CBT Report: MSc Clinical Applications of Psychology - PS7011

This report presents a comprehensive analysis of John's case, a 26-year-old unemployed man experiencing depression, utilizing Cognitive Behavioral Therapy (CBT). The report delves into John's mental and physiological difficulties, exploring the impact of unemployment on his well-being and the resulting symptoms like insomnia, loss of interest, and social withdrawal. It examines the functional disorganization John experiences and identifies the aetiology of his psychological and physiological disturbances, referencing the DSM-IV-TR. The report applies the Five Aspect Case Formulation to understand his condition, detailing the situation, thoughts, behaviors, and physical sensations associated with his depression. It rationalizes the use of CBT, outlining its applicability to John's specific challenges. The report also includes a Q&A section, addressing Beck's cognitive model and behavioral therapy techniques like Exposure and Response Prevention (ERP). The analysis covers the application of CBT to break down John's issues and find a suitable solution to overcome his problem.

Running head: APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
Application of Cognitive Behavioural Therapy: A Report
Name of the Student
Name of the University
Author note

1APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
Executive Summary
The purpose of this report is to enquire into the mental and physiological difficulties faced by
John and to delve deeper into each of the aspects of his current situation in life. To obtain a
reasonable insight to his problems, Cognitive Behavioural Therapy or CBT is considered.
The steps of this therapy are discussed in details and related with John’s condition. The report
concludes with the idea that CBT can be used as an effective measure to reduce one’s
sufferance by means of analysing, comprehending, improving and regulating an individual’s
perspective of his or her life.

2APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
Table of Contents
Introduction................................................................................................................................3
Discussion..................................................................................................................................3
Section A................................................................................................................................3
Possible Functional Disorganisation Experienced by John...............................................3
Aetiology of John’s Psychological and Physiological Disturbances.................................4
Five Aspect Case Formulation (Greenberger & Padesky, 1995) Explaining John’s
Condition............................................................................................................................6
Situation/Trigger:.................................................................................................................6
Thoughts/images.................................................................................................................6
Behaviour..........................................................................................................................6
Long-term costs...............................................................................................................6
Short-term benefits..........................................................................................................6
Affect..................................................................................................................................6
Body/Physical Sensations..............................................................................................6
Rationalising CBT Treatment through Conceptualization of John’s Difficulties..............7
Section B: Q & A...................................................................................................................8
Conclusion................................................................................................................................10
References................................................................................................................................11

3APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT

4APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
Introduction
Human beings are equipped to analyse a situation emotionally and confer meaning to
all circumstances they are in. However, at times, when faced with situations that interfere
with their coping capabilities, humans are unable to assert how different events have different
effects in their lives. Such scenarios are instrumental in disorienting their mental functional
capabilities and thus they fall victims of certain mood disorders such as Depression. As
opined by (Varvatsoulias, 2013), Depression or Major Depressive Disorder consist of a range
of problems that causes to pose serious threat to an individual’s mental and physical well-
being. It affects their social skills, makes him or her redundant, unproductive and can even
have fatal consequences like suicide. However, it is a treatable disorder, preferable when
diagnosed early. Cognitive Behavioural Therapy or CBT is considered as the most accepted
resolution of this issue (Corrie, Townend & Cockx, 2015). The aim of this report is to discuss
how John, the subject of the given case study, succumbs to the negative alterations in his life
and in what ways can Cognitive Behavioural Therapy helps him regain his emotional stability
and reinstate his positive outlook towards life. In this course, the steps to formulate a
successful CBT is also elucidated.
Discussion
Section A
Possible Functional Disorganisation Experienced by John
There exist a significant correlation between unemployment and psychological stress.
Loss of job is associated with three disrupting aspects in an individual’s life: lack of security,
deficiency of a regular routine and social recoil. In the given case study, John exhibits
symptoms corresponding to these aspects. As stated in DSM-IV-TR, it is a complex
procedure to set the accurate boundaries of mental health and mental disorder, however,

5APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
supporting evidence from the case study itself indicate that John is suffering from Depression
(Redhead, Johnstone & Nightingale, 2015). The stigma of unemployment has substantially
affected his sense of self-worth. John has been continuously unsuccessful in his attempts of
securing a job for eight months. The fact has triggered hopelessness in him followed by a
sheer disinclination towards appearing for further interviews. His condition could be
identified as being ‘vocationally handicapped’. Such functional disorientation has led to
chronic psychological stress and anxiety within him. His defiance towards socialization is a
strong indicator of his diminishing self-esteem. As discussed by (Barnard & Teasdale, 2014).
Lack of adequate family support can also be attributed to his bouts of depression.
Unemployment often lowers the individual’s socio-economic status which can be positively
correlated with embarrassment to socialize which in turn is significantly related to
depression.
Depressive disorders are often manifested by abnormal physical symptoms such as
insomnia, lack of appetite and reduced sexual interest. Increased somatization renders
unfavourable assessment of self-health (Gold, 2015). It often comes off as a common illness
characterised by deterioration of mood and a strong aversion from day-to-day activities. It
interferes with the ability of the individual to think optimistically. As epidemiologic studies
suggest, in absence of proper treatment, depression can persist for months or even years. John
had been an efficient student throughout and had got his first job immediately after
completing his studies. He also happened to be the main bread winner of the family owing to
his father’s untimely death and was responsible for his mother and younger siblings. These
factor contributed to his surmounting anxiety, but, he was too demoralized to keep on trying
for a new job. His inner conflict between his duties and his fixated hopelessness to discharge
those duties had taken the depression to an advanced level. It had made him severely

6APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
reluctant to take proper care of his health that created major obstruction in his sleep cycle,
appetite and social skills.
Aetiology of John’s Psychological and Physiological Disturbances
In John’s case, unfavourable factors within his occupational area had triggered certain
predisposing factor, in his personality, leading to depression. These included proneness to
insomnia, anxiousness, habitual irritability and social isolation. As stated by (Berking et al.,
2013), other factors, of biochemical nature, such as deficient levels of neurotransmitters like
serotonin, norepinephrine and dopamine make an individual highly susceptible to depressive
illnesses. Depression might or might not have genetic predisposition.
One of the most important precipitating factors responsible for John’s proliferating
mental derangement is losing his job. Major life events such as this often cause to disrupt an
individual’s positive outlook towards life (Driessen et al., 2014). Further, his problem had
remained unresolved for a considerable amount of time which had eventually lowered his
self- esteem and attention towards personal care.
John’s depression had perpetuated as a result of is inattention towards his disorder. He
was unemployed for eight months and his inability to secure a job within this period had him
question his self-worth. This fact had extended his confounding judgment about other
possible alternatives in life (Hans & Hiller 2013). Also, his social recoil had cut sources of
any possible social support.
As opined by (Corrie, Townend & Cockx, 2015), protective measures against depression or
related mood disorders follow a basic path to resolution. The first and foremost is to accept
one’s shortcomings and look for an alternative that can guarantee an optimistic future. In
John’s case, he could seek family or peer support or consult a professional who can help him
reduce his dysfunctional cognitions. It takes relentless motivation to overcome depression

7APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
and though not easy, one has to develop congenial coping strategies and resilience to stress.
Through jogging and reasonable amount of physical exercise, John can divert his attention
from the redundant thoughts and channelize his positive energy towards enhancing his self-
belief and confidence (Ehde, Dillworth & Turner, 2014).

8APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
Five Aspect Case Formulation (Greenberger & Padesky, 1995) Explaining John’s
Condition
Situation/Trigger:
Loss of Job
Affect
Distress
Hopelessness
Suicidal speculations
Feeling of Dejection and
Melancholy
Thoughts/images
He cannot secure another job, in-
spite of trying for eight months and
therefore has no hope for a happy
and fulfilling life.
Behaviour
Avoiding social Interaction
Watching TV, absent mindedly for long
hours
Unwillingness towards any other kind of
physical mobility
Body/Physical Sensations
Disturbed sleep and Insomnia
Tired and drained
Lack of appetite
Prolonged hours of Fatigue
Short-term benefits
CBT applied on Depression
helps in overcoming the residual
symptoms.
Mental and Physical Relaxation
Long-term costs
Formulate constructive strategies to
efficiently deal when faced with
similar situation.
Emotional stability

9APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
Rationalising CBT Treatment through Conceptualization of John’s Difficulties
A rationale of the Cognitive Behavioural Therapy or CBT consists of four unique
aspects:
 It should be simple for the patients to comprehend and undergo
 It must strive to expatiate the source of the problem
 It should have a substantial amount of acceptability among the patients
 It should not pose any threat to their conscience
The CBT Model is applicable for most Mood Disorders. In Case of John, the Model
would be used to comprehend Depression (Ehde, Dillworth &Turner, 2014). The parameters
under each component of the model is explained as follows:
 Environmental Predisposition: Sudden loss of job
 Vulnerabilities: Prolonged Unemployment was leading to diminished self-esteem and
triggering suicidal tendencies
 Emotions: Thoroughly filled with Despair and Anguish
 Physical: Fatigue, Insomnia, Loss of Appetite
 Thought Process: Failure in life, Self-Loathing
 Behavioural Attributes: Refusal to interact with anyone
Two possible CBT treatments for John are:
1. Visiting a therapist who would be helping john to break down his inconveniences,
based on the above parameters, into exclusive parts and analyse each part separately
(Morrison 2014). John could opt for weekly or bi-weekly sessions. In the course of
the therapy John could gain an understanding of his dilemma and eventually with his
progress, find a suitable solution to overcome his problem

10APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
2. Take appropriate medication and physical therapy sessions including meditation
(Hofmann, Asmundson & Beck, 2013). This would help him regain his emotional
stability and help confront his problem with conviction.
Section B: Q & A
1.
Beck’s Cognitive Model consists of a Triad with three key elements circumscribing an
individual’s Belief System (Wills, 2013). These three elements correspond to the individual’s
cognition about Self, the immediate surrounding Environment and the inferences drawn for
Future (Leichsenring et al., 2013). John is suffering from Depression due to sudden loss of
his job. His cognition analogous with the three elements would be as follows:
 Self- his life is meaningless as he is unworthy of securing a second job for eight
whole months.
 Environment- his academic or past professional credentials have no value to other
companies
 Future- since there was no alteration in eight months, he would remain unemployed
for the rest of his life.
At the first level, the therapist attempts at intervening by collecting sufficient evidences
that indicate a clear pattern of the patient’s self-loathing attributes. At the second level, the
therapist engages the patient in productive discussion and helps him in understanding the
gaps in his repeated attempts to reach his goal. At the third level, the therapist extends his
discussion about the options and alternatives at the patient’s disposal which he can
contemplate. Any future scope at reviving one’s stature helps the individual let go off his
hopelessness (KUYKEN & DUDLEY, 2013).

11APPLICATION OF COGNITIVE BEHAVIOURAL THERAPY: A REPORT
2.
Behavioural Therapy or Experiments constitute of a set of activities pre-planned by the
therapist based on the initial observation of a patient. The therapist formulates the design for
the purpose of letting the patient gain a clear insight about their own problems and assess
their belief systems. Then, the therapist proceeds to test him or her. As observed by (Stangier
et al., 2013), it primarily accounts for a thought recording procedure by which the patient
tries to see the problem and the solution separately. The solution forms the alternate belief
system. The therapist, at this point, outlines an operational framework that the patient can use
to gain confidence on this positive belief.
The Exposure and Response Prevention (ERP) Method, the therapist first aims at bringing
out the hidden obsessions and compulsive tendencies of the patient by exposing him or her to
pre designed articles like pictures or objects, then guiding the patient to restrain from giving
in to the compulsions (Wills, 2013).
Both Behavioural Experimentation and ERP are similar in the aspect that they try to bring
out the repressed thoughts, notions and feeling of the patients and place those before them for
confrontation so that they can overcome the stigma associated with the negativities. However,
a primary aspect that distinguishes between the two methods is that, in behavioural
experimentation, the therapist encourages the patient to freely associate his or her thoughts to
their current situation and gain insightful resolution to deal with the issue (Trauer et al.,
2015). In ERP, the therapist presents the patient with an object or image that can trigger their
hidden obsessions or tendencies and then proceeds to help him or her control those
unwarranted obsessive compulsive signals. Behavioural Therapy, therefore, is primarily
utilised in case of treating Depression or Dysthymic Disorder, whereas, the Exposure and