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Lookup NU author(s): Dr Stephen Barton, Peter Armstrong, Dr Kevin Meares
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 The Author(s). Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies. Cognitive behavioural therapy (CBT) is an effective treatment for depression, but a significant minority of clients are difficult to treat, including those with histories of relational trauma. The model of Beck et al. (1979) proposes that adverse childhood experiences lead to negative core beliefs, and these create a susceptibility to depression. However, Beck's model does not identify trauma as a subset of adverse experiences. An alternative view is that traumatised clients internalise conflicting representations of self and it is conflict, interacting with trauma memories, that creates a vulnerability for depression. In this formulation, methods from the treatment of post-traumatic stress disorder (PTSD) could be incorporated into the treatment of depression, to emotionally process trauma memories and resolve self-identity conflicts. The aims of this study were to: (1) report the treatment of a 67-year-old man with recurrent depression and a history of prolonged relational trauma, and (2) to explore how memory processing from the treatment of PTSD can be incorporated into the treatment of recurrent depression. A single case observational design was used in the long-term treatment of a depressed traumatised client. The client received 47 individual sessions over 19 months in routine clinical practice in a tertiary CBT service. He completed repeated measures of mood, memory intrusions and sleep disruption. The client responded well to treatment with clinically significant improvements across measures of mood, memory and sleep. The effects were sustained over an 18-month follow-up. Memory processing was successfully integrated into a high-intensity treatment for recurrent depression. This is a promising approach for depressed clients with histories of relational trauma. Key learning aims (1) To consider how imaginal reliving can be incorporated into CBT for recurrent depression, when relational trauma is present. (2) To consider the cognitive processing mode of depressed traumatised clients when appraising beliefs about self and others. (3) To consider vulnerability to depression based on intrusive memories and conflicting self-representations, not only core beliefs.
Author(s): Barton SB, Armstrong PV, Meares K, Bromley EHC, Whitton D
Publication type: Article
Publication status: Published
Journal: Cognitive Behaviour Therapist
Year: 2024
Volume: 17
Online publication date: 15/04/2024
Acceptance date: 04/03/2024
Date deposited: 08/05/2024
ISSN (electronic): 1754-470X
Publisher: Cambridge University Press
URL: https://doi.org/10.1017/S1754470X24000126
DOI: 10.1017/S1754470X24000126
Data Access Statement: Copies of the single case dataset are available from the first author on request.
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