1. Military Child Education Coalition National Training Seminar Washington DC July 29, 2014 Jeff Bergmann, PhD, LPC, NCC Clinical Psychology, George Mason University Lieutenant Colonel, US Army

2.  introduction (5 minutes)  cognitive-behavioral theory (5 minutes)  conceptualization of how depression develops (5 minutes)  maintenance of depressive symptoms (5 minutes)  treatment plan development (10 minutes)  conceptualization of how suicidal ideation develops (10 minutes)  maintenance of suicidal symptoms (10 minutes)  treatment plan development (10 minutes)  teen case studies practical exercise (20 minutes)  questions (10 minutes)

3. Information for this workshop is taken from the CBT Teen Depression Manual authored and utilized by Dr. Christy Espisito-Symthers in training psychologists at George Mason University. Information presented in this workshop is not intended for use by unlicensed mental health professionals, does not reflect endorsement by George Mason University, the US Army or the Department of Defense. The material presented reflects the views of the presenter and is intended for self-awareness educational and informational purposes only. This workshop presents cognitive-behavioral theory conceptualization of the development and maintenance of teenage depression and suicidal ideation. Information is presented to describe the connection of thoughts, behaviors, and feelings to the development and maintenance of depression and suicidal ideation. The information includes how a cognitive-behavioral therapy treatment plan is developed and implemented. Practical application include processing two case studies of military-connected teenagers, one dealing with depression and the other depression and suicidal ideation, for the purposes of illustrating the cognitive-behavioral conceptualization and developing a treatment plan. The following skills would be introduced and illustrated: deep breathing, progressive muscle relaxation, problems solving, thought challenging, cognitive restructuring, behavioral activation, and suicidal ideation safety plans.

4.  deep breathing  progressive muscle relaxation  problem solving  thought challenging  cognitive restructuring  behavioral activation  suicidal ideation safety planning

5.  Discuss the Cognitive Behavioral Theory of personality, the development and maintenance of depressive symptoms, and approach to treatment.  Utilize patterns of problematic thinking to challenge irrational thoughts.  Recognize differences between upward and downward cognitive spirals.  Assess suicidal intent.  Create a suicidal ideation safety plan.  Practice Cognitive Behavioral Therapy skills in a teen case study.

6.  List the 3 parts of our personality according to Cognitive Behavioral Theory.  Employ at least two Cognitive Behavioral Therapy skills.  Discuss how upward and downward spirals explain the relationship between thoughts, behaviors, and feelings.  Explain how to assess suicidal ideation.  Apply Cognitive Behavioral Therapy skills to create a suicidal ideation safety plan.  State that I had the opportunity to practice Cognitive Behavioral Therapy skills during the workshop.

10.  15 year-old April just relocated to Texas  April hates hot weather  April thinks Texas is obnoxious  April left her 17 year-old boyfriend back in NY and is worried the relationship won’t last  April is not adjusting well in her new school and her mom has noticed an increased pattern of withdrawal  April says no one in Texas likes her

11.  Depression Development & Maintenance  CBT Triangle  Thinking-Behaving-Feeling Spirals  Treatment Plan  Psychoeducation (Information)  Thought Challenging & Cognitive Restructuring  Behavioral Activation

15.  DEGREE OF SUICIDE RISK  1. How frequent have your suicidal thoughts been (everyday, few days a week, etc.)? How long do they last when you do have them (most of the day, few hours, few minutes)?  2. Have you told anyone about your suicidal thoughts?  3. Do you have a suicide plan? How long have you been thinking about this plan? Have you made preparations for this plan? Have you acted on this plan in any way (e.g., held pills in hand)? Do you intend to act on this plan?  4. Have you made any final preparations for a suicide attempt (e.g., suicide note, given away belongings)?  5. One a scale of 1 (not at all likely) to 10 (highly likely), what is the likelihood that you will make a suicide attempt?

16.  PREFERRED METHOD FOR SUICIDE  1. If you were to make an attempt, how would you do it?  2. Do you have access to this method at your home or anyone else’s?  3. Do you have access to guns at your home or anyone else’s? Do you have access to ammunition?  4. Do you have access to pills at your home or anyone else’s? If so, how many, what type, and how are they stored (e.g., locked up)?  INTOXICATION  1. Have you used any alcohol or drugs recently? Was the use of drugs or alcohol associated with your suicidal thoughts?  2. If yes, do you plan to continue to use drugs or alcohol? Do you have access to drugs or alcohol?

17.  SUICIDE PRECIPITANT  1. What triggered your suicidal thoughts?  2. Does that problem still exist?  3. Can you avoid this problem in the future? Do you intend to avoid this problem?

18.  1. Do you actually want to die? Or, is it that you don’t really want to die but do want to escape an intolerable situation?  2. Do you think that things will get better with time or is this situation hopeless?  3. What reasons do you have for living? Let’s list any reasons that you have on this Reasons For Living List.  [Note: Examples might include future plans mentioned in previous sessions, leaving parents/siblings/family member/pet he/she cares about, the way people might feel if he/she committed suicide, things he/she will never get to do, or anything important to the teen.]

20.  1. Can you 100% promise that you will not attempt suicide between now and the next outpatient appointment? (Note - this is asked for assessment purposes not intervention)  2. Can you promise that you will inform an adult should you feel in danger of making a suicide attempt? Who will you tell? (Inquire about people in and outside the home). What are their phone numbers? Let’s write them down on this Safety Plan. Be sure to keep them by your phone at home.  3. If there is not an adult available when/if you were to feel in danger of attempting suicide, will you promise to phone me (if during hours when I am available), call the suicide hotline, go to/have someone take you to the nearest emergency room, or call 911 for help? Can you think of anything that could get in the way of you using this plan?  4. Will you make every effort to avoid activities/situations which you believe may increase the chance of thinking about or attempting suicide?  5. If you are unable to avoid these activities/situations or others that leave you feeling very upset, what can you do to help calm yourself down? These can be things that you can do or tell yourself. Let’s write them down on this Safety Plan.  [NOTE: If teen was able to list any reasons for living be sure to have him/her include “read reasons for living list” as a coping technique].

27.  Deep Breathing  Progressive Muscle Relaxation

28. Questions/Discussion