Cognitive change processes in a group cognitive behavior therapy of depression

The present study attempted to examine the causal relationships among changes in automatic thoughts, dysfunctional attitudes, and depressive symptoms in a 12-week group cognitive behavior therapy (GCBT) program for depression. In all, 35 depressed patients attending the GCBT program were monitored with the Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale, and Beck Depression Inventory at the pre-treatment, 4th and 8th sessions, and post-treatment. The results were as follows: (1). GCBT reduces negative cognitions; (2). changes in automatic thoughts and dysfunctional attitudes lead to change in depressive symptoms; and (3). automatic thoughts play a mediating role between dysfunctional attitudes and depression. The findings taken as a whole support the Causal Cognition Model of depression.     

Evaluative beliefs as mediators of the relationship between parental bonding and symptoms of paranoia and depression

This study was aimed to explore the distinct pathways that lead to depression and paranoia. We first examined the association of dysfunctional parenting experiences and negative self-evaluations in depression and paranoia. Furthermore, we also examined whether different self-evaluative beliefs could mediate the relationships between dysfunctional parenting experiences (i.e. parental overprotection or lack of care) and the development of depression and paranoia. A sample composed of 55 paranoid patients, 38 depressed patients and 44 healthy controls completed the Parental Bonding Instrument (PBI), the Evaluative Beliefs Scale (EBS) and some clinical scales. Our analyses revealed that lack of parental care and negative self–self evaluations were associated with depression symptoms. Analyses also revealed that parental overprotection and negative other–self evaluations were associated with paranoid symptoms. Furthermore, negative self–self and other–self evaluations fully mediated the relationship of parental overprotection and paranoia, whereas negative self–self evaluations partially mediated the relationship between lack of parental care and depression. These findings suggest that distinct patterns of parental practices may contribute to the development of different dysfunctional schemas which in turn may lead to either depression or paranoia.     

Relationship of Internet addiction with cognitive style,personality, and depression in university students

Background

The aim of the study was to investigate the relationship of dysfunctional attitudes, self-esteem, personality, and depression with Internet addiction in university students.

Methods

A total of 720 university students participated in the study in Bülent Ecevit University English Preparatory School which offers intensive English courses. Students were evaluated with a sociodemographic data form, Beck Depression Inventory (BDI), Dysfunctional Attitudes Scale form A (DAS-A), Internet Addiction Scale (IAS), Rosenberg Self-Esteem Scale (RSES), and Eysenck Personality Questionnaire Revised/Abbreviated Form (EPQR-A).

Results

The results indicated that 52 (7.2%) of the students had Internet addiction. There were 37 (71.2%) men, 15 (28.8%) women in the addicted group. While the addicted groups' BDI, DAS-A perfectionistic attitude, need for approval, RSES, EPQR-A neuroticism, and psychoticism scores were significantly higher, EPQR-A lie scores were significantly lower than those of the non addicted group. According to the multiple binary logistic regression analysis, being male, duration of Internet usage, depression, and perfectionistic attitude have been found as predictors for Internet addiction. It has been found that perfectionistic attitude is a predictor for Internet addiction even when depression, sex, duration of Internet were controlled.

Conclusions

To the knowledge of the researchers, this study is the first study to show the dysfunctional attitudes in Internet addiction. It can be important to evaluate dysfunctional attitudes, personality, self-esteem and depression in people with Internet addiction. These variables should be targeted for effective treatment of people with Internet addiction in cognitive behavioral therapy.     

Study of the integrated cognitive model of depression among Latin-Americans

OBJECTIVE: The objective of the present study is to test the validity of the integrated cognitive model (ICM) of depression proposed by Kwon and Oei with a Latin-American sample. The ICM of depression postulates that the interaction between negative life events with dysfunctional attitudes increases the frequency of negative automatic thoughts, which in turns affects the depressive symptomatology of a person. This model was developed for Western Europeans such as Americans and Australians and the validity of this model has not been tested on Latin-Americans. METHOD: Participants were 101 Latin-American migrants living permanently in Brisbane, including people from Chile, El Salvador, Nicaragua, Argentina and Guatemala. Participants completed the Beck Depression Inventory, the Dysfunctional Attitudes Scale, the Automatic Thoughts Questionnaire and the Life Events Inventory. Alternative or competing models of depression were examined, including the alternative aetiologies model, the linear mediational model and the symptom model. RESULTS: Six models were tested and the results of the structural equation modelling analysis indicated that the symptom model only fits the Latin-American data. CONCLUSIONS: Results show that in the Latin-American sample depression symptoms can have an impact on negative cognitions. This finding adds to growing evidence in the literature that the relationship between cognitions and depression is bidirectional, rather than unidirectional from cognitions to symptoms.     

Safety behaviors and dysfunctional beliefs about sleep: testing a cognitive model of the maintenance of insomnia

OBJECTIVE: Our aim was to determine if insomnia severity, dysfunctional beliefs about sleep, and depression predicted sleep-related safety behaviors. METHOD: Standard sleep-related measures (such as the Insomnia Severity Index; the Dysfunctional Beliefs About Sleep scale; the Depression, Anxiety, and Stress Scale; and the Sleep-Related Behaviors Questionnaire) were administered. Additionally, 14 days of sleep diary (Pittsburg Sleep Diary) data and actual use of sleep-related behaviors were collected. RESULTS: Regression analysis revealed that dysfunctional beliefs about sleep predicted sleep-related safety behaviors. Insomnia severity did not predict sleep-related safety behaviors. Depression accounted for the greatest amount of unique variance in the prediction of safety behaviors, followed by dysfunctional beliefs. Exploratory analysis revealed that participants with higher levels of depression used more sleep-related behaviors and reported greater dysfunctional beliefs about their sleep. CONCLUSION: The findings underlie the significant influence that dysfunctional beliefs have on individuals' behaviors. Moreover, the results suggest that depression may need to be considered as an explicit component of cognitive-behavioral models of insomnia.     

Dysfunctional attitudes in former psychiatric inpatients

In order to test the hypothesis that patients who are predisposed to depression have an enduring cognitive style, dysfunctional attitudes (Dysfunctional Attitudes Schedule), neuroticism and extraversion (Maudsley Personality Inventory), and severity of depression (Levine-Pilowsky Depression Questionnaire) were measured in a survey of former patients with previous diagnoses of either depressive or nondepressive psychiatric conditions. We found that there were no significant differences in dysfunctional attitudes between these groups of patients and that their scores were similar to those reported for normal populations. There was, however, a correlation between introversion and high dysfunctional attitude scores. Possible implications regarding interactions between cognitive style, personality, and predisposition toward depression are discussed as well as a suggestion that a history of a suicide attempt may predict a poor response to cognitive psychotherapy.     

Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: a randomized wait-list control design

This study examined the effectiveness of a cognitive-behavioral treatment (CBT) group for Chinese people with depression in Hong Kong. Ninety-six subjects with depression were randomly assigned to CBT and control groups. After 10 weeks of treatment, participants in the CBT group had significantly fewer symptoms of depression, dysfunctional rules, and negative emotions, and significantly more adaptive coping skills when compared to the participants in the control group. Effect size statistics showed medium to large differences in symptoms of depression, coping skills, dysfunctional rules, and assumptions and negative emotions between the participants of the two groups (Cohen's d, between 0.50 and 0.88, except for positive emotions). Forty percent of the participants in the experimental group achieved a clinically significant level [reliable change index (RC)>1.96] of improvement. Lastly, the results of a multiple regression analysis provided some evidence of a linkage between cognition and depression among the participants in the experimental group. The design and content of the CBT groups, which aimed at facilitating the understanding and modification of automatic thoughts and dysfunctional rules, and of negative and positive coping skills among the participants, might have contributed to the initial positive results.     

Memory biases in remitted depression: The role of negative cognitions at explicit and automatic processing levels

Background and objectives

Cognitive models propose that depression is caused by dysfunctional schemas that endure beyond the depressive episode, representing vulnerability factors for recurrence. However, research testing negative cognitions linked to dysfunctional schemas in formerly depressed individuals is still scarce. Furthermore, negative cognitions are presumed to be linked to biases in recalling negative self-referent information in formerly depressed individuals, but no studies have directly tested this association.In the present study, we evaluated differences between formerly and never-depressed individuals in several experimental indices of negative cognitions and their associations with the recall of emotional self-referent material.

Methods

Formerly (n = 30) and never depressed individuals (n = 40) completed measures of explicit (i.e., scrambled sentence test) and automatic (i.e., lexical decision task) processing to evaluate negative cognitions. Furthermore participants completed a self-referent incidental recall task to evaluate memory biases.

Results

Formerly compared to never depressed individuals showed greater negative cognitions at both explicit and automatic levels of processing. Results also showed greater recall of negative self-referent information in formerly compared to never-depressed individuals. Finally, individual differences in negative cognitions at both explicit and automatic levels of processing predicted greater recall of negative self-referent material in formerly depressed individuals.

Limitations

Analyses of the relationship between explicit and automatic processing indices and memory biases were correlational and the majority of participants in both groups were women.

Conclusions

Our findings provide evidence of negative cognitions in formerly depressed individuals at both automatic and explicit levels of processing that may confer a cognitive vulnerability to depression.     

Internalized stigma in schizophrenia: Relations with dysfunctional attitudes,symptoms, and quality of life

Internalized stigma refers to the process by which individuals with mental illness apply negative stereotypes to themselves, expect to be rejected by others, and feel alienated from society. Though internalized stigma has been hypothesized to be associated with maladaptive cognitions and expectations of failure, this relationship with dysfunctional attitudes has not been fully examined. In the present study, 49 individuals with schizophrenia or schizoaffective disorder completed the Internalized Stigma of Mental Illness Scale (ISMI; Ritsher et al., 2003) in addition to measures tapping defeatist performance beliefs, beliefs regarding low likelihood of success and limited resources, negative symptoms, depression, and quality of life. Consistent with prior research, internalized stigma was correlated with depression and quality of life but not with negative symptoms. Further, internalized stigma was correlated with both measures of dysfunctional attitudes. After controlling for depressive symptomatology, the relationship between internalized stigma and beliefs regarding low likelihood of success and limited resources remained significant, and though the correlation between defeatist performance beliefs and internalized stigma was no longer significant, it was of a similar magnitude. Overall, these data suggest that dysfunctional attitudes play a role in internalized stigma in individuals with schizophrenia, indicating a possible point of intervention.     

Relationship between dysfunctional cognitions and depressive subtypes

The results of this study suggest that the relationship between cognitions and severity of depression hypothesized by cognitive theorists may be relevant only to a subgroup of depressives. In a sample of 40 inpatients with major depression who received the Dexamethasone Suppression Test (DST), scores on the Dysfunctional Attitude Scale were equivalent in suppressor and nonsuppressor groups, as well as in melancholic and nonmelancholic depressive groups. Neither was there a difference between suppressors and nonsuppressors on measures of depression. However, in the nonmelancholic group, there was a significant relationship between dysfunctional cognitions and severity of depression. This relationship was not found in the melancholic group. Finally, independent of diagnostic and biological subtype, patients with elevated levels of dysfunctional cognitions when compared with the remaining sample revealed greater severity of depression, more days in hospital and more readmissions to hospital.     

Perfectionism,Interpersonal Sensitivity,Dysfunctional Beliefs,and Automatic Thoughts

Although research suggests increased neuroticism, perfectionism, interpersonal sensitivity, dysfunctional beliefs, and automatic thoughts during the symptomatic phase of depression, the research on temporal stability of these factors showed mixed results. The present study examined personality and cognitive factors in patients remitted from depression. Thirty-five patients remitted from depression, sixty-six currently depressed patients, and eighty-five nonclinical participants were assessed on the Multidimensional Perfectionism Scale (MPS-F), Interpersonal Sensitivity Measure (IPSM), Eysenck's Personality Inventory (EPI), Dysfunctional Attitude Scale (DAS), and Automatic Thoughts Questionnaires (AT Q-Positive & AT Q-Negative). Timidity, fragile inner-self, personal standards, and parental criticism were identified as source level factors in depression. Patients in remission reported highest social desirability, need for organization, and frequency of positive automatic thoughts. Results from the Discriminant Functional Analysis (DFA) indicated that higher scores on positive automatic thoughts and social desirability discriminated the remitted group from the currently depressed and normal sample. The findings highlight the importance of specific dimensions of personality as significant source level factors in depression. The role of specific dimensions of personality and cognitive factors that may aid in remission and maintenance of gains is also emphasized. The cultural influence on some of the variables is discussed. Results are discussed with respect to their implications for psychological interventions and research.     

Cognitive vulnerability in moderate, mild, and low seasonality

This study examined the association between cognitive vulnerability factors and seasonality. Students (N = 88), classified based on the Seasonal Pattern Assessment Questionnaire as experiencing moderate (n = 26) or mild (n = 32) seasonality, and nondepressed, low-seasonality controls (n = 30) completed explicit (i.e., dysfunctional attitudes, automatic negative thoughts, seasonal attitudes, and rumination) and implicit (i.e., implicit associations test) measures of cognitive vulnerability at one winter and one nonwinter assessment. Relative to low- and mild-seasonality participants, moderate-seasonality participants endorsed more automatic thoughts and rumination in winter and more dysfunctional attitudes across both seasons. Moderate- and mild-seasonality participants endorsed more maladaptive seasonal attitudes than did low-seasonality participants. All groups demonstrated increased dysfunctional attitudes, automatic thoughts, and rumination and stronger implicit associations about light and dark during the winter. The findings support a possible cognitive mechanism of winter depression onset and/or maintenance unique to individuals with moderate, as opposed to mild, seasonality.     

Caregiving, repetitive thought, and immune response to vaccination in older adults

Chronic stressors such as caregiving have been associated with reduced antibody production after vaccination and elevated interleukin (IL)-6 in older adults. However, individual differences in repetitive thought, that is, frequent or prolonged thought about oneself and one's world, can modify perception and effects of stress. For example, worry during stressful circumstances has been associated with poorer immune outcomes, whereas cognitive processing has been associated with better outcomes. The present study tested the relationship of caregiving and two types of repetitive thought, negative (e.g., worry) and neutral (e.g., reflection), to pre- and post-influenza vaccine antibody and IL-6. Dementia caregivers (n=14) and controls (n=30) were interviewed and had blood drawn pre- and post-vaccine in a multi-wave study. Multi-level models found that caregivers had higher IL-6 than controls after vaccination (t(23)=2.36, p<.05). There were several interactions between caregiver status and repetitive thought in predicting both depression and immune responses to vaccination. Among caregivers, negative repetitive thought predicted more depression and lower antibody titers, whereas neutral repetitive thought predicted less depression and higher antibody titers, but also higher post-vaccination IL-6. Among controls, negative repetitive thought predicted more depression but higher antibody titers, whereas neutral repetitive thought predicted less depression and lower post-vaccination IL-6. In mediational tests, depression did not account for the effects of repetitive thought. Results generally support beneficial effects of neutral repetitive thought and detrimental effects of negative repetitive thought, but those effects may be reduced or even reversed depending on life circumstances.     

Attachment,pain and detachment for the adults in divorce

Working from Beck's latest theoretical model (modes model, 1996), this study aimed to investigate cognitive and affective factors which may help to understand the processes involved in erectile dysfunction. Results suggest that sexually dysfunctional subjects differ from functional subjects in a range of cognitive and affective variables: sexual attitudes ('macho latino' attitude, demands for women's satisfaction and catastrophization of sexual failure consequences); automatic thoughts in sexual situations (performance demand and failure anticipation thoughts) and affect in the sexual context (essentially negative and directly connected to the above mentioned automatic thoughts). Results permit a re-examination of the main role performed by the cognitive-affective factors in sexual dysfunctional processes of this dysfunction and possibly suggest some future therapeutic approaches.     

Social relationships reflected by depressive inpatients

In a study of 100 inpatients suffering from depressive symptoms, the influence of cognitive characteristics (negative automatic thoughts and dysfunctional attitudes) and of the severity of depression on the emotional reflections of social relationships were investigated at admission, discharge and 3 months follow-up. The reflections of strained relation and rejection in the family or partnership were significantly determined by negative cognitive patterns and severity of depression. The prognostic aspects of the assessed psychological characteristics and the psychotherapeutic implications of the results are discussed.     

Dysfunctional attitudes in depressed patients before and after clinical treatment and in normal control subjects

To evaluate the role of maladaptive thinking patterns in depression, the authors administered the Dysfunctional Attitude Scale to 112 depressed patients before and after 3-6 weeks of treatment with antidepressants or placebo. Twenty-two normal subjects were also assessed twice. Depressed patients had a significantly higher initial mean score than control subjects, but during treatment their score significantly decreased, and the posttreatment score of those with complete recoveries was nearly as low as the control subjects' final score. The higher the initial dysfunctional attitude score the poorer the response to treatment. Patients with endogenous depression had significantly lower scores than nonendogenously depressed patients.     

Evaluation of the integrated cognitive model of depression and its specificity in a migrant population

This study empirically tested the specificity of the integrated cognitive model (ICM) of depression, which postulates that negative life events interact with dysfunctional attitudes to increase the frequency and severity of automatic thoughts, subsequently affecting depressive symptoms. We also examined the three competing models: the linear mediation model, the alternative etiologies model, and the symptom model. We anticipated that we might examine these models more appropriately using data from a population at an increased risk of developing depressive symptoms. As such, two-wave panel data were obtained from a group of 107 Korean migrants who had been in Australia less than 1 year. Structural equation modeling revealed that the ICM provided an adequate and much better fit than the three competing models. The ICM was also found to support the cognitive specificity theory of depression and anxiety. These findings suggest that dysfunctional attitudes can be a common cognitive moderator of depression and anxiety, whereas automatic thoughts and anxious self-statements can be specific cognitive mediators of anxiety and depression, respectively.     

The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression

Background

The main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms.

Methods

120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis.

Results

According to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms.

Conclusions

Assessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression.     

Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients

The aim of this study was to evaluate possible interactions between severity of borderline personality features (BPFs), dissociative experiences, and alexithymia among substance-dependent men while controlling for their current age, depression, and anxiety. Participants were 200 substance-dependent men consecutively admitted to a dependency treatment unit. The Borderline Personality Inventory, the Toronto Alexithymia Scale, the Dissociative Experiences Scale, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory were administered to all participants. Severity of negative affect, alexithymia, dissociative experiences, and BPF were correlated with each other. Being younger, severity of dissociative experiences, difficulty in identifying feelings, depression, and trait anxiety predicted the severity of BPF in linear regression analysis. These findings suggest that alexithymia and dissociative experiences may be a way of coping with depression and chronic anxiety, but they also seem to be related to the severity of BPF independent of the negative affect and from each other.     

Correlations of attitudes toward antipsychotic drugs with insight and objective psychopathology in schizophrenia

OBJECTIVE: The aim of this cross-sectional study was to examine the relationships between attitudes toward antipsychotics, insight, and other clinical variables in stable schizophrenia. METHODS: Fifty Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision-(DSM-IV-TR)-diagnosed schizophrenic outpatients were evaluated through a psychiatric assessment. Drug attitudes were measured using the Drug Attitude Inventory and insight using the Scale for the Assessment of Unawareness of Mental Disorder. Differences between patients taking first- or second-generation antipsychotics were investigated. RESULTS: Lack of insight, more severe scores on the positive and general psychopathology subscales of the Positive and Negative Syndrome Scale (PANSS), and later age at onset of schizophrenia correlated with worse global medication attitude. The multiple regression analysis revealed that unawareness of the need of treatment predicted poorer drug global attitude (R(2) = 0.312). Patients taking second-generation antipsychotics showed lower negative attitudes and better global drug attitudes than patients treated with neuroleptics. CONCLUSION: The impact of the awareness of the need for treatment on global medication attitude needs to be a main focus of interventions targeting compliance.