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Cognitive Intervention

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Cognitive Intervention: Cognitive Restructuring Theory
BSHS/312
Elaine McCullough
Marc Warren, Samantha Smith, Brandy Schneider, and Herlinda Rahn
University of Phoenix

Abstract This paper will examine the use of Cognitive Restructuring in regards to Stroke Victims and Adolescent Interventions. It will also identify questions regarding interventions. It is an in depth look into interventions too help assist the victims suffering from stroke and adolescent issues. The paper includes an introduction, in depth analysis of backgrounds and interventions associated with stroke and adolescent behavior, intervention questions, and the conclusion.

Cognitive Restructuring Definition
The cognitive restructuring theory holds that your own unrealistic beliefs are directly responsible for generating dysfunctional emotions and their resultant behaviors, like stress, depression, anxiety, and social withdrawal, and that we humans can be rid of such emotions and their effects by dismantling the beliefs that give them life.
Thought challenging–also known as cognitive restructuring–is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. The cognitive restructuring model is a proven model in addressing behavioral issues concerning stroke victims and adolescents. Our focus will be addressing the insights into these interventions.
Cognitive Interventions for Stroke Victims As most of us know behavioral changes are difficult. But for a stroke victim it can be even more difficult due to cognitive impairments after a stroke. These changes are not only hard to accept, but create a challenge due to physical, cognitive and emotional impairments that often follow a stroke. After a stroke, the ability to return to a regular routine and activities now depend on the individual’s ability modify behaviors. One of the challenges one may face after a stroke is difficulty relating with others among other behavioral challenges relating to this type of injury. One of the steps in overcoming this challenge is building a trusting relationship with the stroke victim; this develops throughout the rehabilitation process. Encouraging the patient too understand the benefits of setting goals. This trust is achieved through honesty, caring and regular interaction always trying to achieve realistic expectations. Other Interventions include developing a plan that the stroke victim is happy with, so that it is more likely to be effective(White, Seckinger, Doyle, and Strauss, 1997). Take into consideration their weaknesses and strengths, and prioritize the needs. Take into consideration the individuals learning style through written information, oral or both. Take into consideration the willingness of the injured during the therapy or other rehabilitation strategy. Strategies should be practical, considering time, cost, concerns, and environment limitations. Psychotherapy is another intervention that may also benefit a stroke victim affected with less severe cognitive deficits. Prigatano (1986) suggests that psychotherapy would increase the understanding of what has happened, the injury and its effects. I would also help the person with accepting, being realistic of expectations, strategies, and changes that have to be made. In addition to the interventions a structured feedback may be necessary, as an individual may not recall the moment the stroke occurred. A therapist may want to review with an individual insight of the event providing an opportunity for preventative strategies and be able to develop self monitoring skills to be included in the plan. Research and studies have been conducted using the Functional Independence Measure (FIM). Patterns and analysis have been noted that based on hazard rate analysis, from observation on individual respondents, stroke survivor's chance of falling in any given month is 11%. FIM is used to assess progress during inpatient rehabilitation and can predict stroke rehabilitation outcomes. FIM is used to assess a patient’s level of independence while bathing, grooming, bowel and bladder control, transfers, ambulation and communication. FIM is a tool that has been studied extensively to study a patient's progress. Preventing falls in a stroke victim is very important. That is why understand the occurrence of falls following discharge is key to prevention and timing appropriate prevention interventions to maximize their effectiveness. Cognitive restructuring is made part of a process to change a client’s thoughts, feelings or behavior. Adolescent interventions have centered on behavior modification, this has been used to both change and manage behavior. An example of an exercise used to assist clients is documenting daily events that bring on unwanted actions. Adolescents suffering from depression are often asked to record thoughts on situations happening is day to day life. When a situation happens that furthers or intensifies the clients unwanted behavior, thoughts are recorded, this is to monitor and change specific behaviors and thoughts. By reporting ones thoughts and feelings the individual can document what has happened, what thoughts are happening, and what changes need to be made to improve the unwanted behavior. By continuing to document feelings and thoughts of depression, the adolescent will be able to notice a change in their own behavior; they will be able to realize that emotions are dictating how they react to certain events. With the documenting process of cognitive restructuring, many individuals will be capable of changing their own thought process for the better. Each session with the depressed adolescent should be well structured with feedback from the adolescent, frequent feedback allows the client to be heavily involved and will bring about different emotions. Emotions are the overall goal, being aware of one’s emotional state during life events is a key to altering the depressive behavior.
Further intervention steps in cognitive restructuring for adolescents will include coping skills and scheduling. Depression is a sickness that can affect every part of daily life. Scheduling teens will help them interact with others and enhance social with draw, along with becoming active with other teens goals should be made to take steps to further the intervention towards success. Coping skills will also be worked on to improve one’s social skills, this will allow the client to be comfortable and feel more relaxed when in social situations. Cognitive behavioral therapies help individuals to overcome behavior the need assistance with, by learning to change negative behavior clients will have a more fulfilled daily life. With every intervention there are many questions that arise. Questions can include:
Will I get better? In many cases the patient does get better after having a stroke. “Recovering your abilities begins after the stroke is over and you’re medically stable” (American Heart Association, 2012). “Some improvement occurs spontaneously and relates to how the brain works again after it’s been injured” (American Heart Association 2012). “Stroke rehabilitation programs help you improve your abilities and learn new skills and coping techniques”. “Depression after stroke can interfere with rehabilitation” (American Heart Association, 2012). “It’s important to treat depression. Improvement often occurs most quickly in the first months after a stroke, then continues over years with your continued efforts” (American Heart Association, 2012).Often after this question is asked the next one happens to come in to discussion with the patient and doctor.
What is stroke rehabilitation?
When the immediate crisis of a stroke has passed and you’ve been stabilized medically, it’s time to consider rehabilitation therapy (American Heart Association, 2012). After a stroke, you may have to change or relearn how you live day to day (American Heart Association, 2012). Rehabilitation may reverse some of the effects of stroke (American Heart Association, 2012).
Who will be part of my rehabilitation program?
The rehabilitation team may include: Physical Therapist, Occupational Therapist, Rehabilitation nurse, Speech Therapist, Recreational Therapist, Psychiatrist or Psychologist, Specialists, and Vocational Rehabilitation Counselor.
“The goals of rehabilitation are to increase independence, improve physical functioning, help you gain a satisfying quality of life after stroke and help you prevent another stroke”
(American Heart Association . (2012).
What will I do in rehabilitation?
Rehabilitation programs often focus on:
“Activities of daily living such as eating, bathing and dressing”. Mobility skills such as transferring, walking or self-propelling a wheelchair”. “Communication skills in speech and language”. “Cognitive skills such as memory or problem solving”. “Social skills in interacting with other people”. “Psychological functioning to improve coping skills and treatment to overcome depression, if needed” (American Heart Association. (2012).
What should a caregiver do?
Common responsibilities of care giving include: “Providing physical help with personal care and transportation”. “Managing financial, legal and business affairs”. “Monitoring behavior to ensure safety”. “Managing housework and meal preparation. Coordinating health care and monitoring medications”. “Helping the survivor maintains learned rehab skills and work to improve them”. “Providing emotional supports for the stroke survivor and family members”. “Encouraging the stroke survivor to be as independent as possible”
(American Heart Association. (2012).
Is there assistance for caregivers?
Many people find caring for another person very rewarding. But there are times when a stroke survivor’s needs are too much for any one person, but sometimes a caregiver just needs a break. These community resources may be helpful: “Adult day care — professional supervision of adults in a social setting during the day” (American Heart Association. (2012). “Adult foster homes — supervised care in approved (licensed) private homes”
(American Heart Association. (2012). “Meal programs (Meals on Wheels) — a federally sponsored nutrition program. Home health aide service — in-home personal care assistance” (American Heart Association. (2012). “Homemaker assistance — supervised, trained personnel who help with household duties” (American Heart Association. (2012). “Respite care — people come into the home for a limited time to give caregivers a break” (American Heart Association. (2012). “Some nursing homes also provide short-term respite care” (American Heart Association. (2012).
There are also many questions regarding to adolescence interventions. A few questions include:
How does the program regard the children it serves? Does the program have the competencies to effectively treat the needs of your family and child? Does the program involve parents and align with your family's personal values and belief system? What kind of services you provide for the child to help them change their behavior? Does the program help the child prepare for future issues with the problem in which they are being intervene on? During intervention stages is it encouraged for loved one to write words of encouragement to get stronger to overpower that addiction or issue that teen is being helped with for change?
It is never easy going through a mind altering situation. People suffering from strokes know that all too well. Through no fault of their own life has changed. And now the process of rehabilitation begins, the physical, emotional, and behavioral. Cognitive restructuring is an effecting model in helping victims of stroke overcome the challenges of anxiety, depression, fear, doubt and other behavioral issues. Cognitive restructuring serves as an effective model for helping adolescents as well. It seeks to provide a new way of think and channeling new behaviors to overcome negative ones.

Reference
American Heart Association. (2012). Let’s Talk About Changes. Retrieved from http://www.strokeassociation.org/idc/groups/strokepublic/@wcm/@hcm/documents/downloadable/ucm_309716.pdf
American Heart Association . (2012). Let’s Talk About Stroke. Retrieved from https://ecampus.phoenix.edu/secure/aapd/cwe/citation_generator/web_01_01.asp
American Heart Association . (2012). Let’s Talk About Stroke. Retrieved from http://www.strokeassociation.org/idc/groups/strokepublic/@wcm/@hcm/documents/downloadable/ucm_309723.pdf Deacon, B. J., Fawzy, T. I., Lickel, J. J., & Wolitzky-Taylor, K. B. (2011). Cognitive Defusion Versus Cognitive Restructuring in the Treatment of Negative Self-Referential Thoughts: An Investigation of Process and Outcome. Journal Of Cognitive Psychotherapy, 25(3), 218-232. doi:10.1891/0889-8391.25.3.218 Laura M. Wagner (2009) BMC Geriactrics,Falls among community-residing stroke survivors following inpatient rehabilitation: a descriptive analysis of longitudinal data M. Pepping, & B .C. Woods (Eds.), Neuropsychological rehabilitation after brain injury. Baltimore: John Hopkins University Press. NeuroRehabilitation, 9, 205-212.

Prigatano, G. P. (1986). Psychotherapy after brain injury. In G. P. Prigatano, D. J. Fordyce, H. K. Zeiner, J. R. Roeche,
White, S. M., Seckinger, S., Doyle, M., & Strauss, D. L. (1997). Compensatory strategies for people with traumatic brain injury.

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