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D. J. Ha, S. H. Schwartz, L. Nehmad, R. DiGiuseppe; Cognitive Distortions Associated with Poor Adherence to Glaucoma Medical Therapy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2771.
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Recent attempts to improve medication adherence in glaucoma patients have centered on patient education and strict monitoring. While important, these tools may not reach their potential absent a more comprehensive understanding of the patient’s cognitive state. The aim of the current study was to determine the relationship between common cognitive distortions (as the term is used in cognitive behavioral therapy) and adherence to glaucoma therapy.
Structured interviews were conducted with 146 patients undergoing medical therapy at the Glaucoma Institute of SUNY Optometry. Using a Likert scale, a subject’s agreement with each of 22 statements related to glaucoma therapy was determined. Statements were formulated so that they fell within the standard taxonomy of cognitive distortions commonly employed in psychiatric practice (e.g., Beck, 2005). Self-reported adherence to glaucoma therapy was also determined.
24% of the sample reported missing a dose once a week, and 21% reported going a week or longer without taking medication. The cognitive distortions most strongly correlated with poor adherence fell into the category of emotional reasoning, which occurs when emotions unduly color a person’s cognitions, often leading to maladaptive behaviors. Specifically, agreement with statements that reveal depressed or anxious emotional reasoning was strongly correlated with poor adherence (Pearson two-tailed; r = 0.244, p = 0.003 and r = 0.298, p = 0.000, respectively). In comparison, dichotomous thinking, fortune telling, mind reading, and other distortions commonly cited in the psychiatric literature were not significantly correlated with medication adherence. Adherence was not correlated with the severity of the disease as measured by the most recent mean deviation (OD: r = -.013, p = .889; OS: r = .031, p = .735) and visual acuity (OD: r =.034, p = .685; OS: r = .067, p = .422) nor was it correlated with the number of medications taken (r = .121, p = .147) or duration of treatment (r = -.051, p = .544).
Subjects who manifest depressed or anxious emotional reasoning are less likely to take glaucoma medications as prescribed. Emotional reasoning is common in clinical depression and anxiety disorders. It also occurs in the absence of manifest mood disorder and may be a factor in the adherence behavior of patients with no history of depression or anxiety. Our findings provide the basis for future controlled prospective studies to determine if the identified cognitive errors can be modified through brief psycho-educational programs and whether such interventions affect adherence.
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