Issues Relating to Cultural and Human Diversity in Evidence Based Practice (EBP)

The ever-changing world has led to the emergence of different disorders, both physical and psychological, with complexities that grow with time. The advancement in the diseases have resulted to the advancements in the medical setups and procedures of medication. Psychological disorders are now a common factor nowadays. The Cognitive Behavioral Therapy (CBT) is an advanced branch of psychotherapy that originally dealt mainly with the analysis and treatment of depression and the like, but is now used in treating a number of psychological disorders. This report deals with the systematic cognitive model, which is developed in order to focus mainly on the needs of Kelly and Lorena.

Human behavior is characterized by the set of assumptions and the idiosyncratic rules that uphold the traits of their reactions to the outer world and the environment in which they survive. Every human uses this set of rules or the values, which is generally termed as ethics frames their outlook to life. Anxiety and depression is the cause of the unfulfilled expectations and the vacant thoughts that dwells deep within the human mind (Beidas et al., 2013). Some most common elements, relating to the ego and self esteem, are those which are essentially egocentric where an individual expects that the world will function according to the person’s likes and dislikes. CBT evaluates these areas of the human psyche, uncovers the truth underlying beneath the existentialism and eccentric outlook, and aims at manipulating and modifying the thinking process of the patients assuring a positive change in the behavior (Al-Naggar, Abdel-Salam & Al-Haggar, 2015).

  

The above figure helps in illustrating the correlation and interdependence between the factors that influence the behavior of an individual. The figure stresses more on the core beliefs of the individuals which can be classified broadly under three categories- self, others and future. The report aims at analyzing the important factors pertaining to the psychological traits and distortions and the ways in which the cognitive behavioral theory with close association with the Evidence Based Practice (EBP) helps in curing and allocating the distortions accordingly.   

Psychotherapy is an evidence-based evaluation, but the term ‘evidence based’ should be used carefully as the study and the evaluation is a limiting factor in assessing the verification due to the availability of more diverse cases based on the population. Diverse population is a limiting factor it brings out a general outlook to the psychiatric problems.

Recommendations for Relating EBP with Diverse Population

The growth and expansion of the population in USA, and reports indicate that by the end of 2050 there will be a very few inhabitant identified as European or American. The concept of diversity should be made clear before one concludes the topic to their own insight. The application of psychotherapy differs from densely populated areas to less populated areas. From an individual point of view the differences in the techniques of psychotherapy differs from individual identities as well as collective identities. Culture and heritage also plays an important role in determining the psychological realms of the individuals. There are different parameters that must be considered in order to make use of an effective psychotherapy. Many scholars have considered the issues of cultural diversity and its influence on the CBT yet no such rules limited the practitioners from making use of the diversity as a tool and adapting themselves to the specific cultural group (Gorenstein, 2007).

Diverse research methods and techniques have been encored by the researches in order to integrate issues for different and diverse cases. The very first evaluation and a framework was created by Bernal and colleagues which focuses mainly on ecological validity in accordance with the diverse nature of the community (Gilson, 2009). The framework conceptualized eight dimensions depending on the prevalent culture of the specific group. They are being illustrated in this section of the analysis.

1. Suitable language should be used for the interventions.
2. Metaphors to be used in the interventions.
3. Intellectual knowledge must be kept in the fields of values, customs and traditions of the members.
4. Acknowledging the contextual influences in the client’s life
5. The bonding between the client and the therapist should be simple and brief.
6. A theoretical approach in solving the issues of the client
7. Targets to be achieved depending on the rules and norms.
8. The techniques that are involved in achieving the goal of healing

An implementation or an adaptation of the intervention will take no time, but before doing so a researcher must consider the manner in which the researcher is going to organize the intervention in order to bring forth the desired therapeutic effect. Organizing an intervention is an important step before choosing an intervention because the proper organization helps in making the intervention work out in the best possible manner. There are general discussions too relating to the frequency of the interventions being delivered to the clients or if the intervention should be delivered in groups or on an individual basis and the like.

Proper knowledge and research must be undertaken as for a particular population or a cultural group before even adapting or considering any interventions. The diversity in the group and the difference in the needs of the clients is the only reason behind undertaking this research work.  The balance in the group and individual characteristics determines another important factor that denotes the effectiveness of the interventions on the clients from a different point of view.

Recommendations of EBP of CBT

In this modern era evidences and research into the refined psychological traits is a phenomenal work to be undertaken in order to make advancements in the CBT. Education and financial status plays an important role before considering and allocating the interventions accordingly (Inerian, 2007).

Diversity in the clinic helps in effectively mingling with the customs and traditions of the client, by which an effective psychiatric treatment can be provided, keeping in mind the diverse requirement of the clients (Hwang, 2006).

The cases of Kelly and Lorena, on which this report concentrates, is an evidence based application of CBT.  Lorena is being portrayed, in the case, as a person who had a previous history of family violence and her probable tendency of hanging out or maybe to figure out what could be done. It might be because of the injustice that infested her when she saw her mother working for the family’s source of income and her father unemployed. On the other hand, Kelly enjoys her absolute freedom through her impulsive nature- a sudden urge to do anything she desires at any point of time irrespective of the environment or the time.

A detailed plan has been formulated in this section to bring out the best results in an organized manner (Winterowd, Beck & Gruener, 2003).  

Session Zero

• Rapport building and creating an interest in the mind of the client
• Evaluating the subject of the program clinically

First session

• A brief discussion based on the expectations the subject holds from this recovery program.
• A continuous monitoring of the change of moods of the subject bringing out the negative attitude for stressing on the subject’s peculiarity
• Describing the Cognitive behavioral theory and the strategies that they are going to follow

Second session

• Mood check and taking a feedback about the first session
• A discussion on the reactions of the cognitive model of depression

Third session

• Evaluation and feedback on the home based assignments (if assigned)
• A set of general guidelines to identify negative thought and how to prevent them from coming

Fourth session

• Discussion based on eliminating negative and automatic thoughts

Fifth session

• Adhering to the general discussion that took place in the fourth session.
• Reviewing and establishing a discussion on the source of the automatic thoughts
• The participant or the client, being aware of the negative thoughts and by then can identify the negative thoughts that come in the mind, demonstrate to the person ways of correcting cognitive distortions.
• Arrangement should be made for further sessions in the same format.

Sixth, seventh and eighth sessions

• Follow the previous formats
• Exercises and drills to release the patient of the psychological barrier and getting engaged into daily activities
• Continuation in the process of eradicating the negative thoughts

Closing session

• Preparing for the termination of the patient’s therapy
• Defining the future problems to the clients helps them in anticipation and formulating strategies
• At the termination of the session participants or the clients should be encouraged to take hold on to the assignments and continue performing them at home so that the automatic thoughts does not arise out once again (Valmaggia et al., 2008)

 Elements of the CBT

The above guidelines being a general approach towards the EBP are essentially flexible for treating depression in a valid and effective way (Taylor, 2006). Certain modifications can be made depending on the situation and the level of requirement of the client. The essential elements of CBT that can be taken as a part of any psychiatric program are briefly discussed in this section:

1. The counselor must follow the same structure for every counseling session though in certain cases the invariant nature does not work out.
2. The counselor must introduce to the clients the apparent cognitive model and make their perceptions clear as to the functioning of the model
3. The counselor is needed to formulate all possible guidelines and itinerary of the case in order to make the case lucid and then establish the cognitive formulation in the first two sessions of the recovery program.
4. The counselor is required to build a rapport with the client in order to make the client feel at home and easy to converse verbally. It makes the client open up to the counselor by which it becomes possible for the counselor to read the psychological traits and advancements of the client (Rimondini, 2011).

Conclusion

Therefore, from the above analysis it can be concluded that though the fields of psychiatry and the study of human brain and its nature and advancements relating to the cognitive behavioral treatments and the EBP, there are still significant limitations and backdrops that are needed to be avoided and removed. Interventions, in the modern era, are not always helpful and due to the diverse cultural population, researchers cannot stick on to the pre-formulated intervention. The advent of modernization and globalization and with the introduction of different psychological issues complexities tend to emerge. There are different ways in which they can be treated and the ways are defined through the above analysis.

References 

Al-Naggar, Z., Abdel-Salam, M., & Al-Haggar, M. (2015). Biofeedback and cognitive behavioral therapy for Egyptian adolescents suffering from chronic fatigue syndrome. J Pediatr Neurol, 04(03), 161-169. https://dx.doi.org/10.1055/s-0035-1557320

Beidas, R. S., Mychailyszyn, M. P., Podell, J. L., & Kendall, P. C. (2013). Brief cognitive-behavioral therapy for anxious youth: The inner workings. Cognitive and behavioral practice, 20(2), 134-146.Culliney, T. (2014). Notes on Predatory Behavi our in Rhinacloa forticornis (Hemiptera: Miridae ). Curr. Agri. Res. Jour, 2(1), 01-04. https://dx.doi.org/10.12944/carj.2.1.01

Gilson, M. (2009). Overcoming depression. Oxford: Oxford University Press.

Gorenstein, E. (2007). Cognitive-Behavior Therapy for Reduction of Persistent Anger (Gorenstein et al.). Cognitive And Behavioral Practice, 14(2), 243. https://dx.doi.org/10.1016/j.cbpra.2007.02.003

Hwang, W. (2006). Cognitive-Behavioral Therapy With Chinese Americans: Research, Theory, and Clinical Practice (Hwang et al., pp. 293–303). Cognitive And Behavioral Practice, 13(4), 339-340. https://dx.doi.org/10.1016/j.cbpra.2006.04.017

Inerian, A. (2007). Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Clients (Interian, et al.). Cognitive And Behavioral Practice, 14(1), 122-123. https://dx.doi.org/10.1016/j.cbpra.2006.10.002

Rimondini, M. (2011). Communication in cognitive behavioral therapy. New York: Springer.

Rosner, R., Lyddon, W., & Freeman, A. (2004). Cognitive therapy and dreams. New York: Springer Pub. Co.

Taylor, R. (2006). Cognitive behavioral therapy for chronic illness and disability. New York: Springer.

Valmaggia et al.,. (2008). WITHDRAWN: Continuing Education Quiz: Cognitive Behavioral Therapy across the Stages of Psychosis: Prodromal, First Episode, and Chronic Schizophrenia. Cognitive And Behavioral Practice. https://dx.doi.org/10.1016/j.cbpra.2007.02.008

Winterowd, C., Beck, A., & Gruener, D. (2003). Cognitive therapy with chronic pain patients. New York: Springer.