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.     

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.     

Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder

Background and ObjectivesNegative automatic associations towards the self and social cues are assumed to play an important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n = 45) and panic disorder patients (n = 24) and whether there existed gender differences in this respect.MethodsWe used a single-target Implicit Association Test and an Implicit Association Test to measure dysfunctional automatic associations with social cues and implicit self-esteem, respectively.ResultsResults showed that automatic associations with social cues were more dysfunctional in socially anxious patients than in both control groups, suggesting this might be a specific characteristic of social anxiety disorder. Socially anxious patients showed relatively low implicit self-esteem compared to non-clinical controls, whereas panic disorder patients scored in between both groups. Unexpectedly, we found that lower implicit self-esteem was related to higher severity of social anxiety symptoms in men, whereas no such relationship was found in women.ConclusionsThese findings support the view that automatic negative associations with social cues and lowered implicit self-esteem may both help to enhance our understanding of the cognitive processes that underlie social anxiety disorder.     

Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up

Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).     

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.     

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.     

Seasonal variation in mood in African American college students in the Washington, D.C., metropolitan area

OBJECTIVE: The authors attempted to estimate the occurrence, frequency, and pattern (winter versus summer) of seasonal affective disorder in African American college students. They hypothesized that winter seasonal affective disorder would be more prevalent than summer seasonal affective disorder. METHOD: Undergraduate and graduate college students who identified themselves as African Americans living in the Washington, D.C., metropolitan area were invited to participate in the study. The Seasonal Pattern Assessment Questionnaire was used to calculate a global seasonality score and to estimate the frequency of seasonal affective disorder and subsyndromal seasonal affective disorder. The frequency of the summer versus winter pattern of seasonality of seasonal affective disorder was compared by using multinomial probability distribution tests. The effects of gender and the awareness of seasonal affective disorder were evaluated with a two-way analysis of variance. RESULTS: Of 646 students who were invited to participate, 597 returned the questionnaires, and 537 (83.1%) fully completed them. Winter seasonal affective disorder was significantly more prevalent than summer seasonal affective disorder. The mean global seasonality score was 8.3 (SD=5.3). The majority of the subjects (80%) were not aware of the existence of seasonal affective disorder. CONCLUSIONS: The authors found that the frequency, magnitude, and pattern of seasonality of mood in African American students were similar to those previously reported in the general population at similar latitude, but that awareness of the existence of seasonal affective disorder, a condition with safe and effective treatment options, was lower.     

Evaluating implicit attractiveness beliefs in body dysmorphic disorder using the Go/No-go Association Task

Cognitive-behavioral models of body dysmorphic disorder (BDD) suggest the disorder is characterized by exaggerated beliefs about the significance of appearance. However, previous studies assessing automatic associations regarding the importance of attractiveness failed to find any differences between individuals with BDD and healthy control participants using the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998). An open question is whether the BDD and control groups indeed implicitly evaluate attractiveness comparably, or whether methodological factors (e.g., the IAT design requirement of a relative comparison category for attractiveness) made it difficult to observe group differences. To address this question, we evaluated explicit and implicit attractiveness beliefs among individuals with BDD (n = 36), individuals with a dermatological condition (n = 36), and psychiatrically healthy control participants (n = 36) using the single target category Go/No-go Association Task (GNAT; Nosek, & Banaji, 2001). Indeed, BDD participants had significantly stronger implicit associations between attractive and important, relative to the other groups, whereas there was no difference between the dermatology and control groups. Further, the GNAT was effective at classifying individuals with BDD above and beyond the prediction offered by an explicit measure of attractiveness beliefs. The GNAT may be a useful tool for assessing implicit associations in clinical populations because it does not require an explicit comparison target category, which is a restriction of many implicit measures.     

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.     

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).     

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.     

Dysfunctional Attitudes and Perfectionism and Their Relationship to Anxious and Depressive Symptoms in Boys with Autism Spectrum Disorders

In spite of increasing interest in cognitive behaviour therapy for emotional disorders in children with autism spectrum disorders (ASD), little research has explored the relevance of the cognitive model in this population. This study explores dysfunctional attitudes and perfectionism in boys with ASD and the relationship with anxious and depressive symptoms. Compared to a typically developing group (n = 42), boys with ASD (n = 41) endorsed more dysfunctional attitudes and reported higher emotional symptoms. The relationship between emotional and cognitive variables was weak in both groups, although in the ASD group dysfunctional attitudes were significantly associated with reported obsessive–compulsive symptoms. Reasons for elevated dysfunctional attitudes in the ASD group are discussed and the roles of cognitive inflexibility and social impairments are explored.     

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.     

Implicit gambling attitudes in problem gamblers: Positive but not negative implicit associations

BACKGROUND AND OBJECTIVES: Implicit attitudes (associations) are involved in the generation of substance use behaviors. However, little is known about the role of this automatic cognitive processing in deregulated behaviors without substance use, such as abnormal gambling. This study examined whether problem gamblers exhibit both positive and negative implicit attitudes toward gambling-related stimuli. METHODS: Twenty-five problem gamblers and 25 control participants performed two unipolar (pleasant; unpleasant) Single-Target Implicit Association Tasks (unipolar ST-IAT), in which gambling pictures were associated with either pleasant (or unpleasant for the negative unipolar ST-IAT) or neutral words. Explicit attitudes toward gambling were also recorded. RESULTS: We found in problem gamblers: (i) both positive implicit and explicit attitudes toward gambling; (ii) no negative implicit gambling association; (iii) that only positive explicit attitudes positively correlated with the gambling severity score. LIMITATIONS: (i) the use of only one type of reaction time task; (ii) the use of both words and pictures in a same IAT; (iii) problem gamblers have been compared to non-gamblers instead of being contrasted with healthy non-problem gamblers. CONCLUSIONS: Whereas our gamblers experienced deleterious effects related to gambling, implicit attitude toward gambling remained positive, thus hampering attempts to quit gambling. Possible clinical interventions targeting implicit cognition in problem gamblers were discussed.     

Cultural differences in depression-related stigma in late-life: a comparison between the USA, Russia, and South Korea

ABSTRACT Background: Depression is a common and treatable illness in late-life. However, many do not seek treatment and may suffer from the stigma of the illness, which may vary across cultures. The aim of this study was to compare attitudes about depression in primary care practices in South Korea, Russia, and the USA. Methods: A cross-sectional study was undertaken using a self-administered questionnaire and PHQ-9 diagnostic survey with 1,094 patients aged 60-93 years who attended a primary care clinic in Korea, Russia, or the USA. Results: The mean age of participants was 71 years, with 61% being female. US patients were older and had higher education levels. Russian participants were more likely to be widowed and had lower self-rated health. The majority of participants agreed that depression is a kind of disease (Korea 77%, Russia 61%, USA 79%). Only 6% of US patients believed depression means a person is weak, compared to 78% (Korea) and 61% (Russia). Fewer US patients endorsed depression as a normal part of aging (29% vs. Korea at 42% and Russia at 54%). Among participants in the USA, age correlated negatively with endorsement of a medical model of depression (p = <0.001). Conclusions: Though there was wide variation between countries in attitudes about depression, the majority of each endorsed items reflected a medical model of depression. Korean and Russian participants endorsed the view of depression as a personal weakness more than participants in the USA. Demographic correlates of negative attitudes about depression were moderate to weak.     

Religious Coping Style and Cultural Worldview are Associated with Suicide Ideation Among African American Adults

The purpose of this study was to examine whether specific religious coping styles and cultural worldview would be associated with thoughts of suicide given higher levels of stress in a community-based sample of African American adults. African American men and women (n?=?134) completed measures of religious coping, cultural worldview, stressful life events, depression symptoms, and suicide ideation. Higher ratings of suicide ideation were observed for African Americans who endorsed a more self-directing religious coping style. The self-directing religious coping was more frequently endorsed by participants who identified with a more Eurocentric cultural worldview that espouses an individualist philosophy. Together, these findings provide some insight to how religious coping and culture are related to suicide vulnerability for African Americans who are not in clinical care.     

Nocturnal cognitive hyperarousal,perinatal-focused rumination,and insomnia are associated with suicidal ideation in perinatal women with mild to moderate depression

ObjectivesThis prospective study explored associations among insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with depression.MethodsFrom late pregnancy through early postpartum, 39 depressed women completed 17 weekly surveys assessing SI, insomnia, depression, stress, and cognitive arousal.ResultsWomen with nocturnal cognitive hyperarousal at baseline, relative to those with low cognitive arousal, were at greater risk for new onset SI (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR = 5.66, p = 0.037) or perinatal-focused rumination (OR = 11.63, p = 0.018). Daytime perseverative thinking was not uniquely associated with SI.ConclusionsNocturnal cognitive arousal predicts the development of new onset SI, and perinatal-focused rumination is also uniquely associated with SI-risk in late pregnancy and early parenting. Critically, SI-risk is highest when perinatal women endorsed insomnia and high cognitive arousal at the same time. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression.     

Decreased cortisol response to awakening is associated with cognitive vulnerability to depression in a nonclinical sample of young adults

Due to its high intraindividual stability, the cortisol awakening response (CAR) may be regarded as a trait measure of the dynamics of the HPA-axis activity. The present study aimed at investigating associations of the CAR with rumination as a cognitive vulnerability marker for depression assessed by both a trait measure and by experimental manipulation. After induction of sad mood by viewing a sad sequence of a movie, 42 healthy university students were randomly induced to either ruminatively self-focus on their feelings or to distract themselves from their mood by concentrating on respective text cards for 8min. Trait rumination and distraction were measured by the Response Styles Questionnaire (RSQ) at baseline (T0), while current mood was recorded before (T1) and after (T2) the mood induction as well as after the rumination/distraction induction (T3) using the Positive and Negative Affect Schedule (PANAS). Basal saliva cortisol levels were measured independently on a different day. After mood induction, levels of mood were lowered significantly. Participants subsequently induced to ruminate kept their negative mood whereas participants induced to distract themselves showed a reduction in negative mood. Self-focused trait rumination amplified low mood in both induction conditions. A decreased CAR was associated with self-focused rumination and with less improvement of sad mood after induced distraction. We conclude that the two variables apparently share specific vulnerability qualities towards depression by hampering the adaptive shift of attention to external cues during dysphoric moods, probably involving lowered disinhibition of task-irrelevant negative emotional processing. The present study provided first indications of a possible relationship between a cognitive vulnerability marker for depression and characteristics of basal neuroendocrine activity regarding their association with the course of experimentally induced dysphoric mood.     

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.     

Implicit motives and cognitive variables: Specific links to vulnerability for unipolar or bipolar disorder

Cognitive variables contribute to the etiology of affective disorders. With the differentiation between explicit and implicit measures some studies have indicated underlying depressogenic schemata even in bipolar disorders. We tested for differences in implicit motives and cognitive variables between patients with remitted unipolar and bipolar disorder compared to controls and in a high-risk sample. Additionally we investigated whether affective symptoms relate to those variables. We cross-sectionally examined N=164 participants (53 with bipolar disorder, 58 with major depression, and 53 without affective disorders) and a high-risk sample (N=49) of adolescent children of either parents with unipolar or bipolar disorder or of healthy parents. The Multi-Motive-Grid was used to measure the implicit motives achievement, affiliation, and power, in addition to the cognitive measures of self-esteem, dysfunctional attitudes, and perfectionism. Unipolar and bipolar groups did not differ from healthy controls in implicit motives but showed higher scores in the cognitive factors. Adolescents at high risk for unipolar disorder showed lower scores in the power and achievement motives compared to adolescents at low risk. Subsyndromal depressive symptoms were related to the cognitive variables in both samples. Our results underline the importance of cognitive-behavioral treatment for both unipolar and bipolar disorder.