Disease Models and Social Learning Therapy

Introduction

Various enhancements in long-term personal and clinical outcomes for different people who experience mental disorder are moderate, though recovery has been proved to be possible. Although the experience for recovery is inherently personal, the process is usually non-linear and complex, and there exists a wide range of possible recovery contributors and contexts. These could either be professional or nonprofessional; thus, mental health recovery-oriented models need to be fostered (Frost et al., 2017). The models expound the behavior of human development, both socially and psychologically, and many researchers emphasize on alleviating suffering or pain. Integrated recovery model (IRM), cognitive behavior therapy (CBT), and biological models are frequently used to help in explaining the treatments as well as the causes of psychological illnesses from different approaches. This paper compares and contrasts the integrated recovery approach to cognitive and biological models while also discusses the various phases from the perspectives of the three models.

Overview of the Models

Integrated Recovery Model (IRM)

The model is designed to improve the health, social inclusion, and wellbeing of an individual by offering an easy access to evidence-based psychosocial interventions (EBPIs). The approach takes place in a service context which provides support to recovery, both as a process, as well as an outcome (Frost et al., 2017). The evolution has been characterized by the following five broad challenges: the overall framework of service delivery, significant perspectives of recovery, psychiatric literature, implementation, and the stages of review and evaluation (Frost et al., 2017). IRM revolves around the constantly changing needs of an individual, and the main focus is on the underlying process and the service structure. Thus, IRM works to reinforce hope as the core catalyst for functional and indicative recovery. In the model, practices of clinical rehabilitation (CR), the process, and partnership simplify access to psychosocial EBPIs, promoting social inclusion, hope, self-agency, and recovery. Indeed, the core components of IRM and related processes, phases, and strategies of evaluation give an illustrative scenario of the model.

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Cognitive Behavior Therapy (CBT)

As a model, CBT bases its argument on the cognitive theory of psychopathology. The framework offers a description on individual’s perceptions of, or the impulsive opinions about, how different situations may affect their behavioral and emotional reactions. The opinions of people are regularly distorted and become dysfunctional whenever they are distressed (Kazantzis et al., 2018). Individuals are in a position of identifying and evaluating their thoughts (which occur spontaneously either verbally or imagined) and correct them. The distress is said to decrease as they do so, and as such, they can behave more functional, and the physiological arousal is reduced, especially in the case of anxiety. Essentially, the victims get a chance of learning how to modify and identify their distorted beliefs.

The vague opinions impact the way affected people process information, thus leading to the inaccurate beliefs. CBT tries to explain a person’s behavioral, physiological, and emotional responses as arbitrated by their discernment. These are greatly influenced by how individuals interact with the world along with their beliefs and experiences (Kazantzis et al., 2018). The patients are taught how to participate in the process of evaluation independently. They are also assisted in designing experiments which help them to thrive between various sessions, as well as to test cognitions which occur in form of predictions (Kazantzis et al., 2018). Problem solving and evaluation are then done by the therapist when the thoughts of the patient are valid. Consequently, the therapists work with outcomes in understanding the difficulties of every patient.

Biological Model

The biological model aids in the treatment of mental illness linked to a physical cause, for instance, a broken leg. The framework is widely implemented by psychiatrists as compared to psychologists, as the former considers the outlying symptoms to be an outward sign of an inner disorder. Psychiatrists believe that grouping and classifying the symptoms together into a syndrome, the real cause can be revealed and the right physical treatment given (Salicru, 2020). In essence, the psychiatrists’ main focus is on neurophysiology, genetics, neurotransmitters or neuroanatomy, and the approach contends that the illness is connected to the functioning and the physical structure the brain.

Similarities of the Models

The biological model is similar to the IRM in that both are paternalistic and distinguished by emphasis on the illness, limitations, and weaknesses rather than the possibility of growth. They both instill hope by implying that biology is just a destiny, and more emphasis should be put on the external locus of control (Frost et al., 2017). The physician is viewed by the consumer to be an oppressive and a powerful figure who acts best out of misguided beneficence and might be even fostering chronicity and helplessness. Since the biological model makes sure that genetic causes of illness are addressed, and medication is received properly, the IRM guarantees that patients are involved in their treatment directly, which makes the two models complementary.

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An essential aspect in both the IRM and the CBT is learning, with both models underlining experiential knowledge, as well as how the facet helps in self-management. Support is also offered in the recovery journey by the use of different tools which cultivate positive thinking by teaching the patient the importance of social inclusion and skill recovery (Frost et al., 2017). The two models underscore the levels of knowledge to identify situations which can be treated and validated reliably. Hope is built on the grounds that as long as the clients are learning and utilizing the required tools at the professionals’ disposal, the journey to recovery is successful.

Differences Between the Models

IRM Vs Biological

While the IRM is a subjective approach, which is more personalized in caring for the people with mental disorders, the biological model is objective because it emphasizes scientific reality. It postulates that mental disorders are caused by physiological conditions, and the focus is on using medications for treatment. The IRM stresses on the significance of phenomenological and subjective practices as well as of the autonomous rights of an individual in the process of recovery. Decisions made by care recipients about treatment not only depend on facts or scientific grounds, but also on values (Frost et al., 2017). The act of science provides a chance of identifying alternative potential treatments, the efficient distribution of the outcome probability, and the effects associated with each of the therapeutic options. On the other hand, in IRM, the decision to be made on the preferred combination of anticipated effects, as well as the improvement is a value judgment (Frost et al., 2017). The resolution made by the consumer reflects more their values rather than those of the psychiatrist, even in situations where professionals try to adhere to the principle of the priority of consumers’ opinions.

IRM Vs CBT

In contrast to the IRM, which focuses on a person’s abilities and strengths, CBT bases its argument on the psychopathology and deficits of an individual. It places belief in the patient to get their own experience and be in a position to participate actively in their treatment (Frost et al., 2017). Conversely, CBT lays emphasis on the weak areas of the patient and attempts to evaluate them, encouraging the client to work on personal improvement. It offers peer support and individual empowerment that people should cope with their disabilities and work on recovery. While the IRM proffers treatment to all persons with mental illness, CBT is applicable on individuals with specific disorders which are not severe.

Assessment Steps

IRM

The assessment phase in IRM marks the start of a journey, whereby the major elements that sustain and generate hope are nurtured and reintroduced in a careful manner. Early intervention which reduces social sequelae is the goal of the phase, and building real and sustainable trust is critical in this stage because it develops a positive adjustment to the illness (Frost et al., 2017). An opportunity of ensuring safety, managing financial and legal issues, and addressing physical health issues is provided. In addition, any other likely event which is feared to affect the patient, their families, partners or friends, is identified. Breaching an individual’s coping and protective strategies may culminate in an acute psychosis, a feeling of denial, shock, anxiety and exhaustion (Frost et al., 2017). The reactions are mostly fueled by stigma, and a risk of exacerbation by management and treatment plan is likely to be experienced.

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Biological Model

Biological model involves a clinical assessment in which information is collected and conclusions are drawn by the use of psychological and observational interviews as well as neurological tests. This is done to help determine the patient’s problem and present the underlying symptoms. In particular, the skills, emotional, cognitive and functioning abilities, personal characteristics, social and cultural context are assessed (Salicru, 2020). Clear accounting of the symptoms and their effects on one’s daily life helps to determine the degree to which the person is adversely affected. If the treatment is needed, then decision has to be made on the best therapy likely to work on the patient. To determine if the treatment worked, monitoring is done prior to, during, and after the process.

CBT

The CBT model assumes that a patient can be taught how to approach his problems in a rational way. The emphasis is thus put on rational understanding; the cognitive therapist will typically begin treatment by explaining the nature of her approach. At the start of the therapy, the patient’s view of his problems and the cause of the condition is assessed (Kazantzis et al., 2018). Careful attention is paid to specific meanings which the victim assigns to some events, and how they relate to feelings and abnormal behavior. Essentially, CBT model is introduced and collaborative therapy process started by listening carefully to establish rapport.

Diagnosis

Biological Model

In the diagnosis phase, assessment data is used in the biological model to determine whether the symptoms presented are consistent with the criteria for diagnosing mental disorder. This is delineated in the classification system ICD-10 or DSM-5, and clinical utility should be present in the diagnosis utility (Salicru, 2020). It helps in the determination of prognosis, potential outcome, and the treatment plan as well. However, being diagnosed does not mean that one should be treated; the decision depends on the severity of the symptoms.

IRM

An initial treatment which reduces fear associated with diagnosis and symptom onset is initiated, and a collaborative recovery-oriented plan commenced. The plan is usually considerate of the aspirations and wishes of the patient, as well as of their family. The strengths, potential risks, and protective factors of the patient should be well understood to certify that the consumer’s investment of hope is placed well (Frost et al., 2017). A holistic plan supporting hope via a wide range approaches designed to build confidence and address the vulnerability underscores the significance of involving specialists at the early stages. If there is a need for physical rehabilitation, care is supposed to be exercised to ensure the victim successfully returns to pre-episode functioning (Frost et al., 2017). Therefore, to develop an individual, tailored, supportive and multi–modal program, a thorough assessment should be done.

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Understanding that an effective determination of positive symptoms is not an indication of a return to pre-episode functioning, reinforces the need for care. Therefore, a detailed assessment helps to develop a multi-modal, supportive and individually tailored skill building package, which is later combined with other treatments in the process of recovery (O’Keeffe et al., 2018). With an aim of demonstrating an unequivocal obligation to the objectives of the recovery-oriented plan, various nonclinical as well as clinical services such as triage and emergency assessment, community and acute patient services, and programs of early intervention are involved.

CBT

To diagnose mental illness using CBT model, the therapist thoroughly conducts a detailed functional analysis of the behavior of a person. This is mainly intended to help in identifying the consequences and past experiences exhibited by the client, which serve as maintaining and triggering factors. They may arise from social, physiological, emotional, environmental or cognitive domains (Kazantzis et al., 2018). The analysis has its focus on the effectiveness, range, and number of the patient’s coping skills. Since the model seeks to identify and remediate deficits in coping skills, adaptive skills and strengths are also assessed. Features in the emotional state and thoughts are determined to aid in recognizing situations which are likely to pose a risk to the patient. What was done or felt before, during and even after the risky incidences is assessed in order to correctly assess the coping abilities and attributional processes.

Treatment Planning

IRM

The aim of a treatment plan is to show that the sense of possibility together with the hope are key factors in the healing process. At the initial stages, an integration of a wide array of EBPIs is necessary to aid in the restoration of interpersonal, personal, and regular coping competencies and skills (Frost et al., 2017). This may equally offer a chance to remedy developmental disparities and lifetime goals, thus contributing to renewed feeling of self. As confidence develops in individual capabilities and environmental adjustments, a more elaborate base for further pathway or goal-oriented reasoning emerges. Undertaking an exploration of new and confirmatory incidences will definitely consider an extent of positive risk taking, and there may be a requirement of detailed approaches to uphold personal dignity. Through the entire phase, the emphasis is explicitly on the establishment of self-agency, specifically in relation to mental recovery, physical healing, and social inclusion.

Establishing a set of processes and interventions which aim at achieving and maintaining optimal operation in the victim’s environment is also very critical. This is because the model aims at helping the client apprehend their goals, in a manner that builds confidence and trust (O’Keeffe et al., 2018). In addition, the model affirms as well as reaffirms that hope instillation in the functional skills is justified, and also supports independent exploration of more sustaining personal goals. In ensuring the recuperation of self-agency and control, it is extremely significant to understand the involved risks and make sure that personal dignity is protected.

Biological Model

After diagnosis in the biological model, the psychiatrist prescribes treatment which may include drugs, electroconvulsive therapy (ECT) or psychosurgery depending on the severity of the illness. However, for over a long time, drugs have been used predominantly by many psychiatrists to treat mental disorders (Salicru, 2020). For instance, mono-amine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and antidepressants are used to treat OCD, anxiety, and depression. There are various generations of antipsychotic drugs which help in treating schizophrenia, and they act by blocking d2 receptors (Salicru, 2020). Antipsychotic drugs can be used to treat by blocking d2 (dopamine) receptors. In case drugs and ECT fail to help the patient, psychosurgery is done. Such intervention involves the brain nerves thought to trigger the disorder are either cut out or burned.

CBT

Case conceptualization is a treatment framework which helps to better understand the patient’s current problems and the intervention techniques to be used. Therapists define a plan which gives the best opportunities for change to the client (Kazantzis et al., 2018). This is the best roadmap for both the psychiatrist and the patient as it includes a foundation to assess progress. A problem list is generated, which includes the current difficulties and the treatment goals highlighted. By making use of the already recognized self-report symptom inventories, the therapeutic progress is evaluated, and the baseline functioning is measured. Cognitions are also assessed, the thoughts as perceived by the client are examined, and the precipitating situations and behaviors considered.

Exposure therapies, which emphasize on activating cognitive and affective processes are used to facilitate the recovery process. Disclosure to feared situations, memories, objects or images helps in overcoming fear, and trauma. Virtual reality exposure (VRE) is another treatment therapy which incorporates real-time computer generated imitation, and devices which track the victim’s body, responding to body motions (David et al., 2018). The approach aids in overcoming some disadvantages experienced in traditional imaginal exposure, and has an advantage over in-vivo exposure.

Relapse and Post-Treatment Management

IRM

The relapse management helps to re-establish in and reconnect with the community, and also explore the various opportunities for social inclusion and independence. With a new hope and confidence and the competencies developed so far, the psychiatrist need to develop a supportive structure, coupled with progressive skill refinement and utilization, to pursue a range of personal goals. An advanced exposure to less supported events such as social, community situations, and independent living, is also necessary (Frost et al., 2017). The investment of hope is validated and larger levels of self-agency and self-esteem developed through exploring opportunities.

CBT

Managing future psychological and psychosocial stressors is a difficult task for patients without a therapist. It is thus important to plan for tools that the client will use for some specific symptoms, and when there should be a need to contact a psychiatrist after cognitive therapy. Taking time to prepare the patient for the inevitable is key as it encourages and empowers them and helps in managing a possible relapse. To be able to identify future problematic situations, a functional assessment is usually required (Kazantzis et al., 2018). Responding to concerns by checking the patient regularly and addressing their questions maintains the therapeutic relationship and offsets negative emotions. Booster sessions are scheduled, whereby the self-management stressors and symptoms are checked, and the skills learned are refreshed.

Biological Model

Psychotherapeutic and psychological interventions such the CBT, peer support, and monitoring help patients manage relapse after medical treatment. Critical incident stress management and psychological debriefing educate patients on trauma and encourage sharing of experiences as well as emotional responses (Salicru, 2020). In addition, depending on the outcome of the treatment, various drugs are also administered to help the patients relax and manage different situations. The psychiatrist monitors the patient closely to assess the progress and recommend a need for further examination.

Conclusion

In summary, the treatment models make a significant difference for people with mental illness because they consider their needs. Particularly, the IRM emphasizes empowerment, hope, and self-management and fosters confidence and positive energy towards recovery. The biological model has its roots in science and evidence, and it is possible to implement it with humanity and compassion. Irrespective of the treatment model employed, the recovery experience is personal and the process may be non-linear, but the goal for the models is to improve the individual’s quality of life.

References

David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in psychiatry, 9, 4. Web.

Frost, B. G., Tirupati, S., Johnston, S., Turrell, M., Lewin, T. J., Sly, K. A., & Conrad, A. M. (2017). An integrated recovery-oriented model (IRM) for mental health services: Evolution and challenges. BMC Psychiatry, 17(1), 1-17. Web.

Kazantzis, N., Luong, H. K., Usatoff, A. S., Impala, T., Yew, R. Y., & Hofmann, S. G. (2018). The processes of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 42(4), 349-357. Web.

O’Keeffe, D., Sheridan, A., Kelly, A., Doyle, R., Madigan, K., Lawlor, E., & Clarke, M. (2018). ‘Recovery’in the real world: Service user experiences of mental health service use and recommendations for change 20 years on from a first episode psychosis. Administration and policy in mental health and mental health services research, 45(4), 635-648. Web.

Salicru, S. (2020). Retiring categorical systems and the biomedical model of mental illness: The why and the how—a clinician’s perspective. Psychology, 11(8), 1215-1235. Web.

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