Conceptualization and Treatment Plan - Term Paper Example

Conceptualization and Treatment Plan Abstract Jacob suffers from presenting symptoms which include irritability, impatience, inadequate sleep, depression, withdrawal from social activity, and memory gaps. Based on the behavioral theories, these changes in behavior are attributed to the damage in the brain cells. However, with the application of behavioral therapy, possible changes in the patient’s behavior can be implemented. Behavioral therapy can serve to reinforce positive behavior and dissuade negative behavior, eventually guiding the patient towards the desired or the proper behavior. Behavioral therapy can provide means of coping with depression, and it can also help the patient establish sleep hygiene patterns which can eventually help the patient gain adequate rest and sleep. With this learned behavior, more positive changes in the patient’s life can be secured, and challenging behavior deterred. Conceptualization and Treatment Plan Presenting Concerns Based on the case summary of Jacob, his presenting concerns include his deteriorating ability to concentrate on engagements. He is also manifesting emotional instability and changes in his personality trait. The changes in his personality mostly represent a shift from being jovial and social to being emotional and being easily and unnecessarily irritable. He has become withdrawn and he often avoids conflicts with other people. He has also become impatient and his relationship with other people has worsened. His ability to communicate with other people has also become compromised, with his eloquence deteriorating and his ability to connect words failing. As a result, he has become a slow speaker. His memory impairment is also a major concern, as he often does not recognize family and friends. Disrupted sleep and depression also emerged as presenting concerns for Jacob. Based on the behavioral theory, human behavior is founded on principles of learning theories which define human behavior, and that human behavior is not involved with internal conflicts or issues with object representations (Martin & Pear, 2007). Primarily due to the deterioration of the patient’s brain cells, these behavioral changes are manifesting (Martin and Pear, 2007). The patient did not always behave the way he is now behaving; however, the neurological damage caused by the disease on his brain cells has caused the manifestation of major changes in his behavior and attitudes. Case Conceptualization Based on the presenting symptoms of the patient, the changes in his behavior need to be addressed in order to help the patient regain some of his normal behavioral manifestations. Behavioral therapy seeks to address challenging behaviors of the patient, providing the patient as well as his careers, with the means to cope with these challenges. Goal 1: To manage behavioral and psychotic symptoms (depression, irritability, impatience) Interventions: 1. Training and education of family and caregivers on psychosocial activities they can carry out including: a. Routine activities (Alzheimer’s Association National Board of Directors, 2011). Routine activities can help refocus the patient’s energy and attention, teaching him habits which he can later unconsciously acquire (Jones and Butman, 2001). By establishing routines, the patient will likely become less irritated and less impatient about other activities which may not go his way. He would be able to make reasonable expectations at particular times of the day without having to make a superior effort to plan his activities. For example planning a daily walk around his neighborhood for an hour a day every morning from 6am to 7am would ensure that he would have sufficient exercise. Scheduling an activity every afternoon from 3pm to 4 pm with his friends in the community would also give him an opportunity to interact with his friends while also ensuring a routine activity he can rely on in his daily itinerary. Sooner or later, he can get used to the activity even without being reminded of the time. The activity also provides structure in his life which at other times may seem confusing and overwhelming. Amidst the confusion and numerous activities he may be involved in, he can rely on that specific time of the day to be with his friends or to exercise. The behavioral therapy supports operant conditioning, where with the concept of reward or favorable feelings, positive behavior can be reinforced and can eventually become the dominant and expected behavior (Jones and Butman, 2001). b. To separate the individual from what is upsetting to him or her (Alzheimer’s Association National Board of Directors, 2011). Jacob can sometimes become impatient and irritated and then soon after become isolated from his family and friends. During these instances, or before challenging behaviors are triggered, it is important to remove the individual from the upsetting environment (Alzheimer’s Association National Board of Directors, 2011). Redirecting the attention of the patient to other activities would be a helpful intervention during these instances. Moments of impatience and irritability can be eased through therapeutic communication. Sometimes, it is often best to back away momentarily from the patient during these moments of impatience (Osborn and Saunders, 2010). And then gradually, with calm and neutral tones, one can then ask the patient for permission to approach. After permission is granted, using positive and calming statements, the caregiver can then ask the patient what he is feeling (Osborn and Saunders, 2010). Discussing pleasant calming events can also help the patient relax. Offering the patient possible options can also help him find an opening, offering him a way out of what he may perceive to be a mental or emotional trap (Alzheimer’s Association National Board of Directors, 2011). Under these conditions, the behavioral therapy involves the process of looking into the interaction between the characteristics of the individual, the environment, and the actual behavior (Osborn and Saunders, 2010). After thorough assessment of such conditions, it is possible to make the necessary adjustments to one’s reactions to the patient and then gain a corresponding reaction in the patient’s actions. 2. Goal: To manage memory gaps and improve memory recall. Intervention: It is often best to avoid asking the patient where he placed certain items, because failing to remember where they placed certain items can further cause them to believe that they are indeed experiencing memory gaps (Alzheimer’s Association National Board of Directors, 2011). These instances are likely to trigger more instances of alarm and anxiety to an already agitated patient. When they are agitated, the more difficult it is to establish therapeutic communication with them. Instead, it is often best to keep valuables in secure places, locking cupboards in order to reduce access for the patient (Gold and Budson, 2008). These remedies can prevent the loss of things, however, it is also possible to improve the patient’s memory through behavioral therapy, specifically classical conditioning where items are paired with each other – one may be an unconditioned stimulus and the other a conditioned stimulus. Pairing one with the other constantly can trigger the remembrance of the other, and vice versa (Gold & Budson, 2008). 3. Goal: To manage and eliminate the patient’s depression Intervention: First of all, it is always best to acknowledge that most patients with Alzheimer’s disease are suffering from depression (Alzheimer’s Association National Board of Directors, 2011). Most of the time, doctors prescribe antidepressants for these patients, however, other non-pharmacological therapies, including behavioral therapy are also recommended. In general, it is always best to try to encourage the patient to participate in various activities, especially in activities which they prefer (Gauthier et.al, 2010). After encouraging their participation in activities with other individuals, they can be taught how to avoid thought processes which can often lead them to depression (Murdock, 2009). 4. Goal: To allow for restful sleep. Intervention: Restful sleep is an important element in the patient’s care because it can lessen the patient’s agitation during the hours he is awake (Alzheimer’s Association National Board of Directors, 2011). Behavioral therapy can best be applied in order to ensure restful sleep. The caregivers and the patient can coordinate with each other on sleep hygiene or routines which can send signals to the brain that it is time to rest and sleep (Alzheimer’s Association National Board of Directors, 2011). Such routine is often based on the individual patient’s sleep hygiene; especially those activities which would likely help him sleep better. Some patients often read a book before they go to sleep or drink a cup of warm milk. Moreover, avoiding long naps during the daytime and avoiding coffee so near bedtime can also help reduce the possibility of insomnia (Alzheimer’s Association National Board of Directors, 2011). In effect, these are all reinforcing behaviors which can guide one step into another, and which can reinforce the direction of the activity or the manifestation of the positive behavior. 5. Goal: To re-engage him in his social life and interactions with other people. Intervention: Behavioral therapy dictates that re-engaging the Alzheimer patient into the social community involves the process of relearning the process of social engagement (Jones and Butman, 2001). Discussing with the patient what to say to other people in social occasions and gathering can help refresh the patient about positive behavior. Sometimes, practicing in small settings which are more controlled and familiar can provide the patient with a more comfortable environment where he can get used to interactions, and where he can re-learn socialization activities (Jones and Butman, 2001). 6. Goal: To reinforce positive behaviors. Intervention: Self-control behavior is an important element in the management of Alzheimer’s disease patients (Alzheimer’s Association National Board of Directors, 2011). This intervention emphasizes behavior, not emotions, in an effort to prevent difficult behavior and to manage difficult behaviors when they manifest. Difficult behavior is often triggered by something or someone, hence, it is often best to prevent the manifestation of these triggers (Murdock, 2009). Where positive behaviors manifest, it is always important to support, praise and reinforce such behavior in order to help the patient recognize that he has done something good and that he should continue to strive for more positive behavior in order to gain more praise and reinforcement (Murdock, 2009). In instances where negative behaviors manifest, it is always best to observe such behavior, consider the triggers, and analyze a plan based on such observations (Martin & Pear, 2007). Behavioral therapy helps to shape proper and suitable behavior among patients by using the distinct qualities which patients already have. For caregivers who are vigilant in the patient’s treatment, they can also focus on actions which can help the patient develop a sense of belongingness in his preferred group (Martin & Pear, 2007). By encouraging and guiding the patient towards this end, it is possible to reduce the occurrence of negative behaviors and to reinforce positive behavior or activities. In the end, these are important learning and behavioral points for the patient who is already suffering from social isolation (Martin & Pear, 2007). Behavioral therapy under these circumstances is about providing guiding points for the patient to consciously and sometimes unconsciously follow; eventually veering him away from the negative and challenging behavior and towards the more positive and favorable behavior. Conclusion After the above therapy is implemented for the patient, the challenging behavior or the presenting concerns for the patient would hopefully be reduced and instead, the more positive actions would manifest (Jones and Butman, 2001). In effect, the patient’s irritability and impatience would be reduced, and instead be replaced with more preoccupation with other activities, including socialization. Behavior therapy can also help reinforce and improve the patient’s memory through classical conditioning processes, most specifically pairing items with each other in order to trigger recall (Jones and Butman, 2001). Behavioral therapy can also manage depression by teaching the patient coping skills, preventing thought processes from leading from one indication to another. Behavioral therapy can also help provide restful sleep by establishing patterns of behavior which can help signal the brain that it is type to sleep or rest. This would be known sleep hygiene or sleep routine (Alzheimer’s Association National Board of Directors, 2011). Despite these applications, the behavioral therapy may still prove to be difficult in the management of the patient’s depression. In most instances, behavioral therapy alone is not sufficient to manage the patient’s depression (Alzheimer’s Association National Board of Directors, 2011). Other pharmacological therapies may be needed to reinforce the management of the patient’s depression. Nevertheless, behavioral therapy can help provide guidance for the patient in how to cope with his condition and his symptoms (Murdock, 2009). Behavioral therapy can provide reinforcement for positive behavior, thereby helping reduce the manifestation of difficult or challenging behavior. References Alzheimer’s Association National Board of Directors (2011). Challenging behaviors. Retrieved from http://www.alz.org/documents_custom/statements/challenging_behaviors.pdf. Gauthier, S., Cummings, J., Ballard, C., & Brodaty, H. (2010). Management of behavioral problems in Alzheimer’s disease. International Psychogeriatrics, 1-27. Gold, C. & Budson, A. (2008). Memory loss in Alzheimer’s disease: implications for the development of therapeutics. Expert Reviews. Retrieved from http://people.bu.edu/abudson/Gold-Budson%20Exp%20Rev.pdf Jones, S. and Butman, R. (2001). Modern psychotherapies: a comprehensive Christian appraisal. New York: InterVarsity Press. Martin, G. & Pear, J. (2007). Behavior modification: What it is and how to do it. Upper Saddle River, NJ: Pearson Prentice Hall. Murdock, N. (2009). Theories of counseling and psychotherapy: A case approach. New Jersey: Pearson Prentice Hall. Osborn, G. & Saunders, A. (2010). Current treatments for patients with Alzheimer’s disease. J American Osteopathic Association, 110(9), S16-S26. Read More