cognitive behavioral therapy for depression an introduction n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Cognitive Behavioral Therapy for Depression– an introduction PowerPoint Presentation
Download Presentation
Cognitive Behavioral Therapy for Depression– an introduction

Loading in 2 Seconds...

play fullscreen
1 / 34

Cognitive Behavioral Therapy for Depression– an introduction - PowerPoint PPT Presentation


  • 324 Views
  • Uploaded on

Cognitive Behavioral Therapy for Depression– an introduction . Dr Kate Hardy, Clin.Psych.D Post Doctoral Fellow Prodromal Assessment, Research and Treatment Team (PART), UCSF Kate.Hardy@ucsf.edu. Objectives . Develop a shared formulation of depression with a client

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Cognitive Behavioral Therapy for Depression– an introduction' - jaden


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
cognitive behavioral therapy for depression an introduction

Cognitive Behavioral Therapy for Depression– an introduction

Dr Kate Hardy, Clin.Psych.D

Post Doctoral Fellow

Prodromal Assessment, Research and Treatment Team (PART), UCSF

Kate.Hardy@ucsf.edu

objectives
Objectives
  • Develop a shared formulation of depression with a client
  • Elicit negative automatic thoughts with a client
  • Use the downward arrow technique to explore core beliefs
  • Apply cognitive and behavioral interventions in the treatment of depression
  • Know where to locate further reading and information regarding CBT for depression
what is depression
What is depression?
  • Persistent sad, anxious or "empty" feelings
  • Feelings of hopelessness and/or pessimism
  • Feelings of guilt, worthlessness and/or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
what is depression continued
What is depression - continued
  • Insomnia, early–morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

From NIMH website (http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml)

evidence base
Evidence base
  • NICE guidelines – mild vs moderate
  • NIMH – ‘By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking and behaving that may contribute to their depression’.
  • NIMH also recommends IPT
  • NIMH suggests that ‘for mild to moderate depression psychotherapy may be the best treatment option’
cognitive model of depression

Core beliefs

Underlying assumption

Critical incident

Activate assumptions

Thoughts

Feelings

Behaviour

Physical

Cognitive Model of Depression

Early Experiences

slide7

Early experiences lead people to develop core beliefs

  • From core beliefs unhelpful assumptions are generated that organize perception and govern behavior
  • Critical incident triggers the assumptions
  • Leading to negative automatic thoughts (NAT’S) which have knock on effect to mood, behavior and physiology
five areas of cbt
Five areas of CBT

Environment

Thoughts

Biology

behavior

Mood

maintaining factors

Core beliefs

Underlying assumption

Critical incident

Activate assumptions

Thoughts

Feelings

Behaviour

Physical

Maintaining Factors

Early Experiences

first sessions
First sessions
  • Socialize to the model
  • Previous experience of therapy and expectations
  • Contracting
  • Assessment
  • Problem list
  • Goal setting
  • Agenda setting
goal setting
Goal Setting
  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Time limited
be goal smart
Be goal SMART
  • I want more friends
  • I want to stop worrying
  • To stop thinking negatively about everything
what if the client can t think of a goal
What if the client can’t think of a goal?
  • Magic/miracle question (solution focused therapy)
            • If I had a magic wand and I could use that wand to change everything for you over night so that everything was better for you what would be the first thing that you would notice in the morning that would tell you things had changed?
  • Helps client to start to think of life without the problem
scaling questions
Scaling questions
  • Asking client to rate on a scale the worst they have ever been
  • The best they have ever been
  • Where they would like to be on that scale
  • What is realistic
eliciting negative automatic thoughts hot thoughts
Eliciting Negative Automatic Thoughts (Hot thoughts)
  • Aim is to encourage the client to notice what is going through their mind when they have a strong reaction to a situation
  • Link this thought to an emotion and rate the emotion
  • Thought is an interpretation of the situation and it is this thought that governs the emotional response
  • The thought with the highest emotional rating is the hot thought (NAT)
downward arrow technique
Downward Arrow Technique
  • Technique to identify underlying assumptions and core beliefs that drive the NAT’s
  • Explore what the NAT means to the individual
  • Can also ask the client to complete the following statements:
          • I am
          • Others are
          • The world is
downward arrow
Downward arrow

I am going to be rejected again

(If that were true what would that mean )

I’ll never have close relationship

If I get close to people I get hurt

I need to protect myself

case study diana
Case study – Diana
  • 50 year old woman
  • Married (second marriage)
  • Five children (three at home)
  • Previous CBT for depression with Graduate Mental Health Worker
  • Reported that she found this helpful but wants additional sessions as depression has returned
background
Background
  • Was adamant that she wanted to explore her childhood to help explain her current problems
  • Didn’t think she could improve long term without this
  • Had liked CBT previously hence referral currently
  • Not on medication for depression at that point
current situation
Current situation
  • Working as a support teacher for children with learning disabilities
  • Living with three of her children and disabled husband
  • Sixteen year old son with severe autism and behavioral difficulties
  • Poor physical health
  • Reported difficult relationship with husband
  • Past suicidal ideation and some during the sessions but no plan
problem list
Problem list
  • Recurrent relapse of depression
  • Not happy at work
  • Feels ‘walked all over’ by family and colleagues
  • Feels like she is taken for granted by friends and family
smart goals for diana
SMART Goals for Diana
  • To voice disagreements in a meeting at work and reduce worry about this from an 8 to a 3
  • To spend thirty minutes a day doing something that she wanted to do (listening to music, reading)
  • To identify triggers to low mood and keep mood above a ‘4’ for 80% of the time
  • To understand the origins of recurrent low mood and links to current difficulties
early experiences
Early experiences
  • Impoverished area
  • Never finished school – left school early to take care of mentally ill relative
  • Father had diagnosis of schizophrenia and was physically violent to Diana’s mother
  • Diana observed physical violence but was never physically abused herself
formulation for diana

Core beliefs

I need to keep quiet

Underlying assumption

If I speak up I will make the situation worse

Critical incident (s)

Activate assumptions

Thoughts

I can’t get my point across

No one likes me/listens to me

I can’t say anything

Feelings

Anxious

Depressed

Upset

Behavior

Keep quiet

Leave the room

Avoid people at work

Physical

Nauseous

Heart racing

Formulation for Diana

Early Experiences

Observe physical violence

interventions
Interventions
  • Behavioral activation
        • Monitor activities through a daily diary
        • Rate each activity out of 10 for pleasure and mastery (sense of achievement)
        • Rate level of depression
        • Schedule activities based on information from the diary
interventions continued
Interventions continued
  • Thought challenging
          • Use thoughts identified on thought record and rate how much believe the thought
          • List all evidence that supports the thought
          • List all evidence that suggests the thought is not true 100% of the time
          • Based on the evidence re –rate how much you believe the original thought, an alternative thought and re-rate emotion
interventions continued1
Interventions continued
  • Behavioral experiments
          • Identify belief to be tested
          • Rate conviction in this belief
          • Design experiment
          • Identify any problems with the experiment and ways to overcome it
          • Record expected outcome
          • Usually do experiment as homework but can be done in session
          • Record actual outcome
          • Create alternative belief based on new evidence
interventions used with diana
Interventions used with Diana
  • Behavioral experiment – when disagree in a meeting speak out and observe what happens
          • Prediction that people would not speak to her following this (rate this belief)
          • Observed that people spoke to her just as much after the meeting (re-rate belief and create new belief based on this evidence)
          • Also found that people appreciated her input (further evidence)
  • Survey
          • Asked children how they knew she loved them and how does she know they love her
interventions used continued
Interventions used continued
  • Consideration of evidence – judge and jury
              • Rather than instantly believing NAT – considered evidence for and against the thought.
              • Presented this as from perspective of prosecution and defense
              • Final decision up to the judge (Diana)
              • Decision to accept the thought or throw it out of court
  • Relaxation
sue case study
Sue – case study
  • Using information sheet try to develop a formulation for Sue (in pairs)
  • Consider her early experiences and what beliefs these may have given rise to
sue core beliefs and assumptions
Sue – core beliefs and assumptions
  • Core Beliefs
        • I need the help of others
        • I am not good enough
        • Other people will always let me down
  • Assumptions
        • I need to be perfect to be accepted
        • If I am not passive/accepting I will be rejected
        • I have to be careful or people will disappoint me
possible interventions
Possible interventions
  • In pairs think about what interventions could be developed with Sue
interventions used
Interventions used
  • Tallying – surveyed how often she told James she loved him (found it was very frequent)
  • Developed goal to reduce this and set up behavioral experiment
  • Behavioral experiment to reduce contact with parents
  • Role play to practice more assertive interaction with parents
recommended reading
Recommended Reading
  • Greenberger and Padesky (1995) Mind over Mood
  • Fennell M.J.V (1989) Depression. In K. Hawton, P.M. Salkovkis, J. Kirk & D.M. Clark (Eds) Cognitive Behaviour Therapy for Psychiatric Problems: A practical guide.
  • Bennett-Levy, J. et al (2004) Oxford guide to behavioural experiments in Cognitive Therapy
  • Mood gym (http://moodgym.anu.edu.au)
  • http://medschool.ucsf.edu/latino/manuals.aspx#GroupCognitiveBehavioralTherapyofMajorDepression