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his week's discussion will focus on treatment planning for the case of John who is likely experiencing an episode of major depressive disorder under the DSM-V. Because it is important to have the client be self-aware, have self-efficacy and be on board for their own self-improvement, deferring to the client as expert in their own life to inform goals is useful. As John himself identified, three long term goals are: Reducing depression and anger Improve relationships that have been affected (he says he wants to no longer disappoint his wife) increasing motivation to do important things (he says he wants to be motivated to play ball with his son) While these are good goals, it is helpful to target more specific objectives to work towards achieving long term goals. Three short term objectives could be the following: Processing negative emotions through ACT workbook/thought journaling Cutting back on drinking in the next two weeks (he specifically mentions his wife's disappointment in his drinking) Improving sleep (while his lack of motivation stems from his overall depression, targeting symptoms will help, and improving sleep quality should improve mood/motivation/energy to engage in activities with his son) An intervention that is helpful to treat these goals is CBT, and specifically, a version of CBT that might be helpful is acceptance and commitment therapy (ACT). ACT is a version of CBT that uses acceptance and mindfulness strategies to help clients process and accept difficult emotions, and learn to be present and change behavior in line with their values. Given that John is internally suffering from his experience hearing about death and war in Iraq, and struggling with the resultant depression and doubts about life, it is important that he find techniques to manage and process these thoughts (Society of Clinical Psychology, n.d.). In a study specifically on veterans and the use of ACT for depressions and suicidal ideation in veterans, the authors

found that ACT reduced depression symptoms. The techniques of ACT helped clients accept their painful emotions rather than judge themselves or fight the urge to avoid those emotions. "According to the ACT model, excessive and misapplied efforts to control these difficult thoughts and painful emotions may paradoxically increase the patient's difficulty (i.e., suffering about one's pain). These very control efforts may increase the likelihood of the negative consequences created by avoidant behavior. ACT therapy teaches patients to practice experiential acceptance of—rather than focusing on the escape from—unwanted thoughts and emotions." (Walser et. al., 2015). Given the above, here is how I would use CBT and Acceptance and Commitment Therapy techniques to achieve the short term objectives described above. Processing negative emotions through ACT workbook/thought journaling - Here John could use ACT specific workbooks like the The Mindfulness and Acceptance Workbook for Depression: Using Acceptance and Commitment Therapy to Move Through Depression and Create a Life Worth Living (Robinson & Strosahl), or thought journaling, to start to process, accept, and practice mindfulness regarding his traumatic thoughts from Iraq. Cutting back on drinking in the next two weeks - Here using CBT techniques of successive approximation or "breaking it down" to accomplish goals in smaller achievable doses would involve having John set a goal of limiting drinking from 3 drinks a night to 2 drinks a night over the next week. (Skedel, 2023). Improving sleep through mindfulness activities. Here using CBT and ACT techniques of mindfulness could help improve John's sleep, with the goal of increasing motivation to spend time with his son. This could be combined with activity scheduling, so John could set a goal of one game with his son for the week and a consequent reward that he values (see Skedel, 2023, on activity scheduling as a CBT technique). References

Skedel, R. (2023, February 24). CBT for Depression: How It Works, Examples, & Effectiveness. Choosing Therapy. https://www.choosingtherapy.com/cbt-for- depression/Links to an external site. Society of Clinical Psychology, Division 12. (n.d.). Diagnosis: Depression, Treatment: Acceptance and Commitment Therapy for Depression. https://div12.org/treatment/acceptance-and-commitment-therapy-for- depression/Links to an external site. Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of acceptance and commitment therapy in treating depression and suicidal ideation in veterans. Behaviour Research and Therapy, 74, 25-31. https://doi.org/10.1016/j.brat.2015.08.012Links to an external site.

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