CBT for Depression Treatment Series Week 6

Hey there everybody and welcome back to the Week by Week guide to depression treatment. This is part six and I'm your host, Dr. Donnellice Snipes. Helpful hint in depth videos on each of the topics that we talk about can be found@docsnipes.com YouTube so as we go through talking about grief and trauma and loss and mindfulness and all that other stuff, if you want to learn more about those particular topics, you can find Those videos@docsnipes.com YouTube in session six I start out as usual by reviewing we review morning and evening mindfulness logs for themes related to how people are feeling physically, affectively, cognitively, themes in their environment and their relationships. You know, what's going on? Do things seem to be improving? Is their physical health improving? Have we had some setbacks somewhere? What themes am I seeing and how do they correlate with what's going on in terms of what the person is working on, are they sleeping better? And as they sleep better, how's that impacting the other areas? Explore any meditation and distress tolerance skills that are working for the person to help them get into to their wise mind. And I generally touch on this every week because I want to remind people to be practicing their meditation and distress tolerance skills and I want them to be able to quickly come up with those. When I ask them what distress tolerance skills are working for you, I want somebody to be able to rattle those off right away because that means when they're in distress, it'll be easier for them to access those tools. It'll be easier for them to recall the tools that are helpful if they are basically right on the tip of their tongue, so to speak. Review progress and trends in baseline data for the person's top three symptoms. I know we do this every week, but it's important because because we're looking for those incremental improvements in the issues or in the symptoms that brought the person into treatment to begin with. The top three symptoms of their depression are they improving or not? And if not, what's changed? If so, great. The person can see that what they're doing is working. Review the nutrition log and success in making basic changes that have been identified. I talk regularly about how sleep and nutrition are fundamental aspects to recovery from anything, whether it's depression or addiction or physical illness. They are so crucial. So this is something else that I touch on pretty much every week. Review the cognitive distortions Remember the cognitive distortions worksheet you started doing a couple weeks ago? We're going to go back through Those each week you're supposed to be identifying or using these worksheets when you start feeling anxious or angry or depressed to identify thinking errors that might be contributing to it and to addressing it. Ultimately, the hope is that restructuring becomes more second nature. So eventually you won't need to do the worksheets, and you're going to be able to kind of do it in your own head and identify. As soon as you have a thought that's unhelpful or a distortion, you're able to quickly identify that and reframe it without having to go through the rigmarole of the worksheet. Then we move on to discussing what events the person's triggers were related to and why they promote a sense of unsafeness or disempowerment. Anxiety, anger, and depression, remember, are triggered when we feel a threat, when we feel unsafe or disempowered. So we're going to look at when you started feeling anxious, something happened. When we go back to basic cognitive behavioral something happened that was the activating event. The consequence was that you got angry, anxious, depressed, started feeling an unpleasant feeling. We're going to look at those beliefs that contributed to you feeling unsafe or disempowered, and we're going to start trying to figure out what's that related to? Why is it every time you experience this particular situation, it triggers anger in you, and what is that related to from the past? Because clearly you learned that this situation can be threatening from something that happened in the past. So we're going to start trying to connect the dots. We'll review the grief process. Remember last week you were supposed to watch the videos on the grief process. This week, finally, week six, we move from learning tools and developing skills to deal with the stress into processing. The first five weeks, it was so important to start helping you feel empowered, start helping you feel like you had the tools to deal with distress before we start ripping off the band aid. So now we're going to start exploring the losses identified from your autobiography and what stage you're at in the grief process at this moment. Remember, the grief process isn't linear. You don't go denial, anger, bargaining, depression, acceptance, and done. It's just not that way. You know, you bounce back and forth between stages or phases of the grief process, which is why I say at this moment, you know, based on, you know, whatever you identify, how are you feeling about that at this moment? Are you depressed about it? Angry? Do you feel kind of at peace with it? Where are you at? So in week six, we're going to start processing the autobiography. We're going to read through the autobiography, highlight traumatic events and make notes of themes, whether they're related to loss, rejection, abandonment, whatever. And we're going to try to start grouping some of these traumatic events so we can see undercurrents, if you will, that are. That often are contributing to your anxiety, depression, or anger in the present. We'll apply the cognitive distortions worksheet to any cognitive distortions. So as we're going through the autobiography, I may notice, or you may notice themes such as, I'm not lovable no matter what I do, I was a bad child, my parent just didn't care about me, or people can't be trusted. So these are very common themes that may emerge out of autobiographies, but they are also all laden with cognitive distortions, thinking errors. I as a person am not lovable, am never lovable, no matter what I do. So that's a pretty hopeless, helpless, disempowered place. So we're going to look at distortions like overgeneralization and personalization to examine, you know, where did that thought come from? Why do you have. Why do you have this belief? Who taught you that? What taught you that? And let's examine it with fresh eyes. I was a bad child. And we've talked in other sessions about how it's important to separate behaviors from the person number one. So you may have been a child who made bad choices, but you were a lovable child. And then we want to start looking at why did you make those bad choices? Remember, behavior is communication. What were those choices? Communicating? Were they communicating, Hey, I feel anxious. I. I need somebody to prove to me that you're going to be there to help me feel safe. I need somebody to give me some structure so I don't feel out of control or I need. I'm acting this way because I need somebody to pay attention. You know, kids need guidance and structure and love and proactive attention from their caregivers. And if they don't get it, they will act out in order to get those needs met. My parents didn't care about me. We can look back and looking with fresh eyes. A lot of times it's not that the parent didn't care about the child. It's that the parent was so overwhelmed with their own crap that they couldn't even cope with or notice the child. It's not that they didn't care. They just couldn't get out of their own head. And then people can't be trusted. This is a pretty global statement. So we're going to look at, you know, what taught you that. And yes, some people are not trustworthy. This is true. So how can you differentiate trustworthy from non trustworthy? Basically? And we're going to apply that cognitive distortions worksheet to. To all of these. We're going to examine how you developed this particular belief, and then we will address it using facts, control and probability. As we're processing the autobiography, we're also going to identify triggers for current distress related to past experiences. There have been a lot of times that I've worked with clients for this first five weeks, and we've made a lot of progress working on addressing cognitive distortions and things. But sometimes some of the triggers for their distress seemed sort of elusive. You know, it's like they couldn't identify exactly what was causing them to feel anxious or angry in this particular situation, have an ongoing undercurrent of depression. And when we start going through the autobiography, some of those triggers that they didn't even connect before start becoming more apparent. And again, we start connecting the dots. We'll also begin processing grief and loss identified in the autobiography. Remember, at the last week you were supposed to make a list of losses that you identified from writing your autobiography, and this week we're going to start processing those. It's important to process at least one loss each week. Now you may be like, well, I've got a laundry list of losses that's like three pages. Okay, one at a time. And the goal of therapy, here's a hint here. The goal of therapy is not to make you dependent on the therapist to process these things. It's to help you develop the tools working with the therapist, practicing with the therapist, so then you can continue to do it on your own. A lot of times when we start processing grief and loss and those sorts of things, I will do it for three, maybe four or five weeks, depending on the intensity of the losses and, you know, the individual. But my goal is to help people develop the skills so they can continue processing the losses on their list one at a time as they have the energy on their own. They don't need to be in therapy for months or years. You know, the whole goal is to help people develop tools so they can live happier and healthier. So process at least one loss each week. Sometimes the loss, there's losses that are minor, if you will, and you can do one a day. And then some of the major losses may take. It may be really intense, and it Takes an entire week to, you know, really process it and digest it and recover from processing it. And it's important using your mindfulness to be aware of am I ready? Am I recharged enough to start addressing another loss? Or do I still need to do more with this one? You can group some losses together if they have similar themes, for example, lost friendships or deaths. Sometimes you need to process each one individually, but you can do similar ones, you know, back to back. So for example, my grandmother, my grandfather, my dad and my mom all died of cancer. Those were all pretty traumatic, devastating losses. And I learned a little bit from each one. They didn't happen all at the same time. So I might process the cancer deaths. Oh, and my uncle. Sorry, I forgot my uncle in there too. I might process all my cancer deaths in 1 week or 12 week span and then move on to other things. So questions to help you start processing your loss. What was the loss? What happened? We'll use the death of a parent. So that was the loss. What secondary losses did you have as a result of this loss? So you may not have only just lost a parent, but you lost a best friend, you may have lost a mentor. You may have maybe if you were young when this happened, you had to move because you couldn't stay in the same house after that parent died because the surviving parent couldn't afford to maintain that house. You know, there, there can be a lot of losses, secondary losses associated with any change, any primary loss. What are your thoughts and feelings about this loss? And remember a lot of times our easy, most easily identiful and identifiable feelings and thoughts. That's the tip of the iceberg. The majority of it is underneath the water. So really think. Very rarely do we have simple emotions like I'm just angry about this. I may be angry, depressed, guilty, grief stricken. You know, all of those things. So really explore how you feel about this particular situation and why. Use the cognitive processing worksheets to process these feelings and thoughts. You're going to go back through and look at the cognitive distortions associated with it. You're going to look at the facts, control and probability based on what you know. How does that change how you feel about it? How is this loss continuing to impact me today? Now, sometimes we can experience losses and they can be learning moments for us and it can continue to have a positive impact. For example, my parents and my family, when they passed away from cancer, it caused me to become more aware of the risk factors for cancer, learn more about it, and as a result of that I make healthier choices in order to protect myself from cancer henceforth. And finally, what do I need to do to integrate this into my storyline? And we've talked before, and especially in the videos on grief, about thinking about your life like a television series or a book. And whenever we experience a loss, it's kind of like the end of a chapter or the end of a season. The character in that season or in that in that chapter continues to influence the rest of the characters henceforth. But how does that work into the narrative? You will continue to work on your mindfulness worksheets, your baseline data collection, doing your happiness breaks at lunch, monitoring your thoughts for cognitive distortions and completing the worksheets, and positive journaling and processing. At least one loss this week.