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IV. Methodology – one quantitative research design. develop a…
IV. Methodology – one quantitative research design. develop a specific research method addressing the CV, IV, and EV concerns from the literature review and tailored to the specific clinical setting. As part of the methodology, student should describe the role research ethics influence the research proposal.
* (a) Steps to specifically address one CV concern *
Information to assist with (A) CV concern
Cognitive Behavioral Therapy and Mental Health Among University Students
According to the CDC (2021), 1 in 5 individuals in the United States will experience a mental illness due to numerous factors such as trauma, physical health conditions, substance use, and environmental or biological factors. The CDC also states that individuals between the ages of 18-29 are more likely than any other age group to experience issues like depression and anxiety. Therefore, mental health services and treatment are essential to improve the lives of individuals with mental health disorders and behavioral health issues. Treatment methods may include individual therapy, group therapy, and medication management to learn coping skills and reduce symptoms and impairments. Through individual therapy, mental health professionals use evidence-based practices to meet clients’ needs, preferences, and goals through psychotherapy. Some evidence-based practices include acceptance and commitment therapy, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), solution-focused therapy, and exposure therapy. A specific and most practiced intervention utilized by marriage and family therapists is cognitive behavioral therapy (CBT).
Cognitive behavioral therapy (CBT) is a psychotherapy and an evidence-based practice that has been the most effective in treating mental and physical health issues. Furthermore, it is an effective intervention in treating various topics, including depression, anxiety, panic attacks, post-traumatic stress disorder, obsessive-compulsive disorder, eating disorders, grief and loss, bipolar disorders, schizophrenia, substance use disorders, and managing life stressors. (CBT model founders) In recent years, CBT has been found most effective in treating depression, stress, and anxiety in populations like university level students, as they are more inclined to face these kind of mental health disorders. The cognitive model is based on the theory that how you think determines how you feel and behave. Individuals dealing with depression or anxiety experience cognitive distortions that can cause a drastic change in the way they think and behave. Different CBT techniques can aid an individual when identifying those negative moods and behaviors and can help them create better patterns of behavior.
Literature Review
Construct Validity
Cognitive behavioral therapy has shown to be an effective treatment for improving mental health problems among university students (Irie, Yokomitsu, & Sakano, 2019). Mental health problems can have a negative impact on academic performance and social function of university students (Irie, Yokomitsu, & Sakano, 2019). College tends to be a vulnerable time for students especially during a pivotal time of developmental transitions (Farabaugh et al., 2018). Farabaugh’s study identified that CBT significantly reduces depression, anxiety, and suicidality among university students. The study used the manual developed by the cognitive therapy research group at the University of Pittsburgh (Shaw, 1984). Researchers identified the dependent variables of the study as anxiety, depression severity, perceived stress, and negative cognitions. The variables were measured using the Beck Anxiety Inventory, the Dysfunctional Attitude Scale, the Automatic Thoughts Questionnaire, and the Perceived Stress Scale (Farabaugh et al., 2018). Participants in the study completed the measures pre-and post-intervention (Farabaugh et al., 2018). The ten threats of construct validity include inadequate preoperational explication, mono-operation bias, evaluation apprehension, experimenter expectancies, confounding constructs and levels of constructs, restricted generalizability across constructs, mono-method bias, hypothesis guessing in the experimental condition, interaction of different treatments, and interactions between testing and treatment. Based on the ten threats to construct validity the researchers did an effective job making sure the measure of interest assess what it claims to assess.
The American College Health Association reported that half of college students suffer from significant depression (Nyer et al., 2015). Suicide is the second leading cause of death among adolescents with suicide rates tripling over the last decade (Esposito-Smythers et al., 2019). Nyer’s study identified evidence that short-term, individually tailored manual-based CBT can be beneficial for reducing depressive symptoms and suicidal ideation among college students (Nyer et al., 2015). The 6-week CBT intervention followed the Sequenced Treatment Alternatives to Relieve depression manual. Researchers identified the variables of the study as depression, suicidal ideation, and basic demographics. The variables were measured using the Demographic Questionnaire, the Beck Depression Inventory, The Beck Depression Inventory #9 Suicide item, and the Suicidal Behaviors Questionnaire (Nyer et al., 2015). Students completed the array of measurements both pre- and post-intervention (Nyer et al., 2015). Based on the ten threats to construct validity the researchers did an effective job making sure the measure of interest asses what it claims to assess.
Internal Validity
Farabaugh’s study utilized a novel recruitment strategy and examined the efficacy of CBT provided by specialists in a depression clinical research center (Farabaugh et al., 2018). College students among four universities who were experiencing symptoms of depression were given twelve weeks of flexible manualized CBT (Farabaugh et al., 2018). All study procedures were approved by the Institutional Review Board (Farabaugh et al., 2018). The study was only open to undergraduate students over eighteen years old who were willing to take part in a mental health screening (Farabaugh et al., 2018). Threats to internal validity include history, maturation, testing, instrumentation, statistical regression, attrition or mortality, interaction with selection, ambiguity regarding casual direction, diffusion or imitation of treatments, compensatory equalization of treatments and compensatory rivalry by control group participants. To make sure the study has internal validity it is important that the researchers are always vigilant to the occurrence of threats. For participation in the study students received a $10 gift card to their college bookstore and a packet of mental health resources available in the area (Farabaugh et al., 2018). The study was limited since it had no control group thus, they were not able to control for variables such as time, staff attention, and assessment visits (Farabaugh et al., 2018). Based on the thirteen threats of internal validity the researchers did an effective job in making sure the research was conducted in a manner that allows us to rule out alternative explanations.
Nyer’s study recruited participants through a college-based depression and suicide screening conducted by the Massachusetts General Hospital, Depression Clinical and Research Program at a university in northeastern United States (Nyer et al., 2015). The study included 9 participants who were enrolled in 6 weeks of individual cognitive behavioral therapy with an individually tailored manual based treatment (Nyer et al., 2015). Inclusion criteria included being between the age 18-24, English speaking, and have at least moderate depressive symptoms and/or suicidal ideation (Nyer et al., 2015). Students were given a $10 voucher for there participation and a list of mental health resources in the area (Nyer et al., 2015). The study was limited since it had no control group they are not able to rule out the possibility that the observed results were due to factors such as time, history, or regression to the mean (Nyer et al., 2015). Based on the thirteen threats of internal validity the researchers did an effective job in making sure the research was conducted in a manner that allows us to rule out alternative explanations.
External Validity
Numerous studies on CBT have evaluated the efficacy of CBT on depression among university studies. Farabaugh et al. (2018) and Nyer et al. (2015) are well casually well-defined studies due to revolution in design, and internal validity, which are essential for major scientific breakthroughs in social science. For instance, using novel recruitment strategies and including participants with depression characteristics enable the studies to demonstrate internal validity. However, researchers go beyond the study’s outcomes to care about making inferences about the effects at hand, which is the utmost goal of the study. Notably, researchers’ main goals are to use the results of a well-researched study to understand or apply the results to a larger population. As such, Findley et al. (2021) define external validity as the extent to which inference from a particular study applies to the larger population. Inference is what sets sociology aside from history. Terms such as generalizability and transportability are generalized when referring to all credible external validity. The measures that account for external validity fall under the M-STOUT framework, which describes these measures as a mechanism, setting, treatment, outcomes, setting, and time (Findley et al., 2021) as a determinant of external validity.
Threats to external validity include lack of well-defined scope, target population, sample units treatment, outcome, settings, time, and mechanism. Findley et al. (2021) argue that a study must identify the scope, which is a specification of the applicability and limitation of the study. The study must also determine the sample population, treatments must have construct validity, and outcomes must be replicated through matching weight or simulation. Setting refers to the environment in which information is collected. Experimental observation has merits and drawbacks when it comes to inference. Experimentation studies can address the challenge of inference through sub-grouping analysis, weighting, and stratification, while observation can address the problem through random sample selection (Findley et al., 2021). Time and mechanism also have received little attention and are important for validity. The limited sense mechanism is mediators occurring after treatment and before outcomes. Notably, the mechanism works through treatment to affect the outcome. In the broadest sense, mechanisms include constraints and interactions.
Palacios et al. and Bantjes et al. studies evaluated the feasibility, acceptability, effectiveness, and satisfaction of a supported internet-delivered CBT (ICBT) for university students with depression, anxiety, and stress. Palacios et al. study recruited 102 participants from three programs, including 52 choosing Space from Anxiety, 31 choosing space from Depression, and 19 choosing space from stress (Palacios et al., 2018). The students were recruited from three different campus centers, a representative population of university students with depression. The treatments showed internal validity by using only approved methods. Bantjes et al. (2021) study recruited 175 participants from a university, of which 86.1% were female with a mean age of 22.6. The specific description of the participants improves their external validity and transferability. The studies were only open to university studies and with depression, anxiety, and stress. Both studies used evidence-based screening measures such as the Patient Health Questionnaire 9 (PHQ-9) and the stress subscale of the depression, Anxiety, and Stress Scale (DASS-21) (Palacios et al., 2018). Additionally, the authors specifically indicated the scope and limitation of the study in terms of CBT techniques and the mental illnesses they targeted. Notably, based on the features of external validity mentioned above, the authors did an adequate job of ensuring the studies generalizable to the overall university population with anxiety, depression, and stress.
Implications
The different studies reviewed above all contain both great internal and external validity which help show that the research can be trusted and it is a valid source of information. Those studies focused on using cognitive behavioral therapy in order to treat mental health issues like depression and anxiety among college students. Cognitive behavioral therapy can be a very effective approach to utilize when treating college students suffering from a variety of mental health illnesses. Cognitive behavioral therapy focuses on the idea that how one thinks plays a big role in how one feels and behaves. In the research study conducted by Nyer et al. (2015), the researchers found that short-term and individually tailored cognitive behavioral therapy within a time frame of six weeks helped the participants reduce their depressive symptoms and suicidal ideation. According to Banties et al. (2021), their research also found a significant improvement in depression and anxiety symptoms that their participants were originally experiencing after being treated with cognitive behavioral therapy. The articles reviewed above focus only on college students which helped narrow down the research pool and provide the most accurate results. The articles are robust in nature because like mentioned before they focus on one single population, and they use large samples within that population which help increase their internal and external validity.
Although the articles reviewed above do contain good internal and external validity, there are some limitations and weaknesses in the research. One of the main weaknesses in a couple of the articles above is that the researchers did not include a control group during their study. This could pose the question that the research is not valid because there is nothing to compare the treatment group to. Another weakness that is evident in the research articles reviewed above is that the majority of them provided the participants with an incentive of sorts, this could have caused the participants to feel the need to meet what they believe are the researchers’ expectations and therefore exaggerate or lie about their improvement. One limitation that the above research articles contain is that they mainly only focus on mental disorders like depression, anxiety and stress leaving out other mental disorders that college students could be facing. This in turn greatly limits the generalizability of the research findings to only students who face those mental disorders, perhaps if the studies focused on a larger scope of mental disorders this limitation would not exist.
Based on the evaluation of Banties et al. (2021), the student model of cognitive behavioral therapy (CBT) appears to be effective in reducing symptoms of anxiety and depression among university students. The studies included in the review showed moderate to large effect sizes for CBT interventions in reducing symptoms, and the effects were sustained over time. However, the review also identified several weaknesses and limitations of the research, which may affect the robustness of the articles reviewed. Some of these limitations include: small sample sizes: Many of the studies included in the review had small sample sizes, which limits the generalizability of the findings. High risk of bias: Several of the studies included in the review had a high risk of bias due to inadequate blinding, incomplete outcome data, or selective outcome reporting. Heterogeneity of interventions: The interventions varied in their format, duration, and content, making it difficult to compare their effectiveness, and a Lack of long-term follow-up.
The study protocol described by Benjet et al. (2022) has several implications related to the treatment of depression and anxiety in university students in Latin America. Some of these implications include: Internet-delivered cognitive behavior therapy (CBT) can be an effective and accessible treatment option for university students with depression and anxiety. The study aims to evaluate the effectiveness of both guided and unguided CBT programs delivered through an online platform, which could be particularly beneficial for students who may have limited access to traditional face-to-face therapy. Pragmatic trials can provide valuable information about the real-world effectiveness of interventions. The study is designed as a pragmatic trial, which means that it will be conducted in a real-world setting and will evaluate the effectiveness of the intervention under everyday conditions. This type of trial can provide important insights into how the intervention might work in practice and how it can be implemented in real-world settings.
The study has implications for the scalability and sustainability of mental health interventions. The use of an online platform for delivering CBT has the potential to reach a large number of students in a cost-effective and efficient manner. If the study finds that the intervention is effective, it could provide a model for how mental health services can be scaled up and sustained in resource-limited settings. The study highlights the need for culturally sensitive and relevant mental health interventions. The study is being conducted in two Latin American countries, and the intervention has been adapted to be culturally sensitive and relevant to the local context. This is important because cultural factors can influence how mental health problems are experienced and perceived, and interventions that take these factors into account are likely to be more effective. Overall, the study protocol has important implications for the development and implementation of mental health interventions in Latin America and other resource-limited settings.
The randomized controlled trial carried out by Saleh et al. (2018) has several implications related to stress management among university students. Some of these implications include: Stress management interventions can be effective in reducing stress levels among university students. The study evaluated the effectiveness of a stress management intervention program, which included psychoeducation and relaxation techniques, and found that it was effective in reducing stress levels among participants. Stress management interventions can be delivered in group settings. The intervention program in this study was delivered in group settings, which is a cost-effective way of reaching a large number of students. Group interventions can also provide opportunities for social support and can help participants feel less isolated in their stress management efforts.
Stress management interventions can be incorporated into university curricula. The intervention program in this study was incorporated into the university curriculum as an elective course. This highlights the importance of integrating stress management into university education, as it can help students develop important skills for managing stress throughout their academic and professional lives. Stress management interventions can have long-term effects. The study followed up with participants three months after the intervention ended and found that the effects of the intervention persisted. This suggests that stress management interventions can have lasting effects on participants’ ability to manage stress. Overall, the study has important implications for stress management among university students. It provides evidence that stress management interventions can be effective, delivered in group settings, incorporated into university curricula, and have long-term effects. These findings can inform the development and implementation of stress management programs for university students, which can help improve their mental health and academic performance.
