Stress-stimulated volitional coping competencies and depression in multiple sclerosis

OBJECTIVE

The present study examined the relationship between volitional modes of coping (self-regulation, volitional inhibition, and self-control) and depression in individuals with multiple sclerosis.

METHODS

A cross-sectional study of 121 participants aged 22-60 years with clinically defined MS who were consecutively admitted to a neurological rehabilitation center during a 23-month period. Correlation analyses and hierarchical regressions were conducted to evaluate the predictive value of volitional competencies (Volitional Components Questionnaire, short form, VCQ-S) on depression (Centre for Epidemiologic Studies Depression Scale, CES-D), while controlling for demographic (age, gender, and education) and certain clinical variables (Expanded Disability Status Scale, EDSS; disease duration; and Modified Fatigue Impact Scale, MFIS).

RESULTS

Hierarchical regression analyses of depression revealed a model in which 68% of the variance in the CES-D was explained by daily stress situations (VCQ-S), self-regulation (VCQ-S), fatigue (MFIS), and education. However, when the analysis included only participants who had scored above the cut-off of the CES-D (n=42), the VCQ-S factor volitional inhibition seemed to play a more relevant part in depression. In particular, the VCQ-S scales stimulation of self-access, stimulation of volitional inhibition, self-motivation, and emotional perseverance/state orientation after failure appear to be valuable predictors on CES-D.

CONCLUSIONS

The results suggest that personality-accentuated volitional coping competencies elicited by daily stressful situations could be a relevant factor for depressive mood states in individuals with MS. However, to clarify the exact relationships of this rather circular framework, longitudinal study designs with objective measurements and a stronger focus on MS-specific stressors are needed.

Improving volitional competence is crucial for the efficacy of psychosomatic therapy: a controlled clinical trial

BACKGROUND

Although skills of will (volitional competences), such as self-motivation or emotion regulation, are particularly necessary for patients with psychiatric and psychosomatic disorders, it is unknown whether volitional deficits can be reduced and thereby the efficacy of psychotherapy increased. We investigated the effect of a group therapy for improving volitional competence in an inpatient rehabilitation program.

METHODS

In a controlled clinical trial, patients from a rehabilitation clinic participated either in the volition group therapy in addition to the standard cognitive behavioral therapy (volition group, VG) or in the standard cognitive behavioral therapy (standard group, SG). Patients were tested for volitional competence, depressive symptoms, total psychiatric symptomatology, and physical complaints prior to, at the end of inpatient therapy and after 6 months of follow-up (n = 242).

RESULTS

At the end of inpatient therapy, better improvement in volitional competence was observed in the VG than in the SG [e.g. self-motivation: effect size (ES) 0.96 vs. 0.39; ANCOVA: F(1, 209) = 16.58; p < 0.001]. Patients with greater volitional improvements had a better rehabilitation outcome. In the VG, depressive symptoms as well as total psychiatric symptomatology decreased significantly more than in the SG [ES: 1.18 vs. 0.87, F(1, 207) = 4.68, p < 0.05, and ES 1.12 vs. 0.73, F(1, 205) = 4.68, p < 0.05, respectively], but not physical complaints [ES: 0.62 vs. 0.48, F(1, 207) = 1.08, n.s.].

CONCLUSIONS

Effect size increased in patients with initially low volitional competence and high motivation to participate in a volitional training. These results might lead to a more systematic assessment and training of volitional competence.

Diagnostik von Ressourcen im Alter

Zusammenfassung: Als Ergänzung zur psychopathologisch orientierten Diagnostik zieht seit einiger Zeit die Beschäftigung mit Stärken, Kompetenzen und Ressourcen einer Person Aufmerksamkeit auf sich, zuletzt unter den Bemühungen der Positiven Psychologie. Gerade die Alterspsychotherapie kann von einer Ressourcenorientierung profitieren. Dieser Artikel verfolgt zum einen das Ziel, Instrumente zur Diagnostik verschiedener Ressourcen darzustellen, zum anderen Befunde zu positiven Konsequenzen dieser Ressourcen im Alter zusammenzufassen. Berücksichtigt werden emotionale Ressourcen (positiver Affekt, Lebenszufriedenheit, Selbstwerterleben), motivationale Ressourcen (Kontrollüberzeugung, Selbstwirksamkeitserwartung, dispositionaler Optimismus, optimistischer Attributionsstil, Hoffnung, intrinsische Lebensziele), volitionale Ressourcen (Handlungsorientierung, Selbstregulation und Selbstkontrolle, Aufmerksamkeitsregulation, Emotionsregulation), interpersonale Ressourcen (Bindung, Altruismus, soziale Verantwortung, Vergebung, Humor) und soziale Ressourcen (soziales Netzwerk, soziale Unterstützung, Partnerbeziehung). Diskutiert wird die Notwendigkeit einer Diagnostik der Ressourcen in der Psychotherapie, vorgeschlagene Änderungen am DSM-IV und Schlussfolgerungen für geplante Forschungsprojekte.