A Social-Cognitive Perspective on Reassurance-Seeking and Depression

A Social-Cognitive Perspective on Reassurance-Seeking and DepressionAuthor(s): William P. Sacco and Karen J. NicholsonSource: Psychological Inquiry, Vol. 10, No. 4 (1999), pp. 298-302Published by: Taylor & Francis, Ltd.Stable URL: http://www.jstor.org/stable/1449452 .

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COMMENTARIES

A Social-Cognitive Perspective on Reassurance-Seeking and Depression

William P. Sacco and Karen J. Nicholson Department of Psychology University of South Florida

Joiner, Metalsky, Katz, and Beach (this issue) are to be commended for advancing theory and research on interpersonal factors in depression, a complex phe- nomenon that warrants our careful attention. In this commentary we attempt to show how their conceptualization would be viewed from the perspective of a social-cognitive model of interpersonal processes in depression (Sacco, 1999).

A Social-Cognitive Model of Interpersonal Processes in Depression

This model (see Figure 1) seeks to describe a bidirectional interactional process whereby both the depressed (or depression-prone) target and others in the social environment influence interpersonal outcomes. Responses to a depressed target arise in part because of the depressed person's less socially skillful behavior (Segrin & Abramson, 1994) and in part because of autonomous cognitive and affective processes that serve to perpetuate a negative mental construction of the depressed person (Carlston & Skowrowski, 1994; Forgas, 1995). The reactions of others are expected to influence adversely the depressed person's self-concept, affect, and behaviors. These depressive reactions, in turn, reinforce the tendency of others to think negatively about the depressed person.

The model focuses on two social-cognitive constructs: attributions about the depressed person's be-

haviors, and mental representations in memory of the depressed person's attributes, behavioral tendencies, interests, values, and so on, termed a person schema. An extensive empirical literature shows that attributions mediate affective and behavioral reactions to others across a variety of situations and relationships (Bradbury & Fincham, 1990; Sacco & Dunn, 1990; Weiner, 1993). The person schema is assumed to organize abstract and concrete information, which then al- ters how new information about a depressed target is processed (Fiske, 1995; Murray, Holmes, & Griffin, 1996; Sacco, Dumont, & Dow, 1993).

A large literature demonstrating reciprocal causa- tion between affect and social judgment (Forgas, 1995) suggests that social cognition influences and is influ- enced by affect. Thus affective reactions are an important component of the model, as they serve to exaggerate the valence of cognitions about the target (Murray & Sacco, 1998). In the case of depressed targets, others' affective reactions are primarily negative (Sacco & Dunn, 1990; Sacco & Macleod, 1990; Sacco, Milana, & Dunn, 1985, 1988).

Each of these factors (schema, attributions, and affect) is expected to contribute independently to the other's relationship satisfaction (Sacco & Murray, 1997) and behavioral reactions to the depressed. Nega- tive behavioral responses, when perceived by the depressed target, are posited to influence adversely the target's self-esteem, mood, and behavior and contribute to

Negative Person Scema

Relationship Dissatisfacfion

Negative

a or: AL Rejection, Perception Self-concept,

riticsm, * of Other's Affect, Non-genuine AppraisaU Behavior:

Suppor upr erse

Negative Attributions

About Targets Behsviors

Figure 1. A social-cognitive model of interpersonal processes in depression. From "A Social-Cognitive Model of Interpersonal Processes in Depression " by W. P. Sacco, in The Interactional Nature of Depression: Advances in Interpersonal Approaches, T. E. Joiner & J C. Coyne (Eds.), in press, Washington, DC: American Psychological Association. Reprinted with permission.

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feelings of loss and alienation. Perceptions of negative appraisal and reduced support are hypothesized to be the most proximal catalysts for depressive reactions.

Finally, negatively biased information processing commonly found among depressed individuals is assumed to influence perceptions of appraisals and support. Thus, a basic tenet of cognitive models of depression (Sacco & Beck, 1995) is integrated into the model. However, whereas cognitive models focus on the depressed person's distortion of social perceptions, our model emphasizes a reciprocal causal relation. Negative perceptions result partly from others' actual behaviors and partly from autonomous cognitive processes that serve to perpetuate the depressed person's negative mental model of the self in relation to others. Perceived negative reactions are believed to depress the target's mood and, concurrently, activate a self-relevant negative cognitive network, which should alter interpretations and responses to subsequent interpersonal stimuli (Segal & Ingram, 1994).

This working model is intended to be integrative and heuristic. It attempts to organize and place into a coher- ent framework some major conceptual units raised by the study of interpersonal aspects of depression. Al- though most applicable to the role that interpersonal processes play in the maintenance or worsening of depression, similar interpersonal processes may be involved in the development of depression. A host of studies suggests that growing up in an environment characterized by negative appraisals, rejection, and crit- icism increases the risk for later manifestations of low self-esteem and depression (Brewin, Andrews, & Gotlib, 1993; Felson, 1989; Lefkowitz & Tesiny, 1984).

Social-Cognitive Responses to Reassurance-Seeking Behavior

How does the Joiner et al. proposal interface with the social-cognitive model? Joiner et al. have made a strong case for excessive reassurance-seeking as one class of social behaviors that may lead to negative interpersonal reactions and depression. The social-cognitive model offers some hypotheses about factors that could play a role in these reactions. First, attributions about the cause and controllability of the reassurance-seeking should mediate affective and behavioral reactions to reassurance-seeking behaviors (Sacco et al., 1993; Sacco & Dunn, 1990). We have found, for example, that psychological help-seeking behaviors evoke more negative affective reactions and greater rejection in response to a depressed, relative to a nondepressed, target. When the target was depressed, others also made more dispositional and controllable attributions about the cause of the problem for which help was sought, and these attributions mediated affective reactions (Sacco & Dunn, 1990). In another study, depressed targets were expected to make more future

requests for psychological help, a proxy for stable attributions. Path analyses indicated that this expectation led to a desire to avoid the depressed person through its impact on angry feelings toward the depressed person (Sacco et al., 1985).

Negative reactions should also be stronger and more enduring when a negative person schema guides information processing of the target's behaviors. Vari- ous studies provide evidence that the cognitive context through which reassurance-seeking or other negative behaviors are filtered mediates and moderates the interpersonal outcome. Two studies reported by Joiner et al. (Joiner & Metalsky, 1998, Study 4; Katz, Beach, & Joiner, 1999) found that high reassurance-seeking pre- dicted subsequent depressive symptoms only when roommates or dating partners viewed the target negatively. More generally, studies from our lab indicate that others reliably exhibit negative trait conceptions of depressed persons and that this negative cognitive context mediates interpersonal reactions to targets such as negative affect and rejection (Sacco, 1999). For example, husbands of women with a recent history of major depression evidenced negative trait conceptions of their wives and were less maritally satisfied. Trait conceptions mediated the association between depression and marital dissatisfaction (Sacco et al., 1993). Mothers randomly assigned to think about either positive or negative characteristics of their child reported an improved mood in the positive condition; however, thinking about negative features lowered mood only in those with preexisting negative views of their child (Murray & Sacco, 1998). In summary, research suggests that social cognition in the form of schematic person information and causal attributions may play a role in the process by which reassurance-seeking evokes negative affect, rejection, and, ul- timately, depressive symptoms in the target.

Finally, evidence suggests that person schemas may be resistant to change (e.g., Sherman & Klein, 1994). Therefore, for those with positive schemas, any negative reactions to initial displays of reassurance-seeking should be mild and transient (Murray & Sacco, 1998), and repeated exposure to reassurance-seeking (i.e., excessive) should be necessary to change their predomi- nant view (Bargh, Lombardi, & Higgins, 1988). Likewise, after a well-developed and possibly biased negative person schema is established, it may be difficult to alter the tendency to interpret the depressed person's behaviors in a negative light, even after symptoms have remitted (Sacco et al., 1993).

Alternate Behaviors and Outcomes: Generality of the Social-Cognitive

Model

Joiner et al. attempt to show that excessive reassurance-seeking behavior is causally related to depression

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but not to other clinical syndromes. In doing so, they aptly note and provide evidence concerning the criteria of covariation, temporal antecedence, and nonspuriousness. However, the latter requirement-to rule out alternative causes and outcomes-is ex- tremely difficult, if not impossible, to satisfy with correlational data. High scores on the Reassur- ance-Seeking Scale could be a marker or epiphenomenon of a variety of active ingredients.

In contrast, the social-cognitive model provides a more general perspective and is applicable to a wider range of social behaviors and disorders. First, various social behaviors besides excessive reassurance-seeking are likely to evoke negative affective reactions, relationship dissatisfaction, and rejection. For example, evidence suggests that rejection of depressed persons could be, in part, due to broadly defined social skill deficits (Youngren & Lewinsohn, 1980), speech fluency and eye contact (Segrin & Abramson, 1994), negative and poorly timed self-disclosures (Jacobsen & Anderson, 1982; Gurtman, 1987), or doc- ile-dependency (Hokanson & Butler, 1992). Second, aversive social behaviors exhibited by those with (or prone to developing) disorders other than depression may evoke comparable negative reactions. For example, we have found lower relationship satisfaction among mothers who have children with nonspecific child disorders (Sacco & Murray, 1997). These mothers also evidenced more negative trait conceptions of their child and made more dispositional attributions about negative events occurring to their child. Consis- tent with the social-cognitive model, the association between child disorder and relationship satisfaction was fully mediated by the valence of trait conceptions of the child and partially mediated by attributions about the child's behaviors (Sacco & Murray, 1997).

The social-cognitive model can also apply to a wider range of relationships. Of particular theoretical importance is the reliable finding that strangers react negatively to depressed persons even after minimal contact (Gotlib, 1990). It would be difficult to attribute these reactions to excessive reassurance-seeking behaviors, which seems to require repeated occurrences and, as measured by the Reassurance-Seeking Scale, are directed toward "people you feel close to." Perhaps more difficult for the reassurance-seeking conceptualization are studies of strangers who are simply led to believe they are or will be interacting with either a depressed or a nondepressed target. These strangers rate the depressed target more negatively on a wide range of traits (Hall & Sacco, 1983; Nicholson, 1997) and experience more negative affect during an interaction de- spite the absence of behavioral differences (Nicholson, 1997). Moreover, when both depressed and nondepressed targets perform equally poorly on a task, depressed targets are less likely to be chosen for a future work team, an indicant of rejection that was fully

mediated by trait ratings (Nicholson, 1997). These findings suggest that others' reactions to depressed persons cannot be explained solely by observations of social behaviors such as excessive reassurance-seeking. Rather, consistent with the social-cognitive model, simply knowing someone is depressed may be sufficient to activate a stereotypical negative schema about depressed persons, which influences subsequent information processing, affect, and behavior (Cane & Gotlib, 1985; Hall & Sacco, 1983). The content of this schema is likely to include expecta- tions of excessive reassurance-seeking along with other behaviors associated with depression.

Finally, the social-cognitive model also does not as- sume that negative appraisals and withdrawal of support will invariably lead to depression. These negative social reactions must be perceived and, when perceived, their likelihood of causing depressive symptoms, versus no symptoms or symptoms of other disorders, may be moderated by a variety of factors. Moderating variables could include cognitive vulnera- bilities such as dysfunctional attitudes (Sacco & Beck, 1995), attributional style (Abramson, Metalsky, & Al- loy, 1989), vulnerable self-esteem (Roberts & Monroe, 1992), or the tendency to ruminate in response to interpersonal stress (Nolen-Hoeksema, Parker, & Larson, 1994), as well as noncognitive factors such as extrarelationship social support (Barnett & Gotlib, 1988) or a genetic-biological diathesis.

Similarly, scores on the Reassurance-Seeking Scale may reflect not only the tendency to engage in reassurance-seeking behaviors but, perhaps as importantly, a social-cognitive diathesis characterized by heightened vigilance for perceiving negative appraisals and rejection, with exaggerated valuing of approval and support. Thus, both the social-cognitive diathesis and the resultant socially aversive reassurance-seeking behaviors may play important roles in the development and maintenance of depression. In this way, the social-cognitive model incorporates traditional cognitive perspectives on depression (Sacco & Beck, 1995).

Treatment Implications

The social-cognitive model offers an integrated, systems-oriented perspective on the treatment of depression. Like the reassurance-seeking conceptualization, it suggests that depressed (or depression-prone) individuals should be made aware of their possible negative impact on others and helped to modify poten- tially aversive social behaviors such as excessive reassurance-seeking (e.g., social skills training). In addition, the model suggests that treatment might include several other components such as:

1. Modify others' detrimental attributions toward and negatively biased cognitive representations of the

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depressed person, which may remain after symptoms remit or be reactivated by any hints of relapse (e.g., attributional retraining, monitor positive behaviors).

2. Help significant others reduce negative affective reactions to the depressed target's responses as well as negative affect stemming from external stressors (e.g., job stress), both of which may foster more negative social-cognitive and behavioral interpersonal responses (e.g., stress management).

3. Enhance adaptive relationship responses in both members of the dyad (e.g., communications training, behavioral marital therapy).

4. Assess and treat underlying social-cognitive diatheses in the depressed or depression-prone person that possibly bias social perceptions and heighten sen- sitivity to negative appraisals and rejection (e.g., cognitive therapy).

In summary, Joiner et al. provide evidence that excessive reassurance-seeking behaviors may be one important component of a complex interpersonal process involved in the development and maintenance of depression. Their findings and conceptualization are consistent with a more general social-cognitive model (Sacco, 1999). Their work should stimulate and challenge clinical scientists to extend this critical area of inquiry.

Note

William P. Sacco, Department of Psychology, Uni- versity of South Florida, Tampa, FL 33620. E-mail: sacco@chuma 1 .cas.usf.edu

References

Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopeless- ness depression: A theory-based subtype of depression. Psycho- logical Review, 96, 358-372.

Bargh, J. A., Lombardi, W. J., & Higgins, E. T. (1988). Automaticity of chronically accessible constructs in person X situation effects on person perception: It's just a matter of time. Journal of Per- sonality and Social Psychology, 55, 599-605.

Barnett, P. A., & Gotlib, I. H. (1988). Psychosocial functioning and depression: Distinguishing among antecedents, concomitants, and consequences. Psychological Bulletin, 104, 97-126.

Bradbury, T. N., & Fincham, F. D. (1990). Attributions in marriage: Review and critique. Psychology Bulletin, 107, 3-33.

Brewin, C. R., Andrews, B., & Gotlib, I. H. (1993). Psychopathology and early experience: A reappraisal of retrospective reports. Psychological Bulletin, 113, 82-98.

Cane, D. B., & Gotlib, I. H. (1985). Implicit conceptualizations of depression: Implications for an interpersonal perspective. Social Cognition, 3, 341-368.

Cariston, D. E., & Skowronski, J. J. (1994). Savings in the relearning of trait information as evidence for spontaneous inference gen- eration. Journal of Personality and Social Psychology, 66, 840-856.

Felson, R. B. (1989). Parents and reflected appraisal process: A lon- gitudinal analysis. Journal of Personality and Social Psychol- ogy, 56, 965-971.

Fiske, S. T. (1995). Social cognition. In A. Tesser (Ed.), Advanced socialpsychology (pp. 149-193). New York: McGraw-Hill.

Forgas, J. P. (1995). Mood and judgment: The Affect Infusion Model (AIM). Psychological Bulletin, 117, 39-66.

Gotlib, I. H. (1990). An interpersonal systems approach to the conceptualization and treatment of depression. In R. E. Ingram (Ed.), Contemporary psychological approaches to depression (pp. 137-154). New York: Plenum.

Gurtman, M. B. (1987). Depressive affect and disclosures as factors in interpersonal rejection. Cognitive Therapy and Research, 11, 87-99.

Hall, R. L., & Sacco, W. P. (1983, March). The depression stereotype and its interpersonal impact. Paper presented at the annual meet- ing ofthe Southeastern Psychological Association, Atlanta, GA.

Hokanson, J. E., & Butler, A. C. (1992). Clusteranalysis of depressed college students' social behaviors. Journal of Personality and Social Psychology, 62, 273-280.

Jacobson, N. S., & Anderson, E. A. (1982). Interpersonal skill and depression in college students: An analysis of the timing of self-disclosures. Behavior Therapy, 13, 271-282.

Joiner, T. E., Jr., & Metalsky, G. I. (1998). The relative specificity of excessive reassurance-seeking to depressive symptoms among adult and youth psychiatric inpatients. Manuscript submitted for publication.

Katz, J., Beach, S. R. H., & Joiner, T. E., Jr. (1999). Contagious depression in dating couples. Journal of Social and Clinical Psy- chology, 18, 1-13.

Lefkowitz, M. M., & Tesiny, E. P. (1984). Rejection and depression: Prospective and contemporaneous analysis. Developmental Psychology, 20, 776-785.

Murray, S. L., Holmes, J. G., & Griffin, D. W. (1996). The benefits of positive illusions: Idealization and the construction of satisfaction in close relationships. Journal of Personality and Social Psychology, 70, 79-98.

Murray, D. W., & Sacco, W. P. (1998). Effect of child-relevant cognitions on mother's mood: The moderating effect of child-trait conceptions. Cognitive Therapy and Research, 22, 47-61.

Nicholson, K. J. (1997). Cognitive, affective, and behavioral reactions to depressed versus nondepressed targets during an inter- active task. Unpublished master's thesis, University of South Florida, Tampa.

Nolen-Hoeksema, S. N., Parker, L. E., & Larson, J. (1994). Rumina- tive coping with depressed mood following loss. Journal ofPer- sonality and Social Psychology, 67, 92-104.

Roberts, J. E., & Monroe, S. M. (1992). Vulnerable self-esteem and depressive symptoms: Prospective findings comparing three alternative conceptualizations. Journal of Personality and Social Psychology, 62, 804-812.

Sacco, W. P. (1999). A social-cognitive model of interpersonal processes in depression. In T. E. Joiner & J. C. Coyne (Eds.), The interactional nature of depression: Advances in interpersonal approaches (pp. 329-362). Washington, DC: American Psy- chological Association.

Sacco, W. P., & Beck, A. T. B. (1995). Cognitive theory and therapy. In E. E. Beckham & W. R. Leber (Eds.), Handbook of depression: Treatment, assessment and research (2nd ed., pp. 329-351). New York: Guilford.

Sacco, W. P., Dumont, C. P., & Dow, M. G. (1993). Attributional, perceptual, and affective responses to depressed and nondepressed marital partners. Journal ofConsultingand Clini- cal Psychology, 61, 1076-1082.

Sacco, W. P., & Dunn, V. K. (1 990). Effect of actor depression on ob- server attributions: Existence and impact of negative attributions toward the depressed. Journal of Personality and Social Psychology, 59, 517-524.

Sacco, W. P., & Macleod, V. A. (1990). Interpersonal responses of primary caregivers to pregnant adolescents differing on depression level .Journal of Clinical Child Psychology, 19, 265-270.

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COMMENTARIES

Sacco, W. P., Milana, S., & Dunn, V. K. (1985). Effect of depression level and length of acquaintance on reactions of others to a re- quest for help. Journal of Personality and Social Psychology, 49, 1728-1737.

Sacco, W. P., Milana, S., & Dunn, V. K. (1988). The effect of dura- tion of depressive episode on the response of others. Journal of Social and Clinical Psychology, 7, 297-311.

Sacco, W. P., & Murray, D. (1997). Mother-child relationship satisfaction: The role of attributions and trait conceptions. Journal of Social and Clinical Psychology, 16, 24-42.

Segal, Z. V., & Ingram, R. E. (1994). Mood priming and construct ac- tivation in tests of cognitive vulnerability to unipolar depression. Clinical Psychology Review, 14, 663-695.

Segrin, C., & Abramson, L. Y. (1994). Negative reactions to depressive behaviors: A communication theories analysis. Journal of Abnormal Psychology, 103, 655-668.

Sherman, J. W., & Klein, S. B. (1994). Development and representa- tion of personality impressions. Journal of Personality and So- cial Psychology, 67, 972-983.

Weiner, B. (1993). On sin versus sickness: A theory of perceived re- sponsibility and social motivation. American Psychologist, 48, 957-965.

Youngren, M. A., & Lewinsohn, P. M. (1980). The functional relation between depression and problematic interpersonal behavior. Journal of Personality and Social Psychology, 41, 243-252.

The Flip Side of the Reassurance-Seeking Coin: The Partner's Perspective

William B. Swann, Jr. and Jennifer K. Bosson Department of Psychology University of Texas at Austin

"Do you really think I'm the type of person who'd tell you that I love you if it wasn't true?"

-The exasperated partner of a clinically depressed person

As citizens of this "Prozac nation," we are regularly encouraged to think of depression as something that ex- ists "inside" people, as an imbalance in the brain's neurotransmitters. Viewed from this vantage point, the arguments ofJoiner, Metalsky, Katz, and Beach (this issue) seem radical indeed, for they shift the focus of attention away from the innerworlds ofdepressed persons and onto the idiosyncratically skewed worlds that depressed persons create around themselves. According to Joiner et al., depression is as much about problems in how depressed persons relate to others as it is about their faulty thought processes. In particular, building on Coyne's (1 976) observation that depressed persons tend to evoke the ire of their partners, Joiner et al. propose that depressed persons alienate others by engaging in excessive reassurance-seeking (e.g., Joiner & Metalsky, 1995; Katz & Beach, 1997).

Although some of the crucial empirical pieces in Joiner et al.'s argument have not yet been put into place, they make a good case that excessive reassurance-seeking may sour the intimate relationships of depressed persons. Yet precisely why excessive reassurance-seeking should elicit negative reactions from relationship partners is not clear. According to Joiner, Alfano, and Metalsky (1993), excessive reassurance-seeking signals to partners that "the self-enhancing feedback they provide [to the depressed person] is not incorporated" (p. 129). We wonder, however, why partners of depressed persons should be

so troubled by this alleged "failure to incorporate" their reassurance? Is it merely that partners are frus- trated because they feel that they are not being listened to? Or does the problem run deeper than this?

We believe that the excessive reassurance-seeking of depressed persons is problematic not so much because it signals that their partners are being ignored but because it threatens their partners' fundamental beliefs about who they are. Specifically, when depressed persons indicate that they are unconvinced by their partners' expressions of love and reassurance, their partners receive the implicit message that they are not credible sources of feedback. Excessive reassurance-seeking by depressives thus communicates to partners that their expressions of love and statements of support are not "honest," "trustworthy," or "reliable"-the underlying message is that they, themselves, cannot be believed. Insofar as nondepressed partners think of themselves as honest, trustworthy, and reliable (which most people surely do), the un- abated incredulity of depressed persons will represent a direct challenge to their beliefs about themselves.

Why should such disconfirmation oftheir self-views be disturbing to the partners of depressed persons? The answer to this question was alluded to by Joiner et al. in their discussion of self-verification theory (Swann, 1983, 1990, 1996). According to self-verification theory, people desire evaluations that they perceive as ac- curate, because such evaluations reinforce their perceptions that the world is predictable and controllable (for earlier related treatments, see Aronson, 1968; Lecky, 1945; Secord & Backman, 1965). Specifically, self-verifying feedback bolsters people's feelings that they know themselves and that others know them for

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A Social-Cognitive Perspective on Reassurance-Seeking and Depression