Mental Health Nursing

186 Acute Mental Health Nursing
reader will be able to appreciate some of the underpinning theory and
overall should be equipped with some of the basic knowledge which is
necessary to develop cognitive behavioural skills. The chapter will include
the following sections.
• The basis of cognitive behaviour therapy (CBT) and its application
within the in-patient setting.
• CBT: a longstanding tradition in nursing.
• The CBT framework (including measurement and experimentation).
• Specific cognitive behavioural techniques.
• Summary.
• Conclusion.
The basis of cognitive behaviour therapy (CBT)
and its application within the in-patient setting
While the term cognitive behaviour therapy (CBT) is very well known
now to most mental health professionals, it might be worth (by way of
introduction) describing how this current concept has evolved. The roots
and origins of CBT go back to the turn of the 20th century when various
behavioural psychologists began to develop various theories of learning.
As most readers will know, Ivan Pavlov, a Russian psychologist, was
foremost in this movement, and most nursing students will have read
about Pavlov’s work with dogs and conditioned reflexes. Similarly, the
behavioural theories of Skinner, which were developed in the 1930s and
1940s, focused on learning by reinforcement, and this work was originally
applied in educational settings. Once more, most nursing students will
have received a basic introduction to operant conditioning and other
‘Skinnerian’ concepts. I will not therefore reiterate the history of learning
theories, other than to say that it is important to recognise that the theories
relating to classical conditioning and operant conditioning originally
underpinned some of the later treatment approaches which became known
as behaviour therapy.
Behaviour therapy for neurotic problems developed from the learning
theory approaches in the 1950s. A South African psychiatrist (who had
settled in the USA), Joseph Wolpe, developed treatments based on classical
conditioning theories. Wolpe’s work led to the first treatments of
phobias by a process known as systematic desensitisation. In this approach
Wolpe coupled with the anxiety stimulus, another stimulus which was
incompatible with anxiety, a process known as reciprocal inhibition. In
practice, Wolpe taught patients to relax in association with presenting
them with images of the things they feared. Thus, in graduated doses of