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OSC1021 Cognitive Behavioural Therapy

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OSC1021 Cognitive Behavioural Therapy

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OSC1021 Cognitive Behavioural Therapy

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Course Code: OSC1021
University: Open Study College is not sponsored or endorsed by this college or university

Country: United Kingdom


1.Should the assignment be presented like an essayNo, this assignment is a report and should be organised in two sections: section A that deals with the Clinical Conceptualisation and a section B: Q & Q section, where you will be providing answers to the Q1, Q2 and Q3. 
2.Should the questions be re-stated in section B?No, you can entitle the section: Q&A section and then list your answers under Q1, Q2 and Q3.
3.Should I include the modified Five-Area Case Conceptualisation in text or in the Appendix?Both are fine although I think it is better, if your formatting allows you, to include it in text, so that you can discuss the diagram in the relevant section of the report. You will not be penalised if you include it in the Appendix instead. The CBT report assignment brief is given in word format so you can download it and copy and paste the diagram and complete it in word in your own report.
4.How many words shall I allow for the Q & A section?The questions should be answered in a succinct way. I am not entirely sure what exactly would be the word count for this section, but I would think c800 words would suffice. Remember that + or – 10% words still counts and that references are not included. Diagram word count need not be counted in. 


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.
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, 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 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 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).
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:

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 (Morrison2014). 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
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.

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).
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 Response Therapy is primarily used for diagnosing Obsessive Compulsive Disorder (Varvatsoulias, 2013).
As described by (Hofmann, Asmundson & Beck, 2013), the objective of CBT is manifold and not restricted within the boundaries of only making the patient ‘feel positive or better’. It makes the patient tread on the path of self-awareness and make decent use of their emotional intelligence. This leads the patients to analyse their current scenario, emphasizing on the specific inconveniences and distorted perceptions causing the core emotional distress. Eventually, when the patient adapts an understanding of the crudeness of their old belief system which had induced the painful experiences, the therapist helps them formulate techniques to gain self-control and segregate the healthy feelings from the unhealthy ones. With repeated reinforcement and encouragement on behalf of the therapist, the patient is able to control the negative emotions from further aggravation and identify the path towards forming constructive and progressive core beliefs. The entire process is of a continuous nature which an individual, who had been suffering in the past from any kind of mood disorder, needs to religiously follow in order to prevent the recurrence of past episodes.  
To conclude from the above discussion it can be stated that Cognitive Behavioural Therapy is an effective method to depreciate the effects of mood disorder like Depression. However, a successful CBT essentially depends on the productive co-operation between the therapist and patient and their urgency to work towards unravelling the core issues tormenting the patient. Along with this, the therapist must also identify the various other unrelated factors that contribute in provoking the patients and help them comprehend the same. CBT lays down the fundamental aspects of resolving depressive disorders and thus it can be established that John, the subject in the given case suffering from depression, needs to consult a therapist and undergo CBT to overcome his problems.
Barnard, P., & Teasdale, J. (2014). Affect, cognition and change: Re-modelling depressive thought. Psychology Press.
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.
Corrie, S., Townend, M., & Cockx, A. (2015). FOUR The Fundamentals of CBT Case Formulation. Assessment and Case Formulation in Cognitive Behavioural Therapy, 55.
Driessen, E., Van, H. L., Don, F. J., Peen, J., Kool, S., Westra, D., … & Dekker, J. J. (2014). The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. FOCUS, 12(3), 324-335.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.
Gold, P. W. (2015). The organization of the stress system and its dysregulation in depressive illness. Molecular psychiatry, 20(1), 32.
Hans, E., & Hiller, W. (2013). Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression: A meta-analysis of nonrandomized effectiveness studies. Journal of Consulting and Clinical Psychology, 81(1), 75.
Hofmann, S. G., Asmundson, G. J., & Beck, A. T. (2013). The science of cognitive therapy. Behavior therapy, 44(2), 199-212.
KUYKEN, W., & DUDLEY, R. (2013). Case formulation in cognitive behavioural therapy: a principle-driven approach. In Formulation in Psychology and Psychotherapy (pp. 38-64). Routledge.
Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., … & Ritter, V. (2013). Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. American Journal of Psychiatry, 170(7), 759-767.
Morrison, A. P. (Ed.). (2014). A casebook of cognitive therapy for psychosis. Routledge.
Redhead, S., Johnstone, L., & Nightingale, J. (2015). Clients’ experiences of formulation in cognitive behaviour therapy. Psychology and Psychotherapy: Theory, Research and Practice, 88(4), 453-467.
Stangier, U., Hilling, C., Heidenreich, T., Risch, A. K., Barocka, A., Schlösser, R., … & Weck, F. (2013). Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled trial. American Journal of Psychiatry, 170(6), 624-632.
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of internal medicine, 163(3), 191-204.
Varvatsoulias, G. (2013). Irene: A Case Study on Major Depression. Philotheos, 13, 297-318.
Wills, F. (2013). Beck’s cognitive therapy: distinctive features. Routledge.

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