CBT Depression Case Study: How Treatment Changed a Life
Patient Information:
- Age: 32
- Gender: Female
- Background: Single, high school teacher living in a large urban city.
History or Cause:
Nandini, a 32-year-old high school teacher, was always a diligent and dynamic person. However, work stress and personal issues started affecting her emotional well-being. Important changes in Nandini's life happened over the past year: the collapse of a long-term relationship and increased demands at work. The resultant feelings of isolation and helplessness were there. Nandini dismissed her emotional issues at first, but as the months went by, the symptoms intensified. She constantly felt fatigued, overwhelmed, and disconnected from the world around her.
Along with these emotional changes, Nandini started experiencing very severe disruptions in her sleep, often spending hours awake before falling into a restful sleep cycle. She also experienced a very significant loss of appetite and no longer enjoyed doing things she used to love, like reading and gardening. Eventually, Nandini realised these feelings weren't temporary, and they weren't going away by themselves.
Diagnosis:
After several months of suffering from symptoms, Nandini approached her primary care physician for help. She was referred to a psychologist, who diagnosed her with Major Depressive Disorder (MDD), a clinical disorder that is defined by continuous sadness, hopelessness, and a lack of interest in daily activities. Nandini was evaluated using a range of standardised measures, including the Beck Depression Inventory (BDI), which enabled her therapist to assess the severity of her symptoms.
The diagnosis process put Nandini's depression at a moderate to severe level, where it was greatly affecting her daily functioning. Nandini's therapist explained that her depression was likely a result of interaction among different life stressors, inadequate coping methods, and deep-seated negative thinking patterns. These negative thought patterns had become so entrenched for Nandini that they contributed to her failure to deal with emotional stress healthily.
Treatment:
Once she had been diagnosed, Nandini and her therapist agreed to pursue Cognitive Behavioural Therapy (CBT) as the chief therapeutic approach for her depression. CBT is an evidence-based, structured therapy implemented over the short term. It helps people to identify and change distortions concerning their thoughts and behaviours implicated in mental health problems. For Nandini, CBT would entail challenging harshly judgmental and distorted beliefs she had cultivated for some time, as well as assisting her in building adaptive skills to cope better when stressful situations occurred.
Program:
Nandini received her 12-week-long CBT program consisting of 50-minute weekly sessions; however, her therapist had assured her that extra sessions could be scheduled if they were needed. Throughout these sessions, the focus remained chiefly on:
- Cognitive Restructuring: Nandini, working along with her therapist, was trying to identify her negative patterns of thinking, such as catastrophising, black-and-white thinking, and overgeneralisation. For example, once Nandini thought, "I won't ever be good enough for work," the therapist got Nandini to construct evidence against the statement to paraphrase it into something more balanced.
- Behavioural Activation: The therapist instructed Nandini to perform activities she enjoyed, even though she had no desire to do anything. At first, this was something as basic as walking around the block or chatting with a friend. Gradually, these little things helped Nandini regain the importance of connecting with the world.
- Mindfulness Techniques: Nandini also learnt mindfulness techniques such as deep breathing and meditation to help her stay focused in the present moment and relieve the anxiety that most often came hand in hand with depressive thoughts.
Medical Treatments (Optional):
While CBT was the primary method of therapy, Nandini's therapist also recommended a trip to a psychiatrist to evaluate putting her on an antidepressant in addition to CBT. Following extensive evaluation, Nandini was initiated on SSRIs because her symptomatology necessitated it, especially to augment treatment by normalising neurotransmitter activity in the brain.
Therapy:
The therapy covered all the problems that made Nandini depressed. CBT sessions were designed to attend to cognitive concerns and restructuring of those thoughts that led to behaviour changes. Cognitive therapy became primed to counter her distorted beliefs and boost her cognitive coping patterns, rewriting them to lessen emotional avoidance.
Also, Nandini was urged to attend group therapy once a month, during which she would be able to meet others who were going through the same process of depression. This was meant to make her feel less lonely and convince her that she was not isolated in her experience. Group therapy also allowed her to learn coping mechanisms and gain experience from peers.
Improvements/Recovery Timeline:
- Week 1-2: The first two weeks involved a thorough assessment of Nandini’s thoughts, feelings, and behaviours. She was introduced to medications in weeks 1-2, and in the meantime, she began to understand how inappropriate thoughts were the main reason for mental depression. The introduction of medicines led to a slight improvement in her sleep and appetite; however, her emotional symptoms remained prominent.
- Week 3-4: By now, Nandini was starting to practice cognitive restructuring. She was beginning to notice that some of her negative thoughts were beginning to lose their grasp over her. She had also started making some small behavioural changes, such as taking walks after school, and was beginning to feel slightly better.
- Week 5-8: Nandini, after six weeks of therapy, said that she felt a bit lighter. Those depressive moments did not seem so overwhelming anymore. She did not yet feel entirely "normal" but was regaining confidence in controlling her emotions. In an attempt to enjoy doing routine things with friends, such as having a coffee, gardening.
- Week 9-12: Nandini made very substantial progress at the end of 12 weeks. She fought much of her negative thinking and was feeling much, much less emotionally distressed. Her nighttime problems had disappeared, and she was back to actively participating with her kids and comrades. Dr. Vinita, still seeing her weekly, was now talking more about techniques to prevent relapse and sort out the progress she had made.
Our Success:
Impact on Patient’s Life:
After her treatment, Nandini was a transformed individual. She had regained faith in her capability to handle stress and was more conscious of her emotional needs. The skills she learnt at CBT gave her the power to detect negative thoughts in time and challenge them before they went deeper into more serious depression. Her love for school life returned, with Nandini feeling connected to her students and colleagues. The passion returned for things she loves: reading, cooking, socialising with friends, etc.
Family and Community:
As Nandini's recovery took hold in her life, there was a secondary improvement seen in her relationship with perceived family and friends. She rekindled connections with her family and extended family, involving them in social activities that she had refused in the past. Now, she has been present for her friends much more effectively-your impact in helping them in their distressed times.
Future Steps:
Nandini had continued to progress considerably in therapy, but continued coming in for therapy twice a month and maintaining the medication regimen prescribed by her psychiatrist. She also participated in an alumni support group for former patients who had undergone CBT for depression. Nandini's continued commitment to her personal mental health would ensure that she would stay on the path of recovery, ready to take on any challenges that might cross her way in the future.
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Jagruti Rehabilitation Centre is a leading facility specializing in mental health, dementia, and addiction recovery. The team of psychiatrists, psychologists, and caregivers is committed to empowering individuals on their journey to recovery.
