Factor Structure and Psychometric Properties of the Children's Negative Cognitive Error Questionnaire with a Clinically Depressed Adolescent Sample

Propiedades psicométricas del Children's Negative Cognitive Error Questionnaire en población española adolescente y joven

El objetivo de este estudio era analizar las propiedades psicométricas de la versión española del Children’s Negative Cognitive Errors Questionnaire (CNCEQ) en una muestra de población joven. El CNCEQ es uno de los procedimientos de autoinforme más utilizados para medir cuatro tipos de distorsión cognitiva (pensamiento catastrófico, sobregeneralización, personalización y abstracción selectiva) en tres áreas de contenido (social, académica y deportiva). A pesar de ello, no existen estudios que analicen las propiedades del instrumento entre los jóvenes. El estudio utilizó una amplia muestra (N = 2040; entre 12 y 22 años; 50,7% hombres y 47,3% mujeres) de diferentes centros educativos. La validez de constructo se evaluó mediante un análisis factorial exploratorio, y la consistencia interna mediante el coeficiente alfa de Cronbach. También se realizaron contrastes de medias para evaluar la validez discriminante y se llevó a cabo un análisis de correlación y regresión para explorar la validez de criterio. Los resultados indican que el CNCEQ permite evaluar las distorsiones cognitivas autodegradantes entre los jóvenes con suficientes garantías psicométricas. Su uso por parte de los profesores les permitirá adaptar sus actividades para tener en cuenta la presencia de distorsiones cognitivas entre sus estudiantes.

Moderators and Predictors of Response After 36 Weeks of Treatment in the Treatment for Adolescents with Depression Study (TADS)

This study investigated pretreatment variables associated with depression severity in adolescents following maintenance treatment for major depressive disorder (MDD). Data was derived from the Treatment for Adolescents with Depression Study (TADS). Participants received one of three treatments: cognitive behavioral therapy (CBT), fluoxetine (FLX), or combined CBT and fluoxetine (COMB). Participants received 12 weeks of acute treatment, 6 weeks of consolidation treatment, and 18 weeks of maintenance treatment (N = 327, M age = 14.62 yrs). Outcome was measured by the Children's Depression Rating Scale-Revised. Results showed adolescents with shorter depressive episodes, better global functioning, less suicidal ideation, better health/social functioning, and greater expectancy of positive treatment response were more likely to have lower depression severity following 36 weeks of treatment, regardless of modality. Adolescents with lower initial depression demonstrated lower depression severity if treated with CBT. FLX was more effective in reducing depression severity in adolescents with severe baseline depression than for those with mild or moderate depression. Adolescents with higher family incomes were more likely to have lower depression severity if they received CBT only. In conclusion, adolescents with shorter depressive episodes, better health, social, and global functioning, less suicidal ideation, and greater expectancy for treatment at baseline respond equally well to CBT, fluoxetine, and combined treatment. Adolescents who are more severely depressed at baseline may have a better treatment response if they are treated with FLX; whereas adolescents of higher income are more likely to have a better response if they receive CBT only.

Latent Profiles of Cognitive and Interpersonal Risk Factors for Adolescent Depression and Implications for Personalized Treatment

A personalized approach to treatment with patients being matched to the best-fit treatment has been proposed as one possible solution to the currently modest treatment response rates for adolescent depression. Personalized treatment involves identifying and characterizing subgroups likely to respond differently to different treatments. We investigated the feasibility of this approach, by focusing on two key risk factors that are the purported treatment targets of cognitive behavioral therapy (CBT) and interpersonal psychotherapy for depressed adolescents (IPT-A): negative unrealistic cognitions and interpersonal relationship difficulties, respectively. We sought to learn whether subgroups high and low on the two risk factors, respectively, might be identified in a large sample of depressed, treatment-seeking adolescents. Latent class analysis (LCA) was conducted on measures of the two risk factors among 431 adolescents (age 12-17) in the Treatment for Adolescents with Depression Study. LCA identified three classes: (1) adolescents with high levels of problems in both family relationships and cognitions (21.6% of sample), (2) adolescents with moderate levels of problems in both domains (52.4%), and (3) adolescents with low levels of problems in both domains (26.0%). These subgroups did not predict treatment outcome with CBT or CBT + fluoxetine (COMB). The results challenge a current assumption about how treatments could be personalized, and they support a multi-causal model of depression rather than a risk-factor-specific model. Strategies other than risk factor-based personalizing for case assignment to CBT vs. IPT-A are discussed.

Changes in cognitive distortions and affectivity levels in adolescent depression after acute phase fluoxetine treatment

INTRODUCTION

It is supposed that both antidepressants and psychotherapies work in a manner consistent with cognitive theories of depression when changing negative affective and cognitive distortions. This study evaluated changes in cognitive distortions (i.e. systematic misinterpretations of new information) and affectivity in adolescent major depressive disorder (MDD) after acute phase treatment with fluoxetine.

METHODS

Twenty-five adolescents (mean age 15.10 years (SD = 1.19); 17 (68%) females) with MDD receiving fluoxetine were followed for 8 weeks. Clinician rating scales of MDD and self-reports of cognitive distortions and affectivity were completed before and after the treatment.

RESULTS

Seven (28%) adolescents showed significant improvement in cognitive distortions, 11 (44%) showed a significant decrease in negative affect, and 15 (60%) showed a significant increase in positive affect. The responders to fluoxetine had significantly decreased level of negative affect (62.5%) and an increased level in positive affect (81.2%) compared to non-responders, whereas there were no differences between the two regarding changes in cognitive distortions.

CONCLUSIONS

Treatment with fluoxetine over 8 weeks led to reductions in cognitive distortions, with decreased negative and increased positive affect in adolescents with MDD. Improvements in affectivity levels closely corresponded to reductions in depressive symptoms and were greater than improvements in cognitive distortions.

Beck's cognitive theory and the response style theory of depression in adolescents with and without mild to borderline intellectual disability

AIM

This study tests the validity of Beck's cognitive theory and Nolen-Hoeksema's response style theory of depression in adolescents with and without MBID.

METHODS

The relationship between negative cognitive errors (Beck), response styles (Nolen-Hoeksema) and depressive symptoms was examined in 135 adolescents using linear regression.

RESULTS

The cognitive error 'underestimation of the ability to cope' was more prevalent among adolescents with MBID than among adolescents with average intelligence. This was the only negative cognitive error that predicted depressive symptoms. There were no differences between groups in the prevalence of the three response styles. In line with the theory, ruminating was positively and problem-solving was negatively related to depressive symptoms. Distractive response styles were not related to depressive symptoms. The relationship between response styles, cognitive errors and depressive symptoms were similar for both groups.

CONCLUSION

The main premises of both theories of depression are equally applicable to adolescents with and without MBID. The cognitive error 'Underestimation of the ability to cope' poses a specific risk factor for developing a depression for adolescents with MBID and requires special attention in treatment and prevention of depression. WHAT THIS PAPER ADDS?: Despite the high prevalence of depression among adolescents with MBID, little is known about the etiology and cognitive processes that play a role in the development of depression in this group. The current paper fills this gap in research by examining the core tenets of two important theories on the etiology of depression (Beck's cognitive theory and Nolen-Hoeksema's response style theory) in a clinical sample of adolescents with and without MBID. This paper demonstrated that the theories are equally applicable to adolescents with MBID, as to adolescents with average intellectual ability. However, the cognitive bias 'underestimation of the ability to cope' was the only cognitive error related to depressive symptoms, and was much more prevalent among adolescents with MBID than among adolescents with average intellectual ability. This suggests that underestimating one's coping skills may be a unique risk factor for depression among adolescents with MBID. This knowledge is important in understanding the causes and perpetuating mechanisms of depression in adolescents with MBID, and for the development of prevention- and treatment programs for adolescents with MBID.

Negative Cognitive Errors in Youth: Specificity to Anxious and Depressive Symptoms and Age Differences

Background: Negative cognitive errors are important in the etiology and treatment of youth internalizing problems, but less is known about their unique relations with anxiety and depression. Aims: The major purpose of this study was to examine associations between distinct negative cognitive errors and anxiety and depression in youth. Method: In a community sample of children and adolescents (aged 9–17; N = 278) negative cognitive errors were assessed using the revised version of the Children's Negative Cognitive Error Questionnaire (CNCEQ-R). Anxiety and depression were assessed with the Multidimensional Anxiety Scale for Children and Children's Depression Inventory, respectively. Results: The strongest predictors of anxiety were the negative cognitive errors “underestimation of the ability to cope” and “mind reading”. The strongest predictors of depression were the errors “selective abstraction” and “overgeneralizing”, with the first error explaining most variance. Analyses of age effects showed that, in comparison to adolescents, children reported higher scores on the total CNCEQ-R score, and on the errors “overgeneralizing”, “personalizing”, and “mind reading”. Conclusions: The findings underscore the importance of researching the role of distinct cognitive processing in youth with anxiety and depression and further development of the CNCEQ-R. Implications for clinical practice are discussed.

Cognitive measures of adolescent depression: unique or unitary constructs?

The factor structure of several self-report questionnaires assessing depression-relevant cognitions frequently employed in clinical research was examined in a sample of 390 adolescents (M age = 14.54; 216 girls; 74% Caucasian) with current major depressive disorder enrolled in the Treatment of Adolescents with Depression Study. A four-factor solution resulted, accounting for 65% of the total variance. The factors were labeled (a) Cognitive Distortions and Maladaptive Beliefs, (b) Cognitive Avoidance, (c) Positive Outlook, and (d) Solution-Focused Thinking. Internal consistencies for the factor-based composite scores were .83, .85, .84, and .82, respectively. Girls endorsed more negative cognitions than boys on three of the four factors. Maladaptive cognitions were positively related to severity of depression and predicted treatment response. Taken together, findings indicated that there are four distinct domains of cognitions that are present among adolescents with depression that are tapped by several widely used self-report measures of cognitions.