CBT and Emotional Regulation for Depression

This assignment analyzes the potential benefits of Cognitive Behavioral Therapy (CBT) combined with emotional regulation training for a client named Jim experiencing depression. It explores how these interventions can address Jim's symptoms and improve his long-term mental health outcomes, drawing on research highlighting the limitations of traditional face-to-face CBT in achieving sustained results. The analysis emphasizes the importance of integrating emotional regulation skills into CBT to enhance its effectiveness.

0Running head: GRIEF COUNSELLING
Grief counseling
Name of the student:
Name of the University:
Author’s note

1GRIEF COUNSELING
Summary of the case scenario:
Age: Jim is a 48 year old sales manager
Situation: Jim is married with three children and he has come to counseling session with the
problem of low mood, poor sleep and little interest in activities.
Presenting problems: The presenting problem for Jim is that he is experiencing low mood, sleep
disturbance and loss of interest in activities due to unfortunate events in his life. All the
symptoms are indication of depression in patients as these comes under the DSM IV criteria for
depression.
Treatment goals:
The main treatment goal for Jim is
 To address the symptom of low moods and loss of interest in activities
 To achieve psychosocial health and functioning for client
 To improve the health related quality of life
Chosen intervention:
Cognitive behavioral therapy (CBT) along with emotional regulation training and
psychoeducation is chosen as an intervention for Mr. Jim because Jim has been suffering from
low mood due to unfortunate events in life. Psychoeducation will help to identify the thought
leading to low moods in patients. This will ensure use of appropriate emotion regulation skills to
regulate mood alterations in patient. As dysfunctional thinking mainly affects the mood, sense of
self, physical appearance and behavior of people, CBT is effective in recognizing and addressing
negative thought patterns in client (Yoshimura et al., 2013).

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Treatment planning:
Problem/issues: The presenting issues for Jim is low mood, no interest in daily life activities and
difficulty in sleeping. This is a serious issue as continous period of depressive symptoms may
increase the severity of illness and the patient may also start developing suicidal thoughts which
might cause risk to their life. As the severity of the symptom will increase, the quality of life will
decrease (Kroenke et al., 2013). Research evidence has also showed that depressive symptoms
affect both emotional and physical functioning of affected people which influences all domains
of quality of life (Brenes, 2007). Jim has witnessed negative life incidence which is the main
perpetuating factor for his current symptom. For instance, he witnessed an accident in which he
lost his family members and he also experience complications during a surgery. Therefore, this is
indicative of post-traumatic disorder in client too as shocking incidents has altered his normal
behavior and attitude towards life. Hence, planning appropriate treatment plans for Jim is crucial
to reduce impairment in most quality of life and promote recovery in client.
Aims of the intervention:
The immediate need for Jim is to address his mood disorder and low interest in daily
activities. Hence, the main aim of any intervention chosen for client will be to address low mood
and depressive symptom. In addition, as shocking incidents in life has reduced his motivation
and interest in personal and careers goals, there is a need to change his negative thought pattern
and develop positive thinking and attitude towards life.
Method of implementation (Treatment plan):
Treatment plan start date: 20th October 2017

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Type of session: Couple
Frequency of session: Weekly
Treatment interventions: Cognitive behavioral therapy
Contacts with other agencies: Not required
Primary issues: Low mood, depressive symptoms and poor interest in activities
Secondary issues: Poor interaction with family members and low quality of life
Short terms goals: The short term goal for Jim is to ensure that the problem of low mood in
client is addressed and Jim develops the skills to cope with depressive symptoms. This will
depend on inquiring about factors leading to low moods and the coping strategies currently
employed by client to deal with it.
Long term goals: The long term goal of therapy or intervention is to help client develop meaning
in life and increase their motivation to develop concrete goals for life. Another focus of attention
was to improve Jim’s relation with his wife and children as currently he is unable to relate well
with his wife and children.
Literature review on most appropriate intervention
As the main presenting problem in patient is related to low mood and loss of pleasure in
activities, there is a need to find most appropriate intervention to address the problem in client.
One of the study gave the indication that pharmacological interventions can reduce depressive
symptoms in patients with chronic physical health problems. All types of antidepressants was
found be effective in depression in the context of chronic physical condition Taylor et al., (2011),

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however this intervention cannot be applied in the case scenario of Jim because his presenting
problem was not due to illness, instead it was due to unfortunate incidents in life such witnessing
an accident that lead to loss of his family members.
In many patients, shocking events in life result in poor mood regulation in patient,
Sijbrandij, Kunovski, & Cuijpers, P. (2016) proposed the effectiveness of internet-delivered
cognitive behavioral therapy for post traumatic stress disorder. Review of the effect of this
intervention is likely to be useful for Jim because his presenting problem of low mood was due
to unfortunate incidents in his life. The CBT intervention via internet mainly focus on psycho-
education related to anxiety management techniques. The main aim of the CBT protocol is
cognitive restructuring of maladaptive emotions in clients. Although face to face session during
CBT is effective for client, however the advantage of internet focused intervention is that people
living in remote areas can readily access these interventions. People who avoid treatment due to
fear of stigmatization can also take advantage of this mode of intervention. Other benefit of this
type of intervention is that it is more flexible and cost effective compared to face to face therapy
sessions. The only disadvantage is that patients may not keep continuous touch with such
intervention in the absence of physical presence of a therapist. Hence, in the context of Jim,
interaction with patients at face to face level is crucial to mitigate his health issues. To maximize
positive outcome in client, there is a need to analysed research literature that compares the
effectiveness of face to face CBT with internet delivered therapy to treat patients with
depression.
Research also points out to the use of CBT based psychoeducation intervention to treat
patients suffering from bereavement. This is most relevant for Jim’s case because of the incident
of losing one of his family members in an accident. The psychoeducation interventions mainly

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regarding teaching clients about aspects of bereavement and coping with themes. The myths
regarding cultural context of greif was also discussed and the dual process model for coping with
grief was explained. All information was also integrated with participant’s personal story to
ensure that client related to the information completely. The final outcome of the intervention
was that intensity of greif and depressive symptoms decreased in patients and passive coping
style was reduced (Wittouck et al., 2014). Hence, this form of CBT can act as supportive
intervention for clients like Jim suffering due to bereavement or loss of family members.
Another research is found useful to decide whether internet based or face to face CBT
intervention is most effective for Jim. Wagner, Horn, & Maercker, (2014) conducted a
randomized controlled trial to compare the effect of internet-based and face-to-face CBT therapy
for patients with depression. The internet based intervention group and the face to face
intervention group received CBT therapy for the same time frame and the primary outcome
variable measured in participants included depression score and the secondary variable included
suicidal ideation, hopelessness, low mood and anxiety in participants. The conclusion from the
study was that internet based therapy was found to be equally effective as face-to-face
intervention, however larger effect size was seen with the physical involvement of a therapist in
treatment. In addition, different in outcome was seen in two groups after 3 months follow up.
The results showed that in face-to-face group, the depressive symptoms worsened. The
explanation for this result was that as online intervention has less guidance, hence people are
most likely to have higher sense responsibility to implement the treatment. This explanation is
not totally justified in the context of Jim or other clients because all clients may not have the
same sense of responsibility to continue with the treatment.

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As one of the symptom is related to low mood in patient, the research by Driesse &
Hollon, (2010) proves that CBT is efficacious for acute treatment of depression compared to
other alternative of antidepressant medication. This is because it is one of the best known
empirically supported treatment for depression and most widely practiced. The intervention is
considered very muvh related to the presenting problem of Jim as CBT is based on the
assumption that inaccurate beliefs and maladaptive information processing plays a major role in
the etiology of depression. Hence, inaccurate beliefs coming in Jim’s mind might be a reason for
low mood and considering the theoretical assumptions underlying CBT, the intervention is
relevant for Jim. However, one important consideration before implementing the intervention is
that prognostic factors of patients and moderators in their must be examined as this likely to
influence the efficacy of the intervention.
As Driesse & Hollon, (2010) showed that certain predictors such as moderators and
prognostic variables for patient determines the effectiveness of CBT as a treatment option for
patients with depression, Berking et al., (2013) suggested important strategy to improve the
efficacy of intervention. The researcher used randomized controlled trial method to show that
emotion regulation skills training can enhance the effectiveness of inpatient CBT for major
depressive disorder. Incorporating routine CBT with emotion regulation skills training (ERT) is
likely to improve outcomes during the therapy and enhance the reduction of depressive
symptoms in patient. . Some of the examples of intervention for improving emotional regulation
in patients include emotion focused therapy, exposure based cognitive therapy and dialectical
behavior therapy (Holtforth et al., 2012). Berking et al., (2013) emphasized that deficits in
emotional regulation skills in clients affects the management of major depressive disorder and
combining CBT with emotional regulation training was found to enhance response rate and

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higher remission rate in patients compared to just use of CBT. Hence, this is a significant
research study as it has given the direction that CBT-ERT is an enriched version of CBT and it is
likely to improve well-being in patients and mitigate negative effects. In the context of Jim, this
intervention will most beneficial for achieving the long term goal of treatment.
Conclusion from literature review
The main conclusion from the literature review is that CBT-ERT is the most optimal
treatment of choice for Jim as it is likely to enhance achievement of both long and short term
goals for Jim. As Wagner, Horn, & Maercker, (2014) has presented the limitation of face-to-face
CBT intervention in improving long term outcome of clients after follow-up, use of emotional
regulation training is likely to address this limitation and improve long term health outcome for
Jim too.

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Reference
Berking, M., Ebert, D., Cuijpers, P., & Hofmann, S. G. (2013). Emotion regulation skills training
enhances the efficacy of inpatient cognitive behavioral therapy for major depressive
disorder: a randomized controlled trial. Psychotherapy and Psychosomatics, 82(4), 234-
245.
Brenes, G. A. (2007). Anxiety, depression, and quality of life in primary care patients. Primary
care companion to the Journal of clinical psychiatry, 9(6), 437.
Driessen, E., & Hollon, S. D. (2010). Cognitive behavioral therapy for mood disorders: efficacy,
moderators and mediators. Psychiatric Clinics of North America, 33(3), 537-555.
Holtforth, M. G., Hayes, A. M., Sutter, M., Wilm, K., Schmied, E., Laurenceau, J. P., & Caspar,
F. (2012). Fostering cognitive-emotional processing in the treatment of depression: A
preliminary investigation in exposure-based cognitive therapy. Psychotherapy and
psychosomatics, 81(4), 259-260.
Kroenke, K., Outcalt, S., Krebs, E., Bair, M. J., Wu, J., Chumbler, N., & Yu, Z. (2013).
Association between anxiety, health-related quality of life and functional impairment in
primary care patients with chronic pain. General hospital psychiatry, 35(4), 359-365.
Sijbrandij, M., Kunovski, I., & Cuijpers, P. (2016). Effectiveness of internet‐delivered cognitive
behavioral therapy for posttraumatic stress disorder: A systematic review and meta‐
analysis. Depression and anxiety, 33(9), 783-791.

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Taylor, D., Meader, N., Bird, V., Pilling, S., Creed, F., & Goldberg, D. (2011). Pharmacological
interventions for people with depression and chronic physical health problems:
systematic review and meta-analyses of safety and efficacy. The British Journal of
Psychiatry, 198(3), 179-188.
Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-
behavioral intervention for depression: a randomized controlled non-inferiority
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Wittouck, C., Van Autreve, S., Portzky, G., & van Heeringen, K. (2014). A CBT-based
psychoeducational intervention for suicide survivors. Crisis.
Yoshimura, S., Okamoto, Y., Onoda, K., Matsunaga, M., Okada, G., Kunisato, Y., ... &
Yamawaki, S. (2013). Cognitive behavioral therapy for depression changes medial
prefrontal and ventral anterior cingulate cortex activity associated with self-referential
processing. Social cognitive and affective neuroscience, 9(4), 487-493.