METACOGNITIONS AND THOUGHT CONTROL STRATEGIES IN UNIPOLAR MAJOR DEPRESSION: A COMPARISON OF CURRENTLY DEPRESSED, PREVIOUSLY DEPRESSED, AND NEVER-DEPRESSED INDIVIDUALS

Marianne Halvorsen, PhD Specialist in Clinical Neuropsychology

University Hospital of North Norway EABCT The Hague 2014

METACOGNITIVE MODEL ! Thinking styles and metacognitions.

! Cognitive-attentional syndrome (CAS): ! Heightened self-focus, repetitive

negative thinking, maladaptive coping behaviour and threat monitoring.

Wells 2000;2009; Wells & Matthews, 1994

PREVIOUS RESEARCH ! Rumination and metacognitions in either healthy

samples or already depressed individuals. !  Lack of studies investigating:

!  metacognitions in different phases of MDD. !  worry-related metacognitions in MDD. !  a broader range of thought control strategies

! worry (“I dwell on other worries”)*

! distraction (“I keep myself busy”)*

! reappraisal (“ I try to reinterpret the thought”)*

* Thought Control Questionnaire (Wells & Davies, 1994); Halvorsen et al. in press.

THE PRESENT STUDY

! Aim: !  To explore how worry-related

metacognitions and a broad range of thought control strategies differentiated: ! currently depressed individuals (n =37) ! those who had recovered (n =81) ! never depressed individuals (n = 50)

METHODS ! Participants/ procedure:

!  The University outpatient clinic in Tromsø, Norway.

!  Convenience sample.

!  All participants were non-hospitalized.

Tromsø, pop. 72.000

PARTICIPANTS/PROCEDURE ! Diagnoses were based on DSM-IV-TR using

the SCID-I interview: !  Including:

a)  currently depressed b)  having previously experienced a major

depressive episode in the past and fully recovered for at least the last 8 weeks or longer.

c)  having never been clinically depressed !  Excluding:

!  MDE in partial remission, on-going/past manic/hypomanic episode, dysthymic disorder, or psychotic symptoms. Participants with a history of known brain damage or a MDE due to a general medical condition.

Description of the design/samples see Halvorsen et al. (2010, 2011, 2014)

DEMOGRAPHIC AND CLINICAL CHARACTERISTICS (N= 168) Variable Currently

depressed (n = 37) M(SD)

Previously depressed

(n = 81) M(SD)

Never-depressed

(n = 50) M(SD)

Significant test

Female/male 27/10 71/10 39/11 X2(2) = 4.23, p = .12

Age 37.49 (11.98) 37.42 (9.61) 38.06 (12.66) F(2,165) = 0.06, p = .95

Education, y. 13.76 (3.84) 15.12 (2.64) 15.10 (3.63) F(2,165) = 2.53, p = .08

BDI-II 24.00 (9.06) 6.94 (7.21) 2.71 (3.04) F(2,162) = 114.74, p <.001, 1>2>3

BAI 17.41 (9.81) 6.42 (6.30)

2.35 (2.76) F(2,164) = 58.75, p <.001, 1>2>3

Antidepressant 17.41 (9.81)

6.42 (6.30) X2 (1) = 3.43, p = .06

Single/recurrent MDE

10/27 26/55 X2 (1) = 0.31, p = .58

MEASURES !  The Metacognitions Questionnaire-30 (MCQ-30; Wells &

Cartwright-Hatton, 2004).

!  Positive beliefs about worry (e.g., “Worrying helps me to solve problems”)

!  Negative beliefs about worry concerning uncontrollability and danger (e.g., “When I start worrying I cannot stop”)

!  Cognitive confidence (e.g., “I do not trust my memory”)

!  Need of control (e.g., “It is bad to think certain thoughts”)

!  Cognitive self-consciousness (e.g., “I monitor my thoughts”).

MEASURES !  The Thought Control Questionnaire (TCQ; Wells &

Davies, 1994). !  Distraction (e.g., “I keep myself busy”) !  Punishment (e.g., “I tell myself not to be so stupid”). !  Worry (e.g., I dwell on other worries”) !  Social Control (e.g., “I talk to a friend about the

thought”) !  Reappraisal (e.g., “I try to reinterpret the thought”).

!  The Ruminative Response Scale (RRS; Nolen-Hoeksema & Morrow, 1991) !  RRS-total score used (e.g., “I think about how alone I

feel”.

Table 2 Means and standard deviations of predictor variables as a function of group membership (N = 168) Predictor variable

Currently depressed (n = 37) M (SD)

Previously

depressed (n = 81) M (SD)

Never

depressed (n = 50) M (SD)

RRS-total

56.57 (11.65)

43.38 (12.31)

32.04 (7.09)

MCQ-30 Positive beliefs Negative beliefs Cognitive confidence Need of control Cognitive self-consciousness

9.54 (3.60)

14.54 (4.29) 13.84 (4.98) 11.97 (3.50) 13.19 (3.55)

8.14 (2.85)

10.70 (4.16) 9.74 (3.53) 8.80 (2.77)

12.41 (3.76)

8.44 (2.36)

8.34 (1.67) 9.54 (2.74) 8.74 (2.33)

11.84 (3.69)

TCQ Distraction Punishment Reappraisal Worry Social control

13.83 (3.28) 10.97 (3.90) 14.19 (3.96) 12.03 (2.56)

13.25 (1.80)

14.91(2.99) 9.61 (2.72)

15.20 (3.58) 10.14 (2.45) 12.89 (2.24)

15.94 (2.52) 8.28 (1.62)

13.18 (4.15) 9.32 (2.18)

12.60 (2.21)

Note. MCQ Metacognitive Questionnaire; RRS Ruminative Response Scale; TCQ Thought Control Questionnaire

SUMMARY OF CANONICAL DISCRIMINANT FUNCTIONS

Eigenvalues

Function Eigenvalue % of Variance Cumulative %

Canonical

Correlation

1 ,828a 79,9 79,9 ,673

2 ,208a 20,1 100,0 ,415

a. First 2 canonical discriminant functions were used in the analysis.

Wilks' Lambda

Test of Function(s) Wilks' Lambda Chi-square df Sig.

1 through 2 ,453 125,188 22 ,000

2 ,828 29,898 10 ,001

Table 3 Structure matrix: Pooled within-groups correlations between discriminating variables and standardized canonical discriminant functions.

*Largest absolute correlation between each variable and any discriminant function. MCQ Metacognitive Questionnaire; RRS Response Style Questionnaire; TCQ Thought Control Questionnaire

Variable Function 1 Function 2 RRS-total .91* -.04 MCQ-Negative beliefs .68* .12 TCQ-Worry .44* .17 TCQ-Punishment .39* -.04 TCQ-Distraction -.29* -.05 MCQ-Cognitive self-consciousness .15* .01 TCQ-Social control .12* .03 MCQ-Need of control .45 .56* MCQ-Cognitive confidence .47 .56* TCQ-Reappraisal .11 -.45* MCQ-Positive beliefs .15 .30*

!

Never%depressed%

Previously%depressed%

Currently%depressed%

22%

21%

0%

1%

2%

22% 21% 0% 1% 2%

Group!centroid!

CAS: MCQ-Negative beliefs RRS-Rumination TCQ-Worry TCQ-Punishment %

MCQ-Need of control MCQ-Low cognitive confidence MCQ-Positive beliefs

TCQ-Distraction

TCQ-Reappraisal

Figure 1. Perceptual map of groups in discriminant space. CAS Cognitive Attentional Syndrome; MCQ Metacognitive Questionnaire; RRS Response Style Questionnaire; TCQ Thought Control Questionnaire

CONCLUSION ! Function 1 discriminated among each of the

groups: !  Never-depressed used more distraction !  Currently depressed used rumination,

worry and punishment as self-regulatory strategies and hold strong beliefs about the uncontrollability/danger of thinking.

!  Previously depressed group was in-between: ! CAS and negative metacognitions have

stable-trait like properties that distinguish depression-prone individuals from those who are not vulnerable.

CAS = cognitive- attentional syndrome

CONCLUSION !  Function 2: Never-depressed and currently

depressed did not differ, suggesting it is not specific to current depression. !  Recovery? !  Use of reappraisal among previously depressed.

! Not a ’normal’ state? ! Previously depressed may still have ”extended

processing” = CAS activated, but their content has changed.

! Further studies should examine if the use of reappraisal can generate counterproductive effects later on by keeping the CAS (i.e., extended thinking) activated. ! Relapse marker?

LIMITATIONS !  Only information regarding current antidepressant

medication use. !  Future studies should assess exposure to other

treatments. !  We did not assess the presence of comorbid Axis-I

disorders among the participants. !  The low mean score on BAI for the previously

depressed indicated that few had clinical levels of anxiety symptoms.

! No conflict-of-interest. ! Co-researchers:

!  Roger Hagen, Odin Hjemdal, Norwegian University of science and Technology.

!  Knut Waterloo, Martin Eisemann, Catharina Wang University of Tromsø, Norway.

THANK YOU!

marianne.halvorsen@unn.no