Introduction
With the growing concern of behavioral disorders, nurses are becoming increasingly concerned about the effect of different developmental stages on the personality outcome in children. Nurses working with children often report certain kind of behaviors that may impede the process of care, in severs, cases, children end up with psychological problems that demand special psychiatrist attention. Behavioral disorder management units take care of people identified with some developmental problems, this paper will use a literature review method to discuss the application of cognitive behavioral therapy approach in management diagnosed at disturbed. To answer the research question, this study will explore theories behind behavioral development process, solution, previous research on the subject and methodologies applied by the researchers as well as research findings.
Literature Search
Behavioral development disorder is a common problem, thus, there is a large amount of research on the subject. This study will use secondary sources of data, a literature review of selected sources will be handy in the generation of data on the subject. The source used in this research generated from online databases that include EBSCOhost, PsychINFO, Education Research Complete and the CINHAL databases. Source used were selected using qualification criteria, only sources published in English and not older than 2000 were used in the research. The studies must also involve human subjects, either qualitative, quantitative or systematic review approaches used in generating data. Keywords used in the literature search include:
- Cognitive behavioral therapy AND personality Development
- Child group cognitive behavioral therapy
- Cognitive behavioral therapy AND disturbed children
Six articles qualified for use in the review after assessment of the sources based on the qualification criteria. Below is an annotated bibliography of the articles used in the research in terms of theoretical framework, method, analysis tools, findings, conclusion, limitation, and strengths.
Annotated Bibliography
Martin, A., Volkmar, F., & Lewis, M. (2007). Lewis’s child and adolescent psychiatry. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
The author explores the application of Lewis’s model and child and adolescent counseling for better behavioral development. The author bases arguments on Family System Theory. The author uses a literature review method to explore the subject, the sample article used consisted of publications in personality development. The researcher integrates clinical research and realities of personality development. The author found that and skipping critical stages of interaction, improper social integration and desire for perfecting children by the parent might lead to behavioral development problems. While the study has the strength of using credible data, it does wholly depend on secondary data, thus, the research may be flowed by original source author biases. Nevertheless, the use of literature allows the researcher to gather information from different authors on the subject hence increasing the applicability of the findings.
Avny, S., & McLeod, B. (2010). Group CBT reduces child anxiety diagnoses compared with nonspecific group support. Evidence-Based Mental Health, 13(1), 18-18. http://dx.doi.org/10.1136/ebmh.13.1.18
Avny and McLeod compared the effectiveness of group psychiatrist support to individualized support. The researcher modeled the study in accordance with Strength Based Theory concepts. The sample population consisted of 112 children between the ages of 7 and 16 diagnosed with anxiety disorder. Approaches used include group CBT and attention GSA. Intervention approaches involved cognitive restructuring, social skill training, gradual exposure, assertiveness and personal management. The outcome of the process was analyzed based pm exposure tasks. The study found that CBT at the group level is effective in reducing child anxiety compared to other counseling procedures. By using actual respondent, the study generated credible data with possibilities of deployment in actual cases; however, the study is limited in terms of generalization due to small nature of the patient population and focus on a limited cultural context. The findings can be improved by expanding the subject population and research region.
Staal, J. A. (2012). Functional analytic multisensory environmental therapy for people with dementia. International Journal of Alzheimer’s Disease, 2012.
The research is based on identifying the effects of environmental based therapy in the treatment of people with dementia. On the process, however, the same ecological therapy approaches can be used in disturbed children cases. The use of environmental methods is a powerful approach to the treatment and management of disturbed children on cognitive attributes. The research carried out to determine the effectiveness of the process. The outcome was that environmentally managed dementia treatment had an efficient treatment outcome that affected the overall treatment. The paper introduces the FAMSET method of addressing and managing dementia. Which entails the use of multisensory environmental factors such as “within session techniques, integrating behavioral interventions with emotion-oriented care.” The research proves that these approaches play an essential role in the treatment and management of the condition and similarity can be included in the treatment of disturb children.
Haugland, B. S. M., Raknes, S., Haaland, A. T., Wergeland, G. J., Bjaastad, J. F., Baste, V., … & Hoffart, A. (2017). School-based cognitive behavioral interventions for anxious youth: study protocol for a randomized controlled trial. Trials, 18(1), 100.
The article identities cognitive based therapy as an efficient process in managing the case of disturbances in youths and children suffering from disturbed behaviors. The process in this case is approached in the school setting to cater for the inclusion of the children into the regular daily routine but also enabling a sense of care and management of their condition. The inclusivity ensures that the children do not develop following cases of depression on top of their condition but can interact with others in the school environment while still managing their conditions. CBT in school gives the children access to readily available facilities and services for their assistance. The facilities in the institutions enable the requirements to be managed efficiently and achieve a sensible and productive condition process.
Chien, H. C., Chung, Y. C., Yeh, M. L., & Lee, J. F. (2015). Breathing exercise combined with cognitive behavioral intervention improves sleep quality and heart rate variability in major depression. Journal of clinical nursing, 24(21-22), 3206-3214.
This article approaches the discussion based on the effects that the CBT has on the victims or the patients whose conditions are being addressed using the methods. Sleep quality is identified as the primary outcome of the process. Disturbances in children health and cognitive behaviors have a negative effect on the sleep quality for the children. Based on this article, the contribution of the therapy to the sleep quality and heart health are discussed. Lack of sleep and depression are related in many cases. The effect of the behavioral intervention has a substantial effect on the impact the condition has on the family, the victims and their general health. With limited sleep especially in children, health challenges are liable to attack. The methods, however, can address these cases and effect good health.
Seng, E. K., & Baskin, S. M. Psychological Approaches to Headache.
Disturbances in children also consist of random and prevalent cases of headaches; it is essential therefore to address the heightened instances of problems in the treatment and management process. This journal article approaches the CBT through the process of treating the headaches and minimizing their contribution to the general disturbances in the children. The methods that are applied are focused on the process that can be used in addressing the headaches but the effects as described entail the process of handling the overall disturbances cases. The therapy approach enables the victim to attain a condition peaceful conditions. Progressive cases of a migraine in the children and other members of the society, in this case, affect the health and depression management in the victims. The article, therefore, approaches the condition from an angle aimed at managing the effects of the depression and in the same process enables the victim to achieve a suitable state where the disturbance is managed.
Boyle, C., Lynch, L., Lyon, A., & Williams, C. (2010). The use and feasibility of a CBT intervention. Child and Adolescent Mental Health, 16(3), 129-135. http://dx.doi.org/10.1111/j.1475-3588.2010.00586.x
The authors discuss the applicability of CBT in a different context and the possibilities achieving better feasibility. The study does not have a specific theoretical framework but borrows from a wide range of behavioral theories including Sigmund Freud’s psychodynamics and Strength-Based Theory. The sample population consisted of 280 school pupils in their second year of study subject to two life-skills lessons daily. The data were analyzed using descriptive questionnaire while qualitative data collected through teacher-pupil focused group. The study showed the 64.5% accepted to have learned something, 48.4% would recommend it to a friend. 56.3% agreed that the lessons were interesting whole 43.1% felt motivated. Content analysis of the intervention identified central themes as acceptability, change, guidance and target population showed in quantitative data. Overall, the research concluded that CBT had great potential, affordable and effective intervention for group mental intervention. The study was experimental in nature provided guiding results on the relevance of CBT application in the real world, however, the study might suffer from human factors, the judgment on impact may be influenced personalities unrelated to the context of the investigation. The lack of an approach to limit errors means that the study has limited application unless under settings.
Lundkvist-Houndoumadi, I., & Thastum, M. (2015). Anxious Children and Adolescents Non-responding to CBT: Clinical Predictors and Families’ Experiences of Therapy. Clinical Psychology & Psychotherapy, 24(1), 82-93. http://dx.doi.org/10.1002/cpp.1982
The aim of the research was to identify situations in which children and youths might be unresponsive to CBT intervention. The researcher used Sigmund Freud’s psychodynamics theory in a mixed method approach to study the case. The sample population consisted of 106 youths between age 7 and 17 diagnosed with anxiety disorder. The sample was identified using clinical global impression of improvement scale in a 3-month follow up. 22.6% of the subjects did not respond to the intervention, a regression analysis showed that youths with social phobia might not respond positively to CBT intervention. Youths with a comorbid mood disorder were four times likely to be non-responsive to CBT. The data were analyzed using the interpretative phenomenological method. Two-control setup was also used to verify the data, the two groups were youths not subjected to therapy and manualized group format. The mixed method approach provided a new perspective interpretation of challenges that may lead unresponsiveness to therapy. The author suggests that some children do not gain from CBT interventions; it will be helpful in identification of cases for better intervention tools. By using an experimental approach, the researchers’ generated data that could be applied on a wider scale, however, the study has the limitation of ignoring other factors that might have led to unresponsiveness.
Sawyer, M., & Nunez, D. (2014). Cognitive-Behavioral Therapy for Anxious Children: From Evidence to Practice. Worldviews on Evidence-Based Nursing, 11(1), 65-71. http://dx.doi.org/10.1111/wvn.12024
The authors note that anxiety is a common problem in children, even with the high prevalence of the problem, just a small portion of children seek medical help. The researchers posit that cognitive behavioral therapy is the first line of solution to the problem. However, feasibility, affordability and transportability problems limit the application of cognitive behavioral therapy in actual practice. The research aims to unearth the reasons behind the discrepancies in access and application of CBT in a medical setting and offer suggestions to overcome the problem. The research does not employ a specific theoretical framework, but review literature based on Strength-Based Theory. The researchers use a systematic review of research articles published between 2007 and 2012, the sources used in the research were identified through Cochrane, PubMed, CINAHL, and PsycINFO database search. The literature used involved over an hour-long session for a period of 12 visits. Ten of all the sources identified provided sufficient data suggesting that CBT was effective for the intervention group as compared to the control group; the sources also showed that CBT was more effective than comparable therapies. However, a combination of CBT and pharmacological management proved to be more effective than when CBT was used alone, suggesting that including elements of pharmacological management within CBT could improve the outcome. The study recommended that meeting clinical demands and patient needs, it is important to address feasibility and affordability characteristics. The study concluded that CBT is an effective evidence-based approach to solving child development problems, especially about anxiety. The use of literature review approach allowed the researchers to compare findings from different authors hence coming up with a generalized conclusion, however, the use of secondary sources without error reduction approach allowed author biases to affect the study findings thus raising concerns on the applicability of the conclusion.
Nielsen, M. (2015). CBT group treatment for depression. The Cognitive Behavior Therapist, 8. http://dx.doi.org/10.1017/s1754470x15000173
Nielsen explores depression as a common problem; it also outlines the application of CBT in the management of depression, it documents CBT is an effective solution to the problem. The study is experimental involving 48 participants from Specialized Treatment Unit for Depression and Anxiety at the Psychiatric Centre Copenhagen, Bispebjerg Hospital. The study involved a follow-up running over a 5-year period. The study relied on Strength-Based Theory. The patient had been diagnosed with depressive symptoms. The results were measured using Beck Depression Inventory (BDI-II) score; relapse was measured using the rate of readmission. The study showed that CBT had was effective in reducing depressive episodes during the study period and that it was effective in reducing the readmission rates. The study documented strengthening of social skills and self-esteem from the patient feedback. By using experimental study, the study mimicked actual clinical setting thus have a good applicability in the actual scenario, the researchers also used standard tools to measure the impact of the intervention. However, the study could benefit from extensive literature review to remove environmental biases that may affect the study conclusion and improve its validity.
Historical Review of Framework
As the name suggested, cognitive behavioral therapy emerged as an application of two components that shapes personality, this are the cognitive abilities and the expressed behavior. The theory combined emotions, family and environmental influence on personality development and the resulting behavior. The framework is a discovery by Dr. Aaron T Beck in the 1960s while working as a psychiatrist at the University of Pennsylvania. His practice allowed him to conduct research on different elements defines personality disorders. The theory integrates influences from behavioral therapy and cognition. Since its discovery, the theory has been effective in patients of all ages.
Theoretical Framework
The articles included in the study involved follow up or systematic review of the literature. The literature used focused on either application of cognitive behavioral therapy in the management of anxiety disorder, traumatized children, the feasibility of application or comparative study on the relative effect of CBT and other approaches in the treatment of developmental disorders. One of the articles is a book while five are peer-reviewed articles. Two research was a literature review and four sources were experimental studies.
The literature involves three major theories. One of the theories identified in the study Psycho Theory developed by Sigmund Feud, the application of this theory was evidenced in two studies Lundkvist-Houndoumadi & Thastum (2015) and Boyle, Lynch, Lyon & Williams (2010). The theory assess behavior based on the cognitive structure and the environmental interaction with other components that affects behavior. The baseline theory is that human personality is a factor of their id, ego, and superego. The interaction between these components creates the totality of personality. The studies reviewed focused on the application of this potential to solve personality disorders. According to the theory, experiences from the past have the potential of influencing present behaviors. (Lundkvist-Houndoumadi & Thastum, 2015) invoked the theory in attempting to rewire personality by creating new experiences while Boyle, Lynch, Lyon & Williams (2010) studied the applicability of the theory, both studies documented that CBT based on Sigmund Feud’s theory produced positive results. However, a problem with the theory as applied in the studies is that it failed to explore other components other than cognition that may influence behavior.
A second theoretical framework used by researcher is the Family Systems Theory, this was an evidenced in a study by Martin, A., Volkmar, F., & Lewis, M. (2007). The theory proposes that each member of a family is affected by the structure, organization and transactional nature of the family. In the setting, when the family exerts an inappropriate force on a child, the child might develop anxiety or depressive symptoms. However, these effects could be reverted to cognitive behavioral therapy. The design of the study revealed several case scenarios in which the theory affects behavior and possibilities of overcoming the negative outcomes. A problem with the theory is that it ignores the uniqueness of individuals and the diversity of outcome when applied to the developmental process.
The strength-based theory was also applied in the study, four studies, Nielsen (2015), Sawyer & Nunez (2014), Boyle, Lynch, Lyon & Williams (2010) and Avny & McLeod (2010) conducted experimental studies to understand the applicability of the theory in the management of personality disorders. Empowerment theory explores the process by which individual access resources such as personal skills and take control of systems such their lives. The subjective element of the theory is self-efficacy, this is the ability of one to access and regulate events in their lives. The objective component is individual’s own strength to dictates outcomes. The researcher revealed that the success of a cognitive behavioral therapy depended on how much is empowered a child to rise above their behavioral challenges. The four studies implemented social activities to help individual employ their own strength to help overcome trauma. During the intervention, children were able to explore their personality. The four studies suggested that the subjects showed remarkable progress. However, the theory did not take into consideration familiar structure that makes work to revert the progress.
Summary of the State of Science
Current research explores the different approaches to management of child development disorder, however, there is a need for future research to explore the implication of child CBT on parents. In most the studies, the researcher focused on the child and ignored the implication of the therapy approach on the parent, some theoretical frameworks used, such as family system theory, can have significant implications on the family system. The validity of this design can be improved through randomized controlled trials, the findings can also improve the applicability of the intervention. The study suggests that more nurses should be trained on care approaches for psychologically disturbed patients; this will improve the ability of nurses to deliver quality care.
References
Avny, S., & McLeod, B. (2010). Group CBT reduces child anxiety diagnoses compared with nonspecific group support. Evidence-Based Mental Health, 13(1), 18-18. http://dx.doi.org/10.1136/ebmh.13.1.18
Boyle, C., Lynch, L., Lyon, A., & Williams, C. (2010). The use and feasibility of a CBT intervention. Child and Adolescent Mental Health, 16(3), 129-135. http://dx.doi.org/10.1111/j.1475-3588.2010.00586.x
Chien, H. C., Chung, Y. C., Yeh, M. L., & Lee, J. F. (2015). Breathing exercise combined with cognitive behavioural intervention improves sleep quality and heart rate variability in major depression. Journal of clinical nursing, 24(21-22), 3206-3214.
Haugland, B. S. M., Raknes, S., Haaland, A. T., Wergeland, G. J., Bjaastad, J. F., Baste, V., … & Hoffart, A. (2017). School-based cognitive behavioral interventions for anxious youth: study protocol for a randomized controlled trial. Trials, 18(1), 100.
Lundkvist-Houndoumadi, I., & Thastum, M. (2015). Anxious Children and Adolescents Non-responding to CBT: Clinical Predictors and Families’ Experiences of Therapy. Clinical Psychology & Psychotherapy, 24(1), 82-93. http://dx.doi.org/10.1002/cpp.1982
Martin, A., Volkmar, F., & Lewis, M. (2007). Lewis’s child and adolescent psychiatry. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Nielsen, M. (2015). CBT group treatment for depression. The Cognitive Behavior Therapist, 8. http://dx.doi.org/10.1017/s1754470x15000173
Sawyer, M., & Nunez, D. (2014). Cognitive-Behavioral Therapy for Anxious Children: From Evidence to Practice. Worldviews on Evidence-Based Nursing, 11(1), 65-71. http://dx.doi.org/10.1111/wvn.12024
Seng, E. K., & Baskin, S. M. Psychological Approaches to Headache.
Staal, J. A. (2012). Functional analytic multisensory environmental therapy for people with dementia. International Journal of Alzheimer’s Disease, 2012.