This book provides the foundations and training that social workers need to master cognitive behavior therapy (CBT). CBT is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that CBT and practice represents a strongly supported approach to social work education and practice. The book covers the most common disorders encountered when working with adults, children, families, and couples including: anxiety disorders, depression, personality disorder, sexual and physical abuse, substance misuse, grief and bereavement, and eating disorders. Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating CBT’s effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients.
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When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.
This chapter covers major depression and discusses the syndrome of depression as defined by criteria in the various versions of the Diagnostic and Statistical Manuals (DSMs) issued before the newly minted DSM-5. It considers the prevalence in time and across national boundaries. The chapter discusses the role of events and genetics in bringing on depression. It provides the link between depressive behaviors and systemic inflammation, and reviews the efficacy, and side effects for various treatments. There has been speculation that brain-derived neurotrophic factor (BDNF) might play a causal role in creating symptoms of depression. Repetitive transcranial magnetic stimulation (TMS), which involves external application of an electrode, is a Food and Drug Administration (FDA)-approved treatment for major depression. In the clinical literature, exercise has demonstrated efficacy in ameliorating major depression. Cognitive behavioral therapy is as effective as antidepressants, although it may be slower to achieve results.
Medical problems challenge older adults’ abilities to cope with illness, and at times they experience co-occurring psychological disorders. Therefore, social workers must provide services to assist older adults who are experiencing acute or chronic medical conditions. Older adults experiencing arthritic pain often experience a co-occurring depression. The major cancers experienced by older adults are breast cancer; chronic lymphocytic leukemia; lymphocytic lymphoma; colorectal cancer; lung cancer; mouth, head, and neck cancers; multiple myeloma; prostate cancer; skin cancers; and vulvae cancer. Those older adults suffering from diabetes have a greater chance of co-occurring vascular and cardiovascular conditions and a greater rate of institutionalization and subsequent mortality. Coordination with family members and caregivers about self-care issues, medicine compliance, safety issues, health socialization, and exercise is important because social workers often overlook psychoeducation with medically ill clients.
This chapter describes the need for a specific focus on counseling women and girls. It discusses the fundamental tenets of empowerment feminist therapy (EFT). Gender and gender differences are not inherently problematic; however, issues arise when they become markers for which individuals are esteemed or devalued. Violence against women is a serious public health issue in every country in the world. Violence against women and girls takes many forms, some of which are accepted cultural practices that have severe negative repercussions for females’ physical and psychological well-being. Child marriage and female genital mutilation are two of these cultural practices. Due in part to trauma, oppression, and gender-role expectations, women and adolescent girls experience the highest rates of anxiety, depression, and posttraumatic stress disorder (PTSD). Out of the feminist movement, and in response to the biases inherent in mental health treatment, feminist therapy came into existence.
Anxiety is often a normal reaction to stress, and there will always be situations that create stress and discomfort. In social work practice, recognition of the primary types of anxiety-related mental health disorders and the medications used to treat these disorders is an essential first step for comprehensive treatment. When medication alone is not enough, psychosocial interventions can assist the client in controlling anxious feelings. This chapter emphasizes the importance of being familiar with the medications and supplemental psychosocial interventions that can be effective in treating these disorders. Social work professionals often provide key services, including assessment and diagnostic and treatment services, to those who suffer from anxiety conditions. In terms of direct intervention efforts, many of the techniques described in the chapter can be used to help clients suffering from depression because the symptoms of anxiety and depression frequently overlap.
This chapter suggests that Irrational Beliefs (IB’s) play a major role in the creation of human disturbance, and that people make themselves disturbed mainly by escalating their goals, desires, and preferences into absolutistic musts and demands. Rational Emotive Behavior Therapy (REBT) hypothesizes that Irrational Beliefs rarely exist by themselves, but are preceded by or associated with rational ones. One can use modeling techniques with resistant clients by showing them that no matter how difficult they find it to reduce their disturbed feelings, as well as to reduce their anxiety and depression about these feelings. They can also read and learn about other very disturbed people who have used REBT, Cognitive Behavior Therapy (CBT), and other therapy methods to considerably help themselves. Encouraging clients to do an effective cost-benefit analysis of their various forms of resistance seems to be mainly a cognitive method of therapy.
The value of efficiency is quite important in practically all psychotherapy, but is often neglected. Feeling better has a great advantage, but it is limited in many respects. In Rational Emotive Behavior Therapy (REBT), an existential view of depth-centeredness in psychotherapy has various advantages over less depth-centered views. Pervasiveness in psychotherapy may be defined as a therapist helping his or her clients to deal with many of their problems, and in a sense their whole lives, rather than with a few presenting symptoms. Extensiveness in psychotherapy means that clients can be helped not only to minimize their disturbing negative feelings for example, anxietizing, depressing, and raging but also to maximize their potential for happy living that is, to be more productive, creative, and enjoying. Efficiency in therapy, particularly with resisting clients, therefore consists of convincing them thoroughly that they’d better go for a more elegant, rather than a less elegant, change.
This chapter presents a case study of a woman who finds a counselor for her 11-year-old son. The son’s family possessed many qualities characteristic of “growth-fostering relationships” defined in relational-cultural theory (RCT). The woman portrayed the son as a healthy young boy with few developmental problems or health concerns. The priorities for his counseling goals included: to assess the risk that he might harm himself and put in place interventions for safety; to determine what significant life events contributed to his anxiety and depression; to increase his feelings of connection to others; to reduce the occurrence of his nightmares; to support him in developing a stronger voice in order to ask for help when he needed it and to express his needs. Adlerian play therapy and mutual storytelling proved to be a good fit for him, and helped the author understand his view of self and his world.
Years of research have revealed that certain techniques reliably lead to improved quality and quantity of sleep and increased satisfaction with sleep. Together these techniques can be called “cognitive behavioral therapy for insomnia” (
CBT-I). In the mid-1990s two important reports were published on these techniques. These reports were based on meta-analyses. In a meta-analysis, the research data from many studies of a given treatment are carefully combined to provide the overall story on the treatment’s usefulness. In these particular meta-analyses, the authors reviewed studies that had compared CBT-Itechniques with no treatment or with a placebo treatment. Research shows that CBT-Iis useful even if one have some mild to moderate symptoms of anxiety or depression, or some long-lasting medical problem like chronic pain or cancer. This book shows how to deal with and overcome insomnia if one has insomnia that has lasted longer than 4 weeks.