And now, over to Joe Hayes for the first blog! There are signs that we are failing people with depression.
A Counselling Case Study Using CBT - Counselling Connection
A recent study published in BJPsych found that only 1 in 5 people with depression in high-income countries, and 1 in 27 people in low- and middle-income countries, received adequate treatment Thornicroft et al. Moreover, it is this story that seems to capture the public imagination.
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The other powerful narrative has been that antidepressants are no more effective than placebo and that pharmaceutical companies cannot be trusted because they have hidden this from us. Undertreatment of depression? Overtreatment of depression?
CBT Case Studies
We are repeatedly told that the increasing placebo effect is the reason for drug companies withdrawal from psychiatric drug development. Professor Irving Kirsch and colleagues played an important part in developing this narrative with their highly cited meta-analysis Kirsch et al. The overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance.
We also find that efficacy reaches clinical significance only in trials involving the most extremely depressed patients, and that this pattern is due to a decrease in the response to placebo rather than an increase in the response to medication. Kirsch et al. This finding has now been refuted by a number of study level and individual-participant level meta-analyses Melander et al.
Further, the study by Kirsch et al. Despite the conflicting evidence, the idea that baseline severity impacts on antidepressant treatment effectiveness was taken up wholeheartedly by NICE and other agencies. Interestingly, whilst this was going on, albeit more quietly, similar findings were being reported concerning psychotherapy : CBT might only be effective when depression is most severe and may be little better than placebo Driessen et al.
This phenomena was described in a Mental Elf blog from last year. This new meta-analysis published in the BJPsych Furukawa et al, seeks to address the issue of initial severity effects by identifying all randomised controlled trials of CBT versus pill-placebo and accessing and meta-analysing individual-participant data IPD-MA.
Traditionally meta-analysis involves combining and analysing quantitative evidence from a number of studies to produce a pooled effect estimate. In this design the researcher obtains raw patient level data from each study identified as relevant. This approach has particular strengths: it increases the power to detect differential treatment effects across individuals and makes it possible to look at the influence of baseline characteristics in this case illness severity on outcome.
Studies were eligible if they were randomised controlled trials RCTs of adults with major depressive disorder MDD who received an intervention of face-to-face individual or group CBT, with a control group of individuals receiving pill-placebo. The search for eligible RCTs was comprehensive and used a number of databases, but did not search grey literature or approach researchers in the field to identify potentially unpublished studies.
Authors were then contacted, and individual-level participant data was requested. Whilst these exclusions are logical, we must be aware that this analysis is therefore likely to exclude a large number of trials of CBT for depression.
Both these scales are widely used in depression research, but a number of issues have been raised with them, especially in delineating clinical significance from statistical significance Fava et al. Additionally in this meta-analysis, included RCTs used different versions of these scales, with different item questions and numbers of items. To do this raw scores at baseline and endpoint were divided by study-specific standard deviations. The authors then investigated whether the standardised baseline score modified the effect of the symptom change score i.
Multiple imputation was used to manage missing data.
Relevant Childhood Data
Since Cognitive Behavioural Therapy CBT emerged, it has become one of the most popular and widely taught therapeutic modalities. It is currently dominating psychological therapies, especially in the UK following the introduction of the Improving Access to Psychological Therapies IAPT government initiative in Modern CBT has its roots in cognitive therapy Beck, and behaviour therapy as developed by Wolpe CBT focuses on a relatively simple idea: the way we think.
Formulations in CBT Introduction This essay discusses what we understand by case conceptualization which is also called case formulation this paper refers to it in that term in Cognitive Behavioral Therapy CBT , and reminds us of some historical background and conceptual underpinnings of CBT case formulation. Further the paper draws some differences with Psychiatric Diagnosis.
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The essay includes some critics from. For example, cognitive behavior therapy CBT , which is usually a short term treatment for a variety of psychological disorders, is a widely used empirically supported intervention used in schools. The use of EBP in schools stimulates effective psychological practices and improves public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention apa. EBP plays an important. Title: Psychological Approaches within Mental health Nursing.
Introduction This case study applies the core principles Cognitive Behavioural Therapy CBT as an intervention in management of patients with depression. Although usually delivered by a health care practitioner trained in its use, CBT may also be delivered electronically via computer programs and the Internet.
I am convinced that CBT has something to offer many of our patients who have conditions that we find difficult to treat. Consider CBT for patients who you suspect have anxiety or trauma-related disorders.
The benefits of this short-term, goal-oriented approach are Skip to main content. CBT is worthwhile—but are we making use of it? J Fam Pract.