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Cbt. depression

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COGNITIVE BEHAVIOUR THERAPY FOR DEPRESSION

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Cbt. depression

  1. 1. Cognitive Behavioural Therapy for Depression
  2. 2.  Cognitive behavioral therapy (CBT) is an effective treatment for depression.  At the heart of CBT is an assumption that a person's mood is directly related to his or her patterns of thought. Negative, dysfunctional thinking affects a person's mood, sense of self, behavior, and even physical state.  The goal of cognitive behavioral therapy is to help a person learn to recognize negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking.
  3. 3.  At the same time, therapists who practice CBT aim to help their patients change patterns of behavior that come from dysfunctional thinking.  Negative thoughts and behavior predispose an individual to depression and make it nearly impossible to escape its downward spiral.  When patterns of thought and behavior are changed, according to CBT practitioners and researchers, so is mood.
  4. 4. The focus and method of cognitive behavioral therapy sets it apart from other, more traditional therapies:  CBT is based on two specific tasks: cognitive restructuring, in which the therapist and patient work together to change thinking patterns, and behavioral activation -- in which patients learn to overcome obstacles to participating in enjoyable activities. CBT focuses on the immediate present: what and how a person thinks more than why a person thinks that way.  CBT focuses on specific problems. In individual or group sessions, problem behaviors and problem thinking are identified, prioritized, and specifically addressed.  CBT is goal oriented. Patients working with their therapists are asked to define goals for each session as well as longer-term goals. Longer-term goals may take several weeks or months to achieve. Some goals may even be targeted for completion after the sessions come to an end. Contd……
  5. 5.  The approach of CBT is educational. The therapist uses structured learning experiences that teach patients to monitor and write down their negative thoughts and mental images. The goal is to recognize how those ideas affect their mood, behavior, and physical condition. Therapists also teach important coping skills, such as problem solving and scheduling pleasurable experiences.  CBT patients are expected to take an active role in their learning, in the session and between sessions. They are given homework assignments at each session -- some of them graded in the beginning -- and the assignment tasks are reviewed at the start of the next session.  CBT employs multiple strategies, including Socratic questioning, role playing, imagery, guided discovery, and behavioral experiments.  CBT is time limited. Typically, treatment with CBT lasts 14 to 16 weeks.
  6. 6.  Anyone with mild or moderate depression can potentially benefit from cognitive behavioral therapy, even without taking medication. A number of studies have shown CBT to be at least as effective asantidepressants in treating mild and moderatedepression. Studies also show that a combination ofantidepressants and CBT can be effective in treating major depression.  CBT can be an effective treatment for mild and moderate depression in adolescents as well. It's also been shown to be effective at reducing relapses in patients who experience frequent relapses after having gone through other treatments.  Nearly two out of every three patients who are treated successfully for depression are treated with medications alone. Other patients, though, have lingering symptoms even when medication is partially working. CBT can be effectively used to treat many of these patients. Contd……
  7. 7.  Although a wide range of people respond well to cognitive behavioral therapy, experts point out that the type of person likely to get the most benefit is someone who:  Is motivated  Sees him or herself as able to control the events that happen around them  Has the capacity for introspection
  8. 8.  Cognitive restructuring refers to the process in CBT of identifying and changing inaccurate negative thoughts that contribute to the development of depression. This is done collaboratively between the patient and therapist, often in the form of a dialogue. For instance, a college student may have failed a math quiz and responded by saying, "That just proves I'm stupid."  The therapist might ask if that's really what the test means. In order to help the student recognize the inaccuracy of the response, the therapist could ask what the student's overall grade is in math. If the student answers, "It's a B," the therapist can then point out that his answer shows he's not stupid because he couldn't be stupid and get a B. Then together they can explore ways to reframe what the performance on the quiz actually says.  The "I'm stupid" response is an example of an automatic thought. Patients with depression may have automatic thoughts in response to certain situations. They're automatic in that they're spontaneous, negative, and don't come out of deliberate thinking or logic. These are often underpinned by a negative or dysfunctional assumption that is guiding the way patients view themselves, the situation, or the world around them.
  9. 9.  Other examples of automatic thinking include:  Always thinking the worst is going to happen. For instance, a person may convince himself he is about to lose his job because the boss didn't talk to him that morning or he heard an unsubstantiated rumor that his department was going to cut back.  Always putting the blame on oneself even when there is no involvement in something bad that happened. For example, if someone did not return your call, you might blame it on the fact that you are somehow a very unlikeable person.  Exaggerating the negative aspects of something rather than the positive. Think of someone who exercises a stock option from a bonus a week before the stock rises another 10%. Instead of enjoying the bonus money he just got, he tells himself he never gets the breaks or that he's too afraid to take risks that he should take. If he weren't, he would have known to wait.
  10. 10.  The idea in CBT is to learn to recognize those negative thoughts and find a healthier way to view the situation. The ultimate goal is to discover the underlying assumptions out of which those thoughts arise and evaluate them. Once the inaccuracy of the assumption becomes evident, the patient can replace that perspective with a more accurate one.  Between sessions, the patient may be asked to monitor and write down the negative thoughts in a journal and to evaluate the situation that called them up. The real goal is for the patient to learn how to do this on his or her own.
  11. 11.  Behavioral activation is another goal of CBT that aims to help patients engage more often in enjoyable activities and develop or enhance problem-solving skills.  Inertia is a major problem for people with depression. One major symptom of depression is loss of interest in things that were once found enjoyable. A person with depression stops doing things because he or she thinks it's not worth the effort. But this only deepens the depression. Contd…..
  12. 12.  In CBT, the therapist helps the patient schedule enjoyable experiences, often with other people who can reinforce the enjoyment. Part of the process is looking at obstacles to taking part in that experience and deciding how to get past those obstacles by breaking the process down into smaller steps.  Patients are encouraged to keep a record of the experience, noting how he or she felt and what the specific circumstances were. If it didn't go as planned, the patient is encouraged to explore why and what might be done to change it. By taking action that moves toward a positive solution and goal, the patient moves farther from the paralyzing inaction that locks him or her inside the depression.
  13. 13.  Mental health professionals who practice CBT receive special training and follow a manual in their own practice. Although actual sessions may vary, they typically follow this outline:  The session begins with a check on the patient's mood and symptoms.  Together, the patient and therapist set an agenda for the meeting.  Once the agenda is set, they revisit the previous session so they can bridge to the new one.  The therapist and patient review the homework assignment and discuss problems and successes.  Next they turn to the issues on the agenda, which may or may not all get addressed.  New homework is set.  The session ends with the therapist summarizing the session and getting feedback from the patient.  A typical session lasts 50 minutes to an hour.
  14. 14.  Some other types of therapy are open ended in that there is no clear end date established. With CBT, the goal is to terminate therapy at a certain point, usually after 14 to 16 weeks.  It takes about eight weeks for the patient to become competent at the skills that are being taught in therapy and to reasonably understand the model. While this is going on, the patient usually experiences a significant reduction of symptoms. Between eight and 12 weeks patients often experience a remission of symptoms. During the remaining time, they continue to practice the skills learned and to address issues related to ending the sessions. Contd….
  15. 15.  More severe cases of depression may take longer to resolve. For most patients, though, 14 to 16 weeks with occasional sessions during the first year to reinforce the new skills is adequate. "Booster" sessions are sometimes recommended to help reduce the risk for relapse and provide "refreshers" for making use of core CBT skills.
  16. 16. Have you ever felt anxious, sad, isolated, stressed, or hopeless? Consider using Cognitive Behavioral Therapy (CBT) to address these feelings. This is one type of therapy among many, but it has become widely used in recent years. CBT focuses on acquiring a set of skills so you can be more aware of how your thoughts and emotions are interconnected. CBT can also improve your feelings by changing negative or dysfunctional thoughts and behaviors. Seeking professional help will enhance your ability use CBT effectively.
  17. 17.  There are Five Methods: Identifying Negative Thoughts Challenging Negative Thoughts Problem-Solving Your Primary Concern Using Relaxation Techniques Finding Professional Help
  18. 18.  You may believe that a bad situation leads to negative feelings. The CBT approach challenges this by stating that it is the thoughts we have that lead us to have those emotions. A situation gives rise to a thought which in turn leads to a feeling or action.[1]  Here is an example of how a positive outcome is linked to thought: You went to the gym and exercised. You thought that you accomplished your fitness goal for the day. You felt satisfied and happy.  Now here is an example of a negative outcome: You went to the gym and exercised. You thought that you didn't push yourself hard enough to meet your goal. You felt disappointed or not good enough.
  19. 19. You have brief thoughts throughout the day that are triggered by a situation. You may not notice or pay attention to these thoughts, but with CBT it is important to have awareness of these quick thoughts. Pay specific attention to negative (or maladaptive) thoughts that you have when reflecting on a situation.[2]  Maladaptive automatic thoughts are distorted reflections on an event, but you may accept them as true. These maladaptive thoughts may then trigger feelings of sadness, anxiety, frustration, or hopelessness.  Here is an example of a maladaptive automatic thought-- "I'm a failure, and I'll never amount to anything." This thought is after you get a lower grade than you wanted on a class exam. You then feel hopeless and depressed.  Now here is a positive thought process--"This is just one exam, and I can continue to work hard at this to bring my grades up." You are more likely to be hopeful with this thought.
  20. 20. Underneath your automatic thoughts, you may have core beliefs that are distorted reflections of reality. These core beliefs are what drive these maladaptive thoughts. Thinking about how your core beliefs may be skewed towards negative thinking will help you to understand why maladaptive thoughts occur.  Your core beliefs are related to your self-esteem or self-confidence. You may believe that you are unlovable or not-good-enough which leads to a pattern of obsessive behavior or continued feelings of anxiety or depression.  While CBT acknowledges how core beliefs impact your present problems and thoughts, the techniques of CBT do not focus primarily on the past history of one's core beliefs but instead on how to address the present problems at hand.
  21. 21. There are many different ways that you may distort your thoughts which lead to negative emotions or behaviors. Notice the ways that you think or talk about a problem, and how you may be doing one or more of the following:[4]  Catastrophizing by predicting only negative outcomes in the future  Having all-or-nothing thinking  Discounting the positive  Labeling something or someone without knowing more about it or them  Rationalizing based on emotions rather than facts  Minimizing or magnifying the situation  Having "tunnel vision" by seeing only the negatives  Mind reading in which you believe you know what someone is thinking  Overgeneralizing by making an overall negative conclusion beyond the current situation  Personalizing the situation as something specifically wrong with you
  22. 22. By putting your thoughts in writing, you will be able to see your thoughts and emotions a little differently. The thought record should include a section about the situation, the automatic thought, and the emotion, and a separate section that reflects on the pros-and-cons, and another possible way to think about the situation. Your thought record should help to answer all these questions:  What actually happened? Include where, what, when, and how.  What thought went through your mind? Create rating scale of how much you believed it was true such as from 1-10 or 1-100.  What emotion did you feel? Rate the intensity using a scale.  What has happened to make you believe this thought is true?  What has happened to disprove this thought?  What is another way to look at this situation?  How would you rate your mood after reviewing all these questions? Use a scale.
  23. 23. Just like when making an argument, your thinking may have pros and cons, or different ways of seeing the same thing. Think about the alternative ways of seeing a situation, or how to imagine a different approach or reaction to the situation.[6]  Open your mind up to other possible outcomes or ways of thinking.  Identify alternative ways of thinking about a situation that are possible or believable to you.  Consider asking someone you trust to identify different ways of thinking about the situation. Does that other person understand the problem or situation in a different or more positive way? Listen closely to those alternatives.
  24. 24. Think about something that you enjoy or enjoyed in the past, or something that you may want to accomplish but have not done yet. Consider activities that are possible or achievable possibly in the short term. Reimagine activities as small, doable goals.[7]  Consider scheduling one pleasant activity a day. It can be a different one each day, the same, or combination of a few. Make these activities small, but something that you can look forward to doing.[8]  If you used to play music in a band and want to be a musician again, think about activities to start with, such as playing music once a week at home. Set aside time when you can play with few distractions.
  25. 25. Create an action plan. Consider writing down your goal, and then writing out your small steps. Think about the steps you need to take in the next week, month, or year, and create a timeline of how each step follows the next one.[9]  Look for alternative options or behaviors to accomplish a goal if there are barriers.  For example, a successful businessman has a physical disability that makes it difficult to continue working. He may have a goal to be working again. Consider an alternative goal of being productive, and then the plan will have more options than barriers. He may be able to teach others about business, talk with students about how to be an entrepreneur, or be productive by providing advice or guidance to his family.
  26. 26. Use a daily calendar to monitor your emotions throughout the day. Consider making a "schedule for your emotions" by writing down what you are feeling every 3-4 hours. Look at any patterns that you see over time.[10]  Do you always feel bad at the beginning of the day and then by 12 noon you're feeling good? Think about any triggers between those times.  Or vice versa, do you feel good in the morning before work, but by 2pm each day you're feeling miserable? Identify if there were specific things or events that occurred.
  27. 27. Once you have learned to identify triggers that lead to negative thoughts and behaviors, you will be more self-aware about how to activate the brain. The moment you have a negative thought, use that moment to evaluate the truth behind that thought, and what may be a different way to approach it.[11]  Come up with positive and self-affirming statements that you can remember. Use these positive statements to guide you when your anxiety or depression is triggered.  Use positive affirmations about yourself, your life, and the world around you. Identify positive things, even if they are small, that can help to train your brain to think positively.
  28. 28. If there is a problem that you are trying to solve, use CBT techniques to help you focus your thoughts in a clear way. When you have a lot of different emotions and thoughts in your head at once, you may need to focus on only one problem at a time.[12]  Avoid attempting to solve multiple problems at once. Start small and focus on the one problem that is your primary concern.  Focus on taking an active rather than a passive role when solving problems.
  29. 29. Brainstorm all the possible options, whether they are bad, good, or neutral. Write down these various options. Even ideas that seem impossible at first may help to jumpstart you in the right direction.  Think about solutions or advice you might give to someone else who is facing this same problem.  Consider talking with a close friend or someone you trust for additional options.
  30. 30. Think about each option available to you, Stick with the most logical options first, then create pros and cons for each. Consider the pros and cons of the options that may seem very challenging last. [15]  This list will help you to see other options in a more balanced way. Make sure to look at both the positives and negatives, and not just one or the other.  Consider whether you need advice from an expert or a professional for certain pros and cons, such as a financial advisor, lawyer, or healthcare professional.
  31. 31. Examine how the pros and cons stack up relative to one another. Consider creating a rank order for your options.  Talk with someone you trust about whether these rankings seem realistic. Ask them if they have any concerns about the plan you think is best.
  32. 32. Find out the steps you need to take to enact the plan you have chosen. Your pros and cons list for the option you have chosen may help you to understand the steps you need to take and the ones to avoid.  Create a timeline of small steps that you need to do. With organization and planning you are more likely to carry out and achieve your goals.
  33. 33. Avoid being easily deterred if your plan does not go the way you wanted. Go back to the planning phases of problem solving and figure out what missteps may have been made or not addressed.  If the plan led to a positive outcome, enjoy that moment. Even if the problem is not fully "solved," be thankful that you are headed in the right direction.  If the plan still needs some tweaking and negative thoughts still arise, keep going and stay motivated. Most negative thoughts, feelings, and situations don't go away overnight, but that doesn't mean they are impossible to work on.
  34. 34. Breathing exercise can help you to cope with stressors, triggers, and automatic negative thoughts. While relaxation techniques may not "get rid of the problem," it is important to learn how to focus your mind and energy constructively to avoid anxious or obsessive thoughts. Consider this abdominal breathing technique:[18]  Place one hand on your chest and the other on your abdomen.  Exhale with your mouth, and take a slow deep breath in with your nose.  Inhale as deeply as you can and hold for 7 seconds.  Slowly exhale through your mouth for 8 seconds.  As you release the air with relaxation, contract gently your abdomen to remove the remaining air from your lungs.  Repeat this cycle for a total of 5 deep breaths. Try to have rate of one breath every 10 seconds. This helps both your heart rate and your mind.
  35. 35. This is another relaxation technique that starts with deep breathing, but focuses your mind on how to release muscle tensions the body. This can help relieve anxiety. It can be done with the guidance of a mental health or holistic health professional.[19]  Focus on deep breaths, and notice your breathing.  Focus on tensing and releasing muscles in the body for five seconds each.  Focus your mind on your body parts, starting with the feet. The progression is feet, legs, pelvis, stomach, back, arms, neck, and face.
  36. 36. These techniques can help you redirect your negative thoughts or stressors to something peaceful and safe. They can help you when triggers for maladaptive thoughts occur. You can also do these at night before bed. Your peaceful place can be somewhere you have been before, or possibly dreamed about. Visualize this way:[20]  Close your eyes, and imagine a peaceful or happy place  Notice the colors, shapes, movement, light and textures of this place  Listen to sounds around you that emerge  Notice smells in this place  Focus on any sensations of touch such as the floor or earth beneath you, the temperature, or anything you can touch.
  37. 37. There are many professionals who are trained in specialized forms of CBT such as Trauma-focused Cognitive Behavioral Therapy, Problem-Solving Therapy, and Acceptance and Commitment Therapy.[21] Contact a counseling center or private practice therapist in your local community and find out about their experience with CBT. When looking for a mental health professional, consider these:[22]  Licensed professional counselors  Licensed clinical social workers  Licensed psychologists  Licensed Marriage and Family Therapists  Certified addiction counselors
  38. 38. Most health insurance plans have behavioral health as part of your (or your family's) medical coverage. Consult your insurance company about local providers. Find out if the mental health professionals covered under your insurance are specialized in CBT.  Consider consulting with your primary care doctor for possible referrals for a trained mental health specialist.  If you need a medication consultation, request a referral for a psychiatrist or mental health nurse practitioner.
  39. 39. There may be low or no-cost options through your school if you are a student. Also, many employers have employee assistance programs to help employees who are going through difficult transitions.  Find out if there may be options to go to a counseling center through your school. Ask if there are counselors who specialize in CBT.  Identify if your employer has an employee assistance program. Contact the number available. The information discussed through the employee assistance program is confidential. It may be free of charge for the first few counseling sessions.
  40. 40. There are crisis hotlines available if you are in immediate crisis. There are also hotlines to find places for treatment and local resources in your area.

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