Manual for Group Cognitive-Behavioral Therapy of Major Depression A ...

Manual for Group Cognitive-Behavioral Therapy

of Major Depression

A Reality Management Approach

Participant Manual

Ricardo F. Mu?oz, Ph.D. Chandra Ghosh Ippen, Ph.D.

Stephen Rao, Ph.D. Huynh-Nhu Le, Ph.D. Eleanor Valdes Dwyer, L.C.S.W.

Drawings by Erich Ippen, M.S.

Cognitive-Behavioral Depression Clinic Division of Psychosocial Medicine San Francisco General Hospital

University of California, San Francisco

May 2000

? Copyright 2000 Mu?oz, Ghosh Ippen, Rao, Le, & Dwyer

COGNITIVE-BEHAVIORAL TREATMENT FOR DEPRESSION Part III: Participant Notes: Introduction Version 2000: May, 2000

TABLE OF CONTENTS

Purpose of the group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The rules of the group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Group introductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Mood check-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Depression information sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Cognitive-Behavioral treatment model. . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Thoughts 1: Thoughts and your mood. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Thoughts 2: Identifying helpful/positive and harmful/negative patterns 18

of thinking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thoughts 3: Decreasing and talking back to your negative thoughts to 26

improve your mood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thoughts 4: Increasing your helpful thoughts to improve your mood and 38

using thoughts to live the life you want. . . . . . . . . . . . . . . . . . . . . Activities 1: Activities and your mood. . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Activities 2: Relaxing and planning to do pleasant activities. . . . . . . . . . 54 Activities 3: Identifying and overcoming roadblocks to doing pleasant 66

activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Activities 4: Setting goals and shaping your reality. . . . . . . . . . . . . . . . . . 79 People 1: People contacts and your mood. . . . . . . . . . . . . . . . . . . . . . . . . 94 People 2: Interpersonal relationship problems and feelings, thoughts, 107

and behaviors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . People 3: Improve your relationships and manage your mood. . . . . . . . . 122 People 4: More tools to improve your relationships and your mood. . . . . 131 Health 1: Understanding the relationship between depression and health. 144 Health 2: Depression, Poverty, and Health . . . . . . . . . . . . . . . . . . . . . . . . 156 Health 3: Depression, Sleep, and Health. . . . . . . . . . . . . . . . . . . . . . . . . . 168 Health 4: Depression, Other Emotions, and Health . . . . . . . . . . . . . . . . . 181

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COGNITIVE-BEHAVIORAL TREATMENT FOR DEPRESSION Part III: Participant Notes: Introduction Version 2000: May, 2000

PURPOSE OF THE GROUP

The kind of therapy we provide in this group is called "COGNITIVE BEHAVIORAL THERAPY"

"Cognitive" refers to our thoughts. "Behavioral" refers to our actions. Depression has most to do with our feelings.

By learning how our thoughts and actions influence our feelings,

we can learn to manage our depression.

? We focus on what is going on in one's life right now. ? During the group, you will learn skills and strategies to help you

manage your depression, meaning ? To make the feelings of depression less intense. ? To make the time we are depressed shorter. ? To learn ways to prevent getting depressed again. ? To learn ways to better manage our lives, despite real

difficulties and problems. ? Our treatment for depression consists of sixteen sessions.

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COGNITIVE-BEHAVIORAL TREATMENT FOR DEPRESSION Part III: Participant Notes: Introduction Version 2000: May, 2000

The sessions are divided into four sections or modules.

1) How thoughts affect your mood. (4 sessions). 2) How your activities affect your mood. (4 sessions) 3) How contacts with other people affect your mood. (4 sessions). 4) Mood and health. (4 sessions).

We will be working on breaking the following four cycles:

Depression

Depression

Depression

Depression

Negative Thoughts

Low Activities

Few & Negative People Contacts

Health and other Emotional Problems

New members are welcomed at the beginning of each of these modules.

The group meetings are helpful because they: ? allow time to share your concerns with others ? provide support from others in the group ? help members realize that they are not alone in having real problems

However, the most important effect of the group is that during the group you will:

? gain a greater understanding of factors that affect your depression. ? learn practical skills, so you can make changes in these factors and

improve your mood. ? learn ways to manage difficult life problems that you are facing. ? learn to avoid unnecessary suffering.

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COGNITIVE-BEHAVIORAL TREATMENT FOR DEPRESSION Part III: Participant Notes: Introduction Version 2000: May, 2000

THE RULES OF THE GROUP

1. Try to come every week (call us or the clinic 206-5189 if you can't make it)

2. Come on time

3. Confidentiality (What is said in the group stays in the group)

EXCEPTIONS: (things leaders cannot keep confidential 1) if we hear about child abuse or neglect 2) if we hear an older adult (older than 65) is being abused or neglected 3) if we hear someone is in danger of hurting themselves or someone else in the future

4. Listen to and support each other

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5. Be respectful

6. Share time as evenly as possible

7. Complete your personal project for the week

to get the most out of the group

8. Tell us if you are unhappy with the group or your treatment

9. You don't have to do anything you don't want to do

10. You don't have to share everything. You have a right to keep some things private.

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