David C. Zuroff

Interpersonal relatedness and self-definition: Two prototypes for depression

Abstract This paper reviews recent research that indicates the importance of differentiating subtypes of depression based on two types of experiences that lead individuals to become depressed: (a) disruptions of interpersonal relations and (b) threats to self-integrity and self-esteem. We review research with clinical and nonclinical samples that investigated the relationships of these distinctions to the quality of current interpersonal relationships and to differential sensitivity to various types of stressful life events, as well as to aspects of early life experiences, especially the quality of the parent-child relationship. We also evaluate research evidence that considers the role of these two dimensions in clinical depression. In addition to proposing an etiologic model about aspects of the onset and recurrence of depression based on the interaction between personality predispositions and types of stressful life events, we place these observations about depression in a broad theoretical context of contemporary personality theory which defines two primary dimensions of personality development and psychopathology.

Self-Critical Perfectionism and Daily Affect: Dispositional and Situational Influences on Stress and Coping

This study of university students (64 men and 99 women) examined both dispositional and situational influences of self-critical (SC) perfectionism on stress and coping, which explain its association with high negative affect and low positive affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Structural equation modeling indicated that the relation between SC perfectionism and daily affect could be explained by several maladaptive tendencies associated with SC perfectionism (e.g., hassles, avoidant coping, low perceived social support). Multilevel modeling indicated that SC perfectionists were emotionally reactive to stressors that imply possible failure, loss of control, and criticism from others. As well, certain coping strategies (e.g., problem-focused coping) were ineffective for high-SC perfectionists relative to low-SC perfectionists.

Examining scale discriminability in the BDI and CES-D as a function of depressive severity.

Scale discriminability is the ability of a measure to discriminate among individuals ordered along some continuum, such as depressive severity. We used a nonparametric item-response model to examine scale discriminability in the Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) in both college and depressed outpatient samples. In the college sample, the CES-D was more discriminating than the BDI, but a standard CES-D cutoff score of 16 overestimated the likely prevalence of depression (45%). The CES-D may be more effective than the BDI in detecting differences in depressive severity in college students but may be less specific. In the depressed outpatient sample, the CES-D was again more discriminating than the BDI. The superior scale discriminability of the CES-D offers one explanation for its poorer specificity in college samples. Endorsing many items that discriminate at low levels of depressive severity can result in scores that exceed a cutoff criterion.

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.

The Therapeutic Relationship in the Brief Treatment of Depression: Contributions to Clinical Improvement and Enhanced Adaptive Capacities.

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patients perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed from these relationship measures. Multilevel modeling demonstrated that a perceived positive therapeutic relationship early in treatment predicted more rapid decline in maladjustment subsequent to the relationship assessment. This effect occurred equally across all 4 treatment conditions. A positive early therapeutic relationship also predicted better adjustment throughout the 18-month follow-up as well as development of greater enhanced adaptive capacities (EAC). Controlling a wide range of patient characteristics did not eliminate the effects of the therapeutic relationship on rate of improvement during treatment and on EAC. Thus, independent of type of treatment and early clinical improvement, the therapeutic relationship contributes directly to positive therapeutic outcome.

Autonomous motivation for therapy: A new common factor in brief treatments for depression

Abstract The authors propose a new common treatment factor, autonomous motivation (Deci & Ryan, 2000), defined as the extent to which patients experience participation in treatment as a freely made choice emanating from themselves. Ninety-five depressed outpatients were randomly assigned to receive 16 sessions of manualized interpersonal therapy, cognitive–behavior therapy, or pharmacotherapy with clinical management. Self-report and interviewer-based measures of depressive severity were collected at pretreatment and posttreatment. Autonomous motivation, therapeutic alliance, and perceived therapist autonomy support were assessed at Session 3. Autonomous motivation was a stronger predictor of outcome than therapeutic alliance, predicting higher probability of achieving remission and lower posttreatment depression severity across all three treatments. Patients who perceived their therapists as more autonomy supportive reported higher autonomous motivation.

Flux, pulse, and spin: dynamic additions to the personality lexicon.

Personality constructs were proposed to describe intraindividual variability in interpersonal behavior. Flux refers to variability about an individuals mean score on an interpersonal dimension and was examined for the 4 poles of the interpersonal circumplex. Pulse and spin refer to variability about an individuals mean extremity and mean angular coordinate on the interpersonal circumplex. These constructs were measured using event-contingent recording. Latent state-trait analyses indicated high stability of flux in submissive, agreeable, and quarrelsome behaviors and some stability in the flux of dominance. Further analyses indicated moderate to high stability in pulse and spin. Neuroticism predicted greater pulse, spin, and submissive behavior flux. Extraversion predicted greater flux in agreeable behavior. In contrast, Agreeableness predicted reduced spin and quarrelsome behavior flux. Social environmental variables predicted greater flux in dominant behavior. Flux, pulse, and spin provide reliable and distinctive additions to the vocabulary for describing individual differences.

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 subjects and partners 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.

Nonparametric Item Analyses of the Beck Depression Inventory: Evaluating Gender Item Bias and Response Option Weights.

Since the introduction of the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), studies have documented its effectiveness as a self-report measure of depression (for a review, see Beck, Steer, & Garbin, 1988). These studies report on the effectiveness of the BDI within and between groups but do not examine the psychometric properties of the BDI as a function of the severity of depression within groups. Previous research reporting gender differences on the BDI has neither distinguished group mean differences from differences due to gender item bias (Thissen, Steinberg, & Gerrard, 1986) nor examined how such differences between men and women may vary as a function of depression. Furthermore, despite the large number of studies investigating the BDI, few studies have directly assessed the appropriateness of the weights assigned to response options. In this article, we use techniques based on item response theory to evaluate item performance as a function of the severity of depression as well as to examine gender item bias and the appropriateness of the weights assigned to response options in both depressed outpatient and nonpatient college samples. Items on the BDI consist of groups of graded statements, or options, reflecting different degrees of severity for the symptom domain assessed by that item. For each item there are four op

Ambivalence over emotional expression and negative life events: Mediators of depressive symptoms in dependent and self-critical individuals

We examined life events, emotional intensity, and ambivalence over the expression of emotion as possible mediators to account for the relation between Dependency, Self-Criticism and depressive symptoms. Dependency in both men (N = 74) and women (N = 76) was related to a greater number of negative relationship events and ambivalence over the expression of emotion, both of which predicted self-reported, depressive symptoms. Self-Criticism in women was related to a greater number of negative academic events and ambivalence, both of which also predicted depression. Self-Criticism in men was related only to ambivalence, which predicted depression. The mediational model including life events and ambivalence successfully accounted for 74% of the effect of personality on depression for women, and 47% of the effect for men.