David A. F. Haaga

Empirical status of cognitive theory of depression

Studies testing cognitive theory of depression (Beck, 1963, 1987) and defining depression as a clinical syndrome are reviewed. Many aspects of the theorys descriptive claims about depressive thinking have been substantiated empirically, including (a) increased negativity of cognitions about the self, (b) increased hopelessness, (c) specificity of themes of loss to depressive syndromes rather than psychopathology in general, and (d) mood-congruent recall. Evidence that depressive thinking is especially inaccurate or illogical, however, is weak. Fewer studies have tested the theorys causal (diathesis-stress) hypotheses, and there is no strong evidence supporting them.

Sampling of empirically supported psychological treatments from health psychology: Smoking, chronic pain, cancer, and bulimia nervosa

Interventions in health psychology and behavioral medicine represent an integral area of research for the development of psychological therapies to enhance health behaviors, manage symptoms and sequelae of disease, treat psychological symptoms and disorders, prolong survival in the face of a life-threatening illness, and improve quality of life. A sampling of interventions in health psychology and behavioral medicine is offered that meet the criteria for empirically supported treatments for smoking cessation, chronic pain, cancer, and bulimia nervosa. Evidence for empirically supported treatments is identified, along with promising interventions that do not yet meet the criteria as outlined by D. L. Chambless and S. D. Hollon (1998). Evidence for the effectiveness and clinical significance of these interventions is reviewed, and issues in this area of research are outlined.

Introduction to the special section on stepped care models in psychotherapy.

Not all patients need the same type and intensity of intervention. Some may be helped greatly by reading a self-help book, watching an instructional video, or using a computer program. Others could benefit from a brief psychoeducational group conducted by a paraprofessional, and still others may require long-term individual treatment from a highly trained professional therapist with specialized expertise. In an environment of limited resources, it makes sense to provide all the time, expertise, and individual attention a patient needs, but not more. Stepped care models represent attempts to maximize the effectiveness and efficiency of decisions about allocation of resources in therapy. This article introduces a special section addressing these resource allocation issues in the context of prevalent disorders (e.g., generalized anxiety disorder, panic disorder, eating disorders, and alcohol dependence) for which empirically supported psychosocial treatments are available.

Normative Values for the Beck Anxiety Inventory, Fear Questionnaire, Penn State Worry Questionnaire, and Social Phobia and Anxiety Inventory

Community norms are reported for the Beck Anxiety Inventory (BAI ; A. T. Beck, N. Epstein, G. Brown, & R. A. Steer, 1988), Fear Questionnaire (FQ ; I. M. Marks & A. Mathews, 1979), Penn State Worry Questionnaire (PSWQ ; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990), and Social Phobia and Anxiety Inventory (SPAI ; S. M. Turner, D. C. Beidel, C. V. Dancu, & M. A. Stanley, 1989). The demographic profile of the samples closely matched the 1990 U.S. national census. On the SPAI, women scored higher than men on the Agoraphobia subscale, and the lowest income group scored higher than higher income participants on the Difference and Social Phobia subscales. Participants under 45 years of age exceeded those aged 45-65 on the BAI, the PSWQ, and FQ Social Phobia, Blood/Injury, and Total Phobia scores. Percentile scores are provided for all measures, as well as discussion oftheir usefulness for assessing clinical significance of therapy outcomes.

Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research

Resolving whether subthreshold depressive symptoms exist on a continuum with unipolar clinical depression is important for progress on both theoretical and applied issues. To date, most studies have found that individuals with subthreshold depressive symptoms resemble cases of major depressive disorder along many important dimensions (e.g., in terms of patterns of functional impairment, psychiatric and physical comorbidity, familiality, sleeping EEG, and risk of future major depression). However, such manifest similarities do not rule out the possibility of a latent qualitative difference between subthreshold and diagnosable depression. Formal taxonomic analyses, intended to resolve the possibility of a latent qualitative distinction, have so far yielded contradictory findings. Several large-sample latent class analyses (LCA) have identified latent clinical and nonclinical classes of unipolar depression, but LCA is vulnerable to identification of spurious classes. Paul Meehls taxometric methods provide a potentially conservative alternative way to identify latent classes. The one comprehensive taxometric analysis reported to date suggests that self-report depression symptoms occur along a latent continuum but exclusive reliance on self-report depression measures and incomplete information regarding sample base rates of depression makes it difficult to draw strong inferences from that report. We conclude that although most of the evidence at this time appears to favor both a manifest and latent continuum of unipolar depression symptomatology, several important issues remain unresolved. Complete resolution of the continuity question would be speeded by the application of both taxometric techniques and LCA to a single large sample with a known base rate of lifetime diagnosed depressives.

unconditional Self-acceptance and Psychological Health

Low self-esteem is usually considered unhealthy, but according to rational-emotive behavior therapy, any level of self-esteem reflects a dysfunctional habit of globally evaluating ones worth; it would be preferable to accept oneself unconditionally. This hypothesis was tested by examining several correlates of scores on a novel questionnaire measure of unconditional self-acceptance (USA). In a nonclinical adult sample, statistically controlling for self-esteem, USA was inversely correlated with anxiety symptoms and with narcissism, positively correlated with state mood after imaginal exposure to negative events. Other predicted associations of USA (with depression, happiness, and self-deception) either were not evident or became nonsignificant when self-esteem was taken into account. Discussion centered on the conceptual and operational distinctions between self-esteem and self-acceptance.

Effects of Transcendental Meditation practice on brain functioning and stress reactivity in college students

This randomized controlled trial investigated effects of Transcendental Meditation (TM) practice on Brain Integration Scale scores (broadband frontal coherence, power ratios, and preparatory brain responses), electrodermal habituation to 85-dB tones, sleepiness, heart rate, respiratory sinus arrhythmia, and P300 latencies in 50 college students. After pretest, students were randomly assigned to learn TM immediately or learn after the 10-week posttest. There were no significant pretest group differences. A MANOVA of students with complete data (N=38) yielded significant group vs treatment interactions for Brain Integration Scale scores, sleepiness, and habituation rates (all p<.007). Post hoc analyses revealed significant increases in Brain Integration Scale scores for Immediate-start students but decreases in Delayed-start students; significant reductions in sleepiness in Immediate-start students with no change in Delayed-start students; and no changes in habituation rates in Immediate-start students, but significant increases in Delayed-start students. These data support the value of TM practice for college students.

A Randomized Controlled Trial on Effects of the Transcendental Meditation Program on Blood Pressure, Psychological Distress, and Coping in Young Adults

BACKGROUND Psychological distress contributes to the development of hypertension in young adults. This trial assessed the effects of a mind-body intervention on blood pressure (BP), psychological distress, and coping in college students. METHODS This was a randomized controlled trial (RCT) of 298 university students randomly allocated to either the Transcendental Meditation (TM) program or wait-list control. At baseline and after 3 months, BP, psychological distress, and coping ability were assessed. A subgroup of 159 subjects at risk for hypertension was analyzed similarly. RESULTS Changes in systolic BP (SBP)/diastolic BP (DBP) for the overall sample were -2.0/-1.2 mm Hg for the TM group compared to +0.4/+0.5 mm Hg for controls (P = 0.15, P = 0.15, respectively). Changes in SBP/DBP for the hypertension risk subgroup were -5.0/-2.8 mm Hg for the TM group compared to +1.3/+1.2 mm Hg for controls (P = 0.014, P = 0.028, respectively). Significant improvements were found in total psychological distress, anxiety, depression, anger/hostility, and coping (P values < 0.05). Changes in psychological distress and coping correlated with changes in SBP (P values < 0.05) and DBP (P values < 0.08). CONCLUSIONS This is the first RCT to demonstrate that a selected mind-body intervention, the TM program, decreased BP in association with decreased psychological distress, and increased coping in young adults at risk for hypertension. This mind-body program may reduce the risk for future development of hypertension in young adults.

The specificity of attributional style and expectations to positive and negative affectivity, depression, and anxiety

Ninety-four undergraduate subjects completed measures of trait positive and negative affectivity, anxiety, depression, optimism, hopelessness, and attributional style. After writing about negative events or hearing a tape describing a positive academic experience, they completed measures of state positive and negative affect and of self-efficacy expectancies. Positive affectivity was associated with attributional style for positive, but not negative, events. Negative affectivity was associated with attributional style for negative, but not positive, events. Negative event attributional style was specifically associated with anxiety; expectancies and positive event attributional style with depression. Attributional style predicted state positive affect following completion of negative essays, but not negative affect, nor either affect following the positive tape. Effects of attributional style on affect were partially independent of expectations. Results are discussed in terms of the importance of distinguishing between processes related to positive and negative affect in order to distinguish anxiety from depression.

College Students' Willingness To Seek Help for Their Learning Disabilities.

Eighty-six university students with learning disabilities (LDs) completed measures of self-esteem and of perceptions of their LDs. In addition, they rated their willingness to seek help from academic services in response to two experimental manipulations: (a) they read vignettes about a student requesting help from professors or peers and receiving positive or negative reactions; and (b) they listened to audiotaped radio advertisements for academic services on a college campus, emphasizing either learning or performance goals. Participants reported the most willingness to seek help after reading about a positive reaction from a professor and the least willingness to seek help after reading about a negative reaction from a professor. In a nonsignificant trend, participants were more willing to seek help after hearing the ad emphasizing performance goals, such as improved grades. Students who viewed their LDs as more stigmatizing, non-modifiable, and global were less likely to report a willingness to seek help in response to negative situations and had lower overall self-esteem. These results suggest that learning services departments could bolster use of academic support by (a) intervening with faculty to try to prevent negative reactions to requests for accommodations and (b) attempting to destigmatize LDs among students themselves.