Cognitive Behavioral Therapy - Essay Example

Psychosocial Interventions in Mental Health Nursing Introduction Cognitive behavioural therapy stems from the theories of mental illness that attempts to combine two different theories about the causative elements of several mental ailments along with other factors. While delivering nursing care to the clients suffering from a range of disorders, the nurses must have working knowledge of different approaches to manage these clients, specially those with anxiety, depression, and/or psychotic illnesses in order to be able to improve the outcomes of care in such patients. It is widely held that apart from other reasons, the psychosocial factors play important roles in causation of many such illnesses of the categories mentioned above (Tarrier & Wykes, 2004). The behavioural theory of psychosocial causation of mental illnesses contends that mental illness symptoms in anxiety and depression are actually manifestations of internal and external stressors, and this springs from the human behavioral responses to these. This is particularly true for anxiety and associated symptoms, and behaviourally, these are conditioned responses to these stressors. On the other hand the cognitive theory poses that in many cases of psychiatric illnesses of all the above categories, the manifestations are governed by faulty thinking pattern or miscognition. These are known to lead to misperceptions of an individual about future, the world, and the self, and these in turn contribute to the client experience anxiety (Hyer, Yeager, Hilton, & Sacks, 2009). The need for development of current knowledge is therefore paramount on the part of mental health nurses, and the evidence base thus developed would promote the mental health nurses to deliver care in a more effective manner (Wilshaw, 1997). This indicates the necessity of initiatives from the mental health nurses to develop their own knowledge, and research on nursing applications of cognitive-behavioural therapy can serve as the resources for current evidence. Consequently, in this assignment, a literature review will be conducted looking for evidence relevant to nursing knowledge and delivery of cognitive behavioural therapy in clients with mood disorders such as anxiety and depression and psychotic illnesses such as schizophrenia, personality disorders, and bipolar illnesses. Review of Literature While considering nursing care in these patients, it is now evidenced that the cognitive symptoms of these illnesses can most effectively be cared for through delivery of cognitive behavioural therapy, where the relevant distortions in the thought content and thought patterns of these individuals may be effectively intervened. It has also been observed that despite being effectively utilized in the management of mood disorders, such as, anxiety and depression, this approach can actually be very effective as a part of several care regimens in other psychotic illnesses such as schizophrenia (Zimmermann, Favrod, Trieu, & Pomini, 2005). Many studies have been conducted on the topic of efficacy and delivery modes of cognitive behavioural therapy in patients in a range of mental illnesses, and the consensus now is that many such illnesses of diverse etiologies have a cognitive-behavioural component that can be delivered even at the level of community through the mental health professionals who are in close contacts with such individuals across the time spectrum of the care delivery (Wykes, Steel, Everitt, & Tarrier, 2008). Mental health nurses are in a unique position to deliver such care if they are appropriately informed and trained on the modes of delivery and can drastically alter the care outcomes in these clients. Due mainly to their ongoing relationships with such patients, they can teach them to control distortions of thoughts that may prevent development and maintenance of these mood disorders or alter the consequences of these thought patterns on the processes of other psychotic illnesses. (Chan & Leung, 2002) In relation to the theoretical context of cognitive behavioural therapy, studies (Hurley et al, 2006) have indicated that all mental illnesses, apart from having other etiological factors involved in clinical presentations, can be modeled according to the basic propositions of cognitive-behavioural theories. It is known that in anxiety disorders, the individual experiences interfere with the ability to function in social, occupational, and vocational areas, and in many cases, these are responsible for the physiological symptoms related to the classical fight-or-flight response (Hurley, Barrett, & Reet, 2006). This is more so important in cases where medications or other approaches fail to produce desired outcomes leading to severe interference and distress in the lives of the individuals in the social and personal milieus. As far as nursing care is concerned, cognitive impairment needs to be addressed in all such care plans, and the literature in this area suggests that nursing interventions to improve cognitive domain also positively modifies thought and behaviour patterns leading to better therapeutic outcomes (Schneider & Cook, 2008). As Bradshaw and colleague (2004) described, in order to be able to deliver cognitive-behavioural nursing care, the nursing assessment must establish the cognitive-behavioural status through standard assessment tools prior to care planning. Cognitive impairment also compromises safety, self-care activities, social interactions, and behavioural manifestations. In depression, there are noted cognitive distortions related to expectations about self, future, and environment. Consequently, the behaviour is manifested as hopelessness about the future, unrealistic devaluation of self, and dissatisfaction about activities and environment. Cognitive behavioural approaches may result in rapid residual symptom relief, and this can be achieved through assistance to the client in identification and recognition of dysfunctional patterns of thought and behaviour to bring in rationality to these so the aberrant thought pattern is consistently disputed by the clients (Bradshaw & Roseborough, 2004). In case of schizophrenia, as indicated by Turkington et al. (2006) most metaanalysis support the use of cognitive behavioural therapy. These can provide benefits in management of residual symptoms and poor insight, and at the same time, improve adherence to treatment regimens. Although studies in the research settings provide tangible results, its use in the community settings to a full range of clients by the nonexperts have not been supported by trials. This study agrees to the unique position of the mental health nurses since they are considered to be the largest workforce with regular contact with the affected people. This study examined, thus the effects of nurses delivering care to these people following training in cognitive behavioural therapy approaches. It was demonstrated that across certain outcome measures, the results of such interventions were effective. Most significant effects were observed in insight, social interactions, and control of negative symptoms such as reduced volition and apathy. Improvement in insight is very significant since that may result in improved use of coping strategies and management adherence (Turkington, Kingdon, Rathod, Hammond, Pelton, & Mehta, 2006). Despite these positive effects with interventions, it can be argued that these findings may not be generalizable enough. Moreover, whether such interventions can be feasible in day to day working lives of these affected individuals, that remains a question. Malik et al. (2009) indicated increasing evidence of the usefulness and efficacy of cognitive behavioural therapy (CBT) in psychotic illnesses. They studied the durability of the effects of cognitive behavioural therapy provided by mental health nurses in community based individuals. The three outcomes that were considered were secondary outcomes at a 24-month followup, and these included occupational recovery and days hospitalized, and the primary outcome was considered to be relapse. All these nurses were trained on CBT for 10 days, and the design of the study was a 2:1 randomized trial on 205 patients. This study indicated that a community-based mental health nursing approach delivering CBT can maintain the recovery in terms of lesser relapse and need for rehospitalization in the intervention group (Malik, Kingdon, Pelton, Mehta, & Turkington, 2009). However, sustained effects on functionality remain questionable due to insignificant effects on occupational recovery. Thus further studies on reinforced intervention are indicated. Diefenbach et al. (2008) explored the possibility of community based cognitive behavioural interventions in the community level, where anxiety disorders are very much prevalent, especially in older adults. Although this study was performed in older adults with late life anxiety, the principles are well applicable in the general population affected with anxiety disorders. The need for intervention arises due to the fact that these disorders have been observed to produce progressive cognitive and functional decline and may also worsen depression in affected or susceptible individuals. This study examined a community-based approach of cognitive behavioural intervention to find positive effects in these anxiety and depressive disorders. CBT had been demonstrated to improve the secondary symptoms of worry, anxiety, and depressive symptoms and thus had been posited to be effective in improving the quality of life in the affected individuals. A generalized approach through initial care delivery in the community or in primary care through mental health nurses is a possibility to avail the benefits of such approach in a mass scale; however, there are paucity of studies in this area. One evident benefit is improvement in accessibility to care, which is probable through care delivery by trained mental health nurses, and thus the conclusion of this study is significant in that these may be very effective in individuals who worry about future events through modification of their negative and catastrophic thinking patterns (Diefenbach, Tolin, Gilliam, & Meunier, 2008). Beech (2000) concluded that depression can be very effectively treated by CBT, and if this is delivered through mental health nurses, the wider application in the population through mental health nursing care delivery at community level due mainly to the fact that this approach is facilitated by nurse-patient interactions and probability of protracted periods of patient times by these nurses. Given the economic and social consequences of depression, this approach appears to be an acceptable one, and the practical feasibility should be explored through further research (Beech, 2000). Conclusion Cognitive behavioural therapy is an important therapeutic approach in management of a range of mental illnesses including anxiety, depression, and psychotic disorders. The major effects of such intervention are reduction of residual symptoms and improvement in functionality of the effected individual who are even resistant to psychotropic medications. Although the occupational and social effects are nonsustainable over a prolonged period of time, due to economic and social concerns of such illnesses care delivered by trained nonexpert mental health professionals such as mental health nurses has been demonstrated to be effective, significant, and useful due to ability to provide symptomatic relief, to improve adherence to therapy, and to improve social interactions. The mental health nurses are most suitable due to their accessibility and proximity to these patients in the community level; however, for using this approach at a policy level in mass scales or in primary community care involving prevention would need training of the nurses in a mass scale, which would need further detailed studies on such approaches in cognitive behavioural therapy. Bibliography Beech, B. (2000). The strengths and weaknesses of cognitive behavioural approaches to treating depression and their potential for wider utilization by mental health nurses. 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