Stephen Barton

Role loss and emotional adjustment in chronic pain

Chronic pain interrupts behaviour, interferes with functioning, and may affect a persons identity: their sense of self. We tested whether loss of role and personal attributes and current and past self‐concept differentiation, predicted adjustment as indexed by measures of depression. Chronic pain patients (n=80) completed measures of pain (MPQ), disability (PDI), depression and anxiety (BDI, HADS). Measures of role and attribute loss and self‐concept differentiation were derived from a Role‐Attribute Test in which participants identified four social roles in four domains (friendship, occupation, leisure, family) and nominated two personal attributes in each role prior to pain onset and current. Participants reported mean losses of 3.38 roles, and 6.97 attributes. Greater losses were observed in friendship, occupation and leisure domains compared with the family domain. Multiple regression analyses revealed that after controlling for demographic and clinical differences, role and attribute loss predicted depression scores. There was no evidence that depression was associated with past self‐concept differentiation. The results are discussed with reference to the methodology used and the relevance of self‐identity to understand adjustment to chronic pain.

Possible selves in chronic pain: self-pain enmeshment, adjustment and acceptance

The aim of this study was to test whether enmeshment of self and pain predicted adjustment (depression and acceptance) in a chronic pain population. 89 chronic pain patients completed standardized self‐report measures of depression and acceptance and generated characteristics describing their current actual self, hoped‐for self and feared‐for self, and made judgments about the degree to which their future possible selves (hoped‐for and feared‐for) were dependent on the absence or presence of pain, i.e. enmeshed with pain. Hierarchical multiple regression analyses showed that after accounting for the influence of demographics (age, gender), pain characteristics and the degree of role interference attributable to pain, the proportion of hoped‐for self characteristics that could be achieved even with the presence of pain predicted the magnitude of depression and acceptance scores. The findings are discussed with reference to the enmeshment hypothesis and theories of self‐discrepancy, self‐regulation and hopelessness.

Sentence completion test for depression (SCD): An idiographic measure of depressive thinking

OBJECTIVES This study set out to investigate the reliability and validity of the Sentence Completion Test for Depression (SCD) as a clinical measure. In contrast to questionnaire measures of depressive thinking, respondents finish incomplete sentences using their own words. This elicits idiographic information concurrent with measuring depressive thinking. METHOD In Study 1, measures of negative thinking were tested between a depressed group and a non-depressed control group. A preliminary item analysis was conducted and replicated on separate samples in Study 2. Psychometric properties of the test were investigated. In Study 3, idiographic validity and sensitivity to change were explored in a sample of clinical cases with reference to cognitive-behavioural case-formulation. RESULTS In Study 1, the depressed group produced more negatives and fewer positives, and the SCD demonstrated good content validity, internal consistency and inter-rater reliability. The preliminary short-form had comparable psychometric properties, and these were replicated on new samples in Study 2. Sensitivity and specificity values were above 90% in both studies. In Study 3, idiographic content generated hypotheses about target problems and dysfunctional beliefs within cognitive-behavioural case-formulation, and SCD scores were sensitive to clinical change. CONCLUSIONS The SCD demonstrates good construct validity, internal consistency, inter-rater reliability, sensitivity, and specificity. It offers an idiographic assessment of depression that is complementary to questionnaire measures, particularly by generating hypotheses about target problems and dysfunctional beliefs within a cognitive-behavioural case-formulation. This is achieved without loss to reliability and validity at the nomothetic level.

Schemas as Memories: Implications for Treatment

Schemas are usually viewed as core dysfunctional beliefs, lying dormant until activated by a salient trigger (i.e., the diathesis-stress model). It is suggested that they are long-standing, stable themes that are specific to the individual. They are formed during childhood in an attempt by the person to cope with life events and environmental situations. Once schemas are active, they become the engine room of negative automatic thoughts and serve to bias information negatively. This prototypical description has a number of implications. Indeed, it clearly suggests that schemas are stored units of information that can be activated at some future time under the “appropriate” cueing conditions—in other words, they are memories. Developing this perspective, this article argues that therapists should have a broader concept of the nature of schemas and, rather than viewing them solely as cognitions, therapists should view them as stored multisensory representations. As such, schemas can be adequately described as representations of past experiences that are composed of cognitions and sensory features (olfactory, tactile, taste, etc.) that are both stored and retrieved as coherent units. Hence, when treating someone with depression, in addition to assessing the cognitions, one should determine whether there are sounds, tastes, body postures, and/or other sensory features associated with the patient’s experience of his/her depression. If such features are found to be present, they need to be assessed appropriately and duly targeted with suitable intervention strategies.

A Systematic Review of the Rates of Depression in Children and Adults With High-Functioning Autism Spectrum Disorder

ABSTRACT Accurate population rates of depression can inform allocation of health resources and service planning, to counter the impact of depression on quality of life and morbidity. A systematic review of the rates of depression in children and adults with autism spectrum disorders (ASD) and without intellectual disability (high-functioning [HF] ASD) was conducted. Nineteen studies met inclusion criteria. Reported rates of depression varied; the reasons for this are discussed including availability of psychometrically valid and reliable measures of depression for people with HF ASD, and heterogeneity of study design. Further examination of the phenomenology of depression in HF ASD linked to the development of psychometrically valid assessment measures would facilitate epidemiological studies, improve clinical case recognition, and inform treatments and interventions.

Self-Organization in Bipolar Disorder: Compartmentalization and Self-Complexity

The present study investigated compartmentalization and self-complexity of self-structure in people with a history of bipolar disorder. Remitted bipolar, recovered depressed and healthy control participants described aspects of themselves using experimenter-provided positive and negative traits. Compartmentalization was assessed by the partitioning of positive and negative traits between self-aspects. Complexity was assessed by both the number of self-aspects people generated and the degree of overlap between the self-aspects. The remitted bipolar and recovered depressed groups demonstrated greater compartmentalization than healthy controls and the remitted bipolar group also demonstrated greater self-complexity than healthy controls when self-aspects relating to the depressed and manic states were included. Compartmentalization may be a generic feature of mood disorder. In addition, bipolar disorder is characterized by a complex, differentiated self-concept with distinctive beliefs about the self in depressed and manic states. Therapeutic implications are discussed.

CHANGING CORE BELIEFS WITH THE CONTINUUM TECHNIQUE

Eliciting, evaluating and changing core beliefs are established features of cognitive behaviour therapy (CBT). However, care must be taken when working at this level of cognition. This is because therapists are dealing with core constructs that, whether dysfunctional or otherwise, influence the patients self-concept, her world and future. This paper examines when it is appropriate to work at this level and some of the specific problems regarding assessment and the consequences of belief change. It is evident that achieving lasting cognitive change is a difficult task, and this may be in part due to the poor quality of the literature and training in the area. In an attempt to address this, the final section of the paper offers a set of practical guidelines concerning the continuum technique, a well-known CBT method for targeting, evaluating and changing core beliefs. It highlights process features (e.g. planning, management, and interpersonal skills) as being crucial in creating contexts in which change can take place. The work has been written for trainee cognitive therapists and those with a working knowledge of CBT who are seeking to improve their abilities in the use of change methodologies.

Early intervention for adults at high risk of recurrent/chronic depression: Cognitive model and clinical case series.

. This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individuals core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the models validity and the therapys efficacy.

Quantifiers in depressed future thinking: All of the future will be bleak, but some of it will be good

The aim of this study was to explore the impact of quantifiers on depressed future thinking. Universal quantifiers, such as all and none, express bleak expectations and their global nature suggests no alternatives or exceptions (e.g., “ None of the future will be happy; all of it will be bleak”). We hypothesised that less extreme quantifiers would access alternative future perspectives. Depressed participants with high levels of hopelessness generated continuations to sentence stems that quantified different amounts of future time. Averaging over conditions, the depressed were more negative than never-depressed controls, but differences were attenuated in response to the quantifier some —the depressed were more positive and less negative under this condition (e.g., “ Some of the future…will be good”). By differentiating subsets of the future, some produced contrasts with negative global models and accessed positive alternatives.

Protocol for a feasibility study and randomised pilot trial of a low-intensity psychological intervention for depression in adults with autism: the Autism Depression Trial (ADEPT)

Introduction High rates of co-occurring depression are reported in autism spectrum disorder (ASD), a neurodevelopmental condition characterised by social communication impairments and repetitive behaviours. Cognitive-behavioural interventions adapted for ASD have been effective for anxiety problems. There have been evaluation studies of group cognitive-behavioural therapy for co-occurring depression, but no randomised trials investigating low-intensity psychological interventions as recommended in clinical guidelines for mild-moderate depression. Methods and analysis A feasibility study comprising a randomised controlled trial (RCT) and nested qualitative evaluation is under way as preparation for a definitive RCT. Participants (n=70) will be randomised to Guided Self-Help: a low-intensity psychological intervention based on behavioural activation adapted for ASD or treatment as usual. Outcomes including depression symptoms, anxiety, social function and service use will be measured at 10, 16 and 24 weeks postrandomisation and will be blind to group allocation for measures that are not self-administered. The analysis will aim to establish the rates of recruitment and retention for a larger-scale RCT as well as the most appropriate measure of depression to serve as primary outcome. The qualitative study will purposively sample up to 24 participants from each treatment group to consider the acceptability and feasibility of the intervention and the trial design. Ethics and dissemination Ethical approval has been received from WALES REC 3 (IRAS project ID: 191558) and the Health Research Authority with R&D approval from Avon and Wiltshire Mental Health Partnership and Northumberland, Tyne and Wear Foundation NHS Trusts. To our knowledge, this is the first study of a low-intensity intervention for depression in adults with autism. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal publications reporting the quantitative and qualitative research findings of the study and presentations at national and international conferences. Trial registration number ISRCTN54650760; Pre-results.