青少年抑郁综合认知模型及其性别差异

Beck抑郁认知理论认为功能失调性态度和自动思维对抑郁的形成和发展有着重要的影响, 但是不同水平的认知因素在青少年抑郁中起什么样的作用还有待于进一步的研究。根据Oei和Kwon (2007)综合认知模型(ICM), 我们假设在青少年负性生活事件和抑郁症状间功能失调性态度是调节变量, 而自动思维是中介变量。研究采用开学初和临近期末间隔近四个月两个时间点的纵向数据搜集方式, 对613名初中生施以青少年生活事件量表(ASLEC)、功能失调性态度问卷(DAS)、自动思维问卷(ATQ)以及流调中心用抑郁量表(CES-D), 然后通过路径分析对模型进行了拟合度和性别差异检验, 结果表明：(1)各变量显著相关(p<0.01), 且各变量间隔四个月两个时间点的分数差异显著(p<0.01); (2)修正后的青少年抑郁综合认知模型较好地拟了数据, 且功能失调性态度与负性生活事件的交互作用对自动思维的影响上女生的路径系数显著大于男生。结论：功能失调性态度在负性生活事件和青少年抑郁症状间起调节作用, 而自动思维从中起到了认知中介的作用, 且该模型性别差异显著。     

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.     

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.     

Decreased approach motivation in depression

The present study examined relations between choice preference and reaction time to emotionally valenced words, dysphoric symptoms (BDI), and dysfunctional attitudes (DAS) in clinically depressed (CD; n= 61), previously depressed (PD; n= 42), and never depressed controls (ND; n= 46). The results showed: (1) NDs and PDs exhibited a choice preference for the relatively more positive words and differed significantly from CDs; (2) PDs and CDs exhibited longer reaction time and differed significantly from NDs; and (3) BDI and DAS were positively associated with reaction time to positively valenced words, whereas no associations were found for reaction time to negatively valenced words. The increased reaction time, in PDs and CDs, is discussed as a possible vulnerability factor to depression, which may be related to decreased approach motivation.     

Dysfunctional attitudes and psychosocial stress: The differential prediction of future psychological symptomatology

The interactive effects of dysfunctional attitudes, stressful life events, and social support on symptoms of depression and general psychological distress were investigated in the present study. Self-report measures of these five constructs were administered to 57 female undergraduates twice, with 3 months between testing sessions. Whereas the interactions of dysfunctional attitudes with stressful life events and with social support were expected to predict the subsequent severity of symptoms of depression, it was hypothesized that these two-way interactions would not predict symptoms of general psychological distress. These predictions were confirmed, with the exception that the interaction between dysfunctional attitudes and stressful life events was not a significant predictor of depressive symptoms. Specifically, it was found that the combination of a high number of dysfunctional attitudes measured at Time 1 with a low level of social support measured at Time 2 was positively related to the level of depressive symptoms assessed at Time 2. These results suggest that dysfunctional attitudes moderate the relationship between stress and mild depressive symptomatology. The implications of these findings for an interactional model of depression, as well as for directions for future research, are discussed.Preparation of this article was facilitated by a Medical Research Council of Canada Studentship to the first author, and by Grant MA-8574 from the Medical Research Council of Canada to the second author.     

Induced mood change and dysfunctional attitudes in remitted bipolar I affective disorder

This study investigated the possibility that, in remitted bipolar I affective disorder, dysfunctional attitudes are mood-state dependent. Participants were 120 individuals with remitted bipolar I disorder, remitted unipolar depression, or no history of affective disorder. The Dysfunctional Attitudes Scale (DAS; Weissman, 1979) was completed before and after positive or negative mood challenge. Following mood increase, the bipolar group changed significantly less in DAS total score than did the other 2 groups, and in goal-striving and achievement attitudes relative to the unipolar group. These findings did not provide clear support for the mood-state dependency theory in bipolar disorder, arguing instead for the presence in bipolar I disorder of dysfunctional cognitions that show characteristic resilience in the face of minor positive mood increase.     

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-SF1). In addition, because 2 versions of the DAS are needed for certain study designs, they also developed a 2nd short version (DAS-SF2). 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-SF1 and DAS-SF2 provide an efficient and accurate assessment of dysfunctional attitudes among depressed individuals.     

Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants

This study investigated self-reported state (anxiety, physical symptoms, cognitions, internally focused attention, safety behaviors, social performance) and trait (social anxiety, depressive symptoms, dysfunctional self-consciousness) predictors of post-event processing (PEP) subsequent to two social situations (interaction, speech) in participants with a primary diagnosis of social anxiety disorder (SAD) and healthy controls (HC). The speech triggered significantly more intense PEP, especially in SAD. Regardless of the type of social situation, PEP was best predicted by situational anxiety and dysfunctional cognitions among the state variables. If only trait variables were considered, PEP following both situations was accounted for by trait social anxiety. In addition, dysfunctional self-consciousness contributed to PEP-speech. If state and trait variables were jointly considered, for both situations, situational anxiety and dysfunctional cognitions were confirmed as the most powerful PEP predictors above and beyond trait social anxiety (interaction) and dysfunctional self-consciousness (speech). Hence, PEP as assessed on the day after a social situation seems to be mainly determined by state variables. Trait social anxiety and dysfunctional self-consciousness also significantly contribute to PEP depending on the type of social situation. The present findings support dysfunctional cognitions as a core cognitive mechanism for the maintenance of SAD. Implications for treatment are discussed.     

The relationship between personality pathology and dysfunctional cognitions in previously depressed adults

Multivariate and univariate regression models were used to examine the relationship between Axis II personality pathology and dysfunctional cognitions in a follow-up study of 40 formerly depressed inpatients. A dimensionalized measure of overall Axis II pathology was significantly and positively related to dysfunctional attitudes (Dysfunctional Attitudes Scale [DAS]) and maladaptive negative event attributions (Attributional Style Questionnaire-Negative Composite [ASQ-N]); the Axis II measure accounted for approximately 29% of the variance in DAS and 14% of the variance in ASQ-N, after controlling statistically for subsyndromal depressive symptoms (Beck Depression Inventory [BDI]). Axis II pathology was not significantly associated with positive event attributions, and no significant Axis II x BDI interaction effects were observed. A secondary canonical analysis of Axis II clusters was largely consistent with a hypothesized general personality pathology factor associated with dysfunctional cognitions, though a more specific association between Axis II Cluster C pathology and dysfunctional attitudes was also observed.     

Dysfunctional Attitudes and Suicidal Ideation in Psychiatric Outpatients

To determine if specific sets of dysfunctional attitudes were related to suicidal ideation, the 100-item Dysfunctional Attitude Scale (DAS) was administered to 908 psychiatric outpatients along with the Beck Depression Inventory (BDI), Hopelessness Scale (BHS), Self-Concept Test (BST), and Scale for Suicide Ideation (SSI). The SSI was used to classify the outpatients into 97 (10.7%) suicide ideators and 811 (89.3%) nonideators, and the DAS was scored for nine subscales described by Beck, Brown, Steer, and Weissman (1991) . None of the DAS subscales discriminated the ideators and nonideators or was significantly related to SSI total scores of the suicide ideators after controlling for sex, age, diagnosis of a mood or panic disorder, comorbidity, presence of a personality disorder, a history of a past suicide attempt, the BDI, the BHS, and the BST. The contributions of sets of dysfunctional attitudes for identifying and explaining suicidal ideation were overshadowed by a history of a past suicide attempt and hopelessness.     

Processing of emotional information in seasonal depression across different cognitive measures

This study examined memory for emotional material, endorsement of emotional adjectives, and negative attributional style (NAS) in seasonal affective disorder (SAD). SAD patients showed elevated NAS and increased endorsement of negative self-referent adjectives, but no memory bias for negative material, when compared with never-depressed controls. Longitudinal analyses revealed that none of these cognitive measures significantly predicted later symptom levels independent of initial symptom levels, in the SAD patients. The cross-sectional findings for adjective endorsement and memory were replicated in a second experiment. These data provide further evidence that depression-related memory effects in SAD are different from those found in nonseasonal depression. Accounts of these differences involving putative mood-repair processes and/or an absence of dysfunctional negative schemas in SAD are discussed.     

The Role of Rumination in Predicting Seasonality

The impact of the changing seasons on mood and behavior (i.e., seasonality) has long been of interest to researchers. Recently, researchers have begun to look beyond biological explanations to investigate psychological variables that may play a role in the development of seasonal affective disorder (SAD) and subsyndromal (S-SAD) levels of seasonality. Rumination, in particular, has received initial support as a process that predicts more severe levels of winter depression. In the first study, we assessed the effects of rumination, current weather conditions, current level of depression, and attitudes toward weather conditions as predictors of seasonality. In addition to weather conditions, weather attitudes, and current depression, rumination emerged as a significant predictor of seasonality in females but not for males. In the second study, we followed individuals categorized as being high (S-SAD) and low in seasonality over time and assessed for depression at Time 1 and Time 2. Rumination, in addition to current weather conditions and weather attitudes, emerged as a significant predictor of depression for females in the S-SAD group. The results of these studies provide support for the role of rumination in seasonal depression, particularly for females. This type of research may contribute to attempts to better explain gender differences in seasonal depression.     

Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing

According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n?=?30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.

     

The Influence of Anticipatory Processing on Attentional Biases in Social Anxiety

Research on cognitive theories of social anxiety disorder (SAD) has identified individual processes that influence this condition (e.g., cognitive biases, repetitive negative thinking), but few studies have attempted to examine the interaction between these processes. For example, attentional biases and anticipatory processing are theoretically related and have been found to influence symptoms of SAD, but they rarely have been studied together (i.e., Clark & Wells, 1995). Therefore, the goal of the current study was to examine the effect of anticipatory processing on attentional bias for internal (i.e., heart rate feedback) and external (i.e., emotional faces) threat information. A sample of 59 participants high (HSA) and low (LSA) in social anxiety symptoms engaged in a modified dot-probe task prior to (Time 1) and after (Time 2) an anticipatory processing or distraction task. HSAs who anticipated experienced an increase in attentional bias for internal information from Time 1 to Time 2, whereas HSAs in the distraction condition and LSAs in either condition experienced no changes. No changes in biases were found for HSAs for external biases, but LSAs who engaged in the distraction task became less avoidant of emotional faces from Time 1 to Time 2. This suggests that anticipatory processing results in an activation of attentional biases for physiological information as suggested by Clark and Wells.     

Automatic and self-reported attitudes in romantic relationships

Two studies used response latency measures to assess automatic attitudes that individuals are unwilling or unable to reveal about their partners. In Study 1, participants (n = 51) in dating relationships completed two response latency measures (Time 1) and several relationship self-reports (Times 1 and 2). Participants who faced high barriers to exiting (BTE) their relationship generally showed a negative association between their relationship self-reports and automatic attitudes, and there was some evidence that automatic attitudes at Time 1 predicted relationship satisfaction at Time 2. Study 2 (n = 41 couples) replicated the BTE finding and showed that image-based response latency measures may assess automatic attitudes more effectively than word-based measures. A negative correlation between self-reported and automatic attitudes among high-BTE participants suggests that they may overreport relationship positivity to quell feelings of doubt about a relationship they cannot feasibly dissolve.     

Cognitive failures,dysfunctional attitudes,and symptomatology: A longitudinal study

Abstract

A longitudinal study is presented in which a group of mature students were assessed at four months apart for their symptom levels, the occurrence of life events, and two putative cognitive vulnerability measures of dysfunctional attitudes, and of a proneness to cognitive failures. The results showed that although both the Time 1 cognitive measures were significantly correlated with symptom levels four months later, only the effect for cognitive failures remained significant when the initial symptom levels were taken into consideration. Speculations are presented about the possible nature of this vulnerability, and it is concluded that future studies of cognitive vulnerability should not limit themselves to self-reported negative thoughts or attitudes.     

The Dysfunctional Attitude Scale: How well can it measure depressive thinking?

The Dysfunctional Attitude Scale (DAS) was designed to measure patterns of maladaptive thinking held by depressed individuals. Despite its wide use as a research and clinical tool, only a few studies to date were designed to examine its psychometric properties in a clinically depressed population. Moreover, problems of low sample size and limited tests of validity call these findings into question. The present study was designed to examine psychometric properties of the DAS in clinically depressed inpatients and in nondepressed clinical controls. Intertest correlations between the DAS parallel forms and between each form with total test scores ranged from r=.84 to r=.97. Intratest stability coefficients were r=.88 to r=.97. Support for the DAS as a valid measure of dysfunctional cognitions in depressed patients was also indicated. Of those scoring high on the DAS, 73% received an independent RDC diagnosis of clinical depression, while only 36% of those receiving low DAS scores were so diagnosed.     

Social rank and affiliation in social anxiety disorder

The present study examined the interpersonal lives of individuals with social anxiety disorder (SAD). According to evolutionary and interpersonal theories, we construed the interpersonal world using the social rank and the affiliation psychological systems. Two studies assessed measures of social rank, affiliation, social anxiety and depression among a population of treatment-seeking individuals with SAD. In study 1, individuals with SAD without major depressive disorder (MDD; n=42) were compared to healthy controls (n=47). In study 2, individuals with SAD and MDD (n=45) were compared to individuals with other anxiety disorders and MDD (n=31). Results indicated that SAD was related to perceiving oneself as having low social rank, being inferior, and behaving submissively, as well as to low perceived intimacy and closeness among peer relations, friendships and romantic relations. SAD was distinctly associated with these perceptions above and beyond the symptomatic (study 1) and the syndrome-level (study 2) effects of depression. These findings were further supported by a path analysis of the SAD participants from both studies. Our findings highlight the need to address both social rank and affiliation issues in the assessment and treatment of SAD.