Socialcognitive theories of depression

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The threads of various strands for current social-cognitive theories of depression can be seen first in the work on the vulnerability that arises for an individual who overinvests in one particular role (Becker, 1971) or goal (Arieti & Bemporad, 1978); and second in the work on life events and depression carried out by Brown and Harris (1978), in which a number of social vulnerability factors were highlighted because of their interaction with adversity to increase an individual's likelihood of developing depression. These earlier ideas have been drawn together more recently by a number of theorists including Abramson et al. (2002), Brown, Bifulco, and Harris (1987; Harris et al., 2000), Champion and Power (1995; Champion, 2000), and Gotlib and Hammen (1992; Rottenberg & Gotlib, 2004). Although these theories differ in terms of emphasis and detail, they focus on a number of related proposals that can be schematised as follows:

1 The vulnerable individual has a high level of investment in one particular role or goal.

2 The individual may pursue this role or goal, whether it is work-based or inter-personally based, with considerable success.

3 The occurrence of a severe event that matches the role or goal and which thereby threatens it increases the likelihood of depression.

4 The influence of social-cognitive factors is seen to be strongest for first episodes of unipolar depression, but the repeated experience of adversity and depression may lead to a sense of 'defeat' (e.g., Gilbert, 1992) in which the individual disinvests in all domains including those that were previously overinvested.

5 In addition, most theories identify a number of other vulnerability or protective factors. Key factors include whether or not the individual has a close confiding relationship (e.g., Champion, 1990; Wills & Fegan, 2001), and issues such as self-esteem and the self-concept (e.g., Bifulco et al., 1998), and attributional style, dysfunctional attitudes, coping, and emotion regulation strategies (e.g., Nolen-Hoeksema, 2002).

The evidence in favour of some form of social-cognitive theory of depression has been well documented over a number of years by Gotlib and Hammen (1992, 2002; Hammen, 1997, 2005; Rottenberg & Gotlib, 2004), who have also offered their own potential integration. The data show clearly that depression is not simply the consequence of the occurrence of severe life events, although such events may well be upsetting. As Freud (1917) emphasised in Mourning and Melancholia, it is normal to experience sadness over the loss of someone or something important, but it is not normal for this sadness to turn into depression. To give an example, it is well known from the epidemiology of depression that about twice as many women as men develop depression (e.g., Weissman & Klerman, 1977). However, there is no simple biological explanation for this difference, because for example the rates vary dramatically with marital status; thus, the rates are highest for married women but lowest for married men, with single men and women showing about the same rates (Nolen-Hoeksema, 1990, 2002). We will consider this and other evidence in greater detail in Chapter 7. For the present discussion it must be emphasised that emotions and emotional disorders occur in social contexts. Although we disagree with the extreme viewpoint that emotions are solely social constructions (e.g., Harre, 1987), we also believe that many theories of emotion and the emotional disorders have paid insufficient attention to social factors.

In terms of the weak points of social-cognitive theories of depression there are a number of comments that must be made. First, there has been poor agreement over the measurement of social factors whether this be the measurement of social support, the self-concept, or roles and goals. Because of the diversity of measurement, it is often impossible to determine whether a negative result has occurred simply because of the inadequate measurement of a factor, or whether a particular positive finding is artefactual and therefore unique to the idiosyncrasies of a particular measure. The area of social support is probably the best example of this diversity and inconsistency (see e.g., Brugha, 1995, for a summary). Second, social-cognitive models often appear to hedge their bets over whether they are models of the onset of disorders, of the maintenance of disorders, of recovery from disorders, or of relapse of disorders. Similarly, even where some attempt is made to untangle, for example, onset and maintenance, the models are developed in an ad hoc fashion that may be difficult to replicate.

One clear exception to this criticism is evident in the work of George Brown and his colleagues. Although their early work focused on the role of adversity and vulnerability in the onset of depression (Brown & Harris, 1978), later work has extended to longitudinal studies of the maintenance, recovery, relapse, and recurrence of depression. For example, in a study of recovery from depression Brown, Lemyre, and Bifulco (1992) found that recovery is associated with both the occurrence of positive life events that can offer a fresh start for the individual and with the presence of positive evaluations of the self in an interview measure of self-esteem.

Third, the models are often poor at explaining how vulnerability factors such as overinvestment in a role or goal arise in the first place; the models tend to be "adultocentric" and apply mainly to the life stage that the researchers themselves have reached! We must ask, therefore, how the models apply at other stages in the lifespan. For example, can they account for the fact that although, as noted above, the female:male depression ratio is approximately 2:1 in adults, up until mid-adolescence the reverse is true and about twice as many boys as girls develop depression (e.g., Nolen-Hoeksema, 1990)? Although such findings lend themselves to psychosocial models, none of the existing models yet provides an adequate account.

Finally, on a more general note it must be stated that social-cognitive accounts of depression are well in advance of equivalent accounts of other disorders; this discrepancy could suggest that sadness and its disorders are par excellence interpersonal emotional states, but the alternative view that useful psychosocial accounts of disorders of, say, anxiety or disgust have yet to be developed is equally appealing. (See Chapter 7 for a more detailed discussion of these social-cognitive models in relation to depression.)

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