Dysfunctional Attitude Scale Scores Research Articles

Salivary apelin hormone response and dysfunctional attitudes in adolescents in Türkiye: a relational screening model

BackgroundAdolescence is the period in which physical and emotional changes occur through hormones, the individual acquires gender characteristics and prepares for the adult role psychologically and physically. Dysfunctional attitudes are beliefs and attitudes that can lead to depression by causing negative thoughts about oneself, others, and the future.Dysfunctional attitudes negatively affect children’s mental health. Hormones have a significant impact on human behavior and cognitive functions. However, little is known about the role and influence of hormones on dysfunctional attitudes. Apelin is a hormone responsible for controlling emotions by regulating emotional behavior. The level of dysfunctional attitudes is one of the important issues in nursing practice in terms of protecting and improving children’s mental health. However, little is known about the role and impact of hormones on dysfunctional attitudes.This study aimed to examine adolescents’ dysfunctional attitudes and salivary apelin hormone levels in terms of sociodemographic variables.MethodsThe study was conducted in a relational screening model with 151 adolescents aged 9–14 years who were reported to be clinically healthy in Türkiye. Apelin hormone levels were analyzed by ELISA technique in the saliva samples of the participants. In the evaluation of dysfunctional attitudes, the relationship between the score obtained from the dysfunctional attitude scale and salivary hormone levels was evaluated.ResultsIn the study, a negative, strong and statistically significant correlation was found between the average salivary apelin hormone level and dysfunctional attitudes of adolescents (p =.000). Mean salivary hormone levels of apelin in adolescent girls and boys were 0.696 (SD 0.052) ng/ml, respectively; while 0.671 (SD 0.047) ng/ml was determined (p =.002), dysfunctional attitudes scale scores were 52.95 (SD 14.43); it was determined as 59.04 (SD 14.22) (p =.006). On the other hand, the highest average salivary apelin hormone level (p =.038). and the lowest level of dysfunctional attitudes were determined in adolescent girls aged 13–14 years (p =.028).ConclusionsIn our study, we found that while the salivary apelin hormone levels of adolescents decreased, their dysfunctional attitudes increased. We found that adolescents’ dysfunctional attitudes decreased with age. In contrast, apelin hormone levels increased with age.

Cognitive predictors of depression and anxiety in individuals with newly diagnosed Multiple Sclerosis

Background and objectivesDeterminants of psychosocial adjustment in newly diagnosed Multiple Sclerosis (MS) patients include not only disease-related factors but also cognitive-behavioral factors. This study aimed to investigate the level of depression and anxiety symptoms and to examine the role of cognitive distortions in the development of depression and anxiety in newly diagnosed MS patients. Methods63 MS patients and 58 healthy controls 18–65 years of age were included. Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Dysfunctional Attitudes Scale (DAS), Automatic Thoughts Questionnaire (ATQ) were administered to the sample. ResultsMS patients had significantly higher HAM-D and HAM-A scores (p<0.05). HAM-D and HAM-A scale scores were correlated with each other in the MS patients group (p<0.05). ATQ scores were significantly higher in the MS group than healthy controls (p<0.01). HAM-D and HAM-A scores were also both correlated with ATQ and DAS scores in MS patients group (p<0.05). There is a statistically significant difference for marital status and ATQ scores between the MS patients group with significant depressive symptoms (according to HAM-D cut off point above 17) and those without significant depressive symptoms (p<0.05). ATQ is the only independent variable that predicts the depression levels (OR=1.12 CI=1.068–1.176; p<0.001) in stepwise regression analysis. The overall disclosure percentage of the model to 52%. ConclusionsAutomatic thoughts are a vulnerability factor for the development of depressive symptoms in newly diagnosed MS patients. Psychological stress affects not only MS patients with advanced-stage but also newly diagnosed MS patients.

The impacts of maternal separation experience and its pattern on depression and dysfunctional attitude in middle school students in rural China

In China, because of the growth of economically driven rural-to-urban migration, there are lots of children in rural area who are separating or have separation experience with their parents. Until now, few studies focused on solely maternal separation and no research studied whether its pattern will affect children's later psychological status. The aim of this study was to determine whether early or late maternal separation affects depression and dysfunctional attitude in middle school students and what is the role of cumulative duration and meeting frequency. Maternal separation experience was obtained by using questionnaires. We got early maternal separation group first. Then, late maternal separation and control group were obtained with the same number by matching grade, sex and family socioeconomic status. All the students in the three groups completed the scales of Children's Depression Inventory (CDI) and Dysfunctional Attitude Scale (DAS). Both CDI and DAS scores of early separation group are higher than the other two groups. When we split the data by sex, only females presented the same results. When cumulative duration is short, there is significant difference in both scores of CDI and DAS among the three groups, which showed the scores of early separation group are higher than the other two groups. When the cumulative duration is long, there is no significant difference among the three groups. When meeting frequency is high, there is no significant difference among the three groups. When it is low, there is significant difference among the three groups, which showed the CDI and DAS scores of early separation group are higher than the other two groups. Furthermore, the same results are also found in females. Early maternal separation may exert negative influence on student's depression and dysfunctional attitude. The sex, cumulative duration and meeting frequency may also play important roles in the effect.

Effect of cognitive behavior therapy combined with exercise intervention on the cognitive bias and coping styles of diarrhea-predominant irritable bowel syndrome patients.

BACKGROUNDIrritable bowel syndrome (IBS) is a common digestive system disease with a high incidence rate and is common in women. The cause of IBS remains unclear. Some studies have shown that mental and psychological diseases are independent risk factors for IBS. At present, the treatment of IBS is mainly symptomatic treatment. Clinically, doctors also use cognitive behavioral therapy to improve patients' cognitive ability to diseases and clinical symptoms. In recent years, exercise therapy has attracted more and more attention from scholars. Improving the symptoms of IBS patients through psychosomatic treatment strategy may be a good treatment method.AIMTo explore the effects of an intervention of cognitive behavioral therapy combined with exercise (CBT+E) on the cognitive bias and coping styles of patients with diarrhea-predominant irritable bowel syndrome (IBS-D); and to provide a theoretical reference for the management of IBS.METHODSSixty IBS-D patients and thirty healthy subjects were selected. The 60 IBS-D patients were randomly divided into experimental and control groups. The experimental group was treated with the CBT+E intervention, while the control group was treated with conventional drugs without any additional intervention. The cognitive bias and coping styles of the participants were evaluated at baseline and after 6 wk, 12 wk and 24 wk using the Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Pain Coping Style Questionnaire (CSQ) instruments, and the intervention effect was analyzed using SPSS 17.0 statistical software.RESULTSAt baseline, the scores on the various scales showed that all subjects had cognitive bias and adverse coping styles. The IBS Symptom Severity Scale (IBS-SSS) scores, ATQ total scores, DAS scores and CSQ scores of the two groups were not significantly different (P > 0.05). Compared with baseline, after 6 wk of the CBT+E intervention, there were significant differences in the ATQ scores, the dependence and total scores on the DAS, and the catastrophization, distraction and prayer scores on the CSQ (P < 0.05). After 12 wk, there were significant differences in the scores for perfectionism on the DAS and in the scores for reinterpretation, neglect and pain behavior on the CSQ in the experimental group (P < 0.05). After 24 wk, there were significant differences in the vulnerability, dependence, perfectionism, and total scores on the DAS and in the catastrophization, distraction and prayer scores on the CSQ in the experimental group (P < 0.01). The IBS-SSS scores were negatively correlated with the ATQ and DAS total scores (P < 0.05) but were positively correlated with the CSQ total score (P < 0.05).CONCLUSIONIntervention consisting of CBT+E can correct the cognitive bias of IBS-D patients and eliminate their adverse coping conditions. CBT+E should be promoted for IBS and psychosomatic diseases.

Relationship between dysfunctional beliefs and stress coping methods in drug-addicted patients: A sample of Turkey.

Background:Dysfunctional beliefs are believed to have an effect on substance abuse. Drug-addicted individuals experience difficulties with coping in stressful situations and therefore, start reusing these drugs.Aim:This study was conducted to determine the relationship between dysfunctional beliefs and stress coping methods in drug-addicted patients.Materials and Methods:The population of this descriptive and cross-sectional research study comprised 51 patients who were admitted to the Alcohol and Drug Addiction Treatment Center of a state hospital, diagnosed with drug addiction, and consented to participate in our study. The data were collected by using the Sociodemographic Information Form, the Dysfunctional Attitude Scale (DAS), and the Coping Assessment Questionnaire (COPE). The data obtained were evaluated by percentage, correlation, one-way analysis of variance, Mann–Whitney U-test, and Kruskal–Wallis test.Results:The average COPE score of the drug-addicted patients was found to be 171.60 ± 23.35. The average DAS score of the drug-addicted patients was determined to be 161.66 ± 36.94. A statistically significant difference was found between the DAS and COPE scores of the patients (P < 0.05).Conclusions:It can be concluded that these patients have dysfunctional beliefs and exhibit emotion-focused coping attitudes. More comparative studies investigating the dysfunctional beliefs of alcohol- and drug-addicted people and coping methods should be conducted.

A novel task for examining the neural basis of Theory of Mind deficits in bipolar disorder

Deficits in theory of mind (ToM) processing have been observed in people with bipolar disorder (BD), but the neural basis of these deficits remains unclear. Here, we studied the relations between neural activation, dysfunctional beliefs and behavioral responses in people with BD during a second-order ToM task. Twenty-five patients and 25 healthy-control participants (HC) underwent functional magnetic resonance imaging (fMRI) while performing a novel ToM task. The Dysfunctional Attitudes scale (DAS) and the Brief Hypomanic Attitudes and Positive Predictions Inventory (BHAPPI) were used to assess dysfunctional beliefs. Significant differences in neural activation were observed between HC and BD patients in regions associated with ToM processing: medial frontal, cingulate, anterior cingulate and superior temporal gyri. Correlations between DAS scores and neural activity in medial frontal and cingulate gyri were observed for HC only. Increased activation in brain regions associated with ToM processing in patients compared to HC provides further evidence of disruption in networks controlling social-cognitive processes. Whether this results from compensatory responses to maintain appropriate behavior is unknown.

The measurement of cognitive reactivity to sad mood in patients remitted from major depressive disorder.

ObjectivesCognitive reactivity (CR) to sad mood is a risk factor for major depressive disorder (MDD). CR is usually measured by assessing change on the Dysfunctional Attitudes Scale (DAS‐change) after sad mood‐induction. It has, however, been suggested that the versions of the DAS (A/B) are not interchangeable, impacting the reliability and validity of the change score. The Leiden Index of Depression Sensitivity‐Revised (LEIDS‐R) is an alternative self‐report measure of CR. Studies examining the relationship between LEIDS‐R and DAS‐change have shown mixed results. We examined whether scores of these CR measures differed between remitted MDD and controls, the relationship between these CR measures, and the effect of order of DAS administration on DAS‐change.DesignCross‐sectional design with two groups (remitted MDD and controls).MethodsSixty‐eight MDD patients remitted from ≥2 previous episodes, not taking antidepressants, and 43 never‐depressed controls participated in a mood‐induction and filled in the DAS‐A/B in randomized order before and after mood‐induction, and LEIDS‐R separately.Results LEIDS‐R scores and pre‐mood‐induction DAS scores were significantly higher in remitted MDD than controls (p < .001, Cohen's d = 1.48; p = .001, Cohen's d = 0.66, respectively). DAS‐change did not differ between these groups (p = .67, Cohen’s d = 0.08). LEIDS‐R correlated with DAS‐change (r = .30, p = .042), but only in the group that filled in DAS‐B before DAS‐A. In remitted MDD, DAS‐change was dependent on the order of DAS versions before and after mood‐induction (10.6 ± 19.0 vs. −1.2 ± 10.5, for order B‐A and A‐B, respectively), with a significant group × order interaction (p = .012).ConclusionsExisting DAS versions are not interchangeable, which compromises the usefulness of mood‐inductions in clinical practice. The LEIDS‐R seems a valid measure of cognitive vulnerability to depression.Practitioner points Clinical implications: Cognitive reactivity (CR) is a risk factor of depressive recurrence. The current measurement of CR, by assessing change on the Dysfunctional Attitudes Scale (DAS) after mood‐induction, is not reliable.The Leiden Index Depression Sensitivity‐Revised (LEIDS‐R) is an alternative CR measure. In contrast to mood‐induction, it reliably assesses depression vulnerability.The use of mood‐inductions for clinical/research purposes is unnecessary. Limitations of the study: We were not able to examine the effect of previous treatment, which could have affected results as psychological treatments probably have differential effects on CR.Examining un‐medicated patients may have led to selection of a sample not completely representative for the general MDD population.We did not administer both parallel versions of the DAS (A/B) before and after mood‐induction. This might have provided better understanding of their differential sensitivity to change.

A Scenario-Based Cognitive Behavioral Therapy Mobile App to Reduce Dysfunctional Beliefs in Individuals with Depression: A Randomized Controlled Trial.

While self-administered mobile app-based cognitive behavioral therapy (CBT) has shown efficiency and effectiveness over the past decade, attempts to address automatic and negative beliefs have been lacking. The purpose of this study was to introduce and verify a mobile app that directly intervenes in dysfunctional thoughts. This app-based treatment includes recognizing automatic and negative thoughts of the protagonist of scenarios, writing advice directly to the main character, and sharing advice provided by other participants. Thirty-four participants diagnosed with Other Specified Depressive Disorder were recruited and randomly allocated to a CBT-based mobile-app program, the Todac Todac (TT group), or a daily mood chart app program (control group). Participants were asked to use the software for 3 weeks. Assessments for autonomic thoughts and clinical symptoms were administered at baseline and at a follow-up evaluation. After completing the 3-week program, Dysfunctional Attitude Scale (DAS) scores in TT group were lower than they were in the control group. In clinical measures, both TT group and control group showed reduced Beck Depression Inventory-II (BDI-II) scores and situation-dependent trait version of State-Trait Anxiety Inventory (STAI-X2) at follow-up. However, TT group showed significantly reduced STAI-X2 scores compared to control group. For all participants, changes in DAS scores were correlated with BDI-II and STAI-X2 scores. Our preliminary findings provide promising evidence that scenario-based CBT mobile apps can be used to deliver feasible and efficacious cognitive therapy. Long-term research is needed to determine the impact and effectiveness of this new treatment format.

The Relations of Cognitive, Behavioral, and Physical Activity Variables to Depression Severity in Traumatic Brain Injury: Reanalysis of Data From a Randomized Controlled Trial.

To explore the relations of cognitive, behavioral, and physical activity variables to depression severity among people with traumatic brain injury (TBI) undergoing a depression treatment trial. Community. Adults (N = 88) who sustained complicated mild to severe TBI within the past 10 years, met criteria for major depressive disorder, and completed study measures. Randomized controlled trial. Participants were randomized to cognitive-behavioral therapy (n = 58) or usual care (n = 42). Outcomes were measured at baseline and 16 weeks. We combined the groups and used regressions to explore the relations among theoretical variables and depression outcomes. Depression severity was measured with the Hamilton Depression Rating Scale and Symptom Checklist-20. Theory-based measures were the Dysfunctional Attitudes Scale (DAS), Automatic Thoughts Questionnaire (ATQ), Environmental Rewards Observation Scale (EROS), and the International Physical Activity Questionnaire (IPAQ). Compared with non-TBI norms, baseline DAS and ATQ scores were high and EROS and IPAQ scores were low. All outcomes improved from baseline to 16 weeks except the DAS. The ATQ was an independent predictor of baseline depression. An increase in EROS scores was correlated with decreased depression. Increasing participation in meaningful roles and pleasant activities may be a promising approach to treating depression after TBI.

White-matter density abnormalities in depressive patients with and without childhood neglect: A voxel-based morphometry (VBM) analysis

Childhood maltreatment (abuse or neglect) can result in changes to the brain structures and functions that underlie adult depression. Few studies have explored the impact of childhood maltreatment on white-matter microstructure, especially for childhood neglect. Nineteen depressive patients who experienced childhood neglect, 21 depressive patients who did not experience childhood neglect, and 20 healthy control subjects were compared in this study. The Childhood Trauma Questionnaire (CTQ), Hamilton Depressive Rating Scale (HAMD), Self-Rating Depression Scale (SDS), and Dysfunctional Attitude Scale (DAS) were used to evaluate each subject. High-resolution T1-weighted 3T magnetic resonance imaging scans and a whole-brain optimized voxel-based morphometry (VBM) approach were also used. Compared with healthy controls, the depressive group of subjects with childhood neglect showed significantly lower white-matter densities in the bilateral inferior parietal lobe (IPL) [43 −32 24] [−42 −42 25], whereas the depressive group without childhood neglect showed significantly lower densities in bilateral sub-lobar extra-nuclear white matter [27 −15 16] [−27 32 4]. White-matter densities in the bilateral sub-lobar extra-nuclear [−25 −17 18] [27 −13 20] and right brainstem midbrain [9 −34 −13] regions were higher in the depressive patients with childhood neglect than in the depressive patients without childhood neglect. White-matter densities in the bilateral inferior parietal lobe were negatively correlated with neglect total scores on the CTQ and with HAMD and DAS scores. White-matter densities in the bilateral sub-lobar extra-nuclear region were only negatively correlated with HAMD scores. Subjects that have depression with or without childhood neglect show different white-matter microstructural abnormalities.

Evaluating the Mood State Dependence of Automatic Thoughts and Dysfunctional Attitudes in Remitted Versus Never-Depressed Individuals

The cognitive model of depression specifies the role of schema-driven negative processing biases in the onset and maintenance of depression. Research has shown that cognitive reactivity, or the ease with which negative thinking patterns are activated by mild changes in negative mood, is related to relapse and recurrence. The goal of this study was to examine cognitive reactivity following a mood prime in individuals vulnerable to depression. Formerly (n = 28) and never (n = 36) depressed individuals were assessed on two measures of negative cognition, the Automatic Thoughts Questionnaire (ATQ) and Dysfunctional Attitudes Scale (DAS), before and after participating in a sad or neutral mood induction procedure (MIP). The negative mood induction resulted in increased belief in negative automatic thoughts across groups; however, only the formerly depressed participants assigned to this condition demonstrated increased DAS scores. Importantly, individuals who completed the neutral mood induction did not exhibit increases in negative cognition, providing evidence against the possibility that the MIP itself may lead to increases in negative cognition. These findings are discussed in relation to understanding the role of negative cognition and vulnerability to depression.

Hypomanic Personality, Stability of Self‐Esteem and Response Styles to Negative Mood

This paper aims to study dysfunctional self-schematic processes, abnormal coping styles, over-responsiveness to reward stimuli (indicative of an over-sensitive behavioural activation system) and stability of self-esteem in relation to subclinical hypomania. Three cross-sectional studies were conducted on selected students on the basis of their scores on the Hypomanic Personality Scale (HPS) (study 1) and on elevated HPS and Dysfunctional Attitude Scale scores (studies 2 and 3). In studies 1 and 2, participants completed questionnaires and kept a self-esteem diary for 6 days. In study 3, the experience sampling method was used to assess momentary self-esteem, emotion and use of different coping styles over a 6-day period. Study 1 demonstrated that hypomanic traits are associated with high fluctuations in self-esteem. In study 2, high scores on both the HPS and the Dysfunctional Attitude Scale, but not the HPS alone, were associated with bipolar spectrum symptoms. These participants showed more evidence of alcohol and substance abuse, greater self-esteem fluctuation and dysfunctional coping styles (rumination and risk-taking) compared with controls. Changes in self-esteem were related to the use of these strategies. Vulnerability to bipolar disorder is associated with a combination of depression-related and reward-related processes.

The maintenance effect of cognitive-behavioural treatment groups for the Chinese parents of children with intellectual disabilities in Melbourne, Australia: a 6-month follow-up study

Caring for a child with intellectual disability can be stressful. No data on the longer-term effects of cognitive-behavioural treatment (CBT) on parents from a Chinese-speaking background who have children with intellectual disabilities are available in the literature. This study attempted to fill this research gap by examining the maintenance effect of CBT among the Chinese parents of such children in Melbourne, Australia. Thirty-nine participants took part in our CBT groups and attended follow-up meetings. A questionnaire comprising four instruments, the Parenting Stress Index (PS) - Parent Domain, General Health Questionnaire-12 (GHQ-12), Abbreviated Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-18) and Dysfunctional Attitude Scale (DAS), was administered to the participants at the pre- and post-test stage and at the 6-month follow-up. One-way repeated-measures analyses of variance revealed significant time and group effects in the PS (F(2,27) = 16.93, P < 0.001), Q-LES-Q-18 (F(2,27) = 15.98, P < 0.001), GHQ-12 (F(2,27) = 81.93, P < 0.001) and DAS (F(2,27) = 15.50, P < 0.001) scores at the three measurement times. The participants continued to maintain significant improvements in mental health and quality of life and declines in the severity of parenting stress and dysfunctional attitudes at the 6-month follow-up. Effect size analyses revealed mostly large differences in the foregoing measurements (Cohen's d = 0.76-2.18) between the pre-test and 6-month follow-up. Employing a cut-off score of 3/4 in the GHQ-12 to identify at-risk and not-at-risk cases, approximately 90.5% of the participants could be classified as not-at-risk at the follow-up. Lastly, regression analyses showed that changes in DAS scores significantly predicted changes in the GHQ-12 and Q-LES-Q-18 scores at the follow-up. This study provides preliminary evidence of the 6-month maintenance effect of CBT groups for the Melbourne-resident Chinese parents of children with intellectual disabilities.

Cognitive Behavioural Group Treatment for Chinese Parents with Children with Developmental Disabilities in Melbourne, Australia: An Efficacy Study

This study attempted to test the efficacy of a culturally attuned cognitive behavioural therapy (CBT) group for Chinese parents with children with developmental disabilities at risk of developing mental health problems in Melbourne, Australia. It was hypothesized that the participants in the experimental group would have less parenting stress and fewer dysfunctional attitudes, rules, and values, and better mental health and quality of life than the participants in the control group post-test. A total of 58 participants were randomly assigned into CBT and waiting list control groups. While ANCOVAs were used to compare the differences in General Health Questionnaires-12 (GHQ-12), Parenting Stress Index- Parent Domain (PSI-PD), Quality of Life Enjoyment and Satisfaction Questionnnaire-18 (Q-LES-Q-18) and Dysfunctional Attitude Scale (DAS) between participants of the experiemental and control groups, effect size statistics were performed to measure the magnitude of changes in the above instruments at post treatment. After ten weeks of treatment, the participants in the CBT group showed significant improvement in GHQ-12, Parenting Stress Index (PSI)-Parent Domain and Q-LES-Q-18 scores, but not in DAS scores. The effect size statistics revealed large differences in GHQ-12, PSI-Parent Domain and Q-LES-Q-18 scores between the participants in the experimental and control groups at post-treatment. When a GHQ score of 4 or greater was used as the recommended cut-off score, about 89% and 10% of the participants in the experimental and control groups, respectively, were classified as not at-risk cases at post-treatment. The initial findings suggest that a culturally attuned CBT group may help Chinese parents with children with developmental disabilities to reduce their parenting stress and improve their general mental health and quality of life.

Dysfunctional Attitudes and Cognitive Schemas in Bipolar Manic and Unipolar Depressed Outpatients

Dysfunctional thought patterns are presumed to underlie cognitive biases in mood disorder patients. However, few studies have compared dysfunctional thought patterns in bipolar manic and unipolar depressed patients. Cognitive schemas and dysfunctional attitudes were evaluated using the cognitive checklist for mania and Dysfunctional Attitudes Scale (DAS) in 34 bipolar manic, 35 unipolar depressed, and 29 nonpsychiatric control subjects. Unipolar depressed subjects had significantly higher total DAS scores and subfactor scores as compared with nonpsychiatric controls, whereas bipolar patients had intermediate scores between both groups. Significant correlations emerged between cognitive checklist for mania total and subcomponent scores and the DAS (total, performance subfactor, and approval subfactor scales) for the bipolar, but not the unipolar or nonpsychiatric control groups. Core beliefs among bipolar patients appear negativistic during manic phases, potentially reflecting an overcompensation for depression. The findings support clinical approaches targeting depressive cognitions regardless of the presence of manic symptoms.

Dysfunctional attitudes and personality disorder comorbidity during long-term treatment of MDD

A key component of how depression may impact personality pathology involves an understanding of how cognition and dysfunctional attitudes may change as a result of experiencing a depressive state, and how these changes may affect reporting of personality disorder symptoms. This study examines whether dysfunctional attitudes are related to the stability of personality disorder diagnoses. The sample comprised 64 outpatients who were treatment responders following an 8-week acute treatment phase for major depressive disorder (MDD), met criteria for remission throughout a 26-week continuation phase, and completed a personality disorder assessment Structured Clinical Interview for DSM-III-R Axis II Disorders (SCID-II) at the beginning and end of each treatment phase. The Dysfunctional Attitude Scale (DAS) was given to patients at the beginning of the continuation phase. We found that following successful treatment of the MDD, individuals with stable personality disorder diagnoses (e.g., meeting criteria for a personality disorder at both the beginning and endpoint of continuation treatment) had greater severity of dysfunctional attitudes (P =.001) at the beginning of the continuation treatment compared to those who never met criteria for a personality disorder during continuation treatment. Though there was no significant relationship between DAS scores and the stability of a Cluster A or Cluster B personality disorder diagnosis, there was a significant relationship between DAS scores and the stability of a Cluster C personality disorder diagnosis (P <.001). Outpatients who had a stable Cluster C personality disorder diagnosis had higher scores on the DAS at the beginning of continuation treatment compared to outpatients who never met criteria for a Cluster C diagnosis. This finding suggests that dysfunctional attitudes that persist beyond remission of MDD may be a marker for certain personality disorders that are stable across long-term treatment.

Differences in cognitive factors between “true drug” versus “placebo pattern” response to fluoxetine as defined by pattern analysis

Pattern analysis has identified two types of response patterns to antidepressants: "true drug" response (TDR) and "placebo pattern" response (PPR). This study examines the relationship between cognitive factors and TDR and PPR to fluoxetine. We assessed 310 outpatients meeting DSM-III-R criteria for major depressive disorder (MDD) who were enrolled in an 8-week open trial of fluoxetine 20 mg/day. Response patterns were determined using the clinical global impressions-improvement (CGI-I). We administered the following self-rated scales to all patients at the baseline visit and at endpoint: perceived stress scale (PSS), cognitions questionnaire (CQ), Beck hopelessness scale (BHS) and dysfunctional attitudes scale (DAS). One hundred and thirty-four patients had TDR, 66 patients had PPR, and 110 patients were non-responders (NR). Demographic variables and severity of depression at baseline (HAMD-17) were not significantly different between the two response pattern groups. We compared cognitive factors before and after treatment across patients with TDR and PPR, and there were no significant differences at baseline in CQ, PSS, BHS, and DAS scores. At endpoint, outpatients with PPR had significantly lower scores on the PSS (p < 0.001) compared to the patients with TDR, even after adjusting for multiple comparisons and severity of depression at endpoint. Significant differences in cognitive/psychological factors, specifically lower post-treatment perceived stress, accompany "placebo" pattern of response to antidepressant treatment and differentiate it from "true drug" response pattern, as defined by pattern analysis.

Dysfunctional Attitudes, Gender, and Psychopathology as Predictors of Pain Affect in Patients With Irritable Bowel Syndrome

This cross-sectional study investigated the relationship between dysfunctional attitudes and the emotional unpleasantness of pain (pain affect) in a large sample (N= 281) of severely affected patients with irritable bowel syndrome (IBS). Subjects completed measures of pain, dysfunctional attitudes, and psychopathology as part of baseline assessment of an NIH-funded clinical trial featuring cognitive therapy for IBS. Drawing from the cognitive model of emotion, we predicted that patients with IBS would have a propensity toward negative thinking, as measured by the Dysfunctional Attitude Scale (DAS), and as a result rate pain affect as higher than patients with healthier cognitions. Consistent with these predictions, DAS scores for a sizable proportion of IBS patients were elevated compared to those from normative samples. Further, multiple regression analyses showed that dysfunctional attitudes account for approximately 11% of the variance in pain affect when control variables (gender, age, psychopathology) were held constant. These data are discussed in light of clinical implications for treating patients from a cognitive therapy orientation.

Do dysfunctional cognitions mediate the relationship between risk factors and postnatal depression symptomatology?

Background This study investigated the mediating role of general and maternal-specific dysfunctional cognitions, in the relationship between non-cognitive risk factors and postnatal depressive symptomatology. Methods An Australian community sample comprising 406 postnatal women responded to the Dysfunctional Attitude Scale (DAS), the Maternal Attitudes Questionnaire (MAQ), the Vulnerable Personality Style Questionnaire (VPSQ) and the Edinburgh Postnatal Depression Scale (EPDS). They also responded to several questions related to perinatal and postnatal experiences. Results Path analysis demonstrated that different mediational pathways operated for different risk factors. The relationship between having a difficult baby and postnatal depression was fully mediated by maternal-specific dysfunctional cognitions (MAQ scores), whereas the relationship between past history of depression and postnatal depression was partially mediated by general dysfunctional cognitions (DAS scores). Finally, the relationship between a vulnerable personality and depressive symptomatology was mediated by both DAS and MAQ scores. Limitations The study employed a correlational design. Thus, all inferences regarding possible causal pathways are tentative. In addition, the generalisability of these findings to other populations needs to be demonstrated in future research. Conclusions The results of the study are consistent with the view that risk factors may influence postnatal depression indirectly through at least two distinct cognitive mediators (dysfunctional maternal and general cognitions). It may be possible to target therapies more effectively by identifying the relevant mediating mechanism(s) for individuals with different risk profiles.

Pain and depression: Relationships of pain catastrophizing, depression, and dysfunctional attitudes

The relation between pain and depression is well established but not well understood. Cognitions, beliefs, and attitudes are thought to influence depression and perceived pain. Pain catastrophizing leads to heightened pain experience, and dysfunctional attitudes may predispose to depression. This study used a structural-equation, cross-lagged panel analysis to examine dysfunctional cognitions in relation to depression and experimental pain. 82 college students were administered the Pain Catastrophizing Scale (PCS), Beck Depression Inventory-II (BDI-II), and Dysfunctional Attitudes Scale (DAS) two weeks prior to a cold pressor task (CPT), and again immediately after the CPT. Pain response was measured by tolerance time (TOL), Visual Analogue Scale (VAS) ratings, and the abbreviated McGill Pain Questionnaire (MPQ). Total MPQ score predicted post-CPT PCS scores (p < .01) but not post-CPT BDI-II or DAS scores, and VAS ratings predicted TOL (p < .005). Post-CPT PCS scores were higher than pre-CPT scores (p < .05), but BDI-II and DAS scores did not change significantly. Pre-CPT measures were not significantly related to pain response, but pre-CPT PCS predicted post-CPT BDI-II (p < .01) and DAS (p < .025) even with pre-CPT levels on these two variables controlled. Pre-CPT BDI-II was not significantly related to post-CPT PCS (p > .10) or DAS (p > .5), whereas Pre-CPT DAS approached significance in predicting post-CPT PCS (p < .06) and BDI-II (p < .07) with pre-CPT scores controlled. These results, although preliminary and based on only part of our ultimate sample, suggest that individuals who are predisposed toward pain catastrophizing are more likely to report dysfunctional attitudes and depressive symptoms following exposure to pain (i.e., catastrophizing before induced pain mediated the relationship between induced pain and depression, and between induced pain and dysfunctional attitudes). Importantly, the relationship between pain catastrophizing and future depression was not mediated by induced pain.