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Compare and contrast assessment Depression, [CBT is considered a level one…

- - - - client heterogeneity may obscure important effects
      - https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/about-rdoc
        Explains problems with RCT designs
      - Opposite potential problem with visual inspection –
        sensitive to detecting small intervention effects
        • Effect size may not have any relation to a change that is
        important or clinically significant in the lives of clients
        (Kazdin, 2017).
        • The general relevance of statistical inference to single-case
        data remains a highly controversial topic (Ator, 1999; Baron,
        1999; Fisch, 2001).
      - Drop out rate seemed high
        19 completing treatment in the CBT condition only 4 attended all 15 sessions
        26 completing treatment in the TAU condition
        
        (24 cbt) (25 tau) post assess
        14c,18t follow up1
        14c,15t follow up 2
      - Final study underpowered
        44 per condition
        Power calculations in STATA
        indicated that 70 adolescents per condition (assuming an alpha of 0.05, a statistical power, 1-beta, of 0.80 and a
        drop-out of 20% would be required to detect a difference in depression diagnosis between conditions.
    - - Preregistered
      - Explained randomisation process
        Randomization was conducted after pre-treatment
        assessment and was executed per adolescent by computer generated block randomization and stratified per
        mental health care center by the primary researcher (no involved in other assessments)
    - - Method
        
        primary outcome was depressive or dysthymic disorder based on the KSADS
        Only for 6 to 18 the participants are 12 to 21 does this effectively assess older people?
        
        D(o)pression course
        
        The intervention contains
        representative CBT components
        namely: psycho-education (information about depression and the rationale
        for the etiology of the complaints and the treatment of them), setting attainable goals (translate large goals into
        realistic short term goals), self-monitoring (registration of the mood, activities and thoughts), activation (planning
        frequent, joyful activities), improving social skills and communication skills (improvement and stimulation of social behavior), relaxation techniques, cognitive restructuring (identifying and changing unrealistic negative
        thoughts about the self, others and events), role play and problem solution skills (teaching the creation of solutions
        for problems via brainstorm, choosing, trying and evaluating) and relapse prevention.
        
        Integrity of treatment between therapists was assessed and found to be good but no statement regarding continuity for client (same therapist every time)
        
        Treatments in both conditions were delivered by psychologists with at least one year of experience
        within professional mental health care. The therapist in the CBT condition had also at least one year of
        experience in conducting CBT. two day training this manual
        37 therapists in each condition -no overlap
        
        Assessment schedule
        The following assessments took place; prior to treatment (pretreatment assessment), within treatment (mediator
        assessments), immediately after treatment or after 15 sessions (post treatment assessment), six months after
        treatment (six-month follow-up) and 1 year after treatment (1 year follow-up). In this paper, we will present the
        post treatment and six-month follow-up results.
- - - - What are the graphs actually saying could they be misleading?
  - - - Methodology
        
        AB design
        
        Baseline, termination follow up assessed by Children's depression rating scale.
        
        Intervention manual CBT - not stated what manual used -CBT only condition- extra sessions offered (up to 12) if not remitted at 12 sessions
        
        s 1-4 Pyschoeducation cog restructuring
        homework log pos neg thoughts daily
        identify dysfunctional thoughts
        dep measure-36-26
        New school-suggested to impact these results
        
        s 5-8 Behavioural activation
        pleasant activities, time management, goal setting
        Homework
        log pleasant activities, weekly planner, goals and steps to complete them.
        Barriers pleasant act-neg thoughts, parental permission
        Dep score 26-25
        
        s 9-12 psychoed interpersonal relationships
        maintaining social support
        assertive communication skills
        Still guilt, anger, sadness re parents relat
        dep score 25-25
        
        Somewhere in here there was a family therapy session
        Could this confound results later
        extra session-no mention of when
        
        further sessions
        s 13-16
        four sessions around parents relationship- not part of manual?
        Restructing thoughts
        role play
        No longer MDD
        dep score 25-19
        
        Modifided the manual to address family problems can this be appropriately measured - is the reduction of MDD based on family therapy and
        
        Pre mid post Measures of Depression CDI- measured symptoms 2 to 4 weeks but graph is not clear as to when.
        test-retest reliability of the CDI varies quite considerably and somewhat unsystematically with the length of the intertest interval and the characteristics of the sample being studied brook 2001
        This variation between measurments may also be misleading
        Self concept PHCSC Disfunctional attitude DAS, suicide ideation SIQ-jr
        
        only reports pre post and fllow up does not state mid measures
        This may have helped better understand what parts of treatment were impacting what outcomes
      - Requirements of single case designs
        (Kazdin)
        • A major requirement of single-case designs is specification of the goals
        of treatment or those symptoms and areas of functioning that are to be
        altered.
        • Identify prior to applying treatment what sorts of changes will be used
        to evaluate progress and then how these will be measured
        • Use of measures that can be administered or obtained on several
        occasions
        • The use of repeated observations of performance over time to compare
        performance under different conditions
        • Since baseline performance is used to predict how the client will
        respond in the immediate future, it is important that the data are
        relatively stable.
        • The greater the variability in the data, the more difficult it is to draw
        conclusions about the effects of the treatment.
        
        Look at this study using this lense
        Hermeneutic Single-Case
        Efficacy Designs
        • Aim to:
        • (1) demonstrate that change occurred;
        • (2) examine the evidence for concluding that therapy
        was responsible for the change;
        • (3) examine alternative explanations for the change; and
        • (4) examine which processes in therapy might have
        been responsible for change.
        
        Example of Latency of Change
        (Kazdin) • The closer in time that the change occurs after
        the intervention has been implemented, the
        clearer the intervention effect.
    - - AB design has absence of other in formation that could be making difference in this case change of school, family therapy was used given the cultural aspects the introduction of this may be a confounding factor that is not measured (outcome not purely a cbt thing) difficult to tease apart what made a difference here given lack of methodological rigour.
        Causal influences throughout may have impacted outcomes
        
        Cook and Campbell’s (1979) list of internal validity threats (see Chapter 8) can be used; in addition, Elliott (2002) highlights validity threats that are specific to single-case studies.
        
        page 199 of text book go through alternative explanations
        
        Records of therapy sessions . Audio or video recordings, or detailed process notes, are an excellent source of information about what actually happens in sessions. (They can also be used to corroborate or clarify self-report data.) Therapeutic relationship measures can be administered every session, or less frequently (e.g., every three to five sessions). The most widely used such measure today is the revised short form of the Working Alliance Inventory (Hatcher & Gillaspie, 2006). Self-report session measures can be completed by the client or the therapist. The Helpful Aspects of Therapy Form (Llewelyn, 1988) is a qualitative measure of client perceptions of significant therapy events. The Session Evaluation Questionnaire (Stiles, 1980) and the Session Impacts Scale (Elliott & Wexler, 1994) are quantitative measures of clients’ immediate reactions to sessions. Orientation-specific measures, completed by the therapist or the supervisor after each session, can be used to assess the therapist’s adherence to the treatment model (e.g., the Revised Cognitive Therapy Scale: Blackburn et al., 2001).
        
        Barker, Chris, et al. Research Methods in Clinical Psychology : An Introduction for Students and Practitioners, John Wiley & Sons, Incorporated, 2015. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/acu/detail.action?docID=4038573.
      - hey are poor at establishing typicalities or general laws.
      - Also met criteria for GAD, separation anxiety disorder and ADHD what is really at play is depression result of others? Maybe check DSM criteria for differencial diagnosis
        Lack of progress during goal setting time management may be ADHD related - however mention of incomplete homework and possible internalised symptoms may impact
        Greatest stressor family problems - familt therapy may have confounded results - cultural familismo - correlates with teen depress- may be a confound
      - Mention of previous medication but no dose offered nor mention of meds during study
        states in discussion antidepressants were used but does not give detail regarding dose or consistency of use
      - this study did not conduct any statistical analyses, therefore findings could only be inferred.
    - - good for looking at phenomena in depth, demonstrating that certain phenomena exist, or disconfirming theories by providing counterexamples. T
    - - Does this study answer the aim?
        No it does not because it doesn't investigate the specific variables that may impact outcomes for this client. Alt diagnosis- meds-cult-family therapy-school change.
        stated later DISC-V assessement Mdd criteria no longer met was reason to stop treatment.
  - - - page 198 of textbook goes through a good example of a case study does this match up?
- - - - Small n diagnosis of MDD was established using the
        Diagnostic Interview Schedule for Children (DISCIV).
        Symptoms of depression were assessed every 2–4 weeks
        throughout therapy using the Children’s Depression
        Inventory—CDI. The Children’s Depression
        Rating Scale—
        CDRS-R[18] was also used to assess
        depressive symptoms at baseline, termination, and
        follow-up (Table 1).
        Self concept Piers Harris Children’s Self-concept Scale—PHCSC,[19]
        Hopelessness Scale for Children—HSC,[20] the
        Dysfunctional Attitude Scale—DAS,[21] and the
        Suicide Ideation Questionnaire—SIQ-Jr[
      - RTC To assess depression in first instance primary outcome measure was presence of a depression diagnosis based on a semi-structured diagnostic
        interview, the Kiddie-Schedule for Affective Disorders and Schizophrenia, present and lifetime version40.
        Secondary outcomes included depressive symptoms, severity of depression, global functioning, suicide risk,
        and comorbidity.
        Depression primary outcome assessed KSAD
        Degree of depressive symptoms was measured by means of self-report using the Child Depression Inventory-II (CDI-2) self and parent report
        
        Severity of depression was rated by the therapist on the one item Clinical Global Impression-severity scale (CGI-S)
        Global functioning of the adolescent was assessed by the therapist on the Children Global Assessment Scale
        (CGAS) both rated by therapist
        Suicide criteria were assessed with the Suicide Criteria Assessment (SCA) self report
        Comorbid psychopathology was assessed on two levels namely on diagnosis level with the K-SADS (present or
        absent) and
        on symptom level with the Youth Self Report scale (YSR)55 for adolescents and the Child Behavior
        Check List (CBCL) for parents
        Demographic information was gathered by questions