CORNELL HD 3700 - CBT_Case_Study(1) (1) (12 pages)

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CBT_Case_Study(1) (1)



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CBT_Case_Study(1) (1)

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Pages:
12
School:
Cornell University
Course:
Hd 3700 - Adult Psychopathology
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FindArticles Perspectives in Psychiatric Care Oct Dec 1998 Article Print friendly Cognitive therapy for the suicidal patient A case study Reilly Christine E TOPIC The use of cognitive therapy to treat a suicidal patient PURPOSE To demonstrate through the use of a case study the cognitive therapy method in treating a suicidal patient SOURCE The author s own clinical work CONCLUSION Suicidal people often demonstrate perfectionism social sensitivity difficulty problem solving and hopelessness Cognitive therapy addresses these problems by helping patients plan activities track destructive thinking and its impact on feelings and behaviors and substitute constructive thinking thus decreasing hopelessness Key words Cognitive therapy depression suicide Suicide is responsible for more than 31 000 deaths a year making it the ninth leading cause of death in America Anderson Kochanek Murphy 1997 The single most predictive risk factor for a completed suicide is a psychiatric diagnosis As in the case of depression and panic disorder cognitive therapy research has made a significant contribution toward understanding the variables in suicide A task force of the National Institute of Mental Health Center for Studies of Suicide Prevention developed a tripartite classification system in 1973 to describe suicidal behavior suicide ideation suicide attempt and completed suicide Beck et al 1973 Within these three processes the variables of intent lethality and method can be assessed so the clinician can evaluate the degree to which a suicidal patient is at risk There has been much discussion in the literature about the relationship of suicidal intent to degree of lethality in the suicide attempt Beck Resnik Lettieri 1986 Riggs McGraw Keefover 1996 Weishar 1996 This research suggests greater suicidal intent leads to greater lethality of method chosen If the patient is knowledgeable about the method chosen to end life the degree of intent is considered to be high potentially placing the patient at higher risk for completion in a subsequent attempt Weishaar 1996 Common assessment tools used in clinical practice for assessing the suicidal patient include the Beck Depression Inventory BDI the Beck Hopelessness Scale BHS and the Scale for Suicide Ideation SSI The BDI is a 21 item self report questionnaire that measures depressive symptoms on a 4 point scale It targets two important itemshopelessness and suicidal ideation items 2 and 9 The higher the sum on the scale the greater the degree of depressive symptoms the patient is experiencing The BHS is a 20 item true false self report questionnaire assessing the level of pessimism and hopelessness of the respondent The SSI is a 19 item interview administered inventory that assesses the intensity of and specific attitudes plans and behaviors concerning suicidal behavior Many factors play a role in suicidal ideation and behavior Hopelessness frequently has been reported to be the most critical psychological variable predictive of suicidal ideation and behavior Degree of hopelessness along with a negative self concept a variable predictive of suicide independent of hopelessness compose two of the three components of Beck s negative cognitive triad found operating in depressed individuals Beck Steer Epstein Brown 1990 Cognitive distortions cognitive rigidity and dysfunctional assumptions also have been cited as leading to suicidal thinking Rainier et al 1987 found that perfectionistic attitudes toward the self and sensitivity to social criticism accounted for independent variance in suicide ideation In a sample of psychiatric outpatients four specific dysfunctional attitudes were positively associated with suicidal ideation feeling vulnerable to becoming depressed accepting other people s expectations feeling that it is important to impress others and being sensitive to the opinions of others Beck Steer Brown 1993 Hewitt Flett and Turnbull Donovan 1992 explored three types of perfectionism associated with suicidal threats and impulses expectation of self selforiented expectations of others other oriented and expectations that others hold for the person socially prescribed perfectionism Only socially prescribed perfectionism predicted variance in suicide ideation scores that was not otherwise accounted for by depression and hopelessness Perceived and actual difficulties in solving problems are other characteristics found among those who consider suicide Priester Clum 1993 Rudd Rajab Daham 1994 It is not clear whether problem solving ability beliefs about self efficacy regarding problemsolving ability or a combination of both are factors contributing to thoughts about suicide Bonner and Rich 1988 argue that hopelessness causes low problemsolving appraisal and poor problem solving attempts Suicide may seem to be a solution for the person who is struggling with problems and cannot tolerate the anxiety of problem solving The following case illustrates the concepts found in cognitive therapy research as significant factors in the suicidal patient While alleviating hopelessness in the suicidal patient is a primary intervention this case highlights the importance of targeting the dysfunctional attitudes and socially prescribed perfectionism to inoculate the patient against future suicidal episodes It illustrates the therapeutic strategies used to increase cognitive flexibility decrease sensitivity to perceived social expectations and increase tolerance of anxiety in problem solving and interpersonal conflicts Setting The Beck Institute for Cognitive Therapy and Research is a nonprofit outpatient mental health clinic in suburban Philadelphia The Institute is staffed by seven doctorally prepared licensed clinical psychologists trained in cognitive therapy Referrals come from a variety of sources including physicians former patients other psychologists and several managed care organizations Aaron T Beck MD founder of cognitive therapy is president of the Institute and his international reputation draws many people to the Institute particularly treatment resistant patients who have dropped out of other therapies Patient Jane not her real name a 28 year old Caucasian patient was referred to the Institute by her father a high profile businessman in Philadelphia At the time her father made contact with the Institute his daughter has just been admitted to a psychiatric facility in central Texas following her first suicide attempt She had checked herself into a hotel overdosed on


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