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The Effectiveness of CBT In Reducing Depression: A Systematic
Review
Ira Ayu Maryuti
1Faculty of Nursing Universitas Airlangga
iraayu.maryuti@gmail.com
Keywords: depression, cognitive behavior therapy, therapy depression.
Abstract: The purpose of making this Systematic Review is to evaluate effectiveness of Cognitive Behavioral Therapy
as a depression intervention in lowering depression levels. Keywords used, namely: depression, cognitive
behavior therapy, therapy depression. Journal article search is done electronically using multiple databases:
DOAJ, Sage, Proquest, JAMA Net, Google Scholar. The year limit used is 10 years (2007 -2017). From the
literature search results obtained fourteen selected journal articles. The thirteen studies raised in this study
all have control groups. There are 3 studies conducted at the age of the child, 9 studies in adulthood, 1 study
at the age of the elderly. In improving the next Systematic Review, it may be necessary to note the
homogeneity of age groups. So that more can focus in doing evaluation
1 INTRODUCTION Cognitive Therapy- Behavior is a therapy that
combines cognitive and behavioral aspects. This
Depression is a disturbance of feelings experienced therapy by approaching the client to recognize
by individuals of different ages and may interfere negative thoughts that can lead to negative
with various aspects of life's functions, ranging from perceptions and emotions. Improper thoughts and
motivation, emotion, cognitive, behavioral, and emotions will affect the behavior of individuals,
biological (Gilbert, 2000). Depression occurs in all until it is considered to require therapy (Kennerley
ages of human development, ie from infancy to & Kirk, 2007).
elderly.
The prevalence of depression in children is
estimated to be 0.5-2%. In certain populations it is 2 METHOD
estimated to reach 10-20% with clinical problems.
The cause of depression in children is not known for Literature searches are performed in major databases
certain, but this can lead to various symptoms, such as PROQUEST, DOAJ, SAGE, JAMA Net,
among others: facial expressions sedi, easy to shed and GOOGLE SCHOLAR by including keywords:
tears, irritability, withdraw from the interests that depression, cognitive behavior therapy, depression
can usually be fun, therapy. The time limit used is 2007 to 2017. Finally
Interventions to overcome depression are now got 13 articles that meet the inclusion criteria.
widely developed through biological and Inclusion criteria of the article are: 1) depressed
psychological approaches, as well as a combination patients, 2) the treatment provided is cognitive
of both. Both of these approaches proved effective behavior therapy, 3) the parameters assessed is
for treating depression in the elderly (Das, decreased depression level.
Greenspan, Muralee, Choe & Tampi, 2007). The Depression rate parameters assessed using a
biological approach is done by administering highly variable instrument. The instruments include:
antidepressant medicines by skilled medical using Beck Depression Inventory (BDI), scalewas,
personnel. Psychological approaches include locally validated versions of Posttraumatic UCLA
psychotherapy, such as Cognitive Behavioral Stress
Therapy (CBT), Interpersonal Therapy (IPT), and Reaction Disorder Index (range, 0-4).
Dialectical Behavioral Therapy (DBT) therapy. nonparametrict Friedman or Wilcoxon standard on
The 9th International Nursing Conference 2018 630
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SPSS software, Geriatric Depression Scale (GDS) of depression, accidental sampling, 3 ) are willing to
and Brief Depression rating Scale (BDRS. be respondents. The measuring tool used to assess
the level of depression is Beck Depression Inventory
(BDI). The intervention was conducted in 6
3 RESULT meetings, with 1 pre-intervention session, 8
intervention sessions, and 1 post-intervention
3.1 Depression in children session. The meetings take place twice a week, each
meeting takes 60 minutes. After the intervention
Research Dikla Eckshtain and Scott T. Gaynor there was a significant decrease in depression rates
(2011) stated that the total samples meeting the in 2 participants, but in another participant, the
inclusion criteria were as many as 15 children in decrease in depression was not significant, probably
open clinical trials. The measuring tool used Scale influenced by higher rates of depression early in the
Revised rating is semi structured interviews assessment and a history of major depression.
analyzed using standard Friedman or Wilcoxon Research conducted by Kenneth E. Freeland
nonparametrictes on SPSS software. Cognitive at.all (2010) states that the study was conducted in
Behavioral Therapy (CBT) using 16 session patients with depressed heart failure, and in getting
combinations of 7 sessions. This study was followed respondents as many as 158 people who meet the
up for 1 month and 6 months after the intervention, criteria of inclusion. The study was conducted in a
which resulted in a significant decrease in clinical trial with a single blind result. After 6
depression rate in all respondents. months of cognitive-behavioral therapy, 73% of
The study of David A. Brend et al (2015) states respondents were able to complete with lower
that a total sample of 316 respondents met the depression score on Beck Depression Inventory
inclusion criteria. Randomized design of clinical (BDI-II).
trials. CBT interventions are given weekly for 90 Research conducted Elizabeth O Elizabeth
minutes in 6 sessions. Scalewas gauges are used to O'Connor et.al states that depression screening in
measure depression levels. After follow-up the pregnant and postpartum women, then there are 9
results showed the depression rate decreased respondents who meet the inclusion criteria. This
significantly. study was conducted in clinical trials. After
Laurra K. Muray et.al's (2013) study indicated Cognitive-Behavioral therapy, after 3-5 months
that the total sample was 131 people as the treatment follow-up showed that there was a decrease in
group, and 126 as the control group. Design a depressive symptoms assessed using Postnatal
randomized clinical trial study between Cofnitive Depression Scale.
Behavioral Therapy (CBT) interventions with In the study of S. Darius Tandon et.al states that
ordinary care. CBT intervention was conducted in in the working population of adolescents and young
10-16 sessions. The measuring instrument used is adults the need for mental health interventions to
using locally validated versions of UCLA Stress reduce symptoms of depressive disorders. The study
Posttraumatic Disorder Reaction Index (range, 0-4). design is quasi-experimental study. After
Results at follow up, mean item changes in symptom recruitment was obtained as many as 517
trauma score were -1.54 (95% CI, -1.81 -1.27), respondents who meet kreiteria inclusion. Cognitive-
81.9% reduction, for TF-CBT and -0.37 ( 95% CI, Behavioral Therapy is done on site for 30 minutes,
0.57 to-0.17), 21.1% reduction, for the TAU group. this is done continuously for 1 year, then do follow-
The mean change of Item for a function is-0.76 up, in get decrease significantly decrease of
(95% CI, -0.98 to -0.54), 89.4% reduction, and -0.54 symptoms of depression.
(95% CI, 0.80 to -0.29 ), a reduction of 68.3%, for Evan M. Forman et.al (2007) stated that the total
TF-CBT and TAU groups, respectively. The respondents were given as many as 109 people. With
difference in the changes between the groups was the design of clinical trials. Interventions of CBT
statistically significant for the outcome (p, 0.001). and CT were performed. respondents were given the
right to terminate therapy whenever they wanted, so
3.2 Depression in adulthood there were some respondents who did not complete
the intervention until it was completed. Respondents
Research Hapsarini Nelma (2012) states that the who performed the intervention to completion
total sample used is 1 (one) person that meets the showed a significant decrease in depression rates, as
inclusion criteria include: 1) in Diabetes Mellitus indicated by the results of BDI-II measurements.
type 2 patient with GDP> 150mmhg, 2) experience
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Steven D. Hollon et.al (2014) states that the total design doubleblind randomized clinical trials for 12
number of respondents who met the inclusion weeks. Having done DCS actions when combined
criteria of 452 participants, 227 were randomized to with CBT will give a significant effect.
CT combined with ADM Treatment groups, and 225 In Meta Analysis Erica S. Weizt et al (2014)
for the treatment of group ADMs alone. Patient claimed to obtain abstract 14902 source data after
designs were randomly assigned to ADM alone or randomized clinical trials where and ADM were
CT treatment combined with ADM treatment. compared in patients with depressive disorders.
Treatment was continued for 42 months until shows that the base of depression severity is
recovery was achieved. The survival analysis based notmoderate reduction in depressive symptoms
on the hazard subdistribution model used for the between CBT and ADM in outcomes (β = 0.00; P =
treatment outcome model. cognitive therapy 0.96). The same result is seen using BDI. Basic
combined with drug treatment enhanced relative rate depression severity is also not moderate probability
of recovery relative to drug alone; These effects may of response (OR, 0.99; P = 0.77) or remission (OR,
be limited to patients with severe nonchronic 1.00; P = 0.93) between CBT and ADM.
depression.
Constance Guille et al (2015) states that the 3.3 Depression in the elderly
number of respondents who met the inclusion
criteria was 199. Randomized clinical trial design Retna Arjadi's research (2012) states that the total
was conducted at 2 university hospitals with 199 sample used is 3 (three) elderly people who
internships from several specializations during the experience depression, selected by accidental
2009-2010 academic year or 2011-2012. The study sampling. Measurements used to assess depression
was conducted from May 2009 to June 2010 and levels are Beck Depression Inventory (BDI),
May 2011 through June 2012, and data were Geriatric Depression Scale (GDS) and Brief
analyzed using intent-to-treat principles, including Depression rating scales (BDRS). Measurements are
recent observations. INTERVENTION Trainees made at the beginning and end of CBT intervention.
were randomly assigned to two study groups (wCBT The intervention was conducted in 10 meetings, with
and attention-control group [ACG ]), and completes 1 pre-intervention session, 8 intervention sessions,
a study that lasts 30 minutes each week for 4 weeks and 1 post-intervention session. The meetings take
before starting the apprenticeship. The results show place twice a week, each meeting takes 60 minutes.
that there is a decrease in suicidal intentions. After the intervention there was a significant
Zindel V. Segal et.al (2010) states that the total decrease in depression rates in 2 participants, but in
number of respondents selected because menmenuhi another participant, the decrease in depression was
inclusion criteria as many as 160 people. The not significant, probably influenced by higher rates
research design used was randomized for 18 months. of depression early in the assessment and a history
Patient's intervention in remission discontinues them of major depression.
antidepressants and attended 8 weekly group
sessions of MBCT, continued to take their
therapeutic doses of antidepressant drugs, or the 4 CONCLUSIONS
active drug was stopped and diverted to the placebo.
Results: The intention-to-treat analysis showed Cognitive Behavioral Therapy (CBT) is a form of
significant interactions between the acute phase mental exercise, especially depressed patients. CBT
quality of remission and subsequent prevention of makes significant improvements in the depression
relapse in randomized patients (P = 0.03). Among therapy stage to practice over and over again. Of the
the unstable delivery services (1 or more Hamilton 13 studies examined proved that CBT could be
Rating Scale for Depression scored 7 during another benefit found to reduce depression levels, it
remission), patients in both MBCT and maintenance is expected to be an alternative in rehabilitation of
treatments showed a 73% decrease in hazard depressed patients to achieve better quality of life..
compared to placebo (P = 0.03), while for delivery
services stable (All Hamilton Scale Rating for the
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