|Year : 2016 | Volume
| Issue : 4 | Page : 244-249
The effectiveness of solution-focused brief therapy on reducing depression in women
Mojtaba Habibi1, Kobra Ghaderi2, Samaneh Abedini1, Nina Jamshidnejad1
1 Department of Family Therapy, Family Research Institute, Shahid Beheshti University, Tehran, Iran
2 Department of Counseling, Allameh Tabataba'i University, Tehran, Iran
|Date of Web Publication||2-Sep-2016|
Prof. Mojtaba Habibi
Department of Family Therapy, Family Research Institute, Shahid Beheshti University, Tehran
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to determine the effectiveness of solution-focused brief therapy (SFBT) on reducing depression in head-of-family women under the protection of the State Welfare Organization of Iran. Materials and Methods: The sample consisted of 30 women who were randomly selected based on acquiring scores upper than median on Beck Depression Inventory (BDI) scale, and were randomly assigned to the intervention and control groups. With a pretest and posttest control group design, subjects in the experimental group underwent 8 weekly sessions of SFBT. Both groups were evaluated using BDI-II scale in pretest and posttest, and data were analyzed using ANCOVA. Results: Findings showed no significant difference between the two groups in the pretest, while SFBT, significantly decreased depression scores in the intervention group. Conclusion: SFBT could be used as an intervention program in target groups and the general population of women with depression.
Keywords: Depression, solution-focused brief therapy, women
|How to cite this article:|
Habibi M, Ghaderi K, Abedini S, Jamshidnejad N. The effectiveness of solution-focused brief therapy on reducing depression in women. Int J Educ Psychol Res 2016;2:244-9
|How to cite this URL:|
Habibi M, Ghaderi K, Abedini S, Jamshidnejad N. The effectiveness of solution-focused brief therapy on reducing depression in women. Int J Educ Psychol Res [serial online] 2016 [cited 2020 Apr 2];2:244-9. Available from: http://www.ijeprjournal.org/text.asp?2016/2/4/244/189671
| Introduction|| |
Major depressive disorder (MDD) is one of the most common illnesses and often carries massive personal and social cost; moreover, across many cultures, nations, and ethnicities women are twice as likely as men to experience symptoms of MDD. Lifetime prevalence for MDD in women is 21.3%, compared with 12.7% in men. Depression can have significant diver's effects on social, familial, and educational function and is an important predictor of psychological well-being and suicidal thoughts and behavior. Despite the high prevalence of MDD in women and the possible serious implications on their lives, it is often unrecognized and untreated in this population, which needs more investigation. Hence, addressing depression symptoms can improve the psychological and social life of women considerably; there is a significant need for applying feasible and approved psychological interventions for women. It is well-documented that reduction of depression symptom can be highly beneficial for other family members particularly children, and social and occupational function of these women. There is a wide array of risk factors lead to high level of depression among woman such as marital quality or status, priority anxiety disorders, stressful life events, personality, and given the etiologic role of genetic factors in major depression. Recent researches have focused on, however, men and woman. Experience the same stressors; they have a considerable difference in biological responses, self-concepts, and coping style. One of the well-documented factors contributed in depression is maladaptive cognitional, emotional, and behavioral coping skills toward stressors. Impaired coping strategies to stress can sensitize both individual's biological and psychological systems to future stress and make them more vulnerable to react with learned helplessness and depression symptoms.
Therefore, applying psychological intervention that enhance patient's skills for having much more adaptive response toward stressors have can be considerably effective.
Furthermore, the long-term psychological therapies and effects are an important barrier for clients with a diagnosis of MDD. Moreover, the reluctance of many depressed young people to engage with mental health services highlights the importance of low threshold and easily accessible interventions. Based on previous findings one of the feasible and brief interventions for reducing depression complaints is solution-focused brief therapy (SFBT). SFBT is a widely used therapeutic approach in coaching, couples therapy, and psychotherapy. According to several meta-analyses and reviews, it has positive and considerable effects in a broad range of settings and psychological problems. Review studies showed the significant effectiveness of SFBT on depression as an outcome. One study investigated depressed college students and found that one session SFBT was as effective as one session of interpersonal therapy with a meaningful decrease in depressive symptoms. Other studies on SFBT, with adult populations, showed that SFBT was related to a reduction of depressive symptoms over time. SFBT shifts the focus away from the problem formation and problem solving, to clients, strengths, and resiliencies. In SFBT, clients look for solutions to obtain goals and strongly stress on the client's autonomy to achieve them, this therapy can enhances expectancy and hopefulness too.
SFBT helps depressed clients by regarding their abilities and skills, to find the “solutions” and “exceptions.” This approach assumes that everything is changeable, and its concentration is on solutions and the power of language. This approach helps depressed clients shape their mental image around the solutions and consider the solution-focused behaviors that make them enables for reaching their goals. Client in exploring his own way of solving the problems experienced who believed that the attempted solution would often perpetuate the problem, rather than solving it and that an understanding of the origins of the possibilities for action (and change) revealed by the client, rather than adapting the therapy to a diagnostic classification. SFBT has a nonpathological view on people; hope and self-confidence can be rebuilt by inviting their clients to encourage their success by noticing and valuing their small changes. Many studies have examined the feasibility of SFBT on internalizing and emotional problems. However, there is limited research on the effectiveness of this protocol for enhancing psychological well-being of women specifically Iranian women. Hence, the aim of this study was to test the effectiveness of SFBT for managing depression symptoms in a population of women. We hypothesized that, as compared to age and gender-matched controls, women who completed an SFBT program would show fewer depression symptoms.
| Materials and Methods|| |
This semi-experimental study was a pretest and posttest design with a control group. The statistical population consisted of women under the protection of Kashan's State Welfare Organization during 2010–2011 who were collected through random sampling method; women were eligible if (a) age 25–40-year-old, (b) were in in borderline or clinical range on depression based on Beck Depression Inventory (BDI), (c) were at least 1 month beyond the first diagnosis of depression, (d) had not received any psychological interventions or psychiatric medications in the 6 months preceding the study; women who had major cognitive dysfunction or developmental disability were excluded. Women who had been prescreened for eligibility were approached by a clinical psychologist with a letter containing information about the research protocol. 30 of the 70 women who were invited declined to participate. Baseline assessments were conducted after participants signed informed consent/assent forms. Participants were age and gender matched, then randomized to one of two groups (we used the simple randomization technique, which participants were randomly assigned to the two groups in blocks of 15 using a software-generated randomization plan. They were coded consecutively; the first 15 were assigned to experimental, and the second 15 to control. BDI was carried out as the pretest in both groups, and the intervention group received the SFBT in eight 45 min weekly sessions, with the control group receiving no treatments. Moreover, the research protocol was approved by Research Ethic Committee of Family Research Institute of Shahid Beheshti University.
Framework design and description of the general principles of solution-focused therapy.
The therapist began with self-introduction, tried to know the participants more, explained the principles of the therapeutic sessions, and reminded them of the importance of their presence in the sessions at specified times. The pretest was taken in this session.
Participants were asked to write their goal of taking part in the sessions and bring their notes the next session.
Setting the goals in a positive, specific, tangible, and measurable way.
The therapist began by asking the participants to talk about their notes about their goals of participating in sessions. Wherever the written goals were vague, the needed instructions were given so that the participants could determine positive, accurate, and tangible goals. Participants were asked to talk freely about their problem and to talk about their goal and reasons for being a part of the therapy session. They were asked to rank their problems from 0 to 10 and to talk about the solutions that may change them in a positive way. Moreover, they were recommended to express their expectations of life in a clear and precise manner, so that they can evaluate their resources for reaching these wants.
The therapist asked the participants to write down what they thought about the miracle question: “Suppose a miracle is going to happen tonight, and when you are sleeping, all your problems will be solved. What are you going to notice? What will change in your life? When you wake up in the morning, what is it that will grab your attention and tell you that there has been a miracle? What will other people around you notice?”
Omission of the disruptive behavior patterns by the use of the miracle question.
Participants handed in their homework at the beginning of the session. Then a discussion was formed about the participants' answers. The therapist helped them realize the different aspects of the solutions that were latent in their answers and were already present in their lives, and explained to them how they have already experienced pieces of this very miracle in their lives without noticing.
Participants were asked to write down their abilities and to bring their notes the next session.
Understanding the existence of positive exceptions in life, increasing hope, and reducing the level of problems.
Participants handed in their homework at the beginning of the session and discussed the exceptions they have experienced in life. The therapist advised the participants not to look for faults with themselves and others and instead, to focus on the positive behaviors, as this attitude will make the change. Then the therapist asked them, “in the past, when you did not feel sad and were satisfied, what was it that you were doing differently?”
Participants were asked to write down the answer to the above-mentioned question as well as, “how have other people with same problems as yours solved their issue? What solutions can you find?”
Realizing own abilities and applauding others when needed.
The therapist began by asking the participants to talk about their goals written in the correct manner. The participants were applauded by the therapist for correct presentation of their goals so that they would realize how they could effectively use their abilities and resources. The therapist then described a specific situation in life (like isolation and withdrawal of a family member) and asked them to talk about their interpretation of the situation and think about what others would have done, had they faced with such a problem. What will they do different after the problem is solved? The therapist also reminded them that different people have different interpretations of the same event, and each react to the situation based on their interpretation. Therefore, a change in the attitude leads to a change in the behavior.
Participants were asked to think about behaviors and reactions, different from their current behavior and reaction toward the problem and to include the word “instead” in their everyday life, so that in unpleasant situations when they feel weak with depression they can think about how they can feel instead of having unpleasant feelings. This will lead them toward action. The participants were asked to write down few instances and bring their notes the next session.
Learning new ways of thinking, feeling, acting and behaving, and experiencing new feelings by the use of the very significant word “instead.”
Participants handed in their homework thought about the question and conveyed their opinions. The therapist challenged their opinions to help them understand the different aspects of the solutions. Participants then were given sometimes to think about the asked questions and answer them. The therapist discussed their answers with them, pointed out the latent solutions in their answers, and applauded them.
Participants were asked to think about how to stabilize and sustain the changes that happen during the sessions and to discuss their answers the next session.
Clear understanding of the participants, of changes made in their lives by themselves, and realization of the personal skills they have used in the process.
The session began by participants talking about the last session's homework, conveying their opinions, and discussing them. The therapist asked them questions in order to achieve the session goals.
Participants were asked to think about the following question, write down their answers and bring their notes to the next session. “Suppose that you are to send a picture of yourself to a friend, after the therapy sessions are over. When your friend sees you in the picture, how will they assess your feelings? What are you doing in the picture? What changes will your friend notice in you? How will they assess your current status?”
Objectives: Final revision of the previous content, conclusion and the posttest.
The session began by participants talking about the last session's homework. The therapist began a discussion using the results of the exercise and reminded the participants that they could repeat the same task anytime they wanted. The therapist explained to the participants that the solutions to their life issues are latent inside them and by discovering these solutions, people can work out their problems. A written summary of all past content, including exceptional moments, the miracle question, and the new changes, was distributed among the participants. Each participant had 3 min to talk about their achievements with others applauding the speaker. The posttest was taken at the end of the session.
Beck Depression Inventory II
The BDI-II contains 21 questions related to the depressive symptoms. Each answer is scored on a scale value of 0–3 and the score range is between 0 and 63. The standardized cutoffs used are: 0–13 for minimal depression, 14–19 for mild depression, 20–28 for moderate depression, and 29–63 for severe depression. Studies carried out about BDI-II consistently show high internal consistency coefficients in the range of 0.89–0.94 even in different populations. The reliability coefficient of this test is between 0.78 and 0.93 and the reliability coefficient of the re-test 0.48 for psychotic patients and 0.74 for university students. In 2005, Ghasemzadeh et al. examined the psychometric properties of a Persian language version of this instrument (BDI-II) in a sample of 125 consisting of Tehran University of Medical Sciences and Allameh Tabataba'i University students. The results report the reliability and concurrent validity of the BDI-II-Persian as 87% and 74%, respectively.
| Results|| |
The statistical sample consisted of 30 working and homemaker women. Nine of them were 20–24 years old, 10 (the highest frequency) were 25–29, 5 were 30–34, and 7 were more than 34 years old.
Statistical indicators in [Table 1] show the median and the standard deviation of the pretest of the two groups. There is no significant difference in the pretest of the intervention and the control group P ≥ 0.05, while a significant difference exists in the posttest of the groups.
|Table 1: Descriptive indicators of solution-focused brief therapy in reducing depression|
Click here to view
Results of [Table 2] prove the assumption of the normal distribution with the Kolmogorov–Smirnov test. The conditions of homogeneity of variances and the homogeneity of the regression coefficient are also met. The result of the ANCOVA test of the effectiveness of the SFBT proves this approach effective in reducing the depressive symptoms in women.
|Table 2: ANCOVA results of shows the effectiveness of the solution-focused on reducing depression in the intervention and control group|
Click here to view
| Discussion|| |
Results of the analysis of the data, by the use of the ANCOVA test in the two intervention and control groups, proved the SFBT effectiveness on reducing the depression of women under the protection of the State Welfare Organization. This result is consistent with previous studies, which show the feasibility of SFBT on various psychological issues. SFBT has received empirical support for various psychological maladjustments such as depression and alcohol dependence, anxiety, and obsessive-compulsive disorder. Moreover, the effectiveness of SFBT on the quality of life and well-being is well-documented. Furthermore, these results are consistent with researches done by Elliot and Kim  and Cepukiene and Pakrosnis. Elliot and Kim found out through their studies that solution-focused intervention can reinforce the positive beliefs in the minority and underprivileged students and is significantly acceptable psychological predictor in treating temperament disorders and anxiety. Cepukiene and Pakrosnis' study showed that SFBT is an effective approach for making positive changes in adolescents with behavioral problems. SFBT can decrease depression symptoms through various mechanism and techniques, which help clients to determine their objective goals in a positive, specific, tangible, and measurable manner; through miracle question they can have a more clear view about their goals and solutions for reaching them. These techniques can boost the self-confidence of clients, which completely is associated with depression symptoms. Through SFBT's techniques and questions, clients practice to control disruptive behavior patterns and enhance their skills for finding and assessing different solutions, which lead to higher level of hopefulness, optimism, and autonomous, which address depression symptoms. Moreover, by applying techniques clients try to change their attitude and have new ways of thinking toward stressors, personal and environmental resources, and their latent abilities and interpersonal conflicts, which can boost their mood and goal-oriented behavior. Conducting this program in this clinical setting raised several challenges. One of the limitations of the current study is that the restriction of individuals who participated in our study and lack of controlling probable effective factors such as marital satisfaction, social and economic status, comorbid anxiety disorders, and so on. Moreover, it was difficult for participants to stay engaged with SFBT follow-up assessment; therefore, we could not assess the effectiveness of intervention after posttest. Moreover, we only use from BDI and did not use another questionnaire for more clarification. Reports from psychiatric blind to the treatment condition might offer a more reliable of an indicator of change than self-reports. Future evaluations of SFBT would benefit by including behavioral, psychophysiological, and neurological measures in addition to self-report measures. Psychological mechanisms of change also need an investigation to examine how internal changes effect the observable behavior changes. Follow-up assessments are needed to ascertain what, if any, long-term effects may accrue.
| Conclusion|| |
Through SFBT training and related activities, women in this study were encouraged to explore the exceptions and to remember situations in, which they were not depressed and these practices emphasize and encourage their competency for necessary actions. The therapist's questions in SFBT helped the participants to re-experience their thoughts and beliefs about their problems. Moreover, taking part in treatment sessions, regular weekly participation, supporting others, commenting and giving opinions about other participants' lives, and issues were other factors that and effect their depression. Enhancing participants' skills that may have helped them to be more confident about choosing how to respond to difficult circumstances in, which they had little control. SFBT teaches women to be more aware of thoughts and feelings in order to make changes. SFBT teaches acceptance of own abilities in women; self-confidence that is essential to problem-solving and emotional resiliency. SFBT help participants for forming clear intentions and beginning to effect meaningful changes. The integration of SFBT principles with finding solutions skills appeared to enhance women's self-confidence for dealing with serious life stressors and the resulting physical, psychological, and interpersonal changes.
According to the positive findings of these studies, it is recommended to use this approach in treating larger samples. It is also recommended that the same study is carried out as a comparative one on samples of men and women so that the results could be generalized to a larger population and this stage we cannot generalize these results to other women with different condition and characteristics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 2000;68:615.
Nolen-Hoeksema S. Gender differences in depression. Curr Dir Psychol Sci 2001;10:173-6.
Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB. Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity, and recurrence. J Affect Disord 1993;29:85-96.
Buunk BP, Gibbons FX, Buunk A. Health, coping, and well-being: Perspectives from social comparison theory. Mahwah: Psychology Press; 2013.
Noble RE. Depression in women. Metabolism 2005;54 Suppl 1:49-52.
Goodman SH. Depression in mothers. Annu Rev Clin Psychol 2007;3:107-35.
Kendler KS, Kessler RC, Walters EE, MacLean C, Neale MC, Heath AC, et al
. Stressful life events, genetic liability, and the onset of an episode of major depression in women. Focus 2010;8:459-70.
Coyne JC, Aldwin C, Lazarus RS. Depression and coping in stressful episodes. J Abnorm Psychol 1981;90:439-47.
Garnefski N, Legerstee J, Kraaij VV, Van Den Kommer T, Teerds J. Cognitive coping strategies and symptoms of depression and anxiety: A comparison between adolescents and adults. J Adolesc 2002;25:603-11.
Katon W, Robinson P, Von Korff M, Lin E, Bush T, Ludman E, et al.
A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry 1996;53:924-32.
Nau DS, Shilts L. When to use the miracle question: Clues from a qualitative study of four SFBT practitioners. J Syst Ther 2000;19:129.
Spilsbury, G. Solution-focused brief therapy for depression and alcohol dependence: A case study. Clin Case Stud 2012. DOI:1534650112450506.
Johnson LD, Miller SD. Modification of depression risk factors: A solution-focused approach. Psychotherapy 1994;31:244.
Liu X, Zhang YP, Franklin C, Qu Y, Chen H, Kim JS. The practice of solution-focused brief therapy in mainland China. Health Soc Work 2015;40:84-90.
Gingerich WJ, Eisengart S. Solution-focused brief therapy: A review of the outcome research*. Fam Process 2000;39:477-98.
Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory – Second Edition: BDI-II-PERSIAN. Depress Anxiety 2005;21:185-92.
BienAime JK. Managing performance anxiety in music students: Using a solution focused approach. Nova Southeastern University; 2011.
Yang F, Zhu S, Luo W. Comparative study of solution-focused brief therapy (SFBT) combined with paroxetine in the treatment of obsessive-compulsive disorder. Chin Ment Health J 2005;19:288-90.
Pelsma DM. School counselors' use of solution-focused questioning to improve teacher work life. Prof Sch Couns 2000;4:1.
Elliott W, Kim JS. The role of identity-based motivation and solution-focus brief therapy in unifying accounts and financial education in school-related CDA programs. Child Youth Serv Rev 2013;35:402-10.
Quick EK. Solution focused anxiety management: A treatment and training manual. London: Academic Press; 2013.
Blundo R, Bolton KW, Hall JC. Hope: Research and theory in relation to solution-focused practice and training. International Journal of Solution-Focused Practices 2014;2.
Carr SM, Smith IC, Simm R. Solution-focused brief therapy from the perspective of clients with long-term physical health conditions. Psychol Health Med 2014;19:384-91.
Kim JS, Franklin C. Understanding emotional change in solution-focused brief therapy: Facilitating positive emotions. Best Pract Ment Health 2015;11:25-41.
[Table 1], [Table 2]