Anxiety, emotional security and the interpersonal behavior of individuals with social anxiety disorder.

BACKGROUND: Interpersonal functioning is central to social anxiety disorder (SAD). Empirical examinations of interpersonal behaviors in individuals with SAD have frequently relied on analogue samples, global retrospective reports and laboratory observation. Moreover, research has focused on avoidance and safety behaviors, neglecting potential links between SAD and affiliative behaviors. METHOD: The influence of situational anxiety and emotional security on interpersonal behaviors was examined for individuals with SAD (n=40) and matched normal controls (n=40). Participants monitored their behavior and affect in naturally occurring social interactions using an event-contingent recording procedure. RESULTS: Individuals with SAD reported higher levels of submissive behavior and lower levels of dominant behavior relative to controls. Consistent with cognitive-behavioral and evolutionary theories, elevated anxiety in specific events predicted increased submissiveness among individuals with SAD. Consistent with attachment theory, elevations in event-level emotional security were associated with increased affiliative behaviors (increased agreeable behavior and decreased quarrelsome behavior) among members of the SAD group. Results were not accounted for by concurrent elevations in sadness or between-group differences in the distribution of social partners. CONCLUSIONS: These findings are consistent with predictions based on several theoretical perspectives. Further, the present research documents naturally occurring interpersonal patterns of individuals with SAD and identifies conditions under which these individuals may view social interactions as opportunities for interpersonal connectedness.

Enhanced adaptive capacities after brief treatment for depression.

Using data from the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program, the authors examined predictors of the intensity of depressive symptoms after the brief treatment of depression. Multilevel modeling was applied to measures of depression and stress assessed at termination and at 6-, 12-, and 18-month follow-ups. The slope of depression on stress was used to index stress reactivity. Patients with high mean levels of stress experienced more intense depressive symptoms, but this effect was moderated by patients' reports of the extent to which they had acquired enhanced adaptive capacities (EACs) in treatment. Patients who reported high EAC early in the follow-up were more resilient in the face of stress than those with low EAC. Greater EACs were found for patients who received psychotherapy than medication or placebo and, across all treatments, for patients with a stronger therapeutic alliance. These findings suggest that treatments should be evaluated in terms of their impact on patients' developing adaptive capacities as well as the reduction of symptomatology.

The effect of tryptophan on social interaction in everyday life: a placebo-controlled study.

In monkeys increasing serotonin function enhances affiliative interactions and promotes the acquisition of dominance. To examine whether similar effects occur in humans, we treated 98 subjects for 12 days with the serotonin precursor tryptophan (1g TID) and for 12 days with placebo in a double-blind, cross over study. Agreeableness/quarrelsomeness and dominance/submission were measured using an event-contingent method, in which subjects reported on various behaviors during important social interactions throughout their day. Tryptophan decreased quarrelsome behavior, but only when placebo was given first, suggesting that a decrease in quarrelsomeness when tryptophan was given first may have carried over into the subsequent placebo period. Tryptophan increased dominant behavior, an effect that was independent of the order of treatment, the broad social context, and the subject's and partner's sex. Our results suggest that serotonin may enhance dominance in humans, as in monkeys, and illustrate the advantages of the event contingent methodology in studying the associations between biology and human social interaction.

Relation of therapeutic alliance and perfectionism to outcome in brief outpatient treatment of depression.

Prior analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program demonstrated that perfectionism was negatively related to outcome, whereas both the patient's perception of the quality of the therapeutic relationship and the patient contribution to the therapeutic alliance were positively related to outcome across treatment conditions (S. J. Blatt, D. C. Zuroff, D. M. Quinlan, & P. A. Pilkonis, 1996; J. L. Krupnick et al., 1996). New analyses examining the relations among perfectionism, perceived relationship quality, and the therapeutic alliance demonstrated that (a) the patient contribution to the alliance and the perceived quality of the therapeutic relationship were independent predictors of outcome, (b) perfectionistic patients showed smaller increases in the Patient Alliance factor over the course of treatment, and (c) the negative relation between perfectionism and outcome was explained (mediated) by perfectionistic patients' failure to develop stronger therapeutic alliances.

Generativity in midlife and young adults: links to agency, communion and subjective well-being.

Three questions stimulated by Erik Erikson's theory of generativity were addressed: 1) Is generativity associated with greater subjective well-being? 2) Are agency and communion additive or interactive predictors of generativity? 3) Does generativity play a distinct role during the midlife period? Among ninety-eight midlife adults, generativity was positively related to positive affectivity, satisfaction with life, and work satisfaction. Generativity was independently predicted by agentic (masculine) and communal (feminine) traits. Among fifty-eight young adults, generativity predicted positive affect at home. Generativity was independently predicted by agentic (power) and communal (love) interpersonal orientations. Using event-contingent recording of agentic and communal behavior at work, agency was a stronger predictor of generativity for young adult men, and communion was a stronger predictor for young adult women. The studies demonstrate that generativity has similar relations to agency and communion in young and midlife adults; however, generativity may be a stronger predictor of subjective well-being in midlife adults.

Dependency, self-criticism, interpersonal behaviour and affect: evolutionary perspectives.

Evolutionary accounts of vulnerability to depression have focussed either on the attachment system (Bowlby, 1980) or the social rank system (Gilbert, 1992; Price, 1972). According to a two-factor evolutionary model, depression-prone dependent and self-critical individuals suffer from insecurities regarding both attachment and social rank, but they differ in their strategies for dealing with those insecurities. Event-contingent recording was used to assess agentic (dominant-submissive) and communal (agreeable-quarrelsome) interpersonal behaviour as well as affect in 119 employed adults over 20 days. Participants also completed questionnaire measures of agency and communion. Self-criticism predicted low levels of agency and low levels of communion. In the sample as a whole, agentic and communal behaviours were associated with pleasant affect, but highly self-critical participants experienced relatively less pleasant affect when they acted communally or agentically. Individuals with high levels of immature dependency (neediness) were low in agency, whereas those with high levels of mature dependency (connectedness) were high in communion. Implications for evolutionary theories of vulnerability to depression were discussed, and interpersonal processes that may contribute to vulnerability were identified.

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.

When and how perfectionism impedes the brief treatment of depression: further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the brief (16-week) treatment of depression (S. J. Blatt, D. M. Quinlan, P. A. Pilkonis, & T. Shea, 1995) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists, independent clinical evaluators, and the patients and that this effect persisted 18 months after termination. In addition, analyses of comprehensive, independent assessments made during the treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample, in the latter half of treatment, between the 9th and 12th sessions. Implications of these findings are discussed, including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary, externally imposed termination date.

Interpersonal responses to threats to status and interpersonal relatedness: effects of dependency and self-criticism.

OBJECTIVES: Previous research investigating the interpersonal environments of dependent and self-critical individuals has focused primarily on attachment issues, such as relationship satisfaction. DESIGN: In the present study, we examined how dependent and self-critical individuals respond to experimentally manipulated events that threaten or bolster self-worth and status. METHOD: Forty pairs of female college students were allowed to believe, first, that they outperformed a close friend or were outperformed by a close friend on 14 trials of a behaviour detection task and, second, that friends generally agreed or disagreed with them on a second 14 trials, in which participants informed friends who had the better response. RESULTS: Dependent women were more concerned with maintaining interpersonal relatedness, whereas self-critical women were more concerned with preserving self-worth and status. Dependent women adopted the responses of friends they outperformed, praised friends even when friends disagreed, and minimized disagreement with disagreeing friends. In contrast, self-critical individuals contested threats to status and self-worth, withheld praise from friends who challenged them, and did not minimize disagreement with disagreeing friends. CONCLUSIONS: Results support the utility of an interactional framework in which depressive personality styles, such as dependency and self-criticism, and situational events interact to regulate interpersonal behaviour.

Analysis and revision of the Depressive Experiences Questionnaire: examining scale performance as a function of scale length.

Revisions of the Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) have failed to replicate the degree of orthogonality routinely observed with the original Dependency and Self-Criticism scales. Item performance on the DEQ was examined by computing correlation coefficients between factor-derived scores and unit-weighted composite scores for Dependency and Self-Criticism as a function of (a) the importance of individual items in predicting factor-derived Dependency and Self-Criticism scores and (b) scale length. Analyses identified sets of unit-weighted items that optimally preserve the psychometric properties of the original DEQ scales, including between-scale orthogonality, while reducing the number of items used to measure Dependency and Self-Criticism. Findings were replicated in college (N = 172) and clinical (N = 83) samples. Limitations of exploratory principal components and confirmatory factor analysis as tools for revising scales are discussed.

Validating the McGill revision of the Depressive Experiences Questionnaire.

Research has identified important psychometric differences between the original Depressive Experiences Questionnaire (DEQ; Blatt, D'Affliti, & Quinlan, 1976) and two of its most widely used revisions, which have failed to preserve the degree of between-scale orthogonality routinely observed with the original Dependency and Self-Criticism scales. The purpose of this study was (a) to examine construct validity for the recently developed McGill revision of the DEQ (Santor, Zuroff, & Fielding, this issue), which preserves between-scale orthogonality; (b) to compare the McGill revision of the DEQ with other existing revisions with respect to measures of personality, motivation, and interpersonal relatedness; and (c) to explore the correlates of items that appear to be responsible for maintaining the degree of orthogonality between measures of Dependency and Self-Criticism. Results suggest that (a) the McGill revision of the DEQ offers more valid estimates of the relations among dependency, self-criticism, and other theoretically relevant constructs, such as depressed mood and agreeableness, than other existing revisions and (b) items differentiating Dependency and Self-Criticism assess broad interpersonal orientations that can be characterized as communal or agentic. Results validate the newer McGill scales, further support the utility of the methods used in their development, and provide insights into the differences between Dependency and Self-Criticism.

Characteristics of effective therapists: further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient treatment of depression to take longer than did moderately and less effective therapists.

Interpersonal factors in brief treatment of depression: further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program.

Previous analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program indicate minimal differences in therapeutic outcome among 3 brief treatments for depression, but patients' pretreatment level of perfectionism had a significant negative relationship with residualized measures of clinical improvement. The present analyses indicate that the quality of the therapeutic relationship reported by patients early in treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism, but significantly predicted therapeutic gain at moderate levels of perfectionism. These findings suggest that the extensive efforts to compare different manual-directed treatments need to be balanced by commensurate attention to interpersonal dimensions of the therapeutic process.

Dependency, self-criticism and social interactions.

We investigated the social interactions of college students varying in dependency and self-criticism. Forty-eight college students used a modified version of the Rochester Interaction Record to record quantitative and qualitative features of every 10-minute or longer interaction during a seven-day period. Daily measures of mood were also collected. Dependency was related to more frequent and more intimate interactions, and self-criticism was negatively related to pleasantness of social interactions. Although dependency and self-criticism were both associated with daily dysphoria, the social interaction findings could not be attributed to the effects of mood. The social environments associated with dependency and self-criticism may influence the aetiology and course of depressive episodes.

Subscales within the dependency factor of the Depressive Experiences Questionnaire.

Recent theoretical formulations differentiate two types of depressive experiences: one focused on interpersonal issues, such as loss, abandonment, and loneliness; the other focused on issues of self-esteem, such as failure, guilt, and lack of self-worth and autonomy. The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976, 1979) assesses these two types of depression. Symptom-based measures of depression (i.e., the Beck Depression Inventory, Beck, Rush, Shaw, & Emery, 1979) have highly significant correlations with the DEQ Self-Criticism factor but only marginally significant correlations with the DEQ Dependency (or interpersonal) factor. Through the use of facet theory and Smallest Space Analysis (Guttman, 1982a), two facets were identified within the DEQ Dependency factor that appear to assess two different levels of interpersonal relatedness. One facet, labelled dependence, includes items expressing feelings of helplessness; fears and apprehensions about separation and rejection; and intense, broad-ranging concerns about possible loss unrelated to a particular relationship. The second facet, labelled relatedness, includes items that consider feelings of loss and loneliness in reaction to disruption of a relationship with a particular person. The dependence facet had significantly higher correlations with measures of depression, whereas the relatedness facet had significantly higher correlations with measures of psychological well-being, especially in women. Thus, the DEQ Dependency factor appears to contain two facets that assess interpersonal relatedness at different developmental levels and correlate differentially with measures of depression and of psychological well-being.

Depressive personality styles and the five-factor model of personality.

The depressive personality constructs described by Blatt (1990; Dependency and Self-Criticism) and Beck (1983; Sociotropy and Autonomy) were examined in relation to the five-factor model of personality. Male (N = 91) and female (N = 81) undergraduates completed the Depressive Experiences Questionnaire (Blatt, D'Afflitti, & Quinlan, 1976), the Personal Style Inventory (Robins et al., 1993), and the NEO Personality Inventory (NEO-PI; Costa & McCrae, 1985). Friends of the subjects completed a peer-report version of the NEO-PI. Dependency and Sociotropy were positively correlated with Neuroticism and with Agreeableness in both men and women. In women, Self-Criticism and Autonomy were positively correlated with Neuroticism and negatively correlated with Agreeableness. In men, Self-Criticism was positively correlated with Neuroticism, but Autonomy was negatively correlated with Agreeableness and Openness. Similarities and differences between Blatt and Beck's constructs were discussed. Research addressing vulnerability to depression may be able to profit from work on the five-factor model of personality.

Depressive symptoms: effects of negative affectivity and failing to accept the past.

Conceptual problems with existing measures of Erikson's ego-integrity construct were identified. It was hypothesized that a core component of ego-integrity involves how individuals evaluate and reflect on past experiences. Accepting the past was formally defined and operationalized and was conceptualized as one source of self-worth central to many formulations of depression. Findings demonstrate that accepting the past was related to a measure of ego-integrity in an elderly community sample, demonstrated superior predictive and incremental validity than ego-integrity in predicting concurrent depressive symptoms, and was unrelated to reminiscing about the past. Failing to accept the past was related to depressive symptoms even after accounting for effects due to age, sex, and physical symptoms. However, accepting the past was moderated by trait negative affectivity. Accepting the past predicted depressive symptoms only in individuals reporting high negative affectivity.

The Bulimic Automatic Thoughts Test: initial reliability and validity data.

The Bulimic Automatic Thoughts Test (BATT) was designed to address some of the limitations found in previous measures of the cognitions of bulimic patients. In this study, bulimic, depressed, obese, and normal subjects were differentiated on the BATT, which suggests that it is a useful measure for detecting cognitions specific to bulimic patients. Scores on the BATT improved after a trial of cognitive-behavioral therapy for the bulimic subjects. The BATT may be useful in predicting which bulimic women will continue to have distorted thinking after treatment and will require additional intervention.

A measure of overt self-criticism: validation and correlates.

A measure of overt self-criticism was constructed and validated for 38 high and low scorers out of 300 undergraduates, using reports by knowledgeable others.

Situational dieting self-efficacy and short-term regulation of eating.

The Situation-Based Dieting Self-Efficacy Scale (SDS) measures dieters' beliefs in their abilities to adhere to a diet in eating situations. The scale has high internal consistency and test-retest reliability. Female dieters were recruited who were either high or low on SDS, and assigned either to consume a high calorie preload or to a no preload condition. Subjects with high SDS ate less in a subsequent "taste rating" task than subjects with low SDS. Amount eaten was not predicted by hunger, weight, palatability, mood, or restrained eating style. This finding challenges the tendency to view all dieters as equally likely to lapse in response to dietary challenges.