SOCW 6060 Week 6 - Discussion Responses - Using Research to Select a Therapeutic Modality

Week 6: Cognitive Theory and Cognitive Behavior Theory

By now, you may recognize that no one theory will explain and predict every phenomenon.

Theory guides the development of specific therapeutic modalities. To understand a therapy, it may be helpful to first review the historical forces of psychology. The first force was psychoanalysis, the second force was behaviorism, the third force was humanism, and the fourth force was multiculturalism. Drawing from this progression, the first wave of behavior theory argued that all behaviors are learned and if one wants to modify behaviors, then one can unlearn them. This led to behavioral therapy based on rewards and punishment, which is considered the first wave of behavioral therapy. Since then, cognitive theory was introduced, arguing that it is crucial to factor individuals’ mental states and cognitions. Over the years, Aaron Beck’s cognitive behavior therapy, Albert Ellis’s rational emotive theory, and William Glasser’s choice theory have become prominent, falling into the second wave of cognitive therapy. Finally, the third wave of behavioral therapies include dialectical behavioral therapy, mindfulness-based cognitive behavior therapy, and acceptance and commitment therapy.

This week, you explore several theoretical orientations that fall under cognitive and cognitive behavior theory. Continue to pay special attention to the theories’ merits and limitations in how they apply to real-life situations.

Learning Objectives

Students will:

· Apply cognitive and cognitive behavior theories to social work practice

· Evaluate research studies on cognitive and cognitive behavior treatment

· Evaluate the strengths and limitations of cognitive and cognitive behavior theories

Learning Resources

Note:  To access this week’s required library resources, please click on the link to the Course Readings List, found in the  Course Materials  section of your Syllabus.

Required Readings

Turner, F. J. (Ed.). (2017). Social work treatment: Interlocking theoretical approaches (6th ed.). New York, NY: Oxford University Press.

· Chapter 4: Cognitive Behavior Theory and Social Work Treatment (pp. 54–79)

· Chapter 5: Cognitive Theory and Social Work Treatment (pp. 80–95)

González-Prendes, A. A., & Thomas, S. A. (2009). Culturally sensitive treatment of anger in African American women: A single case study. Clinical Case Studies, 8(5), 383–402. 

Graham, M. A., Sauerheber, J. D., & Britzman, M. J. (2013). Choice theory and family counseling: A pragmatic, culturally sensitive approach. Family Journal, 21(2), 230–234. 

Document: Worksheet: Dissecting a Theory and Its Application to a Case Study (Word document)

Document: Theory Into Practice: Four Social Work Case Studies (PDF)

Required Media

Sommers-Flanagan, J., & Sommers-Flanagan, R. (2014). Counseling and psychotherapy theories in context and practice [Video file].  

This week, watch the “Behavioral Therapy” and “Cognitive-Behavioral Therapy” segments by clicking the applicable links under the “Chapters” tab.

Optional Resources

Gregory, V. L. (2010). Cognitive-behavioral therapy for bipolar disorder: implications for clinical social workers. Journal of Social Service Research, 36(5), 460–469. https://doi.org/10.1080/01488376.2010.510950

Gregory, V. L. (2010). Cognitive-behavioral therapy for schizophrenia: applications to social work practice. Social Work in Mental Health, 8(2), 140–159. https://doi.org/10.1080/15332980902791086

Pössel, P., & Knopf, K. (2011). Bridging the gaps: An attempt to integrate three major cognitive depression models. Cognitive Therapy & Research, 35(4), 342–358. https://doi.org/10.1007/s10608-010-9325-z

(Only read pp. 342–344)

Hinton, D. E., & Pollack, M. H. (2009). Introduction to the special issue: Anxiety disorders in cross-cultural perspective. CNS Neuroscience & Therapeutics, 15(3), 207–209. doi:10.1111/j.1755-5949.2009.00097.x

Robey, P., Burdenski, T. K., Britzman, M., Crowell, J., & Cisse, G. S. (2011). Systemic applications of choice theory and reality therapy: An interview with Glasser Scholars. The Family Journal, 19(4), 427–433. https://doi.org/10.1177/1066480711415038

Discussion: Using Research to Select a Therapeutic Modality

Imagine that some of your colleagues mention using cognitive behavior therapy, dialectical behavioral therapy, acceptance and commitment therapy, and reality therapy. Your colleagues continue to say that based on their experiences, they really like these therapies and that they appear to work. Your instincts also tell you that perhaps they might be helpful for your client in your case study. However, from Week 1, you recall that experiences and instincts as sources of knowledge are quite limited because they are biased. Instead, it is important to utilize existing research and data to support your choices of interventions. Theory helps inform the evidence-based practice process that should guide social workers’ practice.

In this Discussion, you examine the research related to a therapy based on cognitive or cognitive behavior theory to determine its effectiveness.

Respond to two colleagues who selected a case study different from yours:

· Compare and contrast the article you selected with your colleague’s article in terms of how they might inform appropriateness for use with the identified client.

· Explain how reviewing the different studies presented in this Discussion influenced your decision about whether you would use the therapy, given various evidence for the different treatment modalities.

Colleague #1 GR  Initial Post

RE: Discussion - Week 6

COLLAPSE

Top of Form

Provide the Reference for the Study You Found Using APA Guidelines

I selected the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) that is designed to be delivered in 12 to 16 sessions (Ramirez de Arellano et al., 2014).  It uses exposure techniques and cognitive behavioral principles to treat and prevent behavioral problems, posttraumatic stress, and depression in children and adolescents and their nonoffending caregivers (Ramirez de Arellano et al., 2014). 

Briefly Paraphrase, in Two to Three Sentences, the Methodological Context of the Study and the Findings

For this study, Ramirez de Arellano et al. (2014) reviewed individual studies, meta-analyses, and research reviews from 1995 to 2013, including a survey of databases such as American Psychological Association, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, U.S. National Library of Medicine and National Institutes of Health, Published International Literature on Traumatic Stress, Applied Social Sciences Index and Abstracts, Educational Resources Information Center, and Social Service Abstracts.  Ramirez de Arellano et al. (2014) limited the review to international and U.S. studies in English that investigated TF-CBT and other cognitive-behavioral approaches (Ramirez de Arellano et al., 2014).   Articles included quasi-experimental studies, meta-analyses and systematic review articles, and single-group time-series design studies (Ramirez de Arellano et al., 2014).  Studies that met the inclusion criteria were examined and benchmarks were considered based on the quality and number of studies to indicate the overall research quality and strength of the evidence (Ramirez de Arellano et al., 2014).   

Evaluate the Findings in Terms of its Applicability or Appropriateness for the Client in Your Case Study

All the studies reviewed adhered to the five critical elements of the TF-CBT intervention which include, coping strategies, such as identification of feelings, cognitive coping, and relaxation; psychoeducation, cognitive processing of trauma-related thoughts and beliefs; caregiver involvement, such as conjoint sessions and parent training; and gradual exposure, for example, through in-vivo exposure or imagining (Ramirez de Arellano et al., 2014).  Psychoeducational materials provide treatment that can be tailored to individuals who have experienced sexual abuse, physical abuse, natural disasters, and interpersonal violence (Ramirez de Arellano et al., 2014).  I think the findings of the study apply to Tiffani because so many of the key techniques might help improve her situation.  That is because Tiffani’s presenting problem involves running away from home as she was repeatedly sexually abused by her uncle and his friend (Plummer et al., 2014).  She was pimped by Donald and was later sold to another pimp called John T. before she was arrested for prostitution and sent to live at Teen First, a group home with a counseling program for adolescent victims of sexual exploitation and human trafficking (Plummer et al., 2014).  Therefore, this approach could address her childhood traumatic experiences.

Determine Whether You Would Use or Not Use the Therapy You Selected for the Tiffani Bradley Case Study (Consider How Culturally Relevant it is, How Aligned it is with Social Work Ethics, Etc.) and Explain Why

I believe the therapy is culturally relevant to Tiffani’s case because the population sample reviewed was majority Caucasian, and the treatment applies to children between ages three and 18 (Ramirez de Arellano et al., 2014).  In this case, Tiffani is a 16-year-old Caucasian female (Plummer et al., 2014).  There is some risk of bias since most of the research was conducted by the creators of the TF-CBT approach (Ramirez de Arellano et al., 2014).  However, even with that limitation, the evidence indicated the effectiveness of the therapy approach (Ramirez de Arellano et al., 2014).  The TF-CBT was found to be moderately effective in reducing sexual and general behavior problems (sexualized behavior) and depressive symptoms and were highly effective in reducing posttraumatic stress disorder (PTSD) symptoms over time (Ramirez de Arellano et al., 2014).  For example, Tiffani needed to address her early childhood traumatic experiences and adjust her thoughts around her self-worth and about Donald (Plummer et al., 2014).  I could use TF-CBT to help her improve her life by exploring with her adaptive coping strategies, such as identification of feelings, cognitive coping, and relaxation and cognitive processing of trauma-related thoughts and beliefs (Ramirez de Arellano et al., 2014).

References

Plummer, S.-B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Sessions: Case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

Ramirez de Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Huang, L., & Delphin-Rittmon, M. (2014). Trauma-focused cognitive-behavioral therapy for children and adolescents: Assessing the evidence. Psychiatric Services, 65(5), 591-602. doi:10.1176/appi.ps.201300255

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Colleague #2 EA 

Initial Post -

COLLAPSE

Top of Form

Provide the reference for the study you found using APA guidelines.

Kor, P. P. K., Liu, J. Y. W., & Chien, W. T. (2019). Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A pilot randomized controlled trial. International Journal of Nursing Studies, 98, 107–117. doi- 10.1016/j.ijnurstu.2019.02.020

 Briefly paraphrase, in 2 to 3 sentences, the methodological context (i.e., research method, how data was collected, and the instruments used) of the study and the findings.

Researchers used a single-blinded, parallel-group, randomized controlled trial to study the feasibility of modified mindfulness-based cognitive therapy with adult caretakers of individuals with dementia.  Using a convenience sampling from a community center that supports elderly dementia patients and their caregivers, 36 participants met inclusion criteria to be included in the study. The majority of participants were female with a mean age of 57.1 years, most of whom were the adult children of the care recipients (Kor, Liu & Chien, 2019).  The modified mindfulness-based cognitive therapy group  (18) and the control group received the usual family support and psychoeducation on caring for individuals with dementia.  The following instruments were used:

· Perceived Stress Scale (PSS);

· Zarit Burden Scale (ZBI);

· Center for Epidemiological Studies Depression Scale (CESDS);

· Hospital Anxiety and Depression Scale-Anxiety (HADS-A);

· Brief Resilience Scale (BRS);

· 12-Item Short Form Health Survey Version 2 (SF-12v2);  

· Five Facets Mindfulness Questionnaire Short Form (FFMQ-SF);

Outcome measures were completed at baseline, immediately after the intervention and at the 3-month follow-up.

The researchers found that mindfulness-based cognitive therapy is appropriate for family caregivers of individuals with dementia. “at the 3-month follow-up on reducing stress, improving symptoms of depression, and alleviating the sense of burden felt by the caregivers” (Kor, Liu & Chien, 2019). 

Evaluate the findings in terms of its applicability or appropriateness for the client in your case study.

Helen is the 52-year-old daughter-in-law of a person with dementia.   She is age appropriate, and is navigating an individual with dementia which is her major stressor presently.

Determine whether you would use or not use the therapy you selected for the client in your selected case study (consider how culturally relevant it is, how aligned it is with social work ethics, etc.) and explain why.

Culturally, this study was conducted in Hong Kong, which according to Hofstede Insights, is a collectivist culture. Greece, Helen’s culture, is also a collectivist culture.  The tools and questionnaires had cultural versions which were used as appropriate.  Helen has described her cultural norms as such a way that helping Helen to be mindful and practice Dialectical Behavior Therapy (DBT) could be affective for teaching Helen healthy ways to cope with her stress, whereas attempting to convince her to delegate her roles may not be culturally appropriate at this time.  The use of DBT in Helen’s case respect her values, and practices the social work code of ethics; “Social workers treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity. (National Association of Social Workers [NASW], 2017).

References

Kor, P. P. K., Liu, J. Y. W., & Chien, W. T. (2019). Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A pilot randomized controlled trial. International Journal of Nursing Studies, 98, 107–117. doi:10.1016/j.ijnurstu.2019.02.020

National Association of Social Workers. (2017). NASW code of ethics. Retrieved April 1, 2020, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

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