Case Studies in Cognitive Behavioral Intervention

Dedicated to all the people who trusted me in my professional and academic journey

Contents

1. List of Figures

2. List of Tables

3. Foreword

4. Preface

5. Acknowledgments

6. CBT Across Mental Health Conditions

   Susmita Halder

7. Chronic Stress in Working Adults

   Akash Kumar Mahato

8. Adults with Traumatic Experience

   Sampurna Chakraborty

9. Depression and Loneliness in the Elderly

   Avinash De Sousa and Susmita Halder

10. Mild Cognitive Impairment with Anxiety and Depression

    Arpita Roy Chowdhury and Susmita Halder

11. Somatization in Adults

    Anuna Bordoloi and Diya Chatterjee

12. Stress and Depression in Gen Z

    Pooja Bharadwaj and Roseline Florence Gomes

13. Emotional Dysregulation and Emerging Psychopathology in Adolescents

    Debaleena Ghosh, Nishant Goyal, and Susmita Halder

14. Self-Harm Behavior in Adolescents and Young Adults

    Divya Prasad and Sharbari Dutta

15. Psychoactive Substance Addiction in Youth

    Arya Arvind and Joydeep Das

16. Managing Trichotillomania

    Snehal Jog, Pragya Lodha, and Avinash De Sousa

17. Challenges in Romantic Relationships

    Madhurima Dey Sarkar and Susmita Halder

18. Cognitive Behavioral Couple Therapy for Marital Health

    Aparajita Chakraborty and Atanu Kumar Dogra

19. Overcoming Selective Mutism

    Ann Choolackal

20. Managing Crisis in Adolescents with Law Violations

    Saranya Banerjee and Sanjukta Das

21. Distress and Coping in Psychogenic Nonepileptic Seizures

    Jacob K. John and Vishranti Uttam Sathe

22. Diabetes and Related Psychological Conditions

    Shinjini Samajdar and Akash Kumar Mahato

23. HIV-Related Illness Anxiety

    Neha Parashar and Arun Kumar V

24. CBT for Community Well-Being

    Arif Ali and Fayaz Ahmad Paul

25. Essentials Skills for CBT Practitioners

    Susmita Halder

26. Notes on Contributors

Figures

1. Figure 2.1 Components of conventional assessment in chronic stress leading to psychotherapeutic formulation

2. Figure 2.2 CBT case formulation for chronic fatigue

3. Figure 3.1 Therapy conceptualization of Dr. R based on Barlow’s Triple Vulnerability Model (Barlow et al., 2009)

4. Figure 3.2 Tailored therapeutic formulation of Dr. R based on CBT conceptualization

5. Figure 3.3 Tailored psychoeducation model for Dr. R

6. Figure 3.4 SUDs and HAM-A scores

7. Figure 3.5 Tailored CBT case conceptualization of anxiety linking it with traumatic experience

8. Figure 4.1 Case formulation

9. Figure 5.1 Case formulation of Patient 1

10. Figure 5.2 Case formulation of Patient 2

11. Figure 5.3 Case conceptualization of Patient 1 from the Awareness of Age-Related Change (AARC) Model

12. Figure 6.1 Expanded CBT model of medically unexplained symptoms proposed by Deary et al. (2007)

13. Figure 6.2 Cognitive perceptional model of somatoform disorders by Kirmayer and Taillefer (1997) adapted to the case of Dr. S.

14. Figure 6.3 Cognitive behavior model for health anxiety proposed by Salkovskis et al. (2003), adapted to the case of Mr. R.

15. Figure 8.1 The emotional dysregulation trap

16. Figure 9.1 Family dynamics and self-harm behavior

17. Figure 10.1 Blueprint of CBT formulation

18. Figure 12.1 Case formulation of the case under study

19. Figure 14.1 CBT formulation of Selective Mutism

20. Figure 15.1 Pictorial representation of the Skill Deficit Model

21. Figure 17.1 Prevalence of diabetes—India

22. Figure 17.2 Clinical history taking of a diabetes patient

23. Figure 17.3 Physiological basis of depression in diabetes

24. Figure 17.4 Factors associated with anxiety symptoms in diabetes

25. Figure 17.5 Role of CBT in diabetes management

26. Figure 17.6 CBT model for diabetes management

27. Figure 17.7 Case formulation 1

28. Figure 17.8 Case formulation 2

29. Figure 17.9 Psychotherapeutic plan for diabetes

Tables

1. Table 4.1 Outcome Measures

2. Table 5.1 Performance of Patients 1 and 2 on the Neuropsychological Tests

3. Table 5.2 Intervention Plan for Both the Patients

4. Table 5.3 Comparison of Negative and Positive Aspects of Aging of Patient 2

5. Table 8.1 A Thought Record

6. Table 10.1 Outcome Measures: Pre and Post Intervention

7. Table 12.1 Session-Wise Intervention Planning for Using ACT with Conflicts in Romantic Relationships

8. Table 15.1 Strengths and Deficits Profile Through Psychological Assessment

9. Table 15.2 Three Modes of Intervention

10. Table 15.3 Outcome of Intervention

11. Table 16.1 Clinical Indicators Used to Differentiate Between Epileptic Seizures (ES) and Psychogenic Nonepileptic Seizures (PNES)

12. Table 17.1 Psychotherapeutic Approach Offered

13. Table 18.1 Session Content Used During Psychoeducation

Foreword

In this day and age, where our world is increasingly digital and hectic, coupled with post-COVID recovery issues compounded by a rapidly aging society with increasing psychological problems among the young, psychotherapy is no longer reserved for classic psychiatric disorders such as major depressive disorder and generalized anxiety disorder. We have moved from a volatile, uncertain, complex, and ambiguous world to a brittle, anxious, nonlinear, and incomprehensible (BANI) world with massive disruptions due conflicts, political tensions, climate crises, and diseases. Watching the news itself can be a traumatic exposure on top of the continued waves of toxicity that are frequently seen on social media.

Even in contemporary academia, things are heating up. Competition is getting much tougher, and higher education institutions are racing toward higher rankings every year, on top of providing the best education they can give to the new generation of learners who come with their set challenges and vulnerabilities growing up in the COVID-19 era. Being an academic myself, I am feeling the heat as I write this foreword because there are tons of overdue tasks (with this one being one of them) and newly landed tasks to get done within a concise while. It is difficult enough to just stay afloat because complacency has no place in a BANI world. I know, because my role as a professor at a private not-for-profit university involves constant innovation in leadership to ensure that the institution thrives! There’s no slowing down to keep on achieving.

I bring up this sense of pressure and feeling overwhelmed at the beginning of a book on cognitive behavior therapy (CBT) because I’d like to make the point that there is a massive role for CBT in our world today. In a huge population such as India, it is even more pressing for CBT to go beyond the basics. At the point of writing, India has the largest population in the world, with 1.428 billion people, surpassing China in 2023. This means it technically has the greatest number of people in need of psychological help. If we were to apply the numbers, 1 in 5 people at any one time would experience a significant psychological problem!

So, the timing of this book is a very good one. The urgency with which its editor, Dr. Susmita Halder, got me to pen a few words is a testament to its importance. I agreed to write this forward because I fervently believe that India can lead the way in bringing CBT forward toward population-level impact to address the mental health of its people in an increasingly challenging world. Dr. Halder, the current Secretary of the Asian Cognitive Behavioral Therapies Association (ACBTA) has the advantage to steer the development of CBT in India and the rest of Asia.

Although not from India myself, my work with ACBTA as the former Secretary has given me enough exposure to inform me of the dynamism of the mental health professional community in the country. Having attended the 8th Asian CBT Congress at the All India Institution of Medical Sciences (AIIMS) in New Delhi in 2024, I am convinced that the hunger and passion that I saw in the local delegates in wanting to learn more about CBT and to research it would bear fruit in the form of novel interventions to suit its people and culture. It is a fascinating time for the development of CBT in India. One other reason why I agreed to write this foreword is because I truly admire Dr. Halder’s academic integrity. I have been following her work since I met her in Berlin for the 9th World Confederation of Cognitive and Behavioral Therapies 2019 where she wowed the crowd with her presentation on clinical neuropsychology. She impresses me as a very systematic and meticulous researcher and clinician whose methodical approach to work brings about excellence in outcomes. It is no wonder that she is the current Dean of Arts and Social Studies at St. Xavier’s University, Kolkata where she is also a full professor. So, it is a great honor for me to say some words to celebrate this book. There is no doubt that Dr. Halder has brought together a very experienced group of authors to share their insights for the research and practice of CBT in India. Under her leadership, I believe it would be a major reference not just in India but in the whole of Asia, if not the world.

This book, I feel, has the main elements to steer the practice and research of CBT beyond just typical psychiatric disorders but into addressing contemporary issues as presented in its chapters. CBT has become a mainstay in the world of evidence-based psychotherapy. As such, it is very apt that this book looks into how CBT can be applied in the concerns of today’s society.

As a clinical psychologist by training, I am heartened to see a good range of very pertinent conditions being discussed in this book and how CBT can be applied as part of the overall treatment. These include issues of an increasingly aging society such as loneliness and neurocognitive disorders. The phenomena of Generation Z youths being more susceptible to depression and anxiety as well as self-harm are also touched on, which is very relevant given its global relevance growing up in a largely digital world where social media has become a large part of their reality. Daily concerns such as romantic relationships and marriage quality are also covered, making it more or less a complete family picture with regards to CBT application.

There is also a balance of topics looking into medical conditions such as diabetes, HIV/AIDS as well as rare conditions such as selective mutism, trichotillomania (hair pulling) and nonepileptic seizures. The book also covers childhood trauma and self-harm, something that is increasingly brought up in therapeutic settings. I am especially excited about discussions on new wave CBT methods and community mental health because of its focus on population-level impact.

I believe this book is the first of its kind for India. There have been chapters and special volumes on CBT in India but not a complete book. I congratulate Dr. Susmita Halder and her team of authors on the publication of this book. I look forward to seeing it being a main reference for all mental health providers in India and beyond. Let this be a first of many editions of the book, as the science of research and art of therapy evolves. My sincere gratitude goes to Dr. Halder for having me as part of this project. To you, the readers, I hope you enjoy this book and have it as your reference for learning and reflections. Namaste.

Dr. Alvin Lai Oon Ng, DPsych, FMASO

Professor of Psychology

Department of Psychology

School of Medical and Life Sciences

Sunway University, Malaysia

August 2, 2024

Preface

Cognitive behavioral therapy (CBT) is often touted as the gold standard in psychotherapy. It stands as a cornerstone in the field of psychology, offering a structured approach to understand and address a wide range of mental health issues crossing cultural boundaries.

As a therapist, navigating the complexities of human behavior and thought processes can be challenging, yet immensely rewarding. This book, Case Studies in Cognitive Behavioral Therapy: Beyond the Basics, presents a collection of insightful and instructive cases that delve into applying CBT techniques in real-world settings. Over the past fifteen years of my clinical practice, I have extensively used CBT in my clinical training in diverse mental health conditions and found it equally effective in reducing suffering and maintaining wellness. The awareness regarding mental health issues has seen a positive trend, and there is a growing number of people consulting psychotherapists for mental health needs apart from the conventional anxiety and depressive disorders.