Advanced Deficit Hyperactive Disorder

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Relevant and irrelevant variables

Referring to the case study, several variables can be identified which adequately fit within the behavioural approach. Critically analysing the chronology of the symptoms in Sally’s behaviour, it can be strongly suggested that her current state of being a victim of MDD, is not a reaction to an isolated event rather it began 3 years ago when she was preparing for her first child (Mary) to leave home and then Jack. Lejuez Brown and Hopko (2009) mentioned that this significantly relevant to Sally because her parents had always reinforced ‘success’ in her and for Sally, it was a priority, with self-punishment for the perceived failures. Skinner (1971) in this regards mentioned that this phenomenon will result in the development of negative emotional side-effects because of unachieved goals. As Sally could have used the area of motherhood to feel pride for herself and can feel some sense of accomplishment, the loss of the role along with the accompanying reinforcement had played an extremely significant role in the development of her depression, especially MDD, as per the behavioural formulation.

Several other variables have been identified in the behaviour of Sally leading to depressed behaviour and MDD, for e.g. she mostly avoids swimming only because of the fear that others will think of her as an overweight in the swimsuit. These types of behaviours are specific targets for the interventions to be designed because such behaviour will lead to less exercise and absurdly getting heavier. Further, despite the fact that she was having a strained relationship with her children, she is also getting far away from her husband, therefore, reducing access to interpersonal reinforcements.

Lejuez Brown and Hopko (2009) mentioned that analysing the case of Sally one might believe that the behavioural approach of formulating and treating a patient of MDD would find Sally’s problem of anxiety and the loss of confidence as irrelevant but these variables are quite relevant. The loss of confidence in Sally has affected many aspects many of her life which have led to such behaviours that made her every matter worse. In contrast to the cognitive approach of conceptualization which focuses directly on the lack of confidence, the focus of this approach is on the previous approaches along with the link of the latter with the current circumstances. In this regards, and specifically in the behavioural formulation, the lack of confidence is not itself the problem rather serves as the preliminary point for the identification of the behavioural experiences that ultimately lead to the lack of confidence. As per the perspective of Sally, the problem is her anxiety and the loss of confidence, the success of the behavioural will largely depend on upon helping her understand that her depression can be reduced through an interaction with the social world (Jacobson and Gortner, 2000).

Behavioural formulation

During the initiation of the behavioural therapy, Sally was a given a score of 30 on the Beck Depression Inventory scale developed by Beck et al. (1961), thus, placing them in the low severe level depression as the maximum severe level depression is 63. The depressive symptoms reported by her includes impaired concentration, fatigue, social withdrawal, feelings of shame, guilt and failure, consistent low mood, increased appetite, ineffective patterns of sleep and increase of tearfulness. More specifically, Sally mentioned that he had stopped in engaging in almost all of the preemptive activities including recreational activities such as exercising and household responsibilities. She further mentioned that she had lost interest in her home, appearance and career. All of these issues lead to the exacerbation of already decreased self-confidence.

The behavioural formulation of the case of Sally presents evidence regarding the loss of contingent reinforcements necessary for a healthy behaviour and the identification of some coping behaviours possessing an immediate negative reinforcement value. This whole process, according to Lejuez Brown and Hopko (2009) is producing greater negative consequences, therefore, leading towards the lack of confidence and the development of anxiety. From the behavioural aspect of formulation, interesting aspects of this case study is the fact that Sally believes that her behaviour is influenced by her mood states, feelings and thoughts and the goal of the behavioural therapy must be to make changes at this level (Lejuez, Hopko and Hopko, 2003).

Treatment approaches

A number of scholars and clinicians have focused on Behavioural Activation (BA) as an effective treatment approach in the past few years including Jacob, et al. (2013) and Renner, et al. (2016). As the case of Sally indicates clear loss of contingent reinforcements, BA approach would be effective in dealing with Sally (Lejuez, Hopko and Hopko, 2003). Hopko, Lejuez and Hopko (2004) further mentioned that this approach will be modified to focus on her symptoms of anxiety. Hopko, et al. (2003) defined BA as a therapeutic process having an emphasis on structured attempts at “engendering increases in overt behaviours” which are then believed to bring the client in contact with the contingent reinforcements while simultaneously producing improvements in mood, thoughts and quality of life. Despite the fact that BA approaches are mainly used to treat the individuals having clinical depression, they have been found effective in treating anxiety and MDD and facilitates the naturalistic behaviour in vivo exposure (Hopko, Lejuez and Hopko, 2004). Apart of this, BA approach also initiates a proactive behaviour, the lack of which is the major symptom of MDD and significant present in Sally, which ultimately helps in the formulation of a sense of control and effectively addresses situations which are anxiety or depression-provoking (Moradveisi, et al. 2013).

Cognitive conceptualization of Sally’s case

The cognitive conceptualisation of the case of Sally can be seen from the perspective of cognitive therapy as advocated by Beck (2005) because the erroneous and maladaptive thought processes of the client requires effective assessment and then interventions. Dysfunctional thinking, in depression, usually adopts the form of unwarranted pessimism, overgeneralized assumptions regarding hardships for the world and oneself, significant negative self-assessment and the potential of overlooking the opportunities for hope while solving complex and everyday problems. When such negative biases are manifested in the thoughts of an individual, it leads to the development of “automatic thoughts”