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Excerpt
Without a doubt, the effects of depression are devastating. Of the approximate 15% of Americans who suffer an episode of major depression at some point during their lives, approximately half will suffer at least one additional episode and for many a lifelong struggle with depression will ensure. Given the suffering and economic cost imposed by depression, it is no wonder that the successes of cognitive models of depression have been much heralded. Cognitive explanations of the phenomena and symptomatology of depression and the treatment models that flow from them have enjoyed solid empirical support and wide popularity.
The topic addressed by this book, cognitive vulnerability to depression, represents what has been one of the more intransigent puzzles in the recent understanding of depression: how to document and study the cognitive patterns theorized to underlie and to be causally involved in the onset, maintenance, and recurrence of depression among individuals who are not currently depressed. Despite the successes of cognitive approaches in explaining and treating depression, researchers had until recently been strikingly unable to discover evidence of depressive cognitive patterns in apparently vulnerable individuals once an episode of depression had remitted. Recent thinking and methodological approaches, spearheaded by the authors of the present volume, seem to be in the process of unlocking the gates to productive study and deepened understanding of vulnerability to depression.
According to cognitive models of depression, an important (though not necessarily an exclusive) cause of depression is a tendency to apprehend and experience one's world in a negatively biased way. For example, A.T. Beck (e.g., 1967) describes the "cognitive triad" of negative perceptions of self, world, and future that characterizes depressive thinking and that plays, in his model, a causal role in bringing about and maintaining episodes of depression. According to this model, deep-level assumptive structures (schemas, dysfunctional beliefs) are presumed to give rise to consciously accessible phenomena ("automatic thoughts"). So, for example, a depression-prone person may have deep-level, implicit assumptions about her own unlovability that lead her to consciously interpret innocuous remarks or small social slights in ways that distort their meaning and magnify their importance. Treatments stemming from these models that have focused on teaching people to challenge and modify their dysfunctional assumptions and beliefs have enjoyed well-documented successes, with recovery rates in the same general range (60 to 70%) as claimed for pharmacological treatments.
Until recently, a fly in this soup has been the fairly persistent failure of researchers to find evidence of depressive thinking in purportedly vulnerable individuals except during episodes of depression. Such failures have been a challenge to theory because they threaten the notion that depressive thinking is more than a symptom or concomitant of depressive mood-the claim that it is a preexisting and causal factor in bringing about a depressive episode. They have also been disappointing because the ability to detect vulnerability out of episode offers an enormously promising tool for etiological research and for early intervention and/or preventive efforts.
A central argument of the book is that some form of priming or challenge must be used to activate or make accessible the depressive thinking patterns underlying depressive vulnerability in currently nondepressed individuals. As the authors point out, prominent cognitive theories adopt a "diathesis-stress" model of depression and view depressive thinking patterns as diatheses that may not lead to symptoms except in the presence of adversity, particularly adversity that matches the individual's core concerns regarding self.
