Introduction - Exploring Depression Treatment through CBT Methods
Cognitive behavioural therapy is a treatment psychological that is demonstrated with a series of problems such as anxiety, and depression. Cognitive behavioural therapy has importance in improving the quality of life. The therapy has been demonstrated as an effective method to incorporate positive thinking in people's minds with the removal of negative thinking. This will improve the quality of their life. The therapy acts as a mechanism tool to cope with the difficulties in life. People are faced with a lot of challenges to deal with in daily life. The positive effect of therapy is to help them act accordingly to the challenges. Some nurses help patients to treat depression in HIV through intervention. The women who are affected by HIV have faced mental trauma as well as physical. It is natural for them to grow depressed at this time. Cognitive behavioural therapy is important and effective in this time to help women through therapies to set a positive outlook on life in them. Otherwise, the negative thinking can lead to severe depression which will become difficult to treat. Joining a group or talking to the provider will help the individual to deal with depression after getting infected by HIV. In addition to treating depression cognitive behavioural therapy also prevents relapse in patients. It is shown that with continued medication the chances of relapse have been reduced significantly.
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Cognitive behavioural therapy is referred to as the process of changing cognition from negativity to positivity which helps in viewing the world and the people in it, more optimistically. The therapy includes reworking and rewiring the negative cognitions into positive cognitions that would help in exploring solutions to proceed in life with each accomplished stepping stone. It is a structured therapy that involves unveiling the negative thoughts of the individual and exposing the individual to the thoughts (nhs.uk, 2021). This exposure would then lead the individual to respond in an altered way than before which was a negative overt behaviour but after therapy, it should be a result of coping behaviour. Research evidence put forward by Angelakis et al., (2022) suggests that depressive disorders are quite prevalent among women who are HIV-positive as they are more prone to sexual behaviours that are more erratic. Therefore, this leads to more symptoms of HIV that might contribute to HIV among the population of women which thus, which leads to depression.
Figure 1: Trends of Women with depressive disorders
Women who are detected with HIV have twice the risk of being prone to having depressive disorders as this acts as a stressor in the lives of young women who has the cognition that sooner or later this might drastically alter their lives. Research evidence put forward by Turan et al., (2019) suggests that the risk of depression is twice as high in women who are diagnosed with HIV. The diagnosis of HIV is stressful and similarly, the other gynaecological health risks that are attached to the diagnosis also act as a major cause of depression for women who are HIV positive. On the contrary, research evidence suggests that the trending problem behaviours relative to intimacy and partnership are the primary cause of HIV which then leads to other co morbid health issues. Depression is thus, a secondary stressor acting as an additional stressor among the other stressors.
Figure 2: Correlation of HIV and depression in the brain
Cognitive behavioural therapy has been proposed to be effective on women with HIV as the utilization of the cognitive triad is most effective when applying cognitive behavioural therapy. Research evidence proposed by Junkins et al., (2021) suggests that the cognitive triad consists of three aspects which are: negative perspectives about the world, about oneself, and about the future which was originally put forward by Aaron Beck in the year 1967 and treated depression. This cognitive triad of depression was thus, applied to assess the negative cognitions that are instilled in the individual that is to be changed through the application of cognitive behavioural therapy. Similarly, research evidence put forward by Joska et al., (2020) proposes that women with HIV have a risk of depression which high than other diseases in women. Thereafter, cognitive behavioural therapy generally helps these women by delineating their negative cognitions with the application of the cognitive triad of depression, and then they are exposed to these cognitions and are then guided with positive solution exploration. These explorations help in turning to a more positive view about the world, oneself, and the future which thus changes the negative cognitions helping the person with a more optimistic view in life.
Theoretical Framework
The theoretical framework thus, suggests that women who are diagnosed with HIV have a higher risk or twice as high the risk of having depressive disorders that might act as a stressor in their life changing their whole view in their life into negativity. This can alter their social, occupational, and personal life. Thereafter, according to Nyamukoho et al., (2019), it has been evident that cognitive behavioural therapy has been effective in treating depression among women who are diagnosed with HIV and thus, has shown to have positive results in the application of the therapy.
Perspective and Methodology
Introduction
The data collection method is identified as the spectrum of methods that help in formulation research methodology that fulfils the objectives of the research. The present work focuses on the methodology that is derived from the primary quantitative data collection that would help in effective analysis of the data in the present work (Karotiyaki et al., 2021). A quantitative method will be adopted to see the effectiveness of the objectives of the research (Ogueji, 2021). The present work is to evaluate the effectiveness of cognitive behavioural therapy in the reduction of depression among women with HIV, thereafter, fulfilling the criteria of the evaluation of the effectiveness of cognitive behavioural therapy. In this section, the data collection procedures and the relevant analysis methods have been overviewed based on which the rest of the study has been conducted.
Research Philosophy
A research philosophy helps in pointing out the approach which the researchers have adopted to carry out the analysis of data. The four types of research philosophies that are used while conducting a study include “Pragmatism", "Positivism", "Realism", and "Interpretivism”. The present work employs the realism philosophy as the work would be based on a primary quantitative method which refers to the method of data collection that would be based on cause-and-effect relationships, experimentation, and co-relational analysis (Yigit et al., 2019). Evaluating the effectiveness of cognitive behavioral therapy will thereafter, depend on a co-relational analysis that would be employed as the data analysis method that would also rely on the primary quantitative data collection that would determine the findings of the research. Therefore, the realism philosophy of research refers to the independence of the idea that an aspect of research is existent regardless of the perceptions it has about it. In other words, it refers to the independence of the aspects and the idea behind it that is direct and can be critical as well irrespective of the perceptions of people about the same (Wilhelm et al., 2020). The present work is a critical piece of the proposal along with the application of the primary quantitative method which justifies the selection of realism as the current research philosophy.
Research Design
The methodology of the research is developed with an overall strategy of integrated components of the study which are identified logically that are described as research design. In the same manner, a Research design is the scientific method which assists the analysis of the chosen variables that have been incorporated in the study (Newman and Gough, 2020). Therefore, the current research is based on evaluating the effectiveness of cognitive behavioral therapy in the reduction of depression among women with HIV and is more justified as an experimental research design that needs the development of the cause-and-effect relationship. This would determine the base of the research design that would be employed in the present work. The experimental research design would thus, imply the building of a sound and objective research design that would cater to the cause-and-effect relationship among the variables in the present work (Snyder, 2020). The cause is HIV and the effect is depression the effectiveness of cognitive behavioral therapy in the reduction of depression.
Research Approach
Identification of the appropriate procedure for the development of effective research is defined as the research approach. The research approach helps in the development and formulation of the research objectives to assist in the appropriate data analysis in the study. The current research would employ a deductive approach as the nature of this research is more associated with objectivity that is correlated with a scientific inquiry for the present work (Patel and Patel, 2019). Scientific investigation with a critical outlook is a mandatory criterion for choosing the experimental design for the present research which thus, employs a deductive approach. The deductive approach relies purely on a quantitative method and an experimental research design. Experimental research designs are employed solely on the quantitative methods of data collection along with objectivity criteria in the present work.
Data Collection Method
In the development of the research selection and identification of effective data are identified as the data collection method. Based on the effectiveness of the collection of the data, the method to collect the data in the present research is encompassed in the primary quantitative methods. The quantitative method employed in the current research is reliable in the field experimental research method that would have an objective method of data collection that would be a set of empirical data (Babii, 2020). This set of empirical data would act as a set of empirical evidence that would be incorporated into the present work for further analysis on a co-relational basis. Moreover, the questionnaires and other materials included to collect the data would be analyzed on a quantifiable basis to assure that each score is measurable and thus, depicts something about the chosen variables in the present study.
Data Analysis Method
The data which are collected in the research are analyzed with the primary data analysis process which helps to interpret the research topic. The present research work employs an experimental analysis as the present work will be based on a primary data collection method which will include questionnaires that are quantified on the scores obtained. Thereafter, the experimental analysis would be best suited as the present work is based on a scientific investigation that relies on the collection of an empirical set of data that would help in effective quantifiable characteristics of the data collected (Zawacki et al., 2020).
Ethical Consideration
Ethical considerations will be followed in the present work while conducting the whole research on the field. Informed consent is the most important part of the research when working with human participants as keeping them in a blindfolded triangle to meet the research expectations would be a violation of the ethical issues. Thereafter, the participants will be informed about the research and their consent will be noted down. Moreover, they will be assured of the confidentiality of the responses they would give as being a woman with HIV is tough and their confidentiality is of utmost importance (Haas et al., 2021).
Aim and objective
The research aims to evaluate the effectiveness of cognitive behavioural therapy among women who are infected by HIV (Brandt et al. 2018).
Objective
To study the effectiveness of "Cognitive behavioural therapy" in response to depression treatment
To evaluate the rate of women in the population of UK getting infected with HIV
To determine the effect and symptoms of depression in women suffering from HIV
Methods
Literature Search Strategy
EMBASE and MEDLINE are two of the most common databases that are preferred for studies based on medical topics. The literature search for the study will be initiated with these two databases and the secondary databases that would be preferred are CINAHL and CENTRAL. As opined by Kanu, (2019), CINAHL provides a huge range of medical articles and helps choose the required ones based on specific criteria. The study aims to shed light on two health concerns HIV and depression and hence RCT studies will be favoured. Only studies that are in the English language and the ones not older than 2019 will be preferred as per the inclusion criteria. A PICO framework will be used to initiate the search and the table below shows the different search terms and Boolean operators that would be used. The OR operator will be used at first to combine the search terms and search for each PICO element. Followed by that, the AND operator will be used to combine the search results of the previous step. Truncation signs might be used as per necessity.
P
I
C
O
Operator for combing the column terms
Women infected with HIV
Cognitive behavioural therapy
Effectiveness of CBT in reducing symptoms of depression
OR
1. HIV-infected women
2. Cognitive behavioural therapy3. Psychological therapy4. Therapeutic intervention5. Behavioural therapy6. Client-centred therapy7. Patient-centric treatment8. Mental therapy9. Rehabilitation10. Therapist11. 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10
12. Effectiveness of CBT13. Success rate of CBT14. Depression control15. Depression prevention16. Reduction of symptoms17. Reduction of suffering18. 12. OR 13. OR 14. OR 15. OR 16. 17. OR 18.
Table 1: Search strategy based on the PICO framework
The scientific journals specific to depression and health intervention websites will be used for the manual search. The reference lists of the chosen articles will be scanned to find out their relevance to the topic. The PRISMA framework will be used for the management of the search articles and excluding the ones that do not meet the research criterion.
Limitations of the Review
The limitation of the review in the present work is that they lack a critical overview and they rather adopt a descriptive overview in their articles. The review process also had many inaccessible articles. The sources of information which were also reliable are also inaccessible. The inaccessibility of many articles led to a narrow view of the proposed literature review (Snyder, 2020). Furthermore, the criteria that the review of literature is based, on is more on the previously published articles that are the only source of review. Moreover, this presents a narrow and shallow content of the review that has been relied on, for the present study.
PICO (Research question)
A Research question is necessary to justify and align the research objectives of the study. The research question is developed with the help of the PICO framework.
P: The population for the study include women who have HIV
I: The intervention is based on cognitive behavioural therapy effective for the reduction of depression.
C: The comparison would be done among the women with HIV having depression and the women with HIV having no depressive symptoms.
O: The outcome would be based on the effectiveness of CBT for the reduction of depressive symptoms in HIV women in the UK.
Inclusion exclusion criteria
The research is conducted based on the journals and the articles that have been selected for the study. The articles have been selected through a systematic process. The data has been selected through the databases that are needed. In the research study, a criterion has been set up to include and exclude the collected articles with the help of keywords (Kaaya et al. 2022). The outcome of the research is dependent on the article selection, the journals and the required information. The factors in both inclusion, as well as exclusion that is used for the research purpose, have a great impact on the research (Gupta et al. 2020). The inclusion and exclusion factors that are used in the study are illustrated in the table below.
Inclusion
Exclusion
Population
HIV affecting the women in the UK population causes depression in them
Other diseases which harm the population
Language
Only english
Articles in any other language than English
Full-text
Yes
No
Peer-reviewed
Only RCT
Any article that has been peer reviewed
Relevance with the study topic
The selection process of the chosen article has been done basing on selecting the HIV disease that is related to the given topic and the population selection between women who have been affected by the HIV.
The excluded articles have been based on some other diseases of and hence they have been excluded. Only HIV has been included and the other diseases have been excluded from this study.
Date of publication
From the 2018- date
Before 2018
Table 2: Inclusion and exclusion criteria
Analysis
The study of the article is done by selecting the 10 articles and the rule of inclusion and exclusion has been followed. The included criteria are the individuals that are suffering from HIV disease and those other who are suffering from other diseases are excluded. Only the language English is selected for the articles. Other language articles are not selected for the research purpose (Pascoe et al. 2022). The peer-viewed articles are excluded and the articles which are from 2018 till date are included. Other articles which are before 2018 are excluded.
Screening process –PRISMA
Quality assessment
CASP
The Critical Appraisal Skills Programme is a generic tool that is used to evaluate the limitations and the strengths of any research methodology on the qualitative factor. The CASP tool has ten questions and each of the questions focuses on a methodological aspect that is different from each question for the qualitative study.
The different articles and journals are chosen and evaluated by the involvement of the "Critical appraisal skills program (CASP)" tool (Dale and Safren, 2018). The CASP tool for detecting the qualitative proof of the synthesis is done. The CASP tool is a tool which is researcher relevant. The assessment and the evaluation of the qualitative data on the effect of behavioural cognitive therapy among g HIV-infected women, Casp can be taken into the consideration.
CASP Table
CASP Questions
Article 1
Article 2
Article 3
Article 4
Article 5
Article 6
Article 7
Article 8
Article 9
Article 10
Q 1.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Q2.
Yes
Can’t tell
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Q3.
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Q4
No
No
Can't tell
Yes
Yes
No
Yes
Yes
Yes
Yes
Q5.
No
Yes
Yes
Yes
Can’t tell
Yes
Yes
No
Yes
Yes
Q6.
Can’t tell
Yes
Yes
Yes
No
Can’t tell
Yes
Yes
No
No
Q7.
Yes
Yes
Yes
Yes
Can’t tell
No
No
Yes
Yes
Yes
Q8.
Yes
Can’t tell
Can’t tell
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Q9.
Yes
Yes
Yes
Can’t tell
Yes
Yes
Can’t Tell
Yes
Yes
Yes
Q10.
Yes
Yes
Yes
Yes
Can’t Tell
Yes
Yes
Yes
Can’t Tell
Yes
Q11.
Yes
Can’t tell
Can’t Tell
Yes
Yes
Can’t tell
Yes
Yes
No
Yes
CASP Score
8
7
8
9
8
7
8
9
8
10
Table 3: CASP score
Analysis
The CASP tool has been used to evaluate the quality of the articles and journals. The CASP score of articles and journals is above 5. So in conclusion it can be said that all the articles are relevant to the research study and all are selected.
Data extraction tool
Data extraction Table
Author
Year of Publication
country
Study setting
Study design
Population
Result and outcome
Extracted area
Junkins et al. (1)
(2020)
UK
Mental healthcare
Deductive
11 adults
The result observes the feasibility of the medicine administered in the therapy.
Result
Joska et al.) (2)
(2020)
UK
Healthcare
Deductive
160 adults
To evaluate the effectiveness of the intervention in depression with HIV-infected women in low to medium-income households.
Conclusion
Nyamukoho et al. (3)
(2019)
UK
Care clinics
Deductive
198 adults
To evaluate the factors that is associated with depression after analysis of intimate violence.
Result
Ogueji (4)
(2021)
UK
Research Centre(Random clinical trial)
Deductive
840 adults
To explore the experiences of psychological distress among pregnant women affected with HIV.
Discussion
Yigit et al. (5)
(2020)
UK
Hospital(Random clinical trial)
Deductive
186 adults
The outcome on the health behaviour of individuals who are new to HIV decreases the HIV stigma with viral suppression.
Conclusion
Haas et al. (6)
(2021)
UK
government-funded health facilities
Deductive
Non-pregnant women with HIV affected, and women aged above 18 years
The proportion of people in the country who are affected by mental disorders is substantial.
Conclusion
Turan et al. (7)
(2019)
UK
Healthcare
Deductive
914 adults
The higher HIV-related stigma lowers the odds of adherence to optimal ART.
Result
Brandt et al. (8)
(2018)
UK
Clinical Research(Random clinical trial)
Deductive
104
The result indicated that HAMRT is effective in reducing the symptoms of depression among the sample.
Result
Angelakis et al. (9)
(2022)
UK
Research Centre(Random clinical trial)
Deductive
15248 adults
The ultra-complex CBT is affecting individuals with mental health problems.
Discussion
Dale and Safren (10)
(2018)
UK
Research Centre(Random clinical trial)
Deductive
27
The findings are supportive of the potential treatment in improving HIV medication and reducing trauma.
The data extraction tool is used to evaluate the findings and outcomes based on the selected articles and journals. The result depicts the outcomes and effects of cognitive behavioural therapy among the women in different groups who are affected by HIV.
Timetable
The topic has been selected from the "2nd week of January" to "3rd week of January". The identification of the background has taken time from "4th week of January" to "1st week of February". The research and the aim of the objective are done from "2nd week of February" to "3rd week of February". The identification of the research questions are done from "4th week of February" to "1st week of March". The review of the literature has been done from "2nd week of March" to "1st week of April". The collection of the data is done from "2nd week of April" to "4th week of April". The results are conducted from "5th week of April" to "1st week of May". The analysis of the data is done from "2nd week of May" to "3rd week of May". And lastly the discussion and conclusion is done from "4th week of May" to "5th week of May" and conclusion is concluded on the 1st week of June respectively.
Budget and likely funding sources
The articles and journals that are selected are based on primary research. The information has been found in the previous database. The research is done based on the primary findings. Therefore there is a budget for extracting the information through research. And the resources that have been used are based on the primary findings of the articles or journals.
Dissemination of results
The findings of the research have been evaluated and discussed on the effect of HIV affected women with the rising symptoms of depression. The research study will be conducted on the basis of the primary data that have been selected by the articles and journals.
References
Primary selected articles
Haas, A.D., Kunzekwenyika, C., Hossmann, S., Manzero, J., van Dijk, J., Manhibi, R., Verhey, R., Limacher, A., von Groote, P.M., Manda, E. and Hobbins, M.A., 2021. Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study. BMJ open, 11(7), p.e049824.
Joska, J.A., Andersen, L.S., Smith-Alvarez, R., Magidson, J., Lee, J.S., O’Cleirigh, C. and Safren, S.A., 2020. Nurse-delivered cognitive behavioral therapy for adherence and depression among people living with HIV (the Ziphamandla Study): protocol for a randomized controlled trial. JMIR research protocols, 9(2), p.e14200.
Junkins, A., Psaros, C., Ott, C., Azuero, A., Lambert, C.C., Cropsey, K., Savage, R., Haberer, J.E., Safren, S.A. and Kempf, M.C., 2021. Feasibility, acceptability, and preliminary impact of telemedicine-administered cognitive behavioral therapy for adherence and depression among African American women living with HIV in the rural South. Journal of health psychology, 26(14), pp.2730-2742.
Nyamukoho, E., Mangezi, W., Marimbe, B., Verhey, R. and Chibanda, D., 2019. Depression among HIV positive pregnant women in Zimbabwe: a primary health care based cross-sectional study. BMC pregnancy and childbirth, 19(1), pp.1-7.
Ogueji, I.A., 2021. Experiences and predictors of psychological distress in pregnant women living with HIV. British Journal of Health Psychology, 26(3), pp.882-901.
Turan, B., Rice, W.S., Crockett, K.B., Johnson, M., Neilands, T.B., Ross, S.N., Kempf, M.C., Konkle-Parker, D., Wingood, G., Tien, P.C. and Cohen, M., 2019. Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV: the mediating role of depression. AIDS (London, England), 33(3), p.571.
Yigit, I., Bayramoglu, Y., Weiser, S.D., Johnson, M.O., Mugavero, M.J., Turan, J.M. and Turan, B., 2020. Changes in internalized stigma and HIV health outcomes in individuals new to HIV care: The mediating roles of depression and treatment self-efficacy. AIDS Patient Care and STDs, 34(11), pp.491-497.
