NU3342 Therapeutic Interventions In Mental Health

Introduction:

The recent studies have shown a success in a clinical trial with regards to treating emotional conditions with the use of cognitive behavioral therapy basing on the theoretical models (Berry, Haddock, Kellett, Roberts, Drake, & Barrowclough, 2015). For instance, in the disorders of anxiety, the prevailing fear is tested in behavioral approaches to help in reducing the symptoms. Additionally, in the depressive disorders, medics lift the moods by re-evaluating the negative beliefs of the limiting and self-excessive rumination.  In psychosis problems, the same psychological process is active in the experience of hallucination and delusions.  For example, persecutory delusions are perceived as the threat beliefs which are attempts by the patients to make sense of her or his personal experience. On the other hand, hallucinations are perceived as problematic when the patient interprets them as representing destructive and powerful forces (Kråkvik, Gråwe, Hagen & Stiles, 2013).

Thus, in CBTp, thoughts that are seen as fearful are re-evaluated keenly; there is a slow reversal of withdrawal from social contact and activity; while the feelings of control, self-worth, and hope are mostly fostered. The approach employed is based on giving the patients with disorder time to reflect on their experience and, most vital, plans and strategies are developed from the discussion.  The center discussion of this study will be on the recent development with regards to CBTp with their literature reviews, the evidence of its effectiveness and discuss the benefits that the patient will get from the approach.  The study intends to discuss the purpose and effectiveness of the CBTp from both the practical and theoretical perspective.  Additionally, the study will review the literature of the evidence-based and the CBTp. Lastly, the paper will review how the doctors in the field of mental problems can employ the CBTp approach to benefit the patients in regards to kinds of literature from evidence-based.

Psychological Interventions

Psychological interventions are mostly applied when the doctors are preparing the paint to undergo surgical or invasive procedures. They aim at helping one to cope with the procedure or reduce the anxiety in people before surgery. Additionally, they are vital in promoting therapy recovery (Leff, Williams, Huckvale, Arbuthnot, & Leff, 2014). The intervention underlying psychology was not recognized as therapy for psychotic disorders despite the available evidence showing the trials of an effective intervention for the patient undergoing anxiety, panic, obsessive and depression disorders.  The management of psychological disorders is in several ways, for instance, during an interview with a psychologist, an anesthetist or nurse, or more frequently way used is through the booklet. There are five psycho-educational approaches that have been investigated with regards to preparation for various forms of surgery. Two of the approaches are mostly behavioral and educational, that is, they give information to the patient, helping the patient to know what will happen before and after an operation. Additionally, they give the patients skills that may be more beneficial after surgery, for instance, specific exercise or deep breathing (Berry et al., 2015).

Additionally, there are other interventions with the large component of psychology, for instance, modeling, here the patients observe other people overcoming anxiety, relaxation training, and training in cognitive training, in which patients are told to replace their worries with positive thoughts.  However, there are some difficulties in evaluating the studies that have employed this intervention, even though there are evidences to show that all the interventions have potential, especially when one combines the educational and psychological interventions (Kråkvik, Gråwe,  Hagen & Stiles, 2013).

Psychosis

Most of us relate psychosis with a break of reality. Thus, the disorder is characterized by disruption of peoples mind and thoughts that make the patient have difficulty in recognizing what is real from what is not real. These disruptions are mostly experienced as hearing, seeing, and sometimes, believing things that are not real or available. It is vital to know that psychosis is a symptom and not an illness. It is estimated that over 100,000 young people experience the disorder per year in the United State (Turkington, Kingdon & Turner, 2002). In contrary, a recent study has shown that psychosis is taken to be an umbrella for the variety of symptoms. Thus, the symptoms are classified as negative or positive factors. In this regards, the description helps the patient experiencing the condition to tell his or her symptoms.

To break it down further, the positive signs are those that can add some unreality. Thus, one can have a visual hallucination. Thus, he or she sees things that are not available (Dixon et al., 2009).  Also, the positive symptoms influence one’s belief, thus, the patient ends up believing in things that do not make any sense to others (delusion). On the other hand, negative symptoms are those that make one feel that something vital has been taken from them, for example, lack of emotion or enjoyment. In this regards, it can be seen that psychosis is a combination of one’s neurological, unique genetic, environmental and psychological factors. World Health Organization has also defined psychosis disorder as a sequential failure of contact with reality. The organization has also shown that psychosis is a sign of various mental disorders, for instance, bipolar disorder, schizophrenia, psychotic depression or Alzheimer’s condition. It is also of great importance to realize that the psychosis conditions are not permanent. Thus, those suffering from disorders can be treated, and they can lead a healthy and satisfactory life (Turkington, Kingdon & Turner, 2002).

A study by Dixon et al. (2009) has shown that most people who are at high risk to be affected by psychosis are between 15 to 30 years, for men and the ladies, it is between 18 to 30 years. The study by the same author indicates that 80 of every 100 people have the potential to suffer from the psychosis disorders in their life, however, when they are diagnosed early, they can live and manage the condition with the help of the medications that are already available and intervention such as CBT (Morrison, 2017). It is further shown that people experiencing the brief reactive psychotic problem can recover in day or weeks. However, it depends on the source of the stress. It is difficult to ascertain the clear source of the condition; it mostly comes from the abnormalities of the brain. According to Blackburn et al. (2001) has shown that the link between psychosis and life events seems to be controlled by the psychological problem, for instance, the way one reacts to people and the world. Additionally, how one interprets things that surround him or her. Furthermore, there is no existing literature to show the direct link, traumatic events, or distressing moment during one’s childhood, that impact how one will perceive things in life.

Several studies have shown that people who have grown up in a bully environment during their early life, grows up with believing that they are not worthy at all. The person’s ability to grow is greatly influenced. Thus, one lives knowing that he or she is not safe in the world. The disadvantages of such a person are that he or she will tend to avoid all social situations. Thus, it increases anxiety level or the fear to be in public (Van der Gaag, Valmaggia & Smit, 2014). Additionally, such an individual will grow up knowing that other people are mad. This kind of inexplicable behaviors gives experience to stigmatize explanations in broadcasting such as television or newspaper. As an outcome, the patient suits unstable or unwell in their psychological state, which greatly affects their self-confidence. In such a case, CBT potency be taken to be the proper intermediation to develop and create the abnormal familiarity of the patients. To distress, individuals tend to participate in perceptive, behavioural or somatic endeavours to decrease depraved experiences. Stirman et al. (2010), have stated the major issue to be the act to address the circumstance that these endeavours involuntarily distress the patient harmfully, thus charming difficult, in addition to limiting the well-being of the individual experiencing psychosis. With this regards, it is important that therapeutic activities need to be tailored towards identification and modification of these unstable behavior and development of alternatives that might be more helpful. It is also shown that people having mental problems are in the position to experience more than one symptom that includes withdrawal, mood swing, anxiety and social exclusion.

There is various literature showing that studies into CBTp have a long history. For instance, in the mid-twentieth century, chlorpromazine, an example of antipsychotic medicines was introduced in the field of medicine to reduce acute signs; however, it was less effective in its medications. One study shows the side effects of the drug, but it has been widely used to reduce the dependence on long-term hospitalization and physical restraints.

Cognitive Behavioural Therapy

Cognitive behavioral therapy (CBT) is psychotherapy that is goal oriented and short-term treatment that is a more of hands-on, experimental intervention in solving the problem. It aims at changing the pattern of behavior or thinking that is behind the difficulties of people, thus, changing the way they feel (Klein & Knight, 2005). The approach has been applied in treating several difficulties in human beings, for instance, sleeping problems, drug and alcohol abuse, relationship difficulties, depression and anxiety problems. CBT majors on how to change the behavior and attitudes of the person through focusing on the images, thoughts, attitudes, and beliefs held and the way this process relates to person behaviors and a proper way of managing problems from emotions (Turkington, Kingdon & Turner, 2002).

From the available literature, the primary treatment for psychotic disorders has been based on the use of antipsychotic medicines. However, there are several side effects that are as a result of the use of the medicines. Additionally, not all people respond well to the medicine. Thus, about 40% of patients have poor response to the medicines, thus, continues to show the psychotic symptoms (Wykes, Steel, Everitt & Tarrier, 2008). In contrast, CBT is short, mostly taking a minimum of five and maximum of ten months for emotional disorders. In most cases, the patients are needed to attend one session per week which mostly lasts for fifty minutes. During the session, the therapist and patient work together to identify the prevailing problems and develop ways to tackle the condition. Additionally, CBT is advantageous in a manner that it helps the patients to develop principles that are applicable whenever there is a need and this can last the patient for a long time. It is convenient to see the CBT as a combination of behavioral therapy and psychotherapy. Regarding psychotherapy, it is emphasized on the personal meaning, and the way thinking pattern starts from early life. On the other hand, behavioral therapy, the attention is paid close to the relationship between our behaviors, thoughts and our problems. For those physicians who have majored in CBT, they customize and personalize the psychoanalysis to particular needs and individuals’ personality of each patient (Turner, Van Der Gaag, Karyotaki & Cuijpers, 2014).

The CBT medication is based on the theory or model that events themselves do not upset one. However, the meaning people according to them. For instance, if ones thought is negative, it can block individual to see things that are right, or rather, can make one do things that should not have been done. Thus, one hold on the old thinking to the point that he or she is unable to learn new skills. Thus, cognitive behavior therapy aims at helping the person to understand what is going on. It helps one to step aside from the automatic thought and instead, test them. CBT helps people undergoing depression to examine the real-world experience to see what happens to them and others having the same conditions. After bringing one in a more realistic perspective, one will be able to take the right decision. It is factual that negative things normally happen, however, when one is in a disturbed mind, he or she may see his or her prediction and interpretation based on a biased view of the situation, this will only make the problem that is being faced worse. Consequently, it is a function of CBT to help one to correct such interpretations.  Patients having psychotic disorder mostly display cognitive distortions such that the way they perceive and process information does not match the worlds’ reality. Therefore, CBT therapy is based on the cognitive theories and in combining “with the stress-vulnerability model (Stirman et al., 2010).”

Cognitive Behavioural Therapy for Psychosis

Psychological interventions were not taken to be the treatment for the psychotic disorder. Cognitive Behavioural Psychoanalysis for Psychosis (CBTp) was early established as a personal cure; it was later introduced as Team – based intercession. The medication aimed at reducing the distress as result of psychosis disorders symptoms and improving functioning. Studies have suggested that CBT can lead to reducing the positive symptoms, improving the negative symptoms and functionality improvement. Additionally, research shows that CBT can be operative in delaying or preventing the conversion to full neurosis when it is cast-off to people who have been identified to be at risk of developing the psychotic disorder. From these reviews, the CBTp has been identified to be an evidence-based intermediation that is suggested as an addition to prescription administration.

There are various treatment protocols; this has made the field to move towards delineating different CBTp cure levels. These are Full CBTp, which is  defined as an aim to give sixteen or more one-on-one  trip for at least half a year by the therapist having CBT background, for instance, formulation driven CBTp. CBTp-informed interventions, these are interventions that are given by mental health physicians that do not meet the criteria for full CBTp medics, for instance, Coping Strategy Enhancement and nurse delivered CBT informed intercession. Lastly, targeted CBTp intervention, for example, Worry Intervention, which is targeting a particular means with a CBTp psychoanalyst, Cognitive Therapy for Command Hallucinations and an Individual Resiliency Training.

There are various guiding principles that CBTp is grounded. However, a study by Birchwood et al. (2014) has proposed that these three features are more pronounced. They include the combined improvement of a collective origination to enlighten the maintenance and understanding of psychotic signs, and also to help in creating logic of these experience. The second one is based on normalization of the experience of the psychosis to address the stigma associated with a psychotic syndrome. Lastly, the acceptance of the psychotic symptoms that emphasizes the main objectives of these approaches to reduce distress about the symptoms instead of trying to alter the appearance of the symptoms (National Institute for Health and Care Excellence, 2014). Typically, CBTp progresses through five phases, which are made of engagement and befriending, assessment of experience, formulation development, application of intervention and skill building and consolidation of skills. It is recommended that CBTp is administered to the patients that are experiencing the recent onset of the psychotic disorder and those who have been identified to be at risk of developing the condition. For that reason, CBTp has widely been adopted as therapy for an individual. Additionally, Individualized Resiliency Training (IRT) is another established personal therapy model that is particularly designed for people who are undergoing a recent onset of psychosis (Kråkvik, Gråwe, Hagen & Stiles, 2013).

Review of Literatures

This section it will review studies that have been performed in regards to CBT treatment for depression in young adulthood. Most of the studies that have been conducted on CBT for young adult undergoing depression have been carried out in randomized clinical trials (RCTs) (Morrison, 2001). Classically, the RCTs are aimed at comparing the impacts of CBT to cure as customary or a wait-list switch group.  Additionally, the studies comparing CBT to other medications are available. One naturalistic research compared the outcomes of depressed youth who were treated in community health centers for mental to those who were treated with CBT with the aim of decreasing the depressive symptoms (Stafford, Jackson, Mayo-WilsonMorrison, & Kendall, 2013). The researchers in those studies found the same level of depressive symptoms at intake in those two groups.  For those who were treated with CBT, they showed a greater reduction in depression levels after three months, and these levels were reduced throughout their follow-up. On the other hand, the patients who went on community mental health care had to take long before they could attain the same levels; however, similar levels were seen after a year (Heinssen, Goldstein & Azrin, 2014).

A lately conducted review of CBT meta-analyses found sixteen quantitative reviews that comprised of 332 clinical trials that were covering over sixteen varieties of conditions. Accordingly, the article has gained momentum and thus, becoming one of the influential reviews in regards to CBT treatment approach (National Institute for Health and Care Excellence, 2013). Nevertheless, the disadvantage underlying the article is that the search strategy was so restrictive; it only selected one meta-analysis for each condition. Additionally, the article only covers reviews up to 2004; however, more studies have been done and published. To be precise, more than 84% of the works were published after 2004 (Freeman et al., 2015).

According to Burns, Erickson & Brenner, 2014,), environmental and social factors can either be negative or positive for psychosis patient. Additionally, research by (Bertolote & McGorry, 2005) indicates that life events can elevate symptoms and relapse for psychosis patient. Also, the research done by Brabban, Byrne,  Longden, & Morrison  (2016) shows a linkage between auditory hallucination with the social relationship. The researchers in the article argue that the patient claim that the expressions they perceive are factual thus influencing them to have faith in in the opinions. Other research show that CBT has the ability to decrease any positive symptom, improve undesirable signs in case CBT is not tailored conferring to each psychotic patient. In contrary, other studies have rejected the claim arguing that psychotic patient tends not to benefit since therapy does not offer sufficient chance to express their feelings that lead to episodes (Hardy & Loewy, 2012).

The suggested examination will help to elucidate the efficacy and care of CBT for individuals with insanity, both in appraisal to usual cure and in contrast to other, from time to time less concentrated, psychosocial involvements. Research by Newton and Wood (2011), focused on significant change, they sampled nine studies which had been studied by Lynch et al., they found that CBT has no explicit assistance. Similarly, Hutton (2013) in his study he ignored other studies but instead used baseline information while ignoring outcome data. This study made no use “follow up data, clinical response rate, the impact of treatment rate, nor did it assess the adverse effect the study found CBT favourable.” In another study by Lynch, Laws, and Kenna (2010), they examined if CBT had a significant benefit as compared to symptoms subgroup, psychosocial interventions in connection to psychotic symptoms. They found that CBT had benefit was insignificant. The searches further investigated relapse rates; they also included trials of utilizing treatment, they found it does not affect.

However, kingdon and Lincoln (2010) criticized Lynch et al. (2010) results and they found it failed to follow generally acceptable systematic review guidelines. A search by Jones, Hacker, Cormac, Meade, and Irving (2012), the authors studied,” the Cochrane review of CBT for schizophrenia.” They provided an examination of CBT efficiency and destructions as associated to active and indolent treatments across a range of results. The result suggested no convincing and clear advantage of CBT and sometimes much less refined therapies for individuals with schizophrenia. 

According to Xyrichis and Kennedy (2017), opines that CBT for schizophrenia and psychosis is mispresented as psychosomatic intermediation are not reliable as the inconsistency information analysis, scrawny methodology, and biased publications only reporting positive sides of CBT.  Consequently, Walliam, Tapp, and Ferrito (2014).They sampled 27 male patients in a high secure hospital to examine the effectiveness of group CBT, they methodology they used is the comparison between Treatment as usual(TAU) and manualized CBT group. They further compared secondary data and primary data outcome. Further used scale to assess the positive symptoms (SAPS), while scaling for Assess the negative symptoms (SANS) and the primary outcome the psychotic symptoms rating scale (PSYRATS), and subordinate effect used effective societal valuation an inventory of interpersonal problem (IIP-64). Results indicated enhancement on CBT partakers overall on social functioning while on adverse warning sign for affecting devastation, alogia and anhedonia compared to TAU.

Policy and Guideline and Practice Barrier Related to Implementing CBTp

According to the “National Institute for Health and Clinical Excellence (NICE, 2014a),” recommends 16 sessions for CBT this plays significant effects for team delivered CBT. Additionally Holding, Gregg, and Haddock (2016), they found enough evidence suggesting that individuals who attended two CBT meetings and ignored to attend DNA test for scheduled CBT meeting they showed no sign to stop drugs, cannabis smoking irrespective of FEP’s link to medication prompted psychosis. Jolley et al. (2015), asserts that to reduce barriers in clinical practice, reduce cost, and improve mental health practices in executing CBTp in the “United Kingdom” and improve access to “psychological therapies  for persons with unembellished mental illness.” However, Johns, Peters,& Keen (2014), they focus more on reform on routine CBTp, resource distribution to be done in more effective in mental health practice (MHP) is suggested this translates to positive clinical result. On the other hand, Beauchamp, Corbiere, Leclerc, and Lecomte (2013), finds culture in organizations is one of the contributors to barriers of implementing the CBTp they found organizational weakness is caused by poor communication in any organization. Additionally, the NICE guidance suggests that EIS should deliberate extension of service to or beyond three years if the individual shows regaining from mental illness (Bentall, Dunn, Lewis, & Goldsmith, 2015).

Issues for Nursing Practice and Self in Relation to Policy and Guideline

The Early Intervention service (EIS) for psychosis apply quality standard (QS80), it outlines guiding principles with setting out quality standards to be delivered to a user of the recommendation of the service (NICE, 2015a). The further QS80 outline that person experiencing the first episode of psychosis should start medication with first two weeks of referral to early intervention service as this reduces changes for one being hospitalized as suggested by (NICE, 2015b). Similarly, According to NICE (2015c), suggest care coordinator be allocated to an individual immediately, and close relatives have responsibilities in intervention create awareness and support them to encouraging recovering and this reduces distress, possible relapse for persons established with psychosis. In some instances, “it’s not possible for individuals who are referred to EIS to be put in treatments within recommended two weeks span is incapacitate by lack of staffing (Dagnan et al., 2018).” Campellone, Kring, & Fisher (2016), suggest for continued support and monitoring for patients advancement to the certain stigma associated relapse and severe disability.

Conclusion:

CBT has shown to be an effective therapy in psychosis disorders that antipsychotic medications have failed to improve. This interpolation remedy has a substantial influence in plummeting positive indications and improving negative signs, “and there is an evidence-based theory that it helps psychotic patients to learn new abilities to maintain themselves.” Thus, it is recommended that the CBT ought to be taken as one thinkable constituent of a beneficial intercession handling plan for psychotic patients. The mental perception indicates that neurosis is laidback to comprehend than the destructive humiliation it receives.

 Additionally, mental healing consents the individuals to be aware of the obsession world and the indications. For instance, intellectual therapy helps in educating persons about negative symptoms and helps them to counter them behaviorally. The major goal is to help people to come up with alternatives and compare them to other people who are in the same situation. It is now evident that cognitive therapy has gained much attention in the mental health hospitals, unlike its earlier dates where it was developed for a personal level. However, there are other drawbacks that undermine the use of cognitive therapy, for instance, interpersonal engagement, which is a critical factor when one wants to deliver effective treatment. It is common to find a patient having it hard to admit or disclose psychological problems as a result of associated stigma.

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