Brooding rumination, stable or internal attribution biases, and dysfunctional attitudes may raise the risk of behavioral disengagement among patients with depression, according to results published in the Journal of Clinical Psychology. High level internal attribution bias and dysfunctional attitudes, when combined with a tendency to use drugs or alcohol as a coping mechanism, may also affect patients’ willingness to use proactive coping efforts.
In depression, maladaptive emotion regulation skills and coping strategies may produce chronic distress. Rumination, attributional style, and dysfunctional attitudes are key elements of vulnerability to depression, and disengagement is common, contributing to poor treatment outcomes.
The investigators examined the effect of cognitive risk subtypes and coping oriented substance use frequency on later tendencies to behaviorally disengage from stressors. They recruited participants with a history of depressive disorder from 2 outpatient settings and administered a self-report battery at baseline and 3 weeks later. Study measures comprised the Response Styles Questionnaire-Rumination Response Scale, Attributional Style Questionnaire, Dysfunctional Attitudes Scale, and Brief Coping Orientation to Problems Experienced, including the substance use and behavioral disengagement (COPE-BD) subscales.
The study included 70 participants (mean age, 30.95 years; 66% women; 81% white); neither age nor gender were significantly associated with later behavioral disengagement. Brooding rumination had a significant main effect on later behavioral disengagement (β, .29; t, 2.7; P =.009), but demonstrated no significant interaction effect with coping oriented substance use at 3 weeks (ΔR2 <.01; t, -0.46; P =.650).
A stable attributional style, but not internality or globality, demonstrated a significant association with later behavioral disengagement (β, .32; t, 3.0; P =.004). Additionally, an internal attributional style showed a significant interaction effect with coping oriented substance use (ΔR2 =.08; t, 2.8; P =.006).
Dysfunctional attitudes demonstrated a statistically significant main effect on later behavioral disengagement tendencies (β, .35; t, 3.3; P =.002) and interacted with coping oriented substance use in the prediction of behavioral disengagement at 3 weeks (ΔR2 < .08, t = 3.2, P = .002). However, at high levels of coping oriented substance use, dysfunctional attitudes were associated with greater behavioral disengagement later on (β, .01; t, 4.3; P =.002), but at low levels they were not correlated (β <.01; t, 1.2; P =.233).
The results provide further evidence that ruminative thought processing is an important factor in shaping behavior or goal-directed efforts. The investigators suggested that the findings may prove valuable “regarding the hazards and clinical relevance of subsyndromal substance use behavior among outpatients.”
However, study limitations included the lack of information on the types and quantity of substances used in the sample.
The findings indicate that patients with depression who engage in high level brooding rumination are increasingly likely to behaviorally disengage when confronted with stressors over time. The researchers noted that patients with internal attribution styles or dysfunctional attitudes who engage in coping oriented substance use may benefit from “cognitive‐based interventions” for “mitigating stress‐generated avoidance over time.”
Heggeness LF, Bean CAL, Kalmbach DA, Ciesla JA. Cognitive risk, coping-oriented substance use, and increased avoidance tendencies among depressed outpatients: A prospective investigation. J Clin Psychol. 2020;1-15.