Investigating the effectiveness and nature of change in low-intensity CBT : guided self-help for individuals with low mood in New Zealand : a dissertation presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
Loading...
Date
2015
DOI
Open Access Location
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Massey University
Rights
The Author
Abstract
Cognitive Behavioural Therapy (CBT) is an effective treatment for depression, however
many people have limited access to this for a variety of reasons including reduced
resources, limited access to practitioners, and lack of finances. Low-intensity psychological
interventions based on CBT, such as guided self-help, offer a potential solution to this
problem. While such interventions are surfacing in New Zealand, there is no current
research conducted in a New Zealand sample. Furthermore, many research studies
aggregate group outcomes, overlooking the rich information gained from individual time
course data, and assume gradual and linear change, which is not always the case across
psychotherapy. Early rapid response is a pattern of change that has been identified in
traditional CBT studies and more recently in low-intensity CBT and has been associated
with better treatment outcomes. The primary aim of this study was to investigate the
effectiveness of a guided self-help intervention in a New Zealand sample, using Chris
William’s Overcoming Depression and Low Mood self-help book with guidance provided
by a practitioner either face-to-face or over the telephone. This study also aimed to identify
whether participants in this low-intensity intervention demonstrated early rapid response.
Nineteen adults experiencing low mood initiated the programme, with 13 completing the
six-week programme, which included four support sessions. Low mood was measured by
the nine-item Patient Health Questionnaire (PHQ-9), and secondary measures of
psychological distress and quality of life were measured by the ten-item Clinical Outcome
Routine Evaluation (CORE-10) and the short form Quality of Life and Enjoyment
Questionnaire (QLES-SF), respectively. Results were analysed in terms of statistical
analyses, visual analysis of individual trajectories across time, and reliable and clinically
significant change analyses. In terms of depression, statistical analyses indicated significant
changes in outcomes measures over the duration of the programme, yet these were not
maintained at follow-up. In contrast, reliable and clinically significant change was
demonstrated by the 54 percent of the participants by termination of the programme and by
77 percent at 12 weeks follow-up. Early rapid response was demonstrated by 44 percent of
participants as measured by the PHQ-9, and these participants maintained reliable and
clinically significant change at termination and follow-up intervals. Secondary measures
also demonstrated similarly positive results. The intervention was evaluated positively by
the New Zealand sample. Implications for future research and clinical practice are
discussed.