Effect of Group Cognitive Behavioural Therapy on Depressive Symptoms in a Sample of College Adolescents in Nigeria

Testing the Impacts of Rational-Emotive Couple Intervention in a Sample of Parents Seeking Divorce

Marital burnout has not been extensively studied despite its huge consequences on family wellbeing and quality of family life. This study, using randomised-controlled trial, tested the impact of rational-emotive couple intervention on marital burnout in a sample of parents seeking a divorce. A total of 67 parents who participated during the rational-emotive couple intervention (RECI) were assessed using the marital burnout scale, Beck depression inventory, and parent rational and irrational beliefs scale. Crosstabulation, multivariate test analysis, and bivariate analysis were used to analyse the data collected. Results show a significant reduction of marital burnout in RECI group participants, and significant improvement was maintained at the follow-up stage. The result of the group and gender interaction effect shows no significant interaction effect of group and gender on participants' marital burnout at Time two and Time 3, respectively. The results indicate that a decrease in parents' irrational beliefs accounts for marital burnout among couples seeking a divorce. Marital burnout is positively associated with depression among couples seeking a divorce. This study concludes that the RECI is an effective intervention that reduces marital burnout which is a direct consequence of irrational beliefs which later metamorphose into depressive symptoms.

Psychosocial interventions for depression among young people in Sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND

Depression among young people is a global health problem due to its rising prevalence and negative physical and social outcomes. The prevalence of depression and the treatment gap among young people in Sub-Saharan Africa (SSA) is higher than global estimates. Most psychosocial interventions for adolescent and youth depression were developed in high-income countries and less is known about their effectiveness in SSA. Due to contextual differences, findings from High-Income Countries (HICs) are less applicable to SSA. Yet, no systematic review of psychosocial interventions for depression among young people in SSA has been conducted.

METHODS

A systematic literature search of four databases (Medline, Web of Science, PsycInfo, and Cochrane library) was conducted. Experimental studies published before May 2024 that evaluated the effect of psychosocial interventions on depressive symptoms among young people (aged 10-24 years) in SSA were included in the systematic review. Effect sizes (Hedge's g (g)) indicating differences between intervention and control groups were calculated using a random effects model.

RESULTS

Twenty-two eligible studies were identified for the systematic review, of which eighteen randomized control trials (RCTs) involving 2338 participants were included in the meta-analysis. The findings revealed that psychosocial interventions significantly reduced depressive symptoms (g = -1.55, 95% CI -2.48, -0.63), although heterogeneity was high (I2 = 98.8%). Subgroup analysis revealed that efficacy differed significantly by intervention type, with Cognitive Behavioural Therapy (9 studies) showing the strongest effect (g = -2.84, 95% CI -4.29; -1.38). While Wise Interventions (a form of positive psychology interventions; 2 studies) had a moderate effect (g = -0.46, 95% C.I -0.53, -0.39), Interpersonal Psychotherapy (2 studies; g = -0.08, 95% CI -1.05, 0.88) and Creative Psychological Interventions (3 studies; g = -0.29, 95% CI -1.38, 0.79) showed smaller, non-significant effects. Sensitivity analysis excluding studies at high risk of bias strengthened the effect size. Few studies assessed factors affecting intervention efficacy and showed mixed effects of age, gender, and adherence levels.

CONCLUSION

Psychosocial interventions, particularly CBT, significantly reduced depressive symptoms among young people in SSA. However, it is crucial to acknowledge the high heterogeneity which likely stems from variations in study populations and intervention delivery modalities. This highlights the need for further research to identify the specific intervention components and delivery methods that work best for distinct subpopulations. Future research should also explore how long intervention effects are maintained and factors affecting efficacy.

A comparison of the effectiveness of cognitive behavioural interventions based on delivery features for elevated symptoms of depression in adolescents: A systematic review

Background

Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities.

Objectives

The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability).

Search Methods

The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand-searching of two databases.

Selection Criteria

Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10-19 years with clinically relevant symptoms or diagnosis of depression were included.

Data Collection and Analysis

Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self-help, and unguided self-help. Effect on depressive symptom score was estimated across validated self-report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow-up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta-analyses were conducted using random effects models where there were two or more head-to-head trials. Network analyses were conducted using random effects models.

Main Results

Sixty-eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty-two RCTs (representing 6435 participants) were included in the pairwise and network meta-analyses for post-intervention depressive symptom score at post-intervention. All pre-specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self-help (SUCRA 83%) and unguided self-help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta-analyses for 6 to 12 month follow-up depressive symptom score. Neither guided self-help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6- to 12-month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self-help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self-help and individual CBT, respectively. Sixty-two RCTs (7347 participants) were included in the pairwise and network meta-analyses for intervention acceptability. All pre-specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta-analytic findings were similar to those of the network meta-analysis for all analyses. There may be age-based subgroup effects on post-intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre-specified sensitivity analyses separating out the type of placebo and excluding cluster-RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations.

Authors' Conclusions

At posttreatment, all active treatments (group CBT, individual CBT, guided self-help, and unguided self-help) except for remote CBT were more effective than no treatment. Guided self-help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16-19 years). Moreover, the studies of guided self-help vary in the type and amount of therapist support provided and longer-term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6- to 12-month outcomes. Although unguided self-help was the lowest-ranked active intervention at post-intervention, it was the highest ranked at follow-up. This suggests the need for further research into whether interventions with self-directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long-term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost-effective would be particularly useful.

Effect of multi-level interventions on mental health outcomes among adolescents in sub-Saharan Africa: a systematic review

OBJECTIVE

In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA.

DESIGN

Systematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach.

DATA SOURCES

A systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021.

ELIGIBILITY CRITERIA

Studies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10-24 years.

DATA EXTRACTION AND SYNTHESIS

We included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants.

RESULTS

Of 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes.

CONCLUSIONS

The evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts.

PROSPERO REGISTRATION NUMBER

CRD42021258826.

Examining the impact of randomized control intervention on depressive symptoms in schoolchildren with atypical behaviors

BACKGROUND

The need to investigate depression among disadvantaged groups motivated this study. This study investigated the impacts of rational emotive behavior therapy (REBT) on depressive symptoms in schoolchildren with atypical behaviors in Enugu State Nigeria.

METHOD

A group randomized controlled design was used to assign 37 schoolchildren to the intervention group and 37 schoolchildren to the waitlisted control group. These people were evaluated at three times (pretest, post-test, and later test) using a dependent measure. The outcome demonstrated that there was no discernible difference between the participants in the treatment group and those in the waitlisted control group at the time of the pretest. The post-treatment test results revealed a considerable improvement among participants as a result of REBT therapy.

RESULTS

The later test result revealed that the treatment's significant improvement was maintained in favor of the REBT group. The outcome of REBT treatment was not moderated due to location. The data showed a significant interaction impact on participants' depression levels in relation to the interaction between groups and gender during therapy.

CONCLUSION

Following the outcomes, we concluded that REBT is a long-term efficacious intervention for treating depressive symptoms in schoolchildren with atypical behaviors in Enugu State Nigeria regardless of location and gender.

The effectiveness of cognitive behavioral therapy-based group counseling on depressive symptomatology, anxiety levels, automatic thoughts, and coping ways Turkish nursing students: A randomized controlled trial

PURPOSE

This study aimed to evaluate the effectiveness of cognitive behavioral therapy (CBT)-based group counseling focused on depressive symptoms, anxiety levels, automatic thoughts, and coping ways among undergraduate nursing students with mild to moderate depressive symptoms.

DESIGN AND METHODS

A randomized, nonblinded, controlled trial was conducted. The study was completed with a total of 63 participants (n = 31, intervention group; n = 32, control group). The effect of the intervention was evaluated with Beck depression inventory, Beck anxiety inventory, automatic thoughts questionnaire, and ways of coping questionnaire. The measurements were taken three times: pretest, posttest, and 2-months posttest.

FINDINGS

CBT-based group counseling was found to reduce depressive symptoms, automatic thoughts, and ineffective coping with stress and to increase effective coping with stress. In both groups, 2-months posttest mean anxiety score was lower than the pre-test mean score.

PRACTICE IMPLICATIONS

CBT-based group counseling reduced depressive symptoms, automatic thoughts, and emotion-focused/ineffective ways for coping with stress.

Rational emotive intervention for work-family conflict and female primary school teachers' well-being

Globally, work and family conflict has been investigated by many researchers. Yet there is an increased prevalence of work-family conflict and its influence on the well-being of the female teaching population, especially Nigerian primary school teachers. This incidence has kept a good proportion of schoolteachers vulnerable to health problems as well as affected their wellbeing. This study evaluates the effect of rational emotive behaviour therapy on improving the well-being of female teachers with irrational behaviours arising from the work-family conflict. This is a randomized study. A total of 69 female primary school teachers in Enugu state Nigeria who met the criteria for inclusion were used as the study participants. Three self-report measures (Work-Family Conflict questionnaire, Multidimensional Health States Scale-Short Form, and Teacher Irrational Belief Scale) were used to collect data. Repeated measures with analysis of variance (ANOVA) were used to determine the effects of the intervention. The findings of the study revealed that REBT had a significant effect on the well-being scores of Nigerian female primary school teachers with work-family conflict when compared to their counterparts in the no-intervention group at Time 2. In addition, the effect of REBT on improving well-being in female teachers with work-family conflict was significantly maintained at the follow-up measurements (Time 3). In conclusion, it is suggested that REBT is an effective intervention for moderating the effect of work-family conflict on the well-being of career female teachers. As such, cognitive behavioural therapists can further examine the effectiveness of REBT using other constructs and cultures.

Intervention for Treating Depression in Parents of Children with Intellectual Disability of Down's Syndrome: A Sample of Nigerian Parents

A good number of parents of children with Down syndrome are prone to depressive disorders. The depressive feelings are attributed to negative perceptions of the situation, self, and the future. Given this, we explored the impact of the family health model of rational-emotive behavior therapy on depressive symptoms in parents of children with intellectual disability of Down syndrome in the COVID-19 pandemic era. This is a randomized pretest-posttest control group design that recruited 88 parents of children with intellectual disability of Down syndrome. We measured the depressive symptoms in parents at Time 1, Time 2, and Time 3 using the Beck depressive inventory and Hamilton depression rating scale. We adopted a family health model rational emotive behaviour therapy intervention in treating the depressive symptoms affecting the parents. The analysis of covariate results showed that at initial assessment there was no significant difference between the treatment group and comparison group at baseline evaluation of depressive symptoms in participants. At the posttest, it had a significant effect on the intervention on participants' depressive symptoms. Likewise, a follow-up result still shows that intervention had a significant effect on participants' depressive symptoms of participants. In conclusion, this study suggests that treatment variable accounted for the effect in decreasing depressive symptoms scores of participants.

Cognitive-behavioural reflective training for improving critical thinking disposition of nursing students

BACKGROUND/OBJECTIVE

The importance of critical thinking in improving treatment practices in, for instance, the nursing profession, cannot be overemphasized. Despite this importance, empirical studies have shown that helping strategies to train learners on critical thinking disposition are needed. Given this knowledge gap, this study investigated the impacts of cognitive-behavioral reflective training for improving the critical thinking disposition of nursing students.

METHOD

Of all the students screened, a total of 167 participants were assigned to the treatment group and waitlisted control group. A researchers-developed training program aimed at improving critical thinking disposition was delivered in English language by therapists.

RESULTS

Repeated-measures ANOVA showed that there was no significant difference between the critical thinking disposition of nursing students in the treatment and control groups as measured by CTDI-M at the posttest. At the posttreatment and follow-up measures, there were consistently improved impacts of CBRT on the critical thinking disposition of nursing students in Nigeria as measured by CTDI-M.

CONCLUSION

Following the results, we concluded that cognitive-behavioral reflective training was beneficial and had sustained improvement in enhancing the critical thinking disposition of nursing students.

Impact of rational emotive behavioral therapy on personal value system of students with visual impairment: A group randomized control study

BACKGROUND

Visually impaired students have been reported to struggle with value system and rash decision making process. This study examined the impact of rational emotive behavioral therapy (REBT) in reducing negative personal value system of visually impaired people.

METHOD

A group-randomized trial design was adopted using 56 students with visual impairment. The participants received a value-based rational emotive behavior progamme and were assessed at 3 points using PVS and ABS-2-AV.

RESULTS

The result of analysis of covariance showed that there was no significant difference between the treatment and control groups in initial personal value in Nigerian as measured by PVS. At the post-treatment the effect of V-REBP was significant in personal value and follow-up assessment respectively in favour of treatment group.

CONCLUSION

We concluded that there is significant impact of rational emotive behavioral therapy on reduction of negative personal value system of students with visual impairment.

Assessment of the Effectiveness of Group Cognitive Behavioural Therapy in Reducing Pathological Gambling

Pathological gambling is a developmental disorder usually associated with a continuous loss of control over gambling; it also involves a preoccupation with gambling and with obtaining money for the same purpose of gambling, irrational thinking, and a continuation of the behaviour despite being aware of its adverse consequences. This study examined the effectiveness of group cognitive-behavioural therapy (GCBT) on pathological gambling among Nigerian students. The study used a group randomised controlled trial design to assign participants to intervention and control groups. A total of 40 undergraduate students, aged 18-30, were classified as pathological gamblers (participants) in this study. Participants completed self-report scales titled South oaks gambling screen and Gambling Symptom Assessment Scale at three-time points. The intervention lasted for 8 weeks. The data collected were statistically analysed using repeated-measures ANOVA. Results revealed that GCBT has a significant effect in decreasing the symptoms of pathological gambling among the participants in GCBT compared to those in the control group and that the improvements were maintained at follow-up. The study concluded that group cognitive-behavioural therapy is impactful therapy in reducing pathological gambling among students. It has also validated the effectiveness of cognitive-behavioural therapy in altering erroneous thoughts and replacing it with a better alternative realistic way of thinking.