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On the Intended Use of the Efficacy Schedule in Cognitive Behavioral Treatment of Depression

Since the most prominent symptom observed in depressive patients is a decrease in interest in activities and a decrease in pleasure and enjoyment, an activity chart is given to the patient after the interview in therapy and the existing situation is first tried to be determined.

The activities of a normal individual include pleasure-oriented fun and performance-oriented compulsory activities. In healthy individuals, pleasure-oriented and performance-oriented activities are balanced. Continuous performance-oriented activity causes burnout. In depressed clients, both pleasure-oriented and performance-oriented activities are considerably reduced. In addition to the general decrease in activity in the daily life of depressed individuals, it is observed that the activities performed are only those that have to be done. With the activity chart, it is aimed for the patient to realize this situation. Seeing the chart, which consists only of obligations and almost no pleasurable activities, allows the patient to question the individual's belief that 'I am very bad at any moment'. At the same time, when the patient fills in the activity chart, it is ensured that he/she realizes when he/she feels pleasure or success. In the first interview, the part related to the day the patient comes to the interview is filled in together with the patient and the therapist until that time, and then the patient is expected to fill in the chart every day until the next session. With this behavioral intervention, which is one of the tools used to recover the patient and make him/her better, the patient writes down the activities he/she does hourly between 06.00 am and 24.00 pm every day and then scores the degree of enjoyment and success.

The therapist should explain the rationale for this chart in the first session and, after discussing the impact of depression on daily activities, the patient is encouraged to start self-monitoring.

In order to work through this chart in the next session, the patient is asked to share what he/she has experienced or noticed while filling in the list and then asked if there is anything on the list that caught his/her attention.

Through socratic techniques or other cognitive techniques, it is aimed to notice a significant decrease in his/her activities, to realize that most of the activities he/she does are activities that he/she has to do, and that the differences in his/her emotional state vary according to the environment or the work done. The aim is to remember how happy people are happy. It is expected to question the belief that there is nothing to be happy about in life by realizing that there are activities that they are successful or enjoy at some times. If no activity is done, it is expected to remember that being happy is a difficult action and that people are happy when they are doing something. Our expectation here is that the patient will achieve a balance between the activities they enjoy and the activities they have to do. It is important to break the cycles so that the cycle of reluctance, inaction and unhappiness can turn into a cycle of desire, action and happiness. In depression, inaction leads to feeling more depressed. When planning activities, the initial aim is to increase pleasure-oriented activities. Planning activities that will increase pleasant feelings and sense of achievement makes the individual feel that they are taking control of their life and reduces aimlessness.

Possible activities should be identified jointly with the client. Activities that he/she likes to do now and in the past, activities that he/she has to do, possible activities that he/she wanted to do in the past and now but did not do. After the lists are created, pleasure and success activities are increased and a ground is created to facilitate cognitive change.


Clinical Psychologist Didem Çengel

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