NURS 2118: Therapeutic Initiatives in Mental Health Assessment Answer

Introduction

The case study is about a patient named Emma Smith who is a 33-year-old female and has been diagnosed with schizophrenia. Emma was born in Queensland and has pursued a career in finance, Emma was diagnosed with depression at the age of 14, however, at the age of 21, the first episode of psychosis is observed and admission to the public mental health unit is done. At the time of admission, it was mentioned that she was sexually assaulted by a co-consumer and there were multiple episodes of seclusion. The patient was then married at the age of 25, however, she experienced a relapse at the age of 29 years. At this time she was admitted to the mother-baby unit because she was 8 months pregnant. After prolonged admission, it was established that she was diagnosed with schizophrenia disorder. However, adequate treatment was provided. In the later stage at the age of 33 years, Emma was again brought to the emergency department and her husband noted some early signs of relapse. It was also noted that she was experiencing poor sleep and appetite, IVF treatment was recommended. In the report, the use of cognitive behavioural therapy (CBT), in the treatment of psychotic and depressive symptoms is being studied. There are several aspects of CBT while utilizing this therapy. Motivational interviewing should be studied and how it will help the patient in improving their condition. In the later part of the assessment data is provided to Emma so it can be presented carefully.

Role of CBT in the Treatment of Depressive and Psychotic Symptoms

CBT is a highly effective treatment option that needs to be adopted in the treatment of psychotic or depressive symptoms. The CBT sessions should provide an opportunity to identify the current life situation which might be a cause or contributing factor to mental health conditions such as depression or anxiety. CBT is also useful for therapists as it will help them identify the pattern of thinking or distorted perception that no longer serves the person. CBT majorly focuses on the person's capacity to change themselves, their feelings, thoughts, or behavior. It can be highly effective as the medicines which are required can be easily used to treat the mental health problem and in addition to it, it is also highly useful in cases where the medicines have not worked effectively (Gautam et al., 2022). It examines and studies psychotic experiences and then coping strategies are developed which help to manage the symptoms. In the treatment with CBT, the challenges need to be identified and any unhelpful thoughts which are present should be controlled over self-help strategies. Several studies have suggested that CBT is highly useful in the treatment of the condition and that medication helps in the improvement. There are about 5 steps of CBT and these 5 steps are described or mentioned below, step 1 is to make a list, step 2 is to record any unproductive thoughts, step 3 is to create any replacement thoughts, and step four is to read the list more often. The last step is step 5, in which the person replaces or notices things more often (Agbor et al., 2022).

CBT also teaches coping skills and it helps to deal with different problems. It majorly focuses on thoughts, attitudes, and beliefs which affect actions and feelings.

CBT aims to stop or mitigate the negative cycles such as breaking down things into smaller elements such as feeling anxious, bad, or scared. If the problems are manageable, then CBT effectively changes negative thought patterns and it improves the way one feels.

CBT works actively and it follows several steps (Vasile, 2020). The first step is to collaborate while identifying troublesome problems. The next step is to observe how a person tends to think or also the thinking habits, the next step is to look at how a person reacts to different situations also known as behaving habits. Step 4 is to consider whether or not thinking or behavior habits are unrealistic and unhelpful. The 5th step is to try and explore new ways of thinking and behavior and how it is effective.

CBT operates on the principle which is dependent on the individual emotional reaction and it is determined by their perception of events, also known as Beck's Model of Emotional Difficulties. CBT is highly effective in managing the symptoms of schizophrenia, it also prevents hospitalization and it improves the overall quality of life. In several cases, it needs to be combined with antipsychotic medication with CBT, and it is highly effective in taking medication (Health Quality Ontario, 2018). The CBT treatment usually involves efforts to change the thinking pattern. Several strategies are included several when learning is concerned. In addition to it distortion in the thinking should be addressed and how it helps to reevaluate reality. A better understanding should be gained and behavior and motivation should be obtained. In the case of CBT, the major goal is to examine how one thinks about the situation. It is highly important to act based on thought and the person behaves accordingly. Stress should be reduced and various action such as participation in the recreational activity needs to be taken so as to reduce the stress (Özdel, 2021).

As the challenges and the beliefs have been rationalised, there are several cognitive approaches which can be easily adopted so as to improve hold over the other person. One can easily comprehend the thought patterns and also take care of the emotions as it can be easily triggered and it can also be led towards the situation of reality. There are several techniques which can be used and the most important one is the cognitive technique, this is essential as it aids in restructuring. Hence, to lower the cognitive disorder, the therapist can adopt several approaches and perspectives which are more sensible and realistic. There are several constructive ways which can be developed so as to think and talk in a clear manner (Webb et al., 2017).

Various Aspects of CBT

There are various aspects of CBT and these majorly revolve around the thoughts, emotions and conduct which are present in CBT. It is considered to be a time-restricted, systematic and direct method which is used in the treatment of a wide range of mental health conditions. The patients are been assisted in growing in a highly adaptive cognition and behaviour, this helps to reduce the distress. It is majorly defined as the psychotherapy approach and it is presented with best evidence and high research. Clinical guidelines are present and these guidelines are present as it will help in the treatment from several aspects of mental illness and there is several data which is taken into account (Davies et al., 2018).

The several aspects of CBT are: the patient should be provided the tool which can be used to transform the behavioural and the cognitive pattern, it will also assist them in understanding the current acting and thinking. At the end CBT has actively attempted to teach the patient to be their therapist. Some common components of CBT are mainly divided in 2 categories and these are mentioned below. First is those who are able to adapt a problem-solving and organised approach of CBT. The main emphasis of CBT is put emphasis on the problem oriented and present approach. It majorly concentrates on the problems which are present and which are going to come in the future(Zhou et al., 2017). In addition to it, it also searches for different ways so as to enhance the current state of the mind, rather than only concentrating on the factors which lead to repeating symptoms and discomfort in the past. The goals should be set in CBT and it should follow all the components of SMART goals which are: it should be specific, measurable, attainable and also realistic. In addition to it, there should be a time limit set to it. The major goal when it comes to CBT patient is to take care of the mental status and work towards it (Sönmez et al., 2019).

The major aim of the activity planning and along with it grading tasks is to work towards improve functioning and slowly increasing the productive and enjoyable experiences. Every day is planned out in well advance and it is done using scheduling of activity. To avoid having to make all the decisions which are same should not be repeated. Other than this the patient and therapist try to reduce the volume of chores in a much more productive and managable list. The task and the assignments which are graded needs to be assisted this is important as it will help to overcome any procrastination or any anxiety-induced circumstances. This is a highly important step as it will break down into small manageable steps. This method majorly involve gathering a baseline of data and then rate it according to their level of mastery or pleasure. In the next step it is used in a jointly manner, all the changes are then devised and it will reactivate the patient (van der Stouwee et al., 2021). These are several methods which are designed to assist the patients so they can reestablish the daily routines. In addition to it, it also increase the enjoyable activities, and addressing issues. The major chunk of behavioral trials which is related to mental health issues is based on anxiety. Additionally, behavioral experiments assist patients so they can develop a tolerance towards anxiety. Before starting any activity (such as walking to the store),a prediction should be made towards the patient. When the job is finished the job, the records of the patient if it is a forecast should be accurate. As a result, the patient will slowly start to reassess their already present forecasts as they accumulate vital information to the contrary (Jones et al., 2018).

For example one of the most common approach which is adopted is therapy, a patient with obsessive compulsive disorder should mainly aim to bring positive thoughts. As it a known fact that CBT is time bound therapy, hence, time should be respected and work should be done accordingly. Majorly CBT usually consist of 5-20 sessions for depression or anxiety when other conditions are also present. It has been witnessed that when CBT is used for treatment of mental illness then it might take more time to complete and slow progress is also seen. A very vital notion is the guided recovery in this the therapeutic potion majorly takes care of the patients point of view and also assist them to broaden their thinking so they can become more aware of all the underlying presumption and new solutions and views can be determined. Activity planning is present and along with it grading task is also present, all of these are present are aimed to improve the function and also increase the productive and enjoyable experience (Chiang et al., 2017). 

There are several advantages of CBT, and these are mentioned below. It has been demonstrated that CBT has a long-lasting favorable impact on patients. In randomized research, it was discovered that patients with depression who had previously received antidepressant medication (ADM) had a higher risk of relapsing through a year of follow-up than those who had previously undergone cognitive behavioral therapy (CBT). Previous CBT had a lasting impact that was at least as potent as keeping patients on ADM (in terms of preventing relapse and recurrence over the follow-up period). The cumulative cost of continuing medicines turned out to be more expensive by the conclusion of the first year of follow-up in a randomized trial comparing CBT and ADM, even though CBT was originally more expensive to give (Chiang et al., 2017). The patient's life experiences, from early on in life, to their time in therapy sessions, are just a few of the variables that need to be taken into account. Based on the information gathered, a conceptualization of the patient is created to give a complete picture of the patient's situation. In each session, this conceptualization is improved as new knowledge becomes accessible (Fordham et al., 2021).

The basic goal of CBT is to rationalize negative ideas and behaviors. During the CBT sessions, one can anticipate learning how to: identify issues, develop an awareness of one's negative thoughts and behavior, recognize that one's thoughts are opinions and be able to distinguish between true and false assumptions, set realistic goals, be more present and kind to oneself, develop a more positive perspective of situations, be more resilient and in control of one's problems, and become one's, own solution provider (Husain et al., 2017).

 Other than this, several assessment tools are used and these assessment tools are highly useful, and it will help to take care of the patient. There are five areas of assessment and these are: first is life situation and the practical problem. The life situation should be such that it should be balanced and working effectively. The second component which needs to be taken into account is altered thinking, in this the general thinking is changed and new ways are adopted. The emotions are also affected and altered, this is known as change in feelings or ways. This altered thinking needs to be controlled and taken into account. The physical feelings are affected and they are altered, hence, ways need to be designed to alter and control physical feelings (David et al., 2018). In several cases, the behavior is also altered, and the activity level is affected due to it. These activity levels need to be managed. While CBT has 4 components and these components are: cognition also known as thoughts, other than this emotions, or feelings also need to be managed, feelings or emotions, and physiology. For the behavioral assessments, there is a questionnaire attached and this aids in-person conversation. Other than this the thoughts, feelings, and behavior of the client are studied. The functional and clinical assessment needs to be followed and these are highly followed (Fordham et al., 2021).

Conclusion

This research proposal is about a case study, a patient named Emma Smith who is a 33-year-old female and has been diagnosed with schizophrenia. CBT has been discussed as a treatment option and how it will help to provide efficient treatment. Several components of CBT are present, all these components need to be studied. Several aspects of CBT need to be understood and it should be worked on. A total of five steps are present and these are: step 1 is to make a list, step 2 is to record any unproductive thoughts, step 3 is to create any replacement thoughts, and step four is to read the list more often. The last step is step 5, in which the person replaces or notices things more often. 

CBT also teaches coping skills and it helps to deal with different problems. It majorly focuses on thoughts, attitudes, and beliefs which affect actions and feelings. CBT is used so widely because it offers several advantages, and all these advantages need to be taken care of. Work should be done, to improve these advantages as these are highly effective and useful. It is necessary to have an understanding of all these things.

References

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