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CBT Approach for Dysthymic Clients
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the last section, we discussed Changing the Lens through which your client views
In this section, we will talk about another cognitive approach for dysthymic
clients. I call this Cognitive Behavior Therapy technique the Negative Mudslide.
main targets of Cognitive Therapy, as you know, involve the conceptual and behavioral aspects of the disorder. The following technique may enable Waylon,
a 49 year old engineer, to think more realistically. As he is able to
see the future more objectively and view himself and his external environment
with more of a perspective, there was a corresponding improvement in the rest
of his symptomology.
♦ CBT: The
Negative Mudslide Technique
The Negative Mudslide concept was particularly
valuable with Waylon who seemed more upset than the thoughts he's reporting
seemed to warrant. I found the visualization of a mudslide helped Waylon see the
pattern of his behavior as a trend in a downward mood, and not just as an isolated
negative mudslide showed Waylon a series of events happening, from first to last.
As you can see this is a similar concept to the ABC and Lens Changing interventions
described on the previous two sections.
you think of falling down a mudslide, do you think of first losing your balance at the top of a hill because of loose ground beneath you? Because the mud on the
hill is soft, it is difficult keep your balance and you will continue traveling
downward. For Waylon one single thought caused him to lose his balance, so to
speak. Once he began to travel down this hill, he began having numerous thoughts
that caused him to panic about something else and slide further. The closer he
gets to the bottom of the mudslide, the faster these thoughts come.
looking into all of his thoughts, from beginning to end, Waylon, a client I had
seen for six sessions, was better able to assess when and where his problems started.
The mudslide pattern helped Waylon to go through the steps of his problems by
focusing on what started the mudslide and what thoughts came from it.
mood was disturbed by underlying beliefs, assumptions, or fears. This is what
made up the soft mud. His "fall" was caused by this soft mud, not by
the thoughts or images he was most aware of.
♦ Example: Here is How the "Negative Mudslide"
Worked with Waylon
had been off work for four months because of his depression. He was to start work
again in two weeks. He came to one of his therapy sessions in deep distress, because
he had, as he said, "fallen apart" last weekend.
Waylon: He'd said, "I
am back to square one. I spent all weekend lying on the couch, feeling low."
We were able to trace the beginning of his falling mood to a moment when he was
helping his wife move boxes in the loft of his house.
asked him, "What was going through your mind when you were moving the boxes?"Waylon: Waylon
answered, "Well, we were just shifting some things. Everything seemed OK.
Then I felt a little tired and I thought I'd better stop. Then, I suddenly began
to feel terrible."
asked, "Can you recall anything else that might have gone through your mind?"Waylon: Waylon
responded, "No, it just hit me."
I said, "You mentioned you felt tired. I wonder if we could just follow that
up. If you had kept feeling tired, what would have happened?"
thought a moment and responded, "If I felt tired of doing that little job, how am I going to cope when I go back to work?"
asked, "How do you feel about that?"
said, "My bosses have been great in the past, but they're bound to lose patience
sooner or later."
then asked, "You mean, you think you may need more time off?"
responded, "If I get tired just moving boxes around in the loft, maybe
I'm not ready for work."
I asked, "And if you're not ready for work, what do you think may happen
when you go back?"
said getting a little upset, "I'll only last a few days. I'll be off again.
They won't stand for it any more. I think that'll be the end of it."
asked, "The end of the job?"
said, "Yes. The job, me, my family - I don't know how we'll keep going if
I can't work. It will be the end of everything."
some silence, I said, "Do you remember you said you felt a little tired when
moving things around in the loft - then felt really bad?"
then asked, "Do you think the feeling tired might have triggered off all
these feelings and worries about work?"
Waylon said, "That may be what happened. I was kind of thinking about not
being able to cope at work - just everything going wrong - but then I just felt
so depressed, I went to lie down and didn't get up all weekend."
continued to try and identify other such situations where Waylon's fear of
the future affected him. With Waylon, it was important to fully assess the
times that his underlying assumptions and fears affected his thoughts and mood
before I proceeded to challenge theses assumptions and fears. His negative mudslide
could be written out during or after this sort of interchange. An example of the
negative mudslide, for Waylon, would be something like this...
asked Waylon to visualize the top of the hill. For Waylon, the top of his
hill was feeling tired.
Merely feeling tired moving boxes in his loft led
to the following mudslide of thoughts:
• If I feel tired from moving
boxes, how am I going to cope with work?
• I probably won't be able
to cope with work
• The bosses will lose patience
• I'll get
no more time off
• Then they'll have to fire me
• The job
will be finished
And finally, at the bottom of the mudslide,
• My family and I will be finished
Waylon understands that his beliefs, assumptions, and fears are just that, he
probably will find it difficult to move onto challenging these assumptions.
Peer-Reviewed Journal Article References:
Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72.
Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378.
McCullough, J. P., Jr., Klein, D. N., Keller, M. B., Holzer, C. E. III, Davis, S. M., Kornstein, S. G., Howland, R. H., Thase, M. E., & Harrison, W. M. (2000). Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): Validity of the distinction. Journal of Abnormal Psychology, 109(3), 419–427.
What do the main targets
of Cognitive Therapy include, and what model is useful to visualize the trend
of a downward mood? To select and enter your answer go to .