Treating Depression by using Cognitive Behavioural Therapy - Coursework Example

Treating Depression by using Cognitive Behavioural Therapy There are different kinds of therapies that are used by psychiatrists during the counseling sessions with their clients. The type chosen to be implemented upon depends on what problem the client has and how easily he would respond to that particular method. One of the most popular types of therapy that is used by the therapists is the Cognitive Behavioural Therapy. This therapy was introduced to the psychological world by Dr. Aaron T. Beck back in the 1960s since when it has become widely popular. Today, it is used by many psychiatrists to assist their clients with their many issues including depression. The Cognitive Behaviour Therapy is one of the most prevalent forms of psychotherapy for depression because “in meta-analyses, CBT has generally surpassed control conditions in efficacy and has had equal efficacy compared with other empirically supported psychotherapies (i.e., IPT and behavior therapy)” (American Psychiatric Association, 2000, p. 47). This is especially because of “the ongoing adaptation of CBT for an increasingly wider range of disorders and problems” (Butler, Chapman, Forman, & Beck, 2006, p. 17). Other therapies that may be used are “interpersonal psychotherapy and psychopharmacological treatments” (Busch, Shapiro, & Rudden, 2004, p. 3). The approach is founded on the grounds of the cognitive model of emotional response – it is the way people identify with themselves and their surroundings that triggers off certain thoughts and then emotions, and not the situation itself (What is CBT?). The therapy allows the clients to understand the way their minds work, realise what they are feeling and how that affects their behaviour. It helps to build “a set of skills that enables an individual to be aware of thoughts and emotions; identify how situations, thoughts, and behaviors influence emotions; and improve feelings by changing dysfunctional thoughts and behaviors” (Cully & Teten, 2008, p. 6). This is a combination of “cognitive psychotherapy with behavioral therapy” (American Psychiatric Association, 2000, p. 47). The goal of the approach is to focus on a particular problem, break it down into several pieces so it becomes easier to solve and then try to come up with a solution for each until the client has managed to face the whole problem. The therapist helps the client realise what behaviours were resulting in creating issues and how changing them would allow the patient to solve the problem. The course of Cognitive Behavioural Therapy includes making the client “learn how to change (“restructure”) negative thought patterns in order to interpret their environment in a less negatively-biased way”, which will, in turn, change their life for the better (Duckworth & Freedman, 2012). Having negative thoughts about the world and overanalysing everything will only make the person distressed until he will expect everything to go wrong. His mind will be so confused that he will unable to look at the situation realistically. Keeping an optimistic outlook will automatically make him perform acts that will lead to a successful life (Mayo Foundation for Medical Education and Research). Cognitive Behavioural Therapy is also generally preferred by the client because it is one of the few therapies which give a result in a limited span of time, usually in around eight sessions whereas other types of therapy can take as long as several years to work (Cully & Teten, 2008, p. 7). It is briefer because the therapist gives instructions to the client and also homework assignments so not only is the client working on his problem during the session but is also trying to get better at home. The client is informed of the short term sessions in the first meeting only so he is aware that the therapy is not going to last forever (What is CBT?). One of the most common mood disorders that people suffer from is depression. It has other names as well: major depression, clinical depression and depressive disorder. It causes the sufferer to constantly feel sad and disinterested in what is happening around them because of one bad experience, “the person loses some source of positive reinforcement” (Klosko & Sanders, 1999, p. 3). This disorder has an impact on the person’s feelings, thoughts, behaviour and can result in a number of emotional as well as physical problems. The individual is so affected that he may be unable to perform even normal daily tasks, and is tired of the world and his life. Despite what people assume, depression is not something that can be treated overnight by trying to make the person happy, the treatment takes a long time to bear fruit. Usually, the individual feels better after having medicine or counseling or both. The person suffers through bouts of depression throughout their life unless his disorder is treated. It is when these episodes are occurring that the person will show certain symptoms. He may feel quite sad or unhappy, is easily irritable or frustrated, and even has outbursts of anger. He often displays lack of interest or pleasure in everyday activities including sex. His sleeping patterns also starts to get affected, he may suffer from insomnia or start sleeping a lot. He gets tired easily and lacks energy so even carrying out everyday chores requires a lot of exertion. There is a change in appetite as well, he may lose or gain weight due to lack or increase of appetite. He may be constantly restless, get easily agitated and anxious, like he may worry a lot and pace whilst he is at it, he may be unable to sit still at one place. His thinking process may become sluggish, bodily movements and speaking also slow down. Often, he may feel guilt-ridden or worries for things that have happened in the past or blames himself for the things that were not his fault. He has problems thinking and making decisions, his memory and concentration level start getting negatively affected. He thinks that life is not worth living; he often has thoughts of committing suicide and even tries to kill himself. He may even suffer from inexplicable physical problems like headaches (Depression). There are also different types of depression that the patient may be diagnosed with. This is because every person reacts to depression in a different way, so their symptoms vary as well. The diagnosis of the patient includes information on the specifier i.e. some special features that the person may display. One of these is called anxious distress which is when he worries about the future and about losing control over what is happening around him. Mixed features are displayed when the patient is depressed as well as manic. He may have a high self-esteem, talk a lot and too fast. There are also melancholic features when the patient displays certain symptoms such as severe depression, he no longer takes interest in something which one used to bring him joy, he wakes up early in the morning but in a bad mood, his appetite changes and he feels guilty and listless. Atypical features include having the ability to enjoy happy events, his food intake increases, his sleeping hours decrease, and he becomes more sensitive to rejection, and often thinks that his arms or legs are feeling heavier than usual. In the psychotic features, the person suffers from depression as well as hallucinations. The delusions are about his low self-esteem or based on other negative thoughts. There is catatonia in which the patient is unable to stay still or remains at a fixed position for a long. Peripartum onset takes place during pregnancy or after the mother has given birth to the child. Seasonal pattern is triggered due to the change in weather, less exposure to sunlight in particular. The Cognitive Behavioural Therapy is a way to treat several kinds of disorders including depression. Since 1977, “CBT for depression has been studied in over 75 clinical trials” (Butler, Chapman, Forman, & Beck, 2006, p. 20). This is because one of the assumptions of the approach is that there is a connection between an individual’s mood and his thoughts, one results in the other. As mentioned earlier, having a negative and dysfunctional outlook to life can influence an individual’s mood, his behaviour, sense of self and even his physical state. Thinking negative thoughts makes a person distressed and depressed, and unless he is not treated, he gets even deeper and deeper into it. Cognitive Behavioural Therapy “encourages persons with depression to reflect on the contents of their cognitions and identifying beliefs and to modify their unrealistic views” (Chen, Jordan, & Thompson, 2006, p. 500). Once the type of thoughts and behaviour change, automatically, the mood of a person changes too. The therapy focuses on helping the client break down the complications in their life, “problem-solving model of depression has been supported by previous studies that show significant deficits in depressed individuals’ problem-solving ability” (Chen, Jordan, & Thompson, 2006, p. 501). The process takes time but slowly and gradually, the client starts having happy thoughts until he squashes down his depression. This therapy is preferred to treat depression rather than the others because of a number of reasons. It “finds what is healthy and builds upon it” (Klosko & Sanders, 1999, p. 5). First, the Cognitive Behavioural Therapy is built on two main tasks: cognitive restructuring and behavioural activation. In the former, the psychiatrist and his client get together to try changing the patient’s thought processes. The latter is about the clients learning how to face their problems and only look forward to the activities that they enjoy. This therapeutic process pays emphases on the present rather than the past; it focuses on what thoughts an individual has instead of discussing over why he has them. Secondly, they work on particular problems that the person faces. The client’s behaviour and thoughts are picked out and addressed to help him get closer to the solution. Initially, the client starts the counseling sessions feeling that he is a useless person who can do nothing right. It is after talking about his negative thoughts that he realises that putting himself down only makes it worse. The therapist does not tell him that he is perfect in every way because that would be a lie. Instead, the client is taught to accept his flaws but focus on his talents as well. He may not be good at doing a particular task but that does not mean that he is bad at everything. Thirdly, the therapist asks the client to define some short as well as long term goals. The person needs to know what objective he has to fulfill by the end of the session and then by the time the therapy ends. However, this may take a long while sometimes between a few weeks to months; the goal may also be aimed for after the sessions have ended. Another reason regarding why Cognitive Behavioural Therapy is used for depressed patients is because the approach is educational. Part of the sessions includes asking the client to monitor, and pen down his negative thoughts and the troubled mental images that he imagines. The objective of this exercise is to identify what influence those thoughts had on his mood, behaviour, and also his physical condition. The client is also taught imperative coping skills like solving their problems and making sure to assign a minimum amount of time of his life doing things that he enjoys so that even when things take a turn for the worse, he has the good memories to look back to. Also, the client has to be involved in the treatment during his sessions and even after them. He is assigned certain work to do which is then looked into and discussed in the following session. These are reviewed by the therapist to see how much progress has taken place. The therapist also uses a number of strategies during the counseling sessions such as role playing, behavioural experiments, guided discovery and Socratic questioning. However, even though Cognitive Behavioural Therapy is quite effective for many, it has some downsides as well. When the client is signing up for getting his treatment through this approach, he has to make sure that he is fully committed to the process. There is only as much that the therapist can advise and help him with, he will not be making the actual decisions for the client, “responses to particular therapeutic interventions are different in different patients” (Busch, Shapiro, & Rudden, 2004, p. 4). It is up to the person to learn how to co-operate so that together they can work on trying to getting rid of the problems. Another concern with this therapy is that it is quite structural so the client who has certain learning disabilities or is not mentally as sharp as the average people, may face a lot of difficulty in trying to understand what his part is during the sessions. Research says “that individuals of better problem-solving appraisal seemed to benefit less from the CBT in regard to the improvement of their problem-solving appraisal and depressive symptoms” which shows that the therapy can “only work efficiently for individuals of certain psychosocial characteristics” (Chen, Jordan, & Thompson, 2006, p. 509). Then there are other critics who take one of the positive part of being treated by Cognitive Behavioural Therapy in a negative manner. The therapist only focuses on the present and not the past, it is because of this that the problem may resurface again in the future because its foundations were not talked about. Usually in other therapies, the psychiatrist solves the worries of the past so that the future would be trouble free. There are other things that affect the outcome of the therapy as well. The “findings of research studies seemed to indicate that gender is an influential factor that plays an important part in participants’ response to therapy”, the males react better to psychotherapies like CBT than the women (Chen, Jordan, & Thompson, 2006, p. 507). It is the same with the age of the client, “the effects of CBT are different for participants of different ages” (Chen, Jordan, & Thompson, 2006, p. 508). Also, the Cognitive Behavioural Therapy is all about the individual and not the people that he comes in daily contact with. It addresses just the feelings, thoughts and behaviour of the client and not the family or friends who may have had an influence on the individual’s personality. Of course, every person responds to the different kinds of therapies in their own individual manner depending on their traits and life problems. For some, Cognitive Behavioural Therapy would be the best way to get better whereas others would feel comfortable with another type of treatment. Bibliography American Psychiatric Association. (2000). Practice Guideline for the Treatment of Patients with Major Depressive Disorder. American Journal of Psychiatry. Busch, F. N., Shapiro, T., & Rudden, M. (2004). Psychodynamic Treatment of Depression. Amer Psychiatric Pub. Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006, January). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 17 - 31. Chen, S.-Y., Jordan, C., & Thompson, S. (2006, September). The Effect of Cognitive Behavioral Therapy (CBT) on Depression: The Role of Problem-Solving Appraisal. Research on Social Work Practice, 16(5), 500 - 510. Cully, J. A., & Teten, A. L. (2008). A Therapists Guide to Brief Cognitive Behavioral Therapy. Department of Veterans Affairs South Central MIRECC. Depression. (n.d.). Retrieved April 12, 2014, from National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/depression/index.shtml?utm_source=BrainLine.orgutm_medium=Twitter Duckworth, K., & Freedman, J. L. (2012, July). Cognitive Behavioral Therapy (CBT)? Retrieved April 12, 2014, from National Alliance on Mental Illness: http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm Klosko, J. S., & Sanders, W. C. (1999). Cognitive-Behavioral Treatment of Depression (Clinical Application of Evidence-Based Psychotherapy). Jason Aronson, Inc. Mayo Foundation for Medical Education and Research. (n.d.). Cognitive behavioral therapy. Retrieved April 12, 2014, from Mayo Clinic: http://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/basics/what-you-can-expect/prc-20013594 What is CBT? (n.d.). Retrieved April 12, 2014, from National Association of Cognitive-Behavioral Therapists: http://www.nacbt.org/whatiscbt.htm Read More