Insight Program: A Cognitive Group Therapy Program for Women

OF MAJOR CONCERN to health care professionals on both national and international levels is the soaring cost of health care. Of related and perhaps equal consequence in the area of psychiatry is the need to provide treatments that last. The well-known "revolving door" syndrome of the early returning discharged psychiatric patient back to the hospital has been discouraging to psychiatric staff as well as to the public. Unfortunately, there appears to be a paucity of research studies conducted to alleviate this expensive problem.

This paper will describe a nursing intervention that continues to be effective over a 3-year period of time after the therapy was discontinued. The purpose of this study was to evaluate the long-term effectiveness of a cognitive-behavioral group intervention based on a holistic health framework facilitated by two psychiatric nurses to reduce depression in women. That this approach may provide an efficient alternative to traditional psychotherapy or psychiatric hospitalization for depressed women is the aim of the intervention model. More specifically, it reports on the effectiveness of short-term group therapy for depressed women completed in England in 1983 with a follow-up study in 1986. Two pilot studies, using pretest-posttest designs, were previously conducted in the midwestern United States (Gordon, 1982; Gordon& Ledray, 1986). This study was conducted in England because of a generous invitation to Verona Gordon by the faculty at the Department of Nursing Studies, Chelsea College, University of London, and the investigator's previous positive experiences with nurses there.

The present paper has two major goals: (a) to describe the long-term outcome of individuals who have completed a cognitive-behavioral treatment group for depression, and (b) to assess the relative improvement in psychological well-being of depressed individuals who participated in a treatment group as compared with a no-treatment control group. Previous research reports by Gordon (Gordon. 1986: Gordon & Gordon. 1987) provide support for the hypothesis that the group intervention used in the present investigation is of therapeutic value to depressed women, at least when their depression level is reassessed immediately after treatment

DEPRESSION - AN INTERNATIONAL PROBLEM

Weissman's (1981) review of 40 years of depression-related research in 30 western countries determined that, although depression affects both men and women, it is more common in women and affects them in their most youthful productive years-most frequently occurring among married women with children. In the United States, for example, more than 40 million people suffer from depression, and two thirds of these people are women (Hirschfeld, 1980). And studies by Guttentag, Salasin, & Belle (1980) at Harvard indicate that there was a rapid increase in the United States of the number of females of all ages and classes afflicted with depression. Eminent researchers (Dohrenwend, 1973; van Keep & Prill, 1975; Tucker, 1977; Notman, 1979) have suggested that stressors occurring in women's daily lives that stem from personal, family, social, and cultural demands upon them may result in their depression. Yet, little systematic research has evaluated the female preponderance for depression (Lobel & Hirschfeld, 1985; Hirschfeld & Cross, 1982). Women do seek counseling; however, there have been few convincing research studies on the effectiveness of various attempted psychotherapies (Fiske et al., 1970). Also, because of the rising high cost of health care, funding agencies insist that treatment approaches in mental health be efficacious, safe, and cost-effective (Parloff, 1980).

Thus, examining the phenomenon of depression and formulating and implementing intervention that effectively addresses the diverse concerns and needs of depressed women, remains a challenge to nurse researchers. The social morbidity of depression is high. It impairs social and occupational functioning--most markedly affecting work performance and the intimate relationships of marriage and parenthood. Depression manifests itself in diminished personal satisfaction, difficulty in communication, increased dependency, anger, and tension, especially with the spouse and children. Further, it has a particularly devastating impact upon a woman's capacity to care for her children (Klerman, Weissman, Rounsaville, & Chevan, 1984).

Three possible psychological explanations for these escalating rates of depression in women have been suggested and described by the theories of (a) Lewinsohn's behavioral model, (b) Seligman's learned helplessness model, and (c) Beck's cognitive model.