The Effectiveness of Cognitive-behavioural Therapy in Treating Depression

In our modern time, depression is strongly talked about when it comes to a mental health issue, also is the use of cognitive behavioral therapies (CBT). When mixing CBT and depression, it introduces a new way of dealing with the symptom of depression and how it can be improved. Depression is a state where it can either be longstanding or recurring, where a person has no longer interest in once pleasurable life experiences, and they are trapped in this depressed mood. CBT focuses on shifting mental actions and process that requires knowledge and understandings through different experiences, thoughts, and senses (Lilienfeld, et al., 2017). Using CBT to aid in depression is common but it still needs to be further researched on. This study is to see how effective cognitive behavioral therapy is to improving depression.

In the first article, Clinical Effectiveness of Individual Cognitive Behavioural Therapy for Depressed Older People in Primary Care. The main purpose of this experiment was to see how effective using Cognitive-Behavioural Therapy to care for older people with depression would work. Using a single-blind, randomized, controlled trial (RCT) with a 4 and 10 month follow up visit. They randomly divided this group of 204 elderly people who have a Geriatric Mental State Diagnosis of depression, into three groups. The three different versions were CBT, Talking Control (TC), and Treatment as Usual (TAU). Each experiment bought something different. CBT main idea of their study was to unmask certain issues that come along with old age. They investigated participants view of themselves as they aged, and how they perceived negative effects when it came to physical ill-health. Additional to this experiment they gave all participants “The Feeling Good Handbook” by Burns with selective chapters to focus on. TC is implicated to stop CBT from being used, role plays involving the therapist's is how they introduced TC to the supervisor so questions that were more difficult could be answered. Therapists were trained not to challenge abnormal beliefs; an were to act and show warmth and interest to the patients, while also encouraging them to discuss everyday topics such as current affairs and hobbies. They did not focus on emotional situations, nor offer problem solving or behavioral task options. Lastly, TAU continued the duration of regular medication, routines, and the basic refers to other services these people were already presented with. Beck Depression Inventory-II (BDI-II) collected the baseline, 4 months check up which is the end of their therapy, and the 10 months check up after the baseline visit. BDI-II contains 21 items and identifies symptoms and attitudes associated with depression, and range depression from 0-13 none or minimal depression, 14-19 mild depression, 20-28 moderate, and 29-63 severe depression. Through the work of CBT in helping improve depression in older people, they found reduction scores in many aspects. A whole 35 improvement score per one session of CBT which is impactful with such little time used. Out of all participants tested in the CBT experience, a 33% felt a 50% greater reduction in BDI-II after using the CBT, meaning they felt their depression shifted half of what it was before. A whole 72% of CBT participants felt it was useful in one way or another. Overall, this experiment shows CBT is an effective treatment when using it to care for older people with depression (Serfaty, Haworth, & Blanchard, 2009). This helps strengthen the research question, for CBT is effective for elderly care and for understanding how effective CBT can be all together.

A second article reviewed was the Guided Self-Help Behavioral Therapy for Depression in Primary Care: A Randomized Controlled Trial. This is a randomized controlled trial (RCT), of a parallel. 281 Individuals entered this study, aged 18 or older. They had to present a BDI-II score of 14 or more and be a part of one of the seven National Health Service general practices in Glasgow, Scotland UK with symptoms of depression. This study compares Guided Self-Help Cognitive Behavioural Therapy (GSH-CBT) with the primary care treatment, and with primary care treatment as per usual (TAU). The purpose of GSH-CBT was to introduce three different types of workbooks connected to CBT ideas, topics like problem-solving, being assertive, overcoming sleep problems, and more were covered. The initial appointment was an introduction to the uses of self-help material. The patient was also giving the first workbook and taught how to utilize it. At the second session, review on the first workbook was done before adding another two workbooks to be used between the last two sessions. The last session was the last review of their progress. Their goal was to evaluate the use of these workbooks, using three 40-minute appointments at 1, 2 and 4 weeks (which can be considered the 2+1 model). The TAU group received the regular access they had to standard treatment from their family doctors, which could include antidepressant prescription, monitoring, and referral to specialists of psychological therapies. BDI-II mean scores fell from 29.8 to 16.4 with the use of CBT and had a 42.6% recovered at the 4-month mark. This alone shows strong evidence that the GSH-CBT packages are effective when offered through the books and face to face meetings. This study aids the research question based on how effective using types of CBT are, this can help in exploring the ways CBT is beneficial for those in improving their depression.

A third article Online randomized controlled trial of brief and full cognitive behavioral therapy for depression. Around 3,000 Men and women, aged, 35-44 were tested for this experiment. Using an RCT, the idea was to see if the effect of a brief CBT would be as effective as an extended CBT, and whether problem-solving and stress management could add components in improving depression. They achieved an online CBT intervention using material from the MoodGYM site; this site’s program involves five 20 to 40-minute modules. In the first module, it is basically an introduction to CBT and things they will use throughout the program. The second part involves methods to challenge them, focusing on their vulnerability and give ways for participants to modify their dysfunctional beliefs through online courses. The third module focuses on behavioral strategies when encountering negative thoughts (depression). The fourth module is all about providing information and feedback. And the last one provides problem-solving skills when it comes to dealing with family and relationships. There is six different versions for this trial, version 1 used module 1 only, Version 2 used module 1 and 5, version 3 used module 1, 4, and 5, version 4 used module 1, 2, and 5, version 5 used 1,2,3, and 5, and then version 6 being the full program used all modules. The finding was that a brief CBT was not effective in reducing depression symptoms through online work, unlike extended CBT which had a good reduction in depression. This study uses the research question for the experiments show how if CBT is going to be effective, it should be an extended version of it.

A fourth article studied was The Current Study Examined the Effect of Cognitive Behavioural Therapy in Groups for Co-Morbid, Clinically Significant Anxiety and Depression in COPD Outpatients of Both Sexes. The purpose of the study was to see if using CBT would be effective in helping treat depression and anxiety in patients with COPD. They put their focus on men, and women aged 40 or older, using an RCT to compare CBT and enhanced standard care. Everyone involved had followed up meetings at 2 and 8 months from the baseline, and the outcomes were measured using the BAI and BDI-II. The design divided people into two different groups according to their post-prochodilatory FEV1 prediction. During their visits, they obtained self-report measures and actigraphy device for sleep. The aim of the CBT group was to help participants change their beliefs and behavioral patterns that aid in their psychological symptoms, having 7 weeks of 2-hour meetings. The other group encountered telephone contact with a member of the study every two weeks in the period of the experiment. Findings show the mean score when down to 28.8, which may still seem high but taking in the initial score it was significant useful. Symptoms of depression and anxiety significantly improved with the use of CBT, and it may also give a rapid relief for COPD. The research question focused on using CBT to treat depression and it is proven through how effective it was determined by the BDI-II.

In the last article, Can Cognitive-Behavioural Therapy Increase Self-Esteem Among Depressed Adolescents? A systematic review. With this systematic review, their objective was to see how effective the use of CBT is for improving self-esteem among depressed adolescents. 82 participants aged 13-18 adolescents, were divided into two experiments of this meta-analysis. The RCT by Reynolds and Coats (1986), 30 participants were included since they suffice the BDI score of 12 or greater, Reynolds Adolescent Depression Scale (RADS) of 72 or greater, and Bellevue Index of Depression (BID) score of 20 or higher. The 30 individuals were split into three groups CBT, relaxation training, and a wait-list control. The partakers had 10, 50-minute group treatments over a five-week span, taking place at the student’s local high school. The use of group discussions and surveys were used, and at the end of the experiment, only 21 subjects were left, due to either dropout rates or not finishing the assessments. Though out of those 21 a high percentage was seen to show the effectiveness of CBT compared to the other groups, which were still effective but not as much. The BDI scale saw number decrease, using CBT lowered people's perceived levels of depression (Taylor & Montgomery, 2007). This again provides an insight into the research question of how effective different CBT can be when used the correct way, as shown throughout the experiment.

This study has provided that the use of CBT does in fact help improve depression in all ages and gender, it can also aid in people going through other mental or physical illnesses. The use of CBT through personal face to face has a longer impacting effect on patients involved, and online versions still do provide a successful use of CBT. The findings throughout are consistent, although four gaps that could be seen in one article or another, one being the dropout rate which was most common in all, no researchers give explanations to why participants left the study. The second gap was how small certain studies were, Reynolds and Coats (1986) talked about how they were limited to an average of 30 per study. Limitations to the GSH-CBT experiment and the Module groups also added a gap for more computerized, book-based work, for they were limited and felt restrain while only following certain criteria along with CBT. Lastly, the use of the BDI-II was used through all experiments so it could be a bias to why all results were so effective. Other than that, it is straightforward with matching results in both sexes of adolescence, adults, and elders about how CBT is effective when it comes to the treatment of depression. Further research can be related through all five articles by they all believed replicating the experiment to strengthen the result would benefit the long run of these solutions. Also, comparing CBT to more different forms of depression treatment and seeing how beneficial it is, one such as the second article the GSH-CBT study wanted its next assessment to use antidepressants and see how they are compared to CBT. Overall, the effectiveness of CBT is valuable for improving those dealing with depression.