The association between cognitive function and subsequent depression: a systematic review and meta-analysis.

Despite a growing interest in understanding the cognitive deficits associated with major depressive disorder (MDD), it is largely unknown whether such deficits exist before disorder onset or how they might influence the severity of subsequent illness. The purpose of the present study was to conduct a systematic review and meta-analysis of longitudinal datasets to determine whether cognitive function acts as a predictor of later MDD diagnosis or change in depression symptoms. Eligible studies included longitudinal designs with baseline measures of cognitive functioning, and later unipolar MDD diagnosis or symptom assessment. The systematic review identified 29 publications, representing 34 unique samples, and 121 749 participants, that met the inclusion/exclusion criteria. Quantitative meta-analysis demonstrated that higher cognitive function was associated with decreased levels of subsequent depression (r = -0.088, 95% confidence interval. -0.121 to -0.054, p < 0.001). However, sensitivity analyses revealed that this association is likely driven by concurrent depression symptoms at the time of cognitive assessment. Our review and meta-analysis indicate that the association between lower cognitive function and later depression is confounded by the presence of contemporaneous depression symptoms at the time of cognitive assessment. Thus, cognitive deficits predicting MDD likely represent deleterious effects of subclinical depression symptoms on performance rather than premorbid risk factors for disorder.

Paradigms, promises, and the potential of clinical psychology.

Both Plaud's and Ilardi and Feldman's articles call for clinical psychology to redefine itself according to a particular paradigm or "unifying framework." This commentary focuses on the nature of clinical psychology as an applied discipline, whether clinical psychology in fact has an urgent need for a unifying framework, and whether radical behaviorism or cognitive neuroscience could provide such a framework. It is concluded that, as an applied field that draws both theory and method from a number of natural and social sciences, clinical psychology is served best by continued development and appropriation of competing scientific viewpoints rather than by fealty to a single perspective or paradigm.

The Therapeutic Realizations Scale-Revised (TRS-R): psychometric characteristics and relationship to treatment process and outcome.

Therapeutic realizations are one of five universal, session-level change processes explicated in the Generic Model of Psychotherapy. Realizations refer to session impacts, the moment-to-moment accomplishments that patients experience within sessions. This study establishes the psychometric characteristics and factor structure of a modified patient-rated measure of session-level effects, the Therapeutic Realization Scale-Revised (TRS-R). In addition, it shows the relationship of the TRS-R to treatment process and outcome from the perspective of both patients and therapists. The findings provide support for the TRS-R as a reliable and valid, multidimensional index of session-level treatment effects.

Temperament, recalled parenting styles, and self-regulation: testing the developmental postulates of self-discrepancy theory.

Self-discrepancy theory (SDT) postulates that self-regulatory systems corresponding to the ideal and ought self-domains emerge from the influences of temperament (e.g., sensitivity to stimuli for positive vs. negative outcomes) and socialization (e.g., parenting behaviors and interpersonal outcome contingencies). This article reports 2 studies testing the developmental postulates of SDT concurrently and retrospectively. Study 1 showed that self-regulation with reference to the ideal vs. the ought domain was differentially associated with recollections of parenting styles of warmth and rejection, respectively. In Study 2, these findings were replicated, and self-regulation with reference to the ideal vs. ought domain was discriminantly associated with questionnaire measures of positive vs. negative temperament. Findings support the developmental postulates of SDT, despite the limitations of retrospective studies.

Stability within the self: a longitudinal study of the structural implications of self-discrepancy theory.

Self-discrepancy theory emphasizes the emotional significance of patterns of relations between the self-concept and ideal and ought self-guides and predicts stability within the self related to structural characteristics independent of specific self-beliefs. It was hypothesized that whereas participants' specific self-descriptions would vary substantially over time, magnitude of self-discrepancy, regulatory focus (the individual's dominant self-guide domain), and other structural features would be stable. Participants (N = 47) were recruited from 2 samples that had completed a self-belief interview and a childhood memory cued-recall task 3 years earlier (T. J. Strauman, 1990). As expected, participants' self-descriptions varied, but magnitude and type of self-discrepancy, associations between self-guide domains and childhood memories, and correlates of regulatory focus were stable.

Introduction: social cognition, psychodynamic psychology, and the representation and processing of emotionally significant information.

This special issue examines two perspectives on how people comprehend and respond to significant features of their lives: psychoanalytic psychology and social cognition. The articles included present new empirical findings relevant to the overlap of psychoanalysis and social-cognitive psychology, as well as commentaries from each perspective. This introduction summarizes important conceptual and methodological challenges in the integration of two such distinct approaches to emotionally significant information.

Effects of motivationally significant stimuli on the regulation of dominant responses.

In 4 experiments, Ss responded as quickly as possible to indicate whether character strings consisted of letters or numbers. Following a warning stimulus that was or was not designed to trigger a motivational-emotional response in particular subgroups (viz., those with high anxiety, discrepant self-concepts, and eating disorders), strings were presented in a central (dominant) location on 75% of the trials or in 1 of 4 peripheral (nondominant) locations. Consistent with hypotheses, response times to peripherally located strings were significantly slower following motivationally significant than following neutral warning stimuli. Contrary to hypotheses, such stimuli did not facilitate responding to centrally located strings. It is proposed that motivationally significant stimuli engender a temporary reduction in control processing that hinders regulation of dominant responses.

Self-discrepancy and natural killer cell activity: immunological consequences of negative self-evaluation.

The study tested whether self-discrepancy theory could account for changes in natural killer (NK) cell activity after exposure to self-referential stimuli. Anxious, dysphoric, and control Ss were pretested and 1 month later covertly exposed to their own self-guides as well as those of another S. Blood samples were drawn for analysis of NK cytotoxicity and cortisol. The dysphoric Ss manifested the greatest actual:ideal discrepancy, whereas the anxious Ss manifested the greatest actual:ought discrepancy. Content analysis of written responses showed that activating discrepancies induced specific negative states; priming discrepancies also increased cortisol for the anxious Ss. NK activity was lower after self-referential priming for both distressed groups, particularly the anxious Ss. The control Ss showed a trend toward increased NK activity after self-referential priming. The study represents the 1st experimental demonstration that negative self-evaluation can alter immune responses.

Self-guides, autobiographical memory, and anxiety and dysphoria: toward a cognitive model of vulnerability to emotional distress.

Several aspects of a cognitive model of vulnerability to emotional disorders based on self-discrepancy theory were tested. Anxious, dysphoric, anxious/dysphoric, and control subjects participated in 3 studies over a 4-month period: screening, assessment of self-guides and self-discrepancies, and an autobiographical memory task in which different types of retrieval cues (including self-guides) were presented and subjects reported childhood memories as they came to mind. Actual:ideal discrepancy was associated with persistent dysphoria, whereas actual:ought discrepancy was associated with persistent anxiety. Self-guide cues resulted in more efficient retrieval and greater unintended negative emotional content than comparable cue types. The groups were differentiated only by negative affect content in response to self-guide cues.

The Factor Structure of SCL-90 and MCMI Scale Scores: Within-Measure and Interbattery Analyses.

This article reports scale-level factor analyses for two widely used self-report measures of psychopathology - the Symptom Checklist-90-R (Derogatis, 1983) and the Millon Clinical Multiaxial Inventory (Millon, 1983) - and compares the obtained factor structures with findings reported in the literature to determine whether each instrument possesses a reliable, meaningful dimensional structure underlying its scale scores. The sample was a heterogeneous group of psychiatric inpatients and outpatients (N = 130). The SCL-90 scale scores formed two highly correlated factors (anxious depression andparanoid thinking), although the scale intercorrelations could be adequately accounted for by a single factor (as in previous reports). The MCMI scale scores formed three factors (anxiousdepression and emotionality, paranoid and manic thinking, and schizoid thinking), of which the first and second were also highly intercorrelated. Supplementary analyses indicated that to a considerable degree the MCMI factor invariance was an artifact of item overlap among the scales. An interbattery factor analysis was then performed to determine whether any common factors could describe the variance shared among the two instruments' subscales. Two interbattery factors were obtained, representing anxious depression and emotionality and paranoid thinking respectively. The two measures, when used separately, appear to offer only limited interpretability of scale profiles, although their combined use appears to permit differentiation between two major symptom configurations.

Self-discrepancies and vulnerability to body dissatisfaction and disordered eating.

Two studies explored the relevance of self-discrepancies for body dissatisfaction and disordered eating. In Study 1, actual:ideal self-discrepancies of female undergraduates correlated with body shape dissatisfaction independent of Ss' body mass and number of appearance-related self-beliefs; actual:ought discrepancy was discriminantly associated with anorexic-related attitudes and behaviors. In Study 2 (using a mixed-gender sample), bulimic-related behaviors were associated with a form of actual:ideal discrepancy (unfulfilled positive potential) whereas anorexic-related symptoms were associated with actual:ought discrepancy. Both genders showed the predicted relations between self-discrepancies and disordered eating, and the predicted associations remained even when appearance-related attributes were excluded from scoring of self-discrepancies.

Long-term biopsychosocial effects of interleukin-2 therapy.

This three-year project evaluates the biopsychosocial effects of interleukin-2 (IL-2) therapy on the first 45 patients treated with the therapy at the Moses Division of the Montefiore Medical Center in Bronx, NY, starting in April 1986. Therapy with IL-2 and lymphokine-activated killer (LAK) cells is a promising new development but requires an extensive amount of supportive care. Various important issues must be considered in planning the care of patients being treated with IL-2, including the effects of the treatment on quality of life, the cost of resources necessary for providing therapy, and the emotional effects of treatments. The instruments used to measure the various aspects of quality of life were the Sickness Impact Profile, the Inventory of Current Concerns, the Symptom Distress Scale, the Acute Physiology and Chronic Health Evaluation Scale, and the Therapeutic Intervention Scoring System. The researchers believe that, in addition to tumor response, the biopsychosocial and financial effects of treatment should be understood.

Self-discrepancies in clinical depression and social phobia: cognitive structures that underlie emotional disorders?

Previous research indicates that self-discrepancies are cognitive structures that can induce emotional discomfort. The present study compared clinically depressed and social phobic subjects (plus controls) to determine whether different self-discrepancies were associated with the two disorders. In Part 1, it was shown that the depressives possessed the greatest discrepancy between their actual and ideal/own self-states, whereas the social phobics possessed the greatest discrepancy between their actual and ought/other self-states. In a later, ostensibly unrelated study, subjects responded verbally to questions about other people while their mood changes, skin conductance responses, and verbalizations were recorded. The questions included attributes from the subject's ideal and ought self-states that were mismatches with attributes from his or her actual self, as well as mismatch attributes from other subjects. Priming with self-referential mismatches induced momentary syndromes of dejection or agitation (depending on the type of mismatch). The depressives and social phobics showed the greatest increases in dejection and agitation, respectively, according to their dominant self-discrepancy. The results suggest that specific cognitive structures may underlie clinical depression and anxiety.

Diagnosis of major depression by self-report.

The Symptom Checklist-90 (SCL-90), Millon Clinical Multiaxial Inventory (MCMI), and Minnesota Multiphasic Personality Inventory (MMPI) test profiles of inpatients and outpatients with DSM-III major depression (n = 48) were contrasted with the test profiles of a control group of patients with diverse psychiatric disorders (n = 68). In addition, the diagnostic efficiency of the relevant depression subscales for the diagnosis of major depression were examined. The results indicated that the three self-report tests may be used to diagnose DSM-III major depression, and that the depressed patients had characteristic test profiles.

Self-discrepancies as predictors of vulnerability to distinct syndromes of chronic emotional distress.

Two types of self-discrepancy differing in both domain and standpoint of self-guide were examined as predictors of vulnerability to chronic emotional syndromes. Study 1 assessed discrepancy between the actual/own self-state and the ideal/own self-guide and between the actual/own self-state and the ought/other self-guide in predicting syndromes of dejection and agitation as well as different types of anger. Actual/own: ideal/own discrepancy (AI) was uniquely related to dejection, frustration, and anger at self as measured 2 months later; actual/own:ought/other discrepancy (AOO) was uniquely related to agitation and to anger at others and resentment. Study 2 used structural equation modeling of the relations between AI and AOO discrepancy and social anxiety versus depression as measured weeks later. A model in which AOO was more strongly associated with social anxiety and AI was more strongly associated with depressive symptoms provided the best fit. The results support the convergent and discriminant validity of a self-discrepancy model of vulnerability to chronic emotional syndromes.

Automatic activation of self-discrepancies and emotional syndromes: when cognitive structures influence affect.

Different types of self-discrepancies are associated with different negative affects. Two studies were conducted to determine whether automatic activation of specific actual-self: self-guide mismatches, as cognitive structures, would induce distinct emotional states. Subjects possessing significant discrepancies between their actual self and either their ideal self-guide (attributes that someone wishes or hopes the person would possess) or their ought self-guide (attributes that someone believes the person has the duty or obligation to possess) responded verbally to an audiotape while "thinking about other people." Study 1 involved two kinds of priming attributes: self-relevant and yoked (another subject's self-relevant attributes). Activating mismatches induced momentary syndromes of dejection (sadness, decreased arousal) in ideal-discrepant subjects but induced agitation (nervousness, increased arousal) in ought-discrepant subjects. In Study 2, subjects were randomized to either self-relevant/nondiscrepant, self-discrepant, or yoked priming. The findings of Study 1 were replicated for the self-discrepant priming condition alone. Results indicate that (a) mismatches constitute cognitive structures and (b) automatic activation of different mismatches via contextual priming induces distinct types of emotional discomfort.