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Mapping the Journey: Effective Goal-Setting in Depression Treatment



In the journey of depression treatment, setting goals plays a crucial role in guiding individuals toward recovery and a more fulfilling life. By outlining clear objectives, patients can cultivate hope, regain control, and pave the way for lasting improvement. This blog explores the significance of goal-setting in depression therapy and offers practical insights into how it can empower individuals on their path to wellness.


 

Setting Goals


Setting goals is important for everyone, but it is especially helpful for people with depression, who are feeling very sad or hopeless. A doctor or therapist can help someone make goals for the next day, week, month, and year. This can help them feel more hopeful about the future.


First, the therapist looks at the problems the person wrote about on a form. Together, they can decide on goals to work on in therapy, like problem-solving, changes in self-esteem, and more. The person can also look at their scores on different self-report scales (e.g., the QIDS-SR16, BDI-II, and BAI) to see how they are doing over time.


Short-term goals might be simple, like meeting friends, doing more exercise, or finishing homework. Sometimes, a goal might just be to come to the next therapy session.


Long-term goals can be bigger, like taking a certain class, getting a new job, or losing weight. Therapy is not just about feeling less sad; it is also about creating a meaningful life that is worth living.


Big goals can include being a better friend, partner, or parent. They can also be about becoming kinder, braver, or more honest. The therapist and the person will check in on these goals often to see how things are going.


 

Enhancing Well-Being: Planning Rewards and Scheduling Activities


One of the first goals in therapy for a person who is feeling very sad is to help them do more rewarding and productive things. This is called behavioural activation, and it involves planning fun activities and scheduling them.


First, the therapist gives the person a Weekly Activity Schedule form to fill out. The person writes down what they do every hour of the day and notes how much fun they have and how accomplished they feel during each activity. This helps both the person and the therapist see how the person's time is being used and if their activities are boring, repetitive, not social, or not fun.


Next, the therapist talks to the person about activities that they used to enjoy but do not do anymore or new activities they think they might like to try. The therapist encourages the person to plan more of these enjoyable activities and fewer low-reward ones, like watching TV or staying in bed. The person then schedules these activities for each day and uses the Weekly Planning Schedule form to predict how much fun and accomplishment they expect from each one.


After doing the activities, the person uses the first form again to rate how much fun and accomplishment they actually felt. This helps the person see that they can control how much fun they have by choosing different activities.


The therapist also helps the person look at their thoughts about these activities. For example, the person might think, "This wasn't as good as it used to be" or "I can't stand doing this." These negative thoughts can be discussed in therapy.


Sometimes, people might resist planning fun activities because they think it is not spontaneous or true to their feelings. The therapist can explain that planning is like exercise: you do not always feel like doing it, but it helps you get better. They can also help the person see that positive activities might take time to feel enjoyable again, but are usually better than doing nothing.


 

Improving Thoughts (Cognitive Intervention)


In cognitive therapy, the first step is to teach the patient about different ways of thinking that can be unhelpful. The therapist helps the patient recognize and sort out these negative thoughts that pop up automatically. They also help the patient find the underlying wrong ideas and negative patterns they have. There are many methods used to challenge these thoughts, ideas, and patterns. For example, they might look at the good and bad sides of a thought, check the facts for and against it, or ask questions like "Why would it bother you if this was true?"


Depressed patients tend to be more affected by bad events and can get depressed again if they keep having these negative thoughts and beliefs. So, it is important to find and challenge all three types of these unhelpful thoughts. Once the patient understands these automatic negative thoughts and how to identify them, the therapist works with them to challenge these thoughts in therapy sessions using different techniques. For example, they might ask the patient to write down their negative thoughts each day and see how accurate they are. They might also help the patient write down what really happened and think of a more reasonable response to these thoughts. Wrong ideas and negative patterns can also be challenged in different ways. Since these happen deeper down in how someone thinks, the therapist usually needs to help the patient more with them.


 

Preparing for Future Depressive Episodes


Many people who get depressed are at risk of having more episodes later on, so it is important to plan ahead. The patient should be warned that another episode could happen. Some patients might need to keep taking medicine to prevent this after their first episode is over. The therapist and patient can talk about what led to past episodes to see if there is a pattern. For example, some patients get more depressed after losing someone important to them. This can make them feel helpless or worthless.


In the planning stage, the therapist gives the patient a handout that describes what depression looks like. Together, they figure out how to handle each set of symptoms. For example, if a patient starts feeling sad and stops doing things, they might agree to try being more active, call the therapist, and leave the house. Patients who have thought about hurting themselves in the past need special planning. They might think back to those times and practice what they could do differently now that they have had therapy.


 

Reducing Therapy Sessions Gradually


It is better to slowly reduce therapy sessions rather than to stop them suddenly. This can mean starting with meetings every two weeks, then once a month, and finally every three months. During this time, the patient is encouraged to come up with their own homework. Continuation of homework is a good sign that things are getting better. Patients are told they can call the therapist and come back if they start feeling depressed again. They might also keep track of how they are doing by using forms like the QIDS-SR16, BDI-II, or BAI.


 

Testing and Challenging a Maladaptive Assumption: “If Someone Doesn’t Like Me, Then I’m Worthless”

Technique

Questions to test and challenge the assumption

Cost-benefit

What are the costs and benefits of this assumption? What are the costs and benefits of caring less about whether people like you? What would you be able to do, think, feel, and communicate if you cared less about whether people like you?

Semantic technique

How would you define “liking”? What is 100%, 50%, 20%, and 0% liking? How would you define “worthless” and “worthwhile”? What is 100%, 50%, 20%, and 0% worthless or worthwhile? Can you point to the particular part of someone (or behaviour) that is totally worthless? Would anyone disagree with your definitions? What do you make of that?

Distinguishing behaviours from people

What are some worthwhile behaviours? Have you ever done a single thing that is worthwhile? Have you completely stopped engaging in worthwhile behaviours? Is there anyone that you know who does everything in a worthless way? If you do some things that are worthwhile, then how can you be worthless?

Examining evidence for and against the assumption

What is the evidence for and against the idea that you are worthless? What is the quality of the evidence? Would a good lawyer, defending you, think that this is good evidence?

Logical analysis

How does someone’s not liking you make you worthless? If that person then likes you, then are you worthwhile? If one person likes you and another doesn’t, are you worthless or worthwhile?

Double-standard technique

Do you know anyone who is liked by everyone? If not, then does that mean that everyone is worthless? Think of some people you admire and like. Does anyone dislike them? Would you consider them worthless? Why do you apply a different standard to yourself than you do to others?

Revision of assumption

 Can you think of a more practical, less negative assumption? (Possible examples: “If someone doesn’t like me, maybe we have different standards, styles, or tastes,” “If someone doesn’t like me, then maybe they don’t know me very well.”)

* Table 2.6 from Treatment Plans and Interventions for Depression and Anxiety Disorders


 

In summary, setting goals in depression treatment is about more than just deciding on targets. It is about taking back control and imagining a future where you feel stronger and more hopeful. By identifying and working towards these goals, you can improve your mental health and feel a sense of pride and optimism. Overall, setting goals is a valuable tool in managing depression and creating a better life for yourself.


 

References:

Leahy, R. L., & Holland, S. J. (2000). Treatment plans and interventions for depression and anxiety disorders (pp. 39-42). New York: The Guilford Press.

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