Research reportAdaptive and maladaptive self-focus in depression
Introduction
Depression is associated with an increased tendency to focus attention on the self (Ingram, 1990). In particular, ruminative self-focus exacerbates dysphoria (Nolen-Hoeksema, 1991), and increases the likelihood, severity and duration of syndromal depression (e.g. Just and Alloy, 1997, Kuehner and Weber, 1999, Nolen-Hoeksema, 2000, Nolen-Hoeksema et al., 1994). Rumination is defined as ‘behaviours and thoughts that focus one's attention on one's depressive symptoms and on the implications of those symptoms’ (Nolen-Hoeksema, 1991).
The deleterious effects of ruminative self-focus can be reduced if depressed individuals shift their attention from self-related information to non-self-related information by engaging in distracting tasks (Nolen-Hoeksema, 1991). However, deliberately redirecting attention away from depressive thoughts and feelings by focusing on non-self-related information may not be an optimal strategy for dealing with persistent or recurrent depressed states. First, it may simply be too effortful. Second, deliberately focusing attention away from negative thoughts and feelings may reinforce tendencies to thought suppression (Wenzlaff and Bates, 1998) and experiential avoidance (Hayes et al., 1996), both of which are associated with recurrence rather than remediation of negative affect. Third, refocusing attention away from negative thoughts and feelings precludes the possibility of (1) knowing what one is thinking and feeling, and (2) developing alternative interpretations or cognitive representations of these experiences on which, according to cognitive models of depression, long-term treatment effects depend Beck et al., 1979, Teasdale, 1999.
An alternative to distraction would be to refocus attention on the self, using forms of self-focus that are not ruminative, and that do not share the deleterious effects of rumination. This possibility is supported by evidence that rumination is only one of a number of possible modes of self-focus, each of which has distinct functional properties McFarland and Buehler, 1998, Trapnell and Campbell, 1999, Watkins and Teasdale, 2001.
Such findings suggest the possibility of training depression-prone individuals in non-ruminative forms of self-focus that, while avoiding the problems associated with rumination, retain the benefits of self-awareness. Teasdale et al. (1995) suggested that recovered recurrently depressed patients should be trained in mindful self-awareness as a way to counter rumination and so reduce risk of future relapse and recurrence. Teasdale (1999) contrasted ruminative self-focus and mindful self-awareness as distinct, and incompatible modes of mind, the former focusing on analytical, “thinking about” experience, the latter focusing on direct, intuitive, experiential awareness of experience in the moment.
From such reasoning, mindfulness-based cognitive therapy for depression (MBCT) (Segal et al., 2002) was developed as a relapse prevention programme. MBCT was designed to teach recovered recurrently depressed patients to be mindfully self-aware as a way to disengage from ruminative self-focus at times of potential relapse. Two randomised clinical trials Ma and Teasdale, submitted for publication, Teasdale et al., 2000 have shown that, compared with treatment-as-usual, MBCT halved relapse rates for patients with three or more previous episodes of major depression.
The effectiveness of MBCT is consistent with the underlying hypothesis that experiential (mindful) self-awareness and analytical rumination are functionally distinct modes of self-attention, and that the former is adaptive whereas the latter is maladaptive. More specific support for this hypothesis requires comparison of these two cognitive modes in experiments where their induction can be more precisely controlled. Adopting this strategy, Watkins and Teasdale (2001) demonstrated differential effects on overgeneral autobiographical memory of experimental inductions of analytical versus experiential self-focus in individuals with major depression.
Overgeneral autobiographical memory (Williams, 1996) refers to a phenomenon where individuals, when asked to recall specific personal memories, produce categoric summaries of repeated events (e.g. “making mistakes” or “playing golf every week”) rather than memories of events at a particular place and time (e.g. “beating my friend Paul at golf last Saturday”). Compared to controls, overgeneral memory is elevated in depression (see Williams, 1996 for review) and patients with post-traumatic stress disorder McNally et al., 1994, McNally et al., 1995 and appears to be a marker of a maladaptive cognitive processing mode; increased categoric recall is associated with poorer long-term outcome in depression Brittlebank et al., 1993, Mackinger et al., 2000, Peeters et al., 2002, Scott et al., 1995 and seasonal affective disorder (Dalgleish et al., 2001) and with the development of PTSD following trauma (Harvey et al., 1998).
Overgeneral memory was originally viewed as a relatively stable trait marker of vulnerability to depression Brittlebank et al., 1993, Williams, 1996, with overgeneral memory remaining unchanged in depressed patients (Brittlebank et al., 1993) and recovered depressed patients (Williams et al., 2000) when retested after 6–7 months. However, recent experimental studies have shown that overgeneral memory is modifiable, at least in the short term. Watkins et al. (2000) showed that a brief distraction induction reduced overgeneral memory in dysphoric and depressed individuals, whereas a rumination induction maintained or increased it. Watkins and Teasdale (2001) compared analytical (ruminative) self-focus, non-analytical (experiential) self-focus, analytical non-self-focus, and non-analytical non-self-focus (distraction) inductions in individuals with major depression. Consistent with the hypothesis that analytical self-attention is associated with overgeneral memory, rumination maintained overgeneral memory, whereas experiential self-focus reduced it.
The aim of the present study was to examine further the hypothesis that ruminative (analytical) self-focus and experiential self-focus are functionally distinct forms of self-attention, and, in depression, the former is maladaptive and is associated with the maintenance of pathological overgeneral memory, whereas the latter is adaptive, and is associated with reductions in overgeneral memory. Watkins and Teasdale (2001) found that experientially focusing attention directly on feelings reduced overgeneral memory in depression, whereas analytical thinking about feelings maintained overgeneral memory. However, in that study, these inductions differed in both item content and instructions, raising the possibility that the results reflected differences in the content to which self-focused attention was directed, rather than differences in processing style associated with distinct modes of self-focus. The present study overcame this ambiguity by using experiential and analytical inductions that focused on identical self-related content, and differed only in the instructions concerning how that information was to be processed.
We predicted that in depressed patients experiential self-focus would significantly reduce categoric memory recall compared to analytical self-focus. Watkins and Teasdale (2001) found that analytical and non-analytical forms of self-focus had equivalent short-term effects on mood. From these findings, we predicted that there would be no differences in effects on depressed mood between experiential and analytical self-focus inductions.
Section snippets
Participants
Twenty-eight volunteers (seven men) (age 18–65, M=41.2 years, S.D.=11.3 years), meeting criteria for current Major Depressive Disorder on the Structured Clinical Interview for DSM-III-R (SCID; Spitzer et al., 1996), were recruited by press advertisements. Ninety-six percent also met criteria for past major depression, 93% were prescribed antidepressant medication and 32% had previously attempted suicide. The mean Beck Depression Inventory (BDI, Beck et al., 1961) score was 25.4 (S.D.=7.4), mean
Results
An alpha level of 0.05 was used for all statistical tests. Table 1 displays means and S.D. for mood measures and proportion of categoric memories. The principal outcome variable (proportion of categoric memories) was normally distributed and met statistical assumptions for parametric analyses. All analyses were initially performed with sex of participant as a between-subjects' factor. There were no significant main effects or interactions with this variable; therefore, all analyses reported
Discussion
This study examined whether different modes of self-focus could produce distinct functional effects on overgeneral memory, a measure predictive of poor long-term course in depression. Specifically, we predicted that, in depressed patients, experiential self-focus would reduce overgeneral autobiographical memory compared to analytical self-focus. This prediction was confirmed. In depressed patients, the experiential self-focus condition significantly reduced categoric memory recall in depressed
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