Cognitive Behavior Therapy
Potential Disorder Affecting John
From the case, it is likely that John is suffering from depression. According to Alexopoulos (2014), depression is a mental disorder that is characterized by low mood, low self-esteem, and lack of interest in normally enjoyed activities. It has been established that since John lost his job, he feels demoralized and hopeless. He has also lost his mood and interest in life. His level of self-esteem has gone down, and he is withdrawing from friends. Through his confession, John indicates that he is having difficulties in sleep due to painful thoughts, poor appetite, and lack of energy to carry out routine activities. Thus, he spends most of his time at home watching TV and sleeping during the day. As a psychologist, these are early signs and symptoms of depression, and, therefore, John requires specialized treatment to treat the disorder (Persons, 2012).
Predisposing, Precipitating, and Maintaining Factors of John’s Difficulties
Predisposing Factors. There are several risk factors that are likely to trigger difficulties that John is facing. First, John was traumatized at his early age when his father died in a car accident. The trauma he faced at that time may have a lasting effect on his mind, and it is likely to be triggered at any time. Second, John was brought about by his mother who struggled too much to help him finish his education. John had anticipated that he would help his mother to educate his siblings. His dreams were cut short when he lost his job and started to feel worthless in the eyes of his mother and the society. Additionally, John was a bright student at school and therefore he anticipated getting a job immediately after he lost his first job. However, for eight months he has not succeeded despite several applications. It is also likely that John has a high social standing among his friends since he got a job immediately after university. Thus, he fears that his ego will go down when friends realize he does not have a job.
Precipitating Factors. There are various factors that trigger John’s state of mental health. The current loss of job is the mainPrecipitating factors. John indicates that his loss of the job came as a shock since he did not anticipate it. The loss of the job triggered most of his past difficulties he had faced and this lead to his depression state.
Maintaining Factors. From the cognitive therapy, there are several factors that will continue to have an impact on John’s situation if not addressed at an early stage. First, he has lost hope in finding another job. It has been noted that job is no longer interested in applying for a job despite even seeing advertisements. Lack of interest in finding another job will lead to more severe difficulties in gaining self-esteem as well as improving his social welfare. It has also been noted that John is no longer interested in physical activities as he used to be. Apparently, he feels so week and spend most of his free time sleeping. He is also keeping away from friends who can help in understanding his situation. If the current situation is not addressed at this early state, it is likely to continue affecting him.
Five Aspects of Case Formulation
Case formulation involves ways of understanding patient’s problem in cognitive behavior therapy. In order to understand John’s problem, I would use five aspect of case formulation which include situation analysis, behavior analysis, physiological analysis, psychological/effects analysis and image analysis (Parker, Roy, & Eyers, 2014). Situation analysis will involve doing an assessment to determine John’s problem. It will involve asking questions that will lead to knowing what he is undergoing through. Physiological analysis will involve assessment of physical symptoms developed by John such as poor eating habit and lack of sleep. Behavioral analysis will involve assessment of John’s behavior in order to understand the disorder he is suffering from. According to the case, John has developed behavior such as keeping away from friends, spending most of the time on TV and lack of interest in physical activities. Psychological analysis involves an assessment of John’s psychological signs and symptoms in order to understand the likely psychological disorder of the patient. From the case, John is suffering from anxiety, low mood, feeling of hopelessness and lack of self-esteem. Finally, image analysis will involve assessment of how John feels about himself. From the assessment, John feels worthless and hopeless and thus, he does not like associating with friends.
CBT treatment for John’s difficulties
From the analysis of John’s difficulties, I would recommend two cognitive behavior therapies in treatment of John’s condition, which include Behavioral Experiment (BE) and Exposure and response prevention (ERP) (Parker, Roy, & Eyers, 2014). According to Alexopoulos (2014), Behavioral Experiment involves collecting information from the patient through observation and experimentation (Doron, et al.,2012). The main aim of the behavior experiment is to test the validity of the patients’ existing beliefs about themselves or others (Parker, Roy, & Eyers, 2014). It is also used to test new beliefs of the patients as well as contribute to the development of the cognitive formulation. Behavioral therapy is a process that involves several phases that include the preparation phase, designing the experiment, run experiment, and evaluation of the experiment. The preparation phase will involve planning the collaboration with John in order to identify his physical and psychological behaviors. At this phase, I will make John understand the rationale of the therapy and get clear on what cognition behavior will be tested. The preparation phase will also help in determining negative predictions that John is making. Designing phase will involve planning an assessment on John with an aim of proving his beliefs. It will also involve defining methods that will be applied in collecting information from John (Doron, Sar-El, Mikulincer, & Kyrios, 2012). At this phase, I will formulate questions that I will ask the John throughout the therapy process. The implementation will involve carrying out the experiment with John. At this phase, I will hold talks with John and asks him/her cognitive questions formulated in the first phase. At this phase, I will monitor John’s behavior and thoughts during the assessment in order to identify changes in behavior. Information from the patient is recorded down for future reference. The final stage will involve evaluation and review of the outcome. It will involve reviewing the information collected to help in the conceptualization of the case (Olatunji, Davis, Powers, & Smits, 2013).
The rationale for using behavioral experiment is that it is considered the most effective way of changing beliefs and attitude of the patient. Studies also show that use of behavioral experiments also increases the level of trust from the patient hence it is considered the best treatment of psychological disorders.
Exposure and response prevention (ERP) involves facing something that has been avoided because it provokes anxiety (Doron, et al.,2012). ERP is based on the idea that therapy is successive when the patient can confront their anxiety by accepting the reality and thus avoid safety behaviors. In treating John’s case with ERP, I will lead John to understand and accept that he lost his job but give him an assurance that the loss of his job is not the end of his life. Although this is likely to trigger his anxiety at the beginning of the therapy, later it will help him in reducing his negative response behavior such as withdrawal from friends and lack of physical exercises.
Behavioral experiment (BE) and Exposure and response prevention (ERP) have similarities and differences in the treatment of psychological disorders. One of the similarities if both therapies is that it focus on behavior and beliefs of the patients both method also aims at changing the response of the patient (Beck, 2011). Among the differences is that behavioral therapy can be used in a wide variety of disorders whereas, Exposure and response prevention can only be used for disorders provoked by anxiety. Although both methods are considered effective in treating mental illnesses there are situations where one is considered appropriate to the other. For example, in treating disorders brought about by anxiety ERP is considered effective than BE. In the other hand, BE is effective where fast treatment is required than ERP (Alexopoulos, 2014).
References
Alexopoulos, G. S. (2014). New concepts for prevention and treatment of late-life depression.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press.
Doron, G., Sar-El, D., Mikulincer, M., & Kyrios, M. (2012). When moral concerns become a psychological disorder: The case of obsessive–compulsive disorder.
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of psychiatric research, 47(1), 33-41.
Parker, G., Roy, K., & Eyers, K. (2014). Cognitive behavior therapy for depression? Choose horses for courses.
Persons, J. B. (2012). The case formulation approach to cognitive-behavior therapy. Guilford Press.