Vol-7, Special Issue-Number4-June, 2016, pp834-844 http://www.bipublication.com
Research Article
The Effect of Group Cognitive Therapy on Reducing Depression in the
Female Patients with Severe Obsessive-compulsive Disorder
Vida Mohammadi Heris and NaimehYousefi* Department of Psychology, TabrizBranch,
Islamic Azad University, Tabriz, Iran
ABSTRACT
Introduction: The high prevalence of mental health problems among psychiatric patients with severe obsessive-compulsive disorder is depression that is one of the methods of non-pharmacological treatment of group cognitive therapy. In this study, the effect of cognitive therapy in reducing depression of female patients suffering from severe obsessive-compulsive disorder examined.
Methods: In this study, patients were randomly divided into control and experimental groups and both groups were tested by Beck Depression Inventory before the intervention (second revision). The experimental group participated in ten sessions of cognitive therapy while the control group received no intervention. At the end of the intervention, both groups were evaluated by the test. Results: The data obtained using dependent and independent T test were evaluated. A positive impact in the cognitive therapy group showed decreased depression.
Conclusion: The method of group cognitive therapy is effective in reducing depression in patients with severe obsessive-compulsive.
Keywords: cognitive group therapy, depression, obsessive-compulsive disorder
INTRODUCTION
Depression is as the third most common mental disorders and disorders, obsessive-compulsive disorder is as the fourth most common mental disorder (Psychiatric Association of America) [1] because of the features that have a devastating impact on job performance, academic and social influence people. (Asin, Mnkbv, Pinto, Cowles, Pagano et al., 2006) [2] Disorder, obsessive-compulsive disorder is a relatively common condition which, according to the World Health Organization of the tenth 5 (Who) conditions that lead people towards disability and always with the destruction of social functioning and poor quality of life. (Wells & Fisher, 2006) [3] Westphal, a professor of Psychiatry University of Berlin (1877) was the first person who focused on the prevalence of the disorder was rarely seen in mental hospitals. (Sbrg, 1989) [4] Clinical experience suggests that number of people are
diagnosed with obsessive-compulsive disorder are increasing due to various reasons such as culture, education, and different pressures. Obsessions like fear is the most important man's mental and psychological diseases and as it may cause helplessnessin person in hisworkplace or location, it should be treated. (EslamiNasab, 2004) [5] Various factors are involved in causing obsessive including the biological factors, psychological and environmental factors that among which family factors are known as one of the strongest predictors of obsession. Many people occasionally have unwanted thoughts, and many sometimes have this enthusiasm in a way that is embarrassing or even dangerous; but only the few suffer from obsessive-compulsive disorder.
uncontrollable thoughts and forces him to repeat the action that interrupt his daily works. Prevalence of the disorder is estimated between 1 and 2 percent of the population and is more common among women than men (Cono and Goulding, 1991; Stein et al., 1997). Usually it begins in early adulthood and often in stressful event such as pregnancy, childbirth, family conflicts or problems. [6]
Obsessions are thoughts, impulses, and annoying ideas that unwittingly come to mind and are known as irrational and uncontrollable acts.
Clinically, the most common obsessions include fears of contamination, fear of sexual or aggressive impulses, or fears about the dysfunction of body (Jenike, Bear, and Minchi Yellowstone, 1990) [7]. It is also possible that obsessions may be appeared in form of doubt, laziness and procrastination and excessive uncertainty.
Compulsion is repetitive behaviors or mental acts that patient to reduce distress caused by the provocative thoughts or does it to prevent terrible events. This obviously has no real connection to its superficial or exaggerated communication. Often someone who repeatedly repeats a certain action, is afraid that if you do not run it, got the terrible consequences. It is possible that an action is repeated a number of times, surprising. The most common disorder is the result of obsessive-compulsive disorder, it has adverse effects on relationships with others,
especially family members.
Persons such as spouses, children, friends, byseeing the need for an inexhaustible frequent washing of hands per minute, wipe the door handle, or counting bathroom floor tiles, are likely to suffer discomfort or even disgust him. This aggressive feelings are probably sinful because they understand that the patient cannot do anything to fix this meaningless affairs. But depression is a collection of morbid symptoms include depressed mood, loss of interest, anxiety, sleep disturbance, loss of appetite, lack of energy and thoughts of suicide. (Lindsay and Paul, 1994) [8] Clinical depression is so common colds has been called psychiatry.
(Williams, 1996; orifice and Sylgmn, 1995) [9] It is believed that about 75% of admissions to psychiatric hospitals to constitute cases of depression. (Blackburn and Davidson, 1992; Bernal and Russolo, 2007) [10], [11]
Depression is a mood disorder that is caused by social and environmental stresses caused due to various physical ailments. It also changes some of the chemical compounds such as serotonin in the nervous system is also effective in the development of this disorder. While a person has other mental illnesses, including obsessive-compulsive disorder usually associated with symptoms of depression. So it can be concluded that the range of factors involved in the pathogenesis of this disorder and that is why the outbreak has spread. (Sadok and Kaplan, 2003) [12] According to the World Health Organization estimates that by 2020, after cardiovascular disease, depression is as the second life-threatening disease and health of people around the world. While only 25 percent of that number will have access to effective treatments. (WHO, 2008)[13] Depression has economic, cultural, health and social costs for patients, their families and the community. DSM data on patients with depression often have symptoms such as watery, irritability, preoccupation, obsessive rumination, anxiety, panic, extreme concerns about the health and glory of the pain and discomfort. In addition, some also are experiencing panic attacks disorder.
have at least one disorder. (Anthony, Downey and Vinson, 1998) [14]
Most people with OCD who have been referred to the clinic are at least one axis I disorders. (Genic, Bear and mini Chilo, 1990) [10]Depression is often a comorbid psychiatric disorder that most obsessed with is to be considered. (Kardonr et al., 2007). [15] Simultaneous occurrence of depression in patients with obsessive-compulsive disorder is very high. In addition, the presence of depression increases the incidence of obsessive-compulsive symptoms. So intense is contributing to the disorder. During a period of depression in patients with obsessive-compulsive disorder, depression is often explicitly. Recent studies in the field of psychiatric comorbidity have come to the conclusion that 75% of adult patients with obsessive compulsive disorder have also experienced depression. This high rate of comorbidity some to conclude that perhaps obsession is another form of mood disorders (Rikiardi and McNally, 1995) [16] So far, several methods have been proposed for the treatment of depression and in this regard, the cognitive view is one of the most influential theories about depression. (Sarason, 2004) [17] Over the past 40 years, at least two major mutations existed in theory and treatment of depression. One is the use of drugs to relieve the symptoms of depression and cognitive therapy. The most common treatments for depression are antidepressants such as Fluoxetine.
This class of drugs are relatively inexpensive. However, depression is the desire to return and one-half to three-quarters of depressed patients within 2 years after recovery again faced with another period of depression. Roots should be in the minds of philosophers like Epictetus cognitive approach, psychologists such as William Shakespeare and Alfred Adler, Horney, Sullivan and Frankel. Before the formation of the cognitive approach in the 1960s and 1970s behavioral psychologists, depression as a lack of skills or lack of reinforcement were considered. State of
anxiety with relaxation training or as a set of phobias using exposure-based techniques, were treated, but none of these methods are not satisfactory in the treatment of the aforementioned disorders.
In other words, it did not seem that behavioral theories can explain properly depression. Therefore, in the 1960s, some therapists were aware of these problems and try to have a great view of behavioral problems in the treatment of anxiety, depression and other disorders resolve. Scientists such as Richard Lazarus, Fva, Emile Camp in 1973, 1972; Bandura, Levin Sun in 1974, Aaron Beck, Albert Ellis, Michael roof in 1975, 1972, Sylgmn in 1974, Rush, Shaw & Emery in 19791977 years based on theories about emotional disorders impair thinking, which thus cognitive view was put forward. [18]
However, cognitive therapy in the late fifties in the treatment of psychological problems and psychiatric disorders such as anxiety and mood disorders, anger management and was used to treat schizophrenia. Cognitive scientists believe the cause of human psychological problems and psychiatric disorders, perceptions and interpretations false, vicious and irrational thoughts that people from environmental events rather than the events themselves.
Cognitive therapy to change faulty thinking patterns so touched and believe that changingthe thoughts and replace the defective healthy thoughts can be greatly reduced human problems and psychological distress. Cognitive therapy provides a sustained pattern of short-term treatment and therapists can treat it simply teach techniques. (Davidson, 2004) [19] Cognitive therapy is an effective intervention for depression, especially in the case of adults. (Holon and Beck 1995; Rink,, Ryan and Dabvys 1997; Roth and Fvnagy 2005) [20] According to Frey (1999) [21] traditional cognitive therapy alters a person's intellectual beliefs, while less manipulated emotional beliefs and some of these interventions make it
more effective.
members of the group and can develop their social skills; especially as more effective than individual therapy, group therapy on improving
performance is adult.
Given the high prevalence of depression, individual therapy cannot be held accountable for this problem. Therefore, we can use the treatment group rather than individual treatment, which is more economical in terms of cost and duration of therapy, cognitive group therapy as seek profit. According to what was said, in this research, we study the effects of cognitive therapy on decreasing depression in patients with obsessive-compulsive disorder.
Main hypothesis and sub-hypotheses
1. There is a significant difference between depression post-test mean scores in both the experimental and control groups. 2.There is a significant difference between depression pre-test and post-test mean scores in subjects in the experimental group. 3.There is a significant difference between depression pre-test and post-test mean scores in subjects in the control group. There are numerous research studies regarding this issue, some of which have been summarized:
* Rastegar and colleagues (2011) conducted group cognitive therapyon 8 depressed students in high schools of Qarchakfor 10 sessions, and after the end of treatment, they found that depression significantly decreased. [23] * HemmatiSabetet al. (2012) investigate the effect of cognitive group therapy on reducing depression on 25 percent of the victims, they conducted cognitive therapy group for 8 sessions on 60 veterans and concluded that depression significantly decreased. [24] * Tise et al (1997) conducted cognitive-behavioral therapy on 59 adolescent patients with depression for 20 sessions,and they found that 71 percent of patients recovered. [25]
* Levinson and colleagues (1999) in a review of six controlled intervention on depression news from a wide impact and improve the way that 63% of patients. [26] * Murphy et al (2001) concluded that
cognitive therapy during the study compared with drug therapy had an equal effect on the
reduction of depression,
But the risk of recurrence of cognitive decline. [27]
* Frriz et al (2002) in a research on the prevention of depressive symptoms in high school students found that cognitive group therapy are effective in preventing depressive symptoms. [28]
* In a study, Blanche (2003) sought to evaluate the effect of cognitive therapy in reducing anxiety and depression in patients with obsessive-compulsive disorder. He used Beck Depression Inventory and questionnaire state / attribute on 40 patients. After a month of group cognitive-behavioral treatment, depression and anxiety in the experimental group were reduced. [29]
In a study by Anthony (2004) Cognitive-behavioral group interventions efficiency of 10 weeks in reducing depression and stress in patients with OCD were and the results showed that cognitive-behavioral interventions to reduce depression and stress in patients with obsessive-compulsive is. [30] * Lvgsdvn (2004) Depression in Women with obsessive-compulsive disorder and primary care concluded that cognitive therapy is effective in reducing depression in these people. [31]
* Hollen, Stewart and Astrank (2006) conducted a study that concluded that cognitive therapy dramatically better than no treatment, behavioral therapy and drug therapy is effective in reducing depression. [32] * Many different research group cognitive therapy on depression treatment effectiveness in patients with obsessive-compulsive disorder have shown (Rzlv, Bernal, Diego Rivera and Medina in 2008, Smiths, Mynhajvdyn and Jarrett 2009; Shamsaei, Rahimi and Zarabyan 2009; Siegel, Astinhar, Friedman, Thompson established 2011) and the expression of all of them is beyond the scope of this discussion. [33], [34], [35]
reducing depression in patients with
obsessive-compulsive disorder.
The present study was designed to examine that issue. The expansion of existing knowledge is important theoretically and practically.
2. METHODOLOGY
This type of research proposals for pilot projects ((pre-test and post-test)) with two experimental groups and the control group.So that the two groups have been formed In order to form groups using random sampling half of eligible subjects in the experimental group and half of the subjects in the control group.Both groups before treatment were evaluated in relation to the dependent variable. Then one of the groups exposed to variable or independent variable was tested (experimental group), and the other group received no intervention in the independent variable (the control group). After Intervention (independent variable applied), both groups were re-evaluated. The data obtained from both dependent and independent T-test was used for statistical analysis.
2-1. Sample and sampling method
All patients admitted to psychiatric and psychological treatment centers in Tabriz by the psychiatrist or psychologist in charge of the medical center, obsessive-compulsive disorder - their practical approved. In order to select a sample of subjects about them was true that the inclusion criteria, 60 were selected randomly, each test and control groups included 30 people randomly. The age range was 24 to 48 years.The average age of both the experimental and control groups, respectively 32.9 and 33.8. All subjects were female and did not use any of antidepressants.
2-2. Inclusion criteria
1.Having severe obsessive-compulsive disorder diagnostic criteria for ADHD based on DSM-IV-TR
2. Confirmation of the diagnosis by a
psychiatrist or psychologist for medical center 3. Not taking antidepressant medication 4. Do not use other methods of reducing
depression 5 females
6. Complete the consent form for treatment 2-3. Instrument
To detect and measure any mental disorders including depression and obsession, there are two ways: A) Therapist specifies the extent and severity of the disorder by observing the behavior and speech or patient references and background checks their behavior through references, or family members, or friends and clinical interviews and observations, and its findings with clinical diagnosis criteria. B) Another very common way is to use the tools and diagnostic, accurate and reliable and common tests that the majority of research used them because of the sheer volume of work and the tools. In this study Yale-Brown Obsessive-Compulsive Disorder Scale was used to assess and scoring OCD patients. This scale consists of Czech list of signs and symptoms of Obsessive-Compulsive Disorder Questionnaire
that assesses.
Czech bookmark list to identify 36 types of obsessions and 23 compulsions can be used. Obsessions obsessed with content types including aggression, sexual contamination, hoarding, religious, symmetry, beauty and variety of different obsessions include Memorizing trivia, fear of saying certain words, despite fears of the superstitious, there are unwanted images, sounds and words
inaudible in mind.
It also evaluated practical obsession also includes cleaning and washing, checking out, order, hoarding and collecting and obsessions Miscellaneous operations include the need to question or confess, use mental rituals to undo bad thoughts, having to touch the objects , superstitious practices and the removal of body hair.
This test has a separate list for assessment of obsessive thoughts and actions, each list has a total of five test material which has 10 articles, any material which is between zero and four scores.
this type of disorders. Cronbach's alpha reliability coefficient of the scale is estimated0.91 to vary from 850 test and the correlation between the two halves. (Goodman
and Press, 1989) [36]
The scale was translated into Persian and its reliability has been proven by khalaji 72/0 with Cronbach's alpha coefficient. (Khalaji, 2000) [37] But the tests and questionnaires have been prepared to assess depression, Beck Depression Inventory, including depressive states is the most appropriate tool for reflection. This study used the questionnaire that contained 21 articles which physical symptoms, cognitive and behavioral measures of depression. Each one has 4 options that can be scored on the basis of zero to 3 degrees of depression from mild to severe. Tshe maximum score on the test is 63 and the minimum is zero. [38]
This questionnaire has been studied by many
people over the years is
And is known as the best inventory in determining depression (Beck et al., 1987 to 1961; Schwab, 1967; Metcalf & Goldman, 1965; Vahabzadeh, 1377) [39], [40], [41] Beck Depression Inventory II (BDI-II) was Yazngry the Beck Depression Inventory that has been developed to measure the severity of depression (Beck, Brown and Steer, 2000) [42] This questionnaire has beenstudied for many years, and completing it takes 5 to 10 minutes. That is what feels right at the time of the questionnaire. Depression score was obtained by summing the scores of options. The cut off point for screening questionnaire is 13. (Marnat,2000) [43] Psychometric studies conducted on the second edition of this questionnaire show that has good reliability and validity, and in general this questionnaire is suitable successor for its first edition. Beck, Steer and Brown (2000) evaluated the internal consistency of the instrument 0.73 to 0.86 and an average alpha for patients 0.86 and
healthy people 0.81.
Also Beck (1972) reported to test the validity of the test by the method of Spearman-Brown 0.93.
In Iran, Ghasemzadeh and colleagues (2005) in their study achieved the test's internal consistency and reliability 0.87through retest
0.73 respectively.
Also Dobson and Mohammad Khani (2007) achieved alpha coefficient for outpatient 0.92 and 0.93 for students and retest coefficients
within a week 0.93. [44]
In addition, a study conducted on 125 students of Tehran University and AllamehTabatabai University to evaluate the reliability and validity of the BDI-II on Iranian population. The results showed alpha 0.78 and test-retest interval of two weeks 0.73, respectively. In addition to statistical data analysis,comparative method with the dependent and independent T test were used in SPSS.
2-4. Implementation
After selecting the sample in this study, people were randomly assigned to two experimental and control groups.Then both groups were assessed with the Beck Depression Inventory, and one of the groups as the experimental group participated 12 sessions of 90 minutes based on Practical Handbook of cognitive therapy intervention by Michael Frey (weekly sessions) which lasted for three months. But the second group (control group) did not receive psychological intervention. Treatment plan used to breakdown have been reported in the following sessions:
possible resistance to treatment and design strategies to deal with this resistance. Assignments: Identify automatic thoughts and register them with the tab B-C, category A-B-C beliefs and writing worst daily.
Third session: Introduction to the foundations of the consequences of behavior, the nature of the training schemes (core beliefs, attitudes and dysfunctional schemas) and the relationship between schemas and their thoughts. As well as identifying patterns using vertical arrow method.
Assignments: Browse assignments second session, practicing injection think, continue writing daily A-B-C-A-B-C completed writing behavioral outcomes and draw a vertical arrow
for two of them.
Fourth Session: Working on vertical arrow and solve problems that members of the group in applying vertical arrow method to identify their negative schemas they encounter. Also enabling participants to identify ten kinds of common negative stereotypes and put their faith in these ten floors. Assignments: Assignments reviewed the previous session and Education Category beliefs.
Fifth Session: Participants gain a clearer picture of how the relevance and appropriateness of negative beliefs, cognitive mapping of how negative beliefs with each
other and their ranking.
Assignments: Review homework before the meeting, a list of the main beliefs and durability due to negative beliefs, the use of ratings subjective units of discomfort, then draw a vertical arrow and categorize beliefs and grading believes the scale of any mental distress.
Sixth Session: accepting that the beliefs varied, and it is possible that people can put their
thoughts about the appeal.
Assignments: Assignments review the previous session, complete an objective analysis of the main list beliefs and the beliefs that have been identified.
Seventh session: understand the usefulness of
different beliefs and they can be based on criteria.
Eighth Session: Learn about their beliefs application of logical analysis. Assignments: Assignments review the previous session, complete and definitive analysis of the logic of all conditional schemas. Ninth session: Achieving participants believed
in the concept.
Assignments: Assignments review session to prepare a hierarchy of positions related to core beliefs, supplying the opposition with their negative beliefs find their opposite beliefs, Card Production of core beliefs one side and the other side is written negative beliefs. Tenth meeting: During the meeting the changing content area perceptual and cortical inhibition is considered optional. Assignments: Assignments review the previous session, perceptual shift education and training by providing vague images of cortical inhibition and do daily exercises optional cortical inhibition or change perception. Eleventh Session: Learn how your punishment
and reward.
Assignments: Review the previous session assignments, self-discipline and self-reward training method to change the thinking, browse the opposition believes, bore fantasy, complete
your maintenance plan
Twelfth Session: Study participants plan to hold a feedback from them about their treatment goals and treatment plan. [20]
2-5 RESULTS AND DISCUSSION
The obtained data were analyzed with SPSS software. The mean scores of depression in both control and experimental groups were compared using the t test for independent groups.
significant after intervention, we concluded the effect of this treatment.
Table 1. Comparison of depression scores of pre-test in both groups by T test
Statistical indicators of Group Frequency
Average SD
df T
Sig.
Experimental 30
33.10 10.17
29 0.40
0.67
Control 30
32.35 11.08
Based on the results in the table, such as the significant level of α=0.05 with degrees of freedom 29 of
sig=0.67 is larger than 0.05. So,there was no significant difference between depression scores at
pre-test in experimental and control groups. (p<0.05)
The result showed that both experimental and control groups before intervention in the experimental group were not significantly different in the degree of depression. To investigate the effect of cognitive group therapy in reducing depression in patients, depression scores at post-test for independent samples were compared, t test was performed in both control and experimental
groups. The comparison results are presented in Table 2.
Table 2. Comparison of experimental and control groups in depression, post-test scores in independent T test.
Statistical indicators of Group
Frequency Average
SD df
T Sig.
Experimental 30
12.07 8.90
29 -5.78
0.00
Control 30
32.15
10.15
Based on the results in the table, such as the significant level of α=0.05 with degrees of freedom 29 of
sig=0.00 is smaller than 0.05. So, there was no significant difference between depression scores at post-test IN experimental and control groups (p >0.05). For a closer look at the Table, the impact of treatment made in reducing depression in patients. The mean depression score in pretest and post-test in both control and experimental groups were compared using t-test for dependent groups. The results are shown in Tables 3 and 4.
Table 3.Comparisonof the pre-test and post-test mean score of depression in the experimental group
Statistical indicators of
Group Frequency
Average SD
df T
Sig.
Pre-test 30
33.10 10.17
29 11.53
0.002
Post-test 30
12.07 8.90
Table 4.Comparison of the pre-test and post-test mean score of depression in the control group
Statistical indicators of
Group Frequency
Average SD
df T
Sig.
Pre-test 30
32.35 11.08
29 0.675
0.705
Post-test
30 32.15
10.15
According to the results of tables,the difference in the experimental group was statistically significant (p>0.05), it proves that cognitive group therapy was effective in reducing depression, but the difference was not significant in the control group. (p<0.05) Mean scores of depression in the experimental group (in the range of 13 to 52) reduced to 11.07at the end of treatment (range from 3 to 38), but in the control group from 35/32 to 15/32 had changed.Depression scores 26 out of 30 patients starting treatment for the rest improved 50% or more. These results support the hypothesis. This means that the experimental group who participated in the
sessions of cognitive therapy showed a significant improvement in depression.
identifying and changing the thinking, behavior and emotional responses inefficient. In this study, the effect of cognitive group therapy in reducing depression in patients with obsessive-compulsive Michael Frey has been investigated.
The results of tests done on the pre-test and post-test in both groups of patients showed that the effect of cognitive group therapy in reducing depression in patients with obsessive-compulsive Michael Frey was significant. The result of the research findings was consistent with AkhoundMakei(1997); Hosseinnejad (1997); Rastegar and colleagues (2011), Tise (1997), Levinson et al. (1999); Murphy et al (2001); Frriz et al. (2002), Paul Bolton (2002) and Blanche (2003), Anthony (2004); Logsdon (2004), Smiths, Minhajodin and Jarrett (2009); Siegel, Astinhar, Friedman, Thompson and
Tasi, 2011).
Group therapy is superior compared to other therapies do this group of patients because of the shared experiences of members and found the patient to the point that others have similar problems, or worse, induction hope to improve, a sense of altruism, social skill development, getting feedback from their behavior, and accept it on behalf of repressed emotions outflow, and a helpful exchange of intellectual sympathy and support for patients and also provides for patients by other groups,.
At the end of each treatment period, subjects were asked after treatment to which they have the most benefit for them. The self-reported several cases have appeared. First, the treatment group, a social support for patients who have previously had created feelings of isolation and loneliness.
The second view other participants, these people are noticing that their problems will be experienced by others and thereby feel lonely, blame and shame and slowed and allowed them to discuss solutions or coping strategies, useful and constructive exchanges have together. Third thought and empathy for problems and other inconveniences helped them to revive the self-esteem.
The total number of patients reported that learning, cognitive restructuring, has enabled them to focus on the positive aspects of life and to more effectively utilize the support and help of others and to better understand the causes of depression and inner skills to modify their depressive thoughts.
CONCLUSION
By considering the results of this study, it can be concluded that cognitive group therapy by Michael Frey can be an effective method in reducing depression in patients with obsessive-compulsive disorder and increase their quality of life.
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