Low Critical Parent Ego State is a Marker of Treatment-Resistant Depression in a Self-Rating Ego gram Questionnaire

Abstract

IntroductionUp to 15% of patients with depression do not show significant clinical response despite pharmacological and psychotherapeutic approaches [1]. Depression is generally considered treatmentresistant depression (TRD) when at least two trials with distinct antidepressants do not produce a significant improvement, although TRD is a heterogeneous condition [1,2]. Evidence indicates that there are multiple possible approaches to treating TRD, and suggests that neurobiological, psychological, and social factors are involved in TRD. Thus, social isolation and problematic personal traits such as "neuroticism" are associated with poor response to therapeutic approaches [2]. The necessity of cognitive and interpersonal therapy [2] and the amelioration of social support [3] have been emphasized in the treatment of TRD.In transactional analysis theory, ego states are a part of an individual's personality at a given time [4,5]. The Egogram presents five spectra in a bar-chart analysis of a person's functional ego states [6], which are categorized as "Critical Parent", "Nurturing Parent", "Adult", "Free Child", and "Adapted Child". Originally, ego states in people are observed and evaluated by psychologists intuitively through the interpersonal relationship between clients and psychologists [4]. A questionnaire has been developed that makes the evaluation of ego states more convenient [7]. Selfrating questionnaire sheets, such as the TEG (Tokyo University Egogram) [8] or Egogram Check List [9], have been widely used in clinical or occupational settings in Japan. There are clinical studies using self-rating egogram in fields of functional somatic syndromes [10,11], psycho-oncology [12], occupational health care [8], and psychiatric disorders (e.g., anorexia and bulimia nervosa) [13]. This is a result of applying a self-rating egogram, TEG to 28 patients with TRD. Materials and Methods Participants