Journal of The West Bengal University of Health Sciences April 2022 Vol 2 Issue 4

Original Article

Cognitive Errors and Coping Strategies in Patients with

Dysthymia and Dissociative [Conversion] Disorder:
A Comparative Study.

Megha Rathi1, Bidita Bhattacharya2, Prathama Guha3

ABSTRACT
Background: Dysthymia and Conversion Disorder are both manifestations of psychological
symptoms due to underlying conflicts and stress. The current study aims to explore
the differences in cognitive errors and coping strategies of adults with Dysthymia and
Dissociative [Conversion] Disorder.
Methods: Cross sectional clinic based comparative study was done. Through purposive
sampling, 300 individuals were selected aged 18-45 years, 100 from each group. For clinical
groups, individuals matching the diagnostic criteria of ICD 10, diagnosed using MINI
Neuropsychiatric Interviewwere included. Control group participants were taken from
the community keeping in mind the socio-demographic background of the clinical groups.
Cognitive Error Questionnaire and Coping Strategies Inventory were administered along
with screening tools. One-way ANOVA with post hoc analysis- Bonferroni was done to see
significant difference in the observed continuous variables and Pearson Product Moment
Correlation to assess the relationship between the variables.
Results: Results indicated that all cognitive errors, namely catastrophizing, over
generalization, personalization and selective abstraction are higher in dysthymia compared
to dissociative [Conversion] disorder. In terms of coping strategies self-criticism and social
withdrawal scores were higher in patients with Dysthymia whereas problem avoidance and
wishful thinking scores were higher in patients with Dissociative [Conversion] Disorder.
There is a significantnegative correlation between cognitive errors and adaptive coping
strategies in all groups.

1. Phd Scholar & Guest Faculty, Calcutta

University, Clinical Psychologist, Caring
Minds, Kolkata
Received on: 31 January 2022
2. Associate Professor, Department of Clinical Revised on: 23 March 2022
Psychology, Institute of Psychiatry, Kolkata Accepted on: 13 April 2022
3. Professor, Department of Psychiatry, Published online on: 30 April 2022
Calcutta National Medical College &
Citation: Rathi M, Bhattacharya B, Guha P. Cognitive
Hospital, Kolkata. Errors and Coping Strategies in Patients with Dysthymia
email: chaudhurip@yahoo.com and Dissociative [Conversion] Disorder: A Comparative
Study. J West Bengal Univ Health Sci. 2022; 2(4):21-36.

©Journal of The West Bengal University of Health Sciences 21

22 Cognitive errors and coping styles

Conclusion: The findings of the study are significant as they may help plan structured
cognitive intervention programs and informed psychotherapy for both conditions.

Keywords: Cognitive Errors, Conversion Disorder, Coping Strategies, Dissociative,

Dysthymia

Introduction being a potential area of interest for the

psychotherapist.3 For example, habitual
“The greatest weapon against stress is our
cognitive errors which are broadly defined
ability to choose one thought over another” –
as verbal statements that reflect biases
William James.
in evaluating information, are believed to
Dysthymia and Dissociative maintain psychological disorders such as
[Conversion] Disorder (DCD) are two depression and anxiety because they bias
important psychiatric disorders in India. how an individual perceives himself or
The term ‘Dysthymia’ refers to long- herself, the future and the world around
standing low-grade depression, accentuated them.4 Cognitive errors are exaggerated
by personality traits, personal and social or irrational thought patterns that are
stressor. Conversion is a condition in believed to perpetuate the effects of
whichpsychological stress is manifested as psychopathological states especially
physical symptoms.In both the disorders, depression and anxiety.5 Cognitive errors
there are interpersonal disturbances thus not only contribute to the development
identified as stressors leading to perceived of depressive symptoms, but they can also be
deprivation of love, affection and care. a communication barrier in the treatment
There also is a need for narcissistic of patients with Dysthymia. Presence of
gratification.1 When this need is thwarted stress or conflict is a prerequisite for the
by real or perceived loss, patients with development of dissociative disorder. Current
Dysthymia tend to introject the loss object neurobiological models describe conversion
and turn their anger on it leading to symptoms as an exaggerated emotional
depressive symptoms; whereas patients response to threat. The abnormal response
with dissociative conversion disorders tend to threat may be linked to cognitive errors
to repress such needs.2 This consequently which explain the significant improvement
leads to increased cognitive errors and use of shown by dissociative disorder patients
maladaptive coping strategies. Researches to cognitive behaviour therapy. However,
have shown strong relationship between research in dissociative conversion disorder
both the disorders, however very few has so far mostly addressed cognitive deficits
studies are available on Dysthymia in India in areas like working memory, attention
population. Thus, we attempted to examine and spatial reasoning rather than specific
the cognitive mechanism that works in the maladaptive cognitions. This is one area
two disorders, similarities and disparities that our study aims to address.
for better therapeutic understanding.
While the importance of cognitive
In recent years, patient characteristics errors in assessing the world in general,
have been receiving marked attention and relationships in particular, is well
as possible contributing factors to the documented;6 lesser insight is available
development of psychopathology and on how they interfere with the therapeutic
shaping of psychiatric symptom, thus process by possibly leading to inaccurate

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Megha Rathi et al23

judgments and illogical interpretations of Objectives

external behaviour. Further, an individual’s
The main objectives of the study are:
way of responding to cognitive errors may
also be influenced by coping strategies in 1. To assess and compare cognitive errors
response to stress. Coping strategies are (catastrophizing, over generalization,
internally motivated ways of responding personalization and selective
to internal and external stressors, and abstraction) between dysthymia and
encompass affective, cognitive and dissociative [conversion] disorder
behavioural components.7 Research has patients and a control group.
shown that maladaptive coping strategies
2. To assess and compare coping
can result in feeling of distress.8 Coping
strategies (problem solving, cognitive
strategies refer to specific efforts, both
restructuring, social support, express
behavioural and psychological that people
emotions, problem avoidance, wishful
employ to master, tolerate, reduce or
thinking, self criticism and social
minimize stressful events.9 Using effective
withdrawal) between dysthymia and
coping strategies with dysthymia can be a
dissociative [conversion] disorder
challenge as it tends to have a strong hold
patients and a control group.
on our life, making it difficult to engage in
behaviour and activities that make one feel 3. To assess the relationship between
better. Thus, the currently study attempted cognitive errors and coping strategies
to see the coping strategies of patients in within the two clinical groups.
order to understand how individuals with 4. To assess the gender difference in terms
dysthymia cope with stress. Research of cognitive errors and coping strategies
findings indicate that patients with in the two groups.
conversion disorder tend to use more of
avoidance focused coping strategies and
active distracting coping strategies in order Methods
to cope with stress.10 Individual with stress Participants: Three hundred individuals
may engage in maladaptive coping which from in and around Kolkata belonging to
gives temporary relief but in long term, the age group of 18-45 years were selected
may aggravate stress. Thus, developing through purposive sampling strategy to
effective coping skills is an important aspect participate in the study. Individuals with at
of treating this disorder and thus its careful least 8th grade of education were included.
investigation is warranted. The study comprised of two clinical groups,
While it is difficult to determine individuals with dysthymia and dissociative
whether maladaptive coping strategies are [conversion] disorder, with 100 participants
the result of cognitive error or vice versa, (50 males and 50 females) in each group.
there is a significant amount of research Participants of the control group (N-100)
that confirms there is a strong relationship were taken from the community keeping in
between the two.11 These are two important mind the socio-demographic profile of the
psychological construct and this exploratory clinical groups. Presence of psychopathology
study aims to address how these two was ruled out using General Health
constructs are related in dysthymia and Questionnaire 12 (GHQ 12). For clinical
conversion disorder as both of them have groups, individuals meeting criteria for
stress as significant underlying contributing F34.1 Dysthymia or F44 Dissociative
factor. [Conversion] Disorder according to ICD

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24 Cognitive errors and coping styles

10 Diagnostic Criteria for Research (DCR) Study Group-2 (Dissociative

were selected from the Mental Health Clinic [Converison] Disorder):
in Kolkata. Diagnosis for dysthymia and
dissociative [conversion] disorder was done Inclusion Criteria
by experienced psychiatrist and clinical • Meeting criteria for F44 Dissociative
psychologist using M.I.N.I 5 International [Conversion] Disorder according to ICD
Neuropsychiatric Interview. Hamilton 10 DCR
Depression Rating Scale was used as a
• Age 18-45 years of age
screening tool. Individuals who scored
less than 7 for dissociative conversion (0-7 • Both Males and females
Sub clinical depression) and 13 (7-13 Mild • 8th grade of education
Depression) for dysthymia in the test were
included in the study. For control group, Exclusion Criteria
the subjects were contacted from within the • History of any other mental illness
community keeping in mind the similarity
in demographic characteristics with the • History of any chronic physical illness
clinical group. On selected control group • Client scoring above 7 in HAM-D
individuals, GHQ- 12 was administered and
those scoring less than 2 were retained in Control Group:
the study. Participants with any chronic
physical and those having a past history of Inclusion criteria
or comorbid mental illness were excluded. • No past or present history of any
All the participants were included in the psychiatric condition
study after obtaining consent from them. • Age 18-45 years
The three groups were matched on the basis
of age, education, religion, socio-economic • Both Males and females
status and area of residence. • 8th grade of education

Exclusion Criteria
Study Group- 1 (Dysthymia):
• History of any chronic mental, physical
Inclusion Criteria
or organic illness
• Meeting criteria for F34.1 Dysthymia • GHQ- 12 scores above 2
according to ICD 10 Diagnostic Criteria
for Research (DCR) Assessments: An information schedule
was prepared to elicit socio-demographic
• Age 18-45 years of age
profile along with current chief complaints
• Both Males and Females of the client and brief history of their
• 8th grade of education psychiatric illness was prepared for the
study. Informed consent was obtained using
Exclusion Criteria the standard informed consent form laid
down by Indian Council of Medical Research
• History of any other mental illness
(ICMR, 2006), the apex body governing
• History of any depressive episode in the biomedical research in India.
past
Cognitive Error Questionnaire
• History of any chronic physical illness 12
is a 24 item self-report Cognitive
• Client scoring above 12 in HAM-D Error Questionnaire to measure the

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Megha Rathi et al25

types of cognitive distortions that Aaron to assess the presence and severity of
Beck theorized lead to depression. This depression. Inter-rater reliability has been
tool assesses four types of distortions; reported to be 0.80–0.98 and the test–retest
catastrophizing, over generalizing, reliability for the HAM-D has been reported
personalizing and selective abstraction. to be 0.81. Validity of the HAM-D ranges in
Lefebvre reported that the general scale between 0.65 to 0.90 with global measures
had internal consistency in the range of 0.89 of depression severity.
to 0.92. Internal consistency as measured
The M.I.N.I. International
by Cronbach’s alpha was 0.90 for the total
Neuropsychiatric Interview18 was
general scale and varied from 0.72 to 0.78
designed as a brief structured interview
for subscales.13 Construct validity of the
for the major Axis I psychiatric disorders
scale range from 0.64 to 0.85.14
in DSM-IV and ICD-10. Validity and
Coping strategies inventory15 reliability studies have been done comparing
is a 72-item questionnaire designed to the M.I.N.I. to the Structured Clinical
assess coping thoughts and behaviours in Interview for DSM III R Patients (SCID-P)
response to a specific stressor. There are a and the Composite International Diagnostic
total of 14 subscales on the CSI including Interview (CIDI). The results of these studies
eight primary scales (Problem Solving, show that the M.I.N.I. has high validity and
Cognitive Restructuring, Social Support, reliability scores and can be administered in
Express Emotions, Problem Avoidance, a brief period of time.
Wishful Thinking and Social Withdrawal),
Procedure: Ethical approval from
four secondary subscales (Problem Focused
Ethics Committee of the Institute was
Engagement, Emotion Focused Engagement,
taken. The prospective clinical patients for
Problem Focused Disengagement and
the study were contacted with the help of
Emotion Focused Disengagement) and
out-patient department of a private mental
two tertiary subscales (Engagement and
health clinic. The non-clinical control group
Disengagement). Cronbach’s alpha reported
participants were contacted from within the
coefficient of reliability for measures of
community. All participants were screened
coping process. The alpha coefficients for the
through clinical interview and assessment
CSI range from .71 to .94. Validity for CSI
tools after taking informed consent. Along
has been assessed using factor structure,
with the information schedule, all the scales
criterion validity and construct validity. All
were administered to the participants
these indicate high validity of the scale. In
individually. The data collected was then
the current study only eight primary scales
scored and tabulated for further statistical
were assessed. Items were scored from 0-4.
treatment and determining the objectives.
General Health Questionnaire 1216
Statistical Analysis: The data was
developed by Goldberg in 1972 consists
statistically analyzed. Levene’s test was
of 12 best items of the original 60 item
initially administered in order to assess
questionnaire. GHQ is a self-administered
the homogeneity of variances for all test
tool, with scoring ranging from 0-1 for
variables. Results indicated homogeneity for
each item. Individuals scoring above 2 are
all the variables. Using SPSS 16, One Way
addressed as psychologically distressed.
ANOVA was done, followed by Bonferroni
The reliability for the scale is found out to
Post hoc analysis. Pearson Product Moment
be 0.90 from Linkert method.
Correlation was computed to further
The Hamilton rating scale for observe the relationship between variables.
depression17 is a 17 item rating scale Mann Whitney U Test was done to assess

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26 Cognitive errors and coping styles

the gender difference between the study study. Post hoc analysis was done using
variables in the two groups. Bonferroni correction. Pearson Product
Moment Correlation was done to see
the relationship between the variables.
Results Manny Whitney U test was done to assess
The current study deals with 300 the gender difference. The level P < 0.05
individuals, aged between 18-45 years with was considered as the cut off value or
a mean age of 29.42 for females and 30.15 significance. Thus, significance for all the
for males. The participants were further result findings was interpreted at 95 %
divided into two main groups, namely study confidence interval.
group and comparative group. The study There was no difference observed in three
group was divided into two sub groups, i.e., groups with respect to age, socio-economic
individuals with Dysthymia and Dissociative status, religion, area and education. Due
[Conversion] disorder. to purposive consecutive sampling, it was
In the current study, one way Analysis not possible to control all relevant socio-
of Variances (ANOVA) was done to see the demographic variables and thus difference
significant difference, if any within three was observed in three groups with respect
groups in terms of test variables under to marital status and family type. In terms

Table 1: Sociodemographic Information

Conversion
Variables Dysthymia Group Control Group
Disorder Group
Mean Age 32.26 years 30.12 31.93 years
Rural (16.7 %) Rural (17.2 %) Rural (15.8 %)
Nature of Population Urban (35.3%) Urban (32.3%) Urban (34.7%)
Suburban (48%) Suburban (50.5%) Suburban (49.5%)
Mean Years of 9.58 years
10.74 years 12.12 years
Education
Socio-economic Low (48.25%) Low (50.58%) Low (49.54%)
status Middle (51.75%) Middle (49.42%) Middle (50.46%)
Unmarried (47%) Unmarried (21.34%) Unmarried (45.12%)
Marital Status Married (45%) Married (67.12%) Married (40.28%)
Divorced (8%) Divorced (11.54%) Divorced (14.6%)
Hinduism (53.12%) Hinduism (47.78%) Hinduism (51.26%)
Religion
Islamic (46.88%) Islamic (52.22%) Islamic (48.88%)
Nuclear (61.28%) Nuclear (30.54%) Nuclear (51.32%)
Family type Joint (35.54%) Joint (42.67%) Joint (37.94%)
Extended (3.18%) Extended (26.79%) Extended (10.74%)

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Megha Rathi et al27

of marital status, it was indicated that with Dissociative [conversion] disorder

majority of patients with conversion disorder patients belonged to extended family,
were married as compared to Dysthymia. In whereas patients with Dysthymia belonged
terms of family type, majority of patients to nuclear or joint family.

Table 2: Summary of Descriptive Statistics for Cognitive errors

Variables Group Mean SD

Dysthymia 18.13 1.20
Catastrophizion Conversion 10.25 1.00
Normal 2.38 1.02
Dysthymia 12.25 .86
Over Generalization Conversion 11.13 .89
Normal 2.31 .48
Dysthymia 18.13 1.36
Personalization Conversion 10.69 .79
Normal 3.13 1.02
Dysthymia 16.69 1.45
Selective Abstraction Conversion 10.75 1.18
Normal 2.31 1.30
Dysthymia 66.19 1.80
Total Conversion 40.31 1.70
Normal 10.44 2.09

Table 3: ANOVA for Cognitive errors

Sums of Mean
Variables Groups df F Sig.
Squares Square
Between groups 1984.500 2 992.250
Catastrophizing 850.500 .004*
Within groups 52.500 58 1.167
Between groups 947.625 2 473.813
Over Generalization 814.189 .012*
Within groups 26.188 58 .582
Between groups 1800.042 2 900.021
Personalization 765.071 .000*
Within groups 52.938 58 1.176
Between groups 1669.792 2 834.896
Selective Abstraction 482.444 .001*
Within groups 77.875 58 1.731
Between groups 24907.167 2 12453.583
Total 3551.121 .002*
Within groups 157.813 58 3.507
Significance was seen at .05 level*

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28 Cognitive errors and coping styles

ANOVA showed that therewas a personalization for normal control group

significant difference between groups is significantly lower than both the clinical
in terms of all cognitive error. Post hoc groups. There was no significant difference
analysis using Bonferroni correction between clinical groups in terms of over
indicated that catastrophizing (F= 850.500, generalization as a cognitive error (F=
p=.002) Personalization (F= 765.071, p= 814.189, p= .012). Over generalization for
.000) and selective abstraction (F (482.44, normal control group is significantly lower
p=.001) in individuals with Dysthymia than both the clinical groups.
was significantly higher than individuals
ANOVA showed that there was a
with Dissociative conversion disorder.
significant difference between groups in
Catastrophizing, selective abstraction and
terms of all coping strategies.

Table 4: Summary of Descriptive Statistics for Coping Strategies

Variables Group Mean SD

Dysthymia 23.50 1.67
Problem Solving Conversion 16.31 2.32
Normal 34.0 2.03
Dysthymia 21.25 1.98
Cognitive Restructuring Conversion 17.00 1.83
Normal 34.31 2.91
Dysthymia 20.69 2.15
Express Emotions Conversion 13.00 2.58
Normal 22.00 7.07
Dysthymia 23.19 2.10
Social Support Conversion 22.19 2.17
Normal 33.44 1.93
Dysthymia 22.25 2.54
Problem Avoidance Conversion 36.31 2.21
Normal 11.94 1.84
Dysthymia 26.00 2.03
Wishful thinking Conversion 27.19 2.90
Normal 13.50 1.59
Dysthymia 35.88 2.36
Self-Criticism Conversion 25.13 3.38
Normal 10.69 2.09
Dysthymia 34.81 .98
Social Withdrawal Conversion 23.50 1.03
Normal 10.50 .82

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Megha Rathi et al29

Table 5: ANOVA for Coping Strategies

Sums of Mean
Variables Groups df F Sig.
Squares Square
Between groups 4693.292 2 2346.646
Problem Solving 488.037 .001*
Within groups 216.375 58 4.808
Cognitive Between groups 2604.875 2 1302.438
247.887 .000*
Restructuring Within groups 236.438 58 5.254
Between groups 2049.125 2 1024.563
Express Emotions 154.263 .000*
Within groups 298.875 58 6.642
Between groups 1240.667 2 620.333
Social Support 144.778 .013*
Within groups 192.813 58 4.285
Between groups 4790.625 2 2395.313
Problem Avoidance 486.907 .001*
Within groups 221.375 58 4.919
Between groups 1840.042 2 920.021
Wishful Thinking 182.836 .002*
Within groups 226.438 58 5.032
Between groups 5111.542 2 2555.771
Self Criticism 358.355 .001*
Within groups 320.938 58 7.132
Between groups 4736.375 2 2368.188
Social Withdrawal 2635.386 .011*
Within groups 40.438 58 .899
Significance was seen at .05 level*

Post hoc analysis using Bonferroni dissociative conversion disorder as compared

correction indicated that problem solving to Dysthymia. There was no significant
(F=488.037, p=.002), cognitive restructuring difference between clinical groups in terms
(F = 247.887, p=.002), express emotion of social support (F=144.778, p=.218) and
(F=154.263, p=.002), self-criticism wishful thinking (F= 182.836, p=.283).
(F=358.355, p=.001) and social withdrawal
In terms of dysthymia and dissociative
(F= 2635.386, p=.002)in individuals with
conversion disorder, significant positive
dysthymia was significantly higher than
correlation was observed between total
individuals with dissociative conversion
cognitive error and coping strategies of
disorder. Problem solving, cognitive
problem avoidance, wishful thinking, self
restructuring, social supportand express
criticism, and social withdrawal. Significant
emotion for normal control group is
negative correlation was observed between
significantly higher than both the clinical
total cognitive error and coping strategies
groups. Whereas, problem avoidance,
of problem solving, cognitive restructuring
self criticism, wishful thinking and social
and social support. In terms of Dissociative
withdrawal is significantly lower in control
[conversion] disorder, there also was
group than both the clinical groups.
significant negative correlation observed
Problem avoidance (F= 486.907, p=.000)
between total cognitive error and express
is significantly higher in individuals with
emotions.

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30 Cognitive errors and coping styles

Table 6: Table showing Correlation between Cognitive error and coping strategies
Dysthymia- Dissociative
Coping Strategies Values Cognitive [Conversion] Disorder
Errors – Cognitive Errors
r -.653 -.746
Problem Solving
p .000* .000*
r -.689 -.881
Cognitive Restructuring
p .000* .000*
r -.208 -.885
Express Emotions
p .157 .000*
r -.737 -.559
Social support
p .000* .000*
r .412 .709
Problem Avoidance
p .004* .000*
r .768 .733
Wishful thinking
p .000* .000*
r .958 .918
Self criticism
p .000* .000*
r .982 .766
Social Withdrawal
p .000* .000*
Significance was seen at .05 level*

Table 7: Gender Difference in Cognitive Errors

Dysthymia D[C]D
Variables Gender Mean Mann Mean Mann
Sig Sig
Rank Whitney U Rank Whitney U
Male 9.12 9.00
Catastrophizing 27.0 .586 28.0 .657
Female 7.88 8.00
Male 7.25 11.62
Over Generalization 22.0 .254 7.00 .005
Female 9.75 9.38
Male 10.12 7.94
Personalization 19.0 .151 27.5 .606
Female 6.88 9.06
Selective Male 8.62 7.50
31.0 .914 24.0 .384
Abstraction Female 8.38 9.50
Male 8.62 5.69
Total 31.0 .915 9.50 .016
Female 8.38 11.31
D[C]D - Dissociative [Conversion] Disorder

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Megha Rathi et al31

A significant difference has been found [Conversion] Disorder for the variable Self-
between males and females with Dissociative criticism (p value- .028). Males have scored
[Conversion] Disorder for the variables over higher in self-criticism as compared to
generalization (p value- .005) and total females.
cognitive error score (p value- .016). Males
have scored higher in over generalization Discussion
whereas females have scored higher in total
cognitive error. Socio-demographic factors: In terms
of socio-demographic variables, Table 1
A significant difference has been found indicated that there was no difference
between males and females with Dysthymia observed in three groups with respect to
for the variable self-criticism (p value- .030). age, socio-economic status, religion, area
Males have scored higher in self-criticism. and education. Due to purposive consecutive
sampling, it was not possible to control
A significant difference has been found all relevant socio-demographic variables
between males and females with Dissociative and thus difference was observed in three

Table 8: Gender Difference in Coping Strategies

Dysthymia D[C]D
Variables Gender Mean Mann Mean Mann
Sig Sig
Rank Whitney U Rank Whitney U
Male 10.00 9.38 25.0 .455
Problem solving 20.0 .196
Female 7.00 7.62
Cognitive Male 7.56 9.38 25.0 .451
24.5 .425
Restructuring Female 9.44 7.62
Male 10.38 9.06 27.5 .633
Express emotion 17.0 .111
Female 6.62 7.94
Male 10.69 9.00 28.0 .671
Social support 14.5 .121
Female 6.31 8.00
Problem Male 8.44 10.00 20.0 .198
31.5 .957
avoidance Female 8.56 7.00
Male 8.62 7.50 24.0 .398
Wishful thinking 31.0 .915
Female 8.38 9.50
Male 11,06 11.75 6.00 .005*
Self-criticism 11.5 .030*
Female 5.94 5.25
Social Male 7.50 7.38 23.0 .327
24.0 .375
withdrawal Female 9.50 9.62
D[C]D - Dissociative [Conversion] Disorder

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32 Cognitive errors and coping styles

groups with respect to marital status and the situation as being much worse than they
family type. In terms of marital status, really exist.21 Cognitive distortions are not
it was indicated that majority of patients specific to depressive symptoms but rather
with conversion disorder were married as related to general distress or negative
compared to dysthymia. Marriage though thoughts.22 High use of personalization can
is a positive event, it becomes stressful as be explained with learned helplessness
it requires adjustment in the lifestyles of model of depression.23 Learned helplessness
an individual and in interaction with the refers to a situation when people feel
significant others in the environment.19 helpless to avoid negative situations as
Further, marriage also leads to previous experience have shown them
responsibilities that cause stress to both that they are unable to control or avoid
males and females leading to dissociating aversive stimuli. Thus, depressed people
symptoms in order to escape stress. Further, tend to endure aversive stimuli rather than
it was observed that in terms of family coping with it effectively. Cognitive triad
type, majority of patients with dissociative theory postulated that depressed individual
[conversion] disorder patients belonged to tends to have negative view towards self,
extended family, whereas patients with environment and future.24 Catastrophizing
dysthymia belonged to nuclear or joint is defined as a negative forecast of future
family. In extended family, there are more events.25 Thus, negative view towards future
responsibilities and household chores, and may lead to catastrophizing in dysthymic
equal importance is given to all members. individuals. Cognitive model of emotional
In such situation, individual gets more disorder emphasizes the role of biased
attention when unwell leading to conversion information processing in the psychological
symptoms (secondary gain). Moreover, in functioning of depressed individuals.26
nuclear families, client feels lack of social This relatively stable negative schema
support leading to more distress during developed in depressed individual along
stress leading to development of affective with biased processing leads to selective
disorders.20 abstraction in Dysthymia individuals.27 The
efficacy of Cognitive behaviour therapy in
Cognitive Errors: Patients with the treatment of conversion symptoms by
dysthymia had significantly more cognitive identifying and restructuring cognitions,
errors than patients with dissociative altering illness behaviour and behavioural
conversion disorder. Personalization, activation has been emphasized.28 Thus,
catastrophizing and selective abstraction implication of cognitive restructuring in
were higher in patients with dysthymia treatment of conversion disorder implies the
whereas overgeneralization is higher in both presence of cognitive errors in the patients.
dysthymia and dissociative [conversion]
disorder. Patients with dissociative Cognitive errors are more common in
[conversion] disorder use higher cognitive dysthymia which may be explained by the
errors as compared to normal control group. fact that in case of dissociative conversion
Cognitive behavioural theorists suggest that disorder, the problem is more in the
depression results from maladaptive, faulty environment rather than inherent biased
or irrational cognitions. Depressed people cognitive styles. Hence cognitive behaviour
tend to view themselves, their environment therapy for conversion disorder needs to lay
and future in a negative pessimistic light. more stress on modifying the environment,
They tend to misinterpret facts, blame or teaching the client more effective means
themselves for misfortunes and would see of handling them.

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Megha Rathi et al33

Coping Strategies: Social support, of loneliness and abandonment; whereas

problem solving and cognitive restructuring introjective depression refers to concern
scores were higher in control group, self- about self-worth, achievement and self-
criticism and social withdrawal scores were definition. This excessive concern about self-
higher in patients with Dysthymia and worth and self-esteem leads to self-criticism
problem avoidance and wishful thinking to meet expected ego ideals. Dysthymic have
scores were higher in patients with a negative view of themselves and the world
Dissociative [Conversion] Disorder. Problem around them and as such may perceive
solving and cognitive restructuring is higher threat in the environment leading to social
in patients with dysthymia as compared to withdrawal.
dissociative [conversion] disorder. Social
support is significantly lower in both the Relationship between cognitive
study groups. Problem solving, social errors and coping strategies: Cognitive
support and cognitive structuring require distortions and cognitive coping tend to
active coping and planning. The patients be interlinked. According to information
with dissociative [conversion] disorder have processing model, negative cognitive
low resilience and perceive high conflict in processing of stressful events activates
family.29 They further tend to repress their the primal cognitive mode which lead
conflicts rather than confronting them which to maladaptive coping whereas positive
makes active coping like problem solving perception may enhance negative thinking
difficult for them. Stress generational model patterns.Cognitive theory posits that
of depression postulates that depressive individuals engaging in maladaptive coping
symptoms tend to develop with increased experiences undergo greater stress leading
stress which tends to create interpersonal to negative thoughts about oneself, blaming
problems and significant impairment in self and rumination which consequently
social, occupational and personal life.30 leads to increased cognitive errors and
These problems tend to further increase distortions.
stress for an individual and thus hinder their Gender difference: In terms of
problem solving ability. Problem avoidance cognitive errors, female have higher
is the push away or avoidance of one’s own cognitive distortions as compared to males.
problems. Individuals with conversion Males tend to distract themselves from
disorder mostly avoid or suppress their their mood by engaging in physical or
stress which is ultimately converted into instrumental activities, whereas females
physical symptoms. Responding to negative are less active and ruminate over possible
emotions and stress with disengagement negative events.33 Due to this rumination,
like denial and wishful thinking was less women tend to become prone to cognitive
effective in regulating negative emotion distortion as compared to males.34
and buffering stress.31 Thus, higher use
of these strategies leads to higher levels In terms of coping strategies, male tend
of depressive symptoms and problem to have higher self-criticism than females.
behaviour. High self-criticism in Dysthymia With reference to gender role stereotype35
can be explained with the psychodynamic/ male tend to perceive higher role of being
cognitive developmental model.32 He care giver in family along with leadership
had distinguished between two types of and being a bread earner of the family in
depressive symptoms. Anaclitic depressive work place. This tends to set high ideals for
symptom refers to excessive concern male. If males are unsuccessful to fulfil their
about relationship, dependency, feelings obligations, they tend to suffer a narcissistic

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34 Cognitive errors and coping styles

injury, leading to lowered self-esteem and The present study’s findings also yield
high self-blame in terms of self-criticism. implications for prevention and intervention
efforts. Study gives an insight into cognitive
No study is free of limitation and the
errors and coping strategies associated with
present study also has a few limitations.
the disorder, which in turn may assist to
The study comprised 20 individuals in each
plan intervention strategies to prevent the
group but a larger sample could have yielded
development of psychopathology. Better
more information, thereby enriching the
understanding of how the cognitive errors
study and increasing generalizability. The
and coping strategies of an individual are
study entailed patient from only one clinic
at play during a mental illness can facilitate
leading to problems in generalizability and
the therapist to address them and intervene
external validity. Self-report inventories
appropriately in structured intervention
were used in the study which automatically
programme.
included the self -reporting biases. All socio-
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