Cognitive-Behavioural Treatment for Depression in Adults Case Study

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Chapter 1: Introduction

 1.1 Introduction

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The problems which are associated with a person’s mental health such as depression and anxiety have become the second largest health problem around the world. Over half of the 1 million annual suicide deaths are caused by depression. Although the prevalence of major depressive disorder in primary care is about 10%, the most effective evidence-based treatments are unclear (Sinyor, Fefergrad & Zaretsky, 2015).

A recent randomized trial has found that the alliance is more strongly associated with improvement in depressive symptoms in cognitive behavioural analysis system of psychotherapy. This therapy emphasizes on enhancing collaborative working relationships as compared to brief supportive psychotherapy for depression.

Snippe et al. (2015) aimed to compare the association between alliance and outcome in cognitive behaviour therapy (CBT) and mindfulness-based cognitive therapy (MBCT) for depressive symptoms in diabetic patients. This study also seeks to control for prior symptom change. It is crucial to consider the possibility of early symptom improvement influencing patients' alliance ratings because this could lead to confounding the alliance-outcome association.

This research focuses on depression patient’s age between 18 years old and older. Also this specific research work will identify the effects and impacts of cognitive theoretical treatments effects on the mental health of patients. Then study what else does the therapist lack in providing advice and rehab and how can improve the treatment for depression.

1.2 Research Aims

The purpose of this research is to identify the cause of depression as well as study ways of treating symptoms according to depression severity for depression patients. Furthermore, what other areas does the therapist fall short in when it comes to offering guidance and rehabilitation. The objective of this study is to examine the influence of therapists on patients, specifically focusing on the advancements in depression treatment over the last ten years and how can we enhance the treatment options for depression.

1.3 Research Questions

What is group cognitive therapy?

This research question aims to explain what group cognitive therapy for depression is and how the method of group cognitive therapy is used to treat depression according to its severity. With the proper identification and understanding of different types of cognitive theories and therapy techniques this study will identify the impacts of these therapy techniques on the patients with depression problem.

How does CBT help treat depression?

This research question aims to indicate how cognitive therapy could help to treat depression in adults and what the impact of CBT on depression. This research work will identify the importance of the CBT therapy process during the treatment of depression among the patients.

What is the success rate of CBT for the treatment of depression?

The final research question aims to indicate how significant and harmful CBT is for depression treatment, the success percentage compared to the past decade and how the therapist developed from the past.

Chapter 2: Literature review

2.1 Introduction

The following literature review will be divided into three key sections: a summary of depression treatments and types of depression disorders, an examination of the effects of depression treatments, and a comparison between group and individual CBT.

2.2 Overview of types of depression disorders

It was identified that most of the people who have depression are now cared with primary approaches which is 64% in the USA and 90% in the UK (Ramanuj et al. 2019). Investigation on low-intensity mental interventions, precisely cognitive behaviour therapy-based approaches, has changed the treatment of depression and anxiety throughout the UK. These techniques are now used for the treatment of various patients with anxiety and depression in the UK. In between the year 2009 and 2012, more than one million people get these new cares, with the rate of recovery exceeding 45%, which produced in 45,000 people.

There are different types of depression, such as major depressive disorder (MDD) and persistent depressive disorder (PDD), which was formerly known as dysthymic disorder (Williams & Wilkins, 2014).

Cognitive-Behavioural Treatment for Depression in Adults Case Study

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Positron-emission tomography (PET), a type of brain scan, has revealed that depressed patients have a marked change in activity in certain areas of their brain when feeling despondent. PET imaging shows that these patients have increased blood flow, which reflects brain cell activity, in a specific area in the middle of the brain (Lozano and Mayberg, 2015).

Depression disrupts the normal functioning of neural circuits. However, brain scans can help identify therapies that can improve the circuits' natural ability to respond to and correct this imbalance. By examining the results of a scan, it is possible to determine whether cognitive-behavioural therapy or medication can help restore balance. In cases where the circuits have lost their self-correcting responsiveness, other treatments, such as deep-brain stimulation, may be necessary.

There are several treatments available for depression, including nonpharmacological interventions like brain stimulation. According to Schlaepfer et al., (2012) “electroconvulsive therapy (ECT)” is a very significant and effective therapy technique based on simulation used for depression treatment. However, patients and their families may fear about the side effects of ECT's, mostly cognitive cases. For the resolving of these side-effects researchers are now developing personalised care recently.

CBT is the most extensively researched psychological intervention. Research indicates that CBT is more effective than standard treatments, especially for treating depression with coexisting physical conditions. However, there is no conclusive evidence to support the superiority of CBT over other psychological or pharmacological treatments for depression. Additionally, problem-solving therapy is an effective intervention, particularly for situational depression caused by stressful social circumstances. Interpersonal therapy is also effective in the treatment of acute depression and for preventing relapses (Ramanuj et al. 2019).

Depression is a treatable mental health condition that can be addressed through talk therapy with the help of a trained therapist. Two clinical modalities that have been proven effective in treating depression are cognitive behavioral therapy and interpersonal therapy. This particular research work includes various important descriptions about these mental health problems but it lacks the clarification of these theories with proper examples (Williams & Wilkins, 2014).

2.3 Overview of the impact of treatments for depression 

Building a non-defensive and genuine relationship with patients is crucial in primary care. With the rise of remote technology, video messaging and online communication have gained significant interest in maintaining this relationship.

Ramanuj et al (2019) conducted the “PREDICT-NL study” in 2012 to analyse the natural course and various results of the “Major Depressive Disorder (MDD)” which is present in primary treatment. Based on 1338 participants in an examination, 174 of them (13%) were identified as depressed at the initial stage of the examination. Between these peoples, 17% have chronic depression. On the other hand 40% faced a fluctuating course and 43% faced a decrease of their specific symptoms. It was identified that patients who have chronic depression faced more prominent symptoms of their diseased mental health conditions.

2.4 A comparison of group and individual CBT

Amick et al. (2015) stated that patients who participated in the trials were mostly females aged between 18 and 65 years, with the majority having a mean age between 35 and 45 years. In some trials, chronic or recurring depression. These include a past history of recurring depression, a history of dysthymia, the presence of other psychiatric disorders, the co-occurrence of chronic medical conditions, an earlier age of onset, a family history of mood disorders, more severe depressive symptoms initially, and a failure to fully recover after acute treatments. Chronic depression often coexists with low levels of social integration and negative social interactions at the beginning of all trials was at least moderate, with most trials reporting moderate to severe depression. The daily dosage of every second-generation antidepressant drug fell within the standard range recommended for adults. After six months, patients who underwent rational emotive therapy or cognitive therapy reported considerably lower scores on the 17-item Hamilton Rating Scale for Depression in comparison to those who were prescribed second-generation antidepressant medication. In a study in this trial, patients' scores on the 17-item Hamilton Rating Scale for Depression continued to decrease, with one-year scores being lower in the problem-solving therapy group than in the second-generation antidepressant group. However, these differences did not reach statistical significance when comparing second-generation antidepressants to problem-solving therapy. The group that underwent problem-solving therapy showed a higher rate of remission after one year, while the group that received second-generation antidepressants did not show a statistically significant difference. However, it was found that this particular research study have some theoretical limitations also. It was examined that this research can include more theories for the proper understanding of their result data.

2.5 Conclusion

A review of various antidepressants and non-pharmacological modalities such as brain stimulation are explored. However, concerns regarding the cognitive side effects continue to revolve around ECT as one of the most powerful stimulation therapies. These concerns have led the researchers to come up with other approaches like vague nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation. Essentially this research study emphasizes the need for careful consideration of the associated risks that accompany these interventions.

The most common psychological intervention is cognitive-behavioural therapy, which is also extensively researched. According to studies, it is more effective than standard interventions in the treatment of depression comorbidity with physical conditions, yet there is no clear proof that it outperforms other psychological and pharmacological treatments (Ramanuj et al. 2019). Besides, problem-solving therapy and interpersonal therapy are recognized as being effective in dealing with situational depression as well as for relapse prevention.

According to the researchers, talk therapy done by trained therapists, particularly, cognitive behavioural therapy and interpersonal therapy, proves powerful in treating depression. By changing one’s thinking patterns and adopting a more positive outlook, CBT helps to change one’s perspective on life. On the other hand, interpersonal therapy focuses on improving relationships that are vital to someone suffering from depression. Combination of drugs and talk therapy is outlined, showing evidence of success for the people that are willing to get well.

This research work concludes with a discussion of why it is important to develop a real relationship with patients when transitioning to primary care. It also points out that remote technology such as video messaging and online communication helps the therapeutic alliance. The PREDICT-NL study in 2012 also revealed those who have chronic or recurrent MDD in primary care.

Depression management involves an individualized, comprehensive and multi-faceted treatment, which includes different therapies and aspects, based on extensive research and studies.

Chapter 3: Methodology

3.1 Introduction

The cognitive behaviour of adults can be analysed properly by going through some important methods essential for the completion of this research work. In this chapter, the methodologies for this entire research work are discussed properly. A wide variety of research techniques will be described throughout this entire chapter with the proper consideration of research onion’s classes. 

3.2 Research onion

Figure 1: Research Onion

3.3 Research Design

The research design explains the method that was adopted for the completion of the methodology of this paper. The research was done depending on the sources that were available on different platforms of the internet (Jager et al. 2021). The research methodology allows the creation of a proper structure of the process that is involved in the completion of this chapter. The quantitative analysis method was selected for the beginning of the research work for this paper. The research questions also helped in understanding the research plan for this paper. The proper method was adopted and the resources helped vastly for the completion of this paper.

3.4 Research Philosophy

The philosophy method of interpretivism was adopted for the research philosophy section of this chapter. The interpretive process can be used for getting information that is not given certain information but rather given neutrally (Waller et al. 2020). Philosophy describes the idea that has helped in understanding the paper and the ethics that were followed for the completion of this paper. The resources should be used methodically for proper implication of the theories that are discussed by the researchers. Research philosophy is an important section for the completion of this chapter (Kaidesoja Cooper & Fordham, 2023). Proper analysis of the important information that is necessary for the completion of this paper is necessary for the effective use of the information from different resources. The research philosophy can be used for the proper creation of the ideas that are incorporated in this paper. Interpretive helps in understanding the important information for the completion of this chapter.

3.5 Research Approach

The research approach helps in understanding the way the research was done for the paper and the way the data was collected for the completion of this paper. The deductive approach is chosen for this particular research work. The method is suitable for the completion of this paper (Beck, 2020). Different resources such as journals, articles, magazines, and other papers have helped in the collection of proper data that has been used in this paper for a better understanding of this paper. The quantitative method is useful and the resources are very helpful for this paper. The researchers have explained different theories for a better understanding of this paper.

3.6 Research Strategy

The action and grounded theory research strategies are chosen for this particular research work. These two theories are identified for this research study because of the secondary data collection and analysis factors of depressed patients’ information (Erten Uyumaz et al. 2021). The qualitative research approach helps in identifying the proper data and information that are related to this paper. The journals helped vastly in the understanding of the methods that are adopted for this research paper.

3.7 Research Method

The mono method of research paper has helped in understanding the research process that is used for the completion of this research paper (Thomas et al. 2020). The qualitative data approach for secondary analysis has helped in understanding the journals and identifying the relevant information of the journals and other resources that could be used for better analysis of this paper. The researchers have explained different methods using different theories that have helped in understanding this paper. Development of the proper data for the creation of improvised thoughts that could be implemented for the completion of this chapter and create impact in this paper.

3.8 Data Collection Method

The data is collected based on the secondary data analysis method. In this section, different journals, internet sources, articles, and magazines were gone through for thorough research of the data that are needed for this job. The data collection has helped in the understanding of the process that needs to be done for the completion of this research paper (Getu et al. 2021). The journals and other resources have shown that the cognitive behaviour of children depends on their mental condition and creates a great impact on their lives in various ways. The resources have also shown the various parameters that create depression in the minds of children. Depression in children can lead to various chronic diseases that could affect the health condition of children. The researchers have given many theories that have occurred in the real world and also provided the solutions that are needed to prevent these problems from taking place in the future.

3.9 Data Analysis Method

The data analysis method helps in understanding the method that has been adopted for conducting the methodology of this paper. The paper follows a qualitative approach to data collection for secondary analysis for this research paper. The journals have helped vastly in the collection of relevant data for the completion of this chapter (Thomas et al. 2020). The secondary information that will be collected for this research study will be analysed with the help of different previously concluded research studies information in a well-structured method.

3.10 Research Ethics

This particular research study will be properly done following all of the ethical factors that are related to the secondary data collection and analysis process (Husband, 2020). It was examined that the collection of different patient data for this project includes various privacy-related issues which will be dealt with properly during this research work. On the other hand, it was found that there are various research data are present related to healthcare that contain copyrights (Jowett, 2020). During the time of data collection, this research work will properly analyze those ethical factors. Also, the data that will be collected and analyzed throughout this research process will contain proper data sources.

3.11 Time Horizontal

Figure 2: Gantt chart

3.12 Conclusion

Throughout this entire chapter, a wide variety of research methods are identified which becomes very significant for the development of this research work. It was identified that the secondary collected data became the most appropriate data collection method to identify the CBT treatment in depressed adult patients. The research strategies and approaches are also found as best fitted for this research work.

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