Experience of cognitive behaviour therapy in psychiatric practice in Nigeria: II: Illustrative case histories

In order to give practical guidance to interested therapists, the author uses four illustrative cases to show how the technique of cognitive behaviour therapy can be applied in the clinical setting in Nigeria. First, a detailed cognitive assessment of the predisposing, precipitating and perpetuating factors associated with the presenting complaints is carried out. This helps the patient to realise that the symptoms are predictable, and therefore potentially surmountable. Second, the patient and therapist jointly formulate the problem in a few itemised statements. Third, the patient and therapist jointly articulate a set of cognitions (statements of insight) by which the problem in each formulated statement can be overcome. Fourth, as homework exercises, the patient affirms the set of cognitions at least twice daily, as if instructing him/herself (self-instructional training). This helps to make the insights received in therapy sessions to become deeply ingrained in consciousness, and positively affect behaviour in ordinary circumstances of daily living. Finally, a "diary of daily transformation" is articulated, with which the patient monitors the self, in order to see that insights obtained are applied in daily living experience. Educated, articulate and committed patients with circumscribed psychological problems can achieve significant improvement in 3-20 weekly sessions.