Mirrors clinical experience
Participants who did not indicate they deserved to get better were significantly more often diagnosed with several conditions, compared with their counterparts who indicated they did deserve to get better:
- Major depressive disorder (MDD): 75.4% vs. 53.3%, respectively; P < .01.
- Panic disorder: 36.2% vs. 23.2%; P < .05.
- Agoraphobia: 27.5% vs. 11.6%; P < .01.
- Obsessive-compulsive disorder (OCD): 14.5% vs. 4.5%; P < .01.
- Posttraumatic stress disorder: 44.9% vs. 25.9%; P < .01.
- Borderline personality disorder: 29.0% vs. 17.9%; P < .05.
There were also significant differences between those who did not vs, did believe they deserved to get better in program completion (52.3% vs. 68.8%, respectively; P < .01), missed days (mean, 1.7 vs. 1.3; P < .05), and length of treatment (mean days, 14.1 vs. 11.8; P < .05).
Dr. Zimmerman called these preliminary findings “consistent” with his clinical experience.
He noted he was “surprised” that OCD had the highest odds ratio (OR, 3.5) of being associated with a sense of undeservingness. “But when I thought about it, I realized that it makes sense because people with OCD have insight and are often embarrassed by their symptoms,” he added.
Dr. Zimmerman was not surprised that MDD was associated with this sense of undeservingness. A second study currently under review is focusing specifically on MDD.
“One of the things we found, not surprisingly, was that some of the cognitive symptoms of depression, such as guilt and sense of worthlessness, are associated with it,” he said.
‘Snapshot in time’
Commenting for this news organization, Ken Duckworth, MD, chief medical officer of the National Alliance on Mental Illness called this a “novel, important, and creative study.”
The “hypothesized role of shame squares with my experience. And the association with OCD, depression, and trauma are also consistent with what I have seen,” said Dr. Duckworth, who is also an assistant clinical professor at Harvard Medical School, Boston. He was not involved with the current research.
“The role of hopelessness, often seen as a core feature of depression and to some extent OCD and trauma, is an opportunity to see if treatments like cognitive-behavioral therapy [CBT] can make a difference. How to engage people in CBT, which works directly at changing one’s automatic negative thoughts, is important,” Dr. Duckworth said.
Describing the study as a “snapshot in time,” he noted it would be interesting to follow patients longitudinally.
“I think a whole subset would look back and say, ‘I remember feeling [undeserving] but now that I’ve gotten medication or CBT or therapy, I’m happy I got better,’” said Dr. Duckworth.
No source of study funding was listed. Dr. Zimmerman, his coauthor, and Dr. Duckworth report no relevant financial relationships.
A version of this article first appeared on Medscape.com.