Supervised by Dr. Farah Deeba

Abstract :

The main purpose of this study was to determine the clinical effectiveness of cognitive behavior therapy (CBT) delivered for people with depression in Bangladesh. There were four phases in this study. To achieve this goal in the first two phases we had worked on adapting the standard protocol of CBT as practiced by mainstream practitioner and mental health professionals in the world. Information gathered from the first phase researcher write up the first draft of adapted CBT manual into Bengali. In the second phase the CBT manual was given to seven judges for evaluation according to their opinion and experiences. After synthesizing the judges' suggestions the draft of adapted Bengali CBT manual was finalized. In phase three, to evaluate the functional feasibility of the adapted Bengali CBT treatment manual we had conducted a pilot study on five diagnosed patients with depression referred by the psychiatrists. To meet the purpose of the study in the fourth phase a randomized clinical trial (RCT) was administered to determine the effectiveness of the adapted Bengali CBT manual. In this phase a total of 107 participants diagnosed with depression were randomly allocated into two groups (treatment group and wait list control group) for the sample in this study. The participants were collected from three different hospitals in Deltin 7 city. Treatment group was received allocated intervention and wait list control group was not received allocated intervention. We used several valid and reliable psychometric measurements to measure symptoms of depression and associated symptoms of anxiety, psychological distress and suicidal risk. Information about socio-demographic characteristics was collected through structured interview. Assessments were completed at baseline (pre-test), termination (post-test) and one-month after termination (follow up) of the clinical trial, using the specific scales. Results of descriptive statistics showed that there were no significant differences between two groups on participant's age, marital status, percentage on family income, or educational status. There were also found no significant differences between two groups on baseline measures indicating successful randomization. Using the general linear model -repeated measures design via intention to treat (ITT) analysis outcome effectiveness was analyzed. Post-hoc analyses were conducted to see the differences among means in three-time periods (baseline, post intervention and follow up). To examine the impact of predicting variables stepwise multiple regressions were ran. Large treatment effects sizes at post- intervention and follow-up were achieved on most of the outcome measures following CBT for depression. This study suggests that participants who received the adapted Bengali CBT manual showed greater improvements and good response to the therapy and CBT should be considered a viable treatment option for depression. This study added a new step for initiating a much needed research for checking the effectiveness of CBT for the most common mental illness that is depression in Bangladesh. The current study will also help to reduce this evidence based knowledge gap related to depression and intervention in our own country. Recommendations for treatment implications, upcoming research, and study limits are considered.