Assignment 2 CBT & Depression

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Yorkville University *

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PSYC6163

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Psychology

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Oct 30, 2023

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docx

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Assignment 2: CBT & Depression 1 Assignment 2: CBT & Depression MACP Program, Yorkville University PSYC6163-23S-O-3AP: Counselling Methodologies - Behavioural and Cognitive Modalities August 12, 2023 Abstract:

2 This paper explores the cognitive triad's impact on depression, revealing how negative perceptions of oneself, the world, and the future intensify cyclical patterns in the example of a hypothetical client Elaine. Therapists can counter these patterns using cognitive behavioural therapy. The comprehensive overview examines depression's maintenance processes, involving negative cognitive patterns, maladaptive behaviours, emotional cycles, physical aspects, and environmental factors, all contributing to the self-perpetuating cycle. Addressing these facets is pivotal for intervention and recovery. Elaine's case illustrates the complexity of her depressive state, stemming from traumatic events and ongoing pressures. A tailored approach integrating psychoeducation, safety assessment, cognitive restructuring, emotion regulation, behavioural activation, social support, and medication evaluation is necessary for her recovery journey. This treatment plan utilizes the cognitive model, ensuring a collaborative effort to break the depression cycle and foster recovery. Keywords : cognitive triad, depression, cognitive behavioural therapy, maintenance processes, therapeutic intervention, recovery, tailored approach, cognitive model. The Cognitive Triad The cognitive triad, a foundational concept rooted in Dr. Aaron Beck's (1976) work, is a pervasive pattern of negative cognition observed in those with clinical depression. This triad is marked by three interconnected yet distinct facets: negative thoughts about oneself, the world (or others), and the future (Kennerley et al., 2017). Firstly, individuals grappling with depression often harbour feelings of worthlessness, self-blame, and guilt, which casts a shadow over their self-perception (Fenn & Byrne, 2013). This low self-worth and internalized blame lead to distorted views about their interactions and the world around them. They may perceive the world as biased against them and believe that others harbour negative sentiments towards them. Lastly, this sense of internal and external bleakness culminates in a pessimistic outlook for the future. They foresee a continuum of their present struggles, anchored in hopelessness and despair. Each element of this triad cyclically reinforces the others, creating a relentless

3 loop of negative cognition. To facilitate healing, therapists must employ strategies like cognitive behavioural therapy to help patients recognize and challenge these maladaptive patterns, fostering a more balanced and hopeful perspective. Maintenance Processes in Depression: A Comprehensive Overview Depression, a complex mental health disorder, is sustained and perpetuated by several intertwined cognitive and behavioural patterns. These are often referred to as the "maintenance processes." Understanding these processes is crucial to therapeutic interventions and breaking the cycle of depression (Kennerley et al., 2017). Negative Cognitive Patterns: Central to depression's maintenance is the prevalence of negative thoughts. Individuals interpret events through a negative filter, generating automatic negative thoughts (NATs) (Kennerley et al., 2017). For instance, minor setbacks may be viewed as major failures. Such thoughts lead to rumination and self-criticism (Moorey, 2009), where individuals overthink, interpret excessively, and blame themselves for negative events. This cognitive bias skews perception, emphasizing threats and ignoring other aspects of situations (Beck & Haigh, 2014). Behavioural Patterns: Maladaptive behaviors, formed as coping mechanisms, worsen depression (Moorey, 2009). Actions like overeating, substance misuse, or isolation provide fleeting relief but deepen the depression. Withdrawal and avoidance, avoiding enjoyable experiences due to fear of failure or criticism, heighten isolation and sadness. Emotional Cycles: The maintenance cycle's emotional facet manifests as persistent sadness, emptiness, or hopelessness (Moorey, 2009). These dysphoric moods can further fuel negative thought processes, creating a feedback loop where emotions and thoughts feed and sustain each other. Physical and Motivational Aspects: Physical depression symptoms (insomnia, fatigue, reduced appetite) may be misread as personal inadequacy (Kennerley et al., 2017). This misinterpretation

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4 strengthens negative self-views, deepening depression. These symptoms reduce motivation to engage in mood-improving activities. Environmental Factors: Environmental constraints, including family, work, and physical location, can also contribute to maintaining depression (Moorey, 2009). The environment might limit the individual's capacity to break depressive cycles by reinforcing negative patterns or restricting access to positive interventions. The "vicious flower" metaphor aptly captures these intertwined processes, with each factor representing a petal. To truly overcome depression, one must address each petal, stopping their contribution to the flower's sustenance (Kennerley et al., 2017). It is essential to remember that the maintenance processes can vary among individuals. Not all those suffering from depression will experience every cycle in its entirety. However, recognizing these patterns and understanding their interplay is crucial for therapeutic intervention (Kennerley et al., 2017). Therapists aid clients in challenging negative thoughts, boosting activity, and improving problem-solving. Breaking this cycle is key to easing depression and facilitating recovery. Course of Treatment: Step 1 Hypothetical Client with Depression: Elaine, a 27-year-old grad student from Vancouver, is displaying symptoms of depression. Her recent adversities, including the sudden death of her sister and the pressure of her Ph.D. program, have affected her mental well-being. Elaine is avoiding social gatherings and has stopped participating in activities she once enjoyed. She is forgetful and has trouble completing tasks. Her sleep pattern is irregular, and she experiences fatigue, leading to missed classes. Elaine has lost weight and has little interest in food. She occasionally suggests she feels adrift and has suicidal thoughts. Her academic performance has declined, and she feels the pressure of her family's expectations. Her partner, Lucas, is

5 concerned about their relationship, as Elaine's interest in intimacy has diminished, and her sleep patterns are inconsistent. Problem List: Social Withdrawal : Elaine's increasing tendency to avoid social settings, stop hobbies, and retract from personal relationships mirrors observed behaviours in depressive individuals (Kennerley et al., 2017). Erratic Sleep Patterns: Elaine's inconsistent sleep, leading to significant fatigue and neglect of daily responsibilities, resonates with typical depressive symptoms (Kennerley et al., 2017). Physical Manifestations: Noticeable weight loss, extreme fatigue, and appetite irregularities are consistent with the issues highlighted in other cases (Kennerley et al., 2017). Cognitive Challenges: Elaine's struggle with focus and memory, especially concerning her academic tasks, aligns with documented symptoms in similar cases (Kennerley et al., 2017). Emotional Turmoil: Persistent emotional distress, hopelessness, and veiled references to self-harm need urgent attention (Kennerley et al., 2017). Interpersonal Struggles: Elaine's relationship strain, especially her reduced intimacy and misaligned schedules with Lucas, mirrors challenges noted in previous instances (Kennerley et al., 2017). Academic Concerns: Elaine's dwindling academic output and heightened anxiety over not aligning with her family's expectations is a notable problem (Kennerley et al., 2017). A comprehensive and tailored strategy is crucial for Elaine, addressing her concerns and the broader societal pressures she is grappling with. The Course of Treatment: Step 2 Introducing the Cognitive Model to Elaine: It is all about the connections between our thoughts, feelings, and actions. When Elaine thinks she is failing her Ph.D. program, it affects her emotions and actions. Feeling down, she might avoid social events or tasks. CBT steps in to spot these thoughts, challenge them, and shape healthier thinking patterns (O’Donohue & Fisher, 2008). Elaine's Case Formulation: Problem Development: Elaine's challenges arise from traumatic events and ongoing pressures. Her sister's sudden death likely triggered existential thoughts due to grief.

6 Combined with a demanding Ph.D. program and familial expectations, this reinforced negative self- perceptions. Not meeting her own or her family's standards deepened her depressive state. Maintaining Processes: Feedback Loops: Elaine's social withdrawal and avoidance of activities she once enjoyed, like hiking, form a self-perpetuating cycle. Avoidance might provide short-term relief from anxiety or distressing thoughts. However, in the long run, it feeds into her depressive state by reducing exposure to positive experiences and social support. Cognitive Patterns: Elaine's potential constant ruminations about her sister's demise, academic performance, and family expectations are repetitive negative thoughts that exacerbate her mood and reinforce her depressive beliefs. Physical Impact: The erratic sleep patterns further compound her cognitive difficulties. Insufficient or irregular sleep can harm mood, cognitive functioning, and overall health, further reinforcing her depressive symptoms. Interpersonal Dynamics: Strained relationships, especially with Lucas, can be both a symptom and a contributor. If Elaine perceives her relationship as another area of "failure" or a source of stress, it can worsen her emotional state. Simultaneously, depression can strain relationships, creating a feedback loop. Avoidance Behaviors: The diminishing interest in previously loved activities, such as hiking or environmental advocacy, serves as a method of avoiding potential triggers or negative feelings. However, this avoidance further deprives Elaine of potential positive reinforcement from engaging in these activities. Analysis of Problem Development and Maintenance: Elaine's depression is likely caused by traumatic events and ongoing stressors, including the sudden loss of a loved one and the pressures of her Ph.D. program and familial expectations. Her behavioural responses, such as withdrawing from social events and neglecting hobbies, reinforce her negative beliefs and perpetuate her depressive state. Her cognitive patterns, marked by ruminative thoughts about her sister's passing, academic pressures, and perceived personal failures, further entrench her depressive symptoms. Erratic sleep patterns compound her cognitive challenges and overall well-being.

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7 Comprehensive Analysis of Key Maintaining Processes: Elaine's depressive state is maintained through a combination of cognitive, behavioural, and physiological factors: Cognitive Maintenance: Ruminative thinking patterns about loss, academic stress, and relational dynamics constantly feed her negative emotions (Kennerley et al., 2017). Behavioural Maintenance: Social withdrawal and activity avoidance deprive her of potential mood-enhancing experiences and supportive social interactions. Avoidance might offer short-term relief but reinforces depressive thoughts in the long run (Kennerley et al., 2017). Physiological Maintenance: Irregular sleep patterns can have a detrimental effect on cognitive functioning, emotional regulation, and overall well-being, feeding back into her depressive state (Kennerley et al., 2017). Interpersonal Maintenance: Strained relationships, particularly with Lucas, may be sources of stress and perceived failure, reinforcing her depressive symptoms. At the same time, her depressive state can further strain these relationships, creating a vicious cycle (Kennerley et al., 2017). A multifaceted approach addressing these maintaining factors, rooted in the cognitive model, will be instrumental for Elaine to progress. The Course of Treatment: Step 3 Symptom Reduction Plan: Elaine's symptoms require a comprehensive approach targeting various aspects of her life. A collaborative and tailored strategy should be employed: Psychoeducation: Introduce Elaine to depression and its common symptoms, emphasizing that her experiences are not uncommon. This will help normalize her feelings and reduce self-blame (Kennerley et al., 2017). Safety Assessment: Given Elaine's occasional references to self-harm and suicidal ideation, conduct a thorough safety assessment. If she is in immediate danger, involve mental health professionals or crisis intervention services (Austin & Craig, 2017). Cognitive Restructuring: Utilize cognitive restructuring techniques from Cognitive Behavioural Therapy (CBT) to help Elaine challenge and modify her negative thought patterns. Encourage her to identify and evaluate her automatic negative thoughts, replacing them with more balanced and realistic alternatives. Emotion Regulation: Teach

8 Elaine emotion regulation skills, such as mindfulness and grounding techniques (Kennerley et al., 2017). These skills can help her manage overwhelming emotions and reduce the intensity of her distress. Behavioural Activation: Implement a behavioural activation plan (discussed further below) to increase her engagement in meaningful and enjoyable activities, counteracting the effects of social withdrawal and lethargy (Grudin et al., 2023). Social Support: Encourage Elaine to reconnect with friends, family, and her hiking club (Grudin et al., 2023). Social support can be crucial in improving her mood and reducing isolation (Kennerley et al., 2017). Medication Evaluation: Consult with a psychiatrist to assess the need for medication intervention. When combined with therapy, medication can effectively manage depressive symptoms (Austin & Craig, 2017). Activity Scheduling and Behavioural Activation: Behavioural activation aims to increase engagement in positive activities to counteract the effects of depression. The goal is to break the cycle of withdrawal and isolation. Here is a plan for Elaine: Activity Identification : Work with Elaine to identify activities she used to enjoy before her depression (Kennerley et al., 2017), (Austin & Craig, 2017). These include hiking, environmental advocacy, spending time with loved ones, engaging in creative hobbies, and self-care activities. Goal Setting: Help Elaine set achievable goals related to these activities. Start with small, manageable steps to avoid feeling overwhelmed. Activity Scheduling: Collaboratively create a daily or weekly schedule that includes various activities. Ensure a balance between responsibilities, leisure, social interactions, and self-care (Kennerley et al., 2017). Behavioural Tracking: Encourage Elaine to keep a journal where she records her mood before and after engaging in activities. This can help her recognize the positive impact of behavioural activation (Kennerley et al., 2017). Gradual Exposure: If Elaine experiences resistance or anxiety towards certain activities, implement a gradual exposure approach. Break down the activity into smaller steps and progressively increase her involvement (Kennerley et al., 2017).

9 Additional Early-Stage Cognitive Strategy : Given Elaine's cognitive challenges and the cognitive model's application in CBT, introducing a cognitive strategy can be beneficial: Thought Record : Teach Elaine how to use a thought record worksheet. When she experiences distressing thoughts, guide her in recording the situation, the automatic thought, emotions, evidence supporting the thought, evidence against the thought, and alternative, balanced thoughts (Kennerley et al., 2017). Socratic Questioning: Use Socratic questioning to help Elaine explore and challenge her negative beliefs (Austin & Craig, 2017). Ask questions like, "What evidence supports this thought? What evidence contradicts it? What is the worst that could happen? What is the best? What is the most likely?" Cognitive Distortions: Educate Elaine about common cognitive distortions (e.g., all-or-nothing thinking, catastrophizing, mind reading) and help her recognize when these distortions influence her thinking (Kennerley et al., 2017). Cognitive Coping Statements: Assist Elaine in creating a list of positive and balanced statements she can use to counteract negative thoughts. Encourage her to refer to these statements when she experiences cognitive distortions (Kennerley et al., 2017). By combining symptom reduction strategies, behavioural activation, and early-stage cognitive techniques, Elaine can begin her journey toward recovery. It is essential to regularly assess her progress, adjust the strategies as needed, and maintain a supportive and collaborative therapeutic relationship throughout the process. Moreover, involving mental health professionals, such as therapists and psychiatrists, is crucial to provide comprehensive care for Elaine's complex case.

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10 References Austin, A. & Craig. S. (2015). Transgender affirmative cognitive behavioral therapy: clinical considerations and applications. Professional Psychology: Research and Practice, 46(1), 21-29. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press. Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6(9), 579- 585. Grudin, R., Vigerland, S., Ahlen, J., Widstroem, H., Unger, I., Serlachius, E., & Engberg, H. (2023). “Therapy without a therapist?” The experiences of adolescents and their parents of online behavioural activation for depression with and without therapist support. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-023-02142-7 Kennerley, H., Kirk, J., & Westbrook, D. (2017). An introduction to cognitive behaviour therapy - Skills and applications (3rd ed.). Sage Publications. Moorey, S. (2009). The Six Cycles Maintenance Model: Growing a "Vicious Flower"" for Depression. Behavioural and Cognitive Psychological Therapy, (38)2 173-184. https://doi.org/10.1017/s1352465809990580 O’Donohue, W.T. & Fisher, J. (2008). Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your Practice. John Wiley & Sons, NJ.