Inflexibility in depression: Comparative analysis of cognitive, explanatory, coping, and belief flexibility.

Background: Flexibility, or the ability to adapt to changing circumstances, is crucial for psychological health. Depression is often characterized by inflexibility in various domains. Aim: This cross-sectional study aimed to assess, compare, and examine the correlations between cognitive, explanatory, coping, and belief flexibilities in individuals with major depression. Materials and Methods: A sample of 40 adult patients with major depressive disorder (MDD) was compared with 40 healthy matched controls using the Wisconsin Card Sorting Test, Attributional Style Questionnaire, Coping Flexibility Scale, and the Emotional variant of the Bias Against Disconfirmatory Evidence task. Results: Results revealed that individuals with depression exhibited significant coping inflexibility. They also exhibited belief inflexibility when the stimuli were self-referent and negative. However, no cognitive inflexibility was observed. In the clinical group, cognitive flexibility correlated with both positive and negative belief flexibilities, while explanatory and coping flexibility showed no links. In controls, cognitive flexibility was related to negative belief flexibility, and explanatory flexibility was associated with positive belief flexibility. Multiple regression analyses further showed that cognitive flexibility significantly predicted both negative (β = -0.61, P < 0.001) and positive belief flexibility (β = -0.57, P < 0.001) in individuals with depression, suggesting a potential causal link. Conclusion: These findings suggest that specific areas of flexibility are impaired in depression. Furthermore, different correlation patterns in both groups may have important clinical implications.