Dysfunctional attitudes and episodes of major depression: Predictive validity and temporal stability in never-depressed, depressed, and recovered women.

In a large, community-based sample of women (N = 750), the authors examined the nature of associations between dysfunctional attitudes and depression. Dysfunctional attitudes were evaluated both as a vulnerability factor for depression and as a consequence of depression. A link was found between past depression and baseline elevations in dysfunctional attitudes that was independent of current subsyndromal symptoms, but intensification of dysfunctional attitudes following prospectively evaluated episodes of depression (depressive "scarring") was not observed. Although baseline dysfunctional attitudes predicted an episode of major depression over 3 years of prospective study, this prediction, considered alone or in interaction with negative life events, was redundant with that offered by history of past depression. Further, no significant prediction was evident for the Dysfunctional Attitude Scale (A. N. Weissman & A. T. Beck, 1978) when the formerly depressed and never-depressed cohorts were considered separately. Implications for cognitive theories are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal investigation of information processing and cognitive organization in clinical depression: Stability of schematic interconnectedness.

This study longitudinally investigated information processing and cognitive organization in clinical depression. The main hypothesis was that individuals whose depression had remitted would show a significant cognitive shift on information processing (e.g., deactivation of negative processing) but not on cognitive organizational tasks. Forty-five individuals with clinical depression completed 2 information processing and 2 cognitive organizational tasks at initial assessment. At 6-month follow-up, the sample (23 remitted, 22 stable depressed) was readministered the tasks. As expected, information processing shifted significantly in individuals who had improved symptomatically, whereas negative cognitive organizational indices remained stable. The implications of these results are discussed as they pertain to the cognitive vulnerability, maintenance, treatment, and recurrence of depression. Directions for future research are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of cognitive vulnerabilities to depression: A short-term prospective multiwave study.

The stability of 3 cognitive vulnerabilities--a negative cognitive style, dysfunctional attitudes, and rumination--as well as depressive symptoms as a benchmark were examined to investigate whether cognitive vulnerabilities are stable, enduring risks for depression. A sample of adolescents (6th-10th graders) completed measures of these 3 cognitive vulnerabilities and depressive symptoms every 5 weeks for 4 waves of data across 5 months. Mean-level and differential stability were examined for the sample overall and by age subgroups. A negative cognitive style exhibited mean-level stability, whereas rumination and dysfunctional attitudes showed some mean-level change. Absolute magnitudes of test-retest reliabilities were strong for depressive symptoms (mean r = .70), moderately high for a negative cognitive style (mean r = .52), and more modest for rumination (mean r = .28) and dysfunctional attitudes (mean r = .26). Structural equation modeling showed that primarily enduring processes, but not contextual forces, contributed to the patterning of these test-retest reliabilities over time for a negative cognitive style and dysfunctional attitudes, whereas both enduring and contextual dynamics appeared to underlie the stability for rumination. Theoretical and clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression.

Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The developmental origins of cognitive vulnerability to depression: Temperament, parenting, and negative life events in childhood as contributors to negative cognitive style.

Cognitive models of depression have been well supported with adults, but the developmental origins of cognitive vulnerability are not well understood. The authors hypothesized that temperament, parenting, and negative life events in childhood would contribute to the development of cognitive style, with withdrawal negativity and negative parental feedback moderating the effects of negative life events to predict more depressogenic cognitive styles. These constructs were assessed in 289 children and their parents followed longitudinally from infancy to 5th grade; a subsample (n = 120) also participated in a behavioral task in which maternal feedback to child failure was observed. Results indicated that greater withdrawal negativity in interaction with negative life events was associated with more negative cognitive styles. Self-reported maternal anger expression and observed negative maternal feedback to child's failure significantly interacted with child's negative events to predict greater cognitive vulnerability. There was little evidence of paternal parenting predicting child negative cognitive style. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative data on child and adolescent cognitive measures associated with depression.

As a way to better understand the effects of treatment for depression, comparative data on measures of cognition have been compiled previously for adults. Such data should be able to aid the evaluation of cognition and cognitive change, and may provide valuable information for clinicians and researchers alike. In this article, analogous comparative data on cognitive measures associated with depression in children and adolescents are presented. The reviewed instruments assess cognitive errors, attributional style, dysfunctional attitudes, hopelessness, negative self-statements, and Beck's negative cognitive triad. As with adults, these data may have implications for enhancing understanding of empirically supported treatments for children and adolescents, may be useful in vulnerability research, and may be useful to clinicians seeking to develop treatment strategies and to gauge treatment effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive patterns in symptomatic and remitted unipolar major depression.

Examined maladaptive thinking in 11 endogenous and 13 nonendogenous, unipolar, nonpsychotic depressed 22–70 yr old female patients when symptomatic (Time 1) and, later, when clinically remitted (Time 2). As a control, 17 nondepressed Ss were tested at 2 times, as were 7 unremitted depressed Ss. Ss were administered a battery of scales, including the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Symptomatic depressed Ss had more dysfunctional attitudes, depressive attributional biases, and negative automatic thoughts than did controls, whereas the 2 symptomatic depressed groups did not differ with regard to thinking patterns. With remission, negative automatic thoughts equaled normal control values, although biased attitudes and attributions continued to persist in both endogenous and nonendogenous remitted groups. Attributional but not attitudinal biases correlated with several measures of chronicity, which suggested that attributional biases either result from long-term depressions or lead to greater time spent in depressive episodes. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Normative data on cognitive measures of depression.

The assessment of cognition and cognitive change is important for case conceptualization, monitoring the efficacy of specific interventions, and evaluating treatment outcome in cognitive-behavioral therapy. Unfortunately, a paucity of normative data exists on cognitive measures used for psychotherapy outcome research in depression, and little information is available to guide a practitioner's understanding of the magnitude and clinical significance of a patient's cognitive change. This article presents normative data on 6 self-report instruments that assess negative and positive automatic thoughts, hopelessness, cognitive biases and errors, and dysfunctional attitudes. Normative data were derived from studies published from the date of inception of a given cognitive index to the year 2000. Recommendations for the use of these normative data are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward an integration of psychologic, social, and biologic factors in depression: Effects on outcome and course of cognitive therapy.

The present study attempted to integrate key variables from 3 major domains of theory in depression (cognition, stress, and psychobiology) that are typically studied separately in analyses of course and response to cognitive therapy. Dysfunctional attitudes, negative life events, or sleep electroencephalogram were assessed in 53 outpatients before treatment with cognitive therapy. High levels of dysfunctional attitudes were found to be associated with poorer response to treatment but not for those patients who had experienced a severe negative life event. Examination of the length of time required to achieve remission revealed an effect for rapid eye movement (REM) latency as well as the interaction between REM latency and life events. These results are discussed in terms of the promise of integrative research in the study of depression and its treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of cognitive diathesis-stress models in predicting major depressive disorder in adolescents.

Diathesis-stress predictions regarding the onset of adolescent major depression and nonmood disorders were tested. Adolescents ((N?=?1,507) were assessed for dysfunctional attitudes and negative attributional style, as well as current depressive symptoms, current depressive and nondepressive diagnoses, and past and family histories of psychopathology. Approximately 1 year later, participants were reassessed on all measures. Analyses supported A. T. Beck's (1976) theory of depression (at the level of a trend) but not the hopelessness theory of depression. Findings were suggestive of a threshold view of vulnerability to depression; for those who experienced negative life events, depressive onset was related to dysfunctional attitudes but only when dysfunctional attitudes exceeded a certain level (low = intermediate     

Cognitive vulnerability to depressive symptoms in adolescents in urban and rural Hunan, China: A multiwave longitudinal study.

The current multiwave longitudinal study examined the applicability of two cognitive vulnerability-stress models of depression—Beck's (1967, 1983) cognitive theory and the hopelessness theory (Abramson, Metalsky, & Alloy, 1989)—in two independent samples of adolescents from Hunan Province, China (one rural and one urban). During an initial assessment, participants completed measures assessing dysfunctional attitudes (Beck, 1967, 1983), negative cognitive style (Abramson et al., 1989), neuroticism (Costa & McCrae, 1992), depressive symptoms, and anxiety symptoms. Once a month for the subsequent 6 months, participants completed measures assessing the occurrence of different types of negative events, depressive symptoms, and anxiety symptoms. Results provided support for cognitive vulnerability factors as predictors of increases in depressive symptoms following the occurrence of higher than average levels of negative events in Chinese adolescents. The results also supported the specificity of these two cognitive vulnerability factors as predictors of depressive versus anxiety symptoms following the occurrence of higher than average levels of negative events (i.e., symptom specificity), and the ability of cognitive vulnerability factors to predict prospective change in depressive symptoms above and beyond the effects of trait neuroticism (i.e., etiological specificity). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive styles and life events interact to predict bipolar and unipolar symptomatology.

This study examined the interaction of cognitive style (as assessed self-report and information-processing battery) and stressful life events in predicting the clinician-rated depressive and manic symptomatology of participants with Research Diagnostic Criteria lifetime diagnoses of bipolar disorder (n?=?49), unipolar depression (n?=?97), or no lifetime diagnosis (n?=?23). Bipolar and unipolar participants' attributional styles, dysfunctional attitudes, and negative self-referent information processing as assessed at Time 1 interacted significantly with the number of negative life events that occurred between Times 1 and 2 to predict increases in depressive symptoms from Time 1 to Time 2. Within the bipolar group, participants' Time 1 attributional styles and dysfunctional attitudes interacted significantly, and their self-referent information processing interacted marginally, with intervening life events to predict increases in manic symptoms from Time 1 to Time 2. These findings provide support for the applicability of cognitive vulnerability–stress theories of depression to bipolar spectrum disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficiently assessing negative cognition in depression: An item response theory analysis of the Dysfunctional Attitude Scale.

Despite a central role for dysfunctional attitudes in cognitive theories of depression and the widespread use of the Dysfunctional Attitude Scale, form A (DAS-A; A. Weissman, 1979), the psychometric development of the DAS-A has been relatively limited. The authors used nonparametric item response theory methods to examine the DAS-A items and develop a briefer version of the scale. Using DAS-A data obtained from depressed participants enrolled in 2 large depression treatment studies (N = 367), the authors developed a 9-item DAS form (DAS-SF?). In addition, because 2 versions of the DAS are needed for certain study designs, they also developed a 2nd short version (DAS-SF?). These short forms were highly correlated with the original 40-item DAS-A (rs ranged from .91 to .93), exhibited change similar to that of the DAS-A over the course of treatment, were moderately correlated with related self-report assessments, predicted concurrent depression severity, and predicted change in depression from before to after treatment. Taken together, the authors believe the DAS-SF? and DAS-SF? provide an efficient and accurate assessment of dysfunctional attitudes among depressed individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonassertiveness, dysfunctional attitudes, and mild levels of depression.

Studied the relationships between nonassertion, dysfunctional attitudes, and mild levels of depression, using 89 undergraduates who completed 2 self-report measures of assertion, the Beck Depression Inventory and the Dysfunctional Attitudes Scale (DAS). In accord with past research, it was found that assertion deficits increased significantly with increases in depression scores. The presence of dysfunctional attitudes also accounted for a significant increase in assertion difficulties, over and above that accounted for by depression. In particular, Ss scoring high on the DAS indicated greater difficulty in the resolution of interpersonal conflicts and the comfortable assertion of their own rights, compared to Ss scoring low on this measure. Findings are discussed in terms of the disruptive effects of dysfunctional attitudes on assertive responding and their possible relationship to a cognitive vulnerability model of depression. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial functioning and depression: Distinguishing among antecedents, concomitants, and consequences.

In this article we attempt to distinguish empirically between psychosocial variables that are concomitants of depression, and variables that may serve as antecedents or sequelae of this disorder. We review studies that investigated the relationship between depression and any of six psychosocial variables after controlling for the effects of concurrent depression. The six variables examined are attributional style, dysfunctional attitudes, personality, social support, marital distress, and coping style. The review suggests that whereas there is little evidence in adults of a cognitive vulnerability to clinical depression, disturbances in interpersonal functioning may be antecedents or sequelae of this disorder. Specifically, marital distress and low social integration appear to be involved in the etiology of depression, and introversion and interpersonal dependency are identified as enduring abnormalities in the functioning of remitted depressives. We attempt to integrate what is known about the relationships among these latter variables, suggests ways in which they may influence the development of depression, and outline specific issues to be addressed in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in cognitive content during and following cognitive therapy for recurrent depression: Substantial and enduring, but not predictive of change in depressive symptoms.

The authors examined the amount and durability of change in the cognitive content of 156 adult outpatients with recurrent major depressive disorder after treatment with cognitive therapy. The pre-post magnitude of change was large for the Attributional Style Questionnaire Failure composite (d = 0.79), Dysfunctional Attitudes Scale (d = 1.05), and Self-Efficacy Scale (d = 0.83), and small for the Attributional Style Questionnaire Success composite (d = 0.30). Changes in cognitive content were clinically significant, as defined by their 64%-87% scores overlapping with score distributions from community dwellers. Improvement was durable over a 2-year follow-up. Changes in negative cognitive content could be detected early and distinguished responders from nonresponders. In responders, continuation-phase cognitive therapy was associated with further improvements on only 1 measure of cognitive content. Early changes in negative cognitive content did not predict later changes in depressive symptoms, which the authors discuss in the context of methodological challenges and the cognitive theory of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Vulnerability to Depression: A Taxometric Analysis.

Although there is increasing support for the hypothesis that negative cognitive styles contribute vulnerability to depression, it remains unclear how best to conceptualize the heterogeneity in cognitive vulnerability to depression. Specifically, does this heterogeneity reflect quantitative or qualitative differences among individuals? The goal of this study was to address this question by examining whether the underlying structure of cognitive vulnerability to depression is best conceptualized as dimensional or categorical. Taxometric analyses provided consistent support for the dimensional nature of negative cognitive styles. It appears, therefore, that cognitive vulnerability to depression is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Despite this, the strength of the relationship between negative cognitive styles and depressive symptoms does appear to vary as a function of where along the cognitive style continuum one falls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysfunctional attitudes are mood-state dependent.

To test the hypothesis that self-report of dysfunctional attitudes is mood-state dependent, dysfunctional attitudes were assessed in 43 women before and after they received a depressed or elated mood induction. As predicted, the mood induction produced reliable changes in mood and in dysfunctional attitudes, although the increase in dysfunctional attitudes following the negative mood induction was not large enough to be statistically significant. We also tested the hypothesis, from the cognitive theory of depression, that subjects with previous episodes of depression would report more dysfunctional attitudes than would subjects without such a history. As predicted, subjects who reported previous episodes of depression endorsed more dysfunctional attitudes than did subjects who did not report such a history. However, this effect occurred only for subjects who were in a negative mood state when their dysfunctional attitudes were assessed. These findings support the proposition of the cognitive theory that dysfunctional attitudes are traits but suggest that these traits are mood-state dependent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rational emotive behavior therapy versus cognitive therapy versus pharmacotherapy in the treatment of major depressive disorder: Mechanisms of change analysis.

Cognitive-behavioral psychotherapies (CBT) are among the first-line interventions for major depressive disorder (MDD), and a significant number of studies indicate their efficacy in the treatment of this disorder. However, differential effects of various forms of CBT have seldom been analyzed in the same experimental design. On the basis of data collected in a randomized clinical trial comparing the efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy (SSRI) in the treatment of MDD, the present article investigates the theory of change advanced by REBT and CT. Measures included to test the two theories of change assess three classes of cognitions: (a) automatic thoughts, (b) dysfunctional attitudes, and (c) irrational beliefs. The results indicate that REBT and CT (and also pharmacotherapy) indiscriminately affect the three classes of cognitions. On the long term (follow-up), a change in implicit demandingness seems more strongly associated with reduced depression and relapse prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heterogeneity of cognitive style among depressed inpatients.

An inference from the cognitive theories of depression is that only a subset of depressed individuals should exhibit distinctively negative cognitive styles. Although this inference has been supported by previous research, attempts to characterize these depressives have yielded few identifying variables. This study of psychiatric inpatients and normal control subjects identified several characteristics of depressives with very negative cognitive styles by (a) examining traditional depression subtypes, (b) grouping depressives on the basis of clinical observations, and (c) asking whether sex, developmental events, and history and severity of depression predict cognitive styles. We found that borderline personality disorder, negative family dynamics during childhood, a history of sexual abuse, and severity of depression predict cognitive styles. We speculate that aversive developmental events may contribute to cognitive vulnerability to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)