CHAPTER 3 - METHODOLOGY
This chapter includes the details of the methodology and procedures that were used to collect and analyze data for this study. The study examined the intensity of depressive symptomatology and comorbid anxiety as experienced among a statistically valid sample of subjects (Rosenbaum, 2005), before and after participation in a twelve-week Orthodox neptic-psychotherapeutic treatment program. This study was guided by the following research question: Does Orthodox neptic-psychotherapeutic treatment have an effect on the intensity of depressive symptomatology and comorbid anxiety? To find the answer to this question, a combined quantitative and qualitative research paradigm was employed. The following section summarizes the main assumptions of this integrated research design.
3.1 Paradigm and Methodology
Rigorous quantitative research surveys do not necessarily provide all of the data needed when studying human behavior. Consequently, qualitative methods, (e.g., focus groups, in-depth interviews, etc.), have emerged as an important part of the research paradigm. A brief examination of the quantitative and qualitative models will identify their strengths and weaknesses and how the divergent approaches can complement each other.
Quantitative research uses methods adopted from the physical or hard sciences that are designed to ensure objectivity, generalizability, and reliability. These techniques include (a) the ways research participants are selected randomly from the study population in an unbiased manner, (b) the standardized questionnaire or intervention that participants receive, and (c) the statistical methods used to test predetermined hypotheses regarding the relationships between specific variables. The researcher is considered external to the actual research, and results are expected to be replicable no matter who conducts the research.
The strengths of the quantitative paradigm are that its methods produce quantifiable and reliable data that are typically 'generalizable' to a larger population. This paradigm has a tendency to break down when the phenomenon under study is difficult to measure or quantify. The greatest weakness of the quantitative approach is that it often 'decontextualizes' human behavior in a way that removes the event from its real world setting and ignores the effects of variables that have not been included in the model (Cohen & Manion, 1994).
Qualitative research methodologies are designed to provide the researcher with the perspective of participants through immersion in a culture or situation and direct interaction with those under study (Patton, 1990). Qualitative methods include observations, in-depth and other interviews, focus groups, etc. These methods are designed to help researchers understand the meaning(s) people assign to certain phenomena and to clarify the mental processes underlying behaviors. Hypotheses are often generated during data collection and analysis, measurement tends to be subjective, and in the qualitative paradigm, the researcher becomes the instrument of data collection. Results may therefore vary significantly depending upon who conducts the research.
The advantage of using qualitative methods is that they generate rich and detailed data that leave the participants' perspectives intact and provide a context for human behavior. The focus upon processes and 'reasons why' differs from that of quantitative research, which addresses correlations between variables. A disadvantage is that data collection and analysis may be labor-intensive and time-consuming. Additionally, the qualitative methods are not yet entirely accepted by the mainstream research community and qualitative researchers may find their results challenged as invalid by those outside the field of social sciences. Nevertheless, integrating quantitative and qualitative methods lends depth and clarity to research.
The present study is primarily quantitative in nature but uses qualitative results to give support for and to help interpret or explain the quantitative findings. The quantitative approach incorporated the formulation of the problem statement and research question, which was addressed using the descriptive / predictive quantitative paradigm. The former describes the data, frequencies, etc., and the latter proposes relationships between the variables. The quantitative component included the collection, presentation, and analysis of data and the application of statistical tests. The analyses involved the empirical and the conceptual.
In the descriptive quantitative model, the direct output consisted of descriptive analyses and equations that simply describe the non-falsifiable postdiction of the data, i.e., that explain the data, and of statistical correlations between variables on the basis of input data (Cohen & Manion, 1994). Any prediction is of that which is seen in the data. This is, of course, an important part of the scientific method. The predictive quantitative component, which had prediction as its direct output, and which is falsifiable upon testing, was incorporated and used to legitimately forecast generalizations from the analyses. While the core method of the descriptive model was statistical data distribution, frequency, and analyses, the core method of the predictive method was logical consideration. The indirect output of the descriptive method was limited-scope postdiction and the indirect output of predictive model was broader substantiated prediction based upon subject-specific conceptualization (Cohen & Manion, 1994).
Although the present study was primarily quantitative in nature it also used qualitative results to assist in the interpretation and explanation of the quantitative findings through the Follow-up Interviews. This information, which left the participants' perspectives intact, assisted in providing a context for the quantitative findings. To recap, the purpose of the quantitative component was to provide raw data regarding the pretreatment / post-treatment intensity of depressive symptomatology and comorbid anxiety of the participants. The purpose of the qualitative component was to (a) identify the participants' perceptions of possible factors, or extraneous and confounding variables, related to any changes in the intensity of depressive symptomatology and comorbid anxiety among the study's participants, (b) gain insight from the perspective of the participants regarding the effectiveness of the treatment, and subsequently, (c) proffer an integrated treatment methodology paradigm.
3.2 Research Validity / Reliability
The validity and reliability of the study's quantitative component are directly linked to the validity and reliability of the two test instruments used, and to the procedures of administration. Parts III and VI of the research instrument included pretreatment and post-treatment administrations of the BDI and BAIŽ. These inventories are established measures that are used around the world and have been translated into over 50 languages. The BDI and BAIŽ represented a shift in healthcare professionals' view of depression and anxiety from a psychodynamic perspective to one guided by the patient's own thoughts or 'cognitions'. They also established the principle that self-report questionnaires, when analyzed using techniques such as factor analysis, can suggest theoretical constructs. The BDI and BAIŽ were originally developed to provide a quantitative assessment of the intensity of depression and anxiety. Because they are designed to reflect the levels of depression and anxiety, they can monitor changes over time and provide an objective measure for judging improvement and the effectiveness of treatment methods. The instruments remain widely used in research and have been used in over 2,000 empirical studies. The results of recent research conducted at Chapman University support the reliability, validity, and the multi-cultural relevance and applicability of these measures of depressive and anxious symptomatology (Contreras, 2004).
In order to ensure the validity of the findings derived from this study's qualitative component, a paraphrase or rephrasing technique was used, i.e., the information provided by the participants in the interviews was repeated to them by the researcher, in his (i.e., the researcher's) own words, to confirm whether the researcher had understood the participant's ideas and experiences correctly. The paraphrase was carefully worded to lead to further discussion or increased understanding of the participant's positions. An audit trail was also left, i.e., a record of the processes that were followed to conduct the interviews, how the data was analyzed and interpreted, and of all the materials used and steps followed to conduct this study.
3.3 Participants
The participants of this study were 15 purposively selected male and female volunteers over the age of 18, who at the time of consenting to participate in the experiment, reported that they were suffering from 'depression' and 'anxiety' that had lasted for a period of 6 months or more. They had not sought treatment from mental health professionals and were not suicidal. They all had the permission of a physician to participate in the fasting module [see Appendix D]. The sample consisted of 5 Orthodox Christians, 3 Roman Catholics, 2 Protestants, and 5 agnostics. Table 1 [see p. 124] shows that all participants met the established criteria for participation in the study.
3.4 Sample Size and Heterogeneity in Causal Inference
Purposive sampling does not involve random selection (Mills as cited in Rosenbaum, 2005). However, this does not imply that purposive sampling is not representative of the population. Although many researchers prefer probabilistic or random sampling methods over purposive sampling, and consider them to be more accurate and rigorous, most sampling methods are purposive in nature because the sampling problem is usually approached with a specific plan in mind. In applied social science research, especially in observational studies, there are often circumstances in which it is not feasible, practical, expedient, or theoretically sound to use random sampling (Rosenbaum, 2005).
In this research, the theory and methodology related to observational studies were applied firstly (a) for practical considerations which prevent randomization and demand purposive sampling and (b) in order to reduce, control, and / or exclude extraneous and confounding variables. An example of the related methodology can be seen in the following example. If an observational study were conducted to estimate the effect of wearing a helmet on the risk of death in motorcycle crashes, 1 of 2 different data-sets for such a study would need to be selected (a) a large, heterogeneous sample of crashes that happened on different roads, at different speeds, etc., or (b) a smaller, more homogeneous sample of crashes that all occurred on the same road (Mills as cited in Rosenbaum, 2005).
The goal would be to discover a trustworthy estimate of the treatment effect that is as close as possible to the objective 'truth'. Naturally, many researchers would select the larger sample. It is presumed that a larger sample equates to smaller standard error, less uncertainty, better inference, etc. This is the conventional understanding and popular belief. However, Rosenbaum (2005) in his study on Heterogeneity and Causality: Unit Heterogeneity and Design Sensitivity in Observational Studies comes to the opposite conclusion. He demonstrates that heterogeneity, and not sample size is the determining factor for the sensitivity of inference to hidden bias, internal validity, and generalizability. He also proffers that in some cases, larger samples can indeed compound the effects of extraneous and confounding variables. Rosenbaum's study has real implications for the gathering of data and judging of inferences. In the helmet example above, Rosenbaum cites an observational study that deals with the heterogeneity issue in a succinct manner:
Different crashes occur on different motorcycles, at different speeds, with different forces, on highways or country roads, in dense or light traffic, encountering deer or Hummers. One would like to compare two people, one with a helmet, the other without, on the same type of motorcycle, riding at the same speed, on the same road, in the same traffic, crashing into the same object. Is this possible? It is when two people ride the same motorcycle, a driver and a passenger, one helmeted, the other not. Using data from the Fatality Analysis Reporting System, Norvell and Cummings (2002) performed such a matched pair analysis using a conditional model with numerous pair parameters, estimating approximately a 40% reduction in risk associated with helmet use.
To recap, in observational studies, as opposed to randomized experiments, smaller and more homogeneous samples are the key to increased internal validity and generalizability (Rosenbaum, 2005). For this reason, the sample in this study, although small, is indeed statistically valid. Nevertheless, sample size is cited in this study as a possible limitation.
3.5 Research Instrument and Procedures
As stated in Chapter I, in order to gather information, a seven-part research instrument was used [see Appendices on pages 237 - 263]. Part I included the 'Informed Consent Statement'. Part II was used to collect the qualifying personal and demographic data of each participant. Part III included a pre-treatment administration of the BDI and BAIŽ to determine levels of depressive symptomatology and comorbid anxiety. Part IV included a twelve-week Orthodox neptic-psychotherapeutic treatment plan with homework, including a Fasting Module, 'Jesus Prayer' Curriculum, and a Religious / Spiritual Activities Register. The latter was used in juxtaposition with the information gathered in the individual interviews in Part VII. Part V included weekly monitoring of 'Treatment Homework' to ensure and encourage compliance. Part VI included a second administration of the BDI and BAIŽ to determine if changes had occurred in the levels of the participants' depressive symptomatology and comorbid anxiety. Part VII consisted of individual interviews to discuss participant perception(s) on the role / effects of treatment using neptic-psychotherapeutic interventions / homework, if any, on depressive symptomatology and comorbid anxiety. The findings of these interviews served to elaborate on that which was learned through the quantitative component of the research. The mix of qualitative (Patton, 1990) with quantitative components assisted in explaining and vividly illustrating, by the personal experience that came from the interviews, the findings based upon the statistically valid sample of the target population.
Table 1
Participant
Age
Sex
San Juan Resident
Church Affiliation
Duration Depressive Symptoms
Duration of Anxiety
Currently Experiencing Symptoms
Psychological /Psychiatric Treatment and / or Suicide Attempts
Depression
Anxiety
1
25
F
Yes
Orthodox
12-24 months
12-24 months
Yes
Yes
No
2
27
M
Yes
Orthodox
12-24 months
12-24 months
Yes
Yes
No
3
32
F
Yes
Orthodox
12-24 months
12-24 months
Yes
Yes
No
4
39
F
Yes
Orthodox
24-36 months
24-36 months
Yes
Yes
No
5
31
M
Yes
Orthodox
12-24 months
12-24 months
Yes
Yes
No
6
32
F
Yes
Catholic
12-24 months
12-24 months
Yes
Yes
No
7
30
F
Yes
Catholic
12-24 months
12-24 months
Yes
Yes
No
8
35
M
Yes
Catholic
6-12 months
6-12 months
Yes
Yes
No
9
38
F
Yes
Protestant
12-24 months
12-24 months
Yes
Yes
No
10
32
M
Yes
Protestant
12-24 months
12-24 months
Yes
Yes
No
11
23
F
Yes
Agnostic
12-24 months
12-24 months
Yes
Yes
No
12
32
F
Yes
Agnostic
6-12 months
6-12 months
Yes
Yes
No
13
37
M
Yes
Agnostic
6-12 months
6-12 months
Yes
Yes
No
14
35
M
Yes
Agnostic
6-12 months
6-12 months
Yes
Yes
No
15
39
M
Yes
Agnostic
6-12 months
6-12 months
Yes
Yes
No
3.6 Ethical Considerations
The APA Ethics Code and the UNISA Guidelines for Conducting Research with Human Participants were used as a basis for all ethical considerations in this research. The researcher is committed to increasing scientific and professional knowledge of behavior and to use such knowledge to improve the condition of individuals and society. The APA Ethics Code provided a set of principles upon which this scientific work was based. These principles are (a) beneficence and non-maleficence, i.e., the researcher strove to benefit the participants of the study and took care to do no harm; (b) fidelity and responsibility, i.e., the researcher established relationships of trust with participants, upheld professional standards of conduct, clarified his professional role and obligations, accepted appropriate responsibility for his behavior, and sought to manage conflicts of interest that could lead to exploitation or harm; (c) integrity, i.e., the researcher promoted accuracy, honesty, openness, and truthfulness throughout the research process; (d) justice, i.e., the researcher exercised reasonable judgment and took the necessary precautions to ensure that his potential biases, the boundaries of his competence, and the limitations of his expertise did not lead to, or condone, injustice; and (e) respect for people's rights and dignity, i.e., the researcher respected the dignity and worth of all of the study's participants, and their rights to privacy, confidentiality, and self-determination. The purpose of the study was fully explained to all candidates before they agreed to participate. Special attention was devoted to how information would be used. It was explained that all participant information would be kept confidential and would be used only for the purposes of the research. The subjects were informed that participation in the study was strictly voluntary and that they were free to withdraw their participation at any time. All participants read and signed the 'Informed Consent Statement' in Part I of the research instrument. Once the form was signed, each participant was given a copy for his / her records.
In addition to the above, principles of ethical communication were also considered. According to Booth, Colomb, and Williams (1995), ethical considerations that may arise in the conducting and reporting of research principally revolve around the issue of plagiarism, "that is the appropriation of an individual's ideas and / or writing and claiming them as your own" (Swanson, 2005, p. 1). To minimize ethical concerns in this area, the researcher voluntarily complied with the following principles of ethical communication. The researcher did not intentionally claim writings or research of another person. Appropriate acknowledgement and proper citation of sources were ensured. The original source for all quotations was verified. The researcher did not modify, eliminate, or misreport sources but ensured proper representation and reporting of both literature and research. The integrity of the research was protected and Internet sources used in the research were printed and maintained for future reference (Booth, Colomb, & Williams, 1995; Swanson, 2005).
3.7 Summary
In this chapter, the methods and procedures used in this study were identified and described. The research question was reviewed, followed by a short explanation of the quantitative and qualitative research paradigms, and the reasons for selecting an integrated research design. The validity and reliability of the study and test instruments were discussed in relation to both the quantitative and qualitative components. The demographic and qualifying information of those who participated in the study were presented. Finally, the test instrument was discussed together with procedures and ethical considerations. The purpose of including details of the methodology is to enable others to verify the authenticity of the results of this research or to replicate this study. Chapter IV restates the hypotheses and presents the data, findings, and analysis.
Page created: 11-2-2011.
Last update: 11-2-2011.