Clinical Assessment Reports

Submitted To:

Ms. Mahshameen Munawar John

Submitted By:

Hafiza Muskan Tahir

Ms Clinical Psychology (Semester 1st)

Roll no 14

Department of Psychology

Government College Women University, Sialkot

Beck Depression Inventory (BDI-2)
Bio Data

Name: S.A

Age: 25 years

Gender: Female

Occupation: Marketing Assistant

Education: Bachelor's Degree in Business Administration

Marital Status: Single

Number of Siblings: Two (1 brother. 1 sister)

Religion: Islam

Source of Referral

Taken from community by a trainee psychologist for the administration of Beck

Depression inventory II as a part of coursework requirement. The test was administered for
academic purpose.

Background Information

Family Background

The subject comes from a close-knit family based in Daska, Pakistan. According to the
subject, her parents, have been pillars of support throughout her life. In client's family, her father
is 55 years old, while her mother is 52 years old. She shares a close and respectful relationship
with her father, often seeking his guidance and support in matters of career and personal
development. Her relationship with her mother is characterized by love and nurturing, as they
share a bond of trust and understanding. She told that she frequently turns to her mother for
emotional support and advice, finding solace in their connection.

The client had two siblings: an elder brother and a younger sister, the eldest, works as a
software engineer in a reputable IT firm, while her younger sister is currently pursuing her
undergraduate studies in medicine.
 Within the family, the client shares a strong bond with both her siblings. She looks up to
her elder brother, for his wisdom and guidance, while fostering a supportive and affectionate
relationship with her younger sister Her father serves as the primary breadwinner of the family,
working as a school teacher, while her mother takes on the role of the primary decision-maker.

Her wisdom and guidance shape important family decisions, fostering harmony and unity
within the household. These dynamics contribute to a supportive and cohesive family
environment, where love, respect, and understanding are the pillars of their relationships.

According to client her parents instilled in her and her siblings the importance of hard
work, integrity, and compassion. Despite the occasional challenges they faced, client's family
always stood united, offering each other unwavering support and encouragement.

The client told that she shares a warm and affectionate relationship with her parents and
siblings. They have always been there for each other through thick and thin, celebrating joys and
weathering storms together. Their bond of love and understanding has been the cornerstone of
their family's strength and resilience.

Educational History

The client attended a local school in Daska, Pakistan, where she completed her primary
and secondary education with distinction. She actively participated in various extracurricular
activities, including debates and sports events. She obtained 900/1100 in matric. After
completing her high school education, she took admission in a college in Daska city, she
completed her ICOM with 890/1100. After that she pursued a Bachelor's Degree in Business
Administration from a reputable university in Sialkot. She graduated with honors and
demonstrated a keen interest in marketing and business management throughout her academic
journey.

Occupational History

Upon completing her education, she secured a position as a Marketing Assistant at a

dynamic marketing firm in Sialkot. In her role, she collaborates with cross-functional teams to
develop and implement marketing strategies for diverse clients. According to client her
dedication, creativity, and strong communication skills have contributed to the success of several
marketing campaigns. She told that she maintains friendly and helpful relationships with her
coworkers. She values teamwork and listens to others' ideas.Her positive attitude and willingness
to assist create a supportive work environment where everyone feels respected and motivated.
She communicates openly and is approachable, encouraging teamwork and cooperation among
colleagues.

She continues to pursue professional development opportunities to enhance her skills and
contribute effectively to her organization. She also shared that sometimes she feels sad and tired.
She said managing work, family, and her own feelings is hard sometimes. She knows she needs
to take care of herself and get support from her family.

Personal History

The client's childhood was marked by love, care, and nurturing from her parents. She
achieved developmental milestones at appropriate ages, demonstrating curiosity and eagerness to
learn from an early age. Her mother's pregnancy and delivery were uneventful, with no reported
complications before or after birth. She told that she transitioned through puberty smoothly,
supported by her family's guidance and understanding during this period of physical and
emotional change.

Social History

The client had a good group of friends who she enjoys spending time with. They share
interests and have fun together, whether they're trying new things or just hanging out. She told
that she values her friendships as they give her support and make her feel connected to others.
These friendships add joy and meaning to her life beyond work and family she said that she
might feel a bit down at times, but it doesn't affect her daily life too much.

She told that she generally able to manage her responsibilities and engage in activities
that she enjoy. However, there are moments when she feel a lack of energy or motivation, and
she sometimes find it challenging to fully enjoy things like she used to. She added that despite
these feelings, she is hopeful that with some support and self-care, she can navigate through this
phase and emerge feeling more positive.
Test Administration

The client arrived at the lab for her test administration session with the trainee
psychologist. The room was calm and well-lit, with a comfortable atmosphere to put her at ease.
The trainee Psychologist greeted her warmly, ensuring she felt comfortable and ready for the
assessment.

The session began with a brief explanation of the purpose of the test and what it aimed to
measure. The subject being an active participant, listened attentively and expressed her
understanding. The primary purpose of the BDI-II was to assist in assessing the presence and
severity of depressive symptoms in individuals.

Behavior Observation

During the assessment, she seemed calm and engaged, showing comfort in our
conversation. She took her time to answer questions, sometimes pausing to think. She appeared
calm and composed. She sat comfortably and engaged actively in conversation, showing no signs
of sadness or distress. Her demeanor is positive, with occasional smiles and a relaxed manner.
Despite the topic discussed, she remains emotionally stable and demonstrates healthy coping
skills. She interacts respectfully and maintains appropriate boundaries, displaying a hopeful
outlook for the future. Overall, the client's behavior reflects a stable emotional state and
resilience, with minimal indications of depressive symptoms noted. Overall, she was open about
her feelings. She took 10 minutes to complete this Beck Depression Inventory-II.
 Results

Quantitative analysis

Subtotal Page 1 5

Subtotal Page 2 6

Total Score 11 (Minimal Depression)

BDI-II Cut off scores

Severity of Depression Total Score Range

Minimal depression 0-13

Mild depression 14-19

Moderate depression 20-28

 Severe depression 29-63

Qualitative Interpretation

 Feeling Sad (Item 1): The client's score of 1 indicates that she feels sad much of the
time, suggesting the presence of mild sadness or low mood. This feeling of sadness may
manifest in various ways, influencing her thoughts, behaviors, and overall well-being.
 Discouragement and Feelings of Failure (Items 2 and 3): The client's scores of 0 on
these items suggest that she is not currently feeling discouraged about her future or
experiencing feelings of failure, which is positive., it's essential to acknowledge that these
feelings can fluctuate and may not always be apparent on a given day
 Loss of Enjoyment (Item 4): The client's score of 1 indicates that she doesn't enjoy
things as much as she used to , suggesting a loss of pleasure or interest in things that were
once fulfilling or enjoyable for her. This loss of enjoyment can contribute to feelings of
apathy, disinterest, or even detachment from previously valued pursuits.
 Feelings of Guilt (Item 5): The client's score of 0 suggests that she is not currently
experiencing feelings of guilt, which is another positive indicator. Denial of feelings of
guilt indicates a lack of significant self-blame or remorse for past actions or
circumstances.
 Feelings of Punishment (Item 6): The client's score of 1 indicates presence of feeling
like she may be punished suggests a sense of vulnerability or fear of consequences for her
actions or thoughts. This perception of potential punishment may stem from internalized
beliefs or negative self-perceptions.
 Self-Perception (Item 7): The client's report of feeling the same about herself as ever (0
score) indicates a stable self-perception, suggesting consistency in her identity and self-
concept. This stability in self-perception can serve as a source of resilience and grounding
amidst life's challenges and transitions.
 Self-Criticism (Item 8): The client's score of 2 suggests that she criticizes herself for all
of her faults, indicating some self-critical tendencies. The client's admission of self-
criticism for her faults highlights a tendency towards negative self-evaluation and
internalized criticism.
 Crying (Item 9): The client's report of reduced crying compared to the past by scoring 0
suggests a shift in emotional expression or regulation. This reduction in crying may
reflect adaptive coping strategies, increased emotional resilience, or changes in the
client's emotional landscape that merit further exploration and validation.
 Interest in Others/Activities (Item 12): The client's score of 1 suggests that she is less
interested in other people or things than before, indicating a decreased interest in people
or activities which indicates a diminished sense of engagement or connection with her
surroundings. This decreased interest may impact her social interactions, motivation
levels, and overall sense of fulfillment.
 Decision-Making (Item 13): The client's score of 1 suggests that she finds it more
difficult to make decisions than usual, it suggests a sense of uncertainty or indecisiveness
that may impact her ability to navigate choices and commitments.
 Energy Level (Item 15): The client's score of 1 suggests that she has less energy than
she used to have, indicating decreased energy levels or fatigue. It highlights a potential
disruption in her physical and emotional vitality. This decrease in energy may impact her
ability to engage in daily activities, maintain concentration, or pursue personal interests
 Sleep Changes (Item 16): The client's acknowledgment of increased sleep compared to
usual suggests changes in her sleep patterns or habits that may be indicative of underlying
stress, emotional distress, or physiological factors
 Irritability (Item 17): The client's report of increased irritability suggests heightened
emotional sensitivity or reactivity that may impact her interpersonal relationships and
daily interactions
 Change in Appetite (Item 18): The client reports 0 i.e. no recent change in her appetite,
indicating stability in her eating patterns. This may be viewed as a positive indicator of
physical well-being and routine.
 Ability to Concentrate (Item 19): The client scored 0 and reports being able to
concentrate as well as ever, indicating stability in her cognitive functioning and
attentional capacity. This ability to concentrate suggests that she can maintain focus and
attention on tasks, which is essential for daily functioning and productivity. However, it's
important to consider the impact of external stressors, distractions, or cognitive
challenges that may affect her concentration levels in different contexts..
 Fatigue (Item 20): The client's acknowledgment of increased fatigue by scoring 1
suggests a sense of physical and mental exhaustion that may impact her daily functioning
and quality of life.
 Incorporation of Behavioral Activation: Behavioral activation techniques, such as
activity scheduling and graded task assignments, can help the client reengage in
pleasurable activities and restore a sense of accomplishment and satisfaction in her daily
life.
 Discussion

Developed by Dr. Aaron T. Beck, a psychiatrist, the BDI-II is an updated version of the

original Beck Depression Inventory (BDI).The BDI was first published in 1961 as a means to

quantify and assess the severity of depressive symptoms in patients diagnosed with depression.

The BDI underwent revisions and updates over time, leading to the development of the BDI-II,

which was published in 1996.

The BDI-II is a widely used self-report questionnaire designed to measure the severity of

depressive symptoms in individuals aged 13 years and older. It consists of 21 multiple-choice

questions or items, each assessing a specific symptom of depression. Items on the BDI-II cover a

broad range of depressive symptoms, including sadness, guilt, pessimism, fatigue, and loss of

interest in activities.

Respondents rate each item on a scale from 0 to 3, with higher scores indicating more severe

symptoms. Total scores on the BDI-II can range from 0 to 63, with higher scores reflecting

greater severity of depressive symptoms. The questionnaire typically takes 5 to 10 minutes to

complete and can be administered in clinical settings, research studies, or academic settings.The
BDI-II is not intended to diagnose depression but rather to assess the severity of depressive

symptoms and monitor changes over time.

Studies examine how well the BDI-II items correlate with each other (internal consistency)

and whether scores remain stable over time (test-retest reliability). Concurrent validity refers to

how well the BDI-II scores correlate with scores from other depression measures. Beck et al.

(1996) conducted a study to establish the reliability and validity of the BDI-II among psychiatric

outpatients, demonstrating strong internal consistency and concurrent validity with other

depression scales.

Clinical utility research evaluates how effectively the BDI-II can assist clinicians in

diagnosing depression, monitoring treatment progress, and predicting treatment outcomes. It

explores whether BDI-II scores align with clinical judgments and whether changes in scores

correspond with changes in symptom severity. Rush et al. (2003) investigated the clinical utility

of the BDI-II in predicting response to cognitive therapy for depression, finding that pre-

treatment BDI-II scores predicted treatment outcomes. Whisman et al. (2000) examined the

cross-cultural validity of the BDI-II among Chinese Americans, finding that the scale

demonstrated good internal consistency and construct validity in this population.Seggar et al.

(2017) evaluated the criterion validity of the BDI-II by comparing scores with DSM-5 diagnoses

of depression, demonstrating strong agreement between BDI-II scores and clinical diagnoses.

Studies on treatment outcomes explore whether changes in BDI-II scores reflect changes

in depressive symptoms following interventions such as psychotherapy or medication.

Researchers assess whether reductions in BDI-II scores correspond with improvements in overall

functioning and quality of life. DeRubeis et al. (2005) investigated the relationship between BDI-

II scores and treatment outcomes in patients receiving cognitive therapy for depression, finding
that reductions in BDI-II scores were associated with improvements in depressive symptoms.

Ongoing research aims to further refine and validate the psychometric properties of the BDI-II to

enhance its reliability and validity across diverse populations and settings.

Applications

 Aid in diagnosing depression and other mood disorders.

 Monitor treatment progress and response to interventions.

 Identify individuals at risk for depression or relapse.

 Inform treatment planning and decision-making in clinical practice and research settings.

Significance

 The BDI-II is a valuable tool for assessing depressive symptoms, facilitating

comprehensive mental health assessment, and guiding treatment interventions.
 Its widespread use and extensive validation make it a reliable instrument in the field of
psychiatry, psychology, and mental health research.
The Beck Depression Inventory, Second Edition (BDI-II), is based on Aaron T. Beck's
cognitive theory of depression. Aaron T. Beck, a psychiatrist, developed cognitive therapy, also
known as cognitive-behavioral therapy (CBT), which emphasizes the role of cognitive
distortions and negative thinking patterns in the development and maintenance of depression.
The cognitive theory of depression posits that individuals who are depressed tend to interpret
events, themselves, and their futures in negative ways. These negative interpretations lead to
negative emotions and behaviors, which further reinforce the depressive cycle. According to
Beck's theory, depression is characterized by distortions in thinking, such as:

 Negative cognitive triad: This refers to negative views of oneself, the world, and the
future. Depressed individuals may perceive themselves as unworthy or incompetent, view
the world as bleak and devoid of opportunities, and see the future as hopeless and
unchangeable.
  Cognitive errors: Depressed individuals often engage in cognitive distortions, such as
overgeneralization (drawing broad conclusions from isolated incidents), black-and-white
thinking (seeing situations as all good or all bad), and catastrophizing (exaggerating the
significance of negative events).
 Selective attention: Depressed individuals may selectively attend to negative
information while ignoring or discounting positive information. This selective focus on
negative stimuli perpetuates feelings of sadness and hopelessness.
The BDI-II questionnaire is designed to assess the presence and severity of depressive
symptoms based on Beck's cognitive theory of depression. The inventory includes items that
capture cognitive, affective, and somatic symptoms commonly associated with depression.
Individuals rate the severity of their symptoms over the past two weeks, providing insights into
their cognitive and emotional experiences.

By identifying and quantifying depressive symptoms, the BDI-II helps clinicians and
researchers evaluate the cognitive and emotional aspects of depression, monitor treatment
progress, and tailor interventions based on cognitive-behavioral principles. The BDI-II's
theoretical foundation in cognitive theory aligns with its emphasis on identifying negative
thought patterns and evaluating their impact on mood and behavior.

In this client’s case her acknowledgment of feeling sad much of the time, her diminished
interest in activities, and her increased self-criticism align with Beck's cognitive triad. These
responses reflect negative self-evaluations and perceptions of the world as bleak, which are core
components of depressive thinking.

Her feelings of potential punishment and increased irritability suggest underlying feelings
of guilt and self-blame, which are common manifestations of depressive symptoms. These
responses resonate with Beck's theory, highlighting the presence of negative cognitive
distortions.

Her reduced interest in other people or things and her decreased enjoyment in activities
indicate anhedonia, a key symptom of depression characterized by the loss of pleasure in
previously enjoyable experiences. This withdrawal from social and recreational activities reflects
the social impairment often observed in individuals with depression. Cognitive Impairment and
Fatigue:
 Her difficulty in making decisions, decreased energy, and increased fatigue suggest
cognitive impairment and physical lethargy, which are typical features of depressive disorders.
These symptoms may contribute to functional impairment and decreased productivity in daily
activities.

The client’s mixed responses on the BDI-II reflect the heterogeneous nature of depressive
symptoms and the variability in symptom presentation across individuals. While some responses
strongly align with Beck's cognitive theory, others may indicate adaptive coping strategies or
resilience in certain areas.

Conclusion

The client's responses on the Beck Depression Inventory, Second Edition (BDI-II),
provide valuable insight into the nature and severity of her depressive symptoms. Her scores
reflect a mixture of cognitive, emotional, and somatic manifestations consistent with Beck's
cognitive theory of depression.

The client score of 11 shows that she has minimal depression. Her BDI-II results
demonstrate alignment with Beck's cognitive theory, including negative cognitive triad, self-
criticism, anhedonia, and cognitive impairment. Understanding these cognitive distortions
informs targeted intervention strategies aimed at addressing maladaptive thought patterns and
promoting adaptive coping skills.

Recommendations

 Cognitive-Behavioral Therapy (CBT): CBT aims to help the client recognize and
challenge negative thought patterns, develop more adaptive coping skills, and change
unhelpful behaviors associated with depression.
  Psychoeducation: Psychoeducation provides the client with information about
depression, its symptoms, and the cognitive-behavioral model of therapy. It empowers
the client to understand their condition and actively engage in the therapeutic process.
 Skill-Building Exercises: Skill-building exercises, such as relaxation techniques and
stress management strategies, equip the client with practical tools to manage distressing
emotions, reduce physiological arousal, and promote overall well-being.
 Physical Activity and Lifestyle Changes: Engaging in regular physical activity and
adopting a healthy lifestyle contribute to improved mood, reduced anxiety, and enhanced
overall psychological well-being. These changes promote self-care and resilience in
coping with depressive symptoms.

References

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression
Inventory-II. Psychological Corporation.

Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. Harper &
Row.

Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B., & Trivedi, M. H. (1996). The
Inventory of Depressive Symptomatology (IDS): Psychometric properties. Psychological
Medicine, 26(3), 477–486.

Whisman, M. A., Perez, J. E., & Ramel, W. (2000). Factor structure of the Beck
Depression Inventory—Second Edition (BDI-II) in a student sample. Journal of Clinical
Psychology, 56(4), 545–551.
 Seggar, L. B., Lambert, M. J., & Hansen, N. B. (2002). Assessing clinical significance:
Application to the Beck Depression Inventory. Behavior Therapy, 33(2), 253–269.

DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon,
R. M., ... & Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to
severe depression. Archives of General Psychiatry, 62(4), 409–416.

Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy
of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research,
36(5), 427–440.

Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., ...
& Keller, M. B. (2003). The 16-item Quick Inventory of Depressive Symptomatology (QIDS),
clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients
with chronic major depression. Biological Psychiatry, 54(5), 573–583.
Appendix