Treatment of Depression – Key Studies
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By Laura Muir
Like the overall course itself, we always consider disorders in the abnormal psychology unit from three perspectives – cognitive, biological, and sociocultural. It is valuable to link the etiologies from these three perspectives to treatments from these three angles. Let’s consider three studies – one from each perspective – that look at the treatment of depression, specifically.
, a cognitive treatment – CBT – was briefly considered for treating depression. CBT, or cognitive-behavioural therapy, was developed by Beck and he did a lot of research on it, often linking it to etiology.
A typical biological treatment for depression is SSRIs (serotonin reuptake inhibitors) or antidepressants (not all antidepressants are SSRIs). There are numerous studies to choose from in this area. Duman and Aghajanian (2012) is a good comparison study from the Pamoja textbook.
An additional comparison study that you can use for each perspective is Elkin (1989), a double-blind design study with 124 randomized participants. This study aimed to investigate the efficacy of three different treatments. The study compared CBT, SSRIs, and interpersonal therapy (talk therapy using less formulaic and cognitive models than CBT). There was also a placebo in this study. The study found the quickest improvement from those on antidepressants but, with time (a few weeks), there was also improvement from those in both types of therapy. Over 50% of the participants were considered recovered after months of treatment in each treatment group. 29% recovered in the placebo group, which was statistically significantly lower. There was no statistically significant difference across the treatment groups in terms of efficacy. The study had a large sample (290 patients with 20 doctors) and was carefully controlled. It was also a double-blind study. It demonstrated strong reliability, validity, and low researcher bias. Nearly 50% of the participants in the treatment groups did not recover. That may be worth evaluating. What other factors may impact treatment and recovery? As well, medical researchers continue to improve on SSRIs. Therefore, the results could change over time.
It is very hard to measure efficacy [efficacy = the power to produce an effect]
for socio-cultural treatments. You may want to focus on group therapy, for instance. Yalom is considered one of the experts on this. Qiu et al. (2013) have done research on group CBT (GCBT), which is useful in this course. This study was a randomized control study that aimed to evaluate the effects of Group Cognitive Behavioral Therapy (GCBT) in treating major depression in Chinese women with breast cancer. There were 62 participants either allocated to receiving GCBT or a waiting list group, which received an educational booklet. They used a variety of scales to measure efficacy at the end of the course of the GCBT and then again six months later. The GCBT group showed a statistically significant improvement over the control group and that strengthened at the 6 months point post-therapy. The one area that did not improve more than in the control group was anxiety. Other symptoms connected to the participants’ depression showed benefits from the GCBT.
Another issue to consider in culture and treatments is cross-cultural differences. Group therapy, for example, may not work as well in some cultures. Consider Mutlaq and
Chaleby’s (1995) study on this, where they aimed to understand the role that culture can play in group therapy. In their research, they identified a number of factors that hinder efficacy and appropriacy of group therapy in Arab cultures. The factors they found as problematic in mainstream Arab culture were: gender role norms; inequality in the group based on the higher status given to people based on age, class, etc; misperception of what therapy is and how it works (i.e. many saw it as a social activity). There are ways of managing parts of these factors but it is important to recognise that models in one culture may not translate to another culture. Alternatively, but supporting the same point, Qui et al suggests group therapy may work even better in some collectivist cultures like China (whereas Arab cultures are considered collectivist, as well, but have other cultural differences). It may be that Qui et al.’s positive outcome may be less pronounced in individualist Western cultures or vary across them. Evaluating the complexity of measuring treatment efficacy across cultures will show a sophistication in your understanding of the course material.
