Elkin et al 1989

Question 1

background knowledge

Answer 1

One of the key questions in abnormal psychology is the effectiveness of different treatments. In the treatment of depression, some of the most common treatments are Cognitive-Behavioral Therapy (CBT), Interpersonal therapy (IPT), and drug therapy. Elkin et al (1989) wanted to see if there was any significant difference in the effectiveness of the three approaches to therapy.

Question 2

Approach to CBT

Answer 2

The general approach in CBT for depression involves guiding clients through a number of structured learning experiences. Patients are taught to monitor and write down their negative thoughts to recognize the association between their thoughts, feelings, physiology, and behavior. They learn to evaluate the validity of their thoughts and change dysfunctional thinking. The therapist also teaches adaptive coping skills such as breaking down large problems into smaller steps and decision-making by cost-benefit analysis.

Question 3

Approach to IPT

Answer 3

The goal of IPT is to help the depressed client examine how his or her current interpersonal behavior might interfere with obtaining pleasure from relationships. For example, patients might be taught how to improve communication with others to have more satisfying social interactions and support. The focus is on developing effective social skills and the client’s current life situation. Techniques include discussion of interpersonal problems, exploration of and encouragement to express negative feelings, and the improvement of verbal and non-verbal communication.

Question 4

participants

Answer 4

A total of 250 patients were assigned to treatment. The sample came from three different treatment centers located in Pittsburg, Washington DC, and Oklahoma City.

To be included in the study, patients had to meet the diagnosis of major depressive disorder with symptoms present at least in the two weeks previous to the study. Patients were excluded from the study if they had any other disorder in addition to MDD.

Question 5

procedure

Answer 5

Depressed clients were randomly assigned to one of four treatment conditions for four months: IPT, CBT, the drug imipramine, or a placebo pill. The imipramine and placebo conditions were paired with clinical management in which minimal supportive therapy was provided because of the ethical need to provide some therapy for clients in those conditions.

Question 6

results

Answer 6

There were no significant differences in the reduction of depression or improvement of functioning between CT and IPT or between either of them and imipramine plus clinical management. In general, the three treatments achieved significant and equivalent degrees of success and were for the most part superior to the placebo group. The placebo-plus-clinical management group, however, did show significant improvement.

Question 7

evaluation

Answer 7

• confounding variables
• not rlly representative; Overall, however, studies of the effectiveness of treatment face several limitations. First, by excluding participants because of compounding factors like alcoholism, personality disorders, or suicidal tendencies, the sample becomes less representative of the general population of depressed patients. Therefore, the findings may not be as generalizable as we would wish.
• In addition, there are several problems with comparing these different treatments. First, the goals of the treatments are different. The goal of treatment is often not just “to cure the patient.” Some treatments focus more on the process than the outcome. This means that as the patient is receiving therapy, although the techniques are the same, the way that the therapy is implemented is not. In each session, the therapist determines which technique is most appropriate, based on the progress of the client. Thus, the treatments are not standardized - making it difficult to say that everyone in each condition received exactly the same treatment.

The study monitored the effectiveness of the treatments by information from the patient, therapist, and an objective observer. This use of data triangulation makes the study stronger. Simply getting data from the client could result in demand characteristics - or observer bias from the therapist.