COGNITIVE BEHAVIORAL THERAPY

Cognitive Behavioral therapy

Cognitive Behavioral Therapy

Introduction

Cognitive behaviour therapy (CBT) is a proven method of psychotherapy that proposes it is not events themselves that cause anxiety and maladaptive responses, but rather people's expectations and interpretations of these events. It suggests maladaptive behaviours can be altered by dealing directly with a person's thoughts and beliefs. CBT is a generic term that encompasses a number of approaches, specifically cognitive therapy (CT) and rational emotive behaviour therapy (REBT).

Discussion

Fundamental to quality mental health nursing is the establishment of a "partnership" between the nurse and the client. The nursing process and CBT have a lot in common--both are client centered and strongly emphasise mutuality. The client is involved in defining the problem, identifying goals, formulating treatment strategies and evaluating processes. CBT is educational and skill building, rather than curative, with the therapist taking a facilitative role. There are presently two funded CBT training programmes in New Zealand. These 24-week postgraduate programmes are specifically designed for practising mental health professionals. They are clinically based and students entering them must be registered health professionals, employed full-time within a publicly-funded mental health service.

One of the most common and disabling psychological disorders encountered within mental health and general medical settings is that of an anxiety disorder (Dattilio & Kendall 2000). Research has indicated that people with learning disabilities are more prevalent to psychological disorders than the general population (Hassiotis et al 2000) consequently it could be hypothesised that prevalence rates of anxiety disorders are similar if not greater within the learning disabled population. Professional literature suggests that cognitive-behaviour therapy (CBT) has been an effective treatment against anxiety disorder (Beck 1995) however; this literature has predominately concentrated its focus to within the confines of mental health and general medical settings (Dattilio & Kendall 2000). The ability of people with learning disabilities to identify, evaluate and respond to their dysfunctional thoughts and beliefs, fundamentals of CBT (Beck 1995) have put into question the very use of this treatment programme for this particular client group (Kroese et al 1997). From a professional and personal perspective and through the utilisation of the Seedhouse (1998) 'Ethical Grid' responding to an anxiety disorder by way of CBT could be considered an ethically acceptable clinical intervention. Nationally and locally through government directives, 'Valuing People' (Department of Health 2001) and initiatives such as Health Action Plans (Department of Health 2002) services have recognised that they need to be more responsive to the mental health needs of people with learning disabilities. As a learning disability nurse wishing to ascertain the effectiveness of CBT as a practical intervention when presented with the dual-diagnosis of anxiety disorder and learning disability, is through the use of 'evidence-based practice'.

The construction of an answerable question is the basis of evidence-based practice and should guide the practitioner to how to find an answer (Ridsdale 1998). It is important that each variable under the PICO framework is clearly defined, being as detailed and explicit as possible in order to extend clarification ...