"Sad is How I Am!" Treating Dysthymia in Children and Adults

On the last Track we discussed the ABC's of Cognitive Dissonance.

On this track we will discuss the use of a positive focus as it relates to your child and adult dysthymic clients.

Regarding creating a positive focus... I first explain to my client that where they focus their attention is their choice. As you can see, this Cognitive Behavior Therapy technique compliments the ABC technique presented on the previous track.

I told Michelle, age 25, "The lens through which she views life is selected by her. Although the negative lens is apt to be the only one she has used in recent years, it is not the only one available. It will take time, practice, and very small adjustments to change your focus. Obviously, you will not be able to just "look on the bright side," as people have so often encouraged you to do. Instead, you must train yourself to be aware of positive signs, to pay more attention to the positive feedback you receive from other people, your positive accomplishments, and so on."

Michelle frequently indulged in unproductive thought patterns due to her depression. Michelle stated, "I see myself as unattractive, dull, and boring. I am so convinced of this that when I attracted favorable attention, I yell to myself 'fraud.'" Michelle claimed, "The only reason anyone would be attentive to someone as dull and boring as me is that I had somehow 'conned' them into thinking I was interesting and appealing. So then, I feel guilty and anxious. It's only a matter of time before Jerry, my boyfriend, will discover what I already knew to be true. Once he 'sees through me,' he will reject me."

This assumption of Jerry "seeing through her" caused Michelle to feel panic and depressed. Because Michelle focused only on the negative aspects of her situation and allowed these unproductive thoughts to control her, she robbed herself of her experience with Jerry that could have relieved her depressed mood.

3-Step "Positive Experiences" Diary CBT Technique
Step #1: To help Michelle refocus her thoughts, I suggested she keep a "positive experiences" diary. I suggested she obtain a pocket-size notebook, one that was small enough to carry with her. In it, she was to record everything positive that she experienced, noticed, heard from other people, and accomplished. Everything - meaning whatever was not negative.

She was to include things she accomplished that she might tend to take for granted (getting out of bed, getting dressed, driving on the freeway without having an accident, and so forth). It did not matter that she might have been able to do something better or sooner. If she only did it, she was to write it down. She was to record any positive comments made to her, compliments paid to her, or respectful treatment given to her. Positives that she may not have appreciated lately, including courteous salesclerks, people who held doors open for her, or even the words "thank you."

Step #2: Next, I told her to identify at least two positive aspects of her appearance daily. She need to understand that she did not have to be positively gorgeous or the next Nicole Kidman. If her socks matched, her hair was clean, or her earrings were attractive, then she should write it down.

Step #3: Finally, each day, I suggested that she try to notice ten positives in the world around her: a news story about a medical breakthrough or a fund-raising event, children playing together, the first sign of spring, someone helping an elderly person carry groceries down the street. Do you feel it would be beneficial if you were to tell your client, "If you look for these things, you will find them?"

Have you found, like I, that once your client starts to interpret life situations more accurately, there tends to be a change in their cycle of depression?

Here's the pattern of changing the client's lens from a negative to a positive focus:
-- Realistic cognitions
-- Increased hope
-- Increased self-esteem
-- More appropriate behaviors
-- Begin to interact in a positively reinforcing system

Depression Management Tool Kit

- The John D. & Catherine T. MacArthur Foundatin's Intiative on Depression & Primary Care and 3CM, LLC. (2004). Depression Management Tool Kit.
Reviewed 2023

Peer-Reviewed Journal Article References:
Bird, B. M., & Jonnson, M. R. (2020). Have a seat: Supervisee perspectives on using chair-based role plays in clinical supervision. Journal of Psychotherapy Integration, 30(1), 25–35.

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.

Schaerer, M., Schweinsberg, M., & Swaab, R. I. (2018). Imaginary alternatives: The effects of mental simulation on powerless negotiators. Journal of Personality and Social Psychology, 115(1), 96–117.

Silton, R. L., Kahrilas, I. J., Skymba, H. V., Smith, J., Bryant, F. B., & Heller, W. (2020). Regulating positive emotions: Implications for promoting well-being in individuals with depression. Emotion, 20(1), 93–97.

Online Continuing Education QUESTION 6
What are the steps in changing your depressed adult or child client's focus from negative to positive? To select and enter your answer go to CEU Test.