The Cognitive Behavioral Therapy Model, Formulation of Problem Using CBT - Coursework Example

Paradigms Cognitive Behavioral Therapy Summary of the Case Halima is a nine-year old Iranian girl, who was in the third grade at the Tehran Basic School, during the time of study in August 2012. Halima is the third born in her family, and she lives with her father who is 42 and the 40-year old mother. The two parents are working, and hold doctorate degrees in their respective fields. Her elder brother, who is aged 18, was studying in America at the time. The immediate-elder sister is 15 years old and is in high school. During previous therapy sessions, it had been determined that the parents of Halima were highly rational, insisting on perfection from her, and would rarely express their emotions to the children. They often pressured her to perform well at school; they insisted that it would safeguard her future. The parents are devoted Muslims, who consider daily prayers and the Quran a daily routine. During the therapy session, the mother stated that Halima had been suffering from severe anxiety for a period of one year. Further, she said that Halima used to wake up and cry during the night. The mother stated that the daughter often complained that she was not sure whether she would succeed in her mathematics class at school. Often, she asked the mother to recheck her homework so that she could know that she had completed it successfully. Despite the efforts of the mother, Halima’s anxiety continued, and would worry about other things like the location of her books, school bag, and other diminutive things. Halima had also exhibited compulsive hand washing, in preparation for prayer, during the five times of prayer for Muslims. She demonstrated the need to do everything perfectly. Halima insisted that her problems started during a mathematics class when the teacher threatened of failing them. For that reason, she had started hating mathematics for fear that she would fail. Sometimes, she decided not to go to school since she felt like crying all the time. She explained that she liked all her teachers, except her mathematics teacher. Often, she feared that her parents would die, meditating on how she could continue her life, in case they died. She also feared about a trip that the mother took to visit the elder brother of Halima. Halima felt that she would be left alone, and would not be able to complete her homework without her help. Halima was diagnosed using an interview-based clinical approach, and scored 25 on the obsessive-compulsive rating in a scale between 0 and 40, which implied acute OCD. The symptoms perceived in her included repetitive, unrealistic, time-wasting conduct, which is aimed at stress reduction. Halima found it hard to manage her excessive worry and anxiety, which revealed through difficulty in concentrating, restlessness, clinical distress, and muscle tension. The diagnoses did not identify Halima's case as that of depression, separation anxiety disorder, or school phobia. Her worry and anxiety appeared to be more general than specific since she was diagnosed as suffering from generalized anxiety disorder or OCD. The therapist explained to the parents that their family would take a considerable responsibility in the treatment and the shaping of her psychological disorder – especially obsessions, phobia or anxiety. The parents were encouraged to discourage her obsessive thinking, through avoiding the cases of checking her work again. They were advised to check it once, and then decline to consider her other requests. To suppress the separation anxiety, the mother was encouraged to take her during the trip. The parents were advised to stop insisting on orderliness, to devote more time to talk and socialize with her, and to avoid pressuring her to perform excellently in all subjects. The Cognitive Behavioral Therapy model The CBT model is a model of reviewing the person’s thoughts about themselves, other people, and the world in general. The model also explains the effect of what the person does, on their feelings and thought processes. The model holds the basic assumption that through intervention, a person will be influenced to change their thoughts, and thoughts will result in a change of the person’s thinking inclination. The model holds the assumption that the change of thoughts can help the person feel better (O’Kearney, Anstey, & Von Sanden, 2008). Unlike other therapy models, which emphasize on talking about the issues facing the victim, CBT relies on the problems depicted by the individual. It focuses on addressing the ‘here and now problems’ and the difficulties that the victim is facing. It is guided by the principle of not focusing on the factors leading to the symptoms or the distress, but focuses on devising ways of improving the victim’s state of mind (Tan & Johnson, 2005). CBT is demonstrated to help people overcome different conditions and problems, including depression, anxiety, phobias, panic, bulimia, stress, post-traumatic stress, obsessive compulsive disorder, psychosis, and bipolar disorder. The focal area of CBT could also cover difficulties like low self esteem, anger, and physical health troubles including fatigue and pain. The model is guided by the principle that there is a cause-effect relationship between a situation that happen to a person, their emotions, thoughts, their actions and the physical feelings that result (O’Kearney et al., 2008). The model holds that the different areas affect one another, in that person’s thoughts about a situation can impair their feelings – both emotionally and physically. The problems facing one area also affect the others, and that the thoughts developed about a situation either works constructively or negatively (Tan & Johnson, 2005). Formulation of problem using CBT Halima’s assessment phase has pointed out that she is suffering from GAD (generalized Anxiety disorder) and OCD. From the therapist’s diagnosis, it can be conceptualized that that the family is critical in the skills acquisition stage of Halima, which will help heal her and improve her mental outlook. The family environment was among the factors and the surroundings for application training and skills consolidation, which will lead to the correction of her conditions, including obsession, anxiety, and phobia. Noting the role of the home family environment in causing the development of the situation, Halima’s parents should stop or avoid encouraging her obsessive thinking style, as well as the behaviors of requiring perfection. This will form part of the generalization and maintenance phase. Halima is suffering from separation anxiety, which makes her feel lonely, unattended for, and abandoned anytime she is left alone (O’Kearney et al., 2008). Halima is suffering from the problem of pursuing perfection in all that she does as exemplified through her insistence on cleanliness, orderliness, and discipline. Halima is also suffering from the social problem of feeling distant from her family and parents as her parents and siblings are constantly busy, therefore not available to socialize with her. The weak family structure developed around the working parents, and the distant siblings have caused Halima's feelings of lack of support, which culminated to her separation anxiety (O’Kearney et al., 2008). The religion of Halima’s family also plays a role in the development of the adverse conditions. This is the case as Islam insists on purity and observing prayer times, which has been nurtured in Halima. As a result, when she cannot feel the purity she perceives as well as the religious standards, she feels that she is falling short of the family and social standards (O’Kearney et al., 2008). Goals and objectives for Halima’s case The first goal in Halima’s therapy is to familiarize her with the absence of her mother by exposing her to short periods of her absence at least twice every month for the next three months. The objective of this goal is to make Halima to realize that her parents may have to attend to other responsibilities and leave her alone for sometime. Also, this goal has the objective of enabling Halima to learn how to perform some duties and responsibilities without being very dependent on her mother. It is imperative from the CBT evaluation that Halima relies on her parents for assistance with her homework. By exposing her to short periods of her parents’ absence, Halima will inevitably devise ways to tackle the assignments and learn to be independent. The other objective is to evaluate extent of her separation anxiety disorder. Since the periods of separation will be short, the therapists and parents can be able to observe her behavior during the period of separation and implement the necessary interventions. The second goal in Halima’s therapy is to reduce her fear of failing in mathematics within one month by engaging her in friendly tuition of mathematics problems and offering rewards for good performance. The objective of this goal is to expose Halima to the subject of mathematics in a friendlier environment where she will approach it in a calm and relaxed manner. By doing this, she will be more composed and confident to handle the mathematics assignment without fearing the subject. The other objective is to make her comfortable with the idea of occasional failures as normal occurrences and minimize her panic response by offering encouragement when fails some mathematics questions during tuition at home. This will help to change Halima’s behavior from being feeling less capable to being a normal person prone to occasional failures Rationale/Support for Model Noorbala, Bagheri, Yasamy, and Mohammed (2004) pointed out through an Iranian survey that mental disorders are relatively as prevalent in Iran like in other countries. However, he noted that the rate of mental disorders is much lower at Iran than in the USA. Using CBT, Iranian therapists view OCD as a condition caused by the stress that prevails in a dysfunctional family setting (mostly, among highly patriarchal families). From a CBT approach, a number of factors can be attributed to the OCD developed by Halima. These factors include the parent’s help to solidify her perfection tendencies. This is evident from their continuous pressure on her, requiring her to make her school work perfect, to make sure that she gets high grades, and requiring her to complete her work perfectly (Khodayarifard & McClenon, 2010). However, negative from her expectations, the math teacher insisted that he had to fail the class, which was in disregard to Halima’s perfectionist attitude and attempts. The parents solidified the perfectionist tendencies by accepting to check Halima's homework more than one time. This problem, from a CBT point of view, can be solved through suppressing her perfectionist tendencies. Through suppressing her perfectionist nature, she will learn to accept faults, as well as corrections against the mistakes. In order to overcome Halima's separation anxiety, the parents should provide more time to Halima for socialization than the current time they were providing. At the same time, they can also suppress the outlook that corrections are not acceptable, which were developing during Halima's past years as the parents previously required the best performance from her. The parents would also help overcome the problem of extra-orderliness, which is exhibited by her obsession to hand washing. To suppress the obsession to orderliness, cleanliness and discipline, they should stop over-emphasizing on these values so that she can develop a self balance between the good and the bad. They should also allow her freedom of choice and the liberty to choose what she does with many of her daily chores, compared to the constant pressure they had kept on her. The parents should also offer a home environment that allows Halima an opportunity to make mistakes so that she can learn from them. The actions here include not requiring that she gets good marks in the different subjects (Khodayarifard & McClenon, 2010). Solving Halima’s misconceptions around the values of violating norms, the parents should make it clear that God forgives the people that violate His norms, commands and requirements, including hand washing before praying. Through doing this, she will be able to adjust to the fact that not being remarkably clean is not a sin and that it cannot distance her from religious observance. The emphasis of doing good should also be directed towards learning and not avoiding doing wrong, which made her feel sub-standard. Turner (2006) notes that through involving a child, who is suffering from OCD in corrective activities of CBT, the obsessions of the victim are overcome, which allows them to regain their happy, peaceful and at ease nature. Hill and Beamish (2007) noted that constant feedback about the progress of therapy is necessary as it aids the therapist to recommend further corrective measures, in case the victim does not seem to respond to the corrective measure. Waters and Barrett (2000) noted that different from the CBT of the West, Iranian CBT incorporates the entire family in the therapy. This shows that the Iranian CBT will address Halima’s needs for cultural relevance in therapy, and the spiritual beliefs developed in the family and among their immediate environment. The good with Halima’s case is that the parents have not demonstrated negative treatment on the grounds of gender and sexual orientation. However, age may have played a critical role as the parents expected Halima to perform like the older brother and sister (Turner, 2006). This depicts the need to incorporate the supportive role of the parents, and not the previous role of putting pressure on her, requiring better performance, and perfection in the different areas of performance (Turner, 2006). Conclusion Halima is a nine-year old suffering from the conditions of obsession, phobia, and anxiety. These conditions are evident from her views that everything should be done to perfection. Whenever she did not meet perfection, she felt that she was not right before relations and God. The conditions are evident from her fear that she did not complete her homework well, the fear that the parents would die, and that leaving her would affect her negatively. Her anxiety is depicted through a continued fear about the location of her books. The different conditions point out that she was suffering from generalized anxiety disorder. Through the evaluation of her mental outlook, her emotional response model was evaluated, and the corrective measures of CBT employed. During the CBT, a sound therapeutic relationship was built between Halima, the doctor and the parents. Through a collaborative effort, Halima confessed her fears and feelings of anxiety, which allowed the doctor to apply the best corrective model. Through the structured and directive therapy, including requiring the parents not to recheck her homework, the adverse mental outlook would be suppressed. The educational aspect of CBT included the response of the parents, including that they were to create time to play and socialize with her. Through the strengthening of relationships and suppressing adverse behaviors, Halima was able to regain her composure, and her parents as well as Halima were given homework on what to do, towards overcoming her conditions fully. References Hill, N. R., & Beamish, P. M. (2007). Treatment outcomes for obsessive-compulsive disorder: A critical review. Journal of Counseling and Development, 85, 504-511. Khodayarifard, M., & McClenon, J. (2010). Evaluating secondary trauma: Social adjustment, father-offspring relationship, and religiosity of students in Tehran. Journal of Loss and Trauma, 15, 43-53. Noorbala, A., Bagheri Yazdi, S., Yasamy, M., & Mohammad, K. (2004). Mental health survey in the adult population in Iran. British Journal of Psychiatry, 184. 70-73. O’Kearney, R. T., Anstey, K. J., & Von Sanden, C. (2008). Cochrane review: Behavioral and cognitive behavioral therapy for obsessive compulsive disorder in children and adolescents. Evidence-Based Child Health: A Cochrane Review Journal, 2, 1283-1313. Tan, S., & Johnson, W. B. (2005). “Spiritually oriented cognitive-behavioral therapy”. In L. Sperry & E. P. Shafranske. Spiritually oriented psychotherapy (pp. 77-103). Washington, DC: American Psychological Association. Turner, C. M. (2006). Cognitive-behavioral theory and therapy for obsessive-compulsive disorder in children and adolescents: Current status and future directions. Clinical Psychology Review, 26, 912-938. Waters, T., & Barrett, P. M. (2000). The role of the family in childhood obsessive-compulsive disorder. Clinical Child and Family Psychology Review, 3, 173-184. Read More