Cognitive Behavioral Therapy for Depression Case Study

  1. Introduction

1. 1 Depression

Depression is a low, sad state, where life seems dark and its own challenges are overpowering. It is believed that emotional stress performs a essential role in melancholy. People with depressive disorder often complain about sensing tired all the time and they generally have trouble sleeping. Other medical indications include irritability, anger, and lack of involvement in activities which used to bring pleasure before. An individual may also describe his thoughts as thoughts of emptiness or hopelessness. Moreover, people with despair cannot concentrate, have ram problems, difficulty making decisions, and could have trouble retaining a normal working arrangements or fulfill communal obligations.

1. 2 Cognitive Behavioral Therapy

According to cognitive therapists, people who have psychological disorders can beat their problems by creating new, more functional ways of considering. Cognitive Behavioral Remedy helps a customer seem sensible of frustrating problems by breaking them down into smaller parts. This helps it be easier to observe how they are connected and how they affect him or her. These parts include situation which is more likely to be always a problem, event or a hard situation. With this as the first part, thoughts, thoughts, physical thoughts and actions follow. Therefore, therapists guide clients to challenge their dysfunctional thoughts and try out new interpretations, and finally apply the new means of considering in their daily lives.

1. 3 Cognitive Behavioral Remedy for Depression

For a patient with light or moderate melancholy, CBT may be the most appealing treatment. Within the circumstances of patients with severe despair, this is an effective treatment in conjunction with pharmacological treatment. The primary concentrate on of CBT is to learn whether a person's mood is straight linked to his or her habits of thoughts.

This therapy has two key methods to treat people who have the disorder, comprising the cognitive and behavioral strategy. The cognitive approach is when the clients thinking design is manipulated in a confident way by dealing with the therapist. This is also referred to as cognitive restructuring.

Secondly, the behavioral strategy involves the therapist helping the patient determine how his daily activities can have an impact on the patient's ambiance. Therapists usually help patients cultivate an action plan. In this process, the therapist and patient generate a list of activities which can be then positioned from least difficult to most difficult to attain. As the patient goes from simpler to harder activities, his sense of mastery increases as despair reduces. The technique essentially targets the immediate present, which helps the patient realize what and what sort of person thinks alternatively than why a person feels that way.

  1. Background Information

2. 1 Reasons for referral

Lakshani was once an active teen who is now constantly idle at home or during intercourse. She exhibits no interest in virtually any activity, and appears to lack any type of determination or energy. She is exceedingly sleeping and always somber. So, Lakshani's mother got her to a psychiatrist who then referenced her to a psychologist, since he believed psychotherapy would verify most beneficial for the individual.

2. 2 Presenting problems

Lakshani not only relished playing badminton with her friends and neighbors, but reveled in reading, performing and dancing as well. In the past 3 months, her life has drastically changed. For example, prior to her behavioral change, she used to take pleasure from helping her mom in the kitchen. However, she now spends her complete day curled up during intercourse. Her mother also recognized her insufficient cravings. She says she feels exhausted and sleepy all the time. She no more feels motivated to engage in any type of activity and does not have any goals planned for the future.

2. 4 Previous Psychiatric and Treatment History

Lakshani has previously gone through shows of low feeling after her father left when she was 8 yrs. old and was thus approved with anti-depressants. No psychotherapy had received to her because of this. As of this moment, she is on a minimal dose of anti-depressants.

2. 4 Relevant Family History

Lakshani is the sole child in her family. When Lakshani was just 8 yrs. old, her father divorced her mother to marry an other woman. Although she was near to her father before this event, Lakshani did not get the opportunity to see him after he kept. This was largely because her parents finished off things on specifically bad terms. However, the father re-entered her life a year back, and with her mother's support, the duo reconciled. Corresponding to Lakshani, she has found the reunion difficult, especially since he has as new family.

The mother did not remarry and was supposedly quite distressed about the parting. Though her mother's anguish was apparent to Lakshani, she didn't know very well what to label of it, since Lakshani herself, was attempting to cope with the problem the best she could.

Throughout this ordeal, she became rather attached to her grandparents. She actually is especially near her grandfather.

2. 6 Premorbid Personality

Lakshani was a sociable girl with the capacity of acquiring buddies easily. She loved school and viewed a keen involvement in specific activities and pastimes such as playing badminton with her neighbours, reading, singing and dancing, as mentioned before.

3. 0. Formulation

Lakshani's reason behind her depression is stemmed by many different incidents progressively. The earliest event which influenced her was her parent's divorce. This occurrence had damaged her so severely that she was unable to attend college for a month afterwards. The starting point of similar occurrences later on, particularly the hard split up with her boyfriend, has caused her to suppose that no one in her life cares about her and they will all leave eventually ("no I am not intelligent, I am definitely useless, nobody desires me. " ). Thus her pattern of attributing everything adversely preserves the depressive symptoms. This formulation identifies the different incidents that could have possibly added to Lakshani's negative style in her thinking

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4. Intervention

4. 1. Summary

Lakshani was offered regular appointments and was asked to attend 12 sessions more than a 6 month period. Her treatment typically made up of cognitive behavioral therapy approaches to identify and adjust negative dysfunctional thinking as well as learning ways to avoid a relapse in the future.

4. 2 Proposal and Psychoeducation

The introductory treatment time worked to establish a positive restorative alliance, while maintaining professionalism and reliability. Lakshini disclosed the continuing negative dysfunctional thoughts and how she has, until recently, made no valiant effort to change these contemplations. Her symptoms were talked about and a identification of despair was made. Thus, a dialogue on major depression was unveiled and Lakshini was educated on its effect on a person's behavior and exactly how Lakshini, personally, experiences it. The composition, purpose and specific goals of the future sessions were driven as well as the rules of therapy and boundaries of confidentiality. The following three goals were collaboratively identified

1) Short-Term Goal

Identifying dysfunctional thoughts and how it influences Lakshani's feelings and patterns.

2) Medium-Term Goal

Becoming more energetic and participating in enjoyable activities.

3) Long-Term Goal

Developing interpersonal skills and a cultural support network.

Lakshani was informed that she'll be given an individual project by the end of each procedure to complete prior to the next session. This consists of doing a "mood thermometer" that may provide an improved understanding of the intensity of the depressive symptoms and the client's specific disposition by the end of each day. Lakshani was also asked to track record all her negative and positive thoughts in a diary. Lastly, she was asked to keep a each week schedule of all positive activities she engaged in.

4. 3. Ambiance Thermometer

The ambiance thermometer will permit Lakshani to guage her disposition for this day for every single week. The graph will be evaluated before the start of the next session in order to examine Lakshani's progress. Within the feeling thermometer, Lakshani must draw between 1 to 9, with 9 signifying the happiest Lakshani feels and 1 representing the worst.

Date

Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

 

9

9

9

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9

 

8

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7

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6

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5

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4

4

4

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4

 

3

3

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3

 

2

2

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2

 

1

1

1

1

1

1

1

4. 4 Leisure exercises

Lakshani will be asked to handle specific rest exercises at home, particularly when she feels pressured. This can include deep breathing exercises, wherein she will be asked to sit down in a comfortable position at home while exhaling and inhaling slowly and gradually, making certain she only targets her deep breathing. This will allow her to forget about all other intrusive thoughts in her brain, and she'll have the ability to feel unperturbed and even more tranquil. Other breathing exercises can include relaxation response and intensifying muscle relaxations. Such breathing exercises can be followed by an imagery of visualization exercise, where Lakshani will be asked to assume or imagine herself in a specific situation which she sees most comforting or calming.

4. 3 Identifying negative thoughts (Time 1-4)

While the negative pondering errors and dysfunctional thoughts of Lakshani were identified and identified in the first time, the next three sessions will work how these thoughts can be debated and modified to boost her spirits. In-session exercises can be carried out to identify her common pondering errors. These sessions will provide Lakshani with approaches for increasing positive thoughts and decreasing unsafe or dysfunctional negative thoughts, and thus, lowering depressive symptoms. In other words, cognitive restructuring of her negative thoughts will be followed by behavioral experimentation wherein she'll learn action in situations that acted as a result in on her behalf dysfunctional thoughts.

Cognitive Restructuring

 

Stage

Example in terms of Lakshani's Situation

A

Activating Stage

Friends not picking up the phone when she message or calls plus they do not go back her cell phone calls when they miss them.

B

Belief

They do not need to speak to her.

C

Consequence

Sadness, Bafflement, Loneliness

D

Dispute

"No they get occupied in their lives too. Just because I used to be free at that time it doesn't mean that these were immediately available to answer my call too. And the reason for them never to call back was probably because they were too caught up with whatever these were doing so that is why it slipped their brain. It's little or nothing personal. "

E

Effective New Belief

When I call my friends, once in a while they may not be accessible to answer the phone. But that will not imply that they want to avoid me. I will just call them back on a later time when they could possibly be free.

Behavioral Experimentation

Following the cognitive restructuring, in the behavioral experimentation stage, the Lakshani will be required to become familiar to her newly constructed thought patterns. To carry out so, she will be initially asked take part in role play while imaging a predicament which is considered particularly difficult for her. Afterwards, she will be gradually motivated to engage in these new behavioral mannerisms outside the therapist's office. Thus this might eventually reduce her unhealthy types of thinking and efficiently reconstruct her behaviors to adjust to the situation in a better manner (Pomerantz, 2013)

4. 4 Participating in pleasant activities/ Behavioral Activation (Program 5-8)

Lakshani will be discussed how the existence of depression can limit participation in pleasant activities, which, improves depressive symptoms. During these consultations, activities that Lakshani locates nice will be driven, and the hindrances preventing her from engaging in these activities will be recognized as well. Lakshani will be given a list of pleasurable activities, and she will be then asked to tick each activity she partcipates in on that particular day. This helps to keep a an eye on her improvement and motivates her to engross herself in more and more positive activities. This, subsequently, will reduce her unhappiness.

In order to get this to simpler and easier on her behalf, specific, clear goals can be collaboratively identified, and she can be taught the steps to attain these particular group of goals.

Weekly Activities Schedule

This schedule includes all the activities Lakshani will take part in through the week. She'll be asked to write a plus signal (+) if they were positive and a minus indication (-) if they were negative.

4. 6 Growing interpersonal relationships (Treatment 9-12)

Lakshani will be taught the way the way she interacts with the individuals around her can affect her "ambiance" and vice versa. She, thus, learns the requirement of an good social support network and how to recognize and bolster it. However, she must understand that romantic relationships are always changing, and that certain relationships not working out do definitely not mean she is to blame. So, she is taught how to keep up healthy relationships with her peers and members of the family while contemplating the actual fact that deterioration of specific associations is inevitable and such changes must be embraced.

Specific exercises may also be carried out to help Lakshani create an improved romantic relationship with her peers, wherein she will figure out how to keep realistic objectives of them. Furthermore, she'll be educated assertive communication skills, to be able to help her interact with her friend without being pressurized or insecure.

Lakshani will also be asked to build her own cultural support network in order to assess who will be the people in her sociable circle she most trusts and whom she considers to be her close friends and family. If Lakshani's sociable group is significantly small, she'll be asked to make it greater since she requires a group of people for her to rely on and trust. Creating a good social support network will considerably reduce her depressive symptoms

4. 7 Integration of themes and analysis of therapy

The last program will assimilate all the themes from the previous session while researching and evaluating the therapy and everything the actions Lakshani engaged in. Lakshani emerges information about her involvement and improvement throughout the consultations. She'll be called for opinions about her personal thoughts and experiences throughout the treatment. She'll also be trained strategies that can prevent a relapse.

HABITS TO PREVENT

  • All or nothing at all thinking
  • Discounting the positively
  • Jumping into conclusions
  • Perfectionism
  • Labelling yourself or others
  • Blaming yourself
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