Cognitive and Behavioral Techniques in the Treatment of Depression

Cognitive and Behavioral Techniques in the Treatment of Depression

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck and Dr. Judith Beck discuss ways to implement cognitive and behavioral techniques in the treatment of depression. Dr. Aaron Beck provides several examples to illustrate the efficiency of particular techniques, including behavioral activation, hypothesis testing, utilizing thought records in cognitive restructuring, and activity scheduling, in patients with depression. Both Drs. Beck note that the selection of appropriate CBT techniques depends on the case formulation and the patient's level of severity.

For CBT resources, visit http://www.beckinstitute.org

I've heard that in CBT dismantling studies and I think this may have been the behavioral activation versus cognitive therapy studies. I'm not sure it is not the cognitive restructuring that has significant impact. What is your take on this? So got to go back to formulation. You you have to formulate the case and often times you're help by the theoretical formulation of uh that particular disorder. So, let's say it's a depressed case and he's severely depressed. You don't have him fill out a thought record, do you? If the person's severely depressed to use what I described in my 1980 book as a behavioral activation, you give the patient a schedule. You work with the patient collaboratively in preparing a schedule. And um and then you try to engage the patient in following you. So engagement is very important. You try to engage the patient in trying to follow through. Now if they're severely depressed, they're going to think that it's that's not going to do them any good. And you might even start the behavioral activation right in the office. There's one time I was asked to um see a patient over at the uh VA and he'd been in bed for months, maybe years, and they they just couldn't get him going. And uh he was really hopeless. That was the the whole thing. And if anybody tried to get him to do something uh he would just kind of give up on it. And so I I then asked him a question. I said, “What what do you think? What would you think if I told you that if you followed a few simple instructions that you'd be able to get out of bed and uh you'd be able to play pingpong with the other patients and so on?” And uh he said, “I'd think you're crazy.” And so I said, “Would you like to test that out?” And he said, “Test what out?” I said, “Whether I'm crazy or not.” Well, that really got to him. And that intrigued him. So then what I did with him is I said, “Why don't you sit at the edge of the bed and try to put your two feet down?” And he said, “Well, okay. I don't know what good it's going to do.” I said, “But you agreed that you're going to test out whether I'm crazy or not. So I said, “Okay.” And and then I said, “Will you try standing up?” And he said, “If I stand up, I'll fall.” And I said, “But that's okay. I'm going to hold you.” So then I held him. And then he took a few steps. And he took a few steps more. And then he got tired and he came back. And I said, “Well, what did the experiments show you?” And he said, “I don't know. What was it supposed to show?” I said, “Whether I was crazy or not.” says, “Well, maybe you're just a little psychotic, but not not totally crazy.” But anyhow, so this demonstrated, so I started really right in the session. This then demonstrated to the rest of the ward personnel what they could do with them. And it's true, a week later, I came back and he was indeed playing pingpong with the other. So anyhow, severe patients, you you want to use activity scheduling. moderate patients, you can use uh uh you can use the thought record uh with them uh and you can use a whole lot of other things with them. Now, let's just say they don't respond though to the thought wreckage. Well, there's there's a whole approach that you can use which is similar to what I've been talking about with the schizophrenic patients and that is to get them invested in something outside themselves. And this is particularly true of the depressed patients who are ruminators. If they're ruminators, all of their attention is faced in is b is directed inside. And so you can do simple refocusing techniques like something we call the look point name. have them look at something uh point to it and then name it which is a simple thing but a a far more profound uh approach is to get them invested in something other than themselves. Uh a few years ago I saw a doctor who was moderately depressed. Uh the reason for his depression was twofold. One is he hadn't gotten the promotion that he expected. And the second thing was that his wife had just uh decided to go to work and he wasn't getting as much support from her and he started to think maybe she didn't care for him so much. And so he's seeing the patients and he says, “This is just palrum. It's just a uh it's just a routine thing. I'm like on an assembly line.” And then I said, I want you to focus on each patient that you see and put down whether you're getting pleasure or sense of mastery from each patient. And he said, well, what's the sense of doing that? And I said, well, look, there are reasons why you wanted to become a doctor. And he said, what were the reasons for? He said, because I like to help people. So I said, okay. So then when you're seeing your patients, ask yourself each time whether you think you're helping the patient or not. So what I did is I got him reinvested in something that had at one time been significant to him but had been flooded over by his depression. So the way to break through this tidal wave as it were was to get him again uh invested in something outside of the tidal wave and that's what did it. So there are a whole whole lot of other methods that you can use but it's based on the formulation. So while the first thing that I did when I made my sea change to uh cognitive therapy was to think in terms of the thought records and uh looking for alternative explanations still a very powerful technique but it's by far not the only technique and there are whole whole variety of other things and with experience you'll get a sense as to what's most likely to work with a given patient and so with severely depressed patients it may or may have true of this study. I'm not sure if you are trying to do cognitive restructuring with a severely depressed patient, you're not doing good cognitive therapy, you need to be doing the behavioral activation, right? And behavioral activation is a form of cognitive restructuring because these people that patient I described to you believed that he wasn't able to go be able to be mobile again. And so by doing things they get a a real physical sense of being mobile, being able to be in control of their own body as it were. And this has a very powerful reversal effect.

#Cognitive #Behavioral #Techniques #Treatment #Depression

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