JtT

Jane,

Here are 2 separate posts. Just need a reply for each. Just 2-3 paragraphs with 2-3 sources Thanks!

Assignment: Recommend strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients

1. AF

The use of CBT in groups is similar to the use of CBT in couples and individual therapy.

The technique stays the same, but the approach is different with each. The process of CBT begins with building rapport and forming a therapeutic alliance.  This must happen in all settings.  If the patient(s) do not have a therapeutic relationship with the provider, it is less likely that progress will be made. In their research, Priebe et al. (2020) found “verbal communication” and “nonverbal communication” from the clinician to be the top two most important components of therapy for the patient.  What the clinician communicates is of the utmost importance to treatment adherence and success (p. 2).

CBT involves identifying the problem the individual, couple, or group would like to address.  It is understood that there can be varying problems with groups and couples.   To further explain, the example of treatment with CBT in an individual, couples, and group setting for substance use will be used.   If an individual is struggling with substance use, the approach would be to address the individual’s thoughts about themselves, the world, and others—identifying assumptions or distorted thinking—then working to understand those thoughts and then change them.  In couples therapy, the process changes because there is another person involved.  Both people have an opportunity to share their feelings and work through them in the context of a safe place—the session (Beck Institute for Cognitive Behavior Therapy, 2018).  Another aspect of CBT can be utilized as well: the concept of homework.  This could be very effective for an individual, couple, or group.  It helps to solidify the skills and techniques discussed during the session.  In the case of substance use, it may be using a certain technique instead of drinking or a “how to act in a social situation” when trying to abstain from alcohol (Wheeler, 2020).  Related to group therapy, et al found that group therapy for alcohol use was found to be more effective overall than individual therapy because higher engagement occurred (despite fewer sessions attended on average) and greater ability to address co-morbid problems in a group setting (Wheeler, 2020, p. 41).

There are challenges in this type of situation.  One of the challenges a PMHNP may face is limited experience in therapy settings.  I work in a psychiatric hospital with inpatient, intensive outpatient programs, and individual and medication management programs.  I have not seen a PMHNP running groups within this hospital in any of the settings.  This could result in a much lower comfort level with the material, technique, and group therapy in general.  In assessing the clinician’s ability and level of comfort with the delivery of therapy, the level of comfort and relationship with the patient are directly related to positive, greater treatment outcomes (Fuertes et al., 2019). A second challenge for this provider would be to deliver individual, couples, or group therapy via telehealth or telephone.  Although there has been some research about this, it has been inconclusive because the data is limited and the research did not factor in provider or patient views regarding telephone visits (Irvine et al., 2020).  It can be very difficult to interpret social cues or nonverbal communication when you are not able to see each other.  I feel that this would be a particular challenge in combination with limited experience with CBT.

The references in this post include the resources from Week 5 as well as peer-reviewed journal articles.  Regarding the peer-reviewed journal articles, some are metanalysis of research, some are randomized control trials.  They are published in peer-reviewed journals and are recent—within the past five years to allow for the most up-to-date research. 

2. JL

Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Before explaining how to use CBT (cognitive behavioral therapy), one first must understand what CBT is.  According to the APA (American Psychological Association) CBT is a form of psychological treatment that has been demonstrated to be effective for a wide range of problems (American Psychological Association, 2017). CBT has multiple facets however, at its core CBT treatment usually involves changing one’s pattern of thinking to in turn affect one’s behaviors. CBT is effective for individual therapies, group therapies, and family therapy settings.

CBT Comparisons

CBT in the group setting compared to the individual setting has many differences. Initially group therapy is less expensive than individual therapy however, the principles are still similar. In a CBT group, the group leader serves as the facilitator guiding the members of the group through various psychoeducation related to the CBT topic (I. E. depression, anxiety, insomnia). In the individual CBT, the therapist engages the individual along the same topics as they would in group, but the focus is more individualized. There is still psychoeducation being conducted however, the psychoeducation that has an individualized approach specific to the person seeking therapy.  In most CBT sessions the therapist begins with an assessment this would hold true for the individual therapy. in individual therapy the therapist would listen to the individual and provide therapy after assessing what was heard regarding the topic. However, in Group therapy everyone does not have the opportunity to provide background into their specific needs. Therefore, they are getting a general overview or general information regarding a general topic that may not be specific to their individual needs. In group CBT, the group members may be encouraged by the facilitator to engage one another for support also to breakdown cognitive distortions that have them feeling that they are the only person going through a specific issue. Therefore, the group CBT afford the members the opportunity to learn from each other and facilitator uses the experiences of the group members to illustrate points for the others. However, in individual CBT the person engaged in therapy does not have the secondary support of group members.  In this setting the approaches the therapist uses are different than the ones that are employed during the group setting. The common thread that they both have is that they are both appropriate evidenced based approaches that have efficacy in addressing the client’s needs (Bodryzlova et al., 2019).  The driving force behind the delivery method is the patients desire and readiness to engage.

Group CBT Challenges

When a psychiatric mental health nurse practitioner engages a group in CBT therapy there are some challenges that may be encountered. A group can be a family group or couples, one of the challenges that may face the PMHNP is countertransference. Whenever therapy is being engaged, being mindful of transference and countertransference whether in the group or individual setting is important. The challenge in Group therapy for the PMHNP can be the inability to focus on individuals and identify aspects of their disorders or symptoms (PsychExamReview, 2019).  While this may be a common occurrence that happens in group therapy the provider must be aware that being in a group does not equal similar needs. This may require the provider to speak with the individual after a group away from everybody to identify hurdles that have not been successfully navigated. Also, another challenge the provider will have to navigate in a CBT group are the group dynamics that occur when individuals from different backgrounds trying to address a similar need present (PsychExamReview, 2019). The provider must successfully encourage all members while re directing others who may try to take control of the group. This challenge require skill in savviness on the behalf of the provider.  The PMHNP must also manage the expectations of the group because the members are not all in the same place and can experience education and growth in a group if the facilitator can successfully cultivate it (Ekstedt et al., 2018).

Reference Evaluation

The references that I use for this post can be identified as scholarly in that they have been acquired through peer reviewed sources. Also, the references are within five years of today’s date which brings their relevancy into focus concerning the topic that I am discussing. The articles and the journals that I have referenced have been written for professors’ students or for researchers to enhance their studies or their practice. Many of the references I have chosen follow a strict format presentation of presentation that can be also identified as scholarly. None of the references that were used for this discussion board pose or opinions of a professional, nor are they papers written by a student.  The video that I have referenced in this discussion board posts have come from the approved required media for the class. In many cases YouTube would not be considered a scholarly source however the content of the video that was selected is from a scholarly and reputable source which in turn would make the reference video a scholarly resource. Another reference I have used was gathered from a professional organization that serves as a standard in the psychology profession which qualifies it to be a scholarly source also.

References

American Psychological Association. (2017). What Is Cognitive Behavioral Therapy? APA.org. Retrieved March 30, 2021, from 

https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral#

Bodryzlova, Y., Audet, J.-S., & Bergeron, K. (2019). Group cognitive‐behavioural therapy for hoarding disorder: Systematic review and meta‐analysis. Health & Social Care in the Community, 27(3), 517–530. Retrieved March 30, 2021, from 

https://doi.org/10.1111/hsc.12598

Ekstedt, M., Westman, J., & Kane, K. (2018). Patients’ experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study. BMC Family Practice, 19(1), 111. Retrieved March 30, 2021, from 

https://doi.org/10.1186/s12875-018-0798-2

PsychExamReview. (2019). Cognitive Therapy, CBT, & Group Approaches (Intro Psych Tutorial #241​) [Video]. YouTube.