Self-Responsibility: Relationship with Depression and Anxiety and Relevance for the Treatment Outcome of Inpatients with Major Depression

Abstract

Though in most psychotherapy schools a high self-responsibility (SR) of patients is considered as the basis necessary for the success of psychological treatment, there is neither a uniform definition nor a psychometric operationalisation of SR. Hence, there is no empirical evidence for the actual importance of SR in psychotherapy. This work aims (1) to introduce a definition of SR as well as to develop a questionnaire for its measurement and (2) to evaluate SR in the treatment of depression. In two studies with samples of healthy adults (n=233, n=301), the "Self-Responsibility Inventory" (German: "Selbstverantwortungs-Inventar", SV-I) was developed. In a third study, the SV-I was administered to n=231 psychiatric inpatients with major depression according to the ICD-10 diagnostic criteria. Patients were mainly treated with psychotherapy. The final SV-I version consisted of three scales with 10 items each: "Being determined by others", "Self-determination", "Orientation towards the expectations of others". In healthy adults, poor SR was accompanied by high levels of depression, and high trait anxiety. Inpatients with mental disorders show less SR than healthy individuals. During treatment, SR increased from admission to discharge. It was found that the higher the SR at discharge, the stronger the decrease of depression from admission to discharge. The SV-I appears to be suitable for use in healthy individuals and in clinical groups. Our findings suggest that low SR is related to the development of psychological symptoms and illnesses. SR may be a critical factor for outcome in the psychotherapy of major depression. The SV-I could be a useful tool for understanding psychotherapeutic processes.