Cognitive Behaviour Therapy - Case Study Example

Cognitive Behaviour Therapy (CBT) As a psychotherapeutic approach, Cognitive behavioural therapy (CBT) is applied in dealing with dysfunctional behaviours, emotions and cognitions. It combines behavioural therapy and cognitive therapy. CBT has developed to be one of the famous approaches in dealing with MH disorders. It has since then played a big role in shaping the practice of MH nursing and is yet to shape the future of this profession. Mental health care are services meant to deal with mental disturbances/illness. They range from marital counselling to services for treating severe mental illness. CBT is today widely applied in the treatment of anxiety disorders, substance abuse, insomnia, severe mental disorders, mood disorders and stuttering and complex trauma Development of CBT During the late 19th century, patients with MH disorders, for example, depression and schizophrenia were housed with people suffering from epilepsy and cerebral palsy. Inhuman ways were used in some cases, for example, forcing them to vomit, bloodletting/bleeding and cold /hot baths. Some were removed from the society and put in asylums (Arnold 1971). Philip Pinel was first to introduce humane ways of handling MH patients through observation and talking to them as a method of cure. Categorisation and separation was also used. Physical and psychosocial techniques were used as treatments in order to help the MH patients to reason again (Greenberger and Padesky, 1995). Intelligent and sensitive attendants were hired in some cases so as to work closely with the MH patients. They would read with the MH patients, take them for regular walks and talk to them (Beck, Fennell, and Hackmann, 2008). Insulin shock therapy, lobotomy technique and electroshock (ECT) were adopted in the mid 1940s. Behavioural therapy (BT) was developed in the early 20th century. In Britain Joseph Wolpe used systematic desensitization to deal with neurotic disorders. This was a precursor to fear reduction techniques used today. Popularity of BT was replaced by cognitive therapy (CT) revolution. CT was developed in the 1960s by Abraham Low to deal with patients after psychiatric hospitalization. It was meant to help people who had mental illness to recover. Beck also developed the CT after realizing that patients never revealed some thoughts they had before intense emotional reactions (Beck, 1991). He concluded that cognitions preceded emotional reactions. BT and CT were merged in the 1980s and 1990s to form the CBT. This was mainly after treatments for panic disorder were successfully developed in the UK by David Clark and in the US by David Barlow. Anxiety as a MH problem Anxiety refers to a state of psychological stress characterized by feelings of fear, uneasiness and worry. An example to be discussed here is social anxiety disorder. It is also called social phobia. This is where a person has much fear and avoids public scrutiny, humiliation and interactions. The person can experience it during social interactions or public speaking. Symptoms include sweating, blushing and stammering. The person will often avoid its cause leading to isolation (Ost, 1989). Before the inception of CBT, anxiety as an MH problem was treated by homeopathic medicine. The body’s immune system was caused to fight the anxiety symptoms by introducing substances that provoked same symptoms. Insulin shock therapy, lobotomy technique and electroshock (ECT) were also used (Westbrook, 2007). CBT approaches for treating anxiety According to Rychlak (1981), the two cognitive approaches that can be used in the treatment of anxiety, for example, social phobia are cognitive therapy and rational emotive behaviour therapy (REBT). For example, for a person who has fear of public speaking, the two approaches are aimed at making the person develop self confidence. This should enable them to stand boldly before people, make presentations and express themselves confidently. CT will help the patient critique their assumption that others are keenly watching and judging them negatively. Cognitive restructuring is combined with exposure in the treatment of social phobia. The patients are made to know that their feelings are unrealistic by exposing them to anxiety causing situations. This is done systematically in a structured and sensitive manner. They are exposed to the feared social situation example public speaking but in bearable magnitudes for some time like 2-3 times a week. The stressful situations are classically conditioned so that the social phobia can be unlearned. The CBT will base on the person’s thinking and way of reaction to situations. Social skills training are included at times. CT in this case involves training the patient to manage anxiety, for example, by breathing deeply and allowing the muscles to relax. REBT will help the patients change their reactions to the situations that provoke anxiety. It helps them to have a different attitude towards these situations. The rational component of REBT helps the patients distinguish rational and irrational beliefs, for example, “I am very poor in public speaking”. Its emotive component is used to help patients dispute their irrational believes, for example, being judged negatively. It also helps them to change their emotions, thoughts and behaviours. These may involve shame-attacking exercises, use of humour and rehearsing the embarrassing situations through role playing (Robertson, 2010). Through the behavioural component of REBT, the patients are helped to develop effective thoughts and actions that will help them cope with the stressful situations, for example, using relaxation techniques and building a positive attitude. This will help reduce tension that increases their anxiety and develop confidence (Jones 1924). Limitations of CBT CBT require hard work; it places a lot of cognitive demands on patients. The patients are required to learn a wide range of skills and concepts, for example, remembering and monitoring cognitions and inner states, and applying the new skills when confronted with the stressing situations. The CBT is a complex approach to MH disorders and therefore difficult to train clinicians on how to apply CBT mechanisms in their clinical practice. It is difficult to find CBT qualified therapists in most rural areas and not all CBT therapists are experienced to deal with all MH problems (Robertson, 2010). The non-CBT therapists feel that CBT services are less compared to the attention and funding it receives. Its services do not help to deal with non-psychotherapy matters example reducing unemployment. Though cheap, the CBT approach is scientific yet a scientific perspective is not the best to deal with emotional problems. More research and publication is being done on CBT hence non-CBT therapists feel disadvantaged by the excessive funding and publicity given to CBT. It has made their approaches unpopular yet they produce the sane results as CBT (Grant et al 2010). The importance of adapting and using CB approaches in MH nursing practice The MH nurses work alongside the physicians hence they should also be educated on how to deal with the same patients as the physicians. According to Lee (1995) the teaching of CBT skills should become an integral part of MH pre/post-registration nurse education. This will ensure that MH nurses qualify as trained therapists. With the CBT skills, the MH nurses will be in a position to handle better the MH patients while promoting recovery. They will know how to inspire hope in the lives of the patients and know how to build on the patients’ aspirations and strengths. They will know the services that can be offered to speed up the recovery process. The CBT may involve both inpatient and outpatient treatments. This means that the MH nurses should be experienced on ways of caring for them, especially those whose conditions are severe. This will help the MH patients to easily cope with the hospital environment because hospitalization worsens the psychotic situations for some of them. The nurses will comfortably deal with the MH patients and only call the psychiatric specialist at extreme cases (Butler et al, 2008). CBT and the future of MH nursing According to Dattilio et al (2007), CBT skills will boost the MH nursing career. This is because MH nurses usually practice in multidisciplinary teams therefore CBT training will ease their collaboration with other MH professionals. This will reduce stress on the part of nurses, communication problems and role conflict The MH nurses can practice as part time private therapists because they will provide the MH care in the least restrictive environments, for example, home. Due to low cost, their CBT skills are sure to attract the many people who cannot afford the other therapeutic approaches. Community MH nurses will be very useful in the delivery of CBT by as a treatment modality in public MH services. The MH practice in the 21st century has advanced. Computerized CBT (CCBT) has been developed whereby interactions are made with computer software used in the CCBT sessions. A PC or a voice-activated phone service is used instead of a face- to –face contact with a therapist. This has been used to curb the high cost of therapeutic services or deal with shortage of therapists. It has also provided an option for the depressed and withdrawn people who do not want to speak to anybody about their innermost problems (Robertson, 2010). With increasing cases of MH disorders, there is much chance for the MH nurses to put their skills into practice. This is a good reason why the teaching of CBT skills should become an integral part of MH pre/post-registration nurse education. It also poses a great future for the MH profession. It will also help to offload the workload of the other physicians dealing with the MH patients. References Beck, T. (1991). Cognitive Therapy and the Emotional Disorders. New York : Penguin Books. Beck, T., G., Fennell, M., and Hackmann, A. (2008). Cognitive-Behavioral Therapy for Anxiety Disorders. New York: The Guilford Press Dattilio, M. and Freeman, A. (2007). Cognitive-Behavioral Strategies in Crisis Intervention (3rd ed). New York: The Guilford Press Grant, A, Townsend. M, Mulhern, R, and Short. N (2010). Cognitive Behavioral Therapy in Mental Health Care. (2nd ed) London. SAGE Jones, M (1924). "Elimination of childrens fears". Journal of Experimental Psychology (7) pp 382–397. Lam. D, (2008) Cognitive Behaviour Therapy: A Practical Guide to Helping People Take Control. London : Routledge Lazarus, Arnold A. (1971). Behavior therapy & beyond. New York: McGraw-Hill. Lee, T (1995). "Professional underutilization of Recovery, Inc.". Journal of Psychiatric Rehabilitation (1) pp 63–71. Low, Abraham (1945). "The Combined System of Group Psychotherapy and Self-Help as Practiced by Recovery, Inc.". Journal of Sociometry (3/4) pp 94–99. Ost, G (1989). "One-session treatment for specific phobias". Journal of Behaviour Research and Therapy (1) pp 1–7. Greenberger, D. and Padesky, C.(1995) Mind over Mood; Change How You Feel by Changing the Way You Think. New York. The Guildford press. Robertson, D (2010). The Philosophy of Cognitive-Behavioral Therapy: Stoicism as Rational and Cognitive Psychotherapy. London: Karnac. Rychlak, J. F. (1981). Introduction to personality and psychotherapy (2nd ed.). Boston: Houghton Mifflin Company. Varcarolis. E (2010). Manual of Psychiatric Nursing Care Planning: Assessment Guides, Diagnoses and Psychopharmacology. ( 4th ed) New York: Saunders Elsevier. p 109. Westbrook. D, Kennerley. H and Kirk.J (2007) An Introduction to Cognitive Behaviour Therapy. Skills and Applications. London. SAGE. Read More