Evidence-Based Practice Evaluation

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Major Depressive Disorder

Numerous American citizens of different ages, genders, and races suffer from major depressive disorder. Such feelings have the considerable negative effect on the lives of patients, which is why it is very important to choose the most effective ways of their treatment from the existing variety of practices. It is highly important to implement evidence-based interventions, as well as use an individualized approach to each patient. Moreover, the social worker should pay the additional attention to various diversity issues prior to the utilization of any theory.

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Review of Literature: Theory

Cognitive behavioral therapy is recognized as one of the main methods for treatment of major depression disorder (MDD) and its reflection. The success of the current methodology application is based on the understanding that people reflect their attitudes and psychological issues through reaction on real life events. Such reposes are motivational, cognitive, affective, and behavioral (Corsini, and Wedding, 2011). Their responses are formed under the influence of cognitive processes, the external stimuli, and reinforcements (Corsini, and Wedding, 2011).

Among the main reflections of MDD are the following: concentration problems, sadness or lack of interest, feeling of worthlessness, recurring thoughts of death (Abbasian et al, 2014). “Women are twice more likely to experience depression” (Abbasian et al, 2014). It is connected with the fact that the appearance of the depression is facilitated by such natural processes as pregnancy and first menstrual period (Abbasian et al, 2014). However, “the impact of risk factors across sex was generally stronger on possible recurrent MDD than on a first onset of MDD” (Stegenga, 2012).

The feeling of depression may become stronger under the influence of such factors as weak social skills and unsecsessful relationships (Abbasian et al, 2014). Minority and low-income women are more likely to suffer from depression because they usually face more challenges in their life connected to the lack of financial resources. They are less likely to obtain appropriate medical treatment for timely management of the disorder. Therefore, the reasons and facilitators of female suffering from the MDD include the natural processes, poor communication skills, defective relationships, low income, and minority status.

Different scientists use various methodologies for development of the most effective ways of the major depressive disorder treatment. Such methodologies are based on the understanding of major depression. Clark, Beck, and Alford (1999) created the special model of depression that contains oriented schemas, cognitive structures, and cognitive products. Consequently, the positive effect of treatment of MDD by using the cognitive behavioral therapy can be reached by influencing the “personal style, communication skills and personality” (Jakobsen et al, 2011).

Cognitive behavioral therapy was the chosen treatment method for the patient Debbie Smith, who was diagnosed with MDD. She is a 35 year African American divorced women who suffers from depression, sadness, feeling of worthlessness, and suicidal thoughts, which are worsen by financial difficulties. The method of intervention has been shown to be efficient for treatment of MDD in numerous studies. One study used described effect of stress management training in women suffering from the given disorder (Abbasian et al, 2014). Participants took part in the stress management training based on cognitive-behavioral techniques (Abbasian et al, 2014). The treatment of Debbie Smith incorporates the described methodologies directed on development of various skills, including communicative skills, planning skills, and self-expression skills.

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The study was based on the periodic assessment of patient’s condition by using special scales. The current treatment involves discussion of reports, which she will prepare for each weekly meeting, and grading of the existing problems on a special scale. The reports will relate to the client’s past and present situation. They are necessary for evaluating the program effect on the client and for measurement of thier efficacy. The described study is directed on the linking the causes of the disorder with its signs and symptoms (Abbasian et al, 2014). The proposed intervention for Debbie Smith is based on backgrounds and reflections of the disorder for increasing the control over the behavior, actions, and their consequences. (Abbasian et al, 2014) The current cognitive behavioral therapy is an effective method of “depression reduction and development of social adaptability” (Abbasian et al, 2014).

The benefits of the cognitive behavioral therapy over the medication treatment of low-income young minority women were described by Siddique, Chumg, and Miranda (2012). Their study was focused on the assessment of the effectiveness of depression management by various methods within 6-month and one year period (Siddique, Chumg, and Miranda, 2012). Debbie Smith suffered from financial problems and denied any previous treatment by a psychologist. Consequently, the study described the treatment that contained homework and monitoring activities. During the current treatment process, Debbie Smith will be proposed to perform homework in the form of reports concerning her past and present, through which she will monitor her performance and behavior. Siddique, Chumg, and Miranda (2012) investigated that such kind of therapy is cost-effective, has long-lasting effect, and “provide participants with a set of adaptive coping”.

Review of Literature: Evaluation

The important part of the treating of Debbie Smith is the assessment of the patient’s condition and progress during the treatment. The authors of the described articles used various methodologies for the given purposes. Abbasian et al. (2014) assessed the patients’ progress by using Bells’ social adaptability questionnaire and Hamilton’s depression scale questionnaire. The first questionnaire is based on 160 questions concerning the following issues: home, health social adaptability, professionalism, and emotions (Abbasian et al, 2014). The scores vary from 0 to 32. Hamilton’s depression scale questionnaire evaluates patients’ health and cognitive problems, behavioral disorders, and affection change symptoms by scoring from 0 to 4 or from 0 to 2 (Abbasian et al, 2014).

The treatment of Debbie Smith will be performed by grading of the existing problems on a scale from 1 to 10. Siddique, Chumg, and Miranda (2012) required participants to make homeworks and perform constant monitoring of their condition by using the periodic analysis of the interventions for assurance that they were utilized correctly. Debbie Smith will be proposed to make homeworks in the form of reports concerning her past as well as future. The goals of her homeworks are assessment of patient’s condition and the effectiveness of treatment, as well as creation of the links between patient’s thoughts, actions, and consequences. The successful implementation of various methodologies of cognitive behavioral therapy creates the understanding that the proposed treatment of Debbie Smith would be successful.

Journal Article Critique & Interention Justification

Abbasian et al. (2014) examined the effectiveness of the stress management training on depression in women with depression disorders by using the cognitive-behavioral techniques. The work was a quantitative study based on the evaluation of the treatment effectiveness of 40 women (age range 20-45) who suffered from depression (Abbasian et al., 2014). The treatment was organized in the form of 8 intervention sessions, which cover the following topics: definition of stress its causes, consequences and symptoms, cognitive reconstruction, cognitive and communicative skills, self-expression and anger management skills, breathing and relaxation skills, and problem-solving and planning skills (Abbasian et al., 2014). The data collection was performed by application of “Hamilton's depression scale questionnaire, Bell's social adaptability questionnaire and Cooper's stress questionnaire” (Abbasian et al., 2014). The authors stated that stress management training plays the considerable role in reduction of depression by means of modification of inappropriate social information-processes patterns (Abbasian et al., 2014)

Siddique, Chumg, and Miranda (2012) compared the effectiveness of medication use and application of cognitive behavioral therapy for treatment of low-income young minority women who suffered from depression. The study involved 267 low-income participants with the mean age of 29 years who represent various minority groups (44 % Black, 50 % Latina and 6 % White) (Siddique, Chumg, and Miranda, 2012). The authors made the stress that low-income young people are more likely to suffer from depression as they have more reasons to be upset due to financial problems and discrimination, and fewer abilities to obtain appropriate treatment (Siddique, Chumg, and Miranda, 2012).

Participants were divided into three groups. The first one was treated by medication (paroxetine) for 6 months. The second group received 8-week cognitive behavioral treatment, which involved the performance of homeworks and monitoring activities (Siddique, Chumg, and Miranda, 2012). Women in the last group obtained information concerning depression health treatments available in their communities (Siddique, Chumg, and Miranda, 2012). The authors found out that there were no differences between medication intervention and cognitive behavioral therapy in 6-month treatment. Moreover, the cognitive behavioral therapy was considered the most effective way of intervention at one year (Siddique, Chumg, and Miranda, 2012). Such methodology had the lower remission rates than medicating treatment in 6 month (54.1 % compared to 80 %) and in 12 month (41 % compared to 43.6 %) (Siddique, Chumg, and Miranda, 2012).

The methodologies from the above-mentioned studies were chosen for treatment of Debbie Smith because they enable improvement of social (listening, communication, and building relationships) and cognitive skills, monitoring and evaluation of such improvements through special reports on weekly meetings by using grading scale for assurance that they are utilized correctly, and to maintain consistency, as well as integrity. The reports will be used for building the interrelations between thinking, acting, and consequences of actions regarding the background of patient’s presentation of past and present situation. The idea of such methodology is paying patient’s attention to the process of behavior controlling. The therapy will be directed at the improvement of her social support, decreasing the feeling of sadness and depression, and coping with her financial problems (by recommending her to take financial classes). The treatment of Debbie Smith is based on the combination of methodologies supported by the above-described studies, as they proved to be effective in treatment processes previously.

Diversity Issues

According to the official investigations, women are 50 % more likely to suffer from depression than men (Abbasian et al., 2014). It is connected with natural processes (Abbasian et al., 2014). Moreover, the feeling of depression became stronger under the influence of such factors as weak social skills and unseccessful relationships. Low-income minority women are at greater risk to be influenced by such disorder as they have more reasons for stress (for example, financial problems), and fewer access to treatment. Patients are usually adults with the average age of 32 years. Both studies involve females from 20 to 45 years old. The second study focused on the providing of cognitive behavioral intervention to low-income women. Hence, the researches are relevant for the case of Debbie Smith as she is a woman of the middle age belonging to minorities, who has financial problems and suffers from depression.

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