John's Intrusive Communication Plan

DSM-5 Diagnosis:
300.4 (F34.1) Persistent Depressive Disorder (Dysthymia), with anxious distress, with intermittent major depressive episodes, without current episode, severe.

Problem List:
Lack of trust in others; suspiciousness
Trouble forming meaningful bonds with others
Frequent unwarranted self-criticism
Feeling unworthy or love; unlikeable
Isolation from others
Rumination that makes it difficult to fall asleep
Intrusive thoughts that disrupt daily activities
Anxiety being around people

Treatment Goals:
Learn how to develop trust in others
Overcome barriers that distance John from developing meaningful relationships
Stop self-deprecating thoughts and control intrusive thoughts
Alter isolation response
Lean how to cope and overcome
anxiety

Interventions:
1) Challenge John’s beliefs that cause suspiciousness of others motives.
2) Educate John on how past relationship problems sets up an expectation of betrayal from others.
3) Educate John on how his poor coping skills that he developed early in life are contributing to his depressive symptoms; stop John from isolating himself.
4) Encourage John to seek out new bonds to form with people; make it a goal to make friends.
5) Teach John Acceptance and Commitment Therapy techniques to distance himself from his thoughts to decrease rumination and intrusive thoughts and, in turn, improve sleep.
6) Challenge John’s beliefs of being unlovable, and other self-deprecating beliefs.
7) Teach relaxation techniques to cope with anxiety (e.g., progressive muscle relaxation and diaphragmatic breathing).

Treatment Progress/Results of Outcome Measures:
John has maintained his commitment to therapy and did not allow his self-deprecating thoughts and hopelessness to hold him back from coming to therapy and being engaged in therapy.
After 14 sessions, John no longer experiences suspiciousness of others, and understands how his past relationship problems contributed to his presenting problems. John now enjoys making friends with new people, and having pleasant conversations with strangers. John still experiences self-deprecating thoughts, but much less frequently than when he first started therapy. Johns intrusive thoughts no longer affect his emotions and behaviors in the same ways, and his sleep has improved markedly. While before John would toss and turn in his bed for 4 to 5 hours per night, now John can fall asleep in 10 to 30 minutes. Because of his improved sleep, John reports his rumination to be much more manageable. John now realizes that his fatigue played a large role in his ability to think clearly and not be effected by negative thoughts. John’s anxiety has decreased markedly through learning how to see his thoughts as thoughts, instead of identifying and feeling the emotion of every anxious or depressed thought that comes to his mind. As a result of all of John’s progress, he reports no longer experiencing suicidal thoughts. John practices relaxation techniques regularly and attributes his decrease in anxiety to his regular practice of the techniques. While john still experiences mild symptoms of depression and anxiety, the frequency and intensity of the symptoms have dropped markedly and has allowed John to live a meaningful
life.