The Cognitive-Behavioural Therapy - Research Paper Example

?Social Work Inserts His/Her Inserts Grade Inserts 28.11 Executive summary This paper discusses the application of cognitive behavioral therapy (CBT) in treating the mental condition known as schizophrenia. The paper analyses the application of this therapy through the different stages involved as outline in the article titled “Cognitive Training for Supported Employment: 2-3 Year Outcomes of a Randomized Controlled Trial”. It further highlights the degree to which this therapy can be employed on individuals suffering from schizophrenia. The extensive use of this therapy is also a subject of focus within this paper. The paper also tries to categorize this therapy in terms of set models of classifications for treatment of mental illnesses. The various aspects of the therapy which require improvements are covered within the context of the paper. Introduction Schizophrenia can be identified as a chronic mental illness which is characterized by the inability to process thoughts. Individuals suffering from this condition experience various symptoms. These symptoms may include paranoia as a result of mental instability (American Psychiatric Association, 2000 ). The individual gets the impression that others are conspiring against him/her and thus paranoia begins. Other symptoms may include hallucinations, disorganized speech and delusions. Hallucinations come as a result of the individual hearing voices which do not exist. This condition has been associated with a number of factors. Though there exists a small percentage linked to genetic factors, the condition is immensely associated with substance abuse. The most common drugs associated with this condition include are cannabis and cocaine. Environmental factors like social groups can also be linked to the development of the condition to a small extent. Most of the environmental factors associated though, seem to lead to substance abuse. It is therefore not clear whether there is a direct connection between the environmental factors and schizophrenia. There exist numerous medications which have been used to treat schizophrenia. Being a mental condition, the treatment targets the developed symptoms as there are no viruses or infectious pathogens. The most effective, known methods have been application of first and second generation antipsychotic. These are aimed at getting the individual away from the causative agent. There exist numerous interventions employed commonly in the treatment of this condition. These include cognitive behavioral therapy, substance abuse treatment, family member education, assertive community treatment, training in social skills among others. All these interventions aim at reducing the symptoms displayed by an individual. The intervention Cognitive behavioral therapy is a reality based intervention employed to help people with schizophrenia. It has been extensively used in many cases where symptoms associated with schizophrenia become evident. The king’s college in London developed this intervention. Numerous studies and researches have been undertaken in different parts of the world aiming at providing more information concerning the application of this reality based intervention (Berrios, 1994). This therapy aims at improving cognitive abilities which become drastically reduced by schizophrenia. It targets at restoring the cognitive abilities of an individual suffering from schizophrenia. Supported employment has been profoundly used in the treatment of individuals showing severe symptoms of schizophrenia. Supported employment is part of the cognitive behavioral therapy administered for the treatment of severe mental conditions. Through the use of supported employment, the people with mental illnesses like schizophrenia have been able to maintain competitive employment. The method employed in this study for collecting information was to use individuals with a severe mental condition. Some of the individuals chosen also had to have a history of job failures. They were then divided into two groups and put in different areas of the city of New York. One group would receive supported employment only while the second group was accorded extra service of cognitive training. This study received approval from the board of Mount Sinai school of Medicine. All participants were required to sign a consent form to agree to be part of the study. These forms gave the researchers the power to chose or reject a subject based on the assessment performed. The individuals chosen had to have severe mental condition, be unemployed, and show the desire for employment. A total of forty individuals were subjected to the research program (McGurk, et al 2007). These were persons from different backgrounds living within the city of New York. All these individuals subjected to the study were volunteers. This was necessary in ensuring that the researchers receive maximum cooperation from their subjects. Willing individuals would be able to offer the support desired as they needed the recovery gained from the program. As opposed to other studies in the same field, this research included several individuals under the medication of antipsychotic medicine. A fidelity scale test was performed during entire period of the study. This was done after 26 months on the group under supported employment alone, and after 24 months for the group combining supported employment with cognitive training. A total of 15 items were assessed given a scale of 1-5 on each item. The total was then given out of 75 for all items under measurement. A standard method of measurement was applied to both groups and all then individuals. The aspects under study had to be measured equally so as to compare the outcomes in terms of relativity to one another for the two methods. The principles of fidelity in the supported employment were rated using the supported employment fidelity scale on the domains of staffing, organization, and services. The supported employment group received a fair rating of 60, while the other group received a satisfactory rating of 66. The difference indicated that the cognitive training accorded to the second group had a positive impact on the reinstatement of the cognitive memory for the sick individuals. Aims of the program The research aimed at establishing the extent to which the use of supported employment would help people suffering from schizophrenia in recovery. It sought to establish the cognitive impairment which limited the ability for an individual to carry out duties normally. By classifying the two study groups, the results from each group would provide relevant information regarding the impairment which affected cognitive skills. This information would be vital in determining the level of impairment exhibited by the subjects. The two study groups would enable researchers to determine if cognitive training can help supported employment in the treatment of severe mental conditions. The researchers expected the group subjected to cognitive training to show better response to the treatment. The study would establish whether the racial group of an individual had any effect on the supported employment program. This fact would be established through subjecting people of different races, and having similar condition to the same medication. The research aims at coming up with a method through which the damaged cognitive ability can be repaired. It sought to establish whether the administration of cognitive training to individuals on the supported employment program could repair the impaired cognitive memory. Since previous research has demonstrated that employment support could tremendously help people cope with the condition, the added aspect of cognitive training enriched this research. Subjection to cognitive training would enable the individuals regain the lost memory as a result of the mental illness. The establishment of this fact would immensely improve the supported employment program which has been used effectively for a long time in the treatment of severe mental conditions. Results The study was carried out on subjects who showed symptoms of severe mental illness. These individuals were seeking medical solutions, and the study was able to assist. The two categories of individuals defined by the researchers displayed different outcomes. On the fidelity scale, the group accorded cognitive training on top of the supported employment scored high. This led to the researchers concluding that persons with schizophrenia can achieve better healing status if supported employment is applied together with cognitive training. While the supported employment helps the individuals gain competitive employment, it does not help them recover from the symptoms of schizophrenia. Holistic healing can be achieved, with the application of cognitive training together with the supported employment. This result was, however, just based on the observations. Cognitive functioning was not measured in the fidelity scale, and the effect of the training on the cognitive skill is only a presumption at this stage of the research. Cognitive behavioral therapy can be termed as a recovery system which is community based. It involves a group of individuals within a certain community but focuses on the ones who are mentally ill. According to the clubhouse classification model, recovery treatment interventions need to emphasize on the person. This therapy identifies directly with this aspect of clubhouse model. It thoroughly focuses on enabling the individual with the condition live a normal life within the society with other people who do not have the condition. Cognitive behavioral therapy achieves this through offering the person assistance to interact with other members of the society. Through the supported employment, the sick people gain competitive employment where they work just as the normal persons. Supported employment ensures that their rights are not infringed due to their condition. Clubhouse model emphasizes the use work as a way of keeping the members suffering from the condition away from the causative agents (Cowell & al., 2003). In cognitive behavioral therapy, using supported employment, these members are assigned duties to perform as their response remains monitored. The participation in this program is important as these activities act as obstructions from the causative agents of the symptoms. The individuals are able for a moment to forget about the causes of their problem. The attention of the members is shifted elsewhere. Continued shifting of thoughts can be said to be what instigates the development of well coordinated thinking. This enables the affected individual to regain normal socializing characteristics expected within a society. They are also able to support themselves and make livelihoods from the income they earn in this employment program. In the clubhouse model, members give back to the community as they grow. While on the supported employment program, the sick persons are able to share their experiences with others. This is done through social groups which are established for the sole purpose of passing information. This makes the persons who have undergone the treatment to become lifetime members of certain social networks. It is through these networks that they are able to get information as well as support. Continued support for these members ensures that they do not loose their employment and enables them to gain competitive employment should they loose one. Through this program, these members become productive while getting cured from the symptoms of schizophrenia. Individuals with serious mental illnesses are subjected to a recovery oriented program called PROS (Personalized Recovery Oriented Services). This program has four components: “Community Rehabilitation and Support” (CRS); “Intensive Rehabilitation” (IR); “Ongoing Rehabilitation and Support” (ORS); and Clinical Treatment. The component of clinical treatment is, however, an optional part of the program (Cowell & al., 2003). There is a need to integrate these components into the supported employment. There are several aspects of this program in which more research should be done. This program has only been used as a treatment for schizophrenia in people whose cause seems to relate to depression. There are numerous other causes of schizophrenia and dealing with only one limits the capability of the program. There is need for more research to be done on how this supported employment program can cure schizophrenia in people who exhibit paranoia and other causes. Community rehabilitation and support (CRS) need to be integrated into the application of this program. This would involve educating the public on ways of dealing with people with the condition from the family level. If well informed, family members may be in a position to offer supported employment to those suffering from the condition within the family. The members of the community can also be informed on how to identify symptoms associated with this condition. Through the use of CRS dealing with the condition shall not be left to psychiatrists alone. Community members shall also be able to offer a helping hand towards problem solving. Most people who are subjected to the program are volunteers. There may be need to research on if the supported employment program can be applied to people who don’t volunteer. As a result of the condition, some individuals especially those showing paranoia may not want to volunteer. Supported employment may be able to offer a solution to these people if applied. The Intensive Rehabilitation aspect can be integrated into this program to include the patients who show signs of complete psychosis. This rehabilitation would come in use to assist the individuals achieve personal goals. When an individual reaches complete psychosis, he does not have any control over his/her actions. Through integrating intensive rehabilitation in the supported employment, such individuals would be included in the program. This would in turn increase the different classes of schizophrenia cases which can be treated using cognitive behavioral therapy. Extra research may be needed to establish the presumption made in the results of this research. Cognitive training can be applied in future researches on supported employment. This would entail subjecting the result of the cognitive training to a t-test to establish the effect of cognitive training on the recovery process. Cognitive training can also be studied alone to try and define its efficiency in treating severe mental conditions such as schizophrenia. Individuals who have not had job opportunities previously can also be subjected to the research. This would establish their response to supported employment as a means of securing a job. Conclusion Supported employment can be identified as one of the best ways employed to deal with schizophrenia. It is a modification of the cognitive therapy and has been extensively used in various places and desirable results achieved. Though it cannot be used on every person showing symptoms of the condition, it has a high level of efficiency on those that it has been performed on. It is mainly performed on individuals with schizophrenia who show signs of depression. At times there may be need to combine this treatment with other forms of treatment like medication for it to work better. Though it has been proved to produce positive results, it continues to be used experimentally and there arises the need to carry out more research on its application. When this research is completed the various shortcomings to the treatment method will be eliminated and the method clearly understood. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Publishing, Inc. Berrios G E, a. D. (1994). The notion of Unitary Psychosis: a conceptual history. History of Psychiatry , 13-36. Cowell, A. J. (2003). Deriving Service Costs for a Clubhouse Psychosocial Rehabilitation Program. Administration and Policy in Mental Health and Mental Health Services Research , 323-340. McGurk ,Susan R.; Mueser ,Kim T.; Feldman, Karin; Wolfe, Rosemarie,and Pascaris, Alysia (2007). Cognitive Training for Supported Employment: 2-3 Year Outcomes of a Randomized Controlled Trial: American Journal of Psychiatry 164:437-441. Read More