Efficacy of Cognitive Behavioral Therapy on Depression Level among Patients with Major Depressive Disorder in Mental Health Settings: A Research Proposal
Introduction
Major Depressive Disorder (MDD) has a high prevalence rate; it affects more than 16.1 million American adults of the US population aged 18 years or older (Anxiety and Depression Association of America [ADAA], 2017). MDD is more common in women than in men and can develop at any age (Kessler, Berglund, & Demler, 2003). Major depressive disorder is defined as a mental disorder that is characterized by a general low mood accompanied by low self-esteem and loss of pleasure in normal daily activities (World Health Organization [WHO], 2010). The diagnosis of MDD needs a distinct
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Given the strength of evidence that supports cognitive behavioral therapy as an effective treatment for depression; many clinical practice guidelines strongly recommend CBT as the first line treatment along with antidepressant medication for MDD (Driessen & Hollon, 2010; Tucker & Oei, 2007).
Treating or at least reducing depression levels among patients with MDD is considered an important issue in mental health because of the high risks of its consequences as the suicide attempts, disabilities, and high financial spent on MDD treatment and prevention. However, there is a gap in the literature that discuss the effect of CBT for depression among patients with MDD and little is known about the effectiveness of CBT on MDD in mental health settings yet. This study will have wide application in nursing practice, education, and research. The anticipated outcomes of this study will be used to recommend the importance of cognitive behavioral therapy in treating MDD to be used by healthcare providers as a usual care for MDD. Furthermore, this study will offer a baseline data about for knowledge and research about the effectiveness of depression treatment in routine clinical practice in mental health settings.
Research purpose
The main purpose of this study is to examine the effect of CBT in reducing depression level among patients with major depressive disorder as well as to
CBT also fails to recognise the impact of situations or experiences that are out of the control of the individual and places total responsibility on the individual. Further, research has shown that although CBT is superior in treating anxiety and depression it does so only by reducing/eliminating symptoms and does little to increase well-being, however with a renewed emphasis incorporating symptom reduction and increased quality of life this appears to be changing (Oei & McAlinden,
Joanna-Briggs database was searched using the terms depression and psychotherapy (55,672 results) further narrowed by the past five years (15,427 results) added term effectiveness (5,250 results) added term cognitive behavioral therapy (1,286 results) and added term primary care (390 results), this yielded the articles Linde et al. (2015) as well as Barth et al. (2013). An additional search was completed using the terms antidepressant and minor depression (188 results) then the term effect (104 results) in the last ten years and the publication Barbui, Cipriani, Patel, Ayuso-Mateos, & van Ommeren, M. (2011) was
Approximately 151 million people are currently combating major depressive disorder (MDD) worldwide (Haddad & Gunn, 2011). Major depressive disorder (MDD) affects around one in six men, and one in four women during any given moment of their lives, and in any twelve-month period, nearly five percent of individuals in their surrounding communities are depressed (Haddad & Gunn, 2011). Depressive episodes may appear at any age; however, MDD is most prevalent in adults who are eighteen-years-old to sixty-four-years-old, with a median age of onset being the twenties (Hillhouse & Porter, 2015). The treatment of MDD often consists of evidence-based treatments (EBTs) that include selective serotonin reuptake inhibitors (SSRIs), and cognitive-behavioral
In addition, CBT is effective because it has the capacity to treat a wide variety of psychological disorders. Among adults, it has been proven effective in the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), phobias, obsessive compulsive disorder, post-traumatic stress disorder (PTSD), substance abuse/dependence, common marital problems and diet disorders. To conduct CBT within older individuals, it is important to assess cognitive capacity, evaluate whether a patient has sufficient memory function and cognitive processing skills. A brief cognitive screen such as the Montreal Cognitive Assessment is effective to assess early problems with executive functioning. The Patient Health Questionnaire (PHQ-9) is another recommended screen for severity of depressive symptoms.
Cognitive Behavioral Therapy (CBT) is now one of the most widely used therapeutic treatment regimes in use for the management of MDD. CBT combines elements of talking therapy as well as insights from neuroscience in an attempt to help patients manage their own symptoms and formulate strategies for dealing with risk factors and triggering experiences. CBT has proven an effective treatment model. One of the best known large-sample studies of the effectiveness of CBT was undertaken by Rush et al. in 2006. Their work found that of their 3,671 patients who were treated with CBT and antidepressants there was a 36.8% remission rate per phase of the treatment. Study by Jakobsen et al. (2011) considered the effectiveness of CBT compared with nonintervention
There are strong evidences supporting the use of psychotherapy in the treatment of depression, particularly a standard Cognitive Behavioral Therapy, a high intensity psychological intervention (Department of Health, 2001; National Institute for Health and Clinical Excellence (NICE), 2004, 2009). However, the evidence indicates that patients are not consistently receiving the therapy as a routine clinical care (Shafran et al., 2009). Several problems associated with integrating CBT into treatment include difficulty in accessing services, long waiting times for therapy, expensive service costs, an inadequate and inequitable distribution of CBT therapists in health service (Shapiro, Cavanagh,& Lomas, 2003; Wright et al., 2005) as well as the
primary conclusions of this study were that 77% of participants who successfully completed the MBCT experienced a significant reduction in recurrence rates of almost half in comparison with those who received only treatment as usual (Teasdale et al., 2000). In 2002, Teasdale et al. followed up with a three-part empirical investigation into the effects of MBCT on depression on 148 subjects, ages 21-65 years, who met selection requirements that included DSM-III criteria for major depression. Different subsets of the sample were used for each of the three parts of the study and then compared to a non-depressed control group of similar demographics. Compared with treatment as usual, Teasdale et al. found a significant reduction in relapse of major
Then, two groups received the different treatment. Group A and Group B both received CBT for tens sessions, while Group B additionally received the approach of mutual support. The participants in Group B were randomly paired into 45 subgroups, and were required to contact each group at least twice per week to ask for assistance or social support as needed. Also, the Group B was provided the guidance relative to how to support others from the researchers. The scale of depression of each participant tested by BDI-II every three months for two years after the therapies. The participants in the Group B were asked not contact with their partners after the
Since its invention, CBT has gained a lot of popularity among psychologists with many published research studies to support it use in cognitive behavioural therapeutic interventions. One of the reasons behind its success has been the adaptation of CBT as an applicable therapy to several disorders as well as other related psychological problems. Despite the extensive research on CBT, there still remain unanswered questions on its effectiveness with regards to different disorders and its long-term effects as well as the authenticity of research aimed at proving its level of effectiveness. The main issue has been the increased effects that arise out of combining BT with other therapies in treatments. As a result, there are questions that still
CBT has shown to be as useful as antidepressant medication for individuals with depression and is superior in preventing relapse. Clients receiving CBT for all depression disorders are encouraged to schedule activities in order to increase the amount of pleasure they experience. In addition, depressed patients learn how to restructure negative thought patterns in order to interpret their environment in a less biased way. CBT for Bipolar Disorder and the high-risk depressed client is used as an adjunct to medication treatment and focuses on psychoeducation about the disorder and understanding cues and triggers for relapse. The client will have more reason to gain more confidence in them. Studies indicate
Another study that shows the effectiveness of CBT took a look at the use of CBT for depression in Parkinson’s disease. According to scientists depressed patients with Parkinson’s disease could show greater improvements in anxiety, quality of life, coping, and Parkinson 's disease symptoms if treated with CBT. The purpose of their study was to examine the efficacy of individually administered cognitive-behavioral therapy (CBT), relative to clinical monitoring (with no new treatment), for depression in this medical population.
Anxiety, stress, and depression are commonly treated with CBT, with or without complimentary pharmaceutical/behavioural treatments. It is valuable to assess whether CBT is an effective treatment, for one, that medication use could be avoided. It is widely accepted that CBT is an effective therapy in treating many psychological symptoms,
Terms discussed in paper: CBT: Cognitive-behavioural therapy; HEP: Health enhancement program; TAU: Treatment as usual; TRD: Treatment-resistant depression; Mediators: Measurable changes during a treatment; MBCT: Mindfulness-based cognitive therapy;
CBT as a therapy has its advantages and disadvantages for individual users. Wright (2004) maintains that one advantage of CBT is the evidence-based techniques employed by mental health services. There is evidence to suggest that CBT as a non-pharmacological intervention (psychological) can be as effective as pharmacotherapy (medication) in the treatment of mental health patients and may be useful in cases where medication alone has not worked. There is no shortage of support for this position by Hall and Iqbal (2010), Sudak (2011) and Barlow (2014).
Several studies suggest that CBT and IPT may have specific effects when competently implemented, but only for patients with more severe depression. Among studies that tested for moderation with respect to severity, specific effects were found only among patients with more severe depression, with respect to both psychotherapy and medications (Driessen et al., 2010; Fournier, 2010; Kirsch et al., 2008). Some call this the “dirty little secret” of pharmaceutical industry that has long selectively screened out patients with less severe depression (in order to up the odds of finding drug-placebo differences required to win FDA approval) and then turns around and markets those same medications to people who it knows full well are likely to respond