Final Written Report CA

8/10/2019 Final Written Report CA

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ADARNE, ADVINCULA, AGODON, AGUILAR, AGUINALDO 4-NUR1 RLE1B

Withdrawal: is an adaptive or coping mechanism that involves physically pulling away from, or

psychologically losing interest in, an anxiety-producing situation, person or environment.

Common scenes:

o Child: who consistently plays alone than with a friend

o

Adolescence: becomes absorbed into reading instead of being involved withpeers

o Young adult: jogs alone to avoid personal contact with others

o Adult: who recluse who shuts windows and locks doors to close-out the world

This might be normal but when pattern is consistently used to distance or isolate self from

people or anxiety provoking situation, stressful situation, withdrawal becomes unhealthy. And

being withdrawn is usually found unhappy people and giving them the sense of bitterness and

alone.

Manifestations:

Cold

Distant

Loner

Inability to reciprocate feelings in an interpersonal manner

Developmentally, infantile or child like

Lacks trust of others and self

Chronically

depressed

Hypochondrial Narcissistic Maladaptive

patterns

Person suffering from

organic and

intellectual decline

Devalues and

depreciates self

Feels unworthy

Gives up to many

attachments

Withdraws from

people

Self-respect is lost

Regression to

helpless child

position

Waits to be cared for

Blaming failures

and and

deteriorating

relations

Extremely self-

centered

Proud and selfish

Little energy to love

or feel affection

Uses the cool,

detached style to

cover-up and a

form of being

withdrawn

Defense mechanism

Save self-esteem

Apathy

Seclusiveness

Minimal social

contact

Waits for support

To avoid frustrations,

embarrassment and

distress

Defensive style

Stays home more

Avoids contact with

family

Lives in secrecy


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Inability to show emotions or responds appropriately

Feeling of anxiety

Communicates in a terse but adequate style

Can't maintain relationships

Involves in job that doesn't require acquaintance with others

Never been engaged in dating

Facial expression as an indicator of the affect of Normal and Withdrawn person

Parameter Normal Withdrawn

Range of affect Capacity of expressing a wide

range of emotions in

interpersonal emotions

Capacity for expressing wide range if

emotions is limited. Reserved and distant in

interpersonal emotions

Mobility of affect Orderly and spontaneous

movement. Feelings conveyed by

variety of behavioral clues.Smooth transition from one

emotional state to another

Limited movement of affect. Slow to express

feelings. Apathy, distance, seriousness, lack

of reciprocation,

Appropriateness of

affect

Congruity between ideas or

content of situation and affective

response

Consistency between ideas and emotional

response present at times. Unable to

express warmth and positive feeling

consistently in response to others behaviors

Communicability of

affect

Ability to produce affective

response in another

Leaves others with cold, angry or apathetic

emotional response. Inconsistent in ability to

convey emotion through non verbal clues

Theories in the development of a withdrawn personality

1. Freudian concept (Psychoanalytic)

a.

Level of consciousness (conscious, subconscious, unconscious)

Conscious

o the here and now as it relates to the person and the environment

o

functions when we are awakeo concerned with thoughts, feelings, sensations

o directs our behavior

Subconcious

o ideas and reactions that are stored and partially forgotten

o acts as a watchman because it prevents certain unacceptable disturbing

unconscious memories from reaching the conscious mind


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Unconscious

o largest part of our mind

o storehouse of all memories

o feelings and responses experienced during the individuals entire life

o

materials stored continuously act as dynamic, motivating forces

Human mind never actually forgets any experience but stores in the depths of the

unconscious mind. This includes knowledge, experiences, information and feelings. But

these memories can sometimes not be recalled at will. Sometimes only presented

through dreams, slips of tongue, unexplained behavioral responses, jokes, body

language, and memory lapses.

All behaviors have meaning. No behavior occurs by accident or by chance. Rather, all

behavior is an expression of feelings or needs of which the individual is frequently not

aware of

b. Structure of personality (id, ego, superego)

Id

o pleasure principle

o avoids pain and seeks pleasure

o individual is id at birth

o striving for pleasure through the use of fantasies and images

o

compulsive and without morals Ego

o came from the environment

o reality testing

o deals with the demands of reality

o rational reasonable conscious part of the personality

o can be viewed as:

Ego-syntonic - instincts or ideas that are acceptable to the self; that are

compatible with one's values and ways of thinking. They are consistent

with one's fundamental personality and beliefs Ego-dystonic - thoughts, impulses, and behaviors that are felt to be

repugnant, distressing, unacceptable or inconsistent with one's self-

concept.

Superego

o came from the socialization process

o inhibitor of the id


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o has conscience and ego ideal which punishes and rewards

o can be viewed as:

Punitive superegoacts as a persons guilt

Rewarding superegoas long as the person does not achieve perfection,

he/she is not deserving of any reward

When the individual does not develop an ego strong enough to arbitrate effectively

between the id and the superego, he or she will surely develop intrapersonal and

interpersonal conflicts. When the id is not controlled effectively, the individual functions

in antisocial, lawless ways because primitive impulses are expressed freely. If the

superego is so strong that the individuals life is dominated by its restrictions on

behavior, the person is likely to be inhibited, repressed, unhappy, withdrawn and guilt

ridden. Thus a mature, effective, stable adult life depends on the development of an ego

powerful enough to test reality adequately and then to mediate successfully between

the demands of the id and the superego

Personality is developed by early childhood

c. Defense mechanisms

therefore if there is no equilibrium between an individuals personality, he/she will

experience anxiety that will force him to cope by using defense mechanisms

Narcissistic defenses

o

Denialo Distortion

o Primitive idealization

o

Projectiono Projective identification

o Splitting

Immature defenses

o Acting out

o Blocking out

o Hypochondriasis

o Identification

o Introjection

o Passive-aggressive behavior

o Regression

o Schizoid fantasy

o Somatization

o Turning against the self

Neurotic defenseso Controlling

o Displacement

o Dissociation

o Externalization

o Inhibition

o Intellectualization

o Isolation

o Rationalization

o Reaction formation

o Repression

o Sexualization

o Undoing


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Mature defenses

o Altruism

o Anticipation

o Asceticism

o Humor

o Sublimation

o Suppression

d. Love and intimacy (together with Rollo May)

Psychological health could be determined by a persons ability to function well in two

spheres: work and love

A person able to receive and give love with a minimum of fear and conflict has the

capacity to develop genuinely intimate relationships with others.

Emphasizes the value of sexual love as expansion of self-awareness; tenderness as an

increase of self-affirmation and pride; and orgasm to lose the feeling of separateness

When conflicts arise, there is a decrease ability of person to fuse tenderness andpassionate impulses thus inhibiting the expression of sexuality and closeness to other

people and diminishing the sense of adequacy and self-esteem. If they become severe,

it could prevent the formation of intimate relationships

Eriksonian concept

a. Developmental model

model that spans the total life cycle from birth to death

Life stage Adult behavior reflecting mastery

1. Trust vs. Mistrust

(0-18mos)

-realistic trust of self and others

-sharing openly with others

2. Autonomy vs. Shame and Doubt

(18mos-3y/o)

-self-control and willpower

-pride and sense and good will

-simple cooperativeness

-knowing when to give and take-delayed gratification when necessary

3. Initiative vs. Guilt

(3-5)

-adequate conscience

-appropriate social behaviors

-curiosity and exploration

-healthy competitiveness


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4. Industry vs. Inferiority

(6-12)

-sense of competence

-completion of tasks

-balance of work and play

-cooperate and compromise

-identification with admired others

5. Identity vs. Role Confusion

(12-18 or 20)

-confidence of self

-commitment to peer group values

-emotional stability

-developmental or personal values

-sense of having a place in society

-establishing relationship with the opposite

sex

-testing out adult roles

-exploration of risk-taking behaviors and

freedom

6. Intimacy vs. Isolation

(20-40)

-person reaches full maturity

-young, middle and late adulthood

Marriage

Child-rearing / Parenthood

Work

Divorce

Illness

-ability to give and receive love

-commitment and mutuality with others

--collaboration in work and affiliations-sacrificing for others

-responsible sexual behaviors

-commitment to career and long-term goals

-the intimacy of sexual relations, friendships,

and all deep associations are not frightening

to the person with a resolved identity crisis

-in contrast, the person who reaches the adult

years in a state of continued role confusion is

unable to become involved in intense andlong-term relationships. Without these

connections, a person may become self-

absorbed and self-indulgent. As a result, a

sense of isolation may grow.

-through this stage, a person should be able to

transcend from being dependent to being


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mutually connected with an extended and

more diverse social group

-at middle adulthood, people start to take life

more seriously

-40 is considered the noon of life

-as the children grow older, parents feeling of

needing work will return

-females feel masculine and males feel

feminine

7. Generativity vs. Stagnation

(40-65)

-productive, constructive, creative activity

-personal and professional growth

-parental societal responsibilities

-not only being able to raise theirchildren/family well but also being able to

contribute to the community

-frustrations may develop when people realize

they can no longer achieve new work

challenges

8. Integrity vs. Despair

(65-to death)

-feelings of self-acceptance

-sense of dignity, worth and importance

-adaptation to life according to limitations

-valuing ones life

-sharing of wisdom-exploration of philosophy of life and death

biologic, psychological, social, and environmental factors influence personality

development throughout the life cycle of a person

growth involves resolution of critical tasks at each of the eight developmental stages

lack of resolution of tasks causes incomplete development and difficulties in

relationships

change is a process of growth

Sullivans concept

a. observable data


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three modes of experiencing and thinking about the world

o prototaxic

undifferentiated thought

not seeing the whole in parts or symbols

usually in infancyo parataxic

events are causally related because of temporal or serial connections

o syntaxic

logical, rational, and most mature type of cognitive functioning of which a

person is capable of

all three types of thinking and experiencing occur and function side by side in all persons

b.

interpersonal theory

The total configuration of traits Self-esteem, which develops in various stages and is

the outgrow of interpersonal stages rather than intrapsychic forces

Stage Development

Infancy (birth to years) Anxiety occurs for the first time as a result of the infants

failure to achieve satisfaction f his her primary needs

Childhood(1/2 to 6 years) The main tasks are to become educated as to the

requirements of the culture and to learn how to deal with

powerful adultsJuvenile (6-9 years) Child has a need for and must learn how to deal with peers


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Franz Alexander

developed the concept of corrective emotional experience

people modify the results of their past traumatic events in the analytic situations in

which, with the support and trust from people around, they are able to master the past

traumas and grow from the experience

Gordon Allport

represents the humanistic school of psychology

a sense of self is the only personal guarantee of a person for existence

selfhood develops in stages through:

o propriem- maintenance of self-esteem and identity

o traits-units of personal structure that are common to same culture

o personal dispositions-essence of personality that is unique in every individual

o maturity-greatley extended sense of self and the capacity to relate warmly and

intimately to others.

therefore, people who have developed maturely have zest, enthusiasm,humor, insight,

and security

Eric Berne

developed the so-called transactional analysis

every situation should be recognize as a game or play

with each game, a person is considered a child, an adult or a parent

as a person grows older, he or she should be able to learn and recognize the game and

function as the right kind of player in every game

Erich Fromm

five dominant characters that are possessed and found in every individual

o Receptive-passive

o Exploitative-manipulative

Pre-adolescence (9-12 years) Development of the capacity for love and collaboration with

another person of the same sex develops. CHUM period-

prototype of for sense of intimacy

Early-adolescence (12- 14

years)

Separation from ones family. Development of standards and

values, and the transition of heterosexuality.

Later adolescence ( 14-21years)

Learns to form lasting sexual relationships


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o Marketing-opportunistic and changeable

o Hoarding-saves and stores

o Productive- enjoys love and work

all types are normal, but a person should be able to control it and strengthen it in an

ethical sense

Kurt Goldstein

developed the idea of holoceonosis

every individual strives for fulfillment of ones personalities but as an individual we all

have dynamic properties in which when faced with tensions or disequilibrium, we

always attempt to return to our previous state

when catastrophic situations occur, people have the instinct of becoming fearful,

agitated and regressive and therefore refuses to perform normal and simple tasks which

may lead to permanent failure to cope.

Karen Horney

the three kinds of self-actual, ideal and real

every person has the so-called pride system which pushes the overemphasis of prestige,

intellect, power, strength, appearance and sexual prowess. If not achieved, this could

lead to self-hatred, self-contempt and self- effacement

Abraham Maslow

a hierarchical organization of needs is present in each person.

Physiologic needs, safety needs, love and belongingness, self-esteem and self-

actualization


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Gender and Withdrawn Behavior

Between men and women, men are more prone to withdrawing than women. This phenomenon

can be attributed to their different gender roles. Freud has theorized that peoples childhood

experiences affect his/her characteristics when they reach adulthood. His theory may be related to a

persons psychosexual factors. Psychosexual factors include a persons sexual identity, gender identity

and gender roles. Sexual identity is defined as the anatomical and physiological characteristics one

possess. This includes the infants external genitalia and genetic influence, which is physiologically active

by the 6thweek of fetal life and completed by the end of the 3rdmonth. Gender identity is the sense of

oneself as being male or female. This is determined by parental and cultural attitudes and physical

characteristics. Gender roles are based on the expectations of the society. This is the public expression

of gender identity. This includes everything that one says or does to indicate to others the degree to

which one is male or female. Gender roles are learned upon observing the behavior of others.

Differences of how men and female relate to emotional or behavioral responses are considered learnedbehaviors.

Men and women respond differently to stressful situations. Women tend to share their stress

with others in the hopes of gaining the empathy of others and expect that other females would rely on

them if the roles were reversed. Men, on the other hand, tend to withdraw and act as an individual and

become more egocentric. (Tomova, von Dawans, Heinrichs, Silani & Lamm, 2014). Men have been

discouraged from being emotional since they were kids. They are usually teased when they show their

emotions. Since they are not used to handling emotions, when faced with intense emotions or stressors,

adult men become overwhelmed and confused around these emotions. It takes them more time to

understand and then adapt to emotions, thus causing them to withdraw from a particular situation or a

person.

Associated Disorders

1. Schizophrenia

Withdrawn behavior can be manifested in patients with Schizophrenia. Schizophrenia is the

deterioration of ones personality. This can be attributed to the imbalance, usually due to high amounts,of dopamine levels in the brain. Bleulers Four As are symptoms that are usually manifested with

schizophrenic patients and includes: Affective disturbance (inappropriate, blunted or flat affect); Autism

(preoccupation with self, little concern for external reality); Associative looseness (stringing together of

unrelated topics) and; Ambivalence (simultaneous opposite feelings). DSM-IV-TR Criteria for

Schizophrenia include: A. At least 2 of the following: delusions, hallucinations, disorganized speech,

grossly disorganized or catatonic behavior or negative symptoms (alogia, anhedonia, apathy, blunted


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affect, catatonia, flat affect and avolition); B. Social-occupational dysfunction: work, interpersonal &

self-care functioning below the level achieved before the onset; C. Duration: continuous signs of the

disturbances for at least 6 months; D. Schizoaffective and mood disorders not present and not

responsible for the signs & symptoms and; E. Not caused by substance abuse or a general medical

disorder.

Kit does not have Schizophrenia. Based on the case, Kit has not had any reports of delusions,

hallucinations, disorganized speech nor grossly disorganized behaviors. But, based on the case, he has

shown some negative symptomsanhedonia, apathy and avolition. Also, it cannot be concluded that he

has had a social-occupational dysfunction because there was no evidence shown that he was more

social before than he is upon physical work up.

2. Personality Disorder

Personality disorders are lifelong, inflexible and dysfunctional patterns of behaving and relating.

DSM-IV-TR Criteria for a Personality Disorder would include the presence of at least two of the

following: A. Cognition (thinking about self, people and events); B. Affectivity (range, intensity, lability

and appropriateness of emotional response); C. Interpersonal functioning or; D. Impulse control.

Personality disorders are divided into three clusters namely: Cluster A: Odd-Eccentric behaviors, which

includes paranoid, schizoid and schizotypal personality disorders; Cluster B: Dramatic, Emotional, Erratic

behaviors that includes antisocial, borderline, narcissistic, and histrionic personality disorders and;

Cluster C: Anxious-Fearful behaviors that includes dependent, avoidant and obsessive-compulsive

personality disorders. Cluster A personality disorders are associated with withdrawn behavior.

2.1. Paranoid Personality Disorder

Paranoid personality disorder are those who are suspicious of others, doubts trustworthiness or

loyalty of friends and others, fears confiding in others, interprets remarks as demeaning or threatening,

holds grudges toward others and becomes angry & threatening when he/she perceives being attacked

by others. These people tend to withdraw because of their distrust in the people around them.

Kit does not have a paranoid personality disorder because it was not stated whether he was

suspicious of others. Plus, as seen in the criteria, paranoid personality disorders still have interpersonal

relationships with others and they are still open to the idea of intimacy.

2.2. Schizotypal Personality Disorder


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Criteria for schizotypal personality disorders include: ideas of reference, magical thinking or odd

beliefs, unusual perceptual experiences (bodily illusions), odd thinking & vague, stereotypical,

overelaborate speech, suspicious, blunted or inappropriate affect, odd or eccentric appearance or

behavior, few close relationships and excessive social anxiety. They are uncomfortable around others

but are interested in other people. These people tend to withdraw because social situations are

uncomfortable because of the reactions of others to the persons appearance and behavior.

Based from the case, Kit does not have a schizotypal personality because none of the criteria for

schizotypal personality disorders matches him.

2.3. Schizoid Personality Disorder

People suffering from schizoid personality disorder manifests with a lack of desire for close

relationships or friends, chooses solitary activities, little interest in sexual experiences, avoids activities,

appears cold and detached, lacks close friends, appears indifferent to praise or criticism. They become

loners, vagrants or hermits. They may have a preference for numbers rather than people and may

function well as mathematicians or with computers. Their isolation makes them prone to depression.

These people withdraw because of the fact that they do not enjoy social interactions.

Based on the results of Kits physical work-up, he can be considered to have a schizoid

personality. This is evidences by the fact that he has no contact with his family, him not maintaining any

friendships, choosing to live alone, apathy regarding dearth of social structures, never having engaged indating or other social activities, preference to work alone at home, inability to name any hobbies or

activities that he finds enjoyable and the fact that he works as a data encoder on a night shift.


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MANAGEMENT FOR WITHDRAWN PATIENT:

ATTITUDE THERAPY:

1. Active Friendliness:

Other terms are tender loving care and giving and love unsolicited. Patients needsare attended

to like bathing, combing hair, cutting fingernails

Since the patient is withdrawn and doesnt approach anybody, the approach has to be made from

the nurses side and many attempts will have to be made to initiate any conversation or

communication.

Doing everything within our power to give pleasure to the patient

Attention is given to the patient before he requests it

Used with individuals who are withdrawn and apathetic

NURSING INTERVENTIONS:

1. Make contact or link with the patient. Therapeutic use of family or close friends may be helpful.

2.

Establish and maintain a trusting relationship. Staff must be aware that this may be a lengthy

process requiring patience and perseverance and that the patient may initially reject them.

3. Respect the patients need for silence and inform the patient that the staff is always available when

he/she has a need to communicate.

4. Touch may be used therapeutically by staff who feel comfortable with touch and according to the

patients reception of touch.

5. Maintain consistency regarding appointment times.

6.

Give the patient a positive feedback to both verbal and non-verbal responses.7.

Avoid comments like Seeing you arent busy to a colleague sitting with a withdrawn patient.

8. Gradually introduce the patient to other people and then explore feelings with regard to contact

made with others.

9. Gradually introduce and involve the patient in lifestyle activities again.

10.Use friends and family as a link with the community.


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Nursing Interventions Rationale

Initially encourage the client to spend short

periods of time with other person

Initially encourage the client to express himself

or herself nonverbally

Encourage the client to talk about these

nonverbal communication and progress to

more direct verbal communication as

tolerated. Encourage the client to express

feelings as much as possible.

Interact on a one-to-one basis initially, and

then help the client progress to small groups,

then larger groups as tolerated.

Explain any task in short, simple steps

Using clear, direct sentence, instruct the client

to do one part of the task at a time.

Tell the client your expectations directly. Do

not ask the client to choose unnecessarily. Tell

the client it is time to eat or dressed rather

than asking if she or he wants to eat or dress.

Do not confuse the client with reasons as to

why things are to be done.

Allow the client ample time to complete the

tasks.

Remain with the client throughout the task; do

not attempt to hurry the client. Assist the

client throughout the task; do not attempt to

hurry the client.

Assist the client as needed to maintain daily

functions and adequate personal hygiene.

Teach the client social skills, and encourage

practice with staff members and other clients.

At first client will deal more readily with

minimal stimulation

Nonverbal communication usually is less

threatening than verbalization

By asking the client about writings or drawings

rather than directly about himself or herself or

emotional issues, you minimize the clients

perception of threat. Gradually direct verbal

communication becomes tolerable to the

client.

Gradual introduction of other people

minimizes the threat perceived by the client.

A complex task will be easier for the client if it

is broken down into a series of steps.

The client may not be able to remember all the

steps at once.

The client may not be able to make choices or

make poor choices

Abstract ideas will not be comprehended and

will interfere with task completion.

It may take the client longer to complete tasks

because of lack of concentration and short

attention span.

Trying to rush the client will frustrate him or

her and make completion of the task

impossible.

The clients sense of dignity and well- being is

enhanced if she or he is clean, smells good,

looks nice and so forth.

Increasing the clients social skills and


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Give the client feedback about interactions.

Encourage the client to identify and build

relationship with supportive group outside of

the primary care given by the nurse.

Gradually withdraw assistance and supervise

the clients grooming or other self-care skills.

Praise the client for initiating and completing

activities of daily living.

Teach the client social skills. Describe and

demonstrate specific skills, such as eye

contact, attentive listening, nodding, and so

forth. Discuss topics appropriate for casual

social conversation, such as weather, local

events, news, and so forth.

*Assist the client to approach someone and

ask a question. Use real-life situations, such as

seeking assistance in a store, asking directions,

or renting an apartment.

Practice giving and receiving compliments with

the client. Make sure compliments are sincere.

*Role play situations in which the client mustaccept no to a request and in which the

client must appropriately refuse a request

from someone else.

confidence can help decrease social isolation.

Increasing the clients support system may

help prevent withdrawn behavior in the

future.

It is important fort he client to gain

independence as soon as possible. Positive

reinforcement increases the likelihood or

recurrence.

The client may have little or no knowledge of

social interaction skills. Modeling provides a

concrete example of the desired skills.

Asking questions is an essential skill in daily

life. Using real situations makes the exercise

more meaningful for the client.

Chronically mentally ill clients rarely notice

things about other people without practicing

that skill. Receiving compliments can beawkward due to low self-esteem.

Low frustration tolerance makes hearing a

negative answer difficult for the client. Clients

frequently comply with requests from others,

then regret doing so because they are unable

to refuse in a socially appropriate manner.

MILIEU MANAGEMENT

Arrange nonthreatening activities that involve these patients in doing something like painting

Arrange furniture in a semicircle or around a table this forces patients to sit with someone.

This will permit interactions but should never be demanded

Provide psychosocial rehabilitationthat is training in community living, social skills and health

care skills


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PSYCHOTHERAPY: A treatment modality based on a TRUSTING RELATIONSHIP BETWEEN the THERAPIST

and CLIENT.

COMMON TYPES OF PSYCHOTHERAPY:

Behaviour Therapy

Cognitive Therapy

Dialectical Behavioural Therapy

Interpersonal Therapy

Psychodynamic Therapy

Family Therapy

Group Therapy

BEHAVIOUR THERAPYfocused on helping an individual understand that when they change their

behaviour it can lead to changes in how they are feeling.

a. SELF MONITORINGperson is asked to keep a detailed log of all their activities during the day. The

therapist can see exactly the person is doing.

b. SCHEDULE OF WEEKLY ACTIVITIESthe patient and the therapist work together to develop new

activities that will provide the patient with chances of positive experience.

c. ROLE PLAYINGused to help person develop new skills and anticipate issues that may come up in

social interactions

d. BEHAVIOUR MODIFICATIONpatient will receive a reward for engaging in a positive behaviour.

INTERPERSONAL THERAPYfocuses on the interpersonal relationships

a. IDENTIFICATION OF EMOTIONhelping the person identify what their emotion is and where is it

coming from

b. EXPRESSION OF EMOTIONinvolves helping the person express their emotions in a healthy way.

c. DEALING WITH EMOTIONAL BAGGAGEoften, people bring unresolved issues from pastrelationships to their present relationships.

GROUP THERAPYa therapist and six to twelve participants with related problems

ACTIVITY THERAPIESself-expressive, interactive and with acceptance


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a. ART AND MUSIC THERAPYincreases self-esteem, openness, expression of feeling and reduce

isolation

b. RECREATIONAL THERAPYfun and relives tension

c. EXERCISEpromote physical and mental health

*Challenging activities are not encouraged for withdrawn patients especially in early phase because not

being able to accomplished the activities will lead to decrease self-esteem thus patient may become

more withdrawn.

ASSERTIVENESS TRAININGfirst used in behaviour therapy to countercondition social anxiety.

ASSERTIVESS BEHAVIORenables a person to act in his or her own best interest, to stand up for himself

or herself without undue anxiety, to express honest feelings comfortably and to exercise personal rights

without denying the rights of others.

ASSERTIVENESS COMMUNITY TREATMENTintensive and highly integrated approach for community

mental health service delivery

-serve outpatients

- array of services provided by community-based, mobile mental health treatment teams

- designed to provide comprehensive, community-based psychiatric treatment, rehabilitation, and

support to persons with serious and persistent mental illness who live in the community.

Programs include are:

Personal wellness assessments

Goal setting and motivational counselling

Group physical activity / exercise programs

Group health and wellness learning sessions

Self-management peer support programs

Wellness Navigation to help individuals and families to find appropriate services, support, orprograms that are needed to support health and wellness

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