Measuring blame-related action tendencies and prediction of prognosis in depression

Student thesis: Doctoral ThesisDoctor of Philosophy


Action tendencies are implicit cognitive and motivational states before an action is taken, such as feeling like hiding when experiencing shame or guilt, independent of the actual actions people choose to take. As precursors of social actions, action tendencies provide the key link between depressive emotions and behaviour. However, no empirical study had systematically examined the role of action tendencies in depression. The purpose of this thesis was to measure blame-related action tendencies and determine their role in predicting prognosis in major depression.

In Study 1, I examined the relationship between blame-related emotions and action tendencies and used a text-based task to investigate the role of action tendencies in the vulnerability to depression. 76 participants with remitted depression and 44 control participants had previously been recruited for this study. The results showed that people with remitted depression had a maladaptive profile of action tendencies, including feeling like hiding and creating a distance from oneself.

In Study 2, I developed a novel virtual reality task to assess blame-related action tendencies in people with and without current depression. 98 participants with current and treatment-resistant depression and 40 control participants were recruited and included in the data analysis. Consistent with the finding in Study 1, using Multivariate Analysis of variance, I found that people with current depression also demonstrated a distinct profile of maladaptive action tendencies including feeling like hiding and punishing oneself. In addition, feeling like punishing oneself was specifically associated with a history of self-harm, but not of suicide attempts.

In Study 3, I used these maladaptive action tendencies to determine their role in predicting prognosis of depression after four months of treatment-as-usual in primary care along with other relevant predictors previously described in the literature. All participants with depression enrolled in Study 2 completed monthly online questionnaires during the 4-month follow-up period. I found that maladaptive action tendencies, such as punishing oneself for other people’s wrongdoing, was associated with a poorer prognosis of depression after four
Date of Award1 Aug 2023
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorRoland Zahn (Supervisor) & Lucia Valmaggia (Supervisor)

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