Depressive Cognitive Distortions Research Articles

The Epistemic Relevance of Cognitive Behavioral Therapy

The Epistemic Relevance of Cognitive Behavioral Therapy Chloe Bamboulis (bio) and Lisa Bortolotti, PhD* (bio) Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy (CBT) can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business of enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits. Validity and Utility in Depression All human agents, whether they have a mental health diagnosis or not, behave in ways that diverge from the ideal standards of epistemic and practical rationality, compromising validity and utility. Whereas validity mostly concerns the accuracy of mental representations and the correctness of explanatory hypotheses, utility concerns their adaptiveness. The goal of validity is to see the world, the self, and the future as they are, whereas the goal of utility is to enhance successful and productive behavior avoiding misery. Let's consider Ratnayake's example of a student who "performs mediocrely on a test and consequently believes that they will fail the entire course." Call her Susie. The depressive realism effect suggests that people with mild depressive symptoms are more accurate than controls when rating themselves and predicting their future, but the same epistemic advantage neither applies to those diagnosed with major depression nor extends to tasks that are not self-related. Suppose that Susie evaluates accurately her performance in the test and also accurately predicts that she will fail the entire course: she may be showing validity at the expense of utility. But what about those other thoughts Susie is likely to have due to her depression, about her social interactions and everyday situations? That the world is a cruel place and luck is always against her, that she is weak and unable to control her circumstances? These thoughts may lack both validity and utility. If we think that so-called cognitive distortions in depression only involve practical issues and [End Page 91] not epistemic issues, we may also believe that, if a therapy addresses cognitive distortions effectively, it does so because it boosts utility. But this would be misleading. Epistemic issues include generating implausible hypotheses that do not pass rigorous reality testing, but also arriving at hypotheses without taking into account the relevant evidence that is available. If Susie arrives at a self-prediction that turns out to be correct by simply accepting a negative automatic thought, this does not indicate that she has exercised epistemic rationality. Simply accepting that things will go badly due to negative biases may give rise to correct predictions, but the prediction will not reflect a careful consideration of the factors that are likely to contribute to the future outcome. This has implications for the discussion of the aims of CBT: the epistemic relevance of a therapeutic approach does not merely depend on whether it increases the overall number of accurate representations and correct hypotheses, but in whether it encourages grounding representations and hypotheses on experience and evidence. Does CBT Lead to Epistemic Improvement? The main thesis in Ratnayake's paper is that CBT does not produce more accurate self-evaluations or more reliable self-predictions but encourages a positive way of interpreting reality that, before engaging in therapy, people might not have taken advantage of. The claim, then, is that CBT does not contribute to validity but boosts utility: it may be instrumental to turning people into more practically rational agents, enabling them to navigate their environment in a more successful way. However, for Ratnayake, CBT does not turn people into more epistemically rational agents, because, instead of eliminating distortions from their reasoning, it promotes an interpretation of the facts that protects people from anxiety and depression. Take Susie who comes to believe, with high conviction, that she will fail the whole course because she performed mediocrely in one test. By inviting Susie to think about...

Integrative review of instruments of depressive cognitive distortions

Integrative review of instruments of depressive cognitive distortions

CLOCK gene variants associated with the discrepancy between subjective and objective severity in bipolar depression

BackgroundThe discrepancy between subjective and objective severity of depressive syndromes has been proposed as a predictor of treatment outcome and suicidal risk in depression, and is associated with depressive cognitive distortions. A recent study reported that evening-type depressed patients showed higher depressive cognitions than morning-type patients. Therefore, it can be hypothesized that genetic factors affecting evening preference, such as carrying of the CLOCK rs1801260*C allele, may influence the discrepancy. MethodWe tested this hypothesis in 132 patients affected by a major depressive episode in the course of bipolar disorder. The severity of depression was evaluated using self-rated (Beck Depression Inventory: BDI) and observer-rated (Hamilton Depression Rating Scale: HDRS) measures. The BDI-HDRS discrepancy score was calculated and the effects of the rs1801260 polymorphism on this score and on depressive cognitive distortions, as measured on the Cognitions Questionnaire, were examined. ResultsThe rs1801260*C carriers showed higher BDI-HDRS discrepancy scores than T/T homozygotes. Mediation analysis using bootstrapping procedures revealed that the dimension of depressive cognition “hopelessness” fully mediates the association between the rs1801260 polymorphism and the BDI-HDRS discrepancy. LimitationsMany gene polymorphisms other than CLOCK rs1801260 may also influence the BDI-HDRS discrepancy and depressive cognitive distortions. ConclusionOur current results suggest that factors affecting the biological clock can influence the “non-clock” psychopathological features of mood disorders.

Discrepancy between subjective and objective severity as a predictor of response to chronotherapeutics in bipolar depression

BackgroundChronotherapeutic techniques (sleep deprivation and light therapy) are effective treatments for bipolar depression, but viable predictors of response for the daily clinical practice have not yet been established. The discrepancy between subjective and objective severity of the depressive syndrome has been proposed as a possible predictor of treatment outcome in depression. This study examined whether this discrepancy could predict response to chronotherapeutics in bipolar depression. MethodWe studied 149 consecutively admitted inpatients with a major depressive episode in course of bipolar disorder. Patients were treated with the combination of repeated sleep deprivation and bright light therapy. Severity of depression was evaluated using self-rated (Beck Depression Inventory: BDI) and observer-rated (Hamilton Depression Rating Scale: HDRS) measures. BDI-HDRS discrepancy score at baseline was calculated, and its associations with clinical response and with depressive cognitive distortions, as measured on the Cognitions Questionnaire, were examined. ResultsAmong the 147 completers, 66% responded to treatment (50% reduction of HDRS score). The response rate in patients with low discrepancy scores and in patients with high discrepancy scores were 80.2% and 48.5%, respectively. High BDI-HDRS discrepancy predicted negative response to treatment with odds ratio of 3.79 (95%CI: 1.61–8.93). BDI-HDRS discrepancy was positively associated with depressive cognitive distortions. LimitationsPotential factors affecting the discrepancy and outcome other than cognitive distortion were not examined in this study. ConclusionHigher BDI-HDRS discrepancy can predict poorer response to chronotherapeutics in bipolar depression. The tendency to generalize hopelessness may be a factor influencing the link between the discrepancy and outcome.

Effects of CLOCK gene variants and early stress on hopelessness and suicide in bipolar depression

Background: Patients with mood disorders show a high dependence of behavior on the molecular characteristics of the biological clock. CLOCK rs1801260 gene polymorphism influences circadian behavior in bipolar disorder (BD), with *C carriers showing a delayed sleep onset and worse insomnia. Sleep phase delay and insomnia associate with suicide in the general population. Methods: We investigated the effects of rs1801260, and of exposure to stressful life events, on current suicidal ideation and history of suicide attempts in 87 depressed patients with BD. Results: rs1801260*C carriers currently showed worse Hamilton Depression Rating Scale scores for suicide and worse ratings for depressive cognitive distortions. Previous history of attempted suicide associated with exposure to higher stressful events in the early life, with rs1801260*C carriers showing a higher dependency of the modeled probability of attempting suicide on the severity of exposure to early stress. Discussion: CLOCK rs1801260 modulated the relationship between early stress, adult history of attempted suicide and current suicide ideation. Factors affecting the biological clock can influence “non-clock” core psychopathological features of mood disorders.

Electrophysiological evidence of a typical cognitive distortion in bipolar disorder

Patients suffering from bipolar disorder often report negative thoughts and a bias towards negative environmental stimuli. Previous studies show that this mood-congruent attentional bias could mediated by dysfunctions in anterior limbic regions. The Error-Related Negativity (ERN), which originates in the anterior cingulate cortex (ACC), has been used to research this negativity bias in depressed patients, and could also help to better understand the underlying mechanisms causing the negativity bias in bipolar patients.In this study we investigated error processing in patients with bipolar disorder. Acute depressive bipolar patients (n = 20) and age-matched healthy controls (n = 20) underwent a modified Eriksen Flanker Task to assess test performance and two error-related event-related potentials (ERPs), i.e., the ERN and Error Positivity (Pe) were measured by EEG. Half of the patients were measured again in a euthymic state.We found similar ERN amplitudes in bipolar patients as compared to healthy controls, but significantly reduced Pe amplitudes. Moreover, acutely depressed bipolar patients displayed an ERN and Pe even if they responded accurately or too slow, which indicates that correct responses are processed in a way similar to wrong responses. This can be interpreted as a psychophysiological correlate of typical cognitive distortions in depression, i.e., an erroneous perception of personal failures. This biased error perception partially remained when patients were in a euthymic state.Together, our data indicate that aberrant error processing of bipolar patients may be regarded a trait marker possibly reflecting a risk factor for depressive relapses in bipolar disorder.

Cognitive Distortions in Depressed Women: Trait, or State Dependent?

Objective: According to the cognitive theory developed by Beck, cognitive distortions are important mediators for the onset and maintenance of depressive disorders. It has not been researched if these cognitive distortions are more frequently encountered during the depressive episode, or if they are trait-like features. This study aims to investigate this. The hypothesis of the study is that cognitive distortions are state dependent. Method: Three groups of outpatients (n=178 patients in acute major depressive episode, n=168 depressive patients in remission, n=177 healthy controls) presenting to the psychiatry clinics of three different state hospitals were recruited for the study. The participants were diagnostically interviewed by the MINI according to the DSM-IV criteria. The participants were asked to complete the Cognitive Distortions Scale and the severity of their depression was measured by the Inventory for Depressive Symptomatology. Results: According to the cognitive distortion subscales, except for the self-blame subscale, the acute depressive group scored the highest. Also it was found that the cognitive distortions of the depressive populations, except for the self-blame related ones, statistically differed from the healthy controls’. Self-blame related distortions were mood state dependent. Conclusion: The results have revealed that self-criticism, helplessness, hopelessness and preoccupation with danger related distortions had trait-like features, whereas self-blame related distortions were state dependent. This has clinical implications for the psychotherapeutic treatment of cognitive distortions in depression. Specifically, self-criticism related distortions should be managed during cognitive therapy for depression since the other subscales seem rather problematic.

Off label CBT: a promising therapy or an adjunctive pluralistic therapeutic ingredient?

Off label CBT: a promising therapy or an adjunctive pluralistic therapeutic ingredient?

Adverse childhood experiences worsen cognitive distortion during adult bipolar depression

BackgroundCognitive distortion is a central feature of depression, encompassing negative thinking, dysfunctional personality styles and dysfunctional attitudes. It has been hypothesized that ACEs could increase the vulnerability to depression by contributing to the development of a stable negative cognitive style. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and cognitive distortion, and whether any gender differences exist. AimThe aim of this study was to examine the association between ACEs and cognitive distortions and possible differences between genders in a sample of patients affected by bipolar disorder. Method130 patients with bipolar disorder (BD) (46 men and 84 females), completed the Risky Family Questionnaire to assess ACEs and the Cognition Questionnaire (CQ) to assess cognitive distortions. ResultsA positive association was found between ACE and the CQ total score. Investigating the 5 dimensions assessed through the CQ, only the dimension “generalization across situations” was significantly associated to ACE. An interaction between ACE and gender was found for “generalization across situations”, while no differential effect among females and males was found for CQ total score. ConclusionThis is the first study to report a relationship between negative past experiences and depressive cognitive distortions in subjects affected by BD. Growing in a family environment affected by harsh parenting seems to a cognitive vulnerability to depression; this effect is especially strong in females.

Cognitive Representations (Metaphorical Conceptualizations) of PAST, FUTURE, JOY, SADNESS and HAPPINESS in Depressive and Non-depressive Subjects: Cognitive Distortions in Depression at the Level of Notion

The aim of this study was to see if and how the intensity of depression correlates with the cognitive representation of notions, and if any influence is reversed during remission. The cognitive representation indices used were the valence and number of metaphors produced for a notion. Three adult groups took part: persons with depression (n = 30), persons in remission (n = 12), and a control group (n = 30). Five notions were considered: PAST, FUTURE, JOY, SADNESS, and HAPPINESS. The Questionnaire of the Metaphorical Conceptualization of a Notion was used. The results showed that (a) depressive subjects did not have problems with metaphorical processing, (b) depressive subjects demonstrated strong interpretational negativism, (c) subjects during remission did not present distorted conceptual processing. The results are discussed in the context of theories of automatic metaphor processing, and conceptions of cognitive depressive distortions, in tasks requiring effort and substantial involvement of cognitive resources.

The role of problem orientation and cognitive distortions in depression and anxiety interventions for young adults

Interventions that aim to improve social problem-solving skills can significantly reduce the severity of anxiety and depression symptoms in young people. Anxious and depressed individuals often have a negative orientation to problem solution which acts as a barrier to implementing problem-solving skills. Research with older adults suggests that symptoms impair problem-solving abilities through cognitive processes associated with the development of anxiety and depression. In this study we extend previous investigations by assessing the extent to which specific cognitive distortions and symptoms of anxiety and depression are associated with negative problem orientation (NPO) in a sample of 285 young adults aged 18–25 years. Results found that cognitive distortions and depressive symptoms were strong predictors in a regression model that explained approximately half of the variance in NPO. Results also found that the relationship between cognitive distortions and NPO was strengthened as depressive symptoms became more intense. The distortion ‘You think you know what the future will bring; you expect disaster and gloom’ had the strongest individual association with NPO and depressive symptoms. Implications for enriching prevention and early intervention initiatives for young adults are discussed.

Opposite effects of suicidality and lithium on gray matter volumes in bipolar depression

Mood disorders are associated with the highest increase of attempted and completed suicide. Suicidality in major depressive disorder and in schizophrenia has been associated with reduced gray matter volumes in orbitofrontal cortex. Lithium reduces the suicide risk of patients with bipolar disorder (BD) to the same levels of the general population, and can increase GM volumes. We studied the effect of a positive history of attempted suicide and ongoing lithium treatment on regional GM volumes of patients affected by bipolar depression. With a correlational design, we studied 57 currently depressed inpatients with bipolar disorder: 19 with and 38 without a positive history of suicide attempts, 39 unmedicated and 18 with ongoing lithium treatment. Total and regional gray matter volumes were assessed using voxel-based morphometry. Total GM volume is inversely correlated with depression severity. A positive history of suicide attempts was associated with higher stress in early life. Suicide attempters showed reduced GM volumes in several brain areas including dorsolateral prefrontal cortex, orbitofrontal cortex, anterior cingulate, superior temporal cortex, parieto-occipital cortex, and basal ganglia. Long term lithium treatment was associated with increased GM volumes in the same areas where suicide was associated with decreased GM. Reduced GM volumes in critical cortical areas of suicidal patients could be a biological correlate of an impaired ability to associate choices and outcomes and to plan goal-directed behaviors based on a lifetime historical perspective, which, coupled with mood-congruent depressive cognitive distortions, could lead to more hopelessness and suicide. Lithium could exert its specific therapeutic effect on suicide by acting in the same areas.

A Notional Level of Cognitive Distortions in Depression: Does It Exist? A Voice for Interdisciplinarity in Studying Cognitive Functioning of Individuals with Depressive Disorders

A Notional Level of Cognitive Distortions in Depression: Does It Exist? A Voice for Interdisciplinarity in Studying Cognitive Functioning of Individuals with Depressive Disorders

Perfectionism and depression symptom severity in major depressive disorder

In recent years it has been recognized that perfectionism is a multidimensional construct and two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation [Frost, R.O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449–468; Hewitt, P.L., & Flett, G.L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470]. The present study sought to evaluate the association between various dimensions of perfectionism, higher-order personality dimensions, and self and observer rated depressive symptoms in a group of 145 patients with major depressive disorder. Only three of ten perfectionism dimensions (socially prescribed perfectionism, concern over mistakes and self-criticism) displayed medium to large correlations with depressive symptoms, especially self-report symptoms reflecting depressive cognitive distortions. The results are discussed in relation to the specificity of perfectionism dimensions to depression, adaptive versus maladaptive aspects of perfectionism, and in the context of previous research, much of which has relied on college student samples.

The effects of self-correction on cognitive distortions in depression

Past research has demonstrated that depressed individuals tend to distort their recall of positive feedback in a negative fashion. In the current study an attempt was made to replicate the finding and then to stop this negative distortion through a self-correction (reality-testing) procedure. Groups of depressed and nondepressed college students were randomly assigned to high positive (HP) or low positive (LP) feedback conditions. In the first half of the study, there was a replication of the cognitive distortion of HP feedback by the depressed group. The reality-testing procedure invoked in the second half of the study, however, made no impact on the cognitive distortions made by the depressed group under HP feedback conditions. Under conditions of LP feedback, the reality-testing procedure had the paradoxical effect of increasing the distortions shown by the depressed group. The implications of this study for therapy were elaborated upon and the utility of reality testing, as an isolated treatment component, was called into question.