Cognitive Behaviour Therapy for Depression and Anxiety

Discussion and Conclusion of Blues Begone Research Results

Welcome to the discussion and conclusion section of the Blues Begone research results for cognitive behaviour therapy for depression and anxiety program Blues Begone.

This page forms the ninth article in a series about the Blues Begone User Experience. You can access the complete set of articles at the bottom of this page.

Cognitive Behaviour Therapy for Depression and Anxiety: Aim of the study

The aim of the current study was to explore the individual experience of participants as they engaged with the computerised CBT programme, Blues Begone, and further our understanding of how individuals find might find self-help therapy useful.

 Cognitive Behaviour Therapy for Depression and Anxiety: Benefits of Blues Begone

Analysis showed that by using the Blues Begone programme, most participants gained information to help clarify both their present situation and a way forward, and were offered techniques, strategies and “tools” to help them address their difficulties on a practical, ongoing basis.

cognitive-behaviour-therapy-for-depression-and-anxiety-toolbox-strategies

Through access to the skills development, coping strategies and behavioural techniques offered by the programme, participants were able to put their new learning and theoretical perspectives into practice.  Thus empowered, the benefits of the programme were dramatic for some (Caroline, Frank and Grace in particular), with individuals experiencing an emotional shift, and regaining confidence in their own abilities as a result of recognising and challenging limiting self-beliefs about their capabilities and self-worth.

Cognitive Behaviour Therapy for Depression and Anxiety: Becoming Empowered

However, becoming empowered as part of the self-help process seemed to involve considerably more than being given information and education by the Blues Begone programme.  In line with Frank and Frank’s (1991) hypothesis highlighted earlier, several participants seemed able to use their imagination and powers of symbolisation create a “relationship” with the self-help material, a relationship of sufficient depth as to be able to use it as a source of motivation, support, and encouragement, engendering hope that their situation could be improved.

Cognitive Behaviour Therapy for Depression and Anxiety: Engagement

The Blues Begone programme appeared to be able to engage users, incorporating several factors known to be important to successful face to face therapy: participants were reassured as to any concerns over confidentiality; the facility of being able to carry out self-help activity within the privacy of their own home seemed to provide participants with a secure base from which they could explore their issues; participants appeared to respond positively and felt “welcomed” by the friendly, supportive and often humorous nature of the material, and in the main, found both the content and process of the programme to be credible.

cognitive-behaviour-therapy-for-depression-and-anxiety-computer
It would appear that the characteristics of face to face therapy, long since recognised as being conducive to creating the appropriate environment for therapeutic change, were translated into the self-help media, with the user becoming engaged into the self-help process and motivated to come back for more.   Thus for several of the participants’ the virtual relationship seemed to offer many of the effective attributes of the face to face therapy.

This interaction between participant and self-help material seemed to support the views of Richardson and Richards (2006); that is if the factors that influence success in face to face therapy can be somehow adapted and explicitly incorporated into self-help materials, then self-help activity is likely to be more effective.

Importantly, the nature of participants’ interaction with the self-help material was felt to be active rather than passive, with the structure of the programme offering a physical framework for individuals’ efforts.  Providing a similar function to the behavioural strategy of activity scheduling employed by CBT therapists (see Beck, 1995), this approach seemed to raise the lowered activity levels of some participants’, with individuals reporting an increased sense of mastery and control over their efforts.

 Cognitive Behaviour Therapy for Depression and Anxiety: Structure and Framework

Supported by an overall structure and a variety of frameworks with which to gain clarity and order, several participants were able to find the mental space to focus on their issues, their cognitive abilities being awakened by the stimulation of new information and perspectives.

Whilst not necessarily being able to make use of the intensity and depth of a human relationship to address psychological problems, perhaps users were supported by the Blues Begone programme in a different way, their minds being stimulated instead by a breadth of information and ideas, such that they were able to create new experiences for themselves and through these develop new perspectives and solutions.

Cognitive Behaviour Therapy for Depression and Anxiety: Empowerment and Achievement

Participants’ growing sense of empowerment appeared to be reinforced by their achievements as progress in their self-help activity was recognised by the virtual therapist at key points in the programme and more importantly, by signs of their own clinical improvement.

cognitive-behaviour-therapy-for-depression-and-anxiety-computer-user

 

Research suggests that achievements individuals attribute to their own efforts enhance feelings of mastery and self-esteem more strongly than do those attributed to external factors (see Bandura, 1997 for discussion); perhaps self-help activities relying heavily as they do on the individual’s personal agency have the potential to be particularly effective in this respect.

However it would appear that the foregrounding of the individual in this way may be somewhat of a double edged sword.  Whilst self-help material has the potential to stimulate and facilitate individual psychological process, the responsibility of the “work” of therapy lies with the client. Thus the client’s initial psychological position, their openness to new experience, their willingness to become engaged in and committed to the process becomes essential to the self-help material being used to maximum effect.

Conclusions and Recommendations

In many respects, participants’ experience of the Blues Begone programme revealed that the process of self-help therapy shares several similarities with that of other psychotherapies.  For example: whilst symbolic, findings showed that several participants developed a therapeutic “relationship” with the self-help material; individuals found a healing setting for their work in the privacy and intimacy of their own home rather than in a GP’s surgery or a therapist’s consulting room; the Blues Begone programme offered a framework through which participants could begin to understand their issues; and by means of an interactive format, the programme presented strategies with which participants could begin to restore their mental health.

Blues Begone

Blues Begone is an effective treatment for depression and anxiety

However, participants’ reports also showed that whilst self-help therapy might be considered to have an underlying framework in common with other psychotherapies, the use of that framework varies considerably with the balance of “power” shifting from the therapist to the client.

The responsiveness and degree of the face to face therapeutic relationship cannot be replicated through the self-help media; but it is presumptuous to then assume that the value of this intervention is thus irrevocably diminished.  Findings indicated that most participants (though not all) were able to make use of other sources of support to “mobilise, focus and use their own resources for self-change” (Bohart &Tallman, 1999) and feel hope in the possibility of change.

 Cognitive Behaviour Therapy for Depression and Anxiety: Agent of change

In the absence of the “live” therapist, the client was fore-grounded in the healing process, becoming indeed the primary agent of change.  Thus the role of the self-help material as Bohart and Tallman proposed is to act as facilitator to the client’s process, in the present instance providing participants with structure and stimulus for them to be able to access their own resources and help themselves.  “Interventions” within this type of therapy are offered as aids to clients’ self-growth; not applied to clients as mechanistic techniques designed to change them.

Identifying the appropriate methods by which to do this, and exploring further the nature of the interaction between user and material would appear to be the future challenge of developing this type of therapy; a therapy that deserves to be considered as “a sophisticated intervention in its own right” (Richardson & Richards, 2006)

References

Bandura, A. (1997). Self-efficacy. The Exercise of Control. New York: Freeman

Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. Guildford Press: New York.

Bohart, A.C. & Tallman, K. (1999). How Clients Make Therapy Work: the process of active self-healing.WashingtonDC: American Psychological Association

The Centre for Economic Performance’s Mental Health Policy Group (2006). The Depression Report. A New Deal for Depression and Anxiety Disorders. http://cep.lse.ac.uk/research/mentalhealth

Christensen, A.&Jacobson, N.S. (1994). Who (or what) can do psychotherapy? The status and challenge of non-professional therapies.  Psychological Science, 5, 8-14

Frank, J.D. & Frank, J. B. (1991). Persuasion and Healing.Baltimore: JohnHopkinsUniversity Press

Gould, R.A. & Clum, G.A. (1993). A meta-analysis of self-help treatment approaches. Clinical Psychology Review, 13, 169-186

Hovarth, A.O. & Bedi, R.P. (2002). The alliance. In J.C. Norcross (Ed.), Psychotherapy Relationships that Work: therapist contributions and responsiveness to patients.New York: OxfordUniversity Press.

Ilardi, S.S. & Craighead, W.E. (1994). The role of non-specific factors in cognitive-behavior therapy for depression.  Clinical Psychology: Science and Practice, 1,138-156

Kaltenthaler, E., Parry, G. & Beverley, C. (2004). Computerised cognitive behaviour therapy: a systematic review. Behavioural and Cognitive Psychotherapy, 30,193-203

Mains, J.A. & Scogin, F.R. (2003). The effectiveness of self-administered treatments: A practice-friendly review of the research. Journal of Clinical Psychology, 59, 237-246

McKendree-Smith, N.L., Floyd, M. & Scogin, F.R. (2003). Self-administered treatments in depression: A review.  Journal of Clinical Psychology, 59, 275-288

National Institute for Clinical Excellence (2004a). Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. Clinical Guideline, 22.London: National Institute for Clinical Excellence

National Institute for Clinical Excellence (2004b). Depression: management of depression in primary and secondary care. Clinical Guideline 23. London: National Institute for Clinical Excellence.

National Institute for Clinical Excellence (2006). Computerised cognitive behaviour therapy for depression and anxiety. Review of technology appraisal 51.London: National Institute for Clinical Excellence.

Purves, D. & Purves, B. (2005). Blues Begone. Self Help Solutions Inc.

Richardson, R. & Richards, D.A. (2006). Self-help: Towards the Next Generation. Behavioural and Cognitive Psychotherapy, 34, 13-23

Rogers, A., Oliver, D., Bower, P., Lovell, K. & Richards, D. (2004). People’s understandings of a primary care-based mental health self-help clinic. Patient Education and Counselling, 53 (1), 41-46.

Smith , J.A. & Osborn M. (2003). Interpretative phenomenological analysis. In J.A. Smith (Ed.) Qualitative Psychology. London: Sage

Return from Cognitive behaviour therapy for depression and anxiety – Discussion and conclusion to DrPurves.com Home

Return from Cognitive behaviour therapy for depression and anxiety – Discussion and conclusion to Blues Begone User Experience

Related articles for cognitive behaviour therapy for depression and anxiety program Blues Begone

  1. Blues Begone: The User Experience
  2. Blues Begone Research
  3. Method of Blues Begone Research
  4. Research Results – Part 1
  5. Research Results – Part 2
  6. Research Results – Part 3
  7. Research Results – Part 4 
  8. Research Results – Part 5

 

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