Depression contemporary study Williams et al 2013

Aim

1. To investigate the effectiveness of a 7 day internet delivered imagery based CBM-I as a stand alone intervention for depression, along side CBT

Sample

• 69 participants recruited Sydney Australia ( before this there were more but not everyone met inclusion criteria, 69 fit it )

• Randomised sample of volunteers into control group (31) and experimental group (38)

• Lots of sample attrition: at the end of the 3 months, experimental had 20, control had 22

What happened at the end of the three months to the sample?

Sample attrition 20 experimental completed 22 control completed

Procedure events

1. Both experimental and control group did baseline to see p/s (primary/secondary) measures to see baseline measure of severity of depression

2. 7 days later only experimental group gets CBMI training

3. Both then take p/s measures again

4. Experimental group then had 10 week iCBT course

5. Took p/s measures for both groups again to see effectiveness through if experimental group scores went down

Results

• BDI-II measure had massive decrease after CBM-I and iCBT treatment for experimental group: CBM-I was 27.97 —> 18.96 iCBT was 27.97—> 10.4

• 65% of ppts who had a combined treatment had a significant reduction in their depression

Conclusions

1. Results show that CBMI can effect rapid symptoms reduction. Therefore CBMI could have promise as a stand alone therapy

2. CBMI + iCBT combo does reduce depressive symptoms

Sample strength

• Used exclusion criteria, so there were no significant differences between the two groups in regards to characteristics

• High internal validity - removed extraneous variables

Sample weakness

Exclusion criteria

• limits representativeness if sample as only individuals who fit in exclusion criteria were used

• E.g. excluded bipolar

• Not generalisable to individuals outside the criteria, findings on CBM-I and iCBT being beneficial not generalisable to all depressed individuals

What were the primary measures used for?

See whether treatment was working

What were the secondary measures used for?

To understand how participants were feelings and their emotions

• allowed Williams to gain insight into participants view on effectiveness of interventions

Procedure event timeline strength

Standardised

• Experimental and control group completed pre-treatment intervention questionnaire at start of study to get baseline measures

• Replicable + reliable

Procedure events timeline weakness

Questionnaires may lead to social desirability bias

• inaccurate responses as trying to show therapy was affective and helped improve depression

• Less accurate + valid

Procedure programmes

CBM-I:

• Presented ambiguous scenarios constantly resolved in positive manner

• Train used to have automatic positive bias with how they interpret random information in day to day life

iCBT:

• 6 online sessions

• Cartoon narrative with things like psycho-education, cognitive restructuring, problem solving, relapse prevention

• Best practice CBT + HW assignments

Procedure programmes strength

Both programmes completed online

• High ecological validity as home is normal environment, natural behaviour

Procedure programmes weakness

Task validity

• iCBT used cartoon narratives to converse with patients

• Lacks mundane realism

• May not lead to accurate responses

Aim, results, conclusion strength

Use of intervention beneficial (give example from results)

Can be used to improve lives of depression sufferers

Aim, results, conclusion weakness

Did not record results of control group receiving treatment after experimental group had completed

• can’t conclude combined treatment is most effective at treating depression

• Limits application