Cognitive Behavior Therapy and Depression in Women
Molly Lineberger
Wake Forest University Department of Counseling
ABSTRACT
METHODS
Research to seek peer review and scientifically-based information related
to CBT and major depression in women began with a search for key
terms, “depression,” “women,” and “CBT.” Two data bases, PsychINFO
and PubMed, were explored through the Wake Forest University Z.
Smith Reynolds Library website. The search was limited to articles
published from 2003 through 2013. PsychINFO was the better database
for finding information for this literature review and resulted in 119 hits
Major depressive disorder is a common mental disorder. In the United
States, the twelve-month prevalence of major depressive disorder is
approximately 7% overall, and women are 1.5 to 3 times more likely than
males to be affected (American Psychiatric Association, 2013).
Depression in women is often associated with pregnancy and child
bearing. There are a variety of accepted treatments for depression
including antidepressant medications and psychotherapy (Siddique,
Chung, Brown, & Miranda, 2012).
Preventing Perinatal Depression in LowIncome, Minority Women
•Poor, black urban women
•Pregnant or with a child < 6 months
Feelings
for peer reviewed articles. The PubMed search with the same key terms and
parameters resulted in 8 hits. Not all articles found were appropriate for this
review. After skimming abstracts, 25 articles were selected for closer
inspection, and the search ultimately produced eight randomized controlled
trials, a quasi-experimental study, and two surveys (one quantitative, one
qualitative) for inclusion in this review.
RESULTS – SOME SIGNIFICANT STUDIES
Cognitive Behavior Therapy (CBT) focuses on examining the thoughts
and feelings that influence behaviors. CBT is considered an effective
treatment for major depressive disorder (Butler, Chapman, Forman, &
Beck, 2006).
Thoughts
DISCUSSION
•All participated in a home visitation program
Behaviors
•6 group manual-guided sessions
•CBT improved depression in 84% of participants
•Control group – improved depression in 41%
INTRODUCTION
•Child-care, transportation, meal provided for each session
Depression
(Tandon, Perry, Mendleson, Kemp, & Leis, 2011)
•Serious & pervasive mood disorder
•Persistent feelings of hopelessness, guilt, sadness, or worthlessness
•Effects 7% Americans per year
Preventing Postnatal Depression and
Anxiety
•Pregnant women with mild to moderate depression
•CBT
• 6 weekly 2 hour group sessions
• Manual-based
• Preventing stress, low mood
• Context: pregnancy & caring for infant
•Control group
• Booklet contents briefly reviewed by provider
• Information regarding stress triggers, strategies
• How to access local postnatal support
•
•Lasts ≥ two weeks (American Psychiatric Association, 2013)
•Body aches, irritability, sleeplessness, fatigue
Results: CBT not superior to control intervention
(Austin et al, 2008)
•Thoughts of suicide & suicide attempts
•Impairment mild o severe
♀
Depression in women
Technologically Assisted
Psychotherapeutic Intervention (TAPI)
•Before puberty, equally occurring in girls & boys
(Depression Fact Sheet, n.d.)
Patients, care-providers, and third party payers need continuing
guidance as to the type and cost of effective treatments for depression
(Siddique, Chung, Brown, & Miranda, 2012). CBT is often more
affordable than some other types of therapy because it is usually a shortterm treatment (Cherry, 2013). This literature review looks at CBT
intervention for treating the disorder in women because of the
prevalence of depression in women, and because CBT can be modified
to meet the needs of women in various life situations. Therapy can
consist of a variable number of sessions (Austin et al., 2008).
RESEARCH POSTER PRESENTATION DESIGN © 2011
www.PosterPresentations.com
Austin et al. (2008) found that an individual session reviewing a booklet
of strategies for avoiding pre and postnatal depression was as effective as
a 6-week course of 2-hour group intervention. Authors said the time
patients and a therapist spent going over the booklet may have been an
effective intervention in itself. A study should be designed based on that
finding, as a one-time meeting with a patient would be more cost effective
than a longer, multi-week intervention.
RECOMMENDATIONS FOR FUTURE
RESEARCH
Another finding is the promise that the internet holds for effective CBT
delivery. Without restraints of time or geography, more individuals can
effectively access CBT intervention. The TAPI delivery system in studies
by Openshaw et al. (2011) afforded clients privacy and avoided the
stigma associated with visiting a psychological services clinic. More
studies of the efficacy of internet-delivered CBT should be conducted.
With the ever-increasing presence of stressors in the lives of women,
CBT should continue to be considered an effective intervention for major
depressive disorder. Studies to increase content value based on women’s
life circumstances and to maximize the effects of delivery by internet
would be worthwhile.
REFERENCES
•Twice as prevalent in women as men
•Higher incidence in women after puberty possibly related to lifelong
changes in hormone levels
• Menstrual cycle changes
• Pregnancy
• Miscarriage
• Postpartum period
• Perimenopause
• Menopause
From the review of the literature, it is evident that CBT can be an
effective treatment for major depression in women. Some studies did
show, however, that CBT was not always a highly effective intervention.
A main finding of this review is that CBT is effective when it and the
delivery method are designed to meet the specific patient needs. In the
Tandon et al. (2011) study in which intervention with low-income women
was highly effective, needs such as transportation and child care were met
and a meal was served at each therapy session. In the study by Faramarzi
et al. (2008) involving infertile women in which CBT was superior to
fluoxetine, the authors stressed that an important strength of that
intervention was content tailored for infertile women. More qualitative
studies should be conducted to help modify CBT interventions to meet
specific needs of women in various life situations.
Treating Depression in Infertile Women
•
•Rural Utah
•16 depressed middle-aged women
124 women trying to conceive for 2 years randomized to
•Fluoxetine – prescribed for 90 days
•Control
•CBT – 2 - hour group weekly sessions for 10 weeks
•
CBT adapted for infertile women - “a novel amalgamation”
•1st three sessions – gynecologist explained cause of
infertility for each patient
•
Resolution of Depression by end of 10 – week study:
•Fluoxetine 50%
Control 10%
CBT 79%
• Authors cited CBT as superior to fluoxetine
(Faramarzi et al., 2008)
•10 one-hour manualized CBT sessions
•Participants went to 1 of 2 offices with video equipment
• Internet power points
• Online measures of progress
• Online modules
• Real time video conferencing
•Symptoms improved and continued to improve
3 & 6 months post therapy
(Openshaw, Pfister, Silverblatt, & Moen, 2011)
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