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Abstract

“Extreme responding” is the tendency to endorse extreme responses on self-report measures (e.g., 1s and 7s on a 7-point scale). It has been linked to depressive relapse after cognitive therapy (CT), but the mechanisms are unknown. Moreover, findings of positive extreme responding (PER) predicting depressive relapse do not support the original hypothesis of “extreme” negative thinking leading to extreme negative emotional reactions. We assessed the relationships between post-treatment PER on the Dysfunctional Attitudes Scale (DAS) and Attributional Style Questionnaire (ASQ) and these constructs: coping skills, in-session performance of cognitive therapy skills, age, and estimated IQ. Significant correlates were entered into a model predicting rate of relapse to determine whether these constructs explained the relationship between PER and relapse. The sample consisted of 60 individuals who participated in CT for moderate to severe depression. Results indicated the following relationships: a negative correlation between ASQ PER and IQ, negative correlations between DAS PER and performance of CT skills and planning coping, and a positive correlation between DAS PER and behavioral disengagement coping. IQ scores fully accounted for the relationship between ASQ PER and relapse. These results suggest two potential mechanisms linking PER to relapse: cognitive limitations and coping deficits/cognitive avoidance.

6.5. Limitations

In addition to the limitation of our scoring procedures, limitations of the current study include the relatively small sample, which limited our power to detect relationships among our variables. We also conducted multiple tests without correction to the significance level, which increases the chance of Type 1 error. Also, because these data were not collected to test associations with extreme responding, we were limited with respect to the potential covariates available. For example, we had no direct means of measuring cognitive avoidance. Finally, we examined extreme responding variables at the end of acute treatment, so our findings may not reflect what variables would correlate with change in the PER. We selected end of treatment PER scores to examine in contrast with change for two reasons: 1) it is consistent with how extreme responding has been measured in previous studies (Forand & DeRubeis, 2014; Teasdale et al., 2001) and 2) patterns of change are divergent between instruments, which would have complicated these analyses. Analysis of change in extreme responding should be examined in future work.