Elsevier

Behavior Therapy

Volume 48, Issue 3, May 2017, Pages 349-365
Behavior Therapy

Daily Stress, Coping, and Negative and Positive Affect in Depression: Complex Trigger and Maintenance Patterns

https://doi.org/10.1016/j.beth.2016.06.001Get rights and content

Highlights

  • This paper examines how stress and coping trigger and maintain daily affect in depression

  • Depressed patients completed questionnaires for seven consecutive days

  • Perceived criticism, avoidant coping, and stress increase when daily affect worsens

  • Perceived control and problem-focused coping operate when positive affect increases

  • Avoidant coping and stress maintain depressive mood of self-critical perfectionists

Abstract

Major depressive disorder is characterized by emotional dysfunction, but mood states in daily life are not well understood. This study examined complex explanatory models of daily stress and coping mechanisms that trigger and maintain daily negative affect and (lower) positive affect in depression. Sixty-three depressed patients completed perfectionism measures, and then completed daily questionnaires of stress appraisals, coping, and affect for 7 consecutive days. Multilevel structural equation modeling (MSEM) demonstrated that, across many stressors, when the typical individual with depression perceives more criticism than usual, he/she uses more avoidant coping and experiences higher event stress than usual, and this is connected to daily increases in negative affect as well as decreases in positive affect. In parallel, results showed that perceived control, less avoidant coping, and problem-focused coping commonly operate together when daily positive affect increases. MSEM also showed that avoidant coping tendencies and ongoing stress, in combination, explain why people with depression and higher self-critical perfectionism maintain daily negative affect and lower positive affect. These findings advance a richer and more detailed understanding of specific stress and coping patterns to target in order to more effectively accomplish the two predominant therapy goals of decreasing patients’ distress and strengthening resilience.

Section snippets

Complex Stress, Coping, and Affect Trigger and Maintenance Patterns

Although there are important differences between various cognitive (e.g., Beck, Rush, Shaw, & Emery, 1979), learning (e.g., Martell, Addis, & Jacobson, 2001), and emotion-focused (e.g., Gray, 1990) theories of depression, these theories recognize the importance of withdrawal and approach systems. All of these theories propose that effective treatment involves helping people with depression decrease inhibition and become more engaged with their environment, especially in ways that increase

The Present Study

As Dunkley et al. (2014) demonstrated their multilevel explanatory model in a sample of nondepressed adults, the generalizability of the complex trigger and maintenance patterns to depressed patients is unknown. In terms of within-person emotion dynamics, findings from experience sampling studies have suggested that affective reactivity to daily negative events may be either blunted (Peeters, Nicolson, Berkhof, Delespaul, & De Vries, 2003), comparable (Thompson et al., 2012), or intensified (

Participants

Participants were outpatient adults (between the ages of 18–65) who had a primary diagnosis of current unipolar MDD according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM-IV; American Psychiatric Association, 1994), and were referred for treatment based on clinical interview(s) at one of two teaching hospitals in a North American city from October 2007 to November 2010. In order to be eligible, participants did not have any changes in medications for at least 4

Participant characteristics

The 63 participants ranged from 20 to 61 years of age (M = 40.94 years, SD = 11.54). Of the 56 participants who reported their ethnicity, 80% (n = 45) self-identified as of European descent, 5% (n = 3) as African, 5% (n = 3) as West Indian, 4% (n = 2) as South American, 2% (n = 1) as Middle Eastern, 2% (n = 1) as East Indian, and 2% (n = 1) as Aboriginal. Eighty-three percent (n = 52) of participants reported taking psychiatric medication. The participants had a mean BDI score of 30.40 (SD =

Discussion

The present study was the first to use a daily diary method and MSEM to elucidate how specific stress appraisal and coping mechanisms work in combination to change and maintain daily negative affect and (lower) positive affect in depressed patients. Trigger patterns can be understood as time-proximal state-level (within-person) effects, whereas maintenance patterns are better understood as trait-level (between-persons) effects. Together with previous results (Thompson et al., 2012), our

Conclusion

Our use of a daily diary methodology and MSEM explicated two complex explanatory models that can help clinicians and their patients make more sense of what commonly triggers and maintains negative affect and (low) positive affect in depression. Our results demonstrate complex trigger patterns that shed light on how daily changes in mood are precipitated for the typical person with depression. We also showed how depressive mood is maintained for people with depression and higher self-critical

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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      Citation Excerpt :

      This is noted in the results tables. The measurement model for PA and NA in our SEMs used an item parceling strategy previously employed with the PANAS (Dunkley et al., 2017; Dunkley, Ma, Lee, Preacher & Zuroff, 2014). Recent work has indicated that parceling has many psychometric benefits, including enhanced indicator reliability and the creation of indicators suitably continuous for maximum likelihood estimation (Little, Rhemtulla, Gibson & Schoemann, 2013).

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    This research was supported by a Fonds de la Recherche en Santé du Québec Grant (DMD, DCZ, GM, RW), Bourses de Chercheurs-Boursiers (DMD), Douglas Utting Fellowships for Studies in Depression (ML, JEF), and a Canada Graduate Scholarships Master's Award (JB). Neither of the funding organizations had any role in the design and conduct of the study; in the collection or interpretation of the data; nor in the writing of the report or in the decision to submit it. The authors report no conflict of interest.

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