UNIVERSITY OF SANTO TOMAS – COLLEGE OF NURSING Formatted

Espana Boulevard, Sampaloc, Manila, Philippines 1015

Tel. No. 406-1611 loc.8241 | Telefax: 731-5738 | Website: www.ust.edu.ph

Name: Nica Sharmaine C. Salazar Date: May 15, 2018

Year and Section with RLE: 3NUR-8 RLE 8.5 Clinical Instructor: Sir Beryl Batad

I. Title of the Article:

A. Cognitive-Behavioral Therapy for Bipolar Disorder: Implications for Clinical Social Workers
B. Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of
randomized controlled trials

II. Author:
A. Virgil L. Gregory, Jr
B. Kai-Jo Chiang, Jui-Chen Tsai, Doresses Liu1, Chueh-Ho Lin, Huei-Ling Chiu, Kuei-Ru Chou

III. APA format of bibliography:

A. Gregory, V. L. (2010). Cognitive-Behavioral Therapy for Bipolar Disorder: Implications for
Clinical Social Workers. Journal of Social Service Research,36(5), 460-469.
doi:10.1080/01488376.2010.510950
B. Chiang, K., Tsai, J., Liu, D., Lin, C., Chiu, H., & Chou, K. (2017). Efficacy of cognitive-
behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled
trials. Plos One,12(5), 1-19. doi:10.1371/journal.pone.0176849
 Questions:
1. What is the significance of the research articles you have chosen to your Related Learning
Experience?

These articles first and foremost might help me appreciate more my exposure to the area
where in concepts in Psychiatric nursing are being applied. These articles are significant because
it both tackle the knowledge and the implications of the nursing practice in the Field of Psychiatric
nursing. More importantly, both articles talk about intervention that may alleviate the patient’s
condition. Furthermore, these articles provided the readers with essential knowledge and
information regarding Cognitive-Behavioral Therapy. These articles will help me improve the
quality of care that I am to give to my patients who have Psychiatric problems and will give us
more knowledge on how to properly manage the patients’ condition and at the same time
providing safety. Both articles also gave importance to the role of the Cognitive-Behavioral
Therapy in improving the patient’s condition. The articles additionally, gave importance to the
clinical social workers who are responsible in taking care and rendering CBT to patients with
psychiatric disorder specifically, Bipolar Disorder.

2. What are the implications of the findings to your patient care?

Article A mainly focused on the implications of Cognitive-Behavioral Therapy in Clinical

Social Workers. On the other hand, Article B focused on the efficacy of Cognitive-Behavioral
therapy. In line with this, these studies will not only improve the patient care but will also develop
the skills of the clinical social workers in terms of rendering therapy, particularly the CBT or
Cognitive-Behavioral Therapy. It was indicated in the study that Clinical Social workers who are
considering the use of Cognitive-Behavioral Therapy must be well-aware of the factors that may
limit the use of CBT like those who have many past episodes, complicated cases and those who
are in the latter phase of their disorder. This therapy, supported by Article B also serves as an
alternative therapy to medications in patients with Bipolar Disorder because it was proven to
decrease levels of depression and mania, decrease relapse rates, and increase the levels of
psychosocial functioning.
3. What interventions/innovations/relevant new findings was/were used or implemented in the
study/studies reviewed?

The first and second studies are not entirely different considering they both use Cognitive-
Behavioral Therapy in treating patients with Bipolar Disorder. They both refer to ways in which
we can take care for patients appropriate to their conditions. The first study pointed out that the
role of the Clinical Social Workers is indeed essential in providing specialized care, critical
judgment in completing the care and the assistance needed by patients with Bipolar disorder. the
intervention/s used in the study is the rendering of Cognitive-Behavioral Therapy in patients with
Bipolar Disorder. Cognitive-Behavioral Therapy (CBT) is a short-term, goal-oriented
psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is
to change patterns of thinking or behavior that are behind people’s difficulties, and so change the
way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping
difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT
works by changing people’s attitudes and their behavior by focusing on the thoughts, images,
beliefs and attitudes that are held (a person’s cognitive processes) and how these processes relate
to the way a person behaves, as a way of dealing with emotional problems Martin. B (2018).
According to Article A, Specific objectives of CBT for BD are to teach clients cognitive-
behavioral skills for managing manic-depressive symptoms, educate clients about BD, enhance
compliance with pharmacotherapy, teach clients to effectively cope with stressful events, and
teach clients to monitor the frequency and intensity of their symptoms. Core cognitive-behavioral
techniques, such as daily thought records, the evidence for and evidence against method, cost-
benefit/advantage-disadvantage analysis, consideration of alternative explanations, behavioral
experiments, problem solving, and activity scheduling (J. S. Beck, 1995; Leahy, 2003), have been
applied to the treatment of BD (Otto et al., 2002). It is not yet known which cognitive-behavioral
treatment manual is most successful (Johnson & Tran, 2007).
4. Identify which level of evidence does the selected researches belong:

Both studies are in Level I because the Evidences used came from systematic reviews of
all relevant randomized controlled trials or evidence-based clinical practice guidelines based on
systematic reviews of Randomized Controlled Trials.

5. Create a table and answer the following questions to compare the two studies that you have
identified:

Article A Article B Formatted Table

Population of Not mentioned patients with type I or II BD

Interest

Sample Size Not Mentioned A total of 19 RCTs comprising

1384 patients

Sampling Random Sampling Random Sampling

Technique

Interest of the Study The purposes of this review article are The present review and meta-
to orient clinical social workers to analysis evaluated the treatment
cognitivebehavioral theory, outcomes of patients with BD
intervention, and research on bipolar treated with CBT plus
disorder (BD); identify pros and cons medication and compared these
of applying cognitive-behavioral data with the outcomes of those
therapy (CBT) to social work clients who received standard care
with BD; and identify specific alone
implications for clinical social work
practice.
 Current Applicable Cognitive-Behavioral therapy Cognitive-Behavioral therapy
Practice Psychiatric Nursing Psychiatric Nursing

Outcome The empirical evidence as well as the CBT is effective in decreasing

actual and potential clinical
advantages suggest that the treatment
is a promising intervention for clinical
social workers to consider using,
provided they have proper training
and appropriate clinical supervision.
the relapse rate and improving
depressive symptoms, mania
severity, and psychosocial
functioning, with a mild-to-
moderate effect size. Subgroup
analyses indicated that
improvements in depression or
mania are more potent with a
CBT treatment duration of
>=90 min per session, and the
relapse rate is much lower
among patients with type I BD.

6. Does the interventions/topic support/contradict current nursing practice? Support you answer
using other relevant references?
According to the concepts tackled in our Psychiatric Nursing, Cognitive-Behavioral
Therapy is an effective treatment for various psychiatric disorder, thus, it supports the current
psychiatric nursing practice. According to Article B Cognitive-Behavioral Therapy or CBT is the
non-pharmaceutical intervention of choice for patients with depression and anxiety, the core
concept and treatment practice model were developed by Beck et al. more than 40 years
previously. On the other hand, Article A suggests that According to Newman, (2003) maladaptive
beliefs regarding pharmacotherapy need to be addressed to maximize the outcomes of
psychotherapeutic intervention. This statement from Article A is related to what Article B is
trying prove, that CBT is an alternative treatment for Pharmacotherapy.
7. Would this practice change/improve process of patient care? How about patient outcomes?
This practice will definitely further improve the way we care for our patient’s, and it will
also improve the patient’s outcome eventually. it is clear how important Clinical Social workers
have to be well-aware of reasonable knowledge on Cognitive-Behavioral Therapy, because they
are at the forefront of such management. The empirical evidence as well as the actual and potential
clinical advantages suggest that the treatment is a promising intervention for clinical social
workers to consider using, provided they have proper training and appropriate clinical
supervision. The meta-analysis indicated that CBT has a positive impact on patients with BD in
terms of reducing depression levels, improving mania severity, decreasing relapse rates and
increasing psychosocial functioning. These results suggest that Cognitive-Behavioral Therapy is
indeed an effective regimen in treating patients with Bipolar Disorder.

8. Write a synthesis of the articles read.

Both articles convey that Cognitive-Behavioral Therapy is an effective and efficient in
treating Bipolar Disorder. Article A imparts that it is important for a Clinical Social Worker, or
any personnel rendering Cognitive-Behavioral Therapy, to be knowledgeable of the factors that
may limit the use of CBT. Article B on the other hand, suggests that Cognitive-Behavioral
Therapy is an effective alternative for pharmacotherapy. Both studies were proven effective.

References:

Martin, B. (2018). In-Depth: Cognitive Behavioral Therapy. Psych Central. Retrieved on May 9,
2018, from https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/