CBT Worksheets for Depression E-Book

Dr James Manning ClinPsyD

• Herausgeber: Ridgeman Mental Health Books
• Kategorie: Geisteswissenschaft
• Serie: CBT Worksheets
• Sprache: Englisch

Seitenzahl: 162

Veröffentlichungsjahr: 2024

Beschreibung

*** Please note. This book now contains a link inside that you can use to print out your own blank CBT worksheets ***

If you are a CBT therapist or a CBT therapist in training you are welcome to photocopy the worksheets in this book for your clients. I have made the paper colour and size ideal for photocopying. You can also photocopy any other part of this book, except for pages where there are cartoons.

I wrote this book because I found that many of my clients found it very difficult to remember topics discussed in their sessions. Over time, I found that using specifically tailored worksheets resulted in therapy becoming more streamlined and efficient. Everything included in this book is information that Dr Ridgeway and I use in the real world of clinical practice.

Chapters in the middle of this book have been written to assist you with the development of psychological formulations. The rule sheets, I have included are a rapid way of finding out what rules your clients hold. Once rules are identified it is then relatively easy to isolate beliefs and behaviours connected to them. This will lead to the development of longitudinal formulations which can be very helpful to you and your clients. This in turn will help you to write case studies and process reports.

I have written this book to be easy to read rather than to impress you with complex vocabulary. Where possible I have included explanations for anything that could be viewed as jargon. When I started work as an assistant psychologist – a psychologist in pre-training - I often attended clinical meetings where Clinical Psychologists and Psychiatrists discussed clients. Words such as formulation, negative reinforcement, sub-cortical response, and such like, went right over my head. It was like the clinicians were speaking a different language. Ideally, if you are just starting out in your clinical career this book will tell you most of the things that you need to know about depression at least.

We have used a metaphor of the Black Dog in this book as we have found as it is often an appealing way in to help clients accept their feelings.

Leseprobe

CBT Worksheets for Depression

A PHOTOCOPIABLE CBT PROGRAMME FOR CBT THERAPISTS IN TRAINING: INCLUDES, FORMULATION WORKSHEETS, GENERIC CBT CYCLES, AND MANY OTHER CBT HANDOUTS

Written by Dr James Manning

Voice of the Black Dog by Dr Nicola Ridgeway & Dr James Manning

CBT Worksheets for depression: ISBN: 9781917369145

Written by Dr James Manning, ClinPsyD

This edition printed 2024

Copyright (c) 2024 Ridgeman Mental Health Books

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, scanning, or otherwise, except as permitted under copyright legislation, without the prior permission of Ridgeman Mental Health Books Limits of liability/disclaimer of warranty –

Neither the authors nor Ridgeman Mental Health Books take responsibility for any possible consequences from any treatment, procedure, test, exercise or action of any person reading or following the information in this book. The publication of this book does not constitute the practice of medicine and this book does not attempt to replace any other instructions from your doctor or qualified practitioner. The authors and Ridgeman Mental Health Books advise the reader to check with a doctor or qualified practitioner before undertaking any course of treatment. Whilst the authors and Ridgeman Mental Health Books have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or the completeness of the contents of this book and specifically disclaim any implied warranties or merchantability or fitness for a particular purpose. No warranty may be created or extended. The advice and strategies contained herein may not be suitable for your situation. You should where necessary consult with a professional where appropriate.

Neither Ridgeman Mental Health Books, nor the authors, shall be liable for any loss or profit or any other commercial damages, including but not limited to special, incidental, consequential or other damages. Case examples referred to in this book are generic and based on collective presentations. No relation to any specific person is either implied or intended. Whilst the authors and Ridgeman Mental Health Books have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or the completeness of the contents of this book and specifically disclaim any implied warranties or merchantability or fitness for a particular purpose. No warranty may be created or extended. The advice and strategies contained herein may not be suitable for your situation. You should where necessary consult with a professional where appropriate. Neither Ridgeman Mental Health Books nor the authors shall be liable for any loss or profit or any other commercial damages, including but not limited to special, incidental, consequential or other damages.

Case examples referred to in this book are generic and based on collective presentations. No relation to any specific person is either implied or intended.

Edited by Nick Hodgson

Technical advisor, Dr Nicola Ridgeway

*** A PDF link to blank worksheets for printing is on page 103 at the end of Chapter 19 ***

About the authors

Dr James Manning is a Consultant Clinical Psychologist and the Managing Director of the West Suffolk CBT Service. James has post-graduate qualifications in both Clinical Psychology and Counselling Psychology. He has regularly offered workshops and training to clinicians throughout the United Kingdom on CBT and continues to work as a therapist.

By the author

Think About Your Thinking to Stop Depression

How to Help Your Loved One Overcome Depression

The Little Book on CBT for Depression

A Simple Introduction to Cognitive Behaviour Therapy for Visual Learners

CBT Worksheets

CBT: What it is and how it works (2nd Edition)

My CBT Journal

CBT Worksheets for Anxiety

CBT Worksheets for Teenage Social Anxiety

Breaking free from social anxiety

A Journey with Panic

Fused: A memoir of childhood OCD and adult obsession

How to befriend, tame, manage and teach your black dog called depression using CBT

Contents

Preface

Introduction to ‘the Black Dog’

How the brain works

What encourages the Black Dog to stay?

Serotonin and 5HT

Getting to know your Black Dog

Consider going to a Black Dog expert!

Making a start using CBT

Avoidance and safety behaviours

Self-observation

Cognitive distortions

Rules

Limiting beliefs

Drawing out simple cycles

More cycles

How to complete a CBT cycle

Challenging negative automatic thoughts

Approaching feelings

Working with emotions

Breaking patterns of rumination

Behavioural experiments

Using desensitisation

Exposure

Help with the Black Dog

Conclusion

Regulatory organisations in the UK

References and additional reading

Glossary

Common Medications

Index

Advice for loved ones

Preface

By Dr James Manning

I am grateful for the freedom that psychological knowledge has given me. It has given me a life I value living and it has offered me an opportunity to help many others along the way. At the risk of sounding a total f**k-up, I’ll explain the background to my life. Hopefully, it will give you some kind of an idea about how I developed such a passionate interest in psychology and how I came to write this book.

Between the ages of 15 and 30, I had a visit from a breed of Black Dog, called Dysthymia. Before this, I experienced sensory hyper-sensitivity, excessive avoidance, attention deficit, obsessive compulsive problems, paranoia, and anxiety. In short, during this time I had significant mental health problems.

I knew that I was different from other people at a very young age, as did my family, but I didn’t have any explanation for it. As I got older, I attempted to cope with problems that life presented me using food, drugs, gambling, and alcohol. I developed a significant alcohol problem as soon as I looked old enough to buy alcohol from an off-licence, (which was when I was about 17).

In my early life the emotion that I struggled with the most was low mood: I had a feeling of being slowed down, and an emptiness that sapped my motivation to engage in life. Normal events seemed more effortful and I found myself withdrawing from day-to-day activities. I started to feel unsettled for most of the time, waking up early for no apparent reason – often at 4 am – churning thoughts over and over in my mind, and not being able to go back to sleep. I withdrew from people, preferring to be alone. I became snappy and irritable, and felt on edge. My relationships generally suffered, and I lost most of my friendships.

I prefer not to blame all of my problems on my childhood. In fact, my childhood wasn’t very eventful relatively speaking, at least not when compared to stories I have heard from many of my clients. I was bullied physically by older children and bullied emotionally by my peers (mainly for being socially backward), and I experienced some mild trauma. Both of my parents were working class people who performed well in their careers and rose through the ranks in their respective employment organisations: in my father’s case to a top management position. My father was a perfectionist and highly obsessive. His perfectionist nature paid huge dividends for him at work – financially and professionally. He supervised award winning civil engineering work: in fact, I saw an old photograph of him recently, being given an award by the Queen of England. He had a tendency to be obsessive in all areas, including at home, and became angry at even slight violations of his high standards. Let’s say as a hormonal teenager, I violated his standards pretty much all of the time and he struggled with parenting me as a teenager. In retrospect, he probably found it difficult to parent me because when he looked at me, he saw himself.

My parents emigrated from Ireland when they were teenagers. They were very young when thrust into the responsibilities of parenthood and as you might expect from young parents, they didn’t really have much experience of looking after children, but they were really no different from my friends’ parents.

I think my parents did their best to bring me up, based on the knowledge they had, but I struggled with being a child. If I choose to, I can still hear the sound of my mother’s voice saying the words she repeated almost daily in her soft Irish accent: ‘Childhood are the best years of your life, enjoy it while you can.’ This confused me as my childhood felt terrible! And, to make matters worse it seemed like my life was going to go downhill even further if these were the best years of my life. I had low self-esteem, and deeply entrenched beliefs that I was inadequate, stupid, bad, defective, weak, weird, and worthless as a person. I had no one I could talk to, so I kept my fears to myself and spent a lot of my time fighting my beliefs, keeping them hidden while I worked to prove them wrong.

As a young person, there were a number of positives that I could have drawn something from. By the time I reached 15, outsiders would have considered me a privileged child. I had some friends, and I had the support of a well-off family. I lived in a leafy suburb just outside London, and I had gained entry to a state selective grammar school, which at the time was one of the top schools in the country.

Unfortunately, however, I was not able to use what I had been given. By the age of 15, depression had started to hit me quite hard and my motivation to engage in life began to drop significantly. School teachers were not impressed with my academic performance and reported back to my parents that I was underachieving academically. I passed my first set of exams at 16 and went on to do advanced exams, where I achieved less than spectacular results. By the time I was doing my advanced exams, teachers had noticed the changes in my behaviour and had begun to monitor me more closely. One day my chemistry teacher approached me with a frown on his forehead – which seemed to be furrowed even more than usual – muttering, ‘If you’re not paranoid you should be!’ A short time later I was told that the teachers held a meeting about me and I was placed on report: this is where teachers monitor a student much more closely and have regular meetings with them. By then I had dropped out of most of my sports teams such as rugby and cross-country running, I struggled with my friendship groups and eventually found myself dropped from them. Things weren’t really going too well from a teenager’s point of view. By this time, I already felt that I was a failure in life.

After leaving school you could say that I had a lucky break and gained a position in a small commodity brokers. I struggled to retain this role, not because of my ability to do the technical part of the job, but because of my lack of ability to regulate my mood and deal with interpersonal conflict. Basically, I found it difficult to get on with people. One day I found myself challenging a commodity trader for breaking what I thought were the rules of trading. The problem was that he worked for a very important client. The next day I was invited to my Managing Director’s office and given my notice.

A number of further jobs followed, assisted at times by the support of my parents, but again I experienced interpersonal problems and had further dismissals. As time progressed, I found that my CV was beginning to look less and less promising as I moved from one job to another. On paper I thought I had begun to look unemployable and out of desperation began working for financial companies with dubious or unethical outlooks. Ioon found that I couldn’t work for companies like these, due to my moral stance on life, so I gave up working in the City. Following this, I continued to work my way down the pay scale hierarchy. Eventually the only work I could find was temporary work in factories, delivering pizza, and working as a cleaner for a minimum wage. A friend of mine Joe, a fund manager at Hill Samuel (a leading merchant bank in London at the time) tried to call me and left messages with my parents over a period of several months. I didn’t return his calls. I treated him very poorly considering we had developed a close friendship over a number of years. I basically abandoned him with no thought about how it might affect him.

Moving from plush offices to factories and such was a bit of a culture shock for me and I was dismissed from two of my minimum-wage cleaning jobs for not following the requested instructions. I am embarrassed to admit that practically the only job I didn’t get the sack from before I was 28 was my pizza delivery job at Pizza Hut, and even that job was painful sometimes. From time-to-time I found myself delivering pizza to some of my-now-successful grammar school peers, who appeared speechless when they opened their door to find me standing there with a pizza for them.

By that time my sense of inadequacy was fully reinforced and I had switched off emotionally. I became quite hard-up financially and my mindset had become quite extreme and rigid. I didn’t want to use the unemployment system or to ask my parents for help, as in my mind this would have confirmed to me that I really was not succeeding in life. Sometimes I couldn’t earn enough money to pay rent, so I ended up spending months living in a tent at a campsite where the rent was £4 per day. At other times I could pay the rent but was left eating potatoes and baked beans as my only source of nourishment.

I continuously felt that I was failing in some way. I felt empty inside. I just didn’t feel like I had the energy to do things; I wanted to escape from my problems and myself. The only time I really felt OK was when I was asleep. I became quite reclusive and more nocturnal. I often did not attend events that I had been invited to, mostly without sending an apology or letting people know. I didn’t answer the phone to friends or return their calls. The number of friends I had dwindled to just one. I think the only way that this friend managed to tolerate me was to laugh about the way I behaved, and to recognise that he was not responsible for my behaviour. I felt so insignificant that I genuinely believed other people wouldn’t notice or care whether I turned up late for planned events, or would even be bothered if I attended them at all. All my focus was on myself. It was a pitiful kind of self-loathing with endless questioning about why my life was so broken. I was so detached that I had little regard for other people’s feelings or my own.

Most of the time I did not want to live anymore and hoped I would die. It was as if my body, mind, and personality were unacceptable to me.

Luckily, in my very late twenties and early thirties I found a few excellent therapists. I worked hard on my therapy - which in my case needed a couple of years, as I had left things for so long before getting help. I brought negative and self-defeating thoughts that I had into conscious awareness and began to make significant changes to my life. I changed my life using many of the processes I have covered in this book. I’m 49 now, and I have been fortunate to have worked with my colleague Dr Nicola Ridgeway in treating several thousand clients over the years, and I haven’t looked back since. I am still grateful to have the opportunity to help others who are stuck to free themselves and move on with their lives.

I continue to use many of the exercises and coping strategies that I learnt in my therapy to keep in a good state of well-being. I can state categorically that if I were to stop using my coping strategies now, I would very quickly drift back into mental health problems. I have learnt that psychotherapy is not a quick fix. Many people make initial positive gains after completing a course of therapy, but many relapse after a number of years. An important message I would like to get across, therefore, is that therapy is not a short-term solution to your problems. You will need to keep using what you learn in therapy for the rest of your life: complacency is the biggest risk factor in relapse.

Chapter 1

Introduction to ‘the Black Dog’

The use of the term ‘the Black Dog’ to describe symptoms of depression can be traced back to 40 BC when it was included in the work of the Roman poet Horace. In more recent times it was made famous by Winston Churchill, the Prime Minister of Great Britain during World War II who often referred to his Black Dog, and the Australian writer and illustrator Matthew Johnstone who wrote the best-selling book, I had a Black Dog.

For centuries the Black Dog has been associated with fear, intense pain, and emotional distress. In the literature the Black Dog has a formidable reputation. Run from it, and it will hunt you down relentlessly. Wrestle with it, and it will bare its fangs. Fear it, and it will stalk you unabatedly. Hide from it and it will haunt you until you are all but a shadow of your previous self. Feed it and it will become much bigger than you. For some, suicide feels like the only way to escape from it.

The irony, however, is that the Black Dog is misunderstood. By the time that you finish reading this book you will find out that the Black Dog is not your enemy: nothing could be further from the truth. The Black Dog is loyal and will never let you down. I had my own journey with the Black Dog for many years and at first I didn’t have a good relationship with it. I felt that it was ruining my life. This was until I recognised its true intention. The Black Dog has its own language, and follows a specific set of commands and rules. Once you understand the Black Dog, how it operates, and how to communicate with it, you will find that it will happily remain in the background, rather than taking a dominant role in your life.

What happens when you have the Black Dog?