@2024 Afarand., IRAN
ISSN: 2252-0805 The Horizon of Medical Sciences 2017;23(2):141-148
ISSN: 2252-0805 The Horizon of Medical Sciences 2017;23(2):141-148
Effectiveness of Mindfulness–based Cognitive Therapy on Cognitive-Behavioral Avoidance and Mental Rumination in Comorbidity of Social Anxiety and Depression Patients
ARTICLE INFO
Article Type
Original ResearchAuthors
Ghadampour E. (1 )Radmehr P. (*)
Yousefvand L. (2)
(*) Psychology Department, Literature & Humanities Faculty, Lorestan University, Lorestan, Iran
(1 ) Psychology Department, Literature & Humanities Faculty, Lorestan University, Lorestan, Iran
(2) Educational Management Department, Literature & Humanities Faculty, Lorestan University, Lorestan, Iran
Correspondence
Address: Khorramabad, Kamalvand, Kiloumetr5 Khorramabad-Tehran, Lorestan University, Literature & Humanities Faculty, Psychology DepartmentPhone: +98 (83) 48224904
Fax: -
radmehr.p12@gmail.com
Article History
Received: May 20, 2016Accepted: November 8, 2016
ePublished: March 25, 2017
ABSTRACT
Aims
As one of the most prevalent disorders in the adolescents, the comorbidity of social anxiety disorder and depression leads to bad outcomes for them. The aim of the study was to determine the effectiveness of the midfulness-based cognitive therapy on the cognitive-behavioral avoidance and mental rumination in patients with comorbidity of social anxiety and depression.
Materials & Methods In the controlled follow-up pretest-posttest quasi-experimental study, 30 female high-school students with the social anxiety and depression comorbiduty were studied in Khorramabad in the academic year 2015-16. The subjects, selected via purposeful sampling method, were randomly divided into two 15-person groups including experimental and control groups. Data was collected by the structured clinical interview for Axis 1 disorders, the social anxiety questionnaire for the adolescents, Beck depression inventory- second edition, the cognitive-behavioral avoidance scale, and the ruminative responces scale. Eight 2-hour group mindfulness-based cognitive-therapy training sessions (one session per week) were conducted in experimental group, while control group received no intervention. Finally, posttest was conducted in both groups and a follow-up step was conducted 2 month latter. Data was analyzed by SPSS 19 software using multi-variable covariance analysis test.
Findings The mean scores of the cognitive-behavioral avoidance and mental rumination items in the posttest and follow-up steps significantly decreased in experimental group compared to control group (p<0.01).
Conclusion The mindfulness-based cognitive therapy reduces the cognitive-behavioral avoidance, as well as the mental rumination, in the patients with the social anxiety and depression comorbidity.
Materials & Methods In the controlled follow-up pretest-posttest quasi-experimental study, 30 female high-school students with the social anxiety and depression comorbiduty were studied in Khorramabad in the academic year 2015-16. The subjects, selected via purposeful sampling method, were randomly divided into two 15-person groups including experimental and control groups. Data was collected by the structured clinical interview for Axis 1 disorders, the social anxiety questionnaire for the adolescents, Beck depression inventory- second edition, the cognitive-behavioral avoidance scale, and the ruminative responces scale. Eight 2-hour group mindfulness-based cognitive-therapy training sessions (one session per week) were conducted in experimental group, while control group received no intervention. Finally, posttest was conducted in both groups and a follow-up step was conducted 2 month latter. Data was analyzed by SPSS 19 software using multi-variable covariance analysis test.
Findings The mean scores of the cognitive-behavioral avoidance and mental rumination items in the posttest and follow-up steps significantly decreased in experimental group compared to control group (p<0.01).
Conclusion The mindfulness-based cognitive therapy reduces the cognitive-behavioral avoidance, as well as the mental rumination, in the patients with the social anxiety and depression comorbidity.
Keywords:
Mindfulness Cognitive Therapy ,
Cognitive-Behavioral Avoidance ,
Social Anxiety Disorder ,
Depression,
CITATION LINKS
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[15]Mineka S, Watson D, Clark LA. Comorbidity of anxiety and unipolar mood disorder. Annu Rev Psychol. 1998;49:377-412.
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[17]Fawzy TI, Hecker JE, Clark J. The relationship between cognitive avoidance and attentional bias forsnake-related thoughts. J Anxiety Disord. 2006;20(8):1103-7.
[18]Rodebaugh TL, Holaway RM, Heimberg RG. The treatment of social anxiety disorder. Clin Psychol Rev. 2004;24(7):883-908.
[19]Ottenbreit ND, Dobson KS. Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behav Res Ther. 2004;42(3):293-313.
[20]Kashdan TB, Breen WE, Afram A, Terhar D. Experiential avoidance in idiographic, autobiographical memories: Construct validity and links to social anxiety, depressive, and anger symptoms. J Anxiety Disord. 2010;24(5):528-34.
[21]Backs-Dermott BJ, Dobson KS, Jones SL. An evaluation of an integrated model of relapse in depression. J Affect Disord. 2010;124(1-2):60-7.
[22]Wong QJ, Moulds ML. Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxiety individuals. Behav Res Ther. 2009;47(10):861-7.
[23]Ciesla JA, Felton JW, Roberts JE. Testing the cognitive catalyst model of depression: does rumination amplify the impact of cognitive diatheses in response to stress?. Cogn Emot. 2011;25(8):1349-57.
[24]Dickson K.S, Ciesla JA, Reilly LC. Rumination, worry, cognitive avoidance, and behavioral avoidance: Examination of temporal effects. Behav Ther. 2012;43(3):629-40.
[25]Kao CM, Dritschel BH, Astell A. The effects of rumination and distraction on over- general autobiographical memory retrieval during social problem solving. Br J Clin Psychol. 2006;45(Pt 2):267-72.
[26]McLaughlin KA, Nolen-Hoeksema S. Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther. 2011;49(3):186-93.
[27]Hong RY, Worry and rumination:differentional associations with anxiety and depressive symptoms and coping behavior. Behav Res Ther. 2007;45(2):277-90.
[28]Sarin S, Abela J, Auerbach R. The response styles theory of depression: A test of specificity and causal mediation. J Cogn Emot. 2005;19(5):751-61.
[29]Hofman SG. Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implication. Cogn Behav Ther. 2007;36(4):195-209.
[30]Smith JM, Alloy LB. A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clin Psycho Rev. 2009;29(2):116-22.
[31]Nolen-Hoeksema S. The role of rumination in depressive disorder and mixed anxiety/ depressive symptoms. J Abnorm Psychol. 2000;109(3):504-11.
[32]Kashdan TB, Roberts JE. Comorbid social anxiety disorder in clients with depressive disorders: Predicting changes in depressive symptoms, therapeutic relationships, and focus of attention in group treatment. Behav Res Ther. 2011;49(12):875-84.
[33]Albert U, Rosso G, Maina G, Bogetto F. Impact of anxiety disorder comorbidity on quality of life ineuthymic bipolar disorder patiens: differences between bipolar I and II subtypes. J Affect Disord. 2008;105(1-3):297-303.
[34]Schoevers RA, Deeg DJ, van Tilburg W, Beekman AT. Depression and generali anxiety disorder. Co-occurrence and longituinal patiens inelderly patiens. Am J Geriatr Psychiatry. 2005;13(1):31-9.
[35]Hamilton K, Wershler JL, Macrodimitris SD, Ching LE, Mothersill KJ. Exploring the effectiveness of a mixed-diagnosis group cognitive behavioral therapy intervention across diverse populations. J Cogn Behav Pract. 2012;19(3):472-82.
[36]Mc¬Evoy PM, Perini SJ. Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial. J Anxiety Disord. 2009;23(4):519-28.
[37]Amir N, Beard C, Taylor ChT, Klumpp H, Elias J, Burns M, et al. Attention training in individuals with generalized social phobia: A randomized controlled trial. J Consult Clin Psychol. 2009;77(5):961-73.
[38]Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: Ameta-analytic review. J Consult Clin Psychol. 2010;78(2):169-83.
[39]Khoury B1, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, et al. Mindfulness-based therapy: Acomprehensive meta-analysis. Clin Psychol Rev. 2013;33(6):763-71.
[40]Ost LG. Efficacy of the third wave of behavioral therapies: Asystematic review and meta-analysis. Behav Res Ther. 2008;46(2):296-321.
[41]Eisendrath S, Chartier M, McLane M. Adapting mindfulness-based cognitive therapy for treatment-resistant depression: A clinical case study. Cogn Behav Pract. 2011;18(3):362-370.
[42]Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822-48.
[43]Smits JA, Minhajuddin A, Jarrett RB. Cognitive therapy for depressed adults with comorbid social phobia. J Affect Disord. 2010;114(1-3):271-8.
[44]Hazlett-Stevens H. Mindfulness-based stress reduction for comorbid anxiety and depression: Case report and clinial considerations. J Nerv Ment Dis. 2012;200(11):999-1003.
[45]Ariana-Kia E, Moradi AR, Hatami M. The effectivness of combined of brief behavioral activation therapy and mindfulness-based cognitive therapy in patients with major depressive disorder. J Clin Psychol. 2014;6(1):15-27. [Persian]
[46]Dimidjian S, Beck A, Felder JN, Boggs JM, Gallop R, Segal Z. Web-based Mindfulness-based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther. 2014;63:83-9.
[47]Rapee RM, Spence SH. The etiology of social phobia: Empirical evidence and an initial model. Clin Psychol Rev. 2004;24(7):737-67.
[48]Akiskal H. Mood disorder. In: Kaplan HI, Sadock BJ. Kaplan & Sadock's Comprehensive textbook of psychiatry. Baltimore: Lippincott Williams & Wilkins; 2005. pp. 1284-1431.
[49]Ballinger B, Yalom I. Group therapy in practice. In: Bongar B, Beutler LE, editors. Comprehensive Textbook of Psychotherapy: Theory and Practice (1st Edition). New York: Oxford University Press. 1995.
[50]Hashemi Z, Mahmood-Aliloo M, Hashemi-Nosratabad T. The effectiveness of meta cognitive therapy on major depression disorder: A case report. J Clin Psychol. 2011;2(3):85-97. [Persian]
[51]Sharifi V, Asadi SM, Mohammadi MR, Amini H, Kavian H, Semnani Y, et al. Reliability and feasibility of the persian version of the structured diagnostic interview for DSM-IV. Adv Cogn Sci. 2004;6(1&2):10-22. [Persian]
[52]Ostovar S, Razavyeh A. Examine the psychometric properties of the social snxiety scale for adolescents (SAS-A) for use in Iran. J Psychol Model Method. 2013;3(12):69-78. [Persian]
[53]Moulds ML, Kandris E, Starr S, Wong ACM. The relationship between rumination, avoidance and depression in a non-clinical sample. Behav Res Ther. 2007;45(2):251-61.
[54]Ataie Sh, Fata L, Ahmadi Abhari A. Rumination and cognitive behavioral avoidance in depressive and social anxiety disorders: Comparison between dimensional and categorical approaches. Iran J Psychiatry Clin Psychol. 2014;19(4):283-92. [Persian]
[55]Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000;68(4):615-23.
[56]Geschwind N, Peeters F, Huibers M, Van Os J, Wichers M. Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: Randomised controlled trial. Br J Psychiatry. 2012;201(4):320-5.
[57]Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with achronic medical disease: A meta-analysis. J Psychosom Res. 2010;68(6):539-44.
[2]Teubert D, Pinquart M. A meta-analytic review on the presentation of symptom of anxiety in children adolescents. J Anxiety Disord. 2011;25(8):1046-59.
[3]Väänänen JM, Fröjd S, Ranta K, Marttunen M, Helminen M, Kaltiala-Heino R. Relationship between social phobia and depression differs between boys and girls in mid-adolescen. J Affect Disord. 2011;133(1-2):97-104.
[4]McAleavey AA, Castonguay LG, Goldfried MR. Clinical experiences in conducting cognitive behavioral therapy for social phobia. Behav Ther. 2014;45(1):21-35.
[5]Miers AC, Blote AW, Bogels SM, Westenberg PM. Interpretation bias and social anxiety in adolescents. J Anxiety Disord. 2008;22(8):1462-71.
[6]Voncken MJ, Bogels SM. Social performances deficits in social anxiety disorder: Reality during conversation and biased perception during a speech. J Anxiety Disord. 2008;22(8):1384-92.
[7]Puklek M, Videc M. Psychometric properties of the social anxiety scale for adolescents (SAS-A) and its relation to positive imaginary audience and academic performance in Slovene adolescents. Stud Psychol. 2008;50(1):49-65.
[8]den Boer JA. Social anxiety disorder/social phobia: Epidemiology, diagnosis, neurobiology and treatment. Compr Psychiatry. 2000;41(6):405-15.
[9]Väänänen JM, Isomaa R, Kaltiala-Heino R, Fröjd S, Helminen M, Marttunen M. Decrease in self-esteem mediates the association between symptoms of social phobia and depression in middle adolescence prospective population cohort study. BMC Psychiatry. 2014;14:79.
[10]Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602.
[11]Habibpour Z, Sharifi A. A comparative study about the intensity of depression among girls and boys in teenage period. J Urmia Nurs Midwifery Fac. 2009;7(1):10-2. [Persian]
[12]Stein MB, Fuetsch M, Müller N, Höfler M, Lieb R, Wittchen HU. Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Arch Gen Psychiatry. 2001;58(3):251-6.
[13]Gorman JM. Comorbid depression and anxiety spectrum disorder. Depress Anxiety. 1996-1997;4(4):160-8.
[14]Ranta K, Kaltiala-Heino R, Pelkonen M, Marttunen M. Associations between Peer victimization, self-reported depression and social phobia among adolescents: The role of comorbidity. J Adolesc. 2009;32(1):77-93
[15]Mineka S, Watson D, Clark LA. Comorbidity of anxiety and unipolar mood disorder. Annu Rev Psychol. 1998;49:377-412.
[16]Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991;100(4):569-82.
[17]Fawzy TI, Hecker JE, Clark J. The relationship between cognitive avoidance and attentional bias forsnake-related thoughts. J Anxiety Disord. 2006;20(8):1103-7.
[18]Rodebaugh TL, Holaway RM, Heimberg RG. The treatment of social anxiety disorder. Clin Psychol Rev. 2004;24(7):883-908.
[19]Ottenbreit ND, Dobson KS. Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behav Res Ther. 2004;42(3):293-313.
[20]Kashdan TB, Breen WE, Afram A, Terhar D. Experiential avoidance in idiographic, autobiographical memories: Construct validity and links to social anxiety, depressive, and anger symptoms. J Anxiety Disord. 2010;24(5):528-34.
[21]Backs-Dermott BJ, Dobson KS, Jones SL. An evaluation of an integrated model of relapse in depression. J Affect Disord. 2010;124(1-2):60-7.
[22]Wong QJ, Moulds ML. Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxiety individuals. Behav Res Ther. 2009;47(10):861-7.
[23]Ciesla JA, Felton JW, Roberts JE. Testing the cognitive catalyst model of depression: does rumination amplify the impact of cognitive diatheses in response to stress?. Cogn Emot. 2011;25(8):1349-57.
[24]Dickson K.S, Ciesla JA, Reilly LC. Rumination, worry, cognitive avoidance, and behavioral avoidance: Examination of temporal effects. Behav Ther. 2012;43(3):629-40.
[25]Kao CM, Dritschel BH, Astell A. The effects of rumination and distraction on over- general autobiographical memory retrieval during social problem solving. Br J Clin Psychol. 2006;45(Pt 2):267-72.
[26]McLaughlin KA, Nolen-Hoeksema S. Rumination as a transdiagnostic factor in depression and anxiety. Behav Res Ther. 2011;49(3):186-93.
[27]Hong RY, Worry and rumination:differentional associations with anxiety and depressive symptoms and coping behavior. Behav Res Ther. 2007;45(2):277-90.
[28]Sarin S, Abela J, Auerbach R. The response styles theory of depression: A test of specificity and causal mediation. J Cogn Emot. 2005;19(5):751-61.
[29]Hofman SG. Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implication. Cogn Behav Ther. 2007;36(4):195-209.
[30]Smith JM, Alloy LB. A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clin Psycho Rev. 2009;29(2):116-22.
[31]Nolen-Hoeksema S. The role of rumination in depressive disorder and mixed anxiety/ depressive symptoms. J Abnorm Psychol. 2000;109(3):504-11.
[32]Kashdan TB, Roberts JE. Comorbid social anxiety disorder in clients with depressive disorders: Predicting changes in depressive symptoms, therapeutic relationships, and focus of attention in group treatment. Behav Res Ther. 2011;49(12):875-84.
[33]Albert U, Rosso G, Maina G, Bogetto F. Impact of anxiety disorder comorbidity on quality of life ineuthymic bipolar disorder patiens: differences between bipolar I and II subtypes. J Affect Disord. 2008;105(1-3):297-303.
[34]Schoevers RA, Deeg DJ, van Tilburg W, Beekman AT. Depression and generali anxiety disorder. Co-occurrence and longituinal patiens inelderly patiens. Am J Geriatr Psychiatry. 2005;13(1):31-9.
[35]Hamilton K, Wershler JL, Macrodimitris SD, Ching LE, Mothersill KJ. Exploring the effectiveness of a mixed-diagnosis group cognitive behavioral therapy intervention across diverse populations. J Cogn Behav Pract. 2012;19(3):472-82.
[36]Mc¬Evoy PM, Perini SJ. Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial. J Anxiety Disord. 2009;23(4):519-28.
[37]Amir N, Beard C, Taylor ChT, Klumpp H, Elias J, Burns M, et al. Attention training in individuals with generalized social phobia: A randomized controlled trial. J Consult Clin Psychol. 2009;77(5):961-73.
[38]Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: Ameta-analytic review. J Consult Clin Psychol. 2010;78(2):169-83.
[39]Khoury B1, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, et al. Mindfulness-based therapy: Acomprehensive meta-analysis. Clin Psychol Rev. 2013;33(6):763-71.
[40]Ost LG. Efficacy of the third wave of behavioral therapies: Asystematic review and meta-analysis. Behav Res Ther. 2008;46(2):296-321.
[41]Eisendrath S, Chartier M, McLane M. Adapting mindfulness-based cognitive therapy for treatment-resistant depression: A clinical case study. Cogn Behav Pract. 2011;18(3):362-370.
[42]Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822-48.
[43]Smits JA, Minhajuddin A, Jarrett RB. Cognitive therapy for depressed adults with comorbid social phobia. J Affect Disord. 2010;114(1-3):271-8.
[44]Hazlett-Stevens H. Mindfulness-based stress reduction for comorbid anxiety and depression: Case report and clinial considerations. J Nerv Ment Dis. 2012;200(11):999-1003.
[45]Ariana-Kia E, Moradi AR, Hatami M. The effectivness of combined of brief behavioral activation therapy and mindfulness-based cognitive therapy in patients with major depressive disorder. J Clin Psychol. 2014;6(1):15-27. [Persian]
[46]Dimidjian S, Beck A, Felder JN, Boggs JM, Gallop R, Segal Z. Web-based Mindfulness-based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther. 2014;63:83-9.
[47]Rapee RM, Spence SH. The etiology of social phobia: Empirical evidence and an initial model. Clin Psychol Rev. 2004;24(7):737-67.
[48]Akiskal H. Mood disorder. In: Kaplan HI, Sadock BJ. Kaplan & Sadock's Comprehensive textbook of psychiatry. Baltimore: Lippincott Williams & Wilkins; 2005. pp. 1284-1431.
[49]Ballinger B, Yalom I. Group therapy in practice. In: Bongar B, Beutler LE, editors. Comprehensive Textbook of Psychotherapy: Theory and Practice (1st Edition). New York: Oxford University Press. 1995.
[50]Hashemi Z, Mahmood-Aliloo M, Hashemi-Nosratabad T. The effectiveness of meta cognitive therapy on major depression disorder: A case report. J Clin Psychol. 2011;2(3):85-97. [Persian]
[51]Sharifi V, Asadi SM, Mohammadi MR, Amini H, Kavian H, Semnani Y, et al. Reliability and feasibility of the persian version of the structured diagnostic interview for DSM-IV. Adv Cogn Sci. 2004;6(1&2):10-22. [Persian]
[52]Ostovar S, Razavyeh A. Examine the psychometric properties of the social snxiety scale for adolescents (SAS-A) for use in Iran. J Psychol Model Method. 2013;3(12):69-78. [Persian]
[53]Moulds ML, Kandris E, Starr S, Wong ACM. The relationship between rumination, avoidance and depression in a non-clinical sample. Behav Res Ther. 2007;45(2):251-61.
[54]Ataie Sh, Fata L, Ahmadi Abhari A. Rumination and cognitive behavioral avoidance in depressive and social anxiety disorders: Comparison between dimensional and categorical approaches. Iran J Psychiatry Clin Psychol. 2014;19(4):283-92. [Persian]
[55]Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000;68(4):615-23.
[56]Geschwind N, Peeters F, Huibers M, Van Os J, Wichers M. Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: Randomised controlled trial. Br J Psychiatry. 2012;201(4):320-5.
[57]Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with achronic medical disease: A meta-analysis. J Psychosom Res. 2010;68(6):539-44.