Therapies for Mental Disorders

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy through which a psychiatrist helps an individual to identify distortions in their thinking and to understand the way these distortions result in problems in their lives. CBT, therefore, is used in the treatment of mental disorders by enabling people to lead more productive and less stressful lives through the use of behavioural techniques aimed at changing the identified negative attitudes or thoughts, and therefore improving the maladaptive behaviour (Beck, 2011).

A critical feature of CBT is that psychiatrists work collaboratively with patients and play an educative role by assisting them to understand and identify their distorted belief systems and suggesting strategies of changing or improving them (Hofmann et al., 2012). Therapists select the best behaviour improvement techniques by giving patients assignments, where they list their dysfunctional thoughts, and the therapists then use questionnaires (based on a range of mental disorders) to assess their issues (Beck, 2011).

The other feature is that CBT is premised on the Cognitive Model of Emotional Response which proposes that an individual’s thoughts, rather than their externalities (situations, people, events), influence their behaviors and feelings. As such, CBT benefits by way of an individual’s ability to behave or feel better by changing their thinking (Kazantzis et al., 2018).

Evaluate the strengths and limitations of each approach in the treatment of mental illness (2.2)

A key strength of CBT is that it is briefer and takes the shortest time (an average of 16 sessions irrespective of the patients’ mental disorder) compared to other psychotherapy approaches, some of which take up to years. As a result, CBT has been established as the most rapid psychotherapy approach with regard to the achievement of results (Beck & Dozois, 2011). CBT teaches useful and practical behaviour improvement techniques that can be used in the long-term. CBT is also highly structured and can therefore be offered in various formats, such as in person, in groups, online and through self-help books (David, Cristea & Hofmann, 2018).

A key limitation of CBT is that it requires a high degree of commitment from the patient, and attending CBT sessions and performing additional work in between sessions takes up a lot of their time. Additionally, CBT may not be appropriate for individuals with more intricate mental disorders or mental health needs, or learning difficulties (“Overview – Cognitive behavioural therapy (CBT). (2021).

Discuss any ethical issues associated with each method (2.3)

Ethical issues associated with CBT include the therapists’ requirement to act in accordance with the ethical principles of mental health practice, such as protection of the patients’ privacy and confidentiality, and nonmaleficence (Armontrout et al., 2021; Lawlor-Savage &Prentice, 2014).

Dig deeper into Therapeutic Communication In Mental Health Nursing with our selection of articles.

References

Armontrout, J., Torous, J., Fisher, M., Drogin, E., & Gutheil, T. (2016). Mobile Mental Health: Navigating New Rules and Regulations for Digital Tools. Current psychiatry reports, 18(10), 91. https://doi.org/10.1007/s11920-016-0726-x

Beck, J. S. (2011). Cognitive-behavioral therapy. Clinical textbook of addictive disorders, 491, 474-501.

Beck, A. T., & Dozois, D. J. (2011). Cognitive therapy: current status and future directions. Annual review of medicine, 62, 397-409.

David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 9, 4.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.

Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42(4), 349-357.

Overview - Cognitive behavioural therapy (CBT). (2021). Retrieved 2 December 2021, from https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/

Medical Therapy

Explain how the therapy treats certain mental illnesses Highlight any critical features of the model (2.1)

Medical therapy (or drug therapy) is an approach that involves the use of prescription drugs/medicine in the treatment of mental disorders. Psychiatrists and other doctors are presently using medical therapy to treat mental disorders given that psychoactive drugs are highly effective, and because they can be categorized based on the mental disorder they are used to treat (Caspi & Moffitt, 2018). For example, to treat depression, antidepressants are prescribed, while antipsychotic drugs- such as thiothexene, haloperidol, asenapine, lurasidone, aripiprazole, and so on, are useful in treating psychotic disorders, including schizophrenia and various behavioural disorders (Schumann et al., 2014). Additionally, antianxiety drugs are helpful in treating anxiety disorders, and mood stabilizers to treat bipolar disorder.

A critical feature of this model is that it must observe the World Health Organization’s requirement of rational use of medicines, which outlines that the medications patients receive should be appropriate to their clinical needs, in doses proportionate to their personal requirements, for a sufficient duration, and at the lowest cost (WHO, 1985).

Evaluate the strengths and limitations of each approach in the treatment of mental illness (2.2)

Medical therapy, besides having been identified as effective in rapidly reducing symptoms and enabling patients to lead relatively normal lives (Leucht et al., 2020; Van Putten et al., 1981), is also relatively cheap and presents minimal likelihood of relapse after the discontinuation of drugs. This approach has been established as superior compared to no intervention, and to benefit 50-65% of patients suffering from mental disorders (Insel, 2014). Drug therapy is also acceptable among most patients as it is quicker, simpler and less threatening compared to psychotherapy.

One major limitation linked to medical therapy is that medicine only reduces the symptoms of a mental disorder, rather than deal with its root cause. Drugs also result in multiple side effects, which prompt many patients to stop treatment, while some bring about dependency (Auerbach et al., 2016).

Discuss any ethical issues associated with each method (2.3)

Before commencing medical therapy, psychotherapists must obtain the patients’ or their caregivers’ informed consent, as well as inform them of the dehumanizing effects, if any, that some treatments might have on them.

References

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., ... & Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization world mental health surveys. Psychological medicine, 46(14), 2955-2970.

Caspi, A., & Moffitt, T. E. (2018). All for one and one for all: Mental disorders in one dimension. American Journal of Psychiatry, 175(9), 831-844.

Insel, T. R. (2014). The NIMH research domain criteria (RDoC) project: precision medicine for psychiatry. American Journal of Psychiatry, 171(4), 395-397.

Leucht, S., Crippa, A., Siafis, S., Patel, M. X., Orsini, N., & Davis, J. M. (2020). Dose-response meta-analysis of antipsychotic drugs for acute schizophrenia. American Journal of Psychiatry, 177(4), 342-353.

Schumann, G., Binder, E. B., Holte, A., de Kloet, E. R., Oedegaard, K. J., Robbins, T. W., ... & Wittchen, H. U. (2014). Stratified medicine for mental disorders. European Neuropsychopharmacology, 24(1), 5-50.

Van Putten, T., May, P. R., Marder, S. R., & Wittmann, L. A. (1981). Subjective response to antipsychotic drugs. Archives of General Psychiatry, 38(2), 187-190.

Interpersonal Psychotherapy

Explain how the therapy treats certain mental illnesses Highlight any critical features of the model (2.1)

Interpersonal Psychotherapy (IPT) is an approach that identifies a variety of interpersonal situations or problems that result in mental problems among individuals and suggests personalized solutions to them (Cuijpers et al., 2011). The four main interpersonal problems that IPT identifies and associated with various mental disorders, particularly depression, are grief, interpersonal role disputes, interpersonal deficits, and role transitions (Ravitz & Watson, 2014). Other mental disorders treated by IPT include dysmythia, bipolar, panic, borderline personality and eating disorders.

This approach focuses on and targets existing interpersonal issues to treat depression and other mental disorders. It is therefore short-term and present-oriented. It is also premised on the communication and attachment theories, and acknowledges the critical role played by social factors in our everyday functioning (Weissman, 2020).

IPT is undertaken in three phases/stages. The first stage involves assessment, diagnosis and conceptualization, while the second stage focuses on the issues identified in stage one, as the therapist assists the patient to cope with and overcome them (Klerman & Weissman, 1993). The third stage (termination) involves the therapist and patient discussing progress during the last therapy sessions, acknowledge the end of their therapeutic relationship, and discuss the possibilities of relapse and likely triggers (Stuart & Robertson, 2012).

Evaluate the strengths and limitations of each approach in the treatment of mental illness (2.2)

A key advantage of IPT is that its main goal is to help patients relate better with others and to address problems that result in their depression. IPT has also been found to be as effective as medical therapy (antidepressant medication) in the treatment of depression (Barth et al., 2016).

Among the limitations of IPT include: it often takes longer compared to other psychotherapy approaches, such as CBT; its sessions are unstructured, which might result in some therapy sessions spent on things that are not immediately helpful in addressing the patients’ problems (Lemmens et al., 2019).

Discuss any ethical issues associated with each method (2.3)

Just like in other therapies, therapists undertaking IPT must observe the ethical principles of mental health practice such as nonmaleficence, respect for and the confidentiality and privacy of patients.

References

Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., ... & Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus, 14(2), 229-243.

Lemmens, L. H., Van Bronswijk, S. C., Peeters, F., Arntz, A., Hollon, S. D., & Huibers, M. J. (2019). Long-term outcomes of acute treatment with cognitive therapy v. interpersonal psychotherapy for adult depression: follow-up of a randomized controlled trial. Psychological Medicine, 49(3), 465-473.

Ravitz, P., & Watson, P. (2014). Interpersonal psychotherapy: healing with a relational focus. Focus, 12(3), 275-284.