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Introduction

Cognitive behavioral therapy (CBT) is a type of intervention that focuses on discovering and challenging negative or maladaptive beliefs (Brown & Stoffel, 2011). These maladaptive cognitions contribute to the development of emotional and behavioral problems (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). This intervention approach can be used to combat some of the negative emotions that refugees may experience, such as depression, in efforts to change those negative emotions into positive ones.

Case Study

Gloria, a refugee from Venezuela, has been living in the United States for the past 15 years after escaping a traumatic situation. Gloria currently lives with her youngest daughter and her two grandchildren. In the last year, Gloria has become increasingly depressed and declines to participate in events she previously enjoyed, like church. Yolanda believes that it is because as the kids have grown into their teenage years, they no longer rely on their grandmother to take care of them. After escaping Venezuela, the only thing that kept Gloria engaged in day to day life was knowing that her remaining grandchildren and child needed her to make it through. This is Gloria’s first session of occupational therapy.

Theory

Cognitive behavior therapy (CBT) is an intervention approach that focuses on uncovering distorted beliefs and faulty thinking patterns (Brown & Stoffel, 2011). These ineffective thinking patterns can lead to maladaptive behaviors that may interfere with occupational roles and activities (Brown & Stoffel, 2011). The goal of CBT is to collaborate with the client by practicing positive thinking patterns that will lead to an increase in effective behaviors (Brown & Stoffel, 2011).

Evidence

A meta-analysis conducted by Hofmann, Asnaani, Vonk, Sawyer, and Fang (2012) examined the efficacy of cognitive behavioral therapy (CBT) for various problems such as substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. The researchers performed an additional meta-analysis that also investigated several problems in children and the elderly population.There was strong evidence to support the use of CBT for anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress.

Intervention Plan

Problem Statement

Client’s cognitive distortions are impeding participation in leisure activities secondary to depression.

Short Term Goals

1. Client will identify repetitive negative thoughts she has and write down a positive thought in her journal to replace her negative thoughts with the help of the therapist by the second session to increase participation in leisure activities.
2. Client will identify two activities that help decrease her maladaptive thoughts by the second treatment session to increase participation in leisure activities.
3. Clients family will create a list of 10 reasons they appreciate Gloria to decrease maladaptive thoughts in 1 week to increase social participation.

Long Term Goals

1. Client will identify in her journal 5 beliefs about the origin of her cognitive dysfunction in 1 month to increase participation in leisure activities.
2. Client will challenge each maladaptive belief with two pros and cons and identify whether these thoughts are accurate in 1 month.

Intervention Format

Individual

Setting

Gloria will meet with the occupational therapist at her home for 30 minutes 2x/week for 2 months.

Supplies

Journal and pen/pencil

Agenda

• Meet Gloria and develop rapport to establish trust (2 mins)
• Converse with Gloria about her negative thoughts and emotions and have her write them down (10 mins)
• Have Gloria write down positive thoughts to replace her negative ones (6 min)
• Educate Gloria about the process of CBT and its effects (5 min)
  • Allow Gloria time to ask questions (2 min)
• Provide a summary of the discussion and explain take home activity (5 min)

Documentation

S: Client states that she feels she can no longer help her grandchildren just like she couldn’t help save her family from the cartel and that she feels like a coward.

O: Client participated in a 30 minute session that focused on identifying negative thoughts and replacing them with positive ones to promote leisure participation. Therapist assisted the client in identifying positive thoughts when the client struggled to come up with them on her own. After the therapist provided examples of positive thoughts, the client was able to come up with a few on her own. Therapist then discussed CBT with the client and what to expect in upcoming sessions.

A: Client’s need for assistance in identifying positive thoughts demonstrated her hesitance to restructure her faulty thinking patterns. After the client was prompted by the therapist and provided with examples in identifying positive thoughts, she showed no resistance which demonstrated her viability for being a CBT candidate. Gloria’s negative thoughts outweigh the positive ones indicating the need for continued therapy.

P: Client will continue with OT sessions for 30 mins, 2x/week for 8 weeks focusing on changing her maladaptive thinking patterns in order to increase participation in her preferred leisure activities. Client will be given a homework assignment involving identifying activities that will ease her feelings that is due next session.

References

Brown, C., Stoffel, V., & Munoz, J. P. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F.A. Davis

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. http://doi.org/10.1007/s10608-012-9476-1