cognitive approach to the treatment of depression
Marissa works as a Finance Manager for a large manufacturing organization. She is becoming more and more stressed at work as the company is constantly changing and evolving. It is a requirement of her job that she keeps up with this change by implementing new strategies as well as ensuring focus is kept on her main role of overseeing the budget and future financial forecasts of the company.
At home, Marissa is married and has two twin boys age 5. She picks them up from daycare on her way home, proceeds to make dinner nightly, complete household chores with the few hours she has in the evening before putting the children to bath and bed. She often then, works more hours in her home office to keep up.
She finds that she is working thirteen-hour days in total between her time at the office and working at home at night, six days a week and doesn’t have time for her friends and family. She has started yelling at staff members when they ask her questions and when making small mistakes in their work. She has also started yelling at her children at home and not having conversations with her husband. She is becoming more forgetful about everyday tasks like where she left her keys or to pick up the dry cleaning. Concerned about her stress levels, Marissa decided to attend a counselling session.
Below is an extract from Marissa’s first session with her Therapist:
Transcript from counselling session, after initial discussions the session proceeds as follows:
Therapist: So Marissa, let’s spend a few minutes talking about the connection between your thoughts and your emotions. Let’s first focus on work since you describe it in detail earlier. Can you think of some specific times this week when you were frustrated with work?
Marissa: Yes, definitely. It was on Friday and I had just implemented a new policy for financial reporting. I had imagined that I would get a lot of phone calls about it because I always do but I ended up snapping at people over the phone.
Therapist: And how were you feeling at that time?
Marissa: I felt quite stressed and also annoyed at other staff members because they didn’t understand the policy.
Therapist: And what was going through your mind?
Marissa: I guess I was thinking that no-one appreciates all that I do.
Therapist: Okay. You just identified what we call an automatic thought. Everyone has them. They are thoughts that immediately pop to mind without any effort on your part. Most of the time the thought occurs so quickly you don’t notice it but it has an impact on your emotions. It’s usually the emotion that you notice, rather than the thought. Often these automatic thoughts are distorted in some way but we usually don’t stop to question the validity of the thought. But today, that’s what we are going to do?
The Therapist proceeds to work through the cognitive behavior process with Marissa as follow:
Step 1 — Identify the automatic thought
Together, the Therapist and Marissa identified Marissa’s automatic thought as: “No-one appreciates what I do”.
Step 2 — Question the validity of the automatic thought
To question the validity of Marissa’s automatic thought, the Therapist engages in the following dialogue:
Therapist: Tell me Marissa, what is the effect of believing that ‘no-one appreciates you?’
Marissa: Well, it infuriates me! I feel so undervalued and it puts me in such a foul mood.
Therapist: Okay, now I’d just like you to think for a moment what could be the effect if you changed that way of thinking
Marissa: You mean, if I didn’t think that ‘no-one appreciates me’?
Marissa: I guess I’d be a lot happier in my job. Ha, ha, I’d probably be nicer to be around. I’d be less snappy, more patient.
Step 3 — Challenge core beliefs
To challenge Marissa’s core belief, the Therapist engages in the following dialogue:
Therapist: Marissa, I’d like you to read through this list of common false beliefs and tell me if you relate to any of them (hands Marissa the list of common false beliefs).
Marissa: (Reads handout) Ah, yes,I can see how I relate to number four, ‘that it’s necessary to be competent and successful in all those things which are attempted’. That’s so true for me.
Therapist: The reason these are called “false beliefs” is because they are extreme ways of perceiving the world. They are black or white and ignore the shades of grey in between.
Applications of CBT
Cognitive approaches have been applied as means of treatment across a variety of presenting concerns and psychological conditions. Cognitive approaches emphasize the role of thought in the development and maintenance of unhelpful or distressing patterns of emotion or behavior.
Beck originally applied his cognitive approach to the treatment of depression. Cognitive therapy has also been successfully used to treat such conditions as anxiety disorders, obsessive disorders, substance abuse, post-traumatic stress, eating disorders, dissociative identity disorder, chronic pain and many other clinical conditions. In addition, it has been widely utilized to assist clients in enhancing their coping skills and moderating extremes in unhelpful thinking.
What would your next steps be in aiding Marissa? Identify 3 interventions that Marissa can continue to utilize to help her. Demonstrate your understating of CBT techniques in your psychotherapy tx plan.
Use the SMART system to identify long term goals, short term goals, and interventions that work toward those. What would your follow-up timeline be?
(SMART is a well-established tool that you can use to plan and achieve your goals. While there are a number of interpretations of the acronym’s meaning, the most common one is that goals should be Specific, Measurable, Achievable, Relevant, and Time-bound.)