| dc.contributor.author | Johnsen, Tom Johan | |
| dc.date.accessioned | 2021-11-11T22:30:34Z | |
| dc.date.available | 2021-11-11T22:30:34Z | |
| dc.date.issued | 2021-11-29 | |
| dc.description.abstract | The present thesis` main objective was to examine time-trends related to CBT as an anti-depressive treatment. A meta-analytic approach was the tool for such investigations, in which the formats of individual, group (GCBT), and mindfulness-based cognitive behavioral therapy (MCBT) were explored from a temporal point of view, and the results subsequently summarized in four articles. The meta-analyses measured the development of effect sizes (ES) with time. Potential moderator variables were also investigated. The primary outcome measure was the BDI, while the HDRS was utilized as a secondary outcome measure.
The results revealed large ESs for all treatment formats, ranging from g = 0.80 to 1.89. A significant decline in treatment effects with time was observed across all statistical conditions for individual CBT, while GCBT showed a significant rise in ESs with the passing of time, based on the results from the primary outcome measure. For MCBT, there were found no trends related to the passing of time. Moderator analyses revealed that the fall in ES for CBT was more pronounced for trials where the original treatment manual had been utilized, while the rise in GCBT effect sizes was limited to trials were no specific treatment manual had been used (or reported).
The conclusion is that CBT is efficient in all formats when it comes to battling depression. However, the results also point to the importance of continuous evaluations, updates or adaptations, in order to be in line with societal developments. This applies for treatment formats, manuals, and outcomes measures alike. Flexibility and frequent updating/adaptation are thus considered keywords to achieve the best possible treatment effects for CBT. | en_US |
| dc.description.doctoraltype | dr.philos. | en_US |
| dc.description.popularabstract | In modern society, psychological disturbances and problems are fairly common, and frequently cause suffering, poor health and reduced functioning for a great deal of people. During a lifetime, all of us have either been afflicted by psychological issues, or been acquainted to the problem via family members, friends, or colleagues who are/have been suffering.
Depression is one of the largest and most well-known disorders. Luckily, we have able treatments available for such a debilitating illness. Health professionals are stating that the effectiveness is very high for the most common treatment forms – a claim that is frequently supported through trials measuring treatment effects. So far, so good. But what would you think if you came to realize that the therapy of choice has not been thoroughly evaluated for progress during its 45 years in existence? Or that the content in the treatment has been virtually unchanged since the 1970`s? These uncharted questions paved the way for the studies which the current thesis draws upon.
For individual cognitive behavioral therapy (CBT), the statements above are quite accurate. The treatment method was invented and refined in the 70`s, with a standard treatment manual developed in the same era. At the time, CBT was labelled as the “gold standard” for treating depression, and gained a high stature with professionals, the public, and policy makers. Soon enough, CBT became the driving force in treatment for many psychological disorders, including depression.
These factors motivated the present effort to investigate the temporal development of CBT, as well as its most common variations; group cognitive behavioral therapy (GCBT), and mindfulness-based cognitive behavioral therapy (MCBT).
The tool for evaluating the temporal development of treatment effects was the meta-analysis. This is a procedure which aims to comprehensively and thoroughly summarize all appropriate research trials conducted with CBT from 1976 and onwards, thus widening our knowledge of the phenomenon under investigation. In addition to purely measuring the outcome of treatment trials, chosen variables can also readily be investigated, with the objective being to understand and explain potential interesting findings.
The results from the meta-analyses revealed that CBT, GCBT and MCBT are efficient in battling depression. However, individual CBT performed today is less efficient than it was in previous years. GCBT, on the other hand, seem to be more efficient today than before, while MCBT shows no change in treatment effects with time passing by.
The factor that exerts the largest influence on the observed fall in effectiveness for CBT for depression, is most likely the lack of procedural development with the passing of time. On the other hand, flexibility and adaptation are tied to the increase in treatment effects with time observed for GCBT.
Thus, the main message and conclusion from this thesis is that treatment manuals and procedures should routinely and regularly be updated or adapted, to ensure that treatment is as efficient as possible. Treatment procedures that were accepted as best practice 10-15 years ago, will most likely start to wane if they are not evaluated and adjusted with timely intervals. If diligent efforts are made in the suggested direction, a substantial number of patients could be helped to a quicker and more robust remission from depression – saving both them and society from vast emotional, economical and health-wise suffering. | en_US |
| dc.identifier.uri | https://hdl.handle.net/10037/22972 | |
| dc.language.iso | eng | en_US |
| dc.publisher | UiT The Arctic University of Norway | en_US |
| dc.publisher | UiT Norges arktiske universitet | en_US |
| dc.relation.haspart | <p>Paper I: Johnsen, T.J. & Friborg, O. (2015). The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. <i>Psychological Bulletin, 141</i>, 747-768. Also available at <a href=https://dx.doi.org/10.1037/bul0000015>https://dx.doi.org/10.1037/bul0000015</a>.
<p>Paper II. Friborg, O. & Johnsen, T.J. (2017). The Effect of Cognitive Behavioral Therapy as an anti-depressive treatment is falling: Reply to Ljòtsson et al. (2017) and Cristea et al. (2017). <i>Psychological Bulletin, 143</i>, 341-345. Also available at <a href=https://doi.org/10.1037/bul0000090>https://doi.org/10.1037/bul0000090</a>. Accepted manuscript version available in Munin at <a href=https://hdl.handle.net/10037/12727>https://hdl.handle.net/10037/12727</a>.
<p>Paper III: Johnsen, T.J. & Thimm, J.C. (2018). A meta-analysis of group cognitive behavioral therapy as an anti-depressive treatment: Are we getting better? <i>Canadian Psychology/Psychologie canadienne, 59</i>, 15-30. Also available at <a href=https://doi.org/10.1037/cap0000132>https://doi.org/10.1037/cap0000132</a>.
<p>Paper IV: Thimm, J.C. & Johnsen, T.J. (2020). Time trends in the effects of mindfulness based cognitive therapy for depression: A meta‐analysis. <i>Scandinavian Journal of Psychology, 61</i>(4), 582-591. Also available in Munin at <a href=https://hdl.handle.net/10037/20395>https://hdl.handle.net/10037/20395</a>. | en_US |
| dc.rights.accessRights | openAccess | en_US |
| dc.rights.holder | Copyright 2021 The Author(s) | |
| dc.subject.courseID | DOKTOR-003 | |
| dc.subject | VDP::Samfunnsvitenskap: 200::Psykologi: 260 | en_US |
| dc.title | The temporal development of cognitive behavioral therapy as treatment for unipolar depression. An evaluation based on three meta-analyses, focusing on time-trends, effect sizes, and associated moderators | en_US |
| dc.type | Doctoral thesis | en_US |
| dc.type | Doktorgradsavhandling | en_US |
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