The Effectiveness of Cognitive Behavioural Therapy - Research Proposal Example

Mental Health Research Part A: Framing the Research Question According to the World Health Organisation (WHO), suicide is a critical public health concern and is considered among the top ten causes of death in a number of Western countries (WHO 2005). Suicide incidences especially among young adults experiencing clinical depression are increasingly becoming prevalent in Australia. For instance in Victoria over 500 deaths per year among young adults are as a result of suicide. The suicide rates in Vitoria reflect the national rates of suicide in Australia. It is believed that suicide is a common cause of death especially among young adults in Australia. Young adults between the ages of 18-25 years are often susceptible to risk factors such as sexual abuse, violence, dysfunctional relationships, emotional abuse, work pressure and peer pressure. These risk factors are often associated with substance abuse, clinical depression and suicide attempts (Better Health, 2013; Seguin et al, 2011). Over the years, there have been ongoing debates on which interventions are most suitable for addressing clinical depression and eventually preventing suicide incidences (Dubicka et al, 2010). A considerable number of studies argue that, cognitive behavioural therapy (CBT) can be an effective intervention for addressing clinical depression especially among young adults with suicidal tendencies (Weisz et al, 2009; Hollon et al, 2002). Conversely, some studies show that psychiatric medication such as antidepressants and mood stabilizers are the most effective interventions for addressing clinical depression (Hollon et al, 2005). This study seeks to establish which intervention is suitable for addressing clinical depression among young adults. It will examine how effective is Cognitive Behavioural Therapy (CBT) compared to psychiatric medication in preventing suicide incidences. Research question: In young adults with clinical depression, how effective is Cognitive Behavioural Therapy (CBT) compared to psychiatric medication in preventing suicide incidences. Part B: Literature Review According to Ridgway and Williams (2011) several treatment options to depression exist, however they emphasise on two broad categories namely psychiatric therapy and cognitive therapies. Hollon et al (2005) is of the idea that antidepressant medication proves effective in the prevention of recurrence of depression symptoms provided that medication is not stopped midway. Similarly Wasserman et al (2012) agrees that antidepressant medication significantly reduce the instances of suicide in patients however this only works in patients who respond to the medication. Consequently, suicide rates remain high among repeat suicide attempt patients who do not respond to antidepressant medication. On the other hand, according to The National Institute of Health and Clinical Excellence (NICE) individuals suffering from mild to server depression should be put under CBT treatment. Hollon et al (2005) concurs that CBT is proven to have more lasting effect in reducing depression symptoms in patients. Consequently, patients who are treated through CBT are less likely to relapse back into depression. The effectiveness of CBT compared to the medicinal alternative in treatment of depression among patients who are susceptible to suicide attempts is such that CBT can serve to prevent patients from repeat suicide attempts. Consequently, through CBT, therapist can help patients to solve their problems and improve their sleep. This in turn goes a long way in treatment of depression (Ridgway & Williams, 2011. P. 594). According to Ridgway & Williams (2011) Cognitive Behavioural Therapy through self-help (CBT-SH) is where the patient is attended to with low intensity working schedule from therapists. Therapists have minimal contact with patients and normally assume a supervisory role. Consequently, the patients are treated through a program where they are engaged with therapists at a minimal supervision level. This could be in the form of electronic media such as a DVD or the internet. The results observed in patients were such that they improved their state of being as patients showed regressed depression levels. This therefore suggests that CBT approaches best’s medicinal approaches in treating depression amongst suicidal patients. Consequently, Ridgeway & Williams (2011) conclude that modalities of delivery such as internet, books and electronic media should be explored so as to tap the effectiveness of delivery. Moreover, different patients prefer different teaching methods and as such more research on the patients’ preferences on learning methods should be done In a research conducted by Wasserman et al (2012) it was found that Anti-depressant treatment (ADM) may increase suicide instances, risks and symptoms especially for patients under the age of 25. Consequently, they recommend that side effects of ADM treatment should be monitored closely to ensure that results are effective. For patients suffering from depression whether mild or server, CBT treatment serves to help although it is upon medics concerned to identify whether Low Intensity (LI) or High Intensity (HI) level of therapists involvement in the treatment is required. Wasserman et al (2012) add that CBT is recommended for patients suffering from suicidal tendencies, they add that psychological support from family, friends and significant others goes a long way in providing the emotional support needed to further sustain CBT treatment. However, CBT according to Ridgway & William (2011) CBT-SH has several short falls that include patients doping out from the programme. In addition patients portrayed reservations about their privacy and security especially for patients with minimal contact with their therapists. Furthermore, patients showed concern that CBT-SH did not allow for the therapists to take note of their worsening conditions due to limited access to therapists. Similar occurrences of patient drop outs from treated were also cited by Hollon et al (2005) however, patients both under CBT and Anti-depressant medication (ADM) treatments both dropped out due to varied reasons. Generally, Hollon and his colleagues found that CBT treatment had far reaching sustainability of successful treatment as there was reduced relapse rate as compared to medication withdrawal. However, ADM is regarded as the most effective means in preventing relapse it is their recommendation that the two methods are effective and either one should not be treated with less respect (Hollon et al, 2011). Part C: Methodology Research Design The key aim of this study is to compare the effectiveness of cognitive behavioural therapy and psychiatric medication in preventing suicide incidences in young adults with clinical depression. In order to realise this aim, this study employs a qualitative research approach. A qualitative research approach is a scientific or empirical research study that involves the use of a set of predefined procedures to explore research issues in-depth. This approach uses various interpretative techniques which focus on decoding, describing and interpreting research issues in order to establish meaning. A qualitative research approach will be used in this study mainly because it is suitable for obtaining in-depth information that is contextually specific (Mack & Woodsong, 2005; Merriam, 2009). Participants This study will involve mental health care practitioners such as psychiatrists, mental health nurse practitioners, clinical psychologists and counselors who work closely with young adults experiencing clinical depression. Other specialists within healthcare settings who deal with young adults with suicidal tendencies will also be involved in this study. A total of 21 mental health care practitioners from different mental health care facilities will take part in this study. Prior to the study, these participants will be contacted and informed about the purpose of the study. Subsequently, questionnaires will be administered and interviews conducted with participants who consent to participate in the study. Research Settings This study will be based in mental health care facilities in Western Australia that specialize in providing counseling or psychiatrist services to young adults experiencing clinical depression. Moreover, this study will take place in primary health care facilities that address issues relating to suicidal tendencies among young adults. Data Collection The findings established in this study will be based on qualitative data collected through the use of questionnaires and interviews. Questionnaires will be carefully developed based on the key aims of this study. Subsequently, the questionnaire will be administered to all 21 participants who will take part in the study. Although questionnaires provide a simple, cost effective and less time consuming approach of collecting data, it may provide inexplicit responses and leaves no room for clarifications (Darzi & Athanasiou, 2010).Therefore, interviews will be conducted with three participants so as to provide in-depth understanding and supplement data collected through the use of questionnaires. Data Analysis Data collected through the use of questionnaires and interviews will be compiled, organized and analysed in order to obtain relevant information that answers the identified research question. In this case, data will be analysed based on the grounded theory. Grounded theory is a paradigm of data analysis often employed when analysing qualitative data. When analysing data using this paradigm, no underlying theory or hypothesis is taken into account. Data collected is categorized into similar concepts, each concept is subsequently interpreted and evaluated separately in order to provide explanation or develop a hypothesis about a particular research issue (Allan, 2003). Ethical considerations The findings of this study will be obtained by collecting data on the perspective or views of mental health professional regarding the effectiveness of CBT and psychiatric medication in preventing suicide incidences amongst young adults experiencing clinical depression. Conducting this study elicits various ethical issues that must be taken into account in order to realise the expected outcomes. Some of the ethical issues that will be taken into include; informed consent, privacy and confidentiality of participants. Informed Consent The notion of informed consent is key in meeting the ethical requirements of conducting research. Prior to embarking on any study, it is crucial to obtain consent from relevant authorities and participants who will take part in the study. When conducting this study, a formal consent will be obtained from relevant authorities in the mental health care facilities where this study will be based. The management of these healthcare facilities will be informed about the nature, purpose of the study and the role that mental health care professions will play in the study. Moreover, prior to the study, participants will be contacted and informed about the purpose of the study. This study will only involve participants who provide consent (BERA, 2011). Privacy and confidentiality of participants Data collected during this study will be sensitive in nature mainly because it touches on issues that affect patients with clinical depression. Therefore, utmost measures will be taken to ensure that participant privacy and confidentiality is upheld. Moreover, any sensitive information about patients or the mental health facility will be protected. When conducting the study, participants will be assured of their privacy and confidentiality. Participants will be requested not to indicate their name or any personal information in the questionnaires or during the interviews (BERA, 2011). The names of the participants, their patients and the mental health facilities that they work in will be left anonymous so as to uphold their right to privacy. References Allan, G (2003) “A critique of using grounded theory as a research method”, Electronic Journal of Business Research Methods 2(1): 1-10. British Educational Research Association (BERA) (2011). Ethical guidelines for educational research. Retrieved on May 17, 2013 Better Health (2013). Youth suicide: the warning signs. Retrieved on May 17, 2013 Ridgway N. & Williams,C (2011). “Cognitive behavioral therapy self-help for depression”. Journal of Mental Health 20(6): 593 Darzi, A. & Athanasiou, T (2010). Key topics in surgical research and methodology. New York: Springer Dubicka B, Elvins R, Roberts C, Chick G, Wilkinson P & Goodyer I.( 2010). “Combined treatment with cognitive behavioural therapy in depression: meta analysis”. British Journal of Psychiatry 197:433-440. Hollon, S. D., Thase, M. E., & Markowitz, J. C. ( 2002). “Treatment and prevention of depression”. Psychological Science in the Public Interest, 3: 1– 39 Hollon S,. DeRubeis R, Shelton R, Amsterdam J, Salomon R, O’Reardon J, Lovett M, Young P, . Haman K, Freeman B & Gallop R (2005). “Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression”. Arch Gen Psychiatry 62(4):409-416. Mack, N & Woodsong, C & Family Health International (2005). Qualitative research methods: a data collector's field guide. North Carolina.: Family Health International. Merriam, S (200). Qualitative Research: A Guide to Design and Implementation. New York: John Wiley & Sons. Seguin M, Renaud J, Lesage A, Robert M, Turecki G (2011). “Youth and young adult suicide: A study of life trajectory.” Journal of Psychiatric Research 45(7): 863-870. Weisz J, Southam-Gerow M, Gordis E, Connor-Smith J, Chu B, Langer D, McLeod D, Jensen-Doss A, Updegraff A. & Weiss B. (2009). “Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians.” Journal of Consulting and Clinical Psychology 77(3):383-396 Wassermana D, Rihmer B, Rujescu M, Sarchiapone M, Sokolowski D, Titelman D, Zalsman G, Zemishlany Z & Carli V. (2012). “The European Psychiatric Association (EPA) guidance on suicide treatment and prevention”. European Psychiatry 27 129–141. World Health Organization (WHO). (2005). WHO/Europe report on suicide. Health evidence network. Retrieved on May 17, 2013 Read More