Psychiatry Research 238 (2016) 159–164

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Deficits of cognitive restructuring in major depressive disorder:

Measured by textual micro-counseling dialogues
Nengzhi Jiang a,b, Fei Yu a, Wencai Zhang a,n, Jianxin Zhang a,n
a
Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, PR China
b
Department of Psychology, Weifang Medical University, Weifang 261053, Shandong, PR China

art ic l e i nf o a b s t r a c t

Article history: Cognitive restructuring is an important strategy in cognitive behavioral therapy (CBT). The present study
Received 31 July 2015 aimed to observe cognitive restructuring in major depressive disorder (MDD) patients using textual
Received in revised form micro-counseling dialogue situations. A set of textual micro-counseling dialogues was used to trigger
12 January 2016
cognitive restructuring in 25 MDD patients and 27 healthy adults. The participants read descriptions
Accepted 15 February 2016
(“problems”) and explanations (“solutions”) for psychologically distressing situations. High-, low-, and
Available online 17 February 2016
zero-restructuring solutions were randomly matched to the problems. The participants evaluated the
Keywords: adaptability and emotional valence of the problems and the insightfulness, adaptability, novelty, and
Major depressive disorder emotional valence of the solutions. Insightfulness ratings for high-restructuring solutions were sig-
Cognitive restructuring
nificantly higher relative to those of low-restructuring solutions in healthy adults, while adaptability
Insightfulness
ratings for low-restructuring solutions were significantly higher relative to those of high-restructuring
Adaptability
solutions in MDD patients. Insightfulness ratings for the solutions were significantly predicted by novelty
and adaptability in healthy adults and emotional valence in MDD patients. Lower insightfulness in high-
restructuring solutions and higher adaptability in low-restructuring solutions in MDD patients may re-
flect deficits in cognitive control.
& 2016 Elsevier Ireland Ltd. All rights reserved.

1. Introduction positive reappraisal, and putting into perspective, less frequently

Sustained negative mood and anhedonia are cardinal symp-
toms of major depressive disorder (MDD) (American Psychiatric
Association, 1994). These symptoms may be related to difficulties
in using adaptive regulation strategies such as cognitive re-
appraisal (Campbell-Sills et al., 2006; Kovacs et al., 2008; Kring
and Werner, 2004). Cognitive reappraisal was defined as the re-
interpretation of an emotion-eliciting situation in a manner that
alters its forthcoming emotional impact (Gross and Thompson,
2007). Some studies have found that emotion regulation deficits in
depression were associated with more frequent use of maladaptive
suppression strategies and less frequent use of adaptive re-
appraisal strategies (Ehring et al., 2010; Gross and Thompson,
2007; Lei et al., 2014; Nolen-Hoeksema, 2004). More specifically,
one study found that, relative to healthy adults, MDD patients
used maladaptive strategies, such as self-blame, rumination, cat-
astrophizing, and blaming others, more frequently and adaptive
strategies, such as positive refocusing, refocus on planning,
n
Corresponding authors at: Key Laboratory of Mental Health, Institute of Psy-
chology, Chinese Academy of Sciences, No 16 LinCui Road, Beijing 100101, PR China.
E-mail address: zhangwc@psych.ac.cn (W. Zhang).
(Lei et al., 2014). Other studies have examined the effectiveness of
cognitive reappraisal in experimental task. Some found that re-
appraisal strategies were less effective for MDD patients than they
were for a control group (D’Avanzato, 2013; Johnstone et al., 2007;
Siegle et al., 2007), while others found that the groups did not
differ significantly, but MDD patients benefited less from the use of
reappraisal strategies (Dillon and Pizzagalli, 2013; Ehring et al.,
2010; Platt et al., 2015).
Cognitive restructuring is a core concept in cognitive behavioral
therapy (CBT), which is defined as the process of identifying core
maladaptive beliefs and correcting them by generating more
adaptive alternative modes of thinking (Clark and Beck, 2010;
Holtforth et al., 2006). Cognitive restructuring is believed to be
similar to cognitive reappraisal, as both require participants to
reinterpret negative stimuli or events in a more adaptive or po-
sitive manner (Shurick et al., 2012). Three cognitive restructuring
factors have been identified (Wolgast et al., 2013): cognitive re-
appraisal (changing emotional reactions by altering the appraisal
of an emotion-eliciting stimulus), constructive refocusing (re-
interpreting the function of the situation), and distractive re-
focusing (thinking about something else). Sudden gains (marked
symptom improvements) in MDD patients undergoing CBT have
been found to follow substantial cognitive changes during

http://dx.doi.org/10.1016/j.psychres.2016.02.027
0165-1781/& 2016 Elsevier Ireland Ltd. All rights reserved.
160 N. Jiang et al. / Psychiatry Research 238 (2016) 159–164
preceding therapy sessions (Tang and DeRubeis, 1999; Tang et al.,
2005); therefore, the effects of sudden gains are believed to be
produced via cognitive restructuring. Moreover, cognitive re-
structuring is also known as insight in CBT (Holtforth et al., 2006)
and has been shown to help individuals to obtain “new perspec-
tive on the origins, determinants, meanings, or consequences of
their behaviors, thoughts, intentions, or feelings.” In a clinical
setting, cognitive restructuring often occurs when therapists pro-
vide insightful explanations for clients' problems. However, sui-
table means of triggering a similar cognitive restructuring process
repeatedly in a controlled experimental setting remain unclear.
The present study focused on cognitive restructuring deficits in
depression in an experimental setting according to the experi-
mental paradigm of micro-restructuring developed by Yu et al.
(2015), which is based on a set of textual micro-counseling dia-
logue items in CBT. In this paradigm, “maladaptive thinking” and
“adaptive thinking,” as components of the concept of cognitive
restructuring, are reduced to “problems” and “solutions,” respec-
tively. Participants read a description of a psychologically distres-
sing problem (I feel extremely frustrated because of beginning a
career that I dislike) followed by a randomly matched high-re-
structuring solution including figures of speech (Success in life is
not about holding good cards but playing bad cards well), a low-
restructuring solution with a plain and soothing reinterpretation
(Success depends mainly on effort; it is important to do a good job
now), or a zero-restructuring solution restating the original
meaning of the problem (Your current profession is not your fa-
vorite. You have no hope for the future). Therefore, virtual coun-
seling situations are constructed in the form of textual dialogue. In
Yu et al. (2015) study, psychotherapists and university students
evaluated the dialogue material in terms of insightfulness (the
extent to which it provided enlightenment as to life's challenges or
problems), adaptability (the extent to which it was useful in life),
novelty (the extent to which it was new or distinctive), and
emotional valence (the extent to which it was emotionally posi-
tive) and unanimously agreed that high-restructuring solutions
were associated with the greatest degree of insightfulness and
novelty.
What are the characteristics of the micro-counseling dialogue
paradigm? This paradigm is similar to the traditional cognitive
reappraisal paradigm, in that both aim to change participants'
negative cognition, which is the basic goal of CBT, and the process
can be triggered repeatedly in a controlled experimental setting.
There are also some differences between the two paradigms. For
example, in the cognitive reappraisal paradigm, the participant is
initially taught how to perform a cognitive reappraisal and re-
interpret a negative emotional stimulus to alleviate its negative
impact; this cognitive reappraisal is often self-generated. In con-
trast, in the micro-restructuring paradigm, the participant reads an
explanation of negative stimulus restructuring (Yu et al., 2015).
Cognitive restructuring is performed as a means of understanding
externally provided views. In the cognitive reappraisal paradigm,
experimental materials consist of pictures or film clips
(D’Avanzato, 2013; Ehring et al., 2010; Foti and Hajcak, 2008; Platt
et al., 2015). In the micro-restructuring paradigm, the problems
Table 1
Examples of restructuring materials.
Problem Solution
Zero restructuring
I feel extremely frustrated because of Your current profession IS not your fa-
beginning a career that I dislike. vorite. You have no hope for the future.
I'm not interested in anything because a I have experienced much adversity. I'm
series of distress press on me. listless and don't know what to do.
and solutions are textual descriptions of psychological distress and
adaptive explanation, respectively. In the cognitive reappraisal
paradigm, the effects of cognitive reappraisal are measured ac-
cording to changes to the subjective experience of negative sti-
muli, whereas in the micro-restructuring paradigm, the effects of
cognitive restructuring are measured according to multi-
dimensional subjective experiences, such as insightfulness,
adaptability, novelty, and emotional valence. Relative to the cog-
nitive reappraisal paradigm, the text-based micro-restructuring
paradigm is much closer to true CBT counseling situations.
In summary, the present study aimed to determine whether
MDD patients experienced cognitive restructuring deficits, using a
textual micro-restructuring paradigm. Specifically, four indices of
cognitive restructuring were evaluated: insightfulness, adapt-
ability, novelty, and emotional valence. We hypothesized that
MDD patients' experience of the four indices of cognitive re-
structuring would differ from those of healthy adults.
2. Methods
2.1. Participants
The clinical participants were recruited from the Department of
Psychiatry at the Weifang People's Hospital, Weifang, China. They
were assessed by an experienced psychiatrist using the Structured
Clinical Interview for Axis I DSM-IV Disorders and 17-item Ha-
milton Depression Rating Scale (HDRS) (Hamilton, 1967). Twenty-
five clinical participants met the Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria
for major depressive disorder and scored Z18 on the HDRS
(M¼ 22.40, SD ¼3.40). These participants were assigned to the
depression group, which included 16 women and 9 men ranging
in age from 17 to 53 (M ¼32.96, SD ¼11.12) years, with a mean
educational level of 12.76 (SD ¼ 3.76) years. Healthy participants
were recruited via a community advertisement displayed in Wei-
fang between October and December 2014. Twenty-seven volun-
teers were assigned to the control group, which included 17 wo-
men and 10 men ranging in age from 18 to 52 (M ¼32.85,
SD ¼10.60) years, with a mean educational level of 13.11
(SD ¼3.68) years. Their HDRS scores were o8 (M ¼3.81, SD ¼1.00).
All participants were free of psychotropic medication for a mini-
mum of 2 weeks and had no history of neurological or other
mental diseases. The study was approved by the research ethics
committee of the Institute of Psychology at the Chinese Academy
of Science, and written informed consent was obtained from all
participants.
2.2. Materials
2.2.1. Experimental materials
The experimental materials consisted of 24 pairs of textual
micro-counseling dialogues, which were selected from content
that suited MDD patients in our previous study. Each pair con-
sisted of one problem and three solutions, one for each
Low restructuring High restructuring
Success depends mainly on effort; it is Success in life is not about holding good
important to do a good job now. cards but playing bad cards well.
Anything bad is just temporary; you Life is not about waiting for the storm
should be active in facing life. to pass but dancing in the rain.
 N. Jiang et al. / Psychiatry Research 238 (2016) 159–164 161

restructuring level, as shown in Table 1. The random experimental as the within-subjects factor and the participant groups (depres-
material for each participant consisted of 24 problems, each with a sion and control) as the between-subjects factor. Ratings for the
solution that had been randomly allocated with equal probability zero-restructuring condition were used as baseline responses, to
to that of other solutions; therefore, there were eight pairs of allow the change scores (calculated by subtracting them from the
problems with high-restructuring solutions, eight with low-re- high- and low-restructuring condition scores) to serve as a better
structuring solutions, and eight with zero-restructuring solutions. index of the extent of restructuring and provide a more suitable
The items were presented randomly to avoid order effects. comparison of the differences between the two conditions, as the
influence of baseline differences were excluded.
2.2.2. Cognitive Emotion Regulation Questionnaire (CERQ-short) Two-way repeated-measures ANOVAs were then performed to
The 18-item version of the Cognitive Emotion Regulation assess change scores for insightfulness, adaptability, novelty, and
Questionnaire was used to measure typical use of specific cogni- emotional valence for solutions with two restructuring levels
tive emotion-regulation strategies (Garnefski and Kraaij, 2006). (high- and low-zero restructuring solutions) as the within-sub-
The instrument includes nine subscales: self-blame, acceptance, jects factor and the participant groups (depression and control) as
rumination, catastrophizing, blaming others, positive refocusing, the between-subjects factor. Simple effect analysis was performed
refocus on planning, positive reappraisal, and putting into per- using Bonferroni-corrected multiple comparisons. Multiple re-
spective. Each subscale consists of two items scored on a five-point gression analyses were performed to assess the depression and
Likert scale ranging from 1 (almost never) to 5 (almost always). A control groups, with change scores for insightfulness ratings be-
subscale score is obtained by summing up the scores for two items tween the high- and low-zero restructuring solutions as depen-
(providing a score range of 2–10). Higher subscale scores, reflect dent variables and the change scores for adaptability, novelty, and
more frequent use of a specific cognitive strategy. The CERQ-short emotional valence ratings as independent variables.
has demonstrated acceptable reliability and validity (Garnefski
and Kraaij, 2006). The internal consistency of the CERQ-short was
acceptable in the present study, with Cronbach's α ¼0.74 for the 3. Results
total CERQ-short score and subscales ranging from α ¼0.69 to
α ¼0.81 in the depression group; the alpha for the total score was 3.1. Demographic and clinical characteristics
0.84 and for subscales ranged from 0.71 to 0.87 in the control
group. T-test results showed that the depression group displayed
higher HDRS scores relative to those of the control group. On the
2.3. Procedure CERQ-short, the depression group exhibited higher scores for ru-
mination and catastrophizing and lower scores for positive re-
All participants completed the Cognitive Emotion Regulation
appraisal and putting into perspective relative to those of the
Questionnaire (CERQ-short) and experimental task in a quiet
control group. The depression and control groups did not differ
room. The instructions for the experiment were presented as
significantly according to sex, age, or education (See Table 2).
follows:
Pearson correlations between cognitive emotion regulation
Thank you for participating in our experiment. This is a study
strategies and depressive symptoms were calculated for both
about mental health. The descriptions in row P are some ideas or
groups. Both rumination (r ¼0.4, po 0.05) and catastrophizing
thoughts that clients may have when encountering negative
(r ¼0.4, p o0.05) were significantly positively correlated with
events or problematic settings. The statements presented in row S
HDRS depression scores in the depression group. Other cognitive
are solutions that therapists may provide. Please rate them ob-
emotion regulation strategies were not significantly correlated
jectively from the client's perspective, according to the instruc-
with depressive symptoms in either group (All rs o0.33,
tions, and imagine them vividly, as if you are in an interactive
ps 4 0.05).
counseling scenario.
We asked participants to assess the solutions in terms of in-
sightfulness (i.e., the extent to which there was a cognitive “click” 3.2. Two-way repeated-measures ANOVAs
or enlightenment that would be helpful in understanding life's
challenges or problems), adaptability (i.e., the extent to which the 3.2.1. Problems
solution was functional or helpful in adapting to life's challenges), Average emotional valence and adaptability ratings for
novelty (i.e., the extent to which the solution was new, distinctive,
Table 2
and unexpected), and emotional valence (i.e., the extent to which
Participants' demographic and clinical characteristics.
the solution was emotionally positive). Problems were assessed in
terms of adaptability and emotional valence. All ratings were Variable Depression Control t
provided on a five-point Likert scale ranging from 1 (not at all) to 5
2
(very much). Sex (F/M;χ ) 9/16 10/17 0.006
Age(years) 32.96 7 11.21 32.85 710.60 0.36
Education (years) 12.767 3.76 13.11 73.68  0.34
2.4. Data analysis HDRS scores 22.40 7 3.40 3.81 71.00 27.15nnn
Self-blame 6.767 2.17 5.81 71.69 1.76
All analyses were performed using SPSS 18.0. A chi-square test Blaming others 5.36 7 2.45 4.707 1.38 1.18
Rumination 7.36 7 2.08 6.077 1.54 2.55n
and two sample t-tests were performed to compare sex, age,
Catastrophizing 7.767 2.09 4.487 1.37 6.75nnn
education, HDRS, and CERQ-short subscale scores between the Acceptance 7.28 7 2.40 7.30 7 1.46  0.03
depression and control groups. Pearson correlation coefficients Refocus on planning 7.04 72.48 7.747 2.01  1.12
were calculated to identify relationships between CERQ-short Positive refocusing 4.28 7 1.84 6.377 1.94  3.98
subscale and HDRS scores in both groups. A two-way repeated- Positive reappraisal 6.08 7 2.08 7.487 1.93 2.52n
Putting into perspective 4.52 7 1.71 6.447 1.74  4.02nnn
measures ANOVA was performed to examine the adaptability and
emotional valence of the problems and determine whether they Note: F ¼ female; M ¼male; HDRS¼ Hamilton Depression Rating Scale.
were matched to different levels of solution equally with the three n
p o 0.05.
nnn
restructuring levels (high-, low-, and zero-restructuring solutions) po 0.001.
162 N. Jiang et al. / Psychiatry Research 238 (2016) 159–164

problems matched to three types of solution were calculated and

analyzed for both groups. Two-way repeated-measures ANOVAs
demonstrated no significant main effects for restructuring level or
group and no interaction effect between restructuring level and
group for emotional valence (All Fs o 2.05, ps 40.05; depression
group M7SD: high-restructuring: 1.72 70.68, low-restructuring:
1.69 70.74, zero-restructuring: 1.79 70.73; control group M 7SD:
high-restructuring: 2.00 70.39, low-restructuring: 1.91 7 0.35,
zero-restructuring: 1.91 70.45) and adaptability ratings (All
Fs o2.21, ps 40.05; depression group M7SD: high-restructuring:
1.84 70.73, low-restructuring: 1.88 70.71, zero-restructuring:
1.91 70.73; control group M 7SD: high restructuring: 2.12 70.53,
low-restructuring: 2.107 0.47, zero-restructuring: 2.107 0.59).
That is, different problems matched with different levels of solu- Fig. 2. Change scores for solution adaptability ratings. Change scores for adapt-
tion were shown to be equal in emotional valence and mala- ability ratings were significantly higher in the low-zero condition relative to those
daptability and, therefore exerted no influence on subsequent of the high-zero condition in the depression group. However, the high- and low-
solution ratings. zero conditions did not differ significantly in the control group. þ p ¼0.06.

3.2.2. Solutions
Change scores for insightfulness, adaptability, novelty, and
emotional valence ratings for three types of solution were ana-
lyzed for both groups. This was performed by calculating the dif-
ferences between the four dimensions for high- minus zero-re-
structuring solutions (high-zero condition) and low- minus zero-
restructuring solutions (low-zero condition) for both groups. Two-
way repeated-measures ANOVAs demonstrated a significant in-
teractive effect for restructuring level and group for insightfulness
ratings (F (1, 50)¼ 7.06, p o0.05, η2 ¼0.12; depression group
M7 SD: high-zero: 1.64 70.95, low-zero: 1.73 71.20; control
group M 7SD: high-zero: 1.7070.70, low-zero: 1.28 70.69). Fur-
ther simple effect analyses demonstrated that change scores for
insightfulness ratings in the high-zero condition were significantly
higher relative to those of the low-zero condition in the control
group (Fig. 1); this difference was not observed in the depression
group. In addition, there was a marginal significant interactive
effect for restructuring level and group in adaptability ratings (F (1,
50) ¼3.74, p ¼0.06, η2 ¼0.07; depression group M7 SD: high-zero:
1.79 71.08, low-zero: 2.06 71.27; control group M7SD: high-
zero: 1.88 70.75, low-zero: 1.74 70.76). Further simple effect
analyses demonstrated that change scores for adaptability ratings
in the low-zero condition were significantly higher relative to
those of the high-zero condition in the depression group; this
difference was not observed in the control group (Fig. 2). There
was a significant main effect for restructuring level in novelty
ratings (F (1, 50) ¼ 9.94, po 0.01, η2 ¼0.17; depression group
M7 SD: high-zero: 1.26 70.70, low-zero: 1.06 70.98; control
group M 7SD: high-zero: 1.61 70.85, low-zero: 1.10 70.70). There
were no significant main or interactive effects for emotional
valence ratings (All Fs o2.61, ps 40.05; depression group M7 SD:
high-zero: 1.7771.09, low-zero: 1.91 71.17; control group
M7SD: high-zero: 2.017 0.71, low-zero: 1.88 7 0.72).
3.3. Multiple regression analysis
Multiple regression analysis was conducted for the depression
and control groups, with change scores for insightfulness ratings
in the high- and low-zero conditions as the dependent variable
and change scores for emotional valence, adaptability, and novelty
ratings in the high- and low-zero conditions as independent
variables, as shown in Table 3. All regression models were sig-
nificant (p o0.001). The proportions of the variance in the pre-
diction of change scores for insightfulness ratings explained by the
models ranged from 76% to 86%. In the depression group, change
scores for emotional valence ratings were significant predictors of
those for insightfulness ratings. In the control group, change scores
of adaptability and novelty ratings were significant predictors of
those for insightfulness ratings (See Table 3).
4. Discussion
The present study used a set of textual micro-counseling dia-
logues to trigger cognitive restructuring. This was the first study to
use a counseling-type paradigm involving CBT in a controlled
experimental setting as a means of measuring cognitive re-
structuring in MDD patients. The results showed that
Table 3
Multiple regression analysis using the enter method for depression and control
groups.

Change scores Insightfulness

Depression Control

High-zero Low-zero High-zero Low-zero

β β β β

n
Emotional valence 0.38 0.64 0.15 0.03
Adaptability 0.28 0.18 0.38n 0.47n
Novelty 0.40 0.19 0.45nn 0.46nn
R2 0.80 0.86 0.83 0.76
F 28.64nnn 42.90nnn 36.16nnn 24.10nnn

Fig. 1. Change scores for solution insightfulness ratings. Change scores for in- Note:
n
sightfulness ratings were significantly higher in the high-zero condition relative to p o 0.05.
nn
those of the low-zero condition in the control group. However, the high- and low- p o 0.01.
nnn
zero conditions did not differ significantly in the depression group. *p o 0.05. po 0.001.
 N. Jiang et al. / Psychiatry Research 238 (2016) 159–164
insightfulness ratings for high-restructuring solutions were sig-
nificantly higher relative to those of low-restructuring solutions in
healthy adults, while adaptability ratings for low-restructuring
solutions were significantly higher relative to those of high-re-
structuring solutions in MDD patients. Novelty ratings for high-
restructuring solutions were significantly higher relative to those
of low-restructuring solutions in both groups. Insightfulness rat-
ings were significantly predicted by adaptability and novelty rat-
ings in healthy adults and emotional valence ratings in MDD
patients.
The results demonstrated that a higher degree of insightfulness
was induced by high- relative to low-restructuring solutions in
healthy adults, which is consistent with findings from our previous
research (Yu et al., 2015); however, this result was not observed in
MDD patients. Previous studies have proposed that depressed
patients experienced cognitive control deficits. For example, an
inability to inhibit negative emotional material in working mem-
ory is likely to interfere with reappraisal, which requires the
maintenance of focus on alternative positive appraisals of a si-
tuation (D’Avanzato, 2013); if cognitive resources are depleted in
MDD, automatic negatively biased associative processing cannot
be corrected by controlled, rational reflective processing (Beevers,
2005). Depressed individuals frequently exhibit decreased activity
in cognitive-control brain regions (Siegle et al., 2002, 2007) and
increased activity in affective brain regions (Bench et al., 1993;
Siegle et al., 2007). In the micro-counseling paradigm, high-re-
structuring solutions use figure of speech, which is more novel and
indirect relative to the plain expression of low-restructuring so-
lutions, to convey adaptive appraisals; therefore, more cognitive
resources are required to understand the implications of the ap-
praisals in full. Unlike healthy adults with normal cognitive-con-
trol ability, MDD patients are deficient in cognitive control and
consume excessive cognitive resources by negative descriptions of
problems; therefore, they do not experience the same cognitive
“click” experienced by healthy individuals with high-restructuring
solutions. The finding is consistent with those of previous research
in which MDD patients did not exhibit a relief effect with negative
affect, observed in healthy adults, in cognitive appraisal
(D’Avanzato, 2013; Johnstone et al., 2007; Siegle et al., 2007).
Furthermore, MDD patients used maladaptive cognitive emotion
regulation strategies (rumination and catastrophizing) more fre-
quently and adaptive cognitive emotion regulation strategies
(positive reappraisal and putting into perspective) less frequently
relative to healthy adults, which was consistent with findings from
a previous study (Lei et al., 2014). In addition, insight is believed to
be the core component of the creative process (Bowden and Jung-
Beeman, 2007; Luo and Knoblich, 2007; Luo and Niki, 2003), and
high-restructuring solutions may involve higher creativity. How-
ever, negative mood is traditionally associated with lower crea-
tivity (Baas et al., 2008), which may be the reason that MDD pa-
tients lacked the experience of insightfulness in the present study.
In summary, the lack of enlightenment observed may reflect
cognitive restructuring (or cognitive reappraisal) deficits in MDD
patients.
MDD patients exhibited higher adaptability ratings (the extent
to which dialogues were functional and helpful) for low-re-
structuring solutions relative to those of high-restructuring solu-
tions, which was not observed in healthy adults. The findings
concerning healthy adults are consistent with those of our pre-
vious study (Yu et al., 2015). High-restructuring solutions applied
figure of speech to reinterpret the problem's function or emotional
reaction via indirect expression, while low-restructuring solutions
provided plain and soothing reinterpretation of the problem's
function or emotional reaction via direct expression. Therefore,
relative to high-restructuring solutions, low-restructuring solu-
tions are more accessible to MDD patients characterized by
163
maladaptive cognitive biases and limited cognitive control (Beck,
1979; Disner et al., 2011; Haaga and Beck, 1995; Siegle et al., 2007).
It is worth noting that higher adaptability ratings for low-re-
structuring solutions were not accompanied by higher insightful-
ness ratings, and insight experience alone reflected the process of
cognitive restructuring. Ellis (1963) proposed that individuals with
intellectual insight recognize the advantages of believing certain
rational philosophies but do not actually believe them; therefore,
intellectual insight is “nothing but an idle New Year's resolution
(or fond dream) (p125)”. Emotional insight involves seeing and
believing, thinking and acting, and wishing and practicing. In-
dividuals with emotional insight truly believe, are committed, and
therefore act. Higher adaptability ratings without high insightful-
ness could be considered similar to intellectual insight. Therefore,
we should exercise caution in determining the extent to which
MDD patients could benefit from low-restructuring solutions.
Insightfulness ratings for high- and low-restructuring solutions
were significantly predicted by novelty and adaptability ratings in
healthy adults, indicating that novelty and adaptability contribute
to insightful experiences, which was consistent with findings from
our previous study (Yu et al., 2015). In contrast, insightfulness
ratings for low-restructuring solutions were significantly predicted
by emotional valence ratings in MDD patients, indicating that
positive emotion may be particularly important for insightfulness
in this group. However, it is necessary to obtain further evidence
to form a firm conclusion.
While the present study preliminary measured the cognitive
restructuring of MDD patients in a similar counseling situation of
CBT, two limitations should be noted. First, although it was rea-
sonable to measure cognitive restructuring according to subjective
experiences (i.e., the insightfulness, novelty, adaptability, and
emotional valence) in this study, it should also evaluate other in-
dices (i.e., physiological responses, and brain activation patterns)
to have a better understanding of cognitive restructuring of de-
pressed individuals in future studies. Second, CBT was not suitable
for all the MDD patients (Cuijpers et al., 2014). Thus, a longitudinal
research should launch to study the relationship between cogni-
tive restructuring and therapeutic effect of CBT in MDD patients.
Third, we haven't control the experience of therapy in the de-
pressed and healthy group. Although we used change scores be-
tween three types of solution in the statistics analysis to minimize
this the influence of previous experience of therapy (previous
experience of therapy would play a general influence on each type
of solutions, such an influence could be mostly subtracted with
change scores), the depressed participants with no experience
with psychotherapy should be employed in the future study.
There are some specific implications of the finding in the pre-
sent study: First, the findings of the deficits of cognitive re-
structuring could be potentially used as an index to detect the
cognitive characteristics in the depressed patient samples, which
would promote the understanding of etiology in depression. Si-
milarly, the textual micro-counseling dialogue could be used to
detect the characteristics of cognitive restructuring in the other
samples with mental disorders. Second, the textual micro-coun-
seling dialogue paradigm is suitable for measuring the neural ac-
tivities due to its advantages in “locking multiple events in a
limited time”. We have found the deficits of cognitive restructur-
ing in the depressed participants. This deficits may be correlated
with the abnormal neural activities produced by the micro-re-
structuring processing. This could be an important issue in the
future.
In summary, the present study applied textual micro-re-
structuring dialogues to demonstrate abnormal cognitive re-
structuring in MDD patients, as compared to the general popula-
tion, which was demonstrated in the insightfulness and adapt-
ability ratings for the dialogues.
164 N. Jiang et al. / Psychiatry Research 238 (2016) 159–164
Acknowledgment
This research was supported by the National Natural Science
Foundation of China (No. 31100746 and 31371131), the National Key
Technology Research and Development Program of China (No.
2013BAI08B02), the Key Research Program of the Chinese Academy
of Sciences (No. KJZD-EW-L04), Major Projects of the Beijing Mu-
nicipal Science and Technology Commission (D151100002315003),
Natural Science Foundation of Shandong province (ZR2012CL11 and
ZR2014CL012) and by Key Laboratory of Mental Health, Institute of
Psychology, Chinese Academy of Sciences.
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