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)     

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)     

Cognitive and serotonergic vulnerability to depression: Convergent findings.

Cognitive reactivity (CR) is a psychological vulnerability marker of depression, whereas response to acute tryptophan depletion (ATD; a serotonergic challenge procedure) is a biological vulnerability marker. The aim of this study was to investigate the relationship between these markers. Thirty-nine remitted depressed patients participated in 2 ATD sessions in a double-blind crossover design. CR, assessed prior to the ATD sessions, predicted depressive response to high-dose ATD. CR also diminished the effects of 2 known predictors of ATD response: gender and residual symptoms. Neuroticism and behavioral inhibition were unrelated to ATD response. CR is associated with an increased sensitivity to reductions of serotonin concentrations. These findings present a small step toward unifying cognitive and neurobiological theories of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perfectionism dimensions, perfectionistic attitudes, dependent attitudes, and depression in psychiatric patients and university students.

P. L. Hewitt and G. L. Flett's (1991b) model of perfectionism dimensions (i.e., self-oriented, other-oriented, and socially prescribed perfectionism) was compared with A. T. Beck's model (G. P. Brown & A.T. Beck, 2002) of dysfunctional attitudes (i.e., perfectionistic attitudes [PA] and dependent attitudes [DA]) in predicting depression in 70 psychiatric patients and 280 university students. Socially prescribed perfectionism uniquely predicted both PA and DA. Dysfunctional attitudes failed to consistently predict additional variance in depression beyond perfectionism dimensions (and vice versa). Evidence for Hewitt and Flett's specific vulnerability hypothesis and Beck's specific cognitive vulnerability hypothesis was equivocal. Beck's conceptualization of perfectionism as a unitary cognitive style obscures important information by overlooking the distinction between the self-related and socially based features of perfectionism. Hewitt and Flett's conceptualization of perfectionism as 3 distinct personality traits allows for precise conclusions by recognizing the differential contribution of the self-related and socially based features of perfectionism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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)     

Rumination and interpersonal dependency: Explaining women's vulnerability to depression.

Women are twice as likely as men to suffer from a major depressive episode. Reasons for this gender difference in propensity for depression are not completely understood, although a number of explanations have been articulated. In this article we focus on two constructs that have been linked to gender differences in depression--ruminative cognitive style and interpersonal dependency. Ruminative cognitive style refers to the tendency to respond to depressed or dysphoric mood with repetitive thoughts and behaviours that focus attention on the meaning and consequences of the depressed mood (Nolen-Hoeksema, 1991). Interpersonal dependency reflects an investment in relationships and communion. We propose a theory of how these constructs interact to increase women's propensity to develop depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward bridging the science and practice of depression prevention: What can we learn from cognitive vulnerability?

Depression is a widespread disorder with devastating individual and societal consequences. Although a great deal of research and theory has focused on treatment of acute episodes, progress needs to be made in preventing the emergence of first episodes of the disorder. There has been considerable advancement in understanding psychological vulnerability factors associated with this mood disorder, especially on the basis of cognitive behavioural models and research findings based on this theoretical model. In this paper we review the concept of cognitive vulnerability, with a particular focus on what this body of research work suggests clinically for the prevention of depression. We outline, based on this science, what the effective ingredients of a prevention program could be. We also discuss some of the pragmatic aspects of developing an effective prevention program for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client interpersonal and cognitive styles as predictors of response to time-limited cognitive therapy for depression.

This study examined the relationship between cognitive and interpersonal styles and outcome among 24 clients who received time-limited cognitive therapy for depression. The authors hypothesized that this relationship would be mediated by therapeutic alliance. They found that clients' interpersonal style, particularly an underinvolved style, was predictive of treatment outcome. As predicted, the impact of this style on outcome was mediated through the therapeutic alliance. (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)     

Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study.

The current study examined vulnerability to depression during the transition from early to middle adolescence from the perspective of the response styles theory. During an initial assessment, 382 adolescents (ages 11–15 years) completed self-report measures assessing rumination and depressive symptoms as well as a semistructured clinical interview assessing current and past major depressive episodes. Every 3 months for the subsequent 2 years, adolescents completed self-report measures assessing depressive symptoms and negative events. Every 6 months, adolescents completed a semistructured clinical interview assessing the onset of new major depressive episodes. Higher levels of rumination were associated with a greater likelihood of exhibiting a past history of major depressive episodes, a greater likelihood of experiencing the onset of a future major depressive episode, and greater duration of future depressive episodes. Consistent with a vulnerability-stress perspective, rumination moderated the association between the occurrence of negative events and the development of future depressive symptoms and major depressive episodes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Self-system therapy as an intervention for self-regulatory dysfunction in depression: A randomized comparison with cognitive therapy.

Self-system therapy (SST) is a new therapy based on regulatory focus theory (E. T. Higgins, 1997) for depressed individuals unable to pursue promotion goals effectively. The authors conducted a randomized trial comparing SST with cognitive therapy (CT) in a sample of 45 patients with a range of depressive symptoms to test 2 hypotheses: that SST would be more efficacious for depressed individuals characterized by inadequate socialization toward pursuing promotion goals and that SST would lead to greater reduction in dysphoric responses to priming of promotion goals. There was no overall difference in efficacy between treatments, but patients whose socialization history lacked an emphasis on promotion goals showed significantly greater improvement with SST. In addition, SST patients showed a greater reduction in dysphoric responses to promotion goal priming than did CT patients. The results illustrate the value of a theory-based translational approach to treatment design and selection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perfectionism, stress, and social (dis)connection: A short-term study of hopelessness, depression, and academic adjustment among honors students.

This study tested models of perfectionism predicting psychological distress and academic adjustment and moderators and mediators of those associations in 2 successive cohorts of high-achieving university honors students (N = 499). Participants completed measures early and late in the semester. Adaptive (high standards) and maladaptive (self-critical perceptions of inadequacy in meeting performance expectations) dimensions of perfectionism were found to be significantly associated, in generally expected directions, with concurrent and prospective perceived stress, social connectedness, depression, hopelessness, and perceived academic adjustment. However, some perfectionism effects were reduced when earlier psychological distress and adjustment were controlled in analyses predicting later distress and adjustment. Several effects were moderated and at least partially mediated by perceived stress and social connection. The results suggest several counseling implications for high-achieving, perfectionistic students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' competence in and performance of cognitive therapy skills: Relation to the reduction of relapse risk following treatment for depression.

Cognitive therapy (CT) for depression is designed to teach patients material that is believed to help prevent relapse following successful treatment. This study of 35 moderately to severely depressed patients who responded to CT provides the 1st evidence to suggest that both development and independent use of these competencies predict reduced risk for relapse. Among patients who responded to treatment, both CT coping skills and in-session evidence of the independent implementation of CT material predicted lower risk for relapse in the year following treatment. These relationships were not accounted for by either symptom severity at the end of treatment or symptom change from pre- to posttreatment. Self-esteem, assessed at posttreatment, failed to predict risk for relapse in the year following treatment. Thus, CT coping skills and independent use of CT principles, but not overall satisfaction with oneself, appear to play an important role in relapse prevention. (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)     

Using psychodynamic, cognitive behavioral, and control mastery prototypes to predict change: A new look at an old paradigm for long-term single-case research.

This article illustrates a method of testing models of change in individual long-term psychotherapy cases. A depressed client was treated with 208 sessions of control mastery therapy (CMT), an unmanualized approach that integrates elements of psychodynamic therapy (PDT) and cognitive behavioral therapy (CBT). Panels of experts developed prototypes of ideal PDT, CBT, and CMT process using the Psychotherapy Process Q-set (PQS; J. S. Ablon & E. E. Jones, 1999; E. E. Jones, L. A. Parke, & S. Pulos, 1992; E. E. Jones & S. M. Pulos, 1993). Independent observers rated every 4th session (N = 53) with the PQS. Using correlations between ideal and actual PQS ratings followed by paired t tests, the authors compared adherence to the CMT prototype with adherence to plausible alternative models advocated by the PDT and CBT experts. Bivariate time series analyses determined whether prototype adherence predicted an estimated index of symptom change. Results showed that the therapist's behavior was most consistent with the CMT prototype and that this aspect of the CMT prototype along with particular aspects of the other prototypes influenced estimated symptom change. The results, which replicate and extend earlier findings, support the validity of this approach to studying long-term therapies but also highlight its limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents.

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial.

Objective: To examine whether mindfulness-based cognitive therapy (MBCT) increases momentary positive emotions and the ability to make use of natural rewards in daily life. Method: Adults with a life-time history of depression and current residual depressive symptoms (mean age = 43.9 years, SD = 9.6; 75% female; all Caucasian) were randomized to MBCT (n = 64) or waitlist control (CONTROL; n = 66) in a parallel, open-label, randomized controlled trial. The Experience Sampling Method was used to measure momentary positive emotions as well as appraisal of pleasant activities in daily life during 6 days before and after the intervention. Residual depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (Hamilton, 1960). Results: MBCT compared to CONTROL was associated with significant increases in appraisals of positive emotion (b* = .39) and activity pleasantness (b* = .22) as well as enhanced ability to boost momentary positive emotions by engaging in pleasant activities (b* = .08; all ps     

Bootstrapping conjectural indicators of vulnerability for schizophrenia: A Reply to Faraone's critique of Watt, Grubb, and Erlenmeyer-Kimling.

Presented is a reply to the article "Validating indicators of vulnerability to schizophrenia: A comment on Watt, Grubb, and Erlenmeyer- Kimling", (1983). Demonstration of statistically significant mean differences between high-risk and normal control children provides little information concerning the validity and clinical utility of conjectural indicators of vulnerability to schizophrenia. Taxometric methods offer a promising approach for preliminary testing of the validity and clinical utility of such indicators. It is not required that the indicators be nearly infallible. Accurate identification of vulnerability is still possible by combining several indicators that are fallible but relatively independent within the vulnerable and nonvulnerable subgroups. Mixed-group validation methods would be preferable to criterion-group methods in some vulnerability studies but they require dependable estimates of the base rates of vulnerability in high-risk and control groups, which are not available in the present instance. Because of the lack of an available criterion measure of vulnerability in high-risk studies, uncertainty about the validity of conjectural indicators is presently unavoidable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training and dissemination of cognitive behavior therapy for depression in adults: A preliminary examination of therapist competence and client outcomes.

Objective: In this study, the authors examined the feasibility and effectiveness of training community therapists to deliver cognitive behavior therapy (CBT) for depression. Method: Participants were therapists (n = 12) and clients (n = 116; mean age = 41 years, 63% women) presenting for treatment of depression at a not-for-profit and designated community mental health center for St. Joseph County, Indiana. The training model included a 2-day workshop followed by 1 year of phone consultations. CBT competence ratings from the Cognitive Therapy Scale were obtained prior to training and at 6 and 12 months posttraining. Two different groups of clients, a treatment-as-usual (TAU) group (n = 74) and a CBT group (n = 42), were compared with respect to decrease in symptoms of depression (assessed with the Beck Depression Inventory) and anxiety (assessed with the Beck Anxiety Inventory). Results: Therapists showed significant increases in total scores from pretraining to 6 months posttraining, increases that were maintained at 12 months. The increase in the total score reflected gains on items that specifically measure CBT skills and structure. Although both TAU and CBT resulted in a significant decrease in depressive symptoms, the CBT clients showed significantly greater change than the TAU clients, F(2, 113) = 53.40, p