Training Nurses in Cognitive Behavioral Therapy: Enhancing Community Care of Patients With Serious Mental Illness

Serious mental illnesses (SMI) affect 6.3% of all adults in the United States and impose an enormous burden on the sick individuals, their families, and society at large. Recovery, as opposed to symptom control, is increasingly being considered as an achievable and desirable treatment goal for individuals with SMI. Pharmacotherapy is critical to the treatment of (SMI) but has limitations, including:  High non adherence rates;  Poor response of negative and cognitive symptoms to treatment; and  Inadequate functional improvement. Adjunctive psychosocial treatments are being investigated to improve therapeutic outcomes. In the past 10 to 15 years, cognitive behavioral therapy (CBT) has emerged as the most effective evidence-based adjunctive treatment for these disorders. Access to this type of therapy, however, is constrained by a lack of healthcare professionals trained in CBT. Educating registered nurses in CBT would significantly expand the pool of therapists available to treat the high proportion of individuals with SMI living in the community. This article examines evidence that nurses trained in CBT improve specific outcomes. Three case vignettes are provided to illustrate the effectiveness of CBT interventions offered by nurses. Recommendations are presented for future models of practice. Introduction SMI affects 6.3% of all adults in the United States and poses an enormous burden on the sick individuals, their families, and society at large. According to the 1999 World Health Organization global burden of disease study, severe mental illnesses (bipolar disorder, schizophrenia, severe major depression, and others) collectively account for more than 15% of the overall burden of disease from all causes. Historically, the care of SMI was provided in institutions. In the 1950s and 1960s, the care of SMI moved from institutions to community settings for a variety of reasons,