Maladaptive avoidance processes distinguish chronic from episodic depression

By Lucy Piper, Senior medwireNews Reporter

Patients with chronic depression can be differentiated from those with episodic depression according to their levels of cognitive–behavioural and emotional avoidance, study findings suggest.

Specifically, the 30 study participants with chronic depression reported significantly more cognitive- and behavioural-nonsocial avoidance and behavioural-social avoidance on the Cognitive–Behavioural Avoidance Scale (CBAS) than 30 patients with episodic depression. The differences in scores were 0.52, 0.52 and 0.42 points, respectively.

They also reported greater emotional avoidance on the avoidance subscale of the Need for Affect Scale (NAS–A), with a difference of 0.35 points.

“This particular kind of emotional avoidance refers to restricted emotional expression due to a subjectively perceived lack of skills for adequate emotional expression”, explain the researchers led by Timo Brockmeyer (University Hospital Heidelberg, Germany).

This emotional avoidance was also the best measure for discriminating the chronically depressed patients from those with episodic depression, they report in the Journal of Affective Disorders.

In differentiating between episodic and chronic depression, “a step that has rarely been undertaken so far”, the researchers have expanded on previous research showing elevated levels of cognitive–behavioural and emotional avoidance in individuals with depression compared with those without.

“[T]he present study lends support to the clinical distinction between chronic and non-chronic forms of depression that appears useful against the backdrop of their differences in psychopathology, etiological factors, treatment response, and burden of disease”, the team comments.

It also advocates a stronger focus on maladaptive avoidance processes in the treatment of chronic depression, for which there is at least some preliminary evidence, they say, although “far more research is needed to examine which treatment packages and specific ingredients are best suited to address the specific features of chronic depression.”

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