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Persons JB, Marker CD, Bailey EN. Changes in affective and cognitive distortion symptoms of depression are reciprocally related during cognitive behavior therapy. Behav Res Ther 2023; 166:104338. [PMID: 37270956 DOI: 10.1016/j.brat.2023.104338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
We tested the predictions from Beck's cognitive theory that change in cognitive distortions precedes and predicts change in affective symptoms of depression, and his secondary prediction that change in affective symptoms precedes and predicts change in cognitive distortions during the course of cognitive behavior therapy (CBT; Beck, 1963). We used bivariate latent difference score modeling to examine change in affective and cognitive distortion symptoms of depression over time in a sample of 1402 outpatients who received naturalistic CBT in a private practice setting. Patients completed the Beck Depression Inventory (BDI) at each therapy session to monitor their progress in treatment. We selected items from the BDI to create measures of affective and cognitive distortion symptoms that allowed us to assess change in those phenomena over the course of treatment. We examined BDI data from up to 12 sessions of treatment for each patient. As predicted by Beck's theory, we found that change in cognitive distortion symptoms preceded and predicted change in affective symptoms of depression, and that change in affective symptoms preceded and predicted change in cognitive distortion symptoms. Both effects were small in size. These findings support the notion that change in affective and cognitive distortion symptoms of depression each precedes and predicts the other - that is, they are reciprocal in nature during cognitive behavior therapy. We discuss implications of our findings for the nature of the change process in CBT.
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Affiliation(s)
- Jacqueline B Persons
- Oakland Cognitive Behavior Therapy Center, USA; University of California, Berkeley, USA.
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Bryde Christensen A, Pavlo AJ, Davidson L, Poulsen S, Reinholt N, Hvenegaard M, Simonsen E, Arnfred S. Does one treatment benefit all? Patients’ experiences of standardized group CBT for anxiety and depression. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rukmini S, Sudhir PM, Bhaskar A, Arumugham SS. Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bryde Christensen A, Wahrén S, Reinholt N, Poulsen S, Hvenegaard M, Simonsen E, Arnfred S. "Despite the Differences, We Were All the Same". Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5324. [PMID: 34067758 PMCID: PMC8157163 DOI: 10.3390/ijerph18105324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The rationale for delivering CBT in groups is that patients can model themselves through each other due to their similarities in symptoms. However, there has recently been a shift towards transdiagnostic CBT protocols, in which patients with varied diagnoses participate in the same groups. This shift challenges the rationale of delivering CBT in groups, and it is therefore highly important to understand if and how group cohesion develops in mixed diagnoses CBT groups. The current study used a qualitative comparative framework to investigate the patients' experiences of group cohesion in diagnosis-specific versus transdiagnostic CBT groups. Twenty-three patients were interviewed with semi-structured interviews upon completion of the treatment. Participants had a primary diagnosis of MDD, panic disorder, agoraphobia or social anxiety disorder. A comparative thematic analysis was carried out. Three themes were found: the move from differences to similarities, the role of group cohesion in group CBT and factors helpful and hindering to group cohesion. Group cohesion developed across groups and was considered highly important in both diagnosis-specific and transdiagnostic CBT groups.
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Affiliation(s)
- Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Signe Wahrén
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Morten Hvenegaard
- Mental Health Services, Capital Region of Denmark, 2200 København N, Denmark;
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4200 Slagelse, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
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Audet S. L’étude du changement humain dans le cadre de la consultation d’un professionnel de la relation d’aide : un modèle systémique. PSYCHOLOGIE FRANCAISE 2020. [DOI: 10.1016/j.psfr.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sundquist J, Palmér K, Memon AA, Wang X, Johansson LM, Sundquist K. Long-term improvements after mindfulness-based group therapy of depression, anxiety and stress and adjustment disorders: A randomized controlled trial. Early Interv Psychiatry 2019; 13:943-952. [PMID: 29968371 DOI: 10.1111/eip.12715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although mindfulness-based group therapies (MGTs) for depressive, anxiety or stress and adjustment disorders are promising, there is a substantial lack of knowledge regarding the long-term improvements after such therapies in these common psychiatric disorders. METHODS Two hundred and fifteen patients were randomized in a randomized clinical trial (RCT) (ClinicalTrials.gov ID: NCT01476371) conducted in 2012 at 16 primary healthcare centres in southern Sweden. The patients were randomized to MGT or treatment as usual (TAU) and completed four psychometric self-rated scales after 8 weeks of treatment. Approximately 12 months after the completion of the 8-week treatment, the same scales were repeated. Ordinal and generalized linear-mixed models, adjusted for cluster effects, were used for the analysis. RESULTS For all four psychometric scales (MADRS-S [Montgomery-Åsberg Depression Rating Scale-S], HADS-D, HADS-A [Hospital Anxiety and Depression Scale A and D] and PHQ-9 [Patient Health Questionnaire-9]) the scores at the 1-year follow-up were significantly improved (all P values <0.001) in both groups. Furthermore, there were no significant differences between the MGT and TAU in the psychometric scores at the 1-year follow-up. CONCLUSIONS To the best of our knowledge, this is the first RCT comparing the long-term improvements after MGT with TAU. Although it cannot be excluded that our findings are a result of the natural course of common psychiatric disorders or other factors, they suggest a long-term positive improvement after both MGT and TAU.
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Affiliation(s)
- Jan Sundquist
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Karolina Palmér
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Xiao Wang
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Leena M Johansson
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
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Rohan KJ, Meyerhoff J, Ho SY, Roecklein KA, Nillni YI, Hillhouse JJ, DeSarno MJ, Vacek PM. A measure of cognitions specific to seasonal depression: Development and validation of the Seasonal Beliefs Questionnaire. Psychol Assess 2019; 31:925-938. [PMID: 30920245 PMCID: PMC7988399 DOI: 10.1037/pas0000715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We introduce the Seasonal Beliefs Questionnaire (SBQ), a self-report inventory of maladaptive thoughts about the seasons, light availability, and weather conditions, proposed to constitute a unique cognitive vulnerability to winter seasonal affective disorder (SAD; Rohan, Roecklein, & Haaga, 2009). Potential items were derived from a qualitative analysis of self-reported thoughts during SAD-tailored cognitive-behavioral therapy (CBT-SAD) and subsequently refined based on qualitative feedback from 48 SAD patients. In the psychometric study (N = 536 college students), exploratory and confirmatory factor analyses pruned the items to a 26-item scale with a 5-factor solution, demonstrating good internal consistency, convergent and divergent validity, and 2-week test-retest reliability. In a known groups comparison, the SBQ discriminated SAD patients (n = 86) from both nonseasonal major depressive disorder (MDD) patients (n = 30) and healthy controls (n = 110), whereas a generic measure of depressogenic cognitive vulnerability (the Dysfunctional Attitudes Scale [DAS]) discriminated MDD patients from the other groups. In a randomized clinical trial comparing CBT-SAD with light therapy (N = 177), SBQ scores improved at twice the rate in CBT-SAD than in light therapy. Greater change in SBQ scores during CBT-SAD, but not during light therapy, was associated with a lower risk of depression recurrence 2 winters later. In contrast, DAS scores improved comparably during CBT-SAD and light therapy, and DAS change was unrelated to recurrence following either treatment. These results support using the SBQ as a brief assessment tool for a SAD-specific cognitive vulnerability and as a treatment target in CBT-SAD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division, Veterans Affairs Boston Healthcare System
| | - Joel J Hillhouse
- Department of Community and Behavioral Health, East Tennessee State University
| | - Michael J DeSarno
- Medical Biostatistics Unit, University of Vermont College of Medicine
| | - Pamela M Vacek
- Medical Biostatistics Unit, University of Vermont College of Medicine
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Troesken A, Renneberg B. Entwicklung einer ressourcenorientierten kognitiv-verhaltenstherapeutischen Gruppenbehandlung für chronisch depressive Patienten: Eine Pilotstudie. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000489670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Thompson K, D'iuso D, Schwartzman D, Dobson KS, Drapeau M. Changes in depressed patients' self-statements. Psychother Res 2018; 30:170-182. [PMID: 30422103 DOI: 10.1080/10503307.2018.1543976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: Individuals' use of self-statements reflecting self-criticism, a sense of inadequacy, and low self-worth has been linked to the incidence, severity, and recurrence of major depressive disorder [de Graaf, L. E., Huibers, M. J. H., Cuijpers, P., & Arntz, A. (2010). Minor and major depression in the general population: Does dysfunctional thinking play a role? Comprehensive Psychiatry, 51(3), 266-274. doi:10.1016/j.comppsych.2009.08.006; Riso, L. P., du Toit, P. L., Blandino, J. A., Penna, S., Dacey, S., Duin, J. S., … Ulmer, C. S. (2003). Cognitive aspects of chronic depression. Journal of Abnormal Psychology, 112(1), 72-80. doi:10.1037/0021-843X.112.1.72]. The present study used an observer-rated measure, the Structural Analysis of Social Behavior [Benjamin, L. S. (1974). Structural Analysis of Social Behavior. Psychological Review, 81(5), 392-425. doi:10.1037/h0037024], to examine patients' self-directed communication over the course of psychotherapy.Method: Self-talk in early and late therapy sessions was examined using cases (N = 44) from the cognitive therapy arm of Jacobson and colleagues' component study of cognitive therapy for depression [Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295-304. doi:10.1037/0022-006x.64.2.295, Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … Prince, S. E. (2000). A component analysis of cognitive-behavioral treatment for depression. Prevention & Treatment, 3(1). doi:10.1037/1522-3736.3.1.323a]. We identified changes at treatment termination, and used hierarchical multiple regression to examine whether improvements in patient self-talk influenced treatment outcome up to 24 months post-termination.Results: Trends indicate that patients used friendlier and less critical self-statements at the end of treatment. Decreased self-critical behaviour was associated with fewer symptoms at the end of treatment and up to one year later; increased self-acceptance was linked to symptom improvement a year and a half after termination.Conclusion: Consistent with cognitive theory, reduced self-criticism was associated with better treatment outcomes. Longer-term improvement was linked to the development of friendlier and more accepting self-referential behaviour.
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Affiliation(s)
- Katherine Thompson
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Debora D'iuso
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Deborah Schwartzman
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Keith S Dobson
- Department of Clinical Psychology, University of Calgary, Calgary, AB, Canada
| | - Martin Drapeau
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
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C. Schneider B, Bücker L, Riker S, Karamatskos E, Jelinek L. A Pilot Study of Metacognitive Training (D-MCT) for Older Adults with Depression. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2018. [DOI: 10.1024/1016-264x/a000210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Depression remains one of the most common psychological disorders among older adults. Their response to antidepressants: however, is often unsatisfactory, and despite the proven efficacy of psychotherapies, a large treatment gap remains. Metacognitive Training for Depression (D-MCT) is a low-threshold group intervention. This article examines the feasibility, acceptance, and effects of D-MCT as an add-on intervention among a group of older adults (55+ years; N = 116). Participants completed measures of depression and dysfunctional attitudes, and provided subjective appraisals of the training. Per protocol analyses (n = 55) revealed a significant decrease in depressive symptoms (d = 1.06) and cognitive biases (d = 0.33). The findings demonstrate the feasibility and acceptance of D-MCT among older adults with depression.
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Affiliation(s)
- Brooke C. Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Riker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hemmati Sabet A, Navabi Nejad S, Khalatbari J. Effectiveness of Schema Therapy and Group Cognitive Therapy on Anxiety in Women with High-Risk Sexual Behavior. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2017. [DOI: 10.29252/jgbfnm.14.1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Deodhar JK, Goswami SS. Structure, process, and impact of a staff support group in an oncology setting in a developing country. Ind Psychiatry J 2017; 26:194-200. [PMID: 30089969 PMCID: PMC6058437 DOI: 10.4103/ipj.ipj_59_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health-care staff working in oncology setting experience excessive stress, which if unrelieved can lead to burnout. Staff support groups have been found beneficial. AIMS This study aims to evaluate the structure, process, and impact of a staff support group conducted for field workers involved in cancer screening in an urban tertiary cancer center in a developing country. SETTINGS AND DESIGN Retrospective analysis of staff support group conducted in a tertiary care cancer center. METHODOLOGY Prospectively maintained data with structured notes for documenting the process of the support group sessions for the field workers was analyzed. Impact was analyzed through a feedback questionnaire designed for the purpose completed by participants at 4 months, 1, and 2 years following session completion. STATISTICAL ANALYSIS Descriptive statistics for reporting the overall structure and participants' profile and content analysis for identifying the support group process and themes expressed by the participants were used. RESULTS Eleven participants attended the support group consisting of 8 structured sessions. The processes identified were planning, implementation, and supervision of the lead therapist conducting the group. Work overload, target completion, feeling demoralized, interpersonal conflicts, and importance of team support were the main issues identified. Cognitive behavioral approaches were learnt for stress management. Eight, nine, and all 11 participants found the support group moderately to very useful at 4 months, 1 year, and 2 years, respectively. CONCLUSIONS The support group followed a planned structure, with good implementation, recording of content and supervision, with both short-term and sustained positive impact.
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Affiliation(s)
- Jayita Kedar Deodhar
- Palliative Medicine and Psychiatric Unit, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Savita Sachin Goswami
- Psychiatric Unit, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Sadeghi K, Ahmadi SM, Moghadam AP, Parvizifard A. The Study of Cognitive Change Process on Depression during Aerobic Exercises. J Clin Diagn Res 2017; 11:IC01-IC05. [PMID: 28571165 DOI: 10.7860/jcdr/2017/23687.9611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/23/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Several studies have shown that aerobic exercise is effective in treating the depression and improving the mental health. There are various theories which explains why aerobic exercise is effective in the treatment of depression and improve mental health, but there are limited studies to show how cognitive components and depression improve during aerobic exercises. AIM The current study was carried out to investigate the cognitive change process during aerobic exercises in depressed students. MATERIALS AND METHODS This study was conducted through structural equation modeling; the study sample included 85 depressed students. Participants were selected through purposive sampling method. Beck Depression Inventory (BDI-II), Automatic Negative Thoughts (ATQ), and the Dysfunctional Attitude Scale (DAS) were used as the data collection instruments. The participants received eight sessions of aerobic exercise (three times a week). The obtained data was analysed by AMOS-18 & SPSS 18 software. RESULTS The results showed that depression (p=0.001), automatic thoughts (ferquency p=0.413, beliefs p=0.676) and dysfunctional assumptions (p=0.219) reduce during aerobic exercise; however, it was only meaningful for the depression. The casual and consequential models were not fit to the data and partially and fully interactive models provided an adequate fit to the data. CONCLUSION Fully interactive model provided the best fit of the data. It seems that aerobic exercise reduced cognitive components separately leading to reduce depression.
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Affiliation(s)
- Kheirollah Sadeghi
- Assistant Professor, Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Mojtaba Ahmadi
- Assistant Professor, Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Parsa Moghadam
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aliakbar Parvizifard
- Assistant Professor, Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Wang X, Sundquist K, Hedelius A, Palmér K, Memon AA, Sundquist J. Leukocyte telomere length and depression, anxiety and stress and adjustment disorders in primary health care patients. BMC Psychiatry 2017; 17:148. [PMID: 28438147 PMCID: PMC5404668 DOI: 10.1186/s12888-017-1308-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/11/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The primary aim was to examine possible differences in telomere length between primary health care patients, with depression, anxiety or stress and adjustment disorders, and healthy controls. The second aim was to examine the association between telomere length and baseline characteristics in the patients. The third aim was to examine the potential effects of the 8-week treatments (mindfulness-based group therapy or treatment as usual, i.e. mostly cognitive-based therapy) on telomere length, and to examine whether there was a difference in the potential effect on telomere length between the two groups. METHODS A total of 501 individuals including 181 patients (aged 20-64 years), with depression, anxiety and stress and adjustment disorders, and 320 healthy controls (aged 19-70 years) were recruited in the study. Patient data were collected from a randomized controlled trial comparing mindfulness-based group therapy with treatment as usual. We isolated genomic DNA from blood samples, collected at baseline and after the 8-week follow-up. Telomere length was measured by quantitative real-time (qRT)-PCR. RESULTS Telomere length was significantly shorter in the patients (mean = 0.77 ± 0.12,), compared to the controls (mean = 0.81 ± 0.14) (p = 0.006). The difference in telomere length remained significant after controlling for age and sex. Old age, male sex and being overweight were associated with shorter telomere length. There was no significant difference in telomere length between baseline and at the 8-week follow-up in any of the treatment groups and no difference between the two groups. CONCLUSION Our findings confirm that telomere length, as compared with healthy controls, is shortened in patients with depression, anxiety and stress and adjustment disorders. In both groups (mindfulness-based group therapy or treatment as usual), the telomere length remained unchanged after the 8-week treatment/follow-up and there was no difference between the two groups. TRIAL REGISTRATION (ClinicalTrials.gov ID: NCT01476371 ) Registered November 11, 2011.
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Affiliation(s)
- Xiao Wang
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
| | - Kristina Sundquist
- 0000 0001 0930 2361grid.4514.4Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Anna Hedelius
- 0000 0001 0930 2361grid.4514.4Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Karolina Palmér
- 0000 0001 0930 2361grid.4514.4Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Ashfaque A. Memon
- 0000 0001 0930 2361grid.4514.4Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- 0000 0001 0930 2361grid.4514.4Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
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Kruger JR, Kim P, Iyer V, Marko-Holguin M, Fogel J, DeFrino D, Gladstone T, Van Voorhees BW. Evaluation of protective and vulnerability factors for depression following an internet-based intervention to prevent depression in at-risk adolescents. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2017. [DOI: 10.1080/14623730.2017.1308264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sundquist J, Palmér K, Johansson LM, Sundquist K. The effect of mindfulness group therapy on a broad range of psychiatric symptoms: A randomised controlled trial in primary health care. Eur Psychiatry 2017; 43:19-27. [PMID: 28365464 DOI: 10.1016/j.eurpsy.2017.01.328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/23/2017] [Accepted: 01/25/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The need for psychotherapy in primary health care is on the increase but individual-based treatment is costly. The main aim of this randomised controlled trial (RCT) was to compare the effect of mindfulness-based group therapy (MGT) with treatment as usual (TAU), mainly individual-based cognitive behavioural therapy (CBT), on a broad range of psychiatric symptoms in primary care patients diagnosed with depressive, anxiety and/or stress and adjustment disorders. An additional aim was to compare the effect of MGT with TAU on mindful attention awareness. METHODS This 8-week RCT took place in 2012 at 16 primary care centres in southern Sweden. The study population included both men and women, aged 20-64years (n=215). A broad range of psychiatric symptoms were evaluated at baseline and at the 8-week follow-up using the Symptom Checklist-90 (SCL-90). Mindful attention awareness was also evaluated using the Mindful Attention Awareness Scale (MAAS). RESULTS In both groups, the scores decreased significantly for all subscales and indexes in SCL-90, while the MAAS scores increased significantly. There were no significant differences in the change in psychiatric symptoms between the two groups. The mindfulness group had a somewhat larger change in scores than the control group on the MAAS (P=0.06, non-significant). CONCLUSIONS No significant differences between MGT and TAU, mainly individual-based CBT, were found in treatment effect. Both types of therapies could be used in primary care patients with depressive, anxiety and/or stress and adjustment disorders, where MGT has a potential to save limited resources. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01476371.
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Affiliation(s)
- J Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.
| | - K Palmér
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - L M Johansson
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
| | - K Sundquist
- Center for Primary Health Care Research, Clinical Research Centre (CRC), Skåne University Hospital, Lund University, Building 28, Floor 11, Jan Waldenströms gata 35, 205 02 Malmö, Sweden
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Burlingame GM, Jensen JL. Small Group Process and Outcome Research Highlights: A 25-Year Perspective. Int J Group Psychother 2017; 67:S194-S218. [PMID: 38449275 DOI: 10.1080/00207284.2016.1218287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We summarize major research findings from the past 25 years within the larger evolution of group psychotherapy. Small group process findings are highlighted from a group-as-a-whole, interpersonal relation, subgroup, individual member characteristics, and leader perspective. Special emphasis is given to cohesion and the significant correlation between cohesion and outcome. We note that group therapy is an empirically well-supported treatment for a large number of psychiatric disorders and describe evidence supporting the outcome of various theoretical orientations. Key studies showing outcome equivalence for group and individual therapy are reviewed, followed by a high-level summary of group therapy's efficacy research for depression, bipolar, social phobia, panic disorder, obsessive compulsive, bulimia nervosa, binge-eating, substance-related, trauma-related, HIV/AIDS, breast cancer, chronic pain, schizophrenia, and borderline personality. We conclude with the promise of recent advances for moving the field forward over the next 25 years.
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Tsumura H, Shimada H, Oshikawa Y, Kawata M. Relationship Among Automatic Thoughts, Activities and Events, and Affect in Children. Int J Cogn Ther 2016. [DOI: 10.1521/ijct_2016_09_07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang X, Sundquist K, Hedelius A, Palmér K, Memon AA, Sundquist J. Circulating microRNA-144-5p is associated with depressive disorders. Clin Epigenetics 2015. [PMID: 26199675 PMCID: PMC4509564 DOI: 10.1186/s13148-015-0099-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Depressive/anxiety disorders are the most common types of mental illnesses in the world. The present study was the first to explore the association between plasma microRNAs (miRNAs) and depression/anxiety in primary care patients. Results In total, 169 patients (aged 20–64 years) from 16 primary health centers were enrolled in the present study. The healthy controls were consisted of 52 individuals. We first performed miRNA screening of plasma samples from 11 patients using a Serum/Plasma Focus microRNA Panel comprising 179 miRNA primer sets. Six miRNAs were differentially expressed and were then validated by quantitative real-time (qRT)-PCR in the entire study cohort. The mean plasma miR-144-5p level in the depression/anxiety patients increased significantly compared to baseline (p < 0.0001) after the 8-week follow-up. No significant associations were found between the differentially expressed miRNAs and a change in the Montgomery-Åsberg Depression Rating Scale (MADRS-S) score after the follow-up. In linear regression analysis, the plasma miR-144-5p expression level was inversely related to the depression score (MADRS-S) (β = −0.02, p < 0.01), after adjustment for sex and age, at baseline. In addition, plasma miR-144-5p levels at baseline in the depression/anxiety patients were significantly lower compared with the healthy controls (p < 0.001). Conclusions Our findings show that plasma miR-144-5p levels are associated with depressive symptoms. Although confirmatory analyses are required, plasma miRNA-144-5p is a potential peripheral biomarker for pathologic processes related to depression. Electronic supplementary material The online version of this article (doi:10.1186/s13148-015-0099-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao Wang
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden ; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA USA
| | - Anna Hedelius
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Karolina Palmér
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden ; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA USA
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Köhler S, Unger T, Hoffmann S, Mackert A, Ross B, Fydrich T. Dysfunctional cognitions of depressive inpatients and their relationship with treatment outcome. Compr Psychiatry 2015; 58:50-6. [PMID: 25639696 DOI: 10.1016/j.comppsych.2014.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dysfunctional cognitions can contribute to depression and its maintenance. They may be related to a higher relapse rate and a longer duration of the depressive episode. The relevance of dysfunctional cognitions for acute inpatient treatment of unipolar depression is examined in this study and its variability by cognitive behavioural therapy (CBT). METHODS 222 patients suffering from Major Depressive Disorder (MDD) were evaluated during their inpatient treatment by assessing admission and discharge depression scores and their relationship to dysfunctional cognitions, using the Dysfunctional Attitude Scale (DAS). The relationship between dysfunctional cognitions and treatment outcome was examined. Primary outcome measures were the Hamilton-Rating-Scale (HRSD) and the Beck Depression Inventory (BDI). RESULTS Higher age, depression severity at admission, comorbid personality disorders and recurrent depressive disorders are related with higher DAS-scores at admission. DAS-Scores declined during treatment but to a lower extend than depressive symptom scales (effect size dDAS-G t1-t2 = .31; dHRSD t1-t2 = 2.88; dBDI t1-t2 = 1.38). Higher DAS-scores at admission correlated negatively with the improvement of depressive symptoms during treatment (HRSD: r = -.62; p < .01; BDI: r = -.54; p < .01) and remission rates (HRSD: r = -.65; p < .01; BDI: r = -.48; p < .01). CBT did not additionally reduce DAS-scores compared to pharmacotherapy only. CONCLUSION Dysfunctional cognitions are relatively stable compared to other depressive symptoms and are associated with poorer treatment outcome even in combined treatment of antidepressant medication and CBT during inpatient treatment. Changes of dysfunctional cognitions seem to be a long-term treatment goal, especially because of their association with comorbid personality disorders and recurrent depressive disorders.
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Affiliation(s)
- Stephan Köhler
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Theresa Unger
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Sabine Hoffmann
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Arthur Mackert
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Barbara Ross
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
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Cruwys T, Haslam SA, Fox NE, McMahon H. “That's not what we do”: Evidence that normative change is a mechanism of action in group interventions. Behav Res Ther 2015; 65:11-7. [DOI: 10.1016/j.brat.2014.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/26/2014] [Accepted: 12/05/2014] [Indexed: 11/29/2022]
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Sundquist J, Lilja Å, Palmér K, Memon AA, Wang X, Johansson LM, Sundquist K. Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial. Br J Psychiatry 2015; 206:128-35. [PMID: 25431430 DOI: 10.1192/bjp.bp.114.150243] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individual-based cognitive-behavioural therapy (CBT) is in short supply and expensive. AIMS The aim of this randomised controlled trial (RCT) was to compare mindfulness-based group therapy with treatment as usual (primarily individual-based CBT) in primary care patients with depressive, anxiety or stress and adjustment disorders. METHOD This 8-week RCT (ClinicalTrials.gov ID: NCT01476371) was conducted during spring 2012 at 16 general practices in Southern Sweden. Eligible patients (aged 20-64 years) scored ≥10 on the Patient Health Questionnaire-9, ≥7 on the Hospital Anxiety and Depression Scale or 13-34 on the Montgomery-Åsberg Depression Rating Scale (self-rated version). The power calculations were based on non-inferiority. In total, 215 patients were randomised. Ordinal mixed models were used for the analysis. RESULTS For all scales and in both groups, the scores decreased significantly. There were no significant differences between the mindfulness and control groups. CONCLUSIONS Mindfulness-based group therapy was non-inferior to treatment as usual for patients with depressive, anxiety or stress and adjustment disorders.
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Affiliation(s)
- Jan Sundquist
- Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA;Åsa Lilja, PhD, Karolina Palmér, Msci, Ashfaque A. Memon, MD, PhD, Xiao Wang, MD, PhD, Leena Maria Johansson, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Åsa Lilja
- Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA;Åsa Lilja, PhD, Karolina Palmér, Msci, Ashfaque A. Memon, MD, PhD, Xiao Wang, MD, PhD, Leena Maria Johansson, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Karolina Palmér
- Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA;Åsa Lilja, PhD, Karolina Palmér, Msci, Ashfaque A. Memon, MD, PhD, Xiao Wang, MD, PhD, Leena Maria Johansson, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Ashfaque A Memon
- Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA;Åsa Lilja, PhD, Karolina Palmér, Msci, Ashfaque A. Memon, MD, PhD, Xiao Wang, MD, PhD, Leena Maria Johansson, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Xiao Wang
- Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA;Åsa Lilja, PhD, Karolina Palmér, Msci, Ashfaque A. Memon, MD, PhD, Xiao Wang, MD, PhD, Leena Maria Johansson, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Leena Maria Johansson
- Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA;Åsa Lilja, PhD, Karolina Palmér, Msci, Ashfaque A. Memon, MD, PhD, Xiao Wang, MD, PhD, Leena Maria Johansson, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kristina Sundquist
- Jan Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA;Åsa Lilja, PhD, Karolina Palmér, Msci, Ashfaque A. Memon, MD, PhD, Xiao Wang, MD, PhD, Leena Maria Johansson, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden; Kristina Sundquist, MD, PhD, Center for Primary Health Care Research, Lund University, Malmö, Sweden and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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It's complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clin Psychol Rev 2014; 41:3-15. [PMID: 25595660 PMCID: PMC10080251 DOI: 10.1016/j.cpr.2014.12.003] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/29/2014] [Accepted: 12/10/2014] [Indexed: 11/23/2022]
Abstract
Many attempts have been made to discover and characterize the mechanisms of change in psychotherapies for depression, yet no clear, evidence-based account of the relationship between therapeutic procedures, psychological mechanisms, and symptom improvement has emerged. Negatively-biased thinking plays an important role in the phenomenology of depression, and most theorists acknowledge that cognitive changes occur during successful treatments. However, the causal role of cognitive change procedures in promoting cognitive change and alleviating depressive symptoms has been questioned. We describe the methodological and inferential limitations of the relevant empirical investigations and provide recommendations for addressing them. We then develop a framework within which the possible links between cognitive procedures, cognitive change, and symptom change can be considered. We conclude that cognitive procedures are effective in alleviating symptoms of depression and that cognitive change, regardless of how it is achieved, contributes to symptom change, a pattern of findings that lends support to the cognitive theory of depression.
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Wong DFK, Chan KS, Lau Y. The Role of Perfectionism and Dysfunctional Attitudes in Depression and Quality of Life of a Community Sample of Chinese Adults in Hong Kong. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411390403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Kin Sun Chan
- b Faculty of Social Sciences and Humanities, University of Macau, Macau SAR, China
| | - Ying Lau
- c School of Health Sciences, Macao Polytechnic Institute, Macau SAR, China
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Oei TPS, McAlinden NM, Cruwys T. Exploring mechanisms of change: the relationships between cognitions, symptoms, and quality of life over the course of group cognitive-behaviour therapy. J Affect Disord 2014; 168:72-7. [PMID: 25038294 DOI: 10.1016/j.jad.2014.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to explain how quality of life changes during psychotherapy, using a cognitive-behavioural theoretical framework, and examined whether changes in symptoms or changes in cognitions were more influential with regard to quality of life change. Three different hypotheses were tested that might explain the mechanisms by which quality of life changes during group cognitive-behaviour therapy (CBT) for anxiety and depression. METHODS 127 outpatients with anxiety and/or depression enrolled in a four-week group CBT programme participated. Measures of anxiety and depression symptoms, cognitive change, and quality of life were administered at baseline and post-treatment. Baseline to post-treatment change scores were calculated and entered into multiple regression analyses. RESULTS Reductions in anxiety and depression symptoms were related to increases in quality of life, whereas cognitive changes were not consistently related to changes in quality of life. LIMITATIONS The main limitation was that the study׳s design was not able to assess whether changes in cognitions or symptoms preceded changes in quality of life, as all variables were measured at the same two points in time. CONCLUSIONS These results provided evidence that quality of life changes as a result of or, simultaneously with, symptom change. It appears that group CBT does not improve quality of life through strategies designed to change patients׳ cognitions.
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Affiliation(s)
- Tian Po S Oei
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia; CBT Unit, Toowong Private Hospital, PO Box 882, Toowong, Brisbane, Queensland, Australia.
| | - Niamh M McAlinden
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Tegan Cruwys
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Are Improvements in Cognitive Content and Depressive Symptoms Correlates or Mediators during Acute-Phase Cognitive Therapy for Recurrent Major Depressive Disorder? Int J Cogn Ther 2014; 7:255-271. [PMID: 26401194 DOI: 10.1521/ijct.2014.7.3.251] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The cognitive model of depression posits that cognitive therapy's (CT) effect on depressive symptoms is mediated by changes in cognitive content (e.g., automatic negative thoughts dysfunctional attitudes, failure attributions). We tested improvement and normalization of cognitive content among outpatients (N = 523) with recurrent major depressive disorder treated with acute-phase CT (Jarrett & Thase, 2010; Jarrett et al., 2013). We also tested whether improvement in cognitive content accounted for subsequent changes in depressive symptoms and vice versa. Five measures of content improved substantively from pre- to post-CT (median d = 0.96), and the proportions of patients scoring in "healthy" ranges increased (median 45% to 82%). Evidence for cognitive mediation of symptom reduction was limited (median r = .06), as was evidence for symptom mediation of cognitive content improvement (median r = .07). We discuss measurement and design issues relevant to detection of mediators and consider alternative theories of change.
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Cui L, Shi G, Oei TPS. A study of cognitive vulnerability-stress model of depressive symptoms among Chinese adolescents. Stress Health 2013; 29:383-91. [PMID: 23389904 DOI: 10.1002/smi.2484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022]
Abstract
The objective of the present study is to test the validity of the integrated cognitive model of depression proposed by Kwon and Oei (1994) with a Chinese adolescent sample. A two-wave panel design was used. We hypothesized that the interaction between dysfunctional attitudes measured at time 1 and adolescents' negative life events experienced between times 1 and 2 would predict changes in the frequency of automatic thoughts between times 1 and 2. We further hypothesized that changes in the frequency of automatic thoughts would, in turn, predict changes in the severity of depressive symptoms. Participants were 329 Chinese adolescents. As a comparison, we tested three other competing models: linear mediation, alternative aetiologies and symptom models. All participants completed the Adolescent Self-Rating Life Events Checklist, Dysfunctional Attitudes Scale, Automatic Thoughts Questionnaire and Center for Epidemiological Studies Depression Scale on two occasions-5 months apart. Path analysis was used to test all models. Results of the path analysis indicated that the integrated cognitive model showed an adequate fit for the Chinese adolescent data. During phases of increased depression, dysfunctional attitudes were common cognitive moderators of depression, whereas automatic thoughts were specific cognitive mediators of depression.
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Affiliation(s)
- Lixia Cui
- Beijing Key Laboratory of Learning and Cognition and Department of Psychology, Capital Normal University, Beijing, China
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The distinction between unipolar and bipolar depression: a cognitive theory perspective. Compr Psychiatry 2013; 54:740-9. [PMID: 23608048 DOI: 10.1016/j.comppsych.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of Beck's cognitive theory. METHODS In this study, 70 bipolar patients during a depressive episode, 189 unipolar depressed patients and 120 healthy subjects were recruited. The participants were interviewed by using a structured clinical diagnostic scale. To evaluate the cognitive structure differences, the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were used. RESULTS We found that on the mean ATQ total score, the unipolar depressed patients scored significantly higher (92.9±22.7) than both the bipolar depressed patients (73.2±24.7) and the healthy subjects (47.1±19.6), even after controlling for all confounding factors, e.g. gender, marital status, depressive symptom severity (F = 157.872, p<0.001). The bipolar depressed patients also scored significantly higher on the mean ATQ total score than the healthy controls. On the mean DAS total score, and on the mean score of its subscale of need for approval, the bipolar depressed patients scored (152.8±21.2 and 48.2±7.4, respectively) significantly higher than both the unipolar depressed patients (160.9±29.0 and 51.9±9.7, respectively) and the healthy subjects (127.9±32.8 and 40.2±12.2, respectively), even after controlling for any confounding factor (F=45.803 [p<0.001] and F=43.206 [p<0.001], respectively). On the mean score of the perfectionistic attitude subscale of the DAS, the depressed groups scored significantly higher than the healthy subjects, but they did not seem to separate from each other (F=41.599, p<0.001). CONCLUSIONS These results may help enhance the understanding of the potentially unique psychotherapeutic targets and the underlying cognitive theory of bipolar depression.
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Evans M, Rohan KJ, Sitnikov L, Mahon JN, Nillni YI, Lindsey KT, Vacek PM. Cognitive Change across Cognitive-Behavioral and Light Therapy Treatments for Seasonal Affective Disorder: What Accounts for Clinical Status the Next Winter? COGNITIVE THERAPY AND RESEARCH 2013; 37. [PMID: 24415812 DOI: 10.1007/s10608-013-9561-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Efficacious treatments for seasonal affective disorder include light therapy and a seasonal affective disorder-tailored form of cognitive-behavioral therapy. Using data from a parent clinical trial, these secondary analyses examined the relationship between cognitive change over treatment with cognitive-behavioral therapy, light therapy, or combination treatment and mood outcomes the next winter. Sixty-nine participants were randomly assigned to 6-weeks of cognitive-behavioral therapy, light therapy, or combination treatment. Cognitive constructs (i.e., dysfunctional attitudes, negative automatic thoughts, and rumination) were assessed at pre- and post-treatment. Dysfunctional attitudes, negative automatic thoughts, and rumination improved over acute treatment, regardless of modality; however, in participants randomized to solo cognitive-behavioral therapy, a greater degree of improvement in dysfunctional attitudes and automatic thoughts was uniquely associated with less severe depressive symptoms the next winter. Change in maladaptive thoughts during acute treatment appears mechanistic of solo cognitive-behavioral therapy's enduring effects the next winter, but is simply a consequence of diminished depression in light therapy and combination treatment.
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Affiliation(s)
- Maggie Evans
- University of Vermont, Department of Psychology, Burlington, VT
| | - Kelly J Rohan
- University of Vermont, Department of Psychology, Burlington, VT
| | - Lilya Sitnikov
- University of Vermont, Department of Psychology, Burlington, VT
| | | | - Yael I Nillni
- University of Vermont, Department of Psychology, Burlington, VT
| | | | - Pamela M Vacek
- University of Vermont College of Medicine, Medical Biostatistics, Burlington, VT
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Anisi J, Bahadori MH, Jahanbakhsh M. Developing and Validation of Identifying People in Risk of Addiction Questionnaire (I.P.R.A). INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS AND ADDICTION 2013; 1:183-91. [PMID: 24971260 PMCID: PMC4070132 DOI: 10.5812/ijhrba.8101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 11/06/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022]
Abstract
Background Drug addiction is considered as a problem of the new century which has destructive consequences for both family and society. This ominous phenomenon resulted from many factors. Present research aimed at recognition of inter-personal factors related to addiction and were conducted through a questionnaire to identify the youths at risk of addiction. Objectives Present research aimed at recognition of inter-personal factors related to addiction and were conducted through a questionnaire to identify the youths at risk of addiction. Materials and Methods The design of the present research is correlational analytic. The population consists of all young addicted or non-addicted people between the ages 18 to 35 and the sample consists of 82 addicted and 223 non-addicted young people in Tehran who were selected randomly and simply. The initial form included 120 questions which were administered on the sample in three stages. The data was analyzed through descriptive statistic and factor analysis. Results In this questionnaire four factors of depression and miserableness, having a positive attitude to drug, stress and anxiety and finally seeking high levels of excitement were respectively the strongest factors in predicting the risk of drug-abuse and addiction. The validity of the questionnaire which consists of 75 questions in the final form was calculated through internal consistency. Cronbach alpha of the whole questionnaire was 0.97, which that of the factor of depression and miserableness was 0.96, the factor of a positive attitude to drug was 0.93, the factor of stress and anxiety was 0.90 and the factor of high excitement-seeking was 0.80. Conclusions The evaluation of the questionnaire for identifying the individuals in the risk of addiction showed that the questionnaire benefits from appropriate validity and reliability. Therefore, it can be used in preventive fields and research. Moreover, by illuminating interpersonal factors that are effective in drug abuse, proper strategies can be used to prevent drug addiction.
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Affiliation(s)
- Jafar Anisi
- Behavioral Sciences Research Center, Baqiyatallah University of medical sciences, Tehran, IR Iran
| | - Mohammad Hossein Bahadori
- Behavioral Sciences Research Center, Baqiyatallah University of medical sciences, Tehran, IR Iran
- Corresponding author: Mohammad Hossein Bahadori, Behavioral Sciences Research Center, Baqiyatallah University of medical sciences, Tehran, IR Iran, Tel.: +98-9139000145, Fax: +98-3342231777, E-mail:
| | - Marziyeh Jahanbakhsh
- Behavioral Sciences Research Center, Baqiyatallah University of medical sciences, Tehran, IR Iran
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Horn GL. An investigation into the effects of cognitive behavioral therapy on patients with chronic depression: a small case series. Psychol Res Behav Manag 2012; 5:123-9. [PMID: 23055783 PMCID: PMC3464060 DOI: 10.2147/prbm.s31774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND National Institute for Clinical Excellence (NICE) guidelines recommend a combination of cognitive behavioral therapy (CBT) and antidepressants to treat chronic depression. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is the only therapy model specifically designed for the treatment of chronic depression. OBJECTIVES To determine the clinical response to the CBASP of patients in a specialist clinical service for affective disorder and to ascertain their views on the value of the CBASP for their condition. METHODS Qualitative data from interviews including a questionnaire and objective data from Becks Depression Inventory II symptom rating scales were used to monitor the progress of a small case series of five patients with chronic, treatment refractory depression as they received the CBASP over a 10-month period. RESULTS Common themes from patient interviews show very positive engagement and attitudes to the CBASP from the questionnaire. Rating scales from Becks Depression Inventory II pre- and posttreatment showed very little change for three patients with improvements between 2 and 7 points but deterioration in symptoms of 2 points for the fourth patient. CONCLUSION The CBASP is a well-liked and positive therapy that helps patients manage their lives and deal with personal relationships, although objective data indicate little change in symptom severity.
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Carter JD, Crowe M, Carlyle D, Frampton CM, Jordan J, McIntosh VV, O'Toole VM, Whitehead L, Joyce PR. Patient change processes in psychotherapy: Development of a new scale. Psychother Res 2012; 22:115-26. [DOI: 10.1080/10503307.2011.631195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Wong FKD. Cognitive behavioral group treatment for Chinese people with depressive symptoms in Hong Kong: participants' perspectives. Int J Group Psychother 2011; 61:438-59. [PMID: 21728708 DOI: 10.1521/ijgp.2011.61.3.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study documents the experiences of 20 Chinese people in Hong Kong who participated in group cognitive behavioral therapy (CBT). They were asked to comment on the aspects of the group content and process that they found to be useful or not useful in dealing with their depressive moods. In general, they reported that the groups helped them gain awareness of their thought and behavioral patterns and learn new cognitive and behavioral strategies. Certain aspects of the group process, however, such as the outpouring of negative emotions, were considered by the participants to be counterproductive to their learning and practice of CBT.
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Wong DFK, Poon A, Kwok YCL. The maintenance effect of cognitive-behavioural treatment groups for the Chinese parents of children with intellectual disabilities in Melbourne, Australia: a 6-month follow-up study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2011; 55:1043-1053. [PMID: 21668803 DOI: 10.1111/j.1365-2788.2011.01431.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Caring for a child with intellectual disability can be stressful. No data on the longer-term effects of cognitive-behavioural treatment (CBT) on parents from a Chinese-speaking background who have children with intellectual disabilities are available in the literature. This study attempted to fill this research gap by examining the maintenance effect of CBT among the Chinese parents of such children in Melbourne, Australia. METHOD Thirty-nine participants took part in our CBT groups and attended follow-up meetings. A questionnaire comprising four instruments, the Parenting Stress Index (PS) - Parent Domain, General Health Questionnaire-12 (GHQ-12), Abbreviated Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-18) and Dysfunctional Attitude Scale (DAS), was administered to the participants at the pre- and post-test stage and at the 6-month follow-up. RESULTS One-way repeated-measures analyses of variance revealed significant time and group effects in the PS (F(2,27) = 16.93, P < 0.001), Q-LES-Q-18 (F(2,27) = 15.98, P < 0.001), GHQ-12 (F(2,27) = 81.93, P < 0.001) and DAS (F(2,27) = 15.50, P < 0.001) scores at the three measurement times. The participants continued to maintain significant improvements in mental health and quality of life and declines in the severity of parenting stress and dysfunctional attitudes at the 6-month follow-up. Effect size analyses revealed mostly large differences in the foregoing measurements (Cohen's d = 0.76-2.18) between the pre-test and 6-month follow-up. Employing a cut-off score of 3/4 in the GHQ-12 to identify at-risk and not-at-risk cases, approximately 90.5% of the participants could be classified as not-at-risk at the follow-up. Lastly, regression analyses showed that changes in DAS scores significantly predicted changes in the GHQ-12 and Q-LES-Q-18 scores at the follow-up. CONCLUSIONS This study provides preliminary evidence of the 6-month maintenance effect of CBT groups for the Melbourne-resident Chinese parents of children with intellectual disabilities.
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Affiliation(s)
- D F K Wong
- Department of Applied Social Studies, City University of Hong Kong, Hong Kong, China.
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Jacob KL, Christopher MS, Neuhaus EC. Development and Validation of the Cognitive-Behavioral Therapy Skills Questionnaire. Behav Modif 2011; 35:595-618. [DOI: 10.1177/0145445511419254] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although several theories exist to describe why patients improve in cognitive-behavioral therapy (CBT), in only a limited number of studies has CBT skill acquisition been examined, particularly among patients with complex clinical profiles. Thus, the overarching aim of this research was to develop a tool to measure patients’ use of CBT skills, such that it would have clinical utility for patients and therapists during treatment. In Study 1, the authors developed an initial set of items for the Cognitive-Behavioral Therapy Skills Questionnaire (CBTSQ). They submitted these items to an exploratory factor analysis in an initial administration ( n = 350) and to a confirmatory factor analysis in a second administration ( n = 378). Results indicated that there were two factors (Behavioral Activation and Cognitive Restructuring) with good factor structure and internal consistency, and both the factors evidenced expected relationships with other constructs. In Study 2, the criterion validity of the CBTSQ was investigated on a patient sample in a CBT-oriented treatment setting. Results showed that CBTSQ scores increased following treatment, and Cognitive Restructuring and Behavioral Activation scores predicted reduction of overall psychiatric symptoms and depression. Thus, the CBTSQ appears to be a promising measure of CBT skill acquisition and treatment outcome as well as an instrument that can help patients and therapists monitor progress specifically related to a CBT skills training treatment approach.
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Affiliation(s)
- Karen L. Jacob
- Harvard Medical School and McLean Hospital, Belmont, MA, USA
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Chan AS, Cheung MC, Tsui WJ, Sze SL, Shi D. Dejian mind-body intervention on depressive mood of community-dwelling adults: a randomized controlled trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2011; 2011:473961. [PMID: 19474241 PMCID: PMC3136532 DOI: 10.1093/ecam/nep043] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/23/2009] [Indexed: 01/04/2023]
Abstract
The present study evaluated the effectiveness of a short-term mind-body intervention program on improving the depressive mood of an adult community sample. Forty adult volunteers with various degrees of depressive mood were randomly assigned to the experimental group (Dejian Mind-Body Intervention, DMBI) and control group (Cognitive-Behavioral Therapy, CBT). For each group, a total of four 90-min weekly sessions were conducted. Treatment-related changes were measured using the Beck Depression Inventory (BDI-II), an electroencephalographic indicator of positive affect (i.e., prefrontal activation asymmetry), and self-report ratings on physical health. Results indicated that both the DMBI and the CBT group demonstrated significant reduction in depressive mood. However, among individuals with moderate to severe depressive mood at baseline, only those in the DMBI but not the CBT group showed significant reduction in depressive mood. Besides, only the DMBI group demonstrated a significant increase in prefrontal activation asymmetry, suggesting increase in positive affect. While most psychological therapies for depressive mood normally take several months to show treatment effect, the present findings provided initial data suggesting that the DMBI was effective in improving depressive mood of community adults after 1 month of training.
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Affiliation(s)
- Agnes S. Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
- Integrative Neuropsychological Rehabilitation Centre, The Chinese University of Hong Kong, Hong Kong
- Henan Songshan Research Institute for Chanwuyi, Henan 452470, China
| | - Mei-chun Cheung
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Wilson J. Tsui
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sophia L. Sze
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
- Integrative Neuropsychological Rehabilitation Centre, The Chinese University of Hong Kong, Hong Kong
| | - Dejian Shi
- Henan Songshan Research Institute for Chanwuyi, Henan 452470, China
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Lemmens LHJM, Arntz A, Peeters FPML, Hollon SD, Roefs A, Huibers MJH. Effectiveness, relapse prevention and mechanisms of change of cognitive therapy vs. interpersonal therapy for depression: Study protocol for a randomised controlled trial. Trials 2011; 12:150. [PMID: 21672217 PMCID: PMC3136406 DOI: 10.1186/1745-6215-12-150] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 06/14/2011] [Indexed: 11/22/2022] Open
Abstract
Background Major depression is a common mental disorder that substantially impairs quality of life and has high societal costs. Although psychotherapies have proven to be effective antidepressant treatments, initial response rates are insufficient and the risk of relapse and recurrence is high. Improvement of treatments is badly needed. Studying the mechanisms of change in treatment might be a good investment for improving everyday mental health care. However, the mechanisms underlying therapeutic change remain largely unknown. The objective of the current study is to assess both the effectiveness of two commonly used psychotherapies for depression in terms of reduction of symptoms and prevention of relapse on short and long term, as well as identifying underlying mechanisms of change. Methods In a randomised trial we will compare (a) Cognitive Therapy (CT) with (b) Interpersonal therapy (IPT), and (c) an 8-week waiting list condition followed by treatment of choice. One hundred eighty depressed patients (aged 18-65) will be recruited in a mental health care centre in Maastricht (the Netherlands). Eligible patients will be randomly allocated to one of the three intervention groups. The primary outcome measure of the clinical evaluation is depression severity measured by the Beck Depression Intenvory-II (BDI-II). Other outcomes include process variables such as dysfunctional beliefs, negative attributions, and interpersonal problems. All self-report outcome assessments will take place on the internet at baseline, three, seven, eight, nine, ten, eleven, twelve and twenty-four months. At 24 months a retrospective telephone interview will be administered. Furthermore, a rudimentary analysis of the cost-effectiveness will be embedded. The study has been ethically approved and registered. Discussion By comparing CT and IPT head-to-head and by investigating multiple potential mediators and outcomes at multiple time points during and after therapy, we hope to provide new insights in the effectiveness and mechanisms of change of CT and IPT for depression, and contribute to the improvement of mental health care for adults suffering from depression. Trial registration The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN67561918)
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Affiliation(s)
- Lotte H J M Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands.
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Donnelly R, Renk K, Sims VK, McGuire J. The relationship between parents' and children's automatic thoughts in a college student sample. Child Psychiatry Hum Dev 2011; 42:197-218. [PMID: 20972616 DOI: 10.1007/s10578-010-0210-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Research demonstrates the importance of early social interactions in the development of schemas and automatic thoughts. It does not appear, however, that the existing research examines intergenerational correlations in automatic thoughts. As a result, this study explores the relationship between the automatic thoughts of parents and those of their college-age children in a sample of 252 college students and their mothers and fathers. Results of this study suggest that there are significant relationships between parents' and college students' positive automatic thoughts. Different trends by gender also are noted in the relationships among variables for male and female college students with their mothers and fathers. Further, mothers' positive ATs predicted the positive ATs of their college students, with mothers' ratings of their own communication with their college students mediating partially this relationship. Finally, college students' anxiety and self-esteem is predicted significantly by their mothers' anxiety and self-esteem (respectively) as well as their own positive and negative ATs. These findings suggest the possibility that ATs play a role in the intergenerational transmission of certain domains of psychological functioning.
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A review on assessment and treatment for depression in malaysia. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:123642. [PMID: 21804939 PMCID: PMC3143455 DOI: 10.1155/2011/123642] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/10/2011] [Accepted: 06/09/2011] [Indexed: 11/18/2022]
Abstract
This paper aimed to review the literature on depression that focused on its assessment and treatment in Malaysia. PsycINFO, Medline, local journals were searched, and 18 published articles were included in this paper. Results indicate that research on depression in Malaysia, particularly validation studies and psychotherapy research, was weak and fragmented, with minimal empirical evidence available. Pharmacotherapy still dominated the treatment for depression, and, in terms of psychotherapy, Cognitive Behavioural Therapy (CBT) was recently practiced, but only a few studies have reported on the treatment efficacy of CBT. Major limitations of studies were noted, and, consequently, the problems that are associated with the implementation and future direction of clinical and research on depression in Malaysia were discussed. In short, the contribution of empirical research on the assessment and treatment for depression remained inconsistent and fragmented and urgently in need of further empirical investigation.
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Forsyth DM, Poppe K, Nash V, Alarcon RD, Kung S. Measuring changes in negative and positive thinking in patients with depression. Perspect Psychiatr Care 2010; 46:257-65. [PMID: 20883432 DOI: 10.1111/j.1744-6163.2010.00253.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this article is to describe changes in positive and negative thinking in adult inpatients with depression who attended an Advanced Practice Nurse-led Cognitive Behavioral Therapy group on 1 inpatient unit in a large medical center. DESIGN AND METHODS A descriptive design with a retrospective cohort chart review was conducted (n = 427). Positive and negative thinking were measured by the Automatic Thoughts Questionnaire at admission and at discharge. FINDINGS AND PRACTICE IMPLICATIONS A paired t-test revealed a significant change (p = .001) in both positive and negative thinking in the desired direction between admission and discharge. It is important to measure clinical improvements.
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Affiliation(s)
- Diane McNally Forsyth
- Winona State University Graduate Program in Nursing, Winona State University, Rochester, Minnesota, USA
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Cui L, Lin W, Oei TPS. Factor Structure and Psychometric Properties of the Young Schema Questionnaire (Short Form) in Chinese Undergraduate Students. Int J Ment Health Addict 2010. [DOI: 10.1007/s11469-010-9283-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mukhtar F, Oei TPS. Exploratory and confirmatory factor validation of the Dysfunctional Attitude Scale for Malays (DAS-Malay) in Malaysia. Asian J Psychiatr 2010; 3:145-51. [PMID: 23051574 DOI: 10.1016/j.ajp.2010.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 06/02/2010] [Accepted: 07/18/2010] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate the factor structure of the Malay version of the Dysfunctional Attitude Scale (DAS-Malay) in clinical and nonclinical populations. The DAS is a self-report inventory derived from Beck's cognitive theory of depression to measure beliefs constituting a predisposition to depression. The 40-item DAS-Malay was completed by 315 university students, 495 members of the general community, 167 medical patients, and 113 patients diagnosed with major depressive disorder. Through principal axis factoring, with varimax rotation, two factors were extracted; performance evaluation and self-control. Correlation with depression and other variables indicated that the DAS-Malay held good concurrent validity. In addition, sensitivity and specificity of the total scores of the DAS were evident in this study. The results showed that the DAS-Malay possesses satisfactory psychometric properties suggesting that this instrument is appropriate for use as a cognitive measure in a Malay cultural context although several issues require consideration.
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Affiliation(s)
- Firdaus Mukhtar
- Department of Psychiatry, Faculty of Medicine, Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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Wong FKD, Poon A. Cognitive behavioural group treatment for Chinese parents with children with developmental disabilities in Melbourne, Australia: an efficacy study. Aust N Z J Psychiatry 2010; 44:742-9. [PMID: 20636196 DOI: 10.3109/00048671003769769] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study attempted to test the efficacy of a culturally attuned cognitive behavioural therapy (CBT) group for Chinese parents with children with developmental disabilities at risk of developing mental health problems in Melbourne, Australia. It was hypothesized that the participants in the experimental group would have less parenting stress and fewer dysfunctional attitudes, rules, and values, and better mental health and quality of life than the participants in the control group post-test. METHOD A total of 58 participants were randomly assigned into CBT and waiting list control groups. While ANCOVAs were used to compare the differences in General Health Questionnaires-12 (GHQ-12), Parenting Stress Index- Parent Domain (PSI-PD), Quality of Life Enjoyment and Satisfaction Questionnnaire-18 (Q-LES-Q-18) and Dysfunctional Attitude Scale (DAS) between participants of the experiemental and control groups, effect size statistics were performed to measure the magnitude of changes in the above instruments at post treatment. RESULTS After ten weeks of treatment, the participants in the CBT group showed significant improvement in GHQ-12, Parenting Stress Index (PSI)-Parent Domain and Q-LES-Q-18 scores, but not in DAS scores. The effect size statistics revealed large differences in GHQ-12, PSI-Parent Domain and Q-LES-Q-18 scores between the participants in the experimental and control groups at post-treatment. When a GHQ score of 4 or greater was used as the recommended cut-off score, about 89% and 10% of the participants in the experimental and control groups, respectively, were classified as not at-risk cases at post-treatment. CONCLUSION The initial findings suggest that a culturally attuned CBT group may help Chinese parents with children with developmental disabilities to reduce their parenting stress and improve their general mental health and quality of life.
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Affiliation(s)
- Fu Keung Daniel Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.
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Johnson JE. Cohesion in cognitive-behavioral group therapy for anxiety disorders and major depression. Int J Group Psychother 2010; 60:153-8. [PMID: 20059300 DOI: 10.1521/ijgp.2010.60.1.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Matsunaga M, Okamoto Y, Suzuki SI, Kinoshita A, Yoshimura S, Yoshino A, Kunisato Y, Yamawaki S. Psychosocial functioning in patients with Treatment-Resistant Depression after group cognitive behavioral therapy. BMC Psychiatry 2010; 10:22. [PMID: 20230649 PMCID: PMC2856539 DOI: 10.1186/1471-244x-10-22] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 03/16/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although patients with Treatment Resistant Depression (TRD) often have impaired social functioning, few studies have investigated the effectiveness of psychosocial treatment for these patients. We examined whether adding group cognitive behavioral therapy (group-CBT) to medication would improve both the depressive symptoms and the social functioning of patient with mild TRD, and whether any improvements would be maintained over one year. METHODS Forty-three patients with TRD were treated with 12 weekly sessions of group-CBT. Patients were assessed with the Global Assessment of Functioning scale (GAF), the 36-item Short-Form Health Survey (SF-36), the Hamilton Rating Scale for Depression (HRSD), the Dysfunctional Attitudes Scale (DAS), and the Automatic Thought Questionnaire-Revised (ATQ-R) at baseline, at the termination of treatment, and at the 12-month follow-up. RESULTS Thirty-eight patients completed treatment; five dropped out. For the patients who completed treatment, post-treatment scores on the GAF and SF-36 were significantly higher than baseline scores. Scores on the HRSD, DAS, and ATQ-R were significantly lower after the treatment. Thus patients improved on all measurements of psychosocial functioning and mood symptoms. Twenty patients participated in the 12-month follow-up. Their improvements for psychosocial functioning, depressive symptoms, and dysfunctional cognitions were sustained at 12 months following the completion of group-CBT. CONCLUSIONS These findings suggest a positive effect that the addition of cognitive behavioural group therapy to medication on depressive symptoms and social functioning of mildly depressed patients, showing treatment resistance.
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Affiliation(s)
- Miki Matsunaga
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan,Department of Social and Clinical Psychology, Faculty of Contemporary Culture, Hijiyama University, 4-1-1, Ushitashinmachi, Higashi-ku, Hiroshima, 732-8509, Japan
| | - Yasumasa Okamoto
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Shin-ichi Suzuki
- Faculty of Human Sciences, Waseda University 2-579-15, Mikajima, Tokorozawa, Saitama 359-1192, Japan
| | - Akiko Kinoshita
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Shinpei Yoshimura
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yoshihiko Kunisato
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Dingle GA, Oei TPS, Young RM. Mechanisms of change in negative thinking and urinary monoamines in depressed patients during acute treatment with group cognitive behavior therapy and antidepressant medication. Psychiatry Res 2010; 175:82-8. [PMID: 19969377 DOI: 10.1016/j.psychres.2008.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 12/24/2008] [Accepted: 12/30/2008] [Indexed: 01/21/2023]
Abstract
UNLABELLED This naturalistic study investigated the mechanisms of change in measures of negative thinking and in 24-h urinary metabolites of noradrenaline (norepinephrine), dopamine and serotonin in a sample of 43 depressed hospital patients attending an eight-session group cognitive behavior therapy program. Most participants (91%) were taking antidepressant medication throughout the therapy period according to their treating Psychiatrists' prescriptions. The sample was divided into outcome categories (19 Responders and 24 Non-responders) on the basis of a clinically reliable change index [Jacobson, N.S., & Truax, P., 1991. CLINICAL SIGNIFICANCE a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.] applied to the Beck Depression Inventory scores at the end of the therapy. Results of repeated measures analysis of variance [ANOVA] analyses of variance indicated that all measures of negative thinking improved significantly during therapy, and significantly more so in the Responders as expected. The treatment had a significant impact on urinary adrenaline and metadrenaline excretion however, these changes occurred in both Responders and Non-responders. Acute treatment did not significantly influence the six other monoamine metabolites. In summary, changes in urinary monoamine levels during combined treatment for depression were not associated with self-reported changes in mood symptoms.
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Affiliation(s)
- Genevieve A Dingle
- School of Psychology, University of Queensland, Brisbane, Australia, 4072.
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Kopala-Sibley DC, Santor DA. The Mediating Role of Automatic Thoughts in the Personality–Event–Affect Relationship. Cogn Behav Ther 2009; 38:153-61. [DOI: 10.1080/16506070802694644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wong DFK, Chan KS, Lau Y. The reliability and validity of the Chinese version of the Dysfunctional Attitudes Scale Form A (DAS-A) in a community sample. Int J Psychiatry Med 2008; 38:141-52. [PMID: 18724566 DOI: 10.2190/pm.38.2.b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study investigated the reliability and validity of the DAS-A in a sample of 308 Chinese adults in Hong Kong. METHOD The reliability of the DAS-A and its relevant sub-scales was measured using internal consistency (Cronbach's alpha) and Guttman split-half reliability. Principal components analysis was performed to assess construct validity. Discriminant validity of the DAS-A was performed by examining whether the DAS-A could discriminate between the depressed and the non-depressed subjects in this study. RESULTS The split-half reliability of the DAS-A was found to be r = 0.87; Cronbach's alpha was 0.945; and item-total correlations ranged between 0.36 and 0.75. Factor analysis revealed three factors that were similar to those that were found in other studies: Performance Evaluation, Need for Approval, and Anaclitic Self-Esteem. Discriminant validity suggested that the DAS-A discriminated successfully between the non-depressed and the depressed groups. Nevertheless, some differences were noticed in the relative strength of the factors and in the distribution of the scale items into the three factors. CONCLUSION It was hoped that with this type of cross-cultural information, the universality of the constructs of the DAS-A could be reliably demonstrated.
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Affiliation(s)
- Daniel Fu Keung Wong
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia.
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Faramarzi M, Kheirkhah F, Esmaelzadeh S, Alipour A, Hjiahmadi M, Rahnama J. Is psychotherapy a reliable alternative to pharmacotherapy to promote the mental health of infertile women? A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2008; 141:49-53. [PMID: 18848381 DOI: 10.1016/j.ejogrb.2008.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 04/04/2008] [Accepted: 07/03/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Women with fertility problems experience a higher prevalence of negative emotions than women without fertility problems. The goal of this study was to compare the effects of psychological intervention with psychotropic medication on the mental health improvement of depressed infertile women. STUDY DESIGN In a randomized controlled clinical trial, 89 depressed infertile women that they were recruited and divided into three groups in three groups: cognitive behavior therapy (CBT), antidepressant therapy, and a control group. Twenty-nine participants in the CBT method received 10 sessions on relaxation training, restructuring, and eliminating negative automatic thoughts and dysfunctional attitudes to infertility. Thirty participants in the pharmacotherapic group took 20mg fluoxetine daily for 90 days. Thirty control subjects did not receive any intervention. All participants completed the Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ) at the beginning and end of the study. Paired t-test, ANOVA, chi(2), and McNemar tests were used to analyze the data. RESULTS Fluoxetine significantly reduced the mean of three subscale scores of the GHQ anxiety (7.3+/-4.1 vs. 5.1+/-3.2), social function (7+/-2.8 vs. 4.3+/-2), and depression (7.8+/-5.2 vs. 4.4+/-2.2) but could not significantly change the mean score of psychosomatic signs. The CBT method effectively reduced the mean of all four GHQ subscales: anxiety (8+/-4 vs. 3.2+/-2), social function (7.2+/-2.6 vs. 4.7+/-2.5), depression (7.7+/-4.2 vs. 3.6+/-2.7), and psychosomatic signs (7.5+/-3.2 vs. 5.5+/-3.2). Also, both methods significantly reduced the total GHQ scores. Successful treatment of depression in three groups was fluoxetine group 50%, CBT 79.3%, and control 10%. The mean Beck scores among the groups at the beginning and end of study were, respectively: fluoxetine 23.2+/-8.6 versus 14.3+/-8.5 (p<0.001), CBT 20+/-7.9 versus 7.7+/-4.8 (p<0.001), and control 19.8+/-8.5 versus 19.7+/-8.4 (p=0.9). Although both fluoxetine and CBT significantly decreased the mean BDI scores more than the control group, the decrease in the CBT group was significantly greater than the fluoxetine group. CONCLUSION Psychotherapy, such as group CBT, was superior to or at least as effective as pharmacotherapy to promote the well being of depressed infertile women.
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Affiliation(s)
- Mahbobeh Faramarzi
- Department of Midwifery, Tarbiat Modares University, Faculty of Medicine, Babol University of Medical Sciences, Iran.
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Wong DFK. Cognitive and health-related outcomes of group cognitive behavioural treatment for people with depressive symptoms in Hong Kong: randomized wait-list control study. Aust N Z J Psychiatry 2008; 42:702-11. [PMID: 18622778 DOI: 10.1080/00048670802203418] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study examined the efficacy of a territory-wide cognitive behavioural group treatment programme for Chinese people with depression launched in Hong Kong. METHOD Three hundred and forty-seven subjects with depressive symptoms (i.e. Beck Depression Inventory-Chinese version >9) were randomly assigned to CBT and waitlist control groups. RESULTS After 10 weeks of treatment, participants in the group CBT programme had significantly fewer symptoms of depression, fewer dysfunctional and perfectionist attitudes, and better quality of life when compared to the participants in the control group. Effect size statistics showed small to medium differences in symptoms of depression, dysfunctional and perfectionist attitudes and quality of life between the two groups (Cohen's d, 0.22-0.74). Statistical analysis of the clinical significance indicated that approximately 27% of the participants in the experimental group could be considered as clinically remitted or recovered, respectively (RCI >1.28). Last, multiple regression provided some evidence of a linkage between cognition and depression among the participants in the experimental group. CONCLUSIONS The design and content of the group CBT programme, which aimed at facilitating the understanding and modification of automatic thoughts and dysfunctional attitudes among the participants, might have contributed to the initial positive results.
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Affiliation(s)
- Daniel Fu Keung Wong
- School of Nursing and Social Work, University of Melbourne, Carlton, Vic., Australia.
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