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Benjamin G. Shapero
Temple University
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In his learned helplessness model of depression, Seligman (1975) proposed that the way
individuals view negative events may impact
their affective experience. This initial theory
was further refined in the reformulated learned
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104
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ATTRIBUTIONS IN DEPRESSION
105
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106
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ATTRIBUTIONS IN DEPRESSION
to directly challenge and modify negative cognitive styles. These therapies fall under the general heading of cognitive behavioral therapy
for depression, and their central emphasis is on
the modification of dysfunctional beliefs, expectations, and attributions. Other models of
psychotherapy for depression that place greater
emphasis on promoting acceptance, activating
goal-directed or values-driven behavior, and/or
fostering better interpersonal relationships have
emerged. Although these approaches also incorporate an awareness of negative attributions into
their conceptual and procedural framework,
they tend to emphasize altering the context in
which cognitions occur or the meanings attached to them, rather than changing the content
of the cognitions themselves (Forman, Herbert,
Moitra, Yeomans, & Geller, 2007). In either
case, the value of fostering explicit awareness
of the scriptlike and pervasive nature of depressive attributions and expectations, and the
power they have to influence behavior and
shape life experience, is perhaps the central
clinical implication of the research on attributions in depression.
Over time, individuals with depression create
ongoing, repetitive narratives about events in
their lives and their roles in these events. By
being familiar with their themes, therapists can
facilitate increased awareness of the narratives
and then help find new ways to loosen them,
allowing the client to entertain a more-flexible
worldview that permits a range of responses. As
a first step, clinicians can provide psychoeducation about negative attributions and help clients
recognize that their explanatory conventions
have become habitual and are present in everyday situations.
For example, clinicians can ask clients to
picture the following scenario: You are walking down the street and see someone you know.
You wave to the person and say hello, but
he/she does not acknowledge you and just walks
by. Clinicians can ask clients what thoughts
they might have in this situation and how they
might feel. Gathering this kind of information
will expose clients to their most common assumptions that occur spontaneously without reflection and are often believed to be true, as well
as to the emotional experience that attends the
narrative. To complete this exercise, clinicians
can help clients recognize this familiar narrative
as a private conversation that is habitual and
107
occurs at least partially independent of the actual facts, with which it may or may not be
consistent. The goal is for clients to grasp that it
is not the facts themselves that drive the story
they tell but rather something more internal and
automatica narrative that is colored by a pervasive depressive attributional style. Once therapists have brought awareness to negative attributions over several sessions and taught clients
to recognize these attributions when they happen in the clients lives, therapists can begin to
work with clients to loosen these attributions,
using one or more awareness-based strategies.
Questioning thoughts. The hallmark of
cognitive interventions for depression is the direct identification of dysfunctional, distorted
thinking patterns that are presumed to directly
affect clients negative moods and reduced
goal-directed behaviors. Central to these patterns are the attributions that make up the depressive attributional style. Depressive attributions and expectations can be directly
questioned on rational grounds, thereby helping
clients examine and challenge the validity and
utility of their thoughts. It is preferred that clients, with the help of the therapist, develop their
own strategies for questioning negative attributions. Because many clients are ambivalent to
change, therapists can employ motivational interviewing techniques to help foster collaboration, intrinsic motivation, and commitment to
change (Westra & Aviram, 2013). Inasmuch as
clients have often subscribed to their negative
thinking narratives for some time, it may be
more beneficial for clinicians to use direct questioning to help depressed clients reassess their
thinking patterns, such as, What is the worst
that could happen, and how could you cope?
(J. S. Beck, 2011).
Practicing acceptance. In contrast to the
disputational approach that is traditional in cognitive therapy for depression, a stance of nonjudgmental acceptance that is central to acceptance-based treatments for depression supports
active awareness of private and painful thoughts
without attempting to change their content or
frequency (Hayes, Luoma, Bond, Masuda, &
Lillis, 2006). Clients can learn to accept both
the cognitions associated with negative cognitive style and the attending negative affect without trying to change them. Seeing thoughts as
the familiar, predictable content in a habitual
negative attributional script can help clini-
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108
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ATTRIBUTIONS IN DEPRESSION
109
110
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husbands infidelity. Making those connections helped her feel less at the mercy of a
force that she felt had swelled up from within
and engulfed her. Though still in much pain,
she began to take a more-active approach in
therapy, setting goals and assigning herself
tasks designed to help her feel less overwhelmed and to move forward with her life in
a more deliberate manner.
Gender
Awareness of the tendency for stressful life
events and negative style to interact in ways that
exacerbate the risk of major depressive episodes
may be an especially important consideration in
working with female clients. Their vulnerability
makes them potentially more prone to seeing
themselves as to blame when bad things happen. Females may be especially vulnerable in
marital and family relations, a context in which
men tend to receive more benefit and women
tend to bear more responsibility for keeping the
family and/or household running smoothly (Bianchi, Milkie, Sayer, & Robinson, 2000). In the
case just discussed, the client may have begun
as furious with her husband, but she reserved
her harshest judgments for herself. He had betrayed, but she had failed. He was ashamed, but
she was broken. He would survive and find
someone else, but she would be crushed and
alone. One observation that was especially upsetting to her was that although her husband was
genuinely sorry and seemed motivated to improve the relationship, he was not depressed or
down on himself as she was. Understanding
how relationship stress and trauma may be
viewed and processed differently by male and
female clients, as in this case, can help focus the
clinical work in ways that are more context
sensitive and that better address the complexity
of the clients attributional response.
Temperament and Personality
Research reviewed earlier has suggested that
aspects of temperament or personality may put
people at risk for both increased life stress and
a greater tendency toward negative attributional
style. Clients who report a chronic pattern of
negative withdrawal characterized by avoidance of novel situations, high sensitivity to negative stimuli, and a tendency to become easily
upsetare at risk for the development of de-
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ATTRIBUTIONS IN DEPRESSION
111
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112
anxiety and depression (Cristea, Kok, & Cuijpers, 2015). Nevertheless, the crucial role of
cognitive styles in the development and maintenance of depression suggests that this may be
a useful strategy in helping individuals change
their cognitive appraisals. New directions for
this research include designing novel targets,
including attribution biases, and using innovative paradigms in hopes of developing the utility of this method in a therapeutic context (Macleod, Koster, & Fox, 2009).
Along with interventions aimed at altering
negative cognitions, an innovative, promising
line of research involves promoting positive
attributional style. As a mechanism of resilience, an enhancing attributional style involves
the tendency to ascribe stable and global causes
to positive events, which promotes hopefulness
(Kleiman, Liu, & Riskind, 2013). Enhancing
attributional style predicts decreases in negative, dependent (i.e., self-caused) life events
over time (Kleiman et al., 2013). Thus, it may
be useful for clinicians to work with depressed
patients on building positive cognitive styles to
treat depressed mood and break the stressgeneration cycle. Breeding optimism may foster
more confidence, agreeableness, and proactive
monitoring of well-being in patients. Thus, in
addition to promoting awareness about the attributions for negative experiences, clinicians
could help depressed clients to identify positive
events in their daily lives, such as satisfactory
feedback at work, enjoyable interactions with
loved ones, or personal accomplishments, such
as engaging in housework or exercise. Clinicians can guide clients through an understanding of the causes and consequences of these
positive events. Depressed persons who do not
typically give themselves credit for being a
good employee may attribute positive feedback
at work to external, unstable, and specific
causes (e.g., My boss was in a good mood
today, so he complimented me; This will
never happen again; and I may have performed adequately in my meeting today, but I
am not a good employee otherwise). Clinicians
could help clients to identify these patterns and
work with them to find evidence for internal,
stable, and global attributions for positive
events.
Thus, future research aimed at developing
interventions for those with cognitive vulnerabilities to depression could benefit from includ-
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