RUNNING HEAD: Depression

Depression: Cognitive Therapy or Pharmacology

Shelby Schroeder
4/25/2015
SW 3810
Wayne State

Depresssion

Mental health is something I have become interested in within the last

year. Working with people with mental illnesses is something that I am
becoming very passionate about. Knowing that they need help to function,
but maybe do not always get it is hard for me to see. I specifically have
become interested in helping people with depression.
Hearing their stories is something that drives me to want to help them.
A lot of times now part of their treatment is to go to therapy and talk about
what they are going through with other people who have experienced the
same thing. This is what the article I chose to analyze is called Effectiveness
of Cognitive Behavioral Therapy in Public Mental Health: Comparison to
Treatment as Usual for Treatment- Resistant Depression and was done by
Molly A. Lopez and Monica A. Basco. This studies the level of depression in
patients where one group is given medication and therapy while the other is
given only medication.
Statement of Problem
In the United States we are constantly in a battle for the rights of
people with mental illnesses. Ever since many mental hospitals were closed
in the late 1960s because of the terrible treatments of the residents, they
have been researching what treatments work best for patients with severe
mental illnesses. This is why I am so interested in looking into the different
treatments for different mental ilnesses.

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For my paper, the practice setting could be multiple places. One place
this type of study could be done is in a mental health facility. This would be
the easiest place because they only focus on mental health problems.
Another place this study could take place is at a social agency that focuses
on mental health in the community. Both of these places are very similar, but
the mental health agency will often work with people who live on their own
or with little supervision.
This is a social problem because many people are afraid to take
medications for their mental illnesses, but they are also afraid to go to group
therapies. I think that if they can know what works better then we will be
able to treat patients better. Making the treatments more specific per person
will mean the patients will get better results more efficiently.
Research Design
This study is actually very simple when it comes to the design. They
will have two groups of participants. One group will be referred for as CBT,
which stands for cognitive behavioral therapy, while the other will be
referred to as TAU, which stands for treatment as usual. Before starting the
different treatments they measured the depression level in the participants
in both groups. Then they gave the CBT group the intervention, but did not
give the TAU group anything.
The CBT group would get 18 individual sessions of CBT. The therapists
would record these therapy sessions which would then be used to make sure

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the therapists were following the CBT training they had received and to make
sure the participants were following through with the treatment plans.
Participants in the CBT group continued to receive pharmacological and case
coordination services and have crisis services available as needed.
The TAU group did not receive any CBT so they just continued taking
their medications. Once the 18 weeks had passed they measured the
depression levels in both of the groups again. This is how the two different
groups looked, where O is the observations and X is the intervention:
CBT Group
O--------------------X------------------O
TAU Group
O----------------------------------------O
Although they were very thurough there were some issues with the
research design. Some threats to internal validity are if the participants have
complex needs in their environment, if the therapists have varied
understanding of the CBT treatments, if the participants end up presenting
multiple problems, and whether or not they adhere to the treatment plans.
They controlled the issue with the participants presenting multiple problems
by making that a disqualifier when they did the sampling.
Sampling

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For this article there were a lot of different types of sampling. The
sampling for this artivle was very long and exhausting. Both the therapists
and the patients needing the therapy had to go through a long list of criteria.
This section will go over the three types of sampling used for this study.
The first group that they were sampling for were the therapists they
wanted to do the treatments. Therapists were recruited from publicly-funded
community mental health clinics in Texas. 15 of the states clinics were
intersted in participating in the study. Clinics that chose not to participate
reported that they currently had too few adults eligible for this therapy, had
no therapists eligible to participate, or did not feel they had the time for a
research project. Clinics that wished to participate had to volunteer had to
nominate one or more therapists to be involved in the project. Eligible
therapists had to have a masters degree in a mental health field, have a
license allowing for the administration of therapy, or be under supervision
pursuing professional licensure. Although 17 therapists consented to
participate initially, seven either left employment or did not enroll anyone in
the study. Four additional therapists meeting the same criteria were recruited
in a second wave to replace the initial therapists.
The next group they were sampling for was the cognitive behavioral
therapy group of patients that needed the therapy. Clients who met the
following criteria were asked to participate: age 18 or older, current
diagnosis of MDD or Medically Diagnosed Depression, as determined through

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regular clinic procedures, no evidence of current psychotic symptoms and

Quick Inventory of Depressive Symptomatology score of 11 or greater,
indicating at least moderate symptoms. Clients were excluded from
participation if they had serious suicidal tendencies or were diagnosed with
Bipolar Disorder. Clients were not excluded based on other conditions, like
anxiety, and were permitted to receive other treatments or services as
needed. Once they finally went through all of the criteria and any
disqualifiers, they were left with 83 participants.
The last group they used sampling for was the treatment as usual
group. This group would continue their normal treatment for their depression
theur doctors have prescribed. This meant these participants would continue
to only take the medications they are prescribed. The way they found these
participants is very similar to how they found the CBT group. The only
difference was that the researchers looked for people who would be very
similar to the participants in the CBT group. This way it would be as equal of
a measurment as possible. Other than that, they used the same criteria and
disqualifiers that they did for the CBT group. They also matched the amount
of participants to the CBT group, which means the treatment as usual, TAU,
also had 83 participants.
The way they did the sampling for the participants was very smart.
They wanted to make sure they had as similar of people in both groups as
possible so the measurements were as equal as possible. Also, the

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disqualifiers made a lot of sense as well because if they allowed people who
are having symptoms of psychosis as well as depression they would have a
harder time at measuring their depression levels.
Measurement
The measurment for this study is fairly simple. They used the following
items to measure depression levels in the participants. They used the Quick
Inventory of Depressive Symptomatology-Self Reporting, or QIDS-SR, to
measure the amount of depression in the participants. The QIDS is a 16-item
scale that measures depression symptoms identified in the Diagnostic and
Statistical Manual 4th edition. Scores of 5 or less on the QIDSSR represent
no depressive symptoms, and scores between 6 and 10 indicate mild
symptoms. Moderate symptoms are reflected by scores of 1115; severe by
1620, and very severe by 2127. This test can assess small changes in
depression. They used this depression test both before the study and after to
both groups to see where the depression levels started and where they
ended.
This test was administered at every CBT session for the CBT group and
at every intake and at each medication visit. The CBT group was measured
more often than the TAU group. The clinician version of the QIDS was
administered to CBT participants during a phone interview conducted by
research staff and served as an independent assessment of outcome. With
all of this being said the variables in this study were the level of depression

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and whether or not the CBT helped. The dependent variable is the CBT and
the independent variable is the level of depression.
Data Collection
As stated above under the measurement heading, this study was
dependent on a lot of self reporting. The CBT group would take the QIDS-SR
before every therapy session. The therapists would also do more questioning
at the 1st, 5th, 10th, 15th, and final therapy visits. The therapists would also
give a clinical version of the QIDS over the pgone every few weeks. The CBT
group was also given the Beck Depression Inventory-II (BDI), a 21 item selfreport measure that assesses affect, cognition, behavior, and functioning.
The TAU group had a lot less reporting to do. All they had to do was fill out
the QIDS-SR when they went to see their doctors or to get their prescriptions
filled.
This research may have ended up being a bit different if they did not
administer the clinical version of QIDS over the phone. Often times doing
these studies in person will be more trustworthy answers. By doing this the
therapist will also be able to see their body language as well as their
answers. It is a lot easier to manipulate the answers they would want the
researchers to have over the phone as it would be in person. I also think that
they should have done more reporting with the TAU group as well. This way
they could have better numbers to compare in the end.
Ethics and Cultural Consideration

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This study did not give any real ethics and cultural consideration. For
ethics they made sure the participants were goingt o ta therapist they were
comfortable with. They also made sure the participants knew they were part
of the study and that some of their therapy sessions would be recored to
make sure everything was going as planned. The researchers also only used
tools that had ben approved by the Texas State Health Board.
The demographics for the participants were of the 166 participants,
84.3% were female and 15.7% were male. Participants ranged in age from 19
to 74 years. About half of the participants (50.6%) identified themselves as
Caucasian, with 39.8% identifying themselves as Hispanic/ Latino, 8.4% as
African-American, and 1.2% as Asian. All received a diagnosis of MDD (84.9
% with recurrent episodes); 63 % with severe depression and 25.3 % with
moderate depression. This means that the main portion of the participants
were Caucasian adult women with mild to severe depression.
They also made sure that none of their participants were at risk. They
were incharge of making sure the participants for both groups were safe and
did not end up causing harm to someone or themselves. This is why the
initial screening in their sampling included a disqualifier if they were suicidal.
Also, if they became suicidal during the treatment they had extra resources
to be given out to groups, not just one or the other.
Results and Implications

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The results in this study were very interesting. Over all the levels of
depression is both groups had decreased significantly. The CBT group
showed a greater decrease in the symptoms of depression than the TAU
group. Using the final QIDSSR score, 36.7 % of participants in the CBT group
had a response to the treatment. 24% of participants in the CBT group
experienced full remission of symptoms. Only 22.9% of participants in the
TAU group showed any type of response to treatments and only 12.1% of
participants showed full remission of symptoms. This graph shows what this
trend looks like:

These findings are showing that clients that are diagnosed with
depression will have a greater success with going into full remission if they

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10

take both medications prescribed by their psychiatrist as well as going to

some sort of cognitive behavioral therapy. If anyone who is diagnosed with
depression does both of these things they are more likely to get better
results, faster. This is a great intervention that will continue to be developed
as more researchers study it. The only reasons that it would be dificult to
implement are the lack of therapist that are trained in this type of therapy
and getting the patients to follow through with doing both treatment options.
Depresssion is one of the leading mental health problems in the United
States, but using this intervention we can slowly make it a disease that is
easily treated and possibly make it a thing of the past.