Developing a professional nursing staff pp. Individuals and systems naturally strive for equilibrium.
Interventions with specific subpopulations As indicated by Gisbert et alet al. This type of intervention focuses on the functioning of persons, improving their personal and social skills and providing support to the different roles undertaken in their social and community lives.
All in all, they aim to improve the quality of life of people affected and their families, supporting their social participation in the community in the most active, normalised and independent possible way. They are organised through an individualised process that combines, on the one hand, training and development of the skills and competences that each person requires to effectively function in the community and on the other hand, actions on the environment.
It includes several aspects that vary from pyschoeducation and advice to families to the development of social supports aimed at offering the necessary aid to compensate or strength the level of psychosocial functioning of chronic mental patients Psychosocial interventions in rehabilitation have gained in operativity and efficiency with the incorporation of different extrapolated strategies, adapted from the field of psychology, social learning, behaviour modification, social intervention and human resources, including, among others: This series of psychosocial intervention strategies have proved to be efficient in improving the psychosocial functioning of people with SMI and in their adaptation and maintenance in the community Cognitive-behavioural therapys Cognitive-behavioural therapy CBT is a psychological intervention that is based on the hypothesis that cognitive activity determines behaviour.
Many differences can be found when approaching the cognitive aspects, as some of them focus on structures, beliefs or basic cases as the main causal entities of emotions and behaviour 22,23whilst others focus on processes such as problemsolving, cognitive distortions or thought content: Despite these differences, the following characteristics, which they all have in common, can be pointed out: Behavioural change has been mediated by cognitive activities.
In other words, the systematic alteration and identification of disadaptive cognitive aspects will produce the desired behavioural changes. The acceptance of reciprocal determinism between thought, environment and behaviour.
The therapy is designed to help people identify, test reality and correct dysfunctional conceptions or beliefs. Patients are helped to recognise the connections between cognitions, affection and behaviour, together with their consequences, to make them aware of the role of images and negative thoughts on maintaining the problem.
The techniques applied in this approach include cognitive restructuring, problemsolving, self-instructional training, etc. In general, environmental manipulations are used in cognitive-behavioural modification, as in other approaches, but here these manipulations represent information feedback tests or experiments that provide an opportunity for people to question, reassess and acquire self-control over disadaptive behaviour, feelings and cognitions, at the same time as they practice trained skills.
The therapeutic relationship is collaborative and the active role of the client is emphasised Social Skills Training Social skills are understood as the specific response capacities required for effective social performance Social skills, therefore, are a series of behaviours carried out by an individual in an interpersonal context that express feelings, attitudes, desires, opinions or rights of that individual in a way that adapts to the situation, respecting that behaviour in others, and which generally solve the problems of the situation at the same time as they reduce the probability of future problems to a minimum Social skills training consists in behavioural learning techniques that permit people with schizophrenia and other incapacitating mental disorders to acquire an interpersonal handling of the illnesses and independent living skills to improve their functioning in the community The module postulates that social competence is based on a set of three skills: Following these premises, social skills training has been included in CBT because it is in this paradigm where work is mainly done on social skills of people with schizophrenia.
To be able to acquire this series of attitudes and behaviours, there are social skills training programmes that integrate structured psychosocial interventions, either in groups or individually, or both, created to improve social behaviour and reduce the stress and difficulty in handling social situations.
The components of the social skills training procedure are derived from the basic principles of learning that include operational conditioning, experimental analysis of behaviour, the theory of social learning, social psychology and social cognition There are four key components: Meticulous behavioural assessment of a list of interpersonal social skills.
Emphasis on both verbal and non-verbal communication.
Training focused on the individual's perception and on the processing of relevant social situations, as well as the individual's ability to offer adequate social reinforcements.
Work done at home, as well as the interventions that are carried out in the clinic 8. From another point of view, social skills training can be based on three models: There are very few definitions in literature of any of these three approaches, with respect to their effects on the generalisation of behaviours and the improvement in social functioning The grounds for using social skills training in schizophrenia are based on multiple empiric and conceptual sources.
Social skills and social competence can be considered as protective factors within the stress-vulnerability diathesis model for schizophrenia. Reinforcing the skills and social competence of people with schizophrenia -together with other evidence-based interventions- reduces and compensates the harmful effects of the cognitive deficit, neurobiological vulnerability, stressful events and social maladjustment The studies found analyse the effectiveness of CBT either aimed at people with SMI and a diagnosis of schizophrenia and related disorders or at people with SMI and a diagnosis of bipolar disorders.
No studies have been found that discriminate psychosocial interventions for severe compulsive obsessive disorder or Severe Mental Illnesses as only population.
No trial was able to use a double-blind experiment, due to the difficulties inherent to the concealment process in psychosocial interventions.It has been 5 years since the publication of this Clinical Practice Guideline and it is subject to updating.
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