Professional Documents
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ISSN 2250-3153
**
Clinical Psychologist, Child Development Centre, GEMS Health Care, Masabtank, Hyderabad.
Head of the Department & Rehabilitation Psychologist, Child Development Centre, GEMS Health Care, Masabtank, Hyderabad
I. INTRODUCTION
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International Journal of Scientific and Research Publications, Volume 4, Issue 9, September 2014
ISSN 2250-3153
II. METHODOLOGY
Aim of the study was to investigate the efficacy of cognitive
behaviour therapy (CBT) in Dhat syndrome and co-morbid
conditions. A case study method was used to for the present
study. The sample consisted of three male patients from GEMS,
Hyderabad, Telangana, who were diagnosed as Dhat syndrome
(WHO, 1993) with co-morbid conditions. All of the three
consented patients were single and were in the age range of 20 to
25years. Two of the patients had consulted faith healers before
consulting GEMS Health Care. Pre-post research design was
used to study the efficacy of Cognitive Behaviour Therapy.
Three patients were assessed using Beck Depression Inventory
(BDI-II) developed by Beck in 1990; Hamilton Rating Scale for
Anxiety (HAM-A) developed by Hamilton 1959 and
International index of erectile function (IIEF) developed by
Rosen et al in 1997 and also by clinical interview and
observation. BDI-II, HAM-A and IIEF were used for pre-post
assessment of intervention. Informed consents were taken from
the patients. The patients were undergone for therapies such as
psycho-education, supportive psychotherapy and cognitive
behaviour therapy for 4 months in 18 sessions at GEMS Health
Care, Hyderabad.
The cognitive behaviour therapy was
compiled with activity scheduling, cognitive restructuring
(thought challenging, role playing, positive statements, and
behavioural rehearsal and relaxation therapy (JPMR).
CASE NO-1
Mr. V a 21 yr old male brought by his mother with the
complaints of decreased sleep and appetite, weakness/lack of
energy, loss of interest in pleasurable activities, decreased self
confidence, disturbed activity of daily living, hopelessness,
worthlessness, crying spell/death wishes since 4 years. Onset was
insidious, course was continuous and progress was deteriorating.
Mr. V was a Muslim, Male, educated up to 5 th standard,
working as a knitting worker, belonged to the low SES, and
resided at urban Hyderabad.
In brief history, Mr. V started masturbating from the age of
13 years, due to curiosity and initially he was practiced once in a
week. At the age of 14 years he watched a porn movie with his
colleague and he enjoyed the movie. Gradually his interest
towards watching such kind of movies was increased and the act
of masturbation was also increased up to 6 to 10 times in a weak.
During the age of 15yeras he heard that masturbation is injuries
to health and is prohibited in Islam. He scared and started trying
to control the masturbatory activity, but he used to fail to control
himself; due to this failure he started feeling guilty about his
interest in watching porn movies and masturbatory activities but
still he was fine till the age of 17yrs. Subsequently he started
believing that his physical strength and appearance was
deteriorating due to these activities which also increased his
guiltiness. Finally he used to believe that all his conditions were
due to his masturbatory activity and he had no control over that
and even he did not want to marry as he started to believe that he
had no capacity to make a sexual relationship. In medical history,
he visited many traditional faith-healers (hakim) and hospitals
and also took medicine for the same, but no improvement was
found and he had no record of medicines and any prescriptions.
In family history, Mr. V belonged to a nuclear family and he
was fourth child among seven siblings. His fathers attitude
toward him was critical and he was more attached with his
mother. Interpersonal relationship between family members are
cordial, and attitude towards his illness was supportive except his
father.
Mr. V was born with a full-term normal delivery at home
and no prenatal, natal and postnatal complications were reported
by mother. His developmental milestones were reported to be
normal. Mr. V started his schooling at Etha district (U.P) from
the age of 6 years and used to perform average in studies till 5 th
class. At the age of 13year he started learning zarikam with
one of his friend and after three years he was working
independently. He used to maintain healthy relationship with his
co-workers and supervisor. Mr. V was premorbidly responsible
and an active person; but sensitive towards criticism and used to
be anxious in a stressful situations. He was religious and has
good moral standards and he never been interested towards any
type of substance abuse and also never had been any conflict
with siblings or peers. On MSE he was looking older than his
age, appears short, lean and thin, sitting in a reclined manner,
maintained eye to eye contact partially, whenever enquired about
his personal matters, he used to keep his hands on mouth, speech
tone and intensity was low and productivity was decreased. He
had below average cognitive and intellectual functioning,
preoccupation with sex, ideas of hopelessness, guilt and suicidal
ideation were found in content of thought, mood was irritable
and affect was anxious, judgement was poor and had grade-II
level of insight.
Mr. V was assessed using Beck Depression Inventory
(BDI-II) developed by Beck, 1990; Hamilton Rating Scale for
Anxiety (HAM-A) developed by Hamilton, 1959; International
index of erectile function (IIEF) developed by Rosen et al in
1997; Thematic Apprehension Test (TAT) developed by Bellak
1993; Millon Clinical Multiaxial Inventory (MCMI-III)
developed by Millon et al., 1994. In test findings, he scored 31
on BDI which indicated presence of severe level of depression;
score on HAM-A 15 indicated present level of anxiety was not at
clinical level; scored 31 on IIEF indicated moderate level of
erectile dysfunction. TAT results showed that he had
predominant need for sex, aggression, dominance and affection,
major presses as sexual desire, lust and love. He had main
conflict with need for sex and inferiority and to overcome from
this conflict he used to utilize wishful thinking. On MCMI-III the
results showed that it was a valid profile and his approach toward
testing was frank and self revealing. He comes under
Depressive, schizoid and avoidant Clinical personality trend
means he had worthless self image, and characteristically warm,
tender and non competitive, timidly avoids social tension and
interpersonal conflicts. On severe personality pattern he comes
under schizotypal and borderline group which indicated, he have
estranged self-image and tendency toward himself as forlorn with
repetitive thoughts of lifes emptiness and meaninglessness. On
clinical syndrome scale, elevated score was found on anxiety
scale which indicated, patient might be having estranged selfimage and tendency toward himself as forlorn with repetitive
thoughts of lifes emptiness and meaninglessness. On clinical
syndrome scale, elevated score was found on anxiety scale and
severe clinical syndrome scale, elevated score were found on
Major depression and Thought Disorder, which indicated that he
www.ijsrp.org
International Journal of Scientific and Research Publications, Volume 4, Issue 9, September 2014
ISSN 2250-3153
International Journal of Scientific and Research Publications, Volume 4, Issue 9, September 2014
ISSN 2250-3153
International Journal of Scientific and Research Publications, Volume 4, Issue 9, September 2014
ISSN 2250-3153
www.ijsrp.org
International Journal of Scientific and Research Publications, Volume 4, Issue 9, September 2014
ISSN 2250-3153
CASE NO-3:
Mr. S has moderate to severe level of depression for that he
was provided supportive psychotherapy behavioural strategies
and followed by cognitive techniques.
In initial individual sessions, he was expressed that still he
need to clarify few questions regarding sexuality and he was
provided the information based on his question.
The cognitive distortion was identified such as Religiously
what was happened with me was wrong and god should be
punishing me. He was asked proofs for his believe in which he
was failed. There after he was explained that his believes are
maladaptive by providing suitable examples and also asked him
to write some positive self statements as a home work such as I
have done nothing wrong, it is common for every individual in
early adult hood. It happens with all .
Once again he was explained the process of reproduction
semen and body functions. He taught that our body has ability to
produce it again and again and the semen discharge has no
harmful effects to human beings. Some examples were used to
convince him such as married men do sex every day but they
dont become weak.
IV. RESULTS
Graph-1: Graphical representation of Pre and Post assessment scores of Case-1, Case-2 and Case-3.
60
40
BDI-II
20
BDI-II
0
Pre
asse
ss-1
Pre
asse
ss-2
Pre
asse
ss-3
HAM-A
IIEF
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International Journal of Scientific and Research Publications, Volume 4, Issue 9, September 2014
ISSN 2250-3153
Graph-2: Graphical representation of reduction in scores of BDI-II, HAM-A and IIEF of Case-1, Case-2 and Case-3.
60%
50%
40%
CASE-1
30%
CASE-2
20%
CASE-3
10%
0%
BDI-II
HAM-A
IIEF
Graph-3: Graphical representation of the improvement in Case-1, Case-2, and Case-3 in relation t BDI-II, HAM-A and IIEF.
80%
70%
60%
50%
40%
30%
20%
10%
0%
BDI-II
HAM-A
IIEF
CASE-1
CASE-2
CASE-3
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International Journal of Scientific and Research Publications, Volume 4, Issue 9, September 2014
ISSN 2250-3153
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AUTHORS
First Author Mahesh Tripathi, Clinical Psychologist, Child
Development Centre, GEMS Health Care, Masabtank,
Hyderabad.
Second Author Godishala Sridevi, Head of the Department &
Rehabilitation Psychologist, Child Development Centre, GEMS
Health Care, Masabtank, Hyderabad.
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