In-Depth Review: CBT for Depression and Self-Care in Heart Failure

This assignment presents a detailed critique of a research article focusing on the effectiveness of Cognitive Behavioral Therapy (CBT) for managing depression and promoting self-care among heart failure patients. The critique evaluates the study's abstract, background, methodology, results, and discussion sections, assessing the validity and reliability of the research. The review highlights the study's strengths, such as its well-organized structure and clear presentation of statistical data, while also pointing out limitations like the convenience sampling method and lack of double-blinding. The analysis covers the use of various data collection tools, including the Beck Depression Inventory-II and the Self-Care of Heart Failure Index, and discusses the implications of the findings for healthcare professionals. The critique concludes with suggestions for future research, emphasizing the need to explore predictors of self-care behavior and the association between hospitalization rates and the intervention.

Running head: CRITIQUE OF A PAPER
CRITIQUE OF A PAPER
Name of the student:
Name of the individual:
Author note:

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CRITIQUE OF A PAPER
Name of the paper: Cognitive Behavior Therapy for Depression and Self-care in Heart Failure
Patients a Randomized Clinical Trial
Authors: Kenneth E. Freedland, PhD; Robert M. Carney, PhD; Michael W. Rich, MD; Brian C.
Steinmeyer, MS; Eugene H. Rubin, MD, PhD
This randomized controlled trial is conducted in order to find out the success rate of cognitive
behavioral therapy on the effective management of depression in the patients who have heart
disorders. It has been found that about 15% of the patients who are suffering from cardiovascular
disorders and 205 of the individuals who have undergone coronary artery bypass graft (CABG)
surgery experience major depression. Therefore, this paper has implications in the modern
generation as it discusses the success rate of the behavioral intervention of CBT for such
patients. The paper that is developed by the authors is indeed well organized and sequential with
the present of various data of the statistical analysis making it easier for the readers to
understand. Biasness of the language as well as use of jargons is quite. All the information had
been clearly stated in details under specific headings making it easier for the readers to develop
clear idea about the entire work conducted (Freedland et al. 2015). The statistical approach taken
is complicated as it contains a large number of tools but the outcome has been specific helping to
gain valuable and correct information. Hence, this procedure decided was apt and cannot be
considered abrupt. The gaps in the literature had been clearly depicted by the authors themselves
where they also mentioned about the scopes of further research on the topic. It has been found
that the behavioral intervention of CBT is highly successful for mitigating the issue of depression
in the heart disorder patients built they do not help in enhancing self-care strategies among the
patients. It helps in reduction of the anxiety and fatigue as well as improvement in the social
functioning in the patients resulting in better health-related quality of life. Therefore, healthcare

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CRITIQUE OF A PAPER
professionals can use the evidences in the study for handling patients who have heart disorder
along with depression and provide best treatments. However, further researches are required that
would help the patients to develop motivation to conduct self-care and management successfully.
Part 2- Article review
Name of the article: Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure
Patients- A Randomized Clinical Trial
First author: Kenneth E. Freedland
Journal: JAMA Intern Med
Year published: 2015
Abstract The abstract of the article contains a
comprehensive and detailed explanation of
the randomized controlled trial. Abstracts
usually act as a brief for the readers to
understand about a project. The abstract
addressed an essential issue and contained a
short explanation on the importance of the
research topic. Furthermore, it contained
separate headings to help readers comprehend
the research objective, participants, setting,
interventions, and outcomes. The authors also
provided a thorough account of the results

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CRITIQUE OF A PAPER
that were obtained at the end of the trial,
supported by a concluding statement. Hence,
it can be inferred from the abstract that CBT
is effective for depressive disorder, but not for
heart failure self-care.
Background / introduction The background of the research provided a
meticulous detail of the phenomenon being
investigated. The authors clearly highlighted
the associated between depression and heart
failure. Time and again it has been proved by
researchers that mental stress creates a
negative impact on the cardiovascular health
of a person (Maeda et al. 2013). According to
Lossnitzer et al. (2013) unmanaged
depression has also been allied with increased
blood pressure, irregular heart rhythm, arterial
damage, and weak immune system. The
researchers based their study on these
information and successfully provided an
overview of the extent of connotation between
the two health ailments. The theoretical
framework of the study was grounded on the
fact that cognitive behavioral treatments

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CRITIQUE OF A PAPER
(CBT) have proved their efficacy in
depression management (Naeem et al. 2014).
Thus, they identified a gap in lack of adequate
scholarly literature on the effects of CBT in
heart failure self-care. Nonetheless, a major
drawback of the background section was that
the authors did not present sufficient
information on review of scientific literature
(Ary et al. 2018). No research hypothesis was
also stated by the researchers.
Methods The researchers recruited patients having
suffered from heart failure from the
Washington University Medical Center, for
participation in the trial from January 2010-
June 2013. However, they adopted
convenience sampling procedure which would
lead to over- or under-representation of the
target population and is likely to have
sampling error due to inaccuracies (Etikan,
Musa and Alkassim 2016). Thus, participant
recruitment strategy was incorrect. The
research design was based on randomization
where all participants were assigned to the

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CRITIQUE OF A PAPER
intervention and control group by chance,
rather than choice. Adopting single-blinding
approach was beneficial as it would keep the
participants deliberately ignorant of the group
they were assigned to (Pocock 2013). The
intervention was in accordance to standard
CBT handbooks and supplemental guidelines
for cardiac patients. Intervention was
implemented for six months (1 hour weekly
sessions). Some of the measures were
depression scores, exercise capacity, physical
activity, anxiety, and satisfaction with social
roles and discretionary social activities. Thus,
it can be stated that the researchers took into
account all important measures that were
imperative for determining the efficacy of
CBT. Data collection encompassed use of the
Beck Depression Inventory-II that is one of
the most extensively used psychometric
analysis for evaluating depression severity
among patients (Choi et al. 2014). Use of the
Self-Care of Heart Failure Index was another
correct approach since it acts in the form of a

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CRITIQUE OF A PAPER
realistic decision-making procedure
concerning the selection of behaviors that
uphold physiological stability (Vellone et al.
2013). The Kansas City Cardiomyopathy
Questionnaire was also used for determining
the trial outcomes owing to its validity and
reliability for measuring health status of
patients diagnosed with CHF (Arnold et al.
2013).
Results The researchers presented the study findings
with the help of tabular representations and
graphical diagrams. Following the
information presented on the baseline,
recruitment and retention characteristics of
the participants, the researchers presented
their findings under specific headings and
sub-headings such as, primary outcomes,
secondary outcomes, and follow-up phase, all
of which were correlated to the phenomenon
under investigation. They provided extensive
statistical information to state that Six-month
depression scores were found lower in CBT

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CRITIQUE OF A PAPER
group, compared to the control arm, with the
use of BDI-II (12.8 [10.6] vs 17.3 [10.7]; P
= .008). Furthermore, the researchers also
stated that variations were observed in the
remission rates on the Hamilton Depression
Scale (51% vs 20%; NNT = 3.29; 95% CI,
3.15-3.43; P < .001), and the BDI-II (46% vs
19%; number needed to treat [NNT] = 3.76;
95% CI, 3.62-3.90; P < .001). The tabular
information also made the researchers state
that no significant differences were observed
between the intervention and control group, in
terms of the Self-Care Maintenance and/or
Confidence subscales. Furthermore, low mean
SD in the BDI-II scores, six months following
randomization were found in CBT group T
(12.8 [10.6]), in comparison to the usual care
group (17.3 [10.7]), P = .008. Besides the
tabular representation, the graphs also
explained the outcomes in all subgroups,
defined by their high vs. low baseline scores.
The results section usually contains a detailed
report of the findings based on the research

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CRITIQUE OF A PAPER
methodology adopted by the investigators, for
gathering essential information. Hence, it can
be stated that the researchers were able to
arrange their results in a logical manner,
without any bias.
Discussion The purpose of research discussion is to infer
and define the implication of the results in
light of what had been previously known
about the phenomenon being investigated,
and to clarify any new insight or
understanding about the condition, after the
researchers have taken the findings into their
consideration. The discussion section of this
scholarly literature was able to connect the
readers to the introduction and background of
the study by associating the results obtained
with the research question that has been
explored. The researchers provided a
comprehensive analysis of the fact that
remission rates of depression were found to
be greater in CBT, when compared to the
participants who were subjected to usual care.
This made the researchers suggest that CBT

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CRITIQUE OF A PAPER
acts as a superior form of treatment to usual
care for effective management of depression
among patients who have had heart failure.
Hence, the discussion elucidated this
reassuring result in light of the undesirable
conclusions of the MOOD-HF and
SADHART-CHF antidepressant trials
(Angermann et al. 2016). Furthermore, the
researchers also explained their results and
stated that the intervention (CBT) failed to
demonstrate its efficacy in self-care
maintenance, confidence for heart failure,
which was considered as the co-primary
outcome of the trial. Every research has its
limitations and clarifying these allow the
readers to gain a sound understanding of the
conditions under which the results should be
inferred. Thus, the researchers were correct in
illustrating the limitations of the trial. Certain
limitations were allied with the recruitment
strategy, lack of double-blinding provisions,
and assessment of treatment fidelity by
therapists, and diversity of secondary

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outcomes.
In general It can be suggested that the research was well
written and did not contain any medical
jargon that could not be interpreted by a
reader. At instances where abbreviations were
used for different data collection tools, the
researchers displayed a correct approach in
expanding them for a better understanding.
Furthermore, this was the first research of its
kind that aimed to bring about an alteration in
heart failure self-care amid patients who are
clinically depressed. The article headings and
subheadings were also correctly organized
and summarized, and did not contain any
language that indicated biasness of the
researchers. Additionally, the investigators
also suggested future implications of the
practice by explaining the potential of the
intervention in reducing rates of re-
hospitalization among heart failure patients
who had been diagnosed with clinical
depression. Thus, the article was able to prove
the efficacy of CBT for management of

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depression among heart failure patients.
Suggestions Caution must maintained in future while
determining the association between rates of
hospitalization and mortality, with the
intervention among heart failure patients.
Further research should also aim at exploring
the predictors that create an influence on self-
care behavior among heart failure patients.