Advanced Biomedical Research

Controlled randomized clinical trial of spirituality integrated psychotherapy, cognitive-behavioral therapy and medication intervention on depressive symptoms and dysfunctional attitudes in patients with dysthymic disorder

Authors

1 Department of Psychiatry, Psychosomatic Research Center, School of Medicine, School of Medicine, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran

2 Department of Psychology, University of Isfahan, Isfahan, Iran

3 Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran

4 Psychosomatic Research Center, School of Medicine, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran

Abstract

Background : Due to the controversy over efficacy of cognitive-behavioral therapy for chronic depression, recently, there has been an increasingly tendency toward therapeutic methods based on the cultural and spiritual approaches. The aim of this research was to compare efficacy of spiritual integrated psychotherapy (SIPT) and cognitive-behavioral therapy (CBT) on the intensity of depression symptoms and dysfunctional attitudes of patients with dysthymic disorder.
Materials and Methods: This study had a mixed qualitative and quantitative design. In the first phase, SIPT model was prepared and, in the second phase, a double-blind random clinical trial was performed. Sixty-two patients with dysthymic disorder were selected from several centers include Nour and Alzahra Medical Center, Counseling Centers of Isfahan University of Medical Sciences and Goldis in Isfahan. The participants were randomly assigned to three experimental groups and one control group. The first group received 8 sessions treatment of SIPT, second groups also had 8 sessions of cognitive-behavioral therapy, which was specific to dysthymic disorder and third group were under antidepressant treatment. Beck depression inventory and dysfunctional attitudes scale were used to evaluate all the participants in four measurement stages. The data were analyzed using MANCOVA repeated measure method.
Results : The results revealed that SIPT had more efficacy than medication based on both scales ( P < 0.01); however, it was not different from CBT. SIPT was more effective on the modification of dysfunctional attitudes compared with CBT and medication ( P < 0.05).
Conclusion : These findings supported the efficacy of psychotherapy enriched with cultural capacities and religious teachings.

Keywords

1. McFarland BR, Klein DN. Mental health service use by patients with dysthymic disorder: Treatment use and dropout in a 7 1/2-year naturalistic follow-up study. Compr Psychiatry 2005;46:246-53.  Back to cited text no. 1
[PUBMED]    
2. Avrichir BS, Elkis H. Prevalence and underrecognition of dysthymia among psychiatric outpatients in São Paulo, Brazil. J Affect Disord 2002;69:193-9.  Back to cited text no. 2
[PUBMED]    
3. Bell B, Chalklin L, Mills M, Browne G, Steiner M, Roberts J, et al. Burden of dysthymia and comorbid illness in adults in a Canadian primary care setting: High rates of psychiatric illness in the offspring. J Affect Disord 2004;78:73-80.  Back to cited text no. 3
[PUBMED]    
4. Markowitz JC. Psychotherapy for dysthymic disorder. Psychiatr Clin North Am 1996;19:133-49.  Back to cited text no. 4
[PUBMED]    
5. Almeida AM, Lotufo Neto F. Cognitive-behavioral therapy in prevention of depression relapses and recurrences: A review. Rev Bras Psiquiatr 2003;25:239-44.  Back to cited text no. 5
[PUBMED]    
6. Wampold BE, Minami T, Baskin TW, Callen Tierney S. A meta-(re) analysis of the effects of cognitive therapy versus'other therapies' for depression. J Affect Disord 2002;68:159-65.  Back to cited text no. 6
[PUBMED]    
7. Haby MM, Donnelly M, Corry J, Vos T. Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Aust N Z J Psychiatry 2006;40:9-19.  Back to cited text no. 7
[PUBMED]    
8. Feldman G. Cognitive and behavioral therapies for depression: Overview, new directions, and practical recommendations for dissemination. Psychiatr Clin North Am 2007;30:39-50.  Back to cited text no. 8
[PUBMED]    
9. Propst LR, Ostrom R, Watkins P, Dean T, Mashburn D. Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. J Consult Clin Psychol 1992;60:94-103.  Back to cited text no. 9
[PUBMED]    
10. Post BC, Wade NG. Religion and spirituality in psychotherapy: A practice-friendly review of research. J Clin Psychol 2009;65:131-46.  Back to cited text no. 10
[PUBMED]    
11. Hofmann SG. The Importance of Culture in Cognitive and Behavioral Practice. Cogn Behav Pract 2006;13:243-5.  Back to cited text no. 11
    
12. D'Souza RF, Rodrigo A. Spiritually augmented cognitive behavioural therapy. Australas Psychiatry 2004;12:148-52.  Back to cited text no. 12
[PUBMED]    
13. Smith TB, Bartz J, Richards PS. Outcomes of religious and spiritual adaptations to psychotherapy: A meta-analytic review. Psychother Res 2007;17:643-55.  Back to cited text no. 13
    
14. Pargament KI. Spiritually integrated psychotherapy: Understanding and addressing the Sacred. New York: Guilford Press; 2007.  Back to cited text no. 14
    
15. Aten JD, Worthington EL Jr. Next steps for clinicians in religious and spiritual therapy: An endpiece. J Clin Psychol 2009;65:224-9.  Back to cited text no. 15
[PUBMED]    
16. Cole BS. The integration of spirituality and psychotherapy for people confronting cancer: An Outcome Study. USA: Bowling Green State University; 1999.  Back to cited text no. 16
    
17. Berry D. Does religious psychotherapy improve anxiety and depression in religious adults? A review of randomized controlled studies. Int J Psychiatr Nurs Res 2002;8:875-90.  Back to cited text no. 17
[PUBMED]    
18. Razali SM, Hasanah CI, Aminah K, Subramaniam M. Religious-sociocultural psychotherapy in patients with anxiety and depression. Aust N Z J Psychiatry 1998;32:867-72.  Back to cited text no. 18
[PUBMED]    
19. Azhar MZ, Varma SL. Religious psychotherapy in depressive patients. Psychother Psychosom 1995;63:165-8.  Back to cited text no. 19
[PUBMED]    
20. Azhar MZ, Varma SL, Dharap AS. Religious psychotherapy in anxiety disorder patients. Acta Psychiatr Scand 1994;90:1-3.  Back to cited text no. 20
[PUBMED]    
21. Townsend M, Kladder V, Ayele H, Mulligan T. Systematic review of clinical trials examining the effects of religion on health. South Med J 2002;95:1429-34.  Back to cited text no. 21
[PUBMED]    
22. First MB, Spitzer RL, Gibbon M, Williams J B. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient ed. (SCID-I/P) New York: Biometrics Research, New York State Psychiatric Institute; 2002.  Back to cited text no. 22
    
23. Helen J, Streubert S, Carpenter S. Qualitative research in nursing. USA: William and Wilkins; 2007.  Back to cited text no. 23
    
24. Kaplan HJ, Sadock BY. Comprehensive textbook of Psychiatry. Philadelphia: William and Wilkins; 2005.  Back to cited text no. 24
    
25. Moore RG, Garlund A. Cognitive therapy for chronic and persistent depression. UK: Wiley Press; 2003.  Back to cited text no. 25
    
26. Steer RA, Clark DA, Beck AT, Ranieri WF. Common and specific dimensions of self-reported anxiety and depression: A replication. J Abnorm Psychol 1995;104:542-5.  Back to cited text no. 26
[PUBMED]    
27. Oliver JM, Morphy SL, Ferland DR, Ross MJ. Contribution of the cognitive style Questionnaire and Dysfunctional Attitude Scale to measuring cognitive vulnerability to depression. Cognit Ther Res 2007;31:51-69.  Back to cited text no. 27
    
28. Ebrahimi A, Mousavi SGH. Development and validation of the Dysfunctional Attitude Scale -26 items: Factor structure, reliability and validity in Iranian Psychiatric outpatients. Istanbul, Turkey: Paper presented at the 7th International Congress of Cognitive Psychotherapy; 2011.  Back to cited text no. 28
    
29. Vaccaro B. Spirituality in the treatment of a man with anxiety and depression. South Med J 2007;100:626-7.  Back to cited text no. 29
[PUBMED]    
30. Avants SK, Beitel M, Margolin A. Making the shift from 'addict self' to 'spiritual self': Results from a stage 1 study of spiritual self-schema (3-S) therapy for the treatment of addiction and HIV risk behavior. Ment Health Relig Cult 2005;8:167-77.  Back to cited text no. 30
    
31. Richards PS, Berrett ME, Hardman RK, Eggett DL. Comparative efficacy of spirituality, cognitive, and emotional support groups for treating eating disorder inpatients. Eat Disord 2006;14:401-15.  Back to cited text no. 31
[PUBMED]    
32. Peterson C, Seligman ME. Character strengths and virtues. Oxford: Oxford university press; 2004.  Back to cited text no. 32
    
33. Cole B, Pargament K. Re-creating your life: A spiritual/psychotherapeutic intervention for people diagnosed with cancer. Psychooncology 1999;8:395-407.  Back to cited text no. 33
[PUBMED]    
34. Azhar MZ, Varma SL. Religious psychotherapy as management of bereavement. Acta Psychiatr Scand 1995;91:233-5.  Back to cited text no. 34
[PUBMED]    
35. Bartoli E. Religious and spiritual issues in psychotherapy practice: Training the trainer. Psychotherapy (Chic) 2007;44:54-65.  Back to cited text no. 35
[PUBMED]    
36. Chen TH, Lu RB, Chang AJ, Chu DM, Chou KR. The evaluation of cognitive-behavioral group therapy on patient depression and self-esteem. Arch Psychiatr Nurs 2006;20:3-11.  Back to cited text no. 36
[PUBMED]    
37. Silva de Lima M, Hotopf M. Pharmacotherapy for dysthymia. Cochrane Database Syst Rev 2007;2:CD004047.  Back to cited text no. 37
    
38. Ebn Abi Alhadid. Nahgolbalagheh Description. A Research Done by Mohammad Ebrahim 1387 AH, Beirut, Darolehya. Available from: http://www.al-islam.org/nahjul/commentaries.htm. [Last accessed on 2011 Oct 21].  Back to cited text no. 38
    
39. Majlesi MB. Baharolanvar, Alahadith Noor Comprehensive Software, Qom, 1996: Computer Research Center of Islamic Sciences. Available from: http://www.the-hadith-software.en.softonic.com. [Last accessed on 2011 Jan 10].  Back to cited text no. 39
    
40. Koleini, Mohammad Yaghoob, Koleini MY. Alkafai. Alahadith Noor Comprehensive Software, Qom, 1996: Computer Research Center of Islamic Sciences. Available form: http://www.the-hadith-software.en.softonic.com. [Last accessed on 2011 Aug 05.]  Back to cited text no. 40
    
Advanced Biomedical Research
Volume 2013, June
June 2013
Pages 1-7