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Helping clients ‘restart their engine’ – use of in-session cognitive behavioural therapy behavioural experiments for engagement and treatment in persistent depression: a case study

Published online by Cambridge University Press:  13 April 2020

Lilian Skilbeck ,
Christopher Spanton Open the ORCID record for Christopher Spanton [Opens in a new window]  and
Ian Roylance
Lilian Skilbeck*
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, StratfordE15 4ES, UK
Christopher Spanton
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, StratfordE15 4ES, UK
Ian Roylance
Affiliation:
East London NHS Foundation Trust, Newham Talking Therapies, Vicarage Lane Health Centre, 10 Vicarage Lane, StratfordE15 4ES, UK
*
*Corresponding author. Email: lilskil@hotmail.com
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Abstract

Behavioural experiments (BEs) are a major cognitive ingredient in the cognitive behavioural therapy (CBT) model which can be applied in-session or between-sessions. In-session BEs are particularly effective and widely demonstrated in anxiety disorders, yet they remain under-utilised in depression. Clients presenting with persistent depression are often difficult to engage due to the chronicity of their symptoms and their learnt self-perpetuating demoralised states. Research to date demonstrates the effectiveness of in-session BEs in engagement and treatment in depression. This case study details the treatment of a client presenting with persistent major depressive disorder (MDD) with hopelessness and how in-session BEs effected engagement and treatment. This case study is discussed with reference to strengths, limitations, clinical implications and recommendations for practice and development.

Key learning aims

It is hoped that the reader of this case study will increase their understanding of the following:

  1. (1) Using BEs to help engagement and treatment in persistent MDD.

  2. (2) Instilling hope by starting in-session BEs during the assessment stage.

  3. (3) When to plan or seize opportunities for off-the-cuffin-session BEs.

  4. (4) Setting no-lose BEs to enable clients to widen their perceptual field.

  5. (5) The importance of repeated BEs to consolidate experiential learning.

Keywords

cognitive behavioural therapydepressionbelief modificationcase formulation
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e5
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. New York, USA: Guilford Press.Google Scholar
Fennell, M., Westbrook, D., Bennett-Levy, J. (2004). Depression. In Bennett-Levy, J., Butler, G., Fennell, M., Hackman, A., Mueller, M. & Westbrook, D. (eds), Cognitive Behaviour Therapy: Science and Practice Series. Oxford Guide to Behavioural Experiments in Cognitive Therapy (pp. 205–222). New York, USA: Oxford University Press.CrossRefGoogle Scholar

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