A 15-year-old client presents to the PMHNP for therapy. She reports persistent feelings of sadness for the last year. She has trouble sleeping and has lost 12 pounds in the last few months. She used to enjoy participating in choir and drama club at her school, but no longer enjoys her favorite activities. She is experiencing problems in her social relationships due to difficulty making friends and often feels lonely Diagnosis: Major depressive disorder In the above case scenario, patient meets the criteria for major depressive disorder. She presents with symptoms of persistent feeling of sadness since last year, sleep disturbance, weight loss, anhedonia and social withdrawal
Selected psychotherapeutic approach with rationale:
Cognitive behavioral therapy has been shown effective in the treatment of depression,
anxiety, eating disorder, substance use disorders and other many mental illneses as o
monotherapy or in combination with medications. According to Ritvo et al. (2021),
“Cognitive behavioral therapy is the best validated psychotherapy and in recent years has
been co-ordinated with mindfulness meditation following strong evidence of the combined
efficacy”(p.24380). CBT helps identify negative thoughts that may be contributing to
depression, challenge them and teaches skills to cope and develop positive outlook on life.
Therapeutic techniques to employ:
Techniques like guided imagery, problem-solving skills and cognitive restructuring may be
used in CBT. Guided imagery helps patient visualize realistic outcome. This gives hope and
prevent disappointment. Problem-solving skills helps identify problem and develop solution
to the problem. Cognitive restructuring is a technique used by therapist to help the patient
identify and replace cognitive distortions with balanced thoughts.
Psychopharmacology inclusion with rationale:
CBT therapy may be more effective in combination with anti-depressants. SSRIs and SNRIs
are the first line treatment for MDD. Citalopram and Escitalopram are the first line
treatment for children and adolescents in treatment of depression in conjunction with CBT
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