Submit a 4-5 page, 7th ed. student APA paper, not including title and references. Select a PEER reviewed EBP Research paper from a professional advanced practice journal related to your APN track. i.e. FNP, AGACNP, PSYCH article ….that is < 5 years old. Evaluate the paper using the following criteria. Identify your APN track. What method did you use to find the article? (Cochran library, Silver Platter etc.) Journal name and year of article publication. Title and all authors. Identify the topic and question under study (PICOT if given) Subjects - how many and how were they identified? What were the research methods used in the study? Methodology What did the finding show? Interpret the finding. (i.e. p value and sign levels.) What does this mean? What is the significance of the findings for professional practice in your specific APN track EBP Research Paper
Evidence-Based Practice Research
Student’s Name
Institutional Affiliation
APN Track
My APN track is Psychiatric Mental Health Nurse Practitioner (PMHNP). The APN track comprises health professionals with advanced education and training to diagnose and treat patients suffering from mental health illnesses. Interventions that a PMHNP can implement include psychotherapy, group counseling, and prescribing of medication. The APN tracks intersect with the roles of other professionals, such as social workers, psychologists, and psychiatrists.
The method used to Find the Article.
The research was done through the Cochrane Central Register of Controlled Trials (CENTRAL), Which contains a variety of sources of quasi-randomized controlled trials and randomized controlled trials. The search was completed using keywords such as ‘evidence-based interventions,’ ‘mental health illnesses,’ and other terms. Exclusion criteria were articles that only had abstracts, articles published five years ago, articles that were published in English, and articles from other APN tracks.
Journal name and Year of Article Publication, title, and all authors
The article selected is published in the International Journal of Clinical and Health Psychology. The journal publishes scripts and reports with applied and basic emphasis, including theoretical, experimental, and clinical work that facilitates clinical advancement and health psychology. The journal targets four core domains, including psychopathology, psychotherapy and clinical psychology, health psychology, and clinical neuroscience. The manuscripts submitted to be published in the journal should be novel. The journal publishes empirical studies or original articles and reviews articles. The article was published in 2019. The article is titled ‘A randomized clinical trial of a group and individual cognitive-behavioral therapy approaches for social anxiety disorder’ (Neufeld et al., 2020). It was written by six authors, including Neufeld, Palma, Caetano, Brust-Renck, Curtiss, and Hofman. They work in different academic institutions as follows: Neufeld, Palma, and Caetano work at the University of São Paulo, Brazil; Curtiss and Hofman work at Boston University in the United States, while Brust-Renck works at The Federal University of Rio Grande do Sul (Neufeld et al., 2020).
The Topic and Question Under Study
The topic of study is group and individual CBT approaches as interventions for Social Anxiety Disorder (SAD). Although the PICOT question and hypothesis do not apply to the study, the authors’ aim in conducting the study was to compare the efficacy of individual CBT using a trial-based CBT and group CBT consisting of exposure therapy in treating social anxiety disorder (Neufeld et al., 2020). The topic is based on the concern that SAD is the most recurrent mental health issue among anxiety disorders. SAD is associated with poor-psychological well-being, occupational underachievement, and reduced quality of life (Thompson et al., 2019). Several self-screening instruments, along with the criteria in the DSM-5, are used in diagnosing SAD. In the DSM-5, social phobia changed to social anxiety disorder to differentiate SAD from other phobias. Clinical diagnosis of SAD requires the patient to present with persistent fear for at least six months in none or more performance or social situations (Mithawala, 2021). The healthcare provider must also rule out somatic symptom disorders and certain physical illnesses. CBT has been proven very effective in treating SAD. The authors felt the need to conduct a randomized controlled trial to compare the effectiveness of individual and group CBTs in treating SAD due to a gap in research.
Subjects
The subjects were young adults diagnosed with SAD. The researchers recruited a total of 86 young adults. Twenty-six subjects were initially assigned to the TBCT intervention, 27 to a group CBT, and 33 were on the waitlist control. Participation was voluntary, and contact with the volunteers was made to inform them about the details of the study. Recruitment of the subjects was through the internet, clinical services, the local media, and television. Inclusion criteria included reading skills, writing skills, and adequate understanding. They signed an informed consent. Volunteers excluded from the study were those who did not get a clear SAD diagnosis. The Institutional Review Board of the University of São Paulo authorized all procedures of the study. The board provided ethical approval for the study to be conducted (Neufeld et al., 2020).
Research Methods
The study is a randomized control trial that adopts a pre and post-test design. Randomized control trials are considered effective study designs that provide the most reliable evidence of the effectiveness of interventions. Randomization is effective in minimizing bias and provides the researchers with a rigorous tool to examine a cause-effect relationship between an intervention and outcomes. The ability to minimize bias in randomization results from the ability to balance the characteristics of the participants between groups, which allows the attribution of any difference in outcome to the intervention implemented (Hariton & Locascio, 2018). The authors used interviews in the initial assessment of the participants. The participants received a diagnostic interview to determine whether they met the inclusion criteria. Data collection was through questionnaires answered by the patients after attending 16 therapy sessions. The authors utilized Chi-square to compare categorical variables, while Univariate Analysis of Variance was utilized to compare the continuous variables (Neufeld et al., 2020).
Various instruments were used in data collection and analysis. For example, the Structured Clinical Interview for DSM-4-Clinician (SCID-CV) was used to assess and diagnose Axis I Disorders Pursuant. Social Phobia Inventory (SPIN) was used to assess fear, physiological symptoms, and avoidance. Typical anxiety was measured using the Beck Anxiety Inventory (BAI). The social avoidance and Distress Scale (SADS)was used to measure social discomfort and social events avoidance. The authors utilized the Fear of Negative Evaluation Scale (FNE) to measure the fear of negative evaluation of the social situation, which is a core characteristic of SAD. Screening of major depressive episodes was done using the Patient Health Questionnaire (PHQ-9) (Neufeld et al., 2020).
Findings and Interpretation of the Findings
The results indicated improvement in the participants’ depressive symptoms as indicated in the post-test for both the TBCT and CBT groups. The effect sizes varied as robust changes in responses to the PHQ-9 and SPIN. Most changes identified in symptoms indicated a score reduction by half in all scales except SADS and FNE, which had the smallest effect sizes, but the changes were still significant. No significant differences were reported with the waitlist condition (Neufeld et al., 2020).
From the findings, the regression coefficients representing a contrast between the individual and group CBT interventions and waitlist significantly predicted the recorded Latent change scores as follows (TBCT vs. WL, γ = −21.19, p < .01; Group CBT vs. WL, γ = −22.34, p < .01). The values shows that the participants in TCBT and group CBT experienced significantly more reductions in symptoms of social anxiety compared to the waitlist control. No significant differences in symptom reduction between the Individual and group CBT groups (γ = 1.15 p > .05). The effectiveness of the interventions in reducing depressive symptoms and their differences with the control group were also reported as follows; (TBCT vs. WL γ = −10.37, p < .01; Group CBT vs. WL, γ = −11.14, p < .01). No significant differences in reduction of depressive symptoms between individual and group CBT interventions were reported (γ = .76, p > .05). The p-value helps in rejecting or supporting the null hypothesis. The smaller the p-value obtained by the researcher (s), the stronger the evidence favoring the rejection of the null hypothesis. A p-value greater than 0.05 indicates no evidence of difference (Nahm, 2017). Therefore, the authors did not find any evidence of differences between the individual and group CBT interventions (Neufeld et al., 2020).
Based on the findings of the study, participants in both interventions achieved greater reductions in depressive and social anxiety symptoms. The post-test results showed that the individual and group cognitive behavioral interventions effectively reduced the SAD symptoms, including fear, physiological symptoms, and avoidance. A significant reduction was also reported in symptoms measured by BAI, including general anxiety symptoms and those measured by FNE and SADS. The two interventions also reduced the symptoms of depression, including the frequency of major depressive symptoms and the severity of the symptoms. The results suggest that the two interventions are equally effective in treating SAD by reducing different comorbidity symptoms. The findings of the study are in line with the existing literature supporting the effectiveness of any CBT intervention in reducing social anxiety symptoms and psychiatric symptoms. The study’s findings are also similar to the findings of another previous study that indicated the high efficacy of CBT in treating SAD, making the intervention a gold standard in the treatment of SAD.
The Significance of The Findings for Professional Practice
The findings can be very useful in clinical practice for treating SAD. SAD is the most predominant anxiety disorder affecting adolescents and young people and impairs their functioning capabilities hence the need to be treated successfully (Al‑Johani et al., 2022). As a PMHNP, one should have adequate knowledge about the most effective treatment interventions that should be adopted in treating patients. Existing evidence indicates that CBT is the most effective psychotherapy in treating SAD (Abeditehrani et al., 2020). CBT can be described as an eclectic approach that adopts techniques from behavioral and cognitive theories. The emphasis on CBT as the most effective psychotherapy is based on extensive lab evidence showing that SAD is associated with different forms of avoidant behavior and cognitive bias hence the need to change the thinking patterns of the patient and encourage approach behavior (Narr & Teachman, 2017). The findings of the randomized controlled trials add to the existing literature by showing a lack of significant difference between individual or group CBT. The findings can be used by mental health professionals in clinical decision-making on the best psychotherapy recommended to the patient. The decision made will only be on the basis of cost and convenience and not effectiveness. Group CBT was found to be more effective as compared to individual CBT, while individual CBT was more convenient for scheduling patients for individual sessions. Implementation of the findings in the clinical setting can improve the quality of patient care and patient satisfaction.
References
Abeditehrani, H., Dijk, C., Toghchi, M. S., & Arntz, A. (2020). Integrating cognitive behavioral group therapy and psychodrama for social anxiety disorder: An intervention description and an uncontrolled pilot trial. Clinical Psychology in Europe, 2(1), 1–21. https://cpe.psychopen.eu/index.php/cpe/article/view/2693
Al‑Johani, W. M., AlShamlan, N. A., AlAmer, N. A., Shawkhan, R. A., Almayyad, A. H., Alghamdi, L. M., … & AlOmar, R. S. (2022). Social anxiety disorder and its associated factors: a cross-sectional study among medical students, Saudi Arabia. BMC Psychiatry, 22(1), 1-8. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04147-z
Hariton, E., & Locascio, J. J. (2018). Randomized controlled trials—the gold standard for effectiveness research. BJOG: An International Journal of Obstetrics and Gynaecology, 125(13), 1716. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235704/
Mithawala, P. K. (2021). Managing Social Anxiety Disorder. US Pharm, 46(5), 23-27. https://www.uspharmacist.com/article/managing-social-anxiety-disorder
Nahm, F. S. (2017). What the P values really tell us. The Korean Journal of Pain, 30(4), 241-242. https://synapse.koreamed.org/articles/1159690
Narr, R. K., & Teachman, B. A. (2017). Using advances from cognitive behavioral models of anxiety to guide treatment for social anxiety disorder. Journal of clinical psychology, 73(5), 524-535. https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.22450
Neufeld, C. B., Palma, P. C., Caetano, K. A., Brust-Renck, P. G., Curtiss, J., & Hofmann, S. G. (2020). A randomized clinical trial of group and individual cognitive-behavioral therapy approaches for social anxiety disorder. International Journal of Clinical and Health Psychology, 20(1), 29-37.
Thompson, T., Van Zalk, N., Marshall, C., Sargeant, M., & Stubbs, B. (2019). Social anxiety increases visible anxiety signs during social encounters but does not impair performance. BMC psychology, 7(1), 1-9. https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-019-0300-5