Discussion Responses

Responding to Mercy Nkwelle

Hello Mercy,

Thank you for sharing your post. To manage confidentiality challenges in group and family CBT, the PMHNPs may use confidentiality commitment forms that participants sign indicating they will not disclose information received during any of the sessions (Pietras,2021). Furthermore, conducting regular reminders about confidentiality during the sessions may help to remind the participants about the concern for maintaining confidentiality. Incorporating motivational interviewing (MI) techniques is crucial for managing divergent goals and readiness because participants can learn about their neutral positions and compare them with the goals of therapeutic intervention: Discussion Responses.

Providing pre-session education to establish clients’ appreciation of the nature of the therapy and ensuring that they are in a safe space to work together can foster cooperation. To overcome concerns or resistance before rejoining the group or family-based sessions, PMHNPs might use individual sessions equally. These strategies help improve the therapy process since they help build trust among the participants.

References

Pietras, S., & Wishon, A. (2021). Workforce implications of behavioral health care models. Workforce. Washington, DC, US Department of Health and Human Services. https://aspe.hhs.gov/reports/workforce-implications-behavioral-health-care-models-final-report

Responding to  Nicole  

Hello Nicole,

Thank you for sharing your insightful post. Considering the issue of group dynamics in Group CBT, PMHNPs may employ structured session formats with clear objectives and goals to avoid dominance by some group individuals. Incorporating culturally sensitive facilitator training to correspond to the variability of the group members’ culture is also crucial. For improving treatment adherence and attendance, using alerts or conventional smartphones or applications for sessions and home tasks productivity can help the patients and improve attention and timeliness (Faisal et al., 2021).

As for confidentiality issues, PMHNPs should have a strict confidentiality policy signed by the participants and give verbal reminders occasionally. The facilitators must frequently supervise any exchange to reduce the chances of negative social behavior. Corrective action is taken whenever unhealthy types are identified, making the environment one that fosters only healthy behavioral change. These mechanisms may enhance the group processes and constructive productivity in CBT contexts.

References

Faisal, S., Ivo, J., & Patel, T. (2021). A review of features and characteristics of smart medication adherence products. Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 154(5), 312–323. https://doi.org/10.1177/17151635211034198

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Student 1: Mercy Nkwelle

Cognitive Behavioral Therapy (CBT) is a structured, goal-oriented psychotherapy that addresses dysfunctional thoughts, behaviors, and emotions. It is effective for treating a wide range of mental health conditions, including anxiety, depression, and PTSD (Nakao et al., 2021).

In individual CBT, the focus is entirely on the client’s personal experiences, allowing for tailored interventions and deeper exploration of personal issues. This setting ensures confidentiality and often leads to faster progress as sessions are personalized.

In group CBT, multiple clients with similar issues participate in sessions, providing peer support and shared experiences. Group CBT can normalize symptoms, reduce isolation, and encourage skill-building through interpersonal learning (Nabian, 2023). However, interventions are less individualized, and progress may vary between participants.

Family CBT involves working with multiple family members to address relational dynamics, improve communication, and resolve conflicts. The focus is on collective patterns of thinking and behaving rather than individual concerns. This setting helps to create a shared understanding and promotes problem-solving at the family level.

Challenges for PMHNPs

Confidentiality – In both family and group CBT, confidentiality can be difficult to maintain. Group members may inadvertently share sensitive information outside of the session, undermining trust. In family settings, conflicts or alliances can breach personal disclosures (Kafka et al., 2024). PMHNPs must establish clear ground rules regarding confidentiality and reinforce these consistently.
Divergent goals and readiness – In family or group settings, individuals may have differing levels of motivation and goals for therapy. If some participants resist or sabotage progress, this can disrupt the therapeutic process. PMHNPs can mitigate this by clearly defining shared objectives, fostering open dialogue, and using motivational interviewing techniques to align expectations.

*Articles used in this discussion are scholarly because they have undergone a peer-review process*

References

Kafka, J. X., Kothgassner, O. D., & Felnhofer, A. (2024). A Matter of Trust: Confidentiality in Therapeutic Relationships during Psychological and Medical Treatment in Children and Adolescents with Mental Disorders. Journal of Clinical Medicine, 13(6), 1752. https://doi.org/10.3390/jcm13061752

Nabian, P. (2023). The effect of cognitive-behavioral group therapy on reducing depression and anxiety in patients with mood disorders: Experimental research. Annals of Medicine and Surgery, 85(8), 3901. https://doi.org/10.1097/MS9.0000000000000971

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), 1–4. https://doi.org/10.1186/s13030-021-00219-w

Student 2: Nicole

Cognitive Behavioral Therapy (CBT) is a flexible treatment method applied in different contexts, such as individual, group, and family settings (PsychExamReview, 2019). Every setting presents distinct advantages and difficulties for the PHMNP. Group cognitive behavioral therapy has demonstrated significant effectiveness in the treatment of conditions such as post-traumatic stress disorder, anxiety, and depression (Schwartze et al., 2019).

It promotes social engagement and fosters a sense of community, thereby alleviating feelings of isolation. Participants have the opportunity to gain insights from one another’s experiences and strategies (Schwartze et al., 2019). Another benefit of group therapy is its cost-effectiveness. A single therapist or clinician may provide services to multiple patients, thereby decreasing expenses for each individual involved (Hopkinson et al., 2019).

Numerous benefits have been identified in family cognitive-behavioral therapy. The factors include a decrease in parental rejection and psychological control (Giessen et al., 2019), improvements in family functioning (Bernal et al., 2019), efficacy across multiple disorders (Samar et al., 2023), reduction in psychological distress (Xiu et al., 2019), and improved treatment outcomes (Nyman-Carlsson et al., 2019). Family CBT has demonstrated effectiveness in decreasing parental rejection and psychological control in parent-child interactions, which may be helpful for children experiencing anxiety disorders. The decrease in negative parenting behaviors can enhance the overall family dynamic and promote the child’s mental health (Giessen et al., 2019).

Family cognitive-behavioral therapy can improve family dynamics by decreasing criticism among family members and fostering greater emotional engagement. This is especially clear in instances where cognitive behavioral therapy (CBT) is paired with parent psychoeducation, although the inclusion of psychoeducation did not show a significant advantage over CBT alone in certain studies (Bernal et al., 2019). Family-based treatment (FBT) in conjunction with cognitive-behavioral therapy (CBT) has proven effective in promoting weight gain and alleviating symptoms of eating disorders in adolescents.

This combination may result in notable enhancements in both physical and mental health (Nyman-Carlsson et al., 2019). Individual cognitive-behavioral therapy presents several benefits. This approach includes adaptability to address specific challenges of the patient, fostering high engagement that can enhance treatment adherence, and it has been demonstrated to be more effective in certain populations (Guo et al., 2021).

Group Cognitive Behavioral Therapy may also present certain challenges. Effective management of group dynamics is essential for the success of the group. PHMNPs, as facilitators, must receive appropriate training to address the diverse social backgrounds and cultural differences present among group members. It is essential to also ensure that all participants are equally engaged and that no single individual dominates the conversation, which can also be challenging (Habsy et al., 2024).

A frequent challenge is compliance with treatment protocols. Group cognitive behavioral therapy (CBT) generally exhibits lower dropout rates than individual CBT; however, ensuring consistent attendance and engagement in tasks between sessions continues to pose a challenge (Leeuwerik et al., 2019). Another challenge of group therapy is that it can promote social behaviors and skills, which may not always be beneficial.

For instance, in a group focused on anorexia and bulimia, one participant may acquire knowledge from another participant regarding an alternative method of purging food. (PsychExamReview, 2019) Lastly, ensuring confidentiality in a group setting can be challenging due to the sharing of personal information among multiple participants. Confidentiality plays a vital role in group cognitive behavioral therapy settings, as it helps create a secure environment in which participants can comfortably share their personal experiences and emotions (American Group Psychotherapy Association [AGPA], 2007).

In conclusion, Cognitive Behavioral Therapy (CBT) is a flexible approach that can be modified for use in individual, group, and family settings, each presenting different benefits and challenges (PsychExamReview, 2019). Group cognitive-behavioral therapy effectively addresses conditions like PTSD, anxiety, and depression by promoting social interaction and collective learning, though it necessitates careful oversight of group dynamics and confidentiality (Schwartze et al., 2019).

Family CBT enhances family interactions and mental health results, providing notable advantages for children and families experiencing different disorders (Bernal et al., 2019). Individual cognitive-behavioral therapy (CBT) is particularly flexible, effectively targeting specific patient issues and improving adherence to treatment. Although each setting poses unique challenges, cognitive-behavioral therapy (CBT) continues to be an effective method for psychological intervention, showing adaptability and effectiveness in various therapeutic environments (PsychExamReview, 2019).

References

American Group Psychotherapy Association. (2007). Practice guidelines for group psychotherapy [PDF]. AGPA: American Group PSychotherapy Association. Retrieved December 23, 2024, from https://agpa.org/docs/default-source/practice-resources/download-full-guidelines-(pdf-format)-group-works!-evidence-on-the-effectiveness-of-group-therapy.pdf?sfvrsn=ce6385a9_2Links to an external site.

Bernal, G., Rivera-Medina, C. L., Cumba-Aviles, E., Reys-Rodriguez, M., Saez-Santiago, E., Duarte-Velez, Y., Nazario, L., Rodriguez-Quintana, N., & Rossello, J. (2019). Can cognitive-behavioral therapy be optimized with parent psychoeducation? A randomized effectiveness trial of adolescents with major depression in puerto rico. Family process. https://doi.org/10.1111/famp.12455Links to an external site.

Giessen, D. V. D., Colonnesi, C., & Bogels, S. (2019). Changes in rejection and psychological control during parent-child interactions following CBT for children’s anxiety disorder. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association. https://doi.org/10.1037/fam0000543.Links to an external site.

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 Psychitary, 12. https://doi.org/10.3389/fpsyt.2021.674267Links to an external site.

Habsy, B. A., Putri, R. F., Nursani, R. N., & A’yunin, W. Q. (2024). Review of the theory and practice of cognitive behavioristic group counseling approaches. Jurnal Kajian Pendidikan dan Psikologi. https://doi.org/10.61397/jkpp.v2i1.141.Links to an external site.

Hopkinson, M. D., Reavell, J., Lane, D., & Mallikarjun, P. (2019). Cognitive behavioral therapy for depression, anxiety, and stress in caregivers of dementia patients: a systematic review and meta-analysis. The Gerontologist. https://doi.org/10.1093/geront/gnx217.Links to an external site.

Leeuwerik, T., Cavanagh, K., & Strauss, C. (2019). Patient adherence to cognitive behavioural therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of anxiety disorders, 68, 102135. https://doi.org/10.1016/j.janxdis.2019.102135Links to an external site.

Nyman-Carlsson, E., Norring, C., Engstrom, I., Gustagsson, S., Lindberg, K., Paulson-Karlsson, G., & Nevonen, L. (2019). Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial. Psychotherapy Research, 30, 1011–1025. https://doi.org/10.1080/10503307.2019.1686190Links to an external site.

PsychExamReview. (2019, April 30). Cognitive therapy, CBT, & group approaches (intro psych tutorial #241) [Video]. YouTube.
https://www.youtube.com/watch?v=A2_NN1Q7RfgLinks to an external site.