Effectiveness of Group CBT with Memory Specificity Training and Self-Distancing in Moderately Depressed Adults   Peter John Sabatelli PhD Clinical Psychology Student Texila American University psabatelli@btinternet.com

Group A v Group B: main findings Summary Group A v Group B: main findings Statistically significant with large effect sizes Clinically significant Rumination : mediator for memory specificity Mood improved by AMS via rumination SD enhanced both CBT and MEST Limitations Future research

So What? Stagnation in CBT outcomes for depression (Johnsen & Friborg, 2015) Neshat-Doost et al, 2013, p 7 and Dalgleish et al, 2014, p 8, suggested using MEST as an adjunct with CBT. Kross and Ayduk, 2011, p 189; Kross et al, 2012, p566, suggested using SD with depressed adults, under a ‘’variety of conditions’’ UK participants, not done.

Background OGM: recurrence, increased severity and duration of depression (Williams et al.,2007) AMS: improves depression; reduces vulnerability to relapse (Raes et al., 2009) Self-memory system & CarFAX model MEST studies: Raes et al., 2009; Neshat-Doost et al., 2013; Eigenhuis et al., 2015 Limitations and suggestions

Background cont. FA Knowledge e.g problem solving Capture & Rumination AMS OGM Capture & Rumination Conway, & Playdell-Pearce, 2000) Functional Avoidance-FA FA Suppression (Williams et al., 2007)

Background cont Step back, observer perspective in recalling memories Distancing Step back, observer perspective in recalling memories Memories broad, less detailed Emotions dulled (Williams & Moulds, 2008) Reconstrue Distancing allows broader perspective to be taken Reflection led to active coping( Marroquin et al., 2010) Adaptive explanation, understanding, meaning, insight and sense of closure (Kross et al., 2012; 2014; Kross & Ayduk, 2008, 209, 2011). Emotional Regulation Current & future distress reduced less rumination (Kross & Ayduk, 2008) more problem-solving behaviour (Ayduk & Kross, 2010) and improved mood (Kross, Gard, Deldin, Clifton and Ayduk, 2012).

Psychological Distance Background cont. Psychological Distance Small (Spatial & Temporal) Large Low Construal Level High Concrete, superficial, Abstract, simple, complicated, unrelated primary, neutral, to goals, corresponds related to high to ‘’how’’ questions, goals, correspond contextual to ‘’why’’ type questions; out of context (Trope & Liberman, 2010)

Methodology Ethical approval (BPS, 2014) Mixed group design: 2 x 3 Independent variables : Treatments & Time Dependent variables: AMS, BDI-II, RRS, PSI & WBSI Inclusion and exclusion criteria Recruited via advertisements plus screening Consent obtained & 120 randomised

Results RMANOVA significant result Table 1   Univariate ANOVA: between group results for each dependent variable at post-treatment  ---------------------------------------------------------------------------------------------------------- Hypothesis DV df = F p partial η2 ---------------------------------------------------------------------------------------------------------- One AMS (1, 108) = 16.251, < .0001 .131 Two BDI-II (1, 108) = 406.635 < .0001 .790 Three RRS, (1, 108) = 167.380 < .0001 .608 Four PSI (1, 108) = 258.547 < .0001 .705 Five WBSI (1, 108) = 280.693 < .0001 .722 -----------------------------------------------------------------------------------------------------------  DV=dependent variable; df= degrees of freedom; F= distribution; p = significance level

Results cont. Table 2   Univariate ANOVA: between group results for each dependent variable at three month FU -------------------------------------------------------------------------------------------------------------  Hypothesis DV df = F p partial η2 One AMS (1, 108) = 44.619 < .0001 .292 Two BDI-II (1, 108) = 472.582 < .0001 .879 Three RRS, (1, 108) = 516.389 < .0001 .789 Four PSI (1, 108) = 1101.846 < .0001 .911 Five WBSI (1, 108) = 617.685 < .0001 .851  DV=dependent variable; df= degrees of freedom; F= distribution; p = significance level Independent t-test results: group A significant on all DV’s

Results cont. Multiple regression analysis: the overall model was significant, F (3, 106) = 22.139, p < .001, R2 = .385, accounting for 38.5% of the variance Multiple regression analysis: The overall model was significant, F (4, 105) = 301.059, p < .001, R2 = .920, accounting for 92% of the variance.   Clinical significant for group A- see table 3 Group Pre: BDI-II Post: BDI-II 3mth FU Change 99%CI:Clinical Significance -------------------------------------------------------------------------------------------------------------- A 26.3 8.2 18.1 13.59 (achieved) 3.7 22.6 13.59 (achieved) B 26 14 12 13.59 (not achieved) 10.6 15.4 13.59 (achieved) ---------------------------------------------------------------------------------------------------------------  Note: input used- SD=11.8, test-retest=0.90 (Steer et al., 1999); (Devilly, 2004) . http://www.swin.edu.au/victims

Discussion Hypothesis one to six: null rejected, alternative accepted Confirmed Raes et al., 2009 findings for AMS Greater AMS scores achieved in Group A compared to previous MEST studies. SD may have facilitated AMS recall in MEST. Greater improved BDI-II and RRS, PSI, WBSI scores achieved in Group A compared group B. SD may have enhanced cognitive reframing in CBT and enhanced CBT overall. Clarifies that mood improvement found in previous MEST studies, may have been due to a AMS reciprocal relationship with RRS  

Conclusion Addressed need to enhance contemporary CBT by expanding the work of previous researchers in the area of MEST for depression and self-distancing (SD) Group CBT with MEST and SD is feasible and more effective than group CBT with MEST and possibly group CBT for depression over seven sessions with three month follow-up The treatment was ‘’scalable’’, cost effective may reduce one risk factor OGM’s that is associated depression relapse Limitations and future research

Key references Conway, M.A. & Pleydell-Pearce, C.W. (2000). The construction of autobiographical   memories in the self-memory system. Psychological Review, 107, 261–88. doi: 10.1037//0033-295X. 107.2.261 Johnsen, T. J., & Friborg, O. (2015, May 11). The Effects of Cognitive Behavioral Therapy As an Anti-Depressive Treatment is Falling: A Meta-Analysis. Psychological Bulletin. Advance online publication. doi:org/10.1037/bul Sumner, J.A., Griffith, J.W., & Mineka, S. (2010). Overgeneral autobiographical memory as a predictor of the course of depression: A meta-analysis. Behaviour Research Therapy, 48, 614–625. doi: 10.1016/j.brat.2010.03.013 Williams, J.M.G., Barnhofer, T., Crane, C., Herman, D., Raes, F., Watkins, E., & Dalgleish, T. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133,:122–148. doi:  10.1037/0033-2909.133.1.122