Major Depression: Case Study Investigation

Intervention is driven by working hypotheses (formulations) developed Jointly by patient, his/her family and therapist from the assessment information. Change is brought about by a variety of possible interventions, including the practice of new behaviors, analysis of faulty thinking patterns, and learning more adaptive and rational self-talk skills.

(Hawthorn, Slovakia, Kirk, and Clark, 1989). A probable reason why CB works with depressed patients is that depression interacts with both cognitive and motivational processes.

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This is well evidenced in experimental analogue research with healthy and depressed individuals. Individuals with depression show deficits on a range of cognitive tests (Brown, Scott, Bench, 1994) with the pattern of dysfunction having many of the characteristics associated with front-subtropical impairment. Richness and Nee (2000) found that depressed individuals displayed mild cognitive impairments in comparison with matched controls, particularly in the areas of “adverbial” memory, psychosomatic speed and verbal fluency.

Further in these patients there appears to be considerable variation in the recovery of cognitive function with remission of the depressive episode.

Depressed Monolinguals also snow a loss AT enjoyment Ana decreased Interest In previous activities, which can result in a reduction in purposeful or “goal-directed” behavior. This is because motivational deficits also interact with a range of cognitive tasks (Bernstein De Router, 2000). Left untreated, studies indicate that depression will increase patient handicap, interfere with participation in rehabilitation, and impact on the recovery of cognitive and psychosocial function.

ACTION PLAN Upon getting details of the patient’s case history, I (his therapist chalked out the allowing 10-week Cognitive Behavior Therapy (CB) intervention plan for this patient: Week #1: Engaging the client The first step I’d take is to try and build a relationship of trust with the client on the core conditions of empathy, warmth and respect. I would make note of all the ‘secondary symptoms’ that prompted the patient to seek my help: self-doubt, low self-esteem, anxiety, doubts whether he would be able to help him and a feeling of utter hopelessness and dejection with a loss of interest in any creative or meaningful activity.

The best possible way to engage this client would be to demonstrate to him right at he onset that his situation is not as bleak as he imagines and that he has made the right decision in seeking professional help and that change is possible if he and I decide to work together. The first one-hour session would conclude with the assigning of “homework” to the client: I’d ask him to write down all the problem areas in his work life. Week #2: Assessing the problem, person, and situation Assessment will obviously vary from client to client, but following are some of the most common areas that I will assess: 1 .

Start with the client’s view of what is wrong with his life this insight can evolve room the John’s homework Jotting 2. Determine the presence of any related clinical disorders 3. Obtain a personal and social history 4.

Assess the severity of the problem 5. Note any relevant personality dysfunctions 6. Check for secondary disturbance: how does the client feel about having this problem? 7. Check for any non-psychological causative factors: physical conditions; medications; substance abuse; lifestyle/environmental factors. Homework: Make a list of all the changes that you want to see in yourself as an outcome of this therapeutic process.

Week #3: Preparing the client for therapy 1 .

Clarify treatment goals this would follow from a discussion of the previous day’s homework 2. Assess the client’s motivation to change. 3. Introduce the basics of CB techniques (See Appendix 1). This material can be given to the client as printed handouts 4.

Discuss the various possible approaches to be used and the implications of the treatment 5. Develop a contract with the client make John understand that CB is a collaborative therapy. Homework: Attempt a self-analysis of your problem.

A useful technique is rational self-analysis, which involves writing down an emotional episode in a structured fashion. You need to understand that an event does not cause an emotional experience, but it’s your belief about the event that does so. For instance an “A” (activating event) triggers our “B” (belief about the event – our filter), which results in our “C” (consequence).

A and B are related, but only B causes C. {A B C} Week #4 – 7: Implementing the treatment process Week #4: At this stage, it would be important to delve into John’s past history in order to figure out the genesis of his present neurotic anxiety.

A revelation of the past triggering factors can be a major breakthrough in the therapy and with patience, this vent may happen any time between the fourth to seventh week of the implementation of the CB plan. Homework: Start a diary, where you replay some significant events of your childhood, those that you recall as particularly traumatic important landmarks that made you question your self-worth as a child. These memories can relate to anybody your parents, brother, sister, teachers or peers.

You can make an entry in the following Week #4 – 7: Implementing the treatment process fashion: worksheet example: May 2 My seventeen grade results were to De clearer t day.

I was very positive I’d score high in all the subjects, but when I shared this excitement at the breakfast table with my Dad…..

Week # 5: Identifying unhelpful thinking styles John had the tendency to overlook his strengths, become extremely self-critical and harbor several real or imagined biases against him and the world at large, thinking that he cannot tackle even the commonplace difficulties of life.

He was obsessed with his current or future problems; tended to put a negative slant on things, using a negative mental filter that focused only on his difficulties and failures. In short, he had a very gloomy view of his future and tended to blow things out of proportion, hill making doomsday predictions about how things will work out and Jump to catastrophic conclusions about everything happening in his life.

After allowing the client to vent his spleen, l, the therapist assign the following homework to him: Homework: Write down all your symptoms and troubles and the progress that you are making in all these areas during the course of this therapy. These would be your honest perceptions of what you are gaining from the therapy. Making this inventory will help you look at your problems more objectively – it can provide a degree of emotional distance from the same.

Week # 6 & 7 Employing selectively eclectic approach I would follow a ‘selectively eclectic’ approach with this client.

I would use whatever technique works with him. Since he is an intelligent human being who appears to be well-aware of his debilitating thought patterns, I would prefer to use some of following techniques to attack this faulty thought patterns in this client (Department of Health, 2001): * Rational analysis: Analyses specific episodes from his past to teach him how to uncover and dispute irrational beliefs. * Double-standard dispute: If the client is holding a ‘should’ or is self-doubting, I old ask him to put himself in someone else’s shoes (say his wife) and then imagine how she would react to such a situation. Catastrophe scale: I would invite my client to draw a line down the side of a whiteboard or sheet of paper. Then ask him to put 100% at the top, 0% at the bottom, and 10% intervals in between.

He would then have to rate whatever it is that he is catastrophic about, and insert that item into the chart in the appropriate place. A brainstorming session would follow this exercise. * Playing devil’s advocate: This useful and effective technique (also known as reverse ole-playing) may perhaps get the client to argue against his or her own situational Dealer. Reframing: This may get him to put bad events in correct perspective and re- evaluate those as ‘disappointing’, ‘concerning’, or ‘uncomfortable’ rather than as ‘awful’ or ‘unbearable’. Homework: Imagine the ‘worst case’ scenario a day when everything in office goes wrong.

Write down in minutest details your projections of such a day. Week #8: Skills training, e. G. Relaxation, social skills At this stage the client is given tape recordings of the sessions to replay and listen to t home. He is also given a list of self-help reading material (Appendix 1).

In CB therapy sessions are really experiential ‘training sessions’ through which the client tries out, tests and uses some of the ideas learned. This session can also be used to teach some relaxation techniques to the client. When people feel depressed or anxious, it is normal for them to experience difficulty in doing things. Relaxation techniques will help them manage their anxiety after they have rationally analyses the cause of it. These simple muscle-relaxing exercises will help the client in calming own, turning off the panic button, breathing away stress, and experiencing total body relaxation.

Homework: Practice sitting still and quiet, listening to some relaxing music each day for at least an hour this whole week and share your body’s response to it at the next session with me. Week# 9: Evaluating progress Toward the end of the intervention it will be important to check whether improvements are due to significant changes in the client’s thinking, or simply to a fortuitous improvement in their external circumstances. At this stage it is also important to prepare the client for coping with setbacks. Many people, after a period of wellness, think they are ‘cured’ for life.

That’s when the danger of relapse begins to lurk in their lives.

To avoid this from happening warn the client that relapse is likely for many mental health problems and ensure that they know what to do if and when some of the old symptoms begin to reappear. Homework: Make a list of all you perceive you have gained from this 10-week therapeutic session, along with a record of goals that you feel were not met. Week #10: Recapturing major gains from the therapy and preparing the client for termination This is the gradual weaning away stage.