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05/29/2012

The Intervention Approach: Cognitive Behavior Therapy (CBT)


 

Case Background

A 38 years old female with depression and has medical treatment and follows up in hospital. She lived with her nephew and is being a trainee in a shelter workshop. She has good family support, her siblings and nephews would have gathering usually. She was easy to nervous and emotional. She would cry suddenly during the training, because she thought her background/ history, or something made her feel up sad. She didn't want to let others know her unhappy and suppress her feelings in front of others. She was low self-esteem and worried about others comments. One of her sister passed away few months ago and her other relatives didn't allow her to go to the funeral because they worried her emotions. Although she understand relatives arrangement but she still felt sad and guilty of the absent of the funeral. In additions, she also absent of her elder brother's and aunt's funerals. Her relatives didn't allow her to join. She really felt guilty and felt that she was useless. She would easy to cry because she had suppressed her emotions in front of others.

The Intervention Approach: Cognitive Behavior Therapy (CBT)

In accordance to the case of a 38-year old female suffering from depression, the intervention approach known as the Cognitive Behavior Therapy (CBT) can be use.  Basically, it seems that the patient might suffer from anxiety disorder if the treatment CBT was no properly initiated. Basically, CBT is one of the major orientations of psychotherapy (Roth & Fonagy, 2005) and is a structured problem solving strategic approach to the management of people with mental and psychological problems (Kingdon & Turkson 1998). Clients and therapists such as mental health nurses who provide 24-hour services, work together, once a therapeutic alliance has been formed, to identify and understand problems in terms of the relationship between thoughts, feelings and behaviour (Kinderman & Cooke 2000). The approach usually focuses on current difficulties and relies on the therapist and client developing a shared view of the individual’s problem. This then leads to identification of personalised, usually time-limited therapy goals and strategies which are continuously monitored and evaluated. The treatments are intrinsically empowering in nature, the outcome being to focus on specific psychological and practical skills (e.g. in reflecting on and exploring the meaning attributed to events and situations and re-evaluation of those meanings) aimed at enabling the client to confront their problems by tying together their own resources (Lam & Gale 2000). The attainment and making use of such skills is seen as the primary aim, and the vibrant factor in promoting change is by practicing what has been learned between sessions. Thus CBT initiation is for the individual to ascribe progress in their problems to their own efforts, in collaboration with the therapist.

Basically, people suffering from depression also shows some negative reaction pertaining to their bodily like numbness, rapid heart rate, and excessive sweating and muscle tension. There were also some emotional signs that are often manifested by numerous negative feelings like nervousness, fear, irritability and agitation. Like in our case, this 38-year old female may possible over-predict the outcomes of certain events if her depression was not treated.  Moreover, the simple depression may result anxiety disorders if no immediate treatment has been made (Shear, 2003).

Actually, if the anxiety disorders or the depression was untreated it can also have some effect to physical and mental stability of a person that could resulted to other health and mental problems. In addition, people under this problem of depression may also receive some problems pertaining to the usual life considering that they cannot or no longer handle normal life activities. And for those people who knew that they have disease or disorders they also tend to limit themselves their routines in which less or no risks can be faced.  People like this 38-year old female will also tend to limit opportunities.   For this reason, people suffering from depression or any psychological problems, it is then very important that these people treated right away or imposed certain therapy for them to defeat their psychological troubles.

For this purpose, several therapeutic approaches can be use such as the CBT.  Basically, the cognitive behavior therapy (CBT) is a therapeutic approach that involves talks and conferences. In this therapy, the patients will have to discuss and express their feelings, behaviors and thoughts to a mental health professional. The focus of CBT is to determine these feelings and identify how these are affecting the patients, in terms of their actions. This focus of the CBT makes it a problem-solving therapeutic approach. The main aim of this therapy is to teach individuals how to properly think and react to certain stressful situations. CBT can actually be used for a number of reasons. These include anxiety disorders, phobias, depression, eating disorders, schizophrenia and relationship difficulties (Kassel, 2005).

This psychosocial therapy is based on a non-medication approach, which believes that maladaptive thinking patterns are the ones causing negative emotions. Maladaptive thinking patterns basically pertain to the behavior that leads to an individual’s unproductiveness; thus, this behavior is often used to explain how anxiety problems can interfere with the individual’s normal life activities (Ford-Martin, n.d). Cognitive behavior therapy (CBT) is a general term used to describe the different therapies that combine both behavioral and cognitive interventions in handling psychological disorders.

The aim of the behavioral intervention is to lessen the individuals’ problematic behavior and emotions by means of behavioral modification. The cognitive intervention on the other hand also aims to reduce the persons dysfunctional behavioral and emotional; however, in this case, the process is through the alteration of the individual’s thinking pattern. These two approaches were used based on the theory behind CBT theory. The theory states that people who have psychological troubles like anxiety disorders undergo problems on these two aspects as maladaptive consequences of previous learning. It is then the aim of CBT to reduce the person’s unwanted behavior or distress; this can be done by means of providing a new and more adaptive learning experience (Brewin, 1996).

CBT was developed by two psychologists Albert Ellis and Aaron Beck during the 1960s. The psychologists believed that disturbed emotions and maladaptive behaviors are caused by inappropriate automatic thoughts or irrational thinking pattern. An example of a distorted viewpoint is when the person feels useless when scolded by a superior or when he or she does not please a particular person. A therapist applying CBT will then attempt to make the patient realize this distorted view and change it through cognitive restructuring. Behavioral therapy is also part of the CBT. In this case, the therapist tries to train the person to remove all undesirable behaviors and replace them with good ones. This approach is not after the identification of why the patients behave in certain ways; rather, it is more after teaching the affected individuals how to modify their behaviors (Ford-Martin, n.d).

Basically, CBT is given to the affected patient in order to identify the causes of the negative behavior as well as show the patient how he or she can bring about changes to these behaviors. From other case observations, patients who undergo CBT often have schemas or core beliefs about their self or their surroundings; these schemas are then the ones that must be identified and changed. This can perhaps be explained further through an actual situation. For example, a patient with anxiety disorder has this fear about being with people. Thus, in order to avoid this fear, the person tries to isolate himself or herself from others.

Upon questioning, the patient will state that it is best to avoid people than face rejection. Eventually, the therapist will find out that it is the patient’s inferiority complex that is drawing him or her from others. The lack of love and belief for oneself is the main schema of this case; this then will be the focus of the CBT. The therapist helps the individual the level of reality behind this schema and convinces him or her to realize the truth and what is possible.

The aim of CBT is then to make the patient feel important and loved. This can be done by asking the patient to name his or her family members, relatives and close friends. The purpose of this approach is to make the patient realize that there are people who appreciate his or her for who he or she is. This in turn will make the patient realize the irrationality of his or her distorted schema. As CBT is applied, the patient will start to think that he or she is an interesting person and fun to be with. By teaching the patient to become more appreciative of himself or herself, the maladaptive behavior and thinking pattern is replaced with a more positive schema.

There had been a number of empirical supports that confirm the efficacy of CBT in reducing both short and long term anxiety disorders (Chambless et al., 1996). Similar to how CBT is applied to other psychological conditions, CBT is given to patients with anxiety disorders in order to make the patients aware of the sources of their anxiety. The therapy is also after the learning of the different skills that will help the patients restructure their cognitive and behavioral aspects. This will help the patients to reduce the level of their anxiety or fear.

The treatment approach for patients with depression usually take about ten to fifteen individual or group sessions, utilizing different activities such as CBT, relation training, systematic exposure to causes of anxiety, cognitive restructuring and self-monitoring. The duration of the treatment however, depends significantly on the severity of the patient’s condition. In addition, the outcome and length of the treatment period is based on how the patient can master the concepts of the CBT approach as well as his or her willingness to get better. The skill of the health provider is also an important determinant of the treatment outcome (Demertzis & Craske, 2005).

Objective of the Approach

In the case of 38-year old female with depression, there are a number of specific approaches on how CBT can be administered. With regards to the, I suggest to use the psychoeducation approach of CBT. As the name implies, this approach aims to educate this 38-year old female about different feeling related to depression as well as various behavioral symptoms. This modality also objects to relay the rationale of the treatment plan to the patient and explain how the process will be able to address his or her psychological condition. With regards to the patient suffering from depression, psychoeducation is a useful CBT approach that helps patients to understand physical sensations with the different possible sources of harm. In other words, this approach is helpful in teaching the affected individuals the right feeling or emotion as the situation requires it.

Another CBT technique used for handling psychological disorders is through the self-monitoring strategy. In this case, the aim is to pinpoint the exact cause of anxiety or fear in the individual and identify how the person reacts to this stimulus. This strategy is not only helpful for patients in recognizing their fears, but it also serves as a useful gauge for individuals to recognize their psychological progress. Though this CBT tool may initially show the level of distress the patient is currently in, it is a very helpful approach in motivating the patient to work on their disorder especially if therapeutic success is gradually becoming evident.

In other cases, exposing the individuals to their sources of anxiety repetitively can also help in cognitive and behavioral modification. This is also known as exposure therapy, wherein the resulting effect of this approach is the significant emotional reaction to a certain stimulus. One more specific approach with this type of strategy is called the imagery exposure. In this case, the patients are encouraged to increase their tolerance over an imagined situation.

The deliberate initiation of the physical sensation that patient fear is also used in reducing heightened negative reactions to a particular situation. Examples of these deliberate physical sensations are panic, nausea and increased heart rate. Patients for example will be spun around to initiate a feeling of panic or hyperventilation; the patient will then be taught how to handle these sensations. Redundant exposure will help affected individuals to get accustomed to these used to be overly negative sensations. Eventually, they will be able to handle different stress factors by responding to them appropriately.

CBT Intervention Transcript

In the case of the 38-year old female that was suffering from depression, there are numerous CBT sessions that were considered depending on the type of negative emotions that the therapist will alleviate.   For instance here are some of the transcripts of CBT intervention:

Therapist: Hi! Good morning, are you aware of this session?

Patient: Morning.  Yes, I know what this is. They said that this is for helping me coping up with my emotion that affects my physical capabilities.

Therapist: Good.  Can we proceed?

Patient: Yes, go on.

Therapist: During terrible times, you are not sure you could apply a new way of thinking and control your feelings and emotions?

Patient: To be honest. No.

Therapist: What I would like to do is see if we can bring something on similar emotions during the death of your love ones.  In this way, we can test out your negative predictions. What I would like you to do is just breathe deeply and quickly for a minute and see what emotions you experience.

Patient: seated breathes quickly and deeply for a minute.

Therapist: What do you observed?

Patient: Nothing, just a big breathless a light one.

Therapist: On scale of 0-10, how like your emotions similar in the actual event?

Patient: No much. I guess about 2/10.

Therapist: Ok.  Let’s try it again, a bit longer and feel the same emotions back then.

Patient: seated and breathes for about 80 seconds.

Therapist: How like are the sensations right now?

Patient: I feel kind of heavy, about 6/10. I think I am about to faint.

Therapist: How long do you think it will take to faint?

Patient: I don’t know, I’ve never tough of it that way.

Therapist: Minutes or hours?

Patient: A few minutes I guess.

Therapist: If we found that you did not faint in the next few minutes, what would that mean?

Patient: My prediction is a fear not something based in reality.

Therapist:  Let’s focus on some other things for a few minutes and then come back to this.

Patient: Ok.

Therapist:  The few minutes have passed, you do not seem have fainted?

Patient: No.

Therapist:  For homework, I would like you to test out these negative predictions and remember some negative emotions, ask yourself, what the timescale on the event is. 

CBT Usefulness and Limitations

The studies and clinical trials cited in this discussion emphasize that CBT can also serve as an effective treatment approach not only for in the case of a 38-year old female suffering from depression but in other psychiatric problems as well. One of the most important factors that make CBT useful for both psychology and mental health is its ability to reduce psychiatric symptoms among affected individuals.

It was mentioned that depressions tend to affect the quality of the person’s life. Through CBT, patients are able to realize the roots of their depression, fear or anxiety. The therapists on the other hand, are able to develop suitable treatment plans that will help patient behave and think more appropriately. This ability of CBT helps psychologists and mental health professionals in achieving their goal of treating affected individuals and giving them better quality lives.

Among patients, the use of CBT is also useful not only in reducing the symptoms of their emotional disorders but also in helping them enjoy life more. As they are gradually treated by CBT, they are able to access greater opportunities, perform more activities and produce better work output. In addition, this treatment approach is useful for them in dealing with people and in other actual life situations. Overall, the administration of this treatment approach is useful for patients, especially in giving them the chance to experience and enjoy things that life has to offer.

Patients tend to have different responses to treatment approaches. Although CBT may be a tried and tested strategy for depression problems and other similar disorders, some patients are hesitant to take in medications. The compliance of patients to treatments is also difficult to ensure; for some, this intervention can also be costly that CBT. Hence, another usefulness of CBT to mental health and psychology is the provision of treatment options based on the patients’ individual cases. Therapists are also given more treatment alternatives depending on the needs of their patients. In other words, the addition of psychotherapy improves flexibility in addressing various mental health concerns.

Actually, managing depression problems and other psychiatric disorders is necessary as this let patients to gain a life with better quality. Treating psychological problems will help these people performing various activities. This then led to the introduction of various treatment approaches like CBT. CBT had been confirmed as effective by a number of authors. Therapists and mental health professionals should then consider the distinct features of these treatment approaches and apply them according to the preferences and needs of individual patients.

References

Brewin, C.R. (1996). Cognitive-behavioral therapy Gale Encyclopedia of Medicine by Paula Anne Ford-Martin Theoretical Foundations of Cognitive-Behavior Therapy for Anxiety and Depression. Annual Review of Psychology, 47, 33+.

Chambless, D.L. et al. (1996). An update on empirically-validated therapies. Clin Psychologist, 49(2), 5-18.

Demertzis, K. & Craske, M. (2005). Cognitive-Behavioral Therapy for Anxiety Disorders in Primary Care. Primary Psychiatry, 12(12), 52-58.

Ford-Martin, P. (n.d.). Cognitive-behavioral therapy. Gale Encyclopedia of Medicine. Retrieved October 15, 2010 from www.findarticles.com

Kassel, K. (2005). Cognitive-Behavioral Therapy (CBT). EBSCO Publishing.

Kinderman, P. & Cooke, A. (2000). Understanding Mental illness, Recent advances in understanding mental illness and psychotic experiences, UK: The British Psychological Society.

Kingdon, D. & Turkington, D. (1998). Cognitive behaviour therapy of schizophrenia. In Outcome and Innovation in Psychological Treatment of Schizophrenia (Wykes T., Tarrier N. & Lewis S., eds). John Wiley & Sons, Chichester, 58–80.

Lam, D. & Gale, J. (2000). Cognitive behavioural therapy: teaching a client the ABC model – the first step towards the process of change, Journal of Advanced Nursing. 31(2), 444-451

Shear, M.K. (2003, May). Optimal treatment of anxiety disorders. Patient Care, 37, 18-32.

Roth, A., & Fonagy, P. (2005). What Works for Whom: A critical review of psychotherapy research, Second Edition. London: The Guildford Press.

 

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