Motivational Interviewing and Cognitive Behavioural Therapy for the Treatment of Depression - Essay Example

Integration of Motivational Interviewing and Cognitive Behavioural Therapy for the treatment of Depression. Case study al Affiliation Date Background Kate (not his real name) first experienced symptom of depression when she was 15 years old. At this age, she developed rare conditions that made her have no emotions at all to people of the opposite sex as well his family members. Her case worsened as she grew old. At the age of 19 she had expressed irritable mood and loss of interest in the activities that she used to engage in there before the effects of her ailment (NYU Langone, n.d.). Nevertheless, her performance at school remained unaffected and judged to his performance her condition could be explained as normal. During her late twenties, Kate was easily fatigued even when she was resting. She experienced fatigue even when she had slept for more hours than she was used to there before. At twenty-nine, she could barely do anything as she had decreased body energy. This made her skip even the basic chores at her home and threatening her career. Her parent having noticed the problem she was undergoing decided to take to the hospital where she was hospitalized for a severe case of depression. She was treated extensively with pharmacotherapy and psychotherapy for over few years (NYU Langone, n.d.). At the age of 35, Kate expressed persistent attitude signs and a serious cognitive dysfunction. For the next three years, Kate underwent several medication from MRI testing, EEG, sleep studies and several neuropsychological testing. All of the medication that Kate underwent were not successful until she was thirty-eight years old. She diagnosed with a neurological disease known as Lyme disease at 38 years. However, after diagnose she was treated by antibiotics and other over-the-counter drugs supplements. This did not help her even after being treated with transcranial magnetic stimulation and hyperbaric oxygen. Having undergone through medication for over ten years without signs and indication of improvement, she quit medication and all another psychotherapy. She resulted to neuropsychiatric remedies and sought help from Scott Hirsch, a professor of psychiatry and neurology at Langone Medical Center (NYU Langone, n.d.). The patient was so anxious and hopeless because her problem had persisted to her old age and affected all her dreams in life. Though she demonstrated a high level of intelligence, she had slowed response to actions. Doctors conducted segmental neurological diagnoses, but there were no signs of dyskinesia, myoclonus and tics (NYU Langone, n.d.). The patient though exhibiting cognitive symptoms no neuropsychological clinical analysis indicated that she was ill. All the results showed that Kate was healthy except for her slowed processing speed which recorded an average score. However, the clinical diagnosis of the patient had the consistent symptoms to a depressive disorder (Grant, et al., 2004). Because Kate showed severe symptoms, Doctor Hirsch referred him to Norman Sussman, who is also a psychiatry professor at NYU Langone Treatment Center. The patient underwent a different treatment from the one she had been using. Therefore, instead of using antidepressant, doctors aimed at gaining symptomatic relief by use of non-psychiatry treatment. This called for the use of cognitive behaviour therapy. This method have showed better result for the treatment of anxiety disorders and other cases of severe depressions (Beck, 2011). Beck in his research on depression developed a structured way of treating depression. However, he argued that any treatment would culminate to the proper diagnoses of depression and consequently engaging action to address the problem (Beck, 2011). The Cognitive Behavioural Therapy Model Cognitive Behavioural Therapy is an integrated multisystem model that theories patients and prepares them for treatment (Gega & Norman, 2013). The model relies on behavioural observations and cognitive habit that are discrete to patients. Therefore, mental problem such as that of Kate are unique and require specific therapy that is geared to shape his negative behavioural habit caused by depression and anxiety. However, CBT also considers biological, social, interpersonal and spiritual background of patients to better understand the problem and graph the extent of the mental illness (Giesen-Bloo, et al., 2006). Cognitive therapy, therefore, comprises a therapy that correct negative attitude and thinking among patient with depression and another ailment (Whitfield & Davidson, 2007). Cognitive behaviour therapy or cognitive therapy was recognized as medical practices because of the documented positive results of patients under study. According to Beck, treatment of cases like that of Kate is constructed on the cognitive establishment, beliefs and interactive approaches that are discrete to a particular disorder (Beck, et al., 1979). However, Cognitive behavioural therapy does not work for all patients. Moreover, researchers have noted that Cognitive behavioural therapy work well when it is integrated with other methods of psychotherapeutic treatment (Flynn, 2011). Therefore, for this reason Motivation Interviewing is integrated to Cognitive Behavioural Therapy to treat patients suffering from depression. The fact that depression is a social and economic problem make it a concern in the society. Therefore, it is prudent for health and social practitioners to establish structured way through which they can help patient suffering from depression such as Kate (Beck, et al., 1979). Therefore, the patient would be able to resume to their daily activities as well as engage with other members of the society in making the world a better place for themselves and their children. Psychiatrist needs to determine the kinds of anxiety disorders that patients are suffering from and the possible cause of the disorders. Therefore, through this therapist would choose the appropriate method of the therapeutic procedure to address the challenges that a given patient is going through. For example, a patient anxieties may be as a result of panic, depression, pain or as a result of substance abuse (Herbert & Forman, n.d.). Moreover, before administering Cognitive Behavioural Therapy patients need to provide their history of the treatment that they have gone through over time. All these information is provided by administering questions to the patients by the therapist (Means-Christensen, et al., 2006). Moreover, the therapist need to use two set of question to test anhedonia and mood for signs of depression. In addition, the specialist need to use a single 0-10 item test to know about the pain the patient may be undergoing through (Butt, et al., 2008). This screening establishes the kinds of anxiety a patient is suffering. A positive screening for depression as the results of anxiety disorder requires the patient to undergo Cognitive behavioural Therapy as well as Motivational Interviewing to ensure that he or she recovers fully from depression. The first instances of the utilization of Cognitive Behavioural Therapy is after diagnoses. Patient are to be tested for the four anxiety disorders that include social anxiety, panic, generalized anxiety and post-traumatic stress disorder (Byrne, et al., 2009). And given that there are minimal treatment of anxiety disorder in primary health care, attention is needed to identify patient complaining or being treated for other ailments (Butler, et al., 2010). Thus, is the reason the patient in this case study reached her forties without receiving the proper psychoanalytical approaches. Thus, the patient need a proper diagnose and an ample time with health providers to monitor and observe the patient know which therapeutic procedure is good for the specific needs. Severe case of anxiety and social disposition among patient at an early age require maximum time and enhanced psychiatric treatment (Crane, 2008). Moreover, all patient suffering from depression need to be tested for active and passive thoughts of suicide. This would help assist the patient from situation that may accelerate suicidal thought. However, because Kate have no thoughts of self-harm she, therefore, does not need this kind of therapy. A structured formulation of the client’s problems in keeping with the chosen type of therapy. A good Cognitive Behavioural Therapy is based on a well-established relationship between the caregiver and the patient (Hardy, et al., 1995). For the past, two decade researcher have been concerned about the relationship of the patient and his therapist. According to Gilbert and Leahy (2008) there is evidence that support a good relationship between a patient and therapists to the positive outcome of the therapy (Gilbert & Leahy, 2008). The perception of the patient to the services he or she get from a caregiver is important to his/her recovery. Patients who have had a good relationship have shown quick responses to Cognitive Behavioural Therapy. Moreover, Hardy et al. argue measures to be taken early in the provision of therapy to build on the relationship than think this later in the therapy procedure (Hardy, et al., 1995). A positive relationship is necessary, but it is not usually sufficient for helping a patient to recover. According to Norcross (2002), a 15% of the result of a psychotherapy is dependent on the expectancy effects, 15% on techniques, 30% to ordinary factors and 40% to the extra therapeutic services offered (Norcross, 2002). Therapist using Cognitive Behavioural Therapy need to consider empathy and ability to validate the outcome of a therapy for people who have mental problems such as depression (Leahy, 2008). In addition, when administering Cognitive behavioural Therapy (CBT) there is a proposition that patients differ in their beliefs and philosophies about their causes of pain, emotions or depression. Therefore, therapist need to establish new measures that connect to the client’s beliefs and philosophies in order to easily help them overcome their problem. Hardy and his colleagues (2007) argue that CBT to the depressed patient should be established to ensure that an effective therapy is administered to a patient. Therefore, therapist need to establish a relationship, develop a relationship and maintain a relationship (Hardy, et Al., 2007). The stages are cyclical and not linear as therapist may refer to past stages to ensure that the patient are well catered for a full recovery (Murphy, et al., 2010). Establishing a relationship The objectives of establishing a cordial relationship in CBT is to develop good expectation, intentions, motivation and hope between a patient and a therapist (Davidson, 2007). Therefore, therapist have to ensure that patients such as Kate who suffer from social withdrawal, stress and mood effect are catered. The care should be warmly and with a lot of empathy and genuineness (Bachelor & Horvath, 1999; Rogers, 1957). Therapist ought to negotiate with the client about her goals to ensure she remain in focus to a better future. Thus, in case of Kate she can recover from the loss of interest in doing her activities. And finally, to ensure that the patient remain throughout the therapeutic period, a sense of hope is important in CBT. Collaborative frameworks Cognitive Behavioural Therapy requires that the therapist and client establish a collaborative engagement on the aims and direction that the therapy should focus. This act as an engagement that the help patient participate fully in their recovery. According to Hardy et al. (2007), collaborative framework should start early when the therapy is beginning. The collaborative of clients and therapist is also important in developing a relationship throughout the therapy session. Therefore, this step of CBT requires the therapist to talk more to the patient rather than keeping quiet. In addition, the therapist should be active in encouraging patients to participate in the therapy session. And lastly, the therapist should avoid conflict that may hamper the recovery of depressed patients. Researchers have evidence that patients who mutually involve CBT in the therapy session as well as through homework recover quickly than those that engage CBT during session alone (Grant, et al., 2010). Therefore, patient such as Kate who suffer from mental challenges of anxiety need to practice behavioural changes especially in time of the bad mood so that they can recover more quickly. In addition, therapist need to be positive, tolerant and when affirming a therapy to the patient. This improves on the collaborative engagement throughout the cognitive behavioural therapy (Grant, et al., 2010). Developing a relationship Hardy et al. (2007) model also argue of the importance of taking the therapy forward through developing and consolidating the patient-therapist relationship. This stage came when the patients is comfortable that CBT is working for them, and they are starting to experience changes. During this stage patients are supposed to have developed trust of the caregiver or the therapist and have an open and committed working relationship with the therapist (Grant, et al., 2010). Once a relationship is developed therapist can intervene on a depressed person through behavioural interventions. For example, in the case of Kate therapist can reschedule his routine at home to ensure that she works on her activities. Moreover, the caregiver may consider establishing other chores and assignment to energise the patient. Through this the patient would recover from a lack of interest, reduced psychomotor and low energy (Wright, et al., 2006). The CBT protocol for patient suffering from anxiety disorders ensures expose clients to experience that causes anxiety disorders. Thus, this help prevents the recurrence of behavioural associated with the exposure (Bennett-Levy, 2004). Thus, CBT help therapist interrupt the patient’s behaviours that are central in bringing the anxiety disorders. A description of and justification for the interventional therapeutic approaches you would adopt with this client. This interventional strategy should arise directly from the formulation and be rooted in the type of therapy you have chosen and should not merely represent a standard approach to treating people sharing your patients diagnosis. Kate having been under medication for over ten years with success prompt the use of Cognitive Behavioural Therapy to try and help her recover from mental problems. First, she experiences anxiety disorder. This is one of the symptoms of a mental problem that are catered for through CBT. In addition, Kate though is active in her studies does not have the energy to perform any other task in the home or school. At her early age, she could not play with her schoolmate and was always alone and secluded by another student. And because anxiety disorders are manageable, patients can get professional care to help them out of their situations. And because there are different type of anxiety disorders each patient must seek the best therapy that is tailored to his or her problem (Dodd & Wellman, 2001). Therefore, given that CBT is a log lasting treatment Kate can only get a solution of her problem from a CBT therapist. Through this, she will be able to change her behaviours toward addressing the challenges of anxiety, and mood problem (Wells, 2009). Cognitive Behavioural Therapy dynamically involves the patient in her or his regaining. Therefore, it is best suited to mentally health care together with Motivation Interviewing. Mentally sick patients need to be supported through motivation to ensure that they are not depressed to the point of giving up on therapeutic care. Moreover, because Motivation Interviewing (MI) uses an evidence-based approach it is thus important to integrate it with CBT to ensure that the therapist-patient interaction are linked to positive clinical outcome (Flynn, 2011). In addition, MI addresses challenges of preparation for treatment, patient resistance and ambivalence. On the other hand, CBT provides strategies that bring changes to clinical problems such as anxiety, low self-esteem and depression. Therefore, MI help in minimizing cases of therapeutic dropout and increase patients involvement in participating in the CBT procedures. A description of and justification for the approach you would adopt to measuring client progress. Competent therapist knows the importance of monitoring and evaluation of patient’s progress (Newman, 2013). Monitoring and evaluation provide essential information that underlies the therapeutic procedure. There is a need to address challenges that arise from session of treatment to ensure that the client recovers fully from the social problem, anxiety disorders and resume his or her normal duties. However, the monitoring process involves both the patient and the therapist so as to achieve the best verifiable results. In addition, monitoring may also involve a third party such as a family member. According to Sperry (2010), lack of finding to track clients progress that might result to patients dropping out of therapy and failure to attain therapeutic goals (Sperry, 2010). Therefore, according to Sperry a systematic progress monitoring is essential in CBT treatment as well as another therapy. The most essential thing in measuring patient’s progress is the establishment of a shared responsibility between the patient and the therapist. Through this relationship, both parties will record and address the shortcoming of the therapy while endearing to produce positive outcomes (Hayes, et al., 2008). Through this, the patient and the therapist will be able to share alarming client’s conditions. In addition, a third party can help monitor the progress of a person suffering from mental challenges such as anxiety and mood shifts (Hayes, et al., 2008). This is important because such a person can indicate cases that are not notable to the patients and the therapist. For instance, Kate mother has more knowledge of her daughters condition since she was a small child. Therefore, she can be a good person who can measure Kates condition once she is undergoing Cognitive Behavioural Therapy sessions. Another method that is appropriate in measuring patient’s progress is the use of Social Anxiety Session Change index (SASCI) (Hayes, et al., 2008). This is an index that records the subjective changes in the course of administration of therapy. Through SASCI, patients rate themselves from on session to the other throughout the therapy period. Therefore, SASCI is a good measure of social anxiety, panic and pain (Hayes, et al., 2008). Moreover, SASCI can also provide patients mood situation at different interval of the therapy (Hayes, et al., 2008). Social anxiety can be measured using the following scale (ZUmberg, 2013). 1. Much less 2. Moderate less 3. Slightly less 4. Not different 5. Slightly more 6. Moderately more 7. Much more The scale is used before a session begins and records a patients experiences of anxiety. Therefore, using such a scale index a therapist can know if the CBT is working or not. Moreover, the outcome of such a measure would help clients to stick on the therapy when all his or her needs are addressed appropriately. 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