Towards an Integration of Interpersonal Risk Models of Depression and Cognitive Behaviour Therapy: A Commentary on What Constitutes Interpersonal Therapy

The article by Dobson, Quigley, and Dozois on interpersonal model provides a very useful guide on how to extend cognitive behavioural models of depression to incorporate interpersonal vulnerabilities that influence how depressed people behave towards others. The point is made that interpersonal processes are very likely to influence the onset and course of depression. In this commentary, I extend this analysis further examining the evidence on how interactions within close relationships, particularly couple relationships, interact with individuals' depression. Evidence is also cited on the effectiveness of couple‐based therapy in treating depression.     

Friendship and similarities in social-cognitive and communication abilities: Social skill bases of interpersonal attraction in childhood

Although researchers have examined how different forms of similarity (e.g., demographic similarity, attitudinal similarity) affect interpersonal attraction, little work has focused on how similarities in social-cognitive abilities and communication skills affect attraction and relationship development. The present article suggests how the similarity/attraction literature and filter theories of relationship development can be integrated with research on social skills and cognitive development to provide a framework for understanding how similarities in levels of social skills may affect attraction and friendship formation in childhood. A study was carried out assessing how similarities in levels of social-cognitive and communication skills affected interpersonal attraction and friendship choices by children. It was hypothesized that children would be (a) attracted to and (b) more likely to form friendships with peers who had social-cognitive and communication skills similar in level to their own. Participants (92 grade school children) completed a battery of tasks providing assessments of four social-cognitive and five communication skills. Sociometric procedures were used to determine interpersonal attraction and friendship patterns. Results indicated that children were attracted to peers having social skill levels similar to their own. Moreover, pairs of friends had similar levels of skills related to the expression and management of emotional states.     

Empathic deficits in sexual offenders: An integration of affective,social, and cognitive constructs

A number of researchers have suggested that lack of empathy is a critical feature in the assessment and treatment of sex offenders. However, difficulties with definitions of empathy and corresponding measures of that construct have led to limited and disparate empirical findings supporting this claim. Such findings may be due to a definition of empathy that fails to incorporate other key factors related to sexual offending. Factors such as inaccurate social perceptions, cognitive distortions, deficits in interpersonal intimacy, maladaptive emotional regulation abilities, and other socio-cognitive deficiencies thought to contribute to sexually assaultive behavior also share a number of core developmental features with affect and emotional responding. As socio-cognitive abilities tend to develop simultaneously at times as humans mature, it is suspected that social, cognitive, and affective skills impact one another's development and ultimately dictate the expression of empathy in adulthood. Accordingly, deficits in social skills, interpersonal intimacy, and cognitive processes necessary to emotional stability and appropriate social interaction may be critical to the development and expression of empathic deficits and subsequent efforts to treat or reduce such deficits in sexual offenders. This paper will review and integrate literature examining the relationship of various socio-cognitive factors to empathic deficits in sexual offenders.     

Interpersonal competence across domains: relevance to personality pathology

Interpersonal problems are significant markers of personality disorders (PDs). There is little research examining the specific interpersonal problems which lead to social impairment in PD. This study used canonical correlation analyses to examine the relationship between interpersonal competence and PDs, first as categorized by DSM-IV diagnoses, then as categorized by empirically-derived factors, in a sample at risk for recurrence of major depression. The most significant sources of shared variance were social inhibition and self-disclosure competence. The empirically-derived PD categories accounted for more variance in interpersonal competence than the DSM-IV diagnostic categories. Social skills training in initiation and self-disclosure may be useful for treating individuals with PD who experience interpersonal problems. Empirically-derived categories of PD symptoms may capture interpersonal problems experienced by individuals with PD which DSM-IV categories do not.     

Cognitive and Interpersonal Vulnerabilities to Adolescent Depression: Classification of Risk Profiles for a Personalized Prevention Approach

Despite interest in psychosocial vulnerabilities to depression, little is known about reliable and valid individualized risk profiles that can be used to match individuals to evidence-based interventions for depression. This study investigated well-established cognitive and interpersonal vulnerabilities to depression among youth to discern an evidence-based risk classification approach which is being used in a personalized depression prevention randomized clinical trial. Data were drawn from a general community sample of adolescents (N?=?467; ages 10–16, mean 13.14, SD?=?1.62; 57% females) who were followed prospectively for 3 years. Youth completed measures of cognitive (negative cognitive style, dysfunctional attitudes, rumination) and interpersonal (support and conflict with peers and parents, excessive reassurance seeking, social competence, co-rumination) risks to depression, and then were followed longitudinally for onset of depression. Principal axis factor analyses showed that three latent factors--cognitive vulnerability, interpersonal support, and interpersonal conflict--optimally represented the structure of these risk factors. Clinically practical and meaningful cutoffs, based on tertile cut-off scores on cognitive and interpersonal risk measures, were used to categorize youth into relatively balanced high and low cognitive and interpersonal risk groups. These risk classification groups exhibited validity (AUC?>?0.70) by predicting prospective onsets of depressive episodes at 18-months follow-ups. These findings demonstrate a reliable and valid approach to synthesize psychosocial vulnerabilities to depression, specifically cognitive and interpersonal risks. Results are discussed in terms of using these risk classifications profiles to test personalized prevention of depression during adolescence.     

Cognitive and temperamental vulnerability to depression: Longitudinal associations with regional cortical activity

Posterior cortical activity may be related to individual differences in temperamental emotionality, especially traits implicated in depression vulnerability. We previously reported that electroencephalographic (EEG) indices of cortical activity in posterior regions were associated with temperamental positive emotionality (PE) in early childhood. This project examined whether EEG indices of regional cortical activity, assessed at age 5–6, were associated with child temperament and cognitive vulnerability to depression, assessed at age 7. Asymmetry in posterior cortical activity measured at age 5–6 was associated with PE at follow-up at age 7, and with greater helplessness during a standardised laboratory task simulating a mild interpersonal rejection. Findings provide further support for the notion that low PE and depression are associated with similar patterns of cortical activity. Furthermore, these patterns of activity may have observable behavioural and cognitive correlates that are meaningfully linked to the phenomenology of depression.     

Cognitive,affective and social mechanisms in depression risk: Cognition,hostility, and coping style

Although some research has assessed cognitive variables in individuals at risk for depression, few studies have specifically assessed the role of automatic thinking, and virtually no studies have assessed anger and coping in this group. The current study compared measures of these variables in a high-risk group that was defined on the basis of a previous episode of depression, and a control group comprised of low-risk/never depressed individuals. Even though neither group evidenced depressive symptoms at the time of assessment, group comparisons and regression analyses indicated that high-risk individuals reported more negative automatic thoughts than did low-risk participants and that social support seeking, self-blame, and avoidance emerged as coping predictors of risk as did higher levels of anger and hostility. These data thus suggest patterns of interpersonal, behavioural, and cognitive variables that may characterise depression risk.     

Facial affect processing and depression susceptibility: cognitive biases and cognitive neuroscience

Facial affect processing is essential to social development and functioning and is particularly relevant to models of depression. Although cognitive and interpersonal theories have long described different pathways to depression, cognitive-interpersonal and evolutionary social risk models of depression focus on the interrelation of interpersonal experience, cognition, and social behavior. We therefore review the burgeoning depressive facial affect processing literature and examine its potential for integrating disciplines, theories, and research. In particular, we evaluate studies in which information processing or cognitive neuroscience paradigms were used to assess facial affect processing in depressed and depression-susceptible populations. Most studies have assessed and supported cognitive models. This research suggests that depressed and depression-vulnerable groups show abnormal facial affect interpretation, attention, and memory, although findings vary based on depression severity, comorbid anxiety, or length of time faces are viewed. Facial affect processing biases appear to correspond with distinct neural activity patterns and increased depressive emotion and thought. Biases typically emerge in depressed moods but are occasionally found in the absence of such moods. Indirect evidence suggests that childhood neglect might cultivate abnormal facial affect processing, which can impede social functioning in ways consistent with cognitive-interpersonal and interpersonal models. However, reviewed studies provide mixed support for the social risk model prediction that depressive states prompt cognitive hypervigilance to social threat information. We recommend prospective interdisciplinary research examining whether facial affect processing abnormalities promote-or are promoted by-depressogenic attachment experiences, negative thinking, and social dysfunction.     

Adult attachment dimensions and specificity of emotional distress symptoms: prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms

Three prospective studies examined the relation between adult attachment dimensions and symptoms of emotional distress (anxiety and depression). Across all three studies, avoidant and anxious attachment prospectively predicted depressive symptoms, and anxious attachment was associated concurrently with anxiety symptoms. Study 2 tested a cognitive risk factors mediational model, and Study 3 tested an interpersonal stress generation mediational model. Both cognitive and interpersonal mediating processes were supported. The cognitive risk factors pathway, including elevated dysfunctional attitudes and low self-esteem, specifically mediated the relation between insecure attachment and prospective elevations in depression but not anxiety. For the interpersonal stress generation model, experiencing additional interpersonal, but not achievement, stressors over time mediated the association between insecure attachment and prospective elevations in depressive and anxious symptoms. Results advance theory and empirical knowledge about why these interpersonal and cognitive mechanisms explain how insecurely attached people become depressed and anxious.     

Interpersonal problem solving as a mediator of behavioral adjustment in preschool and kindergarten children

An experimental model tested the mediating function of interpersonal cognitive problem solving skills on behavioral adjustment in preschool and kindergarten children. Relative to controls, nursery-trained youngsters improved in three such skills, kindergarten-trained in two. In both the nursery- and kindergarten-trained groups, increased ability to conceptualize alternative solutions to interpersonal problems significantly related to improved social adjustment. Consequential thinking also emerged as a clear behavioral mediator, especially among kindergarten-aged youngsters. Improvement in behavior could not, however, be attributed to change in causal thinking skills. Having identified two significant behavioral mediators in young children, a beginning has been made to isolate specific thinking skills, which, if enhanced, can contribute to healthy social adjustment and interpersonal competence at an early age.     

Parental Representations and Support-Seeking Behaviors Related to Dependency and Self-Criticism

Cognitive and interpersonal models of depression were integrated by examining the links between parental representations and the interpersonal behaviors of individuals at risk for depression. Study 1 assessed the quantity and type of social support associated with Dependency and Self-Criticism. Study 2 examined the parental representations related to these personality styles, in an effort to document cognitive variables that might contribute to interpersonal behaviors. Self-critics were found to be more dysphoric over a 21-day, self-monitoring period, made fewer requests for social support, and showed lower perceptions of support. Peers did not report providing less support to self-critics, but found them less expressive and did not know them as well. Study 2 found pervasive, negative parental representations associated with Self-Criticism providing a cognitive underpinning to social distancing. Dependent participants reported higher levels of support, which was corroborated by the peer reports. Study 2 found Dependency to be related to favorable representation of parents for friendly and submissive, but not hostile, situations. The impact of cognitive representations for interpersonal functioning is highlighted, and reciprocal processes between the two are discussed.     

Social rejection and ADHD in young adults: an analogue experiment

Poor outcomes in ADHD may be related to problematic social functioning and consequences of social rejection. This study examines how ADHD symptom expression affects mood and social rejection. Working from findings in depression that describe maintenance through negative interpersonal interactions, the authors seek to examine this theory's applicability to poor outcomes in ADHD. In a completely randomized design, 130 participants are exposed to one of several videotape segments that include displays of ADHD, depression, and social anxiety. A normal control is also used. All abnormal videotapes are met with greater rejection than the control. Displays of ADHD elicit similar levels of rejection to those elicited by displays of depression. Additionally, ADHD elicits greater levels of hostile mood, whereas depression elicits high levels of depression and fatigue. Implications for an interpersonal theory of vulnerability in ADHD are discussed along with implications for future research, prevention, and intervention.     

Managing resistance in cognitive behavioural therapy: the application of motivational interviewing in mixed anxiety and depression

While cognitive behavioural therapy is highly effective in the treatment of anxiety and depression, a substantive number of individuals either refuse treatment, fail to respond to treatment or respond only partially. Arguably, ambivalence about change or about engaging in treatment tasks may in part be related to incomplete recovery rates in cognitive behavioural therapy. Motivational interviewing is a client-centred, directive treatment originally developed in the addictions domain whose goal is to enhance motivation for change by understanding and resolving ambivalence. This method has consistently received support for enhancing outcomes in the addictions domain, particularly when used as an adjunct to further treatment. As yet, motivational methods have not been generalized to the treatment of prevalent mental health problems, such as anxiety and depression. The present paper presents the application of a treatment targeting motivation (motivational interviewing adapted for anxiety and depression) to the management of resistance in cognitive behavioural therapy for 3 clients with mixed anxiety and depression. Motivational interviewing is conceived as an adjunct to highly effective traditional cognitive behavioural therapy methods, which is indicated for use with clients resistant to and significantly ambivalent about change-based techniques for managing anxiety or alleviating depression.     

认知能力对学业成绩的影响:有中介的调节模型

学业成绩是衡量学生掌握知识水平的重要指标,受到认知能力、社会支持和学习动机等多重因素的显著影响,而这多重因素间的关系及其对学业成绩的共同作用机制尚不明确。本研究采用标准化的认知能力测验、社会支持量表、学习动机量表对4,973名初中生进行测试,并以各科测验成绩总分的平均值作为学业成绩指标。结果表明：（1）认知能力、社会支持、学习动机均与学业成绩正相关;（2）社会支持在认知能力对学业成绩的影响中起调节作用,学生感受到的社会支持水平越高,学业成绩表现越好,且其认知能力对学业成绩的预测作用越强;（3）社会支持的调节作用部分通过学习动机这一中介变量实现。本研究构建了一个基于个体因素（认知能力和学习动机）和环境因素（社会支持）共同影响学业成绩的理论模型,有利于人们深入理解认知能力影响学业成绩的内在机制和边界条件,为提升学生学业成绩提供了理论依据和实证支持。     

Ruminative and reflective forms of self-focus: Their relationships with interpersonal skills and emotional reactivity under interpersonal stress

Self-focus can be divided into adaptive and maladaptive aspects, that is, self-reflection and self-rumination respectively. This study explores how these distinctive forms of self-focus are associated with interpersonal skills required for beginning and maintaining social relationships, and with negative emotional regulation when one experiences interpersonal problems. A survey of 150 undergraduates (Study 1) indicated contrasting cross-sectional associations between self-reflection and self-rumination and interpersonal skills; self-rumination is associated with perceived impaired interpersonal skills, whereas self-reflection is associated with the improved skills. In Study 2, using a four-wave longitudinal design, we investigated the buffering effects of self-rumination and self-reflection on negative emotional reactivity to interpersonal conflicts. Analysis of multilevel models indicated that self-rumination predicts a greater increase in negative affect after one experiences negative interpersonal events, whereas self-reflection had no such effects on the negative affect. These results suggest that self-rumination is associated with perceived impaired interpersonal skills, which could delay problem solving and exacerbate the effect of interpersonal problems, thereby leading to dysphoria. In contrast, self-reflection might contribute to the maintenance of relationships in usual or stable conditions but does not aid emotion regulation or problem solving in difficult or negative situations such as when one experiences interpersonal problems.     

人际互动中的“自我-他人”区分:多水平的探索

人际互动的根本问题在于我们如何在表征自身想法和感受的同时试图去理解他人的心理和情感状态, 以驾驭复杂的社交环境。最近研究发现个体主要通过模拟自我加工过程实现对他人的理解, 但这种自我加工以及心理模拟在一定程度上混淆了自我与他人。因此, 为进行成功的人际互动, 大脑必须灵活区分自我和他人相关的表征, 这种能力被称为“自我-他人”区分(self-other distinction, SOD)。通过探讨感知、动作、认知以及情感等不同加工水平社会认知过程中的“自我-他人”区分及相应的研究范式, 实现对人际互动过程更全面而深入的理解, 为改善社会认知、情感障碍以及自闭症的干预提供依据。在此基础上, 提出了具体的研究展望。     

Treatment of Depression and Suicide in Older Adults

This article describes a cognitive behavior therapy (CBT) intervention for suicide prevention in older adults. Although many studies have found that CBT interventions are efficacious for reducing depressive symptoms in the elderly, researchers have yet to evaluate the efficacy of such interventions for preventing suicide or reducing suicide risk in older adults. In this article we describe a 12-session CBT protocol for reducing depression, suicide ideation, and other risk factors of late-life suicide. The following aspects of the treatment are described: assessing suicide risk, conceptualizing the problem through a cognitive behavioral framework, developing a safety plan, increasing hope and reasons for living, improving social resources, improving problem-solving skills and efficacy, improving adherence to medical regimen, and relapse prevention. In addition, we review other behavioral and cognitive strategies such as activity scheduling and cognitive restructuring that are commonly associated with CBT interventions for depression. We illustrate the application of these strategies through the use of case examples.     

Treatment of Excessive Interpersonal Dependency: A Cognitive-Behavioral Model

Clients with excessive dependency often seek treatment for an Axis I anxiety or mood disorder. Simply providing treatment for the Axis I disorder may fail to address the long-standing personality factors that may underlie the acute anxiety and depression. A four-stage model has been proposed for the treatment of excessive interpersonal dependency. This model describes strategic ways therapy content and style should change over the course of treatment. Despite the apparent utility of the four-stage treatment model, it may be difficult to apply in many sites that now emphasize short-term approaches to treatment. In many cases, therapy can be designed to address themes that are relevant to both dependency and the Axis I syndrome. Therapy can be focused around helping clients make improvements in stabilizing emotional reactions, enhancing views of the self, and improving social functioning. Treatment focused on stabilizing emotional reactions can help clients confront and develop tolerance for feelings of depression and anxiety. Treatment focused on enhancing views of the self can help clients improve their self-esteem, self-reinforcement and reduce self-criticism. Treatment focused on improving social functioning can enhance social skills, reduce social anxiety and challenge feelings of loneliness. In addition, treatment can focus on reducing specific aspects of interpersonal dependency and confronting developmental antecedents that may underlie the dependency.