creative problem solving therapy for depression

380 Pages·2014·3.61 MB·English

CREATIVE PROBLEM SOLVING THERAPY FOR DEPRESSION:
A CLINICAL RCT STUDY OF CREATIVE PROBLEM SOLVING THERAPY IN
COMPARISON WITH COGNITIVE BEHAVIOURAL THERAPY FOR
ADOLESCENT DEPRESSION IN THE SCHOOL CONTEXT

SOUDABEH ERSHADI MANESH
Counselling and Psychotherapy

School of Education, Communication and Language Sciences
Newcastle University

October 2013

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Dedication
This thesis is dedicated to the memory of my loving husband, Ali, who was my
companion for all the years I’ve known him and his words of wisdom and encouragement
have been the source of support I needed to face challenges in my life. His kind heart and
generosity will forever remain an inspiration to me, my children and all those who knew
him well.

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Acknowledgement
I offer my regards to all those writers and researchers whose knowledge and findings
have been of great value to me and in writing this thesis. Also this thesis would not have
been possible without the support of my supervisor Dr. Sue Pattison and the
encouragement of Dr. Mahmoud Mansour, my professor at Tehran University.
Also I would like to thank the Department of Education in Tehran for their permission for
this research to be carried out and I want to thank all the kind staff and the amazing pupils
at the two schools of Parsian and Bahonar for their cooperation in participating in the
research process. Finally I want to thank my family, my husband Ali and my children
Ashkan and Sogol for supporting me throughout these years.

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Content..........................................................................................................................Page

Abstract...............................................................................................................................1

Chapter one: Introduction to the study
1.1 Introduction ...................................................................................................................4
1.2 Introduction to problems and obstacles .........................................................................4
1.3 Universal and selective prevention programmes..........................................................12
1.4 Depression in the school context in Iran......................................................................18
1.5 Theoretical perspectives...............................................................................................20
1.6 Debate regarding application of CPS to depression research......................................24
1.7 Rationale of the study...................................................................................................32
1.8 The aims and values of the research for the youth in the context of Iran....................36
1.9 Definition of variables..................................................................................................40
1.10 Research aims.............................................................................................................43
1.11 Research questions.....................................................................................................43
1.12 Thesis hypotheses.......................................................................................................44
1.13 Conclusion..................................................................................................................45

Chapter two: Review of the literature
2.1 Introduction..................................................................................................................48
2.2 Definition of depression in youth.................................................................................49
2.3 The estimate prevalence of depression.........................................................................54
2.4 The psychological theories around development of depression and debates...............56
2.4.1 Psychoanalytical theories of depression in youth......................................................58
2.4.2 Cognitive theories of depression in youth.................................................................60
2.4.3 Interpersonal theories of depression in youth............................................................66
2.4.4 Behavioural and social theories of depression in youth............................................70
2.5 An area of agreement among different theories...........................................................74
2.6 Debates regarding therapeutic approaches to depression in youth...............................75
2.6.1 Interpersonal psychotherapy (IPT)............................................................................76
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2.6.2 Cognitive and behavioural therapy (CBT)................................................................80
2.6.3 Creative problem solving therapy (CPST) as an alternative approach.....................83
2.7 How CBT and CPST express depression and what are their effects...........................90
2.8 Empirical studies in problem solving therapy for depression ....................................94
2.8 Conclusion...................................................................................................................99

Chapter three: Methodology
3.1 Introduction................................................................................................................102
3.2 Introduction to the methods of data gathering............................................................103
3.3 Rationale for applying RCT and validity of the design .............................................104
3.4 Semi-structure interview for the purpose of elaboration...........................................110
3.5 Research aims.............................................................................................................111
3.6 Research questions.....................................................................................................112
3.7 Research hypotheses...................................................................................................113
3.8 Independent and dependent variables.........................................................................114
3.9 Pilot study..................................................................................................................115
3.9.1Decisions resulting from pilot study........................................................................118
3.10 Main study design....................................................................................................119
3.10.1 Population and context.........................................................................................119
3.10.2 Randomisation and sampling................................................................................121
3.10.3 Power and sample size justification.....................................................................122
3.10.4 Research tools.......................................................................................................123
3.10.4.1 Beck’s Depression Inventory (BDI-IV).............................................................124
3.10.4.2 Short Mood and Feelings Questionnaire (SMFQ).............................................126
3.10.5 Data collection procedures....................................................................................129
3.10.6 Inclusion and exclusion criteria.............................................................................136
3.10.7 The process of applying interventions..................................................................139
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3.10.8. Random assignment of participants.....................................................................140
3.10.9 Intervention leader................................................................................................141
3.10.10 Interventions........................................................................................................143
3.10.10.1 CBT intervention..............................................................................................143
3.10.10.2CPST intervention.............................................................................................144
3.10.10.3 Control group...................................................................................................145
3.11Individual semi-structured interview.........................................................................147
3.12 Follow up measurement...........................................................................................148
3.13 Data analysis.............................................................................................................148
3.14 Potential ethical issues..............................................................................................151
3.15 Conclusion................................................................................................................154

Chapter four: Results
4.1Introduction.................................................................................................................156
4.2 Quantitative data analysis...........................................................................................157
4.3 Testing hypotheses.....................................................................................................161
4.4 Presentation of qualitative data..................................................................................201
4.4.1 Introduction.............................................................................................................201
4.4.2 The qualitative content analysis process.................................................................201
4.4.3 Results of qualitative content analysis....................................................................208
4.5 Conclusion..................................................................................................................222

Chapter five: Discussion and Implications for future study
5.1 Introduction................................................................................................................223
5.2 Interpretation and discussion of the main findings (quantitative and qualitative).....224
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5.3 Limitations and recommendations.............................................................................238
5.4 Conclusion..................................................................................................................247

Chapter six: Conclusion
6.1 Conclusion..................................................................................................................248

Bibliographic references................................................................................................268

List of Appendices
Appendix 1 Searching strategy.........................................................................................292
Appendix 2 CPS process..................................................................................................294
Appendix 2.1Definition of CPS concepts and tasks.........................................................300
Appendix 3 SMFQ research tool......................................................................................305
Appendix 4 BDI-II research tool......................................................................................306
Appendix 5 Permission letter from education organisation in Tehran.............................307
Appendix 6 Information sheet and consent form for parents...........................................308
Appendix7 Information sheet for all pupils in screening process....................................312
Appendix 8 Information sheet for pupils invited to participate in the study....................319
Appendix 9 Consent form for pupils invited to participate in the study..........................324
Appendix 10 Key messages of CBT................................................................................325
Appendix 11 Summary of CBT intervention...................................................................326
Appendix 12 One example of CBT during the course of the intervention.......................330
Appendix 13 Key messages of CPST...............................................................................349
Appendix 14 Summary of CPST......................................................................................350
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Appendix 15 One example of CPST during the course of the intervention.....................356
Appendix 16 Interview transcription................................................................................371

List of Tables in chapter 2
Table a: The nine symptoms of depression within DSM-IV-TR (2000) criteria……...…51
Table b: The expression of depression by DSM-IV, ICD & NICE………………...……51
Table c: Psychoanalytic theories and therapies…………………...…………………….. 60
Table d: Cognitive theories and therapies………………………………………………. 65
Table e: Interpersonal theories and therapies…………………………………………… 71
Table f: Behavioural and social theories and therapies…………………………………. 74
Table g: Problem solving theories and therapies………………………………………... 89
Table h: CBT versus CPS in definition and the expression of depression…………….....92
Table i: CBT versus CPS, the therapies’ assumptions and therapies’ processes……..… 93

List of Tables in chapter 3

Table A: Research procedure ………………………………………………….……….131
Table B: Data collection procedure..................................................................................133
Table C: Programme timetable for intervention in the first school……………………. 133
Table D: Procedure for applying research........................................................................134
Table E: Description of number of pupils screened.........................................................138
Table F: Semi-Structure Interview Questions..................................................................148

List of Tables in chapter 4

Table 1: Characteristics of pupils in all groups................................................................157
Table 2: Test of normality of distributions.......................................................................158
Table 3: Descriptive scores at baseline for two measures……………….……………...159
Table 4: Between groups- within groups for both tools...................................................160
Table 5: Pearson correlations of the two measures at pre-test........................................161
Table 6: Descriptive statistics: means and standard deviations pre-test and post-test….164
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Table 6.1: Multivariate Testsb repeated measures, of interaction....................................166
Table 6.2: Repeated measures mauchly's test of sphericity.............................................167
Table 6.3: Repeated measures averaged test of significance...........................................168
Table 6.4: Repeated measures univariate tests of significance…………………………169
Table 7 Repeated measures pre-post follow-up means and standard deviations…….…170
Table 7.1 Repeated measures multivariate tests...............................................................171
Table 7.2 Repeated measures Mauchly’s test for sphericity...........................................173
Table 7.3 Repeated measures univariate tests of significance…………………………174
Table 8 Means and standard deviations of patient pre-test post-test SMFQ……………176
Table 8.1 Repeated measures multivariate tests...............................................................178
Table 8.2 Repeated measures Mauchly’s test for sphericity............................................179
Table 8.3 Tests of within-subjects effects repeated measures averaged..........................180
Table 8.4 Repeated measures univariate tests of significance for transformed………..181
Table 9 Means and standard deviations of patient pre-test/post-test follow up………182
Table 9.1 Repeated measures multivariate tests...............................................................184
Table 9.2 Mauchly's test of sphericityb ………………………………………………...185
Table 9.3 Repeated measures univariate tests of significance………………………….186
Table 10 ANOVA analysis of variance comparing the means of three groups..............189
Table 10.1Tests of between-subjects effects pupils’ improvement BDI-II & SMFQ......189
Table 10.2 Tests of between-subjects effects in pupils’ improvement BDI & SMFQ…192
Table 10.3 Scheffe multiple comparisons post hoc tests…………………………..……193
Table 11 Number of pupils not reaching the recovery threshold for depression……… 193
Table 12 Pupils’ score of depression at before and after the therapies………………... 194
Table 13 Tests of between-subjects effects cognitive and somatic factors……………. 197
Table 13.1 Scheffe test of multiple comparison cognitive and somatic factors……….. 198
Table 14 CPS and CBT participant’s answers to question 1…………………………... 209
Table 15 CPS and CBT participants’ answers to question 2…………………………... 211
Table 16 CPS and CBT participants’ answer to question 3…………………………… 213
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Table 17 CPS and CBT Participants’ answer to question 4…………………………… 216
Table 18 CPS and CBT Participants’ answers to question 5………………………….. 218
Table 19 CPS and CBT Participants’ answers to question 6………………………….. 219
Table 20.1: Overall lists of the CPS therapy participants’ views of themselves………………...220
Table 20.2: An overall list of the CBT therapy participants’ views of…………………221

Lists of figures
Figure 1 Procedure flowcharts.........................................................................................165
Figure 2 Power curve for one-way ANOVA from Minitab.............................................122
Figure 3 Estimated marginal means of depression in three groups……………………. 171
Figure 4: Estimated marginal means of depression in three groups…………………… 177
Figure 5 Estimated marginal means of mood and feelings……………………………. 183
Figure 6 Estimated marginal means of cognitive factors……………………………… 199
Figure 7 Estimated marginal means for somatic factors………………………………. 200
Figure 8: The process of the research…………………………………………………...202
Figure 9: CBT versus CPS…………………………………………………………….. 207

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