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The Application of CBT in Different Therapeutic Settings

Cognitive Behavioral Therapy (CBT) is a versatile and widely used therapeutic approach that can be implemented in various settings, including individual, family, and group therapy. The core principles of CBT, which focus on identifying and modifying dysfunctional thoughts and behaviors, remain consistent across these settings. However, the dynamics and challenges inherent in each context can significantly influence the therapeutic process and outcomes.

In individual CBT, the therapist works one-on-one with a patient, allowing for personalized and intensive focus on the individual’s specific issues. This setting provides a safe space for patients to openly explore their thoughts and behaviors without the influence of others, which can be particularly beneficial for those with severe anxiety or depression. For instance, Amano et al. (2023) conducted a study demonstrating that individualized CBT significantly improved future thinking in patients with major depressive disorder, highlighting the effectiveness of personalized interventions in addressing specific cognitive distortions related to depression.

Family CBT involves multiple family members in therapy sessions, addressing the dynamics and communication patterns within the family unit. This approach is particularly useful for issues where family interactions play a crucial role, such as in the treatment of adolescent behavioral problems or family-related stress. The involvement of family members can facilitate a better understanding of the patient’s environment and provide a support network that reinforces therapeutic changes. However, managing differing perspectives and conflicts within the family can pose significant challenges, requiring the therapist to navigate complex relational dynamics and ensure that all voices are heard and validated.

Group CBT, on the other hand, brings together multiple individuals experiencing similar issues, such as depression, anxiety, or schizophrenia, to participate in therapy sessions together. Group therapy can leverage the power of social support and shared experiences, providing a sense of community and reducing feelings of isolation. For example, Chen et al. (2023) found that cognitive behavioral group therapy significantly improved rehabilitation outcomes for community patients with schizophrenia, underscoring the benefits of group settings in fostering social connections and mutual support.

Despite its advantages, group CBT also presents unique challenges. One significant challenge is maintaining confidentiality within the group. Participants must trust that their disclosures will be respected by others, which can be difficult to guarantee in a group setting. Another challenge is ensuring that each group member receives adequate attention. Therapists must balance the needs of the group as a whole with those of individual members, which can be particularly challenging in larger groups or when participants have varying levels of engagement or differing therapeutic needs. Gryesten et al. (2023) highlighted that both patients and therapists often feel the need for a more personalized approach within standardized group CBT, suggesting that individual differences can sometimes be overlooked in group settings.

PMHNPs (Psychiatric Mental Health Nurse Practitioners) may encounter specific challenges when implementing CBT in these different settings. In individual therapy, a challenge might include ensuring the patient remains engaged and motivated throughout the course of therapy, particularly when dealing with severe depression or resistant cases. In family therapy, managing complex family dynamics and conflicts can be demanding, as PMHNPs need to maintain a neutral stance while addressing sensitive issues. In group therapy, PMHNPs might struggle with facilitating group cohesion and managing the dynamics between group members, especially when conflicts arise or when participants have vastly different levels of symptomatology and coping skills.

The sources used to support these points are considered scholarly due to their publication in peer-reviewed journals, which ensures the rigor and reliability of their findings. Peer-reviewed articles undergo a thorough evaluation by experts in the field before publication, providing a high level of credibility. The attached PDFs of these sources will further elucidate the empirical evidence and theoretical underpinnings discussed.

References

Amano, M., Katayama, N., Umeda, S., Terasawa, Y., Tabuchi, H., Kikuchi, T., Abe, T., Mimura, M., & Nakagawa, A. (2023). The effect of cognitive behavioral therapy on future thinking in patients with major depressive disorder: A randomized controlled trial. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.997154Links to an external site.

Chen, X., Deng, X., Sun, F., & Huang, Q. (2023). Effect of cognitive behavioral group therapy on rehabilitation of community patients with schizophrenia: A short-term randomized control trial. World Journal of Psychiatry, 13(8), 583-592. https://doi.org/10.5498/wjp.v13.i8.583Links to an external site.

Gryesten, J. R., Poulsen, S., Moltu, C., Biering, E. B., Møller, K., & Arnfred, S. M. (2023). Patients’ and therapists’ experiences of standardized group cognitive behavioral therapy: Needs for a personalized approach. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-023-01301-xLinks 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.

THIS CANNOT BE LATE. 

DUE JULY 7th BY 10 am MST. 

Understanding the strengths of each type of therapy and which type of therapy is most appropriate for each patient is an essential skill of the psychiatric-mental health nurse practitioner. In this Assignment, you will compare humanistic-existential therapy to another psychotherapeutic approach. You will identify the strengths and challenges of each approach and describe expected potential outcomes.

To prepare:

• Review the humanistic-existential psychotherapy videos in this week’s Learning Resources.
• Reflect on humanistic-existential psychotherapeutic approaches.
• Then, select another psychotherapeutic approach to compare with humanistic-existential psychotherapy. The approach you choose may be one you previously explored in the course or one you are familiar with and especially interested in.

In a 2- to 3-page paper, address the following:

• Briefly describe humanistic-existential psychotherapy and the second approach you selected.
• Explain at least three differences between these therapies. Include how these differences might impact your practice as a PMHNP.
• Focusing on one video you viewed, explain why humanistic-existential psychotherapy was utilized with the patient in the video and why it was the treatment of choice. Describe the expected potential outcome if the second approach had been used with the patient.
• 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. Attach the PDFs of your sources.

VIDEO RESOURCES 

RESOURCES 

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
  • “Culture and Psychiatric Diagnosis”
• Gehart, D. R. (2024). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation (4th ed.). Cengage Learning.
  • Chapter 8, “Experiential Family Therapies”
• Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
  • Chapter 6, “Humanistic-Existential and Solution-Focused Approaches to Psychotherapy”
• Grande, T.  (2019, January 9). Theories of counseling – Existential therapyLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=YvAvc2aWup0
• PsychotherapyNet. (2009, June 29). James Bugental live case consultation psychotherapy videoLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=Zl8tVTjdocI
• ThinkingallowedTV. (2010, September 20). James Bugental: Humanistic psychotherapy (excerpt) – A thinking allowed DVD w/ Jeffrey MishloveLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=mjDNKGIvWPQ