Respond to your peer 

 

ATTACH PDF

 

 

Cognitive Behavioral Therapy (CBT) is based on the belief that psychological health depends on how well a person can positively adapt, both cognitively and functionally, to changing conditions and situations in the environment (Wheeler, 2020). CBT combines cognitive and behavioral techniques using rewards and punishments and attempts to change specific emotional responses to certain stimuli and unique aspects. CBT is much more problem-focused and action-oriented. CBT is straightforward when working with a therapist to have a narrow focus on specific areas of improvement and then try to structure a group of behaviors that will help the individual make progress in specific areas of need (PsychExamReview, 2019)

 

Explanation of how the use of CBT in groups compares to its use in family or individual settings.

Cognitive Behavioral Therapy in a group setting

Group setting CBT is where individuals work on their problems in a group setting. These individuals have their own problems but work on them in a group, and there are some benefits of group therapy, such as encouragement of social behaviors and social skills. Symptoms of withdrawal or reduced social activity can help the individual be more social. Additionally, group therapy allows for feedback from multiple sources and hearing others’ views of their symptoms, their own expression, or anything relevant to the disorder (PsychExamReview, 2019).

 

One method among approaches to the psychological treatment of depression is CBT. Depression symptoms continue in most patients after pharmacological treatment of depression, but CBT effectively controls the symptoms of depression and decreases the rate of relapse. Studies have also shown that CBT reduces the symptoms of depression and anxiety. A meta-analytic review revealed that when depression and anxiety symptoms were examined together, CBT was effective both immediately after treatment and at six-month follow-up. This suggests that CBT should be considered as the first-line psychosocial treatment of choice, at least for patients with anxiety and depressive disorders. CBT leads to a significant improvement in perceived stress and depressive symptoms due to reduced use of avoidance coping strategies and increased use of effective coping strategies among individuals (Demir & Ercan, 2022).

 

Cognitive Behavioral Therapy in Family setting.

CBT in family therapy looks at families as a system of relationships. These relationships influence all family members, which can be relevant for some disorders. There may be some disorders in which the family system increases stress for the person suffering, or they can relate to some symptoms. In couples therapy, the couple will work with the therapist to improve their communication or deal with problems that might influence the relationship. Both partners must be involved in determining which issue, what might occur, and what they need to address. These sessions and communication help to prevent these couples from ruining their relationship (PsychExamReview, 2019).

 

Cognitive Behavioral Therapy in individual setting.

The therapist’s role is to identify where the person or patient might be engaging in these faulty thinking patterns and then review these to try to change those patterns. The therapist challenges the individual and tries to improve the person’s awareness of when this is happening. Then, once they begin to recognize it on their own, they can gradually start to think how they can change those patterns of how they reinterpret the events so that they are not, for instance, jumping to the worst possible conclusion whenever something terrible happens (PsychExamReview, 2019). CBT emphasizes thinking patterns and the role they might play in specific symptoms of mental illness. Certain thinking patterns are associated with symptoms of disorders. The goal is to change those thinking patterns and improve a person’s reasoning for self-control and responses to specific events. There is a greater sense of transparency to therapy in individual settings. The therapist clarifies to the patient why they are doing certain things and the end goal for a particular program behavior. Each session has an agenda, and there is a focus on restructuring certain beliefs and thoughts relevant to the particular outcome we want for the patient (PsychExamReview, 2019).

 

Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings.

One challenge for PMHNPs is to ensure close adherence to the contents of family based CBT program and maintain a high standard of quality in its implementation. It is important that the practitioners attitudes and believes regarding family skills coincide with those of the program. Prevention programs for families are based on different theoretical approaches. These determine the roles ascribed to the practitioners who implement them, providers, trainers, or facilitators who put the specific contents of an evidence-based prevention program for families into practice. The facilitator’s adherence to the program, their attitudes and beliefs about family skills, and their degree of motivation when dealing with families influence the quality of program implementation (Orte et al., 2017).

 

A second challenge is working with children with autism spectrum, anxiety, and CBT. Findings suggest that the relationship between autism features and anxiety may be bidirectional. Children with a strong insistence on sameness may experience significant anxiety in anticipation of changes to their typical routine. The child may argue with their parents and successfully avoid visits. The insistence on sameness may become more pronounced without the opportunity to practice flexibility. Similarly, the child who struggles to navigate complicated social interactions may fear exclusion or bullying; this fear could lead to social isolation and fewer opportunities to develop social communication skills. In other cases this may be anxiety that leads to more direct communication challenges. If anxiety does contribute to more pronounced autism-related challenges, treating anxiety in youth with autism would be expected to result in subsequent improvement in this area, including CBT. This pattern appears to be the case as autism-related challenges have significantly improved following anxiety-focused cognitive behavioral therapy (Fuselier et al., 2023).

 

The third challenge is that the COVID-19 pandemic necessitated transitioning all psychology teaching methods from predominantly in-person to predominantly online care. This shift posed challenges for psychology disciplines as traditional and emerging teaching approaches have primarily been delivered in person, which aligns with traditional clinical service delivery. The COVID-19 pandemic presented a unique opportunity to evaluate innovative teaching methods. Emerging research of psychology programs transitioning their workload and clinical sessions to online treatment (Jona et al., 2022). Although the pandemic has improved over the past few years, online sessions continue. The challenge is privacy for the individual in session, confidentiality due to others being around while in session, and how the individual presents themselves on camera versus in-person sessions.

 

References

Demir, S., & Ercan, F. (2022). The effectiveness of cognitive behavioral therapy‐based group counseling on depressive symptomatology, anxiety levels, automatic thoughts, and coping ways Turkish nursing students: A randomized controlled trial. Perspectives in Psychiatric Care, 58(4), 2394–2406. https://doi.org/10.1111/ppc.13073Links to an external site.

 

Fuselier, M. N., Guzick, A. G., Bakhshaie, J., Wood, J. J., Kendall, P. C., Kerns, C. M., Small, B. J., Goodman, W. K., & Storch, E. A. (2023). Examining the relationship between anxiety severity and autism-related challenges during cognitive behavioral therapy for children with autism. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-023-05912-z

 

Jona, C. M. H., Sheen, J. A., & O’Shea, M. (2022). Benefits and challenges of an online CBT group, utilizing self-practice/self-reflection paradigm for psychology trainees. Training and Education in Professional Psychology. https://doi.org/10.1037/tep0000435

 

Orte, C., Ballester, L., Amer, J., & Vives, M. (2017). Training of practitioners and beliefs about family skills in family-based prevention programmes. British Journal of Guidance & Counselling, 45(5), 573–582. https://doi.org/10.1080/03069885.2017.1343456

 

PsychExamReview. (2019, April 30). Cognitive therapy, CBT, & group approaches (intro psych tutorial #241)Links to an external site.

 THIS CANNOT BE LATE-

I will do the video portion and will provide the content for the eval.

 

Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences to the learning you gain from your weekly Learning Resources. Comprehensive notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last 5 weeks, using the Comprehensive Psychiatric Evaluation Template provided. You will then use this note to develop and record a case presentation for this patient.

• Select a patient that you examined during the last 5 weeks. Review prior resources on the disorder this patient has. 
• Conduct a Comprehensive Psychiatric Evaluation on this patient using the template provided in the Learning Resources. There is also a completed exemplar document in the Learning Resources so that you can see an example of the types of information a completed evaluation document should contain. All psychiatric evaluations must be signed by your Preceptor. You will submit your document in Week 5 Assignment, Part 2 area and you will include the complete Comprehensive Psychiatric Evaluation as well as have your preceptor sign the completed assignment. You must submit your documents using Turnitin. Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies. 
• Develop a video case presentation, based on your progress note of this patient, that includes chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis, including differentials that were ruled out.
• Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning.
• Ensure that you have the appropriate lighting and equipment to record the presentation.
• ASSIGNMENT
• Record yourself presenting the complex case for your clinical patient.
• Do not sit and read your written evaluation! The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video. 
• In your presentation:
• Dress professionally and present yourself in a professional manner.
• Display your photo ID at the start of the video when you introduce yourself.
• Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
• Present the full case. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis, including differentials that were ruled out.
• Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
• Be succinct in your presentation, and do not exceed 8 minutes. Address the following:
• Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?
• Objective: What observations did you make during the interview and review of systems?
• Assessment: What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis, and why?
• Reflection notes: What would you do differently in a similar patient evaluation? Reflect on one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health.  As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

 

 

There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.

 

Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

 

 

 MUST INCLUDE PDF 

As you establish your goals and objectives for this course, you are committing to an organized plan that will frame your practicum experience in a clinical setting, including planned activities, assessment, and achievement of defined outcomes. In particular, they must address the categories of clinical reasoning, quality in your clinical specialty, and interpersonal collaborative practice. 

For this Assignment, you will consider the areas you aim to focus on to gain practical experience as an advanced practice nurse. Then, you will develop a Practicum Experience Plan (PEP) containing the objectives you will fulfill in order to achieve your aims. In this practicum experience, when developing your goals and objectives, be sure to keep psychiatric assessment and diagnostic reasoning in mind. 

 

• Review your Clinical Skills Self-Assessment Form you submitted last week and think about areas for which you would like to gain application-level experience and/or continued growth as an advanced practice nurse. How can your experiences in the practicum help you achieve these aims?
• Review the information related to developing objectives provided in this week’s Learning Resources. Your practicum learning objectives that you want to achieve during your practicum experience must be:
  • Specific
  • Measurable
  • Attainable
  • Results-focused
  • Time-bound
  • Reflective of the higher-order domains of Bloom’s taxonomy (i.e., application level and above)

Note: Please make sure your objectives are individualized and outlined in your Practicum Experience Plan (PEP). While you may add previous objectives to continue to work toward. You must have 3 new objectives for each class, each quarter. 

• Discuss your professional aims and your proposed practicum objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.
• Select one nursing theory and one counseling/psychotherapy theory to best guide your clinical practice. Explain why you selected these theories. Support your approach with evidence-based literature.
• Create a timeline of practicum activities that demonstrates how you plan to meet these goals and objectives based on your practicum requirements.

 

ASSIGNMENT: Record the required information in each area of the Practicum Experience Plan template, including three to four (3–4) practicum learning objectives you will use to facilitate your learning during the practicum experience.