Cognitive Behavioural Therapy - Essay Example

? CBT Assignment number Publish Component A Disorder John can be seen as suffering from depression given John’s general loss of interest in life. In addition, John has lost interest in activities that previously pleased him such as going out with friends, jogging etc. The constant social withdrawal and a generally negative view of the world and the future displayed by John also point to depression as the primary disorder (Rashid & Heider, 2008). Depression tends to ensue due to life events that produce a negative projection o life (Schmidt, 2005). The loss of John’s job due to organisational restructuring can be seen as the pivotal event that allowed the onset of depression. Predisposing, precipitating and maintaining factors In John’s case, the predisposing factors are largely psychological and psychosocial. John displays high anxiety sensitivity through his ideas and behaviour such as not applying to new jobs for fear of being worthless. Another aspect is the early death of John’s father that has inculcated a heightened separation anxiety in John’s childhood. Given John’s childhood in a single parent family, it could be assumed that John came from a lower socioeconomic status than his peers. This in turn leads to a predisposing factor based on the psychosocial aspect. The precipitating factors in John’s case are largely psychosocial in nature. John finished his education at the top end of his class which indicates that John was hardworking and devoted as well as ambitious. The sudden loss of John’s job became the primary precipitating factor for his current state. John’s comparison with his other peers and people from his socioeconomic background tend to reinforce his belief in his worthlessness. Factors that maintain John’s current state are largely psychosocial in nature with some psychological factors too. John’s overwhelming state of worthlessness arrives from his comparison with other people who still have jobs. Moreover, his early attempts at jobs and the resulting failures have reinforced his ideas regarding his lowered self esteem. Consequently, John has adopted a lifestyle that provides little room for the injection of new ideas. The rejection of social contact and relative isolation on John’s part also acts to maintain his state of depression. John’s reluctance in filing new job applications as a means to get another job acts as a psychological factor in maintaining the current status quo. Five Aspect Case Formulation According to Greenberger and Padesky (1995), a five aspect case formulation can be utilised to conceptualise a disorder. The five aspect case formulation can be divided into behavioural, physiological / biological, emotional, cognitive, environmental and reinforcing experiences (Greenberger & Padesky, 1995). These aspects are discussed in detail below to conceptualise John’s problem. Behavioural In terms of behaviour, John can be seen as socially withdrawn and unwilling to socialise at all. Moreover, John has no specific routine and has given up jogging as well. He spends most of his time watching television in an attempt to kill time. John has also stopped applying for jobs at all believing that he is worthless and would not be able to get another job. Physiological / Biological In terms of physiological factors, John’s loss of sleep is an apparent symptom. John has been waking up constantly around 4 am and has been unable to sleep afterwards. In order to deal with this loss of sleep, John sleeps throughout the day which in turn has led to a loss of his jogging routine. Moreover, John’s routine discourages him from leaving his house whether to socialise or to seek a job. Emotional Emotionally, John is in a challenging situation. John feels disconnected from the world around him and feels that he is worthless despite his best efforts. Given also that John lives alone and does not socialise much, it is safe to assume that John does not have emotional support from his family. John’s emotional state needs to be augmented in order to remove him from his status quo. Cognitive In terms of cognition, John has begun to think wrongly about life. Despite a life of struggle as a child and then as an adult, John still lost his job. This in turn has led him to believe that his best efforts will not be able to produce the desired results. The overwhelming focus on getting and keeping a job by John has tied his life down to one method of evaluating life. John’s cognitive style needs to be revised through help to allow John to see life more positively. Environmental The labour market and John’s self ostracised life style serve as the major environmental obstacles that keep John tethered to his depressive state. John’s best efforts as well as an impressive educational track record were unable to provide him with a job. Moreover, the current lifestyle and routine that John practices tends to keep him confined to gloomy ideas and attitudes. It would not be possible to modify the current labour market dynamics but John’s lifestyle could be modified in order to improve his condition. Reinforcing Life Experiences John’s father died early which in turn predisposed him to depressive behaviour and attitudes in life. The glum aspects of John’s life were reinforced first by his loss of a job and then by his failure to find another job. Treatment Plan John’s treatment plan needs to be organised in various phases. The treatment will be based on cognitive and behavioural aspects such that John’s cognition would be modified in order to allow John to change his behaviour. The first step in this process would be to talk to John at length in a few sessions in order to gauge which events John associates to his failures in life. This would allow an evaluation of various events that John has fixated his cognition around. Once such events like the death of John’s father, his loss of a job etc. are marked out, the next step would be to modify John’s cognitive perspectives. John has placed overwhelming importance to his loss of a job in life. This needs to be corrected by allowing John to visualise other ways to succeed in life such as self employment or seeking alternative career paths. John must be made aware of the fact that he has had an exceptional track record and that he can achieve again in life. Moreover, John’s behaviour must also be modified in order for John to climb out of his problems. Once it is ensured that John is taking cognitive change positively, John should be provided with suggestive examples on how to modify his behaviour. It would be unreasonable to expect that John would start to socialise after a few sessions alone. However, it could be ensured that John does begin to move outside his self defined boundaries so that he begins interaction with other people. Among other things, John would be encouraged to go outside and jog on a regular basis so that John can associate positively with the world outside his apartment. Successful behaviour change on the part of John will allow for a confirmation that therapy is actually working for John. Over the time of a few sessions, John could be encouraged to seek professional help to seek a job or to switch career paths. Follow up sessions are recommended depending on the therapist’s discretion. Component B 1. Specify different levels of cognition according to the Beck’s model, and illustrate them using John as an example (propose likely cognitions where they are not explicit from the account given). How and at which point during the course of therapy are these different levels of cognitions addressed and explored? (10 marks) According to Beck’s model, there are three different levels of cognition which are the self, the environment and the future (Beck, Rush, Shaw, & Emery, 1979). In John’s example, the self cognition level explains that John feels worthless as a person because of his life experiences. Similarly, on the environment cognition level, John feels that the world or his environment has been unfair to him such as in the loss of his father and then in the loss of his job. Lastly, the future cognition level in John’s level explains John’s hopelessness as John sees the future as bleak and unable to provide a job for him. Therapy needs to address all three different levels in John’s example in order to provide a lasting solution for the patient. The self level of cognition will be explored first of all during therapy to discover why the patient feels worthless. This would allow an appraisal of the primary cognitive problems of the patient for finding fitting solutions. This would in turn be followed by addressing the environment cognition level to make the patient aware that he is not the only person facing such challenges and that other people are coping with similar circumstance successfully. Lastly, the future cognition level would need to be addressed towards the end of the therapy in order to allow John to realise that his loss of a job is not the end of the world and that he would be able to find a job with enough effort. 2. “The goal of CBT is not simply to make our clients think differently or feel better today. Our goal as therapists is to teach our clients a process of evaluation of their goals, thoughts, behaviours and moods so that they can learn methods for improving their lives for many years to come” (Padesky, 1993). Discuss this statement. (10 marks) The actual contention behind therapy is to allow the affected person to acquire the necessary knowledge and skills to deal with upcoming problems (Hofmann, 2011). Human life tends to present various kinds of situations that certain people may take as challenges and problems. The essential thing that needs to be understood is that situations in themselves are neither problems nor challenges but it is the perception of the involved individual that assumes any given situation as a problem. For example, two different people would tend to view a common situation as changing a flat tyre differently. One person may seen changing a flat tyre as complicated and something to avoid while another person would view such a situation simply as something that would need to be dealt with. The difference lies in how these two people would tend to perceive the subject situation based on their cognition. The responsibility of the therapist is to ensure that the patients visiting them develop the necessary abilities to deal with upcoming situations since it is not realistic to approach a therapist every time a new troublesome situation occurs. The statement above lists the various perspectives that must be modified in patients in order for them to become independent in dealing with situations over the course of their lives. 3. Provide a rationale for the use of behavioural experiments and exposure with response prevention. How are these two interventions similar and what are the key differences? Give examples of where it may be more appropriate to use one rather than the other. (10 marks) Behavioural experiments are carried out to gauge the typical behaviour produced by a patient when confronted with a given situation. This technique is utilised in order to see how the patient would react when confronted with certain aspects of their environment. The use of this technique allows the therapist to evaluate how the patient’s behaviour and cognition interact in order to produce the patient’s actions. On the other hand, response prevention relies on discouraging certain patterns of behaviour in individuals that are not socially acceptable. In such cases, the therapist has a clear idea what the patient’s behaviour is like and the contention is to discourage certain forms of behaviour. Both techniques rely on active participation by the therapist along with the patient as well as close coordination. In the first technique, certain patterns of behaviour are solicited for responses while in the latter technique certain patterns of behaviour are being discouraged. In case of a patient who is shy and reluctant to talk freely to the therapist, behavioural experimentation may be carried out to determine how the individual would react to stress, happiness, panic etc. In contrast, for a patient who is a known offender such as through violent offences, response prevention would be introduced to discourage the violent behaviour on the part of the offender. 4. Provide a rationale for the use of physical techniques such as relaxation or controlled breathing and give examples to illustrate your points. (10 marks) Physical techniques are used in order to relax a patient so that the patient may be able to reflect internally as well as to ensure that the patient cooperates more with the therapist. The contention behind using physical technique is to ensure that the patient’s manic behaviour or actions are soothed down so that the patient can be more accessible. Moreover, the use of physical techniques introduces a host of biological and physiological changes that allow the patient to calm down. For example, a patient who has problems with anger management tends to react too quickly to a provided situation. Such a patient could be convinced to draw long breaths when faced with an anger stoking situation. Drawing long breaths would allow the patient to relax and then to approach the situation. This in turn would ensure that the patient’s response to the anger stoking situation would be far more mature and calm than before. References Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. New York: The Guilford Press. Greenberger, D., & Padesky, C. A. (1995). Mind over mood: A Cognitive Therapy Treatment Manual for Clients. New York: The Guilford Press. Hofmann, S. G. (2011). An Introduction to Modern CBT. Psychological Solutions to Mental Health Problems. Chichester: Wiley-Blackwell. Rashid, T., & Heider, I. (2008). Life Events and Depression. Annals of Punjab Medical College 2 (1). Schmidt, P. (2005). Mood, Depression, and Reproductive Hormones in the Menopausal Transition. The American Journal of Medicine 118 Suppl 12B (12), 54-58. Read More