Online Cognitive Behavioral Therapy: An e-Mental Health Approach to Depression and Anxiety

170 Pages·2019·1.94 MB·English

by  Nazanin Alavi

Nazanin Alavi
Mohsen Omrani
Online Cognitive
Behavioral Therapy
An e-Mental Health
Approach to Depression
and Anxiety
123
Online Cognitive Behavioral
Therapy
Nazanin Alavi • Mohsen Omrani
Online Cognitive
Behavioral Therapy
An e-Mental Health Approach to
Depression and Anxiety
Nazanin Alavi Mohsen Omrani
University of Toronto Brain Health Institute (BHI)
Centre for Addiction and Rutgers University
Mental Health (CAMH) Piscataway, NJ
Toronto, ON USA
Canada
ISBN 978-3-319-99150-4 ISBN
978-3-319-99151-1 (eBook)
https://doi.org/10.1007/978-3-319-99151-1
Library of Congress Control Number: 2018960354
© Springer Nature Switzerland AG 2019
This work is subject to copyright. All rights are reserved by the Publisher, whether
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Acknowledgment
To our parents, Vida, Minoo, Mobin, and Behrooz, for all their
support and sacrifices through the years; and to our two sons,
Kahvian and Dustahn, who light up our lives with their joy
and energy!
v
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mental Health Disorders and Treatment Gaps . . . . . . 1
Limited Care Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Inefficient Resource Allocation . . . . . . . . . . . . . . . . . . 4
Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
What Is Depression? What Is General
Anxiety Disorder (GAD)? . . . . . . . . . . . . . . . . . . . . . . 9
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2 The 12-Step Approach to Online CBT . . . . . . . . . . . . 11
Important Points to Remember in Designing
eCBT Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
How to Design Modules for Online CBT . . . . . . . . . . 15
How to Give Feedback . . . . . . . . . . . . . . . . . . . . . . . . . 15
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3 What Is Depression? What Is Anxiety? . . . . . . . . . . . . 17
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Why Take This Course? . . . . . . . . . . . . . . . . . . . . . . . . . 17
What Is Online CBT? . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
What Does the Course Look Like? . . . . . . . . . . . . . . . 18
Discuss Crisis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Introduce the Clinician Facilitating the Course . . . . . 19
Online CBT Outline . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
What Is Depression/Anxiety? . . . . . . . . . . . . . . . . . . . . 20
Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Goal of the Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
vii
viii Contents
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 22
Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4 What Is the Five-Part Model and How Can It Be
Helpful? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 34
How to Summarize the First CBT Session
for Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
How to Summarize the First CBT Session
for Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 36
What Is the Five-Part Model? . . . . . . . . . . . . . . . . . . . . 37
How to Go Through the Five-Part Model
Step by Step . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 39
Help the Clients with Their Homework . . . . . . . . . . . 40
5 What Is the Connection Between Our Thoughts,
Feelings, Behaviour, Physical Reactions, and
Environment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 45
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 46
What Is the Connection Between
Thoughts and Feelings? . . . . . . . . . . . . . . . . . . . . . . . . . 46
What Is the Connection Between
Thoughts and Behaviours? . . . . . . . . . . . . . . . . . . . . . . 47
What Is the Connection Between
Thoughts and Physical Reactions? . . . . . . . . . . . . . . . . 47
What Is the Connection Between
Thoughts and the Environment? . . . . . . . . . . . . . . . . . 48
Thinking About the Five-Part Model . . . . . . . . . . . . . . 48
Walkthrough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Connection Between Different Parts . . . . . . . . . . . . . . 50
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 51
Contents ix
6 Strategies That Can Be Used in Stressful Situations . . 59
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 59
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 59
What to Do in Stressful Situations? . . . . . . . . . . . . . . . 60
Distracting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Deep Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Why Breathing Is Important . . . . . . . . . . . . . . . . . . . . . 60
How to Do Breathing Exercises? . . . . . . . . . . . . . . . . . 61
Belly Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4 -7-8 Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Roll Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Morning Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Next Week Homework . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Homework 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Homework 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
7 Understanding and Rating Our Feelings,
and the Thought Record . . . . . . . . . . . . . . . . . . . . . . . . 69
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 69
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 70
Feelings and Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Rating Moods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Thought Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Summarize the Session . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 72
Homework 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Homework 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
8 What Are Automatic Thoughts? . . . . . . . . . . . . . . . . . . 81
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 81
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 82
What Are Automatic Thoughts? . . . . . . . . . . . . . . . . . . 82
Questions to Help Identify Automatic Thoughts . . . . 83
x Contents
What Are Hot Thoughts? . . . . . . . . . . . . . . . . . . . . . . . . 83
Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 84
9 Activity Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 93
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 94
What Is Activity Record . . . . . . . . . . . . . . . . . . . . . . . . . 94
Learning from Activity Records . . . . . . . . . . . . . . . . . . 97
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 97
10 What Is Evidence and How Can It Help
Us Rate Our Thoughts and Feeling? . . . . . . . . . . . . . . 105
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 105
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 106
Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
How to Help the Client Find Evidence
That Does Not Support Their Hot Thought . . . . . . . . 107
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 108
11 What Is Alternative and Balanced Thinking? . . . . . . . 117
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 117
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 118
What Are Alternative/Balanced Thoughts? . . . . . . . . 118
Help the Client Find Alternative
or Balanced Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 122
12 Experiments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 131
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 132
Experimenting on the Alternative Thoughts . . . . . . . . 132
Contents xi
Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 135
Homework 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Homework 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
13 Action Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Summarize the Previous Session . . . . . . . . . . . . . . . . . . 145
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 146
Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Next Week’s Homework . . . . . . . . . . . . . . . . . . . . . . . . 148
Homework 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Homework 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Homework 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
14 Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
In This Chapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Welcome Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
What Is This Session About? . . . . . . . . . . . . . . . . . . . . . 157
The Five-Part Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Thought Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Column 1: Situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Column 2: Feelings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Column 3: Automatic Thoughts . . . . . . . . . . . . . . . . . . . 159
Columns 4 and 5: Evidence . . . . . . . . . . . . . . . . . . . . . . 160
Column 6: Balanced/Alternative Thoughts . . . . . . . . . 160
Column 7: Rerate Your Mood . . . . . . . . . . . . . . . . . . . . 161
Experiments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Action Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Using All the Techniques . . . . . . . . . . . . . . . . . . . . . . . . 161
End of the Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163