williams et al - contemporary study UPD Flashcards
aim - P1, A01
The aim of William’s study was to study the impact of ‘imagery-based cognitive bias modification’ (CBM-I) on negative thinking bias, distress and symptoms.
Alongside, seeing whether this intervention would improve the effectiveness of online CBT.
sample - P1, A01
She used a sample of 69 Australian participants who had to complete an online screening questionnaire and then a diagnostic interview by telephone.
The participants were then randomly allocated to either the intervention group or the ‘wait-list’ control group.
By the end of the study, there were only 20 and 22 participants left in each group.
weakness of sample size - P1, A03
One weakness of Williams’s study is that the sample which she used was relatively small and only involved Australian participants.
The small sample size of 69 participants which then ended in being 42 and included only Australians mean that the results can’t be generalised to the wider population of UPD sufferers as CBT may work differently for different cultures and different types of people which may not have been in the sample used.
Therefore, this means that the results from this study may not be generalisable or representative of the wider population due to the small sample size which has been used
COUNTER ARGUMENT TO weakness of sample size - P1, A03
however, the participants used in Williams’s study were randomly allocated to either the intervention group or the ‘wait-list’ control group
random allocation of the participants into each group means that all participants have an equal chance of being in either of the groups
this reduces researcher bias and will limit the effects of participant variables on the results of the study
procedure - P2, A01
- Following allocation, Time one began - baseline measurements were taken of depressive symptoms, distress, degree of disability, anxiety and negative thinking for both the intervention group or the ‘wait-list’ control group by using a BDI-II, K10 and AST-D questionnaires. The intervention group underwent 7 days of imagery-based cognitive bias modification and the ‘wait-list’ control group had no intervention.
- During time 2, all of the participants completed the questionnaires again and the intervention group underwent a 10-week course of internet based CBT, with the ‘wait-list’ control group having no intervention at all.
- In time 3, all of the participants completed the questionnaire again and the ‘wait-list’ control group underwent a 10-week course of internet based CBT without undergoing the initial week of imagery-based cognitive bias modification.
- All of the participants were then asked to rate their satisfaction with the programme on a five-point scale. The imagery-based cognitive bias modification (‘bottom up’) consisted of daily 20 minute sessions for a week and the participants were shown ambiguous scenarios which were resolved in a positive way, to train clients to think positively about events in their everyday lives.
- The internet based CBT (‘top-down’) included a sadness programme which had 6 online lessons showcasing the ‘best practice CBT’ which included homework and access to resources.
strength of the procedure - P2, A03
One strength of Williams study is that the wait-list control group was included in the study.
The wait-list control group completed the same set of questionnaires as the intervention group over the course of the 11-week study period.
The study could establish the extent to which changes in symptoms and distress were due to the interventions and not just the passing of time.
Therefore, this was an important practical consideration which increased the overall validity of the study.
COUNTER ARGUMENT TO strength of the procedure - P2, A03
However, the study could have been improved by collecting further data from the wait-list control group following their 10 week course of internet based CBT without the imagery-based cognitive bias modification.
This would have allowed the researchers to determine how much the additional week of imagery-based cognitive bias modification contributed to the reduction of symptoms.
Furthermore, it would have been helpful if the researchers had followed up both groups several months later to assess the long term impacts of the internet based CBT as well as the short term ones.
Therefore, this means that there is some improvements which could have been made to the study to allow the researcher to establish the effect which the imagery-based cognitive bias modification had on the reduction of symptoms.
findings - P3, A01
During time 2, the imagery-based cognitive bias modification shows to have decreased the mean BDI-II score for the group by 9 points from the time 1 for the intervention group and 3 points for the ‘wait-list’ control group who had experienced no intervention.
During time 3, the internet based CBT reduced the mean BDI-II score by nearly 18 points for the intervention group from time 1, but only decreased it by 7.5 for the ‘wait-list’ control group. The mean overall K10 score decreased by nearly 12 points for the intervention group and only 4 point for the ‘wait-list’ control group from time 1.
Following the imagery-based cognitive bias modification, the mean AST-D score increased by 0.5 for the intervention group, but decreased by 0.3 for the ‘wait-list’ control group.
strength of findings - P3, A03
One strength of Williams’s study is that the findings can help to improve clinical practice.
Symptoms and distress levels can be seen to be significantly reduced without costly face-face time with a clinician, after just seven days of imagery-based cognitive bias modification showed these reductions.
Online services could mean that people on the NHS waiting list may be able to access critical and potentially lifesaving support whilst at home.
Therefore, this means that this is a useful application today in the NHS as users are once again able to enjoy life at work and with their families whilst getting the help and support which they need.
COUNTER ARGUMENT TO strength of findings - P3, A03
However, one weakness of the results is that there were problems with the quantitative data which reduces the validity of the findings
People often do not give honest answers on self-report scales so the intervention participants may over-estimate improvements as they were aware of being in therapy.
Furthermore, quantitative data tells us nothing about why symptoms have improved, where as a semi-structured interview using open questions may have done this.
Therefore, this means that the therapy may not have had the improvement which the results show as the participants have rated this themselves so it may not be as applicable to other people as we may think.
conclusions - P4, A01
The findings of the study suggests that brief, online CBM-I can lead to significant symptom reduction in just one week.
The combined intervention significantly reduced depressive symptoms, distress, disability, anxiety and rumination in people diagnosed with a major depressive episode, suggesting that the integration of a ‘bottom-up’ approach into more traditional ‘top-down’ iCBT may be a useful addition.
weakness of the conclusions - P4, A03
One weakness of the study is that The researchers note that further research needs to be conducted to find out exactly what the nature of the mediating effect of CBM-I prior to iCBT is.
They noted that it could have been due to increased motivation to complete the iCBT but it could equally have been down to the CBM-I training actually helping participants to generate more positive or alternative thoughts in the iCBT intervention, which has made it more effective.
They also note that replications are necessary in order to know whether the effects would be maintained long term.
Therefore, this means that it would be useful to conduct further research following William’s study to find out the significance of the imagery based cognitive bias modification being conducted before the patient underwent internet based CBT
COUNTER ARGUMENT TO weakness of the conclusions - P4, A03
Furthermore, individuals who had disorders such as substance abuse were excluded from the study.
This reduces the validity of the study because findings of the study may not show how CBT can help reduce the symptoms for people with more severe depression.
Therefore, this means that the sample used may need to include people with different forms of depression so it can be established the effect which CBT also has on them.
