Advanced Practice Nurses (APNs) use such information as psychological, lifestyle, history of trauma, and suicidal ideations obtained from the patient assessment data to recommend either cognitive (CBT) or dialectical behavioral therapy (DBT). Nursing evaluation is a fundamental step in providing healthcare services and plays an influential role in selecting and determining an appropriate treatment modality. Since various mental health disorders affect a person’s behavior and cognition differently, the suitable and most effective medical intervention for a given disorder varies. After comprehensively reviewing patient data, APNs recommend CBT or DBT due to the distinctive attributes influencing the suitability of each intervention. For instance, the former primarily supports patients to recognize and change problematic patterns of behavior and thinking while the latter helps people regulate extreme emotions and improve their interpersonal relationships. In this regard, healthcare practitioners should evaluate the available data to gather relevant information, identify the paramount clinical markers, and determine the most suitable therapeutic approach. Although CBT and DBT have proven effective across a wide array of mental health disorders, the decision to recommend any approach is influenced by the insights obtained from the patient assessment data.
Overview and Distinctive Characteristics of CBT
CBT is a psychotherapeutic treatment model, which focuses on identifying, challenging, and changing an individual’s maladaptive cognitive and behaviors, thereby enhancing the regulation of intense emotions and the development of coping mechanisms. According to Fordham et al. (2018), CBT is premised on the concept that distorted cognitions, emotions, and thoughts lead to psychological distress, behavioral and mental disorders. David et al. (2018) corroborate this view and assert that numerous mental health challenges develop and progress from how individuals perceive situations, influencing their reactions, feelings, and behavior. A person’s perceptions are often distorted and detrimental, especially when distressed due to the bidirectional nature of cognitions, thoughts, behaviors, and emotions (Hess et al., 2019). For instance, illusions of hatred by other people may lead a person to self-isolate, resulting in feelings of loneliness, despite such thoughts being unreal. Therefore, CBT suppresses such maladaptive imaginations and false beliefs, enabling individuals to think more realistically and effectively regulate their emotions and behavior.
Although CBT shares numerous features with other psychotherapeutic treatment modalities, it is distinguished by various distinctive characteristics. Among such distinct attributes is the fundamentally collaborative nature of the process between the therapist and the client, who are active participants in the undertaking (Campbell-Sills et al., 2017). Additionally, CBT is structured, problem-focused, and time-limited, with treatment sessions usually ranging between six and 20 (Pybis et al., 2017). It is also characterized by integrating behavioral interventions, summaries and feedback, and a guided discovery where the therapist uses carefully constructed questions to help the patient clarify their thoughts and beliefs.
Overview and Unique Features of DBT
DBT is a psychotherapeutic intervention, which emphasizes the patient’s social and emotional aspects to help them deal with unstable or extreme emotions and harmful behaviors. It focuses on assisting the individual in adjusting problematic thought patterns and equipping them with practical skills for managing the extreme emotional oscillations and improving their interpersonal relationships. May et al. (2016) contend that DBT accentuates the psychosocial component of the treatment, mainly how a person interacts and relates with others across diverse environments and connections. In this regard, the DBT approach recognizes that some people are susceptible to react more intensely and extraordinarily towards specific emotional scenarios, especially in relationships involving friends, family, and romance. By mitigating the resultant challenges occasioned by the intense emotional fluctuations, patients acquire essential tools and skills to focus on the underlying mental health issues, develop a healthy lifestyle, and improve their quality of life.
Distinctive Characteristics of DBT
Although DBT shares many similarities with other cognitive-behavioral interventions, it has various distinct attributes. One such unique aspect is the distinctive focus on dialectics, which emphasizes the need for acceptance, validation, and change (Livesley & Larstone, 2018). This implies that one of the fundamental obligations of the therapist is to help the client develop an attitude of acceptance of the realities and motivate the desire to change. Further, DBT integrates a component of group therapy to help the patient improve their interpersonal domains. This differs sharply from CBT, where the healthcare practitioner does not stimulate the client to accept the current situation or incorporate group sessions in the treatment modality. Therefore, DBT assists individuals in regulating extreme emotions and enhancing their interpersonal connections through validation, acceptance, and behavioral adjustments.
Relevant Clinical Assessment Markers Influencing the Recommendation of DBT or CBT
Different mental health disorders occur due to varying triggers, affect behavior and cognition distinctively, and require specific treatment intervention. This implies that the planning and assigning of an effective therapeutic modality is anchored on the APN’s ability to utilize the insights obtained from the patient assessment data. Beutler et al. (2016) argue that such tools as Systematic Treatment Selection provide therapists with empirically informed guidelines for determining the suitability of a particular therapeutic intervention depending on the patient’s overall profile characteristics. Such information as the patient’s level of anxiety, thought content and process, perception, and cognition fundamentally influence the choice of therapy recommended by the APN (Beutler et al., 2016). Clinicians should understand the underlying problems triggering the presenting symptoms as the basis for selecting a suitable intervention. For instance, APNs will recommend DBT to patients with chronic suicidal ideation occasioned by losing a close family member or challenging financial circumstances. In such a scenario, the suitability of DBT is informed by the need for the patient to accept the prevailing realities, expand distress tolerance, reduce emotional vulnerability, and strengthen the desire to change.
Conversely, APNs will recommend CBT to individuals with such cognitive distortions as false beliefs and ingrained negative thoughts, adversely affecting their mental and behavioral wellbeing. David et al. (2018) posit that therapists help their clients clarify thoughts, identify any maladaptation, and initiate corrective measures through guided discovery and carefully constructed questions. In this regard, the occurrence of distorted thoughts and behaviors despite the absence of a real traumatic or undesirable event will influence the APN’s decision to recommend CBT instead of DBT. Additionally, the patient assessment data will provide valuable insights on the patient’s substance abuse history, impulsivity, any risks of aggression, self-harming behavior, and determine whether it is the basis of the destructive thinking and behaviors. Therefore, such information as current life circumstances, history of trauma and substance abuse, and the presence of self-destructive thoughts ultimately influence the APN’s to recommend one therapeutic strategy over the other.
Barriers APNs Face when Engendering Patient Compliance for Treatment
APNs encounter multiple barriers deterring patients from accepting and complying with the prescribed treatment modality. Among such impediments are anosognosia and the client’s denial of the severity of the illness. A significant proportion of mental health patients are reluctant to acknowledge the extremity of their condition, which adversely affects their willingness to accept and comply with treatment (Muhorakeye & Biracyaza, 2021; Kvarnström et al., 2018). Additionally, negative beliefs, societal, and self-stigmatization of patients seeking therapeutic support impede the ability of APNs to convince clients to comply with the prescription. For instance, individuals with mental health issues may develop internalized shame over their condition, eventually eroding treatment compliance.
Moreover, mental health system impediments, including the absence of integrated and seamless specialty healthcare services, hamper the provision, continuity, and compliance with prescribed modalities. For instance, Wakida et al. (2018) note that there is poor integration of mental health services into primary healthcare, which complicates the provision and acceptability. Other barriers include low mental health literacy, financial challenges, the significantly poor penetration of multicultural competence, and the continuous nature of the treatment. These barriers cumulatively affect the patient’s potential of complying with the prescribed intervention.
Conclusively, cognitive behavioral therapists utilize the insights obtained from the comprehensive patient assessment data to help individuals struggling with mental health challenges. They assist clients in identifying depressing thoughts, evaluating their rationale, and teaching new information-processing approaches and coping mechanisms through CBT or DBT. The former is a problem-oriented and action-focused therapeutic intervention whose overall objective is to assist patients in recognizing and changing problematic or distorted thought and behavioral patterns. The latter emphasizes the acceptance of the realities and equips clients with valuable skills to mitigate the extreme emotional fluctuations. Although the two approaches are highly effective across numerous mental health problems, their suitability is influenced by the clinical hallmarks and insights obtained from the patient assessment data.
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