Discrepant negative self-associations as a risk factor for depressive deterioration after outpatient psychotherapy. (December 2020)

• Record Type: Journal Article
• Authors: Gómez Penedo, Juan Martín; Krieger, Tobias; Koditek, Marie Christine; grosse Holtforth, Martin
• Is Part Of: Journal of behavior therapy and experimental psychiatry. Volume 69(2020)
• Publication Date: 2020-12
• Subjects: Depression -- Deterioration -- Implicit self-associations -- Explicit self-associations -- Discrepancy -- Implicit-association test; Behavior therapy -- Periodicals; 616.89142
• DOI: 10.1016/j.jbtep.2020.101576
• Languages: English
• ISSNs: 0005-7916

Abstract

Abstract: Background and objectives: This paper examines the discrepancy between implicit and explicit negative self-associations (NSA) after cognitive psychotherapy for depression as a predictor of long-term outcome. Methods: One hundred and twenty patients completed an Implicit-Association Test relating the self with depressive attributes and a self-report questionnaire with identical item content, at the end of time-limited outpatient depression psychotherapy. At post-treatment and at 3-, 6-, and 12-month follow-up, patients completed the BDI-II. We used different strategies to operationalized implicit and explicit NSA discrepancies and three-level Hierarchical linear models to analyze the effects. Results: We found significant interactive effects of discrepancy between implicit and explicit NSA and the direction of the discrepancy on long-term outcome. In patients with a greater explicit than implicit NSA (a damaged self-esteem pattern) a greater absolute discrepancy was associated with worse long-term outcome in terms of BDI scores at the end of follow-up and rate of change during follow-up. Consistently, with an alternative method, we found that damaged self-esteem discrepancies were associated with worse estimated BDI-II scores at the end of follow-up. Limitations: The inclusion in the sample of only treatment completers limits the generalizability of the results. Furthermore, the follow-up period captured only the first 12 months after treatment. Conclusions: Our results support the notion that a discrepancy between implicit and explicit negative self-associations may pose a risk factor for deterioration after psychotherapy for depression. Highlights: Discrepant self-views relates to depression severity after one year follow-up. Discrepant self-views are associated with deterioration during follow-up. A damage self-esteem pattern of discrepancy predicted worse long-term outcome.