RESPOND WK5 NRNP 6645
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RESPONDTOWK5DISCUSSIONNRNP6645.docx4
RESPOND TO WK 5 DISCUSSION NRNP 6645
Matthew Aaron
WK 5 main Post
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Cognitive behavioral therapies (CBT) have long been recognized as having great benefit and efficacy for the treatment of a variety of patient issues ranging from chronic pain, to anxiety and depression, and in fact CBT has been shown to generally produce at least a minor positive effect on all patients treated no matter what their initial baseline symptoms may be (Turner et al., 2007). CBT, especially group based, has been found to be a cost-effective way to encourage social behaviors and skills, and also provide often immediate feedback from multiple sources that relate to the patient, and thus reduce isolation and stigma for the engaged patient (PsychExamReview, 2019). CBT, while generally found to be advantageous for most, if not all, patients who are engaged in treatment, has been found to have a different impact depending if it is performed in a group setting versus individual setting.
While individual CBT has long been shown to be able to produce positive changes in patient’s cognitive and behavioral symptoms, its benefits are largely limited by the patient’s own inherent self-efficacy (Turner et al., 2007). The same has not been found to be true, however, with group-based CBT. In fact, it has been shown that in a direct comparison of results between group and individual CBT, group therapy was found to be more effective than individual CBT in producing long lasting and effective positive changes in the recipients/patients (Dogaheh et al., 2011). This may be due, at least in part, to the added sense of support and validation offered by the group setting members who can help in identifying with the patient’s experiences, lending the patient more of a sense of inclusion and safety and hope in the context that if another person can work through these issues, so might they themselves (Marziali & Munroe-Blum, 1995).
Indeed, in individual CBT therapy, the focus is often on the therapist attempting to help the patient to reframe or challenge their own assumptions, behaviors, shame, and guilt, which can be difficult to do in a supportive and nonconfrontational way at times, so that the patient in essence learns to be their own therapists and better cope with their difficulties (Gilbert, 2010). In group CBT, however, there is a greater focus on the structure and interplay of the group as a supportive, safe, and healing environment that works together for mutual benefit, healing, and positive change (Marziali & Munroe-Blum, 1995).
The group setting, while generally found to be more advantageous for positive patient outcomes, is also prone to more problems as there are multiple patients, personalities, and problems to integrate into the therapeutic environment by the therapist. Problems that can arise in the group setting are often placed into two subgroups of issues, with the first being disruptiveness, and the second being hesitancy or member reluctance to engage with others or the therapist in the group setting (Gladding & Binkley, 2007).
With the first group, the disruptive patients, often the therapist must expend extra time and effort to reemphasize the group rules and to build trust not only between the therapist and the disruptive member, but also between that patient and the other group members so as to foster a sense of belonging and support which would negate the problematic patient’s need to cause disruptions as a way to deflect attention from their actual issues/needs/guilt (Gladding & Binkley, 2007). With the second group, much the same approach is used, as the therapist must take extra time and effort, and occasionally meet individually with the hesitant member so as to build enough trust and rapport so that they (the patient) feel empowered and safe enough to actively and productively engage with the group (Gladding & Binkley, 2007). The attached articles and references are deemed to be scholarly by virtue of being published and peer reviewed articles written and developed by experts in the related fields described therein.
ACAPCD-11.pdf An_Interpersonal_Approach_to_G.pdf APTFinal.pdf comparison of group and individual cbt.pdf mediators moderators and predictors.pdf
References
Dogaheh, E., Mohammadkhani, P., & Dolatshahi, B. (2011). Comparison of group and individual cognitive-behavioral therapy in reducing fear of negative evaluation. Psychological Reports, 108(3), 955–962. https://doi.org/10.2466/02.21.pr0.108.3.955-962
Gilbert, P. (2010). An introduction to compassion focused therapy in cognitive behavior therapy. International Journal of Cognitive Therapy, 3(2), 97–112. https://doi.org/10.1521/ijct.2010.3.2.97
Gladding, S. T., & Binkley, E. (2007). Advancing Groups: Practical Ways Leaders Can Work Through Some Problematic Situations. American Counseling Association Professional Counseling Digest, 11(1), 1–2. https://www.counseling.org/resources/library/ACA%20Digests/ACAPCD-11.pdf
Marziali, E., & Munroe-Blum, H. (1995). An interpersonal approach to group psychotherapy with borderline personality disorder. Journal of Personality Disorders, 9(3), 179–189. https://doi.org/10.1521/pedi.1995.9.3.179
PsychExamReview. (2019, April 30). Cognitive Therapy, CBT, & Group Approaches (Intro Psych Tutorial #241) [Video]. YouTube. https://www.youtube.com/watch?v=A2_NN1Q7Rfg
Turner, J. A., Holtzman, S., & Mancl, L. (2007). Mediators, moderators, and predictors of therapeutic change in cognitive–behavioral therapy for chronic pain. Pain, 127(3), 276–286. https://doi.org/10.1016/j.pain.2006.09.005
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Crystal Shaffer
Main Discussion Post Week 5-Crystal Shaffer
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Main Discussion Post-Week 5 Crystal Shaffer
Cognitive Behavioral Therapy
There are many ways to treat mental illnesses, including both pharmacology and psychotherapy. One of the most popular forms of psychotherapy is Cognitive Behavioral Therapy (CBT). This type of therapy can be used for individuals, couples, and families, as well as for many different purposes including both mental health and physical health reasons. For the treatment of depression, CBT is considered state of the art treatment (Walter et al., 2021). The Purpose of this discussion post is to discuss how the use of cognitive behavioral therapy is different when used in groups verses individual therapy, and discuss two challenges that a psychiatric nurse practitioner may encounter while doing therapy.
How Cognitive Behavioral Therapy Works
Often when someone is upset, they go to their friend and vent about their problems. Usually being able to talk and vent helps them feel better. Talk therapy has been used for many years to help people work through their issues. The formal type of talk therapy is called cognitive behavioral therapy and is a type of therapy where people work on turning negative thinking patterns into more positive thinking (Polak et al., 2021). CBT is considered a first-line treatment for many different illnesses including depression in younger patients (Wijana et al., 2021). In the video, the therapist points out that the point of CBT is for the therapist to work with the client regarding their core beliefs (Medcircle, 2019). One way the video discussed to do this is by laddering, where the therapist works through each layer of a person’s feelings to get to their true core belief (Medcircle, 2019). For example, someone may feel they are worthless, and this feeling can affect every relationship in their life. The goal of CBT is to change negative thinking patterns into positive thinking, so that the person can live a happier life.
Individual Therapy
When a patient is getting CBT as an individual the therapist is working with the person alone and all the thought patterns addressed are about their way of thinking. A therapist can spend a lot of time focusing on the core beliefs of the patient and build an individualized plan of treatment for the patient. The goal of individual CBT is to help someone restructure negative and dysfunctional thoughts into more positive thoughts (Walter et al., 2021). CBT is effective in reducing depressive symptoms, decreasing activity in the autonomic nervous systems, and improving cognitive information processing (Walter et al., 2021). For the individual patient participating in CBT, there is a lot of focus on their patterns of thinking and how they can turn their thoughts into more positive thoughts, which will change how they interact with others. Individual CBT sessions work on many different aspects of a person’s life including cognitive restricting, problem-solving skills, coping skills, and psychosocial functioning (Polak et al., 2021). When done correctly, individual therapy, whether short-term or long-term, can help someone have better connections in life, resulting in a more meaningful and positive life for the client doing the CBT (Polak et al., 2021).
Group Therapy
Group therapy is different than individual CBT, as the treatment is done in a group setting with several different people at one time. Group therapy is one of the most common forms of therapy because it is cost-effective, and can treat multiple patients at one-time (Neufeld et al., 2020). For patients with social anxiety disorder, research studies have found that group therapy is a very effective form of treatment for them as it helps reduce anxiety (Neufeld et al., 2020). One of the primary benefits of group therapy for people with social anxiety is that they are exposed to a social situation during the group therapy, which helps them learn to interact and be around other people without feeling as anxious (Neufeld et al., 2020). Being around others and feeling like a person is not alone is one of the benefits of group therapy. Group members can provide support and share life experiences with each other in a manner that cannot be done with individual therapy. Alcoholics Anonymous (AA) and other addiction support groups provide a form of group CBT where members of the group are taught to think about their addiction in a different manner. While conducting AA groups, the therapist needs to be aware of any spiritual beliefs of the members that may motivate them to do better, as well as provide a supportive and empathetic environment to heal (Polak et al., 2021).
Family Group Therapy
Family therapy is very different because the therapist must work with the entire family and how their thoughts and behaviors are affecting other members of the family. One family member may perceive an issue differently than another family member, therefore helping the family understand how their behaviors and thoughts affect each other is an important part of family therapy. For example, one study looked at how family therapy can be beneficial for parents of autistic children with anxiety. Parents who attended family therapy were able to become more aware of their own responses to their child’s anxiety, and learn to model positive coping skills and cognitive restructuring to make situations less anxiety provoking (Driscoll et al., 2020). Learning to coach their child in a more positive manner to overcome anxiety was the primary goal of family therapy (Driscoll et al., 2020).
Possible Challenges
During family therapy a psychiatric nurse practitioner may encounter difficulty with a family member that is unwilling to participate in the therapy or is uncomfortable discussing the issue in front of the entire family. This would cause difficulty as the entire family needs to be treated and invested in the therapy session. Having a conversation trying to understand the reluctance to participate would be a helpful way to handle this possible situation. Another issue that could arise during couples therapy is that one of the clients could try to have the therapist take their side. If this were to happen, the person conducting the therapy needs to remain neutral and remind both parties that they are there to help them communicate better and work on their differences. With group therapy there could be a disruptive patient during the groups that is monopolizing all the time of the group. The nurse practitioner could handle this by reviewing the rules and expectations of the group at the beginning of every session, and reminding the patient that everyone needs time to speak.
Overall, CBT can be a very effective form of treatment for many patients. Therapy can be done individually or in a group setting with strangers or with a family. Therapists must be aware of the differences between individual and group therapy sessions and the benefits each type of therapy provides to clients. Knowing how to handle possible issues that may arise during a therapy session is also important for a nurse practitioner to be aware of.
The articles used for this discussion post are scholarly as they are peer-reviewed articles that have been done within the past five years.
References
Driscoll, K., Schonberg, M., Stark, M. F., Carter, A. S., & Hirshfeld-Becker, D. (2020). Family-centered cognitive behavioral therapy for anxiety in very young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(11), 3905–3920. https://doi.org/10.1007/s10803-020-04446-y
MedCircle. (2019, December 13). What a cognitive behavioral therapy (CBT) session looks like [Video]. YouTube. https://www.youtube.com/watch?v=82WQF3SWwo
Neufeld, C. B., Palma, P. C., Caetano, K. A. S., Brust-Renck, P. G., Curtiss, J., & Hofmann, S. G. (2020). A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder. International Journal of Clinical and Health Psychology, 20(1), 29–37. https://doi.org/10.1016/j.ijchp.2019.11.004
Polak, K., Reisweber, J., & Meyer, B. L. (2021). Transcending self therapy: Four-session individual integrative cognitive-behavioral treatment: A case report. Psychological Services. https://doi.org/10.1037/ser0000539
Walter, D., Buschsieweke, J., Dachs, L., Goletz, H., Goertz-Dorten, A., Kinnen, C., Perri, D., Rademacher, C., Schuermann, S., Viefhaus, P., Woitecki, K., Metternich-Kaizman, T. W., von Wirth, E., & Doepfner, M. (2021). Effectiveness of usual-care cognitive-behavioral therapy for adolescents with depressive disorders rated by parents and patients - an observational study. BMC Psychiatry, 21(1), 423. https://doi.org/10.1186/s12888-021-03404-x
Wijana, M. B., Feldman, I., Ssegonja, R., Enebrink, P., & Ghaderi, A. (2021). A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption. BMC Psychiatry, 21(1), 374. https://doi.org/10.1186/s12888-021-03375-z
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PLS RESPOND TO EACH DISCUSSION AND USE 3 REFERENCES FOR EACH DISCUSSION.
