Does symptom onset create a maladaptive temporal landmark? A qualitative exploration of temporal self-appraisal in anxiety and depression

Abstract

ABSTRACT Objective: To investigate and compare patterns of temporal self-appraisal in anxiety and depression. Specifically, whether these parallel the self-enhancing perceptions of a continuous upward trajectory of self over time characteristic of nonclinical populations; or alternatively, are consistent with patterns found in other psychopathologies. Method: A clinical sample of eight adults diagnosed with an anxiety and/or depressive disorder participated in cross-sectional qualitative interviews exploring the intersection of their self-concepts and mental health perceptions across time. A content analysis was performed to identify patterns of temporal self-appraisal specific to anxiety and depression. Results: Anxiety was typically viewed as “always” having been part of the self, allowing satisfaction with current identity and a hopeful outlook towards managing symptoms in future, based on previous progress in coping. In contrast, depression was generally described as having a sudden onset triggered by external stressors, disrupting sense of self and eliciting temporal comparisons detrimental to present self-view, as well as distress around the uncertainty of recovery. Conclusion: Symptom onset appeared to create a maladaptive temporal landmark, that is, a temporal event that structures individuals’ perceptions of time, in depression but not anxiety. Ego-dystonic depression was interpreted to disrupt self-continuity over time, evoking dissatisfaction with current identity through unfavourable temporal comparisons. Meanwhile, ego-syntonic anxiety enabled self-enhancing perceptions of personal growth, similar to the subjective upward trajectory of self typical of nonclinical populations. Implications for clinical interventions were considered; notably, that cultivating perspectives of improved coping over time may be beneficial to mental health. KEY POINTS What is already known about this topic: • Temporal self-appraisal in nonclinical populations is characterised by a self-enhancing tendency to perceive the self as continually improving over time. • In schizophrenia and posttraumatic stress disorder, symptom onset creates a maladaptive temporal landmark, with past selves prior to this point viewed more favourably than present or future selves. • Depression and anxiety disorders involve disturbances to self-concept and differing temporal perspectives, being past-oriented and future-orientated respectively. What this topic adds: • Anxiety was found to involve a self-enhancing perceived upward trajectory of self across time. • In depression, symptom onset was found to create a maladaptive temporal landmark detrimental to present self-concept. • Developing self-narratives that emphasise personal growth beyond challenging life experiences could serve an adaptive function in response to temporal landmarks.