Read a selection of your colleagues’ responses.
BY DAY 6 OF WEEK 1
Respond to at least two of your colleagues by recommending strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients.
Replies to two posts:
Post #1:
(CBT) Cognitive-behavioral therapy is a type of psychotherapeutic treatment that helps people identify and change destructive or disturbing thought patterns that negatively influence their behavior and emotions (American Psychological Association, n.d.). Under stressful conditions, some individuals tend to feel pessimistic and unable to solve problems. CBT promotes more balanced thinking to improve the ability to cope with stress( Nakao et al.,2021).
Group CBT
Group psychotherapy relies on interactions between group members as a key mechanism for change. In CBT groups, the cognitive-behavioral model taught is often considered more critical than the relationships between members (Whitfield, 2018). Another study by Moloud et al. (2022) notes that Cognitive-Behavioral Group Therapy is a more cost-effective treatment method for depressed patients compared to individual CBT. The authors argue that in a group setting, individuals can better express their thoughts and feelings, engage in interpersonal discussions, and benefit from cooperation and participation. Gryesten et al., 2023 also notes that Group Psychotherapy offers several advantages, including that patients can feel validated by other group members, observe and learn from one another, and receive social support within the group setting .
Family Therapy
Cognitive-behavioral family therapy (CBFT) integrates behaviorism and cognitive approaches within family systems, serving as the family therapy counterpart to cognitive-behavioral therapy. Due to its flexibility and ongoing evolution, CBFT addresses a range of issues, from individual changes within families to altering family interaction styles. Additionally, CBFT provides foundational principles and techniques for various empirically supported interventions and programs ( Lan & Sher, 2019).
Individual therapy
Personalization in psychotherapy emphasizes tailoring treatments to meet the unique needs of individual patients. There are various approaches to personalization, including aligning patient characteristics with specific , accommodating patient treatment preferences , and incorporating patient feedback to modify treatment plans ( Gryesten et al.2023).
Challenges in group therapy
While there are many benefits to using group therapy, such as social interaction and cost savings, there are also numerous challenges that nurse practitioners (NPs) might face. According to Gryesten et al. (2022), some of the biggest challenges in the group format for therapy include patients’ reluctance to discuss personal problems in a group setting, which often necessitates additional individual sessions. Another challenge is personalizing psychotherapy within standardized group Cognitive Behavioral Therapy (CBT), where sessions are structured according to a protocol and must accommodate the needs and preferences of multiple patients.
References
Gryesten, J. R., Poulsen, S., Moltu, C., et al. (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
Moloud, R., Saeed, Y., & Mahmonir, H. et al. (2022). Cognitive-behavioral group therapy in major depressive disorder with focus on self-esteem and optimism: An interventional study. BMC Psychiatry, 22, 299. https://doi.org/10.1186/s12888-022-03918
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. Biopsychosocial Medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219
Whitfield, G. (2018). Group cognitive–behavioural therapy for anxiety and depression. Cambridge University Press. https://doi.org/10.1017/S1352465817000689
Post #2:
Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings
Cognitive Behavioral Therapy (CBT) is a versatile therapeutic approach that can be adapted to various settings, including individual, group, and family therapy. Each setting offers distinct benefits and poses unique challenges, making it essential for Psychiatric-Mental Health Nurse Practitioners (PMHNPs) to understand these differences to effectively utilize CBT.
Individual CBT
Individual CBT focuses on the specific needs of a single client, allowing for a highly personalized approach. The therapist can tailor interventions to the client’s unique cognitive distortions and maladaptive behaviors. This setting offers privacy, which can help clients feel more comfortable sharing personal issues (Pagsberg et al., 2022). However, individual CBT may lack the social support and real-world interaction dynamics that are present in group or family settings, which can be crucial for practicing new skills and behaviors.
Group CBT
In group CBT, multiple clients participate in therapy together, typically sharing a common issue such as anxiety, depression, or substance abuse. This setting provides the benefit of peer support and the normalization of experiences, as clients realize they are not alone in their struggles. Group dynamics can enhance learning through shared experiences and collective problem-solving (Guo et al., 2021). However, managing diverse personalities and ensuring that all group members remain engaged and respectful can be challenging. For example, some individuals may dominate conversations while others may struggle to participate, potentially leading to uneven progress within the group.
One specific challenge in group CBT is maintaining confidentiality. Given the group setting, there is a risk that members may inadvertently disclose sensitive information outside the sessions. PMHNPs must establish clear guidelines and foster a culture of trust and respect to mitigate this risk (Neufeld et al., 2020). Additionally, managing group cohesion and ensuring that the therapeutic environment remains supportive and non-judgmental requires skilled facilitation and continuous monitoring.
Family CBT
Family CBT involves working with family members together to address the dysfunctional dynamics that contribute to a member’s mental health issues. This approach can be particularly effective in treating disorders with a strong relational component, such as childhood behavioral problems, eating disorders, or substance abuse. Family CBT aims to improve communication, resolve conflicts, and strengthen the family unit’s overall functioning (Pagsberg et al., 2022). A major benefit of this setting is the direct involvement of family members in the therapeutic process, which can enhance support and accountability for the individual undergoing therapy.
However, family CBT presents challenges such as resistance to change from family members who may not perceive themselves as part of the problem. Another challenge is balancing the needs and perspectives of multiple family members while maintaining focus on the therapeutic goals. For example, family members may have conflicting views about the issues at hand, which can lead to tension and impede progress (Neufeld et al., 2020). PMHNPs need to employ strategies such as active listening, validation of each family member’s feelings, and structured interventions to navigate these complexities effectively.
Challenges and Strategies for PMHNPs in CBT Settings
Challenge 1: Resistance to Participation in Family CBT
One challenge PMHNPs may encounter in family CBT is resistance from family members who are reluctant to engage in therapy. This resistance can stem from a lack of understanding of the therapeutic process, fear of being blamed, or discomfort with discussing personal issues in a family setting (Guo et al., 2021). To overcome this challenge, PMHNPs can educate family members about the goals and benefits of CBT, emphasizing that the focus is on improving family dynamics rather than assigning blame. Providing a safe and supportive environment where each member feels heard and respected is crucial (Pagsberg et al., 2022). Using motivational interviewing techniques can also help to explore and address ambivalence about participation.
Challenge 2: Ensuring Active Engagement in Group CBT
In group CBT, ensuring that all participants remain actively engaged can be difficult, especially when dealing with diverse personalities and varying levels of motivation. Some group members may dominate discussions, while others may be reluctant to share. PMHNPs can address this by setting clear group rules and expectations from the outset, encouraging equal participation, and using structured activities that require input from all members. Techniques such as round-robin sharing and small group breakouts can help to balance participation (Neufeld et al., 2020). Additionally, providing individual check-ins or feedback sessions can help to address any personal barriers to engagement that may arise.
Scholarly Support
The efficacy and challenges of CBT across different settings are well-documented in the literature. For instance, a study by Pagsberg et al. (2022) highlights the benefits of group CBT for anxiety disorders, noting the role of peer support in enhancing treatment outcomes. Similarly, the work of Neufeld et al. (2020). the importance of addressing family dynamics in the treatment of adolescent substance abuse, demonstrating the added value of family involvement in therapy. Lastly, the comprehensive review by Guo et al. (2021) underscores the effectiveness of individual CBT for depression, providing robust evidence for its tailored and intensive approach. These sources are considered scholarly due to their publication in peer-reviewed journals, their empirical basis, and their contributions to the field of psychotherapy. Each study employs rigorous research methodologies and provides evidence-based insights that inform clinical practice.
References
Guo, T., Su, J., Hu, J., Aalberg, M., Zhu, Y., Teng, T., & Zhou, X. (2021). Individual vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Psychiatry, 12, 674267. https://doi.org/10.3389/fpsyt.2021.674267Links to an external site.
Neufeld, C. B., Palma, P. C., Caetano, K. A. S., Brust-Renck, P. G., Curtiss, J., & Hofmann, S. G. (2020). A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder. International Journal of Clinical and Health Psychology : IJCHP, 20(1), 29–37. https://doi.org/10.1016/j.ijchp.2019.11.004Links to an external site.
Pagsberg, A. K., Uhre, C., Uhre, V., Pretzmann, L., Christensen, S. H., Thoustrup, C., Clemmesen, I., Gudmandsen, A. A., Korsbjerg, N. L. J., Mora-Jensen, A. C., Ritter, M., Thorsen, E. D., Halberg, K. S. V., Bugge, B., Staal, N., Ingstrup, H. K., Moltke, B. B., Kloster, A. M., Zoega, P. J., Mikkelsen, M. S., … Plessen, K. J. (2022). Family-based cognitive behavioural therapy versus family-based relaxation therapy for obsessive-compulsive disorder in children and adolescents: protocol for a randomised clinical trial (the TECTO trial). BMC Psychiatry, 22(1), 204. https://doi.org/10.1186/s12888-021-03669-2Links to an external site.
- 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”
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Gehart, D. R. (2024). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. (4th ed.). Cengage Learning.
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Chapter 10, “Cognitive-Behavioral and Mindfulness-Based Couple and Family Therapies”
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- Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
- Chapter 8, “Cognitive Behavioral Therapy”
- Chapter 21, “Psychotherapeutic Approaches with Children and Adolescents”
- pp. 793–802 only
- Chapter 22, “Psychotherapy with Older Adults”
- pp. 840–844 only