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Effectively Treating Pathological Self-Criticism in Depressed & Dysthymic Clients
Conventional vulnerability model
Results from a number of studies are consistent with the view suggesting that the independent effects of events on mood may be nominal (Alloy & Clements, 1998; Dykman & Johll, 1998; Johnson, 1995; Monroe, Bromet, Connell, & Steiner, 1986; Suh, Diener, & Fujita, 1996). Indeed, several studies have shown that only a small amount of variance in mood scores at follow-up can be attributed to the occurrence of events, after accounting for variance in baseline mood scores. Monroe et al. (1986) showed that baseline depression and marital conflict predicted 37% of the variance in depression at their 1-year follow-up, and the interaction term for social support and events only explained an additional 1% of the variance. Similarly, Suh et al. (1996) found that 37% of the variance in negative mood assessed at 2-year follow-up was attributable to negative mood at baseline, but that negative events did not account for follow-up mood scores after controlling for baseline mood scores.
However, results of these studies need to be reconciled with long-term studies that have found support for the role of life events in increasing the risk for onset of a depressive episode (e.g. Bebbington et al., 1988; Brown, Bilfulco, & Harris, 1987; Brown, Harris, & Hepworth, 1995; Brown & Moran, 1997; Kendler et al., 1995; Lewinsohn, Allen, Seeley, & Gotlib, 1999). Differences between those studies examining the manner in which the severity of depressed mood scores change and covary over time and other studies examining the role of events in increasing the risk of onset of a depressive disorder are important and potentially complex. Indeed, differences may reflect: (a) the manner in which depression is assessed (severity vs episodes); (b) the interval length between testing times; and (c) the manner in which events are assessed (checklist vs interview).
Proximal effects on mood
Moreover, the manner in which mood is typically assessed emphasizes the severity of mood states rather than the duration of mood disturbances or fluctuations. Individuals completing the CES-D are asked to report "how often [they] felt or behaved this way, during the past week." Individuals completing the BDI identify "the one statement in each group [of symptoms] that best describes the way [they] have been feeling during the past two weeks, including today." Strictly speaking, neither measure was designed to assess the duration of symptoms, although one of the key features characteristic of a depressive disorder is its duration. Critics have argued that high levels of distress, no matter how severe, do not warrant the same clinical attention as depressive disorders (Coyne, 1994). High levels of distress are typically short-lived and are infrequently related to a formal diagnosis of depression (Coyne, 1994; Coyne & Schwenk, 1997).
Conceptualizing and classifying events
Ethological models of human behavior have emphasized the importance of the attachment system which governs the manner in which individuals manage separations from individuals to whom they feel emotionally close (Bowlby, 1969), as well as the social rank system governing how individuals maintain and acquire social status within a dominance hierarchy (Gilbert, 1992; Price, 1967; Price, Sloman, Gardner, Gilbert, & Rohde, 1994). Such a view acknowledges that ostensibly different events may address similar needs and that single events may fulfill different needs. Accordingly, losing a romantic partner may threaten the self-worth needs of self-critical individuals just as being fired from a job could threaten the attachment needs of dependent individuals.
Proximal effects on behaviour
In a series of experimental studies, we have shown that outperforming a close friend or romantic partner can precipitate appeasement behavior towards partners in dependent individuals (Israeli & Santor, 2001; Santor et al., 2001; Santor & Zuroff, 1997; 1998), whereas being outperformed by a close friend or romantic partner can produce retaliatory behavior in self-critical individuals (Israeli & Santor, 2001; Santor et al., 2001; Santor & Zuroff, 1997; 1998). This is consistent with the model in which competition in interpersonal contexts can be threatening for individuals high on dependency as well as those high on self-criticism (albeit in different ways) and illustrates that manner in which both social rank and attachment systems can intertwine. These studies have shown that dependency and self-criticism are associated with an array of cognitive, affective, behavioural, and motivational differences. Dependent individuals tend to adopt the responses of friends they outperformed (Santor & Zuroff, 1997), relinquish control over shared resources to less competent friends (Santor & Zuroff, 1998), praise friends even when friends disagreed (Santor & Zuroff, 1997), and minimize disagreement with disagreeing friends (Santor & Zuroff, 1997; 1998). With romantic partners, dependency predicted an increase in the frequency of suggestions and agreeable comments following unfavorable feedback (Santor et al., 2001) and an increase in appeasements following hostile attacks (Israeli & Santor, 2001). In contrast, self-critical women contested threats to status (Santor & Zuroff, 1997; 1998), withheld praise from friends who challenged them (Santor & Zuroff, 1997), did not minimize disagreement with disagreeing friends (Santor & Zuroff, 1997; 1998) and actively exerted control over shared resources (Santor & Zuroff, 1998), even at the expense of a close friend, regardless of the status or behavior of the close friend. With romantic partners, self-criticism predicted a decrease in the frequencies of suggestions and agreeable comments and an increase in the frequency of blaming (Santor et al., 2001) and in unprovoked attacks on others (Israeli & Santor, 2001). These results are consistent with the view promoted by Segal and Ingram (1995) in which it is argued that an activating event is required.
- Santor, Darcy A.; Proximal Effects of Dependency and Self-Criticism: Conceptual and Methodological Challenges for Depressive Vulnerability Research; Cognitive Behaviour Therapy; 2003; Vol. 32; Issue 2.
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