Pugh, Daniel;
(2024)
Identifying distinct trajectories of change in anhedonia during psychological treatment for depression.
Doctoral thesis (D.Clin.Psy), UCL (University College London).
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Abstract
This thesis explores how anhedonia (a core symptom of depression, referring to the loss of interest or pleasure in daily activities) changes during treatment for depression. The systematic review and meta-analysis in Part 1 evaluates the efficacy of evidence-based treatments for depression in alleviating anhedonia. 19-studies were included, with a small-to-medium effect on anhedonia compared to inactive controls. There was limited evidence of differences in efficacy between active treatment types. Significant research gaps were identified, in particular the lack of studies combining psychological and pharmacological treatments. The empirical paper in Part 2 utilises routine outcome data of 19,124-patients receiving depression treatment to identify distinct trajectories of anhedonia change using Growth Mixture Modelling. Responder(37.3%) and non-responder(54.7%) trajectories were identified, with responders expected to show improvement around session four. R3STEP was used for multinomial logistic regression to explore associations between baseline characteristics and trajectory classes. CBT was associated with being in a responding class over Counselling. Predictors of non-response included systemic difficulties such as unemployment, deprivation and long-term health conditions, leading to recommendations for more holistic approaches to depression treatment. Additional risk factors included taking medication, higher baseline anxiety and longer waiting times. The overall lack of efficacy of current depression treatments for anhedonia was highlighted, with clinical implications (e.g. monitoring patients at risk of non-response) and further research recommendations discussed. The critical appraisal in Part 3 reflects on methodological processes and outcomes of the review and the empirical study, and my personal experience and learning from having completed this research.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | D.Clin.Psy |
| Title: | Identifying distinct trajectories of change in anhedonia during psychological treatment for depression |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10197336 |
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