10330558 Research Project MSc

Cognitive Thinking Style, Sleep, and Mood in Older Adults.

Thesis submitted to the University of

Plymouth for the MSc in Psychological Research Methods by Cassie Anderson

(10330558)

Project Supervisor: Dr Catherine Deeprose

August 2013

Cognitive thinking style, sleep and mood in older adults Cassie Anderson 10330558

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Cognitive thinking style, sleep and mood in older adults.

An online study into the relationship between thinking styles, sleep and mood.

Thesis submitted to the University of Plymouth for the MSc in

Psychological Research Methods by Cassie Anderson

Project supervisor: Dr Catherine Deeprose

23.08.13


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The work reported in this thesis received ethical approval from the Faculty of

Science and Technology and complies with the guidelines set by the British

Psychological Society.


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With special thanks to my project supervisor, Dr Catherine Deeprose, for all of her

help, advice, and support.


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Contents

Contents of Tables page 5

Abstract page 6

Introduction page 6

Method page 16

Participants page 16

Materials page 16

Design page 21

Procedure page 21

Results page 22

Discussion page 26

References page 31

Appendices page 35


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Contents of Tables

Table 1: Means and standard deviations of each measure, for depressed and

non-depressed conditions. – Page 23


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Abstract

It is now well established that negative intrusive thoughts are a characteristic

symptom of depression, which have been found to contribute to the maintenance of

the disorder. There are a number of other cognitive processes associated with

intrusive thoughts, which are also affected in depression. Of all depressed

populations, older adults are the cohort at the highest risk of completed suicide, yet

little research specifically targets this population. Given these findings, the current

study aimed to extend the current literature, by bringing together a number of

separate findings relating to cognitive symptoms, and by recruiting older adults from

the community. 49 participants were recruited and subsequently allocated to the

“depressed” condition (N =21) or the “non-depressed” condition (N = 29), based on

their score on the CES-D (Radloff, 1977). Findings suggest that the older adults

placed in the depressed condition, displayed higher levels of particular cognitive

symptoms, which are commonly linked to clinical depression. Analyses also revealed

positive correlations between levels of depressive symptomatology and the extent of

various cognitive symptoms. In addition, the content of intrusions of older adults, was

not found to differ from those reported by younger adults, and was consistent with

previous findings. Replication would be beneficial with a clinical sample.

Introduction

Individuals with depression find that many areas of their daily lives are

affected by their disorder. Symptoms of depression may manifest themselves in the

following four main manners: mood symptoms; motivational or behavioural

symptoms; physical symptoms; and cognitive symptoms (Seligman, Walker &

Rosenhan, 2001). In addition to the very well documented relationship between


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depression and anxiety, (Spitzer, Kroenke, Williams, & Lowe, 2006) two of the best

established symptoms of depression, and other affective disorders, are sleep

disturbances and negative intrusive thoughts (Seligman et al., 2001), though there

are a number of cognitive processes related to these symptoms, which are also

affected by the disorder (Hammen & Watkins, 2008).

Given the nature of depressive symptomatology, clinical depression, along

with other affective disorders, is always incredibly worthwhile of research, in terms of

both theoretical understanding of the disorders, and also in terms of treatment. In

recent years, research has been able to show that individuals in their youth, or early

adulthood, are most at risk of onset of depression (Hammen & Watkins). Despite this

finding however, it is the older population who seem to be particularly vulnerable,

and therefore in desperate need of well-informed and effective treatment. Cases of

depression in older adults are often misdiagnosed, due to the nature of the

symptoms that these individuals exhibit (Hammen & Watkins, 2008). Symptoms of

depression in this sub-population are often mistaken as being consequences of

aging, for example, becoming forgetful, or experiencing feelings of fatigue and a lack

of energy. It is particularly important that such misdiagnoses are addressed however,

as research suggests that, cases of geriatric depression are often the most severe,

with greater levels of hopelessness, and higher rates of suicide being reported

amongst this population (Hammen & Watkins). Such a finding makes focused

research of this sub-population, of great worth.

Individuals with depression are now widely documented to regularly

experience intrusive mental images, thoughts and memories, previously best

recognised for being a common phenomenon of post-traumatic stress disorder

(Brewin, Reynolds & Tata, 1999). It has been suggested that around 85% of


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depressed individuals are expected to regularly experience negative intrusions

(Brewin et al., 1996). Intrusive thoughts are defined as unwelcome thoughts which

are not consciously brought to the surface. Intrusions may also manifest themselves

in the form of mental imagery, and are commonly related to specific, negative

events. (Hall et al., 1997). Severity of depression has also been reported to be linked

to the frequency and intensity of the intrusive thoughts that are experienced, and to

the degree to which depressed individuals attempt to avoid intrusive memories

(Kuyken & Brewin, 1994). It has repeatedly been found that individuals suffering from

negative intrusive thoughts, will often employ avoidance behaviours in order to

suppress their negative intrusions (Hall et al., 1997). In addition it is suggested that

negative appraisals of intrusive thoughts are correlated to depression severity (Starr

& Moulds, 2006). Not only are intrusive thoughts a major characteristic of

depression, there is also research to suggest that intrusions may actually contribute

to the maintenance of the disorder (Newby & Moulds, 2011). In a longitudinal study

of a clinical sample of depressed patients, Brewin and colleagues (1999) reported

that, depression at the follow-up, could be predicted by the levels of intrusive

thoughts and avoidance behaviours at baseline (Brewin, et al., 1999) thus indicating

a positive relationship between the presence of negative intrusive thoughts,

depression, and the tendency to use avoidance strategies.

It is thought that, in depression, negative intrusions are often concerned with

the following topics: familial issues such as illness and death, personal injuries, or

interpersonal dilemmas (Brewin et al., 1996), with familial and interpersonal

problems being the most common (Reynolds & Brewin, 1999), for example topics

such as illness and loss of friends (Deeprose & Holmes, 2010). Depressed patients

have been reported to say that, their experiences of negative intrusive memories


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often manifest in such a way that, it is as though they are reliving their past,

sometimes accompanied by physical effects (Reynolds & Brewin, 1999). Williams

and Moulds (2007) have more recently supported this evidence, and have

additionally suggested that, the degree to which depressed individuals feel as though

they are re-experiencing their past, varies along with the level of distress that the

individual feels at the time of their negative intrusion. Similarly, Starr & Moulds

(2006) have supported this research with their findings that both the frequency of

negative intrusive thoughts and images, and the use of avoidance behaviours, may

be related to the seriousness of depression. These findings suggest that, there may

be a positive correlation between the seriousness of depression, and the degree of

cognitive disturbances, such as intrusive thoughts, and avoidance behaviours, which

are experienced.

Intrusive thoughts and images may be related to a past event or memory, but

it has also been shown that they can concern the prospective future. This therefore

indicates, that individuals with depression also have a propensity for pre-

experiencing the future (Deeprose & Holmes, 2010). Much like negative intrusive

memories, a tendency to pre-experience distressing future events, is associated with

depression. Findings suggest that individuals with unipolar depression, lack the

capacity to pre-experience prospective positive future events (Holmes, Lang, Moulds

& Steele, 2008), while those with bipolar depression, have been shown to pre-

experience the future far too often (Holmes et al., 2008). In a study in which they

created and tested the Impact of Future Events Scale (IFES), Deeprose and Holmes

(2010) reported that higher levels of pre-experiencing were associated with higher

levels of depression. These findings combined, suggest that cognitive processes

concerned with the future, may be affected in the same way that cognitive facets for


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the past are affected, in depression. There is also evidence to support this, that

suggests that recalling the past, and pre-experiencing the future are enabled by the

same construct: episodic memory (Addis, Wong & Schacter, 2008).

Similarly to the findings that depressed individuals experience more intrusive

mental imagery than their non-depressed counterparts, it has also been suggested

that patients with bipolar depression, tend to use visual mental imagery more

frequently than non-clinical populations (Holmes et al., 2011). It was also suggested

that visual mental imagery may be more likely employed than mental verbal thoughts

(Holmes, Geddes, Colm & Goodwin, 2008). Given the tendency for depressed

individuals to experience intrusive thoughts and images (Brewin et al., 1999), the

current research was interested in investigating the relationship between the

presence of depressive symptomatology, and levels of intrusive mental imagery, and

intrusive verbal thoughts. By incorporating a measure for both verbal thoughts and

mental imagery, the current research may attempt to replicate findings of a

relationship, between depression and intrusive mental images and verbal thoughts,

at the same time as offering the potential, for the findings of Holmes and colleagues

(2008) to be extended. Given that negative intrusive thoughts have been repeatedly

shown to act as both a symptom and contributor to the trajectory of depression

(Brewin et al., 1999; Patel et al., 2007; Newby & Moulds, 2011), it is particularly

important that their manifestations are thoroughly researched and well understood, in

turn potentially enabling progress in the development of treatments and therapies

available (Patel et al., 2007).

Another related, and very common, symptom of depression is the disturbance

of sleep, in one form or another (Hall et al., 1997). Sleep studies which are

conducted in a laboratory setting are able to directly monitor sleeping habits of


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depressed individuals. Such studies have been able to demonstrate that depressed

individuals have trouble with falling asleep, and staying asleep; they have also been

shown to display less delta wave activity which is indicative of deep sleep, along with

less rapid eye movement (REM) sleep (Benca, Obermeyer, Thisted & Gillen, 1992).

It has been considered that disturbed sleep, as a result of bereavement, may be

adversely affected by the manifestation of negative intrusions, and the use of

avoidance behaviours (Hall et al., 1997). It is thought that these phenomena are

related to certain psychophysiological changes, which lead to poorer sleep quality in

individuals with bereavement-related depression (Hall et al., 1997). Furthermore, it

has been proposed that individuals who suffer from insomnia often blame their lack

of sleep to cognitive arousal, in the form of uncontrollable thoughts (Nicassio,

Mendlowitz, Fussell & Petras, 1985). Intrusive thoughts and cognitive arousal are

considered to be very similar constructs, both of which are thought to be related to

poor sleep quality in individuals both with and without sleep disturbances (Hall et al.,

1997).

In an attempt to understand this proposed association between negative

intrusive thoughts and sleep disturbances in depression, Hall and colleagues (1997)

investigated how intrusive thoughts, avoidance behaviours, and sleep quality related

to one another, in a sample of participants with bereavement-related depression.

The findings from this research suggested that sleep quality may be affected by the

presence of negative intrusions, and the use of avoidance strategies, such as

rumination, which in turn, may affect the way in which depression develops. Given

the relationship between sleep quality and negative intrusive thoughts, and the

research suggesting a link between depression severity and frequency of negative


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intrusive thoughts, the current research was interested in investigating whether

depression and sleep might share a similar positive correlation.

The avoidance behaviours shown to be related to both negative intrusive

thoughts, and sleep disturbances, in depression, include processes such as

rumination (Starr & Moulds, 2006). Rumination is a mechanism, employed for coping

with negative affect, which requires reflection of the self. It also often consists of an

individual repeatedly appraising their negative emotions (Morrow & Noelen-

Hoeksema, 1990). It has repeatedly been found that use of rumination can predict

higher levels of depressive symptomatology, and the onset of depressive episodes in

major depression (Treynor, Gonzalez & Noelen-Hoeksema, 2003).

An additional avoidance mechanism often employed by depressed individuals

is known as suppression (Starr & Moulds, 2006). Suppression is a modulatory

mechanism employed to inhibit behaviours which express emotions (Gross, 1998). It

is believed to occur late in the process of generating emotions, and is mostly

concerned with affecting the behavioural components of emotional reactions (Gross

& John, 2003). As such, though it prevents the expression of negative emotions,

suppression is not useful for reducing the experience of negative emotion (Gross &

John, 2003). In turn, suppression is considered to lead to poor interpersonal well-

being, due to a conflict between an individual’s actual emotion, and their behavioural

expression (Rogers, 1951; in Gross & John, 2003). In their study, Gross & John

(2003) discovered that participants who used suppression to regulate their emotions,

were more likely to report higher levels of depressive symptoms. Considered

alongside the findings of studies concerned with rumination, this suggests that the

cognitive mechanisms an individual uses to deal with their emotions, particularly


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negative emotions, are largely important in the generation and maintenance of

depressive symptomatology.

In contrast to suppression, reappraisal is considered to be a healthy method

of emotion regulation, associated with greater life satisfaction (Gross & John, 2003).

Reappraisal involves a cognitive alteration in the way a situation is viewed, in order

to change the emotional effect of the situation (Gross & John, 2003). The process of

reappraising an event is believed to happen before any emotional responses have

fully formed. As such, reappraisal can effectively alter the emotions that are

experienced. In the same study in which suppression was investigated, Gross &

John (2003) reported that participants who were more likely to use reappraisal as a

method of regulating their emotions, were less likely to report depressive symptoms,

and were more likely to be satisfied with their life. The Emotion Regulation

Questionnaire (Gross & John, 2003) was devised to simultaneously measure

reappraisal and suppression mechanisms. Given the findings of the relationships

between each of these two mechanisms, and depression, the current study

employed the ERQ in order to establish further exactly how suppression and

reappraisal both correlate with depression, more specifically.

Given that negative intrusive thoughts and sleep quality have been repeatedly

shown to act as both symptoms and contributors to the trajectory of depression

(Brewin et al., 1999; Patel et al., 2007; Newby & Moulds, 2011; Hall et al., 1997), it is

particularly important that their manifestations are well researched and understood.

Additionally, given the findings which have suggested a relationship between

avoidance behaviours, i.e. rumination and suppression, and sleep quality, it also

seemed especially pertinent that these cognitive mechanisms were investigated


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simultaneously, as significant results may provide powerful support for a change in

treatments.

With the discussed issues in mind, the current study aimed to bring together

all of the previous research into the cognitive symptoms of depression, (e.g. Hall et

al., 1997; Starr & Moulds, 2006; Brewin et al., 1996; Gross & John, 2003; Treynor et

al., 2003). The cognitive processes affected by depression, have often been

investigated independently, in terms of their relationship with depression, and with

one another. For example, Hall et al.’s (1997) finding of a relationship between poor

sleep and negative intrusive thoughts, and Starr and Mould’s (2006) proposal of a

correlation between negative intrusive thoughts and rumination. However, it seems

that all of these cognitive symptoms have infrequently been brought together in one

study. Given the common finding that level of depression is linked to the degree to

which these cognitive symptoms, such as poor sleep quality, and presence of

negative intrusions, are manifest, this study aimed to, first of all, establish a link

between depression and these symptoms, and secondly, investigate whether the

extent of disruption of the following cognitive processes, is positively correlated to

the extent of depressive symptomatology: sleep quality, pre-experiencing the future;

intrusive mental imagery and verbal thoughts; suppression mechanisms; and finally

rumination. The study also investigated whether there was a substantial negative

correlation between level of depressive symptoms, and use of reappraisal

mechanisms to regulate emotions. Additionally, the current research was interested

in measuring the relationship between depressive symptoms and anxiety symptoms,

due to the very well-established comorbidity of the two (Spitzer et al., 2006).

Due to the considerable lack of research concerning geriatric depression, an

additional question of interest for the current study, was to examine whether there


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were any differences in the content of intrusions of older adults, as compared with

previous literature, which is much more focused on younger adults. It was expected

that older adults would likely experience intrusions of considerably different content

to younger adults, due to the differences in life stages, i.e. priorities, ambitions, and

so on. This expectation was based on previous suggestions that older adults are less

likely to report details about the self when recalling the past and pre-experiencing the

future (Addis et al., 2008).

Finally, the current research was in interested in a community sample. As this

research was conducted over a period of less than a year, unavoidable time

constraints prevented any clinical populations from being recruited. It was expected

though, that given the evidence for a correlational relationship between depressive

symptomatology and the cognitive symptoms discussed, a community sample would

be sufficient for investigation.

It was hypothesised that participants showing higher levels of depression,

would be more likely to also show a greater degree of the following: pre-experiencing

the future; poor sleep quality; intrusive mental images and verbal thoughts; anxiety

symptomatology, use of suppression to regulate emotions, and finally rumination.

Conversely, it was expected that individuals in the depressed condition would be

less likely to use reappraisal to regulate their emotions. Finally, no specific

hypotheses were made regarding the content of negative intrusions, though it was

predicted that the content of intrusions may differ, compared with those reported by

younger adults from previous literature.


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Method

Participants

Participants (N = 57) were recruited from the community via word of mouth;

posters which were placed in the community (London), in locations such as the

library or the church; or by way of a personal email from the researcher. Emails were

sent to participants selected from the offline pool of older adults from Plymouth

University’s School of Psychology database. Due to unavoidable time constraints,

and also in order to maximise participation figures, it was decided that participants

would be recruited from the community, as opposed to a clinical sample. The only

inclusion criterion that was required for this study was that participants had to be

‘older adults’, i.e. 60 years of age or over. In addition, given the nature of the study,

i.e. an online survey, it was also a given that participants would require access to a

computer and the internet, in order to access the survey. Participants were offered

the opportunity to enter a prize draw for £20 upon completion of the study.

Group membership of participants was determined post-data collection,

according to their score on the CES-D; scores of 16/60 and above are considered

representative of significant depressive symptomatology (Radloff, 1977). Participants

(N = 8) who provided incomplete data, e.g. those who did not finish the survey, were

removed from the dataset prior to analysis, leaving a total of 49 participants. Using

the advised CES-D cut off score, 21 participants were placed in the “depressed”

condition, with the remaining 28 placed in the “non-depressed” condition.

Materials

Materials were presented to participants in the form of an online survey, which

was made available for participants to complete in the comfort of their own home, or


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any other venue of their choice. Though the online survey format allowed

participants to choose to complete the survey in any venue of their choice, they were

advised to complete it in a private place to avoid distraction, and ensure full

confidentiality. The survey was created and presented to participants using the

following website: www.surveymonkey.com (see Appendix A for a web link to the

study). Included in the survey were the following: a consent and information form

(Appendix B) a mini demographics form (Appendix C); the Center for Epidemiologic

Studies – Depression scale (CES-D; Radloff 1977; Appendix D); the Impact of

Future Events Scale – Negative Events for a single event (IFES-N; Deeprose &

Holmes, 2010; Appendix E); the Pittsburgh Sleep Quality Index (PQSI; Buysee et al.,

1989; Appendix F); an intrusive mental imagery questionnaire (McCarthy-Jones,

Knowles & Rowse, 2012; Appendix G); a questionnaire regarding intrusive verbal

thoughts (McCarthy et al., 2012; Appendix H); the Generalised Anxiety Disorder

assessment (GAD-7; Spitzer et al., 2006; Appendix I); the Emotion Regulation

Questionnaire (ERQ; Gross & John, 2003; Appendix J); the Ruminative Responses

Scale (RRS; Treynor, Gonzalez & Nolen-Hoeksema, 2003; Appendix K); and finally,

a short debrief form, with a brief description of the study, a text box for entry into the

prize draw, and a check box to ensure that the participant had read the information

on the page (Appendix L).

The mini demographics form: this was created by the researcher, and

administered to all participants in order to determine the participant’s date of birth,

gender, and number of years in full time education. The purpose of this form was to

provide useful information for later analysis, such as the exploration of any gender

differences. It was also important for the researcher to establish each participant’s

age given that this study was exclusively for older adults.

http://www.surveymonkey.com/


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The CES-D (Radloff, 1997): this measure was administered in order to

establish participants’ levels of depressive symptomatology over the past week.

According to the scoring of this measure, a score of 16 or above is considered to be

representative of present depressive symptomatology. The CES-D consisted of 20

statements which relate to ways the respondent may have felt or behaved. Items are

rated by participants using the following 4-point likert scale: “rarely or none of the

time (less than one day)” (0), “some or a little of the time (1-2 days)” (1),

“occasionally or a moderate amount of the time (3-4 days)”, and “most or all of the

time (5-7 days)” (3). Both ‘negative’ and ‘positive’ statements are included in this

measure, with reverse scorings used for the positive items. There are a total of 16

negative statements, for example “I had trouble keeping my mind on what I was

doing”, and 4 positive statements, such as “I felt I was just as good as other people”.

The purpose of this measure in the current study was to establish participant’s group

membership, i.e. whether participants belong in the “depressed” condition or the

“non-depressed” condition.

The IFES-N (Deeprose & Holmes, 2010): this questionnaire was administered

in order to measure pre-experiencing of the future. The IFES-N for a single event

requires participants to provide one negative future event that they have been

imagining over the past seven days. Following this, participants are asked to

respond to 24 items which are concerned with the personal negative future event

that they had described. These items, such as “I thought about the future when I

didn’t mean to”, are rated using a 5-point likert scale, ranging from “not at all” (0), “a

little bit” (1), “moderately” (2), “quite a bit” (3), to “extremely” (4). Scores on this

measure range between 0 and 96, with higher scores being representative of higher

levels of pre-experiencing the future.


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The PSQI (Buysse et al., 1989): this was given to participants in order to

assess the quality of their sleep over the past month. This measure was specifically

devised for use with older adults, and is able to discern whether sleep quality is

“poor” or “good” by measuring seven specific aspects of sleep. The seven

characteristics that are measured are as follows: subjective sleep quality; time taken

to fall asleep; duration of sleep; sleep efficiency; disturbances of sleep; use of

medication to aid sleeping; and dysfunction during the day (Buysse et al., 1989).

Despite being a subjective measure of sleep quality, thus potentially lending itself to

inaccurate information being portrayed by the participant, the PSQI has been

repeatedly found to have an internal consistency, along with a reliability coefficient of

.83 (Buysse et al., 1989). The 19 items on this measure are separated into seven

components which correspond to the seven aspects of sleep described above. The

scores of these individual seven components, in turn, are summed to achieve a

global PSQI score. The global score can range between 0 and 21 points, with higher

scores being representative of poorer sleep quality (Buysse et al., 1989).

The intrusive mental imagery questionnaire (McCarthy et al., 2012): this

questionnaire was utilised in order to assess participants’ general experiences of

intrusive mental imagery (McCarthy et al., 2012). This questionnaire comprises of

ten questions pertaining to participants’ general experiences of mental imagery,

which are responded to on a five-point scale ranging from “strongly agree” (5),

“agree” (4), “unsure” (3), “disagree” (2), and “strongly disagree” (1), with total scores

able to range from 10 to 50. The higher the total score, the more indicative of the

tendency to experience mental imagery.

The intrusive verbal thought questionnaire (McCarthy et al., 2012): this was

created to be a concise measure of intrusive verbal thoughts. The same response


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scale is utilised for this measure, as is used in the intrusive mental imagery

questionnaire (McCarthy et al., 2012) with possible scores also ranging from 10 to

50, and higher scores representing greater experiences of intrusive mental imagery.

The GAD-7 (Spitzer et al., 2006): this is a seven-item scale used to assess

symptoms of generalised anxiety disorder. This measure requires participants to

answer questions regarding seven common symptoms of generalised anxiety

disorder, that they may have experienced over the past two weeks, for example

“feeling nervous, anxious, or on edge”. Questions are to be responded to using the

following four-point likert scale: “not at all” (0), “several days” (1), “more than half the

days” (2), and “nearly every day” (3). Total scores on this measure can range from 0

to 21, with higher scores indicating higher levels of this trait. The internal consistency

of the GAD-7 measure has been previously shown to be excellent: Cronbach alpha =

.92 (Spitzer et al., 2006).

The ERQ (Gross & John, 2003): this questionnaire is concerned with the

methods that individuals use to regulate and manage their emotions. The ERQ is

comprised of 10 questions about both emotional experience, i.e. how you feel, and

emotional expression, or how you convey your emotions in your behaviour, gestures

and speech (Spitzer et al., 2003). Participants respond to the items on this measure

using a seven-point likert scale, ranging from “strongly disagree” (1), to “neutral” (4),

to “strongly agree” (7). This questionnaire measures the way in which people

regulate their emotions. In particular, an individual’s tendency to use two emotion

regulation strategies, reappraisal and suppression, is measured. Six of the ten items

measure the tendency to use reappraisal, with the remaining four being suppression

items. Participants’ scores are collected separately for each of the two regulation

strategies (Gross & John, 2003).


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The RRS (Treynor et al., 2003): this is a self-report questionnaire designed to

measure rumination. Each of the 22 items on the measure is concerned with a

different topic which the respondent may have been thinking about, to which, using

the scale which ranges from “almost never” (1), “sometimes” (2), “often” (3), to

“almost always” (4), they must indicate how much they ruminate over the content of

the item. Total scores on this measure may range between 22 and 88, with higher

scores indicating a greater propensity for rumination (Treynor et al., 2003).

Design

An independent measures design was used. Participants were allocated to a

condition, either “depressed” or “non-depressed” based on their score on the CES-D.

Participants in both groups were tested on exactly the same variables, as described

in the material section. The independent variable was therefore, whether or not, the

person was currently displaying depressive symptomatology, according to the CES-

D. The dependent measures that were analysed in this study were as follows:

tendency to pre-experience the future; sleep quality; presence of intrusive mental

imagery; tendency to experience intrusive verbal thoughts; presence of

symptomatology typical of generalised anxiety disorder; regulation of emotions; and

finally, tendency to ruminate.

Procedure

Ethical consent for this project was obtained from the Faculty of Science and

Technology Ethics Committee at Plymouth University. On following the link to the

study, participants were presented with a short description of the study, and gave

consent to take part by checking a tick box next to the words “I have read the

information above and I agree to take part in this study”. Participants were presented


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with the questionnaires in the following order: the mini demographics form; the CES-

D; the IFES-N; the PSQI; the intrusive mental imagery questionnaire; the intrusive

verbal thoughts questionnaire; the GAD-7; the ERQ; and the RRS. At the end of the

survey, participants were thanked for their participation and were given a short

debrief. Participants were also presented with a text box in which they were

instructed to enter their email address if they wished to enter the prize draw.

Participants were also required to tick another check box to ensure they had read the

debrief information.

Results

Sample characteristics

The total sample (N = 49) comprised of 26 females (53%) and 23 males

(47%), with a mean age of 65.29 years (range = 60-77). There were no significant

gender differences for any of the measures. All but one participants provided a future

negative event that they had been experiencing over the past seven days, as

required by the IFES-N measure.

General characteristics of negative intrusive thoughts

The majority of participants provided a specific negative intrusive thought

regarding the future, which they had been imagining over the past seven days, as

per the IFES-N for a single future event. Only one participant did not provide any

negative future event. Examples of these negative future events included “feeling

lonely”, “not seeing family”, and “being too tired to keep up my daily activities” and

were similar to examples provided in previous literature. Responses provided by

participants were all viable as future events, as opposed to being characteristics of a

memory.


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Table 1. Means and standard deviations of each measure for depressed and non-

depressed conditions.

IFES-N PSQI Mental

Imagery

Verbal

thoughts

GAD-7 ERQ-R ERQ-S RRS

M S.D. M S.D. M S.D. M S.D. M S.D. M S.D. M S.D. M S.D.

D 35.5 20.3 9.13 4.69 33.1 8.89 32.7 8.29 7.95 5.72 24.9 6.49 17.7 5.02 47.1 12.4

N 13.5 11.8 4.96 2.43 25.5 10.1 23.9 10.1 2.41 1.97 29.0 6.35 14.1 6.39 28.9 5.22

Note: D = Depressed condition; N = Non-depressed condition; ERQ-R = ERQ:

Reappraisal items; ERQ-S= ERQ: Suppression items.

Analyses

Independent t-tests were carried out to compare the “depressed” and “non-

depressed” conditions on all measures included in the survey. Significant findings

were shown for all measures. Following examination of the t-tests, bivariate

correlations were also conducted, between the CES-D and all other measures, in

order to investigate whether the severity of depressive symptomatology correlated

with each of the measures included in this study. The GAD-7 was omitted from T-test

and bivariate correlation analyses.

IFES-N

As predicted, participants allocated to the “depressed” condition (M = 35.5,

S.D. = 20.3) scored significantly higher on the IFES-N for a single event, than their

“non-depressed” counterparts (M = 13.5, S.D. = 11.8; t = -4.495, df = 32, p < .001).

We can interpret this to mean that “depressed” participants reported greater levels of

pre-experiencing of the future than “non-depressed” participants. Additionally, there

was a significant positive correlation between score on the CES-D and score on the


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IFES-N (r = .733, N = 49, p = .000) suggesting that severity of depression

symptomatology increases along with levels of pre-experiencing the future. This was

a fairly strong correlation with 53.7% of the variance explained.

PSQI

Consistent with the researcher’s hypotheses, participants in the depressed

condition (M = 9.14, S.D. = 4.69) scored significantly higher on the PSQI, than non-

depressed participants (M = 4.96, S.D. = 2.43; t = -4.015, df = 47, p < .001). This

indicates that depressed participants reported greater levels of poorer sleep quality

than non-depressed participants did. A bivariate correlation also indicated a

significant positive correlation between CES-D and score on the PSQI (r = .613, N =

49, p = .000), indicating that sleep quality becomes worse as depressive

symptomatology increases. This was a moderate correlation, explaining 37.6% of the

variance.

The intrusive mental imagery questionnaire

Non-depressed participants (M = 25.5, S.D. = 10.1) reported experiencing

significantly less intrusive mental imagery than depressed participants (M = 33.1,

S.D. = 8.88) did (t = -2.776, df = 47, p = .008). Further analyses revealed a

significant positive correlation between levels of depressive symptomatology and

scores on the intrusive mental imagery questionnaire (r = .537, N = 49, p =.000).

This correlation was moderate, explaining 28.8% of the variance.

The intrusive verbal thoughts questionnaire

As expected, depressed participants (M = 32.7, S.D. = 8.29) showed

significantly greater levels of experiencing intrusive verbal thoughts than non-

depressed participants (M = 23.9, S.D. = 10.1; t = -3.288, df = 47, p = .002). A


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bivariate correlation revealed a significant positive correlation between CES-D score

and score on the intrusive verbal thoughts questionnaire (r = .546, N = 49, p = .000).

This correlation was able to explain 29.8% of the variance.

ERQ

Participants were given two scores for the ERQ, one for the reappraisal items,

and one for the suppression items. Analyses revealed that, on the reappraisal items,

participants in the depressed condition (M = 24.9, S.D. = 6.49), scored significantly

lower than participants in the non-depressed condition (M = 29.0, S.D. = 6.35; t =

2.221, df = 47, p = .031). This indicates, in line with the predictions, that depressed

individuals were less likely to use reappraisal to regulate their emotions. Bivariate

correlation also showed a significant negative correlation between score on the CES-

D and score on the reappraisal items of the ERQ (r = -.355, N = 49, p = .012), with

12.6% of the variance being explained by this correlation. Conversely, as expected,

participants in the depressed condition (M = 17.7, S.D. = 5.02) scored significantly

higher on the suppression items, than participants in the non-depressed condition (M

= 14.1, S.D. =6.39; t = -2.165, df = 47, p = .035) suggesting that non-depressed

participants were less likely the use suppression to regulate their emotions. A

significant positive correlation was revealed between the CES-D scores and

suppression item scores (r = .408, N = 49, p = .004) which was able to explain 16.6%

of the variance.

RRS

Finally, in line with the researcher’s hypotheses, participants in the depressed

condition (M = 47.1, S.D. = 12.4) scored significantly higher on the RRS than

participants in the non-depressed condition (M = 28.9, S.D. = 5.22; t = -6.429, df =


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27, p < .001). This result suggests that, as expected, depressed individuals were

more likely to ruminate than non-depressed individuals. In addition, a significant

positive correlation was found between participants scores on the RRS and their

scores on the CES-D (r = .827, N = 49, p = .000). This was quite a strong correlation,

able to explain 68.3% of the variance.

Discussion

The current study attempted to, firstly establish any differences between

depressed and non-depressed individuals on a number of cognitive measures, and

secondly, investigate the relationship between the extent of dysfunction of specific

cognitive processes, and levels of depressive symptomatology, in older adults. As

predicted, and in line with previous research, analyses suggested that participants in

the depressed condition reported poorer sleep quality, greater levels of pre-

experiencing the future, more experiences of both intrusive mental imagery and

verbal thoughts, a greater propensity for rumination, and greater use of suppression

as a mechanism for regulating emotions, as compared with their non-depressed

counterparts. Conversely, and also in line with predictions, depressed participants

were shown to be less likely to use reappraisal as a technique for managing their

emotions, in comparison to non-depressed participants. Additionally, it was found

that the content of the negative future events provided by participants, followed a

very similar vein to those reported in previous literature (Brewin et al., 1996).

Therefore, older adults did not differ, as was expected, in the content of their

intrusions, with younger adults.

Most importantly, this study was able to replicate and extend the findings of

several pieces of research, within one study, and therefore with the same sample.


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More specifically, the results that this study recreated and expanded upon were as

follows.

Findings from this study were able to support the ideas that depressed

individuals are more likely to pre-experience their future (Deeprose & Holmes, 2010)

and experience intrusive mental imagery and verbal thoughts (McCarthy-Jones et

al., 2010). Moreover, these previous findings were expanded upon by the results of

the current study, which suggest that levels of depressive symptomatology increase

hand in hand with the extent of intrusive mental imagery and verbal thoughts

experienced, and with the degree to which the individual pre-experiences the future.

Additionally, the results of this study are in line with the findings of Hall and

colleagues, (1997) which suggested that depressed individuals were more likely to

have a poorer quality of sleep, as well as frequent sleep disturbances. The current

study was also able to expand upon these results, by reporting a positive relationship

between the level of depressive of symptomatology and level of sleep disturbance.

Furthermore, this study was able replicate findings concerned with cognitive

mechanisms used for regulating of emotions. The findings provide support for the

suggestion that depressed individuals are more likely to utilise suppression, as a

method for regulating their emotions, as compared with non-depressed participants

(Gross & John, 2003). This idea was extended in the current study, with the finding

that the extent of depressive symptomatology was positively correlated with the

degree to which suppression was used to regulate emotions. Support was also found

for the notion that depressed individuals are less likely to use reappraisal

mechanisms for regulating their emotions (Gross & John, 2003). This, also, was

expanded upon, with the finding that the extent of depressive symptoms reported


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was inversely related to the participants’ use of reappraisal in emotion management.

This may be interpreted as support for the idea that the use of reappraisal to manage

emotions, is related to greater interpersonal well-being, with use of suppression

being linked to poorer interpersonal functioning and poorer life satisfaction (Gross &

John, 2003).

Evidence was also found for the idea that rumination, as a mechanism for

coping with adverse emotions, is positively related to depression. It has been

suggested that rumination is more likely to occur amongst depressed individuals, as

compared with those who are non-depressed (Treynor et al., 2003), a finding that

was replicated by this study. Additionally, the current research was able to propose

that level of depressive symptomatology may be positively correlated with extent of

rumination.

Finally, it was considered that the content of intrusions reported by older

adults may differ from those commonly recounted by younger adults with depression,

due to the changes in priority that may take place over the aging process. This was

not the case however, and the majority of intrusions were of a similar nature to those

described in much of the previous literature (Brewin et al., 1996). Furthermore, many

of the intrusive prospective thoughts provided by participants in the current study,

were of a nature very similar to the topics suggested to be most common of

depressive intrusions, i.e. familial or interpersonal issues (Reynolds & Brewin, 1999).

However, it must be noted that participants were a community sample, therefore it is

difficult to establish exactly what causes the content of the future thoughts, i.e.

whether they are due to depressive symptoms, or to age-related issues, and so on.

That being said, given that the nature of the reported intrusions was so similar to

those of clinical participants of previous literature (Brewin et al., 1996; Deeprose &


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Holmes, 2010), it would potentially be of great interest to conduct further research in

which a comparison could be made, between the intrusive thoughts of a community

and clinical sample of older adults.

Though online research carries the great advantage of being widely

accessible to potential participants, regardless of geographical location, replications

of this research may potentially be improved by perhaps removing the survey from

the internet, and conducting the research in person. The population in question come

from a generation who did not grow up using computers, and who, now, will not

necessarily have easy access to computers or to the internet. This could be a

potential explanation for the not particularly vast sample size of the current study. By

removing the requirement, that potential participants must have access to the

internet, it is possible that individuals from this age group may become more willing

to participate, thus increasing the sample size and in turn power of the results.

Alternatively, sample size may also be enhanced by keeping the study open for a

longer period of time, which was unfortunately not an option on this occasion, due to

specific time constraints.

Should the study be recreated with another community sample, it may be

beneficial to include an additional measure of depressive symptoms along with the

CES-D, in order to strengthen the categorisation of participants into either the

depressed or non-depressed conditions. If the study were recreated in person, this

could be the addition of an interview with participants, or alternatively, should the

study be replicated as an online survey, another measure such as the Beck

Depression Inventory-second edition (BDIII) could be added (Beck, Steer and

Brown, 1996).


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Ultimately, this research will be most improved by, either replication with a

clinical sample, or the addition of a clinical sample for comparison with the

community sample. Unfortunately, time constraints made the addition of a clinical

sample impossible on this occasion, though replication with the inclusion of clinical

samples of depressed patients, may have the capacity for providing very strong

support for the current literature, and is a very important next step for this research.

In conclusion, the current study was successful in its aims to provide support

for, and expand upon, a multitude of relevant previous literature. The research was

also able to address a particular sub-population which is arguably very vulnerable,

and one which, as of yet, has not been a focus of the literature. In addition, this

research was particularly important due to its capacity for application to both

theoretical research and practice. Theoretically, this study develops the previous

literature by combining aspects of several related studies, thereby strengthening the

current evidence. In terms of practice, the results lend support for much previous

literature which, if it is taken as a whole, and is further expanded upon, could be

used as a basis for seriously improving the tailoring the treatment of depression, to

hone in on the most salient features and symptoms of the disorder. Furthermore, this

is particularly important for the cohort in question, due to the reported high levels of

completed suicide within this group.


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Appendices

Appendix A: web link for the online study

Appendix B: Consent Form

Appendix C: Mini demographics form

Appendix D: CES-D

Appendix E: IFES-N

Appendix F: PSQI

Appendix G: Intrusive Imagery Questionnaire

Appendix H: Intrusive Verbal Thoughts Questionnaire

Appendix I: GAD-7

Appendix J: ERQ

Appendix K: RRS

Appendix L: Debrief form

Appendix M: SPSS output – descriptive statistics and t-tests of all measures,

between “depressed” and “non-depressed” conditions.

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