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.     

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.     

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 in seasonal affective disorder

Research examining dysfunctional attitudes in Seasonal Affective Disorder (SAD) has produced contrasting results. The present study sought to resolve this contradiction by addressing some methodological problems of the previous studies. The study examined dysfunctional attitudes using the Dysfunctional Attitudes Scale (DAS) in individuals with SAD and never-depressed controls. The SAD group were tested both when depressed in the winter (Time 1) and during their remission period (Time 2). At Time 1 the SAD group displayed a relatively elevated DAS compared to controls and to their Time 2 scores. These data therefore provide potential support for a view that SAD is characterized by underlying dysfunctional attitudes.     

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。     

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.     

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.     

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.     

Dysfunctional Attitude Scale (DAS). Psychometrics and Norms of the Swedish Version

Abstract

The Swedish version of the Dysfunctional Attitude Scale (DAS) was examined for reliability, validity and other psychometric characteristics, including non-clinical norms. Parallelism between the DAS-A and DAS-B versions, reliability, test-retest stability and validity of the DAS-A as a measure of depressive cognitive content were supported in lithium-treated euthymic patients with unipolar depressive disorder and healthy controls. Other psychometric properties of the DAS-A were investigated in a randomly selected normal sample (n = 498) of the population between 20 and 70 years of age in a Swedish county. The results were similar to those of earlier normative studies of the scale. A cumulative percentage normative scale of the DAS-A scores is presented.     

The warpy thoughts scale: a new 20-item instrument to measure dysfunctional attitudes

Cognitive theories of psychopathology propose that specific negative cognitive schema held by individuals can increase their likelihood of experiencing depressive episodes. While it has been argued that such dysfunctional attitudes are state measures that occur primarily during periods of depression, a range of research has supported the view that holding dysfunctional attitudes is ongoing, persisting prior to and following depressive episodes. To date, the need for a parsimonious measure of dysfunctional attitudes has not been well addressed. Using data provided by 4545 participants in a free on-line cognitive behavioural therapy program, MoodGYM, we have developed the Warpy Thoughts Scale (WTS), a 20-item instrument measuring dysfunctional attitudes. This scale provides 3 first order factors (Relationships, Achievements and Entitlements) and a higher order factor, Warpy Thoughts, from which a Warpy Thoughts score can be obtained. Confirmatory factor analyses on this model indicated that it provides robust results for men and women and for individuals in a wide range of ages. WTS scores were moderately correlated with levels of depressive and anxiety symptoms (0.39 and 0.40, respectively) and explained up to one-fifth of the variance of these mental health measures. Further validation of the WTS against other measures of dysfunctional thoughts is required.     

Development and validation of a brief version of the dyadic adjustment scale with a nonparametric item analysis model

The main purpose of the current research was to develop an abbreviated form of the Dyadic Adjustment Scale (DAS) with nonparametric item response theory. The authors conducted 5 studies, with a total participation of 8,256 married or cohabiting individuals. Results showed that the item characteristic curves behaved in a monotonically increasing function for all items of the brief 4-item version of the DAS (DAS-4). The DAS-4 proved to be informative at all levels of couple satisfaction. Compared with the 32-item version of the DAS (DAS-32), it was as effective in predicting couple dissolution and was significantly less contaminated by socially desirable responding. In addition, structural equation modeling demonstrated that the underlying latent construct measured by the DAS-4 was very stable over a 2-year period. This brief version has the advantage of being less time consuming and constitutes a promising alternative to the original DAS-32 for clinicians and researchers.     

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.     

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.     

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.     

The endorsement of dysfunctional attitudes is associated with an impaired retrieval of specific autobiographical memories in response to matching cues

Two studies investigated a hypothesis of Dalgleish et al. (2003) that overgeneral memory may arise from matching between task cues and dysfunctional attitudes or schemas. In the first study, 111 euthymic patients with at least two previous major depressive episodes completed the Dysfunctional Attitude Scale: Form A (DAS-A) and the Autobiographical Memory Test (AMT). In the second study, 82 patients with a borderline personality disorder completed the Young Schema Questionnaire (YSQ) and the same version of the AMT. In both studies, patients retrieved less specific autobiographical memories in response to cue words that matched highly endorsed attitudes or schemas. These results suggest that an impaired retrieval of specific memories may be the result of certain cues activating generic, higher-order mental representations.     

Failures to retrieve specific memories in previously depressed individuals: random errors or content-related?

Failures to retrieve specific memories have been related to general tendencies to commit errors in executive functioning tasks, raising the question of whether they are simply a reflection of randomly occurring lapses in cognitive control or whether their occurrence is in any way related to memory content. This study investigated the relation between failures to retrieve specific autobiographical memories and dysfunctional attitudes in individuals at risk for depression and controls. Sixteen previously depressed and 19 never-depressed participants were assessed for dysfunctional attitudes regarding "need for approval" and "performance evaluation". One week later, they were asked to generate specific memories following dependency- and achievement-related cue words, both under single and dual task conditions. In previously depressed participants, dysfunctional attitudes regarding "need for approval" significantly predicted specificity for dependency-related events under dual task conditions. The findings provide qualified support for a role of content and demonstrate how, in previously depressed individuals, content effects can surface when cognitive control is undermined.     

The Depressive Attributions Questionnaire (DAQ): Development of a Short Self-Report Measure of Depressogenic Attributions

A depressogenic attributional style, i.e., internal, stable and global causal interpretations of negative events, is a stable vulnerability factor for depression. Current measures of pessimistic attributional style can be time-consuming to complete, and some are designed for specific use with student populations. We developed and validated a new short questionnaire suitable for the measurement of depressogenic attributions in clinical settings, the Depressive Attributions Questionnaire (DAQ). The 16-item DAQ, and measures of depression and related cognitive concepts were completed by three samples of depressed patients and matched controls, or depressed and non-depressed participants who had been exposed to a recent uncontrollable stressful life event (total N = 375). The DAQ had high (i) internal reliability, (ii) test-retest reliability, (iii) convergent, discriminant and construct validity. It predicted a diagnosis of major depression at 6 months after an uncontrollable stressor, over and above what could be predicted from initial depression severity. Depressed patients rated the scale as acceptable. The DAQ may be a useful short measure of depressogenic attributions, which is easy to administer, and predicts concurrent and future depression. It has possible applications as a screening measure for risk of depression, or as a treatment process measure.     

Dysfunctional beliefs in panic disorder: The Panic Belief Inventory

The Panic Belief Inventory (PBI) was developed to assess beliefs that increase the likelihood of catastrophic reactions to physical and emotional experiences in panic disorder. In the first stage of scale development, 197 panic disorder patients completed the PBI and standard self-report inventories of psychiatric symptomatology. An exploratory factor analysis yielded a 4-factor solution from which a 35-item instrument with 4 scales was constructed. The shortened measure and its scales had good internal consistency and convergent validity and moderate discriminant validity. Subsequently, 22 panic disorder patients who received cognitive therapy completed the PBI and other self-report inventories of dysfunctional cognitions at intake, 4 weeks, 8 weeks, termination, and several follow-up intervals. Results indicated that the PBI decreased significantly across treatment, with the largest decline occurring between intake and 4 weeks into treatment. The PBI correlated more strongly with dysfunctional cognitions associated with anxiety than dysfunctional cognitions associated with depression. These results provide preliminary evidence that the PBI has adequate psychometric characteristics, is useful to assess change in dysfunctional beliefs during treatment, and has the potential to advance cognitive theories of panic.