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Partner Criticism During Therapy for Recurrent MDD

Behav Res Ther; ePub 2018 Dec 21; Vittengl, et al

Some patients with major depression disorder (MDD) elicit or amplify criticism in ways that harm their relationships and psychosocial functioning, according to a recent study. Therefore, they may benefit from additional or strategic treatment. Researchers clarified relations of patient-reported criticism from partners (perceived criticism) and criticism of partners with psychosocial functioning and changes in cognitive therapy (CT) for depression. Partnered outpatients (n=219) received a 12-week CT protocol and completed measures repeatedly. They found:

  • As hypothesized, perceived criticism and criticism of partners correlated with personality (eg, perceived criticism: trait mistrust, self-harm; criticism of partners: negative temperament, aggression), social-interpersonal problems (perceived criticism: cold and overly nurturing behavior; criticism of partners: vindictive and domineering behavior; both measures: poor adjustment in partnered and family relationships), cognitive content (both measures: negative failure attributions, dysfunctional attitudes), and depressive symptom intensity (both measures), although effect sizes were small-moderate.
  • Both criticism measures decreased little during CT and remained elevated compared to community norms, despite the fact that relations between the criticism measures and depressive symptoms included both stable trait and more transient state components.

Citation:

Vittengl JR, Clark LA, Thase ME, Jarrett RB. Partner criticism during acute-phase cognitive therapy for recurrent major depressive disorder. [Published online ahead of print December 21, 2018]. Behav Res Ther. doi:10.1016/j.brat.2018.12.010.

Commentary:

This study supports existing literature regarding the relationship of patients’ personality traits and behavior in either driving their major depressive disorder (MDD) symptoms and/or hindering treatments aimed solely at addressing MDD. For example, a previous study found that if patients with MDD perceived criticism by their partner, even in the absence of clear criticism, it predicted a MDD relapse. Another study found that dysphoria lent towards more perception of criticism. This suggests a bidirectional relationship between dysphoria and perception of criticism and that erroneous over-perception of criticism occurs in MDD patients with repetitive, maladaptive personality traits. This current study is unique in that it addresses this phenomenon in the causation of recurrent depression. In addition, the perception of criticism continued despite the provision of cognitive therapy (CT) to address the MDD. This suggests that in the alleviation of MDD, CT may not address personality-driven symptoms and that ongoing elevated perception of criticism can lead to further MDD recurrence.—Thomas L. Schwartz, MD; Senior Associate Dean of Education, Interim Chair/Professor of Psychiatry, SUNY Upstate Medical University.

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