Abstract
Background
Depression is characterized by a tendency to overestimate the probability of negative life events and underestimate the probability of positive events. Although cognitive behavioral therapy (CBT) targets overly negative future expectations, research has yet to examine how such expectations change relative to one’s experiences. We examined the relation between predictions and event occurrence for positive and negative life events (i.e., informativeness of predictions [IoP]) among patients in CBT for depression. We examined how IoP changed over the course of CBT and whether these changes were related to CBT skill acquisition or symptom reduction.
Methods
At intake and posttreatment, 67 patients were asked to estimate the probability of 40 events in the following week; patients later reported whether the events occurred.
Results
IoP improved for positive but not negative events across treatment. IoP for positive (but not negative) events were also associated with symptoms at intake and therapist-rated CBT skills at posttreatment. However, neither positive nor negative event IoP changes were associated with symptom improvement over the course of CBT.
Conclusions
These findings suggest changes in the informativeness of predictions of positive life events may uniquely change and be important to the development of skills in CBT for depression.
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Data Availability
Pending IRB approval for sharing, the dataset described in this paper is available from the corresponding author on reasonable request.
Notes
In a series of t-tests, we did not find any significant differences between patients offered vs. not offered twice weekly sessions in key study variables (viz., event predictions, outcomes, and IoP) at intake or posttreatment (all ps > .05).
Some prior studies have examined the degree to which pessimistic/optimistic biases (i.e., the average difference between predictions and outcomes for each event) have corresponded to depressive symptoms (e.g., Strunk & Adler, 2009; Strunk et al., 2006). While this paper is focused on IoP, it is worth noting that pessimistic/optimistic bias as examined in these earlier studies did not change over the course of treatment (overall t(42) = -0.28, p = .78, d = 0.12 for positive events t(42) = -0.03, p = .98, d = 0.02, or for negative events t(42) = -0.24, p = .81, d = 0.11). Insofar as there are individual differences in the average probability judgment given for positive or negative events independent of one’s pessimistic/optimistic bias, the approach we take in this paper (focused on informativeness of predictions) may better reveal the extent to which patients experience changes in their views on future life events than the pessimistic/optimistic bias approach used in previous papers.
These analyses were necessarily limited to the portion of the sample that completed the study. We ran a series of t-tests to examine whether those who did and did not complete the study differed on key variables. There were no significant baseline differences on IoP, predictions, and outcomes of positive and negative life events.
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Funding
This study was funded by the National Center for Research Resources [Award Number TL1RR025753]. Writing of this manuscript was in part supported by a Career Development Award, Department of Veterans Affairs, United States [Grant Number RX002952].
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Iony D. Ezawa, Lizabeth A. Goldstein, Daniel R. Strunk declare that they have no conflict of interest.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by The Ohio State University’s Institutional Review Board.
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Ezawa, I.D., Goldstein, L.A. & Strunk, D.R. Improving Positive Life Event Predictions through Cognitive Behavioral Therapy. Cogn Ther Res 44, 1034–1041 (2020). https://doi.org/10.1007/s10608-020-10119-y
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DOI: https://doi.org/10.1007/s10608-020-10119-y