Negative cognitive styles, dysfunctional attitudes, and the remitted depression paradigm: A search for the elusive cognitive vulnerability to depression factor among remitted depressives.

Results from studies using a behavioral high-risk design and approximations to it generally have corroborated the cognitive vulnerability hypothesis of depression, whereas results from remitted depression studies typically have not. Suspecting that design features of previously conducted remitted designs likely precluded them from detecting maladaptive cognitive patterns, the authors conducted a study featuring the remitted design that has been successful in studies of a biological vulnerability for depression. Participants' current depressive symptoms, negative cognitive styles (hopelessness theory), dysfunctional attitudes (Beck's theory), and lifetime prevalence of clinically significant depression were assessed. Participants who had remitted from an episode of clinically significant depression had more negative cognitive styles, but not greater levels of dysfunctional attitudes, than did never depressed individuals. (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)     

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 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)     

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)     

Recurrence of MDD: A prospective study of personality pathology and cognitive distortions.

Major depressive disorder (MDD) is characterized by a high risk of recurrence, especially among individuals whose initial episode occurs during adolescence. Identifying predictors of recurrence of MDD among young samples is therefore of paramount clinical importance. Survival analytic models were used to evaluate the effects of dysfunctional cognitions and Axis II personality pathology on MDD recurrence in a sample of 130 previously, but not currently, depressed young adults. Participants were initially assessed for depression, dysfunctional attitudes, and personality pathology during their first semester in college and then reevaluated via the Longitudinal Interval Follow-up Evaluation interview every 6 months for 18 months. Baseline level of depressive symptoms significantly (HR-1.07, p = .002) predicted recurrence of MDD. In the survival analyses with baseline level of depression serving as a current mood state covariate, overall personality pathology (HR-1.04, p DSM–IV personality disorder cluster scores uniquely predicted recurrence. We discussed the theoretical, empirical, and clinical implications of these findings, and we noted the limitations of the study. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitions, depressive symptoms, and development in adolescents.

Examined the generalizability of cognitive models of depression to adolescents and explored developmental differences with regard to depressotypic cognitions. Self-reported depressive symptoms and various hypothesized cognitive correlates (e.g., automatic thoughts, attributions, dysfunctional attitudes) were investigated in a sample of 688 adolescents in Grades 7–12. Measures of normative adolescent cognitions (e.g., egocentrism, self-consciousness) also were included. There was a strong association between negative thinking and depression in adolescents. There was no association between depressogenic thinking and age, nor did the strength of the association between negative cognitions and depression vary from early to middle adolescence. Finally, negative cognitions were associated with self-report measures of both depressive and anxious symptoms. (PsycINFO Database Record (c) 2010 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)     

Cognition and life stress in depression: Cognitive factors and the definition, rating, and generation of negative life events.

The relationship between cognitive factors and different conceptualizations and measures of life stress poses important questions for contemporary theories of depression. The authors examined whether cognitive factors (dysfunctional attitudes and attributional style) are related to the definition, rating, and generation of negative life events. Life events were assessed with both subjective self-report and more objective interview-based methods in endogenously depressed outpatients. The results partially support the hypothesis that cognitive factors are related to definition and severity ratings of self-report measures of particular types of life events. These relationships held primarily for achievement, as compared with interpersonal, events. The results also support the hypothesis that elevated scores on measures of cognition are associated with the number of objectively defined events occurring prior to the onset of depression, suggesting that some patients may generate the life events that in turn may initiate a depressive episode. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive predictors of symptom return following depression treatment.

This study tested whether poor cognitive change during depression treatment predicted time to return of depressive symptoms. Depressed participants (N=121) completed assessments of dysfunctional attitudes and extreme thinking (i.e., number of totally agree and totally disagree responses) during hospitalization and again after 6 months of outpatient treatment. Participants then completed monthly depression assessments for 1 year. Survival analyses for time to symptom recurrence during follow-up were conducted among participants who reported 50% improvement in their depressive symptoms and were at least partially asymptomatic at the end of treatment (n=53). Poor change in dysfunctional attitudes and poor change in extreme thinking both predicted shorter time to return of depressive symptoms. (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)     

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)     

Daily Depression and Cognitions About Stress: Evidence for a Traitlike Depressogenic Cognitive Style and the Prediction of Depressive Symptoms in a Prospective Daily Diary Study.

The authors examined the stability and dynamic structure of negative cognitions made to naturalistic stressors and the prediction of depressive symptoms in a daily diary study. Young adults reported on dispositional depression vulnerabilities at baseline, including a depressogenic cognitive style, dysfunctional attitudes, rumination, neuroticism, and initial depression, and then completed short diaries recording the inferences they made to the most negative event of the day along with their experience of depressive symptoms every day for 35 consecutive days. Daily cognitions about stressors exhibited moderate stability across time. A traitlike model, rather than a contextual one, explained this pattern of stability best. Hierarchical linear modeling analyses showed that individuals' dispositional depressogenic cognitive style, neuroticism, and their daily negative cognitions about stressors predicted fluctuations in daily depressive symptoms. Dispositional neuroticism and negative cognitive style interacted with daily negative cognitions in different ways to predict daily depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial.

Negative cognitive structure (particularly for interpersonal content) has been shown in some research to persist past a current episode of depression and potentially to be a stable marker of vulnerability for depression (D. J. A. Dozois, 2007; D. J. A. Dozois & K. S. Dobson, 2001a). Given that cognitive therapy (CT) is highly effective for treating the acute phase of a depressive episode and that this treatment also reduces the risk of relapse and recurrence, it is possible that CT may alter these stable cognitive structures. In the current study, patients were randomly assigned to CT+ pharmacotherapy (n = 21) or to pharmacotherapy alone (n = 21). Both groups evidenced significant and similar reductions in level of depression (as measured with the Beck Depression Inventory–II and the Hamilton Rating Scale for Depression), as well as automatic thoughts and dysfunctional attitudes. However, group differences were found on cognitive organization in favor of individuals who received the combination of CT+ pharmacotherapy. The implications of these results for understanding mechanisms of change in therapy and the prophylactic nature of CT are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult attachment security and symptoms of depression: The mediating roles of dysfunctional attitudes and low self-esteem.

Three studies investigated the relation between adult attachment security and symptoms of depression. Study 1 examined the overall magnitude of the association between adult attachment and depression, and Studies 2 and 3 tested whether this relation was mediated by dysfunctional attitudes and low self-esteem. Results from the three studies were consistent with a mediation model. This model suggests that insecure adult attachment styles are associated with dysfunctional attitudes, which in turn predispose to lower levels of self-esteem. Such depletions in self-esteem are directly associated with increases in depressive symptoms over time. Insecure attachment appears to lead to depressive symptoms in adulthood through its impact on self-worth contingencies and self-esteem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vulnerability to depression: Reexamining state dependence and relative stability.

Treatment-related decreases in Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978) scores have been interpreted as evidence that dysfunctional attitudes are state-dependent concomitants of depression. Data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program were used to reexamine the stability of dysfunctional attitudes. Mean scores for Perfectionism, Need for Approval, and total DAS decreased after 16 weeks of treatment. However, test–retest correlations showed that the DAS variables displayed considerable relative stability. Structural equation models demonstrated that dysfunctional attitudes after treatment were significantly predicted by initial level of dysfunctional attitudes as well as by posttreatment depression. The relative stability of dysfunctional attitudes was even higher during the 18-month follow-up period. The results were consistent with Beck's (1967) and Blatt's (1974) theories of vulnerability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Temple-Wisconsin Cognitive Vulnerability to Depression Project: Lifetime history of Axis I psychopathology in individuals at high and low cognitive risk for depression.

The authors tested the cognitive vulnerability hypotheses of depression with a retrospective behavioral high-risk design. Individuals without current Axis I diagnoses who exhibited either negative or positive cognitive styles were compared on lifetime prevalence of depressive and other disorders and the clinical parameters of depressive episodes. Consistent with predictions, cognitively high-risk participants had higher lifetime prevalence than low-risk participants of major and hopelessness depression and marginally higher prevalence of minor depression. These group differences were specific to depressive disorders. The high-risk group also had more severe depressions than the low-risk group, but not longer duration or earlier onset depressions. The risk group differences in prevalence of depressive disorders were not mediated by current depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression.

This study examined the nature of cognitive reactivity to mood changes in formerly depressed patients. Patients who recovered either through cognitive–behavior therapy (CBT; N?=?25) or through pharmacotherapy (PT; N?=?29) completed self-reported ratings of dysfunctional attitudes before and after a a negative mood induction procedure. In response to similar levels of induced sad mood, PT patients showed a significant increase in dysfunctional cognitions compared with patients in the CBT group. To evaluate the effects of such cognitive reactivity on the subsequent course of depression, follow-up analyses reassessed 30 patients several years after initial testing. Results indicated that patients' reactions to the mood induction procedure were predictive of depressive relapse. These findings argue for differential effects of treatment on cognitive reactivity to mood induction and for the link between such reactivity and risk for later depressive relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes toward depression among rehabilitation participants with acute stroke: Evidence of an age cohort effect.

Purpose/Objective: Depression is commonplace after acute stroke and is associated with increased morbidity and mortality. No data exist regarding attitudes about depression among older persons with acute stroke and their potential impact on self-report of depressive symptoms. The objective of this study was to determine if attitudes toward depression affect depression symptom reporting. Research Method/Design: Cross-sectional using data from an inpatient rehabilitation unit. Seventy-two people with acute stroke were surveyed regarding their attitudes toward depression as part of a larger battery assessing their cognitive and emotional functioning. Results: Both age and cognitive status were significant predictors of attitudes toward depression. Older participants expressed significantly more negative attitudes about depression and seeking professional help compared with younger participants. Those with higher cognitive scores held more positive attitudes. However, attitudes about depression were unrelated to participants' responses on self-report measures of depression. Conclusions/Implications: Participants with stroke who were older were more likely to report negative attitudes about depressive symptoms than were younger participants. However, these attitudes do not appear to represent a barrier to their ability to accurately report the presence and severity of depressive symptoms. (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)