Relations of sociotropic and autonomous personality characteristics to specific symptoms in depressed patients

Preliminary Evidence for Sociotropy and Autonomy in Relation to Antidepressant Treatment Outcome

Sociotropy and autonomy are cognitive-personality styles that have been hypothesized to confer vulnerability to different presentations of major depressive disorder (MDD), which may respond differentially to treatment. Specifically, the profile of low sociotropy and high autonomy is hypothesized to indicate a positive response to antidepressant medication. The current study examines sociotropy and autonomy in relation to sertraline treatment response in individuals with MDD. As part of an ancillary study to the larger Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) project, individuals with MDD participated in an 8-week trial of sertraline and completed a self-report questionnaire of sociotropy and autonomy. Discriminant function analyses were used to examine whether sociotropy and autonomy scores could distinguish antidepressant treatment responders (determined by a 50% or greater reduction in depressive symptoms) from non-responders. The sociotropy scale successfully discriminated sertraline treatment responders from non-responders. Further, lower sociotropy was associated with greater improvements in depressive symptomology following sertraline treatment. The current findings suggest individuals with MDD characterized by low sociotropy are more likely to benefit from sertraline. Given the promising results of the Sociotropy-Autonomy Scale in discriminating treatment responders from non-responders, the low resources necessary for administration, and the ease of translation into routine clinical care, the scale warrants further research attention.

Conceptualization and assessment of personality factors in depression

Research that relates personality to depression is one of the dominant themes in the clinical literature. The current paper examines this research from a critical perspective. It is argued that existing research is limited by (i) a failure to adopt a broad conceptual approach to the study of personality and depression; and (ii) the use of personality measures with questionable psychometric properties. Our observations lead us to suggest that greater adherence to established methodology and conceptual developments in the personality field will result in substantial improvements in research on personality and depression, and may ultimately provide a more accurate appraisal of the role of personality factors in depression. In addition to examining important issues, key directions for future research are discussed.

The assessment of dysfunctional attitudes and their role in the onset, persistence and recurrence of clinical depression

Dysfunctional attitudes have been proposed as an important vulnerability factor in the cognitive model of depression. Yet it has often proved difficult to demonstrate their existence in non‐symptomatic populations. We examine the ways in which dysfunctional attitudes have been conceptualized and assessed, from self‐report methods to information‐processing tasks. A s dysfunctional attitudes are typically viewed as latent in non‐symptomatic groups, the importance of priming or activating such variables is emphasized, together with recommendations as to how this may best be achieved. Comparative studies of depressed, control, and at‐risk groups are then considered, together with longitudinal studies that have directly testedpredictions of the cognitive model. Prospective studies of non‐depressed, non‐clinical samples have so far had mixed results in demonstrating that dysfunctional attitudes precede depression or that specific attitudes interact with congruent events in the way the model predicts, although more consistent results emerge from clinical samples with a past history of depression. Possible reasons for the variability in findings are presented, together with suggestions for further research and a revised cognitive model of depression.

The Effect of Beck's Cognitive Therapy and Mindfulness-Based Cognitive Therapy on Sociotropic and Autonomous Personality Styles in Patients With Depression

Background:

Depression is characterized by a great risk of relapse and recurrence. Mindfulness-based cognitive therapy (MBCT) and cognitive therapy are efficacious psychosocial interventions for recurrent depression.

Objectives:

The aim of the present research was to compare the effect of Beck’s cognitive therapy (BCT) and MBCT on reduction of depression and sociotropic and autonomous personality styles in Iranian depressed patients.

Patients and Methods:

The study sample consisted of 30 subjects randomly selected from patients with depression in Mashhad city, Iran. The subjects were assigned randomly to experimental groups. The 2 techniques used for treatment were BCT and MBCT. The data collection instruments used in the research consisted of psychological interview, the Beck Depression Inventory II and the revised Personal Style Inventory (RPSI). The research data was analyzed using repeated measures analysis of variance (ANOVA).

Results:

BCT and MBCT were effective in reducing depression, but BCT and MBCT did not cause any change in the sociotropic and autonomous personality styles in patients with depression.

Conclusions:

The results provide support for the role of BCT and MBCT plays in reducing depression. However, the results did not approve their role in changing sociotropic and autonomous personality styles in patients with depression.

Cognitive Personality Characteristics Impact the Course of Depression: A Prospective Test of Sociotropy, Autonomy and Domain-Specific Life Events

Prospective tests of the impact of sociotropy and autonomy on the course of depression are lacking. In a sample of 97 cognitive high-risk and 62 cognitive low-risk undergraduates who experienced at least one prospective depressive episode, the interactions of sociotropy and interpersonal life events and autonomy and achievement-related life events were examined as predictors of four indicators of the course of depression. Initial analyses failed to support the hypothesis that global scores for sociotropy and autonomy interact with domain-congruent life events to predict the course indicators. The autonomy-achievement events interaction predicted less severe episodes, contrary to hypothesis. Then, factors hypothesized to underlie Sociotropy (Fear of Criticism and Rejection; Preference for Affiliation) and Autonomy were also analyzed. The puzzling autonomy-achievement life event interaction was explained by the underlying Independent Goal Attainment factor. Interactions between Fear of Criticism and Rejection and achievement events, and between Sensitivity to Others' Control and interpersonal events, significantly predicted chronicity, number and severity of episodes. The findings are discussed in terms of the event-congruency hypothesis.

Personality styles in patients with fibromyalgia, major depression and healthy controls

BACKGROUND

The fibromyalgia syndrome (FMS) is suggested to be a manifestation of depression or affective spectrum disorder. We measured the cognitive style of patients with FMS to assess personality styles in 44 patients with fibromyalgia syndrome (FMS) by comparing them with 43 patients with major depressive disorder (MDD) and 41 healthy controls (HC).

METHODS

Personality styles were measured by the Sociotropy and Autonomy Scale (SAS) and the Dysfunctional Attitude Scale (DAS). The Structured Clinical interview for DSM Axis I was applied to Axis I disorders, while the Beck Depression Inventory was used to measure depression severity.

RESULTS

Patients with FMS in general have a sociotropic personality style similar to patients with MDD, and different from HC, but FMS patients without a lifetime history of MDD had a cognitive personality style different from patients with MDD and similar to HC.

CONCLUSION

These findings suggest that a depressotypic personality style is related to depressive disorder, but not to FMS.

DEPENDENCY, SELF-CRITICISM, AND THE SYMPTOM SPECIFICITY HYPOTHESIS IN A DEPRESSED CLINICAL SAMPLE

Several theorists have suggested that interpersonal dependency and excessive self-criticism are characteristics of personalities prone to depression. Here the results of a study are presented in which the hypothesis that these personality styles are connected to specific depressive symptoms in a sample of depressed outpatients (N = 163) was evaluated. Hypotheses were that dependency is specifically associated with the somatic symptom cluster of the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996) and that self-criticism is specifically associated with the cognitive symptom cluster. In measuring the personality styles, the Depressive Experiences Questionnaire (Blatt, D'Affliti, & Quinlan, 1976) was used. No evidence suggesting that dependency is specifically connected to somatic depressive symptoms was found. Self-criticism was specifically associated with cognitive depressive symptoms. However, the results suggest that content overlap might explain the relationship between self-criticism and cognitive depressive symptoms.

The relationship between trait vulnerability and anxiety and depressive diagnoses at long-term follow-up of Generalized Anxiety Disorder

The current study examined the relationship between measures of trait vulnerability and long-term outcome in 83 patients diagnosed and treated for Generalized Anxiety Disorder (GAD) 8-14 years previously. Diagnostic status was assessed by structured interview, and trait affect, trait anxiety and trait depression were measured by the Positive and Negative Affect Scale (PANAS), the State-Trait Anxiety Inventory (STAI-T) and the Personal Style Inventory (PSI), respectively. Trait measures were all highly inter-correlated, and patients with diagnoses of GAD, social phobia and depressive disorders at long-term follow-up recorded very poor scores on all three scales. Trait anxiety recorded pre-treatment was also related to both anxiety and depression at long-term follow-up. However, trait depression showed no significant association with panic disorder. Increased numbers of comorbid diagnoses were strongly related to high levels of both trait anxiety and negative affect (NA). The findings suggest that patients reporting high trait anxiety or NA may suffer from a chronic course of disorder and higher levels of comorbidity over the longer term.

Conceptualizing and measuring personality vulnerability to depression: comment on Coyne and Whiffen (1995)

J. C. Coyne and V. E. Whiffen (1995) reviewed research on personality vulnerability to depression, focusing on S. J. Blatt's (1974, 1990) concepts of dependency and self-criticism and A. T. Beck's (1983) concepts of sociotropy and autonomy. The authors discuss 6 issues raised in that review: (a) the typological or dimensional nature of vulnerability, (b) the theoretical implications of "mixed" vulnerability, (c) the relations of vulnerability to Neuroticism. (d) the potential confounding of vulnerability with concurrent depression, (e) the potential confounding of vulnerability with social context, and (f) the differentiation of dependency from relatedness. The authors conclude that Blatt's and Beck's concepts are continuous, nearly orthogonal dimensions that can be identified and measured independently from Neuroticism, depression, and social context.

A model of risk for major depression: effects of life stress and cognitive style vary by age

Empirical studies increasingly attribute risk for depression to adverse life events, cognitive style, and possibly to the interaction between cognitive style and event type. We present an evidence-based model, developed with independent samples of adults and elderly adults, indicating that risk for major depression associated with these factors varies with age. According to the model, adverse events and need for control, the cognitive style that is a key feature of Beck's concept of autonomy, are significant risk factors for depression in younger adults but not in elderly adults. The cognitive style of sociotropy, characterized by a high need for relatedness and concern about disapproval, is a stable risk factor, independent of age, in posing a risk for depression. The effects of the interactions of adverse event type (achievement events and interpersonal events) and cognitive style in predicting depression each appear to vary with age, expanding prior work, which suggests that adverse events affecting one's personal vulnerability are likely to precipitate depression. Age-specific approaches to reducing risk for major depression are clinically important, and the model presented here suggests that the use of an age-specific perspective would advance research in stress-diathesis models for risk of depression.

Stressful life events interacting with cognitive/personality styles to predict late-onset major depression

The current work evaluated the interaction of life stressors with cognitive/personality styles in predicting late-onset depression in 42 elderly outpatients with DSM-IV unipolar Major Depression and 42 nondepressed controls. Control subjects were matched to cases on age, sex, race, and years of education. As suggested by Beck's cognitive theory of depression, a multivariate model indicated that specific stressful-event types interacted with specific cognitive/personality styles in strongly predicting depression onset, adjusting for the positive associations of medical illness and reduced physical functioning with depression.

Relations between personality and depressive symptoms: a multimeasure study of dependency, autonomy, and related constructs

Seventy-four patients seeking treatment for major depression completed four measures of dependent and autonomous personality and two measures of depressive symptomatology. Relationships among the personality measures were investigated by principal-components analysis, enabling systematic comparison of their composition. Relationships between personality components and symptom dimensions were examined to clarify specific associations that have been proposed but inconsistently obtained in previous research. Neither dependency nor autonomy were unitary constructs, and alternative measures had substantial differences in composition. Some support for symptom specificity was obtained. Dependency and autonomy have distinctive associations with depressive symptoms, but their correspondence to unitary personality dimensions and the equivalence of their alternative scales cannot be assumed.

Sociotropy-Autonomy and the Beck Depression Inventory

Summary: According to Beck's cognitive theory of depression, individuals who score high on the personality dimensions of either sociotropy or autonomy are considered to be vulnerable to depression. Although past research has provided abundant support for the relationship between sociotropy and depression, very little support has been provided for the relationship between autonomy and depression. Two studies were conducted to investigate the relationship between the items of Beck Depression Inventory ( Beck et al., 1979 ), one of the most commonly used measures in the assessment of an individual's level of depression, and measures of sociotropy and autonomy. In both studies, participants completed the Beck Depression Inventory and various measures of sociotropy and autonomy. The results suggested that the majority of the items of the Beck Depression Inventory were related to measures of sociotropy rather than autonomy. These findings suggest that the lack of support for the relationship between autonomy and depression may be due partially to the specific measures used in the assessment of sociotropy and autonomy as well as depression.

Are dependency and self-criticism risk factors for major depressive disorder?

OBJECTIVE

To determine whether dependent and self-critical personality traits are associated with specific types of life events and whether these traits change with pharmacotherapy.

METHOD

Overall, 142 depressed outpatients completing 8 weeks of fluoxetine treatment were administered the Life Experiences Survey (LES) at baseline and the Dysfunctional Attitude Scale (DAS) and Hamilton Depression Rating Scale (HDRS) at baseline and endpoint.

RESULTS

The DAS dependency subscale, but not the self-criticism subscale, showed significant correlations with life events regardless of congruency. Baseline HDRS scores were positively correlated with both DAS subscales and total score. The DAS subscales, the total DAS score, and the HDRS all improved significantly with treatment.

CONCLUSIONS

These results confirm a growing body of research that has found an association between sociotropic or dependent personality traits and life events.

Personality dimensions and depression: review and commentary

OBJECTIVES

The relationship between dimensionally assessed personality and the onset, features, and course of depressive illness will be critically examined and considered in relation to 4 hypothesized models: predisposition or vulnerability: pathoplasty: complication or scar: and spectrum or continuity.

METHOD

Studies that have used clinically depressed adult patients to explore the relationship between personality dimensions and depression will be reviewed.

RESULTS

Higher-order personality factors that have shown a significant and consistent association with major depressive illness include neuroticism, extraversion (negative relationship), and the factors of Cloninger's Tridimensional Personality Model. Neuroticism appears to be the most powerful predictor of depression. Lower-order factors showing a significant and consistent relationship with depressive illness include dependency, self-criticism, obsessionality, and perfectionism. The links between depression and dependency and self-criticism have the strongest empirical support.

CONCLUSIONS

Several personality dimensions are significantly associated with depressive illness, but the evidence that unequivocally demonstrates a true personality predisposition for depression is modest. Measures of personality may prove to be clinically useful for treatment selection.

Self-esteem and self-efficacy; perceived parenting and family climate; and depression in university students

This study examined associations among self-esteem and self-efficacy; perceived unfavorable Parental Rearing Style (perceived PRS) and unfavorable family climate in the family of origin; and depression in undergraduates still in frequent contact with their families (N = 186). Unfavorable perceived PRS and family climate were construed as "affectionless control," in which parents and family provide little affection, but excessive control. Constructs were measured by the Self-Esteem Inventory, the Self-Efficacy Scale, the Child Report of Parental Behavior Inventory, the Family Environment Scale, and the Beck Inventory. Perceived "affectionless control" in both PRS and family climate accounted for about 13% of the variance in self-esteem, self-efficacy, and depression. Neither introversion nor depression mediated the relation between family socialization and self-esteem.

Personality, life events, and depression

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976a) and the Sociotropy-Autonomy Scale (SAS; Beck, Epstein, Harrison, & Emery, 1983) have been used virtually interchangeably to assess personality styles that are believed to influence the development of depressive symptomatology in the context of specific negative life events. This study examined the extent to which these two personality measures overlap and tested the congruency hypothesis. The congruency hypothesis predicts that levels of depression vary as a function of the interaction between personality and the occurrence of thematically related negative life events. Results indicated that the DEQ Dependency and the SAS Sociotropy scales appear to measure similar constructs, whereas the DEQ Self-Criticism and SAS Autonomy scales do not appear to measure similar constructs. Further, support was obtained for the congruency hypothesis using either the DEQ Dependency scale or the SAS Sociotropy scale; however, support for this hypothesis was not obtained for the DEQ Self-Criticism scale or the SAS Autonomy scale.

Treatment utility of the sociotropy/autonomy distinction: implications for cognitive therapy

The treatment utility of the Sociotropy/Autonomy Scale was evaluated by matching or mismatching subjects to either individual or group cognitive therapy according to their dominant personality dimension. Both groups of subjects obtained statistically significant, but equivalent, reductions in depression. Consistent with Beck's (1983) interactional model, tests of clinical significance indicated a higher proportion of matched subjects who displayed marked improvement at follow-up. Implications for cognitive therapy and further research on the assessment of personality dimensions relevant to depression are discussed.

The specificity of sociotropy-autonomy personality dimensions to depression vs. anxiety

Previous cognitive vulnerability studies have identified sociotropy/dependency as a personality characteristic related to depression. We evaluated sociotropy in differential prediction of depression vs. anxiety. Participants (70 females, 42 males) were tested on the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) at two points in time (T1 and T2), separated by an interval of 4 weeks. The Sociotropy-Autonomy Scale (SAS) was administered at T1. Sociotropy was related moderately to the BDI at T1 and T2, but also to the BAI. Autonomy was related to neither. Hierarchical multiple regression analyses found sociotropy to predict anxiety at T2, but not depression. The issue of cognitive vulnerability marker specificity is discussed.

The relationship of sociotropy and autonomy to symptoms, cognition and personality in depressed patients

A growing body of research suggests that the two personality characteristics of sociotropy and autonomy confer vulnerability to depression in response to interpersonal or achievement-related events. This study examined the relationships of these characteristics to severity of symptoms, measures of negative cognition, neuroticism and extraversion in a sample of 118 unipolar depressed patients. Sociotropy was found to be associated with self-reported depressive symptoms independently of anxiety level, with frequency of negative automatic thoughts, with dysfunctional attitudes and neuroticism. It was more strongly related to dysfunctional attitudes reflecting a need for social approval than to those reflecting perfectionism. Autonomy was not associated with self-reported symptoms of depression or of anxiety. It was, however, associated with low extraversion and significantly more associated with perfectionism than social approval. The results support the need for further research to examine the precise roles of a number of psychological factors in the vulnerability to interpersonal life events but also suggest limitations in the relevance of the construct of autonomy to depression.

Clinical characteristics associated with interpersonal depression: symptoms, course and treatment response

A range of theories, including environmental, personality and cognitive theories, have suggested that loss may be a particularly critical form of stress in the etiology and expression of depression. The current study examines whether interpersonal depression predicted a unique clinical presentation and course in subjects with major depression. Subjects who became depressed following a severe interpersonal event were contrasted with two control groups: patients without antecedent stressors and patients with major non-interpersonal stressors. The hypothesized interpersonal subgroup was differentiated from the control groups only in the speed of treatment response. Proposals for future research are discussed.

Exploring the sociotropy-autonomy dimensions in a sample of Turkish psychiatric inpatients

The present study explored the constructs of sociotropy and autonomy with a group of Turkish depressed inpatients, who were administered the Beck Depression Inventory, the Dysfunctional Attitudes Scale, the Automatic Thoughts Questionnaire, and the Sociotropy-Autonomy Scale. A comparison group of students from three SES levels also were included in the study. Comparisons were made on the scale scores among the non-dysphoric students, the dysphoric students, and the depressed patients. The results seem to support the relationship of sociotropy with other depression measures in both samples. However, several problems were encountered with the construct autonomy as it is conceptualized in the Sociotropy-Autonomy Scale.

Responsivity to cognitive therapy as a function of treatment format and client personality dimensions

The effects of treatment format and client personality dimensions upon responsivity to cognitive therapy were investigated. Depressed subjects were assigned to either 12 weeks of individual or group cognitive therapy. The two formats were found to be equally effective in significantly reducing depression. Subjects were categorized at pretreatment using Beck's Sociotropy/Autonomy Scale in conducting a post hoc analysis of the impact of client personality dimensions upon responsivity to treatment. Consistent with Beck's (1983) interactional model, sociotropic subjects who received group therapy and autonomous subjects assigned to individual therapy showed greater improvement than subjects whose predominant personality dimension did not match the type of treatment received.

Diagnostic specificity of the dependent and self-critical personality dimensions in major depression

Validational studies of self-critical and dependent personality dimensions as vulnerability factors for depression have been tested primarily with depressed samples, employing research designs devised to address state vs. trait and trait-situational congruity issues. In this study we examined the diagnostic specificity to depression of these two personality dimensions, comparing Self-Criticism and Dependency scores as measured by the Depressive Experiences Questionnaire (DEQ) in two samples of outpatients: (1) panic disorder with agoraphobia; and (2) non-psychotic, unipolar major depression. As hypothesized, the two groups differed on Self-Criticism, with the depressed group scoring higher, but no differences were found for Dependency. These findings were similar even when depressed mood was partialed out. These results complement a growing body of research associating Self-Criticism, as specifically measured by the DEQ, with depression.

Psychometric properties of the Depressive Experiences Questionnaire for adolescents

Items of the Depressive Experiences Questionnaire (DEQ) were rephrased and simplified to make them appropriate for younger subjects. This adolescent form of the DEQ (DEQ-A) was administered to high school students; a factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. Internal consistency as well as short- and long-term reliability for each of the 3 DEQ-A factors were at acceptable levels. Each factor correlated highly with its counterpart factor in the original DEQ, especially the Dependency and Self-Criticism factors. Correlations of the DEQ-A factors with other measures of depression essentially replicate relationships found between these measures of depression and the original DEQ for adults. The reliability, internal consistency, and validity of the DEQ-A indicate that it could be useful in studying depressive experiences in younger adolescents.

Memory and hedonic tone: 'personality' or 'mood' congruence?

Four groups of healthy women matched for age and IQ were reliably classified on the Eysenck Personality Questionnaire as being either high or low in extraversion or neuroticism. As part of a larger research project, each participant was administered a range of psychometric measures together with three paired-associate learning lists varying in hedonic tone and difficulty levels together with the Beck Depression Inventory. Performance on the hedonic lists covaried with personality categories but, unlike what typically obtains in clinical patients, less association emerged between performance and mood states. Performance was particularly polarized in women scoring high in neuroticism but low in extraversion. Speculations about the apparent correlates of so-called mood congruence in healthy subjects are put forward and parallels are drawn with studies reporting the phenomenon in clinically depressed patients.

Measures of depressive dimensions: are they interchangeable?

Several theorists have posited two focuses for depressive experience and/or vulnerability: dependency and rejection, and self-criticism and failure. In turn, three instruments have emerged, each addressing these two components, respectively: the Depressive Experiences Questionnaire (DEQ; Dependent and Self-Critical scales), the Sociotropy-Autonomy Scales (SAS), and the Anaclitic and Introjective Dysfunctional Attitude Scales (DAS). In this study, we addressed the relations within and among these three pairs of scales in a large undergraduate sample. Generally, the DEQ-Dependent, SAS-Sociotrophy, and DAS-Anaclitic scales showed substantial convergent and discriminant validity. Although this was true also for the DEQ-Self-Critical and DAS-Introjective scales, neither scale was closely related to the SAS-Autonomy scale, which appeared instead to be a better measure of counter dependency than a measure of self-critical, introjective features.