scholarly journals Cognitive behavioural therapy training in Tanzania: a qualitative study of clinicians’ experiences

Author(s):  
Lydia Stone ◽  
Megan A. Arroll

AbstractCognitive behaviour therapy (CBT) in an effective technique used widely in Western countries. However, there is limited evidence as to the utility, perception and understanding of CBT in developing countries. This study describes and investigates the experience of CBT training and practice in a group of practitioners in Tanzania. A qualitative approach to the investigation was used, and seven participants from Tanzania’s only psychiatric hospital who had completed CBT training were interviewed. The resulting verbatim transcripts were analysed via interpretative phenomenological analysis. Five superordinate themes emerged from the analysis: ‘the medical model’, ‘novelty’, ‘practicalities’, ‘process’ and ‘therapist effects’. The two themes ‘therapist effects’ and ‘process’ are discussed in detail as these may be particularly relevant to the clinical application of the therapy in a new culture and context. The implications for future development of CBT in Tanzania are considered. In developing CBT for dissemination in Tanzania, specific cultural and clinical issues highlighted by indigenous clinicians need consideration.Key learning aims(1)To identify what range of factors may influence clinicians’ perception of and learning about CBT when CBT training is delivered in a mental health setting in Tanzania, or to those with East African origins.(2)To consider the use of qualitative research approaches to inform the early stages of adapting CBT for use in new settings and applications.(3)To be able to apply knowledge about cultural differences to standard CBT in order to promote culturally sensitive practice.

2018 ◽  
Vol 7 (11) ◽  
pp. 398 ◽  
Author(s):  
Gaby Resmark ◽  
Brigid Kennedy ◽  
Maria Mayer ◽  
Katrin Giel ◽  
Florian Junne ◽  
...  

Standardised treatment manuals facilitate therapy planning and enhance comparability for research purposes. Within the Anorexia Nervosa Treatment of Out Patients (ANTOP) study, the largest multisite outpatient intervention trial in anorexia nervosa (AN) to date, manualised enhanced cognitive-behavioural therapy (CBT-E) was offered as one treatment modality. The manual consisted of 9 modules, of which Motivation, Nutrition, Formulation and Relapse Prevention were compulsory. Homework worksheets were provided, to ensure the transfer of therapeutic improvements to daily life. This study investigated the use of modules and worksheets in order to explore practice styles of trained therapists in the treatment of AN. This secondary analysis was based on log-sheets (n = 2604) CBT-E therapists completed after each session. Frequencies of modules and worksheets used across all sessions were calculated. Relationships, such as that between use of module and duration of illness, were examined. The most commonly used module was Motivation. In patients with longer illness duration, the module Self Esteem seemed to be particularly important. The worksheet Scales, balancing the pros and cons of AN, was prioritised by therapists. The results underline the importance of motivational work in the treatment of AN, including validating the ambivalence experienced by most AN patients. With increasing duration of illness, resource-oriented elements, such as self esteem stabilisation, should be of focus.


2012 ◽  
Vol 40 (3) ◽  
pp. 271-285 ◽  
Author(s):  
Shin-ichi Ishikawa ◽  
Naoyasu Motomura ◽  
Yasuo Kawabata ◽  
Hidetaka Tanaka ◽  
Sakie Shimotsu ◽  
...  

Background: Thirty-three Japanese children and adolescents diagnosed with an anxiety disorder participated in individual or group Cognitive Behaviour Therapy (CBT) that was modelled after evidence-based intervention programs developed in Western countries. Method: The treatment consisted of: (a) building rapport and education; (b) identifying emotions and recognizing cognitive self-talk; (c) challenging anxious self-talk; (d) developing an anxiety hierarchy and in vivo exposures; and (e) planning for future challenges. Results: Three months following treatment, 20 of the 33 children and adolescents (60.91%) no longer met criteria for their principal anxiety disorders and 16 (48.48%) were free from all anxiety disorders. Self-reported anxiety, depression, and cognitive errors also decreased significantly from pre- to post-treatment and these gains were maintained at 3-month follow-up. For the most part, similar outcomes were found in both the group and individual formats of CBT. Conclusions: This study provides preliminary support for the transportability of CBT in both an individual and group format to Japan.


Author(s):  
Victoria Bream ◽  
Fiona Challacombe ◽  
Asmita Palmer ◽  
Paul Salkovskis

Obsessive-compulsive disorder (OCD) can be a very disabling and distressing problem. Cognitive behavioural therapy (CBT) has been shown to be very effective in helping people to overcome OCD. OCD is a highly heterogeneous disorder, often complicated by contextual factors, and therapists are often left wondering how to apply their knowledge of treatment to the particular problems as they face them in clinical practice. This book guides the reader through understanding the background to and principles of using CBT for OCD in a clear practical ‘how to’ style. It also elucidates the particular challenges and solutions in applying CBT for OCD using illustrative case material and guidance on formulation-driven intervention. The book also addresses commonly occurring complexities in the treatment of OCD; for example, working with comorbidity, perfectionism, shame, and family involvement in symptoms. Throughout the book, tips are provided on receiving and giving supervision to troubleshoot commonly encountered problems. This book provides a guide to improved practice for clinicians at all levels of experience.


2002 ◽  
Vol 30 (3) ◽  
pp. 329-339 ◽  
Author(s):  
Mike Startup ◽  
Mike Jackson ◽  
Emma Pearce

Recently, several RCTs have provided preliminary evidence that cognitive-behavioural therapy (CBT) is effective in the treatment of people suffering from schizophrenia. However, none of these trials has provided complete demonstrations of therapist adherence. Since no suitable scale existed already, the authors devised the Cognitive Therapy for Psychosis Adherence Scale (CTPAS). The main aim of the present research was to test whether the 12 items of this scale could be rated reliably. Ratings were made on 29 sessions of CBT for schizophrenia by two raters independently and their agreement was found to be at least adequate on 10 of the items of the CTPAS. Ratings were also made on relevant items of the Collaborative Study Psychotherapy Rating Scale and agreement was found to be more than adequate for three factor-based subscales derived from these items. The results suggest therapist adherence to CBT for psychosis can be rated reliably and that the CTPAS is likely to be useful in future research on this form of treatment.


Author(s):  
Mary Owen ◽  
Tom Speight ◽  
May Sarsam ◽  
William Sellwood

AbstractThere is evidence that group cognitive behavioural therapy for psychosis (CBTp) is an effective treatment, but much of this research has been conducted with outpatient populations. The aim of this review was to determine the utility of group CBTp for inpatients. We systematically searched Scopus, Web of Science and EBSCO electronic databases to identify relevant research. We reviewed the resulting articles and included those which had been conducted with inpatients, with symptoms of psychosis, using cognitive behaviour therapy, delivered in a group format. Fourteen articles relating to ten studies were identified. Two were randomized controlled trials; two were cohort studies and the rest were pre-/post-intervention studies. There was considerable heterogeneity between the studies and all had methodological limitations. The findings suggest positive trends towards the reduction of distress associated with psychotic symptoms, increased knowledge of symptoms, decreased affective symptoms and reduced readmissions over several years. However, there is currently not enough evidence to draw any strong conclusions regarding the utility of group CBTp for inpatients due to the small number of studies and limitations in quality and generalizability. Therefore, this review indicates the need for further research, particularly large, methodologically rigorous, randomized controlled trials.


Author(s):  
Victoria Boynton ◽  
Christopher Sanderson

Abstract Background: Adult mental health in-patient units primarily provide a service for people deemed to be at significant risk to themselves or others, where treatment cannot be provided safely in the community. Whilst psychological interventions are indicated during episodes of acute mental distress, they are often psychoeducational and skills-based in nature. A common complaint amongst those admitted is the lack of psychological provision at a time of crisis when they most need to make sense of their difficulties Aims: This article reports on service users’ experiences of open group cognitive behavioural therapy where participants choose the therapeutic targets. Method: A total of 75 patients admitted to acute in-patient wards over a 6-month period accessed open group cognitive therapy as part of routine care. Participants completed an evaluation questionnaire that measured their experiences of the group and the usefulness of them within an in-patient setting. Results: A total of 27 participants completed anonymous questionnaires (36%) and the results indicated that participants felt understood, respected and accepted within the group and felt that the group setting was helpful for sharing experiences. In addition, all participants reported that following the group they would be more likely to access psychological therapies in the future. Conclusions: Open group therapy where participants define the therapeutic targets each session is feasible and achievable on acute in-patient units and patients report finding this useful.


2021 ◽  
Vol 3 ◽  
Author(s):  
Giovanna Nunes Vilaza ◽  
Darragh McCashin

The COVID-19 pandemic has intensified the need for mental health support across the whole spectrum of the population. Where global demand outweighs the supply of mental health services, established interventions such as cognitive behavioural therapy (CBT) have been adapted from traditional face-to-face interaction to technology-assisted formats. One such notable development is the emergence of Artificially Intelligent (AI) conversational agents for psychotherapy. Pre-pandemic, these adaptations had demonstrated some positive results; but they also generated debate due to a number of ethical and societal challenges. This article commences with a critical overview of both positive and negative aspects concerning the role of AI-CBT in its present form. Thereafter, an ethical framework is applied with reference to the themes of (1) beneficence, (2) non-maleficence, (3) autonomy, (4) justice, and (5) explicability. These themes are then discussed in terms of practical recommendations for future developments. Although automated versions of therapeutic support may be of appeal during times of global crises, ethical thinking should be at the core of AI-CBT design, in addition to guiding research, policy, and real-world implementation as the world considers post-COVID-19 society.


2002 ◽  
Vol 19 (2) ◽  
pp. 112-120 ◽  
Author(s):  
Denise A. Nisbet Wallis

AbstractThe Cognitive Behavioural Therapy Group Program at Central Coast Mental Health Specialty Clinics includes treatments for generalised anxiety disorder, panic disorder and depression. This study provides empirical validation for hypotheses developed in clinical controlled studies; that is, that cognitive-behaviour therapy provided benefits in the treatment of anxiety and depression in a service setting. This would be reflected in decreases in the symptoms of anxiety and depression and increased self-esteem. Participants (N = 139) were referred to Specialty Clinics, Central Coast Mental Health Services for treatment for depression and/or anxiety in CBT groups. They were tested on the BDI, STAI and the SERS at three time points, prior to entering the group, at termination of the group and at 3-month follow-up. Depression and anxiety symptoms decreased and self-esteem increased between pre- and post-group and the trends continued to 3-month follow-up.


2020 ◽  
Vol 13 ◽  
Author(s):  
Najwan Saaed Al-Roubaiy

Abstract In this paper, rational emotive behaviour therapy (REBT) is presented as the most comprehensive cognitive behavioural therapy (CBT) to date, with over-arching influence on most of the other therapies that came after it. However, despite REBT’s comprehensiveness and the limitations inherent in other CBT approaches, REBT has its limitations. Limitations in REBT theory are explored and an argument is made in favour of rectifying these limitations by incorporating other approaches into REBT (namely cognitive therapy and compassion-focused therapy) to create a more complete integrative psychotherapy model. It is then argued that psychotherapy integration is the future of CBT mainly due to the fact that it reflects how most therapists practise, and due to its utilization of the common factors theory. Finally, the integrative model – which I call Assimilative Integrative Rational Emotive Behaviour Therapy – is presented and demonstrated using a clinical case example. Key learning aims (1) To understand the limitations of cognitive therapy and third-wave CBT approaches. (2) To appreciate the comprehensiveness and over-arching influence of REBT. (3) To understand the limitations of REBT despite its comprehensiveness. (4) To consider rectifying the limitations in REBT by incorporating other models into it. (5) To appreciate the complementary nature of CFT when integrated into other models. (6) To understand the value and relevance of psychotherapy integration. (7) To consider AI-REBT as one possible pathway to psychotherapy integration in CBT.


2008 ◽  
Vol 36 (6) ◽  
pp. 705-712 ◽  
Author(s):  
Craig Steel

AbstractThe past decade has seen considerable growth in the evidence base of cognitive behavioural therapy for psychosis. Consistent reports of moderate effect sizes have led to such interventions being recommended as part of routine clinical practice. Most of this evidence is based on a generic form of CBT for psychosis applied to a heterogeneous group. An increase in the effectiveness of cognitive behavioural interventions may require new protocols. Such therapeutic developments should be based on the theoretical understanding of the psychological processes associated with specific forms of psychotic presentation. The current evidence base of CBT for psychosis is reviewed, and barriers that have held back the development of this research are discussed.


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