Cognitive-behavioral Therapy for the Treatment of Major depressive Disorder:Workforce Development and Service Evaluation in Thailand

Abstract

Abstract
Background: Very few studies have been carried out to examine the efficacy of cognitivebehavioral therapy (CBT) in Thai depressed patients. The authors proposed to develop a training course and evaluate its efficacy and acceptability in Thai depressed patients not responding to antidepressants
Methods: An international expert and two Thai certified therapists held a 5-day workshop of CBT for depression. Ten mental health professionals attended the workshop and received at least
8 sessions of individual supervision from the Thai certified therapists. Based on a few handbooks of CBT for depression, Thai trainers and trainees jointly developed a treatment manual in Thai. Four
trained therapists participated in service evaluation by treating 15 major depressed patients, who did not respond to 4-week treatment of antidepressants.
Results: Three male and 12 female patients participated in this study were treated by four newly trained therapists. At baseline and endpoint, mean scores (SDs) of the Montgomery Asberg
Depression Rating Scale (MADRS) were 33.4 (5.9) and 7.9 (5.4), respectively (p=0.000). Those of the 9-item Patient Health Questionnaire (PHQ-9) were 28.3 (4.6) and 14.5 (2.9), respectively (p=0.000). Thirteen of 15 patients responded to the combined treatment of antidepressant and CBT. By average, patients were satisfied at the end of first treatment session and very satisfied at endpoint.
Conclusions: CBT is beneficial for Thai major depressed patients not responding to antidepressant
therapy. Most patients are satisfied with the treatment. To develop workforce for providing
psychosocial interventions in low- and middle-income countries, other steps additional to training
workshops, in particular service evaluation, are necessary to ensure the quality of newly developed
services and its worth for implementation.