However, with the development of modern science an… Research has shown CBT is significantly more effective than all other psychological treatments for generalized anxiety disorder. Diagnosis: Axis I: Generalized Anxiety Disorder, 300.02 (Active) Axis II: None V71.09 Axis III: See Medical History Axis IV: None Axis V: 60 Current Psychotropics: Paxil 10 mg PO QAM Buspirone 10 mg PO QAM Ambien CR 6.25 mg … 6. The chosen model will either reflect a particular manualized program or should be drawn from general models of anxiety or depression, such as those provided in Chapter 8. Child Trauma Treatment Training Program Page 1 Example TF-CBT Treatment Plan and Goals Name: Date of Plan: DOB: Medical Record #: Diagnosis: Axis I 309.81 Posttraumatic Stress Disorder Axis II Axis III Axis IV Axis V GAF = Treatment Plan: 1. and Treatment Plan Example. Surprisingly, though, there has been minimal research on the clinical utility and accuracy of case formulations and subsequent treatment plans, particularly with regard to child and adolescent populations. Selecting specific CBT techniques The treatment plan must therefore select the specific CBT techniques that will best address the identified problems, sequence the techniques in such a way that progress toward goals is optimized, and implement each technique at an appropriate dose, to ensure that the targeted problem is effectively overcome or managed. Sequencing selected specific CBT techniques for depressive disorders. Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed. CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either individual or g… The treatment plan must therefore select the specific CBT techniques that will best address the identified problems, sequence the techniques in such a way that progress toward goals is optimized, and implement each technique at an appropriate dose, to ensure that the targeted problem is effectively overcome or managed. treatment validity and a reasonable amount evidentiary support for mitigating anxiety or depression symptoms, the F.E.A.R. Specific CBT techniques may focus on a single factor or may deliberately target multiple factors. For example, Figure 9.1 applies the anxiety model presented in Chapter 8 to the case of an 11-year-old boy assessed as meeting criteria for generalized anxiety disorder and social phobia. 2011). This involves taking a hard look at negative … Depending on the manual selected, the therapist may have limited or substantial control on the order of presentation of specific CBT techniques. Once the model has been selected, the therapist should attach relevant evidence gathered during assessment to each aspect of the model. Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). Usually, a parent or caregiver, the child, and a therapist will discuss goals and develop a treatment plan. In determining the sequence of skills for the treatment plan, the therapist may do best to ask him-/herself what skills will be needed prior to implementing exposure and what skills may be developed concurrently with it. For example, altering a persons unhelpful thinking can lead to healthier behaviors and improved emotion regulation. Treatment manuals will provide guidance on the selection of appropriate techniques or, through design, will have made assumptions about the selection of techniques on the basis of the chosen nomothetic model and the target population. Cognitive Conceptualization Diagram: Cognitive-Behavioral Case Formulation. Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains. My literature review on Generalized Anxiety Disorder (GAD) showed that Cognitive-Behavioral Therapy (CBT) is the most effective technique in the treatment of GAD, therefore I will use CBT in the treatment of Susan. The purpose of the case formulation is to create an idiographic model relevant only to a specific case. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions. Figure 9.1 Example of idiographic application of the anxiety model to the case of an 11-year-old boy. As can be seen, a picture emerges from the idiographic model of what is causing and maintaining the presenting problem for the individual. The exact nature of what we … Melissa reports that her panic attacks are … Sample Chapter: Treatment Plans and Interventions for Depression and Anxiety Disorders, Second Edition These strengths should be added to any written or visual representation of the case formulation in a way that emphasizes their importance â for example they can be added to the outer layer of the contextualâidiographic model. •Mood and anxiety disorders are common, treatable diseases •Psychotherapy builds hope •Like much in psychiatry, we know that it works but not how it works •CBT can be an effective treatment for mood and anxiety disorders •Acknowledgements to Karen Swartz, MD! Therapist flexibility in this case focuses more on the tailoring of the technique to the specific cognitions, behaviors, or situations that the client experiences. In addition to developing the idiographic representation of the chosen model, the potential impact that socio-demographics, culture, comorbidity, and development will have on engagement with treatment and on the likelihood of experiencing common obstacles during treatment should be considered. Cognitive behavioral therapy (CBT) has become the leading treatment for anxiety, and with good reason. Age- and gender-specific resources are available for adults and juveniles (males and females).
$.' For the purposes of this chapter, it will be assumed that the therapist has established, through appropriate assessment, that the targeted child or adolescent has an anxiety and/or a depressive disorder that is the basis for presentation to treatment (see Chapter 7 for more details on conducting an assessment). 14 THE PSYCHOPHARMACOLOGY TREATMENT PLANNER implications of the physical examination and laboratory test results. 2012). stream
Dynamic Treatment Planning CBT involves a structured approach to solving problems in a specified number of sessions. Cognitive behavioral therapy (CBT) for child anxiety has been shown to be maximally effective when CBT interventions are matched to the specific anxiety symptoms experienced by the individual (Eisen and Silverman 1993, 1998), and long-term efficacy has been established for a majority of individuals after a CBT program for adolescent depression that incorporated use of case formulation (Treatment of Adolescent Depression [TADS] Team 2009). Meeting Start: 1:00 PM - Meeting End: 1:20 PM This was a n Initial Treatment Team Meeting. The treatment plan can subsequently be adjusted to proactively address these potential barriers, decreasing the likelihood that the barrier will interfere with progress. Alternatively, the case formulation may indicate that excessive reassurance from the parent undermines the childâs ability to learn that (s)he can cope with challenging situations. The initial case formulation, and consequently the treatment plan, must be updated as new information is discovered and as a result of the experience implementing each specific CBT technique with the client. Consequently, after basic psycho-education, exposure would be considered the most essential technique to implement with a child or adolescent who has an anxiety disorder. This book is intended as a practical guide for clinicians who wish to use Cognitive Behavioral Therapy for Depression (CBT-D) with Veterans. Because these individuals often face acute rather than chronic mental health issues and have many coping strategies already in place, Brief CBT can be used to enhance adjustment. Participant(s) Developing the Plan: Susan Lobao (Counselor) Mary Golden (Client) Diagnosis: Example Treatment Plan . These influences can be described within a written case formulation or, if a visual representation of the case formulation is preferred, displayed on the idiographic model as contextual layers that surround the issues identified in the model. Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). Where a therapist is using a module-based treatment manual, the clinical algorithms provided by the manual should be followed. Several different approaches have been devised to guide the production of case formulations (Boschen and Oei 2008; Macneil, Hasty, Conus, and Berk 2012; Persons 1989). Following thorough assessment, the therapist should select the nomothetic model that is appropriate for the presenting individual, his/her family, and the organizational setting in which treatment is being offered. Once an initial case formulation is established, the therapist needs to convert it into a treatment plan. Direct comparison of case-formulated treatment and standardized treatment has shown slight superiority for the former (Persons and Tompkins 1997). It provides a template from which an individualized treatment plan can be derived. Each factor will also vary on the strength of its association with current problems. Theoretically driven, context-aware case formulation Cognitive-Behavioral Case Formulation. Case formulation is the process of identifying the causes, antecedents, and maintaining factors related to a clientâs emotional, interpersonal, and behavioral problems. The competent therapist must ensure that (s)he has a thorough understanding of the purpose of each specific CBT technique, so that (s)he can appropriately link it to the causal or maintaining factor(s) that it is designed to address. Information on comorbidity, family history, current anxiety or depression in immediate family, the clientâs developmental and academic functioning, and the familyâs socio-demographic and cultural environment are also needed for a comprehensive case formulation. Inter-rater reliability of case formulations has been found to be adequate (Kuyken, Fothergill, Musa, and Chadwick 2005), the quality of case formulations improving with therapist experience and training (Eells et al. 9Case Formulation and Treatment Planning for Anxiety and Depression in Children and Adolescents Many of the most popular and effective cognitive-behavioral therapy techniques are applied to what psychologists call “cognitive distortions,” inaccurate thoughts that reinforce negative thought patterns or emotions (Grohol, 2016). Second, it guides the development of a treatment plan that deliberately targets causal and maintaining factors that underlie the problems, increasing the likelihood of appropriate response to treatment. To devise a case formulation, a competent therapist will need to add, to the standard diagnostic and symptom severity assessment tools, a targeted assessment of the typical cognitions, behaviors, and emotions that relate to the presenting problem for the individual, as well as an evaluation of interpersonal processes between the individual and other people (e.g., parents, peers) during periods of high anxiety or low mood. will have made assumptions about the selection of techniques on the basis of the chosen nomothetic model and the target population. Therapist flexibility in this case focuses more on the tailoring of the technique to the specific cognitions, behaviors, or situations that the client experiences. 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