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Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients
Effectively Treating Pathological Self-Criticism in Depressed and Dysthymic Clients

Section 16
Self-Criticism, Depression, and Personality

CEU Question 16 | CEU Answer Booklet | Table of Contents
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In recent years, there has been considerable interest in the relation between marital maladjustment and depression (Bradbury, Fincham, & Beach, 2000; Fincham, Beach, Harold, & Osborne, 1997; Gotlib & vulnerability Pathological Self-Criticism counselor CEUWhiffen, 1989; Whisman, 2001). Although some research indicates that marital maladjustment causes one or both spouses to experience depression (e.g., O’Leary, Christian, & Mendell, 1994), other research indicates that depressive symptoms lead to subsequent marital problems (Dew & Bromet, 1991). Related investigations have shown that certain personality factors associated with vulnerability to depression also play a role in marital maladjustment (see Habke & Flynn, 2002; Hewitt, Flett, & Mikail, 1995).

Although previous research has demonstrated the usefulness of self-reports and spousal reports of personality in marital adjustment problems (Buss, 1991, 1992; Watson, Hubbard, & Wiese, 2000), studies on personality and depression have focused primarily on self-reports, despite expressed concerns about the inherent limitations of relying on self-reports as the sole method of assessment (e.g., Campbell & Fiske, 1959; Flett, Hewitt, Endler, & Bagby, 1995; for the specific relevance for personality research, see Funder, 1999). Theoretically, the exclusive use of self-reports in couples’ research may ignore basic aspects of the depression experience, such as the assumption that depression and adjustment are maintained or increased by close relationships (Coyne, 1976). Convergent evidence shows that depressed individuals can, in fact, induce negative affect and behavior in others with whom they interact closely (e.g., Benazon & Coyne, 2000), consequently affecting the latter’s subjective appraisals and attitudes toward them (for a review see: Bradbury & Fincham, 1990). Perceptions of negative appraisals and reduced support are hypothesized to be the most proximal catalyst for depressive reactions (Sacco, 1999; Sacco & Beck, 1995), thus defining a bidirectional interactional process, whereby both the depression prone individual and his/her marital partner affect each other (Sacco & Nicholson, 1999, p. 298).

The Role of Personality Factors in Depression
In congruence with a long tradition that contrasts other- and self-directedness as two basic modalities of human experience, Blatt and colleagues defined a theory of personality vulnerability to depression involving the dimensions of dependency and self-criticism (Blatt, 1990, 1991; Blatt, Cornell, & Eshkol, 1993; Blatt, Quinlan, Chevron, McDonald, & Zuroff, 1982). According to this model, normal development is characterized by a dialectic interweaving of other and self-directness, that leads to a flexible balancing of the capacities involved in these two processes (Helgeson, 1994). Moreover, the adequate coordination between interpersonal relatedness and self-definition is thought to reduce stress and lead to physical well-being (Blatt et al., 1993). This model assumes that individual differences in the relative emphasis on each of these processes delineate two personality styles—self-criticism and dependency—each with preferred modes of cognition and coping strategies. An overemphasis on self-critical or dependency motives results in dysfunctional attitudes and is assumed to constitute a vulnerability to depression.

Recently, an important difference between dependency and self-criticism has emerged in the research literature: while the association between self-criticism and depression has been corroborated repeatedly in different contexts, dependency appears to entail both vulnerability and resilience components (Besser & Priel, in press; Blatt, Zohar, Quinlan, Zuroff & Mongrain, 1995; Mongrain, 1998; Priel & Besser, 1999, 2000).

In the context of interpersonal relationships, while dependent individuals tend to activate their social environments in order to cope with stress, withdrawal and avoidance of warm behaviors that promote emotional intimacy are the major strategies of self-critical individuals in the face of distress and interpersonal relationships (Blatt & Schichman, 1983). Our previous research has found that dependency is associated with increased spouse support, and increased spouse support mediates the negative association between dependency and depression (Priel & Besser, 2000). In contrast, self-criticism has been associated with relatively low levels of anticipated and received support from the spouse, which, in turn, are associated with increased levels of depression (Priel & Besser, 2000). Selfcriticism is also associated with social avoidance (Alden & Bieling, 1996) and entails a vulnerability to loneliness and lack of intimacy (Blatt, D’Affliti, & Quinlan, 1976; Blatt et al., 1982). Recently, within the context of current relationships, self-criticism was associated with loneliness even after taking related individual differences in levels of depression into account (Besser, Flett, & Davis, in press). Furthermore, in interpersonal contexts, self-criticism was associated with fewer intimacy and fewer affiliative strivings (Mongrain & Zuroff, 1995) and low agreeableness (Zuroff, 1994). However, dependency has been associated with help-seeking behaviors (Bornstein, 1992; Mongrain, 1998), interpersonal warmth and intimacy motivations (Mongrain & Zuroff, 1995), high submissiveness (Santor & Zuroff, 1997), high agreeableness (Zuroff, 1994), and inhibitions about expressing hostility (Fichman, Koestner, & Zuroff, 1994). Finally, Wiseman (1997) found that self-criticism negatively predicted frankness, sensitivity, and trust, whereas dependency positively predicted attachment, giving, and trust.

Thus self-criticism, but not dependency, is emerging as a personality factor that is associated with ambivalence about close interpersonal relations, as well as with fear of disapproval and loss of control and autonomy. It can therefore be argued that emotionally intimate relationships, such as marriage, might be especially threatening to self-critical individuals. Indeed, in a recent study that investigated the interpersonal contexts associated with self-criticism, Whiffen, Aube, Thompson, and Campbell (2000) found that self-criticism was associated with anxiety toward attachment figures, submissive-cold interpersonal behavior, marital dissatisfaction, and depression. This is in keeping with several other studies showing a link between self-criticism and negative interpersonal outcomes (see Mongrain, Vettese, Shuster, & Kendal 1998; Santor, Pringle, & Israeli, 2000; Vettese & Mongrain, 2000).

Attachment Styles and Depression
The effect of early internal models of relationships is a second factor assumed to influence the association between marital maladjustment and depression. Attachment theory assumes a lifelong continuity from early patterns of interpersonal relationships mediated by internal working models of self and others; these models intervene in the interpretation of and reaction to new relationships (Bowlby, 1969, 1973, 1980). The concept of internal working models of attachment was proposed as a cognitive and affective construct that includes the subject’s memories, perceptions, and expectations in relation to significant others. It is believed that the attachment system is activated most strongly under conditions of distress, such as fatigue, illness or fear (Bowlby, 1973, 1979).

A recent body of empirical research, based on Hazan and  Shaver’s (1987) pioneering work, explored attachment patterns in adulthood and demonstrated an important association between these patterns and an individual’s capacity to use significant others as sources of support and comfort (Simpson, Rholes, & Nelligan, 1992). Bartholomew (1990) and Bartholomew and Horowitz (1991) proposed a theoretical classification of internal working models of attachment defined by the positivity of the model of the self and of the model of the other. The positivity of the self involves the degree to which the self is loveable and worthy and to which others are expected to be responsive. The positivity of the other involves a person’s expectations about significant others’ availability and support. The model of the self is characterized in terms of ‘‘anxiety’’ about closeness and dependence on others for self-esteem, and the model of others as ‘‘avoidance of intimacy.’’ These dimensions can be either high or low, and they thus define four different patterns of attachment: secure (positive model of self and other); preoccupied (negative model of self and positive model of other); dismissing (positive model of self and negative model of other); and, fearful (negative model of self and other) (Griffin & Bartholomew, 1994a).

Attachment theory has offered important insights for understanding depression. Bowlby extensively studied processes of depression and mourning, assuming that pathological mourning symptoms reflect failures to internalize secure and positive patterns of attachment (Bowlby, 1980). Moreover, empirical research has shown that patterns of attachment influence depressive symptomatology in adult clinical and community samples (Carnelley, Pietro-Manco, & Jaffe, 1994; Priel & Shamai, 1995). Attachment research suggests that positive models of the other, but not of the self, are critical for individuals’ perceptions of interpersonal relationships as supportive in stressful situations (Besser, Priel, & Wiznitzer, 2002; Priel, Mitrani & Shahar, 1998). Moreover, Ainsworth, Blehar, Waters & Wall’s (1978) basic definitions of patterns of attachment suggest that a positive model of the other may constitute the main dimension involved in affect regulation in stressful situations (e.g., Besser et al., 2002).

Attachment Moderates the Association Between Self-Criticism and Marital Adjustment
In spite of supporting different theoretical positions, both Blatt’s personality vulnerability factors (Blatt et al., 1976, 1982) and Bowlby’s attachment theory (Bowlby, 1969, 1973, 1980) propose two major types of experiences that lead to depression: the disruptions of gratifying interpersonal relationships (e.g., loss) and the disruptions of an effective, essentially positive, sense of self (e.g., failure and guilt) (Blatt & Maroudas, 1992). Moreover, the introjective (self-critical) and anaclitic (dependency) orientation described by Blatt and his colleagues is not independent of attachment styles. Blatt and Homann (1992) hypothesized that insecure attachment is a factor that is involved in the development of self-criticism and dependency. Analyses of the self-reports of adolescent girls found a link between self-criticism and insecure attachment to parents (Thompson & Zuroff, 1999). Earlier research by Zuroff and Fitzpatrick (1995) examined the association between attachment styles and the self-criticism/dependency constructs. These authors found an association between self-criticism and fearful-avoidant styles, and between dependency and anxious/attachment styles, as determined by self-reports.
- Besser, Avi, Priel, Beatriz; A Multisource Approach to Self-Critical Vulnerability to Depression: The Moderating Role of Attachment; Journal of Personality; Aug 2003; Vol. 71; Issue 4.

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Personal Reflection Exercise #2
The preceding section contained information regarding self-criticism, depression and personality.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 16
According to both Blatt’s vulnerability factors, and Bowlby’s attachment theory, what two major types of experiences lead to depression? Record the letter of the correct answer the CEU Answer Booklet.

 
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