Nursing assignment 436

   Assignment: Respond to at least two of your colleagues by providing an additional scholarly resource that supports or challenges their position along with a brief explanation of the resource. Each response must have at least 2 references no more than five years old Colleagues Response # 1 Psychotherapy and biological basis          I believe that psychotherapy has a biological basis and there continues to be emerging evidence supporting this. Psychotherapy has ability to touch many aspects of the clients lives to include self-esteem. Family, work, and relationships (Laureate Education, 2016). Psychotherapy can work alone or in conjunction with psychopharmacology and it is often the first line of treatment (Laureate Eductaion, 2016).          There have been studies on brain changes after psychotherapy for depression, anxiety disorders, and borderline personality disorder that have been published (Karlsson, 2011). Studies have focused on comparing behavior therapy against psychopharmacologic agents such as antidepressants and the changes in the brain with both modalities. “In the recent study by Karlsson and colleagues, clear differences emerged between short-term psychodynamic psychotherapy and fluoxetine among patients with MDD” (Karlsson, 2011).            Many psychotherapies attempt to enhance patients’ problem-solving capacities, self-representation, and regulation of affective states. The brain areas that play a role in these functions include the dorsolateral prefrontal cortex, ventral anterior cingulate cortex, dorsal anterior cingulate cortex, ventral and dorsal subregions of the medial prefrontal cortex, posterior cingulate cortex, precuneus, insular cortex, amygdala, and ventrolateral prefrontal cortex. For example, the mechanism behind the effectiveness of cognitive therapy for patients with MDD could be through an increase in prefrontal function, which is involved in cognitive control, while antidepressant medications operate more directly on the amygdala, which is involved in the generation of negative emotion (Karlsson, 2011). Culture, religion, and socioeconomic influences on the perception of psychotherapy treatment It is important for the advanced nurse practitioner to always treat each client in a holistic manner because each client differ, based on their cultural, religion beliefs, and socioeconomic background. Culture and beliefs affect many aspects of psychosocial intervention, and cultural assessment will be imperative during the initial treatment phase. This assessment will facilitate the groundwork for treatment outcomes and interventions, indicated to tailor the treatment plan to the individual treating. Cultural evaluations completed by the healthcare professional will promote the trust that is imperative in a professional therapeutic relationship (Wheeler, 2014). Some patient’s may have strong spiritual beliefs which provides stabilization in the treatment hierarchy framework for practice (Wheeler, 2014). And individuals’ spiritual beliefs are often a significant strength and/or protective factor that the health professional can utilize to assist with recovery or coping and in addition, incorporating the spiritual aspect of life into therapy ensures that existential needs are not swept under the carpet with psychological/psychiatric terms (such as depression) (Brown, Elkonin,  & Naicker, 2013). Socioeconomic factors may determine if the client would have access to care, if the client would be adherent to the treatment and if the outcome would be successful or not. According to Hawley, Leibert, & Lane, (2014), socioeconomic Status affects therapeutic outcomes and significance of therapeutic intervention because client’s educational level and benefits of health insurance have shown greater compliance with the treatment regimen, therefore, improving client outcome and follow-up. For Nurse Practitioners to successfully diagnose and treat mental illness ethnicity, religion, race, social, economic Status, and culture are imperative to address, and with the competence gained during the initial goal setting and assessment all the factors above must be thoroughly assessed and discussed (Wheeler, 2014). Preparing for successful intervention will encompass the whole patient to include support, socioeconomic means to healthy living and personal spiritual beliefs will identify what drives the client internally for holistic health. Colleagues Response # 2 Explanation of Whether Psychotherapy Has a Biological Basis            Psychotherapy is an interaction between a trained professional and a patient to explore thoughts, feelings, and behaviors with the goal of problem-solving or achieving higher levels of functioning (American Psychiatric Association, 2016). Psychotherapy can be helpful with problems like issues in coping with daily life; traumatic life event, medical illness or loss of a loved one; and specific mental disorders, like depression or anxiety (American Psychiatric Association, 2016).  For example, to show that psychotherapy has a biological basis on the brain and the body, In a study with a client suffering from PTSD who participate in psychotherapy show marked improved dysfunctional cognitive coping strategies and blood pressure  compare with those with no therapy (Schubert et al., 2019). Just like learning to perceive and incorporate new informations, views, and internal processing, psychotherapy produces lasting, detectable physical changes in the brain (Kandel, 2014). Cultural influences on Psychotherapy Treatments For an APPN to treat and diagnose mental illness effectively, the APPN must consider the patient culture, religion and socioeconomics influences to recommend the appropriate psychotherapy treatments (Wheeler, 2014). Although it is not possible to have a vast knowledge base regarding all cultures, practitioners should have a working knowledge of the client’s background and research their culture (Wheeler, 2014). Using generalized knowledge of culture will not be appropriate to work with diverse population.  If the practitioner has conflicting information of the client’s culture, asking question will help build a rapport with the client. For example, a Spanish woman hearing voices of her death husband does not mean she is psychotic. As a practitioner, with the knowledge of different culture, he will not prescribed treatment since what the patient is experiencing is cultural related (Wheeler, 2014). Religious influences on Psychotherapy Treatment            It is important to consider religion in psychotherapy sessions.  Some therapeutic tools such as meditation, prayer, spiritual journaling, forgiveness protocols, using biblical texts to reinforce healthy mental and emotional habits can lead clients to let go of unhealthy anger and move past an abusive situation without justifying the abuse (Kersting, 2015). Clients with religious or spiritual background will be sensitive and willing to interact religiously. Thereby helping them to trust the therapist and hence brings some positive aspect of the human experience in the therapy room. Some people describe the beauty of spiritually guided therapy as experiencing a third presence in the room a spiritual presence or a God presence. There’s a mystery being revealed to the patient in that presence; it is a sort of an epiphany that can be extremely useful in therapy (Kersting, 2015). As being religious can shape culture, being empathetic to patient’s beliefs and incorporating them into therapeutic plan enhances professional dialogue in a therapeutic meaning (Dilip, Barton & Elyn, 2017).When  the client have a relationship of confidence and empathy with their psychotherapist, there is an efficacy of the treatment Socioeconomics Influences on psychotherapy Treatment Socioeconomic factors can hinder clients from getting psychotherapy. Most client who don’t have insurance are unable to pay for services, they are more likely to be discouraged from seeking treatment.  Hawley, Leibert, and  Lane, (2014), noted that social, economic status has a significant influence on therapy. In a research study, results show that  with higher education and access to health insurance even at a free counseling clinic may improve counseling outcome and retention.  The study also pointed out individuals with lower social, economic status levels as having greater dysfunction and greater goal disagreement about treatment has less successful counseling outcomes. These patients are less motivated and lack social support (Hawley, Leibert & Lane, 2014). There are community based services that are also offer for free or low cost based on income. It is also important to know that those with low income have life problems and mental illness as well as client with higher income. ( Jeste, Palmer, Rettew & Boardman, 2015). Conclusively, for an PMHNP to diagnose and treat mental illness effectively,  they must considered the ethnicity, religion, race, social, economic status, and culture of the client Even though, it is not possible to culturally be competent in all cultures, a working knowledge of the backgrounds of those who most seek treatment is essential (Wheeler, 2014).


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