PRESENTED BY:

ZUNAIRA ASHRAF
FATIMA PERVAIZ
MARIAM NIAZ
SOBIYA ALI
 CONTENTS
• DEFINITION
• DIAGNOSTIC CRITERIA
• DIFFERENTIAL DIAGNOSIS
• MANAGEMENT
 THERAPIES
• PSYCHO EDUCATION
• SUPPORTIVE THERAPY
• BEHAVIORAL THERAPY
• FAMILY THERAPY
• CBT
• REBT
 DSM-5 DIAGNOSTIC CRITERIA
The individual must be experiencing five or more
symptoms during the same 2-week period and at least one
of the symptoms should be either (1) depressed more or (2)
loss of interest or pleasure.
• Significant weight loss when not dieting or weight gain, or
• Depressed mood most of the day, nearly every day.
• Markedly diminished interest or pleasure in all, or almost
all, activities most of the day, nearly every day.
• Decrease or increase in appetite nearly every day.
 SHORT TERM GOALS
• Patient will bath and dress in street clothes daily.

• Patient will attend 2 group therapies daily.

• Patient will take medications as prescribed.

• Client will be able to describe at least five affective coping strategies for dealing with stressful
situations within 4 weeks.
• Client will learn to identify negative thoughts and how to replace them with more positive,
adaptive thoughts within 6 weeks.
 LONG TERM GOALS
• Patient will be able to maintain job.

• Patient will be able to describe at least five effective coping strategies for dealing with stressful
situations.

• Patient will be involved with aftercare therapy weekly.

• Patient will verbalize decreased levels of anxiety

• Client will develop the ability to recognize, accept and cope with the feelings of depression
within 12 weeks.
• Different type of depression require different treatment.

• Talking therapies for depression is effective way to treat depression.

• Psychological therapies can help you stay well by identifying and

changing unhelpful thoughts and behavior
“Psychoeducation is an
evidence-based
therapeutic intervention
for patients and their
loved ones that provides
information and
support to better
understand and cope
with illness”
 PSYCHOEDUCATION FOR
DEPRESSION:
 The purpose of psychoeducation is to inform them about what depression is, how
it is caused and how it is treated.
 Psychoeducation can come in many forms such as pamphlet or leaflet, feedback
from screening scores, a website, conversations with your doctor or sessions
with a therapists.
 Blue pages is an example of a website that provides psychoeducation for
depression.
 Psychoeducation can be given to friends and family of someone with a mental
illness.
o Psychoeducation promotes understanding
about depression and can help people with
depression feel more in control of their
health. It can reduce stigma about
depression and direct people to the
treatment options that are available.

o Learning about other treatments, such as

antidepressants and cognitive behavior
therapy, can help people feel more
comfortable in seeking out these treatments
Briefing the patient with their illness
Problem solving training
Communication training
Self assertiveness training
 Psycho education is more effective to
reducing depression symptoms.

 The effect of psychoeducation seems to be

small, and it is not clear if psychoeducation
can lead to long-term improvements in
mood.
 Group psychoeducation
 Individual psychology education
 Family psycho education
 Psychoeducation for friends and care takers
 It aims to improve symptoms and maintain,
restore or improve self-esteem and skills.

 An important element of the supportive

psychotherapy relationship is that it exists
solely to meet the needs of the patient.
 Boundaries are another important
consideration.

 It includes encouraging growth, autonomy and

self-sufficiency.
 Praise:
Abundant praise is a good
supportive technique.
Praise may reinforce
accomplishments or positive
changes in behavior.
• The best praise is reinforcement of the

patient's steps towards achieving his or

her stated goals.

• the praise must be accurate and sincere

 Reassurance is a familiar tactic in general
medicine.

 Like praise, reassurance must be honest.

 As with praise, the patient must believe that

the reassurance is based on an understanding
of his or her unique situation.
 Reassurances given before the patient has
detailed his or her concerns are likely to
carry little weight with the patient.

 The physician must limit reassurance to

areas in which she or he has expert
knowledge or dependable information.
 Normalizing is a form of reassurance.

 It allows the physician to reassure the

patient that their experiences,
thoughts, and feelings are not unusual
or pathological.

 Reassurance and normalizing must not

extend to pathological fears or
relationships.
 Encouragement has a major role in general medicine
and rehabilitation.

 Higher functioning patients may get encouragement to

achieve educational or professional goals.
 Changes in behavior often require small steps. Patients
may discount small steps, seeing each step is of no
great importance.

 A skillful and supportive physician will identify tasks

and activities that can be conceptualized as small
steps.

 Encouragement can be powerful because people want

to believe that their small efforts will lead to
something larger.

 Exhortation is a more insistent form of

encouragement.
 Advice is an important tactic for the physician to use in supportive
psychotherapy.

 Advice is most meaningful when the patient sees it as connected to his or her
goals and needs.

 Advice and teaching are most appropriate in areas where the physician is
professionally expert.
o help the self-esteem of a patient by expressing acceptance, approval,

interests, respect or admiration

o Acceptance is communicated by validating comments and the

avoidance of arguing or criticizing.

o These supportive verbal interactions may be different than most of the

patient's other relationships.

 Change may concern specific behaviors, such as a low level of physical
activity, cigarette smoking, skipping medications, or poor parenting.

 If the physician wants to give useful advice, he or she must be familiar

with some of the emotional problems that may be operating in the
background One way to do this is to ask about a patient's feelings
regarding the current problems in his or her behavior.
 Therapist should know about the important people in a patient's life.

 Higher functioning patients are likely to have important relationships and

to think about their interactions with their significant contacts.
 Lower functioning patients may have an

absence of meaningful relationships in their

lives.

 It may be useful to ask patients about all of the

contacts they have had in the last few days.

 Identification of high risk situations

 Strategies for dealing with high risk situations

 Coping with negative emotional states

 Coping with interpersonal conflict

 Coping with social pressure

 Identifying relapse

 Anticipatory planning for dealing with relapse

Behavioral Therapy
 WHAT IS BEHAVIORAL THERAPY?

• Behavioral therapy is an umbrella term for types of therapy that

treat mental health disorders. This form of therapy seeks to identify
and help change potentially self-destructive or unhealthy behaviors. It
functions on the idea that all behaviors are learned and that unhealthy
behaviors can be changed. The focus of treatment is often on current
problems and how to change them.
 Who can benefit from behavioral therapy?
• Behavioral therapy can benefit people with a wide
range of disorders.
• People most commonly seek behavioral therapy to
treat:
• Depression
• Anxiety
• Panic disorders
• Anger issues
 It can also help treat conditions and disorders such as:
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• ADHD
• Phobias, including social phobias
• Obsessive compulsive disorder (OCD)
• Self-harm
• Substance abuse
• This type of therapy can benefit adults and children.
 Types of behavioral therapy

There are a number of different types of behavioral

therapy:
• Cognitive behavioral therapy
• Cognitive behavioral play therapy
• System desensitization
• Aversion therapy
 Is behavioral therapy effective?
Behavioral therapy has successfully been used to treat a
large number of conditions. It’s considered to be
extremely effective.
• anxiety disorders
• general stress
• bulimia
• anger control problems
• somatoform disorders
• depression
• substance abuse
Cognitive behavioral Therapy

For the management of

depression
 What is CBT?
• According to the Beck Institute, CBT is “a
time-sensitive, structured, present-oriented
psychotherapy directed toward solving
current problems and teaching clients skills
to modify dysfunctional thinking and
behavior.”
 Cognitive triad
• From a cognitive perspective, depressive
disorders are characterized by
people's dysfunctional negative views of
themselves, their life experience (and the
world in general), and their future—the
cognitive triad.
瑨靨镨
鵨’s 聨靨饨鍨琀
魨瘀畨～饨流魨
靨 琀魨
瘀靨
虨爀鍨陨
魨
 Socratic questioning
• seeks to get the other person to answer their
own questions by making them think and
drawing out the answer from them.
 Cognitive Techniques
• help people identify, evaluate, and modify
their internal thoughts, particularly those
associated with emotive symptoms such as
sadness, frustration, excessive worry.
Teaching the mechanism of
depression
 Monitoring Mood
• Client is asked to monitor his/her general
mood each day so he might know how his
mood is effecting his behaviour.
Distinguishing Events, Thoughts, and Feelings
 Cognitive reconstruction
• In cognitive reconstruction therapist helps
the client to alter the way he views the self,
the world and the future.
• Beck talk about the cognitive distortions
that may lead to faulty thinking.
Categorizing the Distortion in
Thinking
A-B-C Technique
 Cost–Benefit Analysis of a
Thought
• Once the patient has identified a thought
that leads to disturbing feelings, the
question is, “Are he motivated to change his
thought?
• Through cost and benefit analysis therapist
helps the client to evaluate his thoughts and
find out the effect of that thought in his/her
life.
 Examining the Evidence

1. 2. 3. 4. 5. 6. 7.
Situation Mood A. Evidenc Evidence Alternativ Rat
T. e that that Does e or
e
Suppo Not Balanced
rts the Support thought Mo
HOT the HOT od
Thought Thought
Now
Who Describ E.g., Write Copy
Wha e alternativ feelin
What
t mood e g
in one am I thoughts. from
Whe
word. afraid Rate 2.
re
Intensit might how Rate
y (0- much
happe intensit
100%) you
n believe y
 瑨靨驨鍨瘀
魨 鍨鹨虨靨镨
～爀 驨流焀甀靨ë
魨

Depression: Behavioural Activation

• Monitoring daily activities
• Assessment of pleasure and mastery
• Graded task assignments
• Cognitive rehearsal and problem solving around
tasks
• Social skills (assertion, communication)
 瑨靨驨鍨瘀
魨～甀爀
鍨鹨獨镨
琀魨鍨琀
瘀 魨
～
流
n ExampleActivity Schedule
Time MON TUES WEDS THURS
6-7 AM Wake Up (60) Wake Up (60) Wake Up (60) Wake Up (60)

7-8 AM Walk, Lie in bed (80) Breakfast (40) Shower, dress (50)
breakfast (40)
8-9 AM Golf (40) Dress (80) Walk (30) Walk (40)
9-10 AM Golf (40) Breakfast (80) Phone call Shopping (30)
(Bob) (30-60)
2-3 PM Shopping Wash Walk (20) Play cards (20)
with Sylvie dishes
Assessing pleasure and mastery
 Pleasurable activities
• If there is a lack of experiences of mastery
or pleasure in your client’s day-to-day life,
therapist can schedule activities that will
make him or her feel better about
themselves.
List of Pleasure activities
 Graded Task Assignment
• There may be some tasks that are “bigger”–
can often be overwhelming for some clients.
• A graded task assignments (GTA) may be a
viable option to help make these
overwhelming tasks more manageable by
breaking them down into smaller tasks.
Problem solving skill
Assertiveness Training
Rational Emotive Behavior
Therapy

For the management of

depression
 What is Rational Emotive
Behavior Therapy?
It was created by Dr. Albert Ellis in 1955.
According to the REBT model, people
experience undesirable activating events,
about which they have rational beliefs
and irrational beliefs. These beliefs then lead
to emotional, behavioral, and cognitive
consequences.
 Techniques in REBT
REBT is a psychological theory and a
treatment consisting of a combination of three
different types of techniques (cognitive,
behavioral, and emotive)
Cognitive techniques:
These are specific strategies to change or
modify unhelpful or negative thoughts related
to a particular event.
 Techniques in REBT

• Behavioral techniques:
• Behavior techniques are basically learning
those techniques Which help to cope in
stressful situations like depression or loss.
• Emotive techniques:
• These techniques are basically designed to
help in changing negative thoughts by
emotional ways like Humour, poems and
songs.
 Managing Depression with
cognitive techniques
The power of our thoughts:
Although we may not always be aware of our
thoughts, they nevertheless can have a strong
effect on how we feel and behave in response
to a particular situation or event.
Re-learning our A-B-Cs:
A = Activating event or situation
B= Beliefs or thoughts
C = Consequence
 Managing depression with
cognitive techniques
• Example 1:
• Person 1: A (Activating Situation) = A
friend does not wish birthday
• B (Beliefs/Thoughts) = “I must have done
something to upset him/her. I am such a
• horrible person.”
• C (Consequence) = Anxious, upset,
depressed
 Managing depression with
cognitive techniques
• Person 2: A (Activating Situation) = A
friend does not wish on birthday.
• B (Beliefs/Thoughts) = he/she may be really
busy and haven’t get time to wish me. May
be she wish me when she got free
• C (Consequence) = neutral
 Managing depression with
cognitive techniques
• The alphabet approach (A-B-C-D-E-F):
• Learning to know and change one’s
thoughts takes practice. Like any new
skill one learn the more he/she practice it
the skill become more better so in order
to do practice to know or change one’s
thought we use self help form in REBT.
• Which is shown in next slide
• In cognitive reconstruction therapist helps
the client to alter the way he views the self,
the world and the future.
• Beck talk about the cognitive distortions
that may lead to faulty thinking.
 Managing depression with
cognitive techniques
• A’s (Activating Events):
In this box, client will write about an
upsetting event that happened to you today.
C’s –Consequences following the events:
In this box, client will write the consequences
of the event.
These can be unhealthy negative feelings,
unhelpful behaviors and negative physical
consequences of distress.
 Managing depression with
cognitive techniques
• B’s (Negative Beliefs):
• In reality, it is not the event itself that upsets
the client but it is his/her negative beliefs (B
s) about the event that upset him/her.
• If client’s beliefs fall into any of the
following categories then he/she has
IRRATIONALbeliefs: Demands,
Awfulizing, Frustration Intolerance, Self
downing, others downing, life downing.
 Managing depression with
cognitive techniques
• D’s (Dispute negative thoughts):
• After recognizing client’s negativ thoughts
the next step is to dispute or challenge them.
There are lots of different ways you can do
this like following are some disputing
techniques:
• Functional disputes
• Empirical disputes
• Logical disputes.
 Managing depression with
cognitive techniques
• E’s (Effective Beliefs):
• Once client successfully disputed negative
beliefs client is ready to replace them with
new more effective or more helpful beliefs.
• These helpful beliefs are like Preferences,
Anti-awfulizing, High frustration tolerance,
Anti self downing, Anti others downing and
Anti life downing.
 Managing depression with
cognitive techniques
• F’s (New More Functional Emotions and
Behaviors):
• By changing client’s negative beliefs into
more helpful ones he can now:
• Feel better emotionally
• Behave in a more helpful way
• Feel better physically
 Managing Depression with
Behavioral Techniques:
• below are some behavioral techniques
which can help in managIng any feelings of
distress, negative thinking, fatigue, or
• other symptoms.
• Activity Scheduling:
• Planning client’s daily and weekly
schedules in advance will help in manaing
client’s daily activities, decrease negative
thoughts and client feels less depressed.
 Managing depression with
behavioral techniques:
• Distraction Techniques:
• Distraction techniques help in taking client’
s mind off of his/her negative thoughts.
• Some distraction techniques are as follows:
• Imagining a pleasant scene
• Take a short walk
• Visualizing a “STOP”Sign
 Managing depression with
Emotive techniques:
• Emotive techniques will help clients to
challenge and change their negative
thoughts.Some of Emotive techniques for
manging depression are as follows:
• Humorous Methods
• Reverse role playing
• Shame Attacking exercises
• We can use Emotive techniques monitoring
form with our clients.
 Network Therapy

• In this includes family, friends, neighbours,

professional groups or persons, and anyone
in the community who has an investment in
the outcome of the current crisis.