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"Sad is How I Am!" Treating Dysthymia in Children and Adults
Dysthymia continuing education social worker CEUs

Section 3
Memory Support Strategies (Part 1)

CEU Question 3 | CEU Test | Table of Contents | Depression
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

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The previous track provided you with interventions to assist your dysthymic child and adult clients with decision making. Just as depression can hinder decision-making, it can also create problems in concentration and memory.

Think of a dysthymic client who can't remember facts, data, tasks, etc. Is it because he or she is focusing on depressed thought patterns and not what they're trying to remember? Would it be helpful to tell your client that, like the other symptoms of depression, concentration and memory problems are commonly experienced when clients are depressed?

I have found that I need to assure my client that concentration and memory problems aren't signs that they're losing their mind, their memory, or that they're stupid. Here are four Cognitive Behavior Therapy interventions (two of which will be covered on the next track) to assist your adult or child client suffering from concentration and memory problems perhaps at work or at school.

Four CBT Interventions to Assist with Concentration and Memory Problems

#1 The "Zen" Method
As I just mentioned, when your patient or client continually thinks about his or her problems, it can interfere with their concentration. Most clients expect that thinking through their problem will help solve the problem. But continual thinking through their problem usually can't solve the problem. This particular technique works because the client will begin to attend to the present, rather than focusing upon a past fear or future anxiety. That is why it is called the "Zen" Method, because it focuses upon the present. As you know, the more your client can focus on what's happening right now, the less rumination he or she will create.

A colleague, Joan, told me about one of her patients, Erin, whose husband Robert had just left her. Erin continually ran the fact that Robert had left her for another woman through her head seemingly hundreds of times a day. Joan explained to Erin that continually replaying the events in her mind would not change her situation. Joan told Erin, "You can control your continuous thoughts about Robert's leaving." Joan first suggested to Erin, "Plan a specific time for thinking about Robert, say thirty minutes each night. You should use these thirty minutes to ruminate to your heart's content." Erin liked to use the term a feeding frenzy of thought.

Joan further explained, "But, if you find yourself ruminating at any other time, say to yourself or out loud, 'Stop it!' and immediately focus on your surroundings." For example, colors are a good one. Say to yourself, "The carpet is green. My watch is silver. The trees are brown with no leaves."

One of the principles of Zen is to focus on the "now." Joan told Erin, "If colors don't work, think about where you are, or what you are doing. You might have to do this fifty to a hundred times a day at first, but eventually it'll become automatic with practice."

As you know, the technical name for Erin's thirty-minute, obsessive-thought, feeding-frenzy session to O.D. on thoughts about Robert is called "prescribing the symptom."

This thirty-minute feeding-frenzy of thought or "prescribing the symptom" helped Erin become aware of the behavior that kept her ruminating and in a depressed state. This thirty-minute feeding-frenzy of thought helped Erin put a limit on thinking about Robert's affair, and continually thinking about checking up on him. As a result, Erin's ruminations were decreased significantly. Joan also suggested that Erin become involved in an absorbing activity and avoid passive activities, like watching TV, staying in bed, or staring out the window.

I might be noted here regarding Erin's depression due to her husband's leaving, according to the National Institute of Health, when comparing men to women, 5%-12% of men will become clinically depressed; however, 10%-25% of women will become clinically depressed. This might be due to the socialization of women to express their feelings more and perhaps more cases of depression are reported, rather than more cases of depression actually existing. What do you think?

Do you have a depressed adult or child client who has problems concentrating due to obsessive thoughts? Would it be helpful to point out to them that passive activities tend to increase ruminations? If you feel the Zen Method of focusing on the present, combined with a thirty-minute feeding-frenzy of thought, would be of assistance to a client you are currently treating, write their name in your Manual in the Personal CD Notes section.

#2 The Rubber Band Method
If your client does not respond well to the "Zen" method, you might dust off the old Rubber Band Technique. This technique is a more dramatic method. It is unlike the "Zen" method due to the fact that minimal physical pain is involved. However, it is similar in the fact that the rubber band snaps your client back into a "present here-and-now" state of mind.

James, age 16, kept having ruminations about his ex-girlfriend, Abby, and it had begun to interfere with his concentration in class. His A and B+ grade-average was slipping to D's and C-'s. Over the period of several months, James became more depressed about Abby's lack of interest in him. His parents arranged his appointment with me for fear of suicide. James had begun waking up at about four in the morning and pacing the floor with obsessive thoughts about Abby.

To help James control his thoughts about Abby's lack of interest in him, or what he could have done differently, and continually visualizing Abby being with her new boyfriend, I suggested that James wear a rubber band on his wrist. Every time he began to think about Abby, he gave himself a snap.

I explained to James, "The snapping of the rubber band interrupts your thoughts and reminds you to concentrate on the teacher, the class session, or whatever else may be going on." As you can see, this brought James back into the Zen or the present and these two methods support each other.

Here's a side note... I myself, at first, questioned the use of the negative reinforcement of pain, as a valid tool, especially if my client had been physically abused in the past. However, I have found that when the client is highly motivated to stop the ruminations, this technique can be extremely effective. I have even had some clients use different colored rubber bands to snap different types of thoughts.

However, a word of warning here, make sure your client understands that both the "Zen" and the "Rubber Band" methods are only temporary methods. The next step is to begin changing some of the beliefs fueling James' ruminations, such as "I can't be happy without Abby," or "I should be perfect." Once James fully realized that he could be happy without his former girlfriend, Abby, his obsessive thoughts about her gradually decreased. The resulting lack of memory and ability to focus on other tasks disappeared.

The next track will provide you with the SQ3R and Egg Timer techniques to increase your client's concentration and decrease memory loss which results from depression.

Peer-Reviewed Journal Article References:
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.

Kajanoja, J., Scheinin, N. M., Karukivi, M., Karlsson, L., & Karlsson, H. (2018). Is antidepressant use associated with difficulty identifying feelings? A brief report. Experimental and Clinical Psychopharmacology, 26(1), 2–5.

Levy, N., Harmon-Jones, C., & Harmon-Jones, E. (2018). Dissonance and discomfort: Does a simple cognitive inconsistency evoke a negative affective state? Motivation Science, 4(2), 95–108.

“Memory support strategies and bundles: A pathway to improving cognitive therapy for depression?”: Correction to Dong, Lee, and Harvey (2017) (2017). Journal of Consulting and Clinical Psychology, 85(12), 1157. 

Rickenbach, E. H., Almeida, D. M., Seeman, T. E., & Lachman, M. E. (2014). Daily stress magnifies the association between cognitive decline and everyday memory problems: An integration of longitudinal and diary methods. Psychology and Aging, 29(4), 852–862.

Online Continuing Education QUESTION 3
How does the Rubber Band technique support the Zen technique? To select and enter your answer go to CEU Test.

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