind, a number of interventions are structured for the client to
assist him or her to identify and modify maladaptive cognitions and behaviors.

ROLE OF THE NURSE IN COGNITIVE THERAPY

Many of the techniques used in cognitive therapy are well within the scope of nursing
practice, from generalist through specialist levels. Cognitive therapy requires an understanding
of educational principles and the ability to use problem-solving skills to guide clients’ thinking
through a reframing process. The scope of contemporary psychiatric nursing practice is
expanding, and although psychiatric nurses have been using some of these techniques in various
degrees within their practices for years, it is important that knowledge and skills related to this
type of therapy be promoted further. The value of cognitive therapy as a useful and cost-effective
tool has been observed in a number of inpatient and community outpatient mental health setting

CONCLUSION

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Aaron Beck is credited with developing cognitive therapy and his approach remains widely used
in the treatment of depression. Cognitive schemas, methods for organizing the way that we view
the world, have evolved into a distorted perception. Examples of these beliefs include
minimizing personal accomplishments. In other words, after a major accomplishment, a client
may state that “anybody could have succeeded,” thus minimizing his or her own success. A
cognitive therapist would draw attention to this faulty reasoning of the client. In other words, the
therapist would challenge the validity of the statement. Therapy often includes a combination of
homework assignments over a series of sessions. In the treatment of depression, a cognitive
therapist would assign homework requiring the client to write down automatic thoughts, or the
habitual thoughts, that precede feelings of depression.

BIOFEED BACK

INTRODUCTION

Biofeedback is an evidence-based approach to enhancing personal awareness and control

over body and mind. Biofeedback combines the values of the complementary and alternative
medicine movement with the biotechnology of modern scientific medicine. The basic
biofeedback paradigm suggests that whenever we provide a human being with feedback about a
biologic process, that feedback enables the individual to increase awareness of the process and
gain conscious control. Biofeedback uses electronic instruments to monitor and feedback
information about physiologic responses.

DEFINITION

A process whereby electronic monitoring of a normally automatic bodily function is used

to train someone to acquire voluntary control of that function.
HISTORY

Clinical biofeedback emerged as a discipline in the late 1950’s. Since that time, its
clinical usefulness and applicability to an array of health conditions have been appreciated by a
growing number of practitioners. Early laboratory experiments with biofeedback showed
concretely the strong link between the mind and body. Subjects of these investigations
demonstrated the ability to alter body functions such as brain waves and heart rate, which were

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previously believed to be outside of conscious control. Simply stated, biofeedback is a process
through which people are taught to improve their health and performance by using signals from
their own bodies

GOAL

(1) Adopting a holistic view of mind, body and spirit

(2) Assigning an active role to the patient in the healing process

(3) Emphasizing the inherent healing power of the living organism

(4) Encouraging lifestyle and habit changes as tools to optimize health

(5) Avoiding invasive treatments that crush disease but harm the patient.

BIOFEEDBACK MODALITIES

Biofeedback provides individuals with information about their performance and, in this sense,
plays an increasingly important part of American diet, exercise

Electromyograph

The electromyograph (EMG) uses surface electrodes to detect muscle action potentials from
underlying skeletal muscles. At least two (and usually three) precious metal electrodes,
designated active and reference, are needed to measure the EMG signal. Clinicians place the
active electrode(s) over a target muscle and the reference electrode over a less electrically active
site. Since the electrodes should detect different amounts of EMG activity (the active electrode(s)
should detect more energy), a voltage should develop between them.

Skin temperature

A feedback thermometer detects skin temperature with a thermistor (temperature-sensitive

resistor) that is usually attached to a finger or toe. Skin temperature mainly reflects arteriole
diameter. Hand warming and hand cooling are produced by separate mechanisms and their
regulation involves different skills. Increased sympathetic activation associated with anxiety and
hypervigilance can produce vasoconstriction and hand cooling. In temperature biofeedback, a

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patient watches temperature displays with at least one-tenth of a degree resolution that are
updated every few seconds.

Electrodermograph

An electrodermograph measures skin electrical activity directly (skin conductance and skin
potential) and indirectly (skin resistance) using electrodes placed over the digits or hand and
wrist. Orienting responses to unexpected stimuli, arousal and worry, and cognitive activity can
increase eccrine sweat gland activity.

Electroencephalograph

An electroencephalograph uses precious metal electrodes to detect a voltage between at least two
electrodes located on the scalp, The EEG records both excitatory postsynaptic potentials (EPSPs)
and inhibitory postsynaptic potentials (IPSPs) that largely occur in dendrites in pyramidal cells
located in macro columns, several millimeters in diameter, in the upper cortical layers. EEG
biofeedback, which is also called neurofeedback, monitors both slow and fast cortical potentials.

Respiration

A pneumography or respiratory strain gauge uses a flexible sensor band that is placed around the
chest, abdomen, or both. The strain gauge method can provide feedback about the relative
expansion/contraction of the chest and abdomen, and measure respiration rate. Strain gauge
biofeedback has two limitations: measurements are in relative units and breathing mechanics can
look correct while end-tidal CO2 and respiratory sinus arrhythmia (RSA) are reduced due to
excessive effort and while heart rate changes are out of phase with the breathing cycle. Two
identical respiration curves can be associated with very different patterns of heart rate variability.

STEPS

The effectiveness of biofeedback in the treatment of physical and mental health problems has
undergone considerable scientific scrutiny. A rating system for the efficacy for biofeedback was
created and adopted by the Boards of Directors of the Association for Applied Psychophysiology
(AAPB) and the International Society for Neuronal Regulation (ISNR).

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The five levels are listed below from strongest to weakest efficacy.

LEVEL 5: EFFICACIOUS AND SPECIFIC

The investigational treatment must be shown to be statistically superior to credible sham

therapy, pill, or alternative bona fide treatment in at least two independent research settings.
Includes: Urinary incontinence in females was assigned to this category.

LEVEL 4: EFFICACIOUS

Six criteria had to be met in order for this level of efficacy to be assigned.

1. In a comparison with a no-treatment control group, alternative treatment group, or

sham (placebo) control using randomized assignment, the investigational treatment is shown to
be statistically significantly superior to the control condition or the investigational treatment is
equivalent to a treatment of established efficacy in a study with sufficient power to detect
moderate differences.

2. The studies were conducted with a population treated for a specific problem, for whom
inclusion criteria are delineated in a reliable, operationally defined manner.

3. The study used valid and clearly specified outcome measures related to the problem
being treated.

4. The data are subjected to appropriate data analysis.

5. The diagnostic and treatment variables and procedures are clearly defined in a manner
that permits replication of the study by independent researchers.

6. The superiority or equivalence of the investigational treatment has been shown in at

least two independent research settings. Meeting these criteria were: Anxiety ,Attention Deficit
etc.

LEVEL 3: PROBABLY EFFICACIOUS

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 This designation requires multiple observational studies, clinical studies, wait list-
controlled studies, and within subject and intra-subject replication studies that demonstrate
efficacy. Includes: Alcoholism/Substance Abuse, Arthritis, Chronic Pain

LEVEL 2: POSSIBLY EFFICACIOUS

This designation requires at least one study of sufficient statistical power with well
identified outcome measures, but lacks randomized assignment to a control condition internal to
the study. Includes: Asthma , Cancer and HIV , Effect on Immune Function

LEVEL 1: NOT EMPIRICALLY SUPPORTED

This designation includes applications supported by anecdotal reports and/or case studies
in non-peer reviewed venues. Includes: Autism , Eating Disorders

CONTRAINDICATIONS

While biofeedback has a remarkable safety record, there are several disorders and conditions
where it is contraindicated or where considerable caution is required. When a patient requests
biofeedback for a medical condition like hypertension, a biofeedback therapist should require a
current evaluation by the patient’s health-care provider and a report of these findings to
determine whether biofeedback is appropriate. Where biofeedback is indicated, the biofeedback
therapist should regularly communicate with the health-care provider concerning patient
progress. In addition, Moss advocates comprehensive evaluation by the biofeedback therapist,
including identification of the presenting problem, medical and psychosocial histories,
assessment of the patient’s risk for suicide and homicide, well-lifestyle, spirituality, diagnosis,
and often a psychophysiological stress profile (PSP) before deciding whether biofeedback is
appropriate. Such an evaluation also enables better selection of specific biofeedback training
modalities and objectives.

NURSES RESPONSIBILITY
 Determine health problem for which biofeedback treatment is sought.
 Interview patient for a health history; include the specific health condition.

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  Assess abilities for carrying out current medical regimen and behavioural intervention.
Assess cultural preferences for behavioural treatments.
 Discuss rationale for biofeedback, type of feedback, and behavioural intervention.
 Explain that the role of the nurse is to provide ten 50-minute sessions once a week, using
the biofeedback instrument to supply physiological information.
 Explain that the patient is the major factor in the successful use of biofeedback and that it
is important to continue to keep a log of the health problem, including home practice
sessions. The patient should consult the physician if other health problems occur.
 Open the session with a 20-minute review of the health-problem log, stressors, and ways
used for coping in the past week; provide counselling for adaptive coping.
 Apply sensors and earphones and let the patient practice relaxation for 20 minutes while
watching the display. Quietly leave the room after the patient masters the technique.
CONCLUSION

Nurses are ideal professionals to provide biofeedback because of their knowledge of

physiology, psychology, and health and illness states. However, to use biofeedback they need to
acquire special information, skills, and equipment. It is recommended that information be
gained from classes and workshops available in many locations in the United States, a few other
countries, and online. Nurses using biofeedback should become certified by the Biofeedback
Certification International Alliance which offers certifications in general biofeedback,
neurofeedback, and pelvic muscle dysfunction biofeedback. Biofeedback is based on holistic
self-care perspectives in which the mind and body are not separated, and people can learn ways
to improve their health and performance. Biofeedback therapists use instruments and teach self-
regulation strategies to help individuals to increase voluntary control over their internal
physiological and mental processes.

PLAY THERAPY

INTRODUCTION

Play therapy refers to a range of methods of capitalizing on children's natural urge to explore and
harnessing it to meet and respond to the developmental and later also their mental health needs.

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It is also used for forensic or psychological assessment purposes where the individual is too
young or too traumatized to give a verbal account of adverse, abusive or potentially criminal
circumstances in their life.

Play therapy is extensively acknowledged by specialists as an effective intervention in

complementing children's personal and inter-personal development. Play and play therapy are
generally employed with children aged six months through late adolescence and young
adulthood.

DEFINITION

Play therapy is a form of counseling or psychotherapy that uses play to communicate with and
help people, especially children, to prevent or resolve psychosocial challenges. This is thought to
help them towards better social integration, growth and development

Play therapy can also be used as a tool of diagnosis. A play therapist observes a client
playing with toys (play-houses, pets, dolls, etc.) to determine the cause of the disturbed behavior.
The objects and patterns of play, as well as the willingness to interact with the therapist, can be
used to understand the underlying rationale for behavior both inside and outside the session.

Play therapy is generally employed with children aged 3 through 11 and provides a way
for them to express their experiences and feelings through a natural, self-guided, self-healing
process. As children’s experiences and knowledge are often communicated through play, it
becomes an important vehicle for them to know and accept themselves and others.

HISTORY

Play has been recognized as important since the time of Plato (429-347 B.C.) who
reportedly observed, “you can discover more about a person in an hour of play than in a year of
conversation.” In the eighteenth-century Rousseau (1762/1930), in his book ‘Emile’ wrote about
the importance of observing play as a vehicle to learn about and understand children.

Friedrich Frobel, in his book The Education of Man (1903), emphasized the importance of
symbolism in play. He observed, “play is the highest development in childhood, for it alone is
the free expression of what is in the child’s soul…. children’s play is not mere sport. It is full of
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meaning and import.” Hermine Hug-Hellmuth (1921) formalized the play therapy process by
providing children with play materials to express themselves and emphasize the use of the play
to analyze the child. In 1919, Melanie Klein (1955) began to implement the technique of using
play as a means of analyzing children under the age of six.

MODELS OF PLAY THERAPY

Play therapy can be divided into two basic types:

Nondirective and Directive.

Nondirective play therapy

Nondirective play therapy, also called client-centered and unstructured play therapy, is
guided by the notion that if given the chance to speak and play freely under optimal therapeutic
conditions, troubled children and young people will be able to resolve their own problems and
work toward their own solutions. In other words, nondirective play therapy is regarded as non-
intrusive. The hallmark of nondirective play therapy is that it has few boundary conditions and
thus can be used at any age This therapy originates from Carl Rogers's non-directive
psychotherapy and in his characterization of the optimal therapeutic conditions.

Directive play therapy

Directive play therapy is guided by the notion that using directives to guide the child
through play will cause a faster change than is generated by nondirective play therapy. The
therapist plays a much bigger role in directive play therapy. Therapists may use several
techniques to engage the child, such as engaging in play with the child themselves or suggesting
new topics instead of letting the child direct the conversation himself. Stories read by directive
therapists are more likely to have an underlying purpose, and therapists are more likely to create
interpretations of stories that children tell.

In directive therapy games are generally chosen for the child, and children are given
themes and character profiles when engaging in doll or puppet activities. This therapy still leaves
room for free expression by the child, but it is more structured than nondirective play therapy.

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There are also different established techniques that are used in directive play therapy, including
directed secondary therapy and cognitive behavioral play therapy.

INDICATONS

PLAY THERAPY IS EFFECTIVE FOR

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, and disability including autism, psychosis, sensory impairment and intellectual
impairment.

ADVANTAGES

1. Helps overcome resistance to therapy

2. Increases communication and socialization
3. Strengthens quality attachments, enhance relationships
4. Gives patients confidence, and dealing with fears
5. Enhance relationship with family
DISADVNTAGES
1. Requires long-term commitment
2. Children/clients might not like it
3. Children with disorders respond in an aggressive way
4. Can cause stress and anxiety

NURSES ROLE

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  Develop a warm and friendly relationship with the child
 Accept the child as he or she is
 Establishes a feeling of permission relationship and is allowed to recognize feelings of
the child
 Experience and reflects the feelings in expressing and reflecting those feelings back in
such a manner so as to develop a good report with the child
 Maintain a deep respect for child's ability e and to solve his or her problems and give the
child opportunity to do so
 Do not attempt to detect child actions are connections in a manner which may cause
trauma to child’s mind
 Thinking wishing for behaving with the child improves relationship between the therapist
and the child as well as allow the therapist to explore internal issues and problems

 The interaction process improves socialization skills of the child and explores ability

CONCLUSION

Play therapy can be a beneficial approach for children, adolescents, and families. It
allows children to enjoy counselling in a way they can understand, free from stress and the
pressure to understand adult conversation. Counsellors who choose to use this form of therapy
must be properly trained in play therapy. Counsellors who are not trained in this form of therapy
should make referrals to best benefit the child and the family.

MUSIC THERAPY

INTRODUCTION

An interpersonal process in which the therapist uses music to help clients to improve or maintain
their health. It is Used with individuals of all ages and with a variety of conditions.

DEFINITION

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 “Music therapy is a systematic process of intervention wherein the therapist helps the
client to achieve health, using musical experiences and the relationships that develop through
them as dynamic forces of change” (Bruscia 1995).

TYPES

There are two types of music therapy: adaptive and palliative.

1. Adaptive music therapy: Used to help people adapt to their handicaps.

2. Palliative music therapy: Used to treat the symptoms of patients with physical, mental and
emotional disturbances

AIMS AND OBJECTIVES

 To explore their feelings.

 To make positive changes in mood and in their emotional state.
 To develop a sense of control over their lives.
 To learn or implement skills to solve problems.
 To improve socialization.

INDICATIONS

 Psychiatric disorders
 Medical problems
 Physical handicaps
 Sensory impairments
 Developmental disabilities
 Substance abuse
 Communication disorders
 Interpersonal problems

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  Aging

GOAL OF MUSIC THERAPY

 Maintain and develop physical skills, cognitive potential, motivation, speech, language,
non-verbal expression, social skills
 Bring about individual changes in mood, releasing tension, expression of feelings, social
interaction, development of self esteem

ADVANTAGES

1. They regain a sense of control over lives.

2. Music therapy strengthens memories.
3. It improves overall mood and emotional well-being.
4. It helps manage pain without the use of drugs.
5. It helps increase their social interactions with others.
6. Music encourages verbal as well as nonverbal communication and promotes social
interaction and relatedness.
7. Promote positive changes in the wellbeing of an individual.
8. Stimulates relaxation response which can therefore lead to physiological changes in the
body.
9. Processed in both hemispheres of the brain and this stimulation has been shown to help in
development of language and speech functions.
10. Music can drastically change and improve mood; some experts say the rhythm of the
music produces a soothing effect on a subconscious level.
ROLE OF A NURSE

 Therapist is using music to bring about change in client’s behavior or emotional state
 Therapist must be open, and willing to listen
 Encourage client

CONCLUSION

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 Music has a ‘whole-brain effect’ Unlike languages, which are mostly localized to the left-
hemisphere, music activates both the right and the left hemisphere , which explains why the
corpus callosum in musicians is larger and more active than non-musicians (this research has
been heavily supported and cited) Given that neurodegenerative diseases such as dementia,
Alzheimer’s and Creutzfeldt-Jakob Disease with the exception of stroke - affect the whole brain,
music may be more effective in preventing these diseases than language training, for example.
Music does not only alter the cortical level but also the subcortical level It does not only alter
grey matter but white matter also. Music therapy induces activity level changes in ‘almost all’
brain structures and modifies dopamine-pathway ‘circuitry ‘and these are reputable studies with
objective assessment (brain scanning).

GROUP THERAPY

INTRODUCTION

Group therapy, the use of group discussion and other group activities in treatment of
psychological disorders. Despite widespread recognition that the groups to which a person
belongs may affect his attitudes and behavior, the traditional medical emphasis on the privacy of
the doctor–patient relationship slowed general acceptance of group psychotherapy

DEFINITION

Group psychotherapy is a treatment of psychological problems in which two or more patients

interact with each other on both an emotional and cognitive levels in presence of one or more
psychotherapies who serve as catalyst , facilitators or interpreters.

Three major kinds of group are : Group Therapy, Therapeutic groups and Adjunctive Groups

Therapeutic group :

Therapeutic group is a group of patients who meet under the leadership of a therapist to work
together to improve mental and emotional health. Example- group of expectant mothers, group
of people with a chronic illness.

Adjunctive Groups :

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Adjunctive Groups deal with selected needs of a group. For example, for sensory stimulation
allow them to have music therapy, for expression of feelings and emotions through dance
therapy

Group psychotherapy:

Group psychotherapy members gain a personal insight improve their interpersonal relationship,
change destructive behavior and make necessary alteration in their behavior.

INDICATIONS

 Drug addictions
 Anxiety disorders
 Depression
 Eating disorders
 Obsessive compulsive disorder
 Schizophrenia

TYPES OF PSYCHOTHERAPY GROUPS

Psychotherapy groups can be classified in various ways such as

1. Traditional groups
2. Encounter groups
3. Homogenous or heterogenous groups
4. Open or closed groups

Group according to mental illness

Traditional groups

Traditional groups include the patient with mental illness and are from the hospital inpatient
department. In the didactic group therapy, lecture is given to the patient along with some film
show, like in the case of excessive drinking or use of drugs.

Encounter Groups

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Encounter group is a form of small group in which the individual learns how his feelings and
behavior affect him and others. This group is not necessarily a group with mental illness. The
individual may have some coping difficulty which he would like to resolve at right time.

Homogenous and Heterogenous Groups

Homogenous groups are composed of patients of the same age, race, sex, socioeconomic level
and similar category of illness. Heterogenous groups vary on all these aspect

Open Groups and Closed Groups

In open groups members may join and leave the group at any time. Closed groups have a specific
number of people, specific time to start and close the group sessions; the duration is three to four
weeks. Inpatients and outpatients both are included in this group

Group according to Mental illness

Neurotic group or patients suffering from psychotic illnesses come under this category

STEPS OF GROUP THERAPY

The steps of group therapy can differ from an individual group therapist to therapist. Some of
the common steps are

 Selecting the members in a group

 Developing contact in a group
 Selection of group leader

Selecting the members in a group

It is very important function of group therapist. She has to decide based on the condition of the
patient who all can be included in the group

Developing contact

It is a very significant factor

 The purpose should be made clear to all the members in the group

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  Time, length and place of the meeting should be announced
 Starting and ending time and how frequently the group sessions will be conducted
 Attendance of the members
 Confidentiality should be maintained within the group
 Role of members is : to report punctually, maintain confidentiality and interact freely

Selecting group leader

Select group leader with carefully she/he should have qualities like

 Maintain a leadership ability.

 Co ordinate team
 Good observation power
 Quick decision-making tendency
 Adequate problem-solving skills.

ROLE OF THERAPIST / NURSE

Role of the therapist- therapist acts as a facilitator and helper. The goals of the nurse therapist
as identified by De Mocker(1981) are :

1) To provide information to the group

2) Allow emotional catharsis
3) Share members perception
4) Share feelings of fear, loneliness and frustration
5) Improve communication skills
6) Provide a role model

CONCLUSION

Group therapeutic techniques are as varied as those of individual therapy and similarly
tend to stress either alleviation of members’ distress by direct measures or the creation of a group
atmosphere conducive to increased self-understanding and personal maturation. Groups of the
first type may have any number of members, sometimes up to 50 or more. Some are primarily
inspirational in that their chief aim is to raise members’ morale and combat feelings of isolation

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by cultivating a sense of group belongingness through slogans, rituals, testimonials, and public
recognition of members’ progress. 

RESEARCH ARTICLE

A study on therapeutic effect of music

Abstract

Side effects of most synthetic drugs used in the treatment of various diseases have led
researchers around the world to conduct studies on the identification of alternative therapies. In
this vein, the present study aims to review the research carried out in association with the
therapeutic effects of music used in the treatment of relatively common diseases. Methods: To
develop this review article, researchers conducted some computer search using keywords in
databases including Google scholar, SID, Iranmedex, Medline, PubMed, Springer, Science
Direct, ProQuest, and ISC, and collected and probed the results of over 100 published articles
from 2000 to 2018 dealing with the effect of music therapy in the treatment of 12 relatively
common diseases. Results: The findings show that music therapy has a positive effect on the
treatment of the diseases studied. Conclusion: Music can have positive effects on pain, sleep
disorders, learning, memory, IQ, depression, anxiety and special diseases such as schizophrenia
and autism.

CONCLUSION

Several theories about the origins of psychological disorders emerged in the twentieth
century, and specific treatments were introduced that corresponded with these theories. Freud’s
(1856–1939) approach to therapy, or psychoanalysis, is perhaps the most well-known

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contemporary approach to therapy. Freud emphasized understanding the unconscious mind as a
central tenet of treating psychological disorders. Freud’s patients would lie on a couch and talk
about their problems through free.

REFERENCE

R. Sreevani, A guidance to mental health and psychiatric nursing, Jaypee publications, new
Delhi 2016(141-144,150-151)

Rajesh G Konnur, textbook of psychiatric nursing, Jaypee publications, new Delhi, 2016
(147,195)

B T Basavanthappa psychiatric mental health nursing, Jaypee publications, new Delhi 2007
(295-348)

J N Vyas , Niraj Ahuja text book of post graduate psychiatry 2nd edition Jaypee publications 2008
2nd volume (766-888)

Online reference

Seyyed Ebrahim Hosseini, Therapeutic Effect of Music A Review, Report of Health Care
Journal, 2018,4(4), 1-13

Therapeutic Effects of Music: A Review

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