What You Can Change . . . And What You Can't*: The Complete Guide to Successful Self-Improvement (47 page)

10
. This case is adapted from I. Marks, S. J. Rachman, and R. Hodgson, “Treatment of Chronic Obsessive-Compulsive Neurosis by
in Vivo
Exposure,”
British Journal of Psychiatry
127 (1975): 349–64.

11
. J. Greist, “Treatment for Obsessive Compulsive Disorder: Psychotherapies, Drugs, and Other Somatic Treatment,”
Journal of Clinical Psychiatry
51 (1990): 44–50. For a complete review of the dozen or more outcome studies of behavior therapy for OCD, see Rachman and Hodgson,
Obsessions and Compulsions
, 299–358; and DeSilva and Rachman,
Obsessive-Compulsive Disorder
, 53–54.

CHAPTER
8
Depression

1
. I have spent most of my life writing about depression. Much of the material in this chapter is adapted from other things I have written, particularly from
chapter 4
, “Ultimate Pessimism,” in
Learned Optimism
(New York: Knopf, 1991), 54–70.

2
. See Seligman,
Learned Optimism
, for the grand tour of explanatory style. Detailed reviews of explanatory style and depression, and extensive bibliographies, can be found in C. Peterson and M. Seligman, “Causal Explanations as a Risk Factor for Depression: Theory and Evidence,”
Psychological Review
91 (1984): 347–74; in P. Sweeney, K. Anderson, and S. Bailey, “Attributional Style in Depression: A Meta-analytic Review,”
Journal of Personality and Social Psychology
50 (1986): 974–91; and in L. Abramson, G. Metalsky, and L. Alloy, “Hopelessness Depression: A Theory-Based Process-Oriented Sub-Type of Depression,”
Psychological Review
96 (1989): 358–72.

3
. L. Robins, J. Helzer, M. Weissman, H. Orvaschel, E. Gruenberg, J. Burke, and J. Regier, “Lifetime Prevalence of Specific Psychiatric Disorders in Three Sites,”
Archives of General Psychiatry
41 (1984): 949–958G; G. Klerman and M. Weissman, “Increasing Rates of Depression,”
Journal of the American Medical Association
261 (1989): 2229–35.

4
. G. Klerman, P. Lavori, J. Rice, T. Reich, J. Endicott, N. Andreason, M. Keller, and R. Hirschfeld, “Birth-Cohort Trends in Rates of Major Depressive Disorder Among Relatives of Patients with Affective Disorder,”
Archives of General Psychiatry
42 (1985): 689–93.

5
. The finding that depression now starts younger comes from the elegant mathematization of the data from a study by T. Reich, P. Van Eerdewegh, J. Rice, J. Mullaney, G. Klerman, and J. Endicott, “The Family Transmission of Primary Depressive Disorder,”
Journal of Psychiatric Research
21 (1987): 613–24.

6
. P. Lewinsohn, P. Rohde, and J. Seeley, “Birth-Cohort Changes in the Occurrence of Depression: Are We Experiencing an Epidemic of Depression?”
Journal of Abnormal Psychology
102 (1993): 110–20.

7
. This is an area so obscured by ideology that you should be guided to the best
disinterested
study. I recommend the very careful review of the topic by S. Nolen-Hoeksema, “Sex Differences in Depression: Theory and Evidence,”
Psychological Bulletin
101 (1987): 259–82. A longer version is S. Nolen-Hoeksema,
Sex Differences in Depression
(Stanford, Calif.: Stanford University Press, 1990). An exhaustive bibliography of the topic and of the controversy discussed in the next few paragraphs of
chapter 8
can be found there.

8
. The most detailed argument for the close symptom correspondence of learned helplessness and
DSM-3
-diagnosed depression is made by J. Weiss, P. Simson, M. Ambrose, A. Webster, and L. Hoffman, “Neurochemical Basis of Behavioral Depression,”
Advances in Behavioral Medicine
1 (1985): 253–75. This paper and the important work of Sherman and Petty (below) also lay out the powerful brain-chemistry and pharmacological similarities between learned helplessness and depression (see A. Sherman and F. Petty, “Neurochemical Basis of Antidepressants on Learned Helplessness,”
Behavioral and Neurological Biology
30 [1982]: 119–34).

9
. Three psychologists have made the major contributions to the recent study of rumination: Julius Kuhl, Susan Nolen-Hoeksema, and Harold Zullow. See J. Kuhl, “Motivational and Functional Helplessness: The Moderating Effect of State-Versus Action-Orientation,”
Journal of Personality and Social Psychology
40 (1981): 155–70; H. Zullow, “The Interaction of Rumination and Explanatory Style in Depression.” Master’s thesis, University of Pennsylvania, 1984; and Nolen-Hoeksema,
Sex Differences in Depression
.

10
. M. McCarthy, “The Thin Ideal, Depression, and Eating Disorders in Women,”
Behaviour Research and Therapy
28 (1990): 205–15.

11
. J. Girgus, S. Nolen-Hoeksema, M. Seligman, G. Paul, and H. Spears, “Why Do Girls Become More Depressed Than Boys in Early Adolescence?” Paper presented at the meeting of the American Psychological Association, San Francisco, August 1991.

12
. S. Hollon, R. DeRubeis, and M. Evans, “Combined Cognitive Therapy and Pharmacotherapy in the Treatment of Depression,” in D. Manning and A. Frances, eds.,
Combined Pharmacotherapy and Psychotherapy in Depression
(Washington, D.C.: American Psychiatric Press, 1990), 35–64. In one well-publicized study, eleven patients who responded well to imipramine took the drug continuously for five years, and only one became depressed. Of nine patients given a placebo, five became depressed. See D. Kupfer, E. Frank, J. Perel, et al., “Five-Year Outcome for Maintenance Therapies for Recurrent Depression,”
Archives of General Psychiatry
49 (1992): 769–73. This suggests that if antidepressant drugs work for you and curtail depression, stay on them even when you’re feeling fine, to prevent recurrence.

13
. For a review of the effectiveness of ECS, see M. Fink,
Convulsive Therapy: Therapy and Practice
(New York: Raven Press, 1979). There is now a whole journal,
Convulsive Therapy
, devoted to ECS. For a cautious view, see J. Taylor and J. Carroll, “Current Issues in Electroconvulsive Therapy,”
Psychological Reports
60 (1987): 747–58. For recent findings, see D. Devanand, H. Sackeim, and J. Prudic, “Electro-convulsive Therapy in the Treatment-Resistant Patient,”
Psychiatric Clinics of North America
14 (1991): 905–23.

14
. A. Beck,
Cognitive Therapy and the Emotional Disorders
(New York: New American Library, 1976), 233–62.

15
. The basic reference to the NIMH collaborative study is I. Elkin, M. Shea, J. Watkins, S. Imber, et al., “National Institute of Mental Health Treatment of Depression Collaborative Research Program: General Effectiveness of Treatments,”
Archives of General Psychiatry
46 (1989): 971–82. The reader should be warned that this is still a guild “hot potato” and that even now the data are disputed and are in the process of being reanalyzed.

The latest findings are about recurrence: M. Shea, I. Elkin, S. Imber, et al., “Course of Depressive Symptoms over Follow-up,”
Archives of General Psychiatry
49 (1992): 782–87; and M. Evans, S. Hollon, R. DeRubeis, et al., “Differential Relapse Following Cognitive Therapy and Pharmacotherapy for Depression,”
Archives of General Psychiatry
49 (1992): 802–8. Both of these major studies find that cognitive therapy fares better than drug treatment (which is tapered off during follow-up) on preventing recurrence of depression. But there is still considerable recurrence even in the cognitive-therapy groups, with drugs showing about 50 percent recurrence over two years and cognitive therapy about 30 percent recurrence.

16
. Elkin et al., “National Institute of Mental Health Treatment of Depression Collaborative Research Program,” 971–82.

17
. G. Klerman, M. Weissman, B. Rounsaville, and E. Chevron,
Interpersonal Psychotherapy of Depression
(New York: Basic Books, 1984).

CHAPTER
9
The Angry Person

1
. Developed by Charles Spielberger in collaboration with G. Jacobs, R. Crane, S. Russell, L. Westberry, L. Barker, E. Johnson, J. Knight, and E. Marks. I have selected the trait-anger questions, inverting some of the scoring of the negatively worded items for easy self-scoring.

2
. R. Ardrey,
The Territorial Imperative
(New York: Atheneum, 1966).

3
. J. Hokanson, “The Effects of Frustration and Anxiety on Aggression,”
Journal of Abnormal Psychology
62 (1961): 346; J. Hokanson and M. Burgess, “The Effects of Three Types of Aggression on Vascular Processes,”
Journal of Abnormal and Social Psychology
65 (1962): 446–49; R. Williams, J. Barefoot, and R. Shekelle, “The Health Consequences of Hostility,” in M. Chesney and R. Rosenman, eds.,
Anger and Hostility in Cardiovascular and Behavioral Disorders
(New York: McGraw-Hill, 1985), 173–85.

4
. S. Greer and T. Morris, “Psychological Attributes of Women Who Develop Breast Cancer: A Controlled Study,”
Journal of Psychosomatic Research
19 (1975): 147–53; M. Watson, S. Greer, L. Rowden, C. Gorman, et al., “Relationship Between Emotional Control, Adjustment to Cancer and Depression and Anxiety in Breast Cancer Patients,”
Psychological Medicine
21 (1991): 51–57.

5
. D. Spiegel, J. Bloom, H. Draemer, and E. Gottheil, “Effect of Psycho-Social Treatment on Survival of Patients with Metastatic Breast Cancer,”
Lancet
2 (1989): 888–91.

6
. S. Greer and T. Morris, “Psychological Attributes of Women Who Develop Breast Cancer,” found higher rates of breast cancer for both anger suppressors and exploders. There is one very serious statistical problem in this study. With a complex trait like Type C, there is a technique called
partial correlation
that can tell us what the active ingredient—anger suppression, helplessness, or lack of fighting spirit—is in the higher rates of cancer. These authors consistently fail to use it.

See M. Seligman,
Learned Optimism
(New York: Knopf, 1991), 167–78, for the documentation of the cancer link to helplessness, hopelessness, and depression. As things stand, my best guess is that any Type C link to breast cancer operates through helplessness, and not through anger suppression.

7
. Williams et al., “The Health Consequences of Hostility,” in Chesney and Rosenman,
Anger and Hostility in Cardiovascular and Behavioral Disorders
, 173–85; K. Matthews, D. Glass, R. Rosenman, and R. Bortner, “Competitive Drive, Pattern A, and Coronary Heart Disease: A Further Analysis of Some Data from the Western Collaborative Group Study,”
Journal of Chronic Diseases
30 (1977): 489–98; G. Ironson, C. Taylor, M. Boltwood, et al., “Effects of Anger on Left Ventricle Rejection Fraction in Coronary Artery Disease,”
American Journal of Cardiology
70 (1992): 281–85.

8
. J. Hokanson and M. Burgess, “The Effects of Status, Type of Frustration, and Aggression on Vascular Processes,”
Journal of Abnormal and Social Psychology
65 (1962): 232–37; J. Hokanson and R. Edelman, “Effects of Three Social Responses on Vascular Processes,”
Journal of Abnormal and Social Psychology
71 (1966): 442–47.

9
. You might ask why regular exercise—e.g., marathon running—decreases your risk of heart attack, since it raises heart rate. During the actual running of the marathon, your heart rate goes way up. But your resting heart rate level during the other twenty-one hours of the day goes down. Indeed, this may be the main benefit of exercise. Your total number of beats per year is now lower, and you don’t reach your beat allotment until later in life.

10
. M. Weissman and E. Paykel,
The Depressed Woman
(Chicago: University of Chicago Press, 1974), 138–53.

11
. K. Dodge and N. Crick, “Social Information-Processing Bases of Aggressive Behavior in Children,”
Personality and Social Psychology Bulletin
16 (1990): 8–22. Dodge’s work is pioneering and has generated an intervention program for conduct disorder in schools.

12
. S. Nolen-Hoeksema, J. Girgus, and M. Seligman, “Depression in Children of Families in Turmoil” (unpublished manuscript). I want especially to exempt my valued colleagues, Joan Girgus and Susan Nolen-Hoeksema, from any responsibility for my speculation that less parental fighting will lower the amount of depression in children.