Cognitive aspects of chronic depression

Article (PDF Available)inJournal of Abnormal Psychology 112(1):72-80 · March 2003with125 Reads
DOI: 10.1037//0021-843X.112.1.72 · Source: PubMed
Previous research on chronic depression has focused on its link with other mood disorders and Axis II personality disorders. However, there are few data examining whether the cognitive perspective applies to this condition. In this cross-sectional study, 42 outpatients with chronic depression were compared with 27 outpatients with nonchronic major depressive disorder and 24 never psychiatrically ill controls on cognitive variables thought to be related to vulnerability to depression (e.g., dysfunctional attitudes, attributional style, a ruminative response style, and maladaptive core beliefs). Both depressed groups were more elevated than a never-ill comparison group. However, chronically depressed individuals were generally more elevated on measures of cognitive variables than those with major depressive disorders even after controlling for mood state and personality disorder symptoms.
    • "This is particular striking taking into account that both psychological variables have been proved to intervene as predictor variables for the treatment outcomes in other mental disorders such as borderline personality disorder, obsessive-compulsive disorder or eating disorders (Bedics, Atkins, Harned, & Linehan, 2015; Fitzpatrick, & Weltzin, 2014; Keeley, Geffken, Ricketts, McNamara, & Storch, 2011). Furthermore, relative to patients with non-chronic depressive mood those with dysthymia or chronic depression have also reported poorer scores on psychological variables such self-efficacy and adaptive coping strategies, which in turn have been postulated as maintenance psychological variables for depressive episodes (Riso et al., 2003; Wiersma et al., 2011). In spite of this evidence, there are no studies aimed at addressing how these additional prominent psychological variables may predict the response and attendance to treatment among dysthymic patients. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Dysthmia constitutes a chronic, mild affective disorder characterized by heterogeneous treatment effects. Several predictors of clinical response and attendance have been postulated, although research on the role of the psychological variables involved in this mental disorder is still scarce. Method: Fifty-four adult patients, who met criteria for dysthymia completed an ongoing naturalistic treatment based on the brief interpersonal psychotherapy (IPT-B), which was delivered bimonthly over 16 months. As potential predictor variables, the therapeutic alliance, coping strategies, perceived self-efficacy, and motivation for change were measured at baseline. Outcome variables were response to treatment (Clinical Global Impression and Beck’s Depression Inventory) and treatment attendance. Results: Stepwise multiple linear regression analyses revealed that higher motivation for change predicted better response to treatment. Moreover, higher motivation for change also predicted treatment attendance. Therapeutic alliance was not a predictor variable of neither clinical response nor treatment attendance. Conclusions: These preliminary findings support the adjunctive use of motivational interviewing (MI) techniques in the treatment of dysthymia. Further research with larger sample size and follow-up assessment is warranted.
    Full-text · Article · Jan 2016
    • "That is, the memory accuracy of negative affective pictures was significantly greater than that of positive affective pictures in the MDD group, but there was no such significant difference found in the HC group. There may be three possible explanations for the mood-congruent memory effect in depressive patients: First, because the maintaining of depressive state is related to increasing negative cognition and contemplation [42,43], the internal concentration of unconscious negative processing would use cognitive resources (particularly the resource of attention). The occupation of these limited resources would affect the processing of positive information, leading to a drop in memory performance on positive emotional information. "
    Article · Jan 2016 · Trials
    • "However, approximately one third of the patients do not respond satisfactorily to the treatment [4, 5], and post-treatment residual symptoms are a common problem; as many as 30–50 % of remitted patients experience residual symptoms at the end of treatment [6]. Residual symptoms of depression are associated with ongoing psychosocial and functional disability and have been demonstrated to predict poorer long-term outcome of major depression, including increased rates of relapse789 . A recent metaanalysis reports relapse rates of around 29 % within 1 year and 56 % within 2 years [10]. "
    [Show abstract] [Hide abstract] ABSTRACT: Cognitive behavioural therapy is an effective treatment for depression. However, one third of the patients do not respond satisfactorily, and relapse rates of around 30 % within the first post-treatment year were reported in a recent meta-analysis. In total, 30-50 % of remitted patients present with residual symptoms by the end of treatment. A common residual symptom is rumination, a process of recurrent negative thinking and dwelling on negative affect. Rumination has been demonstrated as a major factor in vulnerability to depression, predicting the onset, severity, and duration of future depression. Rumination-focused cognitive behavioural therapy is a psychotherapeutic treatment targeting rumination. Because rumination plays a major role in the initiation and maintenance of depression, targeting rumination with rumination-focused cognitive behavioural therapy may be more effective in treating depression and reducing relapse than standard cognitive behavioural therapy. This study is a two-arm pragmatic randomised controlled superiority trial comparing the effectiveness of group-based rumination-focused cognitive behaviour therapy with the effectiveness of group-based cognitive behavioural therapy for treatment of depression. One hundred twenty-eight patients with depression will be recruited from and given treatment in an outpatient service at a psychiatric hospital in Denmark. Our primary outcome will be severity of depressive symptoms (Hamilton Rating Scale for Depression) at completion of treatment. Secondary outcomes will be level of rumination, worry, anxiety, quality of life, behavioural activation, experimental measures of cognitive flexibility, and emotional attentional bias. A 6-month follow-up is planned and will include the primary outcome measure and assessment of relapse. The clinical outcome of this trial may guide clinicians to decide on the merits of including rumination-focused cognitive behavioural therapy in the treatment of depression in outpatient services. Identifier: NCT02278224 , registered 28 Oct. 2014.
    Full-text · Article · Dec 2015
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