research article The Adaptability of Cognitive-Behavioral Therapy Techniques for Depression in China: A Delphi Study
Xiao Miao Li1,3, Zhan Jiang Li1*, Jing Liu1, Si Zu2, Meng Guo1, Hai Ying Han1, Fan Qiang Meng1
1Beijing Anding Hospital, Capital Medical University, Beijing, China
2Beijing Chao Yang Hospital, Beijing, China
3University of Calgary, Calgary, Canada
*Corresponding author: Zhan Jiang Li, Department of Clinical Psychology Research Unit, 2nd floor, Inpatient Building, Beijing Anding Hospital, No. 8 An Kang Alley, De Sheng Men Wai, Xi Cheng District, Beijing, P. R. China. Tel: +861083911000; Email: lizhanjiang1221@sina.com
Received Date: 05 December, 2017; Accepted Date: 22 December, 2017; Published Date: 30 December, 2017
Citation: Li XM, Li ZJ, Liu J, Zu S, Guo M, et al. (2017) The Adaptability of Cognitive-Behavioral Therapy Techniques for Depression in China: A Delphi Study. J Psychiatry Cogn Behav: JPCB-135. DOI: 10.29011/2574-7762. 000035
1. Abstract
1.1. Objective: To explore the adaptability of Cognitive-Behavioral Therapy (CBT) techniques for depression in China among Chinese CBT experts.
1.2. Method: A 34-item rating list on CBT techniques was developed based on literature review. Thirty-one CBT experts in the Delphi study rated by two rounds each technique through four dimensions of maneuverability, frequency of use, contribution to outcomes, and acceptability by the patients.
1.3. Results: The establishment of therapeutic alliance, assessment, psycho-education, and identifying automatic thoughts ranked high on the list, while the pie chart method, social skill training, continuous calibration, problem solving, and cost-benefit analysis were among the least favorite ones. The Kendall’s concordance coefficients on the four dimensions ranged from 0.259 to 0.315 (p<0.05), but the coefficient of variation of social skill training, problem solving, activity monitoring/scheduling, suicidal behavior delay, and behavioral experiments on at least one or two dimensions were greater than 0.25.
1.4. Conclusions: The findings suggest that most CBT techniques are being acknowledged by Chinese CBT experts as adaptable to apply to depression except a few cognitive or certain behavioral ones. Further, the less adaptable behavioral techniques also reveal incongruous opinions among raters especially when considering their acceptability to patients.
2. Keywords: China; Cognitive-Behavioral Therapy; Depression; Delphi study; Techniques
1.
Introduction
Beck's Cognitive-Behavioral Therapy (CBT) for depression
has been a subject of great scientific interest since its first reported clinical trial [1,2].
The positive effect has been extensively proven by various studies over the
past several decades [3-7]. Standard CBT holds
the view that thoughts, feelings and behaviors are
interrelated with each other. In order to ameliorate patients' negative moods
and improve their interpersonal relationship and social functioning, the goals
of most CBT approaches for depression have focused on instructing patients
about a cognitive approach to understanding the etiology and maintenance of
mood disorders, applying specific skills to identify and modify dysfunctional
automatic thoughts, as well as understanding maladaptive
assumptions and beliefs judged as reflecting enduring cognitive structures or
schemas [8]. Furthermore, aside from these
cognitive techniques, CBT also includes certain behavioral strategies, such as
'behavioral experiments’, to address worries and maladaptive behaviors
[9].
Since the first introduction of CBT in China in 1989 [10], an increasing number of Chinese clinicians have adopted the approach in their clinical work.
Statistics have shown that the number of published research papers on CBT grow exponentially
since 1996 [11]. Besides, the efficacy of CBT
for depression among Chinese patients has been proven by many recent studies [12,13].
While those stdies are of great
importance, several aspects regarding their methodology warrant further
examination and questioning. First, though all studies reported CBT as a
treatment, some did not describe in detail any CBT protocols or
specific intervention techniques they used [14,15],
which leads to questions such as whether real CBT was implemented and the
validity
of the conclusions. Second, although a number of researchers did provide a CBT
manual to their therapists to guide treatments, the contents of these manuals
varied from one study to another. Some applied the foreign CBT manuals directly to Chinese patients [16], while others designed the manuals themselves,
based on the theories and techniques widely acknowledged
in CBT publications [17-20]. And among those who
described how they performed in their treatment, they described them in a
general manner, such as identifying automatic thoughts; little is known about
the techniques they chose specifically in identifying automatic thoughts, such
as doing a thought record. Third, most studies addressed the overall
relationship between CBT and the outcomes and little attention was given to the
applicability or adaptability of each technique itself. For example, it remains
unclear how often a certain technique was actually used in treatments, or to
what degree the patients were able to accept it.
In view of the
lack of standardization in the application of CBT techniques in China, a Delphi
method is chosen to gather opinions from Chinese CBT experts on how adaptable
they view the techniques being used in their clinical work and to reach a
consensus on the adaptability of CBT strategies among them. The long-term goal
of this study is to help the development of localized practice guidelines for
depression in China and therefore improve the standardization of CBT techniques
applied both in research and patient care.
2.
Methods
2.1.
The Delphi Method
The "Delphi method" [21] is a
systematic, interactive method that relies on a panel of independent experts
answering questionnaires in two or more rounds, with feedback from each round
provided to help achieve consensus. The process is stopped when a pre-defined
stopping criterion is reached, such as certain number of rounds.
2.2.
Participants
Participants who took part in the
Delphi study were 31 Chinese experts in the field of psychiatry
or clinical psychology; among those were CBT therapists or psychiatrists with
senior professional titles, members of the committee of the CBT academic
conference, and CBT supervisors. Most of them worked in hospitals, while a few
in universities or colleges. Since the experts were from different provinces in
China, each of them was invited to take
part in the study via e-mail. All participants in this
study signed a Letter of Consent for this study.
2.3.
Procedure
2.3.1.
Literature Search for CBT Techniques:
A systematic
literature review on CBT techniques was conducted. The databases included
Pubmed, ScienceDirect, Embase, and CNKI (China National Knowledge
Infrastructure, a database widely used in China). The search terms were cognitive
behavior therapy/cognitive therapy/behavior therapy, and depression, and we
collected the cognitive behavior techniques in the published papers to form the
preliminary list.
2.3.2.
Questionnaire Development: Ten Chinese CBT experts were then
asked to verify the accuracy of each name of the techniques, whether the
techniques included were appropriate, and whether any techniques should be included
in the preliminary list. After the revision, the list of techniques
included 34 items, which could be divided into three categories: basic
techniques (13 items), cognitive techniques (12 items), and behavioral techniques
(9 items). Each item was designed to be rated through four aspects on Likert
rating scales:
(4) acceptability to patients
(from 1, not accept at all to 4, accept entirely), and by these four aspects we
define adaptability.
Besides, the operational definition
of each technique was also strictly discussed and presented at the bottom of
the list, too. Moreover, the experts weighed the significance of each dimension.
The study also included the Inventory of
Degree of Familiarity
(IDF)
[22] to understand the experts' overall degree
of familiarity of the listed techniques and the Inventory of
Basis of Judgment (IBJ) [22]
to comprehend what influence their ratings. The IDF contains 5 levels
ranging from very unfamiliar (0.2) to very familiar (1.0). The judgment can be
based on "practical experiences", "theoretical analysis",
"opinions of other counterparts", and "intuitions". Degree
of the influence to the final judgment can be divided into three levels, "big,
medium, and small" [22]. The
degree of the experts' authority can then be counted by both the IDF
and IBJ scores.
2.3.3.
Two Delphi Rounds: In Round 1, we sent to each expert the CBT
techniques rating list by mail. They were instructed
to rate these techniques; meanwhile, they should consider if there were any techniques
that were important and should be included on the list. The rating lists were
then collected for analysis. In Round 2, the results of Round 1 ratings were
provided to the experts as score references. The feedback included means
and Standard Deviations (S.D.) of each
technique on the afore mentioned four dimensions. The experts were told that
they could revise any of their previous ratings after seeing the feedback.
In addition, they were instructed to weigh the importance of each of the four
rating dimensions in treatment. They should mark each dimension between 0 and
1, and the added score of the four dimensions should be 1.
We use the Statistical Package for the
Social Sciences (SPSS, version 18.0) to analyze data. For each item, the mean
and S.D. were calculated. Besides, the Coefficient
Of Variation (C.V.) and the Kendall's concordance coefficient (ω) were calculated to reveal the degree of consensus the experts
had reached. A score less than 0.25 can be an indicator of good concordance
being reached. The Kendall's concordance coefficient was calculated by using a nonparametric
test of related samples. The scores should be between 0 and 1, with a higher
score indicating a higher degree of concordance. A score above 0.5 represents a
good concordance among experts [22]. Moreover, the overall rank of
each item in Round 2 was also calculated.
3.
Results
3.1.
Participants Characteristics
Of the 31 experts participated in the round one Delphi
study, 28 (90.3%) completed and returned the questionnaires. Therefore, the
round two Delphi study was conducted among these 28 experts, and the response
rate was 100%. Of the 28 experts, 15 (53.6%) were male and 13 (46.4%) were
female. Their mean age was 48.5±8.67 years old.
Nineteen were psychiatrists and 9 were CBT therapists. Eighteen held
professorship and the other 10 held associate professorship. On average, they
had practiced CBT for 15.77±7.76 years at time
of study.
The mean IDF and IBJ scores of the 28 experts were 0.87
and 0.90 respectively. The degree of the experts' authority was calculated as
the mean of IDF and IBJ, which was 0.89 in this study, which suggests the
experts being chosen are of high authority in the field of CBT.
The mean rank (
12224 {2A9D2FEB-A2DC-47C6-B0C3-6C7BBD8DC155} 认知治疗åˆå¹¶è¯ç‰©ä¸Žå•çº¯è¯ç‰©æ²»ç–—抑éƒç—‡å¯¹ç…§ç ”究Journal Article0 0宋志强; 刘桂兰; 韩国玲; 阿怀红 2006223 {E8BC89CA-1A0C-43E5-82E0-42ADF9709D80} 轻性抑éƒéšœç¢è®¤çŸ¥è¡Œä¸ºæ²»ç–—çš„å¯¹ç…§ç ”ç©¶Journal Article0 0æŽåš; 钱一平; 王秀ç; 王建文 2008221 {D1DA6483-1D1B-45D6-8F60-464ECA416E14} 认知行为治疗对抑éƒç—‡æ‚£è€…的疗效åŠç”Ÿæ´»è´¨é‡çš„å½±å“Journal Article0 0贾金鼎; æ¨å»ºç« ; ä½™å¦; 宋新勤; 龙金亮 2011222 {9806C513-7A20-4780-9809-B15769685B31} 认知行为治疗对抑éƒç—‡æ‚£è€…抑éƒçŠ¶æ€å’Œç¡çœ è´¨é‡çš„å½±å“Journal Article0 0æ¨äº‘秀 2011216 {BD7CD53B-D4EF-4BAE-BCDF-DCBD4D05FFAC} 认知一行为治疗对抑éƒéšœç¢ç–—效的循è¯ç ”究Journal Article0 0王娜; æŽå 江 2006217 {7A396B66-AC6A-4AC0-80F4-61F0F52603CC} 认知行为疗法è”åˆè¯ç‰©å¯¹æŠ‘éƒç—‡ç–—效的元分æžJournal Article0 0王广海; 刘志军; å¢å® 2010216 {BD7CD53B-D4EF-4BAE-BCDF-DCBD4D05FFAC} 认知一行为治疗对抑éƒéšœç¢ç–—效的循è¯ç ”究Journal Article0 0王娜; æŽå 江 2006217 {7A396B66-AC6A-4AC0-80F4-61F0F52603CC} 认知行为疗法è”åˆè¯ç‰©å¯¹æŠ‘éƒç—‡ç–—效的元分æžJournal Article0 0王广海; 刘志军; å¢å® 2010301 {FECC7E4C-50C5-4788-956A-D12BB234E8FF} Modern Epidemiology: Methods and ApplicationsBook0 0Zeng, Guang 1994228 {89E63107-0446-46C6-A7B9-D0C14313C509} The role of homework in cognitive behavior therapy of depressionJournal Article0 0Thase, Michael E; Callan, Judith A 2006301 {FECC7E4C-50C5-4788-956A-D12BB234E8FF} Modern Epidemiology: Methods and ApplicationsBook0 0Zeng, Guang 1994215 {40C1BE97-15AD-4BC2-A8BD-E0668FD92D47} Review of Researches on Cognitive Behavioral Theray from 1996 to 2006Journal Article0 0Li, Dan; Li, Zhan Jiang 2009226 {BB051C9C-3471-4278-A77E-CDB935396E35} 现代æµè¡Œç—…å¦æ–¹æ³•ä¸Žåº”用Book0 0曾光 1994205 {EC40B229-0DD7-44F8-810F-D84009B9F874} Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatientsJournal Article0 0Rush, Augustus J; Beck, Aaron T; Kovacs, Maria; Hollon, Steven 1977213 {0AA84199-C4B5-4F93-B17C-656585429AE2} Distinctive activities of cognitive–behavioral therapy: A review of the comparative psychotherapy process literatureJournal Article0 0Blagys, Matthew D; Hilsenroth, Mark J 2002279 {22A60EBA-353A-41CA-BDA1-5CB3899BF126} The Efficacy of Cognitive-behavioral Therapy Combined With Antidepressants for Depression: A Meta-analysisJournal Article0 0Wang, Guang Hai; Liu, Zhi Jun; Lu, Ning 2010286 {1C90B501-7527-4C01-A195-72B799AA329C} Evidence-Based Research on the Efficacy of Cognitive-Behavorial Therapy for Depressive DisordersJournal Article0 0Wang, Na; Li, Zhan Jiang 2006234 {115E782E-408D-45A0-A022-BAAB8A07E0FC} Examining the effects of thought records and behavioral experiments in instigating belief changeJournal Article0 0McManus, F; Van Doorn, K; Yiend, J 2012235 {34CEBF10-37C9-418E-A76E-91FC42322DC5} Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depressionJournal Article0 0Dimidjian, Sona; Hollon, Steven D; Dobson, Keith S; Schmaling, Karen B; Kohlenberg, Robert J; Addis, Michael E; Gallop, Robert; McGlinchey, Joseph B; Markley, David K; Gollan, Jackie K 2006236 {12BC3BD9-8328-4E39-BB54-6F4811736D9D} Do we need to challenge thoughts in cognitive behavior therapy?Journal Article0 0Longmore, Richard J; Worrell, Michael 2007237 {F8A81027-D8EC-4AA8-B5A0-8B0B4A2FEFA7} A component analysis of cognitive-behavioral treatment for depressionJournal Article0 0Truax, Paula A; Addis, Michael E; Koerner, Kelly; Gollan, Jackie K; Gortner, Eric; Prince, Stacey E 1996204 {6C1059BD-D41C-429C-BA04-46BF2E49BE8D} Cognitive therapy of depressionBook0 0Beck, Aaron T 1979301 {FECC7E4C-50C5-4788-956A-D12BB234E8FF} Modern Epidemiology: Methods and ApplicationsBook0 0Zeng, Guang 1994219 {B9FB2484-64C9-4B57-88EF-8F47AC7A794F} Comparative Study on Efficacy of Cognitive-behavior Therapy and Pharmacotherapy and Compliance in Treatment of Minor DepressionJournal Article0 0Sang, Wen Hua; Du, Bo; Zhang, Xiang Yun; Liu, Hui Lan; Zhang, Yan Heng; Wei, Hun Ling; Qi, Guo E; Xu, Tao; Zhang, Xu Jing; Zhang, Ping 2009218 {A77AF477-9F68-40CF-A4A3-EF8BB44EF219} Comparative Study of Treatments with Cognitive Behavioral Therapy in DepressionJournal Article0 0Gao, Yong; Gong, Yu Chun; Guo, Feng Li; Hu, Kui Ying; Zhang, Rong Xing; Luo, Wei Ling 2003226 {BB051C9C-3471-4278-A77E-CDB935396E35} 现代æµè¡Œç—…å¦æ–¹æ³•ä¸Žåº”用Book0 0曾光 1994217 {7A396B66-AC6A-4AC0-80F4-61F0F52603CC} 认知行为疗法è”åˆè¯ç‰©å¯¹æŠ‘éƒç—‡ç–—效的元分æžJournal Article0 0王广海; 刘志军; å¢å® 2010216 {BD7CD53B-D4EF-4BAE-BCDF-DCBD4D05FFAC} 认知一行为治疗对抑éƒéšœç¢ç–—效的循è¯ç ”究Journal Article0 0王娜; æŽå 江 2006217 {7A396B66-AC6A-4AC0-80F4-61F0F52603CC} 认知行为疗法è”åˆè¯ç‰©å¯¹æŠ‘éƒç—‡ç–—效的元分æžJournal Article0 0王广海; 刘志军; å¢å® 2010216 {BD7CD53B-D4EF-4BAE-BCDF-DCBD4D05FFAC} 认知一行为治疗对抑éƒéšœç¢ç–—效的循è¯ç ”究Journal Article0 0王娜; æŽå 江 2006233 {14ABE0FD-C296-4E67-A0DE-C9A618D7E9B5} A component analysis of cognitive-behavioral treatment for depressionJournal Article0 0Truax, Paula A; Addis, Michael E; Koerner, Kelly; Gollan, Jackie K; Gortner, Eric; Prince, Stacey E 1996232 {2B419231-E6AD-45EC-8A7D-07459A71DA41} Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experimentsJournal Article0 0Bennett-Levy, James 2003231 {27C38122-C2D4-4FDA-9280-3919AB11241B} 自动æ€ç»´åŠå½’å› æ–¹å¼å¯¹æŠ‘éƒç—‡ä½œç”¨çš„å¤šå› ç´ åˆ†æžJournal Article0 0éƒæ–‡æ–Œ; å§šæ ‘æ¡¥; 黄æ•å„¿; å´å¤§å…´ 2005230 {6ABFA187-D4CF-4C15-B611-F520B5DF41DC} 认知行为干预对抑éƒç—‡çš„å½±å“Journal Article0 0韩丽霞; 韩冰 2012214 {AB5815F9-7CA9-45C4-BFA5-4558BB3F1435} The Status quo and Trend of Cognitive TherapyJournal Article0 0Ji, Jian Lin; Xu, Jun 1989218 {A77AF477-9F68-40CF-A4A3-EF8BB44EF219} é…åˆè®¤çŸ¥è¡Œä¸ºç–—法治疗抑éƒç—‡ç–—效对照Journal Article0 0高勇; 宫玉春; éƒé£Žä¸½; 胡奎英; å¼ è£æ˜Ÿ; 罗维玲 2003219 {B9FB2484-64C9-4B57-88EF-8F47AC7A794F} 认知行为疗法对轻性抑éƒéšœç¢ç–—效åŠä¾ä»Žæ€§å¯¹ç…§ç ”究Journal Article0 0æ¡‘æ–‡åŽ; æœæ³¢; å¼ é¦™äº‘; 刘å‰å…°; å¼ å½¦æ’; é昆å²; é½å›½å¨¥; å¾æ¶›; å¼ æ—é™; å¼ å¹³ 2009204 {6C1059BD-D41C-429C-BA04-46BF2E49BE8D} Cognitive therapy of depressionBook0 0Beck, Aaron T 1979222 {9806C513-7A20-4780-9809-B15769685B31} 认知行为治疗对抑éƒç—‡æ‚£è€…抑éƒçŠ¶æ€å’Œç¡çœ è´¨é‡çš„å½±å“Journal Article0 0æ¨äº‘秀 2011226 {BB051C9C-3471-4278-A77E-CDB935396E35} 现代æµè¡Œç—…å¦æ–¹æ³•ä¸Žåº”用Book0 0曾光 1994215 {40C1BE97-15AD-4BC2-A8BD-E0668FD92D47} 我国认知行为治疗 1996~ 2006 年文献回顾Journal Article0 0æŽä¸¹; æŽå 江 2009226 {BB051C9C-3471-4278-A77E-CDB935396E35} 现代æµè¡Œç—…å¦æ–¹æ³•ä¸Žåº”用Book0 0曾光 1994219 {B9FB2484-64C9-4B57-88EF-8F47AC7A794F} Comparative Study on Efficacy of Cognitive-behavior Therapy and Pharmacotherapy and Compliance in Treatment of Minor DepressionJournal Article0 0Sang, Wen Hua; Du, Bo; Zhang, Xiang Yun; Liu, Hui Lan; Zhang, Yan Heng; Wei, Hun Ling; Qi, Guo E; Xu, Tao; Zhang, Xu Jing; Zhang, Ping 2009239 {F8CE3205-0E1C-40E6-9445-05FB1DB36640} The efficacy of cognitive-behavioral therapy in the treatment of depressionJournal Article0 0Zhang, Li 2003222 {9806C513-7A20-4780-9809-B15769685B31} 认知行为治疗对抑éƒç—‡æ‚£è€…抑éƒçŠ¶æ€å’Œç¡çœ è´¨é‡çš„å½±å“Journal Article0 0æ¨äº‘秀 2011217 {7A396B66-AC6A-4AC0-80F4-61F0F52603CC} 认知行为疗法è”åˆè¯ç‰©å¯¹æŠ‘éƒç—‡ç–—效的元分æžJournal Article0 0王广海; 刘志军; å¢å® 2010216 {BD7CD53B-D4EF-4BAE-BCDF-DCBD4D05FFAC} 认知一行为治疗对抑éƒéšœç¢ç–—效的循è¯ç ”究Journal Article0 0王娜; æŽå 江 2006212 {FE91304F-3F79-4117-B369-14568B01D901} The current state of cognitive therapy: a 40-year retrospectiveJournal Article0 0Beck, Aaron T 2005215 {40C1BE97-15AD-4BC2-A8BD-E0668FD92D47} 我国认知行为治疗 1996~ 2006 年文献回顾Journal Article0 0æŽä¸¹; æŽå 江 2009222 {9806C513-7A20-4780-9809-B15769685B31} 认知行为治疗对抑éƒç—‡æ‚£è€…抑éƒçŠ¶æ€å’Œç¡çœ è´¨é‡çš„å½±å“Journal Article0 0æ¨äº‘秀 2011224 {2A9D2FEB-A2DC-47C6-B0C3-6C7BBD8DC155} 认知治疗åˆå¹¶è¯ç‰©ä¸Žå•çº¯è¯ç‰©æ²»ç–—抑éƒç—‡å¯¹ç…§ç ”究Journal Article0 0宋志强; 刘桂兰; 韩国玲; 阿怀红 2006223 {E8BC89CA-1A0C-43E5-82E0-42ADF9709D80} 轻性抑éƒéšœç¢è®¤çŸ¥è¡Œä¸ºæ²»ç–—çš„å¯¹ç…§ç ”ç©¶Journal Article0 0æŽåš; 钱一平; 王秀ç; 王建文 2008221 {D1DA6483-1D1B-45D6-8F60-464ECA416E14} 认知行为治疗对抑éƒç—‡æ‚£è€…的疗效åŠç”Ÿæ´»è´¨é‡çš„å½±å“Journal Article0 0贾金鼎; æ¨å»ºç« ; ä½™å¦; 宋新勤; 龙金亮 2011225 {EA837525-CF44-4529-9982-878D1C0B36B3} Consensus methods for medical and health services research.Journal Article0 0Jones, Jeremy; Hunter, Duncan 1995229 {11908A76-3834-416C-B8C9-BB7809456271} 强迫障ç¢è®¤çŸ¥è¡Œä¸ºæ²»ç–—技术æˆåˆ†çš„应用现状调查Journal Article0 0éƒèŒ; 韩海英; æŽå 江 2012213 {0AA84199-C4B5-4F93-B17C-656585429AE2} Distinctive activities of cognitive–behavioral therapy: A review of the comparative psychotherapy process literatureJournal Article0 0Blagys, Matthew D; Hilsenroth, Mark J 2002216 {BD7CD53B-D4EF-4BAE-BCDF-DCBD4D05FFAC} 认知一行为治疗对抑éƒéšœç¢ç–—效的循è¯ç ”究Journal Article0 0王娜; æŽå 江 2006222 {9806C513-7A20-4780-9809-B15769685B31} 认知行为治疗对抑éƒç—‡æ‚£è€…抑éƒçŠ¶æ€å’Œç¡çœ è´¨é‡çš„å½±å“Journal Article0 0æ¨äº‘秀 2011227 {15F082E0-FA2E-4A4E-95CF-4BFF59187F65} Contextualizing psychotherapy as a healing practice: Culture, history, and methodsJournal Article0 0Wampold, Bruce E 2001215 {40C1BE97-15AD-4BC2-A8BD-E0668FD92D47} 我国认知行为治疗 1996~ 2006 年文献回顾Journal Article0 0æŽä¸¹; æŽå 江 2009239 {F8CE3205-0E1C-40E6-9445-05FB1DB36640} The efficacy of cognitive-behavioral therapy in the treatment of depressionJournal Article0 0Zhang, Li 2003276 {DFC7C9B7-5166-40C0-BD7F-77CD96436E2E} Effect of Cognitive Behavior Therapy on the Efficacy and Quality of Life of Patients with DepressionJournal Article0 0Jia, Jin Ding; Yang, Jian Zhang; Yu, Xue; Song, Xin Qin; Long, Jin Liang 2011277 {35F3C9D7-A949-4A19-8FCE-97BB4639E31A} The influence of CBT on the depressive state and quality of sleep in depressionJournal Article0 0Yang, Yun Xiu 2011283 {32D3D3A5-779B-4CA6-B38C-A989FADF7192} Paroxetine, cognitive-behavioral therapy,and their combination in mild depressionJournal Article0 0Li, Jian; Qian, Yi Ping; Wang, Xiu Zhen; Wang, Jian Wen 2008287 {8905DDC6-6A3C-47D7-B947-C91221F1719E} Comparison between the combination of medical treatment with cognitive therapy and simple medical treatmentJournal Article0 0Song, Zhi Qiang; Liu, Gui Lan; Han, Guo Ling; E, Huai Hong 2006211 {5C24AD13-12A7-4BA4-AEC6-EA570318E107} A meta-analysis of the efficacy of cognitive therapy for depression.Journal Article0 0Dobson, Keith S 1989210 {EE0BE62B-D622-4AE9-910C-FAC78882FF33} Unipolar depressionJournal Article0 0Craighead, W E; Evans, D D; Robins, C J 1992209 {89CC49E5-94C5-496B-B776-E852741C22C9} Cognitive behaviour therapy--clinical applications.Journal Article0 0Enright, Simon J 1997208 {5C6AC73C-6580-4481-87A0-FF19D82BEB32} The empirical status of cognitive-behavioral therapy: a review of meta-analysesJournal Article0 0Butler, Andrew C; Chapman, Jason E; Forman, Evan M; Beck, Aaron T 2006207 {59B4660D-BF53-49F7-91EF-41079900C88C} Expansion in the provision of psychological treatment in the United Kingdom. CommentaryJournal Article0 0Rachman, S; Wilson, G Terence 2008206 {CBFA01A6-397E-42D8-A55F-0BB4844001B4} Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic reviewJournal Article0 0Tolin, David F 2010214 {AB5815F9-7CA9-45C4-BFA5-4558BB3F1435} 认知疗法的现状åŠè¶‹åŠ¿Journal Article0 0å£å»ºæž—; å¾ä¿Š 1989205 {EC40B229-0DD7-44F8-810F-D84009B9F874} Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatientsJournal Article0 0Rush, Augustus J; Beck, Aaron T; Kovacs, Maria; Hollon, Steven 1977204 {6C1059BD-D41C-429C-BA04-46BF2E49BE8D} Cognitive therapy of depressionBook0 0Beck, Aaron T 1979273 {6417CA57-C97C-4EFF-905B-99E4EB94091A} Cognitive Behavioral Intervention for DepressionJournal Article0 0Han, Li Xia; Han, Bing 2012291 {1894E973-C9C6-481A-AB3B-0080C525BA2C} Role of Automatic Thoughts and Attributional Styles in Major Depression: A Multifactorial AnalysisJournal Article0 0Guo, Wen Bin; Yao, Shu Qiao; Hang, Min Er; Wu, Da Xing 2005293 {012143A8-76AB-421E-B3A3-406C3C01B39F} Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experimentsJournal Article0 0Bennett-Levy, James 2003298 {E28CB990-01FF-4D15-BAAF-5299F87AC40E} A component analysis of cognitive-behavioral treatment for depressionJournal Article0 0Truax, Paula A; Addis, Michael E; Koerner, Kelly; Gollan, Jackie K; Gortner, Eric; Prince, Stacey E 1996238 {7CA7D004-2CDB-4842-AC85-F45E7AB5C291} An analysis of matching cognitive-behavior therapy techniques to learning styles.Journal Article0 0van Doorn, K; McManus, F; Yiend, J 2012217 {7A396B66-AC6A-4AC0-80F4-61F0F52603CC} 认知行为疗法è”åˆè¯ç‰©å¯¹æŠ‘éƒç—‡ç–—效的元分æžJournal Article0 0王广海; 刘志军; å¢å® 2010216 {BD7CD53B-D4EF-4BAE-BCDF-DCBD4D05FFAC} 认知一行为治疗对抑éƒéšœç¢ç–—效的循è¯ç ”究Journal Article0 0王娜; æŽå 江 2006214 {AB5815F9-7CA9-45C4-BFA5-4558BB3F1435} 认知疗法的现状åŠè¶‹åŠ¿Journal Article0 0å£å»ºæž—; å¾ä¿Š 1989230 {6ABFA187-D4CF-4C15-B611-F520B5DF41DC} 认知行为干预对抑éƒç—‡çš„å½±å“Journal Article0 0韩丽霞; 韩冰 2012231 {27C38122-C2D4-4FDA-9280-3919AB11241B} 自动æ€ç»´åŠå½’å› æ–¹å¼å¯¹æŠ‘éƒç—‡ä½œç”¨çš„å¤šå› ç´ åˆ†æžJournal Article0 0éƒæ–‡æ–Œ; å§šæ ‘æ¡¥; 黄æ•å„¿; å´å¤§å…´ 2005237 {F8A81027-D8EC-4AA8-B5A0-8B0B4A2FEFA7} A component analysis of cognitive-behavioral treatment for depressionJournal Article0 0Truax, Paula A; Addis, Michael E; Koerner, Kelly; Gollan, Jackie K; Gortner, Eric; Prince, Stacey E 1996232 {2B419231-E6AD-45EC-8A7D-07459A71DA41} Mechanisms of change in cognitive therapy: The case of automatic thought records and behavioural experimentsJournal Article0 0Bennett-Levy, James 2003230 {6ABFA187-D4CF-4C15-B611-F520B5DF41DC} 认知行为干预对抑éƒç—‡çš„å½±å“Journal Article0 0韩丽霞; 韩冰 2012215 {40C1BE97-15AD-4BC2-A8BD-E0668FD92D47} 我国认知行为治疗 1996~ 2006 年文献回顾Journal Article0 0æŽä¸¹; æŽå 江 2009301 {FECC7E4C-50C5-4788-956A-D12BB234E8FF} Modern Epidemiology: Methods and ApplicationsBook0 0Zeng, Guang 1994220 {DECF410D-0574-488F-BC50-CE40057B74A8} 认知行为疗法在抑éƒç—‡æ²»ç–—ä¸çš„作用Journal Article0 0å¼ ä¸½ 2003
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{F2F0BADE-0539-416F-8F99-9BE45C02286C}3.3.
Round 2
The mean (M) and C.V. of each item were shown in (Table 2). The Kendall's
concordance coefficient for maneuverability, frequency of use, contribution to
outcomes, and patients’ acceptability were 0.264 (χ2=244.38,
P<0.01), 0.288 (χ2=266.15,
P<0.01), 0.315 (χ2=290.93,
P<0.01), and 0.259 (χ2=239.46,
P<0.01), respectively. The weighing coefficients of each of the four
dimensions were 0.26, 0.19, 0.27, and 0.28. The overall rank see (Table 2) of each technique is based on the weighted summation of
its mean rank in each dimension.
To our knowledge, this was the very
first study in mainland China that explores the adaptability of CBT techniques
for depression. We addressed this issue by the Delphi method. Experts in this
study evaluated each of the basic, cognitive, and behavioral techniques through
four dimensions (maneuverability, frequency of use, contribution to outcomes,
and the patients' acceptability) in two separate rounds. And we assessed the
degree of adaptability by view of the techniques’ overall ranks in the second
round.
In Round 1, the mean scores in
the first dimension showed that all of techniques were considered to have a
relatively high degree of maneuverability, suggesting that the techniques being
listed in this study are applicable on the part of the therapists. As for the
other three dimensions, opinions of the experts varied greatly. The values of
C.V. showed that 16 techniques failed to reach a good consensus in the first
round. In Round 2,
however, this number decreased to six. Meanwhile, the Kendall's
concordance coefficient in the second round was higher than that in round
one. Both the C.V. and the Kendall's concordance coefficient in round two showed
that, for a wide range of techniques consisted of basic, cognitive, and
behavioral ones, a high degree of consensus was obtained within the panel of
Chinese CBT experts.
By looking into the data of Round
2, we found that the experts reached a comparatively higher level of consensus
on each of the basic techniques than techniques in the other two categories. Establishing
the therapeutic alliance, assessment, and psycho-education
ranked high on the list, suggesting that they are of first degree adaptability in
CBT treatment. Generally speaking, they are the ones that have been considered
as the most common factors in almost all types of psychotherapies [23]. In this sense, their adaptability in CBT should
be without doubt. Other basic techniques that fell into the top ten included
making a treatment plan, asking feedback and reviewing the treatment. The
rankings clearly indicate the fundamental nature of these basic techniques. In
contrast with those that can often be seen in psychotherapies other than CBT,
homework assignment is commonly recognized as a component almost exclusively
used in CBT [9]. In this study, experts
generally acknowledged homework assignment as agreeable to apply to Chinese
patients. This result is in line with the finding that homework is of
particular importance in the CBT treatments of depression [24].
The adaptability of cognitive
techniques reached a high degree of consensus as well,
with identifying automatic thoughts ranking first within this
category. The concept of automatic thought, reflecting the basic cognitive
theory of CBT, has been most frequently seen in studies both in China and
worldwide [25-28]. However, techniques that have
often been introduced both by CBT publications and trainings, such as
challenging the suicidal beliefs, cost-benefit analysis, continuous
calibration, and the pie chart method, ranked low in this study. The
findings contradict with the common notion that these techniques are as well
typical in CBT and are the preferred ones to use in treatment. The statistics in
this study also show that the patients seem not very much willing to accept
these easy-to-use techniques. Further research is needed to explore whether
these seemingly applicable techniques are virtually unadaptable in practice. Given
the results in this study, possible explanations might be that since a
proportion of depressive patients have difficulty in concentrating or thinking
effectively, they probably have trouble in following cognitive instructions
that require too much effort. Or it could be that some people might have
already used alternative ways to modify their dysfunctional thoughts or
believes, thus rendering these methods unneeded anymore. Or it could just
because these techniques seem too didactic to the patients.
As for those behavioral
techniques, including activity monitoring/scheduling,
suicidal behavior delay, problem solving, and social skills training,
they all had poor consensus in the dimension of patients' acceptability. Moreover,
they ranked the lowest on the entire technique list. Given that one of
depressive patients' major symptoms is fatigue or lack of energy, it could be
that they are reluctant to conduct these relatively complicated behavioral
activities. Meanwhile, it is worth noting that relaxation training and
assertive training obtain good consensus among experts, even in the
dimension of patients' acceptability. Perhaps it is because these two
activities require less preparation before trying.
Furthermore, cultural factors should also be taken into consideration when
look at our findings. First, techniques that ranked among the bottom ten on
the list are mainly those that aim at modifying the patients' present
maladaptive cognitions or behaviors. Although CBT therapists are believed to use
them in a euphemistic and collaborative way, the nature of those techniques is still
challenging in Chinese culture. Since ordinary Chinese values often emphasize
mild and indirect attitudes, addressing straightly to the patients' problematic
cognitions or behaviors might do harm to a certain extent to the therapeutic
relationships. Second, this Delphi study showed an apparent
preference for cognitive techniques over the behavior ones. To the contrary,
there has been accumulating evidence suggesting that changes in CBT treatments may
primarily be the result of certain behavioral strategies rather than cognitive
ones. Such strategies are often designed to activate patients in behaving
adaptively in their environment [28-31]. To
address this disparity, a possible important factor
is whether the patients' certain characteristics are matched to the
interventions . In Chinese culture, we set store by persuading
through reasoning; therefore, the Chinese generally tend not to try out a thing
unless they have been fully convinced of the benefits of doing it.
In this study, we listed the CBT techniques as
comprehensive as possible and conducted a rather comprehensive evaluation. However,
a few limitations need to be acknowledged. First, some of the techniques
listed in the study were not precise or specific enough. For example, techniques
such as establishing therapeutic alliance, making a treatment plan, reviewing
the treatment, case formulation, can be viewed more as a general component of
psychotherapy rather than a specific technique. Second, we did not distinguish
the degree of severity of depression in this study. It is possible that the ranking of these techniques differs if the experts were
asked to rate them according to the severity of depression. Furthermore, therapy
often has various phases, with each serving distinct functions. The adaptability
of each technique cannot be all the same across different therapeutic phases. Finally,
although all efforts had been made to include all the CBT techniques for
depression from published articles and books, some techniques may
still not be included in this study.
In the future, a close examination of the matching among
techniques, severity of depression, and treatment phases may yield more
important information, and from which we could be able to learn more about why and
under what circumstances some techniques are more adaptable than others.
Moreover, further investigation needs to be done as for whether there are
localized CBT techniques in China and how they have been specifically applied.
Last but not least, it is worth noting that no psychotherapy is simply
technique driven. Future research should focus more on how to implement these
techniques as a whole rather than on the discrete use of each of them.
And for the same reason, apart from instructing the various techniques and
their adaptability, CBT trainings in China should emphasis more often on the
skillful delivery of these techniques.
In conclusion, this was the first Delphi study in
China that examined the adaptability of CBT techniques for depression.
The Chinese CBT experts reached a high degree of consensus on adaptability of both the basic and
the cognitive techniques, but not on all behavioral ones. The adaptability of
certain behavioral techniques for depression under distinct circumstances warrants
further investigation.
5.
Funding： The
National Key Technology R&D Program 2009BAI77B11.
|
Techniques |
Maneuverability |
Frequency of use |
Contribution to outcomes |
Patients' acceptability |
||||||||
|
|
M |
C.V. |
|
M |
C.V. |
|
M |
C.V. |
|
M |
C.V. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Establishing therapeutic alliance |
23.00 |
4.61 |
0.12 |
25.23 |
3.97 |
0.05 |
25.08 |
3.8 |
0.10 |
24.44 |
3.53 |
0.16 |
|
assessment |
22.27 |
4.58 |
0.12 |
24.89 |
3.94 |
0.06 |
22.61 |
3.63 |
0.17 |
22.39 |
3.39 |
0.16 |
|
Making a treatment plan |
18.94 |
4.29 |
0.16 |
22.92 |
3.77 |
0.11 |
18.21 |
3.33 |
0.16 |
21.85 |
3.32 |
0.14 |
|
Setting the agenda |
18.98 |
4.28 |
0.18 |
17.37 |
3.40 |
0.18 |
16.73 |
3.21 |
0.19 |
18.34 |
3.07 |
0.19 |
|
Psycho-education |
23.50 |
4.65 |
0.13 |
23.89 |
3.84 |
0.10 |
22.10 |
3.57 |
0.18 |
22.76 |
3.42 |
0.18 |
|
Normalization |
15.55 |
4.06 |
0.21 |
18.29 |
3.45 |
0.18 |
16.55 |
3.2 |
0.25* |
17.79 |
3.06 |
0.28* |
|
Relapse prevention |
17.90 |
4.23 |
0.19 |
19.69 |
3.52 |
0.21 |
18.27 |
3.33 |
0.21 |
19.60 |
3.19 |
0.26* |
|
Reviewing the treatment |
19.74 |
4.32 |
0.20 |
19.05 |
3.48 |
0.21 |
21.77 |
3.57 |
0.18 |
14.85 |
2.87 |
0.23 |
|
Homework assignment |
15.03 |
3.94 |
0.28* |
15.08 |
3.19 |
0.26* |
17.85 |
3.27 |
0.23 |
14.85 |
2.83 |
0.26* |
|
Case formulation |
16.29 |
4.07 |
0.22 |
18.44 |
3.41 |
0.20 |
16.76 |
3.18 |
0.24 |
19.34 |
3.10 |
0.23 |
|
Curative effect Maintenance |
19.95 |
4.39 |
0.16 |
19.06 |
3.48 |
0.19 |
17.47 |
3.27 |
0.23 |
20.24 |
3.23 |
0.17 |
|
Asking feedback |
20.00 |
4.35 |
0.17 |
19.98 |
3.58 |
0.16 |
18.85 |
3.37 |
0.17 |
19.45 |
3.16 |
0.17 |
|
Motivational interviewing |
16.32 |
4.10 |
0.20 |
16.71 |
3.32 |
0.21 |
16.10 |
3.13 |
0.25* |
16.47 |
2.94 |
0.23 |
|
Cognitive Techniques |
|
|
|
|
|
|
|
|
|
|
|
|
|
Logical reasoning examination |
15.50 |
4.00 |
0.21 |
17.27 |
3.30 |
0.25* |
17.02 |
3.20 |
0.24 |
15.76 |
2.93 |
0.25* |
|
cost-benefit analysis |
12.65** |
3.77 |
0.23 |
13.26 |
2.97 |
0.32* |
11.97** |
2.87 |
0.31* |
14.58 |
2.80 |
0.33* |
|
Automatic thought records |
20.60 |
4.42 |
0.15 |
19.21 |
3.52 |
0.21 |
19.19 |
3.42 |
0.18 |
16.24 |
2.97 |
0.20 |
|
Examining the evidence |
18.85 |
4.23 |
0.21 |
19.69 |
3.50 |
0.23 |
19.29 |
3.37 |
0.24 |
18.03 |
3.03 |
0.20 |
|
The pie chart method |
15.08 |
4.00 |
0.24 |
12.55** |
3.00 |
0.29* |
15.16 |
3.10 |
0.26* |
16.32 |
2.97 |
0.22 |
|
Identifying automatic thoughts |
21.87 |
4.52 |
0.16 |
22.16 |
3.74 |
0.14 |
22.21 |
3.61 |
0.14 |
19.97 |
3.23 |
0.15 |
|
Identifying intermediate beliefs |
17.00 |
4.13 |
0.26* |
16.81 |
3.35 |
0.22 |
18.00 |
3.29 |
0.24 |
17.74 |
3.06 |
0.22 |
|
Identifying core beliefs |
19.61 |
4.35 |
0.19 |
19.69 |
3.55 |
0.19 |
19.65 |
3.45 |
0.19 |
18.35 |
3.13 |
0.20 |
|
Continuous calibration |
12.44** |
3.8 |
0.25* |
11.05** |
2.80 |
0.36* |
11.68** |
2.83 |
0.32* |
15.24 |
2.87 |
0.27* |
|
Role-playing |
15.69 |
4.03 |
0.21 |
13.21 |
3.03 |
0.28* |
17.06 |
3.23 |
0.26* |
13.82 |
2.81 |
0.25* |
|
Socratic questioning |
16.13 |
4.10 |
0.21 |
17.77 |
3.42 |
0.18 |
18.03 |
3.30 |
0.21 |
17.11 |
3.00 |
0.24 |
|
Challenging the suicidal beliefs |
12.26** |
3.77 |
0.24 |
11.79** |
2.94 |
0.25* |
12.71** |
2.87 |
0.28* |
12.13** |
2.68 |
0.22 |
|
Behavioral Techniques |
|
|
|
|
|
|
|
|
|
|
|
|
|
Activity monitoring/scheduling |
18.69 |
4.26 |
0.19 |
17.95 |
3.42 |
0.20 |
16.81 |
3.26 |
0.18 |
17.98 |
3.10 |
0.19 |
|
Social skills training |
18.42 |
4.23 |
0.16 |
17.66 |
3.40 |
0.18 |
18.26 |
3.30 |
0.16 |
17.08 |
3.00 |
0.19 |
|
Problem solving |
16.37 |
4.10 |
0.18 |
14.89 |
3.10 |
0.29* |
14.82 |
3.07 |
0.25* |
14.23 |
2.86 |
0.24 |
|
Behavioral experiments |
18.00 |
4.23 |
0.17 |
19.52 |
3.50 |
0.19 |
20.34 |
3.47 |
0.20 |
19.74 |
3.17 |
0.20 |
|
Signing the safety agreement |
18.79 |
4.27 |
0.17 |
17.65 |
3.37 |
0.20 |
19.29 |
3.40 |
0.18 |
15.89 |
2.97 |
0.21 |
|
Suicidal behavior delay |
14.32 |
3.9 |
0.22 |
11.85** |
2.80 |
0.37* |
11.56** |
2.76 |
0.32* |
10.69** |
2.59 |
0.19 |
|
Emotional recognition |
14.02 |
3.97 |
0.20 |
11.47** |
2.90 |
0.28* |
11.79** |
2.86 |
0.30* |
12.24** |
2.72 |
0.19 |
|
Relaxation training |
14.15 |
3.87 |
0.26* |
14.97 |
3.10 |
0.31* |
15.31 |
3.03 |
0.30* |
19.55 |
3.13 |
0.27* |
|
Assertiveness training |
17.08 |
4.13 |
0.21 |
13.98 |
3.07 |
0.26* |
16.50 |
3.20 |
0.21 |
19.92 |
3.20 |
0.22 |
|
Note: * coefficient of variation (C.V.) ≥ 0.25 |
||||||||||||
Table 1: The mean rank (
), mean (M) and Coefficient of Variation (C.V.) of each technique in Round 1.
|
Dimensions Techniques |
Overall rank (order) |
maneuverability |
Frequency of use |
Contribution to outcomes |
Patients' acceptability |
||||
|
M |
C.V. |
M |
C.V. |
M |
C.V. |
M |
C.V. |
||
|
Basic Techniques |
|
|
|
|
|
|
|
|
|
|
Establishing therapeutic alliance |
26.11（1） |
4.86 |
0.09 |
3.93 |
0.1 |
4 |
0 |
3.93 |
0.07 |
|
Assessment |
25.30（2） |
4.89 |
0.09 |
3.93 |
0.1 |
4 |
0 |
3.68 |
0.14 |
|
Psycho-education |
24.44（3） |
4.93 |
0.08 |
3.86 |
0.15 |
3.82 |
0.12 |
3.64 |
0.15 |
|
Making a treatment plan |
21.29（6） |
4.64 |
0.11 |
3.89 |
0.11 |
3.54 |
0.18 |
3.43 |
0.17 |
|
Asking feedback |
20.93（7） |
4.82 |
0.1 |
3.79 |
0.13 |
3.46 |
0.15 |
3.36 |
0.17 |
|
Reviewing the treatment |
20.16（10） |
4.61 |
0.15 |
3.79 |
0.13 |
3.57 |
0.14 |
3.25 |
0.16 |
|
Normalization |
19.95（11） |
4.61 |
0.15 |
3.71 |
0.14 |
3.39 |
0.17 |
3.42 |
0.15 |
|
Homework assignment |
19.38（12） |
4.54 |
0.17 |
3.64 |
0.2 |
3.57 |
0.18 |
3.18 |
0.19 |
|
Curative effect Maintenance |
19.03（13） |
4.54 |
0.16 |
3.68 |
0.15 |
3.43 |
0.17 |
3.29 |
0.16 |
|
Relapse prevention |
18.89（14） |
4.29 |
0.15 |
3.68 |
0.15 |
3.5 |
0.15 |
3.42 |
0.15 |
|
Case formulation |
17.62（15） |
4.25 |
0.17 |
3.57 |
0.16 |
3.43 |
0.15 |
3.29 |
0.16 |
|
Setting the agenda |
16.30（18） |
4.43 |
0.13 |
3.39 |
0.17 |
3.21 |
0.13 |
3.18 |
0.15 |
|
Motivational interviewing |
15.80（22） |
4.18 |
0.13 |
3.39 |
0.17 |
3.32 |
0.16 |
3.18 |
0.17 |
|
Cognitive Techniques |
|
|
|
|
|
|
|
|
|
|
Identifying automatic thoughts |
22.90（4） |
4.82 |
0.1 |
3.86 |
0.14 |
3.79 |
0.14 |
3.39 |
0.17 |
|
Examining the evidence |
21.79（5） |
4.71 |
0.1 |
3.79 |
0.11 |
3.75 |
0.16 |
3.36 |
0.15 |
|
Identifying core beliefs |
20.56（8） |
4.64 |
0.12 |
3.64 |
0.17 |
3.64 |
0.17 |
3.32 |
0.16 |
|
Automatic thought records |
20.46（9） |
4.64 |
0.13 |
3.75 |
0.16 |
3.57 |
0.16 |
3.29 |
0.18 |
|
Identifying intermediate beliefs |
17.28（16） |
4.5 |
0.14 |
3.54 |
0.16 |
3.29 |
0.21 |
3.11 |
0.2 |
|
Socratic questioning |
16.68（17） |
4.25 |
0.19 |
3.5 |
0.2 |
3.32 |
0.18 |
3.14 |
0.17 |
|
Role-playing |
15.83（21） |
4.29 |
0.11 |
3.29 |
0.16 |
3.32 |
0.16 |
3.21 |
0.18 |
|
Logical reasoning examination |
15.37（25） |
4.25 |
0.14 |
3.46 |
0.17 |
3.25 |
0.18 |
3.04 |
0.14 |
|
Challenging the suicidal beliefs |
12.87（29） |
4.14 |
0.15 |
3.11 |
0.22 |
3.11 |
0.18 |
2.86 |
0.18 |
|
cost-benefit analysis |
12.69（30） |
3.89 |
0.15 |
3.11 |
0.18 |
3.07 |
0.2 |
3.04 |
0.17 |
|
Continuous calibration |
11.94（32） |
3.96 |
0.15 |
3.04 |
0.19 |
2.93 |
0.18 |
3.04 |
0.17 |
|
The pie chart method |
10.09（34） |
3.86 |
0.12 |
2.93 |
0.16 |
2.89 |
0.14 |
2.79 |
0.2 |
|
Behavioral Techniques |
|
|
|
|
|
|
|
|
|
|
Emotional recognition |
16.19（19） |
4.43 |
0.11 |
3.28 |
0.18 |
3.36 |
0.15 |
3.15 |
0.11 |
|
Behavioral experiments |
16.12（20） |
4.18 |
0.13 |
3.46 |
0.17 |
3.39 |
0.22 |
3.04 |
0.25* |
|
Relaxation training |
15.80（23） |
4.18 |
0.21 |
3.18 |
0.21 |
3.39 |
0.15 |
3.15 |
0.23 |
|
Assertiveness training |
15.58（24） |
4.18 |
0.15 |
3.32 |
0.14 |
3.29 |
0.21 |
3.15 |
0.21 |
|
Signing the safety agreement |
15.12（26） |
4.21 |
0.19 |
3.32 |
0.23 |
3.04 |
0.25* |
3.11 |
0.21 |
|
Activity monitoring/scheduling |
14.75（27） |
4.54 |
0.12 |
3.68 |
0.13 |
2.79 |
0.23 |
2.78 |
0.25* |
|
Suicidal behavior delay |
13.68（28） |
4.11 |
0.15 |
2.89 |
0.22 |
3.18 |
0.23 |
3.07 |
0.25* |
|
Problem solving |
12.61（31） |
4.29 |
0.12 |
3.54 |
0.16 |
2.68 |
0.31 |
2.48 |
0.34* |
|
Social skills training |
11.58（33） |
4.21 |
0.18 |
3.29 |
0.16 |
2.64 |
0.26* |
2.59 |
0.29* |
|
Note: * coefficient of variation (C.V.) ≥ 0.25 |
|||||||||
Table 2: The overall rank, mean (M) and coefficient of variation (C.V.) of each technique in Round 2.
1. Beck AT (1979) Cognitive therapy of depression. New York, NY: The Guilford Press.
10. Ji JL, Xu J (1989) The Status quo and Trend of Cognitive Therapy. Chinese Mental Health Journal 3: 129-132.
11. Li D, Li ZJ (2009) Review of Researches on Cognitive Behavioral Therapy from 1996 to 2006. Chinese Journal of Behavioral Medicine and Brain Science 6: 559-560.
12. Wang GH, Liu ZJ, Lu N (2010) The Efficacy of Cognitive-behavioral Therapy Combined with Antidepressants for Depression: A Meta-analysis. Journal of Preventive Medicine Information 26: 511-518.
13. Wang N, Li ZJ (2006) Evidence-Based Research on the Efficacy of Cognitive-Behavorial Therapy for Depressive Disorders. Chinese Journal of Clinical Psychology 14: 416-418.
14. Gao Y, Gong YC, Guo FL, Hu KY, Zhang RX, et al. (2003) Comparative Study of Treatments with Cognitive Behavioral Therapy in Depression. Chinese Journal of Behavioral Medical Science 4: 460.
16. Zhang L (2003) The efficacy of cognitive-behavioral therapy in the treatment of depression. Chinese Journal of Clinical Rehabilitation 7: 479-480.
17. Jia JD, Yang JZ, Yu X, Song XQ, Long JL (2011) Effect of Cognitive Behavior Therapy on the Efficacy and Quality of Life of Patients with Depression. China Journal of Health Psychology 19: 1411-1413.
18. Li J, Qian YP, Wang XZ, Wang JW (2008) Paroxetine, cognitive-behavioral therapy, and their combination in mild depression. Shanghai Archives of Psychiatry 20: 342-345.
19. Song ZQ, Liu GL, Han GL, E HH (2006) Comparison between the combination of medical treatment with cognitive therapy and simple medical treatment. Chinese Journal of Nervous and Mental Diseases 32: 275-276.
20. Yang YX (2011) The influence of CBT on the depressive state and quality of sleep in depression. Journal of Psychiatry 24: 134-135.
22. Zeng G (1994) Modern Epidemiology: Methods and Applications. Beijing: Publishing House of Beijing Medical University and Peking Union Medical College.
26. Guo WB, Yao SQ, Hang ME, Wu DX (2005) Role of Automatic Thoughts and Attributional Styles in Major Depression: A Multifactorial Analysis. Psychological Science 28: 392-394.
27. Han LX, Han B (2012) Cognitive Behavioral Intervention for Depression. Chinese Joural of Rehabilitation 27: 102-103.
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