Clinical Depression Analysis - Assignment Example

?Maximising Life: Continued growth and change management post Depression Clinical Depression strikes three in ten people world-wide. While depressionis a medical condition and often does need medical treatment, it is also an experiential condition. Unlike other medical conditions where recovery is dependent only on proper medical care; a whole plethora of conditions affect recovery from depression. Since the roots of depression are often found in the long – term experiences and the daily lifestyle of the patient, a medical regime is often inadequate in keeping depression at bay. A further compounding factor is the stigma of having had a mental condition; not to mention the fear of returning depression. Patients recovered from clinical depression can be at risk for a relapse unless they are able to identify and nullify the triggers and perpetrating factors from their everyday lives. This is easier said than done; since most of these recovering patients have lived with the factors in question for a relatively long time. Patients who have been struggling with recovery for a long time may also have lost sight of life goals; an experiencing that can be daunting to cope with. The programme “Maximising Life: Continued growth and change management post Depression” is an attempt to provide support to just such people who have moved beyond the need for active medical care, but are still struggling to make sense of the lives they are trying to get back to. While belonging to the group will itself be a form of support to an individual who feels alone in their experience of recovery from depression; the group will attempt to do more than that. This will be an attempt to help people identify triggers, find alternatives to on-going situations that could inhibit recovery, and most importantly, take decisions for a more sustainable and positive existence in an attempt to reduce the chances of their requiring medical attention again. Goals: Acceptance of the need to change the type of life experiences. Finding social support. Finding activities that add to the positive experience. Challenging negative thoughts. Reducing stress. Identifying areas of change to reduce stress. Identifying and implementing specific behaviours that lead in the desired direction of change. Increasing mindfulness. Practical Considerations: Size: 4 to 6 individuals; all adults excluding the professionals leading the group. Location: A local activity room with enough space to move around that also provides privacy. Furniture required: Chairs for each participant and professional, a side table for refreshments, and a small centre table that can be used as and when needed. Composition: Adult patients declared as ‘Recovering from Depression’ by a medical professional and recommended to the group. Duration / frequency: One Hour/per week. Flexible up to two hours for certain activities. Length of Group: One introductory session followed by 10 sessions; extend-able to 12 if the professionals leading the group recommend it. Finances: A sponsor would be required to cover minor expenses like worksheets and small prizes (like bookmarks, key chains, pens, handicrafts, etc.). Closed Group: Preferably. Allowance to be made for individual in urgent need of support. Procedure: The group is lead by a Psychologist, a Social Worker and an Intern. It is preferred that at least two professionals are present at every session as this would ensure smooth functioning for the session without compromising detailed record keeping. Records are used only for making treatment or support decisions and are otherwise confidential, and subject to all aspects of confidentiality. The group opens with the greeting rituals, is then guided towards the discussion of a particular aspect of recovery, and ends with a short closing exercise. The first session is largely an introduction to the concept of assistance for recovery, and an icebreaking session. Following sessions deal with the completion of particular goals; and extra sessions may be added to the format at the discernment of the professionals. Light refreshments are provided for each session. Structure of Introductory session: Welcome; introduction to welcome ritual wherein each member greets each other member before taking places. A broad description of the structure of sessions, and the need for focusing on the goals at hand followed by Feedback from participants Ice – breaking activity: each participant is given a card that has on it a picture that is part of a story. All participants need to co-operate to line up their cards such that a story is formed. They have to do this without verbal communication. Initial sharing of personal stories. Sharing of an immediate experience that has occurred in the last week. This can be an experience that has either reaffirmed the process of recovery, or raises a red-flag that needs to be addressed. * Feedback on experiences from other participants. * The professional provides information on the diet and exercise patterns that help in coping with depression. Introduction to the closing exercise wherein each member of the group writes a small note to each other member. This note can contain a positive message, a suggestion or resource they might find useful or even a confidence booster. *The sharing of an experience should be immediately followed up with feedback for immediacy. General structure of sessions: Welcome ritual (1 – 2 mins.) Sharing of experiences and feedback. (5 – 8 mins.) Introduction to goals and to activity of the day. (2 – 3 mins.) Carrying out of activity. (35 – 40 mins.) Summing up by the professional, including giving out of worksheets and handouts that will help the participants understand and internalise the concepts better. (3 – 4 mins.) Closing ritual. (5 – 8 mins.) Session 1: Understanding and Acceptance Goals: Bringing about Acceptance of the experiences leading to depression. Bringing about Acceptance of need to change the type of life experiences. Finding social support. Tasks / Objectives: Each participant narrates a synopsis of the life they had before diagnosis; the difficulties they were having, and the things that cause them stress. Professional and other participants are allowed to give perspective; but in a non – judgemental and supportive manner. Professional quickly summarises the themes they have found. Participants are asked to write down 5 things that they now feel they should work on; and they possible changes. This is shared with the group, and modifications are made if suggested by feedback. Participants are asked to identify members of their community who they can trust and who will help them keep track of their progress. They are encouraged to contact these persons over the week. Session 2: Working with the World Goals: Finding social support. Finding activities that add to the positive experience. Tasks / Objectives: Participants discuss the interactions they had with the significant community members they had identified. Through discussion, they come up with a list of activities each that they can commit to with that person. Next, participants are asked to fill out a worksheet that helps identifies hobbies and social activities. These are combined to form a generic list. Participants are helped to brainstorm and come up with more activities that can help them develop a sense of positive involvement with life and he society. Each participant is required to choose 5 activities from the entire list, regardless of whether they volunteered it, and commit to incorporating them into everyday life over the succeeding 8 weeks. The professionals help them identify ways to do so, and other participants give suggestions. Session 3: Reducing Stress Goals: Finding activities that add to the positive experience. Challenging negative thoughts. Reducing stress. Tasks / Objectives: The group analyses the attempts to interact with trusted others, and to involve the self in chosen activities. Success is celebrated with nominal prizes, and challenges are examined to identify problem areas, and find solutions. Goals are set for the next week, one amongst which is that the participants ask the trusted community member to write a short description of the participant’s challenges, and their own experiences of seeing the participant cope with depression and recovery. Each participant is asked to fill in the negative thoughts they experience in given contexts. This is then shared with the group, so that each participant realises that others are experiencing similar thoughts. The group is asked to respond to each other’s negative thoughts and provide counter – arguments. These counter – arguments are then listed against the negative thoughts in the work sheet. The participants are asked to observe their thoughts for a week and identify when the negative cognitions occur; and the extent of stress in each situation. Session 4: Reducing Negativity Goals: Challenging negative thoughts. Finding social support. Reducing stress. Identifying areas of change to reduce stress. Tasks / Objectives: The note written by the trusted community member is brought out, and each participant reads aloud the note written for another participant. This helps each person assimilate the support they have from the community by having witnesses to it. The observations on negative thoughts are discussed, so that the participants are able to identify stressors and the thoughts that lead to stress. They are now required to help each other respond to the negative thoughts, and replace them with positive ones which are written alongside the old thoughts. The professional discusses the concept of irrational thoughts and helps the participants identify the types of irrational thoughts that they indulge in. The participants make a commitment to catch irrational thoughts and change them over the next few weeks. The group now discusses the physical settings to the stressful experiences for each participant, and the participant is encouraged to identify the changes that are possible over the next week. Session 5: Directing Change Goals: Identifying areas of change to reduce stress. Identifying and implementing specific behaviours that lead in the desired direction of change. Tasks / Objectives: The participants bring in experiences they have had in following diet and exercise requirements over the last month. Difficulties are discussed and addressed. Successes are rewarded with minor prizes. Goals are set for the next month. The changes suggested for physical elements in the previous session are examined for success, and again, susses is rewarded and difficulties examined for each participant. Participants discuss the experiences with replacing irrational and negative cognitions. Session 6: Sustainable Spontenity Goals: Identifying and implementing specific behaviours that lead in the desired direction of change. Reducing stress and increasing spontaneity. Increasing mindfulness. Tasks / Objectives: The participants are asked to review their stress levels and the events that lead to stress. Questions are resolved and plans are made for future events. The professional helps the participants understand the importance of spontaneity. A group activity that underlines this need is explained. The group forms pairs; in event of an odd number, professional teams with a participant. Each participant is required to ‘Mirror’ their partner for 45 seconds. The twist in the activity is that the motions have to be as unpredictable as possible. The partner who finds the motions predictable can call for a switch before the 45 seconds are up. Next, the participants participate in an activity where they each have to speak on a random, non – associated topic for a minute each. They have only 30 seconds to prepare. At the end of the activity, the group chooses the most spontaneous person, and they get a small reward. The participants make a commitment to attempt spontaneous behaviour over the next few weeks. Session 7: Getting over Mistakes Goals: Dealing with making mistakes. Increasing mindfulness. Tasks / Objectives: Participants are asked to note down mistakes that they have agonised over in the last week. Each mistake is graded in a ten – point scale. Next, they are asked to take each mistake, and write down the name of at least one person they know who has also made that mistake. The group then discusses the activity, identifies the irrational process if any, and reassesses the intensity of each mistake. Next part of the exercise is to help find solutions where possible, and plan how to not let the mistake be repeated. The group then exchanges support and encouragement. Session 8: Self - Appreciation Goals: Liking the self Increasing mindfulness. Tasks / Objectives: The professional helps the participants create a personal ‘Likability’ scale. The participants then rate themselves, as well as each other on the factors. The activity is then discussed. Each participant chooses three persons from their lives they believe like them, and lists the reasons. They then rate the extent to which they feel connected to the statements they have made. The professional then helps them internalise some of the statements about themselves. Each participant commits to going in to their communities and asking three to five persons to list reasons why they are likable. They are encouraged to evaluate these statements over the week, and try to internalise them. Session 9: Working with Emotional Intelligence Goals: Increasing mindfulness. Increasing E.Q. and liking oneself. Tasks / Objectives: The activities set in the previous week are assessed, questions and concerns are responded to, and growth acknowledged. The participants are given Goleman’s Emotional and Social Competency Inventory (ESCI) to solve and submit in the preceding week. The results are now discussed, as is the concept of E.Q. Participants are helped in identifying resources that they can use in increasing their individual EI. They are helped in identifying resources in the community that they can partake from. Session 10: Moving On Goals: Assimilating growth. Tasks / Objectives: The progress of the participants is reviewed and they help in identifying where they have reached on long term goals. The participants share their experiences and provide input to one another that will help in the journey ahead. Participants help each other draw charts that map the growth over the previous 12 weeks. These charts then continue with different colours to map the targeted growth over the next 3-4 months. Each participant is helped to make long term goals, and is provided with medical and societal resource information should they need it in the future. They are encouraged to keep creating resources that they can use to encourage themselves as needed. Small souvenirs are handed out to each participant. Evaluation The participants are asked to fill in a feedback form during the last session. This form collects information on the participants change in daily life experiences as compared to when beginning the sessions. By using the information gathered during the last session and the information in the form, the participants’ growth is evaluated. Any participants who is not seen to have learnt adequate coping is either referred to another group for continued support; or to a counsellor if the participant so wishes. References: Banyai, I. (1995). Zoom.  New York: Penguin. Allen, J. G., (2006). Coping with depression: From catch-22 to hope. US: American Psychiatric Publishing Read More