What is Cognitive Behavioral Therapy (CBT)?
The prevalence of people with mental illness has increased and the introduction of diagnostic criteria for mental disorders has enhanced the screening process to rapidly identify patients with mental issues. Apart from pharmacological interventions for treatment of mental disorders, psychotherapeutic approach has gained wide popularity in the field of mental health for its utility in addressing needs of people with mental health problems. Psychotherapy has found acceptance in both short and long-term management of psychiatric disorders (Barth et al., 2016). Psychotherapeutic approach like cognitive behavioural therapy (CBT), solution-focused brief therapy, acceptance and commitment therapy and mindfulness based stress reduction are often used as primary treatment of choice for patients with depression, major compulsive disorder and personality disorder. Psychotherapeutic approach also allows mental health nurse to identify factors that is needed for the recovery of patient. Each type of psychotherapeutic approach is based on different theories and assumptions. These theoretical aspects are implemented during interaction with patient to influence their thoughts and behaviour (Abbass et al., 2014). The main purpose of this essay is to provide a brief description about CBT and method by which it is delivered to target population group. The essay also provides a critical discussion on the effectiveness of CBT in reduce signs and symptoms of mentally ill patients.
CBT is a short-term goal oriented psychotherapeutic approach which focuses on changing the patterns of thinking of people and treating people suffering from wide range of mental health problems like depression, anxiety disorder, substance abuse and personality disorder. It is based on the basis assumption that cognitive factors like faulty thought patterns play a role in mental illness and this maladaptive cognition in an individual lead to emotional distress and behavioural issues (Hofmann et al., 2012). Maladaptive cognitions include irrational or illogical beliefs about the world or events occurring giving rise to specific thoughts in different situations. It uses both cognitive and behavioural approach to modify dysfunctional thinking and promote positive behavioural change in patient. It incorporates cognitive, behavioural and emotion focused techniques to focus on cognitive and emotional components of mental disorder and promote recovery in patient. Just like other form of psychiatric treatment, the main aim of CBT is to improve function, reduce symptoms and prevent remission of issues in patient. The success of the therapy is dependent on the patient as they need to be actively involved with the psychotherapist and engage in collaborative problem-solving process (Johnsen & Friborg, 2015).
CBT is used particularly with patients who suffer from negative thinking and inappropriate behaviour because of the diagnosis of mental disorders like depression, post traumatic stress disorder and personality disorder. Twomey, O’reilly & Byrne, M. (2014) gives the evidence that CBT is effective for common mental health problem like anxiety and depression. It is also used to treat people who suffer from behavioural problem because of post traumatic stress disorder (PTSD). PTSD is a mental health condition associated with psychiatric morbidity and reduced quality of life because of exposure to trauma or traumatic life events. Trauma focused CBT is delivered to patients with PTSD and psychotherapist delivering the intervention mainly focuses on providing education to patient regarding common reactions to trauma and the method needed to modify cognitive distortions. CBT technique is also favoured because it is a short term structured technique that can be delivered for six-10 months and it can be delivered in various formats like face-to-face session, telephone and computerised format (Kar, 2011). It can be provided in variety of settings too such as community center, mental health clinics, patient home and schools. Currently CBT is being delivered online too and Titov et al. (2017) gives the evidence the evidence that CBT is effective and cost-effective when delivered online too.
The Use of CBT in Mental Health Treatment
CBT is implemented by using cognitive model as a framework to understand presenting problems in client. The main focus is engage in proper communication with clients to understand their presenting issues, current way of thinking and behaviour. Based on the interpretation of current thought pattern, the therapist take the approach to equip clients with all knowledge regarding the approach they can adapt to change their maladaptive cognitive and behavioural patterns (Dattilio & Hanna, 2012). To achieve this, adapting collaborative and problem oriented approach to care is important as this can only help to foster an environment for active engagement of client in the therapy. Entering into proper collaboration with patient is the first step of the therapy and this involves adapting communication techniques like rapport building, empathy and active listening to establish therapeutic relationship with client and work towards identification of maladaptive thought pattern and behaviour (Fenn & Byrne, 2013). Another uniqueness of CBT is that it gives emphasis to the evaluation of present and current problems for patient. According, therapists engaging in mutually agreed goal setting process so that current state of mind of patient can be addressed.
Furthermore, cognitive and behavioural techniques are applied during the therapy to change and address negative thought patterns in client. After getting an understanding about the patient’s perception regarding his illness, therapist can use ‘guided recovery’ as an approach to help client discover alternative methods to interpret an event. The therapist can use probing questions like ‘What do you think caused… ?’ and ‘What is the alternative method to look at the same situation?’ to introduce patients to alternative method of thinking about an event in life (Fenn & Byrne, 2013). Apart from cognitive techniques, behavioural techniques like activity scheduling are used to promote functioning and increase interest in productive and pleasurable activities in life. For patients with anxiety, behavioural training and breathing exercise are some activities that reduce their level of anxiety and autonomic arousal. This type of positive coping technique supports patient to effectively manage mental problems and symptoms of anxiety disorders (Ehde, Dillworth & Turner, 2014).
Therapist need to have general skills and capabilities to deliver CBT. These involves the capability to establish therapeutic and collaborative relationship with patient, detailed knowledge about the principles and theoretical aspects of the therapy, non-judgmental attitude and skills in presenting the interview clearly (Haddock et al. 2014). The next vital stage is the case conceptualization and treatment planning stage. The case conceptualization process begins in the first session and this mainly involves assessment of patient concerns and difficulties by using self-report measures. This method can give good insight into the manner in which the patient thinks and behaves. Based on this assessment, maladaptive thoughts and beliefs are identified and this thoughts and belief are challenges by therapist or nurses. Socratic questioning technique used to challenge maladaptive thoughts and beliefs. Modification of thinking and thought pattern is done by behavioural activation techniques (Cully & Teten, 2008).
Currently, there is widespread application of CBT as many evidence exists regarding the effectiveness of the therapy in treating patients with depression, anxiety disorder and other mental problems. Based on available evidence, the National Institute for Health and Clinical Excellence (NICE) also recommends CBT as an effective treatment option for depression, anxiety, PTSD and obsessive compulsive disorder (Blane et al., 2013). The efficacy of the therapy in treating mental disorder is proved by meta-analysis of randomized controlled trial (RCT). It is a promising adjuvant to pharmacotherapy and the review of several RCTs reveal that compared with group, patients receiving CBT had significantly lower relapse rate at follow-up. Benefit of CBT was also found in improving psychosocial functioning and severity of mania and depression in patients with bipolar disorder. Moderate effect size of the intervention was found and the evidence revealed the clinical benefits of CBT in addressing distorted cognitions and negative mood states in people with bipolar disorder (Chiang et al., 2017). Addressing relapse rate is also a major advantage of the intervention as relapse of symptoms has been found to be a major issue for patients. Wesley, Manjula and Thirthalli (2018) explained that patients with BD suffer from functional impairment even in remission. Hence, finding the evidence for efficacy of CBT in reducing relapse rate can be a new approach to promote recovery in patient.
How to Deliver CBT?
One of the major changes that is seen in the life of people who suffer from mental disorders like depression and anxiety is that they fail to return to work. The diagnosis of these type of disorders increases their job performance and increases sick leave. Hence, diagnosis of mental disorders increases the risk of social and financial cost too. The evidence by Brenninkmeijer et al. (2018) shows the efficacy of CBT in supporting patients to return to work. The study investigated about the efficacy of work-focused CBT compared to general CBT in addressing symptoms of depression. The study gave evidence regarding the effectiveness of CBT in decreasing mental health problems and promoting faster return to work. The research evidence particularly reported about the impact of self-efficacy and mental health symptoms in reducing outcome for patient. Investigating regarding the influence of self-efficacy was important to determine the success of treatment. Individuals with higher baseline self-efficacy have been found to have favourable treatment outcomes (Gallagher et al. 2013). By conducting a quasi-experimental research design, the study further indicated that people who have higher level of self-efficacy are more likely to benefit from work focused CBT. Hence, CBT can be applied to achieve common psychotherapy goals and stimulate return to work. This evidence can encourage practitioners to implement CBT as an optimal treatment option for sick-leave patients with common mental disorders (Brenninkmeijer et al. 2018).
Thase, Kingdon and Turkington (2014) gave an idea regarding the utility of CBT for treatment of patients with schizophrenia and patients with treatment resistance mood disorders. The main challenge or issue found in the treatment of patients with schizophrenia is that they fail to achieve full recovery through the use of anti-psychotic medications. To address this, the adjunctive use of psychosocial therapies was considered to improve outcomes in patient. Thase, Kingdon and Turkington (2014) supported the efficacy of CBT by giving examples of several meta analysis and RCTs which proved the efficacy of CBT in reducing distress and disability by working with these symptoms. Morrison (2009) explains that by the use of CBT, people with schizophrenia suffering from comorbid mood can be effectively treated. Although randomized controlled trials have shown moderate effect size for positive and negative symptoms, however people with hallucination and delusions have responded well to the therapy. Other additional finding was that people with shorter duration of illness predicted better outcomes.
One of the major goals for recovery from mental illness is that people should be supported to help them overcome their disabilities and develop the resilience to manage the struggle associated with mental illness (Thomas et al., 2016). Padesky and Mooney (2012) supports the fact that strength based values can also be applied in CBT technique so that clients build positive qualities and strengthen their personal resilience. However, incorporating strength based approach in CBT requires a shift in therapy perspective and different method of implementation. Fostering resilience would help people to manage negative life events and accept certain circumstances in life. The researcher argues to successfully implement strength based CBT, there is a need to adapt new beliefs and behaviours to develop positive qualities like resilience.
Skills and Capability Required for CBT
The essay gave an insight into the utility and clinical effectiveness of one of the psychotherapeutic approach called the CBT in treating common mental disorders like depression, anxiety disorder and personality disorder. From the discussion on the use of CBT for treating common mental illness, it can be concluded that CBT is a good alternative in place of pharmacotherapy to promote recovery of people with mental illness. The main advantage of pharmacotherapy is that it has many adverse effects and it has the chances of remission too. However, from the discussion on the effectiveness of CBT in treating various types of mental problems, it is understood that CBT can be useful in reducing remission rate, promoting full recovery and reducing functional impairment in affected people. The essay has given evidence regarding the efficacy of CBT in treating people with diverse type of problems. Adequate training should be given to health care professionals and nurses so they develop the skills to incorporate the principles of CBT during the counselling sessions with mental health client.
References:
Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., … & Crowe, E. (2014). Short?term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, (7). DOI: 10.1002/14651858.CD004687
Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., … & Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus, 14(2), 229-243. doi:10.1371/journal.pmed.1001454
Blane, D., Williams, C., Morrison, J., Wilson, A., & Mercer, S. (2013). Cognitive behavioural therapy: why primary care should have it all. The British Journal of General Practice, 63(607), 103–104. https://doi.org/10.3399/bjgp13X663235
Brenninkmeijer, V., Lagerveld, S. E., Blonk, R. W., Schaufeli, W. B., & Wijngaards-de Meij, L. D. (2018). Predicting the effectiveness of work-focused CBT for common mental disorders: The influence of baseline self-efficacy, depression and anxiety. Journal of occupational rehabilitation, 1-11. https://doi.org/10.1007/s10926-018-9760-3
Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PloS one, 12(5), e0176849. Doi: https://doi.org/10.1371/journal.pone.0176849
Cully, J. A., & Teten, A. L. (2008). A therapist’s guide to brief cognitive behavioral therapy. Houston: Department of Veterans Affairs South Central MIRECC. Retrieved from: https://depts.washington.edu/dbpeds/therapists_guide_to_brief_cbtmanual.pdf
Dattilio, F. M., & Hanna, M. A. (2012). Collaboration in cognitive?behavioral therapy. Journal of Clinical Psychology, 68(2), 146-158. doi: 10.1002/jclp.21831.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 69(2), 153. DOI: 10.1037/a0035747
Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6(9), 579-585. Retrieved from: https://doi.org/10.1177/1755738012471029
Gallagher, M. W., Payne, L. A., White, K. S., Shear, K. M., Woods, S. W., Gorman, J. M., & Barlow, D. H. (2013). Mechanisms of change in cognitive behavioral therapy for panic disorder: the unique effects of self-efficacy and anxiety sensitivity. Behaviour research and therapy, 51(11), 767-777. Doi: https://doi.org/10.1016/j.brat.2013.09.001.
Haddock, G., Eisner, E., Boone, C., Davies, G., Coogan, C., & Barrowclough, C. (2014). An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia. Journal of Mental Health, 23(4), 162-165. https://doi.org/10.3109/09638237.2013.869571
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Johnsen, T. J., & Friborg, O. (2015). The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. Psychological Bulletin, 141(4), 747. https://dx.doi.org/10.1037/bul0000015
Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatric Disease and Treatment, 7, 167. DOI: 10.2147/NDT.S10389
Morrison, A. K. (2009). Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont), 6(12), 32. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811142/
Padesky, C. A., & Mooney, K. A. (2012). Strengths?based cognitive–behavioural therapy: A four?step model to build resilience. Clinical Psychology & Psychotherapy, 19(4), 283-290. https://doi.org/10.1002/cpp.1795
Thase, M. E., Kingdon, D., & Turkington, D. (2014). The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments. World Psychiatry, 13(3), 244-250.
Thomas, S., Jenkins, R., Burch, T., Calamos Nasir, L., Fisher, B., Giotaki, G., … & Millington-Sanders, C. (2016). Promoting mental health and preventing mental illness in general practice. London journal of primary care, 8(1), 3-9. https://doi.org/10.1080/17571472.2015.1135659
Titov, N., Dear, B. F., Ali, S., Zou, J. B., Lorian, C. N., Johnston, L., … & Fogliati, V. J. (2015). Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of depression: a randomized controlled trial. Behavior therapy, 46(2), 193-205.
Twomey, C., O’reilly, G., & Byrne, M. (2014). Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Family practice, 32(1), 3-15. https://doi.org/10.1093/fampra/cmu060
Wesley, M. S., Manjula, M., & Thirthalli, J. (2018). Interepisodic Functioning in Patients with Bipolar Disorder in Remission. Indian Journal of Psychological Medicine, 40(1), 52–60. https://doi.org/10.4103/IJPSYM.IJPSYM_211_17
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