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Sep 12 10:37pmLast reply Sep 13 10:29pm

Manage Discussion by Nancy Pierre

Reply from Nancy Pierre

Module 4 Initial Post

For patients with depression, the task of recording their negative thoughts for cognitive behavioral therapy (CBT) can be particularly challenging due to several reasons.

 Depression often causes fatigue and lack of motivation, making it hard for patients to find the energy or focus to complete even simple tasks, like writing. Motivation and low energy can be a factor. Depression can also affect concentration and memory, making it difficult for patients to accurately recall or articulate their thoughts (Wenzel et al., 2016).  Overwhelming negative thinking is also a mitigating factor. Patients may already be consumed by negative thoughts, and the process of writing them down can feel overwhelming or reinforce their feelings of hopelessness. Confronting negative thoughts might feel too painful, leading to avoidance. Emotional pain is not an avenue depressed patients like to encounter. The act of documenting them forces patients to engage directly with distressing emotions they may want to avoid. In addition, having to be consciously aware of certain realities, by writing them down, can often lead to self-critical thinking, which could make patients feel like they’re failing at therapy if they struggle to complete the task or if they judge their entries harshly (Corey, 2023). This difficulty emphasizes the importance of support from the therapist to guide the process, ensuring patients feel safe and encouraged when engaging in such exercises.

In Caribbean cultures, the perception of negative thoughts can be influenced by several factors, including cultural values, family dynamics, and societal norms. While it's important to recognize that the Caribbean is a diverse region with varied traditions and beliefs, there are some general patterns that might affect how negative thoughts are viewed. These factors are stigma around mental health, resilience and strength, and spiritual and religious interpretations.

Mental health issues, including persistent negative thoughts, can be stigmatized in many Caribbean communities. Negative thoughts may not always be openly discussed, and people might avoid sharing them due to fear of judgment or being seen as weak or unstable. This stigma can lead to a reluctance to seek help or address mental health concerns. Caribbean cultures often emphasize resilience, strength, and "toughing things out." Negative thoughts might be dismissed as something one should simply overcome through willpower or faith, without professional help. This can make it harder for individuals to feel validated in expressing or addressing their struggles.

 In some parts of the Caribbean, negative thoughts may be attributed to spiritual or religious causes. Some people may believe that negative thoughts are linked to a lack of faith, a spiritual attack, or punishment from a higher power. In such cases, prayer, religious rituals, or consulting spiritual leaders may be preferred over therapy. Caribbean cultures are often highly collectivist, with a strong emphasis on family and community support. While this can be a protective factor, there might also be pressure to "keep up appearances" for the sake of the family. Negative thoughts might be kept private to avoid burdening others or bringing shame to the family. Being raised in a Caribbean culture, we were often taught to "be strong and resilient." Unfortunately, mental health continues to be viewed as a taboo and something that remains a secret in most families.

Overall, while negative thoughts may be perceived differently across various Caribbean subcultures, there can be significant barriers to addressing them due to stigma, cultural expectations, and reliance on spiritual solutions. Although progress has been made, pertaining to eliminating the stigma of mental health, we still have a long way to go.

References

Corey, G. (2023).  Theory and practice of counseling and psychotherapy (mindtap course list) (11th ed.). Cengage Learning.

Wenzel, A., Dobson, K. S., & Hays, P. A. (2016). Cognitive restructuring of automatic thoughts. In  Cognitive behavioral therapy techniques and strategies (pp. 87–107). American Psychological Association.  https://doi.org/10.1037/14936-005Links to an external site.

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Jeania Romeus

Sep 12 10:16pmLast reply Sep 12 10:49pm

Manage Discussion by Jeania Romeus

Reply from Jeania Romeus

Automatic Thoughts

Cognitive behavioral therapy is a psychotherapeutic intervention that is based on the assumption that understanding an individual’s views or perception toward themselves or a situation will influence their assumptions, behaviors, and reactions. Therefore, Cognitive Behavioral Therapy (CBT) uses various techniques to restructure the patient’s thinking patterns and beliefs to improve self-esteem and eliminate negative thoughts about oneself, the future, and the world. Modifying the patient’s thoughts can also assist in changing the patient’s behaviors and emotions. The use of CBT techniques can be useful in the identification of irrational automatic thoughts such as all-or-nothing thinking; this is common for patients with depression who perceive that they are worthless.

The patients can be asked to document their negative thoughts as part of homework during the CBT session. Homework focuses on generalizing the patient’s knowledge and encouraging the patient to apply the practical skills that he has learned or acquired during therapy (Prasko et al., 2022). However, homework assignments can be difficult as the patient might not feel comfortable opening up or looking deep into themselves to answer difficult questions (Prasko et al., 2022). Homework allows patients to learn how to raise hypotheses and test them in real-life situations hence building independence. Some of the challenges include the chronicity of the patient’s problems, low distress tolerance, and difficulty recording thoughts. It can be difficult for depressed patients to record their negative feelings because these feelings can be too intense making it difficult for the patient to confront them. I can imagine dealing with a depressed patient who is given homework to document the death of a spouse; such a situation can be emotionally overwhelming for the patient. The other difficulty can be linked to the fear of being judged harshly; the patient might not be comfortable sharing their authentic feelings as they feel they can be judged and shamed for their actions or beliefs. A good example is a patient with suicidal ideations; she might not document these ideations because of the fear of being judged negatively by the practitioner. Patients who are still in denial or those who are avoiding or repressing their feelings and emotions will find it difficult to share a true account of their feelings. Overall, asking a patient to record their negative thoughts as homework can be nerve-racking and distressing; the practitioner must be careful to first empower the patient with the needed skills to cope with these negative feelings (Malik et al., 2022).

As an African American, it is saddening to see how mental illnesses are stigmatized within my community. According to the American Psychiatric Association (APA), African Americans believe that mild depression or anxiety would be considered “crazy” in their social circles (American Psychiatric Association. 2020). Furthermore, many believe that discussions about mental illness would not be appropriate even among family members (Bailey et al., 2019). Therefore, the presence of negative thoughts such as feelings of hopelessness and suicidal thoughts will be perceived as a sign of weakness.

An automatic thought record encourages the depressed patient to reflect on a situation that happened and explore the emotions and thoughts that she had as a result of this situation. The patient then works in collaboration with the practitioner to identify and clarify automatic negative thoughts that are irrational and those that are rational; confronting these negative thoughts can assist in eliminating negative schemas hence improving the patient’s mental health and well-being (Prasko et al., 2022). To encourage the patient to use the automatic thought record, I will first educate her on the importance of this technique in identifying any negative thoughts. I will also empower her with practical skills such as breathing exercises that she can use when noting down painful situations to ensure she does not get overwhelmed (Prasko et al., 2022).

References

American Psychiatric Association. (2020).  Addressing mental health stigma in African American and other communities of color.  https://www.psychiatry.org/news-room/apa-blogs/addressing-mental-health-stigma-in-african-americaLinks to an external site.

Bailey, R., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: Current perspectives.  Neuropsychiatric Disease and Treatment,  15(1), 603–609.  https://doi.org/10.2147/ndt.s128584Links to an external site.

Malik, A., Sudhir, P. M., P.V., P., Munivenkatappa, M., Kumar, A., & Sharma, M. P. (2022). Client perspectives on perceived barriers to homework adherence in psychotherapy: An exploratory study from India.  Asian Journal of Psychiatry,  75(1), 103206.  https://doi.org/10.1016/j.ajp.2022.103206Links to an external site.

Prasko, J., Krone, I., Burkauskas, J., Vanek, J., Abeltina, M., Juskiene, A., Sollar, T., Bite, I., Slepecky, M., & Ociskova, M. (2022). Homework in cognitive behavioral supervision: Theoretical background and clinical application.  Psychology Research and Behavior Management,  15, 3809–3824.  https://doi.org/10.2147/PRBM.S382246Links to an external site.