Use the board or Exhibit 13 to demonstrate the following example listing items in the costbenefit columns

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Avoiding usual friends and acquaintances is a of a response to being depressed. This has positive and On the plus side, people often feel they are less over- by responsibilities and feel less inferior or guilty when they are not around other people who are feeling well. Often isolation is a means to cope with irritability or anxiety in social situations. On the down side, withdraw-

experiences. This can lead to feelings of guilt and low self-worth. Sometimes other people gradually begin to expect less of the person who is depressed. They may express that he or she has hurt or angered them. Often there are also material bad effects, such as loss of work time and income. Although bouts of severe irritability, it is usually wise not to select isolation as the one and only way to cope.

Let's select an example from your list on the board.

Therapist Direct

Next, the therapi

ions st will facilitate group participation in a cost-benefit

analysis of at teas

t one or two responses, selected from the group list

by the group me

rubers, ff participation is at a stalemate, then select

examples from the generic list. Take care to be nonjudcjroental when

doing the cost-b

enefit analysis of "Ineffective" coping responses to

depression and s

tress. The therapist may use Exhibit 13 ("Responses

to a Depressive

Episode/Stress That fvfay Trigger a Depressive

j Episode—1: Costs and Benefits''") to complete the cost-benefit analy- ;

j sis. Keep in mind that there are no perfect "responses," and most ;

j responses, if used in a limited manner, can help a person cope with ;

| depression and stress. i | Group members may or may not list substance use or suicidal j behavior among their examples. If they do, the therapist should

| integrate the content of Focus Point 3 into the discussion during

1 Focus Point 2. If substance abuse and suicidal behavior are not men- j i tioned by group members, the therapist must continue with Focus ;

FOCUS POINT 3: Recognize substance abuse and suicidal behavior as ineffective coping strategies for managing stress and depression and begin to understand their high rates of comorbidity with manic-depressive disorder.

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