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International Physical Medicine & Rehabilitation Journal

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Received: January 01, 1970 | Published: ,

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Abstract

This study aimed to confirm the effectiveness of a group-counseling program based on behavioral cognitive approach in reducing the severity of depression and improving the sense of self-esteem among a sample of adolescents in the northwestern Badia district. The participants of the study consisted of thirty (30) student aging 12-14years. They are enrolled in the seventh and eighth grades in one of the schools affiliated with the Northwestern Badia Brigade in the Mafraq region. Among 130 students, they volunteered to participate in the pilot program after obtaining high marks on the Kovacs scale for child and adolescent depression and the self-esteem scale during the first semester of the academic year 2019/2020. The study participants were randomly divided into two groups: an experimental group and a control group. The participants in the experimental group (15 students) underwent a pilot program consisting of 10 sessions, while their counterparts in the control group (15 students) were not enrolled in any training. The results of the multi-variance analysis showed that there are statistically significant differences on the scale of depression between the two study groups in favor of the experimental group in relation to the overall score of the scale. There is also a statistically significant difference on the scale of self-esteem between the two study groups and in favor of the experimental group, which indicates the efficiency of the indicative program in reducing the depression severity and improving self-esteem feelings. The study recommended the importance of applying the Counseling Programs that are based on the Behavioral Cognitive Approach in Reducing Depression symptoms and low Self-esteem among adolescent students.

Keywords: self-esteem, behavioral cognitive approach, depression, adolescents

Abbreviations

WHO, world health organization; CBT, cognitive behavior therapy; CT, cognitive therapy; NIMH, national institute of mental health; GCBC, group cognitive behavioral consoling; SIT, stress inoculation training

Theoretical framework of the study

Children and youth, between the ages of (5-18)years, spend a long period of time in school; This makes schools unique, and perhaps ideal for promoting mental health and early intervention efforts; Where schools are a critical context for promoting the emotional and social development and well-being of children and adolescents; There is a definite need for school support; Where current estimates indicate that one out of every five children and adolescents suffer from mental health disorders.1 One of the most important of these disorders - which in turn affects health and psychological well-being (well-being) in adolescents is what is called depression.

Depression is a widespread disorder, with severe effects on individuals and society, given its chronic severity.2 Depression is known to be a permanent source of ongoing anxiety, which threatens many individuals.3 Everyone sometimes feels upset or sad, and often these feelings are fleeting, and they end within two days. But when a person suffers from a depressive disorder; It interferes with daily life and normal functioning, causes pain, and prevents the enjoyment of activities that were previously enjoyable.4 The World Health Organization (WHO) indicated that mental health problems represent nearly half of all disabilities at the international level among individuals between the ages of (10-24) years students to stay in school and complete their education.5

Depression is a major public health concern, and its prevalence increases significantly during adolescence.6 Depression is defined as “a state of imbalance and extreme sadness that afflicts the individual as a result of the interaction of a group of factors such as a sense of inferiority, social withdrawal, a feeling of lack of focus, distancing from people, and a loss of social interest”.7  Depression can be described as a disorder that causes a decline in mood and substantial changes, such as: loss of appetite, insomnia, excessive sleep, fatigue, loss of energy, preoccupation with negative thinking, constant thoughts of suicide, a sense of inferiority, and a sense of insecurity.8 Depressed individuals suffer from poor job performance, quality of life, and a greater likelihood of developing physical and mental disorders, and comorbidity, meaning that a person is exposed to more than one disease at the same time.9

Reports issued by the World Health Organization(WHO)10 indicated that this disorder involves recurrent bouts of depression, and during these bouts, the individual suffers from a rapid change in mood and a low level of energy; Which leads to a decrease in activity for at least two weeks, and many of those who go through depression suffer from symptoms of anxiety, sleep disturbance, poor appetite, and they may have a feeling of guilt, or low self-esteem, and poor concentration, and symptoms may appear without medical explanation.

As for the prevalence rates of depression among children and adolescents, Chorney, Detweiler, Morris & Kuhn11 indicated an increase in the prevalence rates among children by (1-3%), and among adolescents by (5-6%). On the other hand, John & Susan12 indicated that depression is a mood (emotional) disorder that affects approximately (2%) of children and adolescents. Depression rises significantly with the transition from childhood to adolescence, by (5%) in the pre-adolescent stage, and (20%) in the adulthood stage.13

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5: 2013 issued by the American Psychiatric Association; APA, proof of major depression requires the presence of Symptoms or dysfunction such as feelings of worthlessness, suicidal thoughts, and disruption of daily functioning. The criteria for a major depressive episode (MD), including depressive mood or loss of interest, are diagnosed with at least five of the following criteria:14

  1. Depressed mood most of the time.
  2. A significant decrease in weight without dieting.
  3. Constant insomnia, or excessive sleep.
  4. Increase in movement, or decline and limited physical movement.
  5. A sense of worthlessness, or a growing, inappropriate sense of guilt.
  6. Poor concentration, or the ability to think and make decisions.
  7. Obvious fatigue, or lack of energy.
  8. Recurrent thoughts and obsessions about death or suicide.

Self-esteem is considered one of the most discussed and popular topics in modern psychology. Due to the abundance of articles on this topic; There are more than (35,000) articles. This concept has previously received a lot of attention, due to its association with important life outcomes. Unparalleled interest in the concept of self-esteem began during the seventies. Where results appeared that linked this concept to a variety of social problems, such as drug abuse, unemployment, academic achievement, and violence.15

Self-esteem begins to develop from childhood, and there are factors that mainly contribute to shaping this concept, such as parental attitudes and the environment surrounding the child.16 The family plays a major role in the formation of self-esteem through the experiences and situations that the individual goes through while trying to adapt to the surrounding environment.17

The concept of self-esteem is widely known. However, its definition was not agreed upon by the researchers.18 He defined it19 as a person's comprehensive evaluation of himself as a human being, and considered it as a psychological protection against tension, anxiety, and stress. It also refers to individuals' positive or negative perceptions of their self-esteem and competence, and has a significant impact on development during adolescence.20 According to Iqbal & Khattak,21 the term self-esteem is a definition of the average, or average, of a person's experience of self-esteem, or personal worth. As described by Virgil,15 it is the evaluative aspect that reflects the extent of people's love for themselves, and their belief that they are competent and capable. On the other hand; The permanence and continuity of an individual's self-esteem is linked to important life outcomes, such as: psychological adjustment, academic success, physical health, and satisfaction with relationships with others.22

Thus, individuals with high self-esteem are more able to control and control themselves, and are described as optimistic, realistic in facing challenges, flexible, and the ability to deal with social situations, and they have a sense of their needs and the needs of others, and they act independently in the face of different situations.23 It has been shown to be associated with better mental health outcomes, the ability to adapt to stress and tension, a decrease in the rate of depression, an increase in happiness rates, a better ability in academic performance, and stability in social and emotional relationships.21 While individuals with low self-esteem feel permanently helpless, are described as not optimistic, and lose enthusiasm quickly; Therefore, they are more at risk of mental disorders.24 Moreover, a study conducted by a group of researchers25 indicated that low self-esteem plays a crucial role in the development of mental disorders and social problems, such as depression and anxiety. In order for the individual to achieve a satisfactory degree of mental health and social acceptance; His self-esteem must be positive.26

It can be said that self-esteem is an important aspect of the ability to adapt to the way it reflects on the individual productively. By facing challenges, and being able to overcome them with great flexibility, compared to others who suffer from low self-esteem; Thus, the individual's successes are achieved through this optimistic outlook and high self-confidence.

We conclude from the above that there is a close relationship between depression and self-esteem. The study conducted by Zeigler-Hill15 indicated that low self-esteem may play a major role in the development of depression. which increases the possibility of weak psychological adjustment; Therefore, we need counseling programs based on effective frameworks and methods that help reduce depressive symptoms in adolescents and improve self-esteem. Cognitive-behavioral therapy has proven its efficiency and effectiveness in treating severe depression and reducing its effects.27

Cognitive Behavior Therapy (CBT)

The CBT perspective arose from Cognitive Therapy (CT) for depression in the 1960s when Beck suggested that depressed people were prone to thinking distortedly and usually had a negative view of themselves and the world. their surroundings, and other people.28 Negative thoughts, as described by Beck, are the foundation of CBT; Where this term is used to describe the torrent of ideas, which can be noticed if we try to pay attention to them, as they are negative interpretations of the meanings that we deduce; of what is happening around us, or within us.29

According to Meichenbaum's view, the thoughts or phrases with which the individual addresses himself affect his behavior with the same effect left by the statements of another person.30 Meichenbaum believed that individuals are able to increase their coping competence by adjusting their ideas about their performance during stressful situations.31 In CBT, the therapist works with individuals to help them identify the thoughts, feelings, and behaviors associated with their problems. This is done by encouraging clients to explore different ways of thinking and to look at alternative explanations for their beliefs. . He also suggests that when counselors have developed these skills, they can also learn new behaviors and problem-solving strategies. to reinterpret their thoughts, feelings, and behaviors in more rational ways.28

In this regard, therapists have developed intervention programs designed to help clients understand the cognitive processes that, in turn, influence the behavior of the individual. This approach is based on helping the individual to understand and interpret his negative thinking pattern. With the aim of bringing about a positive and realistic change in the ideas or convictions of the individual.32 In addition, therapists in this direction help the counselors to identify the most dangerous situations that they are likely to encounter, and work on directing a plan to prevent these risks and deal well with them (i.e. a form of relapse prevention).33

The emotional problems of individuals arise because of distorted belief systems about themselves and the world around them, and such beliefs generate negative thoughts that are easily aroused, and most often contain cognitive distortions, and these emotional disorders are usually associated with negative responses such as fear, sadness, anger, and a high level of distress.34 It is important - throughout the treatment period - to provide clients with a vision of the changes that they will do well. Where the focus will not be focused on reducing the impact of mental illness, but rather on enhancing the extent of progress, albeit gradually35 and cognitive behavioral therapy has been shown to be an effective treatment for children and adolescents with emotional and behavioral problems.36 It also includes many therapeutic programs that may help children and adolescents who face psychological and social difficulties such as low self-esteem.37 Cognitive-behavioral therapy is based on employing standardized methods to deal with psychological problems in children and adolescents, and among these methods: relaxation, stimulus control, and teaching some cognitive skills, such as: problem-solving, coping skills, and the skill of immunizing against stress (Stress Inoculation Training (SIT)). Not forgetting the importance of engaging children and adolescents in groups and obtaining more positive results from treatment.38 It is noticeable that many therapeutic methods paid attention to the effect of cognitive processes, so the main goal from this perspective became an attempt to change and modify erroneous ideas. Through targeted therapeutic methods.39

From here came the idea of research in using the cognitive-behavioral therapy approach. Because of its methods and techniques that can be used, which are compatible with the unique background of the client, the type of problems, and the difficulties he faces.40,41

The study problem

Adolescence is considered a transitional stage between childhood and adulthood, and during this transitional stage physical, emotional, and social changes occur that arouse the attention of adolescents42; Since these changes take on a rapid nature, and if the teenager does not find someone to take care of him psychologically, and understand what is going on in his mind; It is possible that he is subject to deviation, and he may have a willingness to harm himself, or even closer to depression. Which causes the destruction and deterioration of his life early. Such programs are concerned with developing the capabilities of adolescents in several respects, such as better self-understanding, and clearer knowledge of goals; Where the National Institute of Mental Health (NIMH) indicated that (80%) of people with depression respond to the evidence for interventions, such as the cognitive-behavioral therapy intervention, and treatment with antidepressant medications.43 In view of my work as a guide in the Ministry of Education, I decided to do this study due to the large number of observations. As such psychological problems are mainly related to the way and pattern of thinking, and the adoption of wrong thinking methods in directing the students themselves.

Specifically, the study attempted to answer the following three questions:

  1. Are there statistically significant differences at the significance level (α = 0.05) in the level of depression between the two study groups (experimental and control) attributed to the cognitive behavioral therapy program?
  2. Are there statistically significant differences at the significance level (α = 0.05) in the level of self-esteem between the two groups of the study (experimental, control) attributed to the cognitive behavioral therapy program?
  3. Are there statistically significant differences at the significance level (α = 0.05) in the level of depression and self-esteem among the experimental group members on the two tests (pre and post) due to the cognitive behavioral therapy program?

The importance of studying

Theoretical importance: The theoretical importance of this study stems from its ability to develop a counseling program based on cognitive-behavioral therapy in reducing the severity of depression and improving the level of self-esteem in a sample of adolescents in the upper basic stage in the Northwestern Badia District. And review the literature on depression, self-esteem and related measures.

Application significance: The importance of applied studies is also highlighted through the provision of reliable measurement tools, and the provision of counseling programs based on scientific frameworks and theories through which psychological services are provided to large segments of students through specialists in the field of educational and psychological counseling. And also providing them with practical programs that can be used to treat psychological disorders such as: depression, self-esteem or other psychological problems, which in turn plays in improving the educational process.

Terminological and procedural definitions

Depression: It is a common mental disorder, which usually causes severe disability and imposes a great burden on individuals, families, and societies.44 It is expressed procedurally by the degree obtained by the subject on the Kovacs list of depression in children and adolescents, which ranges between (26-78).

Self esteem: a term used to reflect a person’s overall evaluative component or assessment of their self-worth, and how individuals perceive and feel their own self-worth.45 It is expressed procedurally according to the degree obtained by the subject on the self-esteem scale, which ranges between (25-50).46–57

Cognitive-behavioral therapy: In this study, it is a group counseling program based on Meichenbaum's Group Cognitive Behavioral Consoling (GCBC) therapy, designed to reduce depression severity levels and improve self-esteem in a sample of adolescents in the Badia district. Northwestern, which the researcher prepared based on some studies and extension programs, which were based on the theory of cognitive-behavioral therapy. The program consisted of ten (10) counseling sessions, at a rate of two sessions per week. In it, strategies were used to clarify concepts, skills to change feelings, negative emotion scheme, problem-solving skills, positive self-talk, evaluation of thinking errors and treatment, and development of an activity plan using specific techniques. The program also provides, with continuous meetings, an opportunity for support and understanding of others, and building positive relationships to alleviate feelings of depression and sadness. And learn life skills that enable them to communicate well and communicate with others.58–70

The limits of the study

  1. Human borders: the sample on which the study was conducted; Whereas, the subjects of this study are seventh and eighth grade students in the upper basic stage.
  2. Spatial boundaries: This study was limited to a public school affiliated to the Directorate of Education of the Northwestern Badia in the Mafraq region.
  3. Temporal limits: This study was conducted in the first semester of the academic year 2019/2020.
  4. Study limitations:
  5. The results of this study are determined by the study tools used, and the indications of their validity and reliability extracted.
  6. The nature of the methodology used in it, and the methods of statistical analysis.
  7. The number of the study sample, its characteristics, and the method of selection.

Acknowledgments

None.

Conflicts of interest statement

The authors have no conflicts of interest to declare.

Funding sources

This research study was not funded by sponsors in its preparation, data and manuscript.

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