The clinical case of a female patient in her 80s diagnosed with cancer, who has undergone an invasive surgery and is facing difficulty regaining strength and weight while restoring her sleep pattern, is an example of a clinical challenge that needs to be addressed. The patient also faces depression and a lack of motivation towards the treatment process. Cognitive-behavioural therapy (CBT) has been recommended as a potential intervention to address these issues. This blog aims to discuss the CBT theory and methods that can be helpful for this clinical case.
CBT is a goal-oriented, short-term therapy focusing on the interconnection between thoughts, emotions, and behaviours. CBT theory argues that negative thoughts and beliefs lead to negative emotions and behaviours, and modifying thoughts and beliefs can change these negative patterns. Therefore, CBT helps individuals identify and challenge negative thoughts and beliefs and replace them with more positive and constructive ones. CBT also emphasises the role of behavioural activation in improving mood and motivation by encouraging individuals to engage in pleasurable activities that they may have stopped doing due to depression or anxiety.
CBT is an evidence-based therapy effective in treating depression and anxiety disorders. The following CBT methods can be helpful for the clinical case.
Cognitive restructuring is a core method used in cognitive-behavioural therapy (CBT) to help individuals identify and challenge negative thoughts and beliefs and replace them with more positive and constructive ones. This method can be particularly useful in addressing the depression and lack of motivation that the patient in this clinical case is experiencing.
The cognitive restructuring process involves several steps. First, the therapist helps the patient identify negative thoughts and beliefs contributing to their depression and lack of motivation. In this patient’s case, negative thoughts may include beliefs that she will not be able to regain her strength and weight or that her illness is a sign of her body failing her.
Once negative thoughts and beliefs have been identified, the therapist works with the patient to evaluate the evidence supporting these thoughts and beliefs. For example, the therapist may ask the patient to consider times in the past when she has overcome physical challenges or to reflect on the progress she has made in her recovery.
Next, the therapist helps the patient develop more balanced and realistic thoughts and beliefs that support their overall well-being. For example, the therapist may encourage the patient to believe that her body is solid and capable of healing with time and effort or that her illness is a challenge that she can overcome with the help of her medical team.
Finally, the therapist works with the patient to develop strategies for integrating these new thoughts and beliefs into daily life. This may include regular self-reflection and self-talk exercises to reinforce positive thoughts and beliefs or engaging in activities that reinforce these beliefs, such as exercise or meditation.
Overall, cognitive restructuring is a powerful method to help individuals overcome negative thoughts and beliefs contributing to their depression and lack of motivation. By identifying and challenging negative thoughts and beliefs, individuals can develop a more positive and realistic outlook on their current situation, which can be vital to maintaining their motivation and engagement with the treatment process.
Behavioural activation is another method that may be useful in helping the patient in this clinical case regain her motivation and increase her engagement with her treatment. This method is based on the premise that individuals can improve their mood and overall well-being by engaging in activities that bring them pleasure and a sense of accomplishment.
The behavioural activation process typically involves several steps. First, the therapist helps patients identify activities they enjoy or find rewarding. These may include hobbies, exercise, social activities, or other activities the patient has enjoyed or wants to try.
Next, the therapist works with the patient to develop a plan for gradually increasing their engagement in these activities. This may involve setting specific goals for how often and long the patient will engage in each activity and developing strategies for overcoming any possible barriers or challenges.
As the patient begins to engage in more enjoyable and rewarding activities, they may experience an improvement in their mood and overall well-being. This can, in turn, help to increase their motivation and engagement with their treatment and improve their ability to cope with the challenges of their illness.
In addition to its benefits for mood and motivation, behavioural activation may also have physical benefits for patients with cancer. For example, regular exercise or physical activity can help improve strength and stamina, which may be necessary for this patient’s recovery and ability to tolerate cancer treatment.
Behavioural activation is a promising method for helping individuals with depression and a lack of motivation to increase their engagement in enjoyable and rewarding activities. By gradually increasing their engagement in these activities, patients can improve their mood, motivation, and overall well-being, which may significantly benefit their recovery from illness.
Relaxation techniques can be a helpful addition to the treatment plan for the patient in this clinical case, as they can help to reduce stress and promote feelings of calm and well-being. Several relaxation techniques may be helpful for this patient, including progressive muscle relaxation, deep breathing, and mindfulness meditation.
Progressive muscle relaxation involves tensing and relaxing different muscle groups throughout the body. The therapist guides the patient through a series of exercises, such as clenching and releasing the fists or tensing and relaxing the shoulders, to help them become more aware of the sensations in their body and learn to release tension and stress.
Deep breathing exercises involve taking slow, deep breaths and focusing on the sensations of the breath moving in and out of the body. The therapist may guide the patient through breathing exercises, such as counting to a certain number while inhaling and exhaling, or instruct the patient to imagine a peaceful scene while breathing deeply and slowly.
Mindfulness meditation involves focusing on the present moment and becoming aware of one’s thoughts and feelings without judgment. The therapist may guide the patient through a meditation exercise, such as focusing on the breath or repeating a mantra, to help them become more aware of their thoughts and feelings and learn to observe them without becoming overwhelmed.
In addition to promoting relaxation and reducing stress, relaxation techniques may also have physical benefits for patients with cancer. For example, deep breathing exercises may help improve lung function and reduce shortness of breath, a common side effect of cancer treatment.
Overall, relaxation techniques can be a helpful tool for promoting relaxation and reducing stress in patients with cancer. By incorporating these techniques into the treatment plan, patients may be better able to cope with the challenges of their illness and treatment and improve their overall well-being.
Problem-solving skills are essential for individuals with cancer, as they can help them to navigate the many challenges and obstacles that may arise during their treatment and recovery. In this clinical case, the patient may benefit from developing problem-solving skills to help her overcome her lack of motivation and difficulty with appetite and navigate the emotional and logistical challenges of her treatment.
Problem-solving skills involve a systematic approach to identifying and addressing problems. The process typically involves several steps, including:
1 Defining the problem: The patient and therapist work together to identify the specific problem that needs to be addressed. In this case, the patient’s lack of motivation and difficulty with appetite may be identified as the primary problem.
2 Generating solutions: The therapist and patient work together to brainstorm potential solutions to the problem. This may involve considering a range of options, such as dietary changes, exercise, relaxation techniques, or social support.
3 Evaluating solutions: The patient and therapist evaluate the potential solutions and consider their feasibility, potential risks and benefits, and the likelihood of success.
4 Selecting a solution: The patient and therapist select the best solution and develop a plan.
5 Implementing and evaluating the solution: The patient puts the chosen solution into action and monitors its effectiveness. If the solution is unsuccessful, the patient and therapist may revisit the previous steps and consider alternative solutions.
By developing problem-solving skills, the patient may become more empowered to take an active role in their treatment and recovery and better cope with their illness’s challenges. In addition to addressing specific problems related to their illness, problem-solving skills may also benefit the patient’s overall well-being, including improved confidence, resilience, and adaptive coping skills.
Overall, problem-solving skills are a valuable tool for individuals with cancer, as they can help them to navigate the challenges of their illness and treatment and promote a sense of empowerment and control. By incorporating problem-solving skills into the treatment plan, patients may be better able to cope with their illness’s physical, emotional, and logistical challenges and improve their overall quality of life.
The clinical case is a female cancer patient in her eighties who has undergone an invasive surgery and is facing difficulty regaining strength and weight while restoring her sleep pattern. She is also experiencing depression and a lack of motivation, which presents a significant clinical challenge. CBT is a potential intervention that can help address these issues. CBT theory emphasises the interconnection between thoughts, emotions, and behaviours. CBT methods such as cognitive restructuring, behavioural activation, relaxation techniques, and problem-solving skills can be helpful in this clinical case. The therapist can work with the patient to identify and challenge negative thoughts and beliefs, encourage her to engage in pleasurable activities, teach relaxation techniques to improve her sleep quality and help her develop problem-solving skills to manage practical problems. CBT can help the patient regain motivation and positivity towards her treatment process and future.
By Ari Sotiriou M.A. psychodynamic psychotherapist co-founder Online Therapy Clinic