Understanding The Effectiveness Of Cognitive Behavioral Therapy (CBT) For Treating Major Depressive Disorder (MDD)

Prevalence, risk factors, and impact of MDD on individuals

Discuss about the Effectiveness Of Cognitive Behavioral Therapy For Treating Major Depressive Disorder.

Psychiatric disorders or mental disorders have provided major research challenges as it is difficult for humans to understand the functionality of the human brain in vivo. Some of the most common psychiatric disorders are anxiety disorders such as phobias and panic disorders, mood disorders, bipolar disorders, and psychotic disorders such as schizophrenia. An individual suffering from such conditions suffer symptoms that cause mild to severe disturbances in behavior and thought, leading to inability to lead a normal life (Polanczyk et al., 2015). Major Depressive Disorder (MDD) is a psychiatric disorder of clinical significance at the contemporary era. Scientists from across the globe have attempted to understand the suitable interventions that can be successfully implemented for combating the high prevalence rate of this condition. Research into this domain points out that, there is a need of undertaking further studies to understand the effectiveness of particular treatment strategies. The present research focuses on understanding the effectiveness of Cognitive Behavioral Therapy (CBT) for treating Major Depressive Disorder (MDD) among individuals aged between 18-25 years. 

Major Depressive Disorder (MDD), at times known as clinical depression, is a particular mental disorder in which the patient suffers a negative change in mood for a long term across different situations. The condition is of major clinical significance since the outcomes of the depression are related to poor mental and physical health conditions (Slavich & Irwin, 2014). While some individuals have depression at different points in life in between which the person has a normal life course, others exhibit the symptoms in a continuous manner. The cause of MDD is thought to be a combination of psychological, environmental and genetic factors. Prominent risk factors include certain medications, family history of the condition, major changes in life course, chronic health issues and substance abuse such as drug or alcohol. The diagnosis of MDD is on the bass of the individual’s experiences and an accurate mental status examination (Schmaal et al., 2017).

Research indicates that MDD has a notable impact on the personal and social relationships of the individuals suffering from. An individual with this condition exhibits how mood pervading different aspects of life, and has a disinterest in different activities in life. It is common for people to be engrossed in feelings that are primarily negative. The impact of the condition is on the different spheres of life, including education, work life and daily activities of living.

Gender differences in the expression of MDD symptoms

Individuals of the age group between 18-25 years are mostly affected by MDD as per research data. It is less common for individuals above the age of 65 years. MDD is prominent in late adolescence that transits into early adulthood. Individuals with MDD in this age group experience more severe outcomes in relation to those who are non-depressed or have adult-onset MDD. The negative implications of MDD among individuals of this age group are well documented (Greenberg et al., 2015).

According to Lai (2017) gender has a prominent role in the expression of MDD symptoms. Statistical data highlights that out of the total number of patients with MDD, 89% of females suffer from it. In contrast the percent of male suffering from the same condition is 57%. The underlying cause behind the high prevalence rate of MDD is associated with sexual dysfunction in females. Lower sexual arousal and lower orgasm in females have been linked with higher risk of developing MDD. Since females are more sexually impaired, the pain and sadness suffered lead to MDD.

Treatment options of MDD have received continual attention in recent times against the increasing prevalence of the disorder across the globe. Cognitive behavioral therapy has shown to be effective in treating the symptoms associated with the condition. The underlying effect is recovery of the neural alternations suffered in MDD (Bajbouj et al., 2017). Transactional direct current stimulation or tDCS acts as a crucial element of CBT that is capable to influence the prefrontal cortex activity. The stimulation activates the individual’s cognitive functions. The tDCS is a good example of cognitive behavioral therapy, which improves the condition of the people those have been suffering from MDD. Research suggests that almost half of the individuals treated with this therapy exhibit improved condition (van der Velden et al., 2015). Since new cases of MDD are detected every year, the potential of CBT as a treatment option is to be exploited to the fullest.

Research in the psychology domain is to be carried out by setting hypothesis at the initial stage that acts as the assumptions about the experiment results. The two hypotheses for the present research were as follows-

H1- Cognitive Behaviour Therapy would improve the symptoms associated with MDD among individuals aged between 18 and 25 years.

H2- Women suffering from MDD and aged between 18 and 25 years would have more benefits from Cognitive Behavior treatment as compared to men.

Study participant selection criteria

Participant

Recruitment of study participants was a crucial part of the research. The participants were recruited on the basis of pre-set criteria. The individuals were diagnosed with MDD as defined by the DSM-V criteria. Further, the prevalence of the disorder was confirmed by the family members of the individuals. A medical assessment was done at the initial stage for assessing the severing the symptoms. Four mental health care units across the city were contacted for recruitment of the participants who had presented at the units with symptoms of the disorder. Recruitment of the participants was done in a randomized manner for eliminating chances of bias. 

The following selection criteria was followed for the recruitment purpose-

• Age between 18 and 25 years
• Diagnosed with MDD
• No developmental disorder
• Absence of diagnosis of other psychiatric disorder other than MDD

The sample population comprised of a total number of 66 participants. While 27 males were recruited, the other 39 individuals were female. The sample size was thought to be appropriate for assessing the impact of the treatment.

Data collection tool determines the reliability and validity of the research undertaken. In the present case, the data collection tool used was close-ended questionnaire. Use of self-administered questionnaires (SAQ), either open-ended or close-ended, is beneficial for collecting rich data and the key feature is that it is designed to be completed by the study participants without any certain intervention of the researchers (Coolican, 2017). The questionnaire was distributed to the participants individually to understand the impact of CBT on individuals as compared to placebo effect. Scoring system for the answers made analysis of the data easy.

The recruited participants were subjected to cognitive behavioral therapy for three months, which was followed by three months of placebo intervention. A placebo treatment is a fake treatment provided to participants as the individuals believe that they are being the actual treatment. The belief of the individuals is that they would benefit from the treatment provided which is not real in the situation. Placebo interventions have an important role as control interventions in studies carried out as experiments (Goodwin & Goodwin, 2016). Informed consent was taken from the potential participants for adhering to ethical principles. The purpose and outcome of the research are to be explained to the participants prior to the research. Further voluntary participation is needed.  The questionnaire was given to the participants prior to the commencement of the CBT treatment and placebo treatment, and also after the treatment course was completed. Approval from the ethics committee was taken since the research involved human participates (Willig & Rogers, 2017). Assurance for safe data handling and storage was given to the participants.

Table 1 Comparison of the baseline treatment and placebo treatment
Pa	Total	Males	Females
Mean age for whole sample	21.151515
Age range for whole sample	8
Total number	66	27	39
Range of baseline scores	36
Range for end of treatment scores	8
Final scores for active treatment groups	2623
Final scores for placebo treatment group	1404
Mean scores for baseline treatment group	50.65 (active), 51.42 (placebo)
Mean score for end of treatment group	10.91 (active), 30.15 (placebo)
Mean final scores for active treatment group	39.74424
Mean final score for placebo treatment group	21.2727

Data collection tool

The main results of the study have been presented in a tabular format above. The total number of participants who completed the study was 66. It is to be highlighted in here the there was a gender bias in the study as more number of females took completed the study. Data analysis was done with the help of simple calculations done in excel sheet. Subtraction of the end of treatment scores was done from the baseline scores in order to calculate the final scores. The final score was the representation of the degree of symptoms as experienced by the participants in relation to MDD. The symptoms that were reported from the study were fatigue or loss of energy, insomnia, feelings of guilt, feelings of worthlessness, restlessness, disinterest or displeasure in daily activities.

From the data obtained it can be stated that the score in the placebo group was lower than the treatment group. This implies that the participants considered the ‘fake’ treatment provided to them as actual CBT, establishing the placebo effect. The placebo treatment did not consider the actual principles of CBT which are based on the idea that feelings, thoughts, actions and physical sensations have an interconnection with each other. The data therefore highlighted that placebo effect was successful in bringing about a change in the feelings and thoughts of the participants in relation to the benefits brought about by CBT. The perception that they had been provided with CBT led to perceived improvements in their symptoms related to MDD, thereby enabling a lower score.

Attention is now to be given on the differences of scores between the two genders. Further analysis of the results indicated that females exhibited more symptoms of MDD as compared to males. This was understood from the score ranging from 24-61 for females at the end of the experiment with CBT intervention, and the score ranging from 22-56 for males. Further, it is to be noted that the scores for males was higher for the placebo group as compared to females. While the score for males was 5-45, the score for females was 0-38. This significant result forms the basis of the statement that the impact of the placebo treatment was more on females than on males. Females thus exhibited less symptoms of MDD after the placebo intervention. The data presented in the above graph is the representation of the significant improvement in MDD symptoms as exhibited by the patients after the treatment.

Results obtained from the study

The presented study was a noteworthy one in understanding the impact of CBT on patients suffering from MDD, both male and female, aged between 18 and 25 years. An in depth analysis of the results from the study leads to the conclusion that the placebo treatment that did not consider implementation of the actual CBT had more effects on the participants in contrast to the actual CBT in relation to the reduction of symptoms of MDD among males and females. It can be interpreted that actual CBT was not successful in reducing the major symptoms of MDD in patients experiencing the same. The placebo treatment was provided to the participants for compelling them to think that they have been provided with CBT. It is to be noted that the patients were not able to understand the differences between the two forms of treatment that were provided.

The hypothesis that CBT would bring improvement in the symptoms associated with MDD among individuals aged between 18 and 25 years was supported by the score that was obtained at the end of the treatment in the treatment group as well as the placebo group. However, the final scores were not in support of this hypothesis. It is indicated from the final scores that the placebo treatment was more significant in improving the symptoms of MDD as compared to the active treatment. The second hypothesis that women suffering from MDD and aged between 18 and 25 years would have more benefits from Cognitive Behavior treatment as compared to men was supported by the final result scores.

The effectiveness of CBT in treating the symptoms of MDD has been established throughout existing literature. As recent study by Rasing et al., (2017) highlighted that depression and anxiety disorders are most common among individuals during adolescence and young age. Cognitive behavioral therapy can act as the primary intervention for addressing the concerns of individuals when provided at the initial stage. Hoffman et al., (2012) had stated that cognitive behavioral therapy is a popular therapeutic approach applied to a wide range of problems such as depression, bipolar disorder and anxiety. Such a treatment is useful for both children and adults at different stages of life. The success rate of the intervention is high since the therapy is based on the principle that mental disorders and psychological distress are regulated by cognitive factors. The results of the present study are however contradictory to such existing literature. The main finding of the study was that placebo treatment was more effective when compared to CBT treatment among individuals of the age group of 18-25 years.

The fact that women are more inclined to suffer from MDD has been repeatedly pointed out in literature. The study of Albert (2015) highlighted that though there exists a difference in socioeconomic factors like education, income, and abuse, the rate of depression is higher in women. The finding of the present research was in support of such previous studies.

The present study had certain limitations regarding sample size and process of data collection. Firstly, the sample size was small, with only 66 participants completing the study. Inappropriate sample size has an impact on the validity of the results of the study (Coolican, 2017). Further, the scores were obtained on the basis of self-administered questions. There is a chance that intervention of the researchers might have influenced the assessment of the symptoms and led to different set of scores (Goodwin & Goodwin, 2016).

Coming to the end of the paper it can be concluded that the research was a significant one since the results was not in alignment with previous studies assessing the impact of CBT on symptoms of MDD among individuals in the age group of 18-25 years. There is a need of further studies in this regard to establish the validity of such research. It is to be highlighted that future studies must consider the limitations of the present study for bringing in noteworthy inferences.

References

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