1. The Efficacy of Psychotherapy in Short-term Psychiatric Inpatient Units Sarah Smith Argosy University, Seattle
2. Introduction The purpose of my literature review was to explore the research on the effectiveness of using psychotherapy techniques, such as cognitive behavioral therapy, with clients who are on an inpatient psychiatric unit. The objective of the research is to find out if clients who are admitted to short term inpatient psychiatric units would benefit from receiving psychotherapy and other therapeutic techniques while they are in inpatient care. I also looked at studies that involved the training of staff who work in psychiatric units that have incorporated specific therapeutic interventions and how those benefitted them.
3. The standard of care that is seen in most community psychiatric inpatient units appears to focus mainly on stabilizing them with psychotropic medication. There tends to be very little, if any focus on psychotherapeutic techniques or psycho education while they are in inpatient care. In this literature review I provided research which argues that clients in inpatient psychiatric units would benefit more from an environment that provides them with psychotherapy while they are there.
4. Effective Psychotherapy Techniques: Cognitive-Behavioral Therapy Most of the supporting data for effective types of psychotherapy used for mental illnesses exists for cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (Arkowitz & Lilienfeld, 2007). Most of the research done on this topic focuses on the use of short-term cognitive-behavioral therapy. According to Comer (2010), CBT is helpful with most types of mental illnesses because it helps clients change their maladaptive and disruptive behaviors as well as the dysfunctional ways of thinking that go along with most mental illnesses. It is usually conducted on a short term basis.
5. Psychotherapy used with specific symptoms or disorders on inpatient units Ian B. Kerrâs (2001) research was done on the efficacy of using brief cognitive analysis therapy (CAT) with inpatient clients whose mania was unable to be controlled with traditional drug therapy. Kerr described CAT as a brief cognitive therapy that helps clients describe self-states, which include their psychosis and delusions, so that they can become aware of the maladaptive coping strategies they use for dealing with their disorder. Buccheri, Trygstad, Buffman, Lyttle, and Dowling (2010) believed that they could help clients suffering from audio hallucinations by developing 5 evidence based programs that would help clients manage them better. The programs included ideas for increased awareness and education for the staff, self assessment tools for patients, evidence based nursing interventions, recommendations for improving staff-patient communication, and a plan for sharing the information with the patientâs treatment team and caregivers upon discharge. The research completed by Kerr (2001) and Buccheri et al. (2010) were both proven to be effective in reducing the symptoms that they focused on.
6. Lisette Rodriguez (2007) case study focused on the course of treatment for âSonia,â an inpatient at an all female psychiatric unit who had been struggling with Bipolar disorder for many years. Her treatment included intensive psycho education and CBT, and the psychotropic medications that she was normally treated with. According to Rodriguez, the medication was helpful but the addition of education and CBT changed her life-long negative thinking and behaviors, which seemed to encourage her medication and treatment compliance.
7. Treating an entire unit with psychotherapy Durrant, Clarke, Tolland, and Wilson (2007) showed that there is also important evidence that including psychotherapy can have a positive effect on all of the clients in a psychiatric unit. They added a CBT model to the normal treatment of 14 clients on an inpatient unit. They believed that after receiving CBT the clients would be able to manage their emotions more effectively and they would show better goal attainment by the time they were scheduled to discharge. Through the use of several psychological measurements Durrant et al. were able to prove their model successful in the treatment of most of the clients who were in the study.
8. Positive outcomes of psychotherapy for staff working with clients Implementing therapeutic techniques, such as CBT may have important consequences for not only the clientâs treatment, but the entire inpatient environment. According to Forsyth et al. (2008), using CBT in an inpatient setting would aid in staff-patient engagement, improve hope inspiring communications, reduce distress, and improve the use of evidence-based therapy with complex groups of clients. Buccheri et al. (2010) believed that therapy that uses staff assisted techniques to help clients control and communicate potentially dangerous behaviors may keep psychiatric units safer from violence and other traumatic experiences.
9. McCann and Bowers (2005) had success with this idea when they trained inpatient psychiatric nurses and staff in CBT and other psychosocial interventions. The nurses and staff involved in the training that McCann and Bowers implemented, stated that they had a positive experience and that they believed they could have a larger impact on their clients with the CBT techniques they were taught.
10. Conclusions and suggestions for future research I have come to the conclusion that when clients think that they are benefiting and learning from their placement on a psychiatric unit, rather than just being medicated, they may also believe that their treatment was more effective. They may get more out of their stay than just being medicated, which may help them benefit in their long-term treatment goals. It seems that staff working with these clients also benefit from the knowledge they gain from using psychotherapeutic techniques. Several areas of interest for further research are brought up from this review of the literature. There is very little research of this kind going on in the United States. More studies like these should be done in the United States so that Americanâs may benefit from a more effective treatment for the growing mentally ill population. There was never any large scale studies found and the conclusions were often vague and lacked any reliable results. It will be important for future studies on the efficacy of psychotherapy on inpatient psychiatric units to use larger populations of inpatients so that the results can be generalized and proven efficacious. Further research like this will hopefully provide evidence that psychotherapy may be used to help treat clients more effectively on inpatient psychiatric units.
11. References Arkowitz, H. and Lilienfeld, S. (2007, October/November). The best medicine? How drugs stack up against talk therapy for the treatment of depression. Scientific American Mind (pp.80-83). Retrieved from http://bama.ua.edu/~sprentic/101%20Arkowitz%20&%20Lilienfeld%202007.htm Buccheri, R., Trygstad, L., Buffum, M. D., Lyttle, K., & Dowling, G. (2010).Comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units. Issues in Mental Health Nursing, 31(3), 223- 231. doi:10.3109/01612840903288568 Comer, R. J. (2010). Abnormal psychology. (7th ed.) NY: Worth. Durrant, C., Clarke, I., Tolland, A., & Wilson, H. (2007). Designing a CBT service for an acute inpatient setting: A pilot evaluation study. Clinical Psychology & Psychotherapy, 14(2), 117-125. doi:10.1002/cpp.516 Forsyth, A., Weddle, R., Drummond, A., & Mann, S. (2008). Implementing cognitive behaviour therapy skills in adult acute inpatient settings. Mental Health Practice, 11(5), 24-27. Retrieved from EBSCOhost database Kerr, I. B. (2001). Brief cognitive analytic therapy for post-acute manic psychosis on a psychiatric intensive care unit. Clinical Psychology & Psychotherapy, 8(2), 117-129. doi:10.1002/cpp.251 McCann, E. E., & Bowers, L. L. (2005). Training in cognitive behavioural interventions on acute psychiatric inpatient wards. Journal of Psychiatric & Mental Health Nursing, 12(2), 215- 222. doi:10.1111/j.1365- 2850.2004.00822.x Mullen, A. (2009). Mental health nurses establishing psychosocial interventions within acute inpatient settings. International Journal of Mental Health Nursing, 18(2), 83-90. doi:10.1111/j.1447-0349.2008.00578.x Rodriguez, L. J. (2007). A closer look: The benefits and effectiveness of cognitive behavioral therapy on a female- specific unit for treatment of bipolar disorder. Issues in Mental Health Nursing, 28(5), 533-542. doi:10.1080/01612840701344498
Hinweis der Redaktion
I was interested in doing this topic because of my job working in an inpatient unit. Explain the purpose and hypothesis
give them some backgroundTell them the type of research that I looked at: research that showed the positive impact of psychotherapy
Start off by explaining that CBT has the most supporting data and why it the most effective treatment for most mental illnesses. CBT is used in most of the studies I looked at
Site the research that looked at using psychotherapy with certain symptoms or disordersExplain Kerrâs CAT and how it works Explain what mania and audio hallucinations are and how the therapy helped relieve these symptoms in the research
Explain Rodriguezâs case study and how the author thought that CBT was more effective then Soniaâs past treatment.
Look at a study that evaluated the use of psychotherapy with an entire inpatient unit so that the class can see the bigger picture of psychotherapy use.
Explain some of the studies that looked at the effects that using psychotherapy has on the staff at an inpatient unit. Explain why I wanted to include this in my paper. Point out that using psychotherapy can create a safer environment for clients and staff.
Tell the class my personal conclusion as well as those of the authors that I chose to look at. Conclusions for future research: tell them that I found very little research on this topic in the United States and tell them my own theory of why. Let them know I think it is important that studies like this be done in the U.S. Tell the class the limitations on most of the studies, which was that they use small samples, information is usually anactodal, conclusions were vague etc. Tell them that I think it is important that larger studies be done. Talk about the recent budget cuts in mental health care and how more studies like these will need to be done so that mentally ill people can have the best quality of care.
