Contemporary Psychological Approaches to Depression: Theory, Research, and Treatment

199 Pages·1990·19.147 MB·English

by  Martin E. P. Seligman (auth.), Rick E. Ingram (eds.)

Contemporary
Psychological
Approaches to
Depression
THEORY, RESEARCH, AND TREATMENT
Contemporary
Psychological
Approaches to
Depression
THEORY, RESEARCH, AND TREATMENT
Edited by
Rick E. Ingram
San Diego State University
San Diego, California
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloglng-In-Publlcatlon Data
Conference on Contemporary Approaches to Depression (1st: 1988 : San
Diego, Calif.)
Contemporary psychological approaches to depression: theory,
research, and treatment I edited by Rick E. Ingram.
p. cm.
"Proceedings of the First Annual Conference on Contemporary
Psychological Approaches to Depression: treatment, research, and
theory--from a conference series on contemporary issues in clinical
psychology, held February 6-7,1988, in San Diego, California."
-T.p. verso.
Includes bibliographical references and index.
IS8N-13:978-1-4612-7909-9 e-ISBN-13:978-1-4613-0649-8
001: 10.1007/978-1-4613-0649-8
1. DepreSSion, Mental--Congresses. I, Ingram, Rick E,
II. Title.
RC537.C646 1988
616.85'27--dc20 90-43004
CIP
Proceedings of the First Annual Conference on Contemporary
Psychological Approaches to Depression: Treatment, Research,
and Theory-from a conference series on Contemporary Issues in
Clinical Psychology, held February 6-7, 1988, in San Diego, California
© 1990 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1990
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N,Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Contributors
L yn Y. Abramson, Department of Psychology, University of Wisconsin, Madison, Wisconsin
Jeanne S. Albright, Department of Psychology, Northwestern University, Evanston, lllinois
Lauren B. Alloy, Department of Psychology, Temple University Philadelphia, Pennsylvania
Aaron T. Beck, Center for Cognitive Therapy, University of Pennsylvania, Philadelphia, Pennsylvania
Robert J. DeRubeis, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
David A. Clark, Department of Psychology, University of New Brunswick, Fredericton, New Brunswick,
Canada
Benjamin M. Dykman, Department of Psychology, University of Wisconsin, Madison, Wisconsin
Mark D. Evans, Department of Psychology, University of Minnesota, Minneapolis, Minnesota
Judy Garber, Department of Psychology and Human Development, Vanderbilt University, Nashville,
Tennessee
Ian H. Gotlib, Department of Psychology, University of Western Ontario, London, Ontario, Canada
Constance Hammen, Department of Psychology, University of California, Los Angeles, California
Steven D. Hollon, Department of Psychology, Vanderbilt University, Nashville, Tennessee
Rick E. Ingram, Department of Psychology, San Diego State University, San Diego, California
Randy Katz, Department of Psychiatry, University of Toronto, Toronto,Ontario, Canada
Gerald I. Metalsky, Department of Psychology, University of Texas, Austin, Texas
Mary J. Naus, Department of Psychology, University of Houston, Houston, Texas
Nancy Quiggle, Department of Psychology and Human Development, Vanderbilt University, Nashville,
Tennessee
Lynn P. Rehm, Department of Psychology, University of Houston, Houston, Texas
Martin E. P. Seligman, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
Nancy Shanley, Department of Psychology and Human Development, Vanderbilt University, Nashville,
Tennessee
Brian F. Shaw, Departments of Psychiatry and Behavioral Sciences, University of Toronto, Toronto,
Ontario, Canada
v
Preface
In 1988, the Deparunent of Psychology at San Diego State University initiated the first in a planned
conference series on Contemporary Issues in Clinical Psychology. It was decided that the focus of this first
conference would be depression. Consequently, a number of distinguished scholars were invited to San
Diego to discuss contemporary theoretical, empirical, and treatment issues in depressive disorders. This
volume contains the results of this conference. Each chapter remains true to the original presentation,
although each has been extensively reworked by the authors for inclusion in a book format, and in some
cases co-authors have aided in revisions for the volume.
Given the sheer quantity and impressive quality of contemporary research, it may not be possible to overstate
the impact of psychological approaches on our understanding of depressive disorders. Accordingly, the aim of
this conference was, within the limited amount of time available for such an endeavor, to chronicle the
current status of the psychology of depression. In inviting participants to this forum, no attempt was made
to reflect only certain theoretical views. Contemporary psychological theory and research in depression,
however, are dominated by cognitive viewpoints, and the influence of cognitive perspectives is thus
unmistakable throughout the present volume.
The conference participants represent a prominent and active group of theorists and researchers. In the first
chapter of this volume, Martin E. P. Seligman addresses the epidemiology of depressive disorders across the
life span and suggests the possibility that an increased reliance on the self over time has left a young
generation vulnerable to depression. In Chapter 2, Brian F. Shaw and Randy Katz examine the current status
of cognitive theoretical approaches to depression and the issues that are confronting these theories. In
Chapter 3, Lynn P. Rehm and Mary J. Naus address the utility of theoretical conceptualizations for the study
of depression. In particular, Rehm and Naus explore theoretical frameworks that may be capable of
integrating diverse theory and research on depression. In Chapter 4, Lyn Y. Abramson, Lauren B. AIloy, and
Gerald I. MetaIsky advance a specific type of depression, hopelessness depression, derived from theoretical
perspectives and research on the reformulated helplessness model of depression. Constance Hammen in
Chapter 5 discusses the issue of vulnerability to depression with a particular focus on the personal,
situational and family aspects of vulnerability. Lauren B. Alloy, Jeanne S. Albright, Lyn Y. Abramson, and
Benjamin M. Dykman focus in Chapter 6 on the growing body of research on depressive realism. In
reviewing this research they discuss mechanisms potentially underlying depression based illusions and
distortions and provide several theoretical perspectives from which to view the phenomenon of depressive
realism. In Chapter 7, Judy Garber, Nancy Quiggle, and Nancy Shanley provide an extensive review of
cognitive theories and empirical research as they relate to depression in children and adolescents. In Chapter
8, Steven D. Hollon, Mark D. Evans, and Robert J. DeRubeis discuss the implications that data on the
efficacy of cognitive therapy have for understanding the basic cognitive mechanisms of depression. Ian H.
Gotlib in Chapter 9 addresses the conceptualization and treatment of depression from an interpersonal
systems perspective. Aaron T. Beck and Christine Padesky also participated in the conference by presenting
an extended clinical workshop on cognitive treatment approaches for depression and anxiety. The clinical
methods presented in this workshop are discussed in Chapter 10 by David Clark and Aaron Beck. Finally, in
Chapter 11 Rick E. Ingram addresses the status of cognitive models and research on depression. Although I
did not present at the conference, I have taken the editor's prerogative to include this material.
As the organizer and coordinator of this conference, I would like to thank a number of people who
made the conference and this volume possible. The conference was sponsored jointly by the Department of
Psychology, College of Sciences, and College of Extended Studies at San Diego State University, and by
vii
viii
Alvarado Parkway Institute in La Mesa, California. Individuals in SDSU departments who deserve special
thanks are William A. Hillix, Chair of the Department of Psychology, Donald R. Short, Dean of the
College of Sciences, and Larry Cobb in the College of Extended Studies. More thanks than I can possibly
give go to Anne Wright and Francesca Sardina in the College of Extended Studies. The conference would
not have succeeded without their tireless efforts to insure that each logistical detail was worked out
flawlessly. Woody Woodaman and Allan Adler at Alvarado Parkway Institute were instrumental in insuring
the success of the conference and deserve special thanks. Thanks also go to the Ph.D. students in the
SDSU/UCSD Doctoral Training Program in Clinical Psychology who volunteered to spend a Saturday and
Sunday working at the conference. My appreciation also goes to those professionals who attended the
conference; I hope that new information was learned and that their thinking was stretched. Finally, I would
also like to offer my thanks to the conference participants. It is encouraging to know that such influential
theorists and researchers can be such nice people.
Rick E. Ingram
San Diego
January, 1990
Contents
1. Why Is There So Much Depression Today? The Waxing of the Individual
and the Waning of the Commons ........................................................................ 1
Martin E. P. Seligman
2. Cognitive Theory of Depression: Where AIe We and Where AIe We Going? ............................ 11
Brian F. Shaw and Randy Katz
3. A Memory Model of Emotion ........................................................................................ 23
Lynn P. Rehm and Mary J. Naus
4. Hopelessness Depression: An Empirical Search for a Theory-Based Subtype ........................... .37
Lyn Y. Abramson, Lauren B. Alloy, and Gerald I. Metalsky
5. Vulnerability to Depression: Personal, Situational, and Family Aspects ................................. 59
Constance Hammen
6. Depressive Realism and Nondepressive Optimistic Illusions: The Role
of the Self. ..................................................................................................... 71
Lauren B. Alloy, Jeanne S. Albright, Lyn Y. Abramson, and Benjamin M. Dykman
7. Cognition and Depression in Children and Adolescents ........................................................ 87
Judy Garber, Nancy Quiggle, and Nancy Shanley
8. Cognitive Mediation of Relapse Prevention Following Treatment for Depression:
Implications of Differential Risk ....................................................................... 117
Steven D. Hollon, Mark D. Evans, and Robert J. DeRubeis
9. An Interpersonal Systems Approach to the Conceptualization and
Treatment of Depression .................................................................................. 137
Ian H. Gotlib
10. Cognitive Therapy of Anxiety and Depression ................................................................. 155
David A. Clark and Aaron T. Beck
11. Depressive Cognition: Models, Mechanisms, and Methods ................................................ .l69
Rick E. Ingram
Index ........................................................................................................................... 197
ix
1
Why Is There So Much Depression Today? The Waxing of the
Individual and the Waning of the Commons
Martin E. P. Seligman
Department of Psychology
University of Pennsylvania
Philadelphia, PA 19174
The story that follows comes in three parts. First I will argue that there is, literally, an epidemic of
depression today. Something has happened, roughly since world War II in America, so that depression is
about ten times as common as it used to be. There are four independent lines of evidence suggesting that this
is so. I will detail two well-done, large scale studies showing that the lifetime prevalence of depression in
young people now exceeds by roughly a factor of ten the prevalence in young people 50 years ago. I will
then look at two contemporary peoples who do not live in modem culture -the Kaluli of New Guinea and
the Old Order Amish of Lancaster County, Pennsylvania. Neither of these pre-modem cultures has depression
at anything like the prevalence we do.
Putting this together, there seems to be something about modem life that creates fertile soil for
depression. The second part of the story is to ask what
I will suggest that four sets of singular historical facts have changed the economic, political, and
institutional situation in the West. Two sets of facts have exalted the self and two others have weakened the
buffering effect of larger institutions I call the "commons". I will suggest that depression is a disorder of the
individual, in particular of learned helplessness, when the self is thwarted. Taken together, this results in
individuals, preoccupied with their own hedonics, who take the ordinary failures of life badly and have few
larger beliefs to fall back on for consolation. Finally, I will speculate on the implications of the epidemic of
depression for the future of individualism and for the psychology of personal control. I end by suggesting
that hope lies in striking a healthier balance between commitment to the self and to the common good.
Is This an Age of Melancholy?
Gerald K1erman first coined the apt term "The age of melancholy" (KIerman, 1979) to describe
modem times in the West. He did so in the course of sponsoring two major epidemiological studies while he
was director of the National Institute of Mental Health. Both of these epidemiological studies suggest a
tenfold difference in rate of depression over the last two generations. Both studies, while the best of their
kind ever done, are imperfect. But when you put them together, they both point independently to what looks
like an important fact.
In the first, the Epidemiological Catchment Area (ECA) study, over 9,500 people were given the
same structured diagnostic interview from 1980 to 1982. Rates of DSM-III disorders were obtained, (Robins,
Helzer, Weissman, Orvaschel, et aI., 1984; Myers, Weissman, Tischler, Holzer, et aI., 1984). Importantly,
this standard interview, given to people of different ages, answers the question "Is the instance of depression
different for people who are born in different times?" The second epidemiological study is a parallel study,
but rather than looking at a large representative random sample, the subjects are close relatives of people
who have major depressive disorder (KIerman, Lavori, Rice, et aI. 1985). This study also has a sample size
large enough to ask the question "Depending on the year in which you were born, do you have a different
risk of depressive disorder?"
Let us now tum to the details of these two studies. In the first (Robins et aI., 1984; Myers et aI.,
1984), the National Institute of Mental Health decided that it was going to spend a great deal of money to
answer defmitively: What is the prevalence of depression in America? Are there male/female differences?
Are there age differences? They did this for most other forms of psychopathology as well. The knowledge
Contemporary Psychological Approaches to Depression
Edited by R. E. Ingram
Plenum Press, New York, 1990 1
2 Chapter 1
18-24 yrs 25-44 yrs 45-64 yrs over 65
born c. 1960 c.1945 c.1925 c. 1910
n=1397 n=3722 n=2351 n=1654
New Haven % 7.5 10.4 4.2 1.8
Baltimore % 4.1 7.5 4.2 1.4
SI. Louis % 4.5 8.0 5.2 0.8
(adapted from Robins, Helzer. Weissman, et aI., 1984)
Figure 1. Probability of depression by age cohort (adapted from Robins, Helzer, Weissman, et aI., 1984).
of these rates allows the rational planning of future therapeutic resources. For those of you who teach or are
students of psychiatric epidemiology, this is a landmark study. We now know wilh considerable certainty
the rates of different disorders in America. But what is going to interest us most is a remarkable fact about
depression that surprised all of the researchers.
Let me fIrst say something about how the study was done. Roughly 9,500 adults were randomly
and representatively sampled. There are six centers, both rural and urban. Only the urban data comprising
Baltimore, New Haven, and St. Louis have been published. What I am going to focus on is the lifetime
prevalence of a major depressive disorder and how it changes wilh your age and Ihe decade of your birth. The
lifetime prevalence of disorder is defIned as the percentage of the population Ihat has had the disorder at least
once in their lifetime. This is a cumulative statistic, so Ihe older you get, everything else being equal, Ihe
more chance you have to get Ihe disorder. So if you look at lifetime prevalence of broken legs, you fInd that
it goes up with age, since Ihe older you are the more opportunites you have had to break a leg. What
everyone expected was that the earlier you were born in the century, the higher lifetime prevalence for
depressive disorder, because you have more years to get it if you were born in 1920 Ihan if you were born in
1950.
The occurrence of major depressive disorder was well-defIned. It was ascertained by asking each
member of the sample if they had each of the symptoms of depression at any time in Iheir lives, going
through these symptoms systematically. These symptoms include prolonged low mood, suicidal Ihoughts
and action, low self-esteem, loss of interest in usually enjoyable activities, lack of motivation, and appetite
loss.
As Figure 1 shows, if you were born around 1960, i.e., about 20-25 years old at the time you were
interviewed, your probability of having had at least one episode of major depressive disorder was 5 or 6%. If
you were 25-44 years old, your risk goes up to about 8 or 9%, as any sensible cumulative statistic should.
Now, however, something odd seems to happen. Even though if you were born around 1925 you've had
much more opportunity to have had Ihe disorder, the rate plummets to little more than 4%. Finally, your
grandparents, born around world World I, have a rate of only about 1% , in spite of 70 years of opportunity to
have had major depressive disorder.
It is irresistible to go artifact hunting now. Briefly, there are several possible artifacts. They are all
pointed to by Ihe fact that most disorders showed a trend in this puzzling direction. Schizophrenia, for
example, had about twice the lifetime prevalence for the two youngest cohorts than for the two oldest
cohorts. But no disorder showed Ihe huge reverse trend Ihat depression did.
Differential survival is one possible artifact; to be included in Ihis sample you had to have made it
to the interview, that is, be alive and not in jailor in Ihe hospital. Perhaps Ihe depressives have died off or
otherwise been eliminated, leaving an inflated number of nondepressed survivors in the oldest groups. Since
there are probably higher rates of mortality, certainly by suicide and even illness in depression-prone people,
Ihis is not implausible. The problem with this account is Ihe sheer size of the difference. A tenfold
difference in depression cannot be accounted for by a presumably much smaller difference in selective
mortality and illness.
Differential memory is a more plausible artifact. On this account, people forget that they had
suicidal Ihoughts or chronic blues. The farlher in time they are from when Ihey had these symptoms, the
more forgetting. If depression tends to occur when you are young, Ihen old people are more likely to be far
in time' away from these symptoms and so to forget them more. In reply to this, when these people are asked
to report depressive symptoms in the last six months, (which holds Ihe forgetting interval constant) young
people have about fIve times as much depression as the oldest group (Meyers et al., 1984). Again, somewhat
plausible, but unlikely to account for a tenfold difference.
Differential wilIingness to report symptoms is also plausible. Perhaps older people are more
reluctant to admit to unpleasant symptoms. Remember, however, that the difference is larger for depression
than for other disorders, so, it is sadness, etc., rather than hallucinations or drinking that old people
Depression and Modernity 3
70
<Je 60
0;
1: 50
.<:0
.~.~
~'C 40
",Q)
QJ.~
:>c n'" 30
~~
aQ:C)QI).
.',C. 20
<:;
10
E
0
0 10 20 30 40 50 60 70
Age, yr
Figure 2. Probabilily of depression among individuals having a depressed reI alive.
particularly avoid reporting. Again, plausible, but unlikely to account for the differences by disorder and very
unlikely to account for a tenfold difference in depression.
Thus, the finding of more depression in people born later in this-century is probably not an artifact
of survival, or reporting, or memory. I lean strongly to the possibility that people born later in this century
have actually experienced much more depression than those born earlier.
Let us now tum to the. second epidemiological study (Klerman, Lavori, Rice, et al., 1985). It is
similar in design and in scale to the fust study. The difference is the sample. In this study, 523 people were
diagnosed as having major affective disorder. They had 2289 fust degree relatives -fathers, mothers, brothers,
sisters, sons, and daughter ~ who all received the same structured diagnostic interview to determine their risk
for major depressive disorder. The size of the sample is large enough to ask the same question of risk with
birth cohort that the ECA sample asked.
Again you see the ten-to-one effect in Figure 2. Consider just females (the males show basically the
same effect, only with half the absolute rate of depression). What the complicated curves show is the
following. Consider just people who were born before 1910, the generation of your grandmothers or great
grandmothers. As you can see, by the time your grandmothers' generation reached age 20, only 1% or 2% of
those who later had a depressed relative themselves had a depressive disorder. By the time they reached age
70, perhaps 10-15% had a depressive disorder. That is a much larger prevalence than the ECA sample,
because these women appear to be at a genetic risk for depression. Now look at the 1950 curve for age 20
and age 30. If you are 30 years old and you were born around 1950 your risk is about 60%, whereas your
great grandmother's risk for depression was about 3% by the time she reached 30. Figures 2 and 3 are
rigorous statistical ways of documenting this phenomenon (Reich. Eerdewegh. et al.. 1988).
1.0
.2
0.8
<3
c
.2 0.6
'"
>
.~ 0.4
<:J>) - Group 1 «25)
0.2 ---- Group 2 (26-44)
..... - GrOup 3 (45+)
10 20 30 40 50 60 70
Age
Figure 3. Distribution of individuals remaining frcc of depression afler a given age.