Cognitive behavioural therapy and hypnosis in the treatment of major depressive disorder: A randomised control trial

Overview There will be 5 intakes (consisting of one CBT group and one CBTH group per intake) over a period of two years. Each intake will involve a pre-assessment period, then random allocation to treatment, followed by 10 consecutive weeks of group based treatment sessions delivered from 7pm-9pm. Each CBT and CBTH will receive the same core CBT treatment, delivered to each group on different nights during the same 10 week period. All groups will be followed up at post treatment, at 6 months and at 12 months. Pre-assessments will be done via Zoom and online self report measures, and all face to face treatment will take place at the Robin Winkler Clinic, School of Psychological Science, at the University of WA. With pandemic protocols in place, all particpants will be encouraged to only attend sessions if healthy, and to observe social distancing when they do so. In the event of non-attendance due to illness or other reasons, shorter make-up sessions will be offered to participants in person or via zoom. Participants will be encouraged to complete weekly self report measures online. All online measures are completed anonymously using participant research numbers. A specific CBT treatment manual will be developed for this study by the principal study investigator, who will also produce the hypnosis scripts. Home based practice will be set for all sessions and these relate to the themes covered in each session, along with listening to the recordings. Participants will be encouraged to use home based practice. Each group based therapy session will last approx. 100 minutes (plus a midway break). Participants will receive a 'therapy file' which will contain weekly handouts covering the main themes for each treatment session, group exercise worksheets and self-report sheets (e.g. activity based self-monitoring forms, thought record forms), all of which have been specifically designed for this study. The face to face treatment will be delivered to all groups by the principal investigator, who is an experienced clinical psychologist, with assistance from a co-facilitator (who will vary from group to group). Fidelity assessments will be conducted on a randomly selected number of pre-assessment interviews and on a randomly selected number of CBTH and CBT treatment sessions. Post treatment and follow up assessments will involve a combination of online self report measures and a short interview by a blinded research assistant using the MADRS (either via zoom or telephone). The core treatment themes of each for the CBTH group are (same as the CBT group): Session 1: Welcome COVID 19 management Group rules and expectations Psycho-education on Major Depression Group Exercise: Why change? Roadblocks to change? Home practice task assigned Session 2: Review home practice Session 1 Sleep and sleep hygiene Goal setting: Specific, Measurable, Achievable, Realistic, Time (SMART) system, graded tasks, implementation intentions Group exercise: goal setting for sleep Home practice task assigned Session 3: Review home practice Session 2 Automaticity, routine and daily activity Increasing self awareness Activity Scheduling Part I: Increasing fun and pleasure Group exercise: Goal setting for fun and pleasure Home practice task assigned Session 4: Review home practice Session 3 Activity Scheduling Part II: Meaningful activity (Life Areas, Values) Trigger Response Avoidance Patterns (TRAPs) Group exercise: Values and TRAPs Home practice task assigned Session 5: Review home practice Session 4 Avoidance, TRAPs and Functional Analysis Trigger Response Alternative Coping (TRACs) Group exercise: TRACs Home practice task assigned Session 6: Review home practice Session 5 Midway goal review Rumination Rumination management: TRAC or re-focus Group exercise: Changing rumination Home practice task assigned Session 7: Review home practice Session 6 Cognitive model (ABC) Ambiguity Self-talk: Automatic thoughts, assumptions, beliefs Attribution style Group exercise: Attribution style Home practice task assigned Session 8: Review home practice Session 7 Cognitive distortions Using evidence Behavioural experiments and surveys Group exercise: Realistic thinking Home practice task assigned Session 9: Review home practice Session 8 Problem-solving (interpersonally) Imagery rehearsal (interpersonally) Role playing (interpersonally) Group exercise: Problem solving Home practice task assigned Session 10: Review home practice Session 9 Review key components Goals review Group exercise: Insurance Policy Group closure and farewell The only difference between the two treatment groups is the last 15-20 mins of each session. Following the core treatment (see above), the CBTH group will be given a different hypnosis based recording to listen to at the end of each session (drawing on the themes of that particular session), and at home in between sessions. These hypnosis recordings will be around 15-20 mins duration.