A comparison of vulnerability factors in patients with persistent and remitting lifetime symptom course of depression

Abstract

BackgroundResearch has suggested fundamental differences between patients with persistent and those with remitting courses of depression. This study investigated whether patients with different lifetime symptom course configurations differ in early risk and cognitive vulnerability factors.MethodsPatients with at least three previous episodes who were currently in remission were categorized based on visual timelines of their lifetime symptom course and compared with regard to a number of different indicators of vulnerability including questionnaire measures of childhood trauma and experiential avoidance.ResultsOf the N=127 patients, n=47 showed a persistent course of the disorder with unstable remissions and symptoms most of the time, and n=59 showed a course with more stable, lasting remissions. Group comparisons indicated that patients with a more persistent course were significantly more likely to have suffered from childhood emotional abuse, and reported higher levels of experiential avoidance as well as related core beliefs. Experiential avoidance partially mediated the effect of childhood emotional abuse on persistence of symptoms.LimitationsThe study is cross-sectional and does not allow conclusions with regard to whether differentiating variables are causally related to chronicity. Self-report measures may be subject to reporting biases.ConclusionsThe results highlight the detrimental effects of childhood adversity and suggest that experiential avoidance may play an important role in mediating such effects.

What happens after five years?: The long-term effects of a four-session Acceptance and Commitment Therapy delivered by student therapists for depressive symptoms

“…The researchers proposed that experiential avoidance could be an integral factor affecting the course and comorbidity development of emotional disorders. Research has shown that a more persistent course of depression is linked to higher levels of experiential avoidance (Barnhofer et al, 2014). Psychological inflexibility was also higher with college students reporting current or lifetime history of depressive and anxiety symptomatology, and it was also associated with depression/anxiety comorbidity (Levin et al, 2014).…”

“…Similar findings on the relationship between the earlier version of the AAQ and various psychological measures of psychopathology and well-being have been reviewed by . Lack of psychological flexibility has been associated with general risk for psychopathology (e.g., Chawla & Ostafin, 2007;Fledderus, Bohlmeijer, & Pieterse, 2010;, as well as to more specific distresses such as depressive symptoms (e.g., Barnhofer et al, 2014;Berking et al, 2009;Bjornsson et al, 2010;Spinhoven, Drost, de Rooij, van Hemert, & Penninx, 2014;Tull, Gratz, Salters, & Roemer, 2004), and comorbid depressive, anxiety and substance use issues (Levin et al, 2014). It has also been theorized to influence the development and maintenance of a variety of psychological problems as well as the deterioration of psychological wellbeing (Kashdan, Barrios, Forsyth, & Steger, 2006;Levin et al, 2014).…”

“…Research on the processes of change highlight the role of psychological inflexibility which has also been related to a wide variety of conditions causing suffering and psychological distress (Barnhofer et al, 2014;Berking et al, 2009;Levin et al, 2014;Ruiz, 2012). In acceptance-and value-based interventions, psychological flexibility and changes in it during the treatment period have been shown to partially or fully mediate positive outcomes (Forman et al, 2012;Hayes, Villatte, Levin, & Hildebrandt, 2011;Lundgren, Dahl, & Hayes, 2008a;Wicksell et al, 2010;Zettle et al, 2011).…”

“…The concept refers to a variety of dynamic, overlapping processes of shifting perspectives, relocating mental resources to meet current and future demands, and balancing between competing life domains and their needs . Lack of psychological flexibility has been associated with various forms of distress, whether social, behavioral or psychological such as depressive symptoms (e.g., Barnhofer, Brennan, Crane, Duggan, & Williams, 2014;Berking, Neacsiu, Comtois, & Linehan, 2009;Levin et al, 2014), and evidence from mediational research supports the role of change in psychological flexibility in mediating positive outcomes (Forman et al, 2012;Ruiz, 2012;Zettle, Rains, & Hayes, 2011). The concept of psychological flexibility and depression relate to each other on various levels of emotional, cognitive and social functioning, and physiological response systems .…”

The neuroscience of depression: Implications for assessment and intervention

“…Specifically, experiencing a greater number of depressive episodes influences the organization of striatal networks (Meng et al, 2014) and may be associated with impaired hippocampal activation during a recollection memory task (Milne, MacQueen, & Hall, 2012) and with selective deficits in down-regulating amygdala responses to negative emotional stimuli using reappraisal (Kanske, Heissler, Schönfelder, & Wessa, 2012), factors that also contribute to risk for relapse. Vulnerability for recurrence of depressive episodes has been found to be associated with poorer outcomes in patients with earlier onset of depression, with increased number and length of depressive episodes (Moylan, Maes, Wray, & Berk, 2013), and with history of childhood trauma (Barnhofer, Brennan, Crane, Duggan, & Williams, 2014). Thus, in such patients, longer and more frequent depressive episodes appear to increase vulnerability for further episodes, precipitating an accelerating and progressive course of illness, leading to functional decline.…”