Top

Gepubliceerd in:

01-04-2013 | Original Article

Is There a Core Process Across Depression and Anxiety?

Auteurs: Timothy Bird, Warren Mansell, Chris Dickens, Sara Tai

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 2/2013

Abstract

There is emerging evidence of overlap across cognitive processes. One explanation of this overlap is the presence of a single, higher-order latent process. In this study we tested for a core process and its ability to account for symptoms of depression and anxiety. Using Structural Equation Modeling we compared a model where processes (worry, thought suppression and experiential avoidance) are treated as separate predictors of symptoms (anxiety and depression) against a model where they are represented by one latent factor. These models were applied in three analyses: a cross-sectional student sample; a longitudinal subset of this analogue sample; and a cross-sectional sample of individuals with long-term health conditions. Comparison of the models showed that while the two sets of models provided comparable fits to the data, the single factor models provided a more parsimonious solution. In addition, the latent factor explained a large proportion of variance in all measured processes, suggesting a high degree of overlap between them. It also explained more variance in symptoms than the processes separately. A Confirmatory Factor Analysis further supported a single factor solution, and the item loadings indicated that the core process represented a perceived inability to control negative thinking.

vorige artikel Cognitive Behavioral Therapy Versus Progressive Muscle Relaxation Training for Multiple Somatoform Symptoms: Results of a Randomized Controlled Trial

volgende artikel From Higher-Order to Underlying Constructs: Examining the Relationships Between Affect and Fundamental Fears

We also conducted the analyses in Fig. 1 after removing problematic items from the AAQ. This had little effect on the results of the analyses [Separate process: X² (6) = 9.82, n.s,, CFI = 1.00, RMSEA = .05 (CI90 = .00, lower, .11, upper); Common Factor: X² (8) = 12.85, n.s,, CFI = 1.00, RMSEA = .05 (CI90 = .00, lower, .10, upper); Chi-square change (2) = 3.08, n.s.]. We therefore only present the results of analyses using the complete scale.

We also tested this model separately for depression [X² (2) = 4.29, n.s,, CFI = .99, RMSEA = .07 (CI90 = .00, lower, .17, upper)] anxiety [X² (2) = 3.60, n.s,, CFI = .99, RMSEA = .06 (CI90 = .00, lower, .16, upper)], and stress [X² (2) = 5.46, n.s,, CFI = .99, RMSEA = .09 (CI90 = .00, lower, .18, upper)], all of which showed moderate to good fit. In all three models the common factor was a significant predictor of the outcome (B _depression = .46, p < .001; B _anxiety = .46, p < .001; B _stress = .46, p < .001).

We also conducted the analyses in Fig. 2 after removing problematic items from the AAQ. This had little effect on the results of the analyses [Separate process: X² (6) = 15.61, p < .05, CFI = .97, RMSEA = .13 (CI90 = .05, lower, .21, upper); Common Factor: X² (8) = 16.80, p < .05, CFI = .97, RMSEA = .11 (CI90 = .03, lower, .18, upper); Chi-square change (2) = 1.19, n.s.]. We therefore only present the results of analyses using the complete scale.

We also tested this model separately for depression [X² (2) = 1.65, n.s,, CFI = 1.00, RMSEA = .00 (CI90 = .00, lower, .19, upper)] anxiety [X² (2) = .96, n.s,, CFI = 1.00, RMSEA = .00 (CI90 = .00, lower, .16, upper)], and stress [X² (2) = 1.11, n.s,, CFI = 1.00, RMSEA = .00 (CI90 = .00, lower, .17, upper)], all of which showed moderate to good fit. In all three models the common factor was a significant predictor of the outcome (B _depression = .34, p < .001; B _anxiety = .50 p < .001; B _stress = .37, p < .001).

We also conducted the analyses in Fig. 4 after removing problematic items from the AAQ. This had little effect on the results of the analyses [Separate process: X² (2) = 6.61, p < .05, CFI = .99, RMSEA = .11 (CI90 = .02, lower, .21, upper); Common Factor: X² (4) = 11.23, p < .05, CFI = .99, RMSEA = .10 (CI90 = .03, lower, .17, upper); Chi-square change (2) = 4.62, n.s.]. We therefore only present the results of analyses using the complete scale.

The common factor models were also separately for depression [X² (2) = 4.56, n.s,, CFI = .99, RMSEA = .08 (CI90 = .00, lower, .19, upper)] and anxiety [X² (2) = 5.47, n.s,, CFI = .99, RMSEA = .10 (CI90 = .00, lower, .20, upper)], both of which showed moderate to good fit. In both models the common factor was a significant predictor of the outcome (B _depression = .63, p < .001; B _anxiety = .83, p < .001).

Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behaviour Research and Therapy, 48, 974–983.PubMedCrossRef

Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24, 1069–1078.PubMedCrossRef

Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRef

Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.CrossRef

Barlow, D. H., Ellard, K. K., Fairholme, C. P., Farchione, T. J., Boisseau, C. L., & Ehrenreich May, J. T. (2011). Unified protocol for transdiagnostic treatment of emotional disorders. New York: Oxford University Press.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.

Browne, M. W., & Crudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.

Byrne, B. M. (1994). Structural equation modelling with EQS and EQS/windows. Thousand Oaks, CA: Sage.

Carey, T. A., Carey, M., Mullan, R. J., Spratt, C. G., & Spratt, M. B. (2009). Assessing the statistical and personal significance of the method of levels. Behavioural and Cognitive Psychotherapy, 37, 311–324.PubMedCrossRef

Carey, T. A., & Mullan, R. J. (2007). Patients taking the lead. A naturalistic investigation of a patient-led approach to treatment in primary care. Counselling Psychology Quarterly, 20, 27–40.CrossRef

Carey, T. A., & Mullan, R. J. (2008). Evaluating the method of levels. Counselling Psychology Quarterly, 21, 247–256.CrossRef

Chaturvedi, S. K. (1991). Clinical irrelevance of HAD factor structure. British Journal of Psychiatry, 159, 298.PubMedCrossRef

Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.PubMedCrossRef

Davis, R. N., & Nolen-Hoeksema, S. (2000). Cognitive inflexibility among ruminators and nonruminators. Cognitive Therapy and Research, 24, 699–711.CrossRef

Dickens, C., Coventry, P., Khara, A., Bower, P., Mansell, W., & Bakerly, N. D. (2012). Perseverative negative cognitive processes are associated with depression in people with long-term conditions. Chronic Illness, 8, 102–111.

Dickens, C., McGowan, L., Clark-Carter, D., & Creed, F. (2002). Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. Psychosomatic Medicine, 64, 52–60.PubMed

Dickens, C., Percival, C., McGowan, L., Douglas, J., Tomenson, B., Cotter, L., et al. (2004). The risk factors for depression in first myocardial infarction patients. Psychological Medicine, 34, 1083–1092.PubMedCrossRef

Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1, 192–205.CrossRef

Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., et al. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. American Journal of Psychiatry, 166, 311–319.PubMedCrossRef

Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.PubMedCrossRef

Field, A. P., & Cartwright-Hatton, S. (2008). Shared and unique cognitive factors in social anxiety. International Journal of Cognitive Therapy, 1, 206–222.CrossRef

Frasure-Smith, N., Lespérance, F., Prince, R. H., Verrier, P., Garber, R. A., Juneau, M., et al. (1997). Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. The Lancet, 350, 473–479.CrossRef

Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189–195.PubMedCrossRef

Garver, M. S., & Mentzer, J. T. (1999). Logistics research methods: Employing structural equation modelling to test for construct validity. Journal of Business Logistics, 20, 33–57.

Gavard, J. A., Lustman, P. J., & Clouse, R. E. (1993). Prevalence of depression in adults with diabetes. An epidemiological evaluation. Diabetes Care, 16, 1167–1178.PubMedCrossRef

Gilbert, P., & Irons, C. (2004). A pilot exploration of the use of compassionate images in a group of self-critical people. Memory, 12, 507–516.PubMedCrossRef

Harvey, A. G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.PubMedCrossRef

Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. Psychological Record, 54, 553–578.

Hayes, S. C., Wilson, K. G., Strosahl, K., Gifford, E. V., & Follette, V. M. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168.PubMedCrossRef

Henry, J. D., & Crawford, J. R. (2005). The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.PubMedCrossRef

Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58, 295–300.PubMed

Hoelter, D. R. (1983). The analysis of covariance structures: Goodness-of-fit indices. Sociological Methods and Research, 11, 325–344.CrossRef

Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29, 409–416.

Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453.CrossRef

Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indices in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRef

Ingram, R. E. (1990). Self-focused attention in clinical disorders: Review and a conceptual model. Psychological Bulletin, 107, 156–176.PubMedCrossRef

Katon, W., Lin, E. H. B., & Kroenke, K. (2007). The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. General Hospital Psychiatry, 29, 147–155.PubMedCrossRef

Lespérance, F., Frasure-Smith, N., Koszycki, D., Laliberté, M.-A., van Zyl, L. T., Baker, B., et al. (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease. The Journal of the American Medical Association, 297, 367–379.CrossRef

Linville, P. (1996). Attention inhibition: Does it underlie ruminative thought? In Ruminative thoughts (pp. 121–133). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

Lovibond, S. H., & Lovibond, P. F. (1993). Manual for the depression anxiety stress scales (DASS). Kensington: University of New South Wales.

Lustman, P. J., Griffith, L. S., Clouse, R. E., & Cryer, P. E. (1986). Psychiatric illness in diabetes mellitus: Relationship to symptoms and glucose control. The Journal of Nervous and Mental Disease, 174, 736–742.PubMedCrossRef

Lyons, C., Nixon, D., & Coren, A. (2006). Long term conditions and depression: Considerations for best practice in practice based commissioning. National Institute for Mental Health in England, Care Services Improvement Partnership. London: Department of Health.

Mansell, W. (2005). Control theory and psychopathology: An integrative approach. Psychology and Psychotherapy: Theory, Research and Practice, 78, 141–178.CrossRef

Mansell, W. (2008). The seven Cs of CBT: A consideration of the future challenges for cognitive behavioural therapy. Behavioural and Cognitive Psychotherapy, 36, 641–649.CrossRef

Mansell, W., Harvey, A., Watkins, E. R., & Shafran, R. (2008). Cognitive behavioral processes across psychological disorders: A review of the utility and validity of the transdiagnostic approach. International Journal of Cognitive Therapy, 1, 181–191.CrossRef

Mansell, W., Harvey, A., Watkins, E., & Shafran, R. (2009). Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy, 23, 6–19.CrossRef

McHugh, R. K., Murray, H. W., & Barlow, D. H. (2009). Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions. Behaviour Research and Therapy, 47, 946–953.PubMedCrossRef

McManus, F., Clark, D. M., Grey, N., Wild, J., Hirsch, C., Fennell, M., et al. (2009). A demonstration of the efficacy of two of the components of cognitive therapy for social phobia. Journal of Anxiety Disorders, 23, 496–503.PubMedCrossRef

McManus, F., Shafran, R., & Cooper, S. (2010). What does a transdiagnostic approach have to offer the treatment of anxiety disorders? British Journal of Clinical Psychology, 49, 491–505.PubMedCrossRef

Menard, S. (1991). Longitudinal research. Newbury Park, CA: Sage.

Mennin, D. S., Holoway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behaviour Therapy, 38, 284–302.CrossRef

Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State worry questionnaire. Behaviour Research and Therapy, 28, 487–495.PubMedCrossRef

Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: Results from the world health surveys. Lancet, 370, 851–858.PubMedCrossRef

Mulaik, S. A., James, L. R., Van Alstine, J., Bennett, N., Lind, S., & Stilwell, C. D. (1989). Evaluation of goodness-of-fit indices for structural equation models. Psychological Bulletin, 105, 430–445.CrossRef

Norton, P. J. (2008). An open trial of a transdiagnostic cognitive-behavioral group therapy for anxiety disorder. Behavior Therapy, 39, 242–250.PubMedCrossRef

Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice, Training, 45, 214–226.CrossRef

Powers, W. T. (2005). Behaviour: The control of perception (2nd ed.). New Cannan, CT: Benchmark Publications.

Roberts, S. B., Bonnici, D. M., Mackinnon, A. J., & Worcester, M. C. (2001). Psychometric evaluation of the hospital anxiety and depression scale (HADS) among female cardiac patients. British Journal of Health Psychology, 6, 373–383.PubMedCrossRef

Ruscio, A. M., Seitchik, A. E., Gentes, E. L., Jones, J. D., & Hallion, L. S. (2011). Perseverative thought: A robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder. Behaviour Research and Therapy, 49, 867–874.PubMedCrossRef

Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583.PubMedCrossRef

Schreiber, J. B., Nora, A., Stage, F. K., Barlow, E. A., & King, J. (2006). Reporting structural equation modelling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99, 323–337.CrossRef

Segal, Z., Teasdale, J., & Williams, M. (2002). Mindfulness-based cognitive therapy for depression. New York: Guilford Press.

Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. G. (2000). Worry and rumination: Repetitive thought as a concomitant and predictor of negative mood. Cognitive Therapy and Research, 24, 671–688.CrossRef

Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., et al. (2009). Mind the gap: Improving the dissemination of CBT. Behaviour Research and Therapy, 47, 902–909.PubMedCrossRef

Spinhoven, P., Ormel, J., Sloekers, P. P., Kempen, G. I., Speckens, A. E., & van Hemert, A. M. (1997). A validation study of the hospital anxiety and depression scale (HADS) in different groups of Dutch subjects. Psychological Medicine, 27, 363–370.PubMedCrossRef

Watkins, E., Moulds, M., & Mackintosh, B. (2005). Comparisons between rumination and worry in a non-clinical population. Behaviour Research and Therapy, 43, 1577–1585.PubMedCrossRef

Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62, 615–640.CrossRef

Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320.CrossRef

Wells, K. B., Golding, J. M., & Burnam, M. A. (1988). Psychiatric disorder in a sample of the general population with and without chronic medical conditions. American Journal of Psychiatry, 145, 976–981.PubMed

Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Erlbaum.

Yuan, K. H., & Bentler, P. M. (2004). On Chi-square difference and z tests in mean and covariance structure analysis when the base model is misspecified. Educational and Psychological Measurement, 64, 737–757.CrossRef

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.PubMedCrossRef

Titel: Is There a Core Process Across Depression and Anxiety?
Auteurs: Timothy Bird
Warren Mansell
Chris Dickens
Sara Tai
Publicatiedatum: 01-04-2013
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 2/2013
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-012-9475-2

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 2/2013

From Higher-Order to Underlying Constructs: Examining the Relationships Between Affect and Fundamental Fears

High-Risk Feedback: A Brief Intervention to Increase Motivation to Change Anxiety

Cognitive Restructuring and Acceptance: An Empirically Grounded Conceptual Analysis

Cognitive Behavioral Therapy Versus Progressive Muscle Relaxation Training for Multiple Somatoform Symptoms: Results of a Randomized Controlled Trial

Clarifying Relations Between Thought-Action Fusion, Religiosity, and Obsessive–Compulsive Symptoms Through Consideration of Intent

Development and Preliminary Validation of the Thought Control Questionnaire for Adolescents (TCQ-A)