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"Dobson, Keith S"
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The Cognitive Therapy Scale and Cognitive Therapy Scale-Revised as Measures of Therapist Competence in Cognitive Behavior Therapy for Depression: Relations with Short and Long Term Outcome
Therapist competence is an important factor in treatment integrity. This study reports on a direct comparison of the original Cognitive Therapy Scale (CTS) with the revised version, the Cognitive Therapy Scale-Revised (CTS-R), as observational instruments designed to evaluate therapist competence in a completed trial of Cognitive Behavior Therapy (CBT) for depression. Treatment sessions (N = 94) from 50 depressed participants (M age = 39.2 years, 76% female, with an average of 5.9 depressive episodes) were evaluated on the CTS and CTS-R by trained independent observers who were blind to treatment outcome, as well as to subject, and session numbers. A comprehensive training program and inter-rater reliability monitoring protocol were employed. Two models were used to compare CTS and CTS-R in relation to change in depression symptoms at termination, 12 and 24 month follow-up while controlling for pre-treatment depression levels and working alliance. Both the CTS and CTS-R demonstrated comparable internal reliability, interrater reliability, and when assessed in early treatment phase, both predicted a statistically significant reduction in depressive symptomatology at termination. No significant competence-outcome relations were detected with late CTS and CTS-R ratings, and the significant positive interaction terms indicated relations with depressive symptomatology were not maintained at follow-up. Given these findings, we encourage future research to examine specific competence domains and “therapist drift” with an increased number of session assessments.
Journal Article
A Cross-Cultural Study of the Cognitive Model of Depression: Cognitive Experiences Converge between Egypt and Canada
Models of depression that arise in the West need to be examined in other regions of the world. This study examined a set of foundational hypotheses generated by Beck's cognitive model of depression among depressed individuals in Egypt and Canada.
We recruited 29 depressed and 29 non-depressed Egyptians and compared their results with those of 35 depressed and 38 non-depressed Canadians. Depression status was ascertained using a structured interview, scores on the Beck Depression Inventory, and scores on the Psychiatric Diagnostic Screening Questionnaire. Participants completed questionnaires designed to measure the frequency of negative and positive automatic thoughts (ATQ-N, BHS, and ATQ-P), and dysfunctional attitudes (DAS).
Depressed individuals in both countries had significantly more negative thoughts about self and future, greater frequency of dysfunctional attitudes, and diminished positive self-thoughts in comparison to non-depressed individuals. Egyptians generally showed significantly more dysfunctional attitudes than their Canadian counterparts.
The four hypotheses that were tested were supported among the depressed Egyptian sample, which is consistent with the cognitive model. Implications for the cognitive-behavioral model and treatment for this group of sufferers are discussed.
Journal Article
Addressing mental illness stigma in German higher education: study protocol for a mixed-methods evaluation of a psychosocial setting-based intervention
IntroductionMental illness stigma is associated with a range of negative consequences, such as reduced help-seeking for mental health problems. Since stigma affects individual, social, and structural aspects, multilevel interventions such as the Canadian programme The Working Mind have been proven to be the most effective. Given the solid evidence base for The Working Mind, it is our aim to implement and evaluate culturally adapted versions of the programme in German higher education, targeting students, employees and managers.Methods and analysisWe will evaluate the programme with regard to its effect on mental illness stigma, openness to mental health problems, willingness to seek help, and positive mental health outcomes. Further, we will investigate the programme’s effectiveness dependent on gender and personal values, various mechanisms of change, and factors facilitating and hindering implementation. The study uses a sequential explanatory mixed-methods evaluation design (QUAN → qual) that consists of three steps: (1) quasi-experimental online survey with programme participants, (2) focus groups with programme participants, and (3) qualitative interviews with programme stakeholders. The quantitative data collected in step 1 will be analysed using 2×3 analysis of variances and a parallel multiple mediation analysis. The results will inform the qualitative data to be collected in steps 2 and 3, which will be analysed using qualitative content analysis.Ethics and disseminationThe study was approved by the local Ethics Committee (Ethics Committee of University Medicine Greifswald; BB 098/23). Participants have to provide written consent before taking part in a focus group or interview. As for the online survey, participants have to give their consent by agreeing to an online data protection form before they can start completing the survey. We will publish central results and the anonymised data in an Open Access Journal. Further, the statistical code will be included as a supplement to the paper(s) documenting the results of the study.Trial registration numberDRKS00033523.
Journal Article
Testing the Cognitive Vulnerability Hypothesis in Previously Depressed Women: Effects of a Sad Mood Induction on Attention and Memory Biases
Researchers have documented biases in attention and memory in depressed and dysphoric individuals. Several studies have examined these biases among previously depressed individuals, and while there is evidence that attention and memory biases persist in remitted depression, the findings are not consistent. One limitation of previous research is that few studies have used a stress or negative mood induction (MI) to activate the cognitive vulnerability posited to underlie attention and memory biases. The present study used a free-viewing eye-tracking paradigm to assess previously depressed participants’ attention biases for positive and negative words before and after a sad MI. Memory biases were assessed using tests of incidental recognition. Only participants who were successfully mood-induced were included in the analyses. Unlike previously depressed participants, never depressed participants exhibited attention and memory biases that favored positive over neutral words, both before and after the sad MI, suggesting a protective bias that is maintained in a sad mood state. After the sad MI, previously depressed participants had smaller attention biases for positive words and smaller memory biases for negative words compared to never depressed participants. The findings are generally supportive of the notion that cognitive vulnerability is maintained to some extent in remitted depression and can be influenced by a sad mood.
Journal Article
What stakeholders think: perceptions of perinatal depression and screening in China’s primary care system
Background
Mental health in China is a significant issue, and perinatal depression has been recognized as a concern, as it may affect pregnancy outcomes. There are growing calls to address China’s mental health system capacity issues, especially among vulnerable groups such as pregnant women due to gaps in healthcare services and inadequate access to resources and support. In response to these demands, a perinatal depression screening and management (PDSM) program was proposed. This exploratory case study identified strategies for successful implementation of the proposed PDSM intervention, informed by the Consolidated Framework for Implementation Research (CFIR) framework, in Ma’anshan city, Anhui province.
Methods
This qualitative study included four focus group discussions and two in-depth individual interviews with participants using a semi-structured interview guide. Topics examined included acceptance, utility, and readiness for a PDSM program. Participants included perinatal women and their families, policymakers, and healthcare providers. Interviews were transcribed verbatim, coded, and analyzed for emergent themes.
Results
The analysis revealed several promising factors for the implementation of the PDSM program including: utilization of an internet-based platform, generation of perceived value among health leadership and decision-makers, and the simplification of the screening and intervention components. Acceptance of the pre-implementation plan was dependent on issues such as the timing and frequency of screening, ensuring high standards of quality of care, and consideration of cultural values in the intervention design. Potential challenges included perceived barriers to the implementation plan among stakeholders, a lack of trained human health resources, and poor integration between maternal and mental health services. In addition, participants expressed concern that perinatal women might not value the PDSM program due to stigma and limited understanding of maternal mental health issues.
Conclusion
Our analysis suggests several factors to support the successful implementation of a perinatal depression screening program, guidelines for successful uptake, and the potential use of internet-based cognitive behavioral therapy. PDSM is a complex process; however, it can be successfully navigated with evidence-informed approaches to the issues presented to ensure that the PDSM is feasible, effective, successful, and sustainable, and that it also improves maternal health and wellbeing, and that of their families.
Journal Article
A psychometric evaluation of the Opening Minds Scale for Workplace Attitudes (OMS-WA), a measure of public stigma towards mental illnesses in the workplace
The anti-stigma Opening Minds initiative (Mental Health Commission of Canada) identified the workplace as one of four critical areas for stigma evaluation and programming. Researchers found, however, that no validated tool to measure stigma in this context existed at the time. The purpose of the current research was to develop and assess the psychometric properties of a multi-component quantitative measure of public stigma towards mental illnesses in the workplace:
Opening Minds Scale for Workplace Attitudes (OMS-WA).
Three studies are discussed. Study 1 outlines the initial development of the OMS-WA, finding a five-factor structure with 23 items (EFA analysis;
N
= 207). Study 2 utilized employees from various businesses to further validate the
OMS-WA
, (
N
= 107), finding good internal consistency and good convergent/divergent validity. Study 3 utilized baseline data from two national large-scale stigma reduction and resiliency programs (first responders and general workplaces) to confirm the factor structure, finding good model fit and reliability with both samples (
N
= 5385;
N
= 1207). Together, these results provide strong evidence of the
OMS-WA
. Its use in measuring workplace stigma related to mental illness is recommended. Considerable future evaluation is warranted, and directions for generalizability studies, as well as suggestions for using the
OMS-WA
in intervention trials, are provided.
Journal Article
Revisiting Gender Differences in Somatic Symptoms of Depression: Much Ado about Nothing?
Women have a higher prevalence of Major Depressive Disorder (MDD) and report more severe depressive symptoms than men. Several studies have suggested that gender differences in depression may occur because women report higher levels of somatic symptoms than men. Those studies, however, have not controlled or matched for non-somatic symptoms. The objective of this study was to examine if women report relatively more somatic symptoms than men matched on cognitive/affective symptoms.
Male and female patients receiving treatment for MDD in outpatient psychiatric clinics in New Jersey and Pennsylvania, USA were matched on Beck Depression Inventory-II (BDI-II) cognitive/affective symptom scores. Male and female BDI-II somatic symptom scores were compared using independent samples 2-tailed t-tests.
Of 472 male and 1,026 female patients, there were 470 male patients (mean age = 40.1 years, SD = 15.1) and 470 female patients (mean age = 43.1 years, SD = 17.2) successfully matched on BDI-II cognitive/affective symptom scores. Somatic symptoms accounted for 35% of total BDI-II scores for male patients versus 38% for matched female patients. Female patients had somatic symptom scores on average 1.3 points higher than males (p<.001), equivalent to 4% of the total BDI-II scores of female patients. Only 5% of male patients and 7% of female patients scored 2 or higher on all BDI-II somatic symptom items.
Gender differences in somatic scores were very small. Thus, differences in the experience and reporting of somatic symptoms would not likely explain gender differences in depression rates and symptom severity.
Journal Article