Institute Inbrief - 04/02/2015
Welcome to Edition 218 of Institute Inbrief! The plethora of studies evaluating the efficacy and effectiveness of CBT (Cognitive Behaviour Therapy) over the last few decades has shown generally solid results for CBT as a treatment for depression (and many other disorders) with different groups, in different modes of delivery, and in manifold settings. In this edition’s featured article, we examine the different findings with respect to aspects such as client preference, mode of delivery of treatment, and comparisons between CBT and other treatment modalities, including antidepressant medication.
Also in this edition:
- Latest news and updates
- Articles and CPD information
- Wellness tips
- Therapist Q&A (new)
- Social media review
Enjoy your reading!
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Hidden in plain sight
Drunk. Junkie. Loser. These are just some of the ugly labels that get thrown around when people talk about addiction. Labels that reinforce the belief that addiction happens to “other” people — or other counselors’ clients.
Counselors know that addiction is a disease, of course. But it’s a disease with a particularly bad reputation, and many counselors may associate it with resistant clients and low rates of successful treatment. For some counselors, it might even seem easier to avoid working with clients who are struggling with addiction. The problem is, that’s not possible.
New Research Finds Memory More Selective Than Previously Thought
New research shows that people may have to “turn on” or prompt their memories to help them remember even the simplest details. Findings from the Pennsylvania State study indicate that memory is far more selective than previously thought, according to researchers.
“It is commonly believed that you will remember specific details about the things you’re attending to, but our experiments show that this is not necessarily true,” said Dr. Brad Wyble, an assistant professor of psychology. “We found that in some cases, people have trouble remembering even very simple pieces of information when they do not expect to have to remember them.”
The Efficacy of CBT Treatment for Depression
The plethora of studies evaluating the efficacy and effectiveness of CBT (Cognitive Behaviour Therapy) over the last few decades has shown generally solid results for CBT as a treatment for depression (and many other disorders) with different groups, in different modes of delivery, and in manifold settings. There is no controversy on one fundamental finding: there is a vast amount of evidence showing that CBT is effective for depression. Let us examine the different findings with respect to aspects such as client preference, mode of delivery of treatment, and comparisons between CBT and other treatment modalities, including antidepressant medication.
The clients like it
CBT is an acceptable treatment modality. A meta-analytic study by McHugh, Whitton, Peckham, Welge, & Otto (2013) identified 644 articles assessing adult patient preferences for the treatment of psychiatric disorders; in order to be included in the meta-analytic investigation, the studies had to include at least one psychological treatment and one pharmacologic treatment. Of the 34 studies which met inclusion criteria, there was a three-fold preference for psychological treatment. That is, the proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69–0.80), which was significantly higher than equivalent preference (i.e., higher than 0.50; P < .001). The authors noted that, given the mounting evidence for enhanced outcomes when clients are allowed to receive preferred psychiatric treatment, strategies should be developed to maximise the linkage of clients to their preferred treatment.
Definitely better than nothing
In meta-analysis examining treatment outcomes of CBT, the intervention yielded large effect sizes for the treatment of depression (Butler, Chapman, Forman, & Beck, 2006). Moreover, several meta-analyses have demonstrated that CBT was significantly more effective than untreated controls, waiting list clients, or those receiving no treatment (Dobson, 1989; Gloaguen, Cottraux, Cucherat, & Blackburn, 1998; Wilson, Mottram, & Vassilas, 2008).
Comparable to other treatments, and just as efficacious
CBT has been compared myriad times with other treatments, including both other psychotherapies and also medications. A study of seven trials randomising 741 participants to treatment of either CBT or interpersonal therapy reported at the end of treatment that:
- The four trials reporting data on the Hamilton Rating Scale for Depression showed no significant difference between the two interventions;
- The five trials reporting on the Beck Depression Inventory showed comparable results (Jakobsen, Hansen, Simonsen, Simonsen, & Gluud, 2012).
Braun, Gregory, & Ulrich (2013) applied two different meta-analytical techniques to 53 studies (3,965 patients) which directly compared two or more bona fide psychotherapies in a randomised trial. Meta-analyses conducted at the end of treatment on five different types of outcome measures directly compared each of the following therapies: CBT, behaviour activation therapy, psychodynamic therapy, interpersonal therapy, and supportive therapies, to all other treatments. Results showed that the treatments were equally efficacious except for the supportive therapies, which were somewhat less efficacious than the other treatments. CBT was superior in studies where therapy sessions lasted 90 minutes or longer; behavior activation therapy was more efficacious when therapy sessions lasted less than 90 minutes (Braun et al, 2013).
CBT, reminiscence therapy, and general psychotherapy were compared for effectiveness in treating depression in a meta-analysis of fourteen international studies of adults 55 or over. All three types of psychotherapy were found to be effective treatments for depression in older patients. Specifically, each individual therapy format was significantly more effective than placebo or no intervention, with CBT and reminiscence therapy having similar efficacy (Peng, Huang, Chen, & Zu, (2009).
Meta-reviews by Haby, Donnelly, Corry, & Vos (2006: 33 studies) and Beltman, Voshaar, and Speckens (2010: 29 studies, see details below) also supported the effectiveness of CBT. The Haby et al investigation concluded that CBT is overall an effective treatment for not only depression, but also panic disorder, and generalised anxiety disorder.
Different delivery formats deliver
The developed world, at least, is experiencing a current and projected shortage of therapists available to offer mental health services, yet as the United Kingdom’s Lord Layard observed in a speech, Britain’s biggest social problem is mental health. He suggested that Britain alone needs an additional 10,000 therapists delivering 10 sessions of CBT to 1,000,000 individuals each year (Sainsbury Centre for Mental Health, 2005, in White, 2008). Accordingly, many mental health experts are looking for alternative delivery formats to the tried-and-true, one-on-one mode of individual therapy, and some researchers have begun to test delivery modes such as computerised, group, and self-help CBT.
A meta-review of computerised CBT
Computer-mediated CBT has the capacity to deliver structured input consistently with precision. Observing that it also offers low-cost, easily accessible, flexible therapy in a non-stigmatising environment, one study conducted an analysis of reviews of efficacy of “cCBT” (computerised CBT) published between 1999 and February, 2011. The search yielded 12 systematic reviews from ten studies covering depression. The meta-review concluded that the limited evidence available supported the efficaciousness of MoodGYM, Beating the Blues, and Colour Your Life, although it also stated that it was not possible to discern the relative effectiveness of one package over the other (Foroushani, Schneider, & Assareh, 2011).
The SAMHSA studies: Computer CBT and guided self-help
In a similar vein, a number of studies listed on the United States Department of Health and Human Services SAMHSA National Registry of Evidence-based Programs and Practices consistently supports the finding of effectiveness of CBT either as a computerised CBT package (with or without minimal therapist help) or as an independent, guided self-help program.
A meta-analysis (of four United States and other-national studies) of depressed adults, with or without anxiety, examined the effectiveness of computerised cognitive behavioral therapy (cCBT) for the treatment of mild to moderate depression. It found improvement in psychological symptoms, depression symptoms, interpersonal and social functioning, quality of life, and participant satisfaction both with treatment and site of delivery (Kaltenthaler, Parry, Beverley, & Ferriter, 2008). In a similar review, a meta-analysis of 12 studies using randomised controlled trials to study internet-based CBT for symptoms of anxiety and depression found that, where therapist support was available, there was a large effect size. In the studies without therapist support, there was also an effect, but the size of it was smaller. The authors suggested that the effectiveness of the interventions was greatly enhanced by the addition of therapist support, but concluded that internet-based interventions are, overall, effective in the treatment of depression and anxiety symptoms (Spek, Cuijpers, Nyklicek, Riper, Keyzer, & Pop, 2007).
Finally of the computer-based studies, a 19-study meta-review by Reger & Gahm (2009) of computer-based CBT treatments for anxiety showed that not only symptoms of anxiety, but also those of depression, general distress, and dysfunctional thinking were relieved post-treatment. General functioning and quality life were improved. The studies, both in the United States and internationally, were conducted between 2000 and 2007, but the authors advised caution in interpreting results, as there were few placebo-controlled studies available and many of the studies had small sample sizes and high dropout rates.
As with computer-based CBT, the effectiveness of CBT guided self-help for anxiety and depression is not well established. One meta-analysis reported on the results of 13 studies of adults, aged 17 to 64, who used guided self-help CBT materials. The studies, conducted between 2003 and 2009 in the United States and other nations, evaluated the effectiveness of randomised, controlled trials of CBT for anxiety and depression. But while clinician and self-report measures found that depressive and anxiety symptoms had substantially reduced, researchers were able to draw only limited conclusions. This was because recruitment methods for the studies differed significantly (self-selected versus referral), many of the studies only partially addressed the issue of fidelity, and amount of therapist help varied widely: between 30 minutes and three hours (Coull & Morris, 2011).
The meta-study by Beltman et al (2010: referred to above) examined 29 studies in the United States and other nations occurring between 1984 and 2008 which investigated the effectiveness of CBT for depression in people with a diversity of somatic diseases (such as cancer, HIV infection, multiple sclerosis, or renal failure). Participants were diagnosed as having depressive symptoms or depressive order as well as the somatic disease. CBT, administered in individual or group sessions, was compared to wait list or treatment as usual. CBT was significantly more effective at reducing both depressive symptoms and depressive disorder than control, with CBT for depressive disorder yielding a larger effect size than for depressive symptoms. The results also suggested that, while individual treatment might be more effective than group therapy in somatically ill people with depressive disorder, group therapy also reduces symptoms. Overall, CBT is effective in treating depressive symptoms in people with a variety of somatic diseases.
Similar findings were obtained from a meta-review of twenty-three studies. Analysis of group CBT versus usual care alone (14 of the studies) showed a significant effect in favour of group CBT immediately post-treatment, with some evidence of benefit maintained at both short term and also medium- to long-term follow-up. Seven of the studies examined group versus individually-delivered CBT; these showed a moderate treatment effect in favour of individually-delivered CBT right after treatment, but no evidence of difference at either short- or medium- to long-term follow-up. Thus, group CBT helps depressed individuals more than usual care, and seems to be no less effective than individual CBT after three months (Huntley, Araya, & Salisbury, 2012).
And CBT is as good as antidepressant medication
One study is particularly noteworthy regarding the question of whether CBT or antidepressant medication helps clients more. The background is that antidepressant medication prevents the return of depression symptoms, but only as long as the medication is continued. The study, by Hollon et al (2005), sought to determine whether cognitive therapy has an enduring effect and to compare this effect against the effect produced by continued antidepressant medication. In outpatient clinics, patients who responded to CBT in a randomised controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal.
Patients who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up. Patients had initially been selected to represent those with moderate to severe depression. The 104 patients who responded to treatment (nearly 60 percent of those initially assigned) were enrolled in the continuation phase. Those withdrawn from CBT were allowed up to three booster sessions during continuation; those assigned to continuation medication were kept at full dosage levels. Results showed that those withdrawn from CBT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8 percent versus 76.2 percent; P = .004) and no more likely to relapse than patients who kept taking continuation medication (30.8 percent versus 47.2 percent; P = 20). The researchers concluded that CBT has an enduring effect extending beyond the end of treatment, seemingly as effective as keeping patients on medication (Hollon et al, 2005).
The Hollon et al study is in line with results from a study by DeRubeis et al (2005, in Otto, 2013), in which 58 per cent of those on CBT and 58 percent of those given antidepressant medication for severe depression were responding to treatments at the 16-week mark. Otto (2013) also reported on a meta-analysis of acute phase treatment, in which either CBT or antidepressant medications were administered (seven studies). Upon discontinuation, those in the CBT group were associated with a 61 percent lower relapse/recurrence rate of the depression. In six studies, CBT was administered as an addition to medication. Adding in the CBT resulted in a 61 percent lower relapse/recurrence rate (Vittengl et al, 2009, in Otto, 2013).
In summary, the answer to the question of why we should employ CBT to treat depression is because it is proven efficacious: far superior to wait list, supportive “treatment as usual”, and controls, and at least as effective as other therapies and antidepressant medication, with more enduring effects than medication. It seems to be most potent delivered in standard one-on-one format, but even in group, computerised, or self-help format, it still reduces depressive symptoms. And clients would far rather do a course of CBT than pop anti-depression pills.
Is there anyone who shouldn’t be treated with CBT? The contraindications
CBT has been used clinically with almost every imaginable client population. Few evidence-based exclusion criteria for the use of CBT with specific disorders have been established. Researchers suspect, however, that many studies of CBT typically exclude certain conditions due to beliefs that these could lead to less improvement in symptoms over the course of treatment. To include individuals possessing such characteristics in a study might be to skew negatively the results, making CBT look less effective than it is with suitable clients; beyond that, such clients may be poorly served by beginning a therapy which can ultimately not achieve measurable results for them.
Typical exclusion criteria consist of comorbid alcohol or other substance disorders, some psychotic disorders, organic brain syndrome, and learning difficulties, with many studies also specifying that participants who have depression not be at risk of suicide. More research on this issue is needed; many believe that individuals with these conditions may still benefit from CBT (Halverson, Bienenfeld, Leonard, & Riemann, 2014). Beyond the question of inclusion in research studies, there is the matter of whether the depressed clients of a clinician not participating in a study may find CBT useful even though the clients’ other issues may cause a smaller effect.
© 2015 Mental Health Academy
This article was adapted from the upcoming Mental Health Academy CPD course “Using CBT with Depression”. Click here to learn more about MHA.
Beltman, M. W., Oude Voshaar, R. C., & Speckens, A. E. (2010). Cognitive-behavioural therapy for depression in people with a somatic disease: Meta-analysis of randomised controlled trials. The British Journal of Psychiatry, 197, 11–19. PubMed abstract: hyperlink.
Coull, G., & Morris, P. G. (2011). The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review. Psychological Medicine, 41, 2239–2252. PubMed abstract: hyperlink.
Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting & Clinical Psychology, 57, 414–419.
Foroushani, P.S., Schneider, J., & Assareh, N. (2011). Meta-review of the effectiveness of computerised CBT in treating depression. BioMed Central Psychiatry. 2011, 11: 31. Retrieved on 24 September, 2014, from: hyperlink.
Gloaguen, V., Cottraux, J., Cucherat, M., & Blackburn, I.M. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 59–72.
Haby, M. M., Donnelly, M., Corry, J., & Vos, T. (2006). Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry, 40, 9–19. PubMed abstract: hyperlink.
Halverson, J.L., Bienenfeld, D., Leonard, R.C., & Riemann, B.C. (2014). Cognitive Behavioral Therapy for depression. Medscape. Retrieved on 5 July, 2014, from: hyperlink.
Hollon, S.D., DeRubeis, R.J., Shelton, R.C., Amsterdam, J.D., Salomon, R.M., O'Reardon, J.P., Lovett, M.L., Young, P.R., Haman, K.L., Freeman, B.B., & Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 2005: Apr, 62(4): 417-422. PubMed abstract: hyperlink.
Huntley, A.L., Araya, R., & Salisbury, C. (2012). Group psychological therapies for depression in the community: systematic review and meta-analysis. The British Journal of Psychiatry (2012) 200, 184-190. Doi: 10.1192/bjp.bp.111.092049 Retrieved on 30 September, 2014, from: hyperlink.
Jakobsen, J.C., Hansen, J.L., Simonsen, S. Simonsen, E., & Gluud, C. (2012). Effects of Cognitive Behavioral Therapy versus Interpersonal Therapy in patients with major depressive disorder: A systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. Psychological Medicine, 42(7), 1343-1357. Doi: https://dx.doi.org/10.1017/S0033291711002236.
Kaltenthaler, E., Parry, G, Beverley, C., & Ferriter, M. (2008). Computerised CBT for depression: A systematic review. The British Journal of Psychiatry. 193, 181–184. PubMed abstract: hyperlink.
McHugh, R.K., Whitton, S.W., Peckham, A.S., Welge, J.A., & Otto, M.W. (2013). Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: A meta-analytic review. Journal of Clinical Psychiatry. 2013: 74(6), 595-602.
Peng, X. D., Huang, C. Q., Chen, L. J., & Zu, Z. C. (2009). CBT and reminiscence techniques for the treatment of depression in the elderly: A systematic review. The Journal of International Medical Research, 37, 975–982. PubMed abstract: hyperlink.
Reger, M. A., & Gahm, G. A. (2009). A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxiety. Journal of Clinical Psychology, 65(1), 53–75. PubMed abstract: hyperlink.
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J., & Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: A meta-analysis. Psychological Medicine. 37, 319–328. PubMed abstract: hyperlink.
Wilson, K. C. M., Mottram, P. G., & Vassilas, C. A. (2008). Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews, 1. Art. No.: CD004853. DOI: 10.1002/14651858.CD004853.pub2.
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Beating the holiday blues
You gaze with disgust at the mountains of dirty laundry, tossed casually next to the half-unpacked suitcase. You feel fidgety – unable to settle into your normal routines – life seems grey, and you are dreading work. Chances are you have a condition that hits most eager travellers: the post-holiday blues. Today is about how to move past them to get back into the swing of regular life.
1. Recognise that feeling flat is normal part of returning
My mother often said that “re-entry is difficult”. No matter how much fun (or not) the holiday was, no matter how well-adjusted you are, and no matter how wonderful your life is, it’s still hard to come off that rhythm of glorious freedom; exciting new sights, sounds, and scents; and invigorating activities. Or put another way, it’s hard to again subject yourself to the constraints of mundane have-to-do tasks and “normal” reality. There is a sense of loss. You may feel sad about the good things that have come to an end, but know that these blues won’t last too long (or if they do, it’s regular depression, and you should see your GP or counsellor).
2. Plan for a smooth return
Thinking you can land at 6:00am and be at work at 8:00am is not good planning. Rather than feeling delighted that you squeezed every minute out of your holiday, you are likely to feel overwhelmed at work with the thousands of emails, your now-cluttered inbox, and looming project deadlines. Much better to come back a day or two early, concentrate on getting over jet lag, and arrive at your desk refreshed and ready. Also, is there anything you can set up before you go – some project or task which is more fun or easier than your other work – which you can do first, to “get your feet wet” and ease back into the work thing? In terms of family, it helps if the kids can meld back into the comfortable familiarity of daily life before facing school.
3. Invite yourself back into your normal home life
How welcome do you feel with all that laundry and your still-full suitcase gleaming malevolently at you? For weeks, you found out how little you needed by living out of your suitcase. Now is the chance to implement a similarly de-cluttered, simpler life at home. So do the laundry, unpack the luggage, de-clutter your house and clean out your fridge. In other words, make your home more spacious and thus more welcoming; then it will be clear where to hang those oh-so-special items you bought to help keep the holiday memories alive.
4. Start thinking in terms of “the holiday cycle”
The holiday doesn’t have to end just because your plane has safely gotten you back home. Take a broader view: you are merely in a different part of an ongoing vacation cycle, and now is the time to explore how the holiday can come home with you. What new foods might you learn to cook that you tasted while away? What new activities might you take up after trying them while away: stand-up paddling anyone? This part of the cycle also calls for sharing what you did while away, so program in time to set up your Facebook photo album – or for those of you who like the feel of the real deal – print out some of your favourite snaps and get them into a physical album or photo frames. Your friends and family might not find your photos as exciting as you found your holiday, but chances are they will enjoy seeing some of the shots, and it is healing for you to organise and share them. Taking this step also helps prepare you to take the next step in the holiday cycle: planning your next trip!
5. Take care of yourself
Hopefully your holiday afforded you the luxury of time to be physically active and the bandwidth to notice how you are eating. For many, though, holidays are a time of splurging on rich foods and drinks, lying around on beaches, and disrupting sleep routines through alcohol, travel, and burning the candle at both ends. The remedy? Not as hard as it seems. Think about it like this:
All the eating out of the holidays may have increased the yearning of you and your family for simple, wholesome, home-cooked meals; make the most of this to get back into a healthy food regimen
If you have been eating or overeating with little physical movement, your body may be screaming at you to do something: anything! Again, this is innate wisdom from your body telling you that it will be a pleasure to get back on track (pick activities you like in order to ease back into regular exercise); following this tip will also help re-establish healthy sleep habits
Keep enthusiasm high by finding/creating some fun things to look forward to (note Point 4); it keeps you more in the holiday mindset of “What fun thing shall we do today?” and avoids re-entering ruts you were in pre-holiday. So, when are they offering that dance class you always wanted to take?
The post-holiday blues “go with the territory” of holidaying, but through good planning and deliberately importing into regular life some of the things which make holidays magical you can stay pumped until the next “All aboard” call!
Written by Dr Meg CarbonattoB.S., M.A., and Ph.D.
This article was originally published in Asteron Life’s Balance Blog. AIPC regularly contributes to Balance’s wellbeing blog category.
Principles and techniques of Motivational Interviewing
If you have even a small track record of helping people change, you are familiar with the dynamics regarding change: client presents with problem (often precipitated by a crisis), becomes aware of compelling reasons to adopt a healthier lifestyle or cease harmful behaviours, and then hems and haws, straddling the fence with incomprehensible ambivalence.
Persuading the client with logic, browbeating them by outlining dire consequences if behaviour is not immediately changed, pulling rank as “the expert”, or even describing in glowing terms the wonderful life they can have if they adopt the good advice often come – frustratingly and bewilderingly – to nothing. Some of these strategies, in fact, have the opposite effect, building resistance and/or undermining the therapeutic relationship which could facilitate the change. Thus, commitment to a motivational interviewing approach must be accompanied by a clear sense of the operating principles, fleshed out with equally clear skills utilisation.
Helping Families Enhance Resilience: Encouraging effective parenting
As the pillars of a family of origin and the ones responsible for the creation of the rest of the family, parents are the prime “movers and shakers” of the family system and all of its dynamics. They know that they are tasked with the crucial function society gives to a family: that of educating and socialising its children. The effective performance of this function serves both the family and the wider society, as well-socialised young people grow into healthy, well-functioning adults who can make positive contributions to their world. As noted, one of the process factors of families that flourish is that they have a legitimate and clear source of authority: that is, a system with established rules and roles, with parents that are effective.
Unfortunately for the attainment of resilience, however, most people in the job of parent have not gone to school to learn how to do that job; rather, anything they have learned has been via serious “on the job” training. What this means is that, although most parents are deeply desirous of being effective, “good” parents, they will tend to parent – for better or for worse – in much the same way that they themselves were parented. Thus, parents may, in that moment of desperation, succumb to techniques that they despised their parents using on them when they were young.
Q&A with Toula Gordillo (Clinical Psychologist)
Q. My fifteen year old daughter Julie comes home from school cranky and irritable all the time. She is a high achiever and is in year 11 at school this year. We feel like we are ‘walking on eggshells’ with her, and cannot say anything to her in case she yells at us. Julie used to be a beautiful, happy girl but she seems withdrawn and angry all the time now. I don’t know what to do. Please help.
A. It is likely that being a high achiever means that Julie is in the habit of putting a great deal of pressure onto herself. This is fine, if she has effective ways of coping with the pressure. From your information though, it would appear that she may not have methods to cope, her methods may be inadequate or she may not be using methods she has already developed in the past.
If Julie is ‘lashing out’ at everyone it is possible that she does not know how to reduce the pressure or is unconsciously releasing her emotions on those with whom she is most familiar. This is usually parents, siblings, teachers or anyone who has regular contact with the young person. If her mood is having a significant impact on her daily life i.e., impacting on her relationships at school with her friends, her family etc., it is possible that significant stress has developed into an anxiety condition.
If she has not sought assistance for her difficulties, depending upon the level of severity, you might like to suggest that she speaks with a counsellor (minor impact on daily functioning) or psychologist (major impact on daily functioning/mental health concerns). Keep the mood light and the suggestion brief. You could say something like, “Do you think it might be good to get some more ways of coping with stress?” If you keep the idea of having counselling low-pressured and just as ‘having a chat’, and give her the choice so that she feels in control of her own life, she is more likely to engage with the process. It could be that she has self-imposed demands i.e., puts unnecessarily high demands upon herself, or that she has negative/pessimistic patterns of thinking. It could also be that she has too many demands and needs to reduce the pressure. All of these issues can be addressed during the course of counselling. Encourage people around her to participate in the process. The first step is to make an appointment!
Toula Gordillo is a Clinical Psychologist, AIPC private assessor/tutor and regular contributor for Institute Inbrief. Toula has an extensive work history as a Clinical Psychologist, Teacher, and Guidance Officer. For more information, visit www.toulagordillo.com.
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CBT in a nutshell
We can broadly define CBT as a combination of cognitive and behavioural therapeutic approaches used to help clients modify limiting, maladaptive thoughts and behaviours, ones that are often inconsistent with consensual reality (Beck, Rush, Shaw, & Emery, 1979). The basic premise of CBT is that troublesome emotions are difficult to change directly, so CBT targets emotions by changing the thoughts and behaviours that are contributing to the distressing emotions.
Generally considered a short-term therapy, CBT often consists of about 8 to 12 sessions in which client and therapist work collaboratively to identify problem thoughts and behaviours. The therapist then uses the troublesome thoughts and behaviours to furnish the client with tools and techniques to alter the way they think, feel, and behave in a given situation. The CBT-generated skill set enables the individual to be aware of thoughts and emotions; to identify how situations, thoughts, and behaviours influence emotions; and to improve feelings by changing dysfunctional thoughts and behaviours.
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- Family Therapy
- Case Management
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