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congestive heart failure, depression, negative thinking



  1. Dekker, Rebecca L. PhD, RN


Background: Depression is a significant clinical problem among patients with heart failure (HF). Cognitive therapy is a potential treatment for symptoms of depression in patients with HF. Cognitive therapy focuses on the reduction of negative thinking, a modifiable risk factor for depressive symptoms; however, researchers have not identified the best instrument for measuring negative thinking in patients with HF.


Objective: The purpose of this article was to review the state of the science in the measurement of negative thinking to provide direction for the measurement of negative thinking in patients with HF.


Findings: Three of the most widely used instruments for negative thinking were selected for review. The Crandell Cognitions Inventory (CCI), Automatic Thoughts Questionnaire, and Cognition Checklist-Depression all have strong evidence for validity and reliability. The CCI has the best potential for measuring negative thinking in patients with HF. The CCI has the advantages of being developed with a clinical population and captures a wide range of negative thinking content. However, the CCI is lengthy (45 items) and needs to undergo rigorous psychometric testing among patients with HF before it can be recommended for use.


Conclusions: Future studies are needed to develop a shortened version of the CCI for use in clinical research and to test its reliability and validity for measuring negative thinking in patients with HF.