Two Key Studies of Psych Treatments of MDD & Phobias (HL IB Psychology)

Key study one (psychological treatment for MDD): March et al. (2007)

Aim: 

• To investigate the comparative effectiveness of:

  • Cognitive Behavioural Therapy (CBT) 

  • Antidepressants (the SSRI fluoxetine)

  • A combination of both CBT and antidepressants 

Participants: 

• 327 adolescent patients diagnosed with MDD aged 12-17 years old 

• The participants came from 13 different locations in the USA

Procedure: 

• The participants were randomly assigned to either the antidepressant group, the CBT group or the combination group

• The children were interviewed and their responses were measured using the Children’s Depression Rating Scale (CDRS)

• The CDRS is a list of 17 items which are rated from 1 to 7 (7 indicating extremely low mood, difficulty having fun, social withdrawal etc.)

• A score of over 40 on the CDRS is used as an indicator of MDD symptomatology

• A score of under 28 on the CDRS is used as an indicator of remission in the patient

• The study was conducted across 36 weeks

Results: 

• After 36 weeks of treatment 81% of the antidepressant group, 81% of the CBT group and 86% of the combined antidepressant and CBT group showed significant improvements in their symptoms

• Suicidal ideation decreased in both the CBT group and the combination group but not to any great extent in the antidepressant group

Conclusion: 

• Adolescents with MDD respond well to CBT and to CBT in combination with antidepressants

• CBT in combination with antidepressants may enhance the safety of the medication

• Overall CBT combination therapy appears to be the best course of treatment for adolescents with MDD

Evaluation of March et al. (2007)

Strengths

• The use of a randomised trial conducted across 36 weeks means that real comparisons could be made between the three groups in real time so that progress could be tracked thus increasing the validity of the findings

• The findings have great application as adolescent and child mental health is an increasingly growing cause for concern, particularly in individualistic cultures such as the USA

Limitations

• It is unclear as to how CBT was effective in combination with antidepressants as the two separate treatments cannot be individually assessed within the combination group which means that the study lacks explanatory power

• The research lacks predictive validity as it there was no follow-up study to assess the long-term effects of combination therapy

Mental health concerns are a growing issue for young people today

Key study one (psychological treatment for phobias): Vigerland et al. (2013)

Sarah Vigerland

Aim: To investigate the efficacy of internet-delivered CBT for children suffering from specific phobias.

Participants: 

• 30 children aged 8-12 years old from Sweden and their parents

• The children had all been diagnosed as suffering from a specific phobia

• This was a self-selecting sample with the participants being recruited via media advertisements

Procedure: 

• The children received six weeks of CBT treatment delivered via an online therapist i.e. not a face-to-face transaction

• The measure used to assess progress across the six weeks was the Clinician Severity Rating (CSR) which measures the degree and intensity of anxiety per patient

• Data was also collected based on each clinician’s rating of their patient’s (and their parents’) general functioning plus self-reports per patient on their levels of anxiety and their quality of life

• The above measures and assessments were taken before and directly after the six-week CBT and then three months after the treatment cessation as a follow-up measure

Results: 

• All of the children showed a decrease in phobia-specific symptoms (shown via reduced CSR scores) 

• 35% of the children no longer met the criteria for specific phobia i.e. their phobic response had been extinguished 

• Both the parents and  their children reported significantly lower levels of anxiety 

• The positive effects of the CBT were still present at the three-month follow-up checkpoint 

Conclusion: Internet-delivered CBT appears to be an effective treatment for children with specific phobia.

Evaluation of Vigerland et al. (2013)

Strengths

• Not all children are able to directly access CBT so the results of this finding have good application as they validate the idea that CBT can be effective when delivered online

• The three months follow-up to check for phobic/anxiety symptoms adds validity to the findings as it demonstrates that online CBT is effective beyond the immediate time period of the treatment phase i.e. the effect has longevity

Limitations

• It is possible that individual differences could have interfered with the study:

  • some of the participants may have liked their therapist more than others did which could result in such participants finding it easier to recover from their phobia than participants who had less liking for their therapist

• The three month follow-up consisted of a phone interview which reduces the validity of the findings as this is unlikely to have enabled the researchers to assess the participants in any great depth

Key terms: Internet-delivered CBT  Clinician Severity Rating Scale  Longevity