EMILIO AGUINALDO COLLEGE

Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING

THERAPEUTIC MODALITIES/TREATMENT
Psychiatric Nursing - RLE

BSN 4-2 (Group C)

Boñon, Eliza
Branzuela, Audrey
Constante, Cheila
Dayrit, Patricia
Gato, Monjay
Gremio, Alyannah
Hermenegildo, Daniela
Mallari, Cyrelle
Masikat, Jonathan
Oliveros, Carlo
Peje, Ishi

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING

Therapeutic Modalities

 Therapeutic Modalities are also known as Counseling Modalities.

 Modalities are essentially the tools a therapist or coach uses to help individuals reach their goals.
Modalities fall into broad categories, such as cognitive and behavioral, somatic (body awareness),
experiential (play or art therapy), and more.
 Psychotherapy helps people understand that they can do something to improve their situation. That leads to
changes that enhance healthy behavior, whether it's improving relationships, expressing emotions better,
doing better at work or school, or thinking more positively.
 Therapy can help people to confront barriers which interfere with emotional, mental, physical, and spiritual
well-being.

What are the Different Therapeutic Modalities?

Individual Psychotherapy

 Defined as the method of achieving change in a person by exploring his/her feelings, attitudes, thinking,
and behavior.
 Involves one-on-one relationship between the therapist and the client. Nurse-client relationship
(compatible) is the key to individual psychotherapy.
 Sessions are typically scheduled once per week for 60 minutes. When the client is experiencing increased
difficulty, sessions may be temporarily scheduled twice per week for a short period of time. As the client
makes progress in achieving his or her goals and nears discharge, sessions may become less frequent (e.g.,
once every two to four weeks). Depending on the client’s preferences and needs, sessions can be also
scheduled for 30 or 90 minutes.

Group Therapy

 Stages of group development: Orientation stage, Working stage, and Termination stage.
 Clients participate in sessions with a group of people. Members share a common purpose and are required
to contribute to the group to benefit others and to benefit from others in return. Working with others
together in a group can decrease a client’s sense of isolation, validate his/her experiences, and help to
develop better interpersonal and coping skills.
 Psychotherapy groups aim for members to learn about their behavior and to make positive behavioral
changes through interactions and communications with other members. It also has a formal structure and is
led by a professional therapist with advanced training (psychology, social work, nursing, or medicine).

Orientation stage → Working stage → termination stage

 common purpose
 contribute to the group to benefit others
 decrease a client’s sense of isolation
 validate his/her experiences
 help to develop better interpersonal and coping skills.
 about their behavior
 make positive behavioral changes

Family Therapy

 In this session, the therapist meets with one or more family members, friends, or significant others with or
without the client present.
 During the initial meeting, the therapist will become acquainted with individuals involved in the client’s
life and obtain feedback about the client’s strengths and areas for improvement.

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING

 This form of modality therapy is where the therapist meets with both members of a couple, family unit, etc.
to discuss their symptoms and how they are impacting their lives as a whole. The psychiatrist will try to get
a better understanding of what each person believes caused these symptoms for them to come up with a
treatment plan that is best suited for the family unit.
 This type of treatment modality helps families understand how their relationships can trigger emotional
distress for individual family members. FST focuses on the family as a system, and how each member’s
behavior affects the whole family.

Cognitive Behavioral Therapy

 Cognitive behavioral therapy (CBT) is a form of psychotherapy or counseling therapy that centers on our
thought patterns and how they affect our attitudes, our emotions and our behaviors.
 According to the Centre for Addiction and Mental Health (CAMH), there are three levels of cognition that
are helpful when understanding how our thoughts are formed:
o Automatic thoughts: these flow without full awareness, without that check for accuracy or
relevance to the present situation
o Schemas: Shaped by our childhoods and life experiences, these are pervasive beliefs we’ve
decided are true about ourselves, which can be dysfunctional
o Conscious thoughts: these are rational and made with the ability to see a situation clearly
 CAMH and the American Psychological Association (APA) outline a few ways CBT helps to reduce
emotional distress with strategies to change thinking and behaviors, such as:
o Identifying if certain thoughts or thinking patterns are distorted
o Understanding that our thoughts are just our ideas, not facts
o Taking a step back to see our situation from different viewpoints
o Gaining a greater understanding of the behavior and motivations of others
o Facing fears, or using role playing to learn how to anticipate and prepare for potentially
problematic interactions
o Building confidence in our actual abilities
o Learning to calm our minds and bodies
 In most cases, CBT is time-based and spread out over a certain number of sessions, with "homework" tasks
in between. These sessions and exercises will teach you to clearly define issues, examine automatic thought
patterns and challenge underlying assumptions about yourself that underlie those thoughts, become more
aware of your emotions in various contexts, set some goals, and concentrate more on how things are than
how they should be—which is a much more manageable reality to live in.
 Here are three commonly used exercises and techniques for CBT:
o Challenging cognitive distortions
o Journaling
o Activity scheduling

Behavioral Modification Therapy

 By enhancing positive behaviors and minimizing or eliminating negative ones, this method of therapy aims
to change the patient's behavior. Obsessive-compulsive disorder, Attention Deficit Hyperactivity Disorder
(ADHD), Tourette Syndrome, and eating disorders are among the disorders that are frequently treated using
BMT.
 Other disorders are phobias, separation anxiety, generalized anxiety disorder (GAD), autism, and disruptive
disorder among other conditions.
 Behavior modifications depend on the idea of conditioning, which is a form of learning. There are two
major types of conditioning:

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Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING

o Classical conditioning depends on a particular stimulus or signal. This learning process creates a
conditioned response through associations between an unconditioned stimulus and a neutral
stimulus.
o Operant Conditioning involves using a system of rewards or punishments. The development of
behavior modification, based on Thorndike's Law of Effect, came from B.F. The aim of Skinner's
"operant conditioning" theory is to alter or mold behavior using a series of rewards and reactive
behaviors. Operant conditioning operates under the premise that examining an action's motivation
and outcomes will help you better understand a person's behavior.
 Skinner believed that there were three types of responses:
o Neutral: Responses that are not positive or negative.
o Reinforcing: Considered to be positive.
o Punishing: Considered to be negative.

Behavioral Modification Techniques

 Understanding how or why a certain behavior began is not the goal of behavior management. The main
objective is to improve behavior, and several techniques have been used to do this. These techniques
consist of:
o Positive Reinforcement: Associating a positive stimulus to a behavior.
o Negative Reinforcement: This is just the opposite of positive reinforcement and is the pairing of
behavior to the removal of a negative stimulus.
o Punishment: Punishment is meant to weaken behaviors by pairing an unpleasant stimulus to a
behavior.
o Flooding: involves exposing people to fear-producing situations or objects intensely and rapidly.
o Systematic Desensitization: This is also used to treat phobias. It involves teaching an individual
to stay calm while focusing on their fears.
o Aversion therapy: is the association of an unpleasant stimulus to an unwanted behavior for the
purpose of eliminating that behavior.
o Extinction: is the removal of all reinforcement that might be associated with a behavior.

Somatic Therapy

 Somatic means relating to the body, so somatic therapy is all about the mind-body connection.
 The somatic approach emphasizes allowing the body to physically re-negotiate past events in order to
provide relief from intrusive thoughts, visions, tension, panic attacks, broken relationships, and depressing
or hopeless moods. By addressing these symptoms on a somatic level, somatic work seeks to release
healing by acknowledging that old experiences can become stuck within the body.
 The goal of somatic therapy is to help patients become more aware of the signs that their bodies are sending
to them that they are stressed or provoked, such as muscle tension, headaches, stomachaches, shallow
breathing, throat tightening, or numbness. Learning how to release or relax from that stress, tension, and
trauma is another aspect of somatic therapy. These methods can include body movement exercises, dance,
mindfulness, and other breathing exercises.
 Somatic therapy techniques are body-focused to help us calm our nervous systems that have been
overloaded by stress.
 One of the most common approaches to somatic therapy is Somatic Experiencing (SE). This was
developed over the last 50+ years by Dr. Peter Levine, who holds doctorates in both medical biophysics
and psychology.

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING

 SE involves discussing stresses or prior traumas with a therapist while being instructed to pay closer
attention to the physical sensations that appear while doing so.

Somatic Therapy Concepts

 Boundary Development: In the context of somatic therapy, this refers to learning how to be attentive to
our own needs and how to feel safe, strong, and protected while coping with suffering and trauma.
Knowing our boundaries can help us deal with challenges or circumstances that may have previously been
emotionally and physically exhausting in the future.
 Breathing: Knowing when we are holding our breath or inhaling slowly may seem obvious, but it can be a
key to knowing when and how to stop and give our bodies a break during a stressful situation. Being
observant of our body and conscious of bodily sensations when we are feeling strong emotions can also be
included in a more general strategy of self-regulation. We can also employ deep breathing to relax when
we're upset.
 Grounding: We experience an overactive nervous system when we detect danger. It's necessary to get out
of that mode, especially when there isn't any actual threat. By applying cold water to your face, controlling
your breathing, tensing and relaxing various body parts, or even just forcing your body to move differently
(get up from a chair, stretch, or leap), you can ground yourself by returning to the present moment.
 Resourcing: It turns out that the phrase "go to your happy place" can actually have psychological
advantages. Resourcing is the process of identifying the resources you have at your disposal—moments of
when you were strong, in a secure environment, or with reliable people—to use when necessary. You keep
a physical journal of the pleasant bodily sensations and feelings connected to such recollections. When you
need to moderate your response to stress, these serve as your anchors.
 Titration and Pendulation: Titration is a word taken from chemistry in which one solution is slowly
added to another until a desired reaction is achieved. Pendulation is like the swinging of a hanging object
side-to-side. During titration, you'll slow down to gradually pay attention to bodily sensations as you talk
through your experiences. This prevents you from becoming overwhelmed during a trauma response.
Pendulation involves the change from resourcing to titration—from tense to calm feelings. This can assist
you in establishing a routine for managing stressors both now and in the future.

Dialectical Behavioral Therapy

 The goal of dialectical behavior therapy (DBT), a type of psychotherapy or counseling, is to teach us how
to manage our emotions, accept the way things are (rather than how they should be), and live in the present.
 In DBT, we constantly practice achieving a balance between acceptance (what we're experiencing is true
and difficult) and transformation (we can change for the better for ourselves).
 DBT was initially created by American psychologist Dr. Marsha Linehan in the late 1970s to help treat
borderline personality disorder, suicidal behavior, and other more complicated disorders involving intense
emotional reactions.
 They started making sure their patients knew their actions were acknowledged (validated), which helped
them learn to have confidence in themselves. Change was made possible by acceptance. Dialectics was
included to help the patient and therapist move on rather than being stuck in intense emotions or rigid
thinking.
 How does Dialectical Behavior Therapy work?
o DBT is a program (it could take up to a year) with stages and skills training with a therapist.
o Stage one: Many people experience mental difficulty at this point, which often leads to destructive
behaviors like substance misuse or self-harm. Taking charge of our behaviors is the aim of stage
one.

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Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4339/41 www.eac.edu.ph

SCHOOL OF NURSING

o Stage two: Even though we have control over our actions, we occasionally suffer in silence.
Moving toward a more emotionally healthy state involves a variety of strategies, including
emotional control and distress tolerance.
o Stage three: This is about learning to live a functioning life, defining some goals, knowing our
self-worth and having self-respect, and being able to cope with both ups and downs of life.
o Stage four: In stage four, we find deeper meaning in life. This could be spiritual for some people,
or other ways to get a sense of connection to the broader world and find joy.

 Throughout these phases, four categories of skills are taught:

o Mindfulness: Techniques used in mindfulness treatment instruct us to be in the now, accepting
our thoughts and feelings without passing judgment on ourselves or others, or attempting to
control them. Focused breathing, which involves inhaling and exhaling while observing your belly
rise and fall, is a basic mindfulness technique.
o Distress tolerance: This is where we develop the ability to handle difficulties without using
unhealthy coping mechanisms like urges or bad behaviors. We learn to accept situations when
change is not feasible and to stop supposing that something "should be.”
o Interpersonal effectiveness: This is about navigating relationships with others, including through
conflict. We learn to ask what others might need, how to say no, and maintain our sense of self in
our relationships with others.
o Emotional regulation: Identifying and naming our emotions can be empowering. This technique
helps us acknowledge our emotions, again without judgement. Eventually, we learn our emotions
do not need to control our thoughts and behaviors.

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