Cognitive Therapy for Depression - Essay Example

? A Review of Related Literature Cognitive Behavioral Therapy Based Approaches to Mental Health Nursing and their Application to Depression of Student Course Title Date of Submission Cognitive-behavioral therapy (CBT) is a widely, thoroughly studied type of psychotherapy. There are currently more or less 400 published studies on CBT. This increase is partly because of the continuous application of CBT in mental health nursing. However, numerous questions are still unanswered concerning the general efficacy of CBT, the degree to which its effects continue after the end of treatment, the characteristics of the control groups through which its efficacy has been determined, and varying efficacy by disorder. This paper presents a literature review of the cognitive behavioral therapy based approaches to mental health nursing and their application to depression. The most remarkable finding published thus far on the treatment of depression has been in a major research, conducted by Keller and colleagues (2000), weighing the outcomes of one of the more recent treatments, nefazodone, against a new treatment, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). The CBASP approach suggests that the mindset of individuals with chronic depression has become retarded or regressed to the most elementary developmental stage. The nature of this mindset makes patient indifferent to forces from the social environment, leading to the belief that they are not able to affect any of the circumstances in their lives. This kind of mindset leads to the submissiveness and vulnerability usual of patients with chronic depression. The technique underlying the therapy is to demonstrate to patients that their decisions and behavior do in fact have significant effects, so that they will be encouraged to adopt behaviors that will yield positive outcomes. These positive outcomes, which stem mostly from social support, work to bring back motivation and enhance mood. Several techniques are implemented in adopting this approach such as the following (Keller et al., 2000, p. 1465): Provision of consistent feedback from the therapist on the interpersonal effects of the patient’s actions. Teaching patients to discriminate between aversive or abusive past interpersonal situations where they could not affect outcomes and current situations where they can. Teaching patients to evaluate systematically whether their actions are assisting them in achieving desired outcomes. The study of Keller and colleagues (2000) presented credible proof that CBASP is very useful in treating chronic depression. The speed of total remission with the combination of medication and CBASP in the study of Keller and colleagues (2000) was almost double the speed of total remission of patients who received medication and cognitive therapy. It is somewhat likely that CBASP will become the most successful therapy for chronic depression. However, this is not yet definite, since the speed of response to medication was significantly greater than in studies using cognitive therapy. Even though the research subjects used in the study of Kelly and colleagues (2000) seem to have higher levels of chronic depression than those in cognitive therapy studies, it is also probable that they were more responsive to treatment. Relapse preventive outcomes have also been reported applying other newer treatment approaches of cognitive therapy. Galante and colleagues (2013) formulated Mindfulness-Based Cognitive Therapy (MBCT) which incorporates several typical cognitive therapy policies into mindfulness approaches. MBCT is given in a group setting with individuals who have experienced severe depression. This treatment was developed particularly with the purpose of enhancing meta-cognitive consciousness in patients who have recovered from depression and who are highly vulnerable to more episodes. By means of mindfulness exercise, MBCT seeks to build a mental ‘group’ of meta-cognitive consciousness that is broader than the meta-awareness associated only with a damaging mindset resulting from standard cognitive therapy (Galante, 2013). In at risk patients, it was concluded that having the capacity to use this kind of mental ‘group’ at instances of possible relapse would make unconstructive emotions and thinking less likely to cause deterioration into severe depression. MBCT was discovered to drastically slow down rates of relapse in patients who had experienced chronic depression. Surprisingly, MBCT was also discovered to lead to boosts in meta-awareness. The decrease in relapse applying a kind of cognitive therapy that does not intend to modify damaging cognitive content also substantiates the assumption that relapse preventive outcomes could be partly caused by the growth of meta-awareness (Galante, 2013). The CBT approach suggests a vital function for various types of avoidance in contact with core ideas. Besides the typical function of behavioral avoidance, several researchers have proposed that emotional and cognitive avoidance have vital social and psychological outcomes. These outcomes, such as weakness of social network and weakened emotional response, function to verify core ideas and to sustain the progression of depression (Kuyken et al., 2001). The impact of avoidance on social adaptation usually in chronic depression has been proven. Several studies have begun investigating more particularly the effect of avoidance on outcome of CBT for depression and on the mechanisms central to the progression of depression. The significance of avoidance in the effectiveness of CBT for depression was supported in the research of Kuyken and colleagues (2001). In a pragmatic investigation of actual CBT, patients with depression who also suffer from avoidant personality disorder experience more symptoms prior to treatment and experience greater residual symptoms later on. The level of affirmation of avoidant beliefs anticipated lower effectiveness of CBT. Even though causal assumptions cannot be obtained from this kind of research, the findings are in line with the likelihood that avoidance is related to progression of depression in treatment and that CBT may be used to cope with avoidant beliefs and avoidance. The application of CBT and use of antidepressant medication are effective treatment choices for depression and are prescribed by guidelines of clinical practice. A current study conducted by Anderson and colleagues (2008) examined the existing findings in advantages and disadvantages of medications and CBT in the maintenance treatment of severe depression. The study looked at CBT therapy of severe depression composed of several sessions studied independently whether administered by a psychiatrist or psychologist in private or public practice. The other forms of treatment that were evaluated in this study involved different sets of antidepressants for maintenance treatment. The general conclusion of the study is that CBT is more economical than medication if administered by a publicly subsidized psychologist. Anderson and colleagues (2008) reached the conclusion that clinical depression must be treated as a ‘chronic episodic’ illness because this would facilitate the assessment of more permanent treatment approaches. They argue that extensive adoption of CBT would result in cost equalization; primarily, because of a decrease in the use of antidepressant medication, and due to a cutback in the use of resources because of decrease in severity and depressive episodes. The only weakness of the study is the method used—purely quantitative. The nature of the topic apparently requires a mixed methodology. A study that provides proof that mental health nurses’ therapeutic abilities can be improved by the adoption of CBT was conducted by Chan and Leung (2002). This study talks about the role of CBT in the treatment of patients with personality disorders and the impact on the practice of mental health nursing. They argue that “mental health nurses play a key role in the rehabilitation of clients, and an important role is to provide individual, group and family psychotherapy” (Chan & Leung, 2002, p. 218). They assume that due to the frequent contact of mental health nurses with their patients they are the most appropriate professionals to administer CBT. The researchers also discuss two tasks that mental health nurses should accomplish if they want to fulfill their part as cognitive behavioral therapists. Primarily, they must achieve independence over their practice and acquire confirmation, from other medical practitioners, that they have the knowledge and abilities to administer CBT. They reach a conclusion that CBT should and can be extensively incorporated into the responsibility of a mental health nurse but the researchers failed to fully consider the needed intensively specialized training (Chan & Leung, 2002). Crawford and colleagues (2002) observe that there are an inadequate number of studies investigating evidence-based practice from the point of view of mental health nurses. In order to deal with this they carried out a qualitative research employing focus groups and semi-structured interviews to determine how mental health nurses view evidence-based practice, as well as the CBT approach. These data collection methods offer a type of methodological triangulation which improves the validity of the research. In this study, the researchers find out the difficulty in using recognized frameworks of evidence based practice in CBT due to the fact that the delivery of this treatment will differ significantly in clinical terms (Crawford et al., 2002). Grabowski (2010) presented an explanation of the relationship between nurse and patient within the perspective of community mental health nursing. Grabowski (2010) recognized the need for community mental health nurses to explain their understanding of the objectives, formation and continuance of relationships with patients with long-term mental disorder in order to create a research-based practice that evidently expresses its importance to the care of these patients. These two studies systematically explained the difficulty of nursing patients with severe mental disorder, like chronic depression, and made a conclusion that the training of mental health nurses has to be rigorous in order to ensure quality nursing care. With regard to CBT, the mental health nurse should be responsive and sympathetic to the patient with depression. Trinidad (2007) conducted a descriptive research which was employed to assess the usefulness of training mental health nurses to carry out psychosocial treatments, such as CBT. They enumerated several competencies that mental health nurses need in order for them to successfully deal with severely mentally ill patients and one such competency was that of CBT. The purpose of the research was to determine whether the application of CBT by the mental health nurses enhanced their patients’ quality of life. Mental health nurses, by employing CBT, were trained to help patients and their families to cope effectively with the disorder. The outcomes showed that the progress in patients’ social functioning were evidently associated with the treatment given, with no progress observed in the control group. Besides proof of the advantages of CBT to the patients it was also observed that there was a considerable improvement in the psychological condition of the caregivers, specifically of their vulnerability to depression (Trinidad, 2007). Karwoski and associates (2006) conducted an exploratory assessment of the progress in measurement associated with CBT. Their initial assumption was that development in measurement techniques should be applied to CBT and other psychotherapies and that measurement is the basis of evidence-based practice. Their findings suggested that current measurement techniques can strengthen evidence-based practice for CBT. The literature review demonstrates that the nurse-patient relationship has surfaced as the general contributing factor to outcome in numerous studies on CBT. However, the study cannot offer a generalizable finding about the effectiveness of CBT in the treatment of depression. The research of Strunk and DeRubeis (2001) focuses on the formulation of a training course in CBT for mental health nurses in the United States. Qualitative assessment at the conclusion of the course showed that the respondents were more at ease with CBT but that nobody thought that they can competently administer the treatment without continuous supervision and assistance. Inadequate opportunities to exercise and enhance the abilities acquired were emphasized as a difficulty in the growth of competence and assurance. The respondents reported problems converting the abilities acquired into their nursing practice as a large number of their patients had serious and chronic mental disorders. It was believed that perhaps the training should be introduced as a ‘sequential program’ where in at first they are taught core CBT competencies suitable to simple mental disorders and then once these core competencies are fully acquired they are trained to deal with patients with more severe and chronic illnesses. Conclusions Mental health treatments that are effectual and readily available to most people are very popular and widely used. Cognitive behavioral therapy (CBT) has been proven to be effective. This literature review tried to show whether CBT is effective in treating depression and how mental health nurses can apply their abilities to their clinical practice. Studies reviewed in this paper reveal that CBT is an effective treatment for mild, chronic, and severe depression. References Anderson, T., Watson, M., & Davidson, R. (2008). The use of cognitive behavioral therapy techniques for anxiety and depression in hospice patients: a feasibility study. Palliative Medicine, 22(7), 814-821. Chan, S. & Leung, J. (2002). Cognitive behavioral therapy for clients with schizophrenia: implications for mental health nursing practice. Journal of Clinical Nursing, 11, 214-224. Crawford, P. et al. (2002). Reluctant empiricists: community mental health nurses and the art of evidence-based praxis. Health and Social Care in the Community, 10(4), 287-298. Galante, J., Iribarren, S., & Pearce, P. (2013). Effects of mindfulness-based cognitive therapy on mental disorders: a systematic review and meta-analysis of randomized controlled trials. Journal of Research in Nursing, 18(2), 133-155. Grabowski, D. et al. (2010). Review: Quality of Mental Health Care for Nursing Home Residents: A Literature Review. Medical Care Research and Review, 67(6), 627-656. Karwoski, L., Garratt, G., & Ilardi, S. (2006). On the Integration of Cognitive-Behavioral Therapy for Depression and Positive Psychology. Journal of Cognitive Psychotherapy, 20(2), 159+ Keller, M.B. et al. (2000). A comparison of nefazodone, the cognitive behavioral analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462-1470. Kuyken, W. et al. (2001). Response to cognitive therapy in depression: the role of maladaptive beliefs and personality disorders. Journal of Consulting and Clinical Psychology, 69, 560-566. Strunk, D. & DeRubeis, R. (2001). Cognitive Therapy for Depression: A Review of its Efficacy. Journal of Cognitive Psychotherapy, 15(4), 289+ Trinidad, A.C. (2007). How Not to Learn Cognitive-Behavioral Therapy (CBT). American Journal of Psychotherapy, 61(4), 395+ Read More