Self-critical perfectionism, dependency and entropy during cognitive behavioural therapy for depression.

OBJECTIVES: This study examined whether 'personality vulnerability' (i.e., self-critical perfectionism or dependency) predicts the trajectory of change, as well as variability and instability (i.e., entropy) of symptoms, during cognitive behaviour therapy (CBT) for depression. DESIGN: Study participants were outpatients (N = 312) experiencing a primary mood disorder. Participants received CBT for depression group sessions over 15 weeks. Self-report measures of self-critical perfectionism, dependency, and depression were collected longitudinally. METHODS: A latent growth mixture modelling (LGMM) statistical approach was used to evaluate the presence of latent classes of individuals based on their longitudinal pattern of symptom change during CBT and to evaluate whether baseline self-critical perfectionism or dependency predicts class membership. A Latent Acceleration Score (LAS) model evaluated whether perfectionism or dependency led to variability in depression symptom change (e.g., velocity) by considering changes in velocity (e.g., acceleration and/or deceleration). RESULTS: LGMM indicated the presence of two latent classes that represent symptom improvement (N = 239) or minimal symptom improvement over time (N = 73). Elevated baseline self-critical perfectionism, but not dependency, predicted a greater likelihood of membership in the class of participants who demonstrated minimal symptom improvement over time. The second analysis examined whether baseline self-critical perfectionism also predicts depression symptom variability and instability. The LAS perfectionism model demonstrated that perfectionism accelerates depression symptom change during the first seven sessions of treatment, then has a decelerating effect on depression symptom change. CONCLUSIONS: Results indicated that higher baseline self-critical perfectionism predicted higher variability and instability in depression symptoms and variability in acceleration and deceleration, over the course of treatment.

Cognitive-Behavioral Therapy for Depression Using Mind Over Mood: CBT Skill Use and Differential Symptom Alleviation.

Cognitive-behavioral therapy (CBT) for depression is highly effective. An essential element of this therapy involves acquiring and utilizing CBT skills; however, it is unclear whether the type of CBT skill used is associated with differential symptom alleviation. Outpatients (N = 356) diagnosed with a primary mood disorder received 14 two-hour group sessions of CBT for depression, using the Mind Over Mood protocol. In each session, patients completed the Beck Depression Inventory and throughout the week they reported on their use of CBT skills: behavioral activation (BA), cognitive restructuring (CR), and core belief (CB) strategies. Bivariate latent difference score (LDS) longitudinal analyses were used to examine patterns of differential skill use and subsequent symptom change, and multigroup LDS analyses were used to determine whether longitudinal associations differed as a function of initial depression severity. Higher levels of BA use were associated with a greater subsequent decrease in depressive symptoms for patients with mild to moderate initial depression symptoms relative to those with severe symptoms. Higher levels of CR use were associated with a greater subsequent decrease in depressive symptoms, whereas higher levels of CB use were followed by a subsequent increase in depressive symptoms, regardless of initial severity. Results indicated that the type of CBT skill used is associated with differential patterns of subsequent symptom change. BA use was associated with differential subsequent change as a function of initial severity (patients with less severe depression symptoms demonstrated greater symptom improvement), whereas CR use was associated with symptom alleviation and CB use with an increase in subsequent symptoms as related to initial severity.

Symptoms of depression and anxiety in children: specificity of the hopelessness theory.

The common etiology hypothesis proposes that depression and anxiety commonly co-occur because they share etiological factors. This study examined the specificity of the hopelessness theory in the development of depressive and anxious symptoms in children. Students in Grades 3 through 6 (N = 418, 47% boys) completed measures assessing inferential styles about causes, consequences, and the self, depressive symptoms, and anxious symptoms. Six weeks later, children completed measures of depressive symptoms, anxious symptoms, and hassles. All 3 inferential styles interacted with hassles to predict increases in depressive symptoms, although this relation only held for children with low levels of initial symptoms. Inferential styles about consequences and the self also predicted increases in anxious symptoms. Consistent with the common etiology hypothesis, after controlling for the association between depressive and anxious symptoms, the effects of inferential styles about consequences and the self persisted.

Behavioural inhibition, anxious symptoms, and depressive symptoms: a short-term prospective examination of a diathesis-stress model.

The purpose of the current study was to examine the relationship between behavioural inhibition (BI) and anxious symptoms within a diathesis-stress framework, using a short-term prospective design. In addition, we examined whether BI acts as a specific vulnerability to anxious symptoms, or as a common vulnerability to both anxious and depressive symptoms. At time 1, 384 children in grades 3 through 6 completed self-report measures of BI, anxious symptoms, and depressive symptoms. Six weeks later, they completed self-report measures of hassles, anxious symptoms, and depressive symptoms. Results demonstrated that children with high BI who experienced high levels of hassles during the 6-week follow-up interval showed increases in anxious symptoms, but not depressive symptoms.

A test of integration of the activation hypothesis and the diathesis-stress component of the hopelessness theory of depression.

OBJECTIVES: This prospective study tested the integration of the diathesis-stress component of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) and Persons and Miranda's (1992) activation hypothesis (i.e. depressogenic inferential styles are typically latent cognitive processes that must be primed in order to be accurately assessed). DESIGN: In order to test the diathesis-stress component of the hopelessness theory, we used a short-term longitudinal design. In order to test the activation hypothesis, inferential styles were assessed both before and after a negative cognitive priming questionnaire. METHODS: A group of 165 university students completed measures of inferential styles about the self, consequences, and causes before and after completing a negative cognitive priming questionnaire (Time 1). Participants also completed measures of depressive symptoms prior to completing the cognitive priming questionnaire and 5 weeks later (Time 2). Finally, negative events occurring between Time 1 and Time 2 were assessed. RESULTS: Contrary to the diathesis-stress component of the hopelessness theory, none of the unprimed inferential styles interacted with negative events to predict increases in depressive symptoms. In line with the integration of the hopelessness theory and the activation hypothesis, however, each of the primed inferential styles interacted with negative events to predict increases in depressive symptoms even after controlling for the proportion of variance in depressive symptoms accounted for by the unprimed inferential style stress interactions. CONCLUSION: Individuals with depressogenic inferential styles are likely to show increases in depressive symptoms following the occurrence of negative events. At the same time, these depressogenic inferential styles are typically latent cognitive processes that must be primed in order to be accurately assessed.

An examination of the response styles theory of depression in third- and seventh-grade children: a short-term longitudinal study.

The goal of this study was to test the response styles theory of depression in a sample of 3rd- and 7th-grade children. In addition, we examined whether the relationship between rumination and increases in depressive symptoms is mediated by hopelessness and low self-esteem. The procedure involved an initial assessment in which depressive symptoms, response styles, hopelessness, and self-esteem were assessed. The procedure also involved a follow-up assessment, 6 weeks later, in which depressive symptoms, hopelessness, and self-esteem were reassessed. Children with a ruminative response style exhibited increases in depressive symptoms over the 6-week period. In addition, the relationship between rumination and increases in depressive symptoms was mediated by both hopelessness and low self-esteem. Last, contrary to our hypotheses, neither distraction nor problem-solving response styles predicted decreases in depressive symptoms over the course of the study.