Application of Behavioral Cognitive Theory - Essay Example

?Case Analysis in Counseling Case Analysis in Counseling Submitted) Introduction Over the past decades, illness has been treated central to the physical symptoms presented by the patient. However, for the last several years, experts advocated that health care providers should treat the patient as a whole including the family. This is because the process of being sick includes other aspects of health which is not an individual event alone but also concerns the family and social relationship. When one member of the family is ill, it is normal for the other members to be likewise affected more so, when the illness entails long term care. Thus, becoming ill and recover from it is a challenge. Being sick may lead to many adverse reactions which may further contribute to the process of the illness and recovery. It creates a change in the environment of the patient affecting her behavior. How the patient behaves during the duration of illness is a strong contributory factor in coping with the illness. With this situation, counseling the patient is deemed empirical. However, before counseling commence, case analysis of the patient should be carried out. Analysis of the patient’s experience of illness includes examining the progress of the illness and the process of recovery identifying the patient’s own psychosocial characteristics that may influence the illness and recovery while intervention suggests psychosocial counseling with the application of behavioral cognitive theory (CBT). The Nature of the Case Melinda is a married 50 year old female with six children who is sick of cervical cancer. She claims she did not have any hospitalization for several months prior to her illness. This is her first consultation with her physician. According to her, she is not supposed to have her consultation if not for a fall from the staircase of their house causing her some bruised at her back and arms. However, the bruises according to her doctors are just but minor health problems as compared to the result indicated in her health history taken from her. Her health history reveals that she is showing warning signs and symptoms of cervical cancer. Accordingly, she had been having vaginal bleedings for several months after her menopausal period. However, she never had any consultations nor alarmed because she believes her menstrual cycle had resumed. In May of 2010, she was diagnosed of first stage cervical cancer. Like any individual who is diagnosed with such illness, she was shocked to hear the result of her laboratory examination as revealed by her physician and is immediately under a circumstance where she had no prior experience (Clarke, et al. 2005) thus, her reaction to the information is devastating. Shock is followed with denial as evident in her statement, “I never had any health problems in the past. Why would I be sick of such disease”? Melinda had married three times one after the other and had been sexually active. From the time of her diagnosis, she lost her appetite, has not been sleeping well and been irritable. She also does not want to sleep with her husband anymore. She defends she is more comfortable to sleep alone in a room. This made a gap in their relationship. Most often, Melinda does not respond when her husband tries to communicate with her. Observation also reveals that she rejects foods and drinks offered by her children. However, her family is regarded to be caring and tried their best to adjust to the behavior change of Melinda. Melinda does not also like to see neighbors and even friends as she shuns away from them whenever they pay visit. When ask if other members of the family had been stricken or have died of the same illness in the past, she answered, “Does it matter” that shows that she is not interested to know her family health history. Her mother died of breast cancer many years ago and a distant relative recently passed away with lung cancer. Now, she is under the care of an oncologist and several other specialists to treat her illness. Her family takes turn to bring her in the hospital for her chemotherapy and other medical procedures needed. Case Analysis The problem with the situation of Melinda is her psychosocial characteristics that influence the progress of her illness and the process of her recovery. Such defective psychosocial characteristics had created several hindrances in achieving treatment goal for a better prognosis of the disease. Analysis of such case will review key issues to include determination of her personality traits, beliefs, and social relationship in relation to her recovery and process of illness. Personality Several personalities have been known to influence the progress of the disease and recovery from it. Patients with positive personalities which include optimism, extraversion and conscientiousness are believed to have a better self-reported health and psychological adjustment (Kern & Friedman, 2011). Furthermore, such positive traits facilitates coping. This is supported with several researches conducted in the study regarding optimism against pessimistic personalities in relation to health and illness. Sick individuals who are optimistic are found to have better coping mechanisms when ill thus, they recover within a shorter period of time. Optimistic patients can participate in their care and treatment. They may comply with their medications, nursing care, laboratory examinations and other treatment regimen required by such illness. Individuals who are also open to discuss their emotions are known to have healthier life style that may not only contribute to staying healthy but also limiting the involvement of other body parts in times of illness. Reason for this could be trace from a perspective that expressing emotions could release toxins from the body. Communicating honestly and pinpointing feelings likewise increase the level of energy pertinent in fighting the presence of virus thus faster recovery is ensured. Such positive personal traits are not found in Melinda. Thus, the health care team is having difficulty in their medical intervention. On the other hand negative personalities such as anger and hostility, being neurotic, anxiety and depression may hasten the progress of the disease. Inappropriate application of such traits may lead to stressful scenario which may in turn lead to the suppression of immune system necessary to defend the body from microbial infection. A strong relationship of this affirmation is evident in the study of Blume, Douglas and Evans (2011) where they explained that depression is a disorder of both immune suppression and immune activation. The authors further pointed out that when the patient is depressed, it is likely that the natural killer cells are decreased and inflammation may set in as a result. Similar studies also found out that cortisol which is an immune suppressing hormone increases during depression resulting in lower immunity and other negative effects. Melinda has such personality as reflected in her losing interest in food, disturbed sleep and irritability. This negative personality aggravated her condition. She claims that every time she is depressed, her episode of vaginal bleeding becomes frequent and profuse. Her hostile personality also hinders her from heeding to treatments. Sometimes she scolds and tongue lash nurses and other staffs of the hospital when procedures are being carried out. Melinda is presented with options of her treatment however she seems not interested. Thus, her planned treatments cannot be carried out effectively and prognosis is uncertain. Beliefs Beliefs are found to be predictor of faster recovery from illness because it could modify behavior of patients to adhere to their medications (Hou, Cleak & Peveler, 2010). However, some of Melinda’s beliefs are not based on such health belief model. She has beliefs that had influenced the progress of her illness. She belongs to an Asian descent but migrated in the United States. Although, she is educated and acculturated with the Western way of living, Melinda still holds some of her health beliefs from her original country. It appears that her understanding of the progression of her illness is her negligence in not practicing the after birth tradition where she has to keep her body warm to protect herself from cold exposures and viruses. She considers the Western lifestyle of wearing thin clothes or even short clothing and not wearing socks after birth is a strong contributory factor in her illness. She gave birth to her four children in the United States. During the initial conduction of other laboratory examinations, the health care team had a difficulty as she always do not cooperate with them because she believes those procedures are not necessary. She still insists that miracles could happen and that she may get well without so much medical interventions. Findings of the study of King, Speck and Thomas (1999) supported such idea that spiritual belief may interfere with the progress of illness mentioning that patients with a strong spiritual faith were more likely to deteriorate in their medical condition. However, Melinda’s belief in traditional therapy such as the use of botanical and homeopathic medicines seems to be in synergistic with modern medicine. Melinda had been using approved medicinal herbs to relieve some of her signs and symptoms like pains. She also had appointments with chiropractors who applied the law of physics and chemistry in treating other physical symptoms. In addition, her belief of meditation helped in the reduction of some psychological factors like insomnia, body aches and lowers blood pressure (Benson, 1998). Social relationship Social relationship involves the interaction with other members of the family, friends and neighbors to include the notions of social integration and social support. The progression and recovery of illness can be determined through interaction of the patient with the significant others around her depending on the intensity and frequency with which the social relationship is held. Being Asian, Melinda has a family with strong family ties where family members are together in any occasion like birthdays, Christmas, New Year celebrations and even in times of death. They demonstrate strong cohesion. Members are caring to their sick and can even sacrifice to deprive their wants and happiness just to care for their sick when caring is mostly needed. Social relation is critical in times of illness for the patient to recover and go back to her normal health. The result of the study of Morrison and company (2002) has identical findings where they explained that contact with friends and support from others is very important for the survival of the ill individual. Social relation could be a source of emotional, informational, instrumental, and financial support which is very essential for the patient to cope because it could exert various beneficial health outcomes. Observation and studies have it too those patients who are frequented by their spouse in the hospital likewise yield a positive result in the process of their recovery. They recover at a faster rate compared to those who are not frequently visited by their partners. In Melinda’s case, social support is strong. Family members and friends were organized to take turn in caring for her even if it proves difficult at times as caring interferes with the schedule of their work and fatigue is taking its toll in them. Although it is evident that members are dedicated to support Melinda cope, there are obvious issues involved. Members have insufficient knowledge and skill in caring for Melinda as this is their first time to experience such change in role in their life. Some members just simply accompany Melinda during her chemotherapy without actually spending quality time with her because at times she is withdrawn, irritable and does not want to discuss any topic related to her treatment and feelings about it. In addition, one member is unskilled in understanding the process of grief and depression Melinda is experiencing at the moment which sometimes causes conflict. This challenged their relationship as a family. It appears that this kind of support does not stimulate Melinda to change her behavior towards her illness. Intervention Since the problem of Melinda lies more in her personality, management does not rely on the physical symptoms alone but to include other health aspects such as the psychological and psychosocial dimensions. This could be accomplished through counseling. Counseling follows certain characteristics of listening, reflection, and clarification if healing is to be achieved. The listening skill of the therapist should be excellent. In a normal scenario in the hospital, it is the physician who does the talking when dealing with a patient. However, when counseling a patient, it is the opposite. The therapist should let the patient do the talking instead. This may allow the patient to tell it all and not hide information which might be vital for her treatment. Listening should be followed with reflection of what the patient divulges. Reflection could be done through asking questions from the patient. Doing this may help the client to recognize her problems when confronted with illness; reflect on her ineffective behavior and thought patterns as a result of illness. However, the reflecting process should be respected and responded appropriately by the counselor for more effective result. Lastly the therapist should clarify what the patient says. Clarification is done through restating what the patient had just said. This process may guide both the counselor and the patient effectively. Counseling is more rounded and realistic when accompanied with cognitive behavioral therapy (CBT). This strategy emphasizes the use of practical methods of approaching emotional problems. It involves a range of technique with the goal to alter patterns of thoughts and behavior that may influence emotions. It focuses on re-arranging or realigning unhealthy behavior to beneficial ones instead. Thus, this strategy is not only for depressed patients but go beyond to treat individuals exposed to traumatic events. The study of Bryant, Mould, and Nixon (2003) found out that cognitive behavioral therapy is also applicable to treat post traumatic stress. With their study, they disclosed that those who participated in the cognitive behavioral therapy reported less intense post traumatic symptoms. Cognitive behavioral therapy’s primary goal is to help depressed individuals become aware of their negative and pessimistic thoughts. When these negative patterns of thinking are identified, the person may now be taught counter- productive and realistic interpretation of events to use in their daily life as an alternative. This could be done through engaging the individual more in behaviors that reinforce positive thinking. For example, Melinda is upset because she is sick unexpectedly. She failed to keep her health in balance. Now, she must get well otherwise she is worthless in her family and to the society in general. With this, she feels depressed. The therapist must teach Melinda to develop rational thinking for her to have healthy coping strategies in return. The therapist should make Melinda realize that there is no evidence that sick people are worthless and that healthy people are worthwhile. Although, the desire to have a healthy life is good enough and would be rewarding to be free of pains and body discomforts, it hardly makes Melinda worthless. Now, Melinda realizes that becoming sick is a saddening situation but not disgusting and that she considers that every person in this world experience events in their life that may disappoint, frustrate, and sometimes can even defeat an individual. Such may change the feelings of Melinda from depression to sadness. Sadness is likely a healthy negative reaction to the situation that may lead her to find ways for a healthier lifestyle. She may start to modify her thinking of illness particularly cancer and live a better happier life. Such example does not only let the client become aware of the distortion in her thinking but also improves her cognition. Without which, the client may not be able to realize that the way she perceives situation is not within the “normal limits” and may continue to behave the way she does. If this continues to happen, it will expose the body to such threat at a level it will no longer cope until it is impossible to recover. Conclusion Becoming ill and being ill is a threat to a person’s well being. It could bring dramatic changes in the person’s behavior that may impair her coping mechanism. More so when the patient’s psychosocial characteristics are not in agreement with modern medicine proving illness could not be managed effectively with medical treatment alone but more importantly the will of the patient to get well. When this happens, the person may display “abnormal” behavior that may contribute to the progression of the illness and impedes recovery. Such scenario calls for counseling intervention that is proven to be a necessity to empower the patient to change negative behavior to positive ones necessary for recovery. Counseling not only helps the patient solve her own problem at hand but may also helpful in her future endeavor when confronted with similar problem. However, counseling should be non judgmental in nature. References Benson, H., (1998). Timeless Healing: The Power and Biology of Belief. Sage journal (4) 2. Brynat, RA., Moulds, ML., Nixon, RV., ( 2003). Cognitive behavior therapy of acute stress disorder: a four-year follow-up. Behavior Res Therapy. 41(4):489-94. Blume J., Douglas, SD., & Evans, DL., (2011). Immune suppression and immune activation in depression. Brain Behavior Immunology.25(2):221-9 Clarke, S. A., Davies, H., Jenney, M., Glaser, A., & Eiser, C. (2005). Parental Communication and children's behavior following diagnosis of childhood leukemia. Psycho-Oncology, 14 (4), 274-281. Hou,R., Cleak, V., & Peveler, R., ( 2010). Do treatment and illness beliefs influence adherence to medication in patients with bipolar affective disorder? A preliminary cross-sectional study. 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