10330558 research project msc
TRANSCRIPT
Cognitive Thinking Style, Sleep, and Mood in Older Adults.
Thesis submitted to the University of
Plymouth for the MSc in Psychological Research Methods by Cassie Anderson
(10330558)
Project Supervisor: Dr Catherine Deeprose
August 2013
Cognitive thinking style, sleep and mood in older adults Cassie Anderson 10330558
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Cognitive thinking style, sleep and mood in older adults.
An online study into the relationship between thinking styles, sleep and mood.
Thesis submitted to the University of Plymouth for the MSc in
Psychological Research Methods by Cassie Anderson
Project supervisor: Dr Catherine Deeprose
23.08.13
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The work reported in this thesis received ethical approval from the Faculty of
Science and Technology and complies with the guidelines set by the British
Psychological Society.
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With special thanks to my project supervisor, Dr Catherine Deeprose, for all of her
help, advice, and support.
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Contents
Contents of Tables page 5
Abstract page 6
Introduction page 6
Method page 16
Participants page 16
Materials page 16
Design page 21
Procedure page 21
Results page 22
Discussion page 26
References page 31
Appendices page 35
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Contents of Tables
Table 1: Means and standard deviations of each measure, for depressed and
non-depressed conditions. – Page 23
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Abstract
It is now well established that negative intrusive thoughts are a characteristic
symptom of depression, which have been found to contribute to the maintenance of
the disorder. There are a number of other cognitive processes associated with
intrusive thoughts, which are also affected in depression. Of all depressed
populations, older adults are the cohort at the highest risk of completed suicide, yet
little research specifically targets this population. Given these findings, the current
study aimed to extend the current literature, by bringing together a number of
separate findings relating to cognitive symptoms, and by recruiting older adults from
the community. 49 participants were recruited and subsequently allocated to the
“depressed” condition (N =21) or the “non-depressed” condition (N = 29), based on
their score on the CES-D (Radloff, 1977). Findings suggest that the older adults
placed in the depressed condition, displayed higher levels of particular cognitive
symptoms, which are commonly linked to clinical depression. Analyses also revealed
positive correlations between levels of depressive symptomatology and the extent of
various cognitive symptoms. In addition, the content of intrusions of older adults, was
not found to differ from those reported by younger adults, and was consistent with
previous findings. Replication would be beneficial with a clinical sample.
Introduction
Individuals with depression find that many areas of their daily lives are
affected by their disorder. Symptoms of depression may manifest themselves in the
following four main manners: mood symptoms; motivational or behavioural
symptoms; physical symptoms; and cognitive symptoms (Seligman, Walker &
Rosenhan, 2001). In addition to the very well documented relationship between
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depression and anxiety, (Spitzer, Kroenke, Williams, & Lowe, 2006) two of the best
established symptoms of depression, and other affective disorders, are sleep
disturbances and negative intrusive thoughts (Seligman et al., 2001), though there
are a number of cognitive processes related to these symptoms, which are also
affected by the disorder (Hammen & Watkins, 2008).
Given the nature of depressive symptomatology, clinical depression, along
with other affective disorders, is always incredibly worthwhile of research, in terms of
both theoretical understanding of the disorders, and also in terms of treatment. In
recent years, research has been able to show that individuals in their youth, or early
adulthood, are most at risk of onset of depression (Hammen & Watkins). Despite this
finding however, it is the older population who seem to be particularly vulnerable,
and therefore in desperate need of well-informed and effective treatment. Cases of
depression in older adults are often misdiagnosed, due to the nature of the
symptoms that these individuals exhibit (Hammen & Watkins, 2008). Symptoms of
depression in this sub-population are often mistaken as being consequences of
aging, for example, becoming forgetful, or experiencing feelings of fatigue and a lack
of energy. It is particularly important that such misdiagnoses are addressed however,
as research suggests that, cases of geriatric depression are often the most severe,
with greater levels of hopelessness, and higher rates of suicide being reported
amongst this population (Hammen & Watkins). Such a finding makes focused
research of this sub-population, of great worth.
Individuals with depression are now widely documented to regularly
experience intrusive mental images, thoughts and memories, previously best
recognised for being a common phenomenon of post-traumatic stress disorder
(Brewin, Reynolds & Tata, 1999). It has been suggested that around 85% of
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depressed individuals are expected to regularly experience negative intrusions
(Brewin et al., 1996). Intrusive thoughts are defined as unwelcome thoughts which
are not consciously brought to the surface. Intrusions may also manifest themselves
in the form of mental imagery, and are commonly related to specific, negative
events. (Hall et al., 1997). Severity of depression has also been reported to be linked
to the frequency and intensity of the intrusive thoughts that are experienced, and to
the degree to which depressed individuals attempt to avoid intrusive memories
(Kuyken & Brewin, 1994). It has repeatedly been found that individuals suffering from
negative intrusive thoughts, will often employ avoidance behaviours in order to
suppress their negative intrusions (Hall et al., 1997). In addition it is suggested that
negative appraisals of intrusive thoughts are correlated to depression severity (Starr
& Moulds, 2006). Not only are intrusive thoughts a major characteristic of
depression, there is also research to suggest that intrusions may actually contribute
to the maintenance of the disorder (Newby & Moulds, 2011). In a longitudinal study
of a clinical sample of depressed patients, Brewin and colleagues (1999) reported
that, depression at the follow-up, could be predicted by the levels of intrusive
thoughts and avoidance behaviours at baseline (Brewin, et al., 1999) thus indicating
a positive relationship between the presence of negative intrusive thoughts,
depression, and the tendency to use avoidance strategies.
It is thought that, in depression, negative intrusions are often concerned with
the following topics: familial issues such as illness and death, personal injuries, or
interpersonal dilemmas (Brewin et al., 1996), with familial and interpersonal
problems being the most common (Reynolds & Brewin, 1999), for example topics
such as illness and loss of friends (Deeprose & Holmes, 2010). Depressed patients
have been reported to say that, their experiences of negative intrusive memories
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often manifest in such a way that, it is as though they are reliving their past,
sometimes accompanied by physical effects (Reynolds & Brewin, 1999). Williams
and Moulds (2007) have more recently supported this evidence, and have
additionally suggested that, the degree to which depressed individuals feel as though
they are re-experiencing their past, varies along with the level of distress that the
individual feels at the time of their negative intrusion. Similarly, Starr & Moulds
(2006) have supported this research with their findings that both the frequency of
negative intrusive thoughts and images, and the use of avoidance behaviours, may
be related to the seriousness of depression. These findings suggest that, there may
be a positive correlation between the seriousness of depression, and the degree of
cognitive disturbances, such as intrusive thoughts, and avoidance behaviours, which
are experienced.
Intrusive thoughts and images may be related to a past event or memory, but
it has also been shown that they can concern the prospective future. This therefore
indicates, that individuals with depression also have a propensity for pre-
experiencing the future (Deeprose & Holmes, 2010). Much like negative intrusive
memories, a tendency to pre-experience distressing future events, is associated with
depression. Findings suggest that individuals with unipolar depression, lack the
capacity to pre-experience prospective positive future events (Holmes, Lang, Moulds
& Steele, 2008), while those with bipolar depression, have been shown to pre-
experience the future far too often (Holmes et al., 2008). In a study in which they
created and tested the Impact of Future Events Scale (IFES), Deeprose and Holmes
(2010) reported that higher levels of pre-experiencing were associated with higher
levels of depression. These findings combined, suggest that cognitive processes
concerned with the future, may be affected in the same way that cognitive facets for
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the past are affected, in depression. There is also evidence to support this, that
suggests that recalling the past, and pre-experiencing the future are enabled by the
same construct: episodic memory (Addis, Wong & Schacter, 2008).
Similarly to the findings that depressed individuals experience more intrusive
mental imagery than their non-depressed counterparts, it has also been suggested
that patients with bipolar depression, tend to use visual mental imagery more
frequently than non-clinical populations (Holmes et al., 2011). It was also suggested
that visual mental imagery may be more likely employed than mental verbal thoughts
(Holmes, Geddes, Colm & Goodwin, 2008). Given the tendency for depressed
individuals to experience intrusive thoughts and images (Brewin et al., 1999), the
current research was interested in investigating the relationship between the
presence of depressive symptomatology, and levels of intrusive mental imagery, and
intrusive verbal thoughts. By incorporating a measure for both verbal thoughts and
mental imagery, the current research may attempt to replicate findings of a
relationship, between depression and intrusive mental images and verbal thoughts,
at the same time as offering the potential, for the findings of Holmes and colleagues
(2008) to be extended. Given that negative intrusive thoughts have been repeatedly
shown to act as both a symptom and contributor to the trajectory of depression
(Brewin et al., 1999; Patel et al., 2007; Newby & Moulds, 2011), it is particularly
important that their manifestations are thoroughly researched and well understood, in
turn potentially enabling progress in the development of treatments and therapies
available (Patel et al., 2007).
Another related, and very common, symptom of depression is the disturbance
of sleep, in one form or another (Hall et al., 1997). Sleep studies which are
conducted in a laboratory setting are able to directly monitor sleeping habits of
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depressed individuals. Such studies have been able to demonstrate that depressed
individuals have trouble with falling asleep, and staying asleep; they have also been
shown to display less delta wave activity which is indicative of deep sleep, along with
less rapid eye movement (REM) sleep (Benca, Obermeyer, Thisted & Gillen, 1992).
It has been considered that disturbed sleep, as a result of bereavement, may be
adversely affected by the manifestation of negative intrusions, and the use of
avoidance behaviours (Hall et al., 1997). It is thought that these phenomena are
related to certain psychophysiological changes, which lead to poorer sleep quality in
individuals with bereavement-related depression (Hall et al., 1997). Furthermore, it
has been proposed that individuals who suffer from insomnia often blame their lack
of sleep to cognitive arousal, in the form of uncontrollable thoughts (Nicassio,
Mendlowitz, Fussell & Petras, 1985). Intrusive thoughts and cognitive arousal are
considered to be very similar constructs, both of which are thought to be related to
poor sleep quality in individuals both with and without sleep disturbances (Hall et al.,
1997).
In an attempt to understand this proposed association between negative
intrusive thoughts and sleep disturbances in depression, Hall and colleagues (1997)
investigated how intrusive thoughts, avoidance behaviours, and sleep quality related
to one another, in a sample of participants with bereavement-related depression.
The findings from this research suggested that sleep quality may be affected by the
presence of negative intrusions, and the use of avoidance strategies, such as
rumination, which in turn, may affect the way in which depression develops. Given
the relationship between sleep quality and negative intrusive thoughts, and the
research suggesting a link between depression severity and frequency of negative
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intrusive thoughts, the current research was interested in investigating whether
depression and sleep might share a similar positive correlation.
The avoidance behaviours shown to be related to both negative intrusive
thoughts, and sleep disturbances, in depression, include processes such as
rumination (Starr & Moulds, 2006). Rumination is a mechanism, employed for coping
with negative affect, which requires reflection of the self. It also often consists of an
individual repeatedly appraising their negative emotions (Morrow & Noelen-
Hoeksema, 1990). It has repeatedly been found that use of rumination can predict
higher levels of depressive symptomatology, and the onset of depressive episodes in
major depression (Treynor, Gonzalez & Noelen-Hoeksema, 2003).
An additional avoidance mechanism often employed by depressed individuals
is known as suppression (Starr & Moulds, 2006). Suppression is a modulatory
mechanism employed to inhibit behaviours which express emotions (Gross, 1998). It
is believed to occur late in the process of generating emotions, and is mostly
concerned with affecting the behavioural components of emotional reactions (Gross
& John, 2003). As such, though it prevents the expression of negative emotions,
suppression is not useful for reducing the experience of negative emotion (Gross &
John, 2003). In turn, suppression is considered to lead to poor interpersonal well-
being, due to a conflict between an individual’s actual emotion, and their behavioural
expression (Rogers, 1951; in Gross & John, 2003). In their study, Gross & John
(2003) discovered that participants who used suppression to regulate their emotions,
were more likely to report higher levels of depressive symptoms. Considered
alongside the findings of studies concerned with rumination, this suggests that the
cognitive mechanisms an individual uses to deal with their emotions, particularly
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negative emotions, are largely important in the generation and maintenance of
depressive symptomatology.
In contrast to suppression, reappraisal is considered to be a healthy method
of emotion regulation, associated with greater life satisfaction (Gross & John, 2003).
Reappraisal involves a cognitive alteration in the way a situation is viewed, in order
to change the emotional effect of the situation (Gross & John, 2003). The process of
reappraising an event is believed to happen before any emotional responses have
fully formed. As such, reappraisal can effectively alter the emotions that are
experienced. In the same study in which suppression was investigated, Gross &
John (2003) reported that participants who were more likely to use reappraisal as a
method of regulating their emotions, were less likely to report depressive symptoms,
and were more likely to be satisfied with their life. The Emotion Regulation
Questionnaire (Gross & John, 2003) was devised to simultaneously measure
reappraisal and suppression mechanisms. Given the findings of the relationships
between each of these two mechanisms, and depression, the current study
employed the ERQ in order to establish further exactly how suppression and
reappraisal both correlate with depression, more specifically.
Given that negative intrusive thoughts and sleep quality have been repeatedly
shown to act as both symptoms and contributors to the trajectory of depression
(Brewin et al., 1999; Patel et al., 2007; Newby & Moulds, 2011; Hall et al., 1997), it is
particularly important that their manifestations are well researched and understood.
Additionally, given the findings which have suggested a relationship between
avoidance behaviours, i.e. rumination and suppression, and sleep quality, it also
seemed especially pertinent that these cognitive mechanisms were investigated
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simultaneously, as significant results may provide powerful support for a change in
treatments.
With the discussed issues in mind, the current study aimed to bring together
all of the previous research into the cognitive symptoms of depression, (e.g. Hall et
al., 1997; Starr & Moulds, 2006; Brewin et al., 1996; Gross & John, 2003; Treynor et
al., 2003). The cognitive processes affected by depression, have often been
investigated independently, in terms of their relationship with depression, and with
one another. For example, Hall et al.’s (1997) finding of a relationship between poor
sleep and negative intrusive thoughts, and Starr and Mould’s (2006) proposal of a
correlation between negative intrusive thoughts and rumination. However, it seems
that all of these cognitive symptoms have infrequently been brought together in one
study. Given the common finding that level of depression is linked to the degree to
which these cognitive symptoms, such as poor sleep quality, and presence of
negative intrusions, are manifest, this study aimed to, first of all, establish a link
between depression and these symptoms, and secondly, investigate whether the
extent of disruption of the following cognitive processes, is positively correlated to
the extent of depressive symptomatology: sleep quality, pre-experiencing the future;
intrusive mental imagery and verbal thoughts; suppression mechanisms; and finally
rumination. The study also investigated whether there was a substantial negative
correlation between level of depressive symptoms, and use of reappraisal
mechanisms to regulate emotions. Additionally, the current research was interested
in measuring the relationship between depressive symptoms and anxiety symptoms,
due to the very well-established comorbidity of the two (Spitzer et al., 2006).
Due to the considerable lack of research concerning geriatric depression, an
additional question of interest for the current study, was to examine whether there
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were any differences in the content of intrusions of older adults, as compared with
previous literature, which is much more focused on younger adults. It was expected
that older adults would likely experience intrusions of considerably different content
to younger adults, due to the differences in life stages, i.e. priorities, ambitions, and
so on. This expectation was based on previous suggestions that older adults are less
likely to report details about the self when recalling the past and pre-experiencing the
future (Addis et al., 2008).
Finally, the current research was in interested in a community sample. As this
research was conducted over a period of less than a year, unavoidable time
constraints prevented any clinical populations from being recruited. It was expected
though, that given the evidence for a correlational relationship between depressive
symptomatology and the cognitive symptoms discussed, a community sample would
be sufficient for investigation.
It was hypothesised that participants showing higher levels of depression,
would be more likely to also show a greater degree of the following: pre-experiencing
the future; poor sleep quality; intrusive mental images and verbal thoughts; anxiety
symptomatology, use of suppression to regulate emotions, and finally rumination.
Conversely, it was expected that individuals in the depressed condition would be
less likely to use reappraisal to regulate their emotions. Finally, no specific
hypotheses were made regarding the content of negative intrusions, though it was
predicted that the content of intrusions may differ, compared with those reported by
younger adults from previous literature.
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Method
Participants
Participants (N = 57) were recruited from the community via word of mouth;
posters which were placed in the community (London), in locations such as the
library or the church; or by way of a personal email from the researcher. Emails were
sent to participants selected from the offline pool of older adults from Plymouth
University’s School of Psychology database. Due to unavoidable time constraints,
and also in order to maximise participation figures, it was decided that participants
would be recruited from the community, as opposed to a clinical sample. The only
inclusion criterion that was required for this study was that participants had to be
‘older adults’, i.e. 60 years of age or over. In addition, given the nature of the study,
i.e. an online survey, it was also a given that participants would require access to a
computer and the internet, in order to access the survey. Participants were offered
the opportunity to enter a prize draw for £20 upon completion of the study.
Group membership of participants was determined post-data collection,
according to their score on the CES-D; scores of 16/60 and above are considered
representative of significant depressive symptomatology (Radloff, 1977). Participants
(N = 8) who provided incomplete data, e.g. those who did not finish the survey, were
removed from the dataset prior to analysis, leaving a total of 49 participants. Using
the advised CES-D cut off score, 21 participants were placed in the “depressed”
condition, with the remaining 28 placed in the “non-depressed” condition.
Materials
Materials were presented to participants in the form of an online survey, which
was made available for participants to complete in the comfort of their own home, or
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any other venue of their choice. Though the online survey format allowed
participants to choose to complete the survey in any venue of their choice, they were
advised to complete it in a private place to avoid distraction, and ensure full
confidentiality. The survey was created and presented to participants using the
following website: www.surveymonkey.com (see Appendix A for a web link to the
study). Included in the survey were the following: a consent and information form
(Appendix B) a mini demographics form (Appendix C); the Center for Epidemiologic
Studies – Depression scale (CES-D; Radloff 1977; Appendix D); the Impact of
Future Events Scale – Negative Events for a single event (IFES-N; Deeprose &
Holmes, 2010; Appendix E); the Pittsburgh Sleep Quality Index (PQSI; Buysee et al.,
1989; Appendix F); an intrusive mental imagery questionnaire (McCarthy-Jones,
Knowles & Rowse, 2012; Appendix G); a questionnaire regarding intrusive verbal
thoughts (McCarthy et al., 2012; Appendix H); the Generalised Anxiety Disorder
assessment (GAD-7; Spitzer et al., 2006; Appendix I); the Emotion Regulation
Questionnaire (ERQ; Gross & John, 2003; Appendix J); the Ruminative Responses
Scale (RRS; Treynor, Gonzalez & Nolen-Hoeksema, 2003; Appendix K); and finally,
a short debrief form, with a brief description of the study, a text box for entry into the
prize draw, and a check box to ensure that the participant had read the information
on the page (Appendix L).
The mini demographics form: this was created by the researcher, and
administered to all participants in order to determine the participant’s date of birth,
gender, and number of years in full time education. The purpose of this form was to
provide useful information for later analysis, such as the exploration of any gender
differences. It was also important for the researcher to establish each participant’s
age given that this study was exclusively for older adults.
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The CES-D (Radloff, 1997): this measure was administered in order to
establish participants’ levels of depressive symptomatology over the past week.
According to the scoring of this measure, a score of 16 or above is considered to be
representative of present depressive symptomatology. The CES-D consisted of 20
statements which relate to ways the respondent may have felt or behaved. Items are
rated by participants using the following 4-point likert scale: “rarely or none of the
time (less than one day)” (0), “some or a little of the time (1-2 days)” (1),
“occasionally or a moderate amount of the time (3-4 days)”, and “most or all of the
time (5-7 days)” (3). Both ‘negative’ and ‘positive’ statements are included in this
measure, with reverse scorings used for the positive items. There are a total of 16
negative statements, for example “I had trouble keeping my mind on what I was
doing”, and 4 positive statements, such as “I felt I was just as good as other people”.
The purpose of this measure in the current study was to establish participant’s group
membership, i.e. whether participants belong in the “depressed” condition or the
“non-depressed” condition.
The IFES-N (Deeprose & Holmes, 2010): this questionnaire was administered
in order to measure pre-experiencing of the future. The IFES-N for a single event
requires participants to provide one negative future event that they have been
imagining over the past seven days. Following this, participants are asked to
respond to 24 items which are concerned with the personal negative future event
that they had described. These items, such as “I thought about the future when I
didn’t mean to”, are rated using a 5-point likert scale, ranging from “not at all” (0), “a
little bit” (1), “moderately” (2), “quite a bit” (3), to “extremely” (4). Scores on this
measure range between 0 and 96, with higher scores being representative of higher
levels of pre-experiencing the future.
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The PSQI (Buysse et al., 1989): this was given to participants in order to
assess the quality of their sleep over the past month. This measure was specifically
devised for use with older adults, and is able to discern whether sleep quality is
“poor” or “good” by measuring seven specific aspects of sleep. The seven
characteristics that are measured are as follows: subjective sleep quality; time taken
to fall asleep; duration of sleep; sleep efficiency; disturbances of sleep; use of
medication to aid sleeping; and dysfunction during the day (Buysse et al., 1989).
Despite being a subjective measure of sleep quality, thus potentially lending itself to
inaccurate information being portrayed by the participant, the PSQI has been
repeatedly found to have an internal consistency, along with a reliability coefficient of
.83 (Buysse et al., 1989). The 19 items on this measure are separated into seven
components which correspond to the seven aspects of sleep described above. The
scores of these individual seven components, in turn, are summed to achieve a
global PSQI score. The global score can range between 0 and 21 points, with higher
scores being representative of poorer sleep quality (Buysse et al., 1989).
The intrusive mental imagery questionnaire (McCarthy et al., 2012): this
questionnaire was utilised in order to assess participants’ general experiences of
intrusive mental imagery (McCarthy et al., 2012). This questionnaire comprises of
ten questions pertaining to participants’ general experiences of mental imagery,
which are responded to on a five-point scale ranging from “strongly agree” (5),
“agree” (4), “unsure” (3), “disagree” (2), and “strongly disagree” (1), with total scores
able to range from 10 to 50. The higher the total score, the more indicative of the
tendency to experience mental imagery.
The intrusive verbal thought questionnaire (McCarthy et al., 2012): this was
created to be a concise measure of intrusive verbal thoughts. The same response
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scale is utilised for this measure, as is used in the intrusive mental imagery
questionnaire (McCarthy et al., 2012) with possible scores also ranging from 10 to
50, and higher scores representing greater experiences of intrusive mental imagery.
The GAD-7 (Spitzer et al., 2006): this is a seven-item scale used to assess
symptoms of generalised anxiety disorder. This measure requires participants to
answer questions regarding seven common symptoms of generalised anxiety
disorder, that they may have experienced over the past two weeks, for example
“feeling nervous, anxious, or on edge”. Questions are to be responded to using the
following four-point likert scale: “not at all” (0), “several days” (1), “more than half the
days” (2), and “nearly every day” (3). Total scores on this measure can range from 0
to 21, with higher scores indicating higher levels of this trait. The internal consistency
of the GAD-7 measure has been previously shown to be excellent: Cronbach alpha =
.92 (Spitzer et al., 2006).
The ERQ (Gross & John, 2003): this questionnaire is concerned with the
methods that individuals use to regulate and manage their emotions. The ERQ is
comprised of 10 questions about both emotional experience, i.e. how you feel, and
emotional expression, or how you convey your emotions in your behaviour, gestures
and speech (Spitzer et al., 2003). Participants respond to the items on this measure
using a seven-point likert scale, ranging from “strongly disagree” (1), to “neutral” (4),
to “strongly agree” (7). This questionnaire measures the way in which people
regulate their emotions. In particular, an individual’s tendency to use two emotion
regulation strategies, reappraisal and suppression, is measured. Six of the ten items
measure the tendency to use reappraisal, with the remaining four being suppression
items. Participants’ scores are collected separately for each of the two regulation
strategies (Gross & John, 2003).
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The RRS (Treynor et al., 2003): this is a self-report questionnaire designed to
measure rumination. Each of the 22 items on the measure is concerned with a
different topic which the respondent may have been thinking about, to which, using
the scale which ranges from “almost never” (1), “sometimes” (2), “often” (3), to
“almost always” (4), they must indicate how much they ruminate over the content of
the item. Total scores on this measure may range between 22 and 88, with higher
scores indicating a greater propensity for rumination (Treynor et al., 2003).
Design
An independent measures design was used. Participants were allocated to a
condition, either “depressed” or “non-depressed” based on their score on the CES-D.
Participants in both groups were tested on exactly the same variables, as described
in the material section. The independent variable was therefore, whether or not, the
person was currently displaying depressive symptomatology, according to the CES-
D. The dependent measures that were analysed in this study were as follows:
tendency to pre-experience the future; sleep quality; presence of intrusive mental
imagery; tendency to experience intrusive verbal thoughts; presence of
symptomatology typical of generalised anxiety disorder; regulation of emotions; and
finally, tendency to ruminate.
Procedure
Ethical consent for this project was obtained from the Faculty of Science and
Technology Ethics Committee at Plymouth University. On following the link to the
study, participants were presented with a short description of the study, and gave
consent to take part by checking a tick box next to the words “I have read the
information above and I agree to take part in this study”. Participants were presented
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with the questionnaires in the following order: the mini demographics form; the CES-
D; the IFES-N; the PSQI; the intrusive mental imagery questionnaire; the intrusive
verbal thoughts questionnaire; the GAD-7; the ERQ; and the RRS. At the end of the
survey, participants were thanked for their participation and were given a short
debrief. Participants were also presented with a text box in which they were
instructed to enter their email address if they wished to enter the prize draw.
Participants were also required to tick another check box to ensure they had read the
debrief information.
Results
Sample characteristics
The total sample (N = 49) comprised of 26 females (53%) and 23 males
(47%), with a mean age of 65.29 years (range = 60-77). There were no significant
gender differences for any of the measures. All but one participants provided a future
negative event that they had been experiencing over the past seven days, as
required by the IFES-N measure.
General characteristics of negative intrusive thoughts
The majority of participants provided a specific negative intrusive thought
regarding the future, which they had been imagining over the past seven days, as
per the IFES-N for a single future event. Only one participant did not provide any
negative future event. Examples of these negative future events included “feeling
lonely”, “not seeing family”, and “being too tired to keep up my daily activities” and
were similar to examples provided in previous literature. Responses provided by
participants were all viable as future events, as opposed to being characteristics of a
memory.
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Table 1. Means and standard deviations of each measure for depressed and non-
depressed conditions.
IFES-N PSQI Mental
Imagery
Verbal
thoughts
GAD-7 ERQ-R ERQ-S RRS
M S.D. M S.D. M S.D. M S.D. M S.D. M S.D. M S.D. M S.D.
D 35.5 20.3 9.13 4.69 33.1 8.89 32.7 8.29 7.95 5.72 24.9 6.49 17.7 5.02 47.1 12.4
N 13.5 11.8 4.96 2.43 25.5 10.1 23.9 10.1 2.41 1.97 29.0 6.35 14.1 6.39 28.9 5.22
Note: D = Depressed condition; N = Non-depressed condition; ERQ-R = ERQ:
Reappraisal items; ERQ-S= ERQ: Suppression items.
Analyses
Independent t-tests were carried out to compare the “depressed” and “non-
depressed” conditions on all measures included in the survey. Significant findings
were shown for all measures. Following examination of the t-tests, bivariate
correlations were also conducted, between the CES-D and all other measures, in
order to investigate whether the severity of depressive symptomatology correlated
with each of the measures included in this study. The GAD-7 was omitted from T-test
and bivariate correlation analyses.
IFES-N
As predicted, participants allocated to the “depressed” condition (M = 35.5,
S.D. = 20.3) scored significantly higher on the IFES-N for a single event, than their
“non-depressed” counterparts (M = 13.5, S.D. = 11.8; t = -4.495, df = 32, p < .001).
We can interpret this to mean that “depressed” participants reported greater levels of
pre-experiencing of the future than “non-depressed” participants. Additionally, there
was a significant positive correlation between score on the CES-D and score on the
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IFES-N (r = .733, N = 49, p = .000) suggesting that severity of depression
symptomatology increases along with levels of pre-experiencing the future. This was
a fairly strong correlation with 53.7% of the variance explained.
PSQI
Consistent with the researcher’s hypotheses, participants in the depressed
condition (M = 9.14, S.D. = 4.69) scored significantly higher on the PSQI, than non-
depressed participants (M = 4.96, S.D. = 2.43; t = -4.015, df = 47, p < .001). This
indicates that depressed participants reported greater levels of poorer sleep quality
than non-depressed participants did. A bivariate correlation also indicated a
significant positive correlation between CES-D and score on the PSQI (r = .613, N =
49, p = .000), indicating that sleep quality becomes worse as depressive
symptomatology increases. This was a moderate correlation, explaining 37.6% of the
variance.
The intrusive mental imagery questionnaire
Non-depressed participants (M = 25.5, S.D. = 10.1) reported experiencing
significantly less intrusive mental imagery than depressed participants (M = 33.1,
S.D. = 8.88) did (t = -2.776, df = 47, p = .008). Further analyses revealed a
significant positive correlation between levels of depressive symptomatology and
scores on the intrusive mental imagery questionnaire (r = .537, N = 49, p =.000).
This correlation was moderate, explaining 28.8% of the variance.
The intrusive verbal thoughts questionnaire
As expected, depressed participants (M = 32.7, S.D. = 8.29) showed
significantly greater levels of experiencing intrusive verbal thoughts than non-
depressed participants (M = 23.9, S.D. = 10.1; t = -3.288, df = 47, p = .002). A
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bivariate correlation revealed a significant positive correlation between CES-D score
and score on the intrusive verbal thoughts questionnaire (r = .546, N = 49, p = .000).
This correlation was able to explain 29.8% of the variance.
ERQ
Participants were given two scores for the ERQ, one for the reappraisal items,
and one for the suppression items. Analyses revealed that, on the reappraisal items,
participants in the depressed condition (M = 24.9, S.D. = 6.49), scored significantly
lower than participants in the non-depressed condition (M = 29.0, S.D. = 6.35; t =
2.221, df = 47, p = .031). This indicates, in line with the predictions, that depressed
individuals were less likely to use reappraisal to regulate their emotions. Bivariate
correlation also showed a significant negative correlation between score on the CES-
D and score on the reappraisal items of the ERQ (r = -.355, N = 49, p = .012), with
12.6% of the variance being explained by this correlation. Conversely, as expected,
participants in the depressed condition (M = 17.7, S.D. = 5.02) scored significantly
higher on the suppression items, than participants in the non-depressed condition (M
= 14.1, S.D. =6.39; t = -2.165, df = 47, p = .035) suggesting that non-depressed
participants were less likely the use suppression to regulate their emotions. A
significant positive correlation was revealed between the CES-D scores and
suppression item scores (r = .408, N = 49, p = .004) which was able to explain 16.6%
of the variance.
RRS
Finally, in line with the researcher’s hypotheses, participants in the depressed
condition (M = 47.1, S.D. = 12.4) scored significantly higher on the RRS than
participants in the non-depressed condition (M = 28.9, S.D. = 5.22; t = -6.429, df =
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27, p < .001). This result suggests that, as expected, depressed individuals were
more likely to ruminate than non-depressed individuals. In addition, a significant
positive correlation was found between participants scores on the RRS and their
scores on the CES-D (r = .827, N = 49, p = .000). This was quite a strong correlation,
able to explain 68.3% of the variance.
Discussion
The current study attempted to, firstly establish any differences between
depressed and non-depressed individuals on a number of cognitive measures, and
secondly, investigate the relationship between the extent of dysfunction of specific
cognitive processes, and levels of depressive symptomatology, in older adults. As
predicted, and in line with previous research, analyses suggested that participants in
the depressed condition reported poorer sleep quality, greater levels of pre-
experiencing the future, more experiences of both intrusive mental imagery and
verbal thoughts, a greater propensity for rumination, and greater use of suppression
as a mechanism for regulating emotions, as compared with their non-depressed
counterparts. Conversely, and also in line with predictions, depressed participants
were shown to be less likely to use reappraisal as a technique for managing their
emotions, in comparison to non-depressed participants. Additionally, it was found
that the content of the negative future events provided by participants, followed a
very similar vein to those reported in previous literature (Brewin et al., 1996).
Therefore, older adults did not differ, as was expected, in the content of their
intrusions, with younger adults.
Most importantly, this study was able to replicate and extend the findings of
several pieces of research, within one study, and therefore with the same sample.
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More specifically, the results that this study recreated and expanded upon were as
follows.
Findings from this study were able to support the ideas that depressed
individuals are more likely to pre-experience their future (Deeprose & Holmes, 2010)
and experience intrusive mental imagery and verbal thoughts (McCarthy-Jones et
al., 2010). Moreover, these previous findings were expanded upon by the results of
the current study, which suggest that levels of depressive symptomatology increase
hand in hand with the extent of intrusive mental imagery and verbal thoughts
experienced, and with the degree to which the individual pre-experiences the future.
Additionally, the results of this study are in line with the findings of Hall and
colleagues, (1997) which suggested that depressed individuals were more likely to
have a poorer quality of sleep, as well as frequent sleep disturbances. The current
study was also able to expand upon these results, by reporting a positive relationship
between the level of depressive of symptomatology and level of sleep disturbance.
Furthermore, this study was able replicate findings concerned with cognitive
mechanisms used for regulating of emotions. The findings provide support for the
suggestion that depressed individuals are more likely to utilise suppression, as a
method for regulating their emotions, as compared with non-depressed participants
(Gross & John, 2003). This idea was extended in the current study, with the finding
that the extent of depressive symptomatology was positively correlated with the
degree to which suppression was used to regulate emotions. Support was also found
for the notion that depressed individuals are less likely to use reappraisal
mechanisms for regulating their emotions (Gross & John, 2003). This, also, was
expanded upon, with the finding that the extent of depressive symptoms reported
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was inversely related to the participants’ use of reappraisal in emotion management.
This may be interpreted as support for the idea that the use of reappraisal to manage
emotions, is related to greater interpersonal well-being, with use of suppression
being linked to poorer interpersonal functioning and poorer life satisfaction (Gross &
John, 2003).
Evidence was also found for the idea that rumination, as a mechanism for
coping with adverse emotions, is positively related to depression. It has been
suggested that rumination is more likely to occur amongst depressed individuals, as
compared with those who are non-depressed (Treynor et al., 2003), a finding that
was replicated by this study. Additionally, the current research was able to propose
that level of depressive symptomatology may be positively correlated with extent of
rumination.
Finally, it was considered that the content of intrusions reported by older
adults may differ from those commonly recounted by younger adults with depression,
due to the changes in priority that may take place over the aging process. This was
not the case however, and the majority of intrusions were of a similar nature to those
described in much of the previous literature (Brewin et al., 1996). Furthermore, many
of the intrusive prospective thoughts provided by participants in the current study,
were of a nature very similar to the topics suggested to be most common of
depressive intrusions, i.e. familial or interpersonal issues (Reynolds & Brewin, 1999).
However, it must be noted that participants were a community sample, therefore it is
difficult to establish exactly what causes the content of the future thoughts, i.e.
whether they are due to depressive symptoms, or to age-related issues, and so on.
That being said, given that the nature of the reported intrusions was so similar to
those of clinical participants of previous literature (Brewin et al., 1996; Deeprose &
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Holmes, 2010), it would potentially be of great interest to conduct further research in
which a comparison could be made, between the intrusive thoughts of a community
and clinical sample of older adults.
Though online research carries the great advantage of being widely
accessible to potential participants, regardless of geographical location, replications
of this research may potentially be improved by perhaps removing the survey from
the internet, and conducting the research in person. The population in question come
from a generation who did not grow up using computers, and who, now, will not
necessarily have easy access to computers or to the internet. This could be a
potential explanation for the not particularly vast sample size of the current study. By
removing the requirement, that potential participants must have access to the
internet, it is possible that individuals from this age group may become more willing
to participate, thus increasing the sample size and in turn power of the results.
Alternatively, sample size may also be enhanced by keeping the study open for a
longer period of time, which was unfortunately not an option on this occasion, due to
specific time constraints.
Should the study be recreated with another community sample, it may be
beneficial to include an additional measure of depressive symptoms along with the
CES-D, in order to strengthen the categorisation of participants into either the
depressed or non-depressed conditions. If the study were recreated in person, this
could be the addition of an interview with participants, or alternatively, should the
study be replicated as an online survey, another measure such as the Beck
Depression Inventory-second edition (BDIII) could be added (Beck, Steer and
Brown, 1996).
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Ultimately, this research will be most improved by, either replication with a
clinical sample, or the addition of a clinical sample for comparison with the
community sample. Unfortunately, time constraints made the addition of a clinical
sample impossible on this occasion, though replication with the inclusion of clinical
samples of depressed patients, may have the capacity for providing very strong
support for the current literature, and is a very important next step for this research.
In conclusion, the current study was successful in its aims to provide support
for, and expand upon, a multitude of relevant previous literature. The research was
also able to address a particular sub-population which is arguably very vulnerable,
and one which, as of yet, has not been a focus of the literature. In addition, this
research was particularly important due to its capacity for application to both
theoretical research and practice. Theoretically, this study develops the previous
literature by combining aspects of several related studies, thereby strengthening the
current evidence. In terms of practice, the results lend support for much previous
literature which, if it is taken as a whole, and is further expanded upon, could be
used as a basis for seriously improving the tailoring the treatment of depression, to
hone in on the most salient features and symptoms of the disorder. Furthermore, this
is particularly important for the cohort in question, due to the reported high levels of
completed suicide within this group.
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Appendices
Appendix A: web link for the online study
Appendix B: Consent Form
Appendix C: Mini demographics form
Appendix D: CES-D
Appendix E: IFES-N
Appendix F: PSQI
Appendix G: Intrusive Imagery Questionnaire
Appendix H: Intrusive Verbal Thoughts Questionnaire
Appendix I: GAD-7
Appendix J: ERQ
Appendix K: RRS
Appendix L: Debrief form
Appendix M: SPSS output – descriptive statistics and t-tests of all measures,
between “depressed” and “non-depressed” conditions.