Cognitive Behavioral Therapy CBT and client's depressive symptoms

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senyrx

Humanities

Description

CBT

Answer the following questions. Please reference any outside reading. Follow guidelines for number of paragraphs per question.

  1. The following client sees you in your office:

You are asked to assess an 82 year-old Caucasian woman in her home. Her daughter and son-in-law live with her and are concerned by her recent behavior. She cries frequently and rarely leaves her bed. Instead she stares at the TV. She is no longer interested in playing cards or visiting her friends. She eats very little, except that she will always eat chocolate pudding. Her memory is intact and she is able to engage pretty well with other people. In other words, her cognitive status appears within normal limits and no signs of dementia are evident. When asked how she feels, she says, “depressed…well wouldn’t you be if you were 82 and all alone?”She denies being suicidal but that she is waiting to die. She states with distress, “Why doesn’t God take me? Why does he let me be just a burden? I can’t do anything anymore!”

Her daughter reports that the symptoms began gradually and are evident all the time now. She rarely expresses happy feelings. She first noticed the depressive symptoms 8 months ago after a fall where her mother broke her hip. She was laid up in a hospital for several weeks and she never returned to her prior level of functioning and activities. While in the hospital, she was diagnosed with hypertension, but otherwise, she was in good health. Her daughter is very distressed because the patient keeps stating that she is “all alone,” yet she (her daughter) is there throughout the day. She is a medical transcriptionist and only leaves to pick up and drop off the work. She is feeling “rejected” and helpless to affect her mother’s mood. Observing the interaction between the patient and her daughter, you notice that the patient is withdrawn and does not engage much and even looks annoyed when her daughter helps her.

A brief history reveals that the patient was the second of 10 children raised during the depression. Her youngest brother died shortly after birth and father died when she was 16 years old. Her family was very poor and would often eat carrot soup for dinner. Her mother parented with great strictness, and as a result, the patient reported that she felt tough- that she could “push” through anything. She was married two times and widowed two times. The first husband was an alcoholic and did not provide well for her and their three children. He died of complications related to drinking when she was in her forties. She reported that, like her mother, she raised her children through such difficult times. She married again after her children were married. The second husband was kinder and financially comfortable. After his death, when the patient was 68, he left her enough money for her to be comfortable.

A major life event occurred after her son’s return from the Gulf War. He was a war hero and received many decorations for his actions. He was also wounded and was left in permanent pain and a limp. He began to drink to self-medicate apparent PTSD symptoms and killed himself when he was 35. Talking about this increases the patient’s apparent distress.

Based on this limited information, do the following (a paragraph each question):

  1. Make a formulation (one paragraph) for this client’s depressive symptoms from the CBT perspective, including suspected causal and maintaining variables. What further information do you need to know to support your formulation and why this information will be helpful?
  2. Based on your formulation, create a treatment plan using specific treatment strategies and discuss why you chose this plan and these strategies. Also include how you would promote compliance.
  3. How would you manage the suicidal ideation if she expressed them?
  4. Let’s say she also reported excessive pervasive anxiety and worry. She worries excessively about her health- reporting excessive distress with every unexplained bodily sensation. Based on what you know, how would your formulation be similar and different than the formulation you made for the depression? What would be the common features in the formulation (between her depression and pervasive anxiety), and thus the common treatment strategies based on these formulations? What would be the contrasting formulation factors and, therefore, differing treatment strategies for addressing the depression and anxiety? (1 paragraph)
  5. Exposure methods have been found to be a very effective technique at reducing acute anxiety, especially when there is an identifiable trigger/avoided object. Because of how well you treated this client, you are asked to treat her son’s acute anxiety triggered by loud sudden noises (that is, for the sake of this assignment, before he died). In a paragraph, a) present the CBT formulation (using learning theory) for his acute anxiety and the subsequent treatment for this formulation. b) How does the cognitive formulation (and therefore, treatment) differ from the learning theory perspective? In another paragraph: based on this formulation, explain how the exposure treatment is made less effective if 1) he is non-compliant to homework (i.e., exposure on his own between sessions), 2) he is consistently arrives 20 to 30 minutes late to the exposure session, and 3) his drinking problem continues during the exposure (i.e., he drinks prior to the session), and 4) how to increase compliance to such an uncomfortable activity. (2 paragraphs)
  6. NOT PERTAINING TO THE ABOVE CASE: If an OCD client asks you to model the behavior before she does every exposure session to be sure that it is safe or ask for many specific examples from you to challenge her obsessive thinking (i.e., asks you to come up with examples of evidence against her obsessive thinking), what is she likely doing and how might it interfere with treatment? Be specific in how it relates to the learning or cognitive theory. How should these client’s efforts be managed most effectively? (1 paragraph)

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Explanation & Answer

Attached.

CBT – Outline

Thesis: The different treatment methods used for intervention in patients with mental
disorders include the CBT which is centered on the human mental and behavioral trends;
it is a reliable method for the treatment of depression.

I.
II.

Formulation from the CBT perspective
Treatment plan

III.

Management of the suicidal ideation

IV.

Intervention for excessive pervasive anxiety and worry

V.
VI.

CBT formulation using the learning theory
OCD client management


Running head: CBT

1

CBT
Name
Institution

CBT

2
CBT

1.

To develop an ideal formulation for the client, the longitudinal method will be the
most appropriate since most of the client’s depressive triggers are rooted in her past
experiences, which were activated by subsequent life events (Persons 2008). The formulation
can be presented as follows:
The patient’s depression is rooted in historical experiences, including the demise of
her youngest brother and her father when she was aged sixteen. It is further aggravated by the
extreme poverty levels experienced by her family and the lack of food during her childhood.
Moreover, her mother was overly strict and too coercive. Further, she underwent two
marriages; the first case involved an alcoholic husband who hardly provided for his family.
The second husband died later, leaving behind children and sufficient money. However, her
son was injured in the Gulf War and developed PSTD symptoms, which eventually drove
him to suicide. She is currently characterized by mood swings and other things like crying,
and she does not wish to talk about her tribulations. It can, therefore, be hypothesized that
“the patient’s depressive symptoms are deeply rooted in her history, and an intervention to
the same would solve her current problems.

2.

From the formulation developed for the client, an ideal treatment or intervention
strategy would be the Cognitive Behavioral Therapy (CBT). The method will play a critical
role in helping the client identify her negative thoughts and induce positive ones in their place
(Persons 2008). The first step involves the identification of the troubling conditions in the
client's life. It is the depression in this case. The second step would involve making the client

CBT

3

aware of her situation. This would involve an interactive conversation to sensitize the client
regarding her situation. The third step involves the identification of behaviors in a bid to
explore different activities with the client to establish the most meaningful ones. It should be
an interactive forum to establish what she would like to do but has not done or what she
already does and would wish to improve. The next step would be setting up an elaborate
action plan to set specific goals and timelines for accomplishment. The final step is
monitoring the client’s progress to ascertain any flaws in the proposed solutions.

3.

To manage the suicidal ideation, I would first seek to establish the underlying risk
factors driving the client to the problem. This would include the critical analysis of her
experiences to ascertain the possible motivators for the suicidal ideation. This step aims at
establishing the primary intent of the patient and evaluating the seriousness of the ideation.
After that, it would be prudent to conduct the activation of her support networks and risk
management systems to deter the progression of the problem. This step involves the careful
planning of the intervention to be implemented. The final step would involve other
interventions such as specialty care, family support, and medical intervention in case of
chronic situations.

4.

The formulation for pervasive anxiety and worry would be similar to that of
depression in that it would involve the examination of the historical experiences responsible
for the condition. It would also highlight the different ways through which the problem is
affecting the client. However, the formulation would differ from that of depression by
examining the current triggers of the condition. In terms of intervention, the process for

CBT

4

intervention would involve the establishment of the intent, develop a plan, and identify the
different means through which the condition will be resolved. The interventions would differ
in the management of anxiety. This is a high state of an individual while depression is a low
state of the individual. While the interventions for depression call for emotional catalysts,
anxiety calls for emotional suppressors.

5.

The first step would involve the identification of the environmental stimuli
responsible for the son’s behavior. This is founded on the fact that psychological learning is
driven by responses to environmental stimuli. The second step would be the formulation of
intervention strategies and implementation. Later, I would conduct a follow up to ascertain
the client’s progress. CBT interventions are not based on individual responses to
environmental stimuli; therefore, the treatment focuses on the individual’s mental orientation
while the learning theory is centered on mediating between the individual and the external
world.

To draft a formulation if the client is not compliant with homework, I would seek
to understand the underlying reasons for the issue. Are they related to the tutors or the nature
of the homework? I would then develop an intervention to motivate the son to depart from his
old ways and comply. Second, I would inform him about the benefits of arriving on time at
the therapy sessions to increase their effectiveness. Lateness leads to him losing on critical
interventions due to time constraint. This would encourage him to come early for the sessions
in a bid to reap the highest benefits.

CBT

5

6.

While OCD drives a client to continuous thoughts about things she wishes to do
repetitively, behavioral modeling can significantly assist in the treatment procedure. In this
case, obsessive thinking may serve as a significant obstacle to the treatment process because
it takes the client back to her previous situation despite any intervention. Also, the persistence
of obsessive thinking may cause the development of resistance from the client towards the
treatment process. The efforts may be effectively managed through the procedural
engagement to enable them to understand the potential harm of their thoughts to the process.
This would develop a positive orientation in the client for the entire treatment process.

CBT

6
Reference

Persons, J. (2008). What Is the Case Formulation Approach to Cognitive-Behavior
Therapy?[Ebook]. Guilford Publications. Retrieved from
https://www.guilford.com/excerpts/persons.pdf?t

Attached.
Attached.

Running head: CBT

1

CBT
Name
Institution

CBT

2
CBT

1.

To develop an ideal formulation for the client, the longitudinal method will be the
most appropriate since most of the client’s depressive triggers are rooted in her past
experiences, which were activated by subsequent life events (Persons 2008). The
formulation can be presented as follows:
The patient’s depression is rooted in historical experiences, including the demise
of her youngest brother and her father when she was aged sixteen. It is further aggravated
by the extreme poverty levels experienced by her family and the lack of food during her
childhood. Moreover, her mother was overly strict and too coercive. Further, she
underwent two marriages; the first case involved an alcoholic husband who hardly
provided for his family. The second husband died later, leaving behind children and
sufficient money. However, her son was injured in the Gulf War and developed PSTD
symptoms, which eventually drove him to suicide. She is currently characterized by mood
swings and other things like crying, and she does not wish to talk about her tribulations. It
can, therefore, be hypothesized that “the patient’s depressive symptoms are deeply rooted
in her history, and an intervention to the same would solve her current problems.
I would require further information such as the patient’s hobbies or areas where
they derive pleasure and any other unmentioned environmental triggers that could be
responsible for her problems. The knowledge of pleasure sources for the client would be
important in diluting the depressive symptoms while other exposures would reinforce the
interventions to be recommended and implemented.

CBT

3

2.

From the formulation developed for the client, an ideal treatment or
intervention strategy would be the Cognitive Behavioral Therapy (CBT). The method will
play a critical role in helping the client identify her negative thoughts and induce positive
ones in their place (Persons 2008). The choice of the treatment strategy is rooted in its
suitability for resolving mental health problems associated with one’s thoughts. The first
step involves the identification of the troubling conditions in the client's life. It is the
depression in this case. The second step would involve making the client aware of her
situation. This would involve an interactive conversation to sensitize the client regarding
her situation. The third step involves the identification of behaviors in a bid to explore
different activities with the client to establish the most meaningful ones. It should be an
interactive forum to establish what she would like to do but has not done or what she
already does and would wish to improve. The next step would be setting up an elaborate
action plan to set specific goals and timelines for accomplishment. The final step is
monitoring the client’s progress to ascertain any flaws in the proposed solutions. I would
promote compliance by maintaining a rapport with the client as well as consistent follow
up actions to ensure that they abide by the therapeutic recommendations.

3.

To manage the suicidal ideation, I would first seek to establish the underlying
risk factors driving the client to the problem. This would include the critical analysis of
her experiences to ascertain the possible motivators for the suicidal ideation. This step
aims at establishing the primary intent of the patient and evaluating the seriousness of the
ideation. After that, it would be prudent to conduct the activation of her support networks
and risk management systems to deter the progression of the problem. This step involves

CBT

4

the careful planning of the intervention to be implemented. The final step would involve
other interventions such as specialty care, family support, and medical intervention in
case of chronic situations.

4.

The formulation for pervasive anxiety and worry would express various
contrasting factors to that of depression. First, it would involve the examina...


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