OCR A2 G543 - Health & Clinical Psychology

Aim: Use HBM model to explain mother’s adherence to a drug regimen for their asthmatic children.

Methodology:

• Correlation design. 111 mothers, Each mother interviewed for 45mins.
• Some participants had a blood test, confirming the adherence.

Findings: There was a positive correlation between mother’s belief about child’s susceptibility to asthma attacks. Also Mothers were more likely to comply, the greater the mother’s education and if married, the more likely she would be to keep to the prescribed routine for administering the medication.

Conclusion: The HBM is a useful model to predict and explain different levels of compliance with medical regimes.

Evaluation:

• Biased sample, not representative of the general population. Also leading questions used.
• High in ecological validity as the children already had asthma.
• High in validity due to blood tests confirming adherence.

Aim: To find out whether locus of control affects our health beliefs

• Internal locus of control: individual controls their health themselves.
• External locus of control: Your behaviour is guided by fate and external circumstances

Procedure: He reviewed 6 pieces of research , which had all investigated an individuals perceptions of the extent to which they could control the outcome of their behaviour, in different situations.

Findings: Participants with an internal locus of control were more likely to show behaviours that would enable them to cope with potential threats, than participants who thought that chance determined the effects of their behaviours.

Conclusion: Locus of control would affect many of our behaviours, not just health behaviour.

Evaluation:

• Reductionist, doesn't take in external factors as to why people do/don't adopt healthy life styles.
• Low in validity due to the use of a review article.

Aim: To assess the self-efficacy of patients undergoing systematic desensitisation in relation to their behaviour with previously phobic objects

Methodology: A controlled quasi-experiment with 10 patients with snake phobias aged 19-57

Findings: Higher levels of post-test self-efficacy were found to correlate with higher levels of interaction with snakes.

Conclusion: Systematic desensitisation enhanced self-efficacy levels, which in turn led to a belief that the participant were able to cope with the phobic stimulus of a snake.

Evaluation:

• All three theories can be accused of being reductionist because it ignores other key influences.
• Natural experiment therefore cause and effect cannot be established.
• Only 10 participants (1 male) therefore this cannot be representative of the general population.
• Also they had replied to a newspaper ad potentially meaning that they had time on there hands and this could of lead to the outcome of biased answers.

Aim: Test the effectiveness of an advertising campaign.

Methodology:

• Quasi-experiment. Two TV advertisements shown both lasting 60 secs.
• Shown in 10 UK regional television areas and questionnaire sent to all these people     

Findings:

• 32% reduction in the number of fires after 12 months and also increase awareness

Conclusion: The advertising was effective as chip pan fires reduced. However the effectiveness decreases overtime. Viewers are also less likely to be influenced by the campaign if overexposed.

Evaluation:

• Small change, therefore the ad campaigns may not be as effective as individuals would think.
• Natural experiment used, cannot establish cause and effect.
• High in EV this is as individuals were shown live broadcasting television adverts

Aim: To investigate whether the behaviour and attitudes of young people in Howard county was different to children in Baltimore county and Montgomery county.

Methodology:

• 7322 children from 47 schools in Howard County, Maryland USA. Aged between 9-15.

Findings:

• All areas have increased in helmet usage (Maryland).
• Only 4% wore helmets before the helmet law and after the law had been passed 47% wore them. Questionnaire response rates were between 41-53%.

Conclusion: Although people may not wear helmets on a daily basis, the law did help improve usage.

Evaluation:

• High in reliability, as a second study was conducted and showed similar results 
• The questionnaire could be biased as parents were asked to help
• The sample is not representative of the general population as only school children were used 
• Effective as in Maryland it is said that wearing helmets will prevent 100 deaths per year

Aim: To study fear arousal applied to oral hygiene in students.

Findings:

• Strong fear-appeal – seen in a more positive light agreed that talk was interesting but didn’t affect their behaviour.
• Low fear-appeal was easier to follow and more people altered their behaviour.

Conclusion: Minimal fear arousal tends to work better than strong arousal. So therefore choosing the right level of fear is important in-order to change/improve individuals health behaviours.

Evaluation:

• Ethical issues – psychological harm in the strong fear arousal group. However if they give up such behaviours perhaps the ends have justified the means.
• Sample cannot be generalised to the general population as students were used.
• Laboratory experiment was used therefore cause and effect can be established.
• This study has high scientific credibility.

Aim: To investigate reasons for non adherence adherence in hypertensive patents.

Methodology: 

• Review article of range of research which identified problems with taking drugs for high blood pressure.
• Only Male Participants used

Procedure: Bulpitt et al analysed the research to identify the effects that taking the hypertensive medication had on peoples lives, both physically and psychologically.

Findings: They found that the drugs can have many side effects including sleepiness, dizziness and lack of sexual functioning. They also found it affected cognitive functioning which impacted on peoples concentration at work and involvement in their hobbies.

Conclusion Bulpitt concluded that the costs of taking some medication appear to outweigh the benefits for many patients, especially with problems such as high blood pressure which have no symptoms.  Therefore some types of treatment (asymptomatic ones) may be more difficult to treat as people cannot feel the benefits of the adherence.

This study used an electronic Track Cap, an electronic device on the bottle top that recorded the date and time of the use of the medication, and this is an objective way of measuring non adherence.

Aim: to see if patients did take their medication regularly and at the correct time of day.

Procedure:

• 57 Patients were told that adherence rates were being measured but not told about the Track Cap device and what it did. 
• The treatment was taken twice a day 8 hours apart. 
• The study was carried out over a 12 week period.
• Compliance was measured by the number of times the track cap was opened, the number of days that the track cap was opened at 8 hour apart intervals and the number of pills left at the end of the 12 week period.

Results:

Over the period the track cap monitoring showed compliance was quite high at 71%. However the count of returned pills put the compliance rate even higher at 92%.  ( However 10 patients dropped out of the study leaving the data being collected from only 47). These results show that compliance with adherence to a treatment of oral, twice a day asthma, maintenance medication is high.

Aim: To see if there was a link between depression and non adherence in diabetic patients medication.

Procedure:

• Volunteers were asked for and excluded I they had history of drug abuse or mental disorder
• 60 diabetic patients were all screened for depression (using Becks depression inventory) and then randomly assigned to two groups, one group given fluoxetine for depression and the other group given an identical looking pill as a placebo. 
• The patients themselves and the doctors did not know which group they had been assigned to in order to avoid demand characteristics.

Results: After 8 weeks the group given the real fluoxetine had far healthier blood glucose levels.  Patients who reported less depressive symptoms also more regularly monitored their blood glucose levels.

Conclusions: Not being anxious or depressed improves compliance with medical requests.

Evaluation:

• Social desirability - the patients may have said they felt better just because they knew the aim
• Validity - used Becks depression inventory which is not scientific and relies on self report

Aim: To see if using a Funhaler could improve children’s adherence to taking asthma medication

Method

• A Field experiment with a RMD, Each child was given the standard inhaler for the 1st week and the funhaler for the 2nd week.
• The participants were 32 Australian children (10 boys and 22 girls) with a mean age of 3.2 (between 1.5 and 6years old).  
• They had all been diagnosed with Asthma and their parents had given informed consent.  
• Parents completed a questionnaire at the end of the second week. 

Findings: 38% more parents were found to have medicated their children the previous day using the funhaler compared to the standard inhaler.

Conclusions: Making a medical regimen fun can improve adherence in children.

Evaluation:

• Social Desirability - Parents completed the questionnaire
• Cannot generalisable - Only conducted within Australia, Unrepresentative only children used

Aim: To measure the psychological and physiological stress response in two categories of employees.

Method: 

• Natural experiment using an IMD
• 24 workers at a Swedish Sawmill.  14 classified as a high stress risk group (finishers).  
• Finishers - machine paced, repetitive work, constrained, socially isolated, complex work
• Cleaners - Control group, self paced, more time to socialise (low risk of stress)
• Daily urine sample taken, body temperature was checked and they were asked to complete a self-report about mood, alertness and caffeine and nicotine consumption, when they first arrived at work and a further four times during the day.  Baseline readings were taken at home before the study started.

Results: In the first urine sample of the day, the high risk group had adrenaline levels twice as high as their baseline and these continued to increase throughout the day.  The control group had a peak of 1.5 times their baseline in the morning and this declined during the rest of their shift.

Conclusions The repetitive, machine-paced work, which was demanding in attention to detail and highly mechanised, contributed to the higher stress levels in the high risk group.

Evaluation: Measured stress in 2 ways: adrenaline levels and self-report, increases reliability.

Aim: - To examine the events and experiences in our life which causes stress

Procedure:

• 5,000 patients medical records examined (all American service men).  From these, they put together a list of 43 life events which seemed to precede (come before) illness.
• At the top of the scale was death of a spouse while at the bottom was minor violation of the law

Findings: Most life events were judged to be less stressful than getting married. But 6, including death of a spouse, divorce and personal injury or illness were rated as more stressful. After calculating the results from the rating scale, the researchers stated that those who score 300+ were more susceptible to both physical and mental illness.

Conclusion: Holmes and Rahe concluded that stress could be measured objectively as an LCU score.  This, in turn, predicts the person’s chances of becoming ill (physically and / or mentally) following the period of stress. Stress actually makes us ill. Also the researchers stated that both positive and negative events cause stress if the events are a change from an individuals normal routine

Evaluation:

• Cannot generalise as only American's were used, Unrepresentative only Men were used

Aim: To compare Hassles and Uplifts and Life Events as predictors of psychological symptoms of stress

Procedure: 

• 100 Californians (mostly white) completed a hassles and uplift rating scale every month for nine months and a life events rating scale (SRRS) after 10 months.  
• Their psychological symptoms of stress were measured using the HSCH and Bradburn Morale Scale every month for 9 months.

Findings: Hassles were consistent from month to month.  For men life events correlated positively with hassles and negatively with uplifts.  For women, both hassles and uplifts were positively correlated with life events.  Hassles correlated positively with psychological symptoms than life events.

Conclusions: Hassles are a more powerful predictor of psychological symptoms of stress than life events.

Evaluation:

• Social desirability bias as questionnaire was used
• Cannot generalisable only Californians were used

Aim: To see if perceived control or actual control can reduce reactions to aversive stimuli.

Method:

• 60 psychology undergraduates shown pics of dead car crash victims and their stress levels were measured using galvanic skin response.  
• Group 1 (predictability & control) they could press a button to terminate and each picture was preceded by a tone 
• Group 2 (predictability, no control) were warned that pictures were 60 seconds apart and were preceded by a tone.  However, length of exposure was controlled by group 1.  
• Group 3 (no predictability and no control) were just told they would see pictures from time to time, again length of exposure was controlled by group 1 

Results: Group 1 experienced the lowest stress response as measured by the GSR, compared to groups 2 & 3. Group 2 showed most stress in response to the tone.

Conclusion: Participants showed less GSR reaction, indicating less stress, when they had control over the situation.  It is likely that being able to terminate aversive stimuli reduces its stressful impact.

Goldstein et al (1992) -

The study found that paramedics blood pressure was higher during ambulance runs or when at hospital, compared to when they were at home. Galvanic skin response can also be used to measure stress as it calculates the electric resistance of the skin, which is an indicator of the level of arousal in the autonomic nervous system. However this measure can only be used in a lab, not in real life.

Lundberg (1976) -

The research conducted a study on train commuters in Sweden and showed how those riding for a shorter, but crowded trip had higher levels of stress in there urine compared to those having a longer, less crowded trip. This shows sample tests are another way of measuring stress, because any hormone will be present in the sample.

Evaluation:

• Reliable as the results are there to see
• Validity is questionable because things other than stress can cause high blood pressure or stress hormones

Self report methods can include questionnaires, interviews and diary-keeping.

Aim: To create a method that estimates the extent to which life events are stressors.

Methodology: A questionnaire designed to ascertain how much each life event was felt to be a stressor.

Participants: 394 subjects from a range of educational abilities, ethnic groups and religions.

Procedure: Each participant was asked to rate a series of 43 life events. Ratings could be based on personal experience and perceptions of other people’s experiences. The amount of readjustment and the time it would take to readjust were both to be considered.

Findings: The final SRRS was completed based on the mean scores allocated by the participants.
Correlations between groups were tested and found to be high in all but one group. Males and females agreed, as did participants of different ages, religions, educational level, but there was less correlation between white and black participants.

Conclusions: These events are mostly ordinary. There are also some socially desirable events which reflect the western values of materialism, success and conformism. The degree of similarity between different groups is impressive and shows agreement in general of what constitutes a life event and how much they cause stress (or readjustment).

The combined approach of Johansson, which showed work as a cause of stress, used both self-report and physiological measures.

Each participant was asked to give a urine sample 4 times during the day, so that their adrenaline levels could be measured. This is a physiological measure. Their body temperature was recorded at the same time. These measures were combined with a self-report where each participant had to say how much caffeine and nicotine they had consumed since the last urine sample.

They also had a list of emotions and feelings such as sleepiness, well-being, calm and irritation. These were on a continuum from minimum to maximum and on a millimetre scale.  The score was how many millimetres from the minimum base point the participant's had marked themselves to be feeling. This combined method of physiological measures and self-reports gave some good qualitative and quantitative data that enable Johansson to compare the two groups, and have some understanding of the impact of higher stress levels on participants.

Aim: To compare SIT with systematic desensitisation and a control group on a waiting list.

Methodology: Field experiment – 21 students assessed before and after treatment using a self-report. Blind test – people assessing Participant's didn’t know which group they were in.

Procedure:

• Each participant’s tested using an anxiety questionnaire. 
• SIT group - Participants received 8 therapy sessions. They were given the ‘insight’ approach to help them identify their thoughts prior to the tests. They were then given some positive statements to say and relaxation techniques to use in test situations.
• Systematic desensitisation group - Participant’s given 8 therapy sessions with progressive relaxation training which they were encouraged to practice at home. They were told to practice relaxation while imagining progressively more anxiety-causing situations.
• Control group - Told they were on the waiting list and they would receive therapy in the future.

Findings: Performance on the tests improved in the SIT group compared to the other two groups, although significant difference was found between the two therapy groups and the control group.

Conclusions: SIT more effective than behavioural techniques such as systematic desensitisation as a way of reducing anxiety in students who are anxiety prone in test situations.

Aim: To see whether biofeedback is an effective method of reducing tension headaches.

Methodology: Experimental method, data collected by measuring muscle tension using an EMG feedback machine with electrodes. 18 Participants used (2 males, 16 females)

Design: IMD. participant's randomly allocated in 3 groups out of 6.
Group A had biofeedback sessions with relaxation training and EMG feedback.
Group B had relaxation training but received pseudo-feedback.
Group C were the control group told they were on the waiting list.

Procedure: For 2 weeks patients kept record of their headaches rating them from 0-5 every hour to give a baseline reading. During the group stages, each participant recorded their headache activity and after 3 months were given an EMG test and completed a questionnaire and MMPI.

Findings: Group A’s muscle tension and reported headaches were significantly lower than Group B’s and C’s. The follow up questionnaire for Groups A and B showed that Group A had more reduction in symptoms than Group B including heart rate and depression.

Conclusions: Biofeedback is an effective way of training patients to relax and reduce their tension headaches, so can be seen as an effective method of stress management.

Aim: To look at how a woman’s social relationships influence her response to breast cancer and survival.

Methodology: Quasi-experiment with women diagnosed with breast cancer. Women naturally fitted into categories based on their existing social support networks so IV not manipulated.

Participants: 133 women with a confirmed diagnosis of breast cancer. IMD used.

Procedure: Patients were sent a self-administered questionnaire to gather information on their demography and existing social networks. Details of their diagnosis were abstracted from their medical records and then their survival and recurrence rates were checked.

Findings: 6 aspects of social network significantly linked with survival were: martial status, support from friends, contact with friends, total support, social network and employment. Qualitative data showed that practical help such as childcare, cooking and transport to hospital were the concrete aspect of support.

Conclusions: Several characteristics of the women’s social networks, including marriage and employment status, are significantly related to survival, so the conclusion is that the more social networks and support, the higher the survival rate of women with breast cancer. The assumption is that therefore the Pp’s stress has been reduced.

There are various definitions of abnormal behaviour in psychology. These include:

Deviation from Statistical Norms - People who deviate from the normal/average. This includes tall/short people, or highly intelligent/lowly intelligent people.

Deviation from social norms - Society has commonly held norms, which has expectations of how people should think and behave. The norms vary depending on culture and change overtime.

Deviation from ideal mental health - If the characteristics of ideal mental health could be determined, then anyone not possessing those characteristics would be see as abnormal.

Failure to function adequately - People who experience personal stress or discomfort will seek the help of a healthcare professional and by doing this they adopt the "sick role" which attaches it. However there distress may be a perfectly normal response to a certain situation.

The elements of abnormality - Rosenhan & Seligman created 7 elements of abnormality and the researchers state the more elements a person has, the greater the certainty of abnormality for that person.

The International Classification of Diseases (ICD) is an international standard diagnostic classification for all general diseases and illnesses and many health management purposes, published by World Health Organisation. It now exists in its tenth revision and is used to diagnose physical/mental conditions. Chapter V is relevant for mental and behavioural disorders.

The ICD-10-classification for mental disorders consists of 10 main groups:

F0 Organic, including symptomatic, mental disorders
F1 Mental and behavioural disorders due to use of psychoactive substances
F2 Schizophrenia, schizotypal and delusional disorders
F3 Mood [affective] disorders
F4 Neurotic, stress-related and somatoform disorders
F5 Behavioural syndromes associated with physiological disturbances and physical factors
F6 Disorders of personality and behaviour in adult persons
F7 Mental retardation
F8 Disorders of psychological development
F9 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence.
In addition, there is a group of “unspecified mental disorders”.

The classification system of the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), consists of five axes of disorders. The five axes of DSM-IV are:

Axis I
Clinical Disorders (all mental disorders except Personality Disorders and Mental Retardation)

Axis II
Personality Disorders and Mental Retardation

Axis III
General Medical Conditions (Have to be related to Mental Disorder)

Axis IV
Psychosocial and Environmental Problems (for example problems with primary support group)

Axis V
Global Assessment of Functioning (Psychological, social and job-related functions are evaluated on a continuum between mental health and extreme mental disorder)

Classification systems have advantages but there are problems and biases in classification systems and the diagnosing of disorders.

·         Reliability – Are diagnosis consistent? We would expect the same set of symptoms to be diadnosed in the same way by any psychiatrist. One way to test this is inter-rated reliability.

·         Validity – Diagnosis may be consistent, but what if it is wrong? (Rosenhan)

·         Type 1 & Type 2 errors – A diagnosis is not always correct (Rosenhan)

·         Ethnocentrism – Can we apply the diagnosis symptoms worldwide (Littlewood)

·         Gender Bias – Why are those involved in the diagnosing and classifying disorders predominantly men, when those being diagnosed and treated are mainly Women. Stereotypical gender roles may be incorrectly diagnosed as pathology.

Types of Phobias

Anxiety could well be a survival mechanism because it raises our physiological response making us react quickly to dangerous situations. However too much anxiety can interfere with normal everyday functioning and can therefore be defined as a disorder. Is the fourth most common disorder in the USA.

1)  Specific Phobias - Fear of a specific object or situation such as fear of spiders etc.

2)  Social Phobias - Fear of humiliation in public places.  Some sufferers fear eating in restaurants or using public toilets, others fear meeting strangers or public speaking.  They are afraid that someone will see them expressing their fear – by blushing, a trembling hand or a quavering voice and think badly of them.  As a result they try to avoid certain social activities and situations.

3)  Agoraphobia - This is a fear of public places – of shopping malls, crowded streets or travelling on public transport.  At first sight agoraphobia appears to be another social phobia.  However, in most cases it begins with a series of panic attacks.  The sufferer has a feeling of impending doom and often fears dying, going mad or losing control.  As a result they are afraid of having a panic attack in a place where they don’t feel safe and where there may be nobody around to help the.  Where social phobics are afraid of others watching them, agoraphobics are fearful for themselves.  Safety, rather than embarrassment is their main concern.

Psychotic disorders are named because the psychosis causes a loss of contact with reality. A psychosis is any disorder that causes a person to have hallucinations leading to confusion and disorientation. 

Psychotic disorders cause a person to loose their sense of reality so they may become more and more isolated and withdrawn. 

Psychosis are treatable with drug therapies and can help people lead a more normal life.  There is evidence linking substance abuse and increase in psychotic illness.   

Psychotic disorders are characterised by delusions, disorganized speech or behaviour and distortions in thinking.

DSM classification for Schizophrenia - Delusions, Hallucinations, disorganised speech, at least 6 months duration etc

Is described as the common cold of mental disorders. Beck and Young suggest that being depressed is normative for humans. However one could argue that there is a great deal of difference, between having a low-mood and clinical depression.

According to Memeroff one must display low-mood for at least two weeks as well as five of the following symptoms:

• Increase/decrease in weight/appetite.
• Insomnia/hypersonic (not being able to sleep).
• Severe tiredness.
• Loss of interest in previously enjoyed activity.
• Poor cognition – focus/concentration.
• Morbidity – thinking about suicide

Aim: To review research on genetic transmission of schizophrenia.

Methodology:

• Review of 3 adoption and 5 twin studies into schizophrenia.
• 711 participants in adoption studies (210 monozygotic, 319 dizygotic).
• Comparison of parents and siblings and adoptive parents and siblings.

Results:

• All three studies showed increased incidence of schizophrenia in biological relatives.
• All twin studies found higher concordance rate in monozygotic twins than dizygotic ones.
• Concordance rates of 58% in monozygotic twins, 12% in dizygotic twins.

Conclusion: Significant genetic input and evidence show a genetic link for schizophrenia.

Evaluation:

• Reductionist view as it ignores other explanations & Difficult to replicate affects reliability.

Aim: To see if it possible to induce fear through classical conditioning if fear transferred to similar objects.

Method: Case study in laboratory conditions

Participants: Little Albert - test at 8 months showed his fear of loud noises

Findings:

• Session 1: 1^st time the bars were struck A. jumped and fell forward.
• Session 2: After 5 presentations, A. reacted to the rat by crying, and crawling away from it.
• During the other sessions he had also developed a fear towards other objects.

Evaluation:

• There is scientific credibility for this explanation and can be repeated.
• Low EV as it was in a laboratory setting and doesn't relate to everyday life
• Ignores the influence of thought processes, therefore reductionist, or biological factors.
• Ethical considerations such as psychological harm as Albert was removed from the study before cured.

Aim: Understand cognitive distortions in patients with depression

Method: Clinical interviews with patients undergoing therapy for depression. 50 patients diagnosed with depression (16 m & 34f) 18-48 middle class

Procedure: Interviews with retrospective reports of patients thoughts + spontaneous reports of thoughts during session

Findings:

• Certain themes appeared in the depressed patients that did not appear in the non-depressed patients. These were low self-esteem, self-blame. Depressed patients had stereotypical responses to situations even where inappropriate. Some patients felt unlovable and alone.

Conclusion: People suffering from mild depression, have cognitive distortions that deviate from realistic or logical thinking. These distortions are only related to depression. 

Evaluation:

• Not representative of the general population as only upper/middle class participants included
• Difficult to observe thoughts in brain and doesn't explain why they develop these thoughts

Aim: To compare drug treatment and non-drug treatments for depression.

Methodology:

• Review article of previous research.
• Concentrated on women diagnosed with depression.
• Independent design

Results:

• Adding psychological treatments to drug therapy didn't increase effectiveness of drug therapy.

Conclusion: Although it would seem logical that two treatments are better than one, the evidence does not show any better outcomes for patients offered combined therapy as opposed to only drug therapy.

Evaluation:

• Biological medical model criticised for turning people into patients, there is little emphasis on self help.
• One could argue that drugs only treat the symptom and not the cause.
• However a range of biological treatments have helped to improve the lives of millions of people.

Aim: Treat girl with specific noise phobias using systematic desensitisation

Method: Case study. Lucy 9 years old with fear of sudden loud noises. She was not depressed.

Procedure: Constructed hierarchy of feared noises, given stimulus of loud noise she paired feared object with relaxation and imagery, this lead to her associating the noise with feeling calm

Findings:

• 1^st session Lucy was reluctant to let balloons be burst even from far. When burst she cried. By 4^thsession she was able to signal a balloon to be burst 10 metres away.
• During the end of a few sessions she started to become less scared until she was able to pop one herself. Her thermometer scores were reduced significantly.

Conclusion: It appears that noise phobias in children are amendable to systematic desensitisation.

Evaluation:

• Effective for phobias but not all dysfunctional behaviours such as psychotic behaviours.
• Behavioural treatments are reductionist because they don’t take into account other factors

Aim: Compare effectiveness of cognitive therapy and drug therapy

Method: Controlled experiment with pps allocated to 1 of 2 conditions. 44 patients diagnosed with moderate-severe depression attending psychiatric outpatients clinics

Procedure: Participants assessed with 3 self-reports before treatment (Becks Depression Inventory, Hamilton Rating Scale and Rasking Scale) for 12 weeks. Patients had 1-hour cognitive therapy session twice a week or 100 imipramine prescribed by visiting doctor for 20mins each week. Cognitive therapy sessions prescribed and controlled and therapists were observed to ensure reliability

Findings:

• Both groups showed significant decrease in depression symptoms on all three rating scales.
• Cognitive treatment group showed significantly greater improvements on self-reports (79% compared with 20% of those with drug therapy).
• Drop out rate was 5% in the cognitive therapy group and 32% in the drug treatment group.

Evaluation:

• Cognitive therapy leads to better treatment of depression.
• High in EV, as patients already suffered depression and visited a psychiatric clinic normally.