eabct the hague 2014
DESCRIPTION
Metacognitions and thought control strategies in unipolar major depression: A comparison of currently depressed, previously depressed and never-depressed individualsTRANSCRIPT
METACOGNITIONS AND THOUGHT CONTROL STRATEGIES IN UNIPOLAR MAJOR DEPRESSION: A COMPARISON OF CURRENTLY DEPRESSED, PREVIOUSLY DEPRESSED, AND NEVER-DEPRESSED INDIVIDUALS
Marianne Halvorsen, PhD Specialist in Clinical Neuropsychology
University Hospital of North Norway EABCT The Hague 2014
METACOGNITIVE MODEL ! Thinking styles and metacognitions.
! Cognitive-attentional syndrome (CAS): ! Heightened self-focus, repetitive
negative thinking, maladaptive coping behaviour and threat monitoring.
Wells 2000;2009; Wells & Matthews, 1994
PREVIOUS RESEARCH ! Rumination and metacognitions in either healthy
samples or already depressed individuals. ! Lack of studies investigating:
! metacognitions in different phases of MDD. ! worry-related metacognitions in MDD. ! a broader range of thought control strategies
! worry (“I dwell on other worries”)*
! distraction (“I keep myself busy”)*
! reappraisal (“ I try to reinterpret the thought”)*
* Thought Control Questionnaire (Wells & Davies, 1994); Halvorsen et al. in press.
THE PRESENT STUDY
! Aim: ! To explore how worry-related
metacognitions and a broad range of thought control strategies differentiated: ! currently depressed individuals (n =37) ! those who had recovered (n =81) ! never depressed individuals (n = 50)
METHODS ! Participants/ procedure:
! The University outpatient clinic in Tromsø, Norway.
! Convenience sample.
! All participants were non-hospitalized.
Tromsø, pop. 72.000
PARTICIPANTS/PROCEDURE ! Diagnoses were based on DSM-IV-TR using
the SCID-I interview: ! Including:
a) currently depressed b) having previously experienced a major
depressive episode in the past and fully recovered for at least the last 8 weeks or longer.
c) having never been clinically depressed ! Excluding:
! MDE in partial remission, on-going/past manic/hypomanic episode, dysthymic disorder, or psychotic symptoms. Participants with a history of known brain damage or a MDE due to a general medical condition.
Description of the design/samples see Halvorsen et al. (2010, 2011, 2014)
DEMOGRAPHIC AND CLINICAL CHARACTERISTICS (N= 168) Variable Currently
depressed (n = 37) M(SD)
Previously depressed
(n = 81) M(SD)
Never-depressed
(n = 50) M(SD)
Significant test
Female/male 27/10 71/10 39/11 X2(2) = 4.23, p = .12
Age 37.49 (11.98) 37.42 (9.61) 38.06 (12.66) F(2,165) = 0.06, p = .95
Education, y. 13.76 (3.84) 15.12 (2.64) 15.10 (3.63) F(2,165) = 2.53, p = .08
BDI-II 24.00 (9.06) 6.94 (7.21) 2.71 (3.04) F(2,162) = 114.74, p <.001, 1>2>3
BAI 17.41 (9.81) 6.42 (6.30)
2.35 (2.76) F(2,164) = 58.75, p <.001, 1>2>3
Antidepressant 17.41 (9.81)
6.42 (6.30) X2 (1) = 3.43, p = .06
Single/recurrent MDE
10/27 26/55 X2 (1) = 0.31, p = .58
MEASURES ! The Metacognitions Questionnaire-30 (MCQ-30; Wells &
Cartwright-Hatton, 2004).
! Positive beliefs about worry (e.g., “Worrying helps me to solve problems”)
! Negative beliefs about worry concerning uncontrollability and danger (e.g., “When I start worrying I cannot stop”)
! Cognitive confidence (e.g., “I do not trust my memory”)
! Need of control (e.g., “It is bad to think certain thoughts”)
! Cognitive self-consciousness (e.g., “I monitor my thoughts”).
MEASURES ! The Thought Control Questionnaire (TCQ; Wells &
Davies, 1994). ! Distraction (e.g., “I keep myself busy”) ! Punishment (e.g., “I tell myself not to be so stupid”). ! Worry (e.g., I dwell on other worries”) ! Social Control (e.g., “I talk to a friend about the
thought”) ! Reappraisal (e.g., “I try to reinterpret the thought”).
! The Ruminative Response Scale (RRS; Nolen-Hoeksema & Morrow, 1991) ! RRS-total score used (e.g., “I think about how alone I
feel”.
Table 2 Means and standard deviations of predictor variables as a function of group membership (N = 168) Predictor variable
Currently depressed (n = 37) M (SD)
Previously
depressed (n = 81) M (SD)
Never
depressed (n = 50) M (SD)
RRS-total
56.57 (11.65)
43.38 (12.31)
32.04 (7.09)
MCQ-30 Positive beliefs Negative beliefs Cognitive confidence Need of control Cognitive self-consciousness
9.54 (3.60)
14.54 (4.29) 13.84 (4.98) 11.97 (3.50) 13.19 (3.55)
8.14 (2.85)
10.70 (4.16) 9.74 (3.53) 8.80 (2.77)
12.41 (3.76)
8.44 (2.36)
8.34 (1.67) 9.54 (2.74) 8.74 (2.33)
11.84 (3.69)
TCQ Distraction Punishment Reappraisal Worry Social control
13.83 (3.28) 10.97 (3.90) 14.19 (3.96) 12.03 (2.56)
13.25 (1.80)
14.91(2.99) 9.61 (2.72)
15.20 (3.58) 10.14 (2.45) 12.89 (2.24)
15.94 (2.52) 8.28 (1.62)
13.18 (4.15) 9.32 (2.18)
12.60 (2.21)
Note. MCQ Metacognitive Questionnaire; RRS Ruminative Response Scale; TCQ Thought Control Questionnaire
SUMMARY OF CANONICAL DISCRIMINANT FUNCTIONS
Eigenvalues
Function Eigenvalue % of Variance Cumulative %
Canonical
Correlation
1 ,828a 79,9 79,9 ,673
2 ,208a 20,1 100,0 ,415
a. First 2 canonical discriminant functions were used in the analysis.
Wilks' Lambda
Test of Function(s) Wilks' Lambda Chi-square df Sig.
1 through 2 ,453 125,188 22 ,000
2 ,828 29,898 10 ,001
Table 3 Structure matrix: Pooled within-groups correlations between discriminating variables and standardized canonical discriminant functions.
*Largest absolute correlation between each variable and any discriminant function. MCQ Metacognitive Questionnaire; RRS Response Style Questionnaire; TCQ Thought Control Questionnaire
Variable Function 1 Function 2 RRS-total .91* -.04 MCQ-Negative beliefs .68* .12 TCQ-Worry .44* .17 TCQ-Punishment .39* -.04 TCQ-Distraction -.29* -.05 MCQ-Cognitive self-consciousness .15* .01 TCQ-Social control .12* .03 MCQ-Need of control .45 .56* MCQ-Cognitive confidence .47 .56* TCQ-Reappraisal .11 -.45* MCQ-Positive beliefs .15 .30*
!
Never%depressed%
Previously%depressed%
Currently%depressed%
22%
21%
0%
1%
2%
22% 21% 0% 1% 2%
Group!centroid!
CAS: MCQ-Negative beliefs RRS-Rumination TCQ-Worry TCQ-Punishment %
MCQ-Need of control MCQ-Low cognitive confidence MCQ-Positive beliefs
TCQ-Distraction
TCQ-Reappraisal
Figure 1. Perceptual map of groups in discriminant space. CAS Cognitive Attentional Syndrome; MCQ Metacognitive Questionnaire; RRS Response Style Questionnaire; TCQ Thought Control Questionnaire
CONCLUSION ! Function 1 discriminated among each of the
groups: ! Never-depressed used more distraction ! Currently depressed used rumination,
worry and punishment as self-regulatory strategies and hold strong beliefs about the uncontrollability/danger of thinking.
! Previously depressed group was in-between: ! CAS and negative metacognitions have
stable-trait like properties that distinguish depression-prone individuals from those who are not vulnerable.
CAS = cognitive- attentional syndrome
CONCLUSION ! Function 2: Never-depressed and currently
depressed did not differ, suggesting it is not specific to current depression. ! Recovery? ! Use of reappraisal among previously depressed.
! Not a ’normal’ state? ! Previously depressed may still have ”extended
processing” = CAS activated, but their content has changed.
! Further studies should examine if the use of reappraisal can generate counterproductive effects later on by keeping the CAS (i.e., extended thinking) activated. ! Relapse marker?
LIMITATIONS ! Only information regarding current antidepressant
medication use. ! Future studies should assess exposure to other
treatments. ! We did not assess the presence of comorbid Axis-I
disorders among the participants. ! The low mean score on BAI for the previously
depressed indicated that few had clinical levels of anxiety symptoms.
! No conflict-of-interest. ! Co-researchers:
! Roger Hagen, Odin Hjemdal, Norwegian University of science and Technology.
! Knut Waterloo, Martin Eisemann, Catharina Wang University of Tromsø, Norway.
THANK YOU!