The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression
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| Language: | English |
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The Ohio State University / OhioLINK
2019
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| Online Access: | http://rave.ohiolink.edu/etdc/view?acc_num=osu1566135185269864 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-osu1566135185269864 |
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oai_dc |
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NDLTD |
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English |
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Clinical Psychology depression life stress assessment disproportionality cognitive therapy psychotherapy process cognitive change |
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Clinical Psychology depression life stress assessment disproportionality cognitive therapy psychotherapy process cognitive change Pfeifer, Benjamin J. The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression |
| author |
Pfeifer, Benjamin J. |
| author_facet |
Pfeifer, Benjamin J. |
| author_sort |
Pfeifer, Benjamin J. |
| title |
The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression |
| title_short |
The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression |
| title_full |
The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression |
| title_fullStr |
The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression |
| title_full_unstemmed |
The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression |
| title_sort |
proportionality of depressive reactions to life stress and clinical outcomes in cognitive therapy for depression |
| publisher |
The Ohio State University / OhioLINK |
| publishDate |
2019 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=osu1566135185269864 |
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AT pfeiferbenjaminj theproportionalityofdepressivereactionstolifestressandclinicaloutcomesincognitivetherapyfordepression AT pfeiferbenjaminj proportionalityofdepressivereactionstolifestressandclinicaloutcomesincognitivetherapyfordepression |
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1719456357506088960 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-osu15661351852698642021-08-03T07:12:25Z The Proportionality of Depressive Reactions to Life Stress and Clinical Outcomes in Cognitive Therapy for Depression Pfeifer, Benjamin J. Clinical Psychology depression life stress assessment disproportionality cognitive therapy psychotherapy process cognitive change Major depressive disorder is a major public health issue, but there is considerable debate regarding its current diagnostic and conceptual status. There has been renewed interest in the discrepancy between the historical emphasis on the disproportionality of depressive symptoms to life stress and the relative lack of emphasis on this concept in modern times (Horwitz, Wakefield, & Lorenzo-Luaces, 2017). Despite the DSM-5’s acknowledgement that clinical judgment is required to distinguish depressive disorder from culturally-consistent responses to major losses or life stress (American Psychiatric Association, 2013), there is little guidance or evidence in the literature as to how clinicians may reliably make judgments of the disproportionality of symptoms to recent stressors. Prior efforts to characterize the clinical implications of conceptually-related depressive subtypes, such endogenous or melancholic forms of depression, have been largely unsuccessful. However, most of these approaches have prioritized distinctions based on the presence or absence of specific symptoms, rather than the proportionality of life stress to symptom severity per se.In this study, I aim to provide a preliminary investigation of the reliability and validity of two novel approaches to the assessment of disproportionality of depressive symptoms to life stress: the Proportionality of Depressive Reactions Interview (PDRI), a narrative rating life stress interview, and the Proportionality of Depressive Reactions-Self-Report (PDR-SR), a brief self-report questionnaire. Two disproportionality scores were constructed using the PDRI rating approach (i.e., disproportionality-interview) and the PDR-SR (i.e., disproportionality-self-report). These scores were used to examine the relation between proposed `complicated depression’ (Wakefield, Horwitz, & Lorenzo-Luaces, 2016) criteria and disproportionality, the role of disproportionality as a moderator of process-outcome relations in CT for depression, and the relation of disproportionality to risk of relapse. These aims were addressed in a sample of 126 patients diagnosed with major depressive disorder who received 16 weeks of cognitive therapy for depression (Beck, Rush, Shaw, & Emery, 1979). I hypothesized that process-outcome relations would be stronger for those high in disproportionality, and that risk of relapse would be higher for those high in disproportionality. Results showed promising evidence for the reliability and validity of both the PDRI and PDR-SR approaches, and modest relations between proposed `complicated depression’ criteria and disproportionality scores. Results failed to support the hypothesis that process-outcome relations would be stronger for those high in disproportionality, with the one exception that disproportionality-self-report moderated the relation between the within-person component of alliance and immediate cognitive change, such those high in disproportionality exhibited a stronger relation between alliance and cognitive change. In exploratory analyses, both forms of disproportionality moderated the relation between the within-person component of immediate cognitive change and subsequent symptom improvement, such that those low in disproportionality experienced a stronger relation between cognitive change and symptom improvement. Neither form of disproportionality significantly predicted risk of relapse during a 12-month follow-up period. Overall, these results show promising initial evidence of the utility of both the PDRI and PDR-SR as assessments of disproportionality, and suggest that this concept may be an important consideration in understanding process-outcome relations in cognitive therapy of depression. 2019 English text The Ohio State University / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=osu1566135185269864 http://rave.ohiolink.edu/etdc/view?acc_num=osu1566135185269864 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |