Effectiveness of Group CBT with Memory Specificity Training and Self-Distancing in Moderately Depressed Adults
Abstract:
Memory specificity training (MEST) alone can
improve mood associated with depression as found in previous studies. The aim
was to build upon and expand on previous MEST and self-distancing (SD) studies
by testing the effectiveness and feasibility of seven treatment sessions with a
three month follow up of group CBT with MEST and SD in moderately depressed
adults in two London Boroughs. Method was to recruit 60 participants from
advertisements and a screening process that included administration of
questionnaires, the autobiographical memory test (AMT) and Beck depression
inventory (BDI-II) and interviewed to confirm they met the inclusion and
exclusion criteria, and met symptoms for depression as listed in the DSM-5.
Consent was obtained and then block randomising done to ensure a balanced group.
There were 55 participants who completed the treatment at all time points and
their data and scores on the AMT and BDI-II was used when running a one way
repeated ANOVA as this was a within group design with repeated measures, using
SPSS 22. The results showed improvements occurred at post-treatment and three
month follow up for AMS and BDI-II scores that was statistically significant
with large effect sizes at post-treatment and three month follow up. Discussion,
the null hypothesis was rejected and the alternative hypothesis was accepted. MEST
with self-distancing is an effective and feasible adjunct with CBT in improving
memory specificity and mood. Limitations included; the study was not fully
blind, no independent therapist, low frequency of supervision for checking
manual adherence, no SCID, short follow up period and reduced generalisability.
Future research could repeat this study using group CBT as a control,
participants recruited from out-patient departments, larger sample size,
improve blinding before random allocation, using SCID, frequent supervision and
use of an independent therapist.
References:
[1]
J. Barth, T. Munder, H. Gerger, E. Nüesch,. S. Trelle, H. Znoj, P. Juni, P. Cuijpers,
Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with
Depression: A Network Meta-Analysis. PLoS Medicine, (2013), 10(5), e1001454.
doi:10.1371/journal.pmed.1001454
[2] P. Cuijpers M. Berking, G. Andersson, L. Quigley, A. Kleiboer A,
K.S. Dobson, A meta-analysis of cognitive behavior therapy for adult
depression, alone and in comparison to other treatments. Canadian Journal of
Psychiatry, (2013), 58, 376-385
[3] E. Driessen, H.L. Van, F.J. Don, J. Peen, S. Kool, D. Westra, M.
Hendrikson,, M. Schoevers., P. Cuipers, J. Twisk, J.J. Dekker, The efficacy of
cognitive behavioral therapy and psychodynamic therapy in the outpatient
treatment of major depression: a randomized clinical trial. American Journal of
Psychiatry (2013), 170:1041–1050. doi: 10.1176/appi.ajp.2013.12070899
[4] V. Hunot, T.H.M. Moore, D.M. Caldwell, T.A. Furukawa, P. Davies, H.
Jones, M. Honyashiki, P. Chen, G. Lewis, R. Churchill R, ’Third wave’ cognitive
and behavioural therapies versus other psychological therapies for depression.
Cochrane Database of Systematic 10 (2013),. Art. No.: CD008704.
doi:10.1002/14651858.CD008704.pub2.
[5] T.J. Johnsen and O. Friborg,
The Effects of Cognitive Behavioral Therapy As an Anti-Depressive Treatment is
Falling: A Meta-Analysis. Psychological Bulletin. (2015), Advance online publication.doi.org/10.1037/bul000015
[6] F. Raes, D. Hermans, A. De Decker, P. Eelen, J.M.G. Williams,
Autobiographical Memory Specificity and affect regulation : an experimental
approach. Emotion (2003), 3, 201-206, doi:10.1037/1528-3542.3.2.201
[7] J.M.G. Williams, T. Barnhofer, C. Crane, D. Herman, F. Raes, E.
Watkins, T. Dalgleish, Autobiographical memory specificity and emotional
disorder. Psychological Bulletin, (2007), 133,:122–148. doi:
10.1037/0033-2909.133.1.122
[8] J.A. Sumner, J.W.
Griffith, S. Mineka, S. Overgeneral autobiographical memory as a predictor of
the course of depression: A meta-analysis. Behaviour Research Therapy (2010), 48,
614–625.doi: 10.1016/j.brat.2010.03.013
[9] F. Raes, J.M.G. Williams, D. Hermans, Reducing cognitive
vulnerability to depression: A preliminary investigation of Memory Specificity
Training (MEST) in inpatients with depressive symptomatology. Journal Behavior Therapy Experimental Psychiatry (2009), 40,
24–38.doi:10.1016/j.jbtep.2008.03.001
[10] H.T. NeshatDoost, T. Dalgleish, W. Yule, M. Kalantari, S.J. Ahmadi,
A. Dryregrov, L. Jobson, L. Enhancing autobiographical memory specificity
through cognitive training: an intervention for depression translated from
basicscience. Clinical Psychological Science (2013), 1:84–92. doi:
10.1177/2167702612454613
[11] E. Eigenhuis, A. Seldenrijk, A. van Schaik, F. Raes, P. vanOppen,
Feasibility and effectiveness of memory specificity training in depressed
outpatients: a pilot study. Clinical Psychology and Psychotherapy. (2015), doi:
10.1002/cpp.1995
[12] E. Kross, Ö. Ayduk, W. Mischel, When asking ‘why’ does not hurt:
Distinguishing rumination from reflective processing of negative emotions.
Psychological Science (2005), 16(9), 709-715. doi:10.1111/j.1467
9280.2005.01600.x
[13] E. Kross and Ö. Ayduk,, Facilitating adaptive emotional analysis
:Distinguishing distanced-analysis of depressive experiences from
immersed-analysis and distraction. Personality and Social Psychology Bulletin,
(2008), 34, 924 –938.doi:10.1177/0146167208315938
[14] E. Kross and Ö. Ayduk, Boundary conditions and buffering effects:
Does depressive symptomology moderate the effectiveness of distanced analysis
for facilitating adaptive self-reflection? Journal of Research in Personality
(2009), 43, 923–927. doi:10.1016/j.jrp.2009.04.004
[15] Kross, E., and Ayduk, Ö. (2011). Making meaning out of negative
experiences by self-distancing. Current Directions in Psychological Science,
20(3), 187-191. doi: 10.1177/0963721411408883.
[16] E. Kross, D. Gard, P. Deldin, J. Clifton, Ö. Ayduk, “Asking Why”
From a Distance: Its Cognitive and Emotional Consequences for People With Major
Depressive Disorder. Journal of Abnormal Psychology (2012), 3, 559 –569. doi: 10.1037/a0028808
[17]
E. Kross, E., Bruehlman-Senecal, J. Park, A. Burson, A. Dougherty, H. Shablack,
R. Bremmer, J. Moser, Ö. Ayduk, Self-talk
as a regulatory mechanism: How you do it matters. Journal of Personality and
Social Psychology (2014), 106(2), 304.doi: 10.1037/a0035173
[18] S.A. Moore and L.A. Zoellner, Overgeneral Autobiographical Memory
and Traumatic Events: An Evaluative Review. Psychological Bulletin (2007),
419–437. doi: 10.1037/0033-2909.133.3.419
[19] Ö. Ayduk and E. Kross, From a distance: Implications of spontaneous
self- distancing for adaptive self-reflection. Journal of Personality and
Social Psychology (2010), 98(5), 809-829. doi: 10.1037/a0019205
[20] A.T. Beck, Cognitive therapy of depression: New perspectives. In
P.J. Clayton & J. E. Barett (Eds.), Treatment of depression: Old
controversies and new approaches. New York: Raven Press (1983), pp. 265-284
[21] J. Gecht, R. Kessel, T. Forkmann, S. Gauggel, B. Drueke, A.
Scherer, V. Mainz, A mediation model of mindfulness and decentering: sequential
psychological constructs or one and the same? BMC Psychology (2014), 2:18.doi:10.1186/2050-7283-2-18
[22] C. McBride, Z. Segal, S. Kennedy, M. Gemar, Changes in autobiographical
memory specificity following cognitive behavior therapy and pharmacotherapy for
major depression. Psychopathology (2007), 40, 147-152
[23] Z. Ranjbarkohan, H.T. Neshatdoost,
H. Molavi, H. M. Maeroofi, A comparison of autobiographical memory specificity
changes following cognitive behavioral therapy and memory specificity training
(MEST) in patients with major depression. Journal of Contemporary Research in
Business (2012), 4(3):450-455.
[24] J.M.G. Williams, J. D Teasdale, Z.V. Segal, J. Soulsby,
Mindfulness-based cognitive therapy reduces overgeneral autobiographical memory
in formerly depressed patients. Journal of Abnormal Psychology (2000), 109,
150-155. doi: 10.1037//0021-843X.109.1.150
[25] A.T. Beck, J.A. Rush, B.F. Shaw, G. Emery, Cognitive therapy for depression.
New York: Guilford Press (1979).
[26] A. Bernstein, Y. Hadash, Y. Lichtash, G. Tanay, K. Shepherd, D.M.
Fresco, Decentering and Related Constructs A Critical Review and Metacognitive
Processes Model. Perspective Psychological Science (2015), 10(5):599–617
[27] T. Dalgleish, A. Bevan, A. McKinnon, L. Breakwell, V. Mueller, I.
Chadwick, S. Schweizer. C. Hitchcock, P. Watson, F. Raes, L., Jobson, L., A.
Werner-Seider., A., A comparison of Memory Specificity Training (MEST) to education
and support (ES) in the treatment of recurrent depression: study protocol for a
cluster randomised controlled trial. Trials.(2014), 15. 1-9.
doi:10.1186/1745-6215-15-293
[28] P. McCrone, S. Dhanasiri, A. Patel, M. Knapp, S. Lawton-Smith,
Paying the price: the cost of mental health care in England to 2026. The King's
Fund, London (2008)
[29] A.J. Ferrari, F.J. Charlson, R.E. Norman, S.B. Patten, G. Freedman,
C.L.J. Murray, T. Vos, H.A. Whiteford, Burden of Depressive Disorders by
Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study
2010. PLoS Med (2013), 10(11): e10001547.doi:101371
[30] N. Sartorius, The
economic and social burden of depression. Journal Clinical Psychiatry (2001),
62(15), 8-11.
[31] American Psychiatric Association. Diagnostic and statistical manual
of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
(2013)
[32] Conway, M. A., and Rubin,
D. C. (1993). The structure of autobiographical memory. In A. E. Collins, S. E.
Gathercole, M. A. Conway, & P. E. M. Morris (Eds.), Theories of memory (pp.
103-137). Hove, Sussex, England:Erlbaum
[33] Peeters, F., Wessel, I., Merckelbach, H., and Boon-Vermeeren, M.
(2002). Autobiographical memory specificity and the course of major depressive
disorder. Comprehensive Psychiatry, 43, 344-350. doi:10.1053/comp.2002.34635
[34] M.A. Conway and C.W.
Pleydell-Pearce, The construction of autobiographical memories in the
self-memory system. Psychological Review, (2000), 107, 261–88.doi: 10.1037//0033-295X.
107.2.261
[35]
K.M. Davis, M.A. Lau, D.R. Cairns, Development and preliminary validation of a
trait version of the Toronto mindfulness scale. Journal of Cognitive
Psychotherapy, (2009), 23, 185-197. doi:10.1891/0889-8391.23.3.185
[36] D. M. Fresco, M.T. Moore, M.H.M. van Dulmen, Z.V. Segal, S.H. Ma,
J.D., Teasdale, J.M.G. Williams, Initial Psychometric Properties of the
Experiences Questionnaire: Validation of a Self-report Measure of Decentering Behavior
Therapy (2007), 38, 234-246, http://dx.doi.org/10.1016/j.beth.2006.08.003
[37] L.M. McCracken, E. Barker, E., J. Chilcot, Decentering, rumination,
cognitive defusion, and psychological flexibility in people with chronic pain.
Journal Behavioral Medicine (2014), 37, 1215-1225. doi: 10.1007/s10865-014-9570
[38] A.T. Beck, R.A. Steer, G.K. Brown, Manual for the Beck Depression
Inventory-II. San Antonio, TX: Psychological Corporation, (1996)
[39] D. Barlow, Clinical Handbook of Psychological Disorders, Fifth
Edition: A Step-by-Step Treatment Manual. The Guildford Press, London (2008)
[40] K. Efthimiou and M. Psoma, Lewinsohn’s cognitive behavioral group
Therapy course for depression: structure, application and efficacy. Encephalos,
(2012), 49, 60-66.
[41] K.P. Suresh, An overview
of randomization techniques: An unbiased assessment of outcome in clinical
research. Human Reproductive Science (2011), 4, 8–11.doi:
10.4103/0974-1208.82352
[42] J.M.G. Williams and K. Broadbent, Autobiographical memory in
suicide attempters. Journal of Abnormal Psychology (1986), 95,
144-149.doi:10.1037/0021- 843X.95.2.144
[43] J.W. Griffith, J.A. Sumner, E. Debeer, F. Raes, D. Hermans, S.
Mineka, R.E. Zinbarg, M.G. Craske, An item response theory/confirmatory factor
analysis of the Autobiographical Memory Test. Memory (2009), 17, 609–623.
[44] Y.P. Wang and C. Gorenstein, Psychometric properties of the
Beck Depression Inventory-II: a comprehensive review. RevistaBrasileira de
Psiquiatria (2013),.35:416– 431. doi:10.1590/1516-4446-2012-1048
[45] G.L. Schlomer, S. Bauman,
S. N.A. Card, Best Practices for Missing Data Management in Counselling
Psychology (2010), Vol. 57, No. 1, 1–10. DOI: 10.1037/a0018082
[46] D.A. Bennett, How can I deal with missing data in my
study?Australian and New Zealand Journal of Public Health, (2001), 25, 464 –
469
[47] C.Y.J. Peng, M. Harwell, S.M. Liou, L.H. Ehman, Advances in missing
data methods and implications for educational research. In S. Sawilowsky (Ed.),
Real data analysis (pp. 31–78). Greenwich, CT: Information Age, (2006)
[48] S.W. Greenhouse and S. Geisser, On methods in the analysis of
profile data. Psychometrika (1959), 24, 95–112. doi: 10.1007/BF02289823.
[49] E. Watkins and J.D. Teasdale,
Rumination and overgeneral memory in depression: effects of self-focus and
analytic thinking. Journal of AbnormalPsychology (2001), 110, 353–357.
[50] M.F. van Vreeswijk and de
E.J. Wilde, de, Autobiographical memory specificity, psychopathology, depressed
mood and the use of the AMT: A meta-analysis. Behaviour Research and Therapy
(2004), 42(6): 731-43
[51] M .Seligman, The
effectiveness of psychotherapy. American Psychologist (1995), 50, 965 –974.
[52] P.C. Kendall and R.S. Beidas, Professional Psychology: Research and
Practice (2007), 38(1), 13-20. http://dx.doi.org/10.1037/0735-7028.38.1.13
[53]The factor structure of the Autobiographical Memory Test in recent
trauma survivors.
J.W. Griffith, B. Kleim, J.A. Sumner, Jennifer and A. Ehlers (2012), The
factor structure of the Autobiographical Memory Test in recent trauma
survivors. Psychological Assessment, 24(3), 640-646.
http://dx.doi.org/10.1037/a0026510