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Watch this simulated role play of a therapy session with Dr Hannah Whitney, Director of CBT programmes within the Charlie Waller Institute.
So Kate, thank you for telling me about what’s been going on for you, and the effect depression’s been having. And I could really hear that depression’s been doing what it does best. And it sounds like it’s taken your world from involving a range of things, like a wide range of things, to now having quite a narrow focus in two ways. In terms of what you’re thinking, it tends to be more negative or more low, but also in terms of what you’re doing. So whereas before you were at work, now I could hear that’s shot. What other things has depression taken away from you?
Pretty much everything, I guess.
I used to be on a netball team. We use to train. And then we used to have a match on the weekend. Haven’t done that for months. Haven’t seen any other girls. OK. That’s something I didn’t know. So you used to train during the week, and play with the team at weekends. Yeah. We were just like in a league. OK. And was there a social side to that? Were they a good bunch? Yeah. No. Really, really nice group of people. We used to go out for a drink after. If it was a Saturday, we’d go out for a drink afterwards if there was a match. And you mentioned you haven’t done that for a few months.
I haven’t done that for– it feels like ages. And as you’re talking about that– and tell me if I get this wrong. But it looks like it’s something that you miss. I do miss it. But I feel like I know it’s been so long. I can’t get in touch with them now, because I’ve let them down, because I’ve not been going. OK. So it’s a really strong example there of what depression’s taken away from you. OK. And what we know with depression is that when we’re feeling low down or depressed, which of those words fits best for you? It’s really, really low. Feeling low. Though we find we do less. And what I mean by that is, that shutting.
I don’t mean we’re being lazy or idle. Because a lot of patients I see say, it’s because I can’t be bothered. I’m just being lazy. And as I’m saying that, it sounds like– or it looks like you might have had those thoughts. I just feel just pathetic. It’s just pathetic. I can’t do it anymore. And so there’s that real negativity that depression brings too. I can hear how you feel you should be doing more. And I can also hear the power of this feeling low meaning you’re doing less through no fault of your own. And what we call that in CBT is withdrawal. We withdraw from our world when we’re depressed. Does that term sort of fit for you? Yeah.
Completely. And then, what was withdrawing or shutting down from those previous activities do? What’s the impact of that? It just makes me feel like I’m useless.
So we’ve put the thought now, I’m useless. Completely useless. And what we see, again, I’m going to put in brackets how we’d call that in CBT, is a loss of sense of achievement and pleasure. Does that make sense that we lose the sense of buzz from our world? Yeah. And I completely, it’s just flat. I just feel flat. And so it sounds like you’ve noticed that loss of achievement and pleasure in seeing your friends on a Saturday for a drink has had a negative impact then on your mood again. Yeah. Yeah. How does this fit with your experience?
Yeah. I know it’s just completely how it is. I just feel stuck. You feel really stuck. And this cycle is really stuck. I can understand that. I don’t know what to do. And that leads us nicely onto when it’s a cycle the good news is, you can reverse these. I’m not saying it’s easy. But I am saying we know how. That’s the good news. So we’ll go onto thinking about what change we can do to impact and get the arrows going the other way. And that will help us to get it in a different direction to improve your mood. OK.

Psychoeducation is a very important part of BA (Behavioural Activation) and should happen before a patient is asked to make any behavioural changes.

It’s the role of the therapist to help the patient understand better how depression ‘works’ and the vicious cycles which help to maintain it (eg in particular how withdrawal and avoidance lead to reduced opportunity for pleasure and achievement and further reductions in mood). seeks to help patients to re-engage with life and re-introduce a variety of previously avoided activities, so it’s really important that people understand why they are being asked to make these changes and what impact this will hopefully have on their mood.

To illustrate what psychoeducation might look like in therapy, we have put together a simulated role play. In this extract, the therapist is played by by Dr Hannah Whitney, Director of Teaching and Learning within the Charlie Waller Institute at the University of Reading, and the patient (Kate) is played by Dr Michelle Lee, Educator for this course and Educational Outreach Lead at the Charlie Waller Institute. While you are watching the clip, focus on how the therapist explains the vicious cycle and anything else that she does which might be considered helpful in this situation.

What does the therapist ask? How does the therapist come across? How does she show empathy (an ability to put herself in the patient’s shoes)? What will you take from this clip? Share your thoughts in the comment section below.

In the next Step, we’ll look at this in closer detail.

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Understanding Anxiety, Depression and CBT

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