The effectiveness among inpatients with depression of a modified cognitive behavior therapy (CBT) program was examined. A group of 300 inpatient admissions with a primary diagnosis of depression attending a private psychiatric clinic were assessed at the beginning and end of a two-week CBT program. The effectiveness of the treatment was demonstrated by improvements on the Beck depression inventory (BDI), the health of the nation outcome scales, locus of control of behaviour scale, and the global assessment of function. The changes on the BDI for patients with depression were benchmarked against estimates generated from published studies. The degree of change in a two-week period for inpatients with depression was similar to that observed in efficacy studies of CBT that typically run over a more extended time. Implications for integrating CBT with inpatient services are discussed. 1. Introduction Translating empirically validated treatments into routine clinical practice is an essential activity that requires a multitude of factors to be addressed. For any given disorder, some of these factors include the type of patients being treated, the setting in which treatment is delivered (including the funding arrangements and costs incurred), the attitudes and perceptions of staff about the treatment, and the other psychological and physical disorders, diseases, and disabilities that may co-occur with the condition being treated [1]. These various factors mean that the translation will first involve a thoughtful adaptation to the given setting that takes into account local issues, current practices, staff attitudes, and funding arrangements. Secondly, translation will involve evaluation of the effectiveness of the resulting treatment plus an empirical consideration of factors believed to influence outcome so that treatment can be further improved [2, 3]. The present paper reports an attempt to translate a cognitive-behavioral program for depression to an inpatient hospital setting. There is sound evidence supporting cognitive-behavioral therapy (CBT) in the treatment of depression [4], but little direction about adaptation to inpatient settings. When considering translation into an inpatient setting, a number of considerations are important. First, people with depression who require inpatient admissions often do so at a time of crisis or extreme symptom severity, and the aim is to quickly and safely return them to levels of independent function. For instance, inpatient treatment may be appropriate if there is a risk of suicide, but a goal will be to reduce
References
[1]
L. E. Beutler and J. Clarkin, Systematic Treatment Selection: Toward Targeted Therapeutic Interventions, Brunner/Mazel Integrative Psychotherapy Series, Brunner/Mazel, New York, NY, USA, 1990.
[2]
L. E. Beutler, “Empirically based decision making in clinical practice,” Prevention & Treatment, vol. 3, article 27, 2000, http://journals.apa.org/prevention/volume3/pre0030027a.html.
[3]
E. A. Newnham and A. C. Page, “Bridging the gap between best evidence and best practice in mental health,” Clinical Psychology Review, vol. 30, no. 1, pp. 127–142, 2010.
[4]
P. E. Nathan and J. M. Gorman, A Guide to Treatments That Work, Oxford University Press, New York, NY, USA, 3rd edition, 2007.
[5]
J. J. Manning, G. R. Hooke, D. A. Tannenbaum, T. H. Blythe, and T. M. Clarke, “Intensive cognitive-behaviour group therapy for diagnostically heterogeneous groups of patients with psychiatric disorder,” Australian and New Zealand Journal of Psychiatry, vol. 28, no. 4, pp. 667–674, 1994.
[6]
A. L. Peterson and T. S. Halstead, “Group cognitive behavior therapy for depression in a community setting: a clinical replication series,” Behavior Therapy, vol. 29, no. 1, pp. 3–18, 1998.
[7]
A. T. Beck, Cognitive Therapy for Emotional Disorders, New American Library, New York, NY, USA, 1976.
[8]
W. McDermut, I. W. Miller, and R. A. Brown, “The efficacy of group psychotherapy for depression: a meta-analysis and review of empirical research,” Clinical Psychology, vol. 8, no. 1, pp. 98–116, 2001.
[9]
P. M. McEvoy and P. Nathan, “Effectiveness of Cognitive Behavior Therapy for diagnostically heterogenous groups: a benchmarking study,” Journal of Consulting and Clinical Psychology, vol. 75, no. 2, pp. 344–350, 2007.
[10]
A. C. Page, G. R. Hooke, and E. M. Rutherford, “Measuring mental health outcomes in a private psychiatric clinic: Health of the Nation Outcome Scales and Medical Outcomes Short Form SF-36,” Australian and New Zealand Journal of Psychiatry, vol. 35, no. 3, pp. 377–381, 2001.
[11]
A. Ellis and R. A. Harper, A New Guide to Rational Living, Prentice Hall, Englewood Cliffs, NJ, USA, 1975.
[12]
A. C. Page and G. R. Hooke, “Outcomes for depressed and anxious inpatients discharged before or after group cognitive behavior therapy: a naturalistic comparison,” Journal of Nervous and Mental Disease, vol. 191, no. 10, pp. 653–659, 2003.
[13]
A. T. Beck and R. A. Steer, Beck Depression Inventory Manual, The Psychological Corporation, Harcourt Brace Jovanovich, San Antonio, Tex, USA, 1987.
[14]
A. R. Craig, J. A. Franklin, and G. Andrews, “A scale to measure locus of control behaviour,” British Journal of Medical Psychology, vol. 57, no. 2, pp. 173–180, 1984.
[15]
M. Rosenberg, Conceiving of the Self, Basic Books, New York, NY, USA, 1979.
[16]
J. K. Wing, A. S. Beevor, R. H. Curtis, S. B. G. Park, S. Hadden, and A. Burns, “Health of the nation outcome scales (HoNOS): research and development,” British Journal of Psychiatry, vol. 172, pp. 11–18, 1998.
[17]
E. A. Newnham, K. E. Harwood, and A. C. Page, “The subscale structure and clinical utility of the Health of the Nation Outcome Scale,” Journal of Mental Health, vol. 18, no. 4, pp. 326–334, 2009.
[18]
American Psychiatric Association., Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, Washington, DC, USA, 4th edition, 1994.
[19]
N. S. Jacobson and P. Truax, “Clinical significance: a statistical approach to defining meaningful change in psychotherapy research,” Journal of Consulting and Clinical Psychology, vol. 59, no. 1, pp. 12–19, 1991.
[20]
L. A. Robinson, J. S. Berman, and R. A. Neimeyer, “Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research,” Psychological Bulletin, vol. 108, no. 1, pp. 30–49, 1990.
[21]
A. C. Page and G. R. Hooke, “Increased attendance in inpatient group psychotherapy improves patient outcomes,” Psychiatric Services, vol. 60, no. 4, pp. 426–428, 2009.