Abstract
This was a randomized controlled trial, conducted to determine the effectiveness of CBT for depression delivered by trained therapists with an adapted Bengali CBT (BaCBT) manual, as compared to a control group. A total of 148 patients with a diagnosis of depression and attending psychiatry departments of three hospitals in Dhaka, Bangladesh, were assessed for eligibility, and 107 were randomly allocated to either treatment (n = 54) or a waitlist (n = 53). Assessments of outcome were completed at 3 time points (pre-test, post-test, and 1-month follow-up). The results revealed significant reductions in depression severity, anxiety, perceived stress, and suicidal ideation in the group that received the intervention, but modest to no significant changes in the control group. This is the first report of the results of an adapted CBT program for depression from Bangladesh. Although several limitations of the study are noted, and further studies are needed to generalize these current results, they indicate that CBT is an efficacious treatment option for depression in varied cultures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. https://doi.org/10.1176/appi.books.9780890425596
Andrews, G. (2001). Should depression be managed as a chronic disease? BMJ (clinical Research Ed.), 322(7283), 419–421. https://doi.org/10.1136/bmj.322.7283.419
Ara, J. (2018). Cognitive behavior therapy for depression : A case report. Journal of Clinical Case Reports, 8(7), 8–11. https://doi.org/10.4172/2165-7920.10001151
Ara, J., & Deeba, F. (2018). Bisonnotar ganio o achorongoto karon ebong roger lokkhon niontrone cognitive behavior therapy-r vumika: Ekti case study vittik monochikitsha mulok nibondhon (Cognitive and behavioral causes of depression and role of cognitive behavior therapy in reducing symptoms of mental illness: A case study report based on psychological treatment). Social Sciene Journal, 12(12), 67–77.
Ara, J., & Deeba, F. (2020). Clinical experiences of a CBT practitioner in Bangladesh. Journal of Psychiatry, 23, 472. https://doi.org/10.35248/2378-5756.20.23.472
Ayalon, L. (2012). Suicidal and depressive symptoms in Filipino home care workers in Israel. Journal of Cross-Cultural Gerontology, 27(1), 51–63. https://doi.org/10.1007/s10823-011-9156-8
Banoo, S. N. (2001). Stress and burden of the caregivers of chronic mental adult patient. (Unpublished thesis). Dept. of Clinical Psychology, University of Dhaka, Bangladesh.
Barrera, M., Jr., & Castro, F. G. (2006). A heuristic framework for the cultural adaptation of interventions. Clinical Psychology: Science and Practice, 13(4), 311–316. https://doi.org/10.1111/j.1468-2850.2006.00043.x
Bass, C., van Nevel, J., & Swart, J. (2014). A comparison between dialectical behavior therapy, mode deactivation therapy, cognitive behavioral therapy, and acceptance and commitment therapy in the treatment of adolescents. International Journal of Behavioral Consultation and Therapy, 9(2), 4. https://doi.org/10.1037/h0100991
Beck, A. T., & Steer, R. A. (1991). Manual for the Beck scale for suicide ideation (p. 63). Psychological Corporation.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond,2nd ed. New York, NY: Guilford Press.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. Guilford Press.
Beltman, M. W., Voshaar, R. C. O., & Speckens, A. E. (2010). Cognitive–behavioural therapy for depression in people with a somatic disease: Meta-analysis of randomised controlled trials. The British Journal of Psychiatry, 197(1), 11–19. https://doi.org/10.1192/bjp.bp.109.064675
Bower, P., Richards, D., & Lovell, K. (2001). The clinical and cost-effectiveness of self–help treatments for anxiety and depressive disorders in primary care: a systematic review. The British journal of general practice : the journal of the Royal College of General Practitioners, 51(471), 838–845.
Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine, 35, 121–126. https://doi.org/10.4103/0253-7176.116232
Cheung, J. T. K., Tsoi, V. W. Y., Wong, K. H. K., & Chung, R. Y. (2019). Abuse and depression among Filipino foreign domestic helpers. A cross-sectional survey in Hong Kong. Public Health, 166, 121–127. https://doi.org/10.1016/j.puhe.2018.09.020
Choo, C., Diederich, J., Song, I., & Ho, R. (2014). Cluster analysis reveals risk factors for repeated suicide attempts in a multi-ethnic Asian population. Asian Journal of Psychiatry, 8, 38–42. https://doi.org/10.1016/j.ajp.2013.10.001
Cuijpers, P., & Smit, F. (2002). Excess mortality in depression: A meta-analysis of community studies. Journal of Affective Disorder, 72, 227–236. https://doi.org/10.1016/s0165-0327(01)00413-x
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376–385. https://doi.org/10.1177/070674371305800702
Deeba, F., & Begum, R. (2004). Development of an anxiety scale for Bangladeshi population. Bangladesh Psychological Studies, 14, 39–54.
Dempster, A. P., Laird, N. M., & Rubin, D. B. (1977). Maximum likelihood for incomplete data via the EM algorithm. Journal of the Royal Statistical Society: Series B (Methodological), 39, 1–38. https://doi.org/10.1111/j.2517-6161.1977.tb01600.x
Department of Health & Human Services. (1999). The fundamentals of mental health and mental illness. Mental health: A report of the surgeon general. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/home.html. Accessed 3 July 2019
Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy of depression. Journal of Consulting and Clinical Psychology, 57, 414–419. https://doi.org/10.1037/0022-006X.57.3.414
Embling, S. (2002). The effectiveness of cognitive behavioural therapy in depression. Nursing Standard, 17(18–31), 33–41. https://doi.org/10.7748/NS2002.12.17.14.33.C3318
Faramarzi, M., Alipor, A., Esmaelzadeh, S., Kheirkhah, F., Poladi, K., & Pash, H. (2008). Treatment of depression and anxiety in infertile women: Cognitive behavioral therapy versus fluoxetine. Journal of Affective Disorders, 108, 159–164. https://doi.org/10.1016/j.jad.2007.09.002
Firoz, A. H., Karim, M. E., & Alam, M. F. (2007). Community based multi-centric service oriented research on mental illness with focus on awareness, prevalence, care, acceptance and follow-up in Bangladesh. Manual on Mental Health for Primary Health Care Physicians. 2nd edn. NIMH & WHO.
Friedman, E. S., Koenig, A. M., &Thase, M. E. (2016). Cognitive and behavioral therapies. In The medical basis of psychiatry (pp. 781–798). Springer, New York, NY.
Garratt, G., Ingram, R. E., Rand, K.L., & Sawalani, G. (2007). Cognitive processes in cognitive therapy: Evaluation of the mechanisms of change in the treatment of depression. Clinical Psychology Science Practice, 14, 224–239. https://doi.apa.org/doi/https://doi.org/10.1111/j.1468-2850.2007.00081.x
Goldberg, D., & Williams, P. (1988). A User's Guide to the General Health Questionnaire. Windsor, Berks: NFER-Nelson.
Hans, E., & Hiller, W. (2013). Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression: A meta-analysis of nonrandomized effectiveness studies. Journal of Consulting and Clinical Psychology, 81(1), 75. https://doi.org/10.1037/a0031080
Hayasaka, Y., Furukawa, T. A., Sozu, T., Imai, H., Kawakami, N., Horikoshi, M., GENKI Project. (2015). Enthusiasm for homework and improvement of psychological distress in sub threshold depression during behavior therapy: Secondary analysis of data from a randomized controlled trial. BMC Psychiatry, 15(1), 302. https://doi.org/10.1186/s12888-015-0687-3
Hays, P. A., & Iwamasa, G. Y. (2006). Culturally responsive cognitive-behavioral therapy. American Psychological Association Press.
Hofmann, S. G., Asmundson, G. J., & Beck, A. T. (2013). The science of cognitive therapy. Behavior Therapy, 44(2), 199–212. https://doi.org/10.1016/j.beth.2009.01.007
Hosain, G. M., Chatterjee, N., Ara, N., & Islam, T. (2007). Prevalence, pattern and determinants of mental disorders in rural Bangladesh. Public Health, 121(1), 18–24. https://doi.org/10.1016/j.puhe.2006.06.018
Hussey, M. A., & Hughes, J. P. (2007). Design and analysis of stepped wedge cluster randomized trials. Contemporary Clinical Trials, 28(2), 182–191. https://doi.org/10.1016/j.cct.2006.05.007
Hwang, W. C., Myers, H. F., Chiu, E., Mak, E., Butner, J. E., Fujimoto, K., Wood, J. J., & Miranda, J. (2015). Culturally adapted cognitive-behavioral therapy for Chinese Americans with depression: A randomized controlled trial. Psychiatric Services, 66(10), 1035–1042. https://doi.org/10.1176/appi.ps.201400358
Gilbody, S., Whitty, P., Grimshaw, J., & Thomas, R. (2003). Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA, 289(23), 3145–3151. https://doi.org/10.1001/jama.289.23.3145
Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta.
Kelly, S. (2006). Cognitive-behavioral therapy with African Americans. In P. A. E. Hays & G. Y. E. Iwamasa (Eds.), Culturally responsive cognitive-behavioral therapy: Assessment, practice and supervision. American Psychological Association.
Kohn, L. P., Oden, T., Muñoz, R. F., Robinson, A., & Leavitt, D. (2002). Brief report: Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Mental Health Journal, 38(6), 497–504. https://doi.org/10.1023/a:1020884202677
Large, M. (2016). Study on suicide risk assessment in mental illness underestimates inpatient suicide risk. BMJ (Clinical research ed.), 532, i267. https://doi.org/10.1136/bmj.i267
Lopez, M. A., & Basco, M. A. (2015). Effectiveness of cognitive behavioral therapy in public mental health: comparison to treatment as usual for treatment-resistant depression. Administration and policy in mental health, 42(1), 87–98. https://doi.org/10.1007/s10488-014-0546-4
McDonald, J. D., & Gonzalez, J. (2006). Cognitive-behavioral therapy with American Indians. In P. A. E. Hays & G. Y. E. Iwamasa (Eds.), Culturally responsive cognitive-behavioral therapy: Assessment, practice and supervision. American Psychological Association.
McMain, S., Newman, M. G., Segal, Z. V., & DeRubeis, R. J. (2015). Cognitive behavioral therapy: Current status and future research directions. Psychotherapy Research : Journal of the Society for Psychotherapy Research, 25(3), 321–329. https://doi.org/10.1080/10503307.2014.1002440
Naeem, Farooq (2011). Adaptation of cognitive behaviour therapy for depression in Pakistan. University of Southampton, Faculty of Medicine, Doctoral Thesis, 203pp.
Naeem, F., Gul, M., Irfan, M., Munshid, T., Asif, A., Rashid, S., Khan, M. N. S., Ghani, S., Malik, A., Aslam, A., Farooq, S., Husain, N., & Ayub, M. (2015). Brief culturally adapted CBT (CaCBT) for depression: A randomized controlled trial from Pakistan. Journal of Affective Disorders, 177, 101–107. https://doi.org/10.1016/j.jad.2015.02.012
Nahar, Jebin (2016). Anxiety and depression during pre and post-menopausal period. University of Dhaka, Doctoral Thesis.
Nemade, R., Reiss, N. S., & Dombeck, M. (2007). Cognitive theories ofmajor depression-Aaron Beck. https://www.mentalhelp.net/articles/cognitive-theories-of-major-depression-aaron-beck/
Padesky, C., & Greenberger, D. (1995). Clinicians guide to mind over mood. Guilford press.
Pang, K. Y. (1998). Symptoms of depression in elderly Korean immigrants: Narration and the healing process. Culture, Medicine and Psychiatry, 22(1), 93–122. https://doi.org/10.1023/a:1005389321714
Scorzelli, J., & Reinke-Scorzelli, M. (1994). Cultural sensitivity and cognitive therapy in India. The Counseling Psychologist, 22(4), 603–610. https://doi.org/10.1177/0011000094224006
Sherrill, J. T., & Kovacs, M. (2002). Nonsomatic treatment of depression. Child and Adolescent Psychiatric Clinics of North America, 11(3), 579–593. https://doi.org/10.1016/s1056-4993(02)00009-3
Sipe, W. E., & Eisendrath, S. J. (2012). Mindfulness-based cognitive therapy: Theory and practice. The Canadian Journal of Psychiatry, 57(2), 63–69. https://doi.org/10.1177/070674371205700202
Startup, M., & Edmonds, J. (1994). Compliance with homework assignments in cognitive-behavioral psychotherapy for depression: Relation to outcome and methods of enhancement. Cognitive Therapy and Research, 18(6), 567–579. https://doi.org/10.1007/BF02355669
Tany, R. F., & Saha, A. K. (2017). A study on stress and anxiety in relation to asthma. Journal of Psychosocial Research, 12(1), 117.
Uddin, M. Z., & Rahman, M. M. (2005). Development of a scale of depression for use in Bangladesh. Bangladesh Psychological Studies, 15, 25–44.
Uddin, M. K., Faruk, O., & Khanam, M. (2013). Psychometric evaluation of the Bangla Beck scale for suicide ideation. Bangladesh Psychological Studies, 23, 85–97.
Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. Basic Books.
Whisman, M. A. (Ed.). (2008). Adapting cognitive therapy for depression: Managing complexity and comorbidity. Guilford Press.
Wong, D. F. K. (2008). Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: A randomized wait-list control design. Depression and Anxiety, 25, 142–148. https://doi.org/10.1002/da.20286
World Health Organization. (2012). Sixty-fifth world health assembly. Retrieved from https://apps.who.int/gb/DGNP/pdf_files/A65_REC1-en.pdf. Accessed 13 June 2018.
World Health Organization. (2017). Depression and other common mental disorders: Global health estimates (No. WHO/MSD/MER/2017.2). World Health Organization. Retrieved from https://apps.who.int/iris/handle/10665/254610. Accessed 15 Mar 2020.
World Health Organization. (2019). National Mental Health Survey of Bangladesh, 2018–19: provisional fact sheet. Retrieved from https://www.who.int/docs/default-source/searo/bangladesh/pdf-reports/cat-2/nimh-fact-sheet-5-11-19.pdf. Accessed 13 June 2021.
World Health Organization. (2020). Depression, World Health Organization. Retrieved https://www.who.int/news-room/fact-sheets/detail/depression. Accessed 18 Apr 2021.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ara, J., Deeba, F. & Dobson, K.S. A Randomized Controlled Trial of the Effectiveness of Cognitive Behavior Therapy for Major Depression in Bangladesh. J Cogn Ther 16, 222–236 (2023). https://doi.org/10.1007/s41811-023-00160-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41811-023-00160-6