Winnie's Case

Front 1

Relevant childhood data

Back 1

Sexual abuse, Unmet parental expectation, Oldest of 5, shy, opposing parental values

Front 2

Core beliefs

Back 2

1. I am Selfish

2. I am Unworthy, Unacceptable and an Outsider

3. The world is scary

4. The future is bleak

Front 3

Unhelpful assumptions and rules

Back 3

I SHOULD always put others first

I MUST perform well

I MUST be Nice, interesting, strong and perfect.

If I'm in co trol then I won't be a nuisance, so people will not hurt me

Front 4

Compensatory strategies

Back 4

I try to be perfect at everything (work, house, relationships)

I am wary what I say to other others and keep myself to myself

Hint 4

Perfect

Isolates herself

Front 5

Critical event

Back 5

Problems of complaints from work and unsatisfactory support from manager

Front 6

Thinking biases

Back 6

Personalisation

Putting blame on oneself for something that isn't directly your fault, or blaming others for something that was your fault. Example of this is when winnie find out her friends partner has been I'll for 3 months. "I should have known"

Labelling

These are usually negative descriptions. It is characterising ourselves or others with labels. We see this when winnies calls herself "selfish".

Should, Must, Ought To

Using words like should and must act as a requirement or a rule for ourselves. This can be emotionally and physically damaging and it is strongly linked to depression. This can reinforce the negative especially when these requirements don't turn out the way they wanted.

Front 7

Safety behaviours

Back 7

Rumination

Avoids people

Hint 7

Overthinks

Isolates herself

Front 8

Situation : Walking with friend finds out friends partner has cancer from 3 months ago.

Back 8

Negative thoughts: I SHOULD have known

Failed her friend and herself

Atleast she still has her husband

I was I'll too

Translation: if I don't put others first I will be rejected, I am selfish for thinking of myself.

Hint 8

Hint: her negative thoughts and what she means. Emotion

Guilt

Sadness:

Jealousy:

Anger:

Front 9

Behaviour

Back 9

Pretended she was okay, cut walk short, went home, fretted, ruminated, then slept.

Hint 9

How did she react to finding out the late news. Hint cut walk short....

Front 10

Physiology

Back 10

Tired, Heavy

Hint 10

How she felt in her body

Front 11

Ventral, Dorsal, Medial

Back 11

Side, Back, Centre

Front 12

MRI

Back 12

Magnetic Resonance Imaging

Hint 12

What they use to see the difference in a brain after CBT

Front 13

Treatment plan

Back 13

1. Establish therapeutic rapport by incorporating incogruence, empathy and unconditional positive regard. Using this may enable or make it easier for winnie to open up as it sets a safe and non judgmental environment.

2. Provide Psycho-education gives clients information about cause, symptoms and treatment of winnies condition. The link between behaviour, mood, physiology and feeling and how certain behavior can maintain depression.

3. Identifying and discriminating emotions and rating their intensity for improvement guidelines. 0-100%

4. Discuss the influence of thinking on her behaviour, physiology and feeling through winnies past experiences.

5. Discuss specific thoughts and common themes that lead to unpleasant emotion and formulation.

6. Identifying rules for living and examin their helpfulness.

7. Monitoring activity levels using diary sheets. Link activity levels, behaviour and mood with a balance of pleasurable and goal oriented activities. Winnie keeps to herself most of the time so an Increase social activities to decrease isolation.

8. Encourage winnie to analyse thoughts and step back from them. See them as thoughts that pass, instead of truths that identify her. Practicing Mindfulness would be a great tool to help with this as it is one of the steps.

9. Conduct behavioural experiments to help increase believavility of alternate thoughts. Practicing self compassion on alternating days.

10. Prevention and management of relapses.

Front 14

Neurobiological effects of CBT

Back 14

GOLDAPPLE ET AL. (2004) Study used Functional Magnetic Resonance Imaging to examine the changes in brain structure and activity following CBT. They found that successful CBT enables increased activity in the limbic system structures, hippocampus and dorsal cingulate. They also found a decrease in activity in the dorsal, ventral and medial areas of the pre-frontal cortex. They govern a number of functions such as cognitive rumination and self referential processing.

These findings suggest that successful CBT changes the brain activity in a way that allows for better regulation of emotion, more positive memories about oneself and reduces the extent to which an individual ruminates about their past.

This is important to winnie as it may help note changes in emotions and their effect on her. This can happen through examining her negative automatic thoughts and beliefs to explore whether they help her or do the opposite. This way, she'll learn to be mindful of the process that may out her in risk of relapse and the techniques to prevent it.

Hint 14

Increases activity in the limbic system, hippocampus (Auto-biographical memory) and the dorsal cingulate (regulation of emotions).

Decreases activity in the dorsal, ventral and medial regions of the pre-frontal cortex. In charge of cognitive rumination and self referential processing.

Front 15

Overgeneral Memory

Back 15

Winnies suffering from previous depression said keeping busy and poor memory. Overgental memories can be picked up because of trauma she os a great candidate for some one who could get it because of sexual abuse from her father. Winnie may be in danger of having an over generalised memory. Studies Hölzel et al. (2011) have shown that mindfulness increases gray matter which is involved in multiple regions and functions of the brain including the memory. This will enable more opportunities to remember more positive Memories.

Hard to recall specific events especially good ones. It maintains depression.

Kuyken, (2006)