This book uniquely combines CBT with the Department of Health stepped care model to provide the first comprehensive case study-approach textbook. A step-by-step guide to using CBT, the book is structured around case examples of clients who present with the most commonly encountered conditions; from mild depression and GAD to more complex, enduring symptoms and diagnosis like OCD, personality disorder and social phobia.

The distinctive practical format is ideal in showing how to put the principles of CBT and stepped care into effect. As well as echoing postgraduate level training, it provides an insight into the experiences the trainee will encounter in real-world practice. Each chapter addresses a specific client condition and covers initial referral, presentation and assessment, case formulation, treatment interventions, evaluation of CBT strategies and discharge planning.

The book also includes learning exercises and clinical hints, as well as extensive reference to further CBT research, resources and reading. It will be invaluable for trainees on Improving Access to Psychological Therapies (IAPT) programs, and anyone studying graduate CBT courses.

Client Presenting with Dysthymia (Chronic Depression)

Client presenting with dysthymia (chronic depression)

Learning Objectives

By the end of this chapter you should be able to:

  • Identify the symptoms of dysthymia using diagnostic criteria
  • Explain the development and chronicity of dysthymia
  • Outline a case formulation and decide on cognitive and behavioural interventions
  • Discuss the implementation and evaluation of the treatment interventions

Diagnostic Criteria

Dysthymia is a chronic type of depression in which low moods continue or persist over a long period of time. Dysthymia can occur alone, or the client may have episodes of more severe depression. It is long lasting and often resistant to treatment.

Dysthymia should be differentiated from major depressive episodes, the diagnostic criteria for which were presented in Chapter 3. In both the DSM-IV-TR (APA, 2000) and ICD-10 (WHO, 2007) dysthymia, ...

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