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Williams et al. (2013) Combining imagination and reason in the treatment…
Williams et al. (2013) Combining imagination and reason in the treatment of depression: a randomised control trial of internet based cognitive bias modification and internet-CBT for depression (CLINICAL CONTEMPORARY STUDY - DEPRESSION)
Aim
To investigate if a combined 7-day treatment of cognitive-bias modification training programme (CBM-I) with internet-based cognitive behavioural therapy (iCBT) after 10 weeks would be effective in reducing symptoms of depression.
Results
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There was no significant difference in any of the baseline measures, age, gender, medication usage or patient's ratings of treatment expectations.
Conclusion
They concluded that the combined intervention of CBM-I and iCBT is effective in improving depression and anxiety symptoms in patients with depression.
Evaluation
✓/✗ Reliability - This study had high reliability due to the standardised procedure and controlled methods used. Multiple primary and secondary baseline measures were used to assess the impact of the treatment and the online screening questionnaires were compared with a diagnostic telephone call if they got through to the sample. However, the final questionnaire was a self-report and not diagnostic so it may be have been subject to demand characteristics.
✗ Generalisability - This study lacks generalisability. This is firstly due to the restrictive inclusion criteria for those with depression, such as those over 65. Furthermore, the sample was taken exclusively from Sydney, Australia making it ethnocentric. So this means we can't be sure of the extent to which other individuals with milder or more severe depressive episodes or geographies may find this combined treatment more effective.
✓ Application - This study shows that combined CBM-I and iCBT are effective very quickly which means that people who need therapy can access it quickly rather than waiting until a therapist is available or the need to pay for expensive face-to-face clinical sessions. Therefore, this alternative is more practical for patients with depression and less troubling for their symptoms.
✓ Ethics - The 69 participants all gave informed consent before the study began and were put through a screening process to check their suitability for the treatment. Furthermore, the participants were given the right to withdraw at different stages of the study, and some did drop out throughout the study. The study was approved by St. Vincent's hospital's human rights ethics committee in Sydney.
✓ Validity - This study had high validity. Interviews and questionnaires were used to measure changes, statistical tests were carried out to determine a suitable sample size to obtain valid results and enlarged this in case of attrition rates, established primary and secondary baseline measures were used to measure depression and participants completed online screening questionnaires such as PHQ9.
Method
Williams used a mix of independent groups with his intervention and WLC, and repeated measures by getting both sets of participants to undergo more than one phase.
Procedure
Applicants for the study completed an online questionnaire about symptoms, and those who had the criteria for unipolar depression were included in the sample. All the patients completed primary and secondary baseline measures, such as K10 (Kessler et al.(2002) and STAI-T (State Trait Anxiety Inventory-Trait Version) respectively. The intervention group did a 7-day CBM-I treatment, then did a post-treatment questionnaire and had a 10-week course of iCBT. The WLC group had no treatment through both the 7-day CBM-I and 10-week iCBT, but received deferred treatment after this.
Sample
69 participants were recruited from online applications via a clinical research unit in Sydney, Australia. They were randomised where 31 participants were in the wait-list control group (WLC) and 38 were in the intervention treatment group.