1. Introduction
In order for American businesses to be successful in a global economy, they must have a productive workforce. What happens when this workforce is suffering from a debilitating illness, such as mental illness? Is a productive workforce able to suffer from such an illness? This is a question that I often ask myself, and one that I will explore in this essay. In exploring this question, I will be drawing on evidence from an academic study done in New Zealand, in which sleep and mental health among a workforce were correlated (Clarke et al., 2006). The importance that this essay has is evident in the following quote: “Studies have demonstrated that the indirect costs associated with diminished productivity of symptomatic employees, absence from work, and reduced work efficiency on the job exceed the direct medical costs and represent a significant portion of the overall cost of depressive illness to employers” (Lerner et al., 1999).
1.1. Importance of Workplace Mental Health
A clearly communicated role within the organisation. Employees who do not know what is expected of them can become stressed and anxious. Providing employees with clear direction and identity can reduce these feelings, and can be achieved through effective management and regular discussion and review of employee roles.
A positive work environment that values and supports employees. This can involve identifying and utilising employee skills, providing ongoing development and training, and giving employees a level of autonomy in their role. Doing so can increase employee satisfaction and pride, which in turn enhances mental well-being.
Employers can create an organisational culture that enhances the well-being of its employees in a number of ways, many of which have a positive impact on the mental health of employees. The Centre for Workplace Mental Health (2017) identified the following protective factors that can reduce the risk of mental health problems occurring in employees.
Good mental health is fundamental for functioning well in everyday life, and is as important in the workplace as it is in our personal lives. As a result, the way in which a person’s mental health is handled by their manager and the culture of their workplace has a direct impact on that person’s productivity, morale, and well-being. One of the best ways to understand the importance of mental health in the workplace is to look at what employers can do to support the well-being of their employees.
1.2. Prevalence of Employee Depression
Mental health problems are one of the main causes of overall disease burden worldwide. Depression is cited as the third leading contributor to the global burden of diseases. A recent study of 24,000 employees in Europe found the average reported prevalence of depression to be 17.2% (range 2.8-28.4%). Depression has also been shown to have a higher prevalence among part-time workers compared to full-time employees. In another European study, depression was found to account for 50% of all absences from work and 37% of all work incapacity. The WHO has estimated that by the year 2020, depression will be the second leading cause of disability throughout the world. These figures and trends clearly indicate that depression is a highly prevalent disorder which will have an increasing impact on organizations throughout the world. Depression is a major cause of presenteeism (being at work, but not fully functioning) and employee turnover, which are both very costly for employers. It has been estimated that the economic burden of depression is 1% of the EU’s GDP, which equates to 200 billion euros. The impact of the recent COVID-19 pandemic is likely to further increase the prevalence of depression in the workplace. The pandemic has been associated with a large volume of job losses, financial strain, social isolation, and health anxiety due to increased risk and exposure to the virus. Recent data from the UK has shown that the prevalence of depression has doubled from 10% to 20% before and after the pandemic. Given the large impact and stigma of the mental health effects of COVID-19, it is likely these rates of depression will be further increased as the pandemic progresses.
2. Understanding Employee Depression
2.1. Definition and Symptoms of Depression
2.2. Causes and Risk Factors
2.3. Impact on Employee Performance
3. Creating a Supportive Work Environment
3.1. Promoting Open Communication
3.2. Encouraging Work-Life Balance
3.3. Providing Mental Health Resources
4. Training Managers and Supervisors
4.1. Recognizing Signs of Depression
4.2. Responding to Employee Disclosures
4.3. Offering Support and Accommodations
5. Implementing Mental Health Policies and Programs
5.1. Developing a Mental Health Policy
5.2. Offering Employee Assistance Programs
5.3. Providing Mental Health Training
6. Reducing Stigma and Promoting Awareness
6.1. Educating Employees about Mental Health
6.2. Challenging Stereotypes and Myths
6.3. Sharing Success Stories and Resources
7. Supporting Return-to-Work Programs
7.1. Facilitating Gradual Return-to-Work Plans
7.2. Providing Workplace Accommodations
7.3. Ensuring Continued Support and Follow-up
8. Monitoring and Evaluating Mental Health Initiatives
8.1. Collecting Data on Employee Well-being
8.2. Assessing the Effectiveness of Programs
8.3. Making Adjustments and Improvements
9. Collaborating with Mental Health Professionals
9.1. Partnering with External Resources
9.2. Consulting Mental Health Experts
9.3. Seeking Professional Guidance
10. Conclusion

Questions
Barriers to Effective Care Coordination:
Identify and explain at least 3 major barriers that can hinder effective care coordination for chronic conditions.
Examples:
Fragmented healthcare systems with limited communication channels between providers.
Lack of patient engagement and understanding of their care plan.
Socioeconomic disparities impacting access to healthcare resources and technology.
Propose solutions to overcome these barriers and create a more coordinated care system.

Answer
1. Fragmented healthcare systems
Effective coordination requires good communication between those involved, so limited communication channels between providers can act as a major barrier to coordination. Communication can be limited in a number of ways, the most simple being the inability to contact a specific individual. This was a common issue witnessed by the author while on a GP attachment. Secretaries often did not take messages from other healthcare providers or would take a message and not pass it on. Email contacts between providers are rarely available, and faxing is now outdated. Phone calls between providers are, of course, a good way of communication. However, without a direct line to the individual, the call is often lost. The use of voicemail is not an effective form of communication.
1.1 Limited Communication Channels
Healthcare systems have areas of specialization divided amongst different providers. This can lead to a patient receiving care from multiple providers within the same health issue, resulting in duplication of tests, uneven care provided, and varied outcomes. Patients with complex needs and chronic diseases often require treatment from multiple providers and specialties. Coordination of care for these patients is often inadequate due to the division of specialization among providers (James, 2003). Effective coordination is an essential component of good healthcare delivery and can be defined as the deliberate organization of patient care activities between two or more participants involved in a patient’s care to ensure that it is safe, efficient, and cost-effective. Coordination can be complex, involving tasks from different individuals across varying facilities and specialties (Gittell et al., 2000).
Introduction to Fragmented Health Care Systems
1.1 Limited communication channels
Providers in hospitals do not receive timely information about the discharge of their patients from the hospital or consultations with specialists. The quality and completeness of clinical information available at the time of a consultation was also identified as a problem, as well as difficulties in obtaining further information from hospital doctors. Changes in patients’ medications were often unclear and undocumented. General practitioners reported that they often had to admit patients to hospital because they could not obtain the medical or paramedical support necessary to sustain them at home or in a residential care facility. In some cases, hospital doctors would not accept patient referrals. These access block problems were perceived by general practitioners to be due in part to public and/or private hospital specialists having waiting lists of their own private patients, and being less inclined to treat public patients. Failure to provide follow-up treatment advice to referring doctors was described as a disincentive to further referrals. In mental health services, the lack of a booking system for patient appointments often complicated the task of arranging specific follow-up treatments. Most of New Zealand’s new health initiatives involve some level of care coordination from primary and community care. Examples include early discharge schemes, health of the older person and disability services programs, needs assessment and long-term care following the closure of hospital beds and the shift of a wider range of medical and surgical treatments from secondary to primary care. At present the potential gains of these initiatives are often not fully realized because they are not underpinned by improved communication and coordination with secondary care services. In some cases primary care doctors have been forwarded discharge and treatment change information for their patients months after the event, and because there is often no guarantee that hospital services will re-accept referred patients, primary care teams may give up on attempts to obtain further services that their patients still require. A lack of clear communication and understanding between the providers of secondary and primary care has also meant that some of the changes to service delivery described in the Introduction have occurred in a way that is ad hoc and unplanned.
1.2 Lack of information sharing
Virtual care coordination (e-health) has become more and more common, and is the use of IT services to plan and manage patient care. Most advances are in web-based, patient-to-provider cases, as they are easy to schedule, document, and revise. These cases have maximum coordination, but think about a patient who needs to see a specialist or get a procedure done. The patient instance again has much coordination with a defined specialist and a procedure time, but these cases are not easily transferable between different sectors of the health care system. He currently still has to fax or email procedure details, with possible drug specifications to his private practice proceduralist, which is basically less than a handoff, so this information could get lost or missed in potential coordination to a follow-up case.
The main issue with destroying the concept of an effective care coordination is that although there are several different forms of care coordination, most cannot be accurately displayed or compared to the traditional method of physician to patient, and the vegetative and emergency cases. Most of this essay is based around the transfer of information from one health care system to the next, and across the broad spectrum of managing the case. Care coordination has shifted to a multidisciplinary team effort over the past decade. The concept of care coordination is taking health care out of the passive mode and the linear patient to provider model, to design patient cases with an emphasis on preventing medical mistakes and anticipating potential setbacks.
1.3 Inadequate coordination between providers
Changes are needed to ensure the right type of coordinated mental health care is provided. For this to happen, mental health specialists must define in common terms what successful coordination will look like. It is too easy to say that coordination is occurring when a patient is seen by various providers in the same agency. Measures of coordination often involve event monitoring and evaluation of treatment effectiveness on the part of the patient and involved providers. Successfully coordinated care will result in a greater effectiveness of simpler treatments in the primary care setting and less need for referral to severe psychiatric medication management. With better measures of successful coordination, it will be possible to reward managed care organizations and provider groups that are coordinating mental health services and more effectively treating mental health patients.
Inadequate coordination between healthcare providers can adversely affect patient care. A healthcare provider may recommend different medications or a treatment course that interferes with treatment priority or diagnosis from another provider. Recommendations for, but no direct referrals to, psychological evaluation or therapy can be interpreted as stigmatizing patients and result in less motivation to follow a treatment course. Patient non-adherence is common in this chaotic healthcare system scenario, as patients often feel confused about proper treatment and may not believe therapy treatment will be effective. Then healthcare providers may misinterpret non-adherence as resistance rather than a problem with access and coordination, resulting in further exacerbating mental health problems. This lack of coordination for mental health treatment is in stark contrast to the care coordination in primary care and general medical settings.
2. Lack of patient engagement and understanding
2.1 Limited health literacy
2.2 Insufficient patient education
2.3 Ineffective communication with patients
2.4 Non-adherence to care plans
3. Socioeconomic disparities impacting access to healthcare resources
3.1 Financial barriers
3.2 Limited availability of healthcare facilities
3.3 Inadequate transportation options
4. Technological challenges in care coordination
4.1 Lack of interoperability between systems
4.2 Inconsistent use of electronic health records
4.3 Limited access to telehealth services
5. Proposed solutions for fragmented healthcare systems
5.1 Implementing care coordination platforms
5.2 Enhancing communication channels between providers
5.3 Establishing care teams and care coordinators
6. Proposed solutions for lack of patient engagement and understanding
6.1 Improving health literacy programs
6.2 Enhancing patient education materials
6.3 Promoting shared decision-making
6.4 Utilizing digital health tools for patient engagement
7. Proposed solutions for socioeconomic disparities
7.1 Expanding access to affordable healthcare services
7.2 Implementing transportation assistance programs
7.3 Addressing social determinants of health
8. Proposed solutions for technological challenges
8.1 Advancing interoperability standards
8.2 Encouraging widespread adoption of electronic health records
8.3 Expanding telehealth infrastructure and reimbursement policies

Questions
Case Study Analysis:
Choose a specific chronic condition (e.g., diabetes, heart disease, asthma).
Identify a case study of a patient with this chronic condition.
Analyze the strengths and weaknesses of the patient’s current care coordination plan.

Answer
1. Introduction
At present, there is an increasing number of people with chronic diseases. The evidence for this claim is in the 133 million Americans, or almost 1 in 2 adults, living with a chronic condition, and this figure is predicted to increase by more than 30% between 2000 and 2020 to 157 million with 81 million having multiple conditions. Projections suggest that chronic diseases will account for three-fourths of the total health care costs in 2023 – more than $4 trillion (Saint T, et al 2000). Chronic diseases are health problems that require ongoing management over a period of years or decades. They include, among others, arthritis, asthma, cancer, COPD, cystic fibrosis, diabetes, cardiovascular disease, and any form of mental retardation. A recent survey identified a total of 139 million Americans living with these diseases. These chronic conditions impact the lives of the people affected in many different ways. In 2000, the Surgeon General’s report on health and behavior revealed that 22% of people living with chronic diseases had limitations in daily activities compared to 3% of those without a chronic condition. People living with chronic condition are also at risk of dying prematurely. It has been shown that 90% of Americans’ annual deaths are caused by chronic diseases and 77% of employer costs are due to productivity losses in employees with chronic conditions. Healthcare providers have also been alerted to pay special attention to their patients living with a chronic condition. In 1998, the National Health Interview Survey (NHIS) reported that 70% of visits to a doctor’s office involved treatments for people with one or more chronic condition. With a large population affected by chronic diseases, care coordination is fundamental in assisting individuals to manage their conditions and improve their overall quality of life. Care coordination is a process that encompasses a wide array of functions and services that help patients with chronic conditions manage their health. Coordination involves organizing patient care and involves information sharing and communication between all participants concerned with a patient’s health to achieve safer and more effective care. Primary care physicians and patients play central roles in care coordination. Information from The Commonwealth Fund analysis in the Tri-Annual National Survey 2007 reported that patients with chronic conditions receive better care from primary care physicians versus specialists. Primary care physicians also report that chronic care management is one of the most challenging aspects of their job. This indicates that care coordination efforts need to improve in linking the efforts of generalists and specialists for patients living with chronic conditions. Improved care coordination ensures that the patient’s needs and preferences for managing their chronic condition are met and that healthcare decisions are agreed upon and followed by the patient. Coordination also supports the self-management of patients to become more involved with their care and in turn achieve clinical and personal goals they have set to improve their overall health. With these points in mind, this paper is centered on the case analysis of a patient named Clarence, living with diabetes, and the coordination efforts between healthcare providers to improve his health outcome.
1.1. Background of the Chronic Condition
Chronic diseases can be difficult to manage. They often need a lot of health services to manage their condition. This is what we call coordination of care. Coordination of care is a fragmented and an ad hoc enterprise with little standardization from patient to patient. Good, clear communication is key to effective care coordination. This is often lacking between primary care physicians and specialists, as well as between these providers and the ancillary services that play such a large role in managing chronic disease, such as pharmacies and laboratories. The way care is often managed and coordinated across the primary and specialty care settings, hospitals, home health agencies, and nursing homes provides an array of dangerous pitfalls for the patients and is an inefficient and expensive way to manage chronic disease. The case for this patient is all too common. This elderly patient has several chronic medical problems: congestive heart failure, hypertension, diabetes, and chronic kidney disease. The plethora of medical issues alone can create its own fragmented care and care coordination impaired by the individual concerns of each specialty involved in this patient’s care. As we detailed the patient’s experience throughout the hospitalization and elegant discussion of the pros and pitfalls of each stage of this patient’s care, it became clear that the systems currently in place provide many obstacles to effective care coordination. Good communication between providers with regard to the patient’s wishes and prior discussions about the care plan is an essential early stage in caring for a patient with chronic disease. Often the patients are not always clear to the physician about their own wishes, and many patients with multiple specialty involvement may have conflicting plans on how to address various issues in their health. This is an instance in which medical decision making becomes complex and difficult. Often a decision on paper A cannot be effectively communicated to provider B. Occurrences like this can lead to the patient’s avoidance of hospitalization for re-admission for an episode of heart failure symptoms.
1.2. Importance of Care Coordination
Care coordination is important to avoid gaps, overlappings, and delays in delivering the care that we need. Coordination may avoid, for example, conflicting treatments among our specialists or duplicate tests. Information is passed on about our needs and the activities of all the people involved in our care. With good information and a clear plan, the activities of the different people involved in our care are more structured and productive. Any changes in our health or the way we are managing our health problem are monitored, and the care plan is revised as necessary. In contrast, without effective care coordination, it is left to us to tell different health professionals what other health professionals are doing for us. We and our family members are forced to understand and keep track of the care that we are receiving and to recognize when it is not going well. Oftentimes, healthcare providers are not even informed about certain treatments or tests that the other providers have ordered. Good care coordination can prevent such burdens on patients and communication errors among providers. Information about changes in the patient’s health can fall through the cracks, with the result that no one takes responsibility for revising the care plan. A chronic care patient’s best choice among treatment strategies may not be considered because different providers are acting independently and no single professional takes responsibility for synthesizing the opinions of the various specialists involved.
2. Case Study Overview
2.1. Patient Profile
2.2. Description of the Chronic Condition
3. Current Care Coordination Plan
3.1. Care Team Composition
3.2. Communication and Information Sharing
3.3. Care Plan Implementation
3.4. Monitoring and Follow-up
4. Strengths of the Current Care Coordination Plan
4.1. Effective Communication Channels
4.2. Comprehensive Care Plan
4.3. Regular Monitoring and Follow-up
5. Weaknesses of the Current Care Coordination Plan
5.1. Fragmented Communication
5.2. Lack of Patient Engagement
5.3. Inadequate Care Plan Updates
6. Opportunities for Improvement
6.1. Enhanced Communication Strategies
6.2. Patient Education and Empowerment
6.3. Integration of Technology
7. Recommendations for Care Coordination Enhancement
7.1. Strengthening Interprofessional Collaboration
7.2. Implementing Patient-Centered Approach
7.3. Utilizing Health Information Exchange
8. Conclusion

Question

Answer
1. Introduction
The question is emerging about why detection and prevention of APTs was so low in 2013. The low detection is happening because target industries lack the capability to detect APT activities. APT attackers have high skill to cover up their activities and delete traces, making it hard to detect. Another reason is that the capabilities of traditional security measures such as anti-virus, intrusion detection and prevention, and firewall are not enough to detect and prevent APT. The existing security measures are only capable of detecting known attacks and malware, whereas APT attackers are using new malware and attack methods to compromise the target efficiency. Known malware and attack methods are actually still of minor use. This is what happened to Coca-Cola. Even though they have an information security program and traditional security measures, these are not enough to prevent their information from APT attacks. In 2009, Coca-Cola detected an APT attack plot on their networks. The attacks involved a group of hackers who were using advanced malware and remote system administration tools to gain unauthorized access to Coca-Cola’s network and affect the company’s operations. These APT attackers were trying to build persistence to stay within Coca-Cola’s network and steal sensitive information for a long time. But unfortunately, from 2009 to 2012, Coca-Cola lost its sensitive files to APT attackers. The results of forensic investigation on data stored in Coca-Cola’s breached systems have found that the malware had already deleted traces and the attackers had cleaned the remote administration tools. This investigation was conducted after Coca-Cola received reports of its sensitive files being copied by malware to unknown locations. In this case, migration of data from a well-known location, the unusual deleted file evidence, and support from reports can be indications of APT attacks.
1.1 Definition of Advanced Persistent Threat
Although the term “advanced persistent threat” has been popular since the early 2000s, it actually dates back to 2006. It is widely believed that the origin of the term APT comes from the United States Air Force. It is thought that they were the first people to use the term to describe a specific type of cyber threat. This belief is strengthened by a quote from a Lt. Col. Greg Rattray in 2009 stated, “The Airforce, by 2006, had identified the complete process of an advanced threat.” This quote shows that by that year they had a complete understanding of the processes and life-cycle of APT.
APT should not be confused with the term AET (Advanced Evasion Technique) which was proposed by network security firm Stonesoft. AET refers to means and methods that penetrate and exploit IT network vulnerabilities, while effectively evading network security systems, appliances, and controls. The AET attacks are the delivery and exploitation phase in the Cyber Kill Chain SM, the APT is the overarching structure and framework for the entire cyber kill chain.
An advanced persistent threat (APT) is a wide-ranging, sophisticated, sustained, and targeted attack against a specific group of people with the aim of achieving a specific agenda. An APT attack includes a number of different steps and a lot of different techniques often spanning a long period of time (such as several months or years). Anti-forensics methods, such as attempts to delete or alter log files, and false data injection, can also be and are often used in APT attacks, increasing the difficulty and complexity of detecting the attack and attribution.
1.2 Overview of Chinese Army Unit 61398
Chinese Army Unit 61398 is a cyber-warfare information operations unit of the People’s Liberation Army (PLA) of China. Though there is no public information about this unit’s numerical designator, it is commonly referred to by the identifier “61398”. Analysts have confirmed that APT activity surrounding Operation Shady RAT is being conducted using the resources of 61398, and APT attacks are traced back to infrastructure around Shanghai. It is unknown how many people work for 61398, but the number is suspected to be quite large and most likely staffed by a variety of military and civilian personnel. This is deduced from the sheer number of English-speaking APT operators observed online in Operation Shady RAT data who may or may not be native English speakers and the wide range of network intrusions into all sectors from this particular threat group.
2. History of Chinese Cyber Espionage
2.1 Early Cyber Espionage Activities
2.2 Emergence of Chinese Army Unit 61398
3. Tactics, Techniques, and Procedures
3.1 Target Selection and Reconnaissance
3.2 Exploitation and Delivery of Malware
3.3 Command and Control Infrastructure
3.4 Data Exfiltration Techniques
4. Notable Cyber Attacks Linked to Unit 61398
4.1 Operation Aurora
4.2 Operation Shady RAT
4.3 Operation Aurora Panda
5. Motivations and Objectives
5.1 Economic Espionage
5.2 Military and Political Intelligence Gathering
5.3 Support for Chinese Industries
6. International Response and Diplomatic Impact
6.1 Accusations and Denials
6.2 Diplomatic Tensions and Consequences
7. Countermeasures and Defense Strategies
7.1 Network Segmentation and Isolation
7.2 Intrusion Detection and Prevention Systems
7.3 Employee Education and Awareness Programs
7.4 Incident Response and Recovery Plans
8. Future Implications and Trends
8.1 Evolution of Chinese Cyber Operations
8.2 Collaboration with Other Threat Actors
8.3 Impact on Global Cybersecurity Landscape

Question
Discuss how cognitive theorists (Kelly, Beck, and Ellis) might address a client with depression and suicidal ideation. After reviewing cognitive therapies in your textbook, what interventions might you suggest. Explain and justify your response.
2. In what ways can spirituality or religious beliefs, or lack of, influence an individual’s personal decision-making process, and how might this impact the choices they make in various areas of their life, such as relationships, career, and personal goals?

Answer
1. Introduction
The introduction provided by David Lester is brief but straight to the point and covers all necessary areas. Lester starts by discussing the severity of the healthcare issue that is depression and quotes a Spanish saying “There is no greater pain than being blind in Granada” which he changes to “There is no greater pain than depression.” A short account of the symptoms and severity of depression is discussed, and then Lester moves onto the topic of suicide. Suicide is a sensitive topic but a necessary one in the field of psychology and healthcare. People relate great sadness and negativity to suicide as something people feel is “the easy way out,” but as Lester points out, “The act of suicide is one of shooting oneself in the head while one in dead aim at one’s foot,” essentially stating that people are self-destructive rather than simply destructive of life, and suicide is the ultimate reflection of this. This puts the severity of depression into an easily understandable perspective. Lester concludes his introduction with an outline of the theoretical development of cognitive theory and finishes with a statement of what he will discuss in this book. This introduction is suitable with no major flaws.
Cognitive Theory of Depression and Suicidal Behaviour by David Lester opens up with a clear and to the point introduction that states the implications of cognitive theories and their strategic development. Tony Beck’s Cognitive Theory and Therapy of Anxiety and Depression also opens with an explicit introduction about the extent of the problem of depression and its link with suicide. In this essay, I will give an overview of these introductions and compare them to my own introduction to the topic of cognitive theories and depression, specifically outlining what I have done differently and the reasons for this.
1.1. Overview of cognitive theorists
As cognitive theory offers an explanation of the onset and maintenance of depression, theories are best researched using causally related treatment studies. i.e. the most convincing tests of a theory come from studies where the cause of a particular disorder or disorder symptoms is manipulated and a change in the dependent variable is observed. Beck has described depression as a disorder of negative thinking, and there is much empirical evidence showing that when depressed people make inferences about self, world, and future they characteristically do so in a negative way, and the same is true for their interpretations of ongoing experience. Following on from this, there is now a large body of research showing that depression is associated with memory biases for mood congruent material and the use of cognitive avoidance strategies. This is only a very general overview of the research within depression, suffice to say Beck’s model has enjoyed a great deal of empirical support and as such it has been adapted and extended so that it can offer a cognitive theory of depression in all its richness and diversity. This is important as according to Beck, a good theory of depression should be able to explain how a single etiological mechanism can cause a disorder with such a wide range of different symptoms.
Research within the field of cognitive psychopathology has now been extended to the field of clinical psychology and there have been a large number of studies of depression and more recently studies of other psychological disorders. Major Depressive Disorder, hereafter referred to as depression, is diagnosed according to the standards provided in the Diagnostic and Statistical Manual of Mental Disorders edited by the American Psychiatric Association. Symptoms of depression include loss of interest or pleasure, significant change in weight or appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, and impaired concentration or indecisiveness. In its severe form, depression is a highly debilitating, long-lasting, and pervasive condition.
Cognitive theory is a theoretical model of mental disorder that postulates that a relatively small number of recurrent cognitive processes are implicated in the various forms of psychopathology. Of these, cognitions that negatively bias the interpretation of ongoing experience or otherwise inferred meaning of an event or stimulus are seen as particularly important. Beck’s (1967) influential model is exemplary. This model holds that depressive symptoms are caused by the latent cognitive structures within the mind. When these cognitive structures take on a negative schema, they can activate a negative self-referent cognitive process when the person is faced with a situation that resembles a particular schema. This can lead to the production of a series of negatively biased automatic thoughts. It is these thoughts that cause the overt psychological and behavioral symptoms of depression. Following on from this, negative automatic thoughts are thought to arise from underlying cognitive errors.
1.2. Importance of addressing depression and suicidal ideation
Depression is a serious and debilitating illness, which affects mental, emotional, and physical health of an individual. It is often reflected in low mood, feeling of sadness, and aversion to activity. Depression increases cognitive vulnerability to negative schema about self, world, and future. A recent research (NIMH, 1999) shows that depression is the top contributor for the suicide and suicide rate is higher in the elderly person, who have medical illnesses, college educated and who live alone, suicide risk is always higher in presence of the symptoms of hopelessness. About 60-70% of people who committed suicide suffer with major depression or bipolar (manic-depressive) disorder and people in this group are the most treatable great proportion of suicide can be averted by the effective treatment of depression and other psychiatric illnesses. Suicidal persons directly express their negative self-schema and hopelessness in a way they talk about their selves and future, and their feeling towards leaving and escaping from an intolerable situation reflect the state of cognitive deconstruction which increasingly becomes activated when hopelessness and negative schema intensifies and diversifies. As Brown and others have suggested, suicidal act is the final common pathway of a broad range of biological and psychiatric states said to increase the risk of such behavior, it can be the consequence of impulsive, aggressive act or carefully planned and executed by the individual who would otherwise make considered rational decision. Cognitive theory of suicide states that suicidal intent is correlated with strong feelings of hopelessness and helplessness, and absence of alternative way of solving the problems, when the hopelessness and helplessness is too severe then the individual will become focused on taking his own life.
2. Cognitive Theories and Depression
2.1. Albert Ellis’ Rational Emotive Behavior Therapy (REBT)
2.1.1. Challenging irrational beliefs
2.1.2. Identifying and disputing negative thoughts
2.1.3. Developing rational alternatives
2.2. Aaron Beck’s Cognitive Therapy (CT)
2.2.1. Recognizing and restructuring negative automatic thoughts
2.2.2. Examining cognitive distortions
2.2.3. Behavioral activation techniques
2.3. George Kelly’s Personal Construct Theory
2.3.1. Identifying and modifying negative constructs
2.3.2. Constructive alternativism
2.3.3. Role of core beliefs in depression
3. Interventions for Depression and Suicidal Ideation
3.1. Psychoeducation on cognitive distortions
3.1.1. Teaching clients about common cognitive distortions
3.1.2. Providing examples and exercises for recognition
3.2. Cognitive restructuring techniques
3.2.1. Guided thought records
3.2.2. Socratic questioning
3.2.3. Cognitive reframing
3.3. Behavioral activation strategies
3.3.1. Setting achievable goals
3.3.2. Encouraging pleasurable activities
3.3.3. Monitoring and challenging negative behaviors
4. Conclusion
4.1. Summary of cognitive theorists’ approach
4.2. Importance of addressing depression and suicidal ideation
5. References