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

Section 20
Depressive Vulnerability: An Expanded Model

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Articulating a threat-based model of vulnerability
On the basis of both experimental and longitudinal studies examining threats to status and attachment, it is argued that the scope of the conventional vulnerability model can and should be expanded to include and formally distinguish the broad goals, underlying needs, and behavioral strategies that dependent and self-critical individuals adopt to manage threatening events and situations to meet those underlying needs. However, expanding the conventional vulnerability model is more complex than articulating a broader number of variables. Rather, it requires an integration of diverse elements, such as motivation, social cognition, and interpersonal behavior within a broader model of human behavior, such as attachment theory or evolutionary theory. Considerable research on dependency and self-criticism has already articulated the internal representations of self and others that are associated with dependency and self-criticism (Zuroff & de Lorimier, 1989; Zuroff & Fitzpatrick, 1995), but this work has not linked these internal representations to the broad goals, needs, and behavioural strategies associated with dependency and self-criticism which are outlined in Table 1. According to a threat-based model of vulnerability, dependency and self-criticism can be conceptualized as personality traits or styles which govern the way in which individuals manage threats to status and emotional closeness with others. Self-critical and dependent individuals are believed to be vulnerable to experiencing a wide range of proximal outcomes, which include mood (Santor & Patterson, 2001), behavioural responses (Santor et al., 2001; Santor & Zuroff, 1997; 1998) and cognitive events (Santor & Zuroff, 1997; 1998) that arise in response to threatening events. Such proximal outcomes may subsequently moderate the onset, maintenance, or amelioration of distal outcomes such as mood and interpersonal difficulties. Dependent and self-critical individuals are vulnerable because they possess characteristics, tend to be exposed to circumstances, or actively contribute to, seek out or manipulate situations (c.f. Buss, 1987) which increase the likelihood of experiencing depressed moods or interpersonal conflict.

The behavioural strategies believed to be associated with dependency are primarily directed towards preserving emotional closeness and intimacy in attachment relationships. Because individuals high on dependency are primarily concerned with maintaining interpersonal relationships and emotional closeness, they are expected to adopt a submissive behavioural strategy characterized by appeasement, submission, praise, apologies, and downplaying disagreement when the loss or withdrawal of emotional closeness is either intentionally or unintentionally threatened. This threat can occur as the result of a disagreement or conflict with the person providing emotional closeness (Santor et al., 2001; Santor & Zuroff, 1997; 1998). The behavioural strategies associated with self-criticism are believed to be more broadly implemented, given that they involve relationships with members of social hierarchies rather than just the other member of an attachment relationship. Because individuals high on self-criticism are primarily concerned with preserving their status, respect, and admiration relative to others, they are expected to make frequent social comparisons with others in order to ascertain and confirm their relative status or rank, particularly when the outcome of the comparison is uncertain or unfavourable. Different behavioural strategies are expected depending on the status of the other and the extent to which retaliation is likely to incur reprisals. With individuals who are equally ranked or subordinate and from whom they typically expect praise and respect (i.e. siblings, friends, and family members), self-critical individuals are expected to downplay or avoid competition by self-handicapping. However, they are expected to retaliate when these individuals directly threaten status or rank (Santor et al., 2001; Santor & Zuroff, 1997; 1998).

Implications of a threat-based model of vulnerability
Despite the increased interest in depressive vulnerability factors in interpersonal contexts (Andrews, 1989; Gotlib & Hammen, 1992; Safran, 1990; Safran & Segal, 1990; Zuroff, 1992), relatively few studies have examined how vulnerability factors may moderate the way in which individuals respond to events that threaten theoretically important needs. Accordingly, it is argued that progress in understanding the impact of vulnerability factors on mood disorder depends on gaining a better understanding of the vulnerability factors themselves and the proximal effects of vulnerability factors on both mood and behavior. However, an expanded vulnerability model, which includes goals, needs, and behaviour strategies carries a number of implications for the manner in which we understand and investigate vulnerability factors.

Behavioural strategies and clinical outcomes
The expanded model also indirectly links vulnerability factors to clinical outcomes through the behavioural strategies that are believed to be associated with dependency and self-criticism in managing threatened or deprived needs. The model implies that whether or not individuals become depressed, depends on the manner in which individuals adapt to threats to underlying needs. It is when individuals high on dependency or self-criticism, responding to threatened intimacy and social rank needs, fail to adapt to those threats that clinical outcomes are likely to ensue.

Accordingly, adaptation can fail in a variety of ways. The behavioural strategy may not be successful: (a) because the strategy was unsuccessful in maintaining emotional support or in preserving social status (for a variety of reasons) or; (b) because of secondary effects that may arise as a result of the behavioural strategy. Results of a recent study examining social comparison and self-criticism showed that individuals high on self-criticism continued to solicit social comparisons even when comparisons were unfavorable. These kinds of results provide some understanding of how self-critical individuals may contribute to situations that maintain their self-critical beliefs and how vulnerability factors can influence the kinds of behavioral strategies individuals adopt to deal with threats to self-worth (Santor & Yazbek, 2001).

One drawback of expanding the conventional vulnerability model to include behavioral strategies is that the predictive value of the expanded vulnerability model may be more difficult to verify. Indeed the effects of vulnerability on the onset, course, and resolution of depressed mood may depend as much on any indirect effects of vulnerability on behavior, cognition, and motivation, as on any direct effects of mood itself. Consequently, the very notion of vulnerability as a unified risk factor may be compromised because the vulnerability factors are related to such a wide range of factors themselves, it becomes very difficult to talk about attributable or relative risk.

Understanding the proximal effects of depressive vulnerability factors is both theoretically important and central to developing effective treatments and interventions. As stated by Folkman and Lazarus (1985), "the essence of stress, coping and adaptation is change…unless we focus on change, we cannot learn how people come to manage stressful events and conditions" (p. 150). Most psychosocial interventions are premised on the notion that one can change the manner in which individuals react to, manage, and adapt to events. Continued progress in understanding the link between vulnerability factors and mood depends on a fuller understanding of depressive vulnerability factors themselves, in particular their proximal effects on both mood and behaviour.

- 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.

Depression Management Tool Kit

- The John D. & Catherine T. MacArthur Foundatin's Intiative on Depression & Primary Care and 3CM, LLC. (2004). Depression Management Tool Kit.

Personal Reflection Exercise #6
The preceding section contained information regarding an expanded model of vulnerability, and some of its implications for treatment.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Hewitt, P. L., Smith, M. M., Deng, X., Chen, C., Ko, A., Flett, G. L., & Paterson, R. J. (2020). The perniciousness of perfectionism in group therapy for depression: A test of the perfectionism social disconnection model. Psychotherapy, 57(2), 206–218.

Monroe, S. M., Anderson, S. F., & Harkness, K. L. (2019). Life stress and major depression: The mysteries of recurrences. Psychological Review, 126(6), 791–816.

Moore, E., Holding, A. C., Moore, A., Levine, S. L., Powers, T. A., Zuroff, D. C., & Koestner, R. (2021). The role of goal-related autonomy: A self-determination theory analysis of perfectionism, poor goal progress, and depressive symptoms. Journal of Counseling Psychology, 68(1), 88–97.

Online Continuing Education QUESTION 20
What is one drawback to expanding the conventional vulnerability model to include behavioral strategies mentioned in this article? Record the letter of the correct answer the CEU Test.

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