How Does Cognitive Flexibility Associate with Depressive Symptoms? A Multiple Mediation Model Including Emotion Dysregulation and Problem-Solving

Yıl 2022, Cilt: 6 Sayı: 11, 23 - 37, 30.06.2022

Servet Kaçar Başaran , Ceren Gökdağ , Zeynep Erdoğan Yıldırım

https://doi.org/10.31461/ybpd.1110174

Cited By: 3

Öz

According to the cognitive-behavioral model of depression, inflexibility in thought processes increases symptoms by causing more negative emotions and behavioral problems. Previous studies have empirically shown that cognitive flexibility is negatively associated with difficulties in emotion regulation, inadequate problem-solving, and depressive symptoms. However, no research includes these variables together to the best of our knowledge. We aimed to clarify the relationships between these variables and test the mediating effect of emotion dysregulation and problem-solving between cognitive flexibility and depressive symptoms via multiple mediation analysis. 275 undergraduate students participated in this study. We used a self-report battery including the Cognitive Flexibility Inventory, Difficulties in Emotion Regulation Scale, Problem Solving Inventory, and Beck Depression Inventory to collect the data. We tested the hypotheses via Pearson correlation analysis and multiple mediation analysis. According to the results, higher levels of cognitive flexibility were significantly associated with lower depression, inadequate problem solving, and emotion dysregulation. Moreover, emotion dysregulation has a mediating role in the relationships between depressive symptoms and cognitive flexibility. Inadequate problem-solving, however, was not a significant mediator. Consisted with previous findings, our results supported the importance of cognitive flexibility and emotion dysregulation for depression. Our study demonstrated the pathways of these variables. Also, results indicated that different therapy approaches that address cognitive flexibility and emotion regulation (e.g., cognitive-behavioral therapy, acceptance and commitment therapy, and emotion-focused therapy) might effectively reduce depressive symptoms.

Anahtar Kelimeler

Depression, Flexibility, Cognitive flexibility, Emotion dysregulation, Problem-solving

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Bilişsel Esneklik, Depresif Belirtilerle Nasıl İlişkilendirilir? Duygu Düzenleme Güçlüğü ve Problem Çözmeyi İçeren Çoklu Bir Aracılık Modeli

Öz

Depresyonun bilişsel-davranışçı modeline göre, düşünce süreçlerindeki katılık, olumsuz duyguların ve davranışsal sorunların artmasını tetiklemekte ve depresif belirtilerin artışına neden olmaktadır. Önceki çalışmalar ampirik olarak bilişsel esnekliğin duygu düzenlemedeki güçlükler, yetersiz problem çözme becerisi ve depresif belirtilerle negatif yönde ilişkili olduğunu göstermiştir. Alanyazında bu değişkenleri birlikte inceleyen bir araştırma bulunmadığından, bu araştırma bu değişkenler arasındaki ilişkileri incelemeyi ve duygu düzenleme ve problem çözmenin bilişsel esneklik ile depresif belirtiler arasındaki aracılık etkisini çoklu aracılık modeli ile test etmeyi amaçlamaktadır. 275 lisans öğrencisinin yer aldığı araştırmada; veri toplama araçları olarak, Bilişsel Esneklik Envanteri, Duygu Düzenlemede Güçlükler Ölçeği, Problem Çözme Envanteri ve Beck Depresyon Envanteri kullanılmıştır. Sonuçlara göre, daha yüksek bilişsel esneklik seviyeleri, daha düşük depresyon, yetersiz problem çözme ve duygu düzenleme güçlüğü ile anlamlı şekilde ilişkili bulunmuştur. Ayrıca bilişsel esneklik ile depresif belirtiler arasındaki ilişkide duygu düzenleme güçlüğünün aracılık etkisi de anlamlıdır. Ancak yetersiz problem çözmenin, bu ilişkide anlamlı bir aracı rolünün olmadığı saptanmıştır. Önceki bulgularla uyumlu olarak mevcut araştırmanın bulguları, duygu düzenleme güçlüğünün ve bilişsel esnekliğin depresif belirtilerin ortaya çıkışındaki önemini desteklemektedir. Ayrıca sonuçlar, bilişsel esneklik ve duygu düzenlemeyi ele alan farklı terapi yaklaşımlarının (örneğin, bilişsel-davranışçı terapi, kabul ve kararlılık terapisi ve duygu odaklı terapi) depresif belirtileri etkili bir şekilde azaltabileceğine yönelik kanıtlar da sunmaktadır.

Anahtar Kelimeler

Depresyon, Esneklik, Bilişsel esneklik, Duygu düzenleme güçlüğü, Problem çözme

Proje Numarası

-

Kaynakça

• Aldao, A. (2013). The future of emotion regulation research: Capturing context. Perspectives on Psychological Science, 8(2), 155-172.
• Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217-237.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
• Ashby, F.G., Isen, A.M., & Turken, U. (1999). A neuropsychological theory of positive affect and its influence on cognition. Psychological Review, 106, 529-550.
• Baginski, A. (2015). Attention regulation, emotion regulation, and cognitive flexibility as mediators of the relationship between mindfulness and academic achievement in high school students (Doctoral dissertation, Eastern Illinois University).
• Beck, A.T. (1991). Cognitive therapy and emotional disorders. Londra: Penguin Psychology.
• Beck, A.T., Rush, A.J., Shaw, B.E. ve Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.
• Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
• Beck, J.S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press.
• Bilgin, M. (2009). Bilişsel esnekliği yordayan bazı değişkenler. Çukurova Üniversitesi Eğitim Fakültesi Dergisi, 3(36), 142-157.
• Campbell-Sills, L., & Barlow, D.H. (2006). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In J.J. Gross (Ed.), Handbook of Emotion Regulation (pp.542-559). New York: Guilford Press.
• Chamberlain, S.R., Fineberg, N.A., Blackwell, A.D., Robbins, T.W., & Sahakian, B.J. (2006). Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. American Journal of Psychiatry, 163(7), 1282-1284.
• Coşkun, Y.D., Garipağaoğlu, Ç., & Tosun, Ü. (2014). Analysis of the relationship between the resiliency level and problem solving skills of university students. Procedia-Social and Behavioral Sciences, 114, 673-680.
• Cyranowski, J.M., Frank, E., Young, E., & Shear, M.K. (2000). Adolescent onset of the gender difference in lifetime rates of major depression: A theoretical model. Archives of General Psychiatry, 57(1), 21-27.
• Dağ, İ., & Gülüm, V. (2013). Yetişkin bağlanma örüntüleri ile psikopatoloji belirtileri arasındaki ilişkide bilişsel özelliklerin aracı rolü: Bilişsel esneklik. Türk Psikiyatri Dergisi, 24(4), 240-247.
• Daly, E.J., Trivedi, M.H., Wisniewski, S.R., Nierenberg, A.A., Gaynes, B.N., Warden, D., ... & Rush, A.J. (2010). Health-related quality of life in depression: A STAR* D report. Annals of Clinical Psychiatry, 22(1), 43-55.
• Dennis, J.P., & Vander Wal, J.S. (2010). The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34(3), 241-253.
• Deveney, C.M., & Deldin, P.J. (2006). A preliminary investigation of cognitive flexibility for emotional information in major depressive disorder and non-psychiatric controls. Emotion, 6(3), 429-437.
• Edward, K.L. (2005). Resilience: A protector from depression. Journal of the American Psychiatric Nurses Association, 11(4), 241-243.
• Ehring, T., Tuschen-Caffier, B., Schnülle, J., Fischer, S., & Gross, J.J. (2010). Emotion regulation and vulnerability to depression: spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10(4), 563-572.
• Fredrickson, B.L., & Branigan, C. (2005). Positive emotions broaden the scope of attention and thought‐action repertoires. Cognition & Emotion, 19(3), 313-332.
• Genet, J.J., Malooly, A.M., & Siemer, M. (2013). Flexibility is not always adaptive: Affective flexibility and inflexibility predict rumination use in everyday life. Cognition & Emotion, 27(4), 685-695.
• Gratz, K.L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54.
• Greenberg, L.S. (2004). Emotion-focused therapy. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 11(1), 3-16.
• Gross, J.J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299.
• Gülüm, İ.V., & Dağ, İ. (2012). Tekrarlayıcı Düşünme Ölçeği ve Bilişsel Esneklik Envanterinin Türkçeye uyarlanması, geçerliliği ve güvenilirliği. Anadolu Psikiyatri Dergisi, 13(3), 216-223.
• Hayes, A.F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.
• Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
• Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2012). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.
• Heppner, P.P., & Petersen, C.H. (1982). The development and implications of a personal problem-solving inventory. Journal of Counseling Psychology, 29(1), 66-75.
• Hildebrandt, L.K., McCall, C., Engen, H.G., & Singer, T. (2016). Cognitive flexibility, heart rate variability and resilience predict fine‐grained regulation of arousal during prolonged threat. Psychophysiology, 53(6), 880-890.
• Hisli, N. (1989). Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji Dergisi, 7(23), 3-13.
• Johnson, S.M., & Denton, W. (2002). Emotionally focused couple therapy: Creating secure connections. In A.S. Gurman & N.S. Jacobson (Eds.). Clinical Handbook of Couple Therapy (pp.221-250). New York: Guilford Press.
• Kaiser, T., Herzog, P., Voderholzer, U., & Brakemeier, E.L. (2021). Unraveling the comorbidity of depression and anxiety in a large inpatient sample: Network analysis to examine bridge symptoms. Depression and Anxiety, 38(3), 307-317.
• Kang, H.J., Kim, S.Y., Bae, K.Y., Kim, S.W., Shin, I.S., Yoon, J.S., & Kim, J.M. (2015). Comorbidity of depression with physical disorders: Research and clinical implications. Chonnam Medical Journal, 51(1), 8-18.
• Katon, W.J. (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry, 54(3), 216-226.
• Kendler, K.S., Thornton, L.M., Prescott, C.A. (2001). Gender differences in the rates of exposure to stressful life events and sensitivity to their depressogenic effects. American Journal of Psychiatry, 158, 587-593.
• Krems, J.F. (1995). Cognitive flexibility and complex problem solving. Complex problem solving: The European Perspective, pp.201-218.
• Kring, A.M., & Werner, K.H. (2004). Emotion regulation and psychopathology. In P. Philippot & R.S. Feldman (Eds.), The regulation of emotion (pp.359-385). Mahwah, NJ: Erlbaum.
• Kring, A.M. & Sloan, D.M. (Eds.). (2009). Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment. Guilford Press.
• Malooly, A.M., Genet, J.J., & Siemer, M. (2013). Individual differences in reappraisal effectiveness: The role of affective flexibility. Emotion, 13(2), 302-313.
• McTernan, W.P., Dollard, M.F., & LaMontagne, A.D. (2013). Depression in the workplace: An economic cost analysis of depression-related productivity loss attributable to job strain and bullying. Work & Stress, 27(4), 321-338.
• Min, J.A., Yu, J.J., Lee, C.U., & Chae, J.H. (2013). Cognitive emotion regulation strategies contributing to resilience in patients with depression and/or anxiety disorders. Comprehensive Psychiatry, 54(8), 1190-1197.
• Nezu, A.M., & Ronan, G.F. (1985). Life stress, current problems, problem solving, and depressive symptoms: An integrative model. Journal of Consulting and Clinical Psychology, 53(5), 693-697.
• Palm, K.M., & Follette, V.M. (2011). The roles of cognitive flexibility and experiential avoidance in explaining psychological distress in survivors of interpersonal victimization. Journal of Psychopathology and Behavioral Assessment, 33(1), 79-86.
• Radkovsky, A., McArdle, J.J., Bockting, C.L., & Berking, M. (2014). Successful emotion regulation skills application predicts subsequent reduction of symptom severity during treatment of major depressive disorder. Journal of Consulting and Clinical Psychology, 82(2), 248-262.
• Rugancı, R.N., & Gençöz, T. (2010). Psychometric properties of a Turkish version of the Difficulties in Emotion Regulation Scale. Journal of Clinical Psychology, 66(4), 442-455.
• Ruiz, F.J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology & Psychological Therapy, 10(1), 125-162.
• Schaeuffele, C., Bär, J., Buengener, I., Grafiadeli, R., Heuthaler, E., Strieder, J., ... & Boettcher, J. (2022). Transdiagnostic processes as mediators of change in an internet-delivered intervention based on the unified protocol. Cognitive Therapy and Research, 46(2), 273-286.
• Sahin, N., Sahin, N.H., & Heppner, P.P. (1993). Psychometric properties of the Problem Solving Inventory in a group of Turkish university students. Cognitive Therapy and Research, 17(4), 379-396.
• Shamay-Tsoory, S.G., Tomer, R., Berger, B.D., & Aharon-Peretz, J. (2003). Characterization of empathy deficits following prefrontal brain damage: The role of the right ventromedial prefrontal cortex. Journal of Cognitive Neuroscience, 15(3), 324-337.
• Stevens, A.D. (2009). Social problem-solving and cognitive flexibility: Relations to social skills and problem behavior of at-risk young children (Doctoral thesis). Available from Proquest Dissertations and Theses database. (UMI No. 3359050).
• Tchanturia, K., Davies, H., Roberts, M., Harrison, A., Nakazato, M., Schmidt, U., ... & Morris, R. (2012). Poor cognitive flexibility in eating disorders: Examining the evidence using the Wisconsin Card Sorting Task. PloS one, 7(1), e28331.
• Viskovich, S., & Pakenham, K.I. (2018). Pilot evaluation of a web‐based acceptance and commitment therapy program to promote mental health skills in university students. Journal of Clinical Psychology, 74(12), 2047-2069.
• Wang, T., Li, M., Xu, S., Liu, B., Wu, T., Lu, F., ... & Wang, J. (2019). Relations between trait anxiety and depression: A mediated moderation model. Journal of Affective Disorders, 244, 217-222.
• Whiting, D.L., Deane, F.P., Simpson, G.K., McLeod, H.J., & Ciarrochi, J. (2017). Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review. Neuropsychological Rehabilitation, 27(2), 263-299.
• Yazar, M.S., & Meterelliyoz, K.Ş. (2019). Klinik olmayan populasyonda depresif semptomatoloji, bilişsel esneklik ve umutsuzluk ilişkisinin incelenmesi. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 8(2), 155-163.
• Young, J.E., Weinberger, A.D., & Beck, A.T. (2001). Cognitive therapy for depression. In D.H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (3rd ed., pp. 264-308). New York: Guilford Press.
• Zarei, M., Momeni, F., & Mohammadkhani, P. (2018). The mediating role of cognitive flexibility, shame and emotion dysregulation between neuroticism and depression. Iranian Rehabilitation Journal, 16(1), 61-68.