PGC851 Clinical Health Psychology And Wellbeing

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PGC851 Clinical Health Psychology And Wellbeing

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PGC851 Clinical Health Psychology And Wellbeing

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Course Code: PGC851
University: Middlesex University

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Country: United Kingdom

Question
Critically evaluate the evidence for the effectiveness of two distinct therapeutic approaches in the treatment of a specific psychological disorder.

Answer
Description of the case study
The case study is about the management of bipolar disorder through cognitive behavior therapy. As per the article (Chiesa, & Serretti, 2011), the objective of the case study was to find out the effectiveness of cognitive behavioral therapy in the management of bipolar disorder in adults. The case involves Mr. X who was presented with symptoms such as insomnia, depressive mood, poor judgment, racing thoughts and changes in mood. Mr. X is 52 years old and he is a married man. After administration of different psychological tests, Mr. X was provided with a proper psychotherapeutic period. As per the case, doctors applied cognitive behavior therapy to the client as he was suffering from swings mood. After all sessions of cognitive behavioral therapy were applied, the results showed a reduction of BDI score, 23 before therapy and 7 after therapy which indicated that bipolar disorder symptoms almost diminished.
The other case study (Reinares, Sánchez-Moreno & Fountoulakis, 2014) involves the use of family intervention therapy in the management of bipolar disorder. The study involves a double-blind controlled study of groups of psychoeducation which was conducted over a six month period for individuals who had bipolar disorder. It included a prospective follow up of at least three years. As per the case, the control group received the usual medical therapy. Their implementation was shown to be effective in managing bipolar symptoms. Therefore, in regards to their findings, the researchers concluded that family intervention therapy as one of the physiotherapies that can be used to manage bipolar disorder.
Description of disorder/Psychological problem
Bipolar disorder is a mental disease that leads to extreme mood changes referred to as mania and hypomania. The main signs and symptoms of bipolar disorder include depressed mood like a feeling of hopeless and sad, loss of interest in activities and significant weight loss. The loss of weight may be as a result of a decrease in appetite (Farhi, et al., 2016). Other symptoms of bipolar include thinking or attempting suicide, feeling of worthlessness and indecisiveness (Geddes & Miklowitz, 2013).  
As per to the National Institute of Mental Health, bipolar mental condition impacts more than 5. 7 million adults in and the typical age of onset is during the early 20s. As per from the archives general psychiatry, it is considered that the prevalence of bipolar condition is about 2.4 percent worldwide (Ferrari, et al., 2016). The disorder severity, patterns of comorbidity and impact on daily life remained the same even though the prevalence differed from one nation to another.
Countries with high income had the highest prevalence of the disorder whereas the nation with lower income had the lowest prevalence (Hibar et al., 2016). Effects of bipolar can be felt both into the lives of patients and those around them. The disorder affects relationships, work, schools performance and many other aspects of one’s daily life (Reinares, Sánchez & Fountoulakis, 2014). 
Description of therapies
Cognitive behavioral therapy can be referred to short-term psychotherapy treatment. The treatment involves a hands-on and practical approach to the problem-solving. Its main objectives are to change patterns of patient behavior or thinking that are behind patients difficulties.  This goal-oriented psychotherapy works by changing the patient’s attitude, beliefs and images.  It is utilized to cure different forms of difficulties such as person’s life issues and drug abuse.
Cognitive behavior therapy builds sets of skills to bipolar individuals that enable them to be aware of thoughts and emotions (Beck, 2011). Cognitive behavior therapy involves therapist identifying how the situation, thoughts, and behavior influence the emotions of an individual. It works by improving the feelings, thoughts, and behavior of the bipolar patient.
On the other hand, family therapy involves a variety of psychoeducation psychotherapy whose main objective is to educate bipolar disorder patient and their families about the nature of their mental disorder (Barde & Bellivier, 2014). It is distinguished from other psychotherapies by the way it involves attention to family relationship and dynamics that play a key role in managing bipolar disorder (Reinares, et al., 2010). It involves teaching patient and their family member about the nature of the bipolar disease, its treatment, and different ways members they can support each other in the management of bipolar disorder.
Family intervention therapy has come to occupy the central position in the management of bipolar disorder.  Family therapy involves several techniques such as structural therapy, Milan therapy, strategic therapy, transgenerational therapy, and narrative family therapy. Structural therapy is a theory that was developed by Salvador Minuchin. It was aimed at assessing power dynamics within the family unit. Currently, it is utilized by many therapists to empower bipolar patients and their family members. Another family technique Milan a family therapy technique which seeks to dismantle beliefs that perpetuate causes conflict within the family members. The other family therapy technique is strategic therapy which closely determines patterns of interaction and conflict within the family member. The technique is utilized by therapists to increase awareness of a certain condition or issue such as bipolar disorder within the family.
Furthermore the narrative family therapy which is utilized by therapists to help person with depression or mental disorders and their families to change their personal narrative by either embracing or recognizing individual gifts, positive qualities and skills in order to help them conquer their issues that they may be facing as a family. The fifth type of family therapy technique used by therapists is transgenerational therapy which is used to examine intergenerational relationships and conflicts within family. Family therapy mostly is a short term intervention that can take four up to twenty sessions. Therapists may use either one or a combination of family therapy techniques depending on the issues and needs of the family.
Discussion of Treatment evaluation studies
The type of study involved in this case is case report where it reports on how effective cognitive behavior therapy was to Mr. X. The case report includes abstract, introduction and literature review on the use of psychotherapy for a bipolar mental disease. The case report also includes the results of the study and discusses these results with the help of a literature review.
The findings of the case study provide evidence of the effectiveness of cognitive behavior therapy in the management of bipolar patients although the evidence is limited. The authors of the article include BDI score before and after therapeutic sessions, the evidence that will determine whether cognitive behavioral therapy was effective in Mr. X’s case. The authors also include mood disorder questionnaire which also gives evidence of effectiveness of cognitive behavioral therapy which was applied to Mr. X. as per the case study, the BDI baseline score was 23 before the therapeutic sessions but after the treatment, the client’s BDI score was 7, an indicative of bipolar symptoms was almost done . Also, the mood disorder questionnaire after therapeutic sessions indicated a decrease in symptoms of bipolar mental disease (Lam, Jones, & Hayward, 2010).  
The study has some limitation that makes it somehow not best in presenting information about bipolar disorder therapy. One of the limitations is that it presents clinical case studies which are always generalized. This means that most of the information presented is generalized and thus some information may be misleading. The case study has used a case of one client instead of several clients suffering from bipolar disorder and thus the information provided is not adequate and maybe somehow misleading as behavioral characteristics of patients vary.
Secondly is that is longitudinal research is required for determining the development of bipolar in the whole lifespan which is not provided by the article research. Also, only cognitive behavior treatment was applied in the case regarding the need of the patient and thus other types of psychotherapies may be more effective in the treatment of bipolar disorder (Geddes & Miklowitz, 2013).
The type of this study involved in this article is a systematic review. This includes a summary of clinical literature regarding psychosocial interventions in bipolar disorder. The systematic review was carried out in Pubmed for articles which were published from 2000 to 2010. Considering the case of family therapy, the bibliographic search found eleven articles which were related to bipolar disorder. There was no control group and the study had redundancy as a result of the search.
One of the limitations of the article is that the search for articles was not methodological systematic, although its development implied conducting an extensive review of research on psychosocial aspect in approach to bipolar symptoms. Also, the article is limited to its review in that it only includes the articles which were published in a short period of time. Moreover, the article includes only one search Pubmed and does not include other health-related searches.
Summary and Conclusion
All forms of therapy treatment in regards to bipolar disorder have their merits and demerits. Cognitive behavioral therapy may one on one interaction with a therapist or involves a group of therapists and other and individuals with bipolar symptoms. Cognitive behavior therapy can be used to managing the symptoms of bipolar disorder, prevention of behaviors which can lead to relapse into the bipolar disease, help control emotion and stress and, can also act as an alternative treatment when other medications are not the best option (Beck, 2011). The main aim of cognitive behavior therapy is to help patients to gain a new outlook by changing negative thoughts and fears to positive thoughts. In conclusion, Cognitive behavior therapy is effective in curing bipolar disorder as it builds sets of skills to individuals that enable them to be aware of thoughts and emotions (Steele, Maruyama & Galynker, 2010). It also works by improving the feelings, thoughts, and behavior of the bipolar patient.
On the other hand, family therapy involves different forms of psychoeducation whose main aim is to educate bipolar disorder patients and their families on ways they can manage the disorder (Miklowitz, 2010).  It involves teaching patient and their family member about the nature of the bipolar disease, its treatment, and different ways members they can support each other in the management of bipolar disorder. As per (Reinares, et al., 2010), family therapy is effective in the management of bipolar disorders as evidently shown in research studies.  Family intervention therapy has come to occupy the central position in the management of bipolar disorder and it involves several techniques such as structural therapy, Milan therapy, strategic therapy, transgenerational therapy, and narrative family therapy. Therapists may use either one or a combination of family therapy techniques depending on the issues and needs of the family (Piet,  & Hougaard, 2011).
Both cognitive behavior therapy and family intervention therapy are effective in the management of bipolar mental condition and their effectiveness depends on the clinical characteristics of an individual (Hofmann et al., 2012). In reference to the clinical characterizes of each individual it is crucial to consider only one type of psychotherapy that may be more effective.
References
Barde, M., & Bellivier, F. (2014). Treatment of bipolar disorder. La Revue du praticien, 64(9), 1195-1202.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford press.
Chiesa, A., & Serretti, A. (2011). Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry research, 187(3), 441-453.
Ferrari, A. J., Stockings, E., Khoo, J. P., Erskine, H. E., Degenhardt, L., Vos, T., & Whiteford, H. A. (2016). The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar disorders, 18(5), 440-450.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682.
Hibar, D. P., Westlye, L. T., van Erp, T. G., Rasmussen, J., Leonardo, C. D., Faskowitz, J., … & Dale, A. M. (2016). Subcortical volumetric abnormalities in bipolar disorder. Molecular psychiatry, 21(12), 1710.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.
Lam, D. H., Jones, S. H., & Hayward, P. (2010). Cognitive therapy for bipolar disorder: A therapist’s guide to concepts, methods and practice (Vol. 101). John Wiley & Sons.
Miklowitz, D. J. (2010). Bipolar disorder: A family-focused treatment approach. Guilford Press.
Miklowitz, D. J., Schneck, C. D., Singh, M. K., Taylor, D. O., George, E. L., Cosgrove, V. E., … & Chang, K. D. (2013). Early intervention for symptomatic youth at risk for bipolar disorder: a randomized trial of family-focused therapy. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 121-131.
Piet, J., & Hougaard, E. (2011). The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clinical psychology review, 31(6), 1032-1040.
Reinares, M., Colom, F., Rosa, A. R., Bonnín, C. M., Franco, C., Solé, B., … & Vieta, E. (2010). The impact of staging bipolar disorder on treatment outcome of family psychoeducation. Journal of affective disorders, 123(1-3), 81-86.
Reinares, M., Sánchez-Moreno, J., & Fountoulakis, K. N. (2014). Psychosocial interventions in bipolar disorder: what, for whom, and when. Journal of affective disorders, 156, 46-55.
Steele, A., Maruyama, N., & Galynker, I. (2010). Psychiatric symptoms in caregivers of patients with bipolar disorder: a review. Journal of affective disorders, 121(1-2), 10-21.

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