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"Yes...But..." cognitive response to partial success: an exploratory research
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"Yes...But..." cognitive response to partial success: an exploratory research

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Presentazione al Congresso EABCT, Reykjavik 2011 nel simposio Cognitive Processes in Depression

Presentazione al Congresso EABCT, Reykjavik 2011 nel simposio Cognitive Processes in Depression

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  • 1. The “Yes, but” cognitive response to partial success: an exploratory research
    Gabriele Caselli1,2, Alina Decsei-Radu3, Francesca Fiore1, Chiara Manfredi1, Sara Querci1, Sara Sgambati1, Daniela Rebecchi1, Giovanni M. Ruggiero1
    & Sandra Sassaroli1
    1StudiCognitivi, Cognitive Psychotherapy School, Italy
    2 London South Bank University, UK
    3 University of Oradea, Romania
  • 2. Cognitive theories of depression
    Cognitive processing biases can act as latent vulnerability factors for emotional and affective disorders (Mathews & MacLeod, 1994)
    Anxious and depressed people prioritize the encoding and elaboration of negative information in order to prepare themselves to flee from potential harmful or dangerous situations (Beck & Clark, 1997; Eysenck, 1997)
    There is a greater risk for depression for people who exhibit a dispositional negative style and a dysfunctional attitude (Abramson et al., 1989; Beck 1987)
  • 3. Three possible outcomes of this dysfunctional attitude
    Cognitive biases: the tendency to distort one’s own experience misinterpreting events in terms of personal failure and tending to exaggerate or over generalize any event that holds any semblance of negative information about oneself (Beck, 1964)
    Chronic and embeddedpessimism: a generalized negative outcome expectancy (Armor & Taylor, 1998); a proximal predictor of adjustment (Scheier & Carver, 1985)
    Ruminativebrooding: a mode of thinking that involves repetitive and passive focus on one’s depressive symptoms as well as their causes and consequences; a cognitive risk factor for depressive mood (Nolen-Hoeksema, 1991).
    The dysfunctional attitude that provides for cognitive biases, pessimistic forecasts and ruminative brooding has been conceptualized as a reaction to negative sensations or thoughts that acts as a trigger for ruminative process itself
  • 4. Clinical evidence: “Yes,but”
    There is a difference between depressed and non depressed individuals in emotional response even to positive stimuli, as firstly described by clinical theories that focused on the concept of anhedonia (Klein, 1974; Meehl, 1975)
    We have hypothesized an attitude towards cognitive re-coding of positive stimuli in a negative way, that should influence depressive mood and symptoms, and that we named the “Yes, but” thinking style
    This cognitive response is characterized by the re-orientation of attention and cognition towards possible negative implications of a positive situation or a proposed positive vision of facts
  • 5. What does “Yes, but” lead to?
    It forbids positive emotional experience
    It re-orients attention towards the negative and even less outstanding aspects of situations
    It enhances the frequency of negative triggers
    It acts as a trigger for ruminative brooding and depressive mood in front of:
    everyday positive experiences
    alternative interpretations emerging from cognitive restructuring techniques
  • 6. Distinguishing “Yes, but” from other cognitive processes
  • 7. Aims
    To investigate the outcome of engaging in the “Yes, but” thinking style on mood and negative automatic thoughts
    To investigate if the impact of this thinking style would have been stronger in depressed rather than non-depressed individuals
  • 8. Methods
    Participants:
    Italian clinical sample: 28 outpatients (19 females) with a diagnosis of moderate depression (mean = 38.8 years; SD = 12.9; range = 18-64)
    Italian non-clinical sample: 28 non-depressed subjects (19 females) recruited from general population (mean= 39.3 years; SD = 13.9; range = 21-67)
    Romanian clinical sample: 30 inpatients (15 females) with a diagnosis of severe depression (mean = 40.2 years; SD = 11.8; range = 20-62) and
    Romanian non-clinical sample: 30 non-depressed subjects (14 females) recruited from general population (mean = 39.6 years; SD = 12.3; range = 20-65)
    Measures: Depression (BDI), Rumination (RRS), Pessimism (LOT-R), Mood and negative thoughts (VAS), Current brooding (RRS modified)
  • 9. Attentional manipulation
    Tasks were adapted from Nolen-Hoeksema and Morrow’s (1993) distraction and rumination task
    Participants were asked to retrieve images of a positive life event for 3 minutes
    Participants were asked to focus on one of two lists of audio recorded items that were presented with an interval of 20 seconds, for 8 minutes
    In the experimental condition participants were asked to focus their attention on what was missing in the recalled situation to be fully happy or satisfied (e.g. “think about what missed to fully reach your goal”, “think about what you could have done better”)
    In the control condition item suggested to focus attention on emotion, sensation and thoughts participants perceived in the recalled episode (e.g. “think about what made you feel satisfied”, “think about what you managed to do”)
  • 10. Procedure
    Written informed consent, SCID, BDI, RRS and LOT-R
    Current brooding, mood and negative thoughts measure (Time 1)
    3 minutes of imagery retrieving and 8 minutes working through their assigned attentional task
    Current brooding, mood and negative thoughts measure (Time 2)
    Open-ended questions investigating what the participants thought the study was testing
    Debriefing
  • 11. Results: Italian sample
    Paired t-test for “Yes, but” condition: t(27)=-22.2; p<.05
    ANCOVA between conditions with the change score of depressed mood between Time 1 and Time 2 as dependent variable, and change in current brooding between Time 1 and Time 2 as covariate.
    The effect of the conditions remained significant [F(1) = 4.90, p=.03] but change score for current brooding appeared to have a significant effect [F(1) = 9.21, p = .004], too.
    The increase in depressed mood following “yes-but” thinking style induction depended on both experimental condition and levels of current brooding.
  • 12. Results: Romanian sample
    Paired t-test was for the “Yes, but” condition: t(28) = -2.70, p = .01
    ANCOVA between conditions with the change score of depressed mood between Time 1 and Time 2 as dependent variable, and change in current brooding between Time 1 and Time 2 as covariate.
    The effect of the conditions remained significant [F(1, 54) = 19.89, p < .001], while the impact of change score for current brooding appeared not significant.
    Thus the increase in depressed mood following ‘yes-but’ thinking induction was not purely dependent on the concurrent levels of brooding.
  • 13. Discussion
    “Yes, but” cognitive response leads to a significant decrease in mood and to a significant increase in negative thoughts independently on the severity and presence of depressive symptoms and not purely dependently on the concurrent change in levels of brooding.
    “Yes, but” thinking style may represent a depressive response to positive stimuli that can hinder positive experiences and thoughts and lead to a decrease in mood and an increase in negative automatic thoughts.
  • 14. Possible “Yes, but” effects
    • Direct effect: the chronic use of “yes, but” thinking style brings to a reduced awareness of the process itself. This may lead people to an impairment in both motivation and commitment to act and to reach satisfaction, sustaining the condition of anhedonia and learned helplessness.
    • 15. Indirect effect: following a positive stimulus, individuals may re-orientate attention on the negative part of experience as an intermediate step for the resumption of negative attitudes which, in turn, can trigger negative thoughts or depressive sensations, worsening mood’s state.
    • 16. Hinderingthe degree of acceptance of alternative beliefs emerging from cognitive restructuring techniques. Functional beliefs could play the role of positive stimuli and act as a trigger for “yes, but” cognitive response.
  • Limitations
    Self-report data subject to errors in measurement
    Lack of an independent check for the reliability of the SCID diagnosis
    The sampling strategy may have lead to different levels of motivation and engagement in the research process
    Previous treatment may have exposed individuals to the identification and the exploration of cognitive constructs
  • 17. Clinical implications
    Assessing “Yes, but” cognitive response to positive stimuli may be useful to identify and socialize a potential detrimental way of thinking that could have an impact on low mood and negative automatic thoughts, even independently from the diagnosis of depression
    Address “Yes, but” thinking style may be beneficial to negative emotion reduction but also to the enhancement of the degree of acceptance of alternative beliefs emerging from cognitive restructuring techniques.
  • 18. Future research
    Deepen investigate both the “yes, but” frequency of use in depressives and non-clinical population, and the reasons that lead people to undertake it
    Understanding these reasons, therapists will be able to call them into question and try to bring evidences of the “Yes, but” damaging nature together with the patient himself
    Patients can learn how to manage their orientation of attention and cognition in a different way, and re-learn their effectiveness in governing it, as a voluntary and not automatic process
  • 19. Thank you for your attention
    Contact details
    Dr.ssa Chiara Manfredi
    Cognitive Psychotherapy School Studi Cognitivi, Modena, Italy
    c.manfredi@studicognitivi.net