Depresyon Hastalarında Ruminasyon ve Bilişsel Esneklik Düzeylerinin İncelenmesi

Yıl 2024, Cilt: 7 Sayı: 1, 1 - 7, 11.03.2024

Furkan Bardak , Selma Çilem Kızılpınar , Makbule Çiğdem Aydemir

https://doi.org/10.36516/jocass.1372677

Öz

Arka plan: Depresyon, sürekli depresif ruh hali, anhedoni, ilgi kaybı ve bilişsel, davranışsal ve fiziksel semptomlarla karakterizedir. Bireylerin bilişsel süreçleri, yüksek nevrotiklik, düşük benlik saygısı gibi birçok psikolojik faktörün depresif duygudurumun etiyolojisinde, alevlenmesinde, sürmesinde ve tedavisinde önemli rol oynadığı bildirilmiştir. Bu çalışmanın amacı, ruhsal bozukluğu olmayan sağlıklı yetişkin bir grup ile depresyon ile takip edilen yetişkin hastalarda ruminasyon ve bilişsel esneklik düzeylerini karşılaştırmaktır.

Gereçler ve Yöntem: Bu kesitsel vaka-kontrol çalışmasında depresyonlu hastalar (n=76, 34,1±9,32) ile sağlıklı kontroller (HG) (n=74, 34,5±10,5) karşılaştırıldı. Tüm katılımcılara Sosyodemografik Bilgi Formu, Beck Depresyon Envanteri, Ruminatif Düşünme Ölçeği ve Bilişsel Esneklik Envanteri uygulandı.

Bulgular: Çalışma, depresif hastaların sağlıklı bireylere göre daha yüksek ruminatif düşünce düzeylerine ve daha düşük bilişsel esneklik düzeylerine sahip olduğunu göstermiştir. Ayrıca bilişsel esneklik ve ruminatif düşünce şiddetinin hasta grubundaki depresif belirti şiddeti değişkenliğinin %35'ini açıklayabildiği saptanmıştır. Sağlıklı grupta ruminatif düşünce şiddeti, depresif belirti şiddeti değişkenliğinin %9'unu açıklayabilmektedir.

Sonuçlar: Çalışmanın sonuçları, ruminatif düşünce ve bilişsel esnekliğin, premorbid dönemde depresyonu öngörmede ve önlemede önemli faktörler olduğunu ve tedavi sırasında formüle etme ve tedavi hedeflerini belirlemede yararlı olduğunu göstermiştir. Bu nedenle, bilişsel esnekliği ve ruminasyonu geliştirmeye yönelik müdahaleler önemlidir. Klinisyenler tedavi yaklaşımlarına bilişsel esneklik ve ruminasyona yönelik müdahaleleri eklemelidir.

Anahtar Kelimeler

Depresyon, Ruminasyon, Bilişsel Esneklik

Investigation of Rumination and Cognitive Flexibility Levels in Patients with Depression

Öz

Background: Depression is characterized by continuous depressed mood, anhedonia, loss of interest, and cognitive, behavioral, and physical symptoms. Many psychological factors such as individuals' cognitive processes, high neuroticism, low self-esteem have been reported to play important roles in the etiology, exacerbation, persistence, and treatment of depressive mood. The aim of this study is to compare the levels of rumination and cognitive flexibility in a healthy adult group without any mental disorders and adult patients followed up with depression.

Materials and Method: In this cross-sectional case-control study, patients with depression (n=76, 34.1±9.32) and healthy controls (HG) (n=74, 34.5±10.5) were compared. The Sociodemographic Information Form, Beck Depression Inventory, Ruminative Thinking Scale, and the Cognitive Flexibility Inventory were performed to all participiants.

Results: The study showed that depressive patients had higher ruminative thought levels and lower cognitive flexibility levels than healthy individuals. In addition, it was found that cognitive flexibility and ruminative thought severity can explain 35% of the variability of depressive symptom severity in the patient group. In the healthy group, ruminative thought severity can explain 9 % of the variability of depressive symptom severity.

Conclusions: The results of the study showed that ruminative thought and cognitive flexibility are important factors when predicting and preventing depression during the premorbid period and are useful when making formulation and determining treatment goals during the treatment. Therefore, interventions to improve cognitive flexibility and rumination are important. The clinicians should add interventions to cognitive flexibility and rumination into their treatment approach.

Anahtar Kelimeler

Depression, Rumination, Cognitive Flexibility

Kaynakça

• 1. Helvacı Çelik F, Hocaoğlu Ç. Major Depresif Bozukluk’ Tanımı, Etyolojisi ve Epidemiyolojisi: Bir Gözden Geçirme. Çağdaş Tıp Dergisi 2016; 6: 51-66. [CrossRef]
• 2. Oral, M. Majör depresyon tanısı almış kadınlarda kişilerarası ilişkiler terapisi yaklaşımına dayalı grupla sosyal hizmet uygulamasının psikososyal işlevsellik üzerine etkisi. Hacettepe Üniversitesi 2016; Ankara.
• 3. Irak M, Albayrak EO. Psychometric properties of the expanded version of the inventory of depression and anxiety symptoms in a Turkish population. Psychological Reports 2020; 123:517-545. [CrossRef]
• 4. World Health Organization. Depression and other common mental disorder 2017. Access Address: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
• 5. Ehring T, Watkins E. R. Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy 2008; 1: 192–205. [CrossRef]
• 6. Struijs SY, de Jong, PJ, Jeronimus BF, van der Does W, Riese H, Spinhoven P. Psychological risk factors and the course of depression and anxiety disorders: A review of 15 years NESDA research. Journal of Affective Disorders 2021; 295: 1347-1359. [CrossRef]
• 7. LeMoult J, Gotlib IH. Depression: A cognitive perspective. Clinical psychology review 2019; 69:51–66. [CrossRef]
• 8. Türkçapar H. Klinik Uygulamalarda Bilişsel-Davranışçı Terapi: Depresyon. 4.Baskı. İstanbul: Epsilon Yayınevi, 2018.
• 9. Dinç M. Aaron Temkin Beck: Eleştirel düşüncenin peşinden yaratıcı bir psikoterapi kuramına. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi 2012; 1: 70-76. [CrossRef]
• 10. Batmaz S, Kocbiyik S, Yalçınkaya-Alkar Ö, Turkcapar M. Cognitive distortions mediate the relationship between defense styles and depression in female outpatients. The European Journal of Psychiatry 2016; 30: 237-247. [CrossRef]
• 11. Pothier B, Dobson KS, Drapeau M. Investigating the relationship between depression severity and cognitive rigidity through the use of cognitive errors. Archives of Psychiatry and Psychotherapy 2012, 2, 35-40. [CrossRef]
• 12. Gotlib IH, Joormann J. Cognition and depression: current status and future directions. Annual review of clinical psychology 2010; 6: 285–312. [CrossRef]
• 13. Watkins ER. Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford, 2018.
• 14. Lyubobirsky S, Layous K, Chancellor J, Nelson K. Thinking about rumination: the scholarly contributions and intellectual legacy of Susan Nolen Hoeksema. Annual Review of Clinical Psychology 2015; 11: 1-22. [CrossRef]
• 15. Lyubobirsky S, Caldwell ND, Nolen-Hoeksema S. Effects of ruminative and distracting responses to depressed mood on retrieval of autobiographical memories. Journal of Personality and Social Psychology 1998; 75: 166-77. [CrossRef]
• 16. Nolen-Hoeksema S. Ruminative coping with depression. Heckhausen. J, Dweck CS (Ed.), Motivation and self-regulation across the life span (ss. 237-256). New York: Cambridge University Press 1998.
• 17. Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology 1991; 100: 569‐582. [CrossRef]
• 18. Just N, Alloy LB. The response styles theory of depression: Tests and an extension of the theory. Journal of Abnormal Psycholog 1997; 106: 221‐229. [CrossRef]
• 19. Mor N, Winquist J. Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin 2002; 128: 638–662. [CrossRef]
• 20. Nolen-Hoeksema S, Morrow J, Fredrickson BL. Response styles and the duration of episodes of depressed mood. Journal of abnormal psychology 1993; 102:20. [CrossRef]
• 21. Stevens AD. Social problem-solving and cognitive flexibility: Relations to social skills and problem behavior of at-risk young children. (Unpublished PhD Thesis) ProOuest Dissertations and Theses database'den reached 2009.
• 22. Dennis JP, Vander Wal JS. The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy Research 2010; 34: 241-253. [CrossRef]
• 23. Martin MM, Anderson CM, Thweatt KS. Aggressive communication traits and their relationships with the Cognitive Flexibility Scale and the Communication Flexibility Scale. Journal of Social Behavior and Personality 1998; 13: 531-540. [CrossRef]
• 24. Martin MM, Anderson CM. The cognitive flexibility scale: Three validity studies. Communication Research Repots 1998; 11: 1-9. [CrossRef]
• 25. Cardom RD. The mediating role of cognitive flexibility on the relationship between cross-race interactions and psychological well-being (Doctoral disserta-tion). Retrieved from 2016. [CrossRef]
• 26. Fu F, Chow A. Traumatic exposure and psychological well-being: The moderating role of cognitive flexibility. Journal of Loss and Trauma 2017, 22(1), 24-35. [CrossRef]
• 27. Asıcı E, İkiz F. A pathway to happiness: Cognitive flexibility. Mehmet Akif Ersoy University Educational Faculty Journal 2015; 1: 191-211. [CrossRef]
• 28. Rubin R, Martin M. Development of a measure of interpersonal competence. Communication Research Reports 1994; 11:33-44. [CrossRef]
• 29. Çikrıkci Ö. The predictive roles of cognitive flexibility and error oriented motivation skills on life satisfaction. International Journal of Eura-sia Social Sciences 2018; 9:717-727. [CrossRef]
• 30. Yu Y, Yu Y, Lin Y. Anxiety and depression aggravate impulsiveness: the mediating and moderating role of cognitive flexibility. Psychology, Health & Medicine 2020; 25: 25-36. [CrossRef]
• 31. Deveney CM, Deldin PJ. A preliminary investigation of cognitive flexibility for emotional information in major depressive disorder and non-psychiatric controls. Emotion 2006; 6: 429-437. [CrossRef]
• 32. Moore RG. It’s the thought that counts: The role of intentions and meta-awareness in cognitive therapy. Journal of Cognitive Psychotherapy: An International Quarterly 1996; 10:255–269. [CrossRef]
• 33. Morris L, Mansell W. A systematic review of the relationship between rigidity/flexibility and transdiagnostic cognitive and behavioral processes that maintain psychopathology. Journal of Experimental Psychopathology 2018, 9(3). [CrossRef]
• 34. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of General Psychiatry 1961; 4:561-571. [CrossRef]
• 35. Hisli, N. Beck Depresyon Envanteri’nin geçerliliği üzerine bir çalışma. Psikoloji Dergisi 1988; 6:118-122. [CrossRef]
• 36. Brinker JK, Dozois DJA. Ruminative thought style and depressed mood. Journal of Clinical Psychology 2009; 65:1–19. [CrossRef]
• 37. Karatepe HT, Yavuz FK, Turkcan A. Validity and reliability of the Turkish version of the ruminative thought style questionnaire. Klinik Psikofarmakoloji Bülteni 2013; 23: 231-241. [CrossRef]
• 38. Gülüm Vİ, Dağ İ. Tekrarlayıcı düşünme ölçeği ve bilişsel esneklik envanterinin Türkçe uyarlaması, geçerliliği ve güvenilirliği. Anatolian Journal of Psychiatry 2012; 13:216-223. [CrossRef]
• 39. Hong RY. Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy 2007; 45: 277–290. [CrossRef]
• 40. Yılmaz AE. Depresyonun üstbilişsel modeli’nin Türkiye’deki bir üniversite öğrencisi örnekleminde incelenmesi. Türk Psikiyatri Dergisi 2016; 27:100-9. [CrossRef] 41. Takagishi Y, Sakata M, Kitamura T. Influence of rumination and self‒efficacy on depression in Japanese undergraduate nursing students. Asian Journal of Social Psychology 2013; 16:163-168. [CrossRef]
• 42. Chen J, Rapee RM, Abbot MJ. Mediators of the relationship between social anxiety and post-event rumination. Journal of Anxiety Disorders 2013; 27:1-8. [CrossRef]
• 43. Watkins ER, Roberts H. Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour Research and Therapy 2020; 127. [CrossRef]
• 44. Yazar MS, Şenyaşar Meterelliyoz K. Klinik olmayan populasyonda depresif semptomatoloji, bilişsel Esneklik ve umutsuzluk İlişkisinin incelenmesi. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi 2019; 8:155-163. [CrossRef]
• 45. Goring HJ, Papageorgiou C. Rumination and worry: Factor analysis of self-report measures in depressed participants. Cognitive Therapy and Research 2008, 32: 554–566. [CrossRef]
• 46. Fresco DM, Rytwinski NK, Craighead LW. Explanatory flexibility and negative life events interact to predict depression symptoms. Journal of Social and Clinical Psychology 2007; 26: 595-608. [CrossRef]
• 47. Karabekiroğlu A, Demir EY, Aker S, Kocamanoğlu B, Karabulut GS. Predictors of depression and anxiety among caregivers of hospitalised advanced cancer patients. Singapore Medical Journal 2018; 59:572-577. [CrossRef]
• 48. Murphy FC, Michael A, Sahakian BJ. Emotion modulates cognitive flexibility in patients with major depression. Psychological Medicine 2012; 42:1373–1382. [CrossRef]
• 49. Nazarzadeh RS, Fazeli M, Aval MM, Shourch RM. Effectiveness of cognitive-behavior therapy on cognitive flexibility in perfectionist. Psychology 2015; 6: 1780. [CrossRef]
• 50. Yasinski C, Hayes AM, Ready CB, Abel A, Görg N, Kuyken W. Processes of change in cognitive behavioral therapy for treatment-resistant depression: psychological flexibility, rumination, avoidance, and emotional processing. Psychotherapy Research 2020; 30: 983-997. [CrossRef]
• 51. Oishi S, Takizawa T, Kamata N, Miyaji S, Tanaka K, Miyaoka H. Web-based training program using cognitive behavioral therapy to enhance cognitive flexibility and alleviate psychological distress among schoolteachers: pilot randomized controlled trial. JMIR Research Protocols 2018; 7. [CrossRef]
• 52. Greenberg J, Reiner K, Meiran N. “Mind the trap”: mindfulness practice reduces cognitive rigidity. PloS one 2012; 7. [CrossRef]
• 53. Johnco C, Wuthrich VM, Rapee RM. The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study. Behaviour Research and Therapy 2014; 57: 55-64. [CrossRef]
• 54. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspectives on Psychological Science 2008; 3:400–424. [CrossRef]
• 55. Wilkinson PO, Croudace TJ, Goodyer IM. Rumination, anxiety, depressive symptoms and subsequent depression in adolescents at risk for psychopathology: a longitudinal cohort study. BMC Psychiatry 2013; 13: 1-9. [CrossRef]
• 56. Davis RN, Nolen-hoeksema S. Cognitive ınflexibility among ruminators and nonruminators. Cognitive Therapy and Research 2000, 24; 699–711. [CrossRef]