CBT for Depression Treatment Series Week 5

Hey there everybody and welcome back to the Week by Week guide to depression treatment part five. I'm your host, Dr. Donnellice Snipes. Remember that in depth videos on each of the topics that we discuss in these videos can be found@docsnipes.com YouTube this set of presentations is really designed just to give you a framework example of what I might use if I'm working with somebody who is experiencing depression. In this session, like with others, I start with a review. I review the morning and evening mindfulness logs for themes and sleep trends. Now when I say pace or themes, what I mean is physical themes for their energy, for their sleep, their nutrition, their pain levels, etc. Affective trends and themes will what triggered anxiety, anger, depression? Cognitively, how were they feeling about the way they were able to think? Did they feel foggy headed or did they have some more clarity in the past week? Environmental themes? What things in the environment? What sensory stimuli were either helpful or unhelpful to them in the past week? So I'm getting more and more information about what promotes happiness and what contributes to depression for the person as we go through week by week. And this kind of granular information can be really helpful to everybody, can be really helpful to the patient because it provides more insight. A lot of times we're so focused on autopilot that we don't notice the little nuances, we don't notice the themes that might be contributing to our sense of hopelessness and helplessness or anxiety or irritability. I explore any meditation and distress tolerance skills that are working for the person to help them when they feel distress, to get into their wise mind. And in the past weeks they have been learning about different meditation and distress tolerance skills. So now we're really trying to identify which ones work for you. Which ones are we going to put into your toolbox and which ones are we going to put back on the shelf? I'm going to review their progress and trends in their baseline data for the top three symptoms. And I said last week, and I said the week before, it's important to keep this data so we can analyze it and see granular progress. We can see those baby steps forward and if there are any baby steps backwards, we can see those too. And we can really dive in and look at them more closely and say, okay, you were on a forward trend and last week you took some steps backwards. I'm wondering what was different last week? What, what changed? What do we need to do differently in order to help you get back on a Forward moving trajectory. This week, I review the nutrition log and success in making basic changes that the person identified last week. Remember, nutrition provides the building blocks for the hormones and neurotransmitters that help you feel everything. So identifying people's nutritional effectiveness, if you will, is really important. Now, I'm not a registered dietitian, so I'm not going to be making prescriptions about what they should and shouldn't be eating. But it's important if there are gaping holes that the person's aware of them and I can make a referral to a registered dietitian to should that be helpful. Review cognitive distortions and identify themes and schema and explore if restructuring is becoming more second nature. Over the past couple of weeks, people have been asked to identify their beliefs that trigger anxiety, anger, depression, and apply the Cognitive Distortions worksheet. They've also been asked to, when they start feeling angry, anxious or depressed, to identify what their belief is that's contributing to that feeling at that moment and apply the Cognitive Distortions worksheet to help them restructure those thoughts to be less extreme in nature or to alter any thinking errors that they may have. We discuss what events these triggers are related to and why they promote a sense of unsafeness or disempowerment. So we're looking at the cognitive distortions. We're looking at what triggered their anger and anxiety and trying to identify in the past, you know, what happened that is making you react in the present with anger or anxiety to this situation. Maybe it's triggering a fear of abandonment, maybe it's triggering a fear of rejection or prior traumas where they experienced loss. Whatever it is, you know, it's important to understand and help the person understand why they are having the emotional reaction to things in the present the way they are. We'll discuss progress on completing their autobiography and any challenges. Now remember, it's not due this week, it's next week, but the first week. A lot of times I find that the first week people really don't do it. Now, it's ideal if they do, if they get started on it, but a lot of times it feels overwhelming to get started with. So this is why we discuss it now to make sure that they have gotten started and if not, do some motivational enhancement and really break it down into more granular chunks so they can get it done. Because the autobiography is really, really crucial to helping us understand the way people's thought process has developed, how their experiences have influenced from the past, are influencing them in the present. And to help them identify grief and trauma issues that are continuing to negatively impact them. We'll discuss the effectiveness of adding positive journaling, which is what they started doing last week. How effective is it in your evening meditations that you're now also ending by focusing for 15, 20 minutes on only what went right that day? Now, prior to that, you were doing your mindfulness and focusing on what went wrong as well, but finishing up by focusing on the positive. How effective is that this week? The objective. So now we move on from review to adding a little bit more. And this I usually the objectives for this week usually end up in the last, you know, 25% of the session because reviewing is so important. My job, as I see it, is to help people take the knowledge that they have and take the information that they've gathered over the past week and process it and start forming it. You know, it's kind of like a puzzle. Each week they come in, they're giving me more pieces to that puzzle and we try to put that together and then we move on to learning a little bit more and future assignments. So the first three quarters of the session focused on review. The last quarter focused on the new objectives. If needed, learn about the impact of alcohol on inflammation, stress and sleep by reading or watching the video on the pharmacology of alcohol. Now, not everybody drinks, so that's not always needed. Learn about the different types of losses, the grief process and strategies for grief resolution by reading various books on grief or watching the video on complicated grief and grief and loss interventions that are on the YouTube channel. Additionally, the person is going to finish writing their autobiography and review it for losses, making a list of the losses that they have experienced. And these can be losses in any of the pacer areas, losses of physical abilities or health, loss of their ability to feel happiness, loss of dreams, the childhood or parents they believed that they should have had environmental losses like losses of things. If they experienced a fire and they lost their home, for example, their loss of safety, now that's not necessarily tangible, but their loss of a sense of safety in their skin or in the world, loss of jobs. You know, there's a lot of different losses that we can experience in the environment and relationship losses. And this obviously includes romantic relationships, family relationships, loss of pets, and loss of self esteem. We have a relationship with ourself and if somebody has experienced a loss of self esteem, that's going to be a loss to be grieved and to be worked on. But it's important to identify all of those losses because we're going to start working on them in the upcoming week. In this week again, there was a lot of review and there was a lot of focus on really understanding and completing that autobiography. The person is going to continue the mindfulness worksheets, baseline data collection, taking happiness breaks at lunch, monitoring thoughts for cognitive distortions or things that trigger their anxiety and anger, and completing the cognitive distortions worksheet, positive journaling if it was helpful, and working on their autobiography for at least 30 minutes per day. They will also watch the videos on the grief process and techniques to address grief and prepare them to start addressing their losses that are identified in their autobiography. So we've addressed sleep, we've addressed nutrition, we've addressed pain, we've started focusing on mindfulness and the autobiography and nature now, learning about new learning about what grief is and the grief process and skills to deal with grief. So we're still stacking that toolbox. And beginning next week we're really going to start addressing some of those losses and traumas that were identified in the autobiography.