disputerer for pr.philos-graden i helsevitenskap og vil offentlig forsvare avhandlingen:
“The temporal development of cognitive behavioral therapy as treatment for unipolar depression. An evaluation based on three meta-analyses, focusing on time-trends, effect sizes, and associated moderators”
Auditoriet er åpent for publikum, men både prøveforelesing og disputas vil bli strømmet.
Disputasen starter kl. 1215
Populærvitenskapelig sammendrag av avhandlingen:
In modern society, psychological disturbances and problems are fairly common, and frequently cause suffering, poor health and reduced functioning for a great deal of people. During a lifetime, all of us have either been afflicted by psychological issues, or been acquainted to the problem via family members, friends, or colleagues who are/have been suffering.
Depression is one of the largest and most well-known disorders. Luckily, we have able treatments available for such a debilitating illness. Health professionals are stating that the effectiveness is very high for the most common treatment forms – a claim that is frequently supported through trials measuring treatment effects. So far, so good. But what would you think if you came to realize that the therapy of choice has not been thoroughly evaluated for progress during its 45 years in existence? Or that the content in the treatment has been virtually unchanged since the 1970`s? These unchartered questions paved the way for the studies which the current thesis draws upon.
For individual cognitive behavioral therapy (CBT), the statements above are quite accurate. The treatment method was invented and refined in the 70`s, with a standard treatment manual developed in the same era. At the time, CBT was labelled as the “gold standard” for treating depression, and gained a high stature with professionals, the public, and policy makers. Soon enough, CBT became the driving force in treatment for many psychological disorders, including depression.
These factors motivated the present effort to investigate the temporal development of CBT, as well as its most common variations; group cognitive behavioral therapy (GCBT), and mindfulness-based cognitive behavioral therapy (MCBT).
The tool for evaluating the temporal development of treatment effects was the meta-analysis. This is a procedure which aims to comprehensively and thoroughly summarize all appropriate research trials conducted with CBT from 1976 and onwards, thus widening our knowledge of the phenomenon under investigation. In addition to purely measuring the outcome of treatment trials, chosen variables can also readily be investigated, with the objective being to understand and explain potential interesting findings.
The results from the meta-analyses revealed that CBT, GCBT and MCBT are efficient in battling depression. However, individual CBT performed today is less efficient than it was in previous years. GCBT, on the other hand, seem to be more efficient today than before, while MCBT shows no change in treatment effects with time passing by.
The factor that exerts the largest influence on the observed fall in effectiveness for CBT for depression, is most likely the lack of procedural development with the passing of time. On the other hand, flexibility and adaptation are tied to the increase in treatment effects with time observed for GCBT.
Thus, the main message and conclusion from this thesis is that treatment manuals and procedures should routinely and regularly be updated or adapted, to ensure that treatment is as efficient as possible. Treatment procedures that were accepted as best practice 10-15 years ago,
will most likely start to wane if they are not evaluated and adjusted with timely intervals. If diligent efforts are made in the suggested direction, a substantial number of patients could be helped to a quicker and more robust remission from depression – saving both them and society from vast emotional, economical and health-wise suffering.
Seniorforsker Peter Fisher, University of Liverpool, UK – 1. Opponent.
Professor Stian Solem, NTNU - 2. opponent.
Førsteamanuensis Ingunn Skre, Institutt for psykologi, Det helsevitenskapelige fakultet, UiT Norges arktiske universitet – leder av komité.
Professor Martin Eisemann, Institutt for psykologi, Det helsevitenskapelige fakultet, UiT Norges arktiske universitet.