CBT Presentation

0:07 according to Beck Institute for cognitive behavioral therapy cognitive behavioral therapy also known as CBT was developed in the 1960s by dr. Aaron Beck CBT is a solution focused therapy it focuses on the relationships between a person's thoughts feelings and behaviors using the example here a person's thought is I hate work I can't get up this transfers to a physical response from the brain of feeling sluggish with no energy the feelings that come along with that is sadness and frustration the feelings and thoughts then transfer into the bigger picture which is the person's behavior in this case staying in bed all day and avoiding people the therapist and the client worked to get together to develop more constructive ways of taking those negative thoughts and creating positive thoughts which then in turn create positive feelings and behaviors

0:53 according to cognitive behavioral therapy basics and beyond by Judy Beck some of the main ideas and principles of CBT are the following it requires good client therapist relationship just like any other type of therapy emphasizes collaboration and active participation the client must be active and involved for CBT to be helpful its educated teachers the client to be his or her own therapist it uses the techniques to prevent relapse homework may be assigned for the client to practice the techniques learned on their own most importantly the therapist does not tell the client what their goals should be or what they should tolerate CBT therapist does not tell their clients what to do it's seaching them how to do it the National Alliance of mental illness defines mental illness as a condition

1:38 that impacts a person's thinking feeling or mood and may affect his or her ability to relate to others and function on a daily basis some examples of mental illnesses that we know are attention deficit disorder or ADHD anxiety disorders autism bipolar disorder depression and post-traumatic stress disorder it's important to know that people with the same diagnosis have different experiences as social workers we may see multiple clients with the same illness yet each case is different treatment will be individualized mental health condition is not the result of one event research states that it can be interlinking causes for example Jeannette environment and lifestyle can be factors into development of a mental health condition there are five mental

2:24 illnesses that are traced to a person's genetics they include depression bipolar ADHD schizophrenia and autism psychiatric conditions are of the most her edible of all disorders findings by researchers at the Duke Institute for Genome Sciences and policy have found that 30 minutes of question and answer about a family history of depression anxiety or substance abuse is enough to predict the patient's future or risk of the condition and the extent of severity this chart here is the statistics in America for adults forty three point eight million delts experience mental illness in a given year which is one in five adults in America one-half of all chronic mental illness such as bipolar begins at age fourteen the rest by age

3:10 24 here the broken down broken down by each disorder 2.4 million American adults live with schizophrenia 6.1 million American adults live with bipolar disorder 16 million American adults live with major depression and 42 million American adults live with anxiety disorders there are so many treatments out there for mental illness however not everyone receives treatment do you ever wonder how many well sixty percent of adults with mental illness did not receive treatment in the last year and fifty percent of youth aged 8 to 15 did not receive mental own mental health services in the last year in general adults are more talked about with mental illness rather than children however seeing how mental illness is

3:56 genetic we are seeing more children diagnosed with mental illness such as autism and it's important to look at those statistics also this chart looks at children and adolescents living with mental illness one in five children ages 13 to 18 have or will have a serious mental illness which is 20% of all children 11% live with mood disorder 10% have behavior or contact disorder and 8% have anxiety disorder mental illness and children have a significant impact on their lives the diagnosis treatment and severity all factored into the overall impact on the life if there isn't a treatment plan or if mental illness isn't caught there are severe implications in this case 90% of

4:42 those who died by suicide had an underlying mental illness in many cases children rely on their parents and schools to look out for signs of mental illness children with mental illness can have a hard time explaining or expressing their feelings if something isn't right in the state of New Jersey 8.7 million residents live with a serious mental illness and 93 thousand children live with a serious mental health condition with this amount of people just in our backyard living with mental illness it's hard not to think that the people walking by us on the street are suffering there are a number of resources for them in the state here in New Jersey the division of mental health and addiction services serve adults with mental with serious mental illness they serve six point five six thousand sixty five hundred people who

5:29 require intensive hospitalization and two hundred and seventy thousand people who are able to live independently and use resources in their community they operated for psychiatric state hospitals such as anchor s greystone park Trenton and Anne Klein forensic Center for Children the Department of Children families children's chairs serve the children and adolescents with emotional and behavioral health challenges as social workers these resources will be an important part of our treatment of our clients we will need to know the resources available whether it be within their community or a state facility good afternoon my name is Danielle Johnson you can call me Danielle I'm working towards obtaining my LCSW attending Kane University's graduate program in social

6:15 work I've been an intern at a BC behavioral center for four months now working with clients that have a diverse need for cognitive behavioral therapy do you prefer being called Lisa or mrs. Smith you can call me Lisa thank you for asking I know that it took a lot of courage to come in and seek help and I thank you for being on time can I get you a glass of water before we start today's session thank you I'd like a glass of water here you go let's start by getting to know you a little bit better tell me about where you were born and where you grew up I was born in Passaic New Jersey that's where I grew up until moving to Essex County when I was about 12 and my parents raised me until they got divorced and I have three sisters and

7:03 three brothers thank you for sharing your family history your family history will help me understand a little bit better so you were born in Passaic New Jersey and you moved to Essex County around 12 years old and you were raised by both biological parents and you have three brothers and three sisters is that right yeah okay tell me about school growing up and what schools like now if you're attending college school was it was fine when I was growing up I didn't have any issues in school and college now is torture okay so you're in college

7:48 now and you're getting through it and growing up school is fine with no issues did I miss anything important no okay can you tell me about things in your life that you consider important Wow things that are important family my family is important good health is important and having a great career that you I enjoy is important okay I see that health family and career are very important to you can you tell me about your current worries or difficulties what would you like to change or improve about your life that's tough I guess

8:35 I've been feeling down in the dumps for a good month now I can't Lisa I'm sorry to hear that you've been feeling down can you tell me more about your symptoms such as sleeping patterns eating habits and interaction with friends family coworkers and if your job has been interrupted by you feeling down well I haven't been able to get out of bed I'm overeating I don't feel like going out with anyone or even talking on the phone with anyone I've been late to work a lot and making excuses to leave early my boss is starting to get mad at me I just don't enjoy the things in life that I used to I see I do have to ask are you

9:22 thinking about hurting yourself or do you have plans to hurt yourself I want you to know that everything you say in our sessions will be kept confidential but I would have to make a report if you are at risk of hurting yourself well I'd sometimes I think about dying but I would never do it so no I don't have a plan okay your openness is really helpful and I want you to know that we can definitely work together to get a better control over your feelings so you can live a normal life again do you want to hear more about how CBT works for depression yes okay today's session has several goals let me know if these work for you one get to know each other better to discuss rules for the sessions

10:10 and three learn what depression is and four to learn how your thoughts affect the way you feel yes I'm desperate to try anything except medication so I think this would be good for me great let's start with some housekeeping I have three basic rules for our sessions one arrive on time to come every week three do personal projects do these seem reasonable yeah great so the purpose of this session is to introduce you to therapy in which you are going to participate the kinds of skills we provide are called cognitive behavioral therapy cognitive refers to our thoughts and behavioral refers to our actions

10:56 depression has most to do with our feelings by identifying thoughts and actions that affect our feelings we can learn to gain more control over them and improve our mood in order to feel better this treatment for depression consists of 12 sessions we focus on what is going on in life right now in the present the therapy is focused on how to control depression in practical ways that can be used now and in the future have you ever been to therapy before to treat depression or something else was it like CBT and if so was it effective yes I've been to therapy before it I don't think it was CVT I really

11:43 don't feel it was effective okay we will divide the sessions into three parts for the first four sessions we will discuss how your thoughts affect your mood the next four sessions will be about how your actions affect your mood the last four sessions will be about how your relationships affect your mood overall this type of treatment will teach you practical skills that you can use in your daily life do you have any questions so far I just don't know anything about my depression of what's causing it how can I fix it if I don't know what's starting it well let's explore what the word depression means together the word depression is used in many ways depression can mean a feeling that lasts

12:30 a few minutes a mood that lasts a few hours or a few days and clinical depression lasts for at least two weeks causes strong emotional suffering and makes it difficult to carry out our daily activities this treatment focuses on treating clinical depression as you stated before you're not interested in the things you once enjoyed you're sleeping too much overeating and work is becoming interrupted can you describe how you've been feeling lately I guess I have been feeling tired all of the time I feel worthless and guilty I feel Spacey I can't concentrate I see you haven't been overly sorry I see you've been overly tired and have

13:18 been feeling guilty and worthless what passes through your mind when you feel sad well I think about how I would be better off dead and that life sucks I think I'm I will never be able to be happy again and that I am meant to feel this way forever so your thoughts are that you'll never be happy again and that you might be better off dead is that right tell me what you do when you're depressed exactly when I'm depressed I don't do it anything I just can't get out of bed and I'm constantly thinking rapid thoughts that don't make much sense and I were to take out for my meals I don't even cook anymore like I used to so you like to cook and be active but

14:06 have been having a tough time doing so describe your relationships with people now that you're depressed well my relationships are pretty distant distant I guess my husband doesn't know how to help me he's supported the best he can be but I can tell that he's starting to get irritated with my laziness he doesn't understand that I'm depressed I've stopped going out with my work friends because I just no longer have the energy to talk and have fun my children are grown so they're not aware of how I'm doing and haven't reached out to them lately see how they're doing right it sounds like you have distanced yourself from your loved ones and have become quite isolated I want to close

14:53 our discussion by reviewing how we understand depression having certain types of thoughts can make you feel more or less depressed and by thoughts we mean things that we tell ourselves thoughts can have an effect on your body thoughts can have an effect on your actions thoughts can have an effect on your mood what does this mean to you it means that thoughts have an effect on my body what I do and how I feel okay I want to give you an example of how a thought can have an effect on your body actions and mood okay so picture yourself walking down the street and you see someone quickly walking behind you he looks serious he's looking at you and you think he's going to rob you immediately your body your actions in

15:41 your mood react to this thought you start sweating your heart races you start to walk faster you feel nervous and afraid the person reaches you and quickly walks past you getting farther away you think that he is just in a hurry so a good way to think about this therapy is that you will learn specific ways to change your thoughts and your actions so that you can feel better the purpose of this therapy is to treat depression by teaching you different ways to better control how you feel what do you think about these four goals one to lessen or eliminate feelings of depression two to shorten the time you feel depressed three to learn ways to prevent or avoid getting depressed again and four to feel

16:28 more in control of your life you know I feel hopeful now that I was able to talk to you and learn more about my depression and that it is treatable but in the beginning of the session you talked about me having to complete personal project what types of projects do you mean great and I'm glad you asked about the homework assignments let's talk about the homework assignment that you will complete this week before our next session this thermometer here lets us evaluate the intensity of depressive symptoms or mood at the end of each day this exercise is called the mood thermometer and you're going to complete it every week we want to see how you feel each day and your mood changes

17:13 throughout therapy to complete it at the end of each day mark how you felt or how your mood was in general for that day for example if it was the worst then you should circle number one if it was regular than you would circle number five and if it was the best then you would circle number ten let's do one to practice using your mood yesterday so bring it complete it to next week's session so we can discuss it do you have any questions or comments about what we have discussed today okay just so you're aware next week we will talk more about thoughts that affect your mood positive and negative thoughts and how depressed

17:59 people think my part of the group presentation is to cover the value and ethical dilemmas that might occur in the mental health field values ulemas in mental health are occur when the social workers values and beliefs are different from the clients an example is when the client wants to have an abortion the social worker has strong religious beliefs against it and those may not be in the best interest of the client another example of the value dilemma is becoming overly emotionally involved in a client case which is failure to establish professional

18:45 boundaries with clients and when the social workers personal values conflict with the values of the Social Work profession the ethical dilemmas in mental health most are centered around confidentiality and privacy involving disclosure of confidential information to a third party paternalism which is a belief that is justifiable to withhold information to clients for their own good or you lie to a client for their own good which is when you deliberately give false information to in response to the clients questions because you feel that it's in their own good that they don't know it's a known entrance or physical interference with clients against their

19:31 wishes for their own good an example of that is forcing clients to receive medical treatment or reside in shelters or against their wishes in regard to confidentiality and privacy disclosing information to parents of a minor is also a common ethical dilemma the social worker needs to know the local and federal laws divided loyalties is another ethical dilemma in mental health that's when there is a conflict between their clients interest the interest of the agency in terms of their clients needs the client the

20:16 agency may have budgetary constraints and the therapist may feel that the the client really needs whatever services they're offering involuntary commitment is another ethical dilemma in mental health that's when a client discloses an intent to harm himself himself or others now you have a duty to warn and that destroys the before the rapport between the therapist and the client Commission of illegal acts is another ethical dilemma the code is that good clients sometimes do bad things so an example of that would be a client who abuses drugs

21:05 or is incarcerated and the social worker has knowledge of that activity value in ethical dilemmas with CBT the ethical dilemma that arises with CBT is that when the therapist is focused more on the practical and technical interventions of therapy and not on a therapist that reputed in relationship another issue that arises with CBT is it's a very popular form of therapeutic intervention and people there are therapists who may believe that they have mastered it and they haven't and

21:54 there's also the failure to acknowledge cultural differences in beliefs and behaviors so that leads to a lack of inclusion of cultural diversity as well with CBT diversity issues in mental health the most significant diversity issue is failure on the part of the therapists to be able to recognize the cultural significance and importance of the client's behaviors and belief systems and diversity issues at cb2 a recurring

22:40 issue in the practice of CBT is the social workers inability to practice with multicultural competence multicultural competence competence and cultural diversity are recurring themes throughout mental health it's very important to take those factors into consideration ok we looked at CBT and cultural diversity issues by looking at a study that examines CBT use among and a substance use among minorities and the treatment efficacy so the issues that arose as a result of the studies were that they basically failed to include ethno racial minorities so therefore you

23:28 cannot measure the efficacy of CBT and substance abuse clients who were not of the dominant culture so socio cultural barriers that was another major issue diversity issue with CBT which is the inability to receive treatment from therapists who share the client's ethnic background and language and they found the studies found that that may have contributed to early treatment dropout among ethnic racial minorities