Dealing with depression can be an overwhelming and isolating experience, but having a clear and comprehensive treatment plan can make a significant difference. In this blog post, we will explore a detailed approach to managing depression, covering various strategies and therapies that can aid in your journey to recovery. Whether you are seeking help for yourself or supporting a loved one, this guide aims to provide practical steps and valuable insights to foster hope and healing.
Writing Treatment Reports
Tables 2.15 and 2.16 are here to help with writing treatment reports for patients with depression. Table 2.15 has examples of symptoms; choose the ones that fit your patient. Be sure to mention how the patient’s symptoms affect their school, work, family, or social life. Table 2.16 has examples of goals and interventions; pick the ones that are right for your patient.
Table 2.15: Sample Symptoms for Major Depression
Affective Symptoms Depressed mood Irritable mood Anhedonia Low motivation | Cognitive Symptoms Feelings of worthlessness Excessive guilt Rumination Pessimism Hopelessness Impaired concentration Difficulty making decisions |
Vegetative Symptoms Lack of interest in usual activities Loss of appetite or increased appetite Weight loss or gain Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue Low energy | Other Symptoms Suicidal ideation (specify whether plan is present and whether there have been prior attempts) Thoughts of death Specify how long symptoms have been present Specify whether there have been prior depressive episodes |
* Table 2.15 from Treatment Plans and Interventions for Depression and Anxiety Disorders
Table 2.16: Sample Treatment Goals and Interventions for Depression
Treatment goals | Interventions |
Eliminating suicidal ideation | Cognitive restructuring, removing access to means, setting up a contract to contact therapist, developing coping strategies for suicidal impulses; developing short-term and long-term goals |
Reducing hopelessness | Examining reasons for hopelessness, examining evidence for and against it, behavioural experiments, activity scheduling |
Engaging in one rewarding activity/day | Reward planning, activity scheduling, graded task assignment |
Reducing negative automatic thoughts | Cognitive restructuring, distraction |
Sleeping 7-8 hours/night | Relaxation, insomnia treatment plan |
Reducing rumination | Antirumination interventions, metacognitive therapy techniques |
Engaging in one assertiveness behaviour/day | Assertion training |
Increasing social contacts (three/week) | Social skills training, reward planning, activity scheduling |
Increasing self-reward for positive behaviours (one/day) | Reward planning, self-reward |
Modifying maladaptive assumptions | Cognitive restructuring, behavioural experiments |
Modifying schema of worthlessness (or other schemas– specify) | Cognitive restructuring, developmental analysis, schema work, empty-chair technique, writing letters to origins of schemas, developing adaptive schemas |
Eliminating impairment (specify– demanding on impairments, this may be several goals) | Cognitive restructuring, problem-solving training, or other skills (specify) |
Eliminating most or all depressive symptoms (BDI-II < 10 for 1 month) | All of the above |
Acquiring relapse prevention skills | Reviewing and practicing techniques as necessary |
* Table 2.16 from Treatment Plans and Interventions for Depression and Anxiety Disorders
Case Example
Assessment | Anne was a 42-year-old divorced woman working in a sales position for a high-tech firm. She reported no history of alcohol or other substance abuse, and indicated that her depression was related to the stress of the separation and divorce, as well as to conflicts with her ex-husband over custody of their 6-year-old child and financial responsibilities. Her depression reflected self-criticism, discouragement about the future, loss of interest in activities, regrets about the past, and irritability, as well as rumination about the current situation and the events leading up to the divorce. Her score on the BDI-II was 32; her BAI score was 12; and she had a slightly elevated score on the MCMI-III for dependent personality. Since she was not currently in an intimate relationship, she did not complete the DAS. There was no current or past suicidal ideation. There was, however, a family history of depression (both her mother and her maternal grandmother had had major depressive episodes). Anne also described some conflicts with her mother over the divorce; she felt that her mother was not as supportive as she (Anne) would want her to be. She also reported some concerns about her ability to maintain the house while relying primarily on her own income, and about the effects on her son of the disputes with her ex-husband. Anne was not currently on any medication for depression, although she was taking eszopiclone (Lunesta) for sleep, as needed. She and the therapist examined the possibility of medication as part of her treatment, but she decided that she wanted to try therapy first without medication. The option of medication was kept open if therapy was not effective enough on its own. The therapist provided Anne with selected chapters from Leahy’s (2010) Beat the Blues before They Beat You. The therapist outlined for her the nature of her depression, including the symptom clusters mentioned above; her significant life events, losses, and role transitions (separation, divorce, financial pressure, living without her husband, conflicts with her mother, increased demands on parenting); and her family history of depression. Behavioral factors were also identified, such as decreased pleasurable activities, some social isolation, and parenting skills that needed to be improved. Furthermore, her rumination was identified as a factor contributing to her depression. The therapist explained to Anne the nature of cognitive-behavioral therapy; how thoughts, feelings, and facts differ; the importance of homework; and the emphasis on functioning in the here and now. A list of distorted automatic thoughts (Form 10.2 in Chapter 10) was given to her, identifying some of her typical patterns of thinking: labeling (“I am a failure”), personalizing (“He left me because I wasn’t interesting enough for him”), fortunetelling (“I will always be alone”), all-or-nothing thinking (“I can’t get anything right”), emotional reasoning (“I feel so lousy. My life is lousy”), and discounting her positives (“A lot of people have friends and good jobs. It’s no big deal”). Anne and her therapist agreed to the following goals: increasing pleasurable activities; increasing socializing with friends and dating opportunities; decreasing self-criticism, rumination, personalizing, and fortunetelling; reducing the stress in dealing with her ex-husband; improving her relationship with her son; and improving her sleep. Anne’s BDI-II score after the first three sessions was 24. She showed some improvement in hopefulness and less sadness, and she felt more decisive. |
Symptoms and comorbid conditions | |
Evaluation of suicidal risk | |
Medication evaluation | |
Bibliotherapy and socialization to treatment | |
Behavioural and skills evaluation | |
Introducing cognitive model | |
Identifying automatic thoughts | |
Establishing goals for therapy |
* Case example from Treatment Plans and Interventions for Depression and Anxiety Disorders
Conclusion
In conclusion, creating a detailed treatment plan for depression is essential for effective management and recovery. By understanding symptoms, setting clear goals, and using appropriate interventions, individuals can find a path to healing. Remember, seeking help and staying committed to the plan can significantly improve well-being and quality of life.
References:
Leahy, R. L., & Holland, S. J. (2000). Treatment plans and interventions for depression and anxiety disorders (pp.52-60). New York: The Guilford Press.
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