Non-Pharmacological
Measures in Psychiatric
Service
Cl.Psy. Monalisha Pradhan
Shree Birendra Hospital
Department of Psychiatry
20
Non-Pharmacological Measures in
Psychiatric Service
PSYCHOTHERAPIES
PSYCHOLOGICAL ASSESSMENT
Psychotherapy
According to Wolberg (1967) psychotherapy
is the treatment, by psychological means, of
problems of an emotional nature in which a
trained person deliberately establishes a
professional relationship with the patient
with the object
a)of removing, modifying or retarding
existing symptoms
b)of mediating disturbed patterns of
behaviour and
c)of promoting positive personality growth
and development.
Sign for
Psychotherapy
…
Sign for Psychotherapy…
Depressed mood
Sadness
Suicidal Ideation
Fearfulness
Negative thinking
Shortness of breathing
Substance use
Family conflict
Suspiciousness
Form of Therapy
Group Therapy Individual Family Therapy
therapy
Cognitive Behavioural therapy
Cognitive behavioural therapy (CBT) helps people identify and
change thinking and behaviour patterns that are harmful or
ineffective, replacing them with more accurate thoughts and
functional behaviours.
It can help a person focus on current problems and how to solve
them.
It often involves practicing new skills in the “real world.” CBT can
be helpful in treating a variety of disorders, including depression,
anxiety, trauma related disorders, and eating disorders.
CBT can help a person with depression recognize and change
negative thought patterns or behaviours that are contributing to the
depression.
CBT is based on the cognitive model of mental illness,
initially developed by Beck (1964).
In its simplest form, the cognitive model ‘hypothesises
that people’s emotions and behaviours are influenced
by their perceptions of events.
It is not a situation in and of itself that determines what
people feel but rather the way in which they construe a
situation’ (Beck, 1964)
Beck (1976) outlined three levels of
cognition
1.Core beliefs - Core beliefs, or schemas, are deeply
held beliefs about self, others and the world
2.Dysfunctional assumptions - rigid, conditional ‘rules
for living’ that people adopt.
3. Negative automatic thoughts
The 'hot-cross bun
model’ emphasis
on …
how an
individual's
thoughts, feelings,
behaviour and
physical
symptoms
interact.
Cognitive Behavioural therapy Cont….
• Cognitive restructuring or reframing. ...
• Guided discovery. ...
• Exposure therapy. ...
• Journaling and thought records. ...
• Activity scheduling and behaviour activation. ...
• Behavioural experiments. ...
• Relaxation and stress reduction techniques. ...
• Role playing.
Thought recording sheet
Time Situation Thought Feeling Consequence
1) Behavioral
10:30 a.m In front of If I suffer from Sad change
television , covid , I will die. worry • Decrease talk
watching news, Who will look • staying alone
news seen after my family,
about demise of I will not go 2) Physiological
no of people outside change
due to covid
• Sweating
• Palpitation
• Tremors
6.00p.m At home What to do , worry
phone call for How to protect • Palpitation
duty in isolation self • Tremors
Interpersonal therapy
Interpersonal therapy (IPT) is a short-term form of treatment. It
helps patients understand underlying interpersonal issues that are
troublesome, like unresolved grief, changes in social or work
roles, conflicts with significant others, and problems relating to
others.
It can help people learn healthy ways to express emotions and
ways to improve communication and how they relate to others. It
is most often used to treat depression.
Dialectical behaviour therapy
Dialectical behaviour therapy is a specific type of CBT that
helps regulate emotions. It is often used to treat people with
chronic suicidal thoughts and people with borderline personality
disorder, eating disorders and PTSD.
It teaches new skills to help people take personal responsibility to
change unhealthy or disruptive behaviour.
It involves both individual and group therapy.
Stages of DBT
• Stage 1: During the beginning of treatment, the most serious and self-
destructive behaviours are the first things addressed. This may include
issues such as self-injury or suicidal behaviours.
• Stage 2: Next, treatment moves on to address issues that affect a
person's quality of life, such as their interpersonal effectiveness,
emotional regulation skills, and ability to tolerate distress.
• Stage 3: The next step is to focus on issues related to self-esteem and
interpersonal relationships.
• Stage 4: At this point, treatment is focused on helping people get the
most out of their lives, including finding ways to experience greater
happiness, strengthen their relationships, and pursue their life goals.
Strategies and techniques
Mindfulness
Distractionskills
Emotion regulation skills
Relaxation skills
Psychodynamic therapy
Psychodynamic therapy is based on the idea that
behaviour and mental well-being are influenced by
childhood experiences and inappropriate repetitive
thoughts or feelings that are unconscious (outside of the
person’s awareness).
A person works with the therapist to improve self-
awareness and to change old patterns so he/she can
more fully take charge of his/her life.
Supportive therapy
Supportive therapy uses guidance and encouragement to
help patients develop their own resources.
It helps build self-esteem, reduce anxiety, strengthen coping
mechanisms, and improve social and community functioning.
Supportive psychotherapy helps patients deal with issues
related to their mental health conditions which in turn affect
the rest of their lives.
Session
Initial stage
Middle stage
15-20 sessions /weekly sessions/ depending upon the
Final stage
problem it may exceed or terminate
ASSESSMENT
PROJECTIVE TEST- RT/TAT/SCT
PERSONALITY TEST-EPQ/MOQ/MMPI/IPDE
COGNITIVE T EST- IQ TEST/BGT/
OBJECTIBE TEST- RATING SXCALES –BDI/BAI/ YMRS/YBOCS
Exposure Therapy
Inthis form of therapy, psychologists create a
safe environment in which to “expose”
individuals to the things they fear and avoid.
The exposure to the feared objects, activities or
situations in a safe environment helps reduce
fear and decrease avoidance.
Variations of exposure therapy
• Imaginal exposure: Vividly imagining the
feared object, situation or activity. For example,
someone with Posttraumatic Stress Disorder
might be asked to recall and describe his or her
traumatic experience in order to reduce feelings
of fear.
In vivo exposure: Directly facing a feared
object, situation or activity in real life. For
example, someone with a fear of snakes might be
• Virtual reality exposure: In some cases, virtual reality technology
can be used when in vivo exposure is not practical. For example,
someone with a fear of flying might take a virtual flight in the
psychologist's office, using equipment that provides the sights,
sounds and smells of an airplane.
• Interoceptive exposure: Deliberately bringing on physical
sensations that are harmless yet feared. For example, someone with
Panic Disorder might be instructed to run in place in order to make
his or her heart speed up, and therefore learn that this sensation is
not dangerous.
Different ways of Exposure Therapy
Graded exposure: The psychologist helps the
client construct an exposure fear hierarchy, in
which feared objects, activities or situations are
ranked according to difficulty. They begin with
mildly or moderately difficult exposures, then
progress to harder ones.
Flooding: Using the exposure fear hierarchy to begin exposure with the most difficult tasks.
Systematic desensitization: In some cases,
exposure can be combined with relaxation
exercises to make them feel more manageable
and to associate the feared objects, activities or
situations with relaxation.
Breathing exercises
Other Psychotherapies …
Motivational Interviewing
Motivational Enhancement Therapy
Relaxation Therapy Like ,
JPMR, Breathing exercises
Mindfulness Meditation
