The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression.

Anders Malkomsen,Theresa Wilberg,Julie Horgen Evensen,Jan Ivar Røssberg,Toril Dammen,André Løvgren

doi:10.3390/ijerph18052292

Abstract

Background: There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. Method: Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. Results: We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. Conclusions: Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.

Highlights

Our study aims to reduce this gap in our body of research by exploring how ten adult patients suffering from major depression experienced improvement in manualized time limited Cognitive behavioral therapy (CBT), using sampling control, manualized treatment, supervision of the therapists and treatment fidelity control
Our analysis resulted in the identification of three important elements in the process of improvement: (1) the relationship between therapist and patient; (2) the therapeutic interventions and (3) gaining insight
This study was designed to gain insight into the process of improvement in CBT for Major depressive disorder (MDD), and the main question was: How do patients experience their process of improvement? None of the patients explained their improvement as a linear experience, but rather as a complex and multilayered process

Summary

Introduction

Major depressive disorder (MDD) is expected to rank first in overall disease burden in high income countries by the year 2030, measured in disability-adjusted life years [1]. Effective methods to prevent episodes of major depression, or to improve the volume or quality of treatment, are highly needed to reduce the burden of the disease [2]. Cognitive behavioral therapy (CBT) is the most researched psychotherapy for treating depressed adults and has consistently been shown at least as effective as other psychotherapies [6]. Some patients do not respond sufficiently to CBT and relapse is common, showcasing the need for more research on the process of improvement in CBT for major depression [6]

Methods

Results

Discussion

Conclusion