Volume 25, Issue 1 (Spring 2023)                   Advances in Cognitive Sciences 2023, 25(1): 30-45 | Back to browse issues page

Ethics code: IR.GUILAN.REC.1400.023


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Haji Hosseini Z, Rezaei S, Zebardast A. The mediating role of self and external-focused attention in the relationship between behavioral inhibition/activation systems and depression symptoms among depressed patients. Advances in Cognitive Sciences 2023; 25 (1) :30-45
URL: http://icssjournal.ir/article-1-1515-en.html
1- Master in General Psychology, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran
2- Assistant Professor, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran
Abstract:   (581 Views)
Introduction
Depression is a globally common disease. Unfortunately, its prevalence is increasing. Behavioral changes are a significant aspect of depression diagnosis. Two separate systems shaping human behavior: 1. The Behavioral Approach System (BAS) and 2. The Behavioral Inhibition System (BIS), which are effective factors in depression.

The level of sensitivity in BAS and BIS is closely related to psychological damage. At the same time, the direct relationship between them can only be explained relatively. Therefore, understanding the intervention mechanism and mediator roles in explaining the causes of depression is important. Self-focused attention is a vital structure that can mediate the effect of brain-behavioral systems on depression. In Beck’s cognitive model, a depressed person suffers from a negative attitude about himself, his experiences, and the future. The consequence of this pervasive negativity is the person becoming depressed. In Well’s metacognitive model of depression, it is assumed that the control of attention becomes inflexible in psychological disorders in such a way that attention is focused on the self with a continuous and repetitive pattern, and processing is based on concern and threat detection. Despite significant progress in the diagnosis and treatment of depression, searching for the vulnerability factors of this disorder and how these factors interact with each other remains a fundamental issue in mental health. Due to the significant prevalence of depression in outpatients of medical and counseling centers, it is of high priority to understand the factors involved in the occurrence and persistence of this disorder.
Methods
The present research design is descriptive and cross-sectional, and in terms of its purpose, it is fundamental research. The current study population consisted of depressed men and women-based on clinical interviews and the results of the Beck’s Depression Inventory-13 (BDI-13) -referring to counseling centers in Qom in the first half of 1400. Two hundred people were selected by purposive sampling method based on the inclusion criteria (18 to 45 years old and admitted to a counseling center in the last month), exclusion criteria (beginning psychotherapy sessions for depression, taking neuropsychiatric drugs for depression, incomplete tests/leaving more than 20% of items unanswered, more than six months passed since the last diagnostic session), and the minimum proportional sample size to perform the structural equation model. They answered the BIS/BAS scale, Beck Depression Inventory-13 (BDI-13), and the Focus of Attention Questionnaire (FAQ) voluntarily. All ethical principles of the research were observed. Therefore, permission was obtained from the University’s Ethics Committee under the code IR.GUILAN.REC.1400.023. The subjectsinformation was coded anonymously. Besides, they had the right to participate knowingly and voluntarily and to withdraw from the research at any stages.
This study used descriptive statistics (mean, standard deviation, skewness, kurtosis, and correlation matrix) and inferential statistics (Pearson’s correlation coefficient and structural equation modeling technique) for data analysis. SPSS-26 and AMOS-24 software were used for statistical analysis. Bootstrap analysis was used in the MACRO program from Preacher and Hayes to test the significance of indirect paths.
Results
One hundred thirty-six women (68%) and 64 men (32%) participated in the study, with an average age of 34.94±8.42 years (women 35.70±8.05 and men 33.32±9.01 years) (n=200). Sixty-nine people were single (34.5%), 84 were married (42%), and 47 were widowed or divorced (23.5%). One hundred seven people were childless (53.5%), and 93 subjects had one to three children (46.5%). Six women (4.4%) had given birth in the last six months, and the rest had no history of giving birth in the previous six months. Thirty-nine people had an undergraduate degree (19.5%), 73 had a bachelor’s degree (36.5%), and 88 had a master’s degree (44%). None of the sample subjects was taking neuropsychiatric drugs before entering the study. The Mardia coefficient for the research variables was 4.521, and the critical ratio was 2.682, less than 5. Therefore, the multivariate normality assumption was valid for the model test.
The structural equation modeling method was used to test the proposed mediating model of self and external-focused attention in the relationship between BAS/BIS and depression symptoms among counseling center clients. The results of the fit indices showed that the PCFI and PNFI indices in the proposed model were greater than 0.5, and they were acceptable. However, the other fit indices of the proposed model are not acceptable. In the first step, the two non-significant paths of the model (BIS to the symptoms of depression and external-focused attention) were removed to improve the model. In the second step, the final model of the research was designed by drawing the correlation between the covariance errors. The results in the Table 1 show that after the modifications, the final model of the research mode has desirable fit indices.
1. The fit indices of the proposed and modified model of the current research*
Fit indices X2 df p-value CMIN/df RMSEA (CL90%) PNFI CFI PCFI IFI GFI SRMR
Proposed model 101.31 8 <0.001 12.662 0.242 (0.20-0.28) 0.598 0.791 0.601 0.796 0.782 0.112
First modified model 101.38 10 0.002 10.139 0.214 (0.17-0.25) 0.673 0.795 0.679 0.800 0.881 0.112
Final model 23.38 9 0.005 2.598 0.090 (0.04-0.11) 0.707 0.968 0.715 0.969 0.968 0.061
The acceptable level of indices: PNFI, PCFI (>0.5), IFI, GFI, CFI (>0.9), RMSEA (<0.08), CMIN/df (<3 good, <5 acceptable)
*Abbreviations; CMIN/DF: Chi-square/degree-of-freedom ratio; RMSEA: Root Mean Square Error of Approximation; PCFI: Parsimonious Comparative Fit Index; GFI: Goodness of Fit Index; PNFI: Parsimonious Normed Fit Index; IFI: Incremental Fit Index; CFI: Comparative Fit Index. SRMR: Standardized Root Mean Squared Residual.

The coefficient of depression variable determination is 0.632, indicating that all exogenous and mediating variables, i.e., BAS, BIS, self-focused attention, and external-focused attention, can predict 63% of the changes in depression symptoms, which is very strong. Indicatively, the coefficients of determining the variables of external-focused and self-focused attention are 26% and 7%, respectively, which is weak. The results of mediating relationships were analyzed using the bootstrap test in the MACRO program to test the mediating paths.
2. Bootstrap results for testing the indirect paths of the final model
Path Index P-value
Data Boot Bias Error Low limit High limit
BAS for depression through self-focused attention 0.0533 0.0948 0.0415 0.0396 0.0243 0.1780 <0.0001
BAS for depression through external-focused attention 0.1158 0.1051 -0.0107 0.0781 -0.0318 0.2789 >0.05
BIS for depression through self-focused attention 0.3401 0.3405 0.0004 0.1696 0.0762 0.7412 <0.0001
BIS for depression through external-focused attention 0.0036 0.0107 0.0135 0.0486 -0.0745 0.1347 >0.05

The obtained results indicated the significance of the indirect paths of BAS/BIS for depression through self-focused attention. The confidence level for this confidence interval is 95%, and the number of bootstrap resampling is 5000 (P<0.0001). No significant mediating effect was observed in other indirect relationships (P>0.05).
Conclusion
Based on the results of the present study, self-focused attention as a key mediator can reduce the protective effects of BAS on the symptoms of depression. On the other hand, intensify the destructive effects of BIS on the symptoms of depression. When depressed people have extreme self-focused attention, they consider situations catastrophic and estimate the probability and consequences of negative events higher than usual. Therefore, to prevent the occurrence of unfortunate consequences, they choose an avoidance approach, and the activity of BIS increases in them. As BIS becomes more active and sensitive, negative emotions engulf the depressed person’s mind. As the source of these negative emotions includes more self-focused attention, BIS becomes more sensitive, and the person avoids new experiences more. Finally, negative emotions and stagnation increase, and this vicious cycle intensify depression symptoms.
Ethical considerations  
This research was conducted after receiving the ethics code number IR.GUILAN.REC.1400.023 from the ethics committee of Guilan University and obtaining the necessary permits, and all ethical considerations regarding patients have been observed. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information. In addition, they were free to leave the study whenever they wished, and the research results would be available if they desired.

Authors’ contributions
Conceptualization: Sajjad Rezaei and Azra Zebardast: played a role in choosing the topic, designing the study, and defining the concepts; Zahra Haji Hosseini was involved in the background and literature search, research implementation, and data collection; all authors discussed the results and participated in editing the final version of the article.

Funding
The authors did not receive funding for this study.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
This article is the result of the master's thesis of the first author with code 145469, approved in the Department of Psychology, Faculty of Literature and Humanities, Gilan University. The article’s second and third authors are thesis’s the supervisor and advisor. The authors would like to express their appreciation and thanks to all the participants in this research.
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Type of Study: Research |
Received: 2023/01/15 | Accepted: 2023/05/9 | Published: 2023/07/10

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