Skip to main content
×
×
Home

Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial

  • E. R. Watkins (a1), R. S. Taylor (a2), R. Byng (a3), C. Baeyens (a1), R. Read (a1), K. Pearson (a1) and L. Watson (a1)...
Abstract
Background

The development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression.

Method

One hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization).

Results

The addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence interval (CI) 1.29–7.26], 3- and 6-month follow-ups, and for rumination and overgeneralization post-treatment. There was no difference in the reduction of symptoms between CNT and RT (mean difference on the HAMD 1.98, 95% CI −1.14 to 5.11), although CNT significantly reduced rumination and overgeneralization relative to RT post-treatment, suggesting a specific benefit on these cognitive processes.

Conclusions

This study provides preliminary evidence that CNT guided self-help may be a useful addition to TAU in treating major depression in primary care, although the effect was not significantly different from an existing active treatment (RT) matched for structural and common factors. Because of its relative brevity and distinct format, it may have value as an additional innovative approach to increase the accessibility of treatment choices for depression.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial
      Available formats
      ×
Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence . The written permission of Cambridge University Press must be obtained for commercial re-use.
Corresponding author
*Address for correspondence: Professor E. R. Watkins, Mood Disorders Centre, School of Psychology, University of Exeter, Exeter EX4 4Q, UK. (Email: e.r.watkins@exeter.ac.uk)
References
Hide All
Baldwin, SA, Murray, DM, Shadish, WR (2005). Empirically supported treatments or type I errors? Problems with the analysis of data from group-administered treatments. Journal of Consulting and Clinical Psychology 73, 924935.
Baskin, TW, Tierney, SC, Minami, T, Wampold, BE (2003). Establishing specificity in psychotherapy: a meta-analysis of structural equivalence of placebo controls. Journal of Consulting and Clinical Psychology 71, 973979.
Beck, AT (1976). Cognitive Therapy and Emotional Disorders. Meridian: New York.
Beck, AT, Steer, RA, Brown, GK (1996). The Beck Depression Inventory, Second Edition. The Psychological Corporation: San Antonio, TX.
Blazer, DG, Kessler, RC, McGonagle, KA, Swartz, MS (1994). The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. American Journal of Psychiatry 151, 979986.
Carver, CS (1998). Generalization, adverse events, and development of depressive symptoms. Journal of Personality 66, 607619.
Carver, CS, Ganellen, RJ (1983). Depression and components of self-punitiveness: high standards, self-criticism, and overgeneralization. Journal of Abnormal Psychology 92, 330337.
Choi, SC, Lu, IL (1995). Effect of non-random missing data mechanisms in clinical trials. Statistical Medicine 14, 26752684.
Christensen, H, Griffiths, KM, Jorm, AF (2004). Delivering interventions for depression by using the internet: randomised controlled trial. British Medical Journal 328, 265.
DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Saloman, RM, O'Reardon, JP, Lovett, ML, Gladis, MM, Brown, LL, Gallop, R (2005). Cognitive therapy versus medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62, 409416.
Devilly, GJ, Borkovec, TD (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behaviour Therapy and Experimental Psychiatry 31, 7386.
Fergusson, DM, Horwood, LJ, Ridder, EM, Beautrais, AL (2005). Subthreshold depression in adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 62, 6672.
Gellatly, J, Bower, P, Hennessy, S, Richards, D, Gilbody, S, Lovell, K (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine 37, 12171228.
Hakamata, Y, Lissek, S, Bar-Haim, Y, Britton, JC, Fox, NA, Leibenluft, E, Ernst, M, Pine, DS (2010). Attention Bias Modification Treatment: a meta-analysis toward the establishment of a novel treatment for anxiety. Biological Psychiatry 68, 982990.
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 12, 5262.
Hollon, SD, Munoz, RF, Barlow, DH, Beardslee, WR, Bell, CC, Bernal, G, Clarke, GN, Franciosi, LP, Kazdin, AE, Kohn, L, Linehan, MM, Markowitz, JC, Miklowitz, DJ, Persons, JB, Niederehe, G, Sommers, D (2002). Psychosocial intervention development for the prevention and treatment of depression: promoting innovation and increasing access. Biological Psychiatry 52, 610630.
Jorm, AF, Morgan, AJ, Hetrick, SE (2008). Relaxation for depression. Cochrane Database of Systematic Reviews 4, CD007142.
Judd, LL (1997). The clinical course of unipolar major depressive disorders. Archives of General Psychiatry 54, 989991.
Judd, LL, Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Paulus, MP, Kunovac, JL, Leon, AC, Mueller, TI, Rice, JA, Keller, MB (1998). A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Archives of General Psychiatry 55, 694700.
Kessler, D, Lewis, G, Kaur, S, Wiles, N, King, M, Weich, S, Sharp, DJ, Araya, R, Hollinghurst, S, Peters, TJ (2009). Therapist-delivered internet psychotherapy for depression in primary care: a randomized controlled trial. Lancet 374, 628634.
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.
Layard, R (2005). Mental health: Britain's biggest social problem? Paper presented at the No. 10 Strategy Unit Seminar on Mental Health on 20 January 2005 (http://cep.lse.ac.uk/textonly/research/mentalhealth/RL414d.pdf).
MacLeod, C, Rutherford, E, Campbell, L, Ebsworthy, G, Holker, L (2002). Selective attention and emotional vulnerability: assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal Psychology 111, 107123.
Mathews, A, MacLeod, C (2002). Induced processing biases have causal effects on anxiety. Cognition and Emotion 16, 331354.
Morisky, DE, Green, LW, Levine, DM (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care 24, 6774.
MRC (2008). Developing and Evaluating Complex Interventions: New Guidance (www.mrc.ac.uk/complexinterventionsguidance) Accessed 10 November 2008.
Murphy, GE, Carney, RM, Knesevich, MA, Wetzel, RD, Whitworth, P (1995). Cognitive behavior therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression. Psychological Reports 77, 403420.
Nolen-Hoeksema, S (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology 100, 569582.
Nolen-Hoeksema, S (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology 109, 504511.
Nolen-Hoeksema, S, Morrow, J (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology 61, 115121.
Peterson, C, Semmel, A, von Baeyer, C, Abramson, LY, Metalsky, GI, Seligman, MEP (1982). The Attributional Style Questionnaire. Cognitive Therapy and Research 6, 287300.
Reynolds, WM, Coats, KI (1986). A comparison of cognitive behavioral therapy and relaxation training for the treatment of depression in adolescents. Journal of Consulting and Clinical Psychology 54, 653660.
Schulz, K, Altman, DG, Moher, D (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Annals of Internal Medicine 152, 16.
Spitzer, RL, Kroenke, K, Williams, JBW, Löwe, B (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 10921097.
Spitzer, RL, Williams, JBW, Gibbon, M, First, MB (1996). Structured Clinical Interview for DSM-IV (SCID). American Psychiatric Association: Washington, DC.
Stevens, SE, Hynan, MT, Allen, M (2000). A meta-analysis of common factor and specific treatment effects across domains of the phase model of psychotherapy. Clinical Psychology: Science and Practice 7, 273290.
Ustun, TB, Ayuso-Mateos, JL, Chatterji, S, Mathers, C, Murray, CJL (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry 184, 386392.
Watkins, ER (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin 134, 163206.
Watkins, ER (2009). Depressive rumination: investigating mechanisms to improve cognitive behavioural treatments. Cognitive Behaviour Therapy 38, 8–14.
Watkins, ER, Baeyens, CB, Read, R (2009). Concreteness training reduces dysphoria: proof-of-principle for repeated cognitive bias modification in depression. Journal of Abnormal Psychology 118, 5565.
Watkins, ER, Moberly, NJ, Moulds, M (2008). Processing mode causally influences emotional reactivity: distinct effects of abstract versus concrete construal on emotional response. Emotion 8, 364378.
Wells, TT, Beevers, CG (2010). Biased attention and dysphoria: manipulating selective attention reduces subsequent depressive symptoms. Cognition and Emotion 24, 719728.
Williams, JBW (1998). A structured clinical interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry 45, 742747.
Wulsin, LR, Vaillant, GE, Wells, VE (2004). A systematic review of the mortality of depression. Psychosomatic Medicine 61, 6–17.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed