Mental Health Nursing

3. Changing cognitive processes.
4. Dealing with anxiety.
5. Dealing with depression.
Increasing activity
Many in-patients, particularly those with schizophrenia or severe depression,
often have very reduced levels of activity. It is therefore important
that staff in in-patient settings are aware of the importance of increasing
the activity of patients who are particularly withdrawn, as apathy and
withdrawal compound depression and helplessness. The care plan therefore
needs to reflect this emphasis. Indeed, for some patients it may be
important to work out an hour-to-hour timetable rather than relying on
those activities that take place during the traditional 10–4 occupational
therapy programme. Obviously, if ward staff are to take an active part in
increasing activity, there is a need for sufficient numbers of staff to be present.
However, there is no reason why family members or volunteers
should not be used to ensure that patients are as fully occupied and active
as possible.
Learning new behaviour
Nurses in in-patient settings are ideally placed to assist patients with the
learning of new behaviour. Some examples of problems which may come
under this heading are as follows:
• poor eye contact;
• deficits in verbal communication;
• deficits in non-verbal communication;
• problems with assertion;
• poor daily living skills.
Cognitive behaviour therapy in in-patient care 193
The central approach to deal with these problems of social behaviour is
social skills training. Although this method of treatment has not received
a great deal of attention in contemporary literature, there is no doubt that
it can be very effective; for example, Smith et al. (1996) reviewed nine
studies of social skills training, and argued that the approach was effective
for a range of problems. Smith et al. also suggested that social skills
approaches, used in combination with medication, could be a very effective
treatment for people with chronic schizophrenia. The approach may,
however, take a great deal of time, and obviously what can be achieved in
the acute ward setting is limited. Nevertheless, ward staff may be in an