Psychotherapeutic Psychology and Mental Health

Introduction

The aim of this assignment is to critically evaluate the effectiveness of psychological therapies established, especially that of cognitive behavioural therapy as shown by recent peer reviewed literature. This work will demonstrate understanding and knowledge of key approaches, concepts and debates within the psychotherapeutic and mental health fields. Additionally, it will provide an informed reflection concerning the role of personal investments and responses in shaping evaluations of approaches, debates and concepts within the psychotherapeutic and mental health fields.

The effectiveness of psychological therapies established

Evidence suggests that the results or outcome of psychological therapies such as cognitive behavioural therpay tend to be long lasting and compared to pharmacological treatments (Shedler, 2010). Shedler (2010) claims that in the treatment of anxiety disorders and depression, psychological therapy patients or clients are equipped with different skills which can be used later after the termination of treatment. These skills can be used in the rest of individuals’ lifetimes, for instance, to cope with one’s maladaptive thoughts and resist relapse into things like drug use (Shedler, 2010).

Cognitive behavioural therapy, as well as other psychosocial therapy techniques have been found to be effective in treating many psychological disorders as shown by evidence from clinical research literatures which indicate different effectiveness with adults, older adults and children (McMain and Pos, 2007). There are large beneficial impacts when psychological therapies such as cognitive behavioural therapies are used compared to patients not seeking treatment (McMain and Pos, 2007; Norcross and Wampold (2011). According to Norcross and Wampold (2011), most structured and valid psychological therapies like CBT (cognitive behavioural therapy) are effective in tackling mental health problems.

Many, if not all psychosocial therapies or approaches, follow proactive and active processes between individuals or a group of more than two people, in an intense functional or working relationship where people determine the causes of their mental health problems and ponder on possible solutions (Greenberger and Padesky, 1995). Through these relationships, mental health professionals make their clients to perceive their problems or the causes of their mental health conditions as challenges and not as threats and give them guidelines and advice about what should be done to overcome the challenges (Greenberger and Padesky, 1995).

Emotional difficulties, childhood disorders, relationship troubles, personal crisis, traumas and fears are some of the reasons why individuals seek psychotherapists’ help (Hawton, Salkovskis, Kirk and Clark, 1989). Researchers claim that all the existing psychological therapy approaches can all be efficient and effective in helping patients with such problems improve when skilled, well-trained and competent professionals are chosen (Hawton, Salkovskis, Kirk and Clark, 1989). There is a long list of psychological therapies which are used today according to the needs of patients to be helped. One of these include the cognitive-behavioural therapies which are based on comprehending how humans think and their behaviours. Created on the foundation that it is possible to achieve change, this approach has been able to help mental health experts to learn and understand how to improve the human behaviour, attitudes and thoughts (Sperry, 2017). It has effectively been used to identify people’s problems and correcting their problematic thought patterns (Sperry, 2017). Using functional behavioural analysis, this approach has been useful in identifying maladaptive behaviours and using a range of methods to train people problem-solving techniques, and to cause cognitive restructuring (Sperry, 2017). It has successfully been used to treat anxiety disorders, traumatic processes, phobias and depression (Sperry, 2017).

Other approaches include the psychodynamic or psychoanalytic therapies which follow Sigmund Freud’s theoretic principles which state that humans occasionally manifest sets of unconscious conflicts that originate from their childhood or pasts (Steinert et al., 2017). This approach has been helpful, using hypnosis or catharsis to improve people’s chances of determining and eliminating the defence mechanisms employed in avoiding solving their original problems (Steinert et al., 2017). There also the humanistic therapies which are used to encourage people to be active change agents by valuing one’s present situation and making the past less important (Hoffman, 2020). Other therapies include the artistic therapies which use artistic expressions to shape people’s emotions. These approaches have been found to be successful in shaping people’s self-discovery and providing them with alternative ways of solving their problems (Ijaz et al., 2018). These therapies, among others have all been found effective in solving problems based on the type of problems and the situations which create the mental health difficulties (Ijaz et al., 2018).

The effectiveness of cognitive-behaviour therapy

According to Clark and Fairburn (2000), cognitive-behaviour therapy comprise a class of therapeutic interventions which share some basic premise that psychological distress and mental disorders are sustained by various cognitive factors. These authors opine that maladaptive behaviours or cognitions contribute to a person maintaining emotional behaviours and distress. They claim that these cognitions include the self, the future, schemas or general beliefs concerning our world which lead to automatic and specific thoughts in certain situations. The primary therapeutic model stipulate that therapeutic practices or strategies should alter these maladaptive behaviours and relieve an individuals of their problematic behaviours and emotional distress (Clark and Fairburn (2000).

In line with the psychiatry medical model, the objective of offering treatment is to reduce symptoms, to improve one’s functioning and to remission disorders (Westbrook, Kennerley and Kirk, 2011). To reach this goal, mental health practitioners encourage a collaborative effort and continued interaction between patients and the carers in the processes of problem-solving to challenge maladaptive cognitions to change the negative behaviour and thought patterns (Westbrook, Kennerley and Kirk, 2011). This is where an approach like cognitive-behaviour therapy comes in. This approach comprises a set of therapeutic practices and interventions which combine different emotion-focused, behavioural and cognitive-focused approaches (Hofmann, 2011).

Among the problems which have been tackled effectively using cognitive-behaviour therapies are anxiety disorders and depression, some of the most prevalent disorders that have been associated with projected long-term and lifetime risks (Wills and Sanders, 2012). Literature shows that cognitive-behaviour therapy has been effective in transforming individual’s dysfunctional thought patterns or maladaptive behaviours to prevent people from maintaining or developing the symptoms associated with anxiety or depression (Wills and Sanders, 2012). Research on cognitive-behaviour therapy (CBT) effectiveness show that this technique is as good as pharmacotherapy in dealing with between mild to average or moderate anxiety disorders and depression with long-term treatment gains and reduce long-term relapse for those suffering from depression (Wills and Sanders, 2012).

Evidence suggests that CBT is a time-limited and structure therapy approach that makes it appropriate for primary care settings. It is usually preferred in situations where patients can be provided with self-help resources in between sessions in primary healthcare (Wills, 2009). One of the reasons why this approach is considered important in health care is because it uses other unique and helpful therapeutic practices to cause behaviour and cognitive change (Wills, 2009). One of this practice is commitment and acceptance therapy which has been used to treat depression. The commitment and acceptance therapy’s goals has been effectively used to equip patients with psychological flexibility techniques to enhance their focus on their thinking to favour change in what is called the cognitive triangle (Wills, 2009).

Another therapeutic practice used in CBT is behavioural therapy that has been successful in making individuals look at their own conditioned and learned behaviours to see how these affect their lives. This approach has helped people re-condition towards inclusive behaviours and actions (Soh et al., 2020). Furthermore, therapists are making use of cognitive analytic therapy, a practice that has been useful in punctual or brief treatments and which have successfully helped to improve people’s behavioural problems and distorted thoughts in just 12 sessions (Hallam et al., 2021). This technique’s effectiveness has mostly been seen in mental health departments in hospitals in helping patients to comprehend why they have certain thoughts or think and behave in certain ways (Hallam et al., 2021).

Lastly, emotive behaviour therapy (EBT), is another different therapeutic practice which has been used to treat rage, sexual dysfunctions, shyness, social phobia and frustrations (Dryden, 2021). Using a more empirical, philosophical and direct approach, therapists have been able to use rationality and reason to bring awareness to people about their emotions and their limiting or destructive thoughts (Dryden, 2021). Using this CBT approach, psychotherapists have been successful in facilitating strategies that lead to constructive and positive thoughts (Murphy et al., 2020).

One other area that CBT has become highly influential is in treating substance use and addition disorders (Sundström et al., 2020). This approach has successfully been used to treat cannabis dependence (Shahzadi, and Abbas, 2020). These researchers found that CBT has higher efficacy for cannabis addiction, with lower rates of dropouts than other control conditions and briefer interventions (Dutra et al., 2008). Smoking cessation has also been achieved with the help of CBT by equipping individuals with coping that have effectively helped to reduce relapse (Huttunen‐Lenz et al., 2010).

To further show the relevance and success of behavioural therapy in treating maladaptive cognition and behaviour pattern, evidence by Oakley Browne et al. (2000) found superior performance of CBT in treating problematic gambling compared to using control treatment. In the treatment of psychotic disorders and schizophrenia, researchers like Bird et al. (2010) found CBT to be effective in treating positive symptoms like hallucinations or delusions. Zimmermann et al. (2005) also found evidence of using CBT in treating psychosis episodes as compared to pharmacotherapy. These researchers found that the use of CBT reduce hospital admissions and relapse than other treatment interventions when dealing with such mental health disorders.

In another study by Pfeiffer et al. (2011), CBT was seen to be effective in treating both Dysthymia and Depression as compared to the use of control conditions like no treatment or waiting list. In their meta-analysis, these researchers found that this method is equally effective to the other psychological treatments when treating dysthymia and depression. Tolin (2010) also found similar results in the use of CBT and psychodynamic therapy in treating anxiety and depression. CBT turned out to be superior post-treatment and six months during follow-up. Other conditions which have effectively been dealt with using CBT is bipolar disorder (Gregory et al., 2018). According to Gregory et al. (2018) in his meta-analysis, CBT demonstrated small to average effect post bipolar treatment. After examining depressive and manic symptoms related to bipolar disorders, Gregory (2010) found that CBT treatment is an effective approach that can lead to positive outcomes in alleviating bipolar related conditions.

Cases of eating disorders have been increasing significantly in the recent years as a cognitive-behavioral problem (Thompson-Brenner 2003). To deal with this approach, the use of CBT has been recommended by cognitive-behavior therapists and researchers. In a study conducted by Thompson-Brenner (2003), it was found that CBT was successful in helping people overcome eating disorders even though it was not as superior as control treatments. The researcher found lower remission rates when CBT was used to treat this condition. In fact, CBT fared substantially better in tackling the rates of remission response compared to other techniques like self-monitoring, behavioral weight loss treatment, supportive psychotherapy, hypno-behavioral therapy, dialectical behavioral therapy and interpersonal therapy.

Other areas where the efficacy of CBT has been investigated is in dealing with criminal behaviors, personality disorders and insomnia. Losel and Schmucker (2015) found CBT to reduce the rates of recidivism and criminal tendencies in ex-convicts. The use of CBT has also been recommended for treating anxiety disorders in adolescents and children (Santacruz et al. 2002). It seemed to be as effective as other psychological therapy techniques like family systems and interpersonal therapy but was more cost effective in dealing with mental health conditions such as suicidal ideations in young individuals (Robinson et al. 2017). Krishna et al. (2015) also found the approach to be effective in treating depression and anxiety in adults and the elderly by alleviating worry and providing people with loneliness coping techniques.

Personal reflection on the importance of CBT

In this reflection section, I am going to use the Gibb’s reflective cycle created by Graham Gibbs in (1988) as learning reflection approach that includes the role of a health practitioner’s feelings in practice (Markkanen et al., 2020).

1. Description:

While working internship as an assistant therapist, I was sent by my supervisor who was also the therapist being seen, to go and tell a former marine who was suffering from Post-Traumatic Stress Disorder that it was his time to see the therapist. When I entered the waiting room he was alone and speaking to himself as if quarrelling with someone else. My supervisor allowed me to stay during this session because it was the patient’s first time and it was just going to be an introduction session. I was, however, to stay in the room, in a place where I could listen and observe but not cause interference or be seen by the patient.

2. Feelings

I was excited about this opportunity because it was going to be the first time, I was witnessing an actual therapy session. I was also sad for the man who had given his all to serve his country but ended up suffering from this mental health problem which was now affecting his family’s quality of life.

3. Evaluation: What was good and bad about the experience?

I soon realised that my supervisor was using cognitive behavioural therapy even during this introduction when she told the patient that his actions, emotions and thoughts were connected and that they needed to work together to change or restructure his thoughts, especially those that influenced his behaviours and actions. The therapist then asked the patient to set some goals together, which they would seek to achieve during the therapy sessions. One of the things that stood out for me during the session was the use of role-playing as suggested by the therapist, something the patient agreed to do. Additionally, the therapist taught the patient how to meditate and other relaxation techniques. Together, these approaches helped them identify the maladaptive thoughts that led to his PTSD.

4. Analysis

As noted by Clark and Fairburn (2000), cognitive-behavioural therapy is useful in identifying and restructuring negative thoughts, something that came out clearly during the therapy session.

5. Conclusion

Besides using role-playing, mediation and relaxation approaches to identify the ex-soldiers negative thoughts, the therapist could also have taught the patient different mental distractions and journaling to identify them.

6. Action Plan

As a future therapist, I plan to learn cognitive do more research on cognitive behavioural therapy and its effectiveness. The understanding of how this approach works in different situations and problems will allow me to help individuals recover from different mental health problems.

References

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Dryden, W., 2021. Rational emotive behaviour therapy: Distinctive features. Routledge.

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Huttunen‐Lenz, M., Song, F. and Poland, F., 2010. Are psychoeducational smoking cessation interventions for coronary heart disease patients effective? Meta‐analysis of interventions. British journal of health psychology, 15(4), pp.749-777.

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