Automatic Thoughts and Cognitive Change In Post-Cardiac Surgery Depression

 

Purpose/Aims: To investigate the role of automatic thoughts in the cognitive change process during an eight-week course of Cognitive Behavioral Therapy (CBT) for depressed post-cardiac surgery (CS) patients. Background:  Cognitive theorists posit that depression results from cognitive distortions manifested by a propensity to experience the world in a negative way. Negative automatic thoughts (ATs) are believed provide a common pathway for cognitive distortions.  In post-CS patients, CBT is known to improve depressive symptoms. However, in this population, there have been no reports of the role of ATs in the cognitive change process during CBT.  Methods: Thirty six depressed CS patients (mean age 64 ± 10 years, 83% male) were randomized to usual care (UC) or 8 weeks of CBT by trained nurses. For this report, patients in the UC group were matched for age and gender to those in the CBT group. At baseline and post-CBT, the intervention group (n=18) completed the Beck Depression Inventory (BDI) and the Automatic Thoughts questionnaire (ATQ), which includes four subscales (i.e. negative self-concepts and expectations [NSNE], personal maladjustment and desire for change [PMDA], helplessness, and low self-esteem [LSE]). The UC group (n=18) completed only the BDI at both points. Group comparisons of changes in BDI scores from baseline to 8 weeks were evaluated by general linear modeling.  Changes in pre- and post-CBT ATQ scores were measured by independent t-tests. Correlations of total BDI scores and ATQ subscale scores were evaluated by Spearman's rho. Results: Compared to UC, the CBT group showed a significant reduction (time x group interaction, p < .001) in BDI scores (Fig 1, Panel A). In the CBT group, there were significant decreases in both BDI (47.46 ± 17.8 vs 16.6 ± 18.9, p = .001) and ATQ (56 ± 20.7 vs 50.4 + 18.5, p = .01) in pre- vs post-CBT scores (Fig 1, Panel B).  All ATQ subscale scores were significantly correlated with BDI scores (NSNE, r_s = .57, p = .01; PMDA, r_s = .52, p = .03; Helplessness, r_s = .74, p < .01; LSE r_s = .53, p = .03). Implications: This study demonstrates a significant improvement in depressive symptoms and automatic thoughts in a small group of post-CS patients who received CBT.  Helplessness was most strongly correlated with depressive symptoms at pre- and post-CBT. Further study in a large population is needed to investigate further the role of automatic thoughts in the CBT process and potentially improve depression outcomes.