Early maladaptive schemas,temperament and character traits in clinically depressed and previously depressed subjects

The Young Schema Questionnaire (YSQ) and the Temperament and Character Inventory (TCI) have been suggested as vulnerability markers for depression. One‐ hundred forty clinically depressed subjects(CD), previously depressed subjects(PD) and never depressed (ND) controls completed the YSQ, the TCI and the Beck Depression Inventory. Results showed that CD and PD differed significantly on early maladaptive schemas, temperament and character traits compared with ND. In accordance with previous research, higher levels of harm avoidance and lower levels of self‐directedness were found in CD and in recovered PD. Moreover, CD and PD showed substantial variability in the scores on the YSQ and the TCI when controlling for concurrent depression severity. In multiple regression analyses, YSQ domain scales of disconnection, impaired autonomy, restricted self‐expression and impaired limits emerged as significant predictors of depression severity. Likewise, as concerns TCI higher order scales, high harm avoidance, low self‐directedness and high persistence emerged as significant predictors of depression severity. Harm avoidance was positively related to several early maladaptive schemas (EMSs), whereas self‐directedness was negatively related to a majority of the EMSs. Our findings indicate the presence of maladaptive personality characteristics in CD and PD. Longitudinal studies are needed to establish their causal role in relation to first‐onset and recurrent depression. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Early maladaptive schemas, high harm [correction made here after initial online publication] avoidance and low self‐directedness may be a part of vulnerability to depression. ? The finding of these personality characteristics in subjects recovered from depression indicates malfunctioning to some degree. ? Addressing such characteristics in therapy should be considered in order to prevent and treat depression from its relapsing and recurring course.     

The temperament and character inventory in major depression

Patients admitted for pharmacological treatment of a non-bipolar major depressive episode completed the Temperament and Character Inventory (TCI) prior to and after at least 6 weeks of treatment. Treatment with various antidepressants resulted in a 43% reduction of symptomatology. Scores on the harm avoidance dimension before and after treatment appeared to be significantly higher as compared to Dutch normative data. TCI scores did not predict response to treatment or show a change during treatment. It is concluded that, in this group of patients, the personality dimension harm avoidance is a trait factor without predictive value for antidepressant responsiveness.     

The relationship between interpersonal problems,negative cognitions,and outcomes from cognitive behavioral group therapy for depression

Background

Interpersonal functioning is a key determinant of psychological well-being, and interpersonal problems (IPs) are common among individuals with psychiatric disorders. However, IPs are rarely formally assessed in clinical practice or within cognitive behavior therapy research trials as predictors of treatment attrition and outcome. The main aim of this study was to investigate the relationship between IPs, depressogenic cognitions, and treatment outcome in a large clinical sample receiving cognitive behavioral group therapy (CBGT) for depression in a community clinic.

Methods

Patients (N=144) referred for treatment completed measures of IPs, negative cognitions, depression symptoms, and quality of life (QoL) before and at the completion of a 12-week manualized CBGT protocol.

Results

Two IPs at pre-treatment, ‘finding it hard to be supportive of others’ and ‘not being open about problems,’ were associated with higher attrition. Pre-treatment IPs also predicted higher post-treatment depression symptoms (but not QoL) after controlling for pre-treatment symptoms, negative cognitions, demographics, and comorbidity. In particular, ‘difficulty being assertive’ and a ‘tendency to subjugate one's needs' were associated with higher post-treatment depression symptoms. Changes in IPs did not predict post-treatment depression symptoms or QoL when controlling for changes in negative cognitions, pre-treatment symptoms, demographics, and comorbidity. In contrast, changes in negative cognitions predicted both post-treatment depression and QoL, even after controlling for changes in IPs and the other covariates.

Limitations

Correlational design, potential attrition bias, generalizability to other disorders and treatments needs to be evaluated.

Conclusions

Pre-treatment IPs may increase risk of dropout and predict poorer outcomes, but changes in negative cognitions during treatment were most strongly associated with improvement in symptoms and QoL during CBGT.     

Anxiety sensitivity profile: dimensional structure and relationship with temperament and character

BACKGROUND: Anxiety sensitivity (AS), the belief that bodily sensations have harmful consequences, is a reliable predictor of panic attacks in both clinical and nonclinical populations. Recently, a new measure of AS has been proposed. The AS profile (ASP) was designed to be a more comprehensive measure of AS, and to be more suitable for the measurement of different AS dimensions. Preliminary evidence (college student sample) suggests that the ASP has 4 dimensions. In the present study, the dimensional structure of the ASP was further investigated, as well as its relationship with temperament and character traits. METHODS: Exploratory and confirmatory factor analysis of ASP scores in two large samples of psychiatric outpatients and nonclinical controls (combined n = 742). Correlations and partial correlations of ASP with temperament and character. RESULTS: Exploratory factor analysis yielded a single AS factor. However, confirmatory factor analysis showed that the 6-dimensional structure, as Taylor and Cox had originally intended it, might be a defendable solution. However, the number of items is much too high, with many subscales consisting of semantic clusters. ASP scores were found to be weakly related to the temperament dimension harm avoidance, corroborating earlier findings that were not statistically significant because of small sample sizes. CONCLUSIONS: The ASP may be shortened from 60 to 24 items without loss of reliability or content. Future studies using challenge paradigms and studies with general hospital patients may further investigate the usefulness of a shortened version of the ASP.     

Obesity and interpersonal problems: an analysis with the interpersonal circumplex

This study examines the interpersonal problems profiles of obese individuals by cluster analysing the interpersonal problems circumplex scores of participants. The Inventory of Interpersonal Problems-Short Circumplex (IIP-32) was completed by 368 treatment-seeking obese individuals. These data were cluster analysed, and groups of obese subjects defined by varying interpersonal problems were compared with regard to psychological distress, self-esteem, body dissatisfaction, quality of life and binge behaviours. Cluster analyses of the IIP-32 resulted in four clusters, which occupied two quadrants of the interpersonal circumplex. Several differences in body mass index, psychological distress, quality of life and body dissatisfaction emerged across the four interpersonal groups. Although obese individuals reported elevated interpersonal distress, these subjects are not homogeneous with regard to interpersonal problems. Psychiatric co-morbidity and psychological distress may explain these interpersonal differences. These findings underscore the importance for clinicians to assess carefully patients' interpersonal functioning, especially with respect to treatment-seeking obese patients. KEY PRACTITIONER MESSAGE: Research has not consistently specified the types of interpersonal problems most frequently experienced by treatment-seeking obese individuals. Most obese individuals share a friendly-dominant interpersonal style. This research supports the importance of measuring and targeting interpersonal variables in the design and evaluation of obesity treatment programmes.     

Interpersonal problems as predictors of alliance,symptomatic improvement and premature termination in treatment of depression

Background

Previous studies reported inconsistent findings regarding the association of interpersonal problems with therapy outcome. The current study investigates if interpersonal problems predict process and outcome of three different treatments for depression.

Methods

The data originate from a randomized clinical trial comparing supportive–expressive psychotherapy, antidepressant medication and pill-placebo for treatment of depression. Interpersonal problems were used as predictors of alliance, symptomatic improvement and premature termination of treatment.

Results

Interpersonal problems related to communion predicted better alliances, but slower symptomatic improvement. Low agency predicted slower symptomatic improvement in supportive–expressive psychotherapy, but not in the medication or placebo condition. Lower interpersonal distress was associated with an increased likelihood to terminate treatment prematurely.

Limitations

The sample size did not allow the detection of small effects within the treatment groups.

Conclusions

Interpersonal problems are influential for the treatment of depression, but parts of their effects depend on the type of treatment.     

Group interpersonal psychotherapy for postnatal depression: a pilot study

Summary We conducted a pilot study to assess the potential effectiveness of group interpersonal psychotherapy (IPT-G) as a treatment for postnatal depression (PND). The study was also established to test a treatment manual for IPT-G, assess the acceptability of this format for participants and test a recruitment strategy for a randomised controlled trial. 18 mothers diagnosed with PND participated in 2 individual session and 8 sessions of group IPT. A two-hour psychoeducational session was also held for the partners of the participants. Measures of depressive symptomatology and social adjustment were administered by an independent clinician at baseline, 4 weeks, 8 weeks and 3 months post treatment. Patient satisfaction with the treatment was also evaluated. Severity scores on the BDI, EPDS and the HDRS decreased from pre- to post-treatment. This was maintained at three months follow up. No overall improvement in the Social Adjustment Scale-Self Report was noted, although there was improvement in their relationship with their significant other. The results confirm previous work that IPT-G may improve symptom severity for women suffering from postnatal depression. Limitations included the use of antidepressant therapy by 67% of subjects and the lack of a control group. There is a need for further randomised controlled trials of IPT-G with larger sample sizes to establish its effectiveness as treatment for PND. An erratum to this article is available at .     

The relationship between interpersonal sensitivity, anxiety disorders and major depression

BACKGROUND: While interpersonal sensitivity, as rated by the Interpersonal Sensitivity Measure (IPSM) has previously been found to be an efficient predictor of depression, there has been less interest in the relationship between the IPSM and anxiety disorders. This study examines the performance of the IPSM in discriminating between cases and non-cases of the various anxiety disorders. The contribution of depression and the perception of parental environment, to any relationships found, are also examined. METHODS: A cohort of 156 men and women has been assessed at 5-yearly intervals since baseline in 1978, in their last year of teacher training. In this fourth wave of follow-up, subjects completed a series of self-report questionnaires, including the IPSM, and scales measuring neuroticism and trait depression. Perceived parental environment, measured at baseline, was also included. DSM-III-R major depression and anxiety disorders were generated using the Composite International Diagnostic Interview. The IPSM subscales were moderately stable over time. 'Timidity' was associated with agoraphobia and simple phobia, and 'separation anxiety' with agoraphobia, panic disorder and generalised anxiety disorder. 'Separation anxiety' and 'timidity' showed differential gender effects for simple phobia. 'Fragile inner self' and 'separation anxiety' were associated with subjects with a history of repeated episodes of major depression, and the former, with perception of poor parental care. LIMITATIONS: The IPSM was not available for inclusion prior to the 1988 wave. CONCLUSIONS: While the IPSM subscales were consistently correlated with neuroticism, they displayed differential associations with specific anxiety disorders, episodes of major depression and early parental environment. These findings offer greater understanding of mechanisms concerning the relationship of vulnerability to anxiety disorders and depression.     

Longitudinal associations between depression and functioning in midlife women

Associations between depression and impaired functioning are well known and have been documented in numerous clinical, primary care and epidemiological studies. Reviews of this research have focused on the elderly. Recent studies suggest that women become increasingly vulnerable during the menopausal transition to declines in physical and role function and increases in depressive symptoms. The purpose of the current research is to review the literature since 1966 for studies examining the association between depression and physical and psychosocial impairment in midlife women. We selected only longitudinal studies that had the potential to elucidate the nature of the complex relationship between depression and functioning. Results of the review indicate evidence for bi-directional associations between depression and functioning in middle-aged women. However, the studies are only broadly informative. Most adjusted for only a limited group of factors that could be associated with both depression and functioning. None of them directly examined potential moderators or mediators of the relationship between depression and impaired functioning.     

Rejection sensitivity and borderline personality disorder

Rejection sensitivity (RS) is defined as a cognitive-affective processing disposition of anxious expectation, ready perception and overreaction to rejection cues. RS is widely investigated in social psychology, but research on RS in clinical samples is scarce. Focus of the present study was to examine the role of RS in patients with borderline personality disorder (BPD) compared to other clinical disorders. The Rejection Sensitivity Questionnaire (RSQ) was adapted for application in clinical and non-clinical samples and proved to be a methodologically sound measure. High correlations between the RSQ and borderline-specific cognitions (Questionnaire of Thoughts and Feelings) were observed. Compared to several clinical samples as well as healthy controls, BPD patients indicated the highest scores on both measures and differed significantly from all other groups, even from patients with social anxiety disorders.     

Pre‐adolescent gender differences in associations between temperament,coping, and mood

Relationships between temperament, coping, depressive and aggressive mood in 8–12‐year‐old boys (n = 185) and girls (n = 219) were investigated, with a focus on gender differences. Children completed two self‐report questionnaires: the Early Adolescent Temperament Questionnaire‐Revised and Children's Coping Strategies Checklist‐Revised1. Comparing boys and girls on three temperament dimensions, positive affectivity, negative affectivity and effortful control, girls scored higher than boys on the first two dimensions. Girls also scored higher than boys on avoidant coping and depressive mood. For both boys and girls, aggressive and depressive mood were predicted by negative affectivity. Coping did not add towards this prediction. Gender specific models of temperament, coping and depressive mood were tested. For girls, both effortful control and active problem solving, accounted for the variability in depressive mood. For boys, only effortful control accounted for variance in depressive mood. Results showed that gender specific vulnerability to depression in girls is apparent before adolescence and can be linked to temperament and coping. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Pre‐adolescent girls are more vulnerable to depression than boys. Interventions focussing on self‐control, emotion regulation and active coping are tailored towards vulnerabilities in temperament and coping in girls.

     

Big Five personality and depression diagnosis,severity and age of onset in older adults

Background

Personality may play an important role in late-life depression. The aim of this study is to examine the association between the Big Five personality domains and the diagnosis, severity and age of onset of late-life depression.

Methods

The NEO-Five Factor Inventory (NEO-FFI) was cross-sectionally used in 352 depressed and 125 non-depressed older adults participating in the Netherlands Study of Depression in Older Persons (NESDO). Depression diagnosis was determined by the Composite International Diagnostic Interview (CIDI). Severity of depression was assessed by the Inventory of Depressive Symptomatology (IDS). Logistic and linear regression analyses were applied. Adjustments were made for sociodemographic, cognitive, health and psychosocial variables.

Results

Both the presence of a depression diagnosis and severity of depression were significantly associated with higher Neuroticism (OR=1.35, 95% CI=1.28−1.43 and B=1.06, p<.001, respectively) and lower Extraversion (OR=.79, 95% CI=.75−.83; B=−.85, p<.001) and Conscientiousness (OR=.86, 95% CI=.81.−.90; B=−.86, p<.001). Earlier onset of depression was significantly associated with higher Openness (B=−.49, p=.026).

Limitations

Due to the cross-sectional design, no causal inferences can be drawn. Further, current depression may have influenced personality measures.

Conclusions

This study confirms an association between personality and late-life depression. Remarkable is the association found between high Openness and earlier age of depression onset.     

The anterior attention network: associations with temperament and neuroendocrine activity in 6-year-old children

The capacity to effortfully control or regulate behavior is of central importance in social development. Individual differences in effortful control have been hypothesized to reflect biologically based, temperamental variation among children. Posner and Rothbart (1994, 1998) have argued that the anterior attention system, which includes areas of the midprefrontal cortex, underlies effortful control capabilities. Furthermore, components of the anterior attentional system are believed to be involved in the regulation of reactive, emotion-related system, such as the hypothalamic-pituitary-adrenocortical system. We assessed 58 six-year-old children's performance on neuropsychological tasks that have been found in functional imaging studies to involve the anterior brain regions which Posner (1995) describes as comprising the anterior attentional system. We then related performance on these tasks to delay of gratification tasks and parent report of temperament and behavior problems as well as home and laboratory cortisol levels. Results provide some support for Posner and Rothbart's model and suggest a relationship between the anterior attentional system and cortisol regulation. However, these data also illustrate the multifaceted nature of effortful control and the need for care when attempting to understand the neural systems involved in the effortful regulation of behavior.     

Interpersonal emotion regulation as a mechanism of social support in depression

Although social support is widely considered to be protective against depression, the mechanisms through which it acts on depressive psychopathology are not well known. This integrative review argues that emotion regulation serves as such a mechanism. First, the literature on the effects of social support on depression is reviewed, with an emphasis on open empirical questions regarding mechanisms linking support and depression. Then, the literature on emotion regulation is reviewed, highlighting its importance as a mechanism in the psychopathology of depression. Finally, potential interpersonal influences on depressive emotion regulation and dysregulation are suggested, drawing from theory and research on psychotherapy and on close relationships. The review suggests that emotion regulation is responsive to interpersonal influences, and that this responsiveness may account for the effects of social support on depression. Implications of an interpersonal perspective for basic and clinical research on depression, close relationships, and emotion regulation are discussed.     

Specificity of cognitive structure in depression and social phobia: a comparison of interpersonal and achievement content

BACKGROUND: The comorbidity between the mood and anxiety is extensive and it is probable that individuals with these disorders share a number of cognitive characteristics. However, comorbidity rates with depression are not uniform among the various anxiety disorders. This study examined the common and distinguishing features of self-schematic structure in major depressive disorder and social anxiety compared to other anxiety disorders in general and to no psychiatric disturbance. METHODS: Participants completed the Psychological Distance Scaling Task, which provided an index of the cognitive organization of positively and negatively valenced interpersonal and achievement self-referent content. RESULTS: The depression and social phobia groups were statistically equivalent on all indices of cognitive organization, and showed greater interconnectedness among interpersonal negative content than both control groups, and less interconnectedness among both positive interpersonal and achievement content than did nonpsychiatric controls. Psychiatric groups were equivalent on negative achievement content but showed greater interconnectedness than controls. LIMITATIONS: This study had a modest sample size and the findings are constrained to females. CONCLUSIONS: Negative interpersonal content is more densely interconnected in individuals with social phobia and depression compared with both other anxiety disorder and nonpsychiatric controls. In addition, both social phobia and depression were associated with less interconnected positive content. These findings are indicative of similarities in the way self-schematic content may be organized in individuals with depression and social phobia. Theoretical explanations of these results and future research directions are discussed.     

MMPI, personality dysfunction and the dexamethasone suppression test in major depression

In this study we examined the relationship of psychopathology and personality dysfunction to neuroendocrine functioning. MMPI profiles were examined for 30 psychiatric inpatients with major depression who were suppressors (60%) and nonsuppressors (40%) on the dexamethasone suppression test. There were no differences between suppressors and nonsuppressors on any of the MMPI scales or on DSM-III Axis-II diagnosis. When subdivided according to T-score elevations above 70 on MMPI scales 4 and 6, or 4 and 9, 30% of the sample, however, met criteria for personality dysfunction. Furthermore, a significantly higher proportion of suppressors (50%) evidenced personality dysfunction than did the nonsuppressors (8%). This suggests that certain MMPI scales are able to identify a subgroup of depressed patients with personality disturbances who also have a hypothalamic-pituitary-adrenal dysfunction.     

Pre‐treatment predictors and in‐treatment factors associated with change in avoidant and dependent personality disorder traits among patients with social phobia

We examined changes in avoidant and dependent personality disorder dimensions, and pre‐treatment and in‐treatment factors associated with such changes in 77 patients, randomized to medication‐free residential cognitive (CT) or residential interpersonal therapy for social phobia. Personality disorders and personality dimensions according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) were assessed at pre‐treatment and at one‐year post‐treatment. Both treatments were associated with a decrease in avoidant and dependent personality dimensions; dependent dimension decreased more in CT. Changes in cognitive factors predicted changes in both personality dimensions, whereas changes in symptoms or interpersonal factors did not. Change in the cognitive factor estimated cost was the most powerful predictor in the avoidant dimension, as it was the only predictor that remained significant in the forward regression analyses. Change in the cognitive factor estimated cost, and treatment were the most powerful predictors of change in the dependent dimension. Pre‐treatment use of anxiolytics predicted larger changes in both PD dimensions. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Improvement in symptoms and cognitions related to social phobia is associated with improvement in dependent and avoidant personality disorder traits.