HEALTH LIBRARY STANFORD VIDEOCAST – CBT FOR MOOD DISORDERS – 17/8/2012 – JENNIFER CULVER

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HEALTH LIBRARY STANFORD VIDEOCAST – CBT FOR MOOD DISORDERS – 17/8/2012 – JENNIFER CULVER

WHY IS PSYCHOTHERAPY IMPORTANT
– even with optimal medications for the treatment of mood disorders, relapse is common
– therapy an improve the illness course for MDE & Bipolar Disorder (BD)

WHAT IS CBT?
– present-focused
– skills-focused
– goal-oriented
– sometimes shorter-term
TRIAD
– central premiss: in a given situation, one’s thoughts, feelings and behaviours are all connected [a triad in which change in any of the three can bring about change overall]
ROLE OF THOUGHTS IS CRITICAL
– the premiss is that thoughts (& their interpretation) influence the way we feel
[our interpretation – not the situation itself – influences our emotional response]
For e.g. I am giving a speech & I see a few people yawning (THE SITUATION)
I feel bad & think my talk must be boring (INTERPRETATION)
I feel embarrassed, angry, disappointed in myself (EMOTIONAL RESPONSE)
Oh, people must be tired & feeling sleepy (DIFFERENT INTERPRETATION)
It might encourage me to engage them more, speak up (DIFFERENT EMOTIONAL RESPONSE)

INTERPRETATION IS CRITICAL & CAN PROFOUNDLY AFFECT HOW WE FEEL & BEHAVE

IN TREATMENT, WE TARGET THESE THOUGHTS:
Distorted/biased thoughts (aka cognitive distortions or thinking errors – not based on facts/full information) lead to problematic moods, emotions and behaviours:
– all or nothing thinking (black & white thinking – one thing goes wrong the whole thing was a disaster)
– mind reading (belief we know what other people are thinking)
– over-generalisation
– catstrophising (assuming the worst case scenario is going to happen & then responding emotionally as if that worst case is going to happen)
– disqualifying the positive / negative
[COGNITIVE THERAPISTS LIKE TO TARGET THESE; NOTE: ALL PEOPLE DO THESE, BUT ANX/MDE TENDS TO FACILITATE THESE]

E.g. OF VICIOUS CYCLE (Snowball Effect aka Downward Spiral):
SITUATION: Boss schedules a meeting with me
INTERPRETATION: I am going to be laid off
FEELINGS: Worried, devastated, angry
BEHAVIOURS: I go and complain to others about the company
FEELINGS: Makes me more angry/worked up
BEHAVIOURS: Sleep all week-end
FEELINGS: Make me more depressed
THOUGHTS: Oh no, here comes the depression again – I will never be able to find a job

COMMON CBT STRATEGIES:
1. Responses to Problematic Thoughts
– Cognitive Restructuring (re-evaluating negative thinking patterns) [raises awareness and helps them understand where their thinking may be distorted; or react and re-interpret those distorted thoughts – NOT POSITIVE THINKING BUT LOOKING FOR ACCURACY/A REALISTIC APPRAISAL]
– strategies to promote effective problem-solving [USED WHERE THOUGHTS ARE ACCURATE]
– mindfulness techniques to help give clients some distance from negative thinking [TO NOT JUST ACCEPT OUR THOUGHTS BUT TO BECOME AN OBSERVER OF OUR THOUGHTS SO THAT WE CAN LET THEM GO BY & THIS GIVES US TIME TO EVALUATE THEM AND NOT JUST GO WITH THEM]
2. Responses to Problematic Behaviours
– Are they effective? [OUR GOAL IS TO REDUCE PROBLEMATIC BEHAVIOURS & INCREASE EFFECTIVE BEHAVIOURS]
– clients are taught to re-enter situations they have been AVOIDING [as AVOIDANCE /WITHDRAWAL is common in clients with MDE – BEHAVIOURAL ACTIVATION IS THEREFORE RECOMMENDED]
– activities that provide mastery/pleasure are planned (sense of accomplishment or fun)
– training in new skills (social interaction, assertiveness/less aggressive, communication)
3. Responses to Painful Feelings
– clients learn how to accept or tolerate painful emotions, and are sometimes taught how to change those emotions in the moment [ALLOW IT; TOLERATE IT – WORK THROUGH THE PAINFUL FEELING]
– relaxation exercises [TO DECREASE OVERALL STRESS]
– strategies to manage extreme emotional reactions are taught [DISTRESS TOLERANCE SKILLS]

GOALS OF CBT FOR THE MANAGEMENT OF MOOD DISORDERS
– improve functioning (positive well-being)
– recognise early warning signs (physiological signs; situational triggers/vulnerabilities)
– prevent relapse
– psychoeducation (awareness raising; boost personalise insight; normalise]
– medication: understanding & adherence (role in management; side-effects)
– mood tracking

WHAT HAPPENS IN A THERAPY SESSION?
– structured with an agenda [ASK: WHAT WILL W E PUT ON THE AGENDA? WHAT IS YOUR MOOD CURRENTLY?]
– homework is a key component [Review]
– assessment and tracking are common & guide treatment
– mood monitoring systems (mood diary)
– thought records [TO AID IN THE CHALLENGE OF NEGATIVE THOUGHTS]
– activity logs
– tracking of behaviours for change [practice of new skills]
[WE MEASURE DEPRESSION THROUGHOUT THERAPY]

[TOOLS – PENCIL & PAPER; APPS]

TOOLS:
– mood chart (daily tracking of mood, medication, sleep, significant life events) [CAN TAKE TO PSYCHIATRIST, PSYCHOLOGIST OR GP – PROVIDES MORE ACCURATE DATA]
– thought records (assist person in becoming aware of their thoughts, evaluating their thoughts, identifying NATs, correcting and replacing those NATS)

CBT improves client self-efficacy and self-agency [THEY ARE AN ACTIVE PARTICIPANT IN THEIR OWN RECOVERY]

LIMITATIONS OF CBT
– requires effort & homework (can be difficult when in the throes of MDE)
– CBT does not work for everyone
– medication works faster & requires less effort up-front (note: all medications have side-effects)

CBT BOOKS
Unipolar Depression
– “Mind Over Mood” (Greenberger & Padesky)
– “Feeling Good – The New Mood Therapy” (Burns)

Bipolar Depression
– “The Bipolar Workbook”
– “Coping with Bipolar Disorder”
– “Managing Bipolar Disorder”

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