Hong Kong Journal of Mental Health                                               Copyright © 2016 by 
       2016, 42(1),  45-51                                     The Mental Health Association of Hong Kong
           Effectiveness of Cognitive Behaviour Therapy (CBT) for People with 
            Depression in Hong Kong: Reflections on Recent Research Findings
                                             Prof. Daniel F K Wong
                           Professor, Department of Social Work and Social Administration, 
                                The University of Hong Kong (Since September 2015)
       Introduction                                           depressive and anxiety disorders. I don’t think 
                                                              I need to give you details of these studies as 
           Thank you very much for inviting me to             you can find them in different journals easily.  
       come and talk about an area that I am very             Underlying this effectiveness is the process 
       passionate about - which is about Cognitive            whereby CBT helps an individual change his/
       Behaviour Therapy (CBT).  But let me start off         her internal cognitions from negative views 
       by saying that I really appreciate the previous        of oneself, others and the future and modify 
       two speakers who have been talking about the           one’s dysfunctional response patterns into more 
       importance of a multidisciplinary integrated           balanced views of oneself and others and the 
       approach to helping people with depression             future. The process also involves helping the 
       and anxiety disorders.                                 person see how his/her dysfunctional attitudes, 
                                                              values and rules in life are affecting his/her 
           One of the questions that came to my mind          negative moods.  Indeed, in the treatment 
       in the past hour or so is - what is the meaning        of depression, helping people change their 
       behind performing expressive arts and physical         dysfunctional attitudes, values and rules have 
       exercises, as spoken by the previous two               been an important focus of our CBT intervention.
       speakers? How do these relate to CBT?  CBT 
       has traditionally been seen as a “rational”                One important therapeutic principle behind 
       therapy - you help your client rationally              CBT is guided discovery. The whole process 
       understand his/her situation and engage in             of our work is to guide the individual to ‘self-
       self-disputing of his/her ‘irrational beliefs’.        discover’ his/her own patterns of cognitive, 
       Through this process, the client’s emotions            emotional and behavioural responses and to 
       improve.  I must say this is a very dated              develop new adaptive patterns of responses. 
       view of CBT, and I am going to suggest that            The whole idea behind is to enable the person 
       changes in cognitions must be accompanied              to acquire life-long strategies to deal with 
       by changes in one’s new experience of the              his/her negative response patterns that have 
       situation. Without new experiences the person          led and may lead to recurrent depressive and 
       will not be able to make substantial changes           anxious moods in the future.  
       cognitively and emotionally.  In our line of 
       work, our team has adopted the Beckian CBT                 Concerning group CBT we do know there 
       model in facilitating changes in people’s lives.       are many studies that support the effectiveness 
                                                              of group CBT for depression and anxieties. 
           There are many studies that have                   How does that work? In addition to the 
       demonstrated the positive effects of CBT for           components pertaining to cognitive, emotional 
                                            th                                           th
       Transcript of Plenary Session (III) of 60  Anniversary Symposium on Mental Health on 9  December 2014.
       Hong Kong Journal of Mental Health                                                                  45
                                                   Prof. Daniel F K Wong
           and behavioural interventions and changes,               CBT for depression and anxieties among Chinese
           changes can also be enhanced through group 
           dynamics - the process of social connectedness,              Having given you a brief overview of 
           mutual support and edification from the group            the current state of CBT, let’s talk about the 
           members.  Moreover, the group also helps                 issues surrounding the effectiveness of CBT 
           individuals develop behavioural plans and                treatments for Chinese people with depression 
           encourages members to implement the activities           and anxieties.  You have heard so much about 
           which invariably lead to acquisition of new              its effectiveness with other cultural groups. But 
           experiences in life.  Let me emphasize this              how effective is it in the Chinese populations?  
           again - by engaging in new activities individuals        I shall use my own studies to give you an idea 
           acquire new experiences in life and this is very         about what has been the treatment outcomes 
           important for cognitive transformation.                  as there are not many other outcomes studies 
                                                                    among Chinese populations in the major 
              Some studies suggest that psychopharmacology          academic journals.
           and CBT have similar short-term effects with 
           results that are very comparable. However,                   Before I launch into this, let me introduce 
           there are some studies that mention that the             very briefly one important centre that is 
           relapse rate for psychopharmacology is higher            involved in CBT work in Hong Kong. The 
           than that of CBT after the termination of                centre is called The Institute of Cognitive 
           medication and CBT treatments. Of course                 Therapy. This is a training and research 
           there are other studies which do not support this        institute independently established by a 
           idea.  All one can say at this moment is that, the       group of enthusiasts in CBT, and all board 
           issue is inconclusive.                                   members have university affiliations.  The 
                                                Figure 1: Project structure (SET)
           46                                                                 Hong Kong Journal of Mental Health
                   Effectiveness of Cognitive Behaviour Therapy (CBT) for People with 
                    Depression in Hong Kong: Reflections on Recent Research Findings
       ultimate objectives of this unit are (1) develop        of the clients (Figure 4). These include: 
       culturally relevant CBT models for Chinese              awareness of one’s physiological responses 
       people with mental health concerns, (2)                 to a triggering event, thought stopping, self-
       conduct evidence-based process and outcome              disputing question, distraction and positive 
       studies relating to CBT, and (3) to train up            self-statement. There’s nothing fancy about 
       professionals who can competently use CBT               these and we did not invent them. What we 
       to facilitate changes in their clients. Indeed,         did create, in this regard, is to make it into 
       we have developed a working model called                a structure so that our clients can easily 
       “SET” - S for services, E for evaluation and            remember them.  Indeed, this presentation fits 
       T for training (Figure 1).  In the past few             the cultural characteristics of Chinese people 
       years we have been very fortunate to have               who prefer counselling to be structured and 
       received more than eleven CBT project                   practical.
       funding from both government and NGOs 
       such as the Social Welfare Development                  Findings of our CBT studies for Chinese 
       Fund. Besides, the institute also conducts two-         people
       year CBT certificate training and day-long 
       workshops in CBT for professionals who are                  This is a summary of the studies that we 
       going for certification as a CBT therapist. In          did since 2006 and I want to briefly go through 
       addition, we help NGOs develop new and                  the findings with you (Table 1).  Many of 
       innovative CBT projects. Lastly, we produce             these studies had good results with moderate 
       CBT Chinese materials in the forms of books,            effect sizes.  For “effectiveness” studies using 
       workshops and pamphlets for professionals               community samples, the results were quite 
       and run public talks and workshops for the              encouraging.  Quite a few of the studies had 
       general public (Figures 2 & 3).                         a follow-up test, although most of them could 
                                                               only be done with a quasi-experimental design.  
       Cultural adaptations of CBT                             True randomization was not possible as some 
                                                               agencies and frontline workers did not feel 
           A major part of our work is to adapt                comfortable in not responding immediately to 
       CBT for use with Chinese populations. To                the needs of their clients.
       facilitate Chinese professionals and clients to 
       be familiarized with CBT terminologies, we                  Specifically, for depression, the results 
       translated the major CBT terms into easily              appear to suggest that CBT may be effective 
       understood Chinese colloquial terms.  For               for the depressed Chinese.  Some studies 
       example, ‘assumption of responsibility’ was             looked at clinical significance, using a 
       translated as ‘攬哂上身’ and ‘catastrophic                  statistical approach.  For example, in one 
                      大難臨頭                                     study, we did find the improvements to be 
       thinking’ as ‘            ’.  By understanding 
       these terms, we hope the clients would be more          quite encouraging - 40% completely recovered 
       aware of their dysfunctional thought patterns           and outside of the clinical range.  In our latest 
       and to find ways of stopping and changing them.         study on depressed Chinese commissioned 
                                                               by the Mental Health Association of Hong 
           Another adaptation was the development              Kong, some improvements were noted in 
                                      五常法                      CBT for people with depression and anxieties, 
       of the ‘Five Strategies’ (             ). These 
       five strategies are actually used to deal with          particularly for anxiety groups with quite a few 
       the negative automatic response patterns                significant positive changes.
       Hong Kong Journal of Mental Health                                                                    47
                    Prof. Daniel F K Wong
              Figure 2: Training manuals and materials and books
              Figure 3: Members  manual, Group materials and worksheets
                   Figure 4: Group materials used
     48                       Hong Kong Journal of Mental Health