From the First Episode to Recurrences: The Role of Automatic Thoughts and Dysfunctional Attitudes in Major Depressive Disorder

Abstract

Negative automatic thoughts (NAT) and dysfunctional attitudes (DA) are causal elements in the onset and maintenance of depression. It has previously been reported that NATs become more prevalent during depressive episodes. DAs are known to be influencing both the first and the recurrent depressive episodes. This study aims to focus on the differences observed in the depressive cognitions of the first episode and the recurrently depressed patients, and to investigate if negative cognitions may be predictive of a depressive recurrence. The hypothesis of the study is that automatic thoughts and dysfunctional attitudes of adult depressed patients might be predictive of a recurrence. For the present study, 100 first episode depressed, 100 recurrent episode depressed, and 100 healthy control subjects were recruited. All patients were diagnosed by a structured clinical interview according to the DSM-IV-TR criteria, and any patients with a comorbid diagnosis were excluded. The participants were asked to complete the Beck Depression Inventory (BDI), the Automatic Thoughts Questionnaire (ATQ), and the Dysfunctional Attitude Scale (DAS). The groups were compared with each other on the scores of their cognitive scales, and hierarchical regression analyses were undertaken to predict the number of recurrences. The ATQ and DAS scores differentiated all three groups, and the highest scores were obtained by the recurrently depressed patients. The hierarchical regression analyses for the prediction of the number of recurrences showed that the highest partial correlation was for the perfectionistic attitude. Correlational analyses revealed that the highest correlation was between the number of recurrences, and the perfectionistic attitude. Our results have indicated that the first episode depressed patients differ from the recurrently depressed patients in terms of their ATQ and DAS scores, and that the number of recurrences may best be predicted by the scores related to perfectionistic attitudes. These results suggest that some cognitions should selectively be addressed in psychotherapy for the prevention of depressive recurrences.