Over the last decade, there has been a recognition that unipolar
depression is a heterogenous disorder with numerous possible etiologies (Craighead
1980; Lewinsohn, Hoberman, Teri & Hautzinger, 1985; Staats & Heiby,
1985), suggesting that studies investigating the correlates, determinants, and
effective treatments must be concerned with multiple factors. Recent reviews
of the depression research and theoretical developments (Heiby & Staats,
1990) suggest that there are numerous behavioral repertoire, environmental,
and biological factors that may be relevant to depression.
These complex theories have been proposed in conjunction with
evidence that unitary theories have failed to account for individual differences
in the onset and response to treatment for depression. For example, while many
theories since Freud's (1933) have proposed the role of an environmental precipitant,
research investigating this as a unitary factor suggest that it may account
for less than ten percent of the variance in the onset of depression when measured
in terms of general negative life events (Hirschfeld & Cross, 1982). If,
indeed, depression is multiple determined, this is what is to be expected when
variables are studied in isolation rather than in conjunction with other possible
Unfortunatelly, much of the effect of such failures to account
for depression from unitary environmental predictors has been to abandon the
study of specific environmental determinants in favor of unitary behavioral
repertoire (e.g., Abramson, Seligman, & Teasdale, 1978) or biological (e.g.,
Stokes, 1987) ones. One exception is a recent study on depression among victims
of spouse abuse which found that one situational (loss of sources of reinforcement,
attributions, and history of depression) indices accounted for 46% of the variance
in depression scores (Sato & Heiby, 1989).
The present study is an attempt to include a subset
of the behavioral repertoire and environmental factors that have been proposed
by the paradigmatic behavioral (PB) theory of depression and enjoy some empirical
support when studied in isolation (Staats & Heiby, 1985; Heiby & Staats,
1990). PB theory was derived by adopting concepts proposed by previous theories
of depression that have empirical support (e.g., Beck, 1967; Bunney & Davis,
1965, Lewinsohn, 1974, Rehm, 1977) as well as introducing additional hypotheses
derived from the general theory of social or paradigmatic behaviorism (Staats,
1975). The PB theory of depression is considered to be a third generation behavioral
theory in witch the basic principles of Pavlovian classical and Thomdkian operant
conditioning are extended to complex human behavior by positing a central function
of emotional stimuli and causal powers to basic behavioral repertoires.
For heuristic purposes, PB theory categorizes behavioral repertoire
involvement in depression as representing either a deficit or an inappropriacy
and as representing the overlapping functional repertoires categorized
as primarily language-cognitive, emotional-motivational, or sensory-motor. Deficits
are viewed as a lack of skills needed to maintain a homeostatic, nondepressed
mood given environmental adversity while inappropriacies are viewed as the presence
of skills which interfere with the maintenance of homeostatic mood. The language-cognitive
repertoire involves language and imagery, the sensory-motor involves instrumental
skills, and the emotional-motivational involves all stimuli conditioned to elicit
an affective response. Affective stimuli are viewed to have attitudinal (or
mood determining), reinforcing, and directive (ARD) functions.
In addition, the PB theory of depression posits that it is
a combination of a number of possible behavioral deficits and inappropriacies
with the current environment and organic conditions that may occasion dysphoria
which, in turn, determines the remaining symptoms of depression. While it is
beyond the scope of this paper to thoroughly describe the PB theory, it must
be noted that the complete theory posits a role of early learning of the behavioral
repertoires, ten deficits and inappropriaces of the behavioral repertoires that
are relevant to maintenance of a homeostatic mood, five dysphoria-eliciting
current environmental conditions, and three areas of organic involvement in
the development of the behavioral repertoires, interference with expression
of the repertoires, and direct elicitation of dysphoria. While the precise contributions
of three variables have not yet been evaluated, the PB theory does predict that,
in order to account for the variance in onset and maintenance of depression,
it is necessary to measure both deficits and inappropriacies in each of the
three functional behavioral repertoires. The purpose of this study is to provide
a partial evaluation of the PB theory by assessing the three repertoires in
a sample of depressed and nondepressed subjects in order o evaluate whether
such correlations are consistent with Craighead's (1980) assertion that depression
is associated with multiple potential determinants.
Behavioral deficits considered in this study which involve
the language-cognitive repertoire include deficit self-administration of positive
ARD stimuli that has been related to depression in terms of self-reinforcement
(e.g. Rehm, 1977; Rozensky, Rehm, Pry, & Roth, 1977). Self-ARD also involves
the emotional-motivational repertoire insofar as the stimuli that can function
as reinforces are viewed as also eliciting mood and directing behavior.
A second deficit concerns internal, global, and stable misattributions
(Abramson et al., 1978). The PB conceptualization of misattributions differs
from Abramson et al. insofar as they are viewed to involve not just thoughts
but both language-cognitive and emotional-motivational repertoires due to the
dysphoria-eliciting properties of the statements involved in assuming responsibility
for and expecting future recurrences of negative events.
A third deficit investigated in this study includes the primarily
sensory-motor functions of social skills (Lewinsohn, 1974) which have been found
to be predictive of depression following exposure to an environmental adversity
(Henderson, Byrne, & Duncan-Jones, 1981), particularly if the adversity
involves a social context (Zuroff & Mongrain, 1987). Because social interactions
often take place on the verbal level and such actions often have mood-eliciting
properties, social skills also represent an overlap of the three functional
repertoires of the PB theory. Poor self-ARD skills, misattributions, and deficient
social skills, misattributions, and deficient social skills are considered to
be deficits because they are believed to represent skills required for adaptative
functioning in the maintenance of a homeostatic mood state and treatment efforts
would focus on their enhancement.
An inappropriacy derived directly from PB theory involves the
emotional-motivational repertoire of having an excess of stimuli to which there
is dysphoric emotional conditioning (i.e., anhedonia). lt is reasoned that individuals
who are saddened by common events are more likely to become dysphoric particularly
in combination with other deficits or inappropriacies related to the maintenance
of a homeostatic mood. Associated with anhedonia may be the inapproppriate language-cognitive
characteristic represented in a negative view of the self, world, and future
proposed by Beck (1967). Such negative views may also be exhibited in what has
been termed poor self-efficacy (Bandura, 1977). Anhedonia, negative views, and
poor self-efficacy are considered to be inappropriacies because their presence
may interfere with maintenance of a homeostatic mood and treatment efforts would
focus on their elimination.
Current situational factors investigated in this study involve
negative life events (Brown & Harris, 1973) and social support (Linn, Dean,
& Ensel, 1986). Negative life events, such as the loss of a loved one, are
viewed as a loss of sources of both reinforcement and noncontingent pleasant
events that effect mood and direct behavior. Social support is viewed as a particular
type of resource for information, materials, and emotional understanding that
elicits positive emotional response in the individual when presented noncontingently
and also can function as reinforcement and directive stimuli when presented
In the present exploratory correlational study, it is hypothesized
that significant variance in depression can be accounted for by the consideration
of the following variables: (1) deficits in self-ARD, attributions, and social
skills; (2) inappropriaces in negative thoughts, including poor self-efficacy,
and negative emotional conditioning (anhedonia); and (3) inadequate sources
of pleasant situations in terms of the presence of negative life events and
the lack of social support. By having a theoretical framework to guide the a
priori categorization of variables, it is possible to consider several possible
correlates of depression with a moderate sample size. In order to evaluate these
hypotheses with a range of depression, subjects were obtained from both a clinical
and a college population.
A total of 140 subjects participated. Twenty subjects were
individuals who had presented themselves for treatment for depression at a private
mental health center in Alicante, Spain and who scored at least 14 on the Beck
Depression Inventory (BDI; Beck, 1967). These subjects participated in this
study at pre-treatment and included 8 males and 12 females whose average was
29 years. Fifty-four subjects were first year students at the Alicante University
School of Medicine who scored at least 14 on the BDI but had not entered treatment
for depression, tatalling 74 depressives. The college student depressives included
31.48% males and 68.51 females with an average age of 19.3 years. Sixty-six
subjects were nondepressed college students also in the first year at the Alicante
University and included 25.7% males and 74.3% females with an average age of
The dependent variable depression was measured by four self-report
instruments. The Depression Adjectives Checklist (DACL, Lubin, 1965), the Beck
Depression Inventory (BDI; Beck, 1967), and the Zung Depression Scale (Zung,
1965). Each of these instruments have been used routinely in depression research
and have acceptable levels of reliability and validity. As indicated in the
Results section, the DACL, BDI, and Zung scores were combined to create a single
composite depression score.
Behavioral deficits were measured by the following instruments:
(1) social skills in terms of deficit assertiveness were measured by the Interpersonal
Behavior Survey, Assertiveness Scale (IBS; Mauger & Adkinson, 1980) which
is a normed instrument with strong evidence of reliability and validity; (2)
attributions were measured with the Attributional Style Questionnaire (ASQ,
Seligman, Semmel, Abramson, & VonBaeyer, 1979) which has only moderate evidence
of reliability and validity and no reported norms but is the only instruments
known available for measurement of internal (I), stable (S), and global (G)
depression-relevant attributions of both positive (P) and negative (N) events,
yielding six scores (ASQIP, ASQSP, ASQGP, ASQIN, ASQSN, ASQGN); and (3) self-ARD
was measured with the frequency of Self-Reinforcement Scale (FSRQ, Heiby, 1982;
1983a,b,c, 1986) which has acceptale indices of reliability and validity but
no published norms.
Behavioral inappropriacies were measured by the following self-report
instruments: (1) anhedonia or excessive negative emotional conditioning was
measured by the Unpleasant Events Schedule (UES; Lewinsohn & Talkington,
1979); the UES was originally conceptualized as an index of environmental events
but here the intensity ratings were used as a measure of the emotional-motivational
characteristics of the subjects; and (2) a negative view of self, the world,
and future was measured by Cautela & Uper's (1976) Negative Thoughts Questionnaire
(NTQ) which does not Nave established psychometric criteria and by two indices
of self-efficacy derived form the Self-Efficacy Scale (Sherer & Adams, 1983);
the first self-efficacy index was derived from the 17 general self-efficacy
(GSE) items of the original 30 item scale while the second index was derived
from the seven items of the original scale pertaining to self-efficacy in social
situations (SSE): each subscale has acceptable levels of reliability and validity
although no established norms.
Situational factors were measured by the following: (1) loss
of sources of reinforcement and other pleasant events was measured by a modified
Spanish version (Vizcarro, 1987) of the PERI Life Events Scale (Dohrenwend,
Krasnoff, Askenasy, & Dohrenwend, 1978) yielding eight scores related to
situational change: total (PERIT), degree (PERIA), desirability (PERIB), anticipation
(PERIC), controlability (PERID), occupational (PERI1), social (PERI2), and other
contexts (PERI3). While the original PERI has adequate psychometric support,
the effects of modifying the instrument are unknown; and (2) the availability
of social support as a source of pleasant events was measured by the Mediators
of Social Support Scale (MSSS; MacFarlane, Neale, Norman, Roy & Streiner,
1981) which yields three scores: total (MSSST), family (MSSSF), and others (MSSSNF).
All of the self-report measures were translated into Spanish and except for
the social support index (Diaz Veiga, 1987), none of the instruments have been
psychometrically evaluated with a Spanish population.
A battery of questionnaires completed by all subjects were
administered in the following order in group settings: IBS (assertiveness scale),
GSE, SSE, FSRQ, ASQ, NTQ, UES, PERI, and MSSS. Subjects were instructed that
the purpose of the experiment was to study risk factors for depression. All
subjects were provided with results of the study.
A composite depression score was computed by the following
formula: DEP = ([DACL score/22] + [Zung score/80] + [BDI score/63])/3. Each
depression score was divided by the highest possible score on that instrument,
summed across instruments, and then divided by the number of instruments in
orden to obtain a weighted proportion index of self-reported depression. This
depression score had a mean value of .3199, standard deviation of .1278 and
range of .1000 to .6810. The correlation between the composite depression score
and the DACL, Zung, and BDI was .87, .79, and .84 respectively. Summary statistics
for all measures are presented in Table 1.
In order too assess the hypotheses that deficits, inadequacies,
and situational factors each contribute to the variance in depression scores,
four standard multiple regressions were conducted. In the first regression analysis,
the composite depression score was predicted by measures of deficit behavioral
repertoires which accounted for 36% of the variance (R =.6015, F(8,131) = 9.282,
P <.0001). Only three of the eight predictors were significant. FSRQ, IBS,
and ASQGN. In the second regression analysis, the composite depression score
was predicted by measures of behavioral repertoire inappropriacies which accounted
for 45% of the variance in depression scores (R = .6699, F(4,1359 = 27.473,
P < 0001). Three of the four predictors were significant. GSE, UES, and NTQ.
In the third analysis, the composite depression score was predicted by situational
factors of life events which accounted for 37% of the variance (R =.6142, F(8.131),
p <.0001). Only PERIA and PERID were significant predictors. The fourth analysis
found no significant predictions of depression from the three measures of social
In order to ascertain the relative contribution of the predictor
variables, a stepwise regression analysis was conducted with the composite depression
score as the dependent variable and the deficits, inappropriacies, and situational
factors which accounted for significant variante in the standard regression
analyses (i.e., FSRQ, IBS, ASQGN, GSE, UES, NTQ, PERIA and PERID) as the independent
variables. Five of these eight predictors (GSE, NTQ, PERID, FSRQ, and UES) account
for 61% of the variance in the composite depression scores (R =.7833, F(5,134)
= 42.56; p <.0001). The addition of any other predictor did not increase
significantly the amount of variance of the composite depression score accounted
for by the regression model.
The results of this study must be viewed within the limits
of the method used. First, it is important to note that the association of deficits,
inappropriacies, and environmental conditions to depression is correlational,
thus not permitting causal inferences. Second, the study did not include nondepressed
psychiatric controls so it is not known if the correlates of depression are
unique to this disorder. Third, subjects were not selected at random and thus
may not be representational. Fourth, the classification of variables as behavioral
deficits versus inappropriacies was not verified through reliability evaluations
of interjudge agreement or construct validity factor analyses. Finally, the
use of translated self-report measures may limit the accuracy of the assessment,
although the use of a composite score may have improved the accuracy of the
assessment of depression. Nevertheless, the findings of this investigation are
consistent with suggestions that a multivariate approach to the study of depression
is warranted (Craighead, 1980) and that a paradigmatic behavioral (PB) theory
(Staats & Heiby, 1985) of depression can provide a heuristic framework for
such investigations in part by suggesting the grouping of variables into clusters
representing behavioral deficits, behavioral inappropriacies, and situational
In the initial series of standard multiple regression analyses,
it was found that variables grouped as deficits, inappropriacies, and situational
factors each accounted for a sizable portion of the variance in composite depression
scores. It was found that the group of deficits in terms of poor self-ARD skills
(FSRQ), poor social skills (IBS), and poor attributional styles (ASQGN, negative
global) accounted for 36% of the variance in the composite depression scores.
In terms of inappropriacies, it was found that dysfunctional general self-efficacy
(GSE), anhedonia (UES), and negative thoughts (NTQ) accounted for 45% of the
variance in composite depression scores. Regarding situational factors, controllable
(PERID) and major (PERIA) life events accounted for 37% of the variance in the
composite depression scores.
The results from the stepwise regression analysis provide additional
evidence that the consideration of numerous factors in depression is warranted.
The results from this analysis suggests that there are independent contributions
to the variance in the composite depression scores from one behavioral deficit
(self-ARD), three behavioral inappropriacies (negative thoughts, poor general
self-efficacy, and anhedonia), and one situational factor (controllable life
events). These five variables accounted for 61% of the variance in the composite
The finding that deficit self-ARD skills are related to depression
is consistent with prior research. Self-reinforcement training (Fuchs &
Rehm, 1977; Heiby, Ozaki, & Campos, 1984) has been found to be effective
in the establishment of positive self-ARD skills and the alleviation of depression.
In terms of inappropriacies, negative thoughts, including those about one's
abilities or self-efficacy, have been found to be amenable to reduction or elimination
with depressives using cognitive therapies (e.g., Teasdale & Fennell, 1982).
Anhedonia has been targeted for reduction in behavioral therapies designed to
increase the frequency in which depressives engage in competing pleasant activities
(Lewinsohn, 1974). And the finding that controllable negative events are related
to depression suggests that the focus of these interventions should include
the individual's response to negative events for which the subject assumes responsibility.
These results suggest it may be warranted to further specify
the exact behavioral deficits and inappropriacies in each case of depression.
It has been argued that depression may be best classified according to the presenting
behavioral deficit or inappropriacy (Heiby, 1989; Heiby & Staats, 1990)
in order to provide individualized treatment for skills that warranted development
or reduction. At least two studies have demonstrated the efficacy of matching
treatment to the particular exhibited deficit or inappropriacy as opposed to
identifying a generic depression intervention (Heiby, 1986; McKnight, Nelson,
Hayes, & Jarret, 1984). The need of matching an intervention to the presenting
behavioral skill deficits or inappropriacies is also suggested from treatment
outcome studies for depression which report variance in the effectiveness of
different treatment (Miller, Norman, Keitner, Bishop, & Dow, 1989).
It is noteworthy that the stepwise regression results found
no significant additional variance accounted for by the inappropriacy of poor
social self-efficacy or the deficits of misattributions and poor social skills.
This may be due to redundancy or inadequate measurement of these constructs.
Attributions and self-efficacy may be particular aspects of negative thoughts
or contingent (self-reinforcement) and noncontingent (positive self-estimulation)
aspects of self-ARD (see Heiby & Staats, 1990; Huesmann & Morikawa,
1985). The lack of predictive power of social skills or social support is inconsistent
with prior research demonstrating the effectiveness of social skills training
for depression (e.g., Bellack, Hersen, & Himmelhoch, 1980) and may be partly
due to the restricted range of social skills (i.e., assertiveness) assessed.
Because the stepwise regression analysis suggested more inappropriacies than
deficits in the prediction of depression, future research may benefit from the
inclusion of inappropriate social skills, such as an aggressive interpersonal
It is also interesting that only controllable life events as
a situational factor appeared significant in the stepwise depression analysis.
This finding is consistent with other research suggesting that it is controllable
negative events that are related to depression as opposed to negative events
in general (Hammen & de Mayo, 1982). This distinction may partly explain
why prior studies investigating global negative events failed to demonstrate
a strong relationship between those events and depression (Hirschfeld &
Cross, 1982). The failure of social support and other negative life events to
contribute to the prediction of depression scores may suggest the peed for more
specific measurement of these constructs as suggested by Ferster (1973) who
argued that contingency variables such as a strained ratio schedule, are causal
in depression. Self-report measures of life events generally classify the events
according to context or intensity not in terms of contingent relations to depressed
behavior. In addition, it may be that social support ad some life events are
predictive of depression when studied in isolation (Linn, Dean & Ensel,
1986) but not when considered in conjunction with behavioral deficits and inappropriacies.
In other words, it may be individual differences in response to environmental
conditions that accounts for depression.
In conclusion, the results of this study provide mixed support
for the paradigmatic behavioral (PB) theory of depression (Staats & Heiby,
1985) as one attempt to develop a complex multivariate theory for this disorder
(Craighead, 1980). The indings support the PB theory assertion that depression
may be better understood if behavioral deficits, behavioral inappropriacies,
and situational factors are considered. While the PB theory also posits biological
determinants of depression, one of these factors were investigated in this study.
The results partly support the PB hypothesis that complex behaviors such as
depression may be better understood if the deficits and inappropriacies considered
are ones which represent the emotional-motivational, language-cognitive, and
sensory-motor functional behavioral repertoires. The present study found correlational
support for the inclusion of inappropriacies and deficits that can be conceptualized
further as representing two of these three functional repertoires. The inappropriacy
of negative thoughts and poor self-efficacy as well as the deficits of poor
self-ARD skills are considered to be primarily language-cognitive factors. The
inappropriacy of anhedonia is considered to be primarily an emotional-motivational
factor. The deficit of social skills is considered to be primarily a sensory-motor
factor but did not significantly account for variance in depression scores in
the stepwise regression analyses. The results of this study are also consistent
with the inclusion of situational factors as part of the PB theory of depression
as opposed to the abandonment of situational factors as some theories suggest
(e.g., Seligman et al., 1979). The finding that controllable negative life events
are related to depression suggests that it is important to consider both behavioral
repertoire and situational conditions in the development of a comprehensive
theory of depression.
Finally, the application of PB theory to a Spanish population
with translated self-report measures provides somes construct validational support
for the PB theory. It has been argued that cross-cultural applications of predictive
models provide a robust test of a theory's explanatory power (Brislin, 1991).
The authors wish to thank Arthur W. Staats for his assistance
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Aceptado el 20 de junio de 1994