ÖMER ŞENORMANCI, Ramazan KONKAN, Oya GÜÇLÜ, Güliz ŞENORMANCI, Mehmet Zihni SUNGUR

The relationship between dysfunctional attitudes, rumination response styles and depression

Amaç: Araştırmamızda, majör depresyon (M.depresyon) hastalarında depresyon ile ruminatif yanıt biçimi ve fonksiyonel olmayan tutumların ilişkisinin araştırılması amaçlandı. Yöntem: Araştırmaya, Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi ayakta tedavi birimlerine başvuran, DSM-IV-TR ölçütlerine göre unipolar depresyon tanısı konulan 60 hasta dahil edildi. Katılımcılar sosyodemografik veri formu, DSM-IV Eksen Bir Tanıları İçin Yapılandırılmış Klinik Görüşme (SCID-I), Beck Depresyon Envanteri (BDE), Fonksiyonel Olmayan Tutumlar Ölçeği (FOTÖ-A), Kısa Form-Ruminasyon Ölçeği (KF-RÖ) ile değerlendirildi. Bulgular: Araştırmamızda, depresyon ile FOTÖ-A mükemmelci tutum puanı, onay görme ihtiyacı, bağımsız tutum puanları arasında negatif yönde, zayıf-orta düzeyde, anlamlı bir ilişki vardı. Depresyon ile KF-RÖ saplantılı düşünme (brooding) puanları arasında pozitif yönde, iyi düzeyde, ileri derecede anlamlı bir ilişki vardı. Depresyon ile KF-RÖ derin düşünme (reflecting) puanları arasında pozitif yönde, orta düzeyde, ileri derecede anlamlı bir ilişki vardı. Depresyonun yordayıcıları olarak saptanan KF-RÖ saplantılı düşünme ve KF-RÖ derin düşünme depresyon riskini arttırırken, FOTÖ-A mükemmelci tutum depresyon için koruyucuydu. Sonuç: Araştırmamızda, literatürün aksine, fonksiyonel olmayan tutumların depresyonla pozitif yönde korele olmadığı ve yordayıcılığının bulunmadığı saptanmıştır. Ancak tek bir araştırmadan yola çıkarak bu yorumu yapmak doğru olmayabilir. Bu sonuca yol açabilecek etmenler tartışılmıştır. Öte yandan araştırmamız, depresyonda ruminasyonun anahtar rolüne dikkat çekmektedir. Depresyon tedavisinde etkinliği bilinen bilişsel davranışçı terapi uygulamalarında ruminatif tepkilerin değerlendirilmesi, ruminatif tepkileri azaltmaya yönelik tedavi tekniklerinin uygulanması, depresyonun psikoterapisinde hedeflenmelidir.

Ruminatif yanıt biçimi ve fonksiyonel olmayan tutumların majör depresyonla ilişkisi

Objective: In our study we aimed to investigate the relationship between rumination response styles, dysfunctional attitudes and depression. Methods: 60 patients diagnosed with depression according to the DSM-IV-TR diagnostic criteria in the Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery outpatient clinics are involved in our study. All participants were administered a sociodemographic questionnaire, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Results: In our study, there was mild-moderate negative correlation between depression and the perfectionist attitudes, need for approval, independent attitudes subscores. The RRS-short version brooding subscore was highly positively correlated with depression. Depression and RRS-short version reflecting score was moderately and positively correlated. As predictors of depression, high subscores of RRS-short version brooding and RRS-short version reflected increased risk for depression, whereas high subscores of DAS perfectionist attitudes are evaluated to be protective for depression. Conclusions: In our study, in contrast to the literature, it was shown that dysfunctional attitudes are not positively correlated with depression nor are they predictors of depression. However, it may not be appropriate to make such comment based on a single study. Factors that can lead to this conclusion are discussed in the study. On the other hand, our study emphasizes the key role of rumination in depression. In practice of cognitive behavioral therapy of which efficacy in treatment of patients with depression has been know, assessment of ruminative responses, treatment techniques for reducing ruminative responses should be targeted.

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1. Beck AT. Depression: Clinical, Experimental And Theoretical Aspects, New York: Harper and Row, 1967.
2. Olinger LJ, Kuiper NA, Shaw BF. Dysfunctional attitudes and stressful life events: an interactive model of depression. Cogn Ther Res 1987; 11:25-40.
5. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta earthquake. J Pers Soc Psychol 1991; 61:115- 121.
6. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspect Psychol Sci 2008; 3:400-424.
3. Kwon S, Oei TPS. Differential causal roles of dysfunctional
7. Watkins ER. Constructive and unconstructive repetitive thought. attitudes and automatic thoughts in depression. Cogn Ther Res Psychol Bull 2008; 134:163-206. 1992; 16:309-328.
4. Nolen-Hoeksema S. Responses to depression and their effects
8. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination on the duration of depressed mood. J Abnorm Psychol 1991; reconsidered: a psychometric analysis. Cogn Ther Res 2003; 100:569-582. 27:247-259.
9. Robinson MS, Alloy LB. Negative cognitive styles and stress- reactive rumination interact to predict depression: a prospective study. Cogn Ther Res 2003; 27:275-291.
10. Ciesla JA, Roberts JE. Rumination, negative cognition and their interactive effects on depressed mood. Emotion 2007; 7:555-565.
11. Ciesla JA, Felton JW, Roberts JE. Testing the cognitive catalyst model of depression: does rumination amplify the impact of cognitive diatheses in response to stress? Cogn Emot 2011; 25:1349-1357.
12. Vanderhasselt MA, De Raedt R. How ruminative thinking styles lead to dysfunctional cognitions: evidence from a mediation model. J Behav Ther Exp Psychiatry 2012; 43:910-914.
13. Thomas J, Altareb B. Cognitive vulnerability to depression: an exploration of dysfunctional attitudes and ruminative response styles in the United Arab Emirates. Psychol Psychother Theor Res Pract 2012; 85:117-121.
14. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV Axis I disorders. Biometrics Research Department. NewYork: NewYork State Psychiatric Institute, 1996.
15. Corapcioglu A, Aydemir O, Yildiz M, Danaci AE, Koroglu E. Structured clinical interview for DSM-IV axis I disorders, clinical version. Ankara: Hekimler Yayın Birliği, 1999 (in Turkish).
16. Beck AT. An Inventory for measuring depression. Arch Gen Psychiatry 1961; 7:151-169.
17. Hisli N. A study on the validity of Beck Depression Inventory. Journal of Psychology 1988; 6:118-123 (in Turkish).
18. Weissman AN, Beck AT. Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. Paper presented at the meeting the American Education Research Association, Toronto, Canada, 1978.
19. Sahin NH, Sahin N. Is functional attitudes in one culture also functional in other? Journal of Psychology 1991; 7:30-40 (in Turkish).
20. Erdur-Baker O, Bugay A. The Turkish version of the Ruminative Response Scale: an examination of its reliability and validity. International Journal of Education and Psychology in the Community 2012; 10:1-16.
21. Beck AT. Cognitive Therapy and the Emotional Disorders, New York: a Meridian Book, 1979.
22. Hollon SD, Kendall PC. Cognitive self-statements in depression: development of an automatic thoughts questionnaire. Cogn Ther Res 1980; 4:383-395.
23. de Graaf LE, Roelofs J, Huibers MJ. Measuring dysfunctional attitudes in the general population: The Dysfunctional Attitude Scale (form A) Revised. Cogn Ther Res 2009; 33:345-355.
24. Alloy LB, Abramson LY, Whitehouse WG, Hogan ME, Panzarella C, Rose DT. Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression. J Abnorm Psychol 2006; 115:145-156.
25. Segal ZV, Gemar M, Williams S. Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression. J Abnorm Psychol 1999; 108:3-10.
26. Norman WH, Miller IW, Keitner GI. Relationship between dysfunctional cognitions and depressive subtypes. Can J Psychiatry 1987; 32:194-198.
27. Robins CJ, Block P, Peselow ED. Endogenous and non- endogenous depressions: relations to life events, dysfunctional attitudes, and event perceptions. Br J Clin Psychol 1990; 29:201- 207.
28. Cane DB, Olinger J, Gotlib IH, Kuiper NA. Factor structure of the dysfunctional attitude scale in a student population. J Clin Psychol 1986; 42:307-309.
29. Imber SD, Pilkonis PA, Sotsky SM, Elkin I, Watkins JT, Collins JF, Shea MT, Leber WR, Glass DR. Mode-specific effects among three treatments for depression. J Consult Clin Psychol 1990; 58:352-359.
30. Power MJ, Katz R, McGuffin P, Duggan CF, Lam D, Beck AT. The dysfunctional attitude scale (DAS): a comparison of forms A and B and proposals for a new subscaled version. J Res Pers 1994; 28:263-276.
31. Chioqueta AP, Stiles TC. Factor structure of the dysfunctional attitude scale (Form A) and the automatic thoughts questionnaire: an exploratory study. Psychol Rep 2006; 99:239-247.
32. Papageorgiou C, Wells A. Positive beliefs about depressive rumination: development and preliminary validation of a self- report scale. Behavior Therapy 2001; 32:13-26.
33. Luminet O. Assessment And Measurement Of Rumination: In Papageorgiou C, Wells A (Editors). Rumination: Nature, Theory, and Treatment Of Negative Thinking in Depression. Chichester: Wiley, 2004, 187-215.
34. Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol 2000; 109:504-511.
35. Spasojevic J, Alloy LB. Rumination as a common mechanism relating depressive risk factors to depression. Emotion 2001; 1:25-37.
36. Burwell RA, Shirk SR. Subtypes of rumination in adolescence: associations between brooding, reflection, depressive symptoms, and coping. J Clin Child Adolesc Psychol 2007; 36:56-65.
37. Joorman J, Dkane M, Gotlib IH. Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases. Behavior Therapy 2006; 37:269-280.
38. Olson ML, Kwon P. Brooding perfectionism: refining the roles of rumination and perfectionism in the etiology of depression. Cogn Ther Res 2008; 32:788-802.
39. Miranda R, Nolen-Hoeksema S. Brooding and reflection: rumination predicts suicidal ideation at 1 year follow-up in a community sample. Behav Res Ther 2007; 45:3088-3095.
40. Roelofs J, Huibers M, Peeters F, Arntz A, van Os J. Rumination and worrying as possible mediators in the relation between neuroticism and symptoms of depression and anxiety in clinically depressed. Behav Res Ther 2008; 46:1283-1289.