Cognitive Behavior Therapy, Research Paper Example

Introduction

Cognitive Behavior Therapy (CBT) is nowadays considered one of the leading psychotherapeutic method that is centered on the close research of interactions of human cognition, emotions and feelings and their further reflection on the human behavior, physical and psychological state. It is a universal method that does not involve medications, that may be universally applied to treating a wide range of psychological disorders, so taking into consideration its efficiency and mildness CBT was chosen as a preferred method for the present work.

The principle underlying application of CBT supposes that the patient has a history of events in his or her life that precede the appearance of mental problems, and the reason as well as the way to treatment should be searched for in the inner state of the patient who used to think destructively and create the unhealthy behavior and attitude that further on negatively influenced their state (Ledley, Marx and Heimberg, 2005).

Thus, the CBT addresses the inner precipitants of the problem and aims at dividing the problem into simplest units that were the initial negative, destructive factors and created the state of psychological disorders. As soon as the problem is identified, the most suitable treatment can be found and the effect produced by such treatment will be genuinely long-term, in contrast to medical treatment that is insecure and unstable in its effect on the patient (Ledley, Marx and Heimberg, 2005).

CBT uses the six step conceptualization model of Persons – it includes gathering data to acquire full understanding of all facts that may or may not be connected with the emergence of the patient’s problem; studying, analyzing and understanding the data; developing a plan of targeting the flawed thinking patterns of the patient; making the patient understand why the old way of thinking is destructive and creating a new thinking pattern that will individually suit the patient and that will effectively substitute the old, destructive one; and reinforcement as well as strengthening of the newly created thinking pattern in the patient so that to fix the result and not to let him or her return back to the old way of thinking. Personal rewards and strong cooperation are vital at that stage due to the fact that reinforcement for patients with mental disorders cannot be influenced in any other way (Ledley, Marx and Heimberg, 2005).

Stating a Problem, Symptoms and Problems of Functioning

As it has already been mentioned in the introductive part, the main breakthrough of the CBT method is to effectively and, what is even more important, correctly state the problem of the patient. Deep and precise understanding of the whole scope of problems that he or she may have will open up many alternatives for the therapist and will outline the main directions at which the therapeutic action should be aimed.

So, coming back to our patient Nikko, it is possible to outline the main list of problems he experiences as follows:

1. Drug and alcohol abuse.
2. Nikko’s being homeless for the last 9 months.
3. PTSD, depression and anxiety.
4. Steady psychotropic medications Nikko is taking (Prozac and Paxil).
5. Blackouts, shakes, seizures.
6. Delirium tremens, hallucinations.
7. Suicide attempts.
8. A set of medical problems: hypertension, glaucoma, arthritis, asthma, neural problems with legs.
9. Insomnia.
10. Hearing ‘noises’ possibly connected with the alcohol abuse.
11. Nightmares and flashbacks to the horrors of Afghanistan.
12. Feeling of loss, loneliness and low self-esteem after the murder of Nikko’s parents.
13. Social problems: lack of identification, financial and medical benefits.

In addition to the list of problems the patient turns out to have it is necessary, according to the six stage conceptualization model, to gather all data that may be relevant to the process of treatment. Thus, one can add the following list of facts that are available from the offered case study about Nikko:

1. He is a 45 year old male of Afghan origin.
2. He is a stocky build framed man, slightly disheveled, with an untrimmed graying beard and moustache.
3. He has several arrests due to unlawful behavior because of alcohol and drug abuse.
4. When a child, Nikko had to escape from the Soviet military.
5. Nikko’s parents and older sister died in Afghanistan.
6. Nikko has four more siblings who live in the USA but he does not live with any of them.
7. Nikko feels depressed about the confinement of immigration services in the US.
8. Nikko had an experience of detox from alcohol, but it lasted for 2 months, after which he resumed drinking.
9. Nikko is pleasant in communication and motivated to seize drinking and taking drugs.
10. He has a strong accent that causes certain difficulties in understanding him for others.
11. The history of his mental problems started after witnessing the murder of his parents at the age of 9.

Thus, coming to the second stage of evaluating the situation currently taking place in the life of the patient, it is possible to summarize his experiences as follows: Nikko is highly motivated to seize his bad habits of drug and alcohol abuse and finally understands that he is unable to do it on his own and needs comprehensive medical and psychological help. He realizes now that the key to his problems is deeper than only physical addiction, so he turns for help on the psychological level to win the battle with his addictions.

The awful pictures of atrocities in Afghanistan and death of his parents remained a deep wound both at his conscious and subconscious levels and gave way to depression, loneliness, low self-esteem and unstable mood, feeling of anxiety etc. To overcome this set of problems it is necessary to correctly and precisely define the mechanism of the problem that triggered it in the distant past and to outline the main objectives for recovery.

Defining the Underlying Mechanism of Listed Problems

The mechanism that underlies the present scope of problems is the irrational belief of Nikko that was generated at his conscious and subconscious levels in his childhood, starting from the moment of his parents’ murder. The reason for his depression and PTSD can be found in the horrifying evidence of murder and other deaths in Afghanistan.

According to Persons and his consideration of the six step conceptualization model, it is first of all necessary to answer the question of what all of his problems have in common (Ledley, Marx and Heimberg, 2005). Judging from the case study and Nikko’s situation, it is possible to say that the main problem Nikko himself sees in his life and health status is his alcohol and drug abuse and the inability to overcome his addiction on his own. From the therapeutic point of view, it is possible to say that the key to all problems of Nikko is the deep psychological trauma he had in his childhood. The first symptom of his PTSD was the sense of loss and loneliness – it is fully understandable taking into consideration that he not only lost his parents, which is a significant stress in itself, but also was present at the moment of their cruel murder.

If one takes a closer look at the life story of Nikko, he or she will find one more irrational belief Nikko has developed for himself – judging from the fact that he lives alone, looks untidy and does not have children, has never been married, is homeless while having four (!) siblings on the territory of the USA, it is possible to understand much about his way of thinking. One can notice that Nikko strives to loneliness and does not want to establish close relations, emotional warmness not only with women who can possible become his wives and have children with him, but also with his own relatives by blood. Hence, the irrational belief Nikko has is that if he becomes close with someone he will be unhappy – this is also a dramatic reflection of his being the witness of his closest people’s deaths.

The possible dialogue based on the information about Nikko from the case study and the CBT theory can look as follows:

Therapist: Mr.Nikko, where are you from?

Nikko: I am from Afghanistan, I lived there with my family.

T: Why did you leave the country?

N: My parents were killed, I was present when this happened… After that my sister died… The situation was unstable, too much violence in the country, so I left.

T: Did you do it yourself, just emigrated to the US?

N: No, before that I was captivated by the Soviets, had to run away… That was a terrible experience for me… After that I moved to the USA.

T: Mr. Nikko, what is the main remembrance you have from childhood, the time spent in Afghanistan?

N: These are my parents… how they were killed… these monsters killed them… I wake up every night thinking about that, even if I drink or smoke and do not have any thoughts, my anxiety lets me know that they are still there, in my head, though I am too distracted by a dose to see them.

T: OK, Nikko, and what about your life in the US? Did you make friends with anyone here? Do you have women here, or kids?

N: No, it was always hard for me to accept someone close to me. I like to be alone. And women do not like the way I live – I can’t think of one to agree to live with a man like me.

T: In what do you see the reason of such antipathy?

N: Look at me – I am always drunk, I take marijuana, I am homeless… What can I offer?

T: And what about relatives? Do you have any in the USA?

N: Yes, three brothers and one sister live here, they have their own families and do not need me. I do not need them, too. Why should they, or I, care?

T: Did you try to establish contact with them?

N: No, I do not want to be not welcome.

T: What is your dream? What would you change in your life?

N: I wish parents were alive and my country did not have a war.

So, judging from such an imaginary dialogue with Nikko one can outline the main precipitants of his current state of health – Nikko still feels much pain about the loss of his parents and wants to have a happy family, but his fear of being not welcome stops him from uniting with the rest of his family and starting a new life. He started taking drugs and alcohol because of his wish to get rid of pain and painful remembrances, but now he realizes it is not the way out and wants to find a more constructive way to recovery.

Obstacles and Desirable Outcomes of Treatment

The first visible obstacle to designed treatment is the addiction to medications that Nikko has been taking for a long period of his life. Prozac and Paxil are two very strong anti-depressant drugs that have a wide range of side effects that may reveal themselves in a different way and combination depending on the dosage or violations of usage. From Nikko’s profile it comes that he is hardly able to take his drugs appropriately because of his strong drug and alcohol addiction. And it is absolutely forbidden to mix drugs of such type with alcohol, set aside drugs in general. Hence, it becomes possible to suppose that the wrong usage of medical substances aggravates Nikko’s problems and the side effects that appear after the violation of usage rules may be even mixed with the real psychological disorders Nikko has.

Looking at the list of side effects, one may see the following similarities with the health record of Nikko: aggravating panic attacks, nightmares, obsessive thoughts (in the Nikko’s case – suicidal ones, loneliness and low self-esteem, confinement of immigration services), unexplainable fear, heart palpitations and tightness in the head, headaches (which may be the reason of hypertension), flashes from memories and images from the past (the pictures of Afghanistan etc.), not feeling comfortable with people (the reason for Nikko being never married and not having children), manic/depressive episodes, tremors (Real SSRI Side Effects, 2009)

Hearing noises (not voices) is also a typical side effect of both Prozac and Paxil, so it is possible to suppose that this symptom comes from medications and not from abuse. These particular medicines also cause many physical problems like low blood sugar or breathing difficulty, which could have worsened the state of Nikko on a physical level. Anyway, it is essential to follow the main rule of CBT – dealing without medications, on a purely psychological and therapeutic level, and to try to eliminate the symptoms that follow from taking drugs (Real SSRI Side Effects, 2009).

The possible outcomes of treatment are diverse because they are targeted at several problems at once. Nikko is an unusual patient because he faces the complex negative effect of medical substances, of psychological disorders and health problems of psychical origin simultaneously. This is why, as it has been stated already, the course of therapeutic action should be targeted at all these spheres in its own way. First of all, it is necessary to distinguish medical substances’ effect from neurotic disorders that Nikko has because of his childhood trauma. Therefore, it may be necessary to postpone the CBT treatment itself for a certain period of time while Nikko will overcome his refusal from Prozac and Paxil. Only after a thorough clinical investigation of Nikko’s health status it will be possible if not to eliminate all medications-related symptoms fully, but at least to detect them and to disregard them for the period of defining the process of CBT treatment. Taking into account the fact that medical treatment will be combined with CBT, one may suppose that the whole scope of problems will be overcome in a complex and comprehensive way.

So, the first stage of CBT treatment, as it comes from the dialogue, will be dealing with the problem of alcohol and drug abuse. As Nikko has realized during his sessions with the therapist, taking alcohol and drugs does not diminish or eliminate the problem of his loss, the horror of his childhood, his anxiety and the current negative life conditions he has. More than that, Nikko has realized that no matter whether he takes drugs and alcohol or not, he still fully agrees that the main precipitant of the problems he is now having was the death of his parents.

Consequently, the main aim of the therapist is to find a set of ways to influence Nikko’s perception of his parents’ death. Surely it is hard to overestimate the tragedy of losing parents, especially being the witness of that drama, but the main task of the therapist is to make Nikko realize that the horror took place through no fault of his, that he and his family became the victims of a broader national situation and that he could have done nothing about that. It may also be helpful to substitute the awful remembrances about parents’ murder by as many good remembrances from early childhood as possible.

The ultimate goal of such therapy should be to form a stable association in Nikko’s mind – when he thinks about parents he should think not about their murder but about what they used to have before the tragedy. The therapist may initiate Nikko’s imaginary dialogue with parents which he could note in his diary for the period of therapy – he could possibly tell his parents about something good he had in life, about his feelings and emotions, about his hopes for the better.

Such a dialogue can possibly have even a deeper therapeutic effect. As soon as Nikko tries to share his thoughts and emotions with his dead parents he may realize that he doesn’t have that much good to share and this may discourage him and even worsen his depression. But if Nikko really does this, it is vital for the therapist to detect the right moment and to create a positive construct in his mind – Nikko ought to believe that as soon as he seizes his addiction, makes peace with his siblings and starts a new life full of positive emotions and meaningful events, he will be able to tell his parents about this, and they would have been proud of him if they were alive. If Nikko accepts this construct and pursues it for a certain period of time, he will surely be able to accept others in his life, restore relations with his relatives and get rid of depression and PTSD (Blenkiron, 2009).

Conclusion

As it comes from the main section, the dominant problem that requires immediate action is the psychological trauma connected with the murder of parents and the physical addiction to drugs and alcohol that formed on that basis. In addition, Nikko has refused from close relations with anyone because of his fear of loss, thus aggravating his depression. These problems are faced in the proposed treatment, so there is strong hope that treatment will yield success.

Other problems, such as absence of home, feeling of anxiety about immigration services or physical problems with health will be solved alongside with the major ones – as soon as Nikko opens his mind for other people and refuses from his irrational belief that only drugs and alcohol can bring him comfort, and that he cannot be close to people because of his fear coming from the tragedies of the past, he will be able to construe his life in a new, positive and helpful way.

In the present case one can predict that Nikko will be considered healthy at least when he finds other pleasures and salvation in his life refusing from medications, drugs and alcohol. He will recover as soon as the remembrance about parents and family does not cause sharp pain in him, as soon as he can talk about the events calmly and reaches harmony with his inner self about the events of distant past. And surely the only means of fixing treatment and strengthening the effect is to see that Nikko has united with his family and does not avoid close relations and feelings.

References

Blenkiron, P. (2001). Cognitive Behavioral Therapy. The RCPsych Public Education Editorial Board. Retrieved December 2, 2009, from http://www.rcpsych.ac.uk/mental healthinformation/therapies/cognitivebehaviouraltherapy.aspx

Ledley, D.R., Marx, B.P., & Heimberg, R.G. (2005). Making cognitive-behavioral therapy work: clinical process for new practitioners. Guilford Press.

Real SSRI Side Effects (2009). Psych Drug Truth. Retrieved December 2, 2009, from http://www.prozactruth.com/sideeffects.htm