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.     

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.     

Dysfunctional attitudes and perceived stress predict depressive symptoms severity following antidepressant treatment in patients with chronic depression

Many patients continue to experience depressive symptoms after optimal pharmacological treatment. The aim of this study was to investigate whether Beck's cognitive diathesis stress model of depression would help predict the degree of improvement in the depressive symptoms of patients with chronic depression receiving antidepressant treatment. The study investigated the dysfunctional attitudes, perceived stress, and depressive symptoms of 117 patients with chronic depression before and after they were treated with an 8-week course of fluoxetine. A hierarchical multiple regression analysis showed a significant effect for the interaction between dysfunctional attitudes and perceived stress explaining severity of depressive symptom following antidepressant treatment. Patients with both high perceived stress and high dysfunctional attitudes prior to treatment reported more depressive symptoms at the end of treatment than patients with high perceived stress and lower dysfunctional attitudes. Surprisingly, in the presence of low perceived stress, patients with higher dysfunctional attitudes experienced less depressive symptoms at the end of treatment than patients with lower dysfunctional attitudes. Results suggest the value of taking into consideration both patients' perceived stress and dysfunctional attitudes when assessing treatment for depressive symptoms.     

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.     

A test of the cognitive content specificity hypothesis in depression and anxiety

The present study tested the cognitive content specificity hypothesis (CCSH) to assess whether anxiety and depression can be differentiated on the basis of cognitive disturbance. One hundred and thirty five depressed participants were administered the Beck depression inventory (BDI), the Beck anxiety inventory (BAI), the automatic thoughts questionnaire (ATQ) and the anxious self-statements questionnaire (ASSQ). It was hypothesised that depressive cognitions would be specifically related to, and predictive of, depressive (but not anxiety) symptoms in a depressed sample. Conversely, it was predicted that anxiety cognitions would be specifically related to, and predictive of, anxiety (but not depressive) symptoms in a depressed sample. Results revealed that the ATQ was the sole predictor of the BDI and similarly, the ASSQ was the sole predictor of the BAI. These findings support the CCSH in depression and provide an integrative framework for a greater understanding of the relationship between anxiety and depression.     

Depressive and anxiety symptoms, dysfunctional attitudes and social aspects in irritable bowel syndrome and inflammatory bowel disease

OBJECTIVE: Biopsychosocial models for both organic and functional gastrointestinal (GI) disorders have been described in the recent literature. The objective of this study was to give further data to this model by assessing stressful life events, social support, psychopathological symptoms, and dysfunctional attitudes in irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and healthy subjects. METHOD: Age- and gender-matched IBS and IBD patients presenting at a tertiary care gastroenterological center completed self-reported questionnaires on stressful life events, social support, depressive and anxiety symptoms and dysfunctional attitudes. For comparative purposes, data from an age- and gender-matched healthy control group were obtained. RESULTS: No significant differences were found between the groups regarding stressful life events and social support. Both patient groups had higher depressive and anxiety symptoms compared to healthy subjects, and IBS patients had higher depressive scores compared to IBD patients. IBS patients had more dysfunctional attitudes compared to both IBD and healthy subjects, while IBD and healthy subjects did not differ on dysfunctional attitudes. CONCLUSIONS: GI patient status is associated with depressive and anxiety symptoms, in addition IBS patients have more severe depressive symptoms and depressogenic dysfunctional attitudes. The fact that functional GI patients are characterized by more severe psychological, but not social parameters, supports the hypothesis that IBS might be related to the range of depressive disorders.     

An experimental test of the maintenance and vulnerability hypothesis of depression in consideration of the cognitive hierarchy

According to Beck's cognitive model of depression the activation of dysfunctional beliefs triggers negative automatic thoughts, which can be interpreted as the proximal "cause" for emotional, somatic, and motivational symptoms of depression. This top-down processes of beliefs causing thoughts and furthermore of thoughts causing symptoms can be called "cognitive hierarchy." Besides these processes there are bottom-up influences as well with dysfunctional beliefs being activated by external and internal events. A differentiation between top-down processes and bottom-up influences can be drawn with the first being seen as causing thoughts and emotions while the latter only activate existing beliefs. To test Beck's maintenance and the vulnerability hypothesis considering the cognitive hierarchy we suggest an experimental paradigm to experimentally manipulate beliefs, thoughts, and emotions separately and independent from each other. To test both hypotheses in an experimental paradigm depressed and nondepressed subjects are asked to concentrate on new beliefs, thoughts, or emotions during the imagination of personally stressful life events in two studies. Based on the top-down processes it was posited that concentration on new beliefs should lead to changes on all three levels of experience. Adding a new thought should cause changes on the levels of thoughts and emotions while new emotions should only change the level of emotions. The results confirm our hypotheses concerning beliefs and thoughts, but adding emotions changes the levels of thoughts as well as emotions. The results support the central role of beliefs in the development and maintenance of depressive symptoms.     

Cognitive patterns and depression: study of a Japanese university student population

According to Beck's cognitive theory, individuals who endure negative self-schemas (dysfunctional attitudes) are more likely to present automatic thoughts consisting of negative schemata of oneself and one's world while experiencing depression. In order to examine the relationships between depression, automatic thought, and dysfunctional attitude, 329 Japanese university students were given a set of questionnaires, including the Center for Epidemiologic Studies Depression Scale (CES-D), Automatic Thought Questionnaire-revised (ATQ-R), and Dysfunctional Attitude Scale (DAS). A structural equation model revealed that depression was predicted predominantly by automatic thought, which was in turn predicted by dysfunctional attitude. The male gender had a tendency to predict dysfunctional attitude. The link between a student's depression and dysfunctional attitude was mediated by automatic thought.     

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.     

Cognitive processes and their relationship to endogenous and reactive components of depression

In this study we investigated cognitive style in depressed inpatients, psychiatric control subjects with and without secondary depression, and nonpsychiatric control subjects with particular emphasis on cognitive patterns and their relationship to endogenous and reactive components of depression. Depressed and psychiatric control subjects were inpatients on acute care psychiatric units at three general hospitals. The nonpsychiatric control subjects were hospital employees. The inpatient sample was selected on the basis of DSM-III diagnosis and Beck Depression Inventory scores. Endogenous and reactive components of depression were assessed by the Endogenous-Reactive Checklist and the Schedule for Affective Disorders and Schizophrenia. Attitudes and attributions were measured by the Dysfunctional Attitudes Scale and the Attribution Questionnaire. Depressed patients endorsed significantly more dysfunctional attitudes than did nondepressed psychiatric control subjects and nonpsychiatric control subjects. Depressed and psychiatric control subjects also made more global attributions for certain kinds of undesirable events than did nonpsychiatric control subjects; stability and internality of attributions did not differ among groups. Further, more endogenous depression was associated with more dysfunctional attitudes, whereas the more reactive the depression, the more internal, global, and stable the attributions. Our findings suggest that dysfunctional attitudes are characteristic of at least some depressive mood states, particularly those high in endogenous symptoms, whereas it remains unclear whether certain attributions are characteristic of general psychopathology or, in the case of internal attributions, are so specific to reactive depressions that group differences are minimized.     

Early maladaptive schemas and social anxiety in adolescents: The mediating role of anxious automatic thoughts

Cognitive models state that cognitions are organized hierarchically, so that the underlying schemas affect behavior via more automatic, superficial cognitive processes. This study aimed to demonstrate that early maladaptive schemas predict anxious automatic thoughts, and to show that such automatic thoughts act as mediators between schemas and prospective changes in social anxiety symptoms. The study also examined an alternative reverse model in which schemas acted as mediators between automatic thoughts and social anxiety. A total of 1052 adolescents (499 girls and 553 boys; M_age = 13.43; SD_age = 1.29) completed measures of early maladaptive schemas, socially anxious automatic thoughts, and social anxiety symptoms at Times 1, 2, and 3. The results revealed bidirectional longitudinal relationships among schemas and automatic thoughts that were consistent in content (e.g., the disconnection/rejection schemas and automatic thoughts of negative self-concept). Furthermore, the automatic thoughts of anticipatory negative evaluation by others at Time 2 mediated the relationship between the other-directedness schemas at Time 1 and social anxiety symptoms at Time 3. These findings are consistent with hierarchical cognitive models of social anxiety given that deeper schemas predict more surface-level thoughts. They also support that these more surface-level thoughts contribute to perpetuating schemas. Finally, results show that early maladaptive schemas of the other-directedness domain play a relevant role in the development and maintenance of social anxiety.     

Rational emotive behavior therapy versus cognitive therapy versus pharmacotherapy in the treatment of major depressive disorder: Mechanisms of change analysis

Cognitive-behavioral psychotherapies (CBT) are among the first-line interventions for major depressive disorder (MDD), and a significant number of studies indicate their efficacy in the treatment of this disorder. However, differential effects of various forms of CBT have seldom been analyzed in the same experimental design. On the basis of data collected in a randomized clinical trial comparing the efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy (SSRI) in the treatment of MDD, the present article investigates the theory of change advanced by REBT and CT. Measures included to test the two theories of change assess three classes of cognitions: (a) automatic thoughts, (b) dysfunctional attitudes, and (c) irrational beliefs. The results indicate that REBT and CT (and also pharmacotherapy) indiscriminately affect the three classes of cognitions. On the long term (follow-up), a change in implicit demandingness seems more strongly associated with reduced depression and relapse prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

School-based prevention of depressive symptoms in adolescents: a 6-month follow-up

OBJECTIVE: Depressive disorders in adolescents are a widespread problem with extensive psychosocial consequences. The authors designed a school-based program to prevent the increase in depressive symptoms. The authors expect the program to reduce dysfunctional automatic thoughts and improve social skills and thus prevent the increase in depressive symptoms. METHOD: The design includes a training group and a nontreatment control group with pre- and post-measurement and 3- and 6-month follow-up. The authors followed up 324 eighth graders in both groups. School classes were randomly assigned to one of the two groups. The prevention program, LISA-T, is based on cognitive-behavioral therapy concepts and targets of cognitive and social aspects. It comprises 10 meetings of 1.5 hours in a regular school setting. RESULTS: Increases in depressive symptoms in nondepressed adolescents in the training group were prevented over a 6-month period. Furthermore, adolescents with subsyndromal depression in the training group reported fewer symptoms, whereas depressive symptoms within the control group did not change. However, the groups did not differ with regard to social skills, frequency of negative automatic thoughts, and depressive symptoms before the prevention program. CONCLUSIONS: LISA-T is an effective school-based prevention program for eighth graders with minimal to mild depressive symptoms, but further research is needed.     

Treatment and Prevention of Depression and Anxiety in Youth: Test of Cross-Over Effects

Anxiety and depression are highly comorbid and share several common etiological processes. Therefore, it may be more efficient to develop interventions that treat or prevent these problems together rather than as separate entities. The present meta-analytic review examined whether interventions for children and adolescents that explicitly targeted either anxiety or depression showed treatment specificity or also impacted the other outcome (i.e. cross-over effects). We addressed this question both within the same type of study (i.e. treatment, prevention) and across study types. Only randomized controlled trials (RCTs) that assessed both constructs with dimensional measures were included in this review. For treatment studies, RCTs targeting anxiety (n = 18) showed significant effects on both anxious and depressive symptoms, although more strongly on anxiety than depression; similarly, RCTs treating depression (n = 9) yielded significant effects on both depressive and anxious symptoms, but stronger effects on depression than anxiety. Thus, there were cross-over effects in treatments purportedly targeting either anxiety or depression, and also treatment specificity, such that larger effects were seen for the target problem at which the treatment was aimed. Anxiety prevention studies (n = 14) significantly affected anxious, but not depressive symptoms, indicating no cross-over effect of anxiety prevention trials on depression. For depression prevention studies (n = 15), the effects were not significant for either depressive or anxiety symptoms, although the effect was significantly larger for depressive than for anxious symptoms. Post-hoc analyses revealed that the effect on depressive symptoms was significant in depression preventions trials of targeted but not universal samples. Implications for transdiagnostic interventions are discussed.     

The specificity of cognitive vulnerabilities to emotional disorders: anxiety sensitivity, looming vulnerability and explanatory style

Mood and anxiety disorders share considerable phenomenological and diagnostic overlap. Several models have advanced the understanding of the phenomenological overlap of anxiety and depression; however, identification of disorder-specific etiological mechanisms remains elusive. Recently, research has advanced several cognitive vulnerability-stress models proposing that one's characteristic way of attending to, interpreting, and remembering negative events contributes vulnerability to psychopathology. These cognitive vulnerabilities may elucidate specific etiological mechanisms that distinguish mood and anxiety pathology. The present study examines the specificity of three cognitive vulnerability constructs, the looming cognitive style, anxiety sensitivity, and explanatory style, in the prediction of latent anxiety disorder symptoms and latent depression symptoms. Structural equation modeling analyses indicated that the looming cognitive style demonstrated specificity predicting only anxiety disorder symptoms whereas anxiety sensitivity and a pessimistic explanatory style predicted both anxiety disorder and mood disorder symptoms. Implications for future research are discussed.     

The relationship between adverse childhood experience and obsessive-compulsive symptoms and beliefs: The role of anxiety, depression, and experiential avoidance

Current cognitive-behavioral models of the etiology of obsessive-compulsive disorder (OCD) suggest that maladaptive appraisal of otherwise normal intrusive thoughts have their origins in early learning experiences. The present study investigated the relationship between adverse childhood experience and OCD symptoms and related dysfunctional beliefs in a general population using a structural equation modeling approach. The role of experiential avoidance and anxiety and depression were also explored in the model. Results indicated that adverse childhood experience was strongly associated with OCD symptoms and beliefs, but after controlling for anxiety and depression the relationship with OCD symptoms became non-significant and only a weak relationship with OCD beliefs remained. Experiential avoidance was significantly associated with OCD symptoms and beliefs and remained significant after controlling for anxiety and depression. Implications of these results in the context of a complete model of the development of OCD are discussed.     

Symptoms of anxiety and depression in the course of cognitive decline

BACKGROUND/AIMS: Anxiety and depression are common inpatients with cognitive decline and Alzheimer's disease (AD), and recognition and treatment of these symptoms can improve their quality of life. The present study investigates anxiety and depression in different phases of cognitive decline. METHODS: The sample consisted of five groups of elderly people in different phases of cognitive decline; four from a community-based sample (Longitudinal Aging Study Amsterdam), and one group of elderly people diagnosed with AD. ANOVAs were performed to investigate group differences in the severity and prevalence of anxiety and depression, and comorbid anxiety and depressive symptoms. RESULTS: The prevalence rates of anxiety, comorbid anxiety and depressive symptoms and depressive symptoms follow a pattern of an increasing prevalence as cognitive performance declines and a decrease in the prevalence when cognitive functioning is severely impaired. AD patients report fewest anxiety symptoms. CONCLUSION: We found that the prevalence of anxiety symptoms, depressive symptoms and comorbid anxiety and depressive symptoms seems to increase in the early phase of cognitive decline, and decreases as cognitive functioning further declines. Elderly diagnosed with AD report less anxiety as expected, probably due to lack of insight caused by AD.     

How ruminative thinking styles lead to dysfunctional cognitions: evidence from a mediation model

Background and Objectives

Dysfunctional attitudes and a ruminative thinking style are of utmost clinical importance because they are found to be crucially implicated in depression vulnerability. In this study, based on the Diathesis-Stress model (Beck, 1967) and the Differential Activation Hypothesis (Teasdale, 1988), we investigated whether inter-individual differences in a ruminative thinking style would be related to the development of depressive symptoms, leading to the activation of dysfunctional attitudes under stress.

Methods

Seventy-six never depressed undergraduate students completed internet questionnaires measuring rumination, depressive symptoms and dysfunctional attitudes at 4 fixed moments in time (T1, T2, T3, T4): T1 was performed six weeks before their exams (considered as a low stress period); T2, T3 and T4 were performed during three consecutive weeks in their final exams (considered as life stress event).

Results

As expected, results revealed that the relationship between rumination, measured both out of (T1) and in (T2) a stressful period, and dysfunctional attitudes (measured at T4) was mediated by increased depressive symptoms (measured at T3).

Limitations

Because the questionnaire for rumination was developed in the context of understanding responses to depressive symptoms, there might be a construct overlap between the predictor and the mediator of the models that were tested. Moreover, because only healthy undergraduates were included, our results demonstrate a decreased generalizability.

Conclusions

These findings indicate that rumination can be conceived as a stable and underlying mechanism leading to depressed mood and dysfunctional attitudes under stress. Moreover, our findings highlight that clinical interventions should not only target dysfunctional schemas and attitudes, but might also benefit from the use of procedures aimed at changing processes such as a ruminative thinking style.     

Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: Exploring mechanisms of change

The purpose of this study was to evaluate treatment specificity and potential mediators of two online therapies for depressive symptoms. We conducted a randomized controlled trial in which 263 participants were randomized to online cognitive behavioral therapy (CBT), online problem-solving therapy (PST) or a waiting list control group. Both treatments were more effective than the control group in reducing dysfunctional attitudes, worry, negative problem orientation and enhancing feelings of control. No differences between the treatments were found on each of the potential mediators. Furthermore, results suggest that dysfunctional attitudes, worrying, a negative problem orientation and perceived control all played a mediating role in CBT as well as in PST. Our findings suggest that regardless of the theoretical background to the therapy, the psychological processes necessary for symptom reduction seem to be comparable.     

Do anxiety sensitivity cognitive concerns and/or depression symptoms independently explain sleep disturbances in a high anxiety sensitive treatment-seeking sample?

Cognitive models of insomnia posit a role for anxiety sensitivity (AS) in sleep difficulties. While sleep disturbances have been linked to AS, particularly AS cognitive concerns, prior studies have rarely accounted for the correlated construct of depression. We used pre-treatment intervention trial data from 128 high AS, treatment-seeking adults with a DSM-5 diagnosis of an anxiety, depressive, or posttraumatic stress disorder to determine whether AS cognitive concerns and/or depression are independently associated with sleep impairment domains (e.g., sleep quality, latency, daytime dysfunction). Participants provided data on AS, depressive symptoms, and sleep impairments. AS cognitive concerns (but not other AS dimensions) were correlated with four of five sleep impairment domains; depression was correlated with all five. Multiple regressions revealed four of five sleep impairment domains were predicted by depression with no independent contribution of AS cognitive concerns. In contrast, AS cognitive concerns and depression were independently associated with daytime dysfunction. Results suggest previous findings linking AS cognitive concerns to sleep impairments may have been largely secondary to the overlap of cognitive concerns with depression. Findings demonstrate the importance of incorporating depression into the cognitive model of insomnia. Both AS cognitive concerns and depression may be useful targets for reducing daytime dysfunction.