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

Mechanisms driving pre- and post-stressor repetitive negative thinking: Metacognitions, cognitive avoidance, and thought control

Background and objectives: Repetitive negative thinking (RNT) is common to multiple emotional disorders and occurs before, during, and following a stressor. One replicated difference between common forms of RNT such as worry and rumination is temporal orientation towards a stressor, with worry being more future-oriented and rumination more past-oriented. Different mechanisms may drive RNT at these different time points. The aim of Study 1 was to examine whether previously demonstrated relationships between post-stressor RNT and mechanisms theorized to drive engagement in RNT, including metacognitive beliefs, cognitive avoidance strategies, and thought control strategies, would be replicated with anticipatory (pre-stressor) RNT. The aim of Study 2 was to replicate these associations in a new sample that completed measures of both pre- and post-stressor RNT.Method: Participants in Study 1 (N = 175) completed the RNT-L in anticipation of a stressor, along with measures of metacognitive beliefs, cognitive avoidance strategies, and thought control strategies. Participants in Study 2 (N = 91) completed the measures both before and after a stressor. Results: Pre- and post-stressor RNT were significantly correlated with all three mechanism measures. Metacognitive beliefs that RNT is uncontrollable and dangerous, and the thought control strategy of punishment, were most consistently and uniquely associated with RNT at both time-points.Limitations: Replication with clinical samples and with reference to a broader array of stressors is required. The correlational design precluded causal conclusions.Conclusions: Common and possibly some distinct mechanisms drive RNT before and after a stressor

Intolerance of Uncertainty as a Contributor to Fear and Avoidance Symptoms of Panic Attacks

Panic disorder symptoms are persistent for 50–80% of cases even after treatment, resulting in experiences of disability and dissatisfaction in life. Previous research has focused on anxiety sensitivity (AS) and its dimensions as contributing to symptoms of panic disorder; however, recent research has suggested that intolerance of uncertainty (IU)—the tendency for a person to consider the possibility of a negative event occurring as threatening, irrespective of the actual probability of its occurrence—may also play a critical role. The current study was designed to assess the specific relationships between dimensions of IU (i.e. prospective IU and inhibitory IU) and the fear and avoidance symptoms associated with panic disorder. Participants included 122 community members (81% women) with a history of at least one panic attack who participated in a larger study on fear. Participants completed measures of AS, IU, and panic disorder symptoms. Correlation and regression analyses supported a significant and substantial relationship between AS, inhibitory IU, and panic disorder symptoms. Inhibitory IU accounted for relatively more variance in avoidance symptoms related to panic disorder than did the fears of physical sensations dimension of AS. As such, further investigation of the role of IU in panic disorder symptoms appears warranted. Comprehensive results, implications, and directions for future research are discussed

Imagery enhancements increase the effectiveness of cognitive behavioural group therapy for social anxiety disorder: A benchmarking study

Emerging evidence suggests that imagery-based techniques may enhance the effectiveness of traditional verbal-linguistic cognitive interventions for emotional disorders. This study extends an earlier pilot study by reporting outcomes from a naturalistic trial of an imagery-enhanced cognitive behavioural group therapy (IE-CBGT, n=53) protocol for social anxiety disorder (SAD), and comparing outcomes to historical controls who completed a predominantly verbally-based group protocol (n=129). Patients were consecutive referrals from health professionals to a community clinic specialising in anxiety and mood disorders. Both treatments involved 12, two-hour group sessions plus a one-month follow-up. Analyses evaluated treatment adherence, predictors of dropout, treatment effect sizes, reliable and clinically significant change, and whether self-reported tendencies to use imagery in everyday life and imagery ability predicted symptom change. IE-CBGT patients were substantially more likely to complete treatment than controls (91% vs. 65%). Effect sizes were very large for both treatments, but were significantly larger for IE-CBGT. A higher proportion of the IE-CBGT patients achieved reliable change, and better imagery ability was associated with larger symptom change. Outcomes compared very favourably to published group and individual treatments for SAD, suggesting that IE-CBGT may be a particularly effective and efficient mode of treatment delivery

Repetitive Negative Thinking in Anticipation of a Stressor

Repetitive negative thinking (RNT) has been confirmed as a transdiagnostic phenomenon, but most measures of RNT are contaminated with diagnosis-specific content. The first aim of this study was to examine the structure of an anticipatory version of the Repetitive Thinking Questionnaire (RTQ-Ant) as a trans-emotional measure of anticipatory RNT. The original RTQ was completed with reference to a past stressor, whereas the RTQ-Ant instructs respondents to link their responses to a future stressor. The second aim was to test if the associations between a range of emotions (anxiety, depression, shame, anger, general distress) and the original post-stressor version of the RTQ would be replicated. Undergraduates (N = 175, 61% women) completed the RTQ-Ant, along with measures of various emotions, with reference to upcoming university exams. Principal axis factor analysis yielded many similarities between the original post-event RTQ and the RTQ-Ant, and some differences. The RTQ-Ant was comprised of two subscales: the RNT subscale measures engagement in repetitive thinking, negative thoughts about oneself, and ‘why’ questions; and the Isolated Contemplation (IC) subscale included items referring to isolating oneself and reflecting on negative thoughts, feelings, loneliness, and listening to sad music. RNT was more strongly related to negative emotions than IC. The RTQ-Ant appears to be a reliable measure of anticipatory RNT that is associated with a broad array of emotions

An exploratory study of the relative effects of various protective factors on depressive symptoms among older people

© Copyright © 2020 Worrall, Jongenelis, McEvoy, Jackson, Newton and Pettigrew. Objective: The present study investigated the relative importance of various factors found to be negatively associated with depressive symptoms in older adults and assessed the potential moderating effect of sociodemographic characteristics for each factor. Method: Depressive symptoms were measured with the Center of Epidemiological Studies Depression Scale. Psychological, social, and physical health measures relating to the following factors were also administered: personal growth, purpose in life, self-esteem, self-efficacy, social support, self-rated health, life satisfaction, and physical activity. Multivariate linear regression analysis was used to investigate the most important factors associated with depressive symptoms, and moderation analyses were employed to identify any moderating effects of sociodemographic factors. Results: Life satisfaction, self-esteem, and purpose in life were found to be negatively associated with depressive symptoms. Only one moderating effect was observed—the negative relationship between life satisfaction and depressive symptoms was significantly stronger among the younger respondents. Conclusion: These findings suggest that strategies for the prevention or amelioration of depressive symptoms across subgroups of the senior population could be optimized by focusing on enhancing life satisfaction, self-esteem, and purpose in life

A test of the core process account of psychopathology in a heterogenous clinical sample of anxiety and depression: A case of the blind men and the elephant?

Many cognitive and behavioral processes, such as selective attention to threat, self-focused attention, safety-seeking behaviors, worry and thought suppression, have their foundations in research on anxiety disorders. Yet, they are now known to be transdiagnostic, i.e. shared across a wide range of psychological disorders. A more pertinent clinical and theoretical question is whether these processes are themselves distinct, or whether they reflect a shared 'core' process that maintains psychopathology. The current study utilized a treatment-seeking clinical adult sample of 313 individuals with a range of anxiety disorders and/or depression who had completed self-report measures of widely ranging processes: affect control, rumination, worry, escape/avoidance, and safety-seeking behaviors. We found that only the first factor extracted from a principal components analysis of the items of these measures was associated with symptoms of anxiety and depression. Our findings supported the 'core process' account that had its origins in the field of anxiety disorders, and we discuss the implications for theory, clinical practice and future research across psychological disorders

Efficacy of transdiagnostic treatments: a review of published outcomes studies and future research directions

Theory and evidence relating to biological and psychological vulnerabilities, comorbidity, latent structure, cognitive and behavioral maintaining factors, and treatment outcome suggest that commonalities across emotional disorders may outweigh the differences. Thus, researchers have recently begun evaluating transdiagnostic (or unified) treatment protocols, which target common maintaining factors, by applying them to individuals with multiple disorders or to mixeddiagnosis groups. The aim of this article is to review the efficacy of unified protocols for anxiety and mood disorders. Evidence suggests that unified treatments are associated with symptom improvement, generally perform better than wait-list controls, are associated with improvements in comorbid disorders, and may compare well to diagnosis-specific treatments. Unified protocols are also associated with high client satisfaction, therapeutic alliance, group cohesion, and positive treatment expectations. However, these conclusions are tempered by the small number of studies and methodological limitations. We propose directions for future research

Group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder: An effectiveness trial

Background Generalized anxiety disorder (GAD) is a common and highly comorbid anxiety disorder characterized by repetitive negative thinking (RNT). Treatment trials tend to exclude individuals with non-primary GAD, despite this being a common presentation in real world clinics. RNT is also associated with multiple emotional disorders, suggesting that it should be targeted regardless of the primary disorder. This study evaluated the acceptability and effectiveness of brief group metacognitive therapy (MCT) for primary or non-primary GAD within a community clinic. Methods Patients referred to a specialist community clinic attended six, two-hour weekly sessions plus a one-month follow-up (N=52). Measures of metacognitive beliefs, RNT, symptoms, positive and negative affect, and quality of life were completed at the first, last, and follow-up sessions. Results Attrition was low and large intent-to-treat effects were observed on most outcomes, particularly for negative metacognitive beliefs and RNT. Treatment gains increased further to follow-up. Benchmarking comparisons demonstrated that outcomes compared favorably to longer disorder-specific protocols for primary GAD. Limitations No control group or independent assessment of protocol adherence. Conclusions Brief metacognitive therapy is an acceptable and powerful treatment for patients with primary or non-primary GAD