Category: Therapy

Overview

Cognitive-behavioral therapy (CBT), as a counseling approach, takes into account an individual’s beliefs, behaviors, and thought processes during a psychotherapy session. In this approach, a counselor works with a client to discover unconstructive personal behaviors and beliefs and replace them with realistic thought patterns.

The aim is to alter specific thoughts and behaviors in order to transform a client’s feelings. Culturally aligned CBT approach has been used to treat depression and different anxiety disorders in ethnic minority clients.

In this paper, the efficacy of CBT in counseling ethnic minorities is investigated through a review of recent literature to identify the qualitative and quantitative research evidence for its use. It evaluates each study’s design, procedure, sample selection, and data analysis and interpretation to find out the degree of empiricism used in the research.

The evaluation has implications for CBT-based interventions applied to ethnic minority clients.

Quantitative Research

Most quantitative studies support the use of CBT to treat various anxiety, PSTD, and depressive disorders. In a quantitative research article by Dwight-Johnson et al. (2011), the efficacy of a modified CBT used to improve the depression outcomes of 101 Latino clients residing in far-flung areas in Washington was evaluated.

The research design involved a randomized control trial/study (RCT) of phone-based CBT applied to Latino patients receiving care in a community clinic (Dwight-Johnson et al., 2011). The researchers used this approach to compare the effectiveness of CBT over standard care (antidepressant therapy) in promoting the outcomes of the subjects.

The RCT design was appropriate as the study sought for a cause-effect relation between phone-based CBT and depression outcomes.

The research site was a rural health clinic (called Yakima Valley Medical Center) serving Latino patients. The researchers trained bilingual locals to recruit patients exhibiting depression symptoms, but without any cognitive, mood, or psychotic disorders.

Randomized groups of the recruited patients received eight sessions of phone-based CBT in Spanish/Latino. A CBT workbook adapted to suit the Latino culture was sent to therapists involved in the intervention.

The intervention focused on strategies to improve “behavioral activation and eliminate negative thoughts” (Dwight-Johnson et al., 2011, p. 939). The subjects’ depression outcomes were evaluated using a patient health questionnaire administered in two interview sessions (baseline and follow-up).

The study involved a convenient sample of 101 minority patients receiving care in a community-based clinic. The sampling technique used was convenience sampling, whereby the research assistants recruited eligible adult patients to participate in the study.

The subjects had to be Latino/Spanish speakers and patients with depressive disorders, but free of bipolar, cognitive, and psychotic disorders. These broad inclusion criteria ensured a representative sample as all eligible subjects from the accessible population could qualify to participate.

Additionally, the exclusion criteria used ensured that subjects with conditions (e.g., Bipolar) that may confound the outcomes of CBT were not enrolled.

The researchers used two statistical measures, namely, t-test and chi-square test to compare the depression outcomes of the two groups based on the interview data.

They created a model based on the assessment of the outcomes of the two interventions at four periods (a categorical variable), namely, “baseline, six weeks, three months, and six months” (Dwight-Johnson et al., 2011, p. 941).

The results indicated that the ‘mean difference’ in depression outcomes between the group receiving standard care and the one under CBT for six months was 0.32. This implies that CBT, in combination with standard care, can enhance the outcomes of depressed minority clients.

However, this result was not statistically significant owing to the limited sample size used.

Ethnic minorities have an elevated risk of developing psychotic disorders due to discrimination. In an article, Rathod et al. (2013) assessed the efficacy of a CBT-based intervention modeled to treat psychosis in ethnic minority clients.

In this study, 33 subjects drawn from three ethnic minority groups in the UK, namely, African Caribbean, Black British, and Muslim communities participated in the research.

The design used was randomized controlled trial, whereby the subjects were randomly assigned to two groups, namely, the standard care (control) and CBT (experimental) (Rathod et al., 2013).

By comparing the outcomes of the two groups, the researchers were able to assess the efficacy of CBT in treating minority clients with psychotic disorders.

The study was conducted at two sites in the United Kingdom and involved subjects diagnosed with a psychotic disorder. The evaluation of their symptoms was done at the start of the CBT intervention, after the intervention, and at six-months after completing the treatment.

At each point, the researchers evaluated their outcomes using two assessment tools: “the comprehensive psychopathological rating scale (CPRS) and the insight scale” (Rathod et al., 2013, p. 321).

In addition to completing these scales, subjects in the CBT group filled a patient experience questionnaire to indicate their views about the treatment. The CBT group received sixteen sessions of cognitive-behavior therapy offered by a counselor while the standard care group received drug therapy.

In this study, both the subjects and the assessors were blinded, which reduced bias in comparative testing.

The sampling procedure employed in this study was purposive sampling. A sample of 35 participants was selected from two medical clinics based on specific inclusion criteria. Eligible participants had to be from the ethnic minority groups in the UK. Additionally, only patients with a diagnosable psychotic disorder were included.

Two participants who did not meet the inclusion criteria were excluded after the screening process. The remaining 33 were randomly selected into two subgroups of 17 (standard care) and 16 (CBT).

Data analysis involved intention to treat (ITT) and sensitivity assessments. The results indicated that the CBT (intervention) group had significantly reduced symptoms compared to the standard care group (Mean = 16.23 vs. 18.60), a difference of 11%.

The subjects in the intervention group had reduced delusions and hallucinations after completing the CBT sessions. Additionally, the CBT group reported high satisfaction with the intervention. These findings affirm the use of CBT to treat ethnic minority clients with psychosis.

A comparison between moderately and severely depressed individuals can give insights into the efficacy of CBT versus drug therapy.

A study by Saddique, Chung, Brown, and Miranda (2012) aimed at establishing whether the level of depression influences the effectiveness of CBT versus antidepressants in the treatment of depressed young minority groups.

The research design involved a randomized control trial of economically disadvantaged young black and Latina women. This design enabled the researchers to assess the post-treatment effects of CBT versus medication between the severely depressed and moderately depressed groups.

The sample comprised of women who were from diverse minority groups, uninsured, and having a diagnosable depressive disorder. Data collection occurred at six months and at one year. Baseline depression levels of the participants were obtained using the Hamilton Depression Rating Scale (HDRS).

Participants diagnosed with depressive disorders (n = 267) were randomly selected into three groups: “CBT, medication therapy, and community referral” (Saddique et al., 2012, p. 998).

The medication group (n = 88) was given an antidepressant (paroxetine) while the CBT arm (n = 90) underwent eight sessions of therapy. The community referral arm (n = 89) received mental health education from clinicians. Data collected using the HDRS were grouped into different categories based on depression levels.

Analysis involved growth mixture modeling to compare the effects of CBT, community referral, and drug therapy.

The results indicated that, for the severely depressed arm, on average, depression levels were higher in the CBT group than the drug therapy group after six months (14.9 vs. 13.9). However, this differential effect was not statistically significant after one year.

For the moderately depressed arm, the depression levels were again higher for the CBT group than the drug therapy group. These results indicate that drug therapy is more effective than CBT in the treatment of moderately depressed women from minority groups.

However, CBT administered for over six months appears to be superior to drug therapy in improving the outcomes of severely depressed clients.

Group-based CBT is a common intervention for treating substance addiction. A quantitative study by Webb et al. (2010) investigated the effectiveness of group-based CBT for reducing tobacco addiction among African Americans.

The researchers hypothesized that abstinence would be higher in the CBT group than in the general education condition. The study design involved a randomized control trial of adult smokers categorized into two groups: the CBT and health education arms (Webb et al., 2010).

The effects of smoking are relatively high among African Americans compared to other ethnic groups. Health education interventions have been found to be less effective. Therefore, by randomizing the subjects to CBT and health education groups, the study was able to evaluate the efficacy of CBT for this demographic.

A convenient sample of 154 adult male and female participants (smokers) participated in this study. They were randomized into the general health awareness condition and the CBT group (Webb et al., 2010). Both groups received six therapy sessions and continuous drug therapy.

The prevalence of abstinence was measured weekly for six months and the data treated to intent-to-treat analyses. The results indicated that post-counseling abstinence was significantly higher among the participants in the CBT group than in the general education subjects after seven days and six months.

This finding was consistent with the study’s hypothesis. The researchers concluded that group-based CBT is effective in treating nicotine addiction among African Americans.

Effective psychotherapy interventions must be culturally adapted to reflect the values and needs of the target minority population. In one study, Cachelin et al. (2014) investigated the efficacy of a CBT program modified to reflect the needs of Mexican American clients.

The research used a quantitative research design (cohort study) to assess the efficacy of the program in reducing binge eating among Mexican American women diagnosed with the problem. The approach allowed the researchers to compare the outcomes of the participants after undergoing CBT counseling sessions for three months.

A sample of 31 women drawn from the Mexican American population in LA participated in the study. A diagnosis of any binge eating disorder and Mexican American racial background formed the inclusion criteria.

The recruited participants went through eight counseling sessions based on a modified CBT program offered in a three-month period. The post-treatment variables measured included “binge eating, psychological functioning, and weight loss” (Cachelin et al., 2014, p. 451).

The study used intent-to-treat analyses to evaluate the data. The results indicated better outcomes in terms of reduced distress, body weight, eating disorders. Participants were also satisfied with the intervention. This implies that a culturally sensitive CBT is effective in treating binge eating disorders among ethnic minority women.

Qualitative Research

The dropout rate among minority clients undergoing CBT treatment is usually high, which leads to low health outcomes. A study by Rathod, Kington, Phiri, and Gobbi (2010) aimed at exploring the cultural values and attitudes that affect the efficacy of CBT applied to ethnic minorities.

The study used a qualitative research design to explore the views and attitudes of the participants towards CBT therapy. The approach was appropriate for examining subjective views in order to gain insight into the patient-related factors that affect CBT outcomes.

The sample (n = 114) was selected from two medical centers in the UK. It consisted of three ethnic minority groups: Black British, African-Caribbean, and Asian British (Rathod et al., 2010). The participants were schizophrenics receiving CBT therapy in the two centers.

The researchers used semi-structured interviews and focus groups to explore the participants’ understanding of the program and the cultural factors that underlie psychotic disorders. Data analysis involved the thematic approach.

The results indicated that most participants held the view that CBT-based interventions that incorporate cultural values and beliefs were useful in treating psychosis. The authors concluded that individualization of CBT therapy requires counselors to understand client-specific and cultural factors that affect its outcomes.

Patient feedback indicates that a culturally structured CBT can increase the outcomes of ethnic minority clients. Jackson, Schmutzer, Wenzel, and Tyler (2006) compared the views of two patient groups under CBT therapy, namely, European Americans and Indians.

The aim of the research was to evaluate the relevance of cognitive behavioral therapy based on the patient ratings of the intervention. The researchers noted that minority patients had certain preferences for CBT and thus, an exploration of the views would inform a culturally suited cognitive-behavioral intervention.

A sample of 52 adult participants drawn from the American Indian and European immigrant population was selected for the study. Their views and opinions were collected using an instrument called the cognitive behavior therapy applicability scale (Jackson et al., 2006).

In this study, the participants ranked their preference for particular aspects of the CBT that they believed suited their cultural context. The three domains that the study explored included active stance, in-session interactions, and formal relationships.

The results suggested that more European American participants preferred a CBT approach that emphasized on “in-session behavior and structured relationship” than American Indians (Jackson et al., 2006, p. 512). On the other hand, both client groups preferred a CBT that required their participation.

Thus, in practice, an effective CBT intervention for American Indians should focus more on active participation than on formal therapeutic relationships.

The efficacy of CBT also depends on the cultural competence of the therapists. An observational study by Shen, Alden, Sochting, and Tsang (2006) explored the efficacy of CBT program prepared in Cantonese language and offered in English to Chinese immigrants.

The aim was to establish whether the CBT assessment procedures were the best for this demographic. The researchers hoped that this would give insights into the type of changes that could be made to the program to enhance depression outcomes of the Chinese clients.

The sample was selected from Chinese immigrants living in Vancouver (Canada) and suffering depressive disorders. Researcher observations indicated that the standard evaluation and treatment procedures were not the best for this population.

In particular, the adaption of the tenets of the CBT from its original version (Cantonese) to English was not optimal. Additionally, the program’s “cognitive modification strategies” failed to consider the beliefs and cultural practices of the Hong Kong immigrants.

The assessment of depression levels was not reflective of the Hong Kong cultural context. This affected the efficacy of the adapted CBT in improving the depression outcomes of Hong Kong immigrants.

Patients at risk of depression, such as adolescents, can benefit from CBT-based interventions. A qualitative study by Duarte-Velez, Bernal, and Bonilla (2010) explored the views of an adolescent lesbian Latino girl who was diagnosed with ‘major depression’ disorder.

The study examined whether a manual-based CBT was consistent with the adolescent’s “sexual identity, family values, and spiritual ideas” (Duarte-Velez et al., 2010, p. 899). The aim of the research was to find out whether CBT was optimal for lesbian minority groups by assessing the participant’s views regarding the intervention.

Using the interviewing method, the researchers explored the role of CBT in improving individual acceptance of homophobia in the family context. The results indicated that CBT enhanced integration and personal acceptance of anti-homosexual views and actions perpetrated by family members.

Furthermore, CBT helped the participant to develop a sexual identity, which resulted in a decline in depression symptoms. One limitation of this study was the small number of participants used. A second limitation of the research was the use of only a female participant, which affected the external validity of the findings.

The validation of the CBT adapted for minorities is often problematic. An exploratory study by Bennett and Babbage (2014) examined the suitability of CBT for Aboriginal clients in Australia. They explored the belief that CBT should be modified to reflect the needs of the individual client in order to achieve positive outcomes.

The study examined aspects of the Aboriginal culture that were incongruent with the tenets of the CBT interventions. In particular, “kinship orientation and collectivism” were the key aspects of the Aboriginal culture that the researchers found to be important in a CBT intervention (Bennett & Babbage, 2014, p. 24).

This indicates that a CBT tailored to these values can yield positive outcomes for Aboriginal Australian suffering mental illnesses.

A comparable study by Weiss, Singh, and Hope (2011) explored the efficacy of CBT in the treatment of anxiety disorders in two immigrant patients. The study used a case study approach to assess the views of the clients on the efficacy of an individualized CBT intervention.

Data collection involved semi-structured interviews, whereby the clients rated the utility of the intervention in helping them overcome social anxiety disorder.

The findings suggested that a CBT protocol could be adapted to suit the needs of clients with diverse cultural backgrounds or non-native English speakers without changing many elements of the intervention.

Program Evaluation Articles

A few articles have evaluated culturally sensitive CBT adapted for the treatment of ethnic minority clients with different disorders. An article by Bennett-Levy et al. (2014) evaluated the effectiveness of “high and low versions of CBT” in treating Aboriginal Australians with mental disorders (p. 5).

The study employed a participatory research approach to collect the views of Aboriginal counselors regarding their perceived usefulness of a CBT program in treating Aboriginal Australian clients. Five trained counselors administered CBT therapy to clients in 10 sessions and evaluated its effect on patient outcomes.

In this study, the counselors evaluated the program based on three main aspects, namely, its usefulness for Aboriginal clients, adaptations that enhanced its efficacy, and specific elements of the program that were effective.

Data manipulation involved transcription and thematic analysis. The results indicated that CBT is a useful intervention for treating Aboriginal clients. Additionally, the counselors reported that CBT improved their counseling skills and wellbeing (Bennett-Levy et al., 2014).

It also reduced burnout and improved the outcomes of the clients. The counselors found CBT to be a pragmatic, highly adaptable, and valuable approach for treating minority clients. Other aspects of the CBT that enhanced its effectiveness included its compatibility with low-intensity interventions and safety.

Thus, it can be concluded that CBT adaptations that reflect cultural contexts are effective counseling techniques.

Trauma focused CBT (TF-CBT) is another popular therapy for molested minors. Strasser (2015) evaluated a TF-CBT adapted for sexually abused minority children.

Child abuse victims suffer PTSD, shame, and multiple anxiety-related disorders. TF-CBT is founded on research evidence and thus, follows specific guidelines for assessing psychological disorders in abused children.

Strasser’s (2015) study evaluated the program based on the evidence-based criteria to determine if it is applicable to abuse victims.

The evaluation established that TF-CBT is an evidence-based approach. A bounty of research supported the use of this intervention for minors suffering from trauma. Additionally, TF-CBT was effective in reducing depression and anxiety in culturally diverse clients.

In particular, the program’s adaptations were found to be effective for treating trauma in two minority cultures, namely, American Indian and Latino. However, the researcher identified aspects of TF-CBT adaptations that limited its effectiveness. Its efficacy for treating anxiety and depression disorders dwindled after 12 months.

In addition, the program did not take into consideration the clients’ preferences and attributes, which limited its efficacy when treating trauma children with hearing impairment.

Implications of the Research for Practice

The purpose of the literature review was to determine the extent to which quantitative and qualitative research affirmed the use of CBT for counseling ethnic minority clients.

The synthesis of primary research has revealed that CBT varies in its effectiveness depending on client type, the nature of the disorder, cultural factors, and duration of the intervention, among others. These findings have implications for the application of culturally adapted CBT in clinical practice.

In recent years, CBT has gained acceptance as the best counseling approach for ethnic minority clients. The quantitative studies (RCTs) reviewed support the use of CBT adaptations to treat depression, psychosis, anxiety disorders, binge eating, and trauma among Latino, African American, American Indians, and Asian Americans.

Qualitative research also corroborates the application of CBT in counseling ethnic minorities. The evaluation of CBT adaptations indicates that the efficacy of cognitive-behavioral therapy depends on how well it incorporates the cultural contexts, values, and preferences of the clients.

These findings have many applications in practice. The finding that the efficacy of CBT depends on how it appeals to cultural and personal factors of the client implies that the treatment of ethnic minorities should be individualized.

Cultural considerations should be incorporated into CBT techniques to create an individualized intervention that can improve the outcomes of the clients. CBT interventions modeled around Western cultural values may not be effective when applied to minority immigrant communities.

In particular, the structuring of therapeutic relationships and interaction approaches should reflect the culture and preferences of the client to achieve positive treatment outcomes.

The review indicates that ethnic minority groups benefit significantly from culturally adapted CBT. However, its efficacy is affected by factors such as the patient’s expectations and preferences, the program’s cultural responsiveness, and the cultural competence of the therapist.

Therefore, culturally sensitive CBT programs can be useful in counseling ethnic minorities with psychosis, depression, and anxiety, among others. These approaches are particularly important because ethnic minorities are underrepresented in the psychotherapy field.

This implies that Western perspectives are predominant in the CBT field such that some of the underlying philosophies are incompatible with certain cultural aspects of the minority groups. Thus, in practice, the perspectives of minority clients should be considered to improve the therapeutic outcomes.

From the review, it is evident that the efficacy of CBT depends, in part, on the cultural competency of the counselors. An awareness of the client’s cultural background and values can help counselors support culturally sensitive CBT interventions adapted for minority clients. This has implications for counseling training and curriculum.

Counseling programs that train students on culturally adapted psychotherapy interventions can enhance their understanding of the specific needs of ethnic minority clients.

The use of culturally adapted CBT has empirical support. The review provides qualitative and quantitative evidence for the use of CBT in the treatment of multiple disorders. This has implications for evidence-based practice (EBP) in psychotherapy. The evidence can help in therapeutic decision-making.

Thus, evidence-based CBT can help counselors in selecting the best CBT adaptation that can maximize the outcomes of a particular minority group.

The review also underscores the need for integrating culture into counseling strategies.

The minorities examined in the studies that benefitted from culturally sensitive CBT include Chinese, Latinos, and African Americans, among others. If cultural factors are not integrated into the development and implementation of counseling interventions for minority clients, their dropout rate will increase.

Additionally, a less culturally sensitive approach can prevent them from seeking counseling services. To enhance its efficacy, CBT should be structured around the specific cultural values of the clients.

References

Bennett, S., & Babbage, D. (2014). Cultural Adaptation of CBT for Aboriginal Australians. Australian Psychologist, 49(1), 19-28.

Bennett-Levy, J., Wilson, S., Nelson, J., Stirling, J., Ryan, K., Rotumah, D.,…Beales, D. (2014). Can CBT Be Effective for Aboriginal Australians? Perspectives of Aboriginal Practitioners Trained in CBT. Australian Psychologist, 49, 1-7.

Cachelin, F., Shea, M., Phimphasone, P., Wilson, G., Thompson, D., & Striegel, R. (2014). Culturally Adapted Cognitive Behavioral guided Self-help for Binge Eating: a Feasibility Study with Mexican Americans. Cultural Diversity and Ethnic Minority Psychology, 20(3), 449-457.

Duarte-Velez, Y., Bernal, G., & Bonilla, K. (2010). Culturally Adapted Cognitive-Behavior Therapy: Integrating Sexual, Spiritual, and Family Identities in an Evidence-based Treatment of a Depressed Latino Adolescent. Journal of Clinical Psychology, 66(8), 895-906.

Dwight-Johnson, M., Aisenberg, E., Golinelli, D., Hong. S., O’Brien, M., & Ludman, E. (2011). Telephone-based Cognitive-behavioral Therapy for Latino Patients Living in Rural Areas: a Randomized Pilot Study. Psychiatric Service, 62(8), 936–942.

Hwang, W., Wood, J., Lin, K., & Cheung, F. (2006). Cognitive-Behavioral Therapy With Chinese Americans: Research, Theory, and Clinical Practice. Cognitive and Behavioral Practice, 13, 293–303.

Jackson, J., Schmutzer, P., Wenzel, A., & Tyler, J. (2006). Applicability of Cognitive-Behavior Therapy with American Indian individuals. Psychotherapy, 43(4), 506-517.

Rathod, S., Kington, D., Phiri, P., & Gobbi, M. (2010). Developing Culturally Sensitive Cognitive Behaviour Therapy for Psychosis for Ethnic Minority Patients by Exploration and Incorporation of Service Users’ and Health Professionals’ Views and Opinions. Behavioral and Cognitive Psychotherapy, 38, 511-533.

Rathod, S., Phiri, P., Harris, S., Underwood, C., Thagadur, M., Padmanabi, U. & Kingdon, D. (2013). Cognitive Behaviour Therapy for Psychosis can be Adapted for Minority Ethnic groups: a Randomised Controlled Trial. Schizophrenia Research, 143(2), 319-326.

Saddique, J., Chung, J., Brown, C., & Miranda, J. (2012). Comparative Effectiveness of Medication versus Cognitive-behavioral Therapy in a Randomized Controlled Trial of Low-income Young Minority Women with Depression. Journal of Clinical Psychology, 80(6), 995-1006.

Shen, E., Alden, L., Sochting, I., & Tsang, P. (2006). Clinical Observations of a Cantonese Cognitive-Behavioral Treatment Program for Chinese immigrants. Psychotherapy: Theory, Research, Practice, Training, 43(4), 518-530.

Strasser, A. (2015). Trauma-focused Cognitive Behavioral Therapy: An Evidence Based Practice Applicable with Minority Children. Chronicles of Psychology, 3(1), 11-19.

Webb, M., de Ybarra, D., Baker, E., Reis, I., & Carey, M. (2010). Cognitive-behavioral Therapy to Promote Smoking Cessation among African American Smokers: a Randomized Clinical Trial. Journal of Consulting Clinical Psychology, 78(1), 24-33.

Weiss, B., Singh, S., & Hope, D. (2011). Cognitive-Behavioral Therapy for Immigrants Presenting with Social Anxiety Disorder: Two Case Studies. Clinical Case Studies, 10(4), 324-334.

In the selected article, researchers hold that psychotherapy mediates effective management of obesity by influencing the lifestyles and behaviors of individuals. Statistics indicate that obesity is a significant public health issue because it affects over 700 million people and exposes them to various medical comorbidities and complications (Castelnuovo et al., 2017). Therefore, this reaction paper criticizes the article by examining its importance to the field of health psychology, the implication of its findings, and additional psychotherapy strategies.

This article is essential to the field of health psychology because it reviews the roles of psychological factors in the management of obesity. The authors underscore that a multidisciplinary approach to the management of obesity is critical as psychologists and psychiatrists aid in the transformation of behaviors and modification of lifestyles (Castelnuovo et al., 2017).

The analysis of psychological factors shows that they have an intricate link with the occurrence and management of obesity. The authors identify the quality of life, anxiety, self-esteem, personality traits, stressful life, mood problems, and eating disorders as some of the psychological factors that influence the management of obesity (Castelnuovo et al., 2017). Hence, the identification of these psychological factors provides critical information to the field of health psychology.

The article is also relevant to the field of health psychology because it highlights the role of psychotherapies in the management of obesity. According to Castelnuovo et al. (2017), cognitive-behavioral therapy (CBT) is one of the psychotherapies that are effective in the management of obesity caused by binge eating disorder. Binge eaters tend to experience more severe obesity and extreme complications than non-binge eaters.

Other psychotherapy methods, such as enhanced focused CBT, enhanced CBT, acceptance and commitment therapy, and therapeutic education, do not only relate to health psychotherapy but also aid in the management of obesity. The incorporation of these psychotherapies in Internet-based and novel approaches highlight their critical role in health psychology.

The findings of this article have significant implications in the field of health psychology. Based on their review, Castelnuovo et al. (2017) recommend the application of CBT as the first-line psychotherapy method in the management of obesity, especially among binge eaters. The field of health psychology ought to undertake empirical research to validate the recommendation before applying it in the long-term management of obesity.

Moreover, the authors describe how the integration of CBT into Internet-based technologies would enhance the management of obesity. In the article, the authors suggest the application of the stepped-care approach to enhance the delivery of CBT and related therapies in the management of psychological factors that predispose people to obesity (Castelnuovo et al., 2017). Therefore, this suggestion implies that health psychology needs to employ CBT and the stepped-care approach for the effective management of obesity.

The authors also presented additional information regarding strategies that facilitate the effective management of eating disorders and obesity. Castelnuovo et al. (2017) propose the utilization of sequential binge, acceptance and commitment therapy, behavioral weight loss, and therapeutic education as supplementary strategies that are relevant to the field of health psychology. The intervention of sequential binge aims to replace the eating disorder with repeated consumption of unpalatable food.

The therapy of acceptance and commitment promotes the ability of people with obesity to regulate their lifestyles and improve self-regulation skills. The aspect of behavioral weight loss comprises the modification of lifestyle through strategies of stimulus control, reinforcement, self-monitoring, and goal-setting. Therapeutic education indirectly relates to psychotherapy because it empowers cognitive abilities and guides people with obesity in the process of treatment for an enhanced clinical outcome. Thus, these additional strategies expound on the essence of psychotherapy in the management of obesity.

Since obesity is a chronic and multifactorial disease that affects a significant proportion of people across the world, the authors recommend the use of cognitive-behavioral therapy as one of the multidisciplinary interventions to help in weight loss among obese individuals. Authors also recommend other psychotherapy interventions, such as sequential binge, acceptance and commitment therapy, behavioral weight loss, and therapeutic education, in the management of obesity.

Reference

Castelnuovo, G., Pietrabissa, G., Manzoni, G., Cattivelli, R., Rossi, A., Novelli, M., … Molinari, E. (2017). Cognitive behavioral therapy to aid weight loss in obese patients: Current perspectives. Psychology Research and Behavior Management, 10,165-173.

Interview

The work of a therapist demands specific skills and competencies from a person. This assumption could be evidenced by therapists answers acquired using the interview. The specialist works with individuals who experience anxiety and mood problems, traumas, or alterations in social behaviors. During the conversation, she emphasized the necessity of enhanced communication skills to establish a contact with a patient and ensure that he/she will trust a specialist. For this reason, it is crucial to be able to understand peculiarities of every individual, his/her behavioral patterns, social expectations, and responses to particular stressors. In the majority of cases, the first contact was fundamental for the establishment of trustful and close relations between the therapist and an individual.

That is why the interviewee is sure that analytical skills play an important role in the work as they help to understand peculiarities of every patient and discover his/her primary needs. She also outlines the unique significance of tolerance and basic ethical principles. It is essential to respect all patients needs, desires, and peculiarities, regardless of their nature. It is the key to positive outcomes as the therapists task is to remain tolerant and analyze the causes of some undesired behaviors to correct or eliminate them. The interviewee outlines numerous ethical dilemmas she faced in her practice; however, the adherence to core social work values and ethical principles helps to solve the majority of problems. Any therapist should respect the dignity of a patient and preserve his/her anonymity. Only under these conditions, an individual will be able to engage in beneficial collaboration and share the most intimate feelings and emotions. In general, her answers prove that the importance of social skills, tolerance, and ethical principles in practice.

Conclusion

Altogether, this interview was beneficial for me. First, I was able to communicate with an experienced specialist and acquire the idea of numerous ethical challenges and problems that might emerge. Second, the interviewee shared her vision of being a professional which was not as idealistic as my own one. I realized that to work efficiently and attain enhanced results, a specialist should combine outstanding social and analytical skills with exceptional competence and knowledge. Moreover, it is fundamental always to consider patients peculiarities as it is the only way to establish trustful relations. The interview also supported my interest to the sphere (traumas, adolescents mood and behavior issues) as the therapist revealed its unique significance necessity to work with this group to guarantee the evolution of the society and its enhanced health.

Introduction

Mindfulness may be described as a non- elaborative, accommodating, present-centered attentiveness in which each reflection, feeling, or awareness that arises in the attentional field is recognized and accepted as it is (Witkiewitz and Marlatt 2007; 74). Mindfulness is also the exercise or habit of cultivating mindfulness. It could also be described as a model comprising self-regulation of awareness of immediate occurrences thus allowing for better acknowledgment of psychological events in the current moment; and taking on a course of curiosity, candidness towards one’s experiences in each instance.

In a study conducted to evaluate the efficacy of mindfulness, two randomized controlled clinical trials were carried out to support the efficacy of mindfulness-based cognitive therapy in averting depressive relapse. The two trials had sample sizes of 145 and 75 individuals respectively and were conducted in Toronto, Cambridge and Bangor for the first one while the latter was conducted in Cambridge, England (Witkiewitz and Marlatt 2007; 75).

Importance of the study

The study was centered on pin pointing the extent to which mindfulness can be incorporated in psychotherapy through personal experience of the therapist as well as the mindfulness training of the patient to achieve willingness or a perceived capacity that will enable the patient to effectively attend to present experience.

The methods used

In the studies mentioned above, individuals who had recovered from at least two instances of depression and were now symptom-free. The individuals were supposed to have been off medication for at least a period of three months prior to the study. Consequently, the individuals were randomized to be administered with either MBCT (Mindfulness-based cognitive Therapy) or to go on with treatment as usual (Witkiewitz and Marlatt 2007; 75). For the group in which MBCT was administered, there was an eight weekly individuals’ participation in addition to four follow-up sessions programmed at intervals of one month, two months, three and four months. Then the individuals in each of the groups were monitored for sixty weeks starting from the time of enrollment.

The outcomes measured

The principal outcome measure was to determine whether and when patients underwent relapse or reappearance described as meeting DSM-IIIR standard for a major depressive episode, in accordance with the assessment of the SCID (Structured Clinical Interview for Diagnosis) and administered in assessments twice a month all the way through the trial (Witkiewitz and Marlatt 2007;

The outcome from the first study showed a considerably different pattern of results. The results were put into two categories; for those with two previous episodes versus individuals who had three or more episodes. For the individuals who had only two previous instances (23% of the sample), there was no statistical difference in the relapse rates between the MBCT and the TAU (treatment as usual). However, the individuals with three or more previous episodes (who comprised 77% of the sample) revealed a statistically considerable difference in relapse rates for those who were administered with at least a minimum effective dose for MBCT ( about 37%) and TAU (about 66%). In addition, the relapse rates between MBCT and TAU showed persistent statistically significant difference when consideration was put to all the individuals who had been allocated to the MBCT condition.

The results therefore supported the efficacy of the MBCT in lessening depressive relapse though the design of the study did not create room for ruling out confounding explanations for the treatment benefits of nonspecific factors [e.g. group participation). The study also indirectly backs up the effects of MBCT as being in harmony with the fundamental theoretical justification of MBCT. Lastly, the MBCT was found to be more effective than TAU since it led to increased metacognitive awareness with regard to pessimistic thoughts and negative feelings (Witkiewitz and Marlatt 2007; 76).

Works Cited

Witkiewitz K., A., and Marlatt G. A., Therapist’s Guide to Evidence-Based Relapse Prevention: Academic Press – 2007: 74-76.

Therapists, who rely on solution focused therapy, emphasise the role of exceptions or the situations when a person managed to cope with a problem that usually seemed insurmountable. Moreover, these practitioners lay stress on the idea that a patient has the strength to overcome such difficulties on a regular basis.

This paper includes the discussion of a video that exemplifies the main techniques included in solution focused therapy. In particular, this video shows how a practitioner can help a person control the outbursts of anger. The task of this professional is to assist an individual in changing his/her views on a certain difficulty. These are the main issues that can be distinguished.

The principles of solution focused therapy were formulated by Insoo Kim Berg and Steve de Shazer (Sharry, 2007, p. 132). This method is aimed at helping clients discover the way in which their difficulties can be overcome. This paper will explore the role of exceptions in this method.

In particular, exceptions can be viewed as those situations when a person was able to cope with his/her challenges. Apart from that, much attention should be paid to the amplification of exceptions. In other words, a therapist should highlight the idea that small successes can be transformed into a norm.

To some degree, this discussion will be based on the role-playing video illustrating a hypothetical interaction between a patient and a therapist. Overall, this video can give viewers deeper insight into the use of solution focused therapy. It is important to mention that solution focused therapy is based on the assumption “that are always exceptions to the problems” (Sharry, 2007, p. 39).

In other words, there are situations when a person is able to overcome a certain difficulty. There are various factors that can influence the behavior of individuals and their relations with other people. More importantly, in many cases, people forget about such situations. Furthermore, they do not analyse them (Sharry, 2007, p. 39). This is why they often feel helpless.

In turn, the task of a practitioner is to urge people to recollect such cases. In part, this principle is reflected in the video. It should be mentioned, a patient is a woman who has problems with anger management (Loveland, 2012). So, she often quarrels with her husband. The practitioner asked her to remember those cases when she did not lose her temper (Loveland, 2012).

Furthermore, he encouraged her to think about the reasons why she was able to control her emotions. Overall, it is possible to argue that this discussion is the first step to identifying solutions to the challenges faced by people. Thus, patients’ perceptions can change. Apart from that, solution focused therapy involves the need to “amplify the exceptions” (Sharry, 2007, p. 39).

In other words, one should encourage a person to think about those qualities that are useful for addressing a certain problem. Moreover, a patient can be asked to speak about his/her experiences on such occasions. This discussion is very important because it demonstrates that a certain problem can be resolved. This approach has been exemplified in this video.

For instance, the patient mentioned deep breathing that often prevented her from venting her spleen on other people (Loveland, 2012). Moreover, they talked about such a method as counting from one to ten. The amplification of exceptions is necessary because it makes an individual feel more confident. Furthermore, the feeling of helplessness does not affect an individual very strongly

. One should keep in mind that the emphasis on exceptions can be useful for solving other problems. For instance, one can speak about work stress, conflicts with relatives and co-workers, or ineffective time management. So, this form of therapy has been used in different settings.

This video highlights the importance of other techniques; for instance, the therapist relied on the so-called “miracle questions” which prompted person to imagine that every problem had been effectively addressed (Sharry, 2007, p. 39; Loveland, 2012). This approach highlighted the idea that it would be easy to overcome a certain problem. Overall, this questioning technique has been rather helpful.

Admittedly, one should remember that it is only a role-playing video illustrating a hypothetical interaction between a patient and a practitioner. In real life, therapists may not face considerable challenges. For instance, it may be difficult for a person to recollect those cases when a certain challenge was effectively overcome. Apart from that, he/she can be very irritated. Nevertheless, this strategy chosen by the practitioner can be applied in various setting if a therapist displays empathy for a person.

Overall, this discussion indicates that exceptions play an important role in solution focused therapy. They are vital for showing that a patient has the strength to cope with a specific challenge. Many people are adversely affected by the lack of confidence. In turn, one should change people’s views on their difficulties.

So, it is important to explore those cases when an individual could address a certain psychological problem or at least reduce its impacts. The chosen video exemplifies the main peculiarities of this technique. It seems that this approach can benefit patients who may encounter various difficulties.

Reference List

Loveland, D. (Executive Producer). (2012). Solution Focused Brief Therapy (SFBT) Demonstration [Video file]. Web.

Sharry, J. (2007). Solution-Focused Groupwork. New York, NY: SAGE.

Introduction

Traditionally, the cultural, economic, social, and physical environments of a mentally ill person have been some of the aspects that need to be considered when looking into the feasibility of any prevention program. This approach guides community psychologists since it allows for examination of a wider personal-environment fit other than just the psychological variables when designing for a prevention program. The second approach of a prevention program that has been widely used for an equally long time is when the prevention and integration programs activities are done in the patient’s day-to-day environment. This approach, though thought to be the best delivery system of both prevention and therapeutic help, has over time lost its niche but governments and granting agencies are looking to its restoration. The other approach that has also been used for a long time is that of directing interventions and preventions measures to the social cycle of a person other than directly to a person. The approach does not ignore the needs of the individual but rather acknowledges that systematic changes as a more efficient way of delivering help to the patient. (Norman, Allen and Julian 2002)

Discussion

Despite the success of the above-mentioned approach, different psychologists have over time designed other prevention and intervention programs. In 1964, Gerald Caplan explained that since prevention consisted of biological, psychological, and sociological procedures, then there are three different stages of prevention, namely primary, secondary and tertiary. Caplan described the primary stage as that of ensuring that no new incidences of mental illness were reported. The secondary measure was meant to ensure that through early detection and early findings, reduction of the period of illness and lightening of the course of disorders were achieved. The third effort, tertiary, was meant to ensure that there is a reduction of impairment caused by mental illness and prevent any possibility of a relapse. Between the years 1983 and 1987, Gordon revised the original classification of preventive stages and came up with three other stages, including universal, selected, and indicated. The universal prevention approach was designed for the general population regardless of whether one was a risk of developing a mental disorder or not. This approach is useful since it prevents incidences (new patients), and it is community-friendly since the methods used are derived from the target community values. The second prevention approach, according to Gordon, is selective. This method is more concerned with a section of the population that is at greater risk of developing mental illness. This group of people can be identified by mostly their economic environment since they are mainly people living in poverty; they can also be identified by their family environment, where families are characterized by a series of family stress, including premature births and or historical factors of mental illness hereditary. For this approach to be successful, the psychologist needs to know the factors that could pose a threat to the patients, such as biological and familial, their impacts, and also the most efficient preventive actions.

The third approach that Gordon found feasible was the indicative approach. This kind of approach is directed to the patients who are already experiencing difficulties and at risk of a relapse. This kind of approach brings the aspect of treatment as the first step to alleviating patients’ current problems. Once the patient has been treated, indicative prevention measures can then be administered to prolong recovery or make adjustments easier. Though these preventive measures have been helpful in one way or another, there has been criticism that classification prevention programs assume more knowledge than actually exist. This is an important criticism since, if not done well, it can be harmful or pejorative. (Norman, Allen and Julian 2002)

Integration of Prevention and Therapy

Though Clinicians and community psychologists share one goal of improving the mental illness status, there have been tensions rising between the two groups of health practitioners mainly because of the nature of their occupations. The community psychologists acknowledge the fact that a mental patient’s environment plays a great role in the healing process of the patient and thus advocate for a larger, community-integrated system for prevention measures that are to a large extent not remunerated. On the other hand, though the clinicians may acknowledge the community factor, they are more interested in the treatment part of it since they are more money-focused and do therefore do not find community projects profitable. (Norman, Allen and Julian 2002)

Conclusion

Community psychologists and clinicians play a very crucial role in ensuring that community health standards are highly maintained. If the two sets of mental health providers are true to their shared mission of improving community health standards, then they should realize sooner that they don’t have a choice but to work together and respect each other’s importance and efforts since they complement each other. The community psychologists should acknowledge that they need clinicians for treatment of already affected persons, and the clinicians should likewise acknowledge the importance of community psychologists since interventions measures have been proved to aid patients to get better faster after they have been discharged from the hospital.

Reference

Norman S, Allen W, and Julian Taplin, (2002) clinical psychology Evolving Theory, practice and research Prentice Hall.

Brekke J, Prindle C and Bae S (2001), Risks for individuals with schizophrenia who are living in the community.

Abstract

This pilot study investigate the attitudes of trainee therapists towards the current fifty hours of mandatory personal counselling needed for completion of their studies at diploma level. It determines whether it should be more or less, and what else would be beneficial in becoming a counsellor or psychotherapist. In this study, ten students of psychotherapy completed a questionnaire. This questionnaire comprised of eight quantitative Likert questions, and two qualitative questions.

Introduction

The field of psychotherapy is known for solving many ailments and mental problems whose cause was mental and emotional sicknesses. The psychotherapy came as a means to assist the clinical therapist to unravel the emotional and the mental dispositions that threatened health of the patients. Psychotherapy is therefore a robust field, which is gaining acceptance all over the world.

As a part of study to qualify as a practicing psychotherapist one is required to undergo fifty hours of personal therapy. Personal therapy is where one is supposed to go to a therapist as a patient although in mind, one may not be sick or in dire need of clinical psychotherapy.

This research report will delve into what other scholars have studied on this subject. It will look into how students of psychotherapy feel about this practice whether it is beneficial to them or not. The other aspect that this research will delve into is that of whether the mandatory fifty hours of personal therapy are enough or not. The report will include the findings of the report and the discussion. The final part of this report will deal with the recommendation or the way forward because of this study.

Literature review

There is a lot of study assessing the role of personal therapy that students of psychotherapy have to undergo in the fulfilment of their course work. There have been various arguments, some that are supportive to this practice while others are negate and see it as a futile procedure that is not necessary. Norcross (2010) indicates that, it did not assist her in getting the much-needed internship, which she was looking for. Irrespective of such feelings, there are a number of reasons, which make this personal therapy important to the scholars.

Freud, the founder of psychotherapy and psychoanalysis was the first advocate of students undertaking this practice. He also went for psychotherapy, which he felt, was a relief and that it helped him to recuperate and deal with his personal issues. Personal therapy for the psychotherapy students is as important as for the therapist himself as it ensures that personal problems and issues do not influence the therapist when offering therapy to a patient.

There is likelihood that the psychotherapists’ personal values and experiences in life may affect the manner in which they treat the patients. To ensure that this does not happen, early training of psychotherapy by taking the clients seat and feeling how the clients feel is a way of becoming a good psychotherapists (Barley & Lambert 2001).

This training is imperative as it ensures that the students develop listening skills. When the students attend the therapy as clients, they see the importance of an empathetic therapist who is able to get into their shoes and identify with their feelings without prejudice. Without ever having to attend this therapy, the student would not learn how to be empathetic. This is an important quality required for anyone to be an effective psychotherapist.

Psychotherapy demands courage from the patient as it involves getting to a stranger and unloading one’s frustrations, fears, uncertainties and success. This is not easy and at times clients are not cooperative and unless the beginner psychotherapist appreciates this fact by sitting at the clients sit one would not ask the patients the necessary questions in fear that it affects the patients’ privacy or feelings (Herman 1993).

Various studies show that students who attended personal therapy also believed that they became more patient and tolerant to other people. During the clinical therapy, it is likely for the patient to pause and think or make unclear statements, which they will elaborate later (Lafferty 1989). Without having gone for such a therapy and without knowing the difficulty of putting ones experiences in words one may fail to understand some of the clients expressions which is not good for clinical therapy.

Students who attended these trainings acknowledged that they stopped putting words in patients mouth and offering unnecessary advice without listening to them. It enables the learners not to avoid the difficult periods of the psychotherapy that are imperative to the patient’s progress. This is an important skill in psychotherapy to enable the clients discover their problems (Lambert 1996).

The other benefit to students who undergo personal psychotherapy is that they gain knowledge of self. This knowledge is critical to any practising psychotherapist as survey done by Association of Psychiatrist indicates that it makes them aware of their personal biases and perceptions and how they react to different situations.

This self-knowledge makes it easier for the practitioner to gain a deeper understanding of the client’s needs and personality without indulging ones biases and personal values. This is imperative in ensuring success as a psychotherapist (Lambert 1996).

Personal therapy classes and gaining self-knowledge help the students to protect the clients from harm. This is because it becomes easier to know how client is likely to respond to certain information based on their personality because they can identify personality types from listening to the client’s words. Knowledge coupled with the increased listening and empathy skills help the student to prevent the client from harm by formulating the relevant therapy and solutions to the patients’ problems and challenges (Barley & Lambert 2001).

The other importance of the personal therapy undergone by students of psychotherapy is that it reduces the stigma associated with psychotherapy. Psychotherapy is challenging and most people do not seek for therapy unless they have problems such as depression.

Going for therapy when one is healthy needs acceptance in the society and there is no better way of making this happen other than ensuring that the students of psychotherapy accept its role in their lives. A psychotherapist who stigmatises or fears taking therapy would be like preaching water and taking wine (Sperry 2003).

Concerning the quantity of time, there is recommendation of fifty hours of therapy. Various studies indicate that the fifty hours are moderately enough. However, there is no conclusive opinion on the number of hours.

Some scholars feel that these hours are too many and likely to create boredom and dislike for psychotherapy while others argue that after the psychotherapy they feel excited and look forward to the next session (Macran 1999). Concerning the necessity of this personal therapy there is a general feeling among different scholars that it enabled them to develop critical skills that are useful in the execution of their duties.

Research methodology

The research focused on ten students of psychotherapy in an attempt to ensure that, the work is successful and the research identified the correct responses and feeling of psychotherapy students in Ireland. Although the sample appears to be small, it is a representative as psychotherapy students are not as many as compared with students in other disciplines such as business, arts or science. Sampling was random by picking the students from the psychotherapy diploma register and no criterion was adopted as a means of sampling.

There was adoption of the two research methodologies as one methodology could not collect the data satisfactorily. This is because there was need for both qualitative and quantitative data to make the study successful. The number of students who agreed on whether the practice was relevant needed quantitative data collection. However, the reasons and feelings behind their responses required qualitative data collection method (Martin 2000).

Ten students attending XXX College, Dublin, Ireland, participated in this study. They were counselling and psychotherapy students who volunteered their time during a research module to fill questionnaires. The module tutor monitored all work to ensure that it was done according to the instructions provided.

The questionnaire assessed the participant’s views on personal therapy during training, should it be mandatory? Has it been beneficial? Is it necessary to continue after the mandatory fifty hours? The questionnaire used eight Likert questions that were quantitative and two open qualitative questions.

Analysis

The following are the findings from the survey. The results indicated that most of the students felt that the personal therapy was necessary. Fifty per cent of the students strongly agreed that the research was necessary; twenty percent agreed that it was necessary and twenty percent were undecided. None of the student disagreed about the necessity of personal therapy as an important part of their study. (n=8) is the number of students who agreed that personal therapy is important.

On whether the student would have completed their studies even without personal therapy forty per cent of the students agreed that they would not have been able to complete their coursework if they had not experienced personal therapy. Forty percent were undecided or unaware of the importance of personal therapy in their studies.

Two per cent disagreed that personal therapy affected their ability to complete their studies and to become therapists. However, the opinion of those supporting personal therapy outnumbered those who disagreed concerning its contribution to ones success in the coursework.

Concerning the importance of personal therapy in continuing personal development, (n=7) seventy percent of the student agreed that it was important. The other thirty percent of the students were undecided. None of the student felt that the personal therapy was not important in their personal development.

On whether the students felt that their personal therapist was fully congruent and understanding most of the responses were positive with fifty percent strongly agreeing that they felt their personal therapist was understanding and aware of their feelings. Thirty percent agreed while twenty percent were undecided. This indicates that there was a strong feeling that the personal therapists were understanding and congruent with the students.

About the relationship between being a client and being a good therapist, (n=7) agreed that one cannot make a good therapist if they cannot let themselves sit at the patient’s seat and experience how it feels. Thirty percent of the students were undecided on this matter. There was no student who disagreed that there was a relationship between having gone through personal therapy and becoming a good therapist.

Concerning whether the personal therapy that the students had in any way influenced their style of therapy, ninety percent agreed. This time there was nobody who was undecided about this matter. However, ten percent of the students disagreed that personal therapy had influenced their style of therapy. This percentage of disagreement is quite high and reasons of their disagreement need to be unearthed.

The importance of continuing with the personal therapy even after the mandatory fifty hours received strong agreement for it to be continued even after the fifty hours of personal therapy. Twenty percent were undecided on whether this should go on or not, however it is imperative to note that there was no student who disagreed that the mandatory fifty hours of personal therapy need an increment.

The last area of study was on how the student felt on being clients and whether it made it easy for them to be counsellors. N=10 agreed that playing the role of client assisted them in their development as counsellors. This only varied where eighty percent strongly agreed while twenty percent mildly agreed.

However, this was unanimous show that the students felt personal therapy enabled them to play their role as counsellors very effectively. The other part of the responses was qualitative and it differed with the students giving detailed reasons as to why they felt that personal therapy was necessary to them.

Interpretation

The necessity of personal therapy to the student therapists is not questionable with most of the students agreeing that it is necessary to them for their future practice as psychotherapist. The strength was shown by the fact that eighty percent agreed with these and there was no disagreement. On whether the personal therapy enables the student to complete their studies in a successful way the answer is positive as seventy percent of the students agreed about this with a minority of the students adopting a different opinion.

On the relevance of personal therapy and its influence on the students’ personal development, there was a widespread agreement that it was important. However, the percentage of undecided students is worth noting.

Thirty percent, who are undecided on such issue shows that they have not felt any impact of the personal therapy on the development of their personal lives. It indicates that the therapy may not have assisted the student to develop the skills needed in personal therapy such as listening skills and empathy. Specialized research on the undecided students is required to establish why these students are undecided.

The percentage of students who agreed that their personal therapist was understanding and congruent with their needs was seventy percent. This shows that the capability of the therapist who is dealing with the students is important in making them understand and feel the importance of personal therapy.

However, there were those who were undecided. These figures of indecision are worrying because they show that some of the students are unaware of the importance of personal therapy and their inability to judge situations that are very important for a therapist is lacking. However, it is imperative to note that there were no students who disagreed on this.

The students were of the opinion that there was a relationship between being a good therapist and going for personal therapy. Their feeling concur with those of the previous studies conducted by other scholars that personal therapy is important for any therapist.

The style of therapy directly relates to the style of their personal therapist. This is because ninety per cent of the students agreed that they adopted their style from their personal therapist.

This affirms the earlier statement that there is need for the students to have personal therapist who are highly qualified as they have a lot of influence on how the students will practice psychotherapy on their patients. However, one student disagreed and it is important to identify whom he felt this style of therapy modelled after. This is because it indicates that ten percent of the students’ style of their therapy was different from that of their personal therapist.

There is need to increase the mandatory number of hours for student’s personal therapy. This is because the number of students who lived in the institution felt that it was necessary for such measures to take place. Eighty percent of the students agreed to support this. This strong feeling about personal therapy indicates the role, which it plays on the practice of the students. Increasing the number of hours would certainly be necessary.

The personal therapies that students undergo ensure that they become good counsellors. This is because of the skills they develop from their experience as clinical patients of psychotherapy. In fact, all the students agreed that personal therapy helped them to become good counsellors.

Limitations of the study

This study was however limited in a number of ways. The scope although representation is small may not represent a diverse feeling of all psychotherapy students in Ireland. The study also failed to classify the students in terms of their demographics such as age and gender as this may affect their perception on psychotherapy.

People would be interested to know how many male students felt that the improved therapy made them good counsellors and how many female students felt likewise. In addition, the study did not look into the specific capabilities that the students developed because of this personal therapy. It is imperative to know whether their empathy and listening skills improved from the fifty hours, which they spent with their personal psychotherapist.

Discussion

Personal psychotherapy on the students is indeed important to those who intend to become psychotherapists or counsellors. The skills and experiences received from that practice prove that personal therapy in the field of psychotherapy is not an outdated practice. This is a major area of influence on the students of psychotherapy.

Its role in framing the students’ style of therapy is effective. In addition, it is important for the personal progress of the students in all aspects of their lives as proved in this study. Other than that, it is imperative to increase the mandatory hours of students’ personal psychotherapy. This will make the students more competent as counsellors as well as psychotherapists.

References

Barley, D & Lambert, M 2001, Research summary on the therapeutic relationship and psychotherapy outcome, Psychotherapy, vol. 38, no. 4, pp. 357-361.

Herman, K 1993, Reassessing predictors of therapist competence, Journal of Counselling & Development, vol. 72, pp. 29-32.

Lafferty, P 1989, Differences between more and less effective psychotherapists: A study of select therapist variables. Journal of Consulting and Clinical Psychology, vol. 57, no. 1, pp. 76-80.

Lambert, M 1996, Current findings regarding the effectiveness of counselling: Implications for practice, Journal of Counselling &Development, vol. 74, pp. 601-608.

Macran, S 1999, How does personal therapy affect therapists’ practice? Journal of Counselling Psychology, vol. 46, no. 4, pp. 419-431

Martin, D 2000, Relation of therapeutic alliance with outcome and other variables: A meta-analytic review, Journal of Consulting and Clinical Psychology, vol. 68, pp. 438-450

Norcross, R 2010, Handbook of psychotherapy integration, Basic Books, New York.

Sperry, L 2003, Becoming an effective therapist, Alyn & Bacon, Boston.

Introduction

There are many different types of group counseling, making it complicated to select which one works best. Thus, the personality of each patient should be the primary consideration in the selection as every person is unique and requires a different approach. According to David, Cristea, and Hofmann (2018), cognitive-behavioral therapy (CBT) is arguably the gold standard of psychotherapy. It is commonly used to treat a wide range of disorders, including anxiety, phobias, depression, and addiction. This type of treatment is effective as it helps clients develop coping skills that can be useful both now and in the future. This paper analyses the efficacy of CBT and argues that it will best assist in facilitating change in-group members with various mental health problems.

The Efficacy of the Method

Cognitive-behavioral therapy is a type of psychotherapy based on the idea of connectivity between thoughts, behaviors, and feelings. It argues that our thoughts and feelings are what affect our behavior the most, meaning that by analyzing them we can influence the way we react to the world. It can be helpful for patients who engage in unhealthy behaviors and do not understand how they can change their actions. For example, a person who spends a lot of time thinking about being sick and getting an untreatable disease may be prone to spend much money on doctors’ visits. If this individual realizes that the fears do not have any basis, he or she might stop going to the hospital that often.

The primary purpose of CBT is to show each patient that even though the world around us in uncontrollable, they are the ones responsible for the way they interpret and deal with events that happen to them. This type of therapy is beneficial as it does not involve medication and allows individuals to be actively engaged in their treatment. Moreover, it shows excellent patient outcomes as it teaches individuals how to improve their current and future life situations.

I have experience in cognitive behavioral therapy, as I have utilized its methods to improve the quality of my life, and studied the studies addressing it. I think that keeping one’s mental attention in the present, rather than worrying about the past or the future is beneficial to anyone, regardless of the circumstances in their lives. I believe that learning this concept in group therapy with a psychologist leading patients through that journey can make a life-changing impact. My research on the topic further supported my belief and revealed that CBT could be helpful for patients with different kinds of mental health issues.

CBT is empirically supported and has been shown to help patients overcome a wide variety of maladaptive behaviors effectively. For example, one recent study analyzed how CBT could help international students to deal with their anxiety and depression (Pan, Ng, Young, & Caroline, 2016). Both short-term and long-term results showed a significant decrease in mental health problems. That is one of the main advantages of CBT is that it teaches techniques that the patients can use for the rest of their lives. A study by Chiang et al. (2015) further confirms the efficacy of cognitive-behavioral therapy.

After it had been performed, one-year follow-up results showed that the level of depression and negative thoughts stayed reduced, reinforcing the long-term effects of the treatment. CBT is inferior to other psychotherapy techniques because the skills learned by the patients alternate their thinking patterns, directly influencing their outlook on the world in a more positive manner. It is not a short-term solution; it is a tool that can help the patient with fighting mental health issues long after the end of the therapy.

Cognitive-behavioral therapy could be especially helpful to patients dealing with chronic and disabling illnesses. Berardelli et al. (2018) performed a study on patients with Parkinson’s Disease (PD) and compared the results of group CBT and education intervention. The results confirmed that CBT was significantly more effective than education intervention, suggesting that CBT therapy gives useful tools that could help with dealing with mental problems developed because of an illness.

In the case of mild depression or anxiety, an alternative to CBT could be a meditation practice. It could be performed both in a group and at home. The goal of meditation is to be able to attach oneself from thoughts and observe them without any judgment or reaction. Getting good at recognizing this takes some time but, it can help reset the negative messages in your head. Multiple studies found that meditation results in small to moderate improvements in reducing emotional symptoms (Goyal et al. 2014).

A good strategy is to combine both cognitive behavioral therapy and meditation practice strategies as CBT helps to analyze negative self-talk, and meditation addresses uncomfortable thoughts that keep arising. There are multiple apps and useful sources online that could help with starting the meditation practice. Meditation is helpful not only for people struggling with mental health issues; anyone trying to have a happier and calmer life could benefit from the practice.

Conclusion

This paper analyzed evidence proving that cognitive-behavioral therapy is an effective group therapy approach that can facilitate short-term and long-term change in patients. Currently, CBT is used as one of the main psychotherapy approaches, helping thousands of people with their mental health issues. However, one cannot forget that each patient is unique, so CBT should not be the exclusive approach used in every case.

References

Pan, J., Ng, P., Young, D. K., & Caroline, S. (2016). Effectiveness of cognitive behavioral group intervention on acculturation. Research on Social Work Practice, 27(1), 68-79. Web.

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

Berardelli, I., Bloise, M. C., Bologna, M., Conte, A., Pompili, M., Lamis, D.,… Fabbrini, G. (2018). Cognitive behavioral group therapy versus psychoeducational intervention in Parkinson’s disease. Neuropsychiatric Disease and Treatment, 14, 399-405. Web.

Chiang, K., Chen, T., Hsieh, H., Tsai, J., Ou, K., & Chou, K. (2015). One-year follow-up of the effectiveness of cognitive behavioral group therapy for patients’ depression: A randomized, single-blinded, controlled study. The Scientific World Journal, 2015, 1-11. Web.

Goyal, M., Singh, S., Sibinga, EM., Gould, NF., Rowland-Seymour, A., Sharma, R.,… Haythronthwaite, JA. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Intern Medicine, 174(3), 357–368. Web.

Introduction

The mental and physical health of every human being are closely connected; they influence one another and can cause different kinds of abnormalities and malfunctions when the balance is ruined. The balance can be said the condition of being healthy (instead of considering oneself healthy) as physically as mentally. Emotions and our attitude are of great importance for the normal maintenance of the whole organism. The middle of the twentieth century gave people two brilliant theories which can be used in psychology for the treatment of depression and other malfunctions.

Cognitive-Behavioral Therapies

Rational emotive behavior therapy was introduced by the American psychotherapist and psychologist Albert Ellis in the middle of the 1950s. This therapy presupposes that a person (can be also referred to as a client or a patient) should he or she upsets himself/herself more often than it seems to be and this emotional state causes other problems with health. “REBT is an active-directive form of psychotherapy in that therapists are active in directing their clients to identify the philosophical source of their psychological problems.” (Ellis, Dryden, 1997, p. 27) The role of the expert who decides whether the client behaves rationally or irrationally is given to the psychologist who also helps to direct the client’s emotions properly. The psychologist appears to be the teacher and the guide for his/her clients.

Another behavioral therapy is cognitive therapy which was developed by the American psychiatrist Aaron Beck in the 1960s. This method presupposes that a client should overcome difficulties in his or her emotive attitude towards a definite problem. “The goal of cognitive therapy is to relieve emotional distress and the other symptoms of depression.” (Beck, 1979, p. 35) As you can see, the attitude of a patient is the core of the problem, according to cognitive therapy. A patient can overcome the problem only by changing his/her mind towards the reaction to the problem. The means to treat the patient is to focus on mistakes in interpreting the events, their reasons, and consequences.

The main difference between rational emotive behavior therapy and cognitive therapy is that the first one is focused on philosophical ideas and helps the client to learn himself/herself, while the cognitive theory approach is aimed at searching for gaps and mistakes in the patient’s attitude towards a definite problem. The REBT expert guides the client and shows him or her about the mistakes, while the expert in cognitive therapy helps the patient to analyze the mistakes and gaps and to develop a different reaction. The REBT is more passive for the client; the client is passive and acquires knowledge about his/her mistakes from his/her instructor. Cognitive therapy involves the patient’s participation in analysis and criticism of the mistakes.

Conclusion

Cognition is one of the methods of struggle with depression and other mental abnormalities which was introduced by psychiatrists. This method presupposes the knowledge about possible reasons for the depression or specific reactions to definite events and ways it can be changed and treated. Cognitive behavior therapies have many features in common. The most obvious difference between the REBT and cognitive therapy lies in the participation of a client in the process of analysis of his or her mistakes in terms of perceiving and understanding the events and developing appropriate emotional reactions.

Reference

Beck, A. T. (1979). Cognitive Therapy of Depression. New York: Guilford Press.

Ellis, A., Dryden, W. (1997). The Practice of Rational Emotive Behavior Therapy. New York: Springer Publishing Company.

Introduction

The purpose of this research paper is to investigate the long-term effects of music therapy on older residents’ agitation manifested with Alzheimer’s disease, dementia and other old age medical complications. Towards this end, this research paper will also take a comparative analysis of the evaluation of studies on music therapy on older residents. The purpose of this study is to compare research studies on music therapy as an intervention to medical complications experienced by older residents brought about by dementia and Alzheimer’s. In brief, this research paper seeks to conduct a comparative analysis, or systematic review of effects of music therapy in older adults to assess the quality of the evaluation of research studies in this area.

The research problem

Agitation leads to severe disturbances in the quality of life of people with Alzheimer’s disease and their carers (Lawlor, 1995). It is well known that the incidences of dementia and older people’s medical complications are steadily rising due to the partial increase in the average life expectancy observed over the past century (Miller, 2008). During the recent past, different research articles abide to the fact that there is need to adequately meet the physical, psychological and social needs of the older people. Research evidence, heath care givers, affected family members and a number of medical reports point to one fact that music and music therapy may have a unique effect on people with dementia, and more specifically on those with probable diagnosis of dementia of the Alzheimer’s type (DAT) (Wigram, Pedersen & Ole Bonde, 2002).

While most research articles abide to one fact that music therapy remains an effective intervention technique in handling the symptoms of dementia, the qualitative nature of the reviewed and methodological approaches observed in the analysis of the studies failed to effectively provide a conclusion on the most effective form of music and therapy practices. There is therefore the need to focus more energy to aid more understating on the role of music therapy on older residents.

Literature review

“The recent qualitative review of literature in the area of music and music therapy and dementia published on this topic suggest that music and music therapy is an effective intervention for maintaining and improving active involvement, social, emotional, and cognitive skills” (Lehrer, Woolfolk & Sime, 2007). In addition to the above, music and music therapy are also effective in the reduction of behavioral problems in individuals with dementias (National Association for Music Therapy, 2007). The role of these present qualitative analysis on this topic have been done with the view of understanding the quality of these studies and carry out a deep analysis on how their methodological approaches influenced the effectiveness of the therapy.

A number of literature on this topic have concurred in one conclusion on the fact that this approach in reducing the level of pain and anxiety in older resident with Dementia remain effective to date. This is because people with Dementia demonstrate different forms of symptoms. According to Lehrer, Woolfolk & Sime (2007), People with Alzheimer’s disease show a range of agitated behaviors, including repetitive acts, behaviors inappropriate to social norms, and aggressive behaviors towards self or others. Furthermore, Grocke & Wigram (2007) illustrates that music therapy is one intervention which aims to create secure, stimulating environments, to meet social and emotional needs, and to reduce agitation displayed by people with Alzheimer’s disease and other types of dementia.

Older people demonstrate high levels of agitation and anxiety often manifested in a lot stress and lack of self control. The explanations provided by a number of research articles towards the effective role of music and music therapy include the effect of music on attention. Familiar music may serve to regulate a person’s arousal to a moderate level (Michel, 1976) or redirect a person’s attention from misleading or confusing stimuli (Michel, 1976).

Hicks-Moore (2005), in his study has successfully presented a comprehensive and relevant academic, theoretical as well as empirical review of literature in his study. In the analysis of the background to the study, Hicks-Moore (2005) has first presented early studies as well as more recent information that are coherent with this article. A literature search was carried out on observations, role of different types of music and ‘phenomenology research methods’. Another well documented article on the role of music and well being of people with dementia is by Sixsmith and Gibson (2007). These authors concur with other researchers on this topic. The authors began by demonstrating the need to incorporate the element of a phenomenological approach to the study that could have an in-depth exploration of problems to be addressed in what he termed as “Seeing things up close’ – using the philosophy of Husserl as a base.

Relevant demonstrative capacity and in-depth analysis on this topic is manifested by Sixsmith and Gibson (2007) to demonstrate connections to other academic works on the topic. In this endeavor, they have achieved the relevance of this study to the current demands in understanding the problems older people with Dementia go through due to the complications of this medical problem always presented in the form of agitation and anxiety. Recent studies have focused on the need to exploring strategies aimed at reducing the effect of Dementia and Alzheimer’s on older residents through the application of music and music therapy.

In this line, Sung and Chang (2005) “Use of preferred music to decrease agitated behaviors in older people with dementia: a review of the literature” explore vast number of resources on this topic. This extensive review of the literature conducted by Sung and Chang (2005), in the area of music and music therapy, grouped, categorized, systematically coded and presented the outcomes of the research in the one of the best formats. “We use meta-analytic which aggregate effect sizes across studies in order to assess the overall relationship between variables” (Sung and Chang, 2005). Success in singing, playing instruments, moving to music, or sharing memories or views related to music, may also meet a person’s un-met needs for self-expression, achievement, and meaning in life (Schmidt -Peters, 2001). Another very effective article towards the understanding of this topic by is Choi , Lee , Cheong and Lee (2009) on “Effects of group music intervention on behavioral and psychological symptoms in patients with dementia: a pilot-controlled trial” seeks to avail the details of the comparison made among studies conducted by trained music therapists and other professionals on the interventions requiring active participation in activities like singing and playing instruments or games. When the above are analyzed comparatively to passive involvement such as listening to music, studies using live versus, taped music and an assessment of behavioral, cognitive or social variables, valid deductions can be made. While Choi, Lee , Cheong and Lee (2009), appreciate the role of music in reducing agitation and anxiety on older people with Dementia and Alzheimer’s, the need to understand the role of both active and passive music involvement is well demonstrated. It is therefore prudent enough to confidently state that the aim of these research articles, the research questions and research problems are comprehensively addressed and all literature evaluated in this research paper relevant.

The framework

Concept of intervention(s)

“Music therapy has been defined as ’an interpersonal process in which the therapist uses music and all of its facets to help patients to improve, restore or maintain health’ (Schmidt -Peters, 2001). Music therapy allover the globe has their roots from different traditions such as behavioral, psychoanalytic, educational or humanistic models of therapy. While techniques used in music therapy are also diverse, they can be broadly categorized as ’Active’, in which people re-create, improvise or compose music, and ’Receptive’, in which they listen to music (Schmidt -Peters, 2001). While the United States makes wide application of the receptive and combined approaches, the European countries lean more towards the application of the active approach.

The underlying fact under these studies is that different forms and types of music have the ability to stimulate emotional and physical changes in the body. “The receptive forms of music are more likely to be influenced by cognitive-behavioral or humanistic traditions and may involve an adjunctive activity performed while listening to live or recorded music, such as relaxation, meditation, movement, drawing or reminiscing”. (Schmidt -Peters, 2001). According to (Schmidt -Peters, 2001), it has been suggested that this form of music therapy can help reduce stress, sooth pain, and energize the body. The most training on this type of music and music therapy are done at the bachelor’s level after which one can proceed to practice professionally after attaining the Board Certification and after going through a specific number of hours in clinical practice.

In the application of active approaches, techniques to stimulate active involvement of the patient, the therapist uses clinical improvisation techniques to stimulate or guide or respond to the patient who may use his/her voice or any musical instrument of choice within his/her capability (such as percussion) (Darnley-Smith & Patey, 2003). This may involve the patients coming with their own written songs that they will sing with the music therapist. These are the models that are referred to as improvisational. They are different from the other techniques because most of them are psycho-analytically informed.

The putative mechanism that makes this technique effective is that mutually and musically developed relationship between the patient and the therapist motivates the patient to experience a different feeling of himself or herself and gain an insight into his or her relational and emotional problems through talking about the musical dialogue (Darnley-Smith & Patey, 2003). Most of these programmes are in the Masters level or more extended in-depth in the undergraduate levels. In the recent past, specialisms have evolved in particular areas, for example Neurologic Music Therapy is the specific application of music to cognitive, sensory and motor dysfunctions in neurological rehabilitation (Darnley-Smith and Patey, 2003). Most music therapeutic approaches always involve a combination of two or more approaches. The choice of approach tends to be based upon the person’s needs, the therapist’s training and the context (Miller, 2008).The delivery of music therapy takes different time periods that range from few weeks to a number of years and their intensities also varies with time. Another aspect of this technique is that it may be delivered individually or in group depending on the needs of the patient.

Paradigms in social interventions

Paradigms form basic images construed within the subject under study suggested by a researcher or prototype. (Miller, 2008), defined paradigm as a set of practices that define a scientific discipline during a particular period. Paradigms in social interventions assist researchers to understand the underlying problems in instances where other forms of paradigm cannot be used to explain certain events, anomalies, and crises. According to Michel (1976), “the social network paradigm is a construct for analysis of social relationships developed in social anthropology”. However, in its analysis and concepts, this paradigm has gone under various forms of transition and development in review of a number of researches and practice in the clinical field. It forms the fundamental basis on which basic research questions that demand further analysis are presented.

When there is a conflict between the available types of paradigms in the analysis of an effective approach to addressing research questions, a new paradigm is created. According to Michel (1976), there are three types of social paradigms which all have with them very different analytic view and expressions in reference to the society. These paradigms include the three paradigms; the structural functionalism, the social-conflict, and the symbolic integrationist. All the three types of social paradigm abide by one fact that the family forms the most fundamental unit in any type of social interaction. According to (Michel, 1976), “The primary role of the family is the socialization of children to that they can truly become members of the society into which they have been born.”

An analysis of the social interventions of the disciplinary matrix reveals six core elements. These include image, practice, theory, interest, research methodology, cognitive and exemplar. The elements of image , cognitive and exemplar are referred to as genotypic elements in that unlike the other three core elements of theory, research methodology, and practice, they generate paradigm and are explicit.

In this research paper, cognitive element will be of more focus in social paradigm intervention because of the fact that cognitive behavior therapy forms a very effective technique of handling Dementia. “Cognitive Behavior Therapy methods were initially developed for depression and anxiety disorders (Michel, 1976) and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse. Furthermore, “they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder” (Michel, 1976). Basic cognitive model indicate the effect of CBT on behavior and emotion of Dementia patients.

Based on the above model, music plays a very fundamental role in affecting the behavior and emotion of older residents. A combination of music therapy and cognitive behavior therapy remains effective in the reduction of pain and anxiety.

Evaluation models

“Evaluation is the systematic acquisition and assessment of information to provide useful feedback about some object” (Lehrer, Woolfolk & Sime, 2007). Evaluation that will be adopted in this research paper will be a scientific experimental model. This is mainly because it undertakes both the scientific and social concepts of the study. The empirically driven feedback can then be achieved. Evaluation as a research process cannot be done in a single phase but involves a continuous activity in the process of undertaking an evaluation of a project. There is need to understand the different interests to be served by the evaluation and that there is a chance of these interests conflicting with one another.

This continuous evaluation requires a model which consists of a series of components and statements on the systemic relationship among various factors referred to the interventions; such as the cost, internal and external factors. The goal is one criterion only. It takes into account all systemic variables that affect the result. The impact model displays three hypotheses. The first is the causal hypothesis, the second is the intervention hypothesis and the third is the action hypothesis. The action hypothesis is used as the evaluative criteria because it tests if the intervention is the causal factor. This model comes from the positivistic paradigm due to the element of causality. The goal free model involves the evaluation of the intervention. This model can be from any of the paradigms.

Qualitative model whose purpose is to derive the meaning of the intervention according to how it is perceived by those who receive it stems from the interpretive paradigm.The paper also employs critical model. This model is used when the intervention is done as praxis and the purpose is empowerment and emancipation. The population is the clientele who are described by their needs, their interpretation and social structures. It stems from the critical paradigm.

Methodology

The objective of this research paper is to carry out an analysis of the relevance and effectiveness of five peer reviewed articles on the effect of music therapy on older people. Towards this, the most effective research model (inductive model) of research was to be applied to generate generalizations. In this chapter, the research philosophy and the research strategy have been provided. The choice of the methodology approaches that have been selected and followed and have been well explained and justified.

Two views about the research process dominate literature, that is, positivism and phenomenology. The positive approach was based on the scientific discoveries made in the 18^th and 19^th century. It was a body of knowledge that existed independently of whether people knew it or not, and the scientists had to find the truth. The believe was that there were laws that governed the operation of the social world and that these could be discovered through social behavior that was seen as a result of external pressure acting on relatively passive people (Lehrer, Woolfolk & Sime, 2007). This traditional research approach leads to the development of methods that concentrated on producing supposedly objective data in the form of statistics.

Phenomenologists disagree with positivists in that human beings can be studied using the same physical objects or other animals. They assert that there is a difference between the subject matter of sociology and natural science (Saunders et.al, 2000). Humans are conscious, active and very capable of making choices unlike animals or objects. In order to analyze the effectiveness of music therapy on older residents with Dementia, the phenomenology approach will be adopted. This is because the social world of business management and organization is too complex to be theorized by definite laws.

Abstracts of each evaluation report

“A non-randomized experimental design was employed with one group receiving weekly music therapy (n¼26) and another group receiving standard nursing home care (n¼19). The levels of agitation were measured five times over one year using the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, J. (1989). The authors noted that an analysis of this techniques revealed that even though music therapy participants showed short-term reductions in agitation, there were no significant differences between the groups in the range, frequency, and severity of agitated behaviors manifested over time. They summarize the article by stating that there is need for more research on the topic and that multiple measures of treatment efficacy are necessary to better understand the long-term effects music therapy programs have on this population”.

Agitation in individuals with severe cognitive impairment is a significant problem that affects care and overall quality of life. Building on research conducted by Goddaer and Abraham (1994), this quasi-experimental study proposed that relaxing music played during meals would exert a calming effect and decrease agitated behaviors among nursing home residents with dementia. It involved a study of thirty residents residing in a Special Care Unit participated in the 4-week study. The Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989) was used to gather data. Baseline data was obtained in Week 1 (no music). Music was introduced in Week 2, removed in Week 3, and reintroduced in Week 4. At the end of the 4-week study, overall reductions in the cumulative incidence of total agitated behaviors were observed. Reductions in absolute numbers of agitated behaviors were achieved during the weeks with music and a distinct pattern was observed.

While therapeutic interventions involving music have been shown to have benefits for people with dementia, little research has examined the role of music and music-related activities in their everyday lives. This paper presents the results of qualitative research that explored this role in terms of the meaning and importance of music in everyday life; the benefits derived from participation in music-related activities; and the problems of engaging with music. Data were collected during in-depth interviews with 26 people with dementia and their carers, who lived either in their own homes or in residential care in different parts of England. The paper illustrates the many different ways in which people with dementia experience music. As well as being enjoyed in its own right, music can enable people to participate in activities that are enjoyable and personally meaningful. It is an important source of social cohesion and social contact, supports participation in various activities within and outside the household, and provides a degree of empowerment and control over their everyday situations. The practical implications for the provision of care and support for people with dementia are discussed. The scope and implications for technological development to promote access to music are also explored.

Background

Music has been suggested as a feasible and less costly intervention to manage agitated behaviors in older people with dementia. However, no review of the literature focusing on study findings of preferred music on agitated behaviors in older people with dementia had been reported. Methods: A review was undertaken using electronic databases with specified search terms for the period of 1993–2005. The references listed in the publications selected were also searched for additional studies Sung & Chang (2005). Results: Eight research-based articles met the inclusion criteria and were included in the review. The preferred music intervention demonstrated positive outcomes in reducing the occurrence of some types of agitated behaviors in older people with dementia. The findings from these studies were relatively consistent in finding improvement in agitated behaviors although the findings in one study did not reach statistical significance. The small sample sizes and some variations in the application of the preferred music intervention mean that caution is needed in drawing conclusions from these studies. Conclusions: This review highlights that preferred music has positive effects on decreasing agitated behaviors in older people with dementia; however, the methodological limitations indicate the need for further research. Relevance to clinical practice: Findings from the review highlight the beneficial outcomes of preferred music in reducing agitated behaviors for older people with dementia. The incorporation of preferred music has the potential to provide a therapeutic approach to the care of older people with dementia.

We investigated the effects of group music intervention on behavioral and psychological symptoms in patients with dementia. Twenty patients were none randomly allocated to either a music-intervention group, or an usual care group. The music-intervention group received 50 minutes of music intervention 3 times per week for 5 consecutive weeks. After 15 sessions, the music-intervention group showed significant improvement with regard to agitation, and the total scores of both patients and caregivers were lower, compared with the control group. These findings suggest that music can improve behavioral and psychological symptoms, especially in patients with dementia and their caregivers.

Persons with mid-stage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types—rhythm playing, exercising with music, and singing. Activity staffs with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staffs, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.

Intervention analysis

Comparative analysis

Population

The six studies had very minimal range across the population. Ledge & Baker (2006) took an analysis of 45 elderly patients of both sexes while Hicks-Moore (2005) undertook a research with 30 participants of both sexes. The ages of the participants in both studies were above 65 years. The studies undertook in this analysis by Sixsmith & Gibson (2007) and Choi , Lee , Cheong & Lee (2009) examined the role of music in reducing the levels of agitations and anxiety on the elderly residents with Dementia and started with populations of 26 and 20 respectively. The last study in this research paper was undertaken by Clair, Mathews & Kosloski, (2005), and shad a total population of 45 individuals consisting of both sexes.

The studies had patients from both sexes that were all older residents with Dementia. All the six studies used in the analysis of this paper were done and concluded in the countries they were initiated. This was to provide relevant data on the specific population under research investigation. The history of the patients under study consisted of those within the mid stage Dementia, acute levels of agitation and those with severe cognitive impairment.

Conceptual Variable

In the analysis of all the six studies used in this research paper, the interventions were positivistic and interpretative paradigms. The former paradigm was manifested throughout the intervention process through the observation of the behaviors of the patients. The applied systems of interventions in the form music therapy were found to have direct relationship with the effects observed on the same patients. Each and every form of intervention carried out was the precipitating agent in the effects observed in patients with Dementia. It is therefore true that the interventions formed the driving factors that shaped the observed results in the patients.

In this sense, this formed the independent variables while the latter formed the dependent variables. Music therapy interventions techniques were applied to reduce the levels of agitation and anxiety on Dementia patients. The intervention process was undertaken in a process designed to effectively monitor the changes in the levels of agitation and anxiety on the patients. Data collection and analyses were critical in these studies. The theme of music therapy intervention is to understand its effect on patients with Dementia. While most of the studies took the positivistic form of paradigm, some studies revealed the application of interpretative form of paradigm.

In this music therapy intervention, treatment design was similar in all the six research studies with minimal variation in design, implementation and the duration of treatment. Ledger & Baker (2006), used a non-randomized experimental design where one group received weekly music therapy (n¼26) and another group received standard nursing home care (n¼19). Hicks-Moore (2005) and Sixsmith & Gibson (2007) used relaxing music during meal time in nursing homes and conducted interviews on the effect music of in every day life among the patients with Dementia respectively. On the other hand, Choi, Lee, Cheong & Lee (2009), used group music intervention on the behavior of people with Dementia. Clair, Mathews & Kosloski (2005), analyzed the active participation of patients under the study while Sung & Chang (2005), carried out an in depth analysis of eight of research articles. In this music therapy intervention, the goal model was used in evaluation of the results.

Implementation Variable

In these research studies undertaken on music therapy on patients with Dementia, three studies were carried out in hospital. These were; Hicks-Moore (2005), Sung & Chang (2005) and Clair, Mathews & Kosloski (2005) while Ledger & Baker (2006), used both home and hospital set up during the implementation of their music therapy intervention. Sixsmith &Gibson (2007), used home set up to carry out the study of music therapy on agitated dementia patients.

This music therapy intervention was both carried out in hospital and home. The people who were involved in this task were social workers and music therapists. The social workers were home care takers of the Dementia patients while the music therapists were stationed at the hospital.

A comparative analysis of the study of the application of music therapy in the reduction of pain and anxiety and agitation on elderly patients with dementia points to one fact that cognitive theories were vast in the studies undertaken. As earlier indicated, the forms of paradigms witnessed across all these studies were interpretative and positivistic. The analysis of the study revealed that their objectives were coherent in that they aimed at analyzing and coming up with valid conclusions on the effectiveness of music therapy on older patients with dementia. To achieve this central objective of this study, a number of activities were undertaken.These included rhythm playing, exercising with music and singing.

Assessment of Methodology

Criteria for Methodological Assessment

This study employed a combination of content and hermeneutic analysis in the comparative assessments of the methodologies used. Content analysis is quantities assessment showing what is expressed as well as depicted in the text. Hermeneutic assessment on the other hand highlights the meaning of the text and its totality. The main aim of using criteria in this methodological assessment was to determine the validity and soundness of each music therapeutic implementation to the patients with dementia.

This music therapeutic study on patient with dementia was analyzed on methodological variables: the research problem formulation, the research study design and data collection, data analysis and interpretation.

The methodological analysis

Scale tested all the variables. The assessment scale involved a combination of four criterions: explicitness, appropriateness, clarity and completeness. In this study, the paradigm was assessed without explicitness because the paradigm is implicit.

Four criteria were used to rate elements of methodology:

1. poor
2. Good
3. Very good
4. Excellent.

The rating ranges from between one and four with one being the lowest and four being the highest. The scores of each patient were added to obtain a numerical ranking. The data on the score for criteria were then ranked into poor, good and excellent.

Methodological Assessment Scale

Comparative Analysis: Methodology

Research problem formulation:

Research problem formulation continued:

As can be clearly observed in the research problem formulation matrix, a list of elements were applied to analyze the formulation problem. These included: paradigm, theory, independent variable, dependent variable, hypothesis, literature review, and objective.

Paradigm

All the studies had implicitly stated paradigms with positivistic and interpretative frameworks clearly spelt out. The first four studies by Ledger & Baker (2006), Hicks-Moore (2005), Sixsmith & Gibson (2007), and Sung & Chang (2005), were dominantly in the application of interpretative paradigm while the last two studies by Choi, Lee, Cheong &Lee (2009) and Clair, Mathews & Kosloski (2005) employed the positivistic paradigm. The theories advanced by the studies applied a mixture of matched and unmatched design and analysis of the intervention. Ledger & Baker (2006), Hicks-Moore (2005) and Sixsmith & Gibson (2007),achieved higher ratings on the explanations of the theories applied in their studies while the rest of the studies consisting of Sung & Chang (2005), Choi, Lee, Cheong & Lee JS (2009) and Clair, Mathews & Kosloski (2005), received fair or poor ratings in the explanations of their theories. From the matrix, it can be observed that that first three had good ratings while the last three had fair ratings.

Independent and Dependent Variables

Studies undertaken by Hicks-Moore (2005), Sung & Chang (2005) and Clair, Mathews & Kosloski (2005), reported excellent demonstration in both Independent and dependent Variables while the other studies had fair demonstration on the same. The first three studies clearly explained various parts of the interventions in vivid terms that were clear to understand. Good examples in this area were done by Hicks-Moore (2005), Sung & Chang (2005), by incorporating different modules in the analysis of both independent and dependent Variables. The incorporations of these modules are effective in the provision of data on the development of the effectiveness of the music therapy. The rest of other studies were specific in the application of the two variables thereby receiving fair grade in this category.

Hypotheses

It is not encouraging because none of the studies clearly stated their hypothesis. All the studies thus scored poor ratings in the development of their hypotheses. This is due to lack of ability to specifically address the information that can be deciphered. The studies by Choi, Lee, Cheong & Lee JS (2009) and Clair, Mathews & Kosloski (2005), portrayed more poor levels of hypotheses presentation. Even though the authors of all the studies suggested that music therapy is an effective treatment technique, they failed to demonstrate this connection to their hypotheses.

Bibliographical review

The literature reviews by Sung & Chang (2005), was an analysis of various research articles on the effect of music therapy on older residents with Dementia. Studies undertaken by Ledger & Baker (2006), Sung and Chang (2005).and Clair, Mathews & Kosloski (2005), demonstrated excellent review of literature on the purpose of the research. The rest of the studies failed to achieve higher degrees in the review of their literature and as such received fair ratings.

Objectives

All the six studies were excellent in their goal statement. Their goals were succinctly stated. All the studies assessed the effect of music therapy in elderly residents with dementia.

Design and data collection

The design and data collection of the six studies were analyzed using the combination of the following components: design, sample, instrument, reliability, validity, appropriate, control and time observed.

Design

Ledger & Baker (2006), were excellent in the design of their studies in that the study was clearly understood. Its variables were precise. The study done by Hicks-Moore (2005) applied a descriptive research design. This form of design gathers data only after the implementation of the intervention thereby making it difficult to determine causality.

Sample

Each of the six studies included elderly residents with Dementia. Five of the six scored excellent ratings due to the fact that used good samples of participants in terms of number, sex, and age. One of the research analysis by Choi, Lee, Cheong & Lee (2009) involved unspecified number of participants in its study that gave it good ratings.

Instruments

The analysis of the six studies revealed that three of them received excellent ratings as a result of instruments used in data collection. Ledger & Baker (2006) and Clair, Mathews & Kosloski (2005) were the best in the application of instruments in data collection. These included the use of relevant questions with some of them having the elements of choice. Studies documented by Choi, Lee, Cheong and Lee (2009), scored average in the application of instruments in that their instruments lacked the aspect of clarity.

Reliability and validity

Four of the six studies scored fair ratings while two of the studies by Clair, Mathews & Kosloski (2005) and Sixsmith & Gibson (2007) scored substandard ratings due to their inability to articulate the reliability and validity of their studies.

Time observed

Clair, Mathews & Kosloski (2005) and Choi, Lee, Cheong & Lee (2009), received the best ratings in this category. These two studies had with them the components of definite lengths of intervention periods as well as the analysis of the intervention process. Ledger & Baker (2006) and Hicks-Moore (2005), scored fair ratings under this category while sung &, Chang (2005), received the lowest ratings of poor due to lack of definite time line.

Data Analysis and interpretation

A comparative analysis of this section was the done using the above parameters that include: analysis of data, interpretation of data, conclusions, and report quality.

Analysis of data

All the six studies tried and achieved fair ratings in their data analysis. Each and every study focused on achieving high ability to effectively demonstrate the balance that exists between the depth of analysis and the purpose of their studies. Most of the studies were able to turn questionnaire responses from the patients themselves into quantitative data that were later analyzed to provide the qualitative component of the data.

This was the effective tool in assessing the effectiveness of music therapy in the patients under study. A total of three studies done by Clair, Mathews & Kosloski (2005) and Choi, Lee, Cheong & Lee (2009), were able to demonstrate higher levels of data analysis that took step by step approach. Furthermore, they were able to portray the existing link between the data and the methodological approaches adopted. This remained fundamental in consideration to the types of study these authors were undertaking.

Interpretation and Conclusion

The studies received fair ratings in the interpretation and conclusion. They were able to moderately interpret analyzed data into understandable criteria. This was achieved through a thorough discussion of the methodologies, interventions, and the results achieved after data analyses. The limitations of their studies were well documented and a number of relevant factors and risks associated with these studies well pointed out. Due to the nature of the studies, all the studies pointed at the social impact on their results. They were written logically and clearly to enable easier understanding of the social impact of the results obtained.

Reports Quality

Sung & Chang (2005) and Choi, Lee, Cheong & Lee (2009), demonstrated excellence ratings in quality reporting due to comprehensible and concise reporting techniques. The authors analyzed the studies and focused on organized, presentable and easily understood report formatting. The implications of the research studies on future research endeavors on the same topic were well illustrated.

Conclusion

Knowledge Development

The purpose of the comparative analysis is to use inductive research and seek to arrive at generalizations pertaining to the effect of music on older adults. The research can affect knowledge development on the following levels: factual, concepts, hypotheses, empirical generalizations, theoretical generalizations, and paradigms. The knowledge development based upon an analysis of the studies can help to the general life of older adults and prevent medical complications associated with Dementia and Alzheimer’s.

All of the studies contribute to knowledge development on a factual level. Sung & Chang (2005) and Choi, Lee, Cheong & Lee (2009), have used assessments to evaluate the role of music in reducing the levels of pain and anxiety on older residents. Scores received on the preliminary assessment were then compared to post-test results after the intervention had been implemented. The knowledge availed to the field of medical care for the older residents by these articles have contributed significantly to knowledge development and the need for further research.

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