Utility and Clinical Effectiveness of Cognitive Behavioural Therapy (CBT) in Treating Common Mental Disorders

The essay gave an insight into the utility and clinical effectiveness of one of the psychotherapeutic approach called the CBT in treating common mental disorders like depression, anxiety disorder and personality disorder.

Running head: MENTAL HEALTH NURSING
Mental health nursing
Name of the student:
Name of the University:
Author’s note

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The prevalence of people with mental illness has increased and the introduction of
diagnostic criteria for mental disorders has enhanced the screening process to rapidly identify
patients with mental issues. Apart from pharmacological interventions for treatment of mental
disorders, psychotherapeutic approach has gained wide popularity in the field of mental health
for its utility in addressing needs of people with mental health problems. Psychotherapy has
found acceptance in both short and long-term management of psychiatric disorders (Barth et al.,
2016). Psychotherapeutic approach like cognitive behavioural therapy (CBT), solution-focused
brief therapy, acceptance and commitment therapy and mindfulness based stress reduction are
often used as primary treatment of choice for patients with depression, major compulsive
disorder and personality disorder. Psychotherapeutic approach also allows mental health nurse to
identify factors that is needed for the recovery of patient. Each type of psychotherapeutic
approach is based on different theories and assumptions. These theoretical aspects are
implemented during interaction with patient to influence their thoughts and behaviour (Abbass et
al., 2014). The main purpose of this essay is to provide a brief description about CBT and
method by which it is delivered to target population group. The essay also provides a critical
discussion on the effectiveness of CBT in reduce signs and symptoms of mentally ill patients.
CBT is a short-term goal oriented psychotherapeutic approach which focuses on
changing the patterns of thinking of people and treating people suffering from wide range of
mental health problems like depression, anxiety disorder, substance abuse and personality
disorder. It is based on the basis assumption that cognitive factors like faulty thought patterns
play a role in mental illness and this maladaptive cognition in an individual lead to emotional
distress and behavioural issues (Hofmann et al., 2012). Maladaptive cognitions include irrational
or illogical beliefs about the world or events occurring giving rise to specific thoughts in

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different situations. It uses both cognitive and behavioural approach to modify dysfunctional
thinking and promote positive behavioural change in patient. It incorporates cognitive,
behavioural and emotion focused techniques to focus on cognitive and emotional components of
mental disorder and promote recovery in patient. Just like other form of psychiatric treatment,
the main aim of CBT is to improve function, reduce symptoms and prevent remission of issues in
patient. The success of the therapy is dependent on the patient as they need to be actively
involved with the psychotherapist and engage in collaborative problem-solving process (Johnsen
& Friborg, 2015).
CBT is used particularly with patients who suffer from negative thinking and
inappropriate behaviour because of the diagnosis of mental disorders like depression, post
traumatic stress disorder and personality disorder. Twomey, O’reilly & Byrne, M. (2014) gives
the evidence that CBT is effective for common mental health problem like anxiety and
depression. It is also used to treat people who suffer from behavioural problem because of post
traumatic stress disorder (PTSD). PTSD is a mental health condition associated with psychiatric
morbidity and reduced quality of life because of exposure to trauma or traumatic life events.
Trauma focused CBT is delivered to patients with PTSD and psychotherapist delivering the
intervention mainly focuses on providing education to patient regarding common reactions to
trauma and the method needed to modify cognitive distortions. CBT technique is also favoured
because it is a short term structured technique that can be delivered for six-10 months and it can
be delivered in various formats like face-to-face session, telephone and computerised format
(Kar, 2011). It can be provided in variety of settings too such as community center, mental health
clinics, patient home and schools. Currently CBT is being delivered online too and Titov et al.

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(2017) gives the evidence the evidence that CBT is effective and cost-effective when delivered
online too.
CBT is implemented by using cognitive model as a framework to understand presenting
problems in client. The main focus is engage in proper communication with clients to understand
their presenting issues, current way of thinking and behaviour. Based on the interpretation of
current thought pattern, the therapist take the approach to equip clients with all knowledge
regarding the approach they can adapt to change their maladaptive cognitive and behavioural
patterns (Dattilio & Hanna, 2012). To achieve this, adapting collaborative and problem oriented
approach to care is important as this can only help to foster an environment for active
engagement of client in the therapy. Entering into proper collaboration with patient is the first
step of the therapy and this involves adapting communication techniques like rapport building,
empathy and active listening to establish therapeutic relationship with client and work towards
identification of maladaptive thought pattern and behaviour (Fenn & Byrne, 2013). Another
uniqueness of CBT is that it gives emphasis to the evaluation of present and current problems for
patient. According, therapists engaging in mutually agreed goal setting process so that current
state of mind of patient can be addressed.
Furthermore, cognitive and behavioural techniques are applied during the therapy to
change and address negative thought patterns in client. After getting an understanding about the
patient’s perception regarding his illness, therapist can use ‘guided recovery’ as an approach to
help client discover alternative methods to interpret an event. The therapist can use probing
questions like ‘What do you think caused... ?’ and ‘What is the alternative method to look at the
same situation?’ to introduce patients to alternative method of thinking about an event in life
(Fenn & Byrne, 2013). Apart from cognitive techniques, behavioural techniques like activity

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scheduling are used to promote functioning and increase interest in productive and pleasurable
activities in life. For patients with anxiety, behavioural training and breathing exercise are some
activities that reduce their level of anxiety and autonomic arousal. This type of positive coping
technique supports patient to effectively manage mental problems and symptoms of anxiety
disorders (Ehde, Dillworth & Turner, 2014).
Therapist need to have general skills and capabilities to deliver CBT. These involves the
capability to establish therapeutic and collaborative relationship with patient, detailed knowledge
about the principles and theoretical aspects of the therapy, non-judgmental attitude and skills in
presenting the interview clearly (Haddock et al. 2014). The next vital stage is the case
conceptualization and treatment planning stage. The case conceptualization process begins in the
first session and this mainly involves assessment of patient concerns and difficulties by using
self-report measures. This method can give good insight into the manner in which the patient
thinks and behaves. Based on this assessment, maladaptive thoughts and beliefs are identified
and this thoughts and belief are challenges by therapist or nurses. Socratic questioning technique
used to challenge maladaptive thoughts and beliefs. Modification of thinking and thought pattern
is done by behavioural activation techniques (Cully & Teten, 2008).
Currently, there is widespread application of CBT as many evidence exists regarding the
effectiveness of the therapy in treating patients with depression, anxiety disorder and other
mental problems. Based on available evidence, the National Institute for Health and Clinical
Excellence (NICE) also recommends CBT as an effective treatment option for depression,
anxiety, PTSD and obsessive compulsive disorder (Blane et al., 2013). The efficacy of the
therapy in treating mental disorder is proved by meta-analysis of randomized controlled trial
(RCT). It is a promising adjuvant to pharmacotherapy and the review of several RCTs reveal that

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compared with group, patients receiving CBT had significantly lower relapse rate at follow-up.
Benefit of CBT was also found in improving psychosocial functioning and severity of mania and
depression in patients with bipolar disorder. Moderate effect size of the intervention was found
and the evidence revealed the clinical benefits of CBT in addressing distorted cognitions and
negative mood states in people with bipolar disorder (Chiang et al., 2017). Addressing relapse
rate is also a major advantage of the intervention as relapse of symptoms has been found to be a
major issue for patients. Wesley, Manjula and Thirthalli (2018) explained that patients with BD
suffer from functional impairment even in remission. Hence, finding the evidence for efficacy of
CBT in reducing relapse rate can be a new approach to promote recovery in patient.
One of the major changes that is seen in the life of people who suffer from mental
disorders like depression and anxiety is that they fail to return to work. The diagnosis of these
type of disorders increases their job performance and increases sick leave. Hence, diagnosis of
mental disorders increases the risk of social and financial cost too. The evidence by
Brenninkmeijer et al. (2018) shows the efficacy of CBT in supporting patients to return to work.
The study investigated about the efficacy of work-focused CBT compared to general CBT in
addressing symptoms of depression. The study gave evidence regarding the effectiveness of CBT
in decreasing mental health problems and promoting faster return to work. The research evidence
particularly reported about the impact of self-efficacy and mental health symptoms in reducing
outcome for patient. Investigating regarding the influence of self-efficacy was important to
determine the success of treatment. Individuals with higher baseline self-efficacy have been
found to have favourable treatment outcomes (Gallagher et al. 2013). By conducting a quasi-
experimental research design, the study further indicated that people who have higher level of
self-efficacy are more likely to benefit from work focused CBT. Hence, CBT can be applied to

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achieve common psychotherapy goals and stimulate return to work. This evidence can encourage
practitioners to implement CBT as an optimal treatment option for sick-leave patients with
common mental disorders (Brenninkmeijer et al. 2018).
Thase, Kingdon and Turkington (2014) gave an idea regarding the utility of CBT for
treatment of patients with schizophrenia and patients with treatment resistance mood disorders.
The main challenge or issue found in the treatment of patients with schizophrenia is that they fail
to achieve full recovery through the use of anti-psychotic medications. To address this, the
adjunctive use of psychosocial therapies was considered to improve outcomes in patient. Thase,
Kingdon and Turkington (2014) supported the efficacy of CBT by giving examples of several
meta analysis and RCTs which proved the efficacy of CBT in reducing distress and disability by
working with these symptoms. Morrison (2009) explains that by the use of CBT, people with
schizophrenia suffering from comorbid mood can be effectively treated. Although randomized
controlled trials have shown moderate effect size for positive and negative symptoms, however
people with hallucination and delusions have responded well to the therapy. Other additional
finding was that people with shorter duration of illness predicted better outcomes.
One of the major goals for recovery from mental illness is that people should be
supported to help them overcome their disabilities and develop the resilience to manage the
struggle associated with mental illness (Thomas et al., 2016). Padesky and Mooney (2012)
supports the fact that strength based values can also be applied in CBT technique so that clients
build positive qualities and strengthen their personal resilience. However, incorporating strength
based approach in CBT requires a shift in therapy perspective and different method of
implementation. Fostering resilience would help people to manage negative life events and
accept certain circumstances in life. The researcher argues to successfully implement strength

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based CBT, there is a need to adapt new beliefs and behaviours to develop positive qualities like
resilience.
The essay gave an insight into the utility and clinical effectiveness of one of the
psychotherapeutic approach called the CBT in treating common mental disorders like depression,
anxiety disorder and personality disorder. From the discussion on the use of CBT for treating
common mental illness, it can be concluded that CBT is a good alternative in place of
pharmacotherapy to promote recovery of people with mental illness. The main advantage of
pharmacotherapy is that it has many adverse effects and it has the chances of remission too.
However, from the discussion on the effectiveness of CBT in treating various types of mental
problems, it is understood that CBT can be useful in reducing remission rate, promoting full
recovery and reducing functional impairment in affected people. The essay has given evidence
regarding the efficacy of CBT in treating people with diverse type of problems. Adequate
training should be given to health care professionals and nurses so they develop the skills to
incorporate the principles of CBT during the counselling sessions with mental health client.

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References:
Abbass, A. A., Kisely, S. R., Town, J. M., Leichsenring, F., Driessen, E., De Maat, S., ... &
Crowe, E. (2014). Short‐term psychodynamic psychotherapies for common mental
disorders. Cochrane Database of Systematic Reviews, (7). DOI:
10.1002/14651858.CD004687
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.
doi:10.1371/journal.pmed.1001454
Blane, D., Williams, C., Morrison, J., Wilson, A., & Mercer, S. (2013). Cognitive behavioural
therapy: why primary care should have it all. The British Journal of General
Practice, 63(607), 103–104. http://doi.org/10.3399/bjgp13X663235
Brenninkmeijer, V., Lagerveld, S. E., Blonk, R. W., Schaufeli, W. B., & Wijngaards-de Meij, L.
D. (2018). Predicting the effectiveness of work-focused CBT for common mental
disorders: The influence of baseline self-efficacy, depression and anxiety. Journal of
occupational rehabilitation, 1-11. http://doi.org/10.1007/s10926-018-9760-3
Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of
cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of
randomized controlled trials. PloS one, 12(5), e0176849. Doi:
https://doi.org/10.1371/journal.pone.0176849

9MENTAL HEALTH NURSING
Cully, J. A., & Teten, A. L. (2008). A therapist’s guide to brief cognitive behavioral
therapy. Houston: Department of Veterans Affairs South Central MIRECC. Retrieved
from: https://depts.washington.edu/dbpeds/therapists_guide_to_brief_cbtmanual.pdf
Dattilio, F. M., & Hanna, M. A. (2012). Collaboration in cognitive‐behavioral therapy. Journal
of Clinical Psychology, 68(2), 146-158. doi: 10.1002/jclp.21831.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for
individuals with chronic pain: efficacy, innovations, and directions for
research. American Psychologist, 69(2), 153. DOI: 10.1037/a0035747
Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural
therapy. InnovAiT, 6(9), 579-585. Retrieved from:
https://doi.org/10.1177/1755738012471029
Gallagher, M. W., Payne, L. A., White, K. S., Shear, K. M., Woods, S. W., Gorman, J. M., &
Barlow, D. H. (2013). Mechanisms of change in cognitive behavioral therapy for panic
disorder: the unique effects of self-efficacy and anxiety sensitivity. Behaviour research
and therapy, 51(11), 767-777. Doi: https://doi.org/10.1016/j.brat.2013.09.001.
Haddock, G., Eisner, E., Boone, C., Davies, G., Coogan, C., & Barrowclough, C. (2014). An
investigation of the implementation of NICE-recommended CBT interventions for people
with schizophrenia. Journal of Mental Health, 23(4), 162-165.
https://doi.org/10.3109/09638237.2013.869571

10MENTAL HEALTH NURSING
Hofmann, S. G., Asnaani, A., Vonk, I. J. 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. http://doi.org/10.1007/s10608-012-9476-1
Johnsen, T. J., & Friborg, O. (2015). The effects of cognitive behavioral therapy as an anti-
depressive treatment is falling: A meta-analysis. Psychological Bulletin, 141(4), 747.
http://dx.doi.org/10.1037/bul0000015
Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder:
a review. Neuropsychiatric Disease and Treatment, 7, 167. DOI: 10.2147/NDT.S10389
Morrison, A. K. (2009). Cognitive behavior therapy for people with schizophrenia. Psychiatry
(Edgmont), 6(12), 32. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811142/
Padesky, C. A., & Mooney, K. A. (2012). Strengths‐based cognitive–behavioural therapy: A
four‐step model to build resilience. Clinical Psychology & Psychotherapy, 19(4), 283-
290. https://doi.org/10.1002/cpp.1795
Thase, M. E., Kingdon, D., & Turkington, D. (2014). The promise of cognitive behavior therapy
for treatment of severe mental disorders: a review of recent developments. World
Psychiatry, 13(3), 244-250.
Thomas, S., Jenkins, R., Burch, T., Calamos Nasir, L., Fisher, B., Giotaki, G., ... & Millington-
Sanders, C. (2016). Promoting mental health and preventing mental illness in general
practice. London journal of primary care, 8(1), 3-9.
https://doi.org/10.1080/17571472.2015.1135659

11MENTAL HEALTH NURSING
Titov, N., Dear, B. F., Ali, S., Zou, J. B., Lorian, C. N., Johnston, L., ... & Fogliati, V. J. (2015).
Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior
therapy for older adults with symptoms of depression: a randomized controlled
trial. Behavior therapy, 46(2), 193-205.
Twomey, C., O’reilly, G., & Byrne, M. (2014). Effectiveness of cognitive behavioural therapy
for anxiety and depression in primary care: a meta-analysis. Family practice, 32(1), 3-15.
https://doi.org/10.1093/fampra/cmu060
Wesley, M. S., Manjula, M., & Thirthalli, J. (2018). Interepisodic Functioning in Patients with
Bipolar Disorder in Remission. Indian Journal of Psychological Medicine, 40(1), 52–60.
http://doi.org/10.4103/IJPSYM.IJPSYM_211_17