This study investigated the effect of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State, Nigeria. The population consisted of male and female adult learners in Benue State Agency for Adult and Non-formal education, Makurdi. The study was a quasi-experimental study which adopted pre-test, post-test control group design. An intact sample of 30 adult learners – 15 in the treatment group and 15 in the control group participated in the study. The treatment group was given cognitive behavioural technique treatment while the control group was given a placebo in form of mere lectures on topics in adult literacy education. The CBT was carried out within eleven psychotherapeutic sessions that lasted for six weeks. Beck Depression Inventory (2004) was used to determine the levels of depression symptoms of each participant before and after the application of cognitive behavioural technique. Five null hypotheses were formulated and tested at 0.05 level of significance. The independent t-test was used in testing hypotheses 1, 3, 4 and 5 while ANOVA was used in testing hypothesis 2. Hypothesis 1 which states that there is no significant reduction of depression symptoms among adult learners after the application of cognitive behavioural technique was rejected (t = 9.24; p = 0.000). Hypothesis 2 which states that there is no significant effect of age on the effectiveness of cognitive behavourial technique in reducing depression symptoms among adult learners in Benue State was retained (f = 2.60; p = .609). Hypothesis 3 which states that there is no significant effect of gender on the effectiveness of cognitive behavourial technique in reducing depression symptoms among adult learners in Benue State was retained (t = 0.107; p = .288). Hypothesis 4 which states that there is no significant effect of marital status on the effectiveness of cognitive behavourial technique in reducing depression symptoms among adult learners in Benue State was retained (t = 0.110; p = .914). Hypothesis 5 which states that there is no significant effect of employment status on the effectiveness of cognitive behavourial technique in reducing depression symptoms among adult learners in Benue State was retained (t = 0.109; p = .327). It was recommended among others that since cognitive behavioural technique (CBT) was effective in reducing depression symptoms among the adult learners, adequate provisions should be made by promoters of adult literacy education in Benue State for regular application of CBT by experienced educational psychologists and guidance counselors so that they can treat adult learners who may show symptoms of depression especially as the causative factors of depression among the adults are on the increase.
|TABLE OF CONTENTS|
|Title page –||–||–||–||–||–||–||–||–||–||–||i|
|Table of Contents-||–||–||–||–||–||–||–||–||viii|
|List of Tables||–||–||–||–||–||–||–||–||–||–||xii|
|List of Figures –||–||–||–||–||–||–||–||–||–||xiv|
|List of Appendices||–||–||–||–||–||–||–||–||–||xvi|
|Operational Definition of Terms-||–||–||–||–||–||–||–||xvii|
|CHAPTER ONE: INTRODUCTION|
|1.1||Background to the Study||–||–||–||–||–||–||–||1|
|1.2||Statement of the Problem –||–||–||–||–||–||–||–||5|
|1.3||Objectives of the Study||–||–||–||–||–||–||–||7|
|1.4||Research Questions –||–||–||–||–||–||–||–||–||7|
|1.5||Research Hypotheses –||–||–||–||–||–||–||–||8|
|1.7||Significance of the Study –||–||–||–||–||–||–||–||9|
|1.8||Scope and Delimitation of the Study –||–||–||–||–||–||12|
|CHAPTER TWO: REVIEW OF RELATED LITERATURE|
|2.02||Conceptual Framework –||–||–||–||–||–||–||–||14|
|2.03||The Concept of Depression||–||–||–||–||–||–||–||14|
|2.04||Symptoms of Depression||–||–||–||–||–||–||–||18|
|2.05||Types of Depression –||–||–||–||–||–||–||–||23|
|2.06||Causative Factors of Depression –||–||–||–||–||–||–||28|
|2.07||The Concept of Cognitive Behavioural Therapy||–||–||–||–||31|
|2.08||Principles of Cognitive Behavioural||Therapy||–||–||–||–||40|
|2.08.1 Criticisms of Cognitive Behavioural||Therapy||–||–||–||–||44|
|2.09||Theoretical Framework –||–||–||–||–||–||–||–||45|
|2.09.1||Aaron T. Beck‟s Theory of Cognitive Behavioural Therapy for Depression||46|
|2.09.2 Judith S. Beck‟s Theory of Cognitive Behavioural Therapy||–||–||–||52|
|2.09.3||Michelle G. Craske‟s Theory of Cognitive Behavioural Therapy||–||–||56|
|2.09.4||Roth and Fonagy‟s Theory of Cognitive Behavioural Therapy –||–||60|
|2.09.5||Meichenbaum‟s Theory of Cognitive Behavioural Modifications||–||–||62|
|2.09.6||The Theory of Attitude Change as applied to CBT||–||–||–||–||68|
|2.10||Mediating Factors of Depression in Adulthood-||–||–||–||–||73|
|2.10.1||Age and Depression-||–||–||–||–||–||–||–||–||74|
|2.10.2||Gender and Depression||–||–||–||–||–||–||–||77|
|2.10.3||Marital Status and Depression||–||–||–||–||–||–||80|
|2.10.4||Employment Status and Depression||–||–||–||–||–||–||82|
|2.11||Review of Related Empirical Studies-||–||–||–||–||–||84|
|CHAPTER THREE: METHODOLOGY|
|3.2||The Research Design –||–||–||–||–||–||–||–||106|
|3.3||Population of the Study –||–||–||–||–||–||–||–||107|
|3.4||Sample and Sampling Technique||–||–||–||–||–||–||108|
|3.5||Control of Intervening Variables||–||–||–||–||–||–||110|
|3.6||Treatment Procedures –||–||–||–||–||–||–||–||112|
|3.6.1||Pretreatment Sessions –||–||–||–||–||–||–||–||112|
|3.6.2||The Treatment Sessions||–||–||–||–||–||–||–||114|
|3.7.1||Validity of the Instrument –||–||–||–||–||–||–||–||115|
|3.7.2||Reliability of the Instrument||–||–||–||–||–||–||–||116|
|3.7.3||Procedure for Data Collection –||–||–||–||–||–||–||116|
|3.7.4||Procedure for Data Analysis||–||–||–||–||–||–||–||118|
|CHAPTER FOUR: RESULTS AND DISCUSSION|
|4.2||Participants‟ Socio-Demographic Data||–||–||–||–||–||120|
|4.3.0||Answering the Research Questions||–||–||–||–||–||–||122|
|4.5||Summary of Major Findings||–||–||–||–||–||–||–||133|
|4.6||Discussion of Major Findings||–||–||–||–||–||–||134|
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
|5.4||Recommendations from the Study||–||–||–||–||–||–||142|
|5.5||Suggestions for Further Researches||–||–||–||–||–||–||143|
OPERATIONAL DEFINITION OF TERMS
The following key terms are operationally defined:
Adult Learners: All those enrolled in adult literacy programme under the auspices of Benue State Agency for adult and Non-formal Education, whatever the literacy level.
Cognitive Behavioural Technique: A form of cognitive restructuring method used to help a person to recognize his negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking, feeling and acting positively so that the individual can be more functional and productive.
Depression: A mood disorder characterized by deep sadness and despair, coupled with persistent feelings of despondency, worthlessness, and hopelessness, causing impaired emotional, cognitive, behavioural, and physical functioning.
Depression symptoms: Cognitive symptoms of depression which include poor concentration and attention, indecisiveness, sense of worthlessness or guilt, poor self-esteem, hopelessness, suicidal thoughts, and memory impairment.
1.1 Background to the Study
The incidence of depression especially among the adult populace has increased dramatically in recent years. It is estimated for example that more than 330 million people worldwide suffer from serious depression. It has also been estimated that in 20 years, depression will be outranked only by cardiovascular disease (Awake, 2004). About 10 to 20 percent of all adults report having one or more episodes in their lives that meet the clinical definition of depression (Ashfield, 2010; Baron, 1998). Once it starts, depression tends to continue to worsen over time. This sends a danger signal to depressed adult learners as they may learn with difficulty and helplessly achieve poor academic performance as a consequence. Of great concern is the fact that depression is frequently recurrent and cyclical, or sometimes chronic. Depression is impairing and is associated with many problems, such as learning difficulties in adults (Hammen, 2009).
Depression can have a toll on academic activity and particularly adult learning activity as the depressed adult learners experience inability to concentrate and pay attention as well as difficulty in making decisions. They feel worthless, hopeless and guilty. They develop poor self-esteem and have memory impairment, They experience restlessness and agitation marked by difficulty in sleeping (Beck, 1999). The cognitions of depressed people lose complete touch with reality where they experience delusions and hallucinations. These delusions and hallucinations that depressed people experience are usually negative in content. Undoubtedly, this condition could seriously inhibit adult learning efficiency and undermine their academic performance. Such depressed adults find that they cannot think, concentrate or remember and these are
indispensable variables for effective learning and academic performance at all levels of education (Owojaiye, 2000; Piaget, 1990; Omoruyi, 2010).
Worse still, people who are depressed are disinterested, disenchanted, lack energy and motivation. They are irritated and may not see the point of doing anything as depression takes over the whole person‟s emotions, bodily functions, behavours and thoughts. They become less physically, mentally and socially active which tends to worsen depression. This could have significant bearing on adult learning (Gleitman, 1996). Depression is more than just a low mood but a serious disorder that could make the adult learner find it difficult to function every day where he is reluctant to participate in activities that were once meaningful and enjoyable including educational activities. There is substantial evidence that depression affects people‟s performance in their various learning activities. For example, Beck (1999) emphasized the importance of mood-dependent memory. That our current moods influence what we remember and what we think which has significant bearing on adult learning.
Depression, as a mood disorder is characterized by sadness, despair, feelings of worthlessness and low self-esteem. It often leads the depressed individual to be physically, mentally and socially inactive. It is the most common psychological disorder that places people in an emotional trap from which it is increasingly difficult to escape (Ashfield, 2010). As one of the most common mental health problems, an episode of major depression may last from 6 to 12 months or longer. Half the people who recover from an untreated episode of depression will slip back into their former state of depression within two years of their former episode.
The Diagnostic and Statistical Manual of Mental Disorders-IV (2000) or DSM-IV pointed out that depression includes a variety of emotional, psychological, behavioural and cognitive symptoms, all of which have significant bearing on life activities of the depressed. The cognitive symptoms, which are the concern of this study as they could have bearing on adult
learning include, poor concentration and attention, indecisiveness, sense of worthlessness or guilt, poor self-esteem, hopelessness, suicidal thoughts, and memory impairment.
Adult learners are generally affected by different mediating factors of depression. For instance, Etta (2001) noted that as one advances in age, one experiences many losses that cause pain. It could be loss of independence, physical ability, mobility, health, long-time career, or loss of someone one loves (e.g. a marriage mate, friend, child or relation). Grieving over these losses is normal and healthy, even if the feelings of sadness last for a long time. Losing all hope and joy, however, is not common. Advancement in age is characterized by soul searching, questioning and assessing the meaning of the achievements of the life structure (middle crisis). For some, the change is gradual and fairly painless. For others, it is full of uncertainties. They question nearly every aspect of their lives and feel that they cannot go on as before. This could be stressful and depressing especially when there are marker events like divorce, nagging spouse, illness, unemployment and change in occupation.
In another development, gender tends to determine the vulnerability of depression among the adults. Naturally, most women are emotionally weaker than men. For instance, Nolen-Hoeksema (2001) cited in Hockenbury & Hockenbury (2002) explained that women are more vulnerable to depression because they experience a greater degree of chronic stress in daily life combined with a lesser sense of personal control than men. Furthermore, women are also prone to ruminate about their problems, adding to the sense of low mastery and chronic strain in their lives. The interaction of these factors creates a vicious circle that intensifies and perpetuates depressed feelings in women.
Among the different mediating factors of depression in adults, marital status is considered to be a significant factor. While Rogers (2011) opined that married people have comparatively low depression rates because they are, for several reasons, emotionally less
damaged by stressful experiences than are unmarried people, Gross (1996) opined that married people have higher depression rates because of the challenges involved in sustaining marriage especially with a difficult spouse amidst socio-economic downturn. In fact, most psychologists argue that marriage is associated with low rates of depression because it shields the individual from exposure to stress.
In discussing risk factors of depression, Witters (2012) explained that employment status has bearing on the possibility of one getting depressed. To Witters, people who are employed tend to be relatively happy, emotionally stable and psychologically contented than people who are unemployed. The employed have purchasing power and means to satisfy their needs. However, other psychologists such as Raven (2013) suggested that work can be a source of depression to some people especially when it is tasking, challenging, unrewarding and done in a poor social and physical environment.
Given the above varying positions in the mediating factors of depression, and given the fact that depression rate has been rising with each successive generation – a trend that has been found not only in the United States and Canada but also in France, Germany, Italy, New Zealand, Taiwan and African countries including Nigeria (Cross-National Collaborative Group, 2000), this present study has become quite necessary and urgent based on current research findings that depression will become an even greater problem by the year 2020 (Lopez & Murray, 1998; Wang, Simon, & Kessler, 2003). It is therefore very necessary that the depressed adult learners in Benue State, in their various categories, be helped in reducing their depression symptoms through psychological therapeutic measures in order to enhance their learning efficiency and academic performance. This is the thrust of the study.
1.2 Statement of the Problem
Being depressed clinically or sub-clinically has become common place in adults‟ daily lives. Adult learners, in their various categories, have peculiar characteristics or circumstances distinct from those of other students which subject them to a depressive state, whether they are in their early adulthood, middle adulthood or late adulthood. All the stages of adulthood present tasks and challenges that are stressors which could result to depression and consequently cause psychomotor and cognitive retardation in the affected adults (Agu, 2010). This ugly trend tends to be affecting and undermining the adult learners‟ interest and enthusiasm towards adult literacy education, giving rise to increasing illiteracy rate among the adult populace.
In Benue State, like in other states of the federation, adult learners, in their peculiar circumstances are exposed to various kinds of risk factors of depression which could impede their active participation in adult literacy classes, thereby hampering the possibility of effectively achieving the goals of Mass Literacy Education in the state. Some are drop-outs from the formal school system with negative experiences. Thus, they may tend to notice, store, and remember information consistent with their negative moods which is one of the risk factors of depression. Some because of advanced age, are experiencing late-life events such as chronic and debilitating medical disorders, losses of friends and loved ones as well as several physiological disabilities which result to depression. Some have numerous and challenging family responsibilities, marital tribulations, societal responsibilities, economic pressures because of the current state of unemployment. Others, because of gender differences particularly women, are more vulnerable to depression. Consequently, they tend to bring unhappy thoughts and memories to mind; to dwell on them, and to enter new negative information into memory. This pattern sets up a self-perpetuating cycle in which the possibility of escape from depressing thoughts or depression itself tends to decrease over time among the adult learners in the state.
It is sad and quite worrisome to note that efforts by successive governments over the years to eradicate illiteracy nationwide especially among the adult populace have failed in Benue State. For instance, the first national literacy campaign launched in 1982; the Mass Mobilization for Social Justice, Self-reliance and Economic Recovery (MAMSER) of 1987 and the educational programme of literacy-for-all by the 2000 all failed to eradicate or significantly reduce illiteracy rate among the adult populace in the state. Furthermore, irrespective of the numerous Adult Literacy centers in the state, there is still a staggering rate of adult illiteracy in the state.
The National Literacy Survey, (2010) puts the adult literacy rate in Benue State at 69.8 percent while the remaining 30.2 percent is made up of illiterates and there is the likelihood that this percentage may rise if urgent measures are not taken since risk factors of depression which affect participation, retention and effective adult learning are increasing daily. In expressing his concern in this regards for instance, Ejembi (2012) found out that the incidence of depression in Benue State is alarming today as the present generation of young and older adults are experiencing higher rates of depression than their predecessors. This situation has been triggered by the present economic hardship coupled with the state of insecurity which has had its toll in several parts of the state where many indigenes have been displaced, lives and property lost. Consequently, those who become depressed are not only older adults but young adults. This will have serious implications for learning generally and adult learning in particular in the state if urgent measures are not taken to reduce the depression level among the adult learners.
Consequent on the aforementioned ugly trend befalling adult literacy education in Benue State, this study was conducted to find out the effect of Cognitive Behavioural Techniques on reducing the symptoms of depression among adult learners so that if found effective, it could be used to salvage the depressive state of the adult learners so that they could concentrate, pay
attention, develop self-esteem, become hopeful and be free from sense of worthlessness and guilt, become enthusiastic and motivated to effectively acquire literacy education, and be sustained in the literacy programme throughout the course duration so that adult literacy education in Benue State becomes efficient, effective and result-oriented. By this, the National Policy on Education (2004) particularly as related to the objectives of Mass Literacy, Adult and Non-formal Education can be effectively achieved in the state.
1.3 Objectives of the Study
The following were the objectives of the study:
- To test the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
- To determine the effect of age on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
- To determine the effect of gender on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
- To ascertain the effect of marital status on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
- To ascertain the effect of employment status on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
1.4 Research Questions
In meeting the objectives of the study, the following research questions were raised:
- What is the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State?
- What is the effect of age on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State?
- What is the effect of gender on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State?
- What is the effect of marital status on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State?
- What is the effect of employment status on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State?
1.5 Research Hypotheses
In line with the research questions, the following null hypotheses were generated.
- There is no significant difference in the pretest and posttest scores of depression symptoms among adult learners in Benue State after the application of cognitive behavioural technique.
- There is no significant effect of age on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
- There is no significant effect of gender on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
- There is no significant effect of marital status on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
- There is no significant effect of employment status on the effectiveness of cognitive behavioural technique in reducing depression symptoms among adult learners in Benue State.
1.6 Basic Assumptions of the Study
The study was carried out with the following basic assumptions:
- That depression which is as a result of some psychosocial factors is present in the various categories of adult learners in Benue State in varying degrees.
- That the presence of depression symptoms may be affecting the cognitive processes of the depressed adult learners to the extent that they may be incapacitated in their behaviours, feelings, thoughts and physical disposition required for regular participation and effective performance in adult education activity in Benue State.
- That cognitive behavioural technique may be effective in reducing depression symptoms among adult learners in Benue State.
- That age, gender, marital status and employment status may affect the effectiveness of cognitive behavioural technique in reducing depression symptoms among the adult learners.
1.7 Significance of the Study
The incidence of depression in adult learners and the implication it has for their learning call for an effective, sustained and well studied psychological therapeutic measure to enhance adult learning. Before such psychological treatment can be effective, there must be adequate information about the depth of depression in the various categories of adult learners (Roland and
Eme, 2010). Therefore, the outcome of this study will be useful in the provision of baseline information in this regard.
Policy makers in adult education, promoters or personnel of State Agencies for Mass literacy, educational psychologists, guidance counsellors, psychotherapists, community service providers, and other student researchers will find the outcome of this study very useful as they will appreciate the incidence of depression in adult learners, its effect on adult learning and the appropriate treatment procedures using Cognitive Behavioural Technique (CBT).
The government, particularly policy makers in education, especially in the area of adult and non-formal education, will find the result of this study very significant as it will provide them with evidence based on empirical data that will help them to formulate effective adult and non-formal education policies and programme packages in view of the avalanche of challenges of adulthood that could cause depression, as well as adequately monitoring and evaluating such policies and implementing such packages in such a manner that depressive factors associated with adult learning are effectively put under control.
The promoters or personnel of Benue State Agency for Adult and Non-formal Education who may not be trained educational psychologists especially in the area of depression, may be facing various challenges promoting adult and non-formal education in the state as they may not be aware of the incidence of depression in adult learners and its effects on the extent of their participation, literacy acquisition and retention in the literacy programme. The outcome of this study will therefore be an eye opener in this direction; to sensitize the promoters or personnel about the cognitive symptoms of depression in the learners and be more empathetic towards the learners when they are stressed and feeling pressured. They will be more aware of the strengths and weaknesses of the learners so that they (the promoters) can package their educational programmes accordingly, carefully handle, and motivate the adult learners in order to control or
reduce those symptoms of depression so as to enhance effective adult learning. They will learn not to let things get out of hand before they take action to support the depressed adult learners.
Separate studies on depression and school activities have been conducted by some educational psychologists (e.g. Thotman, 2011; Roland and Eme, 2010; Olaide, 2000) however, none of these focused on how any therapeutic measure could reduce depression symptoms to allow for effective adult learning in the area of literacy acquisition, let alone in Benue State. There is therefore the need for this present study in the area to fill this gap so that therapeutic measures to reduce depression symptoms in adult learners which could inhibit their thinking, concentration or remembering ability could be ascertained in order to contribute in achieving literacy education in the State. Educational psychologists, especially in the area of adult education, and guidance counsellors will benefit from this study as a reference material in the areas of depression, Cognitive Behavioural Technique, and adult literacy education.
The adult learners themselves who are at the center of this study will benefit from the findings. They will realize that the cause of their problems is the negative conceptions of themselves and the world around them. They will understand that their habitual thinking errors underlie their disorder. Thus, the result of this study will help to restructure their cognition about their past, their present and their future as they will be helped to learn new ways of thinking positively, acting and feeling rationally. This will have positive effect on their learning activities as they will be able to concentrate, pay attention, develop feelings of worth and high self-esteem, become hopeful, decisive and have unimpaired memory all of which are inhibited by depression.
The scholarly importance of this study cannot be overemphasized as the findings will contribute to existing body of knowledge, provide information, open up research areas and assist in the design of such studies for student researchers in educational psychology and other
researches in related fields. In different respects, this study will be a reference material for such student researchers whose research problems may be related to this present study.
1.8 Scope and Delimitation of the Study
This study is an investigation of the effect of cognitive behavioural technique (CBT) in reducing depression symptoms among adult learners in Benue State after scientifically filtering out adult learners with such symptoms using Beck Depression Inventory designed for this purpose. There are varying degrees of depression but this study was concerned with adult learners with mild and moderate depression symptoms because CBT is suggested to be directed at individuals at that level of depression. There are different types of depression symptoms but this study is restricted to cognitive symptoms because of its effects on learning process. The cognitive behavioural techniques adopted cognitive restructuring method based on Beck‟s (2004) template. The study is restricted to Benue State. Male and female adult learners in the adult literacy centers under the auspices of Benue State Agency for Adult and Non-formal Education were used as participants for the study. The choice of this category of students was because adults, whether in their young, middle or late adulthood are exposed to different kinds of stressors that subject them to depression. Findings are limited to Benue State.
The CBT treatment in this study was directed at adult learners with mild and moderate depression symptoms and not extended to severe depression episodes. The findings are thus limited to mild and moderate episodes. Furthermore, the treatment was directed at cognitive symptoms of depression because of its bearing on adult learning and not extended to other symptoms like emotional, somatic (physical), or behavioural. The outcome is thus limited to cognitive symptoms.