Effectiveness of Cognitive Behavioral Therapy in Treating Depression in Older Patients with Dementia

This research proposal aims to study the effectiveness of cognitive behavioral therapy (CBT) in treating depression in geriatric patients with dementia. The study will be conducted in Cairn’s clinic with 25 informal caregivers and 5 psychiatrists. The collected data will be subjected to data analysis.

Running head: RESEARCH PROPOSAL
EFFECT OF COGNITIVE BEHAVIORAL THERAPY IN TREATING DEPRESSION OLDER
PATIENT SUFFERING FROM DEMENTIA
Name of the Student:
Name of the University:
Author Note:

RESEARCH PROPOSAL 1
Executive Summary
Depression is a common disorder observed in older patients. Antidepressants are the best
perceived options for treating severe clinical depression, but its associated side effects are of
major concern in case of the elderly patients. Alternative to the pharmacological interventions,
non-pharmacological interventions like cognitive behavioural therapy (CBT) is used to treat
depression in elderly patients. This research proposal has aimed to conduct a research on the
effectiveness of the CBT in geriatric patients. The research was conducted in Cairn’s clinic. The
participants for the study were 25 informal caregivers of elderly dementia aged 60 and above,
suffering from clinical depression and are under treatment for 6-8 months. 5 psychiatrist should
also be approached for the interview who had been working in this setting for more than 6 years.
The collected data would then be subjected to data analysis.

2RESEARCH PROPOSAL
Table of Contents
Introduction......................................................................................................................................3
Research question........................................................................................................................3
Conceptual framework.................................................................................................................4
Literature review..............................................................................................................................4
Research design and methodology..................................................................................................7
Method and design.......................................................................................................................7
Sampling......................................................................................................................................7
Instruments..................................................................................................................................8
Data collection methods..............................................................................................................8
Data analysis..................................................................................................................................10
Ethical consideration.....................................................................................................................10
Conclusion.....................................................................................................................................10
References......................................................................................................................................12

3RESEARCH PROPOSAL
Introduction
Globally the population is found to be ageing rapidly. Mental health wellbeing is an
important aspect at any stages of life. According to World health organisation’s report, over 20
% of the adults above the 60 years and over suffer from mental health disorders and 6.5 % of the
disabilities among the older adults are contributed by the neurological disorders (Leichsenring et
al., 2013). The most common type of mental disorders that occur in older people are dementia
and depression that affects at least 6-7 % of the older population over the world. Prompt and the
recognition of the mental, neurological and the substance use in the older adults is essential. Both
psychosocial interventions and medications are recommended for treating depression in dementia
patients (Seitz et al., 2012). But Cognitive behavioural therapy has been found to use as
psychological treatment in treating depression in dementia patients.
This research proposal is to find out the effectiveness of psychosocial therapies like
cognitive behavioural therapy in reducing clinical depression in dementia patients.
Research question
1. To find out the effectiveness of cognitive behavioural therapy in treating mental
disorders like depression in geriatric patients suffering from dementia.
2. To find out the find out the effectiveness of CBT in comparison to antipsychotic
medications.

4RESEARCH PROPOSAL
Conceptual framework
Literature review
Dementia is a progressive neurodegenerative disorder that has been identified as the one
of the common mental health disorder in geriatric patient which causes deterioration of the
memory, behaviour, cognition and ability to perform the normal activities of everyday life (Arch
et al., 2012). Depression and anxiety is one of the important clinical manifestation of those with
dementia. According to Muliyala & Varghese, (2010), about 75 % of the elderly patients with
Depression in pedriatic patients
1. hopelessness
2. Social withdrawal
3. Suicidal ideation
CBT techniques
Rational emotive therapy
Cognitive therapy
Multimodal therapy
Dialectical behavioural therapy
coping up skills
Reduction of the irrational beliefs
Identification of the inaccurate thinking patterns.
Addressing modalities like behaviour, sensation, cognituon and
interpersonal factors.

5RESEARCH PROPOSAL
dementia suffer from mild to severe clinical depression. Depression can both be a proposed risk
factor as well as a prodrome of dementia. Clinical depression in dementia patients can be
detrimental as not only can it deteriorate the quality of life of people but is also responsible for
suicidal ideation. Depression are often treated with pharmacological interventions, but elderly
patient with dementia often suffers from chronic somatic disease other than the dementia and
hence most of the elderly patients have to sustain on multiple prescriptions (Holvast et al., 2017).
Prescribing the antidepressants can increase the chance of the adverse drug reaction. According
to studies tho third of the elderly patients receiving antidepressants that are either contraindicated
or are subjected to mild to intense adverse drug reaction (Gunn et al., 2014). Furthermore
tricyclic antidepressants and agents like SSRIs often have sedative and anticholinergic effects
that can be associated to cognitive and physical impairment. Cost effectiveness is another added
advantage of using CBT other than the pharmatherapeutics. The antidepressants required for
treated an allied range of mental health disorders are high and can be difficult to afford. A work
by Siddique et al. (2012), have refereed that CBT produces a sustained response in comparison
to the antidepressant and CBT have also an added advantage of preventing relapse after the
psychotherapy treatment. Although there are quite less evidence based literature to evaluate the
effectiveness of CBT over pharmacotherapy, but a paper by Sinyor, Fefergrad & Zaretsky,
(2015), that could not found any major difference between the efficacy of the pharmacotherapy
and the short term CBT. Hence evidence based non pharmacological treatments are needed for
the treatment of severe clinical depression in the dementia patients (Apóstolo et al., 2016). A
randomised control trial by Wuthrich & Rapee, (2013), has examined the effectiveness of the
psychological program like cognitive behavioural therapy in sixty three community dwelling
elderly individual with age over 60 years. In the study cognitive behavioural therapy was

6RESEARCH PROPOSAL
associated with a reduction in the level of anxiety and depression in dementia patients. Cognitive
behavioural therapy (CBT) can be defined as a goal oriented short tern psychological treatment
that takes a practical approach to problematic living. The goal of the CBT is to change the
behaviour of the people with mental illness by altering their perceptions about life and by
changing the way they feel (Gould, Coulson & Howard, 2012). CBT normally works by
modifying the attitude of the people and by working on their thoughts, beliefs and images. There
are a number of therapeutic approaches under CBT used by the psychiatrists. They are -
Rational emotive therapy, which works by the identification of the irrational beliefs of the
patients and then actively challenging them to change those (Siddique et al., 2012). Cognitive
therapy- This works by the identification of the inaccurate of the distorted thinking patterns,
behaviours and emotional responses. Multimodal therapy that states that psychological problems
should be addressed by treating the different modalities like behaviour, affect, imagery,
sensation, cognition and interpersonal factors. Dialectical behavioural therapy that works by
making the patients to work on their mindfulness and regulation of emotions (Siddique et al.,
2012). Current reviews regarding the psychological treatments for depression has indicated that
CBT is effective is as effective as it is in younger adults and it is much superior to
pharmacological interventions and exercises. An RCT conducted by Titov et al. (2015), have
studied the effectiveness and the cost effectiveness of the internet based CBT. There are
numerous complexities of face to face CBT, especially for the elderly patients due to their
restricted mobility. Other barriers also comes in to play such as stigma, high psychiatry costs and
limited number of therapists (Hofmann et al., 2012). Hence internet based CBT has been
perceived as an option for the elderly patients. iCBT can be provided a self-guided interventions
or therapeutic support can also be provided via emails of video conferencing. All these evidences

7RESEARCH PROPOSAL
about the CBT in treating depression in the older adults is the rationale behind the conduction of
a research on the effectiveness of CBT over pharmacotherapeutics in treating anxiety and
depression in older adults suffering from dementia.
Research design and methodology
Method and design
A qualitative study was conducted in the Ellis & Levy (2012), Cairn’s mental health
clinic. The participants for the study were 25 informal caregivers of elderly dementia aged 60
and above, patient suffering from clinical depression and are under treatment for 6-8 months. 5
psychiatrist should also be approached for the interview who had been working in this setting for
more than 6 years.
The researcher would approach the organisation via a written application seeking
permission from the organisation. The names will be chosen from the directory of the
organisation after seeking a permission from the organisation and an invitation mail will be sent
to the names obtained. The participants will also be contacted via telephone, in case they miss
the mail. An interview should be conducted within the premises of the clinic after obtaining
permission from the authority.
Sampling
The participants will be selected on the basis of criteria that caregivers of the elderly
patients those suffering from cancer and cardiovascular diseases will be excluded from the study,
as these comorbidities can also give rise to depression, but our study will be based on those
elderly people with dementia and suffering from dementia associated depression.

8RESEARCH PROPOSAL
Instruments
A semi structured interview will be conducted will the informal caregivers and the
doctors. The questions asked in the semi structured interview will be constructed on the basis of
a pilot study conducted in the same clinic involving 3 senior registered nurse of the same
organisation. Each of the participants were interviewed privately and all their responses are
recorded electronically by the help of a recorder. A written record was also kept.
Data collection methods
In this research, a qualitative data collection method will be followed. According to
Bergh, and Ketchen, (2011), Interview is one of the most common method of qualitative data
collection method that can be used for exploring the experiences, views, beliefs and motivation
of the individual participants. The usefulness of semi structured interview is that is helps to
explore the particular areas of interest, but also allows the researcher to diverge for pursuing an
idea in more details (Silverman, 2016). The semi structured interview that will be followed will
help to identify the perception of the informal caregivers about how psychotherapies like CBT
have helped in reducing anxiety and depression in the patient.
The duration of the interview session will be of 40-60 minutes. The participants will have
to sign a consent form before the starting of the interview, which will contain a detailed
description of the aims and objectives of the clinical study. All the answers will be recoded with
the help of an audio recorder. Hard copies of all the responses will also be maintained. The
responds will be made to check by the participants for avoiding any kind of response bias. After
the conduction of the interview, the transcription of all the recordings should be done by a

9RESEARCH PROPOSAL
transcriptionist. The professional transcripts will be thoroughly checked by comparing them
with the electronic recording. After that they will be analysed by a statistician.
Semi structure interview questions:-
Questions asked to the informal care givers -
1. How long is your patient suffering from mental health disorder and how long your patient
is under treatment in this clinic?
2. Does your patient have any other comorbidities other than dementia and depression?
3. Does your patient suffer from any kind of adverse effects from the antidepressant
medicines?
4. Are you satisfied with the psychological treatments that they provide in this organisation,
other than the medications?
5. Do the doctors provide you with education, regarding the different coping skills that you
can apply at home while caring for your patient?
6. Which intervention do you find to be better for your patient? The medicines or the
alternative therapies that the doctors provide out here?
Questions asked to the doctors:-
 What are the most common form of mental disorders that you find to occur in the
dementia patients?
 What kind of pharmacotherapeutic agents do you provide to your patients?
 Do the cognitive behavioural therapy provided to the elderly patients brought
about a reduction in the clinical depression in patients?
 Which one do you find it to be better? What CBT techniques do you follow here?

10RESEARCH PROPOSAL
 You have said that they can treat mild and depression? Have you used them for
the severe forms?
Data analysis
A thematic data analysis is recommended for this research proposal. This provides
adaptability and flexibility to the analysts while the data analysis. The steps associated to
thematic data analysis are compilation, disassembling, reassembling, interpretation and finally
conclusion (Savin-Baden & Major, 2013).
Ethical consideration
Ethical consideration in a qualitative research is critical. It helps to determine the
distinction between the acceptable and the unacceptable behaviours on part of the researcher. It
is necessary for the researcher to inform the participants about the aims and the objectives of the
study before the interview (Taylor, Bogdan & DeVault, 2015). Hence all the information should
be informed to the participants via telephonic interactions. The same instructions will also be
written in the consent form which the participants will be made to signs. Ethical approval will be
obtained from the local ethics committee. All the conversations will be held in private places and
all the documents will be stored in closed and protected cabinets to ensure privacy and
confidentiality.
Conclusion
Major depression in the dementia patients pose a high individualised burden of pain,
disability and suffering. CBT techniques has long been used as a non-pharmacological

11RESEARCH PROPOSAL
intervention in treating clinical depression in dementia patients. Hence this research will be
conducted to support the validity of this fact. The data will be collected from the informal
caregivers providing care to the dementia patients and 5 psychiatrist of the clinical setting in the
form of interviews.
Some of the limitations associated to this research proposal is the response bias, which
might arise if the participants do not understand the questions, as some the caregivers might not
understand what the CBT is. Non response bias can occur as participants might not give
responses or high variability in the responses might lead to variability bias. Furthermore the
response obtained from the psychiatrists are self-reported data and is given consciously keeping
in consideration the reputation of the organisation and might not be the actual scenarios.
The important clinical implication for this research proposal is that CBT can also be
tested in other types of mental disorders and such non-pharmacological methods of intervention
should be introduced in primary care settings. Innovations can also be made in the different CBT
techniques applied.

12RESEARCH PROPOSAL
References
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