Metacognitions and emotional schemas: a new cognitive perspective for the distinction between unipolar and bipolar depression

• Published in: Comprehensive psychiatry 2014-10, Vol.55 (7), p.1546-1555
• Main Authors: Batmaz, Sedat, Ulusoy Kaymak, Semra, Kocbiyik, Sibel, Turkcapar, Mehmet Hakan
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - psychology; Bipolar disorders; Case-Control Studies; Cognition; Cognitive style; Depressive Disorder - diagnosis; Depressive Disorder - psychology; Diagnosis, Differential; Emotions; Female; Humans; Male; Medical sciences; Mental depression; Miscellaneous; Models, Statistical; Mood disorders; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology; Psychopathology. Psychiatry; Self esteem; Studies; Young Adult
• ISSN: 0010-440X; 1532-8384
• DOI: 10.1016/j.comppsych.2014.05.016

Abstract Introduction Clinicians need to make the differential diagnosis of unipolar and bipolar depression to guide their treatment choices. Looking at the differences observed in the metacognitions, and the emotional schemas, might help with this differentiation, and might provide information about the distinct psychotherapeutical targets. Methods Three groups of subjects (166 unipolar depressed, 140 bipolar depressed, and 151 healthy controls) were asked to fill out the Metacognitions Questionnaire–30 (MCQ-30), and the Leahy Emotional Schema Scale (LESS). The clinicians diagnosed the volunteers according to the criteria of DSM-IV-TR with a structured clinical interview (MINI), and rated the moods of the subjects with the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Statistical analyses were undertaken to identify the group differences on the MCQ-30, and the LESS. Results The bipolar and unipolar depressed patients' scores on the MCQ-30 were significantly different from the healthy controls, but not from each other. On the LESS dimensions of guilt, duration, blame, validation, and acceptance of feelings, all three groups significantly differed from each other. There were no statistically different results on the LESS dimensions of comprehensibility, consensus, and expression. The mood disordered groups scored significantly different than the healthy controls on the LESS dimensions of simplistic view of emotions, numbness, rationality, rumination, higher values, and control. Conclusions These results suggest that the metacognitive model of unipolar depression might be extrapolated for patients with bipolar depression. These results are also compatible to a great extent with the emotional schema theory of depression.