"Help yourself to CBT" : mechanisms of change within a group guided self-help programme targeting low mood in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Albany, New Zealand
This thesis explores the processes of change within a Low Intensity Cognitive Behaviour Therapy (LICBT) intervention targeting low mood in a community sample of adults in New Zealand. Low intensity interventions (e.g. self-help programmes) are a relatively new area of interest in the area of psychological treatment. They aim to increase people’s access to evidence based methods of therapy whilst removing many of the major issues associated with traditional treatment methods, such as long waiting lists, financial limitations, and inaccessibility to many in the wider community (Lovell & Richards, 2000). LICBT interventions have been shown to significantly improve outcomes for mild to moderate depressive symptoms across different samples (McKendree-Smith, Floyd & Scogin, 2003).
The current study assessed change processes within the guided self-help programme ‘Living life to the Full’ (LLTTF, Williams, 2008). Due to methodological issues, the study was not able to soundly address hypotheses regarding the effectiveness of the programme. However, the statistical significance of changes across outcome measures were examined along with their clinical significance at an individual level. Participants showed statistically significant reductions in psychological distress from baseline to post-programme. Results for depression and quality of life were not significant. When results were examined at a single case level for clinical significance, a number of participants showed clinically significant change across the three main outcome measures.
An analysis of individual change processes was also completed, with the examination of early rapid response patterns for individual participants. Early rapid response patterns occurred for a number of participants, supporting preliminary evidence that certain change patterns apparent in CBT research may also occur in LICBT interventions. A link was also found between early rapid responding and more positive post programme outcomes. Group process results showed that as predicted, the low intensity nature of the programme is likely to have affected the perceived group environment and relationship to the group facilitator.
The LLTTF programme was positively evaluated by the majority of programme completers and though the sample size was small, results suggest this type of intervention is an effective platform from which to further develop low intensity therapeutic paradigms in New Zealand.