Yao Jiayu, Lin Qingqing, Zheng Ziwei, Chen Shuangyi, Wang Yuan, Jiang Wenhui, Qiu Jianyin
Department of Psychological Counseling & Psychotherapy, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gen Psychiatr. 2022 Jun 27;35(3):e100794. doi: 10.1136/gpsych-2022-100794. eCollection 2022.
Many psychotherapy theories emphasise the importance of self-schema and other-schema, but most previous studies focused on the explicit self-schema in major depressive disorder (MDD). However, the limited studies of implicit self-schema in MDD have shown inconsistencies in their findings. Furthermore, only a few studies have investigated the implicit other-schema, and the pathway illustrating how implicit schemas influence depression remains unclear.
The primary aim of our study was to explore the characteristics of implicit self-schema and other-schema in patients with MDD. We also examine the chain-mediating effect of attachment relationships and interpersonal trust.
The present study included 88 patients with MDD and 88 healthy controls (HCs). The Hamilton Depression Rating Scale-17, Experiences in Close Relationships Inventory-Revised Questionnaire, Trust Scale and the Extrinsic Affective Simon Task (EAST) were used to assess depressive symptoms, attachment relationships, interpersonal trust and implicit schemas, respectively. Paired sample t-test was used to compare the reaction time (RT) for positive and negative words within the two groups. Analysis of covariance was used to explore the difference between two groups from the perspective of implicit schemas and interpersonal patterns. The chain mediation model was verified by bootstrap.
(1) For interpersonal patterns, patients with MDD scored significantly higher on attachment anxiety (F=82.150, p<0.001) and attachment avoidance (F=23.192, p<0.001) and scored significantly lower on the predictability (F=30.297, p<0.001), dependence (F=39.728, p<0.001) and faith (F=60.997, p<0.001) dimensions of interpersonal trust. (2) As for implicit schemas, no significant difference was found between the RT for positive self-words and negative self-words in patients with MDD (t=-1.056, p=0.294). However, the HC responded faster to positive self-words than negative self-words (t=-3.286, p=0.001). The RT for positive other-words and negative other-words were significantly different in both patients with MDD (t=2.943, p=0.004) and HCs (t=-2.482, p=0.015), with opposite directions. The EAST effect of other-schema in patients with MDD was significantly different from that in HCs (F=13.051, p<0.001). (3) For the total sample, the EAST effect of other-schema significantly correlated with attachment avoidance, interpersonal trust and depressive symptoms. Attachment avoidance and interpersonal trust were the chain mediators between the EAST effect of other-schema and depressive symptoms (95% CI: -0.090 to -0.008). However, no significant results were found for the EAST effect of other-schema when correlation and mediation analyses were performed for HCs and patients with MDD separately.
This study verified that patients with MDD have abnormal interpersonal patterns and negative implicit schemas. However, no mediating effect of attachment relationships and interpersonal trust was found.
许多心理治疗理论强调自我图式和他人图式的重要性，但此前大多数研究聚焦于重度抑郁症（MDD）中的显性自我图式。然而，对MDD中隐性自我图式的有限研究结果并不一致。此外，仅有少数研究调查了隐性他人图式，且阐明隐性图式如何影响抑郁的途径仍不明确。
我们研究的主要目的是探索MDD患者隐性自我图式和他人图式的特征。我们还检验了依恋关系和人际信任的链式中介效应。
本研究纳入了88例MDD患者和88名健康对照（HCs）。分别使用汉密尔顿抑郁量表-17、亲密关系经历量表修订版问卷、信任量表和外在情感西蒙任务（EAST）来评估抑郁症状、依恋关系、人际信任和隐性图式。采用配对样本t检验比较两组内对积极和消极词汇的反应时间（RT）。协方差分析用于从隐性图式和人际模式的角度探索两组之间的差异。通过自助法验证链式中介模型。
（1）在人际模式方面，MDD患者在依恋焦虑（F = 82.150，p < 0.001）和依恋回避（F = 23.192，p < 0.001）上得分显著更高，而在人际信任的可预测性（F = 30.297，p < 0.001）、依赖性（F = 39.728，p < 0.001）和信念（F = 60.997，p < 0.001）维度上得分显著更低。（2）至于隐性图式，MDD患者对积极自我词汇和消极自我词汇的RT之间未发现显著差异（t = -1.056，p = 0.294）。然而，HCs对积极自我词汇的反应比对消极自我词汇更快（t = -3.286，p = 0.001）。MDD患者和HCs对积极他人词汇和消极他人词汇的RT均存在显著差异（t = 2.943，p = 0.004；t = -2.482，p = 0.015），且方向相反。MDD患者中他人图式的EAST效应与HCs中的显著不同（F = 13.051，p < 0.001）。（3）对于总样本，他人图式的EAST效应与依恋回避、人际信任和抑郁症状显著相关。依恋回避和人际信任是他人图式的EAST效应与抑郁症状之间的链式中介（95%CI：-0.090至-0.008）。然而，当分别对HCs和MDD患者进行相关和中介分析时，未发现他人图式的EAST效应有显著结果。
本研究证实MDD患者存在异常的人际模式和消极的隐性图式。然而，未发现依恋关系和人际信任的中介效应。
