Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research.

Resolving whether subthreshold depressive symptoms exist on a continuum with unipolar clinical depression is important for progress on both theoretical and applied issues. To date, most studies have found that individuals with subthreshold depressive symptoms resemble cases of major depressive disorder along many important dimensions (e.g., in terms of patterns of functional impairment, psychiatric and physical comorbidity, familiality, sleeping EEG, and risk of future major depression). However, such manifest similarities do not rule out the possibility of a latent qualitative difference between subthreshold and diagnosable depression. Formal taxonomic analyses, intended to resolve the possibility of a latent qualitative distinction, have so far yielded contradictory findings. Several large-sample latent class analyses (LCA) have identified latent clinical and nonclinical classes of unipolar depression, but LCA is vulnerable to identification of spurious classes. Paul Meehl's taxometric methods provide a potentially conservative alternative way to identify latent classes. The one comprehensive taxometric analysis reported to date suggests that self-report depression symptoms occur along a latent continuum but exclusive reliance on self-report depression measures and incomplete information regarding sample base rates of depression makes it difficult to draw strong inferences from that report. We conclude that although most of the evidence at this time appears to favor both a manifest and latent continuum of unipolar depression symptomatology, several important issues remain unresolved. Complete resolution of the continuity question would be speeded by the application of both taxometric techniques and LCA to a single large sample with a known base rate of lifetime diagnosed depressives.

An evaluation of stress symptoms associated with academic sexual harassment.

It is clear that sexual assault can precipitate posttraumatic stress disorder. Some theorists have suggested that less severe sexually harassing behaviors may also have trauma-like sequelae. In a study evaluating this hypothesis, 69 female participants completed self-report measures of instances of sexual harassment, basic beliefs, psychological distress/symptoms, and PTSD symptoms. Participants watched videotapes depicting sexual harassment, emotional arousal (not sexual in nature), and a neutral interaction while their heart rate was monitored, and they were interviewed using the SCID for PTSD. Results revealed that those who had been sexually harassed reported more negative basic beliefs, more general distress, and more negative state mood after watching the sexual harassment video, relative to those who had not been harassed. The severity of sexual harassing behaviors experienced was positively correlated with PTSD symptoms. Heart rate reactivity to the videotapes did not differ across groups defined by sexual harassment status.

Introduction to the special section on stepped care models in psychotherapy.

Not all patients need the same type and intensity of intervention. Some may be helped greatly by reading a self-help book, watching an instructional video, or using a computer program. Others could benefit from a brief psychoeducational group conducted by a paraprofessional, and still others may require long-term individual treatment from a highly trained professional therapist with specialized expertise. In an environment of limited resources, it makes sense to provide all the time, expertise, and individual attention a patient needs, but not more. Stepped care models represent attempts to maximize the effectiveness and efficiency of decisions about allocation of resources in therapy. This article introduces a special section addressing these resource allocation issues in the context of prevalent disorders (e.g., generalized anxiety disorder, panic disorder, eating disorders, and alcohol dependence) for which empirically supported psychosocial treatments are available.

Experiences of anger in people who have recovered from depression and never-depressed people.

Previous research has linked anger suppression with depression. This study extended prior research by comparing people who had recovered from a major depression (RD) with those who had never been depressed (ND). The RD group significantly exceeded the ND group in the degree to which they reported holding anger in and being afraid to express it. Also, RD participants were more likely to endorse attitudes consistent with silencing the self theory, believing they must hide their feelings to preserve relationships. They were also more likely to have experienced an anger attack. Both silencing the self and a history of anger attacks were significantly correlated with fear of anger expression; future longitudinal or experimental studies are needed to determine whether these variables play a causal role in anger inhibition and in recurrence of depression.

Effect of stage of change on cue reactivity in continuing smokers.

Three classical conditioning models (the conditioned compensatory response, conditioned withdrawal, and conditioned appetitive motivational models) postulate that drug cues evoke physiological and emotional responses associated with motivational states that prompt drug use. There is accumulating evidence to suggest that factors other than classical conditioning can influence emotional and physiological reactivity to drug stimuli. This study tested whether stage of change affects the nature of reactivity to smoking cues among continuing smokers. Precontemplators (smokers not considering quitting) and contemplators (smokers considering quitting in the near future) watched videotapes containing smoking cues. Emotional and physiological responses to the smoking video were contrasted with responses to a neutral videotape. Precontemplators had lower heart rates than did contemplators in response to the smoking videotape. Both contemplators and precontemplators evinced increased positive affect in response to the smoking cue. A comparison sample of nonsmokers did not show any reactivity to the smoking cue. Implications of these findings for conditioning theories of smoking are discussed.

Priming irrational beliefs in recovered-depressed people.

Major depression has been linked with endorsement of irrational beliefs in cross-sectional research, consistent with the rational emotive behavior therapy (REBT) model. In this study, the authors extended prior research by using multiple measures of irrationality and by comparing never-depressed (ND) controls with people who had recovered from major depression. Contrary to the REBT model, the recovered-depressed (RD) group did not significantly exceed the ND group in irrational beliefs before, during, or after exposure to simulated stressful situations. However, associations between irrationality and negative mood, and to a lesser extent between situation-specific irrationality and personality vulnerabilities, were obtained in the RD group but not in the ND group. These findings are consistent with the possibility that RD persons on average may be especially susceptible to having irrationality primed by negative mood states or by the important setbacks that can lead to such mood states.

Sampling of empirically supported psychological treatments from health psychology: smoking, chronic pain, cancer, and bulimia nervosa.

Interventions in health psychology and behavioral medicine represent an integral area of research for the development of psychological therapies to enhance health behaviors, manage symptoms and sequelae of disease, treat psychological symptoms and disorders, prolong survival in the face of a life-threatening illness, and improve quality of life. A sampling of interventions in health psychology and behavioral medicine is offered that meet the criteria for empirically supported treatments for smoking cessation, chronic pain, cancer, and bulimia nervosa. Evidence for empirically supported treatments is identified, along with promising interventions that do not yet meet the criteria as outlined by D. L. Chambless and S. D. Hollon (1998). Evidence for the effectiveness and clinical significance of these interventions is reviewed, and issues in this area of research are outlined.

Introduction to the special section on measuring cognitive products in research and practice.

This article introduces a special section of the Journal of Consulting and Clinical Psychology titled "Measuring Cognitive Products in Research and Practice." The practice of cognitive behavior therapies--and research on their effectiveness and the validity of the models of psychopathology and therapy associated with these treatments--requires valid assessment of cognition. Cognitive variables can be considered at several levels; the main focus of the articles in this special section is on techniques suited to measurement of cognitive products, thoughts, and images of which people are conscious.

Cognitive coping, history of depression, and cigarette smoking.

People with a history of depression are less likely to succeed in quitting smoking than are those with no depression history. Efforts to help formerly depressed smokers by incorporating the principles and techniques of cognitive behavior therapy (CBT) of depression have yielded mixed results. This study tested a major premise of such treatment programs, that formerly depressed smokers are indeed lacking in cognitive coping skills taught in CBT. Four groups (Positive vs. Negative Depression History x Current Smoker vs. Never Smoker) completed the Ways of Responding (WOR) as a test of cognitive coping. History of depression was associated with use of significantly more "negative" (considered maladaptive by expert cognitive therapists) responses on the WOR. Smokers gave WOR responses lower in quality, as rated by independent coders, than those of nonsmokers. Results are discussed in relation to implications for treatment and for future research.

Sociotropy, autonomy, stress, and depression in Cushing syndrome.

Cognitive theory ascribes nonendogenous depression to latent dysfunctional beliefs activated by stressors impinging upon core values (e.g., rejection for a sociotropic person). To address ambiguities in past tests of the theory, this study measured personality (Sociotropy-Autonomy Scale) and recent stressors (Life Experience Survey and Hassles Scale) among 14 Cushing syndrome patients and 12 controls. Patients scored nonsignificantly higher in sociotropy, and sociotropy correlated positively with depression among patients. Because depression in Cushing syndrome presumably results from biological dysfunction rather than from the interaction of personality and relevant stressors, these results imply that sociotropy may be a consequence of depression as opposed to a contributory cause. There was no congruence between personality and types of stressors reported, which suggest that mood-dependent recall does not account for past evidence of congruence.

Depression and the experience and expression of anger in marital and other relationships.

In prior research using trait self-report measures, depression has been linked to elevated anger experience and anger suppression, whereas observational studies of marital interactions reveal high rates of overt anger expression by depressed people. This study tested whether the key distinction between these contradictory lines of research is a) target of anger expression (people in general versus spouse) or b) method of measurement (self-report versus behavioral observation). Depressed patients (N = 33) scored significantly higher than did nondepressed controls (N = 41) on self-report measures of anger and anger suppression regardless of whether the target of anger was the spouse or others. Group differences were nonsignificant on anger expression. Thus, it appears that the critical feature of studies linking depression with heightened anger expression may be their use of behavioral observations rather than their specific focus on the marital relationship.

Perspectives on depressive realism: implications for cognitive theory of depression.

Beck's cognitive theory of depression has provided a successful description of depressive thinking, with one major exception. The hypothesis that depressed people show biased negative thinking seems contradicted by research indicating that Ss scoring 9 or above on the Beck Depression Inventory were more accurate than their nondepressed counterparts in judging contingencies between their responses and outcomes, seemingly showing "depressive realism". Depressive realism research has attracted attention in numerous areas of psychology, along with critical commentary focused on such issues as whether realism is limited to mild depressive states, whether laboratory tasks are sufficient to document realism, and whether realism is a general characteristic of either depressed or nondepressed people. We analyze the main critiques and show how debates about depressive realism can be heuristic for refinement of cognitive theory of depression.

Thought suppression and smoking relapse: a secondary analysis of Haaga (1989).

Previous research indicates that use of cognitive coping strategies in high risk situations is positively correlated with smoking cessation maintenance. Basic research on self-control of unwanted thoughts, however, suggests that mental coping efforts involving thought suppression should be ineffective. We evaluated this possibility by rescoring the articulated thoughts transcripts of 95 subjects from a one-year prospective study of smoking relapse (Haaga, 1989). Frequent use of cognitive coping tactics for reframing high risk situations (e.g. reminding oneself of negative consequences of smoking) predicted greater likelihood of continuous abstinence in the following three months (49 per cent success for those above the sample median, 20 per cent for those below the median). This effect was marginally significant at a 12-month follow-up. By contrast, thought suppression showed no association with maintenance of non-smoking. Discussion focused on complications in applying laboratory research on thought suppression and on reanalysis of cognitive assessment protocols.

An appraisal of rational-emotive therapy.

Albert Ellis's rational-emotive therapy (RET) is scrutinized on several conceptual and empirical grounds, including its reliance on constructive assessment and its ethical stance. Its professional impact thus far exceeds its scientific status. Opinion varies on how even to define irrational beliefs; 1 consequence is problems in assessing them. Meta-analytic reviews provide support for the general utility of RET, but more qualitative reviews question both the internal and external validity of much of the published research. Lacking are process studies that can shed light on the mechanisms of therapeutic change, a situation likely due to the complexity of RET and to a lack of consensus as well about its very definition. Perhaps more progress can be achieved by forsaking studies of RET as a package and shifting instead to examination of specific therapeutic tactics in particular circumstances.

Discriminant validity of the Inventory to Diagnose Depression.

Measures of depression and anxiety correlate highly with one another. It has been hypothesized that this shared variance partly reflects poor discriminant validity, which could be improved by linking item content more closely to diagnostic criteria. We tested this speculation by comparing the Inventory to Diagnose Depression (Zimmerman, Coryell, Corenthal, & Wilson, 1986), developed to correspond with diagnostic criteria for major depression, with the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979) in terms of discriminant validity. These measures correlated more strongly with each other than with anxiety but did not differ in their relations with anxiety.

Lay beliefs about the causes and consequences of smoking cessation maintenance.

Descriptive research has corroborated the Relapse Prevention (RP) model of smoking relapse, but RP interventions have been generally ineffective. This discrepancy might arise from disagreement between the theory and ex-smokers' beliefs about what determines successful maintenance. We therefore asked 100 recent ex-smokers why they believed they would (or would not) be able to abstain for the following year, and what benefits they anticipated if they did. Modal responses were that personal attributes (e.g., willpower) would determine maintenance and that improved physical health would be its most important result. Twelve-month continuous abstinence was more common among those anticipating improved feelings of psychological or physical well-being than among those anticipating a reduction in problems or a diffuse health benefit.

Catastrophizing, confounds, and depression: a comment on Sullivan and D'Eon (1990)

Sullivan and D'Eon (1990) concluded that catastrophizing and depression were conceptually and operationally confounded. I argue that (a) the procedures they used to study confounding were suboptimal because multiple measures of depression and catastrophizing were not employed and (b) the distinctiveness of constructs might better be regarded as a continuous rather than all-or-none (having adequate discriminant validity versus being confounded) concept.

Self-efficacy for recovery from a lapse after smoking cessation.

Self-efficacy for avoiding any lapse after smoking cessation has often been found to predict maintaining abstinence. We measured recent ex-smokers' self-efficacy for recovery of abstinence (SER) after an initial lapse by using the articulated thoughts during simulated situations (ATSS; Davison, Robins, & Johnson, 1983) paradigm. Subjects with moderate SER maintained abstinence nonsignificantly longer than did those with high SER, significantly longer than those with low SER. This result is consistent with Bandura's (1986) hypothesis that SER should be high enough that ex-smokers do not become hopeless if a lapse occurs, yet not so high that they are tempted to experiment with smoking. The discussion focuses on measurement and conceptualization of SER, in particular its distinctiveness from response-outcome expectations.

Cognitive bias in the articulated thoughts of depressed and nondepressed psychiatric patients.

Beck's cognitive theory of depression postulates several types of cognitive bias among depressed patients. Empirical studies supporting this hypothesis have usually used questionnaire "endorsement" measures of cognition, which may suggest responses to subjects. We used the articulated thoughts during simulated situations (ATSS) method of cognitive assessment in comparing cognitive processes of 15 outpatients with major depression with those of 15 nondepressed psychiatric outpatients in three simulated situations. Depressed patients exceeded nondepressed patients in cognitive bias only in the negative (not the neutral or positive) simulated situation. Discussion centered on the possible utility of ATSS for research on cognition in stressful situations.