SNHU Effects of Cognitive Behavior Therapy Paper You’ll need a theory to guide and underwrite your EBP project. In this folder you will find some suggestio

SNHU Effects of Cognitive Behavior Therapy Paper You’ll need a theory to guide and underwrite your EBP project. In this folder you will find some suggestions, you are not limited to these or even to nursing theory, however, you will need to support your choice with scholarly literature (peer-reviewed article, within 5 years publication. No textbook citations for the theory.). Once you have decided on a theory, you will write a 2-3-page paper (not including cover and reference page) which addresses: 1) Identifying your theory and explaining the basic tenets of the theory (you will need to cite the primary source by the author of the theory, this source may exceed 5 years as it is the primary source; that is you are looking for literature going back to origins of the theory); 2) Explaining the rationale for why this theory is appropriate for the EBP Project, providing examples of how specifically it applies to your project; and 3) Concluding with the theory’s sustainability as it relates to your EBP Project. The paper needs to be submitted in correct APA format, with title page and reference list which do not count in your page count. The body of your paper should include the appropriate headings. My Explanatory theory based on my PICOT question of a veteran of any age, sex, or ethnicity with a history of alcohol abuse with the effects of cognitive behavior therapy (CBT) compared to medication therapy with a reduction in reoccurrence rate after 60 days of treatment? This research question is based on how veterans’ treatment affects his/her recovery from alcohol addiction. You’ll need a theory to guide and underwrite your EBP project. In this folder you will find
some suggestions, you are not limited to these or even to nursing theory, however, you
will need to support your choice with scholarly literature (peer-reviewed article, within 5
years publication. No textbook citations for the theory.). Once you have decided on a
theory, you will write a 2-3-page paper (not including cover and reference page) which
addresses:
1) Identifying your theory and explaining the basic tenets of the theory (you will need to
cite the primary source by the author of the theory, this source may exceed 5 years as it
is the primary source; that is you are looking for literature going back to origins of the
theory);
2) Explaining the rationale for why this theory is appropriate for the EBP Project,
providing examples of how specifically it applies to your project; and
3) Concluding with the theory’s sustainability as it relates to your EBP Project.
The paper needs to be submitted in correct APA format, with title page and reference
list which do not count in your page count. The body of your paper should include the
appropriate headings.
My Explanatory theory based on my PICOT question of a veteran of any age, sex, or ethnicity
with a history of alcohol abuse with the effects of cognitive behavior therapy (CBT) compared to
medication therapy with a reduction in reoccurrence rate after 60 days of treatment? This
research question is based on how veterans’ treatment affects his/her recovery from alcohol
addiction.
Sample theories that have been used in EBP but there are many more and
you are free to choose from others. Just remember to look for fit with your
EBP Project.
Change theories: Change theory guides the development of interventions and assists
evaluation.
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Smpltheory.kld
Kurt Lewin’s change theory
Diffusion of innovation theory (Rodgers)
Motivational theories: This theory seeks to explain why people do what they do,
what inspires them to act toward a particular goal(s).
Deci and Ryan’s self-determination theory
Maslow’s theory of hierarchy of needs
Explanatory theories:
This theory is helpful with EBP and health promotion. Explanatory theory sheds light on
the nature of the problem and helps to identify the range of factors that the health
promotion intervention seeks to modify (Green, 2000).
Green, J. (2000). The role of theory in evidence-based health promotion practice. Health Educ.
Res. 15(2):125-129 doi: 10.1093/her/15.2.125
Learning theories: This type of theory obviously seeks to explain how we learn
and/or process information.
Gestalt theory
Information processing theory
Organizational theories: This type of theory seeks to explain how change is interrelated and effects an entire organizational structure. Thinking of the whole rather than
the individual parts.
Systems thinking theory
Complexity theory
*Knowledge transfer theory: frequently identified with EBP initiatives as are
implementation theories.
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What kind of theory for your EBP Project?
That’s up to you. The importance of theory is to provide you with a guideline for
development. The theory principles will underscore your EBP Project. All kinds of theory
exists for you to choose from. The theory you choose, however, should align with your
approach and EBP project.
There are numerous nursing theories and theories from other disciplines which may be
appropriate. Management and organizational theories talk about brining change about
in the organizational setting. A strong focus for EBP is implementation theory. Theories
from psychology, like social learning theory, look at change from a behavioral
perspective. It is not mandatory that you choose a nursing theory, only that you choose
a theory that you can appropriately apply.
Your 2-3 page paper will address 3 topic areas:
1) Introduce your theory with a basic explanation of what the theory is. You will
need to provide a written explanation of your theory’s origin (how did it come
about, who influenced it?) What are its basic principles? You will need to provide
citation support in this area. Your primary source article citation is included in
this section.
2) Explain the rationale for why this theory is appropriate for the EBP Project, that
is, why did you choose this theory out of all the theories you could have chosen?
How does your theory apply specifically to your EBP Project? Provide 3 specific
examples of how the principles of your theory will guide and apply to your EBP
Project.
3) Conclude with the theory’s sustainability as it relates to your EBP Project. That is,
why is this theory a good choice for the long-term applicability of your EBP
Project? For example, how has your chosen theory stood the test of time? Has it
been repeatedly used in literature and is still considered reliable? How do you
know? What have other authors said about your theory? You will need to provide
citation support in this area.
The paper needs to be submitted in correct APA format, with title page and reference
list which do not count in your page count. The body of your paper should include the
appropriate headings.
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Submit the paper and either the links to access the articles you cite directly (exact
URL, test them in your reference list citation before submitting your paper or you can
submit the article themselves but still need a reference list in APA format for your
paper. At a minimum, the primary source article on theory (who developed and first
wrote on the theory), and 2-3 scholarly articles on your theory.
This assignment is due on or before Sunday of Week 4 by 11:59 pm.
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PICOT Question: Veterans of any age, sex, or ethnicity with a history of alcohol abuse with the
effects of cognitive behavior therapy (CBT) compared to medication therapy with a reduction in
reoccurrence rate after 60 days of treatment? This research question is based on how veterans’
treatment affects his/her recovery from alcohol addiction.
Introduction
Elements
Explains basic
principles and
origin. Provides
original source and
citation (literature).
Chooses
appropriate
theory for EBP
Project
Identifies theory
appropriate to
guide and align
with EBP Project.
Able to explain fit
with 3 specific
examples.
Provides support
for EBP choice
(provides
literature in
support)
Appropriate
literature support
for model and APA
citation. 2-3 articles
and citations in
addition to primary
article.
Evidence of
Critical Thinking
Provides brief
explanation of why
theory will be
appropriate for
sustainability and
addresses all
5
Smpltheory.kld
Potential Points
20
20
20
20
Points Earned
Comments
element of
instructions.
Writing
Mechanics
Submission
provides complete
sentence structure.
Spelling,
capitalization,
punctuation, and
grammar are
correct.
20
POSSIBLE
POINTS:
100
6
Smpltheory.kld
TOTAL
POINTS
EARNED:
Sundström et al. BMC Psychiatry (2017) 17:197
DOI 10.1186/s12888-017-1355-6
RESEARCH ARTICLE
Open Access
High-intensity therapist-guided internetbased cognitive behavior therapy for
alcohol use disorder: a pilot study
Christopher Sundström1* , Martin Kraepelien1, Niels Eék3, Claudia Fahlke3, Viktor Kaldo1 and Anne H. Berman1,2
Abstract
Background: A large proportion of individuals with alcohol problems do not seek psychological treatment, but
access to such treatment could potentially be increased by delivering it over the Internet. Cognitive behavior
therapy (CBT) is widely recognized as one of the psychological treatments for alcohol problems for which evidence
is most robust. This study evaluated a new, therapist-guided internet-based CBT program (entitled ePlus) for
individuals with alcohol use disorders.
Methods: Participants in the study (n = 13) were recruited through an alcohol self-help web site (www.alkoholhjalpen.se)
and, after initial internet screening, were diagnostically assessed by telephone. Eligible participants were offered access to
the therapist-guided 12-week program. The main outcomes were treatment usage data (module completion, treatment
satisfaction) as well as glasses of alcohol consumed the preceding week, measured with the self-rated Timeline
Followback (TLFB). Participant data were collected at screening (T0), immediately pre-treatment (T1), post-treatment
(T2) and 3 months post-treatment (T3).
Results: Most participants were active throughout the treatment and found it highly acceptable. Significant reductions
in alcohol consumption with a large within-group effect size were found at the three-month follow-up. Secondary
outcome measures of craving and self-efficacy, as well as depression and quality of life, also showed significant
improvements with moderate to large within-group effect sizes.
Conclusions: Therapist-guided internet-based CBT may be a feasible and effective alternative for people with alcohol
use disorders. In view of the high acceptability and the large within-group effect sizes found in this small pilot, a
randomized controlled trial investigating treatment efficacy is warranted.
Trial registration: ClinicalTrials.gov (NCT02384278, February 26, 2015).
Keywords: Cognitive behavior therapy, Alcohol use disorders, Alcohol dependence, Internet-based psychotherapy
Background
It is well established that alcohol use has major detrimental effects on physical and mental health. Approximately 6% of all deaths in the world are ascribed to
alcohol [1], currently the third leading risk factor for global disease burden [2]. While consumption levels are
highest in Europe and North America, alcohol use is
rapidly growing in developing countries such as China
* Correspondence: christopher.sundstrom@ki.se
1
Department of Clinical Neuroscience, Karolinska Institutet & Stockholm
Health Care Services, Stockholm County Council, Centre for Psychiatry
Research, Norra Stationsgatan 69, -113 64 Stockholm, SE, Sweden
Full list of author information is available at the end of the article
and India, with a resulting global overall increase in
alcohol use during recent years [1]. Individuals with a diagnosed alcohol use disorder (AUD), i.e. those with impaired control over their alcohol consumption and who
continue drinking despite serious adverse consequences
[3], are estimated to account for about half of all global
alcohol-related harm in developed countries [4]. In particular, the risk of dying from somatic diseases such as
liver cirrhosis, cancer and cardiovascular disease is
several times higher among people with an AUD [5].
The impact of AUD on morbidity and mortality is
monumental, and increasing access to evidence-based
treatment is imperative to health care.
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sundström et al. BMC Psychiatry (2017) 17:197
Both pharmacological and psychological treatment alternatives for people with AUD can be considered
evidence-based [3]. Among the better-known psychological evidence-based treatments are Motivational
Interviewing [6] and cognitive behavior therapies such
as Community Reinforcement Approach [7] and Relapse
Prevention [8]. Although evidence-based treatments
exist, few people with AUD seek help for their problems.
For example, while recent epidemiological data indicated
that 29% of adults in the USA had met the DSM-5 criteria for an AUD at some point in their lives, only 20%
of these reported ever having sought help for their problems [9]. Similarly, a recent study conducted in a primary care setting in six different European countries
found that only one in five people with current alcohol
dependence had received professional help for their alcohol problems [10]. Research has identified several
reasons why people with alcohol problems seek help to
such a low extent. People may not believe that treatment will be effective, they may think that they should
be able to deal with the problem on their own, and
they may deny having a problem altogether; a further
major barrier to seeking help is stigma [11]. In fact,
fear of stigmatization has been shown to reduce the
probability of seeking help for alcohol problems [12], a
phenomenon that follows from the finding that AUD is
the most severely stigmatized psychiatric condition of
all. People with AUD provoke more social rejection
and negative emotions than people with other psychiatric conditions, and are also held responsible for their
condition to a greater extent than people suffering
from depression and schizophrenia [13].
One way of increasing access to psychological treatment is to deliver it online. Advantages of doing this
include cost-effectiveness and overcoming geographical barriers [14]. Delivering treatment online may also
reduce the stigma associated with having to visit a
clinic to receive treatment. There are two distinctly
different ways of delivering psychological treatment
online: programs available directly to the public, usually brief and without therapist contact but with some
levels of automation, and more intensive programs
guided by a therapist mirroring traditional manualbased face-to-face therapy [15] . Internet-based treatment delivered in this latter way is usually based on
cognitive behavior therapy, and is then commonly referred to as ICBT [16]. This form of treatment has
been developed and extensively studied with psychiatric disorders such as depression and anxiety [17],
and there are examples of successful implementation
of ICBT in regular care [18–20]. However, although
potentially vast, the reach of ICBT remains quite limited
and significantly increasing its accessibility is a challenge
that has yet to be addressed [21].
Page 2 of 12
Most of the online psychological treatments developed
to target problematic alcohol use have been rather brief,
low-intensity, automated open access programs without
guidance from a therapist [22]. Although some of these
programs have been based on cognitive behavior
therapy [23, 24], most have focused on delivering ‘brief
intervention’, a form of prophylactic single-session
treatment typically aimed at helping hazardous drinkers
moderate their drinking by providing screening and
feedback on their alcohol consumption [25, 26]. Effects
on alcohol consumption have generally been small [22],
and a recent systematic review noted that the lack of
internet interventions addressing AUDs specifically –
not only hazardous drinking – hampers any clinical
implications [27]. Internet-based treatment based on
cognitive behavior therapy and guided by a therapist
have, to our knowledge, been tested in three controlled
studies [28–30]. Two of these studies evaluated the
same treatment content [28, 29] which has been categorized as low-intensity [22]. The third study could be
considered high-intensity as the therapist contact was
quite extensive and participants were instructed to visit
the program daily [30]. Moderate to large effect sizes
on alcohol consumption were found in comparison to
control groups in these studies (post-treatment 0.59 in
Blankers et al. [28]; 0.75 in Sundström et al. [29]; 1.21
in Postel et al. [30]). Although these results are promising,
none of the studies conducted standard interview-based
diagnostic assessments with participants.
The aim of the present study was to evaluate the feasibility and preliminary effects of a high-intensity therapistguided ICBT program for people with a diagnosed alcohol
use disorder. We hypothesized that ICBT would be acceptable to the participants and that it would be associated with a reduction in alcohol consumption and in
other alcohol-related measures.
Methods
Design
This was an uncontrolled pilot study intended to evaluate the feasibility and preliminary effects of a comprehensive, therapist-guided CBT program for alcohol use
disorders. A within-group design with repeated measures was used.
Procedure and participants
Between March 18 and April 13, 2015, an advertisement
about the study was shown on the Swedish self-help site
alkoholhjalpen.se. Individuals who registered their interest in participating were sent a brief presentation of the
study along with a link to the program homepage where
they could create an account in order to enroll in the
study. The recruitment process was then conducted in
two steps. The first step consisted of providing informed
Sundström et al. BMC Psychiatry (2017) 17:197
consent to participate in the study and completing online screening forms. The forms covered demographic
characteristics (see Additional file 1) and eight questionnaires. The inclusion criterion in this first step was a
score on the Alcohol Use Disorders Identification Test
(AUDIT) [31] of 14 or more for women or 16 or more
for men, indicating harmful use or dependence [32]. Exclusion criteria were a) severe depression as measured
by the Montgomery Asberg Depression Self-Rating
Scale (MADRS-S) [33] (a score of >30); and/or b) suicidal ideation as measured by 5 or 6 points on the
MADRS-S question measuring suicidal ideation (item
9). In the second step of the recruitment process, participants eligible for inclusion after the first step were
contacted and interviewed via telephone by a licensed
clinical psychologist or a clinical psychology student at
the Master of Science (MSc) level. The interview lasted
about 30–45 min and consisted of three parts: 1) a brief
anamnestic interview about the participant’s relation to alcohol and experiences of it (see Additional file 2); 2) a
semi-structured interview for assessing AUD with the
Structured Clinical Interview DSM IV (SCID-IV) [34],
where criteria were adapted to the DSM-5 [35]; and 3) a
structured interview to assess psychiatric comorbidity
with the Mini International Neuropsychiatric Interview
(MINI) [36]. The modules on AUD and Substance Use
Disorders in MINI were not used, since the SCID-IV
interview module on AUD provides more detailed information. Exclusion criteria in the second step of the recruitment process were: a) severe depression as measured
by MINI or the anamnestic interview; b) severe psychiatric
comorbidity as measured by MINI or the anamnestic
interview; c) suicidal ideation according to MINI or the
anamnestic interview; or d) ongoing psychological treatment for alcohol problems. Before receiving access to the
program, participants once again completed two measures: the Time Line Follow Back (TLFB) and MADRS-S
as pre-treatment measures. The treatment phase lasted
12 weeks and included contact via secure messaging with
the therapist. Participants were given consecutive access to the modules in the program after completing
homework assignments in the module worksheets.
Three licensed clinical psychologists (CS, MK, NE)
acted as therapists for the participants and provided
feedback within 48 h during weekdays. Throughout the
treatment, MADRS-S was administered weekly. If participants scored 4 or more at any time on item 9, which
measures suicidal ideation, a therapist contacted them.
At the beginning of the last treatment week, the participants again completed the questionnaires, except for
the Readiness to Change Questionnaire (RCQ), which
was only administered at screening. Participants also
completed the Client Satisfaction Questionnaire-8
(CSQ-8) and other questions concerning evaluation of
Page 3 of 12
the treatment (see Additional file 3) and questions
about whether other forms of support for alcohol problems had been received during the 12 weeks. Participants were als…
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