DEVELOPMENT OF A COMBINED COGNITIVE BEHAVIOR THERAPY AND SELF - CONTROL PROGRAM FOR PSYCHIATRIC PATIENTS HAVING VIOLENT BEHAVIORS

Abstract

               Objective: 1) to develop a combined cognitive behavior therapy and self-control program for psychiatric patients having violent behaviors and 2) to investigate effects of the program developed.

               Methods: This study was a research and development (R&D). The major steps involved the situation analyses, developing the program and testing the effectiveness of the program developed.  Purposive sampling was used to select the subjects according to the inclusion criteria. The subjects were 50 psychiatric patients having violent behaviors, 25 for an experimental group receiving the program and 25 for a control group receiving routine nursing care. The research instruments consisted of 1) The combined cognitive behavior therapy and self - control program for psychiatric patients having violent behaviors, 2) thoughts and emotions on violent behavior questionnaire, 3) self - control inventory, 4) violence assessment scale, and 5) the questionnaire for assessing nurses' perception of the program benefit. All instruments were validated for content validity by 3 experts. The 2nd - 5th instruments had reliability with Cronbach’s alpha coefficient equal to .70, .71, .88, and .76 respectively. Data were analyzed by descriptive statistics, Fisher's exact test, Chi-square test, independent t - test, and repeated measures ANOVA.

               Results: The results revealed as the follows: 1) The combined cognitive behavior therapy and self-control program for psychiatric patients having violent behaviors comprised of five sessions conducting as a therapeutic group in the hospital for a period of one week. The Item Objective Congruence (IOC) of the program was 1. The nurses' perception of the program benefit on very benefit to most benefit was 90.57 percent. 2) Results from repeated measures ANOVA showed that the mean scores of the thoughts and emotions on violent behavior, self-control, and violent behavior were statistically significant differences between experimental and control groups (p < .001) and the mean scores of the 3 variables between before experiment, immediately after experiment, and 1 month after the experiment were statistically significant differences (p < .001).  Multiple comparison analysis showed that the mean scores of the thoughts and emotions on violent behavior and violent behavior immediately after the experiment and 1- month follow - up period were statistically significantly lower than those before the experiment. Additionally, the mean scores of the self - control immediately after the experiment and 1- month follow - up period were statistically significantly higher than that before the experiment.

               Conclusion: The combined cognitive behavior therapy and self - control program for psychiatric patients having violent behaviors could improve the thoughts and emotions on violent behavior, self - control, and violent behavior. The program should be considered as an alternative for nursing intervention in the service system in psychiatric patients having violent behaviors.