See attached. Respond to 2 people.
Respond to NB and Obian Respond to at least two of your colleagues by recommending CBT strategies to overcome the challenges your colleagues have identified. Support your recommendations with at least two evidence-based literature and/or your own experiences with clients.

**Include 2 citations and two references for NB

NB

Discussion – Week 5 Main Post

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Whether used with individuals or families, the goal of cognitive behavioral therapy (CBT) is to modify client behavior. Although CBT for families is similar to CBT for individuals, there are significant differences in their applications. As I develop treatment plans, it is important to recognize these differences and how they may impact the therapeutic approach with families. For this discussion, I will compare the use of CBT for families and individuals and consider the challenges of applying this therapeutic approach to my own client families.

CBT with Families Versus Individuals

Individual CBT has a broadly defined framework with an emphasis on harm-reduction, especially with clients that have anxiety and substance abuse (Wheeler, 2014). Cognitive-behavioral therapy for families is also brief and is solution-focused.  Both are behavioral-based; CBT helps individuals learn to recognize their mistakes in thinking that impacts their behavior, then helps them to make modifications to change that behavior. Family CBT is focused on supporting members to act and think in a more adaptive manner, along with learning, to make better decisions to create a friendlier, calmer family environment (Patterson, 2014).  In family therapy, the goals are a little different; family therapy is focused on meeting the needs of the family, whatever those may be. It’s about learning to make productive changes that work to improve the communication and relationships within the family dynamic (De Groot, 2007). Landa et al. (2016) found that family members showed significant improvements in use of CBT skills, enhanced communication with their offspring, and greater confidence in their ability to help. This study also demonstrated the feasibility of teaching family members CBT skills and all participants reported improved family communication (Landa et al., 2016).
 An example from practicum is a 37-year-old female that is married and struggling with abuse of prescription narcotic medication. She participates in individual CBT once a week and family CBT once a week. She came to therapy because her husband had told her that she “either needs to get help or they need to get a divorce”. She stated that she only took “a few more pills” when her back pain was “too much for her to handle”. My preceptor and I worked with her using open-ended questions to assist with obtaining cognitive and situational information. She would become angry easily when her husband was with us and it was felt that she was not being truthful about her narcotic usage. When she was in individual therapy it seemed like she was being more honest, while when she was in family therapy her stories would change. When the client was in family therapy and was talking about her drug usage, her husband would often time interject and say things like “you finished your prescription bottle two weeks early”, this would make the client very defensive. The client felt like her drug usage was not the problem in their marriage. One of the core principles in using CBT for substance use disorders (SUDs) is that the substance of abuse serves as a reinforcement of behavior and that over time, the positive and negative reinforcing agents become associated with daily activities (McHugh et al., 2010). CBT tries to decrease these effects by improving the events associated with abstinence or by developing skills to assist with reduction (McHugh et al., 2010). Getting the client to realize that her drug abuse use is a problem, is the primary goal currently. New coping mechanisms and stress-relieving skills are learned and utilized until the addict is functioning on his or her own (McHugh et al., 2010).

Challenges with CBT in a Family Setting

The example that was given from my own practicum experience shows the difficulties that may be encountered with CBT in a family setting. The challenges that I encountered was that the patient was not being honest with us in the therapy sessions, due to her fear of the repercussions she would face at home. Some challenges that counselors face when using CBT in the family setting are wondering if the structure of the session and if the proper techniques were effective (Ringle et al., 2015). Some additional challenges we encountered while using CBT in the family setting included difficulties in restructuring the thinking pattern of the clients at the same time. There are also always issues of privacy and confidentiality that may present a challenge in a group or family setting (Ringle et al, 2015). Overall, using CBT in a family setting, family members reported increased empathy and understanding of their family’s experiences, and greater confidence in their ability to help (Landa et al., 2016).  

References

De Groot J, Cobham V, Leong J, & McDermott B. (2007). Individual versus group family-
focused cognitive-behaviour therapy for childhood anxiety: pilot randomized controlled trial. Australian & New Zealand Journal of Psychiatry, 41(12), 990–997. https://doi-org.ezp.waldenulibrary.org/10.1080/00048670701689436
Landa, Y., Mueser, K. T., Wyka, K. E., Shreck, E., Jespersen, R., Jacobs, M. A., Griffin, K. W.,
van der Gaag, M., Reyna, V. F., Beck, A. T., Silbersweig, D. A., & Walkup, J. T. (2016). Development of a group and family-based cognitive behavioural therapy program for youth at risk for psychosis. Early intervention in psychiatry, 10(6), 511–521. https://doi.org/10.1111/eip.12204
McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for
substance use disorders. The Psychiatric clinics of North America, 33(3), 511-25. doi:10.1016/j.psc.2010.04.012

Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of
Family Psychotherapy, 25(2), 132-144. doi:10.1080/08975353.2014.910023
Perry, A. (2014). Cognitive behavioral therapy with couples and families. Sexual & Relationship

Therapy, 29(3), 366-367. doi:10.1080/14681994.2014.909024
Ringle, V. A., Read, K. L., Edmunds, J. M., Brodman, D. M., Kendall, P. C., Barg, F., & Beidas,
R. S. (2015). Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. Psychiatric services (Washington, D.C.). 66(9), 938-45.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to

guide for evidence-based practice. New York, NY: Springer.
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Obian

Initial Post 1

**Include 2 citations and two references for Obian**

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Hi Class,
CBT is based on the idea that how we think, how we feel, and how we act all interact together. Individual’s thoughts determine their feelings and actions. CBT has been proven to be effective in various disorders. Generally, a therapist can do CBT at the family or individual level for substance abuse and anxiety victims. In this regard, the paper seeks to explain the comparison between CBT use in families and individuals and further exploring challenges that therapists might encounter when using CBT in families.
Individual CBT is a collaborative process where a therapist and his client take physiology and schemas to decide a client’s care (Reuman et al., 2020). A good example of an individual CBT is a man attending an individual CBT once a week due to alcoholism. The victim can work openly with the therapist using open-ended questions to obtain cognitive and situational information. The obtained information will be useful for his therapy.
On the other hand, cognitive behavioral therapy for families focuses on supporting members to think and act adaptively and learn how to make informative decisions creating a calm and friendlier family environment. Practitioners felt that a thorough assessment enabled them to make sense of the various issues affecting families and prioritize the challenges presented. Behaviors, emotions, and cognition seem to have a mutual influence on one another (Kolko et al., 2018). In the example above, the wife can express her feelings concerning why her partner was drinking too much alcohol. The man will become defensive and blame his marriage. To help this marriage, a therapist will use positive and negative reinforcement behaviors to maintain sobriety.
Another example is when a child has anxiety issues. I had a parent who presented with her daughter with a history of ADHD. The mother complained about how active and destructive the kid can be both at home and in school. When using the family CBT, parents are directed at refashioning problematic family interactions by improving parent-child, family communication, and problem-solving. Parents are instructed on how to help their child to carry out exposure and cognitive homework and overcome fears through guidance, monitoring, and support, and by giving consistent verbal and material rewards. CBT with Family involvement could reinforce homework completion. Therefore, contingency management was an essential part of the Family CBT (Maric et al., n.d).
While using cognitive behavioral therapy for the family, the therapist might face structuring the formal sessions. The therapist must meet the demand for maintaining and ensuring the clients’ needs are completed using the right techniques (Nyman-Carlsson et al., 2020). Besides, they have to commit to the program to get the best out of it. Also, the therapist faces challenges in identifying the emotions and thoughts of each patient. Besides, some family members might have limited motivation for change. The clients might agree with the principles but can’t seem to alter their actions. Another challenge is that the presence of a family member may initially impede disclosure. Some family members might be too ashamed to open up about their issues, just like in the case of the female speaker in the Johnson video who did not want to talk about her rape because she was told it was her fault for being in the wrong place at the wrong time (Laureate Education (Producer), 2013c). It made her sad, and she continuously blamed herself for the rape. CBT for the family may hinder progress through criticism or refusal to support their loved ones. In conclusion, both family and individual CBT are used to solve the problem despite the challenges a therapist faces in executing the programs.
 
References
Kolko, D. J., Herschell, A. D., Baumann, B. L., Hart, J. A., & Wisniewski, S. R. (2018). AF- CBT for families experiencing physical aggression or abuse served by the mental health or child welfare system: An effectiveness trial. Child maltreatment, 23(4), 319-333.
Laureate Education (Producer). (2013c). Johnson family session 3 [Video file]. Author: Baltimore, MD.
Maric, M., van Steensel, F. J. A., & Bogels, S. M. (n.d.). Parental Involvement in CBT for Anxiety-Disordered Youth Revisited: Family CBT Outperforms Child CBT in the Long Term for Children With Comorbid ADHD Symptoms. JOURNAL OF ATTENTION DISORDERS, 22(5), 506–514. https://doi-org.ezp.waldenulibrary.org/10.1177/1087054715573991
Nyman-Carlsson, E., Norring, C., Engström, I., Gustafsson, S. A., Lindberg, K., Paulson- Karlsson, G., & Nevonen, L. (2020). Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial. Psychotherapy Research, 30(8), 1011-1025.
Reuman, L., Thompson-Hollands, J., & Abramowitz, J. S. (2020). Better Together: A Review and Recommendations to Optimize Research on Family Involvement in CBT for Anxiety and Related Disorders. Behavior Therapy.
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