استراتژی های تنظیم احساسات شناختی در بیماران سرپایی مبتلا به اختلال افسردگی اساسی

The aim of this study was to examine cognitive emotion regulation strategies in adult outpatients with major depressive disorder (MDD). A clinical sample of 191 MDD outpatients and a non-clinical sample of 267 general adults were recruited. Nine cognitive emotion regulation strategies were assessed in all participants (aged 21–65 years). Results showed that MDD participants had significantly higher scores on the following strategies: self-blame, acceptance, rumination, catastrophizing, and blaming others, but lower scores on positive refocusing, refocus on planning, positive reappraisal, and putting in perspective strategies than general populations. In addition, self-blame, acceptance, and catastrophizing positively correlated and positive reappraisal negatively correlated with depressive symptoms in MDD populations. Further logistic regression analyses indicated that five strategies have significant and independent contributions to the prediction of MDD group membership (a higher reported use of self-blame, catastrophizing, and acceptance, and a lower reported use of positive refocusing, and putting in perspective). The results suggest that cognitive emotion regulation strategies may be a useful target for psychological assessment and treatment in patients with MDD.

Emotion regulation refers to a vast area of conscious and unconscious physiological and behavioral cognitive aspects (Gross, 2001). It is associated with human life and helps people to manage or regulate their emotions after the experience of stressful events (Garnefski et al., 2001). The cognitive emotion regulation strategies are cognitive responses to emotion-eliciting events that consciously or unconsciously attempt to modify the magnitude and/or type of individuals׳ emotional experience (Abdi et al., 2012 and Gross, 2001). Although the capacity of cognitive emotion regulation is universal, large individual differences exist not only in the specific strategies by which people regulate their emotions in response to life experiences, but also exist in the extent that people develop symptoms of psychopathology in response to negative experiences (Garnefski et al., 2002a). A number of authors have suggested that individuals׳ cognitive emotion regulation strategies influence the development of depression (Compas et al., 1993, Garnefski et al., 2003 and Martin and Dahlen, 2005). According to this view, the symptoms of depression are viewed as consequences of individuals׳ failure to modulate their emotions in an adaptive way. For example, self-blame, which refers to making internal, rather stable, and global causal attributions for the experience of negative events, is related to higher levels of depression (Anderson et al., 1994, Kubany et al., 1996 and McGee et al., 2001). Ruminative thought commonly refers to the experience of repetitive thoughts in the absence of immediate environmental cueing is generally found to be related to depression (Nolen-Hoeksema et al., 1994, Nolen-Hoeksema et al., 1997 and Nolen-Hoeksema, 2000), although certain forms of ruminative thinking may be helpful in coping with stressful life events (Janoff-Bulman, 1992 and Tedeschi, 1999). Catastrophizing, which refers to thoughts of explicitly emphasizing the terror of an experience, has been found to be related to depression (Sullivan et al., 1995). The present study will focus on the relationship between multiple cognitive emotion regulation strategies and depression in order to fully understand the joint role of different cognitive emotion regulation strategies in the development of depression. Previous research distinguished the cognitive emotion regulation strategies by nine conceptually different aspects: self-blame, acceptance, rumination, positive refocusing, refocus on planning, positive reappraisal, putting into perspective, catastrophizing, and other-blame (Garnefski et al., 2001). Self-blame, blaming others, rumination, and catastrophizing were characterized as maladaptive strategies, and acceptance, refocus on planning, positive refocusing, positive reappraisal, and putting into perspective as adaptive strategies (Garnefski et al., 2001). These strategies have been found to be related to depression in a general adolescent sample (Garnefski et al., 2001, Garnefski et al., 2002b, Öngen, 2010 and Perte and Miclea, 2011), general adults (Martin and Dahlen, 2005, Garnefski and Kraaij, 2006, Garnefski and Kraaij, 2007, Zhu et al., 2008 and Omran, 2011), and psychiatric patients (Garnefski et al., 2002a and Perte and Miclea, 2011). Studies in the general community suggest that cognitive emotion regulation strategies (e.g. self-blame, rumination) are positively, while others (e.g. positive reappraisal, putting into perspective) are negatively, associated with depression symptoms (Martin and Dahlen, 2005, Garnefski and Kraaij, 2006, Garnefski and Kraaij, 2007, Zhu et al., 2008 and Omran, 2011). There is also evidence that currently depressed and recovered depressed individuals both report a more frequent use of maladaptive strategies (e.g., rumination, and catastrophizing) and a less frequent use of functional strategies (e.g., positive reappraisal) (Gross and John, 2003, Garnefski and Kraaij, 2006 and Ehring et al., 2008). These findings may suggest that maladaptive use of cognitive emotion regulation strategies might contribute to the development and persistence of depression. Major depressive disorder (MDD) is one of the most common and most debilitating of the mental disorders, with a twelve-month prevalence of 2–10% (Kessler et al., 1994 and Yu et al., 2005). Knowledge about cognitive emotion regulation strategies in patients with (MDD) may provide more understanding of mechanisms underlying the pathogenesis of major depression as well clues for the advancement of current prevention and treatment approaches. Therefore, the present study comprehensively examined cognitive emotion regulation strategies in adult outpatients with MDD. More specifically, the cognitive emotion regulation strategies used in a MDD adults group was compared to a group of non-clinical adults without symptoms of depression in a cross-sectional design. This paper firstly aims to examine whether cognitive coping strategies differ between major depressive disorder patients and non-clinical subjects. On the basis of previous studies, it was expected that MDD patients would use maladaptive cognitive emotion regulation strategies (e.g., self-blame, catastrophizing and rumination) to a higher extent, and adaptive cognitive emotion regulation strategies (e.g., positive refocusing, positive reappraisal) to a lesser extent than non-clinical populations (Garnefski and Kraaij, 2006 and Ehring et al., 2008). The second purpose of the current study was to examine the relationship between cognitive emotion regulation strategies and symptoms of depression separately in the MDD group and control group. It was hypothesized that relationships between maladaptive cognitive emotion regulation strategies and depressive symptoms would be significantly positive whereas adaptive cognitive emotion regulation strategies and depressive symptoms would be significantly negative in the MDD group just as in general group. The last aim was to study which of the specific cognitive emotion regulation strategies was relatively best able to distinguish between these two samples. It was assumed that together the cognitive emotion regulation strategies would account for a considerable amount of the variance.