Cognitive Behavior Theory was formulated by Aaron Temkin Beck, an American psychiatrist who started research in the area of psychotherapy. According to Beck, “If beliefs do not change, there is no improvement. If beliefs change, symptoms change. Beliefs function as little operational units". He believed that a person’s thoughts and beliefs lead to his behavior and latter actions. Cognitive Behavioral Therapy (CBT) is based on the Cognitive Behavior Theory and is known to follow a psychotherapeutic approach. CBT was formed merging the two techniques from behavior and cognitive therapy. CBT has proven to be helpful in treating many psychiatric problems such as dysfunctional emotions, emotional disorders, anxiety disorders and psychosis.
One of my acquaintances recently developed certain psychological problems. Mrs. X. recently delivered a baby and she lost her job within two months of rejoining her company, after her delivery. Mrs. X. was struggling with making adjustments in her marriage. She was known for not being an adjusting person. She would want something to be a certain way and she would refuse to make adjustments of any kind. Soon after getting married, she started having problems with her husband on small issues. Mrs. X wanted a baby but Mr. X was not ready to be a father yet. He had to adjust in the end and Mrs. X decided to go ahead with planning a family. Mrs. X worked at a multinational organization and she was used to doing things a certain way. When she got back to work after her maternity leave, she found that the company had merged with a bigger conglomerate and there were new employees everywhere. She had to be placed in a new team because of the organizational shuffle. She found it very hard to adjust to the new team and other changes in the organization. She found that the work environment had become much faster paced and she was expected to adapt to the ever changing office environment. She was given added responsibility at her job and she was expected to come up the learning curve and start performing if she wanted to keep her job. There were a lot of job cuts in the organization and people were getting fired every day. Mrs. X. was also facing problems at home because she was not able to find a suitable day care for her infant. She experienced a few panic attacks when she found her desperately trying to balance work and family. She was worried about her baby all the time while she was at work. Mrs. X started showing symptoms such as getting in heated arguments with colleagues at the work place. She also lost two baby sitters because she treated them very badly and yelled at them. After a few such episodes, she realized that it was time to ask for help.
I discovered that Mrs. X. often felt irritated and tense. She also felt distant from her loved ones and was not able to give back to her married relationship. She also reported occasional episodes of severe anger on trivial things such as if someone spilled something on her by accident or bumped into her unknowingly. After she calmed down she felt exhausted tense and emotional.
Mrs. X’s situation is not unusual. The recent occurrences in her life such as marriage, delivering a baby and significant changes at work have demanded her to be extremely efficient and things have not worked the way that she would have liked them to be. Anger is a powerful response, triggered by a negative emotion that results in an attack of variable intensity that is not always appropriate (Murphy). In Mrs. X. case, her anger got channeled towards whoever was in front of her and left her exhausted and feeling sorry after she calmed down.
Mrs. X. conceptualized her husband to be loving caring and someone who would always want the things as she wanted but she was unpleasantly surprised when she learnt that her husband was not ready to have a family like she was. This led to frustration in her life. Mrs. X had also conceptualized her job to be stable and predictable. She was in for a surprise when she returned to work and got to know that her company is undergoing a merger and her job might be at stake if she did not perform up to the mark. One of the things that really ticked off Mrs. X. was that her company did not ask for her opinion or informed her in time before shifting her to another team. They gave her little training to perform her new and added responsibilities. Her concept of her safety was shaken and she started questioning everything in her life. Her marriage was not as well as she had thought before getting married and her work life was in trouble in as well. She was finding it hard to adjust to so many changes, thus leading to outbursts of anger and even episodes of uncontrollable anger. In reality, her husband did not have a stable job and wanted to get settled financially before thinking about extending the family. He was a good person and loved his wife but Mrs. X. failed to see that because she was coping with a lot of stress and change in her life.
Some of the most important steps in the treatment plan would be identifying and responding to dysfunctional cognitions and emphasizing the positive in Mrs. X’s life. I would encourage Mrs. X. to learn to identify certain types of problematic thoughts which are called cognitive distortions (APA.com). There are certain techniques that can help her correctly interpret the people and her surroundings. This will decrease the episodes of panic attacks and bouts of anxiety. This technique will help her to replace her perceptual thoughts with more realistic ones and help her course of treatment.
I would like to use Cognitive Rehearsal technique to identify exactly what are the instances which trigger the uncontrollable anger or panic attacks in the client. It will help Mrs. X. to be prepared for this type of future episodes. I would ask Mrs. X to use her power of imagination to imagine a positive outcome to similar situation and imagine her not getting angry and handling the situation well. Writing in a journal might be another element in the course of her treatment. It will have two benefits; she will be able to vent out her feeling in a non-damaging manner and we will able to review it later to monitor her progress. CBT has been very successful in treating mental disorders that do not involve non-psychotic states. Treating uncontrollable anger is one of the disorders that CBT has proven to be helpful with. The main idea behind using CBT techniques is to integrate cognitive and behavioral aspects of therapy. The counselors try to change the disruptive thought pattern of the patterns which results in more agreeable behavior from the patient.
Beck, J. S., & Beck, A. T. (2011). Cognitive behavior therapy, basics and beyond. New York, NY: The Guilford Press.
Cognitive behavioral therapy . (n.d.). Retrieved from http://www.nacbt.org/whatiscbt.htm
Nystul, M. S. (2010). Introduction to counseling, an art and science perspective. Prentice Hall.
MENTAL STATUS EXAM
PHYSICAL
Appearance – Neatly dressed, carefully polished shoes, wore make up and carried a large purse. Facial expression changed from calm to angry while discussing work.
Behavior – Mrs. X. was alert and seemed interested. Got restless while discussing work and her family. She insisted on sitting on a certain spot in the room.
Motor activity – Normal. The client was sitting in the sofa and exhibited normal behavior.
EMOTIONAL
Attitude – She was open, willing to cooperate and friendly. She used eye contact but got restless and looked elsewhere while discussing certain problems such as her boss at work.
Mood and Affect – Her mood and affect were blunted and expressed various ranges of emotions.
COGNITIVE
Orientation – Normal and appropriate
Attention and concentration – Was able to concentrate on the process and pay attention.
Memory – Answered memory related questions accurately. Thought for a min when presented with questions related to her maternity leave and merger at her company.
Speech and language – Coherent and organized except when got agitated and angry about her work problems. Used profanity while explaining work problems.
Thought – Showed a clear thought process
Insight and Judgment – Client was aware that she had a problem and wanted help to be able to cope with it. She exhibited some problems in the area of judgment because her suggestions to deal with her problems were far from feasible.
Intelligence and abstraction – She indicated high intelligence as she was a college graduate. She also exhibited using metaphors in the conversation.
Perception – Usually normal but suspicious of her colleagues and boss at work.
