Overcontrolled Tendencies in Refractory Depression compared to Acute Non-Chronic Depression; The Importance of Treating Maladaptive Personality Style
Thesis or dissertation
University of Exeter
By 2020 depression is predicted to be the second most frequent cause of disability worldwide. Research suggests that existing methods of treatment are ineffective for many resulting in a large number of chronic, treatment resistant courses (termed refractory depression [RD]). Further evidence suggests that up to 60% of individuals with RD have a co-morbid Personality Disorder (PD), namely Clusters A and C. As such, it has been proposed that individuals with RD fail to respond to existing treatment interventions because these treatments fail to address maladaptive personality styles (i.e., overcontrol tendencies) that may complicate treatment. This project aimed to test this novel assertion by examining whether individuals with RD exhibit higher levels of overcontrol (e.g., skills deficits in the expression and experience of emotion, in forming close relationships and in receptivity and openness) compared to individuals with current, but not chronic, depression and a normal control group. A total of 180 individuals were recruited and based on eligibility criteria were allocated to the following groups: RD, n = 56; acute, non-chronically depressed (ANCD), n = 61; normal control (NC), n = 63. Participants completed a series of self-report questionnaires and as a whole, between group analyses supported study predictions; individuals with RD displayed significantly higher levels of overcontrol compared to both the ANCD and NC groups. More specifically, individuals with RD demonstrated significantly more difficulties with interpersonal relationships and expressing emotions, a significantly greater need for structure and significantly higher levels of maladaptive perfectionism compared to controls. This study forms part of a large multi-centre randomised controlled trial (RCT; REFRAMED) that is designed to study the efficacy of a novel treatment intervention - Radically Open-Dialectical Behaviour Therapy – for individuals with RD.
Doctorate in Clinical Psychology