ابعاد کنترل روانشناختی والدین: ارتباطات با پرخاشگری فیزیکی و رابطه پیش دبستانی در روسیه

This study reports the development of a self-report measure to assess beliefs about and frequency of anti-depressive behaviour. This study tests the hypothesis that people predisposed to depression and mania will be associated with higher levels of unhelpful beliefs about anti-depressive behaviour, sociotropy and autonomy, and higher levels of dysfunctional antidepressive behaviour. Non-clinical participants (112) were asked to complete questionnaires assessing beliefs about and frequency of anti-depressive behaviour, predisposition to mania, depression, sociotropy and autonomy. The results showed that three empirically distinct subscales measuring the beliefs people hold about how to avoid depression can be identified reliably. The questionnaire assessing frequency of antidepressive behaviour also had three subscales. The scales possessed acceptable internal consistency and were moderately stable over a 4–6 week period. Consistent with predictions, it was found that sociotropy, autonomy and beliefs about antidepressive behaviour were significantly associated with depression. Autonomy was found to predict predisposition to mania, and those with high vulnerability to mania scored significantly higher on measures of autonomy, sociotropy and frequency of active coping than those of lowest vulnerability. The theoretical and clinical implications of the findings are discussed.

Bipolar disorder (BD) is an episodic illness, which has adverse psychosocial consequences (Goodwin & Jamison, 1990), and it affects around 1% of the population in its severest form and at least another 1% in milder variants (Depue et al., 1981 and Weissman et al., 1978). Unipolar depression also has significant psychosocial consequences and will affect up to 12% of men and 25% of women at some point in their life (APA, 1994). Research into psychological treatments for BD has been limited and these patients have been long regarded poor candidates for therapy (Goodwin & Jamison, 1990). However, with the increased emphasis on stress-diathesis models of mental disorders over the past two decades and the increased acceptance of cognitive behavioural interventions for individuals with treatment-resistant schizophrenia as well as chronic depressive disorders, research into psychological treatments for BD has started to gain momentum (Scott, 1996). The development of effective cognitive behavioural treatments for unipolar depression has been significantly influenced by advances in knowledge regarding cognitive processes, maintenance factors and underlying vulnerabilities in this disorder (Segal & Swallow, 1994). Similarly, it is likely that developments in the understanding of cognitive processes in bipolar disorder will help to develop more effective psychological treatments for this disorder. Beck's (1976) cognitive theory of depression states that depression is characterised by a negative cognitive triad consisting of negative automatic thoughts regarding self, world and future. This was expanded to recognise that certain clusters of personality attributes or schemas may result in increased susceptibility to depression when these predisposed individuals experience a negative life event that matches their personality vulnerability (Beck, Epstein, & Harrison, 1983). Sociotropy, which is the tendency to invest in positive interchange with other people and be primarily concerned with social themes such as approval and acceptability, and autonomy, which is the tendency to invest in preserving and increasing their independence and be primarily concerned with achievement, were identified as two such vulnerability factors in depression and other emotional disorders. For example, the break-up of a relationship would be likely to trigger depression in a sociotropic individual, whereas losing a job would be likely to trigger depression in an autonomous individual. A number of studies have tested the hypothesis that sociotropy and autonomy are vulnerability factors in the development of depression. Several studies of depressed patients pre- and post-treatment have found sociotropy and autonomy to be stable constructs (Moore & Blackburn, 1996, Scott et al., 1996 and Blackburn, 1996). A number of studies have also found a strong relationship between sociotropy and autonomy scores and negative self-evaluation (e.g. Metalsky, Joiner, Hardin, & Abramson, 1993), as well as with measures of information processing such as recall biases (Moore & Blackburn, 1993) in people predisposed to depression. The observation that depression ratings are frequently as high during the manic phase as they are during the depressed phase of bipolar disorder (Kotin & Goodwin, 1972) has led researchers to suggest that mania is a defense against depression (Winters & Neale, 1985). Neale (1988), in a cognitive reformulation of the ‘manic defense’ hypotheses proposed that unstable self-esteem coupled with unrealistic standards for success (presumably related to autonomy) are the predominant predisposing factors for bipolar disorder. Winters and Neale (1985) also found that social desirability scores are abnormally high in remitted manic patients, which has been used as evidence of defensiveness in bipolar patients. However, it is also possible that this reflects concerns about social approval and social rejection (i.e. sociotropy). There have been a number of recent studies demonstrating that mania is associated with information processing biases similar to those found in depressed patients. Bentall and Thompson (1990) showed that hypomanic students took longer to colour-name depression but not euphoria-related words on an emotional stroop test; a pattern of results consistently found in patients with unipolar depression (Gotlib & Hammen, 1992). This result has since been replicated French, Richards, and Schofield (1996). These studies have been used as evidence to suggest that bipolar patients show attentional bias in the selective processing of negative words, an effect which, the cognitive model postulates, indicates depressogenic content at the schematic level of the informational processing system. Lyon, Startup, and Bentall (1999) found similarities between bipolar manic and bipolar depressed patients, in comparison with non-patients, on measures of attributional style, attentional bias and recall bias. They suggest that these results are consistent with the manic defence hypothesis. The results also suggest that depressive schematic content is activated during both phases of the disorder. Hammen, Ellicott, and Gitlin (1992) studied 49 remitted bipolar patients who had previously been assessed for sociotropy and autonomy at 6–24 month follow-up. They found that onset of symptoms was not associated with stressors which matched the individuals’ sociotropic-autonomous type. However, they did find that symptom severity was significantly associated with sociotropy, interpersonal events and the interaction of the two, and conclude that sociotropy represents a cognitive vulnerabilty for particular types of stressors, eventuating in more severe episodes. Scott, Stanton, Garland, and Ferrier (2000) found that, in comparison to control subjects, patients with bipolar disorder demonstrated significantly higher levels of dysfunctional attitudes (particularly perfectionism and need for approval) and sociotropy, significantly greater over-general recall on an autobiographical memory test and significantly less ability to generate solutions to social problem-solving tasks. Wells and Matthews’ (1994) self-regulatory executive function (S-REF) model of emotional disorders can also be used as a framework for understanding bipolar disorder. This model suggests that vulnerability to psychological dysfunctions is associated with a cognitive-attentional syndrome characterised by heightened self-focused attention, attentional bias, ruminative processing and activation of dysfunctional beliefs. In this model, cognitive-attentional experiences such as biased information processing and cognitive intrusions are mediated by executive processes, which are directed by the patients’ beliefs. Some beliefs are metacognitive in nature and are linked to the interpretation, selection and execution of particular thought processes. Wells (1995) states that such metacognitive beliefs include beliefs about thought processes (e.g. ‘I have a poor memory’), the advantages and disadvantages of various types of thinking (e.g. ‘My worrying could make me go mad’), and beliefs about the content of thoughts (e.g. ‘It is bad to think about death’). Discussing such beliefs with reference to generalised anxiety disorder and obsessive-compulsive disorder, Wells (1995) argues that in these patients, it is their appraisal of and response to their cognitive processes which distinguishes them from non-clinical samples, as opposed to the content of their cognitions. Within the S-REF model, Wells and Matthews suggest that procedural beliefs (self-knowledge and metacognitive beliefs) guide the selection and execution of strategies for the processing of information (such as reasoning strategies, thought control techniques and allocation of attention). Thus, within this framework, beliefs about depression may serve to influence strategies used to avoid depression (termed anti-depressive behaviour by Rippere, 1976). Indeed, Rippere (1977a) suggested that ‘the network of cognitions and metacognitions which are in turn associated with these behaviours’ (p. 466) are as important to our understanding of depression as the negative automatic thoughts themselves and that peoples’ overt behaviour in response to depression is ‘mediated by their second and higher order cognitions’ (p. 465). Rippere (1977a) found a consensus in beliefs about depression and antidepressive behaviour, including the helpfulness of keeping busy or talking to someone. This corresponds to the most commonly reported behaviours found in an open-ended interview study ( Rippere, 1977b) regarding ‘the thing to do when feeling depressed’; these were keep busy (24%), talk to someone about it (24%) and do something you enjoy (18%). It is possible that bipolar patients exhibit the manic defence as a result of catastrophic beliefs about the meaning of depression, and may hold unhelpful beliefs about what strategies should be used to avoid depression. This, in turn, could lead to the adoption of counterproductive antidepressive behaviour. Consistent with this, Lam and Wong (1997) found that bipolar patients classified as poor copers reported coping with their prodromal symptoms of mania by trying to “move about and take on more tasks”, “go out and spend money”, and “find more to do to fill out the extra minutes of the day”, and yet good copers reported coping with depressive prodromes by getting organised and keeping busy (all of which are clearly linked to the symptoms of mania). Nolen-Hoeksema (1991) has also suggested that individuals use a variety of strategies or response styles to cope with negative affect. Using a revision of her response styles questionnaire, Thomas and Bentall (in press) found that predisposition to mania was related to distraction and risk-taking response styles, which also suggests that antidepressive behaviour may be implicated in bipolar disorder. It may be that there is a delicate balance between functional and dysfunctional self-regulatory coping behaviour in bipolar patients. It is also possible that people experiencing recurrent unipolar depression exhibit similar dysfunctional procedural beliefs and corresponding behaviours. It is also possible that sociotropy and autonomy will be related to different types of anti-depressive behaviour and beliefs (for example, autonomous individuals may rely on goal-orientated strategies and activities, whereas autonomous individuals may employ social strategies). This study aims to test the hypothesis that people predisposed to depression and mania will have higher levels of unhelpful beliefs about anti-depressive behaviour than those who are not. It also aims to test the hypothesis that people predisposed to depression and mania will engage in higher levels of dysfunctional antidepressive behaviour. It is also predicted that sociotropy and autonomy will be associated with depressive symptomatology and predisposition to mania.