A Cognitive Therapist Is Working With A Depressed Client

Cbt Assessment Technique : Break Moments Down Into Helpful Components

Once we have identified a specific and relatively recent event, the next job is to break it down into manageable parts. These might include:

• Situation: Who was there? What happened? When did this happen? Where did you experience the problem?
• Triggers: What was happening just before the problem occurred?
• Cognitions: What went through your mind at the time? .
• Emotions: What did you feel? .
• Body sensations: What feelings or sensations did you notice in your body?
• Actions or responses: How did you respond? What did you do to cope? .
• Context: All the while, we need to hold in mind the context in which an event is happening. For example, if David is having worries about his health then it is relevant and useful to know that he has suffered three bereavements in the past year.

The reason that CBT therapists conduct assessments by breaking events down into components is because a cognitive behavioral approach recognizes that these components are interconnected. One component affects other components in understandable ways. Making sense of these connections is called case conceptualization which we will explore in the next section. Some of the most helpful CBT worksheets and information handouts for psychological assessment include:

What Makes The Problem Better

• How often do you experience the problem?
• How have you been coping with the problem that brought you into therapy? What have you tried so far?
• What do you think caused the situation to worsen?
• How does the problem affect how you feel about yourself?
• What avenues have you pursued in the past that have worked well to solve the problem?
• Tell me about a time when you were not experiencing these difficulties.

The Cognitive Model Of Depression

Aaron Beck used the concept of a cognitive triad to explain depression. According to Beck, a person who is depressed has a negative view of him or herself, the world, and the future. As a result of this negative view, the person perceives of him or herself as being inadequate, abandoned, and worthless.

Aaron Beck claimed that depression occurs because the person views his or her future is also negative, and so there is the feeling that the problems will not get better. The person thinks that there is little or nothing he or she can do to cope with, or control the outcome of his or her experiences. This sense of hopelessness could lead to thoughts of suicide.

A common consequence of this negative mindset, is that depressed individuals are unwilling to commit themselves to set goals. Then dependence increases because they see themselves as not competent enough manage, and even attempting everyday tasks become overly difficult. With the high expectation of failure, they are indecisive, and this reflects physical symptoms of low energy, fatigue, and lethargy.

Cognitive therapy uses cognitive and behavioral strategies to address the client’s negative view of self, future, and the world.

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How To Find A Cbt Therapist

You can get psychological therapies, including CBT, on the NHS.

You can refer yourself directly to an NHS psychological therapies service without a referral from a GP.

Or your GP can refer you if you prefer.

If you can afford it, you can choose to pay for your therapy privately. The cost of private therapy sessions varies, but it’s usually £40 to £100 per session.

The British Association for Behavioural & Cognitive Psychotherapies keeps a register of all accredited therapists in the UK and The British Psychological Society has a directory of chartered psychologists, some of whom specialise in CBT.

Treating Depression With Cognitive Behavioral Therapy

• Treatment

Life is a series of ups and downs, and like many people, you may feel down from time to time. Feeling down, or that life is against you, is an all too common feeling in todays society. As many as 14.8 million adults in the U.S. are affected by Major Depressive Disorder, according to figures published by the Anxiety and Depression Association of America.

You might be working longer hours for the same pay, dealing with the stress of bills or having personal relationship problems. You may also be battling a drug or alcohol addiction. Its only natural if you feel a little less than 100 percent sometimes.

However, if that low feeling of despair has taken hold of your life and just wont shift, you could be suffering from depression. Depression can be incredibly lonely, as it makes normal functioning difficult so much so that simply getting through your day can be completely overwhelming, and you turn to drugs and alcohol for comfort.

If youre feeling hopeless and down, there is light at the end of the tunnel, and you dont need to suffer in silence.

Cognitive Behavioral Therapy for depression can restore your zest for life, help you think in a healthier manner and help you overcome an addiction. Before going into in-depth detail about what CBT is and how it helps in treating depression, though, it is helpful to understand the primary types of depression.

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Issues To Consider Before Choosing Cbt

Before choosing CBT, issues you may like to consider include:

• CBT may not be the best form of therapy for people with any type of brain disease or injury that impairs their rational thinking.
• CBT requires you to actively participate in treatment. For example, you may be asked to keep detailed diaries on thoughts, feelings and behaviours. If you are not prepared to put in the work, you may be disappointed with the results of CBT.
• CBT involves a close working relationship between you and your therapist. Professional trust and respect is important. If you dont like the therapist at the first interview, look for another one.
• While CBT is considered a short-term form of psychotherapy, it may still take months or longer for you to successfully challenge and overcome unhealthy patterns of thinking and behaviour. CBT may disappoint you if you are looking for a quick fix.

More Information On Dual Diagnosis

The term dual diagnosis means you have both an addiction and depression. A dual diagnosis can be made up of any addition gambling, sex, alcohol or drugs and any mental disorder bipolar disorder, anxiety, depression and so on.

Dual diagnoses including depression are on the rise in the U.S. According to the Journal of Clinical Psychiatry, one in every three adults struggling with substance abuse also suffers from depression.

Clinical depression increases your risk of hurting yourself. It is also an immune system suppressant that makes you more likely to get sick. When substance abuse is added into the mix, the risk to your emotional and physical health is even greater. This is why enrolling in a CBT course can help you create a healthy and positive new life for yourself.

Ridding your life of bad habits and negative ways of thinking enables you to feel free and happy again. It takes time, but with the right support, you can return to a normal life.

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How Connected Do You Feel To The People Around You

Exploring the dynamics of clients relationships with people in their lives can be a good predictor for how they will respond to forming a relationship in therapy, as we often play out similar tendencies in most of our relationships.

• Tell me about the important relationships in your life.
• What was it like growing up in your family?
• What do people keep doing that you dislike, and what do you wish they would change?
• What wrongs have been done to you that you havent forgiven?

Cognitive Therapy In Adolescents

Although most studies have evaluated adult populations, few have evaluated the effect of CBT in adolescents. A meta-analysis22 of six studies with 191 patients showed that CBT was significantly more effective than placebo or inactive interventions in managing adolescent depressive disorder . Although these findings were demonstrated only in mild to moderate depression, the results warrant further study.

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How The Behavioral And Cognitive Components Work

CBT can be divided into its behavioral and cognitive components.

• Cognitive component. With the support of your therapist, you will learn to identify the negative distorted thinking that creates negative emotions. You will both then question the validity of these emotions, and you will explore new and alternative balanced thoughts.

You uncover your core negative beliefs and discuss how they have affected you. This is a very important part of treatment, as negative thoughts create a lack of energy, focus, and motivation. CBT re-educates you to be more realistic in terms of your thinking, which then helps alleviate your depression.

Youll also be given the chance to explore where your negative core beliefs stem from. Youll be urged to explore whether there is actually any real evidence for or against these.

• Behavioral component. Throughout the behavioral aspect of treatment, your therapist will guide you to measure and assess how your daily routine and activities have an impact on your mood. Your therapist encourages you to explore how your behaviors can help alleviate and improve your depression symptoms.

Your therapist helps you to develop a plan of positive action based on your behaviors, which includes a list of activities in order from easy to more difficult to achieve. As you master the activities from easier to harder, youll begin to experience feelings of achievement, and your depression lessens.

Other Types Of Cognitive

One type of CBT is rational emotive behavior therapy , which was developed by Albert Ellis. Ellis considers strong emotions to result from an interaction between events in the environment and our beliefs and expectations. Some of these beliefs can be too strong or rigid.

For example, maintaining a belief that everyone should like you. With REBT, you would learn to change that belief so that it is less extreme and less likely to interfere with your life. Your belief could then change to wanting people to like you but realizing that not everyone will.

Another form of CBT is dialectical behavior therapy , which was developed by Marsha Linehan primarily to be used for patients with borderline personality disorder . DBT emphasizes working on accepting thoughts and feelings instead of trying to fight them. The goal is to get patients to accept their thoughts and feelings so that they can eventually change them.

Exposure and response prevention therapy is yet another type of CBT that is usually used for obsessive-compulsive disorder . In this therapy, patients are exposed to the situations or objects that cause them the most fear but are not able to engage in the behaviors that help relieve the anxiety they feel .

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The Use Of Cognitive Behavioral Therapy According To Severity Of Depression

Various trials have shown the benefit of combined treatment for severe depression.

Combined therapy though costlier than monotherapy it provides cost-effectiveness in the form of relapse prevention.

Number of sessions depends on patient responsiveness.

Booster sessions might be required at the intervals of the 112th month as per the clinical need.

A model for reference is given in

Treating Depression With Aaron Beck’s Cognitive Therapy

Dr. Yvette Stupart is a clinical counselor and educator. She gives insights on how to experience emotional health and relational well-being.

Research shows that cognitive therapy is an effective way to treat depression.

Albert Ellis, Aaron Beck, and Donald Meichinbaum are major contributors to the cognitive system.” The assumptions that cognitive activity can be monitored, altered, and result in behavioral change are central to cognitive-behavioral therapies. Cognitive-behavioral therapeutic strategies combine cognitive restructuring, coping skills therapies, and problem-solving therapies.

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Using Cbt To Treat Depression

People with depression can have ongoing negative feelings about themselves, other people and the world around them. This negative thinking pattern can become automatic so that they don’t notice when their judgement is irrational or unfair on themselves. CBT can help people with depression by giving them tools to challenge the negative thoughts and override them with more realistic and positive thought processes.CBT is also used to help many more psychological problems. In some cases, other forms of therapy used at the same time may be recommended for best results. Talk to your doctor for further information and advice.

How Does Cbt Differ From Other Treatments For Depression

The method and general focus of Cognitive Behavioral Therapy is a little different from many other, more traditional depression treatments. For instance, CBT:

• Works on changing your thought patterns and on modifying behaviors in the immediate present.
• Specifically addresses your problem thinking and undesirable behaviors.
• Is goal-oriented. Clear goals are set out for each session as well as for the long-term.
• Is educational. You monitor your own feelings and thoughts, and then you commit these to paper. The therapist will also teach you important coping skills, such as problem-solving.
• Allows you to play an active part in your learning and recovery. You will also complete homework assignments that are reviewed at the beginning of the next session.
• Employs multiple strategies, including role-playing, behavioral experiments, and guided discovery.
• Is time limited.

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Iii Challenges Related To Other Issue

Study therapists dealt with complications related to the research milieu and patient population. These circumstances primarily concerned client characteristics and study personnel-client relations.

A. Client characteristics: Working with impoverished patients

1. Description of issue

Because our treatment trials did not charge for therapy, we enrolled a large number of people who were in significant financial straits. Therapists found themselves in much more overtly caretaking roles than would typically be the case in private practice. Additionally, therapists who knew the toll circumstances were taking on their clients occasionally were tempted to give these clients financial or material assistance.

2. Vignette

3. Ethical guidelines

Two guidelines were involved for this situation. The primary guideline, 3.05 , is relevant in terms of staff desire to help H with financial or other assistance, which could introduce another role to the relationship. Additionally, 2.01 is relevant to the therapists concerns about providing services which might be better done by a trained social worker. Please see for a more complete listing of the guidelines.

4. Our course of action

B. Other staff-client issues

1. Description of issue

2. Vignette

3. Ethical guidelines

4. Our course of action

Evidence Base For Cognitive Behavioral Therapy In Depression

Cognitive behavioral therapy is one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder. The uses are recently extended to psychotic disorders, behavioral medicine, marital discord, stressful life situations, and many other clinical conditions.

A sufficient number of researches have been conducted and shown the efficacy of CBT in depressive disorders. A meta-analysis of 115 studies has shown that CBT is an effective treatment strategy for depression and combined treatment with pharmacotherapy is significantly more effective than pharmacotherapy alone. Evidence also suggests that relapse rate of patient treated with CBT is lower in comparison to the patients treated with pharmacotherapy alone.

Treatment guidelines for the depression suggest that psychological interventions are effective and acceptable strategy for treatment. The psychological interventions are most commonly used for mild-to-moderate depressive episodes. As per the prevailing situations of India with regards to significant lesser availability of trained therapist in most of the places and patients preferences, the pharmacological interventions are offered as the first-line treatment modalities for treatment of depression.

Indication for Cognitive behavior therapy as enlisted in .

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Things To Remember About Cbt

As with all new experiences, especially ones that are potentially life-changing, committing to Cognitive Behavioral Therapy can be worrying. It is perfectly normal for you to feel a sense of trepidation, but your therapist will help and guide you through it. It is also important to remember the following:

• Exploring painful feelings and experiences during therapy can be uncomfortable. You may find yourself facing subjects and situations youd generally rather avoid. Throughout this temporary phase, remember that you are learning to deal with these issues constructively and that these feelings will end.
• The success of CBT depends entirely on you. Your therapist is similar to a personal trainer they can encourage and advise you, but you have to do the hard work.
• When youre feeling down, motivation can be difficult to find. This is also true in terms of concentration. Sometimes, you will really need to push yourself.
• To get over a problem, you need to confront it. This may lead to you feeling worse for a short time, however, that quickly dissipates and is replaced by feelings of achievement.
• You are in control at all times as to what is covered in your sessions as well as the pace of them.
• If your symptoms come back, your CBT skills will help you control them. CBT is a way of life, rather than being a short-term fix. Therefore, its important to keep practicing your CBT skills.

How Effective Is Cbt

CBT is an evidence-based form of therapy which means that researchers try to discover what components of therapy work, for which problems, and why. Individual therapy sessions also pay close attention to evidence: clients in CBT are typically encouraged to set personal goals and then record data about whether these goals are being met.

When we ask how effective is CBT? we really mean what is it effective for? and effective compared to what? We also need to consider how often do these conditions get better by themselves?. One way that researchers address these questions is by conducting randomized controlled trials , where different treatments are carefully and systematically compared to one another. The same process is used in medicine to test the safety and effectiveness of new drugs. Over the past few decades thousands of such studies have examined CBT and researchers can now combine the results of these RCTs into meta-analyses to show, in even more reliable ways, which treatments work. The graph below shows the result of a meta-analysis of CBT that was published in 2015 . The results are from 48 studies that compared CBT with treatment as usual for nearly 7000 people with anxiety, depression, or mixed anxiety & depression. The results show a clear effect in favour of CBT more people get better when they receive CBT compared with their usual treatment.

Figure: The effectiveness of CBT vs treatment as usual .

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