INTRUSIVE MEMORIES, COPING AND OUTCOME IN DEPRESSION: TOWARDS A TRAUMATIC PROCESSING MODEL?

Abstract

Recent studies (e.g. Kuyken & Brewin, 1994a) have noted the presence of high levels of disturbing intrusive memories in depressed women. Intrusive memories are best known as a post-traumatic symptom and have received considerable attention from researchers in this field. The presence of a post-traumatic symptom in depression indicates that trauma models might be useful in refining our understanding and treatment of depression. Predictions based on theories of post-traumatic processing were tested in relation to the intrusive memories of a sample of 26 depressed women. The women showed a pattern of intrusive memory experiences which indicate that their memories are likely to be traumatic in nature. The equal availability of childhood and adulthood memories to depressed women contrasts the pattern observed in the 12 control participants, and in other non-clinical samples (e.g. Berntsen, 1996), and is interpreted as lending support to theoretical models of depression which emphasise the importance of childhood experiences to adult depression. The coping strategies deployed to deal with negative intrusive memories were assessed in both groups. The clinical group showed greater use of avoidant coping than controls, in line with predictions derived from the literature regarding coping and depression. The predictive power of coping style for outcome of depression and intrusion was tested by following up 20 of the 26 depressed participants, approximately four months after initial assessment. The data indicate that the use of approach coping, specifically of Positive Reappraisal, in relation to intrusive memories was significantly predictive of better outcome of depression. This finding is interpreted in the context of psychodynamic models of depression. The data also indicate that the use of avoidant coping, specifically of Cognitive Avoidance, is significantly predictive of the maintenance of disturbing intrusions. This finding is interpreted in the context of traumatic processing models. Finally, predictions based on the conceptualisation of dissociation as an avoidant coping mechanism, used to keep traumatic affects and experiences out of consciousness, were tested. Dissociation did not show the pattern of associations predicted, but rather seemed to be more closely allied with passive resignation than active avoidance. The pattern of results obtained in this study are interpreted as lending support to the conceptualisation of depression as a trauma-related disorder, and also as lending support to theoretical models which assign great importance to childhood experiences in the aetiology of adult disorder. Potential implications of the study for clinical practice are discussed, and suggestions made for future research.