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Woods C, Richardson T, Palmer-Cooper E. Are dysfunctional attitudes elevated and linked to mood in bipolar disorder? A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:16-53. [PMID: 37807389 DOI: 10.1111/bjc.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Dysfunctional attitudes (DA) are higher in depression; however, less is understood about their role in bipolar disorder (BD). This paper aimed to explore the presence of DA in BD in comparison to clinical and non-clinical groups. Also explored were the associations between DA and mood states of depression, mania or euthymia in BD. METHODS A systematic review and meta-analysis were conducted. A total of 47 articles were included in the systematic review of which 23 were included in the meta-analysis. The quality of each study was rated. RESULTS The meta-analysis showed significantly higher DA in BD than healthy controls (d = .70). However, no difference was observed between BD and unipolar participants (d = -.16). When reviewing mood state within BD, a significant mean difference was found between DA scores for euthymic and depressed participants (d = -.71), with those who were depressed scoring higher. Three studies found that psychological therapies significantly reduce DA in BD (d = -.38). CONCLUSIONS These findings imply not only that DA are both a characteristic of BD that is not as prevalent in healthy populations but also that a depressed mood state is associated with increased severity. This implies that DA could possibly go 'offline' when mood symptoms are not present. Psychological therapies appear to reduce DA in BD. Implications for future research as well as practice-based implications are expanded on in the discussion.
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Affiliation(s)
- Chloe Woods
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
| | - Thomas Richardson
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
| | - Emma Palmer-Cooper
- Southampton Psychosis and Bipolar Research and Innovation Group, School of Psychology, University of Southampton, Hampshire, Southampton, UK
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Palmer-Cooper EC, Woods C, Richardson T. The relationship between dysfunctional attitudes, maladaptive perfectionism, metacognition and symptoms of mania and depression in bipolar disorder: The role of self-compassion as a mediating factor. J Affect Disord 2023; 341:265-274. [PMID: 37633530 DOI: 10.1016/j.jad.2023.08.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Maladaptive cognitions appear to be associated with the severity of mood symptoms in bipolar disorder (BD), but findings are mixed and generally cross-sectional in design. METHOD This study (n = 331) explored the associations between maladaptive cognitions and mood symptoms in BD over time (3 months), and the potential mediating effect of self-compassion cross-sectionally. Dysfunctional attitudes, maladaptive perfectionism and maladaptive metacognitions were explored separately with depressive and manic symptoms, and with current mood state in BD. RESULTS The results showed maladaptive metacognitions to be the only significant predictor of depression at 3-month follow-up (β = 0.31, p < .001), with no relationship to mania over time. Cross-sectionally, self-compassion partially mediated the relationship between all maladaptive cognitions and depression, with higher dysfunctional cognitions and lower self-compassion predicting increased severity of depressive symptoms. Only the relationship between dysfunctional attitudes and mania was partially mediated by self-compassion, however, the relationship was weak and suggestive that higher self-compassion predicted increased mania. LIMITATIONS The study duration limited the possible analysis. Future longitudinal research is needed. Also, the study sample was not representative of the clinical population, making results less generalisable. Additionally, limited significant findings regarding manic symptoms supports the need for further research into active cognitions during this phase of BD. CONCLUSIONS Maladaptive metacognitions were predictive of future depression severity, therefore, further exploration of metacognitive therapy for BD should be explored. Furthermore, self-compassion was shown to partially mediate the relationship between negative cognitions and mood, therefore further exploration of compassion-based therapies for BD is needed.
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Affiliation(s)
- Emma C Palmer-Cooper
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Chloe Woods
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
| | - Thomas Richardson
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, United Kingdom.
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Quinlivan E, Renneberg B, Schreiter S, Friedel E, Shmuilovich O, Stamm T. Better than expected: the gap between self-reported and objective measures of cognitive performance in remitted bipolar disorder. Front Psychiatry 2023; 14:1258303. [PMID: 37791129 PMCID: PMC10544994 DOI: 10.3389/fpsyt.2023.1258303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Background Studies comparing objective and self-reported cognitive functioning as well as influencing factors in individuals with remitted bipolar disorder are scarce and contradictory. Methods The aim of this study was to compare executive functioning and other objective and self-reported cognitive impairment between 26 individuals with remitted bipolar disorder (15 BD I) and 24 healthy controls using a cross-sectional design. Executive functions were measured by the TAP Go/No-go subtest as well as the Stroop Task. Self-rated functioning was assessed using the Attention Deficit Experience Questionnaire. In addition, possible predictors of self-reported and objective cognitive functioning were examined to perform regression analyses. Results Individuals with remitted bipolar disorder did not differ significantly in executive functions or other objective cognitive domains from the healthy control group, but showed a significantly lower level of self-reported cognitive functioning and self-esteem. While self-esteem was the strongest predictor in healthy controls for self-reported cognitive functioning, severity of illness and subthreshold depressive mood were the most important predictors in individuals with remitted bipolar disorder. Conclusion The results once again demonstrate the cognitive heterogeneity in bipolar disorder. In the treatment of cognitive deficits, factors such as subthreshold depressive symptomatology and self-esteem should be focused on in addition to cognitive training in remitted patients.
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Affiliation(s)
- Esther Quinlivan
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva Friedel
- Department of Psychiatry and Neurosciences, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Olga Shmuilovich
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Thomas Stamm
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Schloss Luetgenhof Hospital, Centre for Personal Medicine, Psychosomatics and Psychotherapy, Dassow, Germany
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Spence R, Kagan L, Nunn S, Bailey‐Rodriguez D, Fisher HL, Hosang GM, Bifulco A. The moderation effect of secure attachment on the relationship between positive events and wellbeing. Psych J 2022; 11:541-549. [PMID: 35582844 PMCID: PMC9546065 DOI: 10.1002/pchj.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/12/2022]
Abstract
Positive events can reduce depression as well as enhance wellbeing. The role of secure attachment style in moderating the relationship between positive events and wellbeing is examined to further understand wellbeing models. Participants (n = 490) included two midlife groups and a student group from the UK. They completed the online Computerized Life Event Assessment Record (CLEAR), a measure of life events, the Vulnerable Attachment Style Questionnaire (VASQ), and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Age was associated with higher rates of wellbeing and secure attachment style. A significant relationship was found between number of positive events and wellbeing, number of people close, and secure attachment score. Hierarchical multiple regression indicated a significant interaction between secure attachment style, number of positive life events, and wellbeing. Simple slopes analysis demonstrated the association between positive life events and wellbeing was significant for secure attachment (B = 1.27, p = .003) but not insecure attachment (B = 0.04, non-significant). This suggests securely attached individuals are better able to take advantage of positive life events than insecurely attached individuals and experience a greater increase in wellbeing.
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Affiliation(s)
- Ruth Spence
- Department of PsychologyMiddlesex UniversityLondonUK
| | - Lisa Kagan
- Department of PsychologyMiddlesex UniversityLondonUK
| | - Stephen Nunn
- Department of PsychologyMiddlesex UniversityLondonUK
| | | | - Helen L. Fisher
- King's College London, Social Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
| | - Georgina M. Hosang
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen MaryUniversity of LondonLondonUK
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Schanz CG, Equit M, Schäfer SK, Michael T. Self-directed passive-aggressive behaviour as an essential component of depression: findings from two cross-sectional observational studies. BMC Psychiatry 2022; 22:200. [PMID: 35303807 PMCID: PMC8933131 DOI: 10.1186/s12888-022-03850-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The self-control model of depression suggests depressive symptoms to derive from distorted self-monitoring, dysfunctional self-evaluation and reduced self-reward as well as increased self-punishment. Building on this model a relationship between self-directed passive-aggressive behaviour, that is, harmful inactivity, and depression has been assumed. This association has been supported by a recent study in an inpatient sample. However, it remains unclear if patients with depressive disorders report more self-directed passive-aggressive behaviour than patients without depressive disorders and if self-directed passive aggression mediates the associations between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. METHODS Study 1 compared self-directed passive-aggressive behaviour levels between 220 psychotherapy outpatients with (n = 140; 67.9% female; Mage = 40.0) and without (n = 80; 65.0% female; Mage = 36.2) depressive disorders. Diagnoses were made based on the Structured Clinical Interview for DSM-IV. Study 2 examined self-directed passive-aggressive behaviour as a mediator of the relationship between distorted self-monitoring and dysfunctional self-evaluation and self-reported depressive symptoms in 200 undergraduate Psychology students. RESULTS Compared to outpatients without depressive disorders, outpatients with depressive disorder reported significantly more self-directed passive aggression (d = 0.51). Furthermore, Study 2 verified self-directed passive-aggressive behaviour as a partial mediator of the relationship between dysfunctional attitudes (abcs = .22, 95%-CI: .14, .31), attributional style (abcs = .20, 95%-CI: .13, .27), ruminative response style (abcs = .15, 95%-CI: .09, .21) and depressive symptoms. CONCLUSION Self-directed passive-aggressive behaviour partially mediates the association between distorted self-monitoring and dysfunctional self-evaluation with depressive symptoms. Future longitudinal studies need to examine a potential causal relationship that would form a base to include interventions targeting self-directed passive-aggressive behaviour in prevention and treatment of depression. TRIAL REGISTRATION Both studies were preregistered at the German Clinical Trials Register ( DRKS00014005 and DRKS00019020 ).
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Affiliation(s)
- C G Schanz
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - M Equit
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - S K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany
| | - T Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbruecken, Germany.
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Remes O, Mendes JF, Templeton P. Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. Brain Sci 2021; 11:1633. [PMID: 34942936 PMCID: PMC8699555 DOI: 10.3390/brainsci11121633] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.
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Affiliation(s)
- Olivia Remes
- Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK
| | | | - Peter Templeton
- IfM Engage Limited, Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK;
- The William Templeton Foundation for Young People’s Mental Health (YPMH), Cambridge CB2 0AH, UK
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A transdiagnostic model of low self-esteem: pathway analysis in a heterogeneous clinical sample. Behav Cogn Psychother 2021; 50:171-186. [PMID: 34852861 DOI: 10.1017/s1352465821000485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell's model, the catalyst model and the Self-Regulatory Executive Function model. AIMS Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample. METHOD Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling. RESULTS Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model. CONCLUSIONS The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.
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Herstell S, Betz LT, Penzel N, Chechelnizki R, Filihagh L, Antonucci L, Kambeitz J. Insecure attachment as a transdiagnostic risk factor for major psychiatric conditions: A meta-analysis in bipolar disorder, depression and schizophrenia spectrum disorder. J Psychiatr Res 2021; 144:190-201. [PMID: 34678669 DOI: 10.1016/j.jpsychires.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 01/15/2023]
Abstract
Insecure attachment has been suggested as a major risk factor for mental health problems as well as a key element for the development and trajectory of psychiatric disorders. The aim of this meta-analysis was to assess whether insecure attachment constitutes a global transdiagnostic risk factor in bipolar disorder, depression, and schizophrenia spectrum disorders. We conducted a PRISMA-based systematic quantitative review to explore the prevalence of insecure attachment among patients of three representative psychiatric disorders - major depression, schizophrenia spectrum disorders and bipolar disorder - in comparison with healthy controls (HC) from a transdiagnostic point of view. Effect sizes on differences of anxious, avoidant and insecure prevalence were calculated based on 40 samples including a total of n = 2927 individuals. Overall, results indicated a large effect on prevalence of insecure attachment across all disorders compared to HC (k = 30, g = 0.88, I2 = 71.0%, p < 0.001). In a transdiagnostic comparison, the only difference was found in avoidant attachment, which was significantly lower (p = 0.04) compared to HC in the schizophrenia spectrum disorder subgroup (k = 10, g = 0.31, I2 = 76.60%, p < 0.0001) than the depression subgroup subgroup (k = 12, g = 0.83, I2 = 46.65%, p < 0.0001). The lack of further transdiagnostic differences between three distinct psychiatric disorders corroborates insecure attachment as a general vulnerability factor to psychopathology. Our findings warrant further investigations, which should explore the pathways from attachment insecurity towards psychopathology. Insecure attachment likely has implications on assessment, prediction and treatment of psychiatric patients.
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Affiliation(s)
- Simon Herstell
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Nußbaumstraße 7, 80336, Munich, Germany.
| | - Ruth Chechelnizki
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Laura Filihagh
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Linda Antonucci
- Department of Education, Psychology and Communication - University of Bari Aldo Moro, Piazza Umberto I, 1, 70121, Bari BA, Italy; Department of Basic Medical Sciences, Neuroscience and Sense Organs - University of Bari Aldo Moro, Piazza Umberto I, 1, 70121, Bari BA, Italy.
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Petrowski K, Berth H, Beiling P, Renner V, Probst T. Patient's and the Therapist's Attachment Representations, Attachment to Therapists, and Self-Esteem-Change Through Psychotherapy. Front Psychol 2021; 12:711296. [PMID: 34795612 PMCID: PMC8593375 DOI: 10.3389/fpsyg.2021.711296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/04/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: The present naturalistic study aims to investigate the differential effects of the patient’s and the therapist’s attachment representations on the attachment to the therapist as perceived by the patient, and their impact on self-esteem-change through psychotherapy. Methods: Attachment variables of N = 573 patients as well as N = 16 therapists were assessed. Attachment representations were measured for therapists and patients via the Bielefelder Questionnaire for Client Attachment Exploration, the Relationship Specific Attachment to Therapist Scales and the Adult Attachment Interview. The patient’s attachment to therapists was evaluated and patients’ self-esteem was measured via the Frankfurter Selbstkonzeptskalen at the beginning and end of psychotherapy. Results: Although there were significant effects of the patient’s attachment representations on the perceived attachment to the therapist as well as between the perceived attachment to the therapist and the amount of self-esteem-change, the therapist’s attachment style had no significant influence on the perceived attachment to the therapist. Conclusion: Self-esteem-change through psychotherapy is influenced by the actually formed attachment relationship as perceived by the patient. The patient’s attachment representations but not the therapist’s attachment style contributes to the actual patient’s attachment to the therapist.
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Affiliation(s)
- Katja Petrowski
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Hendrik Berth
- Medical Psychology and Medical Sociology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Peter Beiling
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - Vanessa Renner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
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Individuals with Major Depressive Disorder Report High Scores of Insecure-Avoidant and Insecure-Anxious Attachment Styles, Dissociative Identity Symptoms, and Adult Traumatic Events. Healthcare (Basel) 2021; 9:healthcare9091169. [PMID: 34574943 PMCID: PMC8469763 DOI: 10.3390/healthcare9091169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: Individuals with major depressive disorder (MDD) report more issues in social interaction compared to the general population. Moreover, dimensions of dissociation are considered dysfunctional strategies to cope with adverse life events. In this regard, current symptoms of MDD could be associated with traumatic events that occurred in childhood and in adult life. Given this background, the aim of the present study was to explore the associations between attachment styles as a proxy of quality of social interaction, dimensions of dissociation, and childhood and adult traumatic life events among individuals with MDD. Method: A total of 300 individuals with MDD (mean age: 31.31 years; 58.7% female) took part in this study. They completed a series of questionnaires on sociodemographic information, attachment styles, dimensions of dissociation, and childhood and adult traumatic life events. Results: Prevalence rates for attachment styles were as follows: anxious/ambivalent attachment style—71.7%; avoidant/dependent attachment style—13%; secure/close attachment style—15.3%. Compared to the general population, the participants reported higher prevalence rates of insecure attachment styles. Current symptoms of dissociation were associated with adult but not childhood traumatic life events. An anxious attachment style was associated with higher scores of dissociation. Conclusion: Psychotherapeutic treatment of individuals with MDD should consider the individuals’ challenging attachment styles and their risk of dissociation. While it is important to consider both adult and childhood traumatic events, in this research, more recent trauma occurring in adulthood was associated with current symptoms of dissociation.
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Impact of Childhood Trauma and Attachment on Resilience in Remitted Patients with Bipolar Disorder. J Affect Disord 2021; 280:219-227. [PMID: 33220557 DOI: 10.1016/j.jad.2020.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/22/2020] [Accepted: 11/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Childhood trauma has been reported to be associated with severe course of illness, insecure attachment, and lower resilience in bipolar disorder. We aimed to examine the impact of childhood trauma on resilience and possible mediating role of attachment on this impact in bipolar disorder. METHODS The study group comprised of 110 remitted patients with bipolar disorder. Hamilton Depression Rating Scale (HAM-D) and Young Mani Rating Scale (YMRS) are administered to verify remission. Childhood trauma questionnaire (CTQ-SF), Experiences in Close Relationships-revised (ECR-R), and Resilience Scale for Adults (RSA) scales administered to all patients. RESULTS More than half of patients in bipolar disorder group reported childhood trauma. HAM-D scores were positively associated with childhood trauma total scores and emotional abuse scores, negatively associated with resilience, with attachment-related anxiety. Total childhood trauma scores were associated with lower scores of resilience, higher scores of attachment-related anxiety and avoidance. Resilience scores were negatively associated with attachment-related anxiety and avoidance. Impact of childhood trauma on resilience was partly mediated by attachment-related anxiety and avoidance, respectively. LIMITATIONS The cross-sectional design of this study is a limitation in terms of determining causality of the identified relationships. CONCLUSIONS Childhood traumas are associated with lower resilience and higher attachment-related anxiety and avoidance. Attachment-related anxiety and avoidance partly mediated the negative effect of childhood trauma on resilience. Since resilience is associated with increased quality of life in bipolar disorder, it might be helpful to develop attachment-informed psychosocial interventions to ameliorate the detrimental effect of childhood trauma on resilience.
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Yang Y, Fletcher K, Murray G. A narrative review of cross-sectional and prospective associations between self-schemas and bipolar disorder. Clin Psychol Psychother 2021; 28:766-783. [PMID: 33386678 DOI: 10.1002/cpp.2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 01/03/2023]
Abstract
The role of self-concept in bipolar disorder (BD) has not been well understood. The present review utilizes the notion of self-schema and interrogates existing research concerning evidence for cross-sectional and prospective associations between four schema-like constructs (i.e. trait self-esteem, dysfunctional beliefs concerning contingent self-worth, early maladaptive schemas and implicit self-esteem) and various facets of BD. Existing findings demonstrate various types of involvement of self-schemas in BD. Of particular clinical relevance, the present review suggests that low trait self-esteem and dysfunctional beliefs concerning contingent self-worth are risk factors for ongoing BD symptoms and mood episodes. The present review also yields important yet unaddressed questions with respect to the evaluative content of self-schemas associated with the hypo/manic phase of BD.
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Affiliation(s)
- Yan Yang
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Australia
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Zhou Y, Arend J, Mufson L, Gunlicks-Stoessel M. Change in dysfunctional attitudes and attachment in interpersonal psychotherapy for depressed adolescents. Psychother Res 2020; 31:258-266. [PMID: 32351173 DOI: 10.1080/10503307.2020.1756513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
ABSTRACT This study examined changes in depressed adolescents' reports of dysfunctional attitudes while receiving interpersonal psychotherapy (IPT-A) and the relationship between the change in dysfunctional attitudes and change in attachment anxiety and avoidance with IPT-A. Forty adolescents (age 12-17) participated in a 16-week randomized clinical trial of 4 adaptive treatment strategies that began with IPT-A and augmented treatment for insufficient responders by adding additional IPT-A sessions or the antidepressant medication, fluoxetine. Measures of attachment anxiety and avoidance (Experience in Close Relationships Scale-Revised [ECR-R]), dysfunctional attitudes (Dysfunctional Attitudes Scale [DAS]), and depression (Children's Depression Rating Scale-Revised [CDRS-R]) were administered at baseline and weeks 4, 8, 12, and 16. Adolescents demonstrated a significant decrease in dysfunctional attitudes (DAS) over the course of treatment. Reductions in dysfunctional attitudes (DAS) were also significantly associated with reductions in attachment anxiety and avoidance (ECR-R), controlling for depression (CDRS-R). Our results suggest that change in adolescents' attachment anxiety and avoidance may be an important mechanism of change in adolescents' dysfunctional thinking patterns.
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Affiliation(s)
- Yuan Zhou
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Jessica Arend
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Laura Mufson
- Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, New York, NY, USA
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14
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Picardi A, Pallagrosi M, Fonzi L, Martinotti G, Caroppo E, Meldolesi GN, Di Gennaro G, De Risi M, Biondi M. Attachment in Patients with Bipolar and Unipolar Depression: A Comparison with Clinical and Non-clinical Controls. Clin Pract Epidemiol Ment Health 2019; 15:143-152. [PMID: 32174996 PMCID: PMC7040468 DOI: 10.2174/1745017901915010143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/20/2023]
Abstract
Background A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce. Objective We aimed at testing the association between attachment insecurity and unipolar and bipolar depression. Methods We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style. Results Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Also, patients with bipolar depression scored significantly higher on attachment-related anxiety than all other groups. In both psychiatric groups, attachment dimensions were not significantly correlated with global clinical severity or severity of depression. Conclusion Despite some study limitations, our results are consistent with some previous studies and provide support to Bowlby's seminal hypothesis that attachment insecurity may predispose to depression. Attachment theory may provide a valuable theoretical framework for future research and for guiding treatment.
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Affiliation(s)
- Angelo Picardi
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Mauro Pallagrosi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Giovanni Martinotti
- Department of Neuroscience and Imaging, University "G.d'Annunzio", Chieti, Italy
| | - Emanuele Caroppo
- Department of Mental Health, Rome 2 Local Health Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Giulio Nicolò Meldolesi
- "Neurone" Foundation for Research in Neuropsychobiology and Clinical Neurosciences, Rome, Italy
| | | | - Marco De Risi
- Epilepsy Surgery Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Massimo Biondi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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15
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Auersperg F, Vlasak T, Ponocny I, Barth A. Long-term effects of parental divorce on mental health - A meta-analysis. J Psychiatr Res 2019; 119:107-115. [PMID: 31622869 DOI: 10.1016/j.jpsychires.2019.09.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023]
Abstract
The aim of this study was to estimate the long-term effects of parental divorce on their offspring's mental health as well as substance-based addiction. We performed a systematic literature search on PubMed, Medline, PsyINFO, PsyARTICLES and PsycNET for the time period from 1990 until March 2018 in English language. In total 54 studies were included in the meta-analysis resulting in 117 effect sizes as well as a total sample of 506,299 participants. A significant association between parental divorce and every aspect of mental health was found with the following pooled ORs (95% CIs): Depression 1.29 (1.23-1.35), anxiety 1.12 (1.04-1.12), suicide attempt 1.35 (1.26-1.44), suicidal ideation 1.48 (1.43-1.54), distress 1.48 (1.37-1.6), alcohol 1.43 (1.34-1.53), smoking 1.64 (1.57-1.72) and drugs 1.45 (1.44-1.46) could be estimated. There was significant association between the effect sizes and the publication date specifically for distress (r = -0.995, p = .005). The results of the meta-analysis show a consistent direction of influence regarding the long-term effect of parental divorce on their children. Individuals affected by parental divorce have a higher risk of developing a variety of mental health conditions, although the effect sizes decreased from 1990 to 2017. Further research should focus on developing programmes to promote the resilience of children affected by divorce.
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Affiliation(s)
- Felicitas Auersperg
- Department of Psychology, Sigmund Freud University Vienna, 1020, Vienna, Austria.
| | - Thomas Vlasak
- Department of Psychology, Sigmund Freud University Linz, 4020, Linz, Austria.
| | - Ivo Ponocny
- Department for Sustainability, Governance, and Methods, MODUL University Vienna, 1190, Vienna, Austria.
| | - Alfred Barth
- Head of the Department of Psychology, Sigmund Freud University Linz, 4020, Linz, Austria.
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Bifulco A, Kagan L, Spence R, Nunn S, Bailey‐Rodriguez D, Hosang G, Taylor M, Fisher HL. Characteristics of severe life events, attachment style, and depression – Using a new online approach. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 58:427-439. [DOI: 10.1111/bjc.12221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lisa Kagan
- Department of Psychology Middlesex University London UK
| | - Ruth Spence
- Department of Psychology Middlesex University London UK
| | - Stephen Nunn
- Department of Psychology Middlesex University London UK
| | | | - Georgina Hosang
- Centre for Psychiatry Wolfson Institute of Preventive Medicine Barts & London School of Medicine & Dentistry Queen Mary University of London UK
| | | | - Helen L. Fisher
- Social Genetic & Developmental Psychiatry Centre Institute of Psychiatry, Psychology & Neuroscience King's College London UK
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