Psychiatric Mental Health - Therapies, part 2: CBT, EMDR, TMS

Emphasis of CBT

CBT aims to address and change an individual's negative distorted thinking ― negative automatic thoughts, underlying cognitive distortions, and underlying beliefs ― with more positive, rational thinking.

Automatic thoughts

Automatic thoughts are immediate, distorted thoughts a patient may have when interpreting events. For example, a nursing student who has a lot of anxiety around taking tests may say inside their head or out loud, “I am a terrible test taker.”

Cognitive distortions

Cognitive distortions are errors in logical thinking (e.g., fortune-telling, catastrophizing). Our example student would follow their negative automatic thought, “I’m a terrible test taker…” with a projection of the worst possible outcome, “...I’m going to fail this exam, and I’m going to get kicked out of my program.” This is catastrophizing.

Underlying beliefs

Underlying beliefs are core beliefs about the self and the world. For our example student, they might express a core belief (having catastrophized the outcome of their test-taking) such as, “I’m a failure.” Another common core (negative/underlying) belief people have is, “I am incapable of love.”

Goals of cognitive behavioral therapy

The goals of cognitive behavioral therapy (CBT) are to replace negative, distorted thoughts with positive, rational ones. This may include the use of thought recording (e.g., writing down and examining associations between situations, thoughts, and feelings).

For our nursing student, as they go to take their nursing exam, a more positive, rational type of thinking might include saying things like, “I’ve put in the hours and am putting my best foot forward. I am well-prepared, and I’m just going to do my best. And when that score comes in, I will deal with that at that time.”

Cognitive behavioral therapy may be used for a number of mental health disorders, including depression, anxiety, substance use disorder, eating disorders, and personality disorders.

What is dialectical behavioral therapy (DBT)?

Dialectical behavioral therapy, or DBT, is a specific type of cognitive behavioral therapy that is focused on improving self-regulation in patients as well as reducing self-destructive behavior. DBT is especially useful with personality disorders, particularly Borderline Personality Disorder.

Eye movement desensitization and reprocessing (EMDR)

Eye movement desensitization and reprocessing, or EMDR, is a therapy that is used to process traumatic memories that cause distress in the individual. It's particularly useful with PTSD and trauma-related disorders. EMDR is not recommended for patients who have seizures.

EMDR procedure

EMDR proceeds through an 8-phase approach, facilitated by a trained therapist. During a session of eye movement desensitization and reprocessing, the patient focuses on the memory of a traumatic event while engaging in eye movements or other bilateral stimulation (that is, stimulating both sides of the brain) to decrease the vividness and distress associated with the event.

Patient teaching for EMDR

Patients should expect EMDR to take from 6 to 12 sessions before therapeutic results are seen.

Transcranial magnetic stimulation (TMS)

Transcranial magnetic stimulation, or TMS, is a noninvasive procedure that uses a magnet to activate the area of the brain that is involved in mood regulation.

TMS procedure

TMS is indicated for treatment-resistant depression. During transcranial magnetic stimulation, a coil is held against the forehead, and electromagnetic pulses are administered, which activate the nerve cells in the brain.

Side effects of TMS

Side effects of TMS can include tingling, as well as contraction of the face or jaw muscles. A mild headache is possible as well.

Patient teaching for TMS

Treatment sessions for TMS last 30 to 60 minutes and do not require anesthesia as opposed to procedures and treatment options that are more invasive.

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Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about cognitive behavioral therapy, or CBT, as well as EMDR, and transcranial magnetic stimulation. Let's first talk about CBT. So CBT is a type of therapy that aims to replace an individual's negative distorted thinking with more positive, rational thinking. So it aims to replace negative automatic thoughts, underlying cognitive distortions, and underlying beliefs that are negative. So let me give you some examples of these. If we have a nursing student who has a lot of anxiety around taking tests, and I've definitely had friends with this issue, and if inside their head or outwardly they say, "I'm a terrible test taker, and I'm going to fail this test. And that's going to make me fail this class and get kicked out of my nursing program. And I'm a failure," these are obviously very negative thoughts that cognitive behavioral therapy would aim to try and change. So we see these automatic thoughts like, "I am a terrible test taker." That's an example of a automatic thought. Cognitive distortions often include things like fortune-telling and catastrophizing, so we can see that our example student here did that like, "I'm going to fail this exam, and I'm going to get kicked out of my program." They are definitely projecting the worst possible outcome, so they are catastrophizing. And when they said, "I am a failure," that's obviously an underlying belief that is very negative and that we would want to change.

So what could be some more positive rational type of thinking as the student goes into their nursing exam? Well, they can say things to themself like, "I've put in the hours, put my best foot forward here. I am well-prepared, and I'm just going to do my best. I'm just going to go in there, I'm going to answer the questions carefully, and I'm not going to change my answers, and I'm going to do my best. And when that score comes in, I will deal with that at that time." So that can be an example of the type of thinking we would want to replace all of that negativity with. So cognitive behavioral therapy can be used with a number of mental health disorders, including depression, anxiety, substance use disorder, eating disorders, as well as personality disorders. So dialectical behavioral therapy, or DBT, is a specific type of cognitive behavioral therapy that is focused on improving self-regulation in patients as well as reducing self-destructive behavior. So DBT is especially useful with personality disorders, particularly borderline personality disorder.

All right. Next, let's talk about eye movement desensitization and reprocessing, or EMDR. EMDR is a therapy that is used to process traumatic memories that cause an individual distress. It's particularly useful with PTSD as well as trauma-related disorders. So during a session of EMDR, the patient would focus on the memory of a traumatic event while engaging in eye movements. And over time, this decreases the vividness as well as the distress associated with the event. It takes about 6 to 12 sessions before therapeutic results are seen, but research has shown that EMDR is very effective for patients with PTSD.

Next, let's talk about transcranial magnetic stimulation or TMS. TMS is a noninvasive procedure that uses a magnet to activate the area of the brain that is involved in mood regulation. So it is used for treatment-resistant depression. And during the procedure, a coil is held against the forehead and electromagnetic pulses are administered, which activate the nerve cells in the brain. Side effects can include tingling as well as contraction of the face or jaw muscles, and a headache is possible as well. Treatment sessions last 30 to 60 minutes. And the good news about TMS is that it does not require anesthesia as opposed to the procedures and treatment options that I'll be talking about in my next video, which are much more invasive.

So before we get to that, though, it's time for a quiz. All right. I have two questions for you. They are straightforward, so no, "Select all that apply," or anything like that.

First question, what type of cognitive behavioral therapy is used to improve self-regulation and decrease self-destructive behavior with personality disorders? The answer is dialectical behavioral therapy or DBT.

Second question, what procedure involves holding a coil against the forehead and the administration of electromagnetic pulses? The answer is transcranial magnetic stimulation.

So hopefully, you got those right. And I'll see you with some more coverage of therapies in my next video. Thanks so much for watching.