Resources. Judith Beck books Oxford Centre: online videos (PW: roleplays) Wellington Psyc Med CBT programme

Transcription

1 CBT for depression Dr. Kumari Fernando Valentine Senior Lecturer/Clinical Psychologist F: Dr. Kumari Fernando (Clinical Psychologist) W: B: T: kumari_fernando 1

2 Resources Judith Beck books Oxford Centre: online videos (PW: roleplays) Wellington Psyc Med CBT programme 2

3 Agenda 1. Depression: general background 2. Case: formulate & treat (discuss) 3. Background (possible topics) 1. Behavioural activation 2. Sleep 3. Rumination 4. Thought challenging 5. Stress Appraisal Coping Model 4. Practice in pairs 5. Refine techniques 3

4 Skills to (Re)Learn Formulation Activity scheduling (mastery/pleasure) Thought challenging Evidence for/against Where is this thought taking you? Quality of the thought Strategies for sleep improvement Dealing with rumination 4

5 Depression Depression symptoms Concentration Guilt Appetite Sleep Psychomotor Agitation Death Interest Energy

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8 Evidence Cuipers et al. (2013): Meta analysis of treatment for adult depression Hofman et al. (2012): 269 meta-analytic studies reviewed 106 meta-analyses examining CBT for substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. CBT for various problems in children and elderly adults. Strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in seven of these reviews and only one review reported that CBT had lower response rates than comparison treatments. 8

9 Basic Model + (childhood) experiences Core beliefs [Cognitive triad] Conditional assumptions Situation Automatic Thoughts *Biases Feelings Behaviour Physiological reactions 9

10 CBT Treatment is usually time-limited and brief (e.g., 6-15 sessions) Treatment is highly structured. Each session involves: A collaborative agenda Mood check Check on homework from last week Homework for the coming week 10

11 CBT Principles 1. CBT is based on an ever evolving, individual conceptualisation 2. CBT requires a sound therapeutic alliance. 3. Emphasises collaborative empiricism and active participation. 4. Goal oriented and problem-focussed. 5. Initially emphasises the present (at least initially) 11

12 CBT Principles 6. Educative, teaching clients to be their own therapists. 7. Aims to be time-limited. 8. Sessions are structured. 9. Teaches clients to identify, evaluate and respond to dysfunctional thoughts. 10.Uses a variety of techniques. 12

13 Myths about CBT 1. It s about positive thinking 2. It deals with surface level problems 3. I tried CBT once and it didn t work (or read a book and it didn t help me) 4. CBT consists of (simple) techniques 13

14 Some CBT components Case conceptualisation/formulation Goal setting Pleasant events scheduling Mastery events Identifying negative automatic thoughts Identifying distortions Challenging automatic thoughts Identifying core beliefs Challenging core beliefs (*flashcards) Behavioural experiments Assertiveness Relaxation techniques 14

15 Third Wave Therapies It s not the thinking, but how we are thinking ACT, DBT, Mindfulness, Meta-cognitive therapy Example: grounding technique 15

16 Mini Summary CBT is strongly founded on the idea of a scientist-practitioner Measurement/continuous assessment is important Case conceptualisation is fundamentally important We are co-detectives with our clients 16

17 Case: Alison (38) CdiZc How would you (1) formulate and (2) treat Alison? 17

18 Sleep Hypothesise what the underlying issue is Muscle tension? Rumination/worry? Association of bed-lack of sleep PMR Sleep hygiene Sleep re-training 18