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Introduction

Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving.  It is used to help treat a variety of diagnosis such as sleeping difficulties, relationship problems, substance abuse, anxiety,  and depression. Negative thinking patterns are considered an underlying reason for dysfunctional emotions and behavior causing problems in occupational performance. Occupational therapists who use CBT work with clients toward solving current problems and teaching them skills to modify dysfunctional thinking and behavior (Taylor, 2006).

Theory

Cognitive behavioral therapy (CBT) uses the following assumptions: Cognition affects behavior; cognition can be monitored and altered; and behavior change is mediated by cognitive change. CBT works by changing people’s attitudes and their behavior by focusing on the thoughts, beliefs, and attitudes that are held and how these processes relate to the way a person behaves, as a way of dealing with emotional problems. The goal of CBT is to replace client’s distorted thinking and unrealistic cognitive appraisals with more realistic and adaptive appraisals (Taylor, 2006).

Evidence

According to a randomized control study conducted by Clarke et al. (2016), cognitive behavioral therapy (CBT) can be an effective treatment for depression in youth who decline or fail to adhere to antidepressant treatments. Partly due to warnings dating back to 2004 about antidepressant-related suicidality, as many as 50% of youth with depression and their families declined antidepressants when offered and about half of those who tried them fail to maintain adherence. As a result, many youths with depression may go under treated or untreated all together. Researchers of this study worked with 212 adolescents with depression between 12 and 18 years old from 2006 to 2012 and found that CBT is a more achievable  treatment for adolescent depression as they were more willing to participate and adhere to this form of treatment. The study also found that the benefits from the CBT could endure for at least one year or longer and may be associated with reduced incidence of more intensive services like psychiatric hospitalization.

Case Study

Aaron is a 13 ­year ­old boy who lives with his parents and two younger siblings. He presents with serious emotional problems. He is often moody and sad without any reason. Sometimes he becomes irritable and withdraws from social situations. He lost his interest in school and was thinking about committing suicide. His mother reports that the teacher complains about her son because he also has behavio­ral problems in school. He is not able to control his strong emotions. He is often angry and frustrated. Aaron was referred to a psychologist and occupational therapist for further evaluation.

Intervention Plan

Problem Statement

Aaron’s current patterns of thinking lead to maladaptive behaviors resulting in isolation, loss of interest in school, and suicidal ideation.

Long Term Goals

1. Aaron will incorporate the use of adaptive behaviors 5/5 times while participating in a role play activity during a dyad therapy session to increase engagement in school by d/c.
2. Aaron will self monitoritor his mood and triggers 7/7 days in a video journal to improve mood, understand triggers, and reduce suicidal ideation by d/c.

Short Term Goals

1. Aaron will identify 3 negative thoughts and 2 challenging sentences for each thought  to disprove his distorted thinking patterns by next tx session.
2. Aaron will create 5 safety plan cards to systematically work through suicidal thoughts by next tx session.
3. Aaron will complete homework that involves creating a “distraction box” to fill with 5 items that provide comfort to help alleviate depressive moods and enhance adaptive strategies by next tx session.

Intervention Format

Individual; Dyad

Setting

Outpatient

Supplies

None.

Agenda

• Greet Aaron (2 mins)
• Review and discuss goals and symptoms (4 mins)
• Discussion and feedback on completed homework (10 mins)
• Set agenda for session (4 mins)
• Role play activity (20 mins)
• Summary statement (5 mins)
• Set new homework (5 mins)
• Client’s summary and feedback about session (5 mins)
• Session reflection and feedback (5 mins)

Documentation

S: Client reports feeling frustrated, moody and depressed for no reason. Client also reports losing interest in school and having thoughts of committing suicide.

O: Client participated in a 60-minute session focused on learning to identify and replace distorted thinking and unrealistic cognitive thoughts with more realistic and adaptive appraisals.

After being instructed on strategies on how to challenge negative thinking, client was able to replace 3 of the maladaptive thoughts with positive thoughts with min verbal cues. Additionally, client engaged in a role play activity designed to identify possible triggers and practice adaptive social skills. Client presented with low motivation and had difficulties with role play.

A: Client presented with ineffective use of strategies to challenge distorted thoughts indicating poor understanding of the link between thought and behaviour and the need for continuous practice in identifying maladaptive thinking patterns. Client’s lack of interest in role play indicate poor social skills, low motivation, and inadequate coping skills. Client continues to be at moderate risk for suicide and needs to continue to be closely monitored.

P: Client will continue to see OT 2x/week for 60 minutes. Client will continue to be monitored for progress in the use of the safety plan cards and distraction box at home for success in challenging maladaptive thinking resulting in isolation, loss of interest in school, and suicidal ideation.

References

Clarke, G., DeBar, L. L., Pearson, J. A., Dickerson, J. F., Lynch, F. L., Gullion, C. M., & Leo, M. C. (2016). Cognitive behavioral therapy in primary care for youth declining antidepressants: A randomized trial. Pediatrics, 137(5). doi:10.1542/peds.2015-1851

Taylor, R. (2006). Cognitive Behavioural Therapy for chronic illness and disability. Chicago, IL: Springer.