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University Microfilms International A Bell & Howell Information Company 300 North Zeeb Road, Ann Arbor, Ml 48106-1346 USA 313/761-4700 800/521-0600 Order Number 9008322 An evaluation of the role of irrational cognitions in depression Herbert, James Dalton, Ph.D. The University of North Carolina at Greensboro, 1989 U-M-I 300 N. Zeeb RA Ann Arbor, MI 48106 AN EVALUATION OF THE ROLE OF IRRATIONAL COGNITIONS IN DEPRESSION by James D. Herbert A Dissertation Submitted to the Faculty of the Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the requirements for the Degree Doctor of Philosophy Greensboro 1989 Approved by Rosemery 0. Nelson-Gray, Ph.D. APPROVAL PAGE This dissertation has been approved by the £o1_ov committee of the Faculty of the Graduate 'School at the "!r. i er 3 i J: v c f North Caro 1 ina at Greensbcr o . Dissertation J?**'-*. <• Advi so1- * lommittes Membe: •3 V t - r ~ * t ;ate or Acceptance cv lommittse jf- tell me if they are the same as or different than the statement you just saw. Eleven trials of four exposures at four msec per trial were presented, with the experimenter coding the subjects' responses. One of the irrational stimuli (I HAVE TO BE PERFECT) and one of the rational stimuli (IT'S OK TO DISAGREE) that were actually employed in the study served as the two comparison stimuli for the entire discrimination task. A three-second interval occurred between the four presentations of each stimulus, with a five second interval between different stimuli. The subject was prompted for her response during each five second interval between stimulus set presentations. Following completion of the discrimination task, participants were asked to complete a brief Post-Experimental Questionnaire (Appendix N). Dependent Measures As noted above, two dependent measures were employed. The first was an agreement rating on a 97 mm visual analogue scale, labeled "agree completely" at one end and "disagree completely" at the other (Appendix 0). This measure was 94 quantified simply by measuring the distance from the left (disagree) pole to the subject's mark (i.e., mm of agreement). The second dependent measure, designed to assess the participants' immediate dysphoric mood state, was a modification of the Depression Adjective Check List (DACL; Lubin, 1965; Appendix P) .6 The modification, introduced by Varga (1973) and subsequently employed by Dauber (1984), consists of a 50-point scale rather than a present-absent choice for each item, thereby increasing the measures sensitivity to finer variations in mood. The sum of the ratings of negative adjectives minus the sum for positive adjectives constituted the actual dependent measure. Five separate versions of the DACL were employed, so that a different version was used for each of the five assessments of each subject's mood (baseline, and after each set of stimulus presentations). In its original form, the different versions of the DACL have been shown to demonstrate high intercorrelations (alternate form reliability ranges from .82 to .84; Lubin & Himelstein, 1976). The sequence of the five versions was counterbalanced across trials so that all versions of the modified DACL were equally represented across all trials and subjects (i.e., each version was used for six of the thirty subjects for any given trial). 95 METHOD II The same 30 subjects who participated in the procedure described above also participated in the second experimental procedure. Method II was conducted immediately following completion of Method I. This project involved administering four items from the Thematic Apperception Test (TAT; Murray, 1943), one of the most widely employed personality assessment measures. The four cards chosen for presentation were Numbers 1, 3BM, 10, & 14 (see Figures 1 through 4, Appendix Q). Card 1 consists of a young boy contemplating a violin that sits on a table in front of him. Card 3BM is a person whose gender is ambiguous huddled on the floor next to a couch, next to whom is an ambiguous object (often seen as a revolver). Card 10 is a close-up of the faces of an embracing man and woman of ambiguous ages. Finally, Card 14 consists of a silhouette of a man against a bright, open window, with the rest of the picture being totally black. Although only two of these cards (3BM and 14) are typically thought to pull specifically for depressive ideation, the other two cards were also chosen because they are known to elicit themes of achievement motivation, dysphoria, and intimacy, among others. These themes are central to the phenomenology of depression, and are reflected in the depressotypic cognitive schemas described by Beck. 96 Upon completion of Method I, subjects were read the following instructions by the experimenter (from Murray, 1943) : This is a test of imagination, one form of intelligence. I am going to show you some pictures, one at a time; and your task will be to make up as dramatic a story as you can for each. Tell what has led up to the event shown in the picture, describe what is happening at the moment, what the characters are feeling and thinking; and then give the outcome. Speak your thoughts as they come to your mind. Do you understand? Here is the first picture. Consistent with standard TAT administrative guidelines, the experimenter refrained from making extraneous comments or providing unnecessary guidelines. The experimenter did prompt subjects, however, if they did not provide a complete response (i.e., if a story did not have a beginning, middle, and ending). The four cards were presented in the order described above to all subjects. All responses were audiotaped and transcribed. In addition to the subjects1 actual responses, four other dependent measures were obtained. These were the response latency between presentation of each card and the first response to that card, the total response time to each card, the total of the response latencies across the four cards for each subject, and the total of the response times for each subj ect. 97 Transcribed copies of each subject's responses were given to 10 doctoral level clinical psychologists employed at Beth Israel Medical Center in New York City. All 10 of the psychologists had received formal training in the administration and interpretation of the TAT. Nine of the 10 rated their familiarity with interpretation of TAT data as "moderate," with one rating of "somewhat." The psychologists reported a mean of 7.55 years of clinical experience (SD = 2.99), and reported having either administered or supervised the administration of an average of 7.90 TAT protocols (SD = 5.78) during the preceding year. Informed consent was obtained following a brief introduction to the purpose of the study. Each psychologist was then given a complete copy of the TAT data, as well as the following written instructions: I want to express my sincere thanks for helping with my dissertation project. Recalling your own years as a graduate student, I'm sure you can appreciate how grateful I am for your assistance. On the pages that follow are TAT stories from thirty subjects. Each subject generated responses to the following cards: #1 (a young boy contemplating a violin that rests on a table in front of him); #3BM (a person sitting on the floor huddled against a couch. On the floor beside the person is an object) ; #10 (a young woman's head against a man's shoulder); and #14 (the silhouette of a person against a bright window. The rest of the picture is totally black) . The cards were administered under standard instructional conditions by a female undergraduate psychology student. 98 The purpose of this study is to assess the sensitivity of the TAT to detect depressotypic themes. Some of the subjects in the study were clinically depressed, whereas others were not depressed. After reading the responses to the four cards for each subject, your task is simply to make a judgment as to whether or not you think the subject was depressed. Please mark your judgments on the form on the following page. In clinical settings, of course, one would never diagnose depression on the basis of TAT data alone. Nevertheless, please make your best judgment on the basis of these limited data regarding whether or not each subject was depressed. You will be given a debriefing statement that describes the study in more detail upon completion of the task. I will also be happy to provide a list of which subjects were depressed and which were not if you would like. Once again, thank you very much for your help. The psychologists recorded their diagnostic judgments (i.e., depressed vs. not depressed) for each of the 30 subjects, and returned these to the experimenter at their leisure. Upon receipt of these data the psychologists were provided with a written and oral debriefing (Appendix R), and a form listing the actual diagnostic status of each subject. METHOD III Upon completion of Method II, all 30 participants engaged in one final task. Each subject was asked to complete two versions of the Dysfunctional Attitudes Scale (DAS, Form A; 99 Weissman & Beck, 1978; Appendix C) . The DAS is a 40 item self-report checklist that was designed to assess the dysfunctional schemas that are thought to underlie depression. The subject rates his or her agreement with each of 40 beliefs on a 1 to 7 Likert scale from "totally agree" to "totally disagree." The standard instructions were modified in the first version of the scale completed by subjects in the present study. Instead of asking subjects to rate their own degree of agreement with each statement, they were asked to rate how much they think someone else might agree with each statement. The following instructions were printed on the form: This inventory lists different attitudes or beliefs which people sometimes hold. Read EACH statement carefully and decide how much you think ANOTHER PERSON (not you) might reasonably agree or disagree with the statement. For each of the attitudes, show your answer by placing a checkmark (/) under the column that BEST DESCRIBES HOW YOU THINK SOMEONE ELSE MIGHT THINK. Be sure to choose only one answer for each attitude. Do not mark how you personally think, but rather how you believe someone else might think. You don't have to have any particular person in mind. Just estimate how much each belief might apply to someone else. For example, the first statement is "it is difficult to be happy unless one is good looking, intelligent, rich, and creative." If you could imagine that it might be reasonable for someone (anyone) to strongly agree with this statement, you would mark "agree very much." Upon completion of the first version of the DAS, subjects were provided with a second copy of the questionnaire, in which the standard administrative instructions were provided. 100 The two versions of the questionnaire were identical except for the different instructions for each. The order of presentation of the two versions was the same for all subjects. That is, version one (modified instructions) always preceded version two (standard instructions). Counterbalancing the order of presentation across subjects was avoided because it was felt that the remitted subjects in particular would be unlikely to endorse many dysfunctional beliefs on the "other person" version of the questionnaire if it followed the standard version. The instructions for the second version were as follows: Now please read each statement again, and decide how much YOU PERSONALLY agree or disagree with each statement. Place your checkmark under the appropriate column like before. Because people are different, there are no right or wrong answers. To decide whether a given attitude is typical of your way of looking at things, simply keep in mind what you are like MOST OF THE TIME. Upon completion of this measure, the participants were thoroughly debriefed both verbally and in writing (Appendix S), thanked for their participation, and dismissed. 101 RESULTS METHOD 1 Check for Subliminalitv of Stimuli In order to evaluate whether or not the stimuli were in lfact below the subjects' recognition threshold during the subliminal conditions, the number of correct discriminations made during the discrimination task was evaluated for each group. Since there were ten discrimination trials, five correct responses would be expected by chance. The depressed subjects had a mean of 5.8 correct responses, compared with 4.2 for the normals and 5.1 for the remitted subjects. A separate t-test was conducted for each subject group in which the number of correct responses was compared to the expected number of five. A significant t-test would indicate that the number of correct discriminations differed significantly from what would be expected on the basis of chance, thereby suggesting that the stimuli could at least sometimes be discriminated by the subjects. In contrast, a nonsignificant t-test would indicate chance responding on the discrimination task, thereby supporting the subliminality of the experimental stimuli. None of the three t-tests reached significance at p < .05 (t = -0.95, 1.81, and -0.17 for the depressed, normal, and remitted groups, respectively), indicating that the 102 accuracy of subjects' discriminations did not differ from what would be expected on the basis of chance. In order to evaluate the possibility of a response bias, additional t-tests compared the number of "same" and the number of "different" responses to the expected five (chance responding for ten trials). Again, a significant t-test would suggest a bias toward responding either "same" or "different," whereas a nonsignificant t-test would suggest that neither response predominated. The mean number of "same" responses was 4.7, 4.2, and 4.9 (t = 0.45, 1.81, and 0.32) , and the mean number of "different" responses was 5.3. 5.8, and 5.1 (t = -0.45, -1.81, and -0.32) for the depressed, normal, and remitted subjects, respectively. None of these t-tests was significant, indicating that all three subject groups responded with a mix of "same" and "different" responses, and none of the groups had a bias toward either response. Although the above analyses are consistent with random responding on the discrimination task, the question remains as to whether the three subject groups differed from one another in either their accuracy or their tendency to give "same" vs. "different" responses. These questions were evaluated by means of three one-way analyses of variance (ANOVA's) by group on the number of correct discriminations, the number of "same" responses, and the number of "different" 103 responses (Table 7). None of these analyses reached significance at p < .05, indicating no differences across groups in the accuracy or the pattern of responses on the discrimination task. It should also be noted that none of the subjects reported seeing anything more than extremely brief flickers of light during the subliminal experimental phases or the discrimination task. Thus, the results of the discrimination task suggest that the experimental stimuli were in fact well below the subject's recognition threshold during the subliminal conditions. The Effects of the Stimuli on Mood Subjects completed a modified version of the Depressive Adjective Check List (DACL) at baseline then again after each of the four within-subjects experimental phases. As described above, the DACL consists of a series of dysphoric and euphoric adjectives with which the subject indicates his or her agreement. The present modification of the DACL consisted of adding a 130 mm visual analogue scale next to each adjective. Rather than agreeing or disagreeing completely with each adjective, subjects rated their degree of agreement on this scale. Scores on the DACL were obtained by measuring the 104 number of mm of agreement for each adjective, then subtracting the total agreement with the euphoric adjectives from the total agreement with the dysphoric adjectives. A one-way ANOVA by group on the baseline DACL reached significance at p = .0001. Tukey's post hoc comparisons (p < .05) revealed that the depressed subjects were more dysphoric than the remitted subjects, who were in turn more dysphoric than the normal subjects at baseline (Table 8) . This pattern is consistent with predictions made regarding the baseline mood states of the three groups insofar as the actively depressed subjects were expected to be more dysphoric than the other two groups. Although the obtained difference between the remitted and normal groups was not specifically predicted, it is quite small in magnitude and of little or no clinical significance. The effects of these baseline DACL differences on the analysis of the experimental data were controlled by means of gain scores (the method recommended by Huck & McLean, 1975). Gain scores were generated by partialling out each subject's baseline level of dysphoria from the subsequent dependent measures. This was accomplished by subtracting the subjects' baseline DACL score from each of the DACL scores collected after the four experimental phases. The resulting gain scores were then analyzed by means of a four-way ANOVA and associated post hoc comparisons, described below (Tables 9 & 10) . The analyses of the gain scores 105 revealed the same pattern of results as the analyses of the unadjusted DACL scores, described below. For this reason, only the results of the analyses of the unadjusted DACL data are reported in detail. The effects of the experimental manipulations on the unadjusted DACL were evaluated by means of a 4 (counterbalanced orders) by 3 (depressed vs. remitted vs. normal subjects) by 2 (subliminal vs. supraliminal stimulus presentation modality) by 2 (rational vs. irrational stimulus valence) ANOVA, with repeated measures on the last two factors (Table 11). The ANOVA revealed a significant main effect for group (p = .0001), and a significant order by modality interaction (p = .0212). Consistent with predictions, Tukey's post hoc comparisons revealed that the depressed subjects were more dysphoric across all experimental conditions than were the remitted and the normal subjects, whereas these latter two groups did not differ from one another (Table 12) . This result is consistent with the baseline difference described above, in which the depressed subjects were more dysphoric at baseline relative to the other two groups. Although the remitted subjects were more dysphoric than the depressives at baseline, this difference disappeared when the data were averaged across the four within-subject experimental phases. 106 The significant order by modality interaction was evaluated not only by means of standard Tukey post hoc comparisons (Table 13), but also by means of a method described by Boik (1979; Table 14). The standard method of exploring a significant interaction involves conducting a series of a posteriori simple effect comparisons. For example, given a significant interaction between two factors A and B, each level of factor A would be compared against all other levels of factor A at a given level of factor B. Each level of factor B would in turn be compared against all other factor B levels at a given level of factor A. The method described by Boik allows more specific hypotheses to be tested by comparing combinations of certain levels of a factor against other levels of that factor. For example, if factor A has four levels, then a comparison could be made between Levels 1+3 and Levels 2 + 4 using a modified F-test. In the present order by modality interaction, there were four levels of the order factor (Orders 1 through 4) and two levels of the modality factor (subliminal vs. supraliminal). The four orders consisted of different combinations of the two within-subjects factors. For example, Order 1 consisted of the following sequence of experimental phases: (a) subliminal-irrational, (b) subliminal-rational, (c) supraliminal-irrational, (d) supraliminal-rational. The sequence of the remaining orders, as well as the mean DACL for 107 each combination of order and modality, is presented in Table 15. A series of interaction contrasts were conducted using the Boik method (p < .05) in which combinations of two order levels were compared to combinations of two other levels (Table 14). These contrasts were performed separately for the subliminal condition and for the supraliminal condition. They permitted an evaluation of whether it was the stimulus valence, the modality of presentation, or some combination of the two that comprised the orders1 contribution to the interaction. These contrasts revealed that orders in which the first stimulus set presented was irrational resulted in more dysphoric mood than orders in which the rational stimuli were presented first. This effect occurred regardless of whether the initial stimulus set was presented subliminally or supraliminally. That is, subjects whose first experimental phase consisted of subliminal presentations of irrational stimuli became more dysphoric than subjects whose first phase was subliminal-rational. Similarly, subjects first presented with supraliminal-irrational stimuli became more dysphoric than subjects first presented with supraliminal-rational stimuli. This effect of the initial stimulus valence occurred for both levels of the modality factor; i.e., on the DACL measures 108 taken after both the subliminal and supraliminal phases. For example, a subject whose first stimulus condition was subliminal-irrational was more dysphoric not only in the initial subliminal phases, but also in the later supraliminal phases, relative to a subject whose first stimuli were subliminal-rational. Thus, the valence of the first stimulus condition encountered, regardless of the modality of presentation, determined the subjects' mood for the remainder of the experimental task. Although the pattern of means for the four orders was somewhat different across the two modalities, thereby yielding the significant interaction on the omnibus test (see Table 15), the more detailed post hoc comparisons revealed the same effect of order for both the subliminal and supraliminal conditions. In summary, consistent with predictions, analysis of the mood data revealed that the depressed subjects were more dysphoric than the remitted and normal subjects across all experimental conditions, whereas the latter two groups did not differ from one another. The valence of the initial stimulus condition presented to subjects determined the degree of dysphoria they reported across all of the experimental phases. Subjects who first encountered irrational stimuli became more dysphoric and remained so throughout the experiment than subjects who first encountered rational stimuli. This stimulus valence effect occurred regardless of 109 whether the stimuli were presented subliminally or supraliminally. This effect, however, did not occur differentially by subject group. Although this pattern of results is consistent with predictions in that the irrational stimuli were expected to result in more dysphoric mood ratings than the rational stimuli, at least in certain conditions, they are inconsistent with predictions in two important ways. First and foremost, there were no differences across the three subject groups in the pattern of effects of the stimulus valence and modality of presentation factors. Recall that according to predictions derived from Beck's theory, the remitted subjects were expected to differ from both the depressives and the normals in their response to these manipulations. Specifically, they were predicted to respond similarly to the depressives in the subliminal conditions, and similarly to the normal subjects in the supraliminal conditions. The second way in which the results are inconsistent with predictions is that the subjects' mood was expected to vary as a function of each of the four experimental phases, rather than being affected only by the first phase encountered. The Effects of the Stimuli on Agreement Ratings 110 Each of the four within-subjects experimental phases described above consisted of the presentation of five stimuli. Recall that following the presentation of each stimulus, subjects rated their agreement with that stimulus on a 97 mm visual analogue scale marked "disagree completely" at one pole and "agree completely" at the other. The degree of agreement with each stimulus was quantified by measuring the number of mm from the left (disagree) pole to the subject's mark. An index of each subject's overall agreement with the stimuli within an experimental condition was obtained by summing the five agreement scores for each stimulus within that condition. Collapsing across the stimuli in this manner made conceptual sense since the stimuli are all hypothesized to reflect the same theoretical construct (i.e., depressotypic cognitive style). In order to evaluate empirically the covariation among the stimuli, a correlation matrix was constructed consisting of the agreement ratings with each of the five individual stimuli as well as the total agreement index (Table 16) . Pearson correlations revealed that the agreement ratings for all stimuli were significantly positively correlated with the ratings for all other stimuli, including the total agreement index (p < .0001 for all comparisons). Given the high degree of positive covariation Ill among agreement ratings with the five stimuli, the total agreement index served as the dependent measure for the analyses described below. The effects of the experimental manipulations on subjects'agreement ratings were evaluated by means of a 4 (counterbalanced orders) by 3 (depressed vs. remitted vs. normal subjects) by 2 (subliminal vs. supraliminal stimulus presentation modality) by 2 (rational vs. irrational stimulus valence) ANOVA, with repeated measures on the last two factors (Table 17).7 The ANOVA revealed a significant main effect for valence (p = .0001). Overall, subjects agreed more with the rational stimuli (x = 305.35) than with the irrational stimuli (X = 178.60). A group by valence interaction also emerged (p = .0001). Tukey's post hoc comparisons (p < .05) revealed that whereas the remitted and normal subjects showed higher agreement with the rational relative to the irrational stimuli, there was no difference across valences for the depressed subjects (Table 19) . Moreover, the three groups did not differ in their degree of agreement with the irrational stimuli. For the rational stimuli, the remitted subjects had higher agreement ratings relative to the depressed subjects, whereas the normal subjects did not differ from either of the other two groups. 112 The ANOVA also revealed a significant modality by valence interaction (p = .0001). Tukey's post hoc comparisons (p < .05) revealed that the rational stimuli elicited higher agreement ratings than the irrational stimuli only in the supraliminal conditions; there were no differences between the stimulus valences in the subliminal conditions (Table 20). Moreover, agreement ratings for the irrational stimuli were lower in the supraliminal conditions relative to the subliminal conditions. The opposite pattern occurred for agreement ratings with the rational stimuli: They were higher in the supraliminal conditions than in the subliminal conditions. Thus, agreement ratings in the subliminal conditions, regardless of stimulus valence, fell midway between the ratings for the supraliminal-rational stimuli on the one hand and the supraliminal-irrational stimuli on the other. Finally, a group by modality by valence interaction also reached statistical significance (p = .0001). Tukey's post hoc comparisons (p < .05) revealed the following results (Table 21) . First, there were no differences between the subject groups in any of the subliminal conditions. In the supraliminal conditions, however, the depressed subjects agreed more with the irrational stimuli and less with the rational stimuli than did the remitted and normal subjects, whereas these latter two groups did not differ from one 113 another. Second, subjects in all groups agreed more with the rational stimuli than with the irrational stimuli when they were presented supraliminally, but did not differ in their agreement with the two stimulus types when they were presented subliminally. Finally, the pattern of results described above for the modality by valence interaction only occurred for the remitted and normal subjects. That is, the remitted and normal subjects agreed more with the rational stimuli when presented supraliminal relative to subliminally, and less with the irrational stimuli when presented supraliminally relative to subliminally. There were no differences between the modality of stimulus presentation given either stimulus valence for the depressed subjects. In summary, subjects' agreement ratings to the individual experimental stimuli were highly positively correlated, as expected. The rational stimuli elicited higher agreement than did the irrational stimuli, but only for the remitted and the normal subjects, and only in the supraliminal conditions. There were no differences between agreement with the rational vs. irrational stimuli for the depressed subjects, or for any subjects in the subliminal conditions. Although it was predicted that the three groups would show this pattern of agreement ratings in the supraliminal conditions, the greater agreement with the rational stimuli by the normal and remitted subjects was not expected to be limited to the supraliminal 114 conditions only. Contrary to predictions, there was no evidence that the subliminal stimuli affected subjects' agreement ratings. This lack of impact of the subliminal stimulation on the agreement ratings stands in contrast to the results of the mood data, in which the rational vs. irrational stimuli differentially affected subjects1 mood even when presented subliminally. Interestingly, the difference between subject groups in their agreement ratings reflected a tendency for the remitted subjects in particular to agree more with the rational stimuli relative to the depressed subjects, rather than a difference between subjects in agreement with the irrational stimuli. This result was not predicted by Beck's theory, which emphasizes the association of a higher than normal degree of irrational beliefs with depression, rather than a lack of adequate rational beliefs. For the remitted and normal subjects, the agreement ratings for the subliminally presented stimuli, regardless of valence, fell midway between the ratings for the supraliminal-rational stimuli on the one hand, and the supraliminal-irrational stimuli on the other hand. No such difference emerged for the depressed subjects. This pattern is consistent with the results described above in which the stimulus valence affected the remitted and normal subjects only, and only in the supraliminal conditions. 115 METHOD 2 Latency Measures As described previously, the latency between presentation of each TAT card and the first response to that card was recorded from audiotapes of subjects' TAT data. In addition, the total response time for each card was also recorded. Contrary to predictions, one-way ANOVA's by subject group revealed no differences across groups in either of these measures (Table 22). Two additional one-way ANOVA's were conducted on the sum of the response latencies across each subject's four TAT responses, and the sum of the total response times (Table 23). Both of these ANOVA's also failed to reach significance. Diagnostic Judgments The psychologists' diagnostic data consisted of categorical "depressed" vs. "not depressed" judgments. The primary dependent measure was the number of "depressed" diagnoses given to each of the 30 subjects. For any subject, this number could range from zero (when none of the ten psychologists diagnosed the subject as depressed) to ten (when all ten psychologists diagnosed the subject as depressed). 116 The mean number of depressed diagnoses per subject by subject group were 6.0 (SD = 1.70) for the depressed group, 1.9 (SD = 1.20) for the remitted group, and 3.5 (SD = 2.07) for the normal group. A one-way ANOVA by group reached significance at p < .05. Tukey's post hoc comparisons (p < .05) revealed that the depressed group was more likely than the remitted group to be diagnosed as depressed (Table 24). The depressed group did not differ from the normal group, however, nor did the normal and remitted groups differ. Although it did not reach statistical significance, there was an interesting trend for the remitted subjects to be less likely to be diagnosed as depressed relative to the normal subjects. In order to clarify the pattern of "correct" vs. "incorrect" diagnoses, a 2 by 2 matrix was constructed for each subject, with the subjects' actual diagnostic status (depressed vs. normal) forming one side of the matrix, and the psychologists1 diagnoses forming the other side. The judgments for the remitted subjects are not included in this matrix since their "true" diagnostic status is ambiguous; their data were instead summarized separately. The means and standard deviations of each cell of this matrix are presented in Table 25. Examination of this table reveals that the psychologists achieved a similar number of hits (6.0) and correct rejections (6.5) , and a similar number of misses (4.0) and false alarms (3.5). 117 In summary, the results of the latency and response time measures revealed no differences across the three subject groups. Although the expected direction of the difference was uncertain, it was predicted that the depressed and remitted subjects would differ from the normal subjects in these time measures. The psychologists correctly diagnosed more of the depressed subjects as depressed relative to the remitted subjects. The number of depressed diagnoses given to the normal subjects did not differ, however, from either the remitted or the depressed groups. This pattern is contrary to predictions made from Beck's theory, in which a greater number of depressed diagnoses was expected to be assigned to both the remitted and actively depressed subjects relative to the normals. METHOD 3 Subjects' scores on each version of the Dysfunctional Attitudes Scale (DAS) were subjected to one-way ANOVA's by subject group. The mean scores for the "other person" version of the DAS were 139.89 (SD = 24.68), 142.80 (SD = 47.58), and 147.30 (SD = 31.89) for the normal, remitted, and depressed subjects, respectively. A one-way ANOVA did not reach significance, revealing no differences across groups (Table 118 26). For the standard "self" version of the DAS, the normal subjects' mean score was 108.78 (SD = 16.28), the remitted subjects' mean score was 107.70 (SD = 22.15), and the depressed subjects' mean score was 152.20 (SD = 43.64). A one-way ANOVA reached significance at p = .0038. Tukey's post hoc comparisons revealed the predicted pattern: The depressives achieved a higher score (indicating more dysfunctional attitudes) relative to the normal and remitted subjects, who did not differ from one another (Table 27). The difference between the modified and the standard versions of the DAS was compared by obtaining a difference score for each subject (DAS-other minus DAS-self), which was subjected to a one-way ANOVA by group. The mean difference scores were 31.11 (SD = 28.14), 35.10 (SD = 35.69), and -4.90 (SD = 68.04) for the normal, remitted, and depressed subjects, respectively. A one-way ANOVA by group on the difference scores failed to reach significance (Table 28). Although the difference scores were not significantly different across subject groups, examination of the means reveals a trend in which the depressives' scores on both versions of the DAS are comparable, and are similar to the normal and remitted subjects' scores on the "other person" version. The normal and remitted subjects, however, tended to endorse fewer dysfunctional beliefs on the "self" version relative to the "other" version. 119 In summary, as predicted, the depressed subjects demonstrated greater endorsement of dysfunctional beliefs relative to the normal and the remitted subjects on the standard, self-focused DAS, and the latter two groups did not differ from one another. Contrary to predictions, however, there were no differences between groups on a modified version of the DAS in which the beliefs of an abstract other person were rated. Recall that it was predicted that both the depressed and the remitted subjects would endorse more dysfunctional beliefs than the normals on this modified version of the DAS. Finally, also contrary to predictions derived from Beck's theory, there were no differences between groups in the difference between the "other" and the "self" versions of the DAS. 120 DISCUSSION The purpose of the present investigation was to examine the hypothesis that a depressotypic cognitive style represents a diathesis condition in the etiology of depression. The cognitive theory of depression proposed by Beck and his colleagues (1976) holds that certain early experiences lead to the development of an irrational, self-defeating view of the self, the world, and the future. These themes, in the form of cognitive schemas, are thought to be situationally and longitudinally stable. They are latent or relatively unavailable to the individual him or herself until activated by a significant stressor, such as a major loss. Once activated, the schemas color a wide range of cognitive processes, resulting in the depressive syndrome. As the depressive episode remits, the schemas once again become latent. There exists a large body of literature documenting the presence of depressotypic cognitions, including the core beliefs reflective of irrational schemas, in actively depressed persons (Hollon & Beck, 1979). The hypothesized presence of depressotypic schemas in depression-prone persons who are currently asymptomatic, however, has generally not been supported. Nevertheless, this negative finding is not 121 inconsistent with Beck's theory, since the majority of prior studies have not assessed for depressotypic schemas in ways that would be expected to expose their presence, given their latent status. If the diathesis aspect of Beck's theory, which is arguably the most critical component of the theory, is to be supported, these latent schemas must somehow be exposed. The present investigation represented an effort to evaluate whether or not such depressotypic schemas are present in the depression-prone person by comparing the performance of actively depressed, remitted, and never-depressed persons using three different assessment methods. Each of the methods was designed to go beyond standard self-report measures in an effort to examine the presence of underlying beliefs of which the subjects themselves were presumably either unaware, or hesitant to reveal. The three methods differed in the degree to which they were obviously designed to assess cognitive schemas. The tachistoscopic procedure was designed to bypass any experimenter demand, social-editing, or defensive processes that might obscure the presence of latent depressotypic schemas. Since the subjects were unaware of the content of the stimuli during the subliminal conditions, they could not intentionally edit their reactions to the stimulation. The Thematic Apperception Test (TAT) task was somewhat less concealed in its purpose, presumably allowing 122 the subjects a greater degree of control over what they revealed about their core beliefs. The Dysfunctional Attitudes Scale (DAS) procedure was the least veiled of the three methods from the subjects' perspective. A review of the predictions for each of the experimental methods, followed by a discussion of the results obtained, is presented below. The results are then discussed in terms of their implications for Beck's theory. Finally, a discussion of how the present results interface with other psychological research on diathesis conditions in the etiology of depression, followed by a discussion of directions for future research, is presented. The Tachistoscopic Procedure The first of the three experimental procedures was essentially a type of mood induction procedure in which participants were presented with five irrational statements derived from the depressotypic schemas outlined by Beck, as well as five rational counterpart statements. The stimuli were presented both subliminally and supraliminally to all subjects by means of a tachistoscope. Following presentation of each stimulus, participants were asked to rate their degree of agreement with that statement along a visual analogue 123 scale. Following each set of stimuli, subjects completed a sensitive mood measure designed to assess subtle changes in mood (especially along a dysphoria-euphoria dimension) that resulted from the previous stimulus set. Mood measure. On the basis of Beck's theory and the results of studies employing the subliminal psychodynamic activation method with depressives (Cox, 1974; Dauber, 1984; Miller, 1973; Rutstein & Goldberger, 1973; Varga, 1973), the following predictions were made for the Depressive Adjective Check List (DACL, Lubin, 1965). These predictions can be summarized as a group by modality by valence interaction. First, it was predicted that the moods of the never-depressed subjects would be relatively unaffected by the stimuli, since they do not hold the depressotypic schemas reflected by the stimuli. The predictions for the actively depressed subjects were less clear. They might be expected to show an increase in dysphoric mood following the irrational stimuli, especially in the subliminal condition. Since their depressotypic schemas are presumed to have already been activated, however, it is not clear that an exacerbation of dysphoria would be expected. The most critical predictions concerned the remitted group. As discussed above, they are hypothesized to hold latent depressotypic schemas but are unable or unwilling to reveal such beliefs on standard self-report measures. It was therefore predicted that the subliminal presentation of 124 the irrational stimuli would result in an increase in dysphoria, with a corresponding decrease in dysphoria following the subliminal rational stimuli. The supraliminal stimuli were predicted to have little or no effect on the remitted subjects' mood. The results of the DACL revealed that the depressed subjects were more dysphoric across all experimental conditions relative to both the remitted and the never-depressed subjects. This result is consistent with the baseline difference between the depressed subjects and the other two groups, and simply confirms the expected finding that the depressives were more dysphoric throughout the procedure. The predicted differential effects by subject group were not obtained. All three groups responded similarly on the DACL to the experimental manipulations. The absence of any differential effects by subject group is, of course, inconsistent with the predictions made according to Beck's theory. The implications of this finding for Beck's theory are discussed along with other results in a separate section below. 125 Close analysis of the data also revealed an interesting and unexpected effect of the stimuli. The valence of the first stimulus set encountered by the participants, regardless of whether it was presented subliminally or supraliminally, determined the degree of dysphoria reported throughout the remainder of the procedure. Subjects who were presented with the irrational stimuli first were more dysphoric across not only that initial phase but also across the three remaining experimental phases, relative to subjects who were presented with the rational stimuli first. This effect occurred for all three subject groups. This finding raises several implications. First, it suggests the occurrence of a kind of primacy effect. The first set of stimuli encountered by the participants appeared to set their mood, leaving it impervious to the effects of the stimuli that followed. Although the present procedure included a ten minute resting period between each experimental phase, it may have been that this was insufficient to allow the subjects' mood to return to baseline. In the only study to examine this issue directly, Silverman et al. (1971) found that the exacerbation of psychopathology that occurred following subliminal stimulation completely dissipated between 15 and 30 minutes later. No similar study has examined this issue with depressives, however, leaving open the question of exactly how long a dysphoric mood induction lasts. 126 The second feature of the above finding is its consistency with the mood induction literature (Averill, 1969; Coleman, 1975; Goodwin & Williams, 1983; Hale & Strickland, 1976; Isen et al., 1978; Masters et al., 1979; Moore et al., 1973; Natale, 1977a, 1977b; Polivy & Doyle, 1980; Strickland et al., 1975). Recall that standard mood induction techniques (e.g., Velten, 1968) involve measuring changes in dysphoria following the presentation of negatively toned statements to nondepressed subjects. A primary criticism that has been raised against such procedures in the study of clinical depression is the possibility that the results are due to experimenter demand effects (Buchwald, Strack, & Coyne, 1981; Polivy & Doyle, 1980). The present results suggest that a negative mood induction is possible in depressed, remitted, and never-depressed persons. Thus, negative mood induction is possible not only in nondepressed persons, but in persons demonstrating a wide range of baseline dysphoria levels. Moreover, the fact that such induction took place even when the stimuli were outside of both the experimenter's and the subjects1 awareness mitigates against an experimenter demand explanation. A third important feature of the results of the tachistoscopic procedure is the finding that the valence of the stimuli had an impact upon the participants* mood even 127 when presented subliminally. This result supports the treatment integrity of the experimental procedure. Despite being well below the recognition threshold, the stimuli nevertheless had an impact on mood. This finding adds yet another small piece of evidence to the growing body of literature documenting the various effects of stimulation without awareness in laboratory studies (Dixon, 1981). Agreement ratings. The predictions for the agreement ratings were similar to the predictions for the mood data, and can also be summarized as a group by modality by valence interaction. Since they hold no predisposition toward depression, the normal subjects were predicted to agree with the rational statements and disagree with the irrational statements, regardless of modality. In contrast, the depressives were predicted to show lower agreement with the rational statements and higher agreement with the irrational statements relative to the normal subjects, regardless of modality. The remitted subjects were expected to respond similarly to the normals during the supraliminal conditions, and to the depressives during the subliminal conditions. That is, they were expected to show relatively higher agreement with the rational stimuli when they were presented supraliminally, and relatively higher agreement with the irrational stimuli when presented subliminally. 128 The results of the agreement ratings did not support the diathesis component of Beck's theory. Although the results were basically consistent with predictions for the depressed and normal subjects, the predictions for the remitted subjects were not supported. Specifically, there were no differences in the pattern of agreement ratings between the remitted and the normal subjects. Both of these groups agreed more with the rational stimuli than with the irrational stimuli, but only when the stimuli were presented supraliminally. There were no differences between the remitted and normal subjects' agreement ratings for the rational vs. irrational subliminally presented stimuli. Similarly, the depressed subjects did not differ in their agreement ratings for the rational vs. irrational subliminal stimuli. These results are consistent with the results of the mood data described above. Like the mood data, they reveal the predicted difference between the actively depressed and the never depressed subjects. These findings are consistent with the large body of literature documenting irrational beliefs among depressives. These findings also validated that the sample of depressed subjects employed in this study was representative of the population described in the literature with respect to the presence of irrational beliefs. 129 Unlike the mood data, however, the agreement ratings were not affected in the subliminal conditions. There are at least two related explanations for this discrepancy. First, it is possible that the more analytical reasoning processes underlying the agreement ratings were less susceptible to subliminal stimulation relative to the more impressionistic mood ratings (cf. Dixon, 1981). Similarly, the subjects may have found the agreement task during the subliminal conditions significantly less plausible than the mood measure. Casual observations of the subjects' reaction to the experimental instructions suggested that the notion that subliminal stimulation may result in slight changes in mood was easier to accept by most subjects than the idea that they could rate their agreement with statements that they could not see. This impression may have led the participants to constrict their range of ratings on the visual analogue scales more for the agreement measures than for the mood measures. This interpretation is supported by comparison of the average standard deviations for the two measures. Although the length of the visual analogue scale for each item of the mood measure was somewhat longer than the scale for the agreement measure (130 mm vs. 97 mm.), the mean standard deviation for the mood measure across all conditions and all groups was over three times as large (367.41) as the standard deviation for the agreement measure (117.88). 130 As noted above, like the mood data, the agreement data were inconsistent with the diathesis component of Beck's theory. This point is discussed further below. The Thematic Apperception Test The Thematic Apperception Test (TAT; Murray, 1943) is one of the most widely used psychological assessment instruments among clinical psychologists, and is included in most standard test batteries in which personality functioning is assessed (Rapaport et al., 1968). One's responses to the ambiguous interpersonal scenes depicted on the TAT cards are held to reflect basic themes around which one's behavior and experiences are organized. Revelation of these themes in TAT responses is not thought to be contingent upon the subjects' awareness of them. The TAT was therefore chosen as a tool for investigating the presence of depressotypic schemas in the remitted depressive. As described previously, there were two types of data extracted from the subject's TAT responses. First, time measures of the latency to the first response to each card, and the total response time for each card were recorded. It was predicted that the actively depressed subjects and the remitted subjects would have longer response latencies than 131 the normal controls. This pattern was predicted since two of the four card administered are known to elicit depressive themes (Holt, 1978; Rapaport et al., 1968), which would be expected to be conflictual or threatening to these individuals, and therefore to result in longer response latencies. The predictions for the total response time were less clear; although the depressives might be expected to have longer total response times relative to the other groups due to their characteristic psychomotor retardation, they might also have shorter times due to lack of interest and involvement in the task. The second class of data obtained from the TAT procedure was the psychologists' diagnostic judgments. It was reasoned that the presence of depressotypic themes among a subject's responses would increase the likelihood that she would be diagnosed as depressed. It was therefore predicted that a higher proportion of the subjects in the depressed and in the remitted groups would be diagnosed as depressed relative to the normal subjects. Both the time measures and the diagnostic data failed to support the predictions. Like the results of the tachistoscopic procedure described above, the results of the TAT data were not consistent with predictions made according to Beck's theory. There were no differences between the 132 subject groups in either of the time measures. Although the depressed subjects were indeed more likely to be diagnosed as depressed relative to the remitted subjects, there were no differences between the normal subjects and either of the other two groups. There was an interesting trend for the remitted subjects to be less likely to be diagnosed as depressed relative to the normal subjects, which is consistent with the fact that only the remitted subjects differed significantly from the depressives. This finding suggests that the responses of the remitted subjects actually contained somewhat fewer depressive themes than the responses of the normal subjects. It is possible that the remitted subjects were going out of their way to give "normal" responses free of any depressive themes. Although intriguing, such an interpretation must remain most tentative due to the relatively small differences in the diagnostic data between the remitted and normal groups. There are at least two potential explanations for the lack of predicted results. First, it could be argued that although the TAT is indeed sensitive to organizing schemas, it is not differentially sensitive to depressotypic schemas, even given the particular cards chosen for administration in the present investigation. That is, although the test may have elicited depressotypic themes, among others, from the depressed subjects, it may have elicited equally conflictual 133 nondepressotypic themes from the nondepressed subjects. This is consistent with the fact that not all of the four cards chosen for administration are typically thought to pull specifically for depressive themes. The similarity in the time measures might therefore be expected. The second explanation for the lack of predicted results concerns the purpose of the TAT in general, and the manner in which the present data were collected in particular. The TAT is generally used to assess idiosyncratic organizing themes, as noted above. It is rarely if ever used alone to make broad nosological diagnostic judgments such as depressed vs. not depressed. The presence of certain themes or other response characteristics across several cards may suggest a diagnostic category. It may be asking too much of the test, however, to yield data that can be used in isolation to make valid clinical diagnoses. Although the TAT was administered under standard conditions during the present investigation, there were three important aspects of the resulting data that may have limited their utility. First, due to time constraints, only four TAT cards were administered to each subject. In normal clinical settings, a minimum of 10 cards are administered, thereby obviously yielding more and richer data. Second, the same four cards were administered to all participants in this 134 study. In typical clinical settings, however, the particular cards chosen for administration are selected from a pool of 30 cards according to the question at hand and to prior knowledge of the subject's personality style, gender, age, etc. Although this was done, of course, in order to avoid potential confounds of presenting different cards to different subjects, it might have reduced the sensitivity of the test. Finally and perhaps most importantly, the diagnosticians did not administer the test themselves, but instead made their judgments on the basis of typewritten transcripts of the subjects' responses. Most clinicians who use the TAT feel that subtle nuances of the subject's verbal and nonverbal behavior frequently yield important data. Moreover, slight variations in administrative style, as well as the stimulus value each administrator him or herself brings into the testing situation, were not accommodated by the present procedure. Inclusion of such administrative nuances was, of course, impossible in the context of the present procedure. Although potentially useful clinically, tests such as the TAT that rely heavily on such subtleties are inherently difficult to employ in controlled experimental investigations. As noted above, the results of the TAT data were not consistent with the diathesis aspect of Beck's model. This point is elaborated below. 135 The Dysfunctional Attitudes Scale The Dysfunctional Attitudes Scale (DAS, Weissman, 1979) is a 40-item self-report inventory designed specifically to assess the depressotypic schemas proposed by Beck. The inventory consists of statements with which subjects rate their degree of agreement along a 7-point scale. Before the standard self-focused version of the DAS was administered in the present investigation, subjects were asked to complete a version of the DAS in which the instructions had been modified. Instead of asking subjects to rate their own degree of agreement with each statement, they were asked to rate how someone else might possibly respond. It was predicted from past research (e.g., Eaves & Rush, 1984; Hamilton & Abramson, 1983) that the depressives would endorse higher agreement with dysfunctional attitudes on the standard version of the DAS than both the remitted and normal subjects, who would not differ from one another. For the "other person" version of the DAS, the results for the actively depressed and the normal subjects were predicted to be the same as for the standard version. The remitted subjects, however, were predicted to respond similarly to the depressed subjects on this modified version, that is, endorsing a large number of dysfunctional attitudes. It was reasoned that when the evaluative context of the test was made less threatening so 136 that their responses were not seen as a direct reflection on themselves, the remitted subjects might reveal the presence of underlying depressotypic schemas. The results of the standard DAS data were consistent with predictions: The depressives expressed stronger agreement with dysfunctional beliefs than did either the remitted or never-depressed groups, and these latter two groups did not differ from one another. This result is consistent with past studies demonstrating higher DAS scores among actively depressed persons relative to control samples (Dobson & Breiter, 1983; Hamilton & Abramson, 1983; O'Hara, Rehm, & Campbell, 1982; Weissman, 1979). Like the previously discussed finding of higher agreement with the supraliminally presented irrational statements in the tachistoscopic procedure, this finding confirmed that the depressives in the present study were typical of the depressive population at large with respect to the presence of dysfunctional cognitions. In contrast to the results of the standard version of the DAS, the results of the "other person" version were not consistent with predictions made from Beck's theory. When instructed to focus on another person rather than themselves, subjects in all three groups endorsed similar levels of dysfunctional attitudes. Examination of the means for each 137 group revealed an interesting pattern. It was not the depressives, but rather the remitted and normal subjects, who were inconsistent in their responses to the two measures. More specifically, although the remitted and normal subjects endorsed less dysfunctional attitudes relative to the depressives on the standard self-focused version of the DAS, all three groups endorsed the same relatively high level of dysfunctional attitudes on the modified version. Thus, depressives saw themselves and others as sharing an equally pessimistic outlook. The normal and remitted subjects, in contrast, viewed others as holding a relatively high degree of dysfunctional attitudes, whereas they rated themselves more positively. This pattern of results suggests that depressed as well as nondepressed persons share the perception that other people hold a high degree of dysfunctional attitudes. Only the depressives, however, endorse such attitudes themselves. This finding, although counter to predictions for the nondepressed subjects, is nevertheless consistent with the "illusory self-glow" literature discussed previously. Recall that numerous studies have consistently found that depressives are more accurate in their evaluative judgments in a wide range of both social and nonsocial situations than are nondepressed persons. For example, Lewinsohn et al. (1980) found that depressives showed a close correspondence between their self-perceptions 138 and the way they were viewed by others, whereas nondepressives saw themselves more positively than others saw them. The present results may reflect a similar process, whereby nondepressed persons attribute a low degree of dysfunctional beliefs to themselves and a high degree of such beliefs to other persons in order to inflate their self-perception. As noted above, like the results of the tachistoscopic procedure and the TAT procedure, the results of the DAS procedure were not consistent with predictions made according to Beck's theory. This issue is discussed next. Implications for Beck's Theory of Depression The three procedures described above were vastly different methodologies all converging in pursuit of the same construct: a depressotypic cognitive style that reflects a vulnerability for the development of depression. In order to be a true diathesis, such a cognitive style must precede the development of depression, and since depression is an episodic phenomenon, must endure beyond the remission of depression, at least in most individuals. The present investigation took advantage of the episodic nature of depression to examine the presence of depressotypic schemas in remitted depressives. Although other researchers have employed remitted depressives 139 in an effort to study depressotypic schemas, the unique feature of all three of the methods employed here is their attempt to bypass the normal editing processes that might otherwise obscure the presence of depressotypic cognitions in asymptomatic depression-prone persons. Such methods represent the only fair test of the diathesis component of Beck's theory, since he repeatedly emphasizes that the depressotypic schemas are latent in the asymptomatic individual (Sacco & Beck, 1985). The remitted and the never-depressed participants did not differ on any of the measures employed in this investigation, findings which do not support Beck's proposal of latent, depressotypic schemas in the asymptomatic depression-prone person. All three experimental procedures were consistent in revealing no differences between these two groups. The most parsimonious explanation of the present results is that depressotypic cognitions are concomitants of a depressed state, rather than enduring traits. As discussed further below, this conclusion is consistent with the conclusions of a recent paper reviewing this body of literature (Barnett & Gotlib, 1988) . The possibility of latent depressotypic schemas in the asymptomatic depression-prone person cannot, of course, be categorically ruled out on the basis of the present results. 140 It is possible that the procedures employed here failed to reveal depressotypic schemas that were in fact present in the remitted depressives. Although this is always a possibility and the null hypothesis that remitted and normal persons are the same can never be definitively proven, the fact that three different methods all designed to reveal such schemas consistently found no differences between the remitted and the normal subjects mitigates against this conclusion. Moreover, the ad hoc argument that the present procedures failed to tap latent schemas can remain plausible only if the presence of such schemas can somehow be revealed in the asymptomatic person. It might also be argued that the negative findings reflected something about the particular remitted subjects employed in the present study. For example, it might be argued that since these subjects were not assessed by the experimenter while they were actually depressed one cannot be certain that they were in fact representative of the population of remitted clinical depressives. Problems in subject selection were quite unlikely, however, for two reasons. First, great care was taken in the selection of the remitted participants for this study to ensure, as much as possible, that they had had at least one prior significant clinical depressive episode. Where possible, collateral data were obtained from outside sources, such as the subject's past 141 therapist, to supplement and validate the retrospective data provided by the subject herself. Secondly, the majority of the subjects employed in this study also served as participants in another dissertation project in which differences on an operant task employing behavioral measures, and on a social task employing physiological measures were found between the remitted and normal subjects (Sigmon, 1989) . Thus, there were no obvious characteristics of the present sample of remitted subjects that would seem to preclude their possessing depressotypic schemas. Thus, Beck's theory continues to represent a useful description of the cognitive content and processes associated with active depressive episodes. Moreover, his cognitive therapy for depression has proven quite efficacious, and is widely considered one of the most effective interventions for the disorder (Blackburn et al., 1981; Carson & Carson, 1984; Rush et al., 1977). The present results, as well as the bulk of the relevant literature, however, argued against the etiological significance of depressotypic cognitions. Psychological Diatheses for Depression Although Beck's theory is arguably the most well known current psychosocial theory of depression, it is by no means 142 the only such theory to propose a diathesis-stress model of the etiology of depression. In a recently published paper, Barnett and Gotlib (1988) presented a thorough review of the literature that has attempted to distinguish concomitants of depression from antecedents and sequelae of the disorder. They evaluated the results of studies examining six psychosocial variables: attributional style, dysfunctional attitudes, personality, social support, marital distress, and coping style. The authors concluded that, consistent with the present results, there is little support for a cognitive vulnerability for depression. In contrast, Barnett and Gotlib found that various disturbances in personality and interpersonal functioning may be more likely to represent psychosocial diatheses for depression. Specifically, they concluded that there is evidence that remitted depressives demonstrate higher levels of dependency, especially in terms of desiring approval, attention, and help from others, relative to controls. At the same time, they also seem to socialize less than never-depressed controls. There is some evidence that depression-prone persons, including remitted depressives, also tend to be less socially integrated than controls, in that they have fewer important relationships and participate in fewer social activities. Finally, there is substantial support for the conclusion that high levels of marital distress is both an 143 antecedent and a sequela of depression, especially among women. It should be noted that excessive dependency and other interpersonal disturbances highlighted by Barnett and Gotlib as enduring sequelae of depression are almost certainly related to some degree of cognitive dysfunction. For example, an excessively dependent person is likely to manifest irrational cognitions such as "if I were to make a decision on my own the consequences would certainly be disastrous." Thus, disturbances in personality and interpersonal functioning may partially vindicate Beck's theory by suggesting specific dysfunctional content areas in depressives' cognition. Moreover, the particular disturbances in interpersonal and personality functioning, and consequently the particular types of irrational cognitions, may differ across subgroups of depressives. The diathesis-stress model represents a useful framework for theories attempting to explain the development and pathogenesis of psychopathology, including depression. The importance of identifying diathesis conditions cannot be overstated, given their potential utility for primary prevention. The probability that a single, general diathesis for depression can be identified, however, is called into question by the growing appreciation of the heterogeneity of 144 depression (Craighead, 1980; Liberman, 1981; McKnight, Nelson, Hayes, & Jarrett, 1984). Heterogeneity of symptom presentation, while pointing to the possibility of multiple etiologies of depression, does not rule out the possibility of a common diathesis for most depressive disorders. For example, many medical conditions (e.g., Lyme's disease) are characterized by widely differing patterns of symptoms across individuals, but share a common etiology. Nevertheless, it is entirely possible that there are many different etiological pathways leading to similar outcomes that fall under the general rubric of depression. If so, there may not be a single diathesis condition that underlies all depressive disorders, but instead multiple classes of both diatheses and precipitants. Directions for Future Research As noted above, the issue of whether or not a single psychosocial vulnerability can be identified in depression remains an open question. Given the rather heterogeneous symptomatology of depressive disorders, however, it would seem wise for future researchers to give strong consideration to the possibility that there may exist multiple etiological pathways to depression. Even within Beck's theory, for example, the specific beliefs that predispose certain 145 individuals to depression may be idiosyncratic, corresponding only roughly to the core dysfunctional attitudes that Beck describes. Although the present results were inconsistent with Beck's proposal of a cognitive diathesis to depression, the issue is by no means resolved. The present investigation was, to the author's knowledge, the first to employ special assessment procedures in an attempt to measure latent cognitive schemas in depression-prone persons. The results of a single investigation, of course, cannot resolve the issue one way or the other. Moreover, as noted above, the null hypothesis that remitted and normal persons do not differ with respect to depressotypic schemas can never be definitively proven. It behooves future researchers to take seriously Beck's repeated assertion that the schemas he proposes are latent in the asymptomatic person. Even if such schemas are present, it cannot be assumed that they can be assessed simply by asking a person to rate his or her agreement with a series of beliefs. The utility of subliminal perception methods. Despite the lack of differential effects by subject group in the present study, subliminal perception paradigms continue to represent potentially useful tools for exploring unconscious processes in clinical populations, including the possibility 146 of latent depressotypic cognitions in depression. It is generally now accepted that under certain conditions, tachistoscopically presented subliminal stimulation can produce measurable effects on a range of dependent measures (Dixon, 1981). The utility of Silverman's subliminal psychodynamic activation method in particular, on which the present tachistoscopic procedure was partially based, however, has recently been called into question. In a recent critical review of the subliminal psychodynamic activation paradigm, Balay and Shevrin (1988) raise three criticisms of Silverman's method and interpretations of his results. First, they noted that the majority of the reported results are based on gain scores in which a measure collected immediately after an experimental stimulus is subtracted from a measure collected after a prior neutral baseline stimulus. They suggested that it is not possible to know if positive results were due to the effects of the "neutral" baseline stimulus or the critical experimental stimulus. Putatively neutral baseline stimuli (e.g., "people are talking") may evoke a temporary increase in anxiety or some other measure of psychopathology. A decrease in anxiety following the "experimental" stimulus (e.g., "mommy and I are one") may therefore simply reflect a return to the true baseline level, rather than an effect of the latter stimulus. This criticism is not relevant to the 147 present design since (a) the baseline mood measure was collected prior to the presentation of any stimulus, and (b) gain scores were not employed in the final analyses reported. Nevertheless, it does offer a more parsimonious interpretation of some of Silverman's more seemingly incredible results. The second criticism concerned Silverman's hypothesis that a single, universal psychodynamic conflict could be identified that underlies the psychopathology of a given diagnostic group. Balay and Shevrin argued that although this position may be true and the issue remains an empirical one, it is more likely that the specific themes or conflicts underlying any individual * s psychopathology are highly idiosyncratic. As an example of this idiographic approach, they point to ongoing work by Shevrin (in press) in which individualized conflictual themes are extracted from interviews and psychological test data. These themes are then presented, along with control stimuli, both subliminally and supraliminally, while brain event-related potentials are monitored. Greater evoked potentials result from the individualized stimuli than from the control stimuli, even when presented subliminally. This criticism is not, of course, unique to Silverman's method. Although Beck allows for somewhat more latitude in the specific dysfunctional beliefs held by different depressed individuals relative to Silverman, he does propose that the dysfunctional cognitions 148 of all depressives can be summarized by a small number of general statements. The third and final criticism of Silverman's method was that he and his colleagues too quickly extended the subliminal psychodynamic activation method to new populations and applications, relying on sometimes complex ad hoc explanations to account for variations and discrepancies in results. Balay and Shevrin argued for the importance of careful demonstration of the contextual conditions necessary for subliminal effects to occur before attempting such broad applications. It is important to note that despite their criticisms of certain details of Silverman's method and interpretations, Balay and Shevrin strongly support the use of subliminal perception methods to investigate unconscious processes in psychopathology, as reflected in Shevrin's own work described above. In fact, one of their major concerns with the subliminal psychodynamic activation paradigm was that it may decrease the credibility of all subliminal applications; "...it would be misleading if the validity of subliminal perception were to stand or fall on subliminal psychodynamic activation research because the validity of the concept has been so well established in other ways" (p. 172). Thus, subliminal perception methods remain potentially useful tools for investigating potential cognitive markers 149 for depression. In order for such methods to achieve their full potential, however, more systematic research is needed into the basic contextual conditions that facilitate the occurrence of subliminal effects. Other approaches to the study of depressotypic schemas. Despite the finding of no differences between the remitted and depressed subjects in the present study, and despite the unknown reliability of the test as it is typically used, the Thematic Apperception Test (TAT) remains a potentially useful tool for exploring depressotypic schemas. As an alternative to the diagnostic approach employed in the present study, experienced clinicians, blind to subject group, might extract general idiosyncratic themes from the data of actively depressed, remitted, and normal depressed subjects. Although there exists a wealth of observational data on the TAT (e.g., Holt, 1978; Rapaport et al., 1968; Tomkins, 1947), there are little controlled data on the degree to which certain themes are consistently reflected in the data of different diagnostic groups. In contrast, the Dysfunctional Attitudes Scale (DAS) appears ineffective in the assessment of latent depressotypic schemas. Numerous studies, including the present one, have found no differences between remitted depressives and never-depressed controls on the DAS. The DAS is indisputably the 150 best existing instrument for measuring the depressotypic schemas postulated by Beck in the actively depressed person. Its straightforward self-report format, however, seems to preclude its ability to detect beliefs that are outside of the subject's awareness, regardless of the mode of administration. In addition to the procedures employed in the present study, another approach to the search for latent cognitive antecedents and sequelae of depression would be to present asymptomatic depression-prone persons with a relevant stressor, then compare any cognitive changes to a pre-stressor baseline measure. For example, remitted depressives could be told that a confederate with whom they had just interacted disliked them. They could then be asked to complete something like the Dysfunctional Attitudes Scale. Some support could be claimed for the existence of latent depressotypic schemas among remitted depressives if they endorsed higher levels of dysfunctional attitudes following the feedback, relative to never-depressed controls. A potential problem with such a study is that presentation of a stressor that would be strong enough to represent a fair test of the theory would almost certainly be ethically problematic. It is not clear if a stressor could be identified that would activate the schemas only enough to measure their effects, but not enough to produce significant dysphoria. Furthermore, the particular 151 stressors that would elicit depressotypic schemas might be idiosyncratic across individuals. Other psychological diatheses for depression. The increased sensitivity to the heterogeneity of depression is reflected in the recent interest in the relationship between various personality disorders and depression (Farmer & Nelson, in preparation; Hirschfeld & Cross, 1987). Estimates of the co-occurrence of DSM-III personality disorders among clinically depressed outpatients range from 48% (Shea, Glass, Pilkonis, Watkins, & Docherty, 1987) to 75% (Pilkonis & Frank, 1988). Akiskal, Hirschfeld, and Yerevanian (1983), among others, have suggested that a dysfunctional premorbid personality predisposes one to the development of depression, and that the symptomatology of the resulting depression will be colored by the nature of the particular personality style. Research in this area is just beginning, and much work is needed to examine the relationship between one's premorbid personality characteristics and factors that lead to depression. In line with the conclusions of the Barnett and Gotlib (1988) review discussed above and consistent with Sigmon's (1989) recent findings, further research on interpersonal factors that render one vulnerable to depression is clearly indicated. Barnett and Gotlib noted that despite the 152 tentative conclusion that interpersonal dependency places one at risk for depression, there have not yet been developed any well-validated measures of this construct. The authors also stressed the importance of further work on the relationship between marital distress and depression. Given the difficulty and expense of longitudinal research, investigators can continue to take advantage of the episodic nature of depression by comparing remitted depressives with never-depressed controls in searching for psychosocial predispositions to depression. Once a promising candidate for such a diathesis is identified, however, longitudinal designs are indispensable in verifying that the factor actually precedes depression, rather than being a consequence or "scar" (Zeiss & Lewinsohn, 1988) of the disorder. 153 FOOTNOTES 1. It has been argued that the term subliminal perception is oxymoronic, since perception by definition implies awareness. As used in the literature referred to in this discussion, however, the term does not require or even necessarily imply awareness. For the sake of simplicity and consistency with this literature, the effects of stimulation in the absence of awareness will be discussed here under the general rubric of "subliminal perception." 2. Gratitude is expressed to Dr. Doris Silverman and to Dr. Joel Weinberger for graciously providing reprints of some of the late Dr. Lloyd Silverman's unpublished manuscripts. 3. As noted by Weinberger and Silverman (1987), all 11 of the therapy and educational adjunct studies that have met these dosage criteria have produced positive results. 4. Gratitude is expressed to Dr. Richard Shull for his helpful insights into this analysis. 5. Of course, not all remitted depressives would necessarily be expected by Beck's theory to hold depressogenic schemas. It is conceivable, for example, that an intervention such as cognitive therapy or psychotherapy received during or subsequent to a person's last depressive episode may have effectively eliminated these schemas. The high rate of relapse, even among persons who have been treated for one or more episodes of clinical depression, however, suggests that the majority of remitted depressives do hold some diathesis condition that renders them vulnerable to future depression. Moreover, the hypothesis evaluated by the present study does not require that all remitted depressives hold depressogenic schemas, but only that a greater proportion of remitted depressives hold such schemas to a greater extent relative to persons who have never been depressed. 6. I am grateful to Dr. Richard Dauber for providing me a copy of this measure. 7. In order to evaluate further any potential differences between the five experimental stimuli, this 4-way ANOVA was re-run adding the stimuli as a fifth within-subjects factor (see Table 18) . The results of this 4 (order) by 3 (group) by 2 (modality) by 2 (modality) by 5 (stimulus) ANOVA revealed only two significant effects involving the stimulus factor: The valence by stimulus interaction was significant (p = .0069), and the modality by valence by stimulus interaction was significant (p = .0111). Despite the significance of the 154 valence by stimulus interaction on the omnibus test, more conservative post hoc comparisons (Tukey's tests with p < .05) revealed no differences across the five stimuli for either the rational or the irrational conditions. Tukey's tests on the modality by valence by stimulus interaction revealed that for all five stimuli, agreement ratings in the supraliminal conditions were greater than in the subliminal conditions for the rational stimuli, with the opposite pattern for the irrational stimuli. 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Although the specific details of the amine theory are controversial, the basic proposition is that depression is caused by a deficit in certain brain neurotransmitters, especially the catecholamine norepinephrine, and the indolamine serotonin. Although these amines make up only 2% to 5% of all neurotransmitters in the central nervous system, approximately 90% of the amine transmitters are found in the limbic system, which is believed to be involved in autonomic arousal and emotional functioning (Hendler, 1982). Numerous studies lend support to the relationship between low levels of amine neurotransmitters and depression (e.g., Mendels, Fiere, Fitzgerand, Ramsey, & Stokes, 1972) . It remains to be demonstrated, however, that a reduction in these substances causes depression, as opposed to being a consequence or a correlate of depression. 186 Current somatic interventions for depression, including psychotropic medications and electroconvulsive therapy, have been shown to be quite effective for many (though not all) depressed persons. The use of somatic interventions presents several problems, however, including contraindicating factors for many individuals, potentially dangerous short-term and long-term side effects, and the potential for chemical dependence in the case of antidepressant medication. Psychoanalytic Theories Virtually all modern theories of psychopathology owe an often-unrecognized debt to the pioneering work of Sigmund Freud (Sulloway, 1983), and current theories of depression are no exception. As early as 1895, in a letter to his friend Wilhelm Fliess, Freud noted three themes that continue to permeate thinking on depression: the theme of loss in the etiology of the condition, the analogy between depression and the process of mourning, and the frequent association of depression and anxiety (Freud, 1895/1950). Early psychoanalytic formulations of depression, first presented by Abraham (1911, 1916) and subsequently developed by Freud (1917), involve the notion of introjection of hostility and anger unconsciously directed toward a lost love 187 object. According to Freud (1917), the depressive harbors a fundamentally ambivalent attitude toward a particular (often abstract) love object. When the object is lost, libido is not divested from the object and displaced onto a new object, as is the normal course in mourning. Rather, the depressive continues to identify with the lost object. As reality testing proceeds, two consequences of this "narcissistic identification" occur. First, the gradual realization that the object is truly lost becomes synonymous with loss of ego, resulting in low self-esteem. Second, feelings of hostility toward the lost object, which are repressed from consciousness, are introjected onto the self, resulting in feelings of worthlessness and guilt, and tendencies toward self-destructiveness. Later Freudians, such as Rado (1928) and Gero (1936), expanded upon Freud's theory to incorporate his tripartite structure of personality functioning, and his theory of infantile sexuality. The ego psychologists, especially Bibring (1953) , emphasized the depressive's realization of the discrepancy between the ego * s actual state and its ideal state, as well as the ego's helplessness to achieve its ideal state. The object-relations theorists (e.g., Klein, 1948? Jacobson, 1971) extended Freudian concepts back into the first months of life, focusing on the relationship between the infant and significant objects in his or her world. 188 Depression (or at least a predisposition toward depression in later life) was held to result from problems in the formation of object-relations, particularly a failure to discriminate sufficiently the self from significant objects. Empirical data directly evaluating psychodynamic theories of depression are sparse, although recent methodological innovations have provided some support for certain psychoanalytic propositions (Silverman, 1976) . Psychoanalytic interventions for depression have rarely been subjected to systematic empirical evaluation. Despite the paucity of "hard" data, the insightful clinical observations and theoretical work of psychoanalysts continues to exert a powerful influence on the study of depression by theorists and researchers from a variety of theoretical perspectives. Behavioral Theories Several behaviorally-oriented theorists have proposed theories and models in an effort to account for the behavior of depressed persons. Common themes among the various behavioral approaches to depression include a loss of reinforcement and a reduction in the overall rate of emitted behavior. Skinner (1953, 1974) conceptualizes depression as an extinction phenomenon. A reduction in reinforcement or the instigation of response cost for operant behavior leads 189 directly to a reduction in the overall rate of operant behavior. The conceptualization of depression as an extinction phenomenon has been central to all behavioral approaches to depression (Hoberman & Lewinsohn, 1985; Lewinsohn, 1975). Similarly, Lazarus (1968) views depression as the result of a loss of reinforcement, resulting in a weakened behavioral repertoire. Ferster (1973, 1981) conceptualizes depression as a reduction in the rate of operant behavior, and suggests three general factors that might produce this reduction. First, a lean schedule of positive reinforcement will result in a decrease in operant behavior, as suggested by Skinner and Lazarus. Second, failure to escape from aversive social stimuli may result in a reduction in behavior. Third, sudden environmental changes may result in removal of discriminative stimuli for ongoing behavior, thereby resulting in a reduced rate of behavior. Ferster also proposes that the verbal behavior of depressives is controlled primarily by immediate states of deprivation rather than by appropriate social cues. Costello (1972) expands upon Ferster*s idea of the removal of discriminative stimuli for behavior as a possible cause for the reduction in the rate of the depressive's behavior. He suggests that depression is the result of a loss of reinforcement effectiveness, rather than a reduction in the rate or amount of reinforcement. This may occur as the result 190 of neurophysiological changes or the disruption of a behavioral chain. Seligman (1973, 1974) describes a model of depression known as "learned helplessness.11 Depression is viewed as the result of repeated exposure to inescapable aversive stimulation. Facing both theoretical and empirical arguments against the original model, Abramson, Seligman, and Teasdale (1978) proposed a revised version of the theory, essentially arguing that it is the perception of noncontingency between behavior and environmental events, in particular unattainable reinforcement and unavoidable punishment, that causes depression. This revised version of the learned-helplessness theory is discussed further in the next section. A deficit in appropriate self-control behavior constitutes the major theme of a model of depression proposed by Rehm (1977, 1981a). Depressed persons are described as having deficits in self-monitoring, self-evaluation, and self-reinforcement behavior. These deficits are considered relatively stable personality traits, and combine with stressful events in the person's life to produce a depressive episode. For example, in the face of a stressful event, depression-prone persons may only attend to negative aspects of the event, as well as only to the immediate consequences of their behavior. They may simultaneously set unrealistic 191 criteria for their behavior, then punish themselves excessively for not attaining their goals. It is this style of interaction with the environment that is hypothesized to lead to depression. Probably the best known behavioral theorist of depression is Peter Lewinsohn. Lewinsohn and his colleagues have proposed a theory of depression in which a low rate of response-contingent reinforcement ("reconposre") functions as an eliciting stimulus for the emission of some depressive respondents, including feelings of dysphoria, fatigue, and other somatic complaints (Lewinsohn, 1974, 1975; Lewinsohn, Weinstein, & Shaw, 1969). A low rate of response-contingent positive reinforcement also produces other depressive behaviors through the process of operant extinction. Finally, some depressive behaviors may be maintained by reinforcement from the social environment. Thus, Lewinsohn combines both operant and respondent processes in his theory of depression. Lewinsohn maintains that a low rate of response-contingent positive reinforcement is a function of three variables: (a) a small number of events that are potentially reinforcing for an individual (determined by biological and experiential factors); (b) a small amount or rate of reinforcement available from the environment; and (c) a deficit in an individual's social skills (Lewinsohn, 1975). 192 Of these factors, a deficit in appropriate social skills is considered especially important to the development and maintenance of depression (Lewinsohn, Weinstein, & Alper, 1970; Libet & Lewinsohn, 1973) . Given a loss of or a reduction in socially-mediated reinforcement, the individual who does not posses the appropriate skills with which to regain or replace this reinforcement is likely to become depressed. Several studies support the general notion of broad social skills problems in depression (Haley, 1985; Herbert, Nelson, & Herbert, 1987; Lewinsohn, Mischel, Chaplin, & Barton, 1980; Weissman & Paykel, 1974; Youngren & Lewinsohn, 1980), but the precise behaviors that are problematic remain largely unidentified (Coyne, 1976a; Libet & Lewinsohn, 1973; Winer, Bonner, Blaney, & Murray, 1981). Regardless of the role played by social skills in depression, several studies have demonstrated the efficacy of social skills training in the treatment of some depressives (Hersen, Bellack, & Himmelhoch, 1980; Lewinsohn, Weinstein, & Alper, 1970; McKnight, Nelson, Hayes, & Jarrett, 1984; Nelson, Herbert, Herbert, Sigmon, & Brannon, 1987; Wells, Hersen, Bellack, & Himmelhoch, 1979). Lewinsohn and his colleagues have recently proposed a new theory of the etiology and maintenance of depression (Hoberman & Lewinsohn, 1985; Lewinsohn, Hoberman, Teri, & Hautzinger, 193 1985) . Briefly, the theory proposes that environmental stressors result in the disruption of automatic, "scripted" behavior patterns, thereby reducing the rate of positive reinforcement and/or increasing the rate of aversive experiences in the individual's environment. This change in reinforcing conditions then results in a heightened state of self-awareness, especially for negative events. This enhanced self-awareness then leads to increased dysphoria and, ultimately, to the various other depressive symptoms. Once the depressive syndrome has emerged, it feeds into the heightened state of self-awareness to create a vicious cycle of symptom maintenance. Although the model is promising, it has not yet been directly subjected to empirical evaluation. Although not explicitly presented as behavioral, Coyne (1976b) presents a theory of depression in which the depressed person's ongoing interactions with his or her social environment serve to establish and maintain depression. The behavior of the depressive is hypothesized to evoke negative reactions in others in the social environment, causing others to desire to reject and to avoid the depressive. Such escape is impossible, however, due to potential repercusions from the social community at large, who might view rejection of a depressed person as insensitive and uncaring. Thus, the competing demands on significant others in the depressive's environment (desire to avoid vs. potential punishment for 194 rejecting the depressive) results in a disturbed pattern of social interaction, which further exacerbates the depression. Coyne's theory, like Lewinsohn's, highlights the role of social behavior in depression, although Lewinsohn's hypothesis of a social skills deficit in depression is not necessary to Coyne's theory. Several studies support the notion that others find interacting with depressives aversive (Coyne, 1976a; Hammen & Peters, 1978; Herbert et al., 1987; Howes & Hokanson, 1979; Strack & Coyne, 1983), although other studies suggest that a tendency to elicit negative reactions in others is not unique to depressives (Boswell & Murray, 1981; Haley, 1985; King & Heller, 1984) . Coyne (1984) outlines an intervention for depression similar to the approaches described by Burgess (1969) and Liberxnan (1970) , in which others (especially family members) are encouraged to provide veridical feedback to the depressed person regarding his or her behavior in social situations. A similar program has recently been proposed by Gotlib and Colby (1987). Although initial clinical reports from these authors appear favorable, further research is needed to evaluate the efficacy of this approach to therapy for depression. 195 Appendix B Review of Basic Research in Subliminal Perception The Poetzl Phenomenon One of the earliest investigations of subliminal perceptual phenomena resulted from the serrendipitous observations of a contemporary of Freud. Poetzl (1917), studying the neurological effects of lesions in the visual system, found that subjects tended to "release" into consciousness at a later time aspects of stimuli that they were unaware of at the initial time of presentation. This phenomenon has been extensively studied, and has come to be known as the Poetzl effect. In general, the effect refers to the subsequent emergence, usually in dreams but also in other modalities, of stimuli of which the subject was unaware during their initial presentation. Poetzl (1917) labeled the effect the "law of exclusion," referring to the fact that only aspects of a stimulus that are excluded from awareness at the initial presentation subsequently emerge in dreams. In one of Poetzl's (1917) original studies, subjects were presented with 10 msec exposures of a slide of the temple ruins at Thebes, and were asked to describe what they saw, to report any subsequent dreams, and to draw their dream imagery. Consistent with the law of exclusion, only those features of 196 the stimulus that were not reported during the initial presentation of the stimulus appeared in subsequent dreams. The Poetzl effect has received a great deal of scientific • attention, and has been shown to be quite robust across methodological variations (see Shevrin, 1986, for a recent review of this literature). The effect has been shown to be relatively independent of the mode of stimulation. The effect has been demonstrated with very brief stimulus exposures (e.g., Fisher, 1954, 1957, 1960; Fisher & Paul, 1959; Fiss, Goldberg, & Klein, 1963; Giddan, 1967; Haber & Erdelyi, 1967; Luborsky & Shevrin, 1956; Paul & Fisher, 1959; Poetzl, 1917; Shevrin & Luborsky, 1958; Silverman, 1965), and with prolonged stimulus exposures (Malamud, 1934; Malamud & Linder, 1931). Moreover, a wide range of dependent measures have been successfully employed, including dream content (Fisher, 1954; Shevrin & Luborsky, 1958), fantasy drawings (Giddan, 1967), reported imagery (Allers & Teler, 1924; Fiss, Goldberg, & Klein, 1963; Luborsky & Shevrin, 1956), word associations (Allers & Teler, 1924; Shevrin & Fisher, 1967; Shevrin & Fritzler, 1968) , and responses to Rorscharch cards (Silverman, 1965; Silverman & Silverman, 1964). In many studies., it has been found that subsequent responses by subjects appear to be related symbolically, rather than literally, to the initial stimulus (Dixon, 1981). 197 Fisher (1954), in fact, has suggested that the content of normal dreams may be determined by symbolic transformation of prior stimulation of which the individual was unaware or to which he or she was not attending. Of course, the primary criticism of the purported demonstrations of symbolic transformation concerns how objectively the content of subjects' dreams, free associations, and the like can be assessed. That is, how can we be certain that the material obtained by subjects is really reflective of the original stimulus? Later replications and extensions of the Poetzl effect leave little doubt as to the validity of such dependent measurement. For example, Giddan (1967) had judges who were blind to experimental condition evaluate drawings made by subjects as to whether or not they were similar to experimental stimuli that had been tachistoscopically presented for 2.5 msec. The judges placed each drawing into one of three categories according to its relatedness to the original stimulus: "Probable," "Possible," and "None." The results confirmed the Poetzl effect, and the raters achieved an acceptably high level of inter-rater reliability. Perceptual Defense At the heart of the "New Look" movement in perception is the phenomenon of perceptual defense. The basic idea is that 198 recognition thresholds are not fixed, but vary as a function of subject characteristics and the nature of the stimulus, with emotionally threatening or anxiety provoking stimuli requiring longer durations for recognition than less arousing stimuli (Erdelyi, 1974) . Most of the work on perceptual defense uses tachistoscopic presentations of verbal or pictorial stimuli. The typical early paradigm involved subjects verbally or otherwise indicating when they recognized a series of stimuli that were presented for different durations. The results of these studies can be summarized as follows (Brown, 1961; Dixon, 1981): (a) an inverse U relationship exists between stimulus affect and recognition thresholds, with medium levels of emotionality producing higher thresholds relative to low or high levels of stimulus affect; (b) this same relationship holds for individual differences across subjects as a function of their anxiety concerning specific conflict areas; and (c) galvanic skin response (GSR) measures taken before stimulus recognition are higher for emotive than for neutral stimuli. Dixon (1958) has designed an alternative paradigm for studying perceptual defense. While subliminal presentations of high vs. low emotive stimuli are presented to one eye, varying intensities of a neutral stimulus — a spot of light — are simultaneously presented to the other eye. The subject is asked simply to respond when he or she sees the spot of 199 light. The emotive or neutral stimuli remain subliminal, and the subject is not even aware of the fact that he or she is being stimulated. The results of several studies using this methodology have demonstrated perceptual defense effects; the awareness threshold of the neutral stimulus in one eye varies as a function of the emotionality of the stimulus presented subliminally to the other eye (Dixon, 1958; Dixon & Haider, 1961; Henley, 1974; Henley & Dixon, 1976). For example, Henley and Dixon (1976) found that stimuli hypothesized to be particularly disturbing to schizophrenics (i.e., words such as "Breast" and pictorial stimuli of mother-child interactions) raised the awareness threshold for a spot of light presented to the other eye. In contrast to normal controls, however, the emotional word "Cancer" lowered rather than raised the recognition threshold for the neutral stimulus. Using a related methodology, Hardy and Legge (1968) demonstrated that visual thresholds for neutral stimuli vary as a function of the emotionality of subliminal auditory stimuli. A second experiment demonstrated the same effects using the converse relation, in which the emotionality of subliminal visual stimuli affected auditory thresholds. Finally, Worthington (1969) asked subjects to compare the phenomenal brightness of pairs of verbal stimuli of varying 200 degrees of emotionality. The stimuli were presented at equal intensities, well below the recognition threshold, such that they appeared as two faint areas of light on a screen. Consistent with other perceptual defense demonstrations, the highly emotive stimuli were consistently judged as less bright relative to the less emotive stimuli. The previously discussed reappraisal of subliminal perceptual phenomena that took place in 1950's focused heavily on purported demonstrations of perceptual defense. Interestingly, even the critics generally acknowledged that the effects described above were well-established. The focus of concern was instead directed toward distinguishing perceptual from response effects. The "response-bias" criticism of subliminal research is discussed further in a later section, but given its particular relevance to the issue of perceptual defense, it is briefly addressed here. The basic idea is that "subjects recognize taboo and neutral words with equal facility but are reluctant to report embarrassing items, requiring greater certainty and therefore longer exposure durations" (Erdelyi, 1974, p. 8). In signal detection terms, the sensitivity (d1) for both types of stimuli are identical, but the decision criterion (B) is more stringent for reporting affectively-laden stimuli. 201 Although it is difficult to imagine that decision criteria are irrelevant to stimulus reporting, it does not appear that all perceptual defense effects can be accounted for simply in response bias terms. Consider, for example, studies by Ruiz and Krauss (1968) and by Zigler and Yospe (1960) in which perceptual defense effects were demonstrated even when subjects were required to respond outloud to neutral stimulus words with taboo words and vice versa. Studies employing signal detection procedures in an effort to distinguish stimulus sensitivity (d1) from response criterion (B) factors suggest that the former are most important (Broadbent & Gregory, 1967; Chapman & Feather, 1972; Dorfman, 1967; Dorfman, Grossberg, & Kroeker, 1965). It is interesting to note that, according to Dixon (1981), both Dorfman, and Broadbent and Gregory initially espoused a response-bias position on perceptual defense, and actually anticipated finding the opposite results than those obtained. Another argument against the response-bias explanation concerns the typical finding of an inverse U relationship between emotionality and recognition thresholds, discussed above. Recall that the threshold for moderately emotive stimuli is generally higher than the threshold for low emotive stimuli. This finding, combined with the results of supportive studies in which subjects were made to respond to neutral items with taboo words, argues against the notion of 202 a response bias against reporting consciously perceived emotive stimuli. In conclusion, the demonstration of perceptual defense effects using a wide range of carefully controlled experimental paradigms leaves the validity of the phenomenon beyond any reasonable doubt. The Effects of Labels upon the Perception of Ambiguous Stimuli One of the most simple demonstrations of subliminal perception involves the effects of subliminally presented verbal stimuli upon responses given to subsequent supraliminally presented ambiguous stimuli (e.g., Erdley & D'Agostino, 1988). In a classic study, Smith, Spense, and Klein (1959) presented subjects tachistoscopic exposures of gradually increasing durations of the words "Happy" and "Angry," interspersed with supraliminal exposures of an expressionless male face. The results revealed that the face was judged as more pleasant when it had just been preceded by "Happy" than by "Angry." Moreover, this effect was no weaker at extremely brief levels of stimulation than at longer durations of exposure. This effect is not confined to the visual modality, as Henley (1975) found that descriptions of an ambiguous face were influenced by stimulation presented below the auditory threshold. Similarly, Groeger (1986) found 203 that subjects' responses on a sentence completion task were influenced by subliminally presented auditory cues. The results of the Smith et al. (1959) study have been replicated by Sackeim, Packer, and Gurr (1977), and by Somekh and Wilding (1973). In the Somekh and Wilding study, the authors presented "happy" and "sad" stimuli subliminally to one eye, while the neutral face was presented simultaneously supraliminally to the other eye. In addition to replicating the results of the earlier study, the Somekh and Wilding study included conditions in which stimuli structurally similar to "happy" and "sad" ("harry" and "sap") were presented under both sub- and supraliminal conditions. Interestingly, these latter stimuli were only misread in the supraliminal condition, having no effect upon descriptions of the neutral face when presented subliminally. Visual Priming Cognitive psychologists interested in semantic memory have extensively studied a phenomenon known as priming, in which recognition of a stimulus (the target) is facilitated by preceding it immediately with a related stimulus (the prime). For example, it takes subjects less time to say the word "chair" when it immediately follows the word "table" than when it follows "bread" (Meyer & Schvaneveldt, 1971) . 204 Of particular interest in the present context is the discovery by Marcel (1974, 1983) that priming effects occur even when the prime is presented subliminally. Marcel's paradigm involves two phases. In the initial phase, the prime stimulus (a picture or a word) is immediately followed by a "masking" stimulus, consisting of randomly oriented characters, which impairs recognition of the prime. The duration of the stimuli and the interval between the prime and mask are manipulated in an effort to find critical values below which the prime cannot be identified. Thus, the masking stimulus effectively renders the prime subliminal to the subject. The second phase involves a series of trials in which supraliminal exposures of target words are preceded immediately by prime-mask stimuli or nonprime-mask stimuli, which are presented tachistoscopically at values well below the predetermined critical recognition threshold. The primary dependent measure is the reaction time to identify the target stimuli. The typical results are lower reaction times for target stimuli preceded by primes than for targets preceded by nonprimes. Using a similar methodology, Fowler, Wolford, Slade, and Tassinary (1981) presented very brief (10 msec) exposures of prime stimuli followed by a mask. The brief stimulus exposure and the prime-mask interval were such that the subjects were 205 at a chance level of guessing whether any prime stimulus had been presented (as opposed to a blank field). Subjects were required simply to indicate if the target stimulus was a word or a nonword string of letters. Again, priming effects were demonstrated; reaction times were lower when the prime was related to the target stimulus, even though subjects reported being unaware of the prime. In both of the paradigms described above, conditions were also included in which the priming stimuli were presented supraliminally. The differences in recognition times between primed and nonprimed targets were the same whether the primes were presented sub- or supraliminally. Thus, the consistent finding of studies of visual priming is that comparable priming effects occur when subjects are unaware of the prime as when the prime is presented supraliminally. A related experiment using nonverbal stimuli was recently conducted by Overbeeke (1986) in The Netherlands. Brief but supraliminal (750 msec) exposures of a profile of a 10-year old boy were preceded by extremely brief (1 msec) tachistoscopic exposures of either a younger profile, an older profile, or a blank card. Following presentation of the supraliminal stimulus, subjects were asked to estimate the age of the profile. Subjects who received the younger prime judged the target profile as significantly younger than those 206 who received the control (blank) prime, although there were no significant differences between judgments of subjects in the older and control groups. Stereoscopic Visual Stimulation Numerous researchers have investigated the perceptual effects of simultaneous but inconsistent stimulation of the two eyes. These investigations suggest that visual stimulation of which a subject is apparently unaware may nevertheless exert an influence upon perception. In studies of binocular rivalry, in which only the information presented to one eye is perceived, changes in the stimulus field of the other (nondominant) eye will result in an immediate shift in dominance, even though the subject does not report noticing the stimulation that precipitated this shift. For example, Walker (1975, 1978) presented subjects with a red field in one eye and a green field in the other, and the subjects reported seeing only one of the two colors. An additional stimulus of moving black and white squares was then presented to the nondominant eye, which immediately caused it to assume dominance, even though the subjects did not report seeing the squares. 207 Other studies demonstrate the influence of factors such as personality variables and gender on perceptual dominance effects. For example, Wells and Bell (1960) presented a portrait of the subject's father to one eye and the subject's mother to the other eye, and found that the boys showed perceptual dominance for the female parent, whereas the girls showed dominance for the male parent. Dixon (1981) reviewd numerous other investigations using stereoscopic visual stimulation that demonstrate the interaction of the content of such stimulation with a range of subject variables to determine perceptual experience (e.g., Beloff & Beloff, 1959; Beloff & Coupar, 1968; Berg & Toch, 1964; Moore, 1966; Pettigrew, Allport, & Barnett, 1958; Purcell & Clifford, 1966? Reynolds & Toch, 1965; Shelley & Toch, 1962; Toch & Schulte, 1961). Moreover, Shevrin and Dickman (1980) cited several studies of binocular rivalry that demonstrated that a visual evoked response is generated by the stimulation of both the dominant and the suppressed eye (e.g., Cobb, Morton, & Ettlinger, 1967; Harter, Seiple, & Musso, 1974; Harter, Towle, & Musso, 1976; Lehman & Fender, 1968; Spekreijse, Van Der Tweel, & Ragan, 1972). 208 The Mere-Exposure Effect The effects of repeated exposure to virtually any stimulus upon subjects' emotional or aesthetic judgments of that stimulus are well documented: Subjects prefer familiar stimuli over unfamiliar ones (Harrison, 1969; Matlin, 1970; Saegert, Swap, & Zajonc, 1973; Zajonc, 1968). Kunst-Wilson and Zajonc (1980) have recently demonstrated that even repeated subliminal exposures to stimuli increase the appeal of these stimuli relative to novel stimuli. This experiment consisted of an exposure phase followed by a test phase. During the exposure phase, 20 irregular octagons were divided into two groups. Half of thesubjects were presented with 1 msec exposures of stimuli from one group, whereas half were presented with stimuli from the other group. Pretesting with a prior group of subjects revealed that such brief stimulus exposures precluded above chance accuracy in judgments as to whether a stimulus or a blank field was presented. During the test phase, all subjects were presented with 1 second exposures of ten pairs of stimuli, each pair consisting of one stimulus from each original group. The subjects were asked to identify (a) the stimulus they liked best, and (b) the stimulus they had seen before. The results indicated that recognition performance was at a chance level, but a clear preference effect for the familiar stimuli was found. These 209 findings were recently replicated and extended by Bornstein, Leone, & Galley (1987) . Medical Conditions: Cortical Blindness and Anaesthesia Studies of blind or partially blind individuals whose periphereal visual organs are intact, but whose condition is caused by damage to central visual pathways are also relevant to the notion of perception without awareness. These studies reveal that cortically blind persons are able to respond to stimuli that they report being completely unable to see (e.g., Ikeda & Wright, 1974; Poppel, Held, & Frost, 1973). In one such study, Weiskrantz (1977) describes an extensive investigation of a man with blindness in both left half fields as the result of a lesion in his right calcarine fissure. When asked to guess the position of stimuli presented on a screen to his blind field by pointing, or to guess whether an 0" or an "X" was presented on a screen, he proved remarkably accurate. He never acknowledged "seeing" these stimuli, however, although he readily acknowledged seeing even a faint stimulus that was presented to his good field. Another medical condition that is relevant to the present discussion concerns surgical patients under deep anaesthesia. McKean (1985) discussed the recent work of Bennett on the effects of auditory stimulation under anaesthesia on 210 subsequent waking behavior. In one study, anaesthesized subjects undergoing surgery were instructed to signal that they heard the message by pulling their ear during a postoperative interview. Almost all of the experimental subjects pulled at their ear during the interview, although none recalled having been instructed to do so, whereas less han half of a control group of subjects pulled at their ear. Other Basic Research Programs In addition to the investigations described above, several other research areas demonstrate that stimuli of which one is unaware can affect behavioral and physiological measures. Several studies demonstrated that visual stimuli presented below the awareness threshold result in cortical evoked potentials (e.g., Begleiter, Gross, & Kissin, 1969; Libet, Alberts, Wright, & Feinstein, 1967; Shevrin & Rennick, 1967). Shevrin and Fritzler (1968) demonstrated that the primary wave amplitude in response to 1 msec tachistoscopic stimulus exposures was greater for meaningful than for eaningless stimuli. Hartley (1969) used the stereoscopic visual stimulation paradigm to demonstrate that cortical evoked responses associated with stimulation of the dominant eye are reduced in magnitude when emotive stimuli, relative to neutral stimuli, are presented to the suppressed eye. 211 Kemp-Wheeler and Hill (1987) recently demonstrated that subjects exposed to subliminal presentation of affectively-laden words, relative to a group of subjects exposed to neutral words, showed significant increases in several physiological measures of anxiety, including sweating, shaking, and muscular tension. Although most of the work in subliminal perception has focused on the visual system, subliminal effects are not limited to this modality. In studies of visceroception, Adam 1978) has demonstrated that internal stimulation of which the subject reports no awareness, such as the inflation of an intestinal balloon and mild electric shocks to the cervix uteri, result in specific EEG responses. Effects of subliminal auditory stimulation have already been discussed. Libet and his associates (Libet, 1973; Libet et al., 1967) have shown that electrical stimulation of the skin results almost immediately in a cortical evoked response, but that the subject remains unaware of the stimulus until it has been presented for approximately 500 msec. Similarly, direct electrical stimulation of the brain only results in perceptable sensation after continuous stimulation for half a second. Finally, subliminal olfactory stimulation, such as weak concentrations of androstenol or aliphatic acid (which is found in vaginal secretions of primates) have been shown o influence affective judgments of photographs and written descriptions of other people (Cowley, Johnson, & Brooksbanck, 1977; Kirk-Smith, Booth, Carroll, & Davies, 1978). PLEASE NOTE: Copyrighted materials in this document have not been filmed at the request of the author. They are available for consultation, however, in the author's university library. These consist of pages: 213-217, Original Version of D.A.S. 218 Appendix D Ethical Considerations The finding in numerous previous studies that subliminally presented stimuli can affect behavior and mood obviously raises important ethical concerns. Silverman (1977) was well aware of these concerns, and has written an extensive report on ethical considerations and guidelines in the use of subliminal stimulation. The unanimous conclusion of experts in the field is that, except under conditions of repeated exposure over several sessions, the effects of subliminal stimulation are "slight, without subjective discomfort, and very fleeting" (Silverman, 1977, p. 3). Recent reviews of the attempted use of subliminal stimulation for advertising purposes (e.g., Moore, 1982) revealed no evidence for their effectiveness in modifying consumer behavior. This is undoubtedly due to the weak and short-lived nature of subliminally-produced effects under most conditions. In fact, the only studies that have reliably yielded lasting effects of subliminal stimulation are the therapy and educational adjunct studies employing Silverman's (1983, 1984) methodology, in which a therapeutic stimulus is repeatedly presented over many sessions. Silverman (1977) presented the following observations that argue against the possibility that subliminal stimulation in a single laboratory session might produce large or lasting effects: 219 "1) Clinically sophisticated experimenters report that even when they make concerted efforts to judge from Ss' reactions whether an experimental or control stimulus had been exposed, they do not see large enough differences to confidently make such judgments. 2) In the debriefing at the end of each experiment, subjects typically react with disbelief that stimuli had been subliminally exposed and sometinmes explicitly comment that there was no change they subjectively experienced during the experiment" (p. 3). In addition to these observations, Silverman (1977) reported two kinds of objective data that reveal the fleeting nature of subliminal effects. First, subjects who received the experimental stimulus in an initial phase and the control stimulus in a second phase (usually one to three days later) have been compared to those who received the opposite order of conditions. Comparisons of the baseline levels of pathology just prior to the second phase have been made in several studies, and reveal "no differences that even approached significance" (p. 4). The second piece of objective data supporting the short-lived nature of subliminal effects comes from a study by Silverman, Pettit, and Dunne (1971, cited in Silverman, 1977). In this study, two assessments of subjects' pathology were made following presentation of experimental and control stimuli. The first was made immediately following stimulus presentation, whereas the second was made 15 to 3 0 minutes later. The first assessment revealed an increase in pathology immediately following the experimental stimulus, as predicted. By the 220 second assessment, however, the level of pathology had completely returned to its baseline level. Finally, in a recent study of mildly depressed women, Dauber (1984) found statistically significant effects of subliminal stimulation on the same dependent measure that was employed in the present study (i.e., a modified version of the Depressive Adjective Checklist). It should be noted, however, that the actual magnitude of these effects was quite small, and an extremely sensitive measure was required to reveal any change in mood. Although the possibility of risk to any participant in the present study was very unlikely, several precautions were taken in accordance with the guidelines proposed by Silverman (1977). Briefly, these included the following: 1) Each participant received detailed information about the experiment prior to his or her participation. No deception was employed, and the absence of deception was explicitly made clear to the subjects. Informed consent was obtained. 2) Subjects were encouraged to ask questions and voice concerns about the experiment. They were reminded that they could choose to discontinue their participation at any time without any penalty whatsoever. 221 3) An extensive oral and written debriefing took place in which the subliminal stimuli were revealed, as well as the rationale for their use. 4) Each participant was invited to contact the experimenter following the experimental session in order to discuss any lingering negative impact he or she thinks the stimuli may have had. In addition to these precautions recommended by Silverman (1977), the following preventative measures were also taken: 1) All subjects who participate in the study were screened for suicidal potential using a standard measure (the SAD PERSONS scale), and were free of significant suicidal risk. 2) All participants not receiving psychiatric or psychological services at the time of their participation (i.e., possibly some of the depressed subjects, and all of the remitted and never-depressed subjects) were provided a list of community mental health professionals upon completion of the initial screening interview. They were explicitly told that the experimenter's giving them this list in no way reflected a judgment that psychotherapeutic services were needed or recommended, but was simply part of the experimental protocol. 222 3) In the unlikely event that a subject were to have become visibly upset or disturbed during any phase of the experimental session, the experiment would have been stopped immediately. The experimenter would have then discussed any potential concerns the subject might have had, and would have made appropriate referrals as needed. It should be noted that no subject reported being disturbed or upset in any way by the tachistoscopic experimental procedure. All 3 0 subjects who began the procedure completed it without incident. Appendix E Consent for Screening 223 I agree to undergo a brief interview and to complete a brief questionnaire to be used in selecting participants for a psychological study on the effects of verbal stimuli on mood. I have been informed that my participation in this interview is completely voluntary, and that I can decide to stop the interview at any time if I wish. I also understand that all information collected from me will be held completely confidential. If I am currently receiving psychological or psychiatric treatment, or if I have received such treatment in the past, I give my permission for the experimenter to contact my therapist to obtain a brief description of his or her view of my main problems. My therapist's name is/was: I understand that if I am selected for participation in this study, the experimental procedure will be explained to me later. At that time, I will be given another opportunity to decide whether or not I want to continue to participate. Signature Date Witness 224 Appendix F Sample Items from the Schedule for Affective Disorders And Schizophrenia — Life-time Version 1. I would like to hear about any problems or difficulties you are having in your life now. 2. When would you say you first noticed that something was wrong (this time)? 3. Are you feeling better now or is it at its worst now? 4. How long has it been since you were (description of full-blown condition)? 5. Did you ever go to a doctor for your nerves? 6. Were you ever a patient in a psychiatric hospital or ward (before)? 7. Were there any (other) times when you or someone else felt you needed help because of your feelings, your nerves, or the way you were acting? 8. Did you ever have a period that lasted at least 1 week when you were bothered by feeling depressed, sad, blue, hopeless, down in the dumps, that you didn't care anymore, or didn't enjoy anything? 9. What about feeling irritable or easily annoyed? 10. During that time did you seek help from anyone, like a doctor, or minister or even a friend, or did anyone suggest that you seek help? Did you take any medication? Did you act differently with people, your family, at work, or at school? 11. How many episodes like this have you had? 12. When you were (depressed, down) , did you have any beliefs or ideas which you later found out were not true — like people being out to get you, or talking about you behind your back, or that your thoughts or movements were controlled? 13. Did you hear voices or other sounds that other people couldn't hear?...have visions or see things that were not visible to other people?.. .What about strange smells, or strange feelings in your body? 225 14. Did people have trouble understanding what you were talking about? 15. Were you unusually cheerful and energetic at any time, just before, during, or right after you were depressed? 16. Have there been any times other than when you were (depressed, manic), that you were (sick, emotionally upset, in the hospital, heard voices, had strange experiences, felt people were against you...?) 17. What have your drinking habits been like? 18. Was there ever a period in your life when you drank too much? 19. Since you have been an adult have you been the kind of person who often has a few days when you feel down or depressed and then at other times has a few days when you feel even better than normal or high? (Does your mood swing from high to low?) (Are you clearly more active during the high periods? Do you have a lot of energy?) 20. Did you ever have a period that lasted at least 1 week when you were bothered by feeling depressed, sad, blue, hopeless, down in the dumps, or that you just didn't care anymore? 21. Have you ever had panic attacks or anxiety attacks when you suddenly felt very frightened and had physical symptoms like...? (When does this happen?) 22. Have you had periods of at least 2 weeks when you felt anxious or tense (jittery, nervous, restless, "uptight") most of the time? 23. How about being bothered by thoughts that kept coming back to you, that didn't make sense, that you couldn't get rid of or put out of your mind? 24. Have you ever tried to kill yourself or done anything that could have killed you? PLEASE NOTE: Copyrighted materials in this document have not been filmed at the request of the author. They are available for consultation, however, in the author's university library. These consist of pages: 226-228, Beck Inventory 229 Appendix H SAPS PERSONS Scale For Assessing the Risk of Suicide Name Subject # Age Date Score Male < 19 or > Depression Yes Previous attempt Yes Ethanol abuse Yes Rational thinking loss No Yes Social supports lacking Yes Organized plan Yes No spouse Yes Sickness Yes 230 Appendix I Therapist Consent Form This statement acknowledges my permission for the participation of a client/patient under my care, as a participant in a psychological research project concerning the effects of subliminal stimulation on mood. The purpose, nature, and procedures of this proje'ct have been fully explained to me. I have been informed that subjects may experience a mild increase or decrease in dysphoric mood as a result of the experimental stimulation, and that past research with this methodology suggests that any such effects are likely to be very mild and fleeting. I understand that any identifying information obtained will be kept strictly confidential, and will be available only to James Herbert, M.A., Pricipal Investigator, Rosemery 0. Nelson, Ph.D., Professor of Psychology at UNCG, and their research associates. I understand that my client/patient has consented to the experimenter's contacting me regarding his or her case. The client's/patient's current diagnosis is (per DSM-III or DSM-III-R; please specify): Axis I: Axis II: Axis III: I understand that informed consent will be obtained from my client/patient prior to his or her participation in the study proper, and that the voluntary nature of the study has been emphasized to him/her. Therapist's signature Date Witness Appendix J Tables Table 1 Descriptive Data by Subject s A M D B M S S G A I D M A # E R A I P D I G I P T N D E A 0 R L S S • I O • s N 01 29 • 2 • 12 7 24 • 1 03 43 1 12 2 21 0 28 51 1 12 1 21 1 02 45 1 12 5 21 0 23 37 1 12 3 22 1 17 34 2 12 10 25 1 27 34 2 12 8 19 1 21 32 1 12 0 16 0 29 32 1 12 1 14 0 30 39 1 12 5 22 0 06 33 2 7 6 33 1 09 38 1 7 3 21 1 25 39 2 11 2 23 1 07 42 1 7 9 27 2 16 20 2 7 4 30 1 19 47 1 7 10 30 2 24 31 1 7 9 24 1 18 46 1 7 3 21 1 22 41 1 7 4 19 0 26 43 1 7 4 22 0 04 26 1 5 24 47 1 08 40 2 5 34 40 2 20 39 1 1 28 43 1 05 25 1 1 29 36 1 15 30 2 1 45 30 2 11 37 1 5 38 41 3 13 34 2 1 36 37 2 10 45 1 2 40 35 2 12 33 2 5 28 35 3 14 53 1 2 22 35 2 Kev to Variables DIAGNOSIS: 1 = Major Depression 7 = 2 = Dysthymia 8 = 5 = Double Depression 11 = 1-Remitted 2-Remitted 5-Remitted MARITAL STATUS: 1 = Married 2 = Single 233 Table 2 One-Way Analysis of Variance and TuJcey Post Hoc Comparisons on Beck Depression Inventory Source Sums of Squares d.f. F P Group 5085.60 2 102.41 0.0001 Error 670.40 27 Group Mean Grouping (Means with same letter significantly different are not at p < .05) Normal 4.20 A Remitted 5.40 A Depressed 32.40 B 234 Table 3 One-Way Analysis of Variance and Tukey Post Hoc Comparisons on MMPI-Depression Scale Source Sums of Squares d.f. F P Group 1631.40 2 42.57 0.0001 Error 517.40 27 Group Mean Grouping (Means with same letter significantly different are not at p < .05) Normal 20.50 A Remitted 25.00 A Depressed 37.90 B 235 Table 4 One-Way Analysis of Variance and Tukey Post Hoc Comparisons on SADPERSONS Sums of Source Squares d.f. F p Group 10.32 2 12.07 0.0002 Error 11.12 26 Group Mean Grouping (Means with same letter are not significantly different at p < .05) Normal Remitted Depressed 0.44 1.00 1.90 A A B 236 Table 5 One-Way Analysis of Variance on Subjects' Age Sums of Source Squares d.f. F p Group " 31.76 2 0.24 0.7860 Error 1633.86 25 237 Table 6 Method I: Outline of Procedure 1. Visual acuity test 2. Baseline DACL 3. First critical stimulus set (5 stimuli, 4 4-msec exposures each in subliminal condition, or 1 4-sec exposure of each in supraliminal condition), followed by agreement ratings after each series of four exposures (subliminal) or one exposure (supraliminal) 4. First critical DACL 5. 5-minute break 6. Second critical stimulus set and agreement ratings 7. Second critical DACL 8. 5-minute break 9. Third critical stimulus set and agreement ratings 10. Third critical DACL 11. 5-minute break 12. Fourth critical stimulus set and agreement ratings 13. Fourth critical DACL 14. Discrimination Task 15. Post-Experimental Questionnaire 16. Debriefing (written and oral) 238 Table 7 One-Way Analyses of Variance On Discrimination Task Data I. Number of.Correct Discriminations Sums of Source Squares d.f. F p Group 12.87 2 1.52 0.2367 Error 114.10 27 II. Number of "Same" Responses Sums of Source Squares d.f. F p Group 2.60 2 0.53 0.5963 Error 66.60 27 III. Number of "Different" Responses Sums of Source Squares d.f. Group Error 2.60 2 0.53 0.5963 66.60 27 239 Table 8 One-Way Analysis of Variance and Tukey Post Hoc Comparisons on Baseline DACL Sums of Source Squares d.f. F p Group 43152536.27 2 148.07 0.0001 Error 17048786.40 117 Group Mean Grouping (Means with same letter are not significantly different at p < .05) Normal Remitted Depressed -547.70 •339.10 815.80 A B C 240 Table 9 Four-Way Analysis of Variance on DACL Gain Scores Source Sums of Squares d.f. Group Order Group X Order 1088744.92 850140.37 1544232.76 Ss(Group X Order) 5183595.63 Modality 59096.57 Valence 5831.11 Group X Modality 2163 00.27 Group X Valence 60744.41 Modality X Valence 47710.17 Order X Modality 48534.40 Order X Valence 60505.98 Grp X Ord X Mod 265710.59 Grp X Ord X Val 164121.11 Ord X Mod X Val 89701.37 Grp X Mod X Val 23230.80 Ord X Grp X Mod X Val 208427.59 Error 2299279.21 2 3 6 18 1 1 2 2 1 3 3 6 6 3 2 6 54 1.89 0.98 0.89 1.39 0.14 2.54 0.71 1.12 3.51 0.47 1.04 0.64 0.70 0.27 0.82 0.1798 0.4224 0.5201 0.2439 0.7128 0.0883 0.4946 0.2945 0.0212 0.7019 0.4099 0.6958 0.5548 0.7623 0.5624 241 Table 10 Tukey Post Hoc Tests on Order by Modality Interaction for DACL Gain Scores SUBLIMINAL Order 3 Order 1 Order 2 Order 4 (-112.92) (17.28) (148.92) (201.72) Order 3 (-112.92) - n.s. * * Order 1 (17.28) - n.s. n.s. Order 2 (148.92) - n.s. Order 4 (201.72) SUPRALIMINAL Order 3 Order 2 Order 4 Order 1 (-88.58) (-45.67) (76.27) (131.78) Order 3 (-88.58) - n.s. n.s. n.s. Order 2 (-45.67) - n.s. n.s. Order 4 (76.27) - n.s. Order 1 (131.78) *p < .05 242 Table 10 (Continued) Tukey Post Hoc Tests on Order by Modality Interaction for DACL Gain Scores ORDER 1 Subliminal (17.28) Supraliminal (131.78) Subliminal (17.28) Supraliminal (131.78) n.s. ORDER 2 Supraliminal (-45.67) Subliminal (148.92) Supraliminal (-45.67) Subliminal (148.92) ORDER 3 Subliminal (-112.92) Supraliminal (-88.58) Subliminal (-112.92) Supraliminal (-88.58) n.s. ORDER 4 Supraliminal (76.28) Subliminal (201.72) Supraliminal (76.28) Subliminal (201.72) n.s. *p < .05 243 Table 11 Four-Way Analysis of Variance on Unadjusted DACL Scores Source Sums of Squares d.f. F p Group 53856421.80 2 63. 64 0. 0001 Order 3066641.15 3 2. 42 0. 1000 Group X Order 1945651.18 6 0. 77 0. 6059 Ss(Group X Order) 7616763.63 18 Modality 59096.57 1 1. 39 0. 2439 Valence 5831.11 1 0. 14 0. 7128 Group X Modality 216300.27 2 2. 54 0. 0883 Group X Valence 60744.41 2 0. 71 0. 4946 Modality X Valence 47710.17 1 1. 12 0. 2945 Order X Modality 448534.40 3 3. 51 0. 0212 Order X Valence 60505.98 3 0. 47 0. 7019 Grp X Ord X Mod 265710.59 6 1. 04 0. 4099 Grp X Ord X Val 164121.11 6 0. 64 0. 6958 Ord X Mod X Val 89701.37 3 0. 70 0. 5548 Grp X Mod X Val 23230.80 2 0. 27 0. 7623 Ord X Grp X Mod X Val 208427.59 Error 2299279.21 6 54 0.82 0.5624 244 Table 12 Tukey Post Hoc Tests on Group Main Effect For Unadjusted DACL Scores Group Mean Grouping (Means with same letter are not significantly different at p < .05) Normal -585.63 Remitted -517.97 Depressed 869.90 A A B 245 Table 13 Tukey Post Hoc Tests on Order by Modality Interaction for Unadjusted DACL Scores SUBLIMINAL Order 2 Order 4 Order 1 Order 3 (-361.42) (-275.94) (98.39) (144.92) Order 2 (-361.42) * * Order 4 (-275.94) * * Order 1 (98.39) Order 3 (144.92) SUPRALIMINAL Order 2 Order 4 Order 1 Order 3 (-166.83) (-150.50) (-16.11) (120.58) Order 2 (-166.83) - n.s. n.s. * Order 4 (-150.50) - n.s. * Order 1 (-16.11) - n.s. Order 3 (120.58) *p < .05 246 Table 13 (Continued) Tukey Post Hoc Tests on Order by Modality Interaction for Unadjusted DACL Scores ORDER 1 Supraliminal (-16.11) Subliminal (98.38) Supraliminal (-16.11) Subliminal (98.38) n.s. ORDER 2 Subliminal (-361.42) Supraliminal (-166.83) Subliminal (-3 61.42) Supraliminal (-166.83) ORDER 3 Supraliminal (120.58) Subliminal (144.92) Supraliminal (12 0.58) Subliminal (144.92) n.s, ORDER 4 Subliminal (-275.94) Supraliminal (-150.50) Subliminal (-275.94) Supraliminal (-150.50) n.s. *p < .05 247 Table 14 Post Hoc Tests on Order by Modality Interaction For Unadjusted DACL Scores Using Method Described bv Boik f!979^ Unlike standard Tukey post hoc comparisons, in which each level of one treatment (A) is tested against every other level of that treatment at a single level of treatment B, the procedure described by Boik allows grouping of the treatment A means. This allows specific hypotheses to be tested, rather than the standard null hypothesis that all levels are the same. The procedure involves computing an F-test, using the following formula to calculate the sums of squares: n q A2 where n = nubmer of subjects per cell, q = number of levels of factor X collapsed across, and A = E cM, where M = the means being compared, and c = the vector coefficients (which must always sum to zero). The vector coefficients are used to determine which means are compared. The vector coefficients for the present analyses are listed in the table below: ORDER 1 2 3 4 First Condition Of Each Order Sub Supra MODALITY Sub Suora Irrational +1 +1 +1 +1 +1 +1 Rational +1 -1 -1 +1 -1 -1 Irrational -1 +1 -1 -1 +1 -1 Rational -1 -1 + 1 -1 -1 +1 1 2 3 4 5 6 COMPARISON NUMBER Comparison 1: F (1,54) = 1.65 (n.s.) Comparison 2: F (1,54) = 67.53 (P < .01) Comparison 3: F (1,54) = 0.10 (n.s.) Comparison 4: F (1,54) = 2.06 (n.s.) Comparison 5: F (1,54) = 15.67 (P < .01) Comparison 6: F (1,54) = 1.28 (n.s.) 248 Table 14 (Continued) Post Hoc Tests on Order by Modality Interaction For Unadjusted DACL Scores Using Method Described bv Boik (1979) Thus, only Comparisons 2 and 5 were significant. Both of these involved comparing orders in which the rational statements were presented first vs. orders in which the irrational statements were presented first, regardless of modality of presentation. 249 Table 15 Sequence of Orders and Means Broken Down By Order X Modality for Unadjusted DACL Scores ORDER SEQUENCE 1 Sub-Irrat / Sub-Rat / Supra-Irrat / Supra-Rat 2 Sub-Rat / Sub-Irrat / Supra-Rat / Supra-Irrat 3 Supra-Irrat / Supra-Rat / Sub-Irrat / Sub-Rat 4 Supra-Rat / Supra-Irrat / Sub-Rat / Sub-Irrat (Note that Sub = subliminal, Supra = supraliminal, Rat = rational, and Irrat = irrational) ORDER MODALITY Sub Suora 1 93.39 -16.11 2 -361.42 -166.83 3 144.92 120.58 4 -275.94 -150.50 250 Table 16 Pearson's Correlations of Agreement Ratings For Individual Stimuli Stimulus Number Sum 0.75678 0.82759 0.71133 0.72874 0.90057 p < .0001 p < .0001 p < .0001 p < .0001 p < .0001 0.74730 0.72358 0.74984 0.89766 p < .0001 p < .0001 p < .0001 p < .0001 0.77877 0.73846 0.91613 p < .0001 p < .0001 p < .0001 0.67760 0.86805 p < . 0001 p < . 0001 0.87578 p < .0001 Sum Definition of Stimuli Rational 1. I don't have to be perfect. 2. I don't have to be loved by everyone. 3. Making mistakes is OK. 4. It's OK to disagree. 5. I don't always have to be successful. Irrational 1. I have to be perfect. 2. I have to be loved by everyone. 3. Making mistakes is terrible. 4. I must agree with everyone. 5. I have to be sucessful at everything. 251 Table 17 Four-Way Analysis of Variance on Sum of Agreement Ratings Sums of Source Squares d.f. F p Group 2127. 64 2 0. 21 0. 8089 Order 13358. 91 3 0. 90 0. 4613 Group X Order 16729. 84 6 0. 56 0. 7546 Ss(Group X Order) 89249. 63 18 Modality 1442. 17 1 0. 28 0. 6012 Valence 421128. 57 1 • o CO 72 0. 0001 Group X Modality 7913. 29 2 0. 76 0. 4733 Group X Valence 120076. 45 2 11. 51 0. 0001 Modality X Valence 393822. 11 1 75. 49 0. 0001 Order X Modality 35069. 31 3 2. 24 0. 0940 Order X Valence 31581. 94 3 2. 02 0. 1223 Grp X Ord X Mod 24559. 71 6 0. 78 0. 5858 Grp X Ord X Val 33131. 37 6 1. 06 0. 3988 Ord X Mod X Val 5382. 86 3 0. 34 0. 7936 Grp X Mod X Val 131569. 72 2 12. 61 0. 0001 Ord X Grp X Mod X Val 27644.73 6 0.88 0.5136 Error 281709.21 54 252 Table 18 Five-Way Analysis of Variance on Individual Agreement Ratings Sums of Source Squares d.f. F p Group 424. 11 2 0. 21 0. 8095 Order 2671. 78 3 0. 90 0. 4613 Group X Order 3345. 97 6 0. 56 0. 7546 Ss(Group Order) 17849. 93 18 Modality 288. 43 1 0. 92 0. 3376 Valence 84225. 71 1 269. 30 0. 0001 Stimulus 1382. 24 4 1. 10 0. 3541 Group X Modality 1582. 66 2 2. 53 0. 0811 Group X Valence 24015. 29 2 38. 39 0. 0001 Group X Stimulus 498. 65 8 0. 20 0. 9908 Modality X Valence 78764. 42 1 251. 84 0. 0001 Modality X Stimulus 593. 27 4 0. 47 0. 7547 Order X Group 3345. 97 6 1. 78 0. 1017 Order X Modality 7013. 86 3 7. 48 0. 0001 Order X Valence 6316. 39 3 6. 73 0. 0002 Order X Stimulus 2892. 66 12 0. 77 0. 6807 Valence X Stimulus 4501. 18 4 3. 60 0. 0069 Grp X Ord X Mod 4911. 94 6 2. 62 0. 0171 Grp X Ord X Stm 3730. 34 24 0, 50 0. 9788 Grp X Ord X Val 6626. 27 6 3. 53 0. 0021 Ord X Mod X Val 1076. 57 3 1. 15 0. 3300 253 Table 18 (Continued) Five-Way Analysis of Variance on Individual Agreement Ratings Source Sums of Squares d.f, Ord X Mod Ord X Val Grp X Mod Mod X Val Grp X Mod Grp X Val Ord X Grp Ord X Grp Ord X Grp Grp X Mod Ord X Mod Grp X Ord Error X Stm X Stm X Val X Stm X Stm X Stm X Mod X Mod X Val X Val X Val X Mod 2916.44 2288.08 26313.94 4141.98 1401.62 798.95 X Val 5528.95 X Stm 4046.00 X Stm 2757.60 X Stm 3628.39 X Stm 2298.15 X Val X Stm 2941.52 106963.24 12 12 2 4 8 8 6 24 24 8 12 24 342 0.78 0.61 42.07 3.31 0.56 0.32 2.95 0.54 0.37 1.45 0.61 0.39 0.6742 0.8341 0.0001 0.0111 0.8103 0.9585 0.0081 0.9644 0.9976 0.1745 0.8318 0.9961 Table 19 Tukey Post Hoc Tests on Group X Valence Interaction For Sum of Agreement Ratings IRRATIONAL Remitted (151.90) Normal (170.70) Depressed (213.20) Remitted (151.90) Normal (170.70) Depressed (213.20) n. s. n.s. n. s. RATIONAL Depressed (261.05) Normal (310.25) Remitted (344.75) Depressed (261.05) Normal (310.25) Remitted (344.75) n.s, * n.s. NORMAL Irrational (170.70) Rational (310.25) Irrational Rational (170.70) (310.25) REMITTED Irrational (151.90) Rational (344.75) Irrational Rational (151.90) (344.75) DEPRESSED Irrational (213.20) Rational (261.05) Irrational (213.20) Rational (261.05) n.s. *p < .05 255 Table 20 Tukey Post Hoc Tests on Modality X Valence Interaction For Sum of Agreement Ratings IRRATIONAL Supraliminal Subliminal (123.87) (233.33) Supraliminal (123.87) Subliminal (233.33) RATIONAL Subliminal Supraliminal (241.30) (369.40) Subliminal (241.30) Supraliminal (3 69.40) SUBLIMINAL Irrational (233.33) Rational (241.30) Irrational Rational (233.33) (241.30) n. s. SUPRALIMINAL Irrational (123.87) Rational (369.40) Irrational Rational (123.87) (369.40) *p < .05 256 Table 21 Tukey Post Hoc Tests on Group X Modality X Valence Interaction for Sum of Agreement Ratings SUBLIMINAL-IRRATIONAL Depressed Normal Remitted (223.40) (232.50) (244.10) Depressed Normal Remitted (223.40) (232.50) (244.10) n.s. n.s. n.s. SUBLIMINAL-RATIONAL Normal (216.90) Depressed (242.80) Remitted (264.20) Normal Depressed Remitted (216.90) (242.80) (264.20) n.s. n.s. n.s. SUPRALIMINAL-IRRATIONAL Remitted Normal Depressed (59.70) (108.90) (203.00) Remitted Normal Depressed (59.70) (108.90) (203.00) n.s. * * SUPRALIMINAL-RATIONAL Depressed (279.30) Normal (403.60) Remitted (425.30) Depressed Normal Remitted (279.30) (403.60) (425.30) n.s. *p < .05 257 Table 21 (Continued) Tukey Post Hoc Tests on Group X Modality X Valence Interaction for Sum of Agreement Ratings NORMAL-SUBLIMINAL Rational (216.90) Irrational (232.50) Rational Irrational (216.90) (232.50) n.s. NORMAL-SUPRALIMINAL Irrational (108.90) Rational (403.60) Irrational Rational (108.90) (403.60) REMITTED-SUBLIMINAL Irrational (244.10) Rational (264.20) Irrational (244.10) Rational (264.20) n.s. REMITTED-SUPRALIMINAL Irrational (59.70) Rational (425.30) Irrational (59.70) Rational (425.30) DEPRESSED-SUBLIMINAL Irrational (223.40) Rational (242.80) Irrational (223.40) - n.s. Rational (242.80) DEPRESSED-SUPRALIMINAL Irrational Rational (203.00) (279.30) Irrational (203.00) Rational (279.30) *p < .05 258 Table 21 (Continued) Tukey Post Hoc Tests on Group X Modality X Valence Interaction for Sum of Agreement Ratings NORMAL-IRRATIONAL Supraliminal (108.90) Subliminal (232.50) Supraliminal (108.90) Subliminal (232.50) NORMAL-RATIONAL Subliminal (216.90) Supraliminal (403.60) Subliminal (216.90) Supraliminal (403.60) REMITTED-IRRATIONAL Supraliminal (59.70) Subliminal (244.10) Supraliminal (59.70) Subliminal (244.10) REMITTED-RATIONAL Subliminal (264.20) Supraliminal (425.30) Subliminal (264.20) Supraliminal (425.30) DEPRESSED-IRRATIONAL Supraliminal (203.00) Subliminal (223.40) Supraliminal (203.00) Subliminal (223.40) n. s. DEPRESSED-RATIONAL Subliminal (242.80) Supraliminal (279.30) Subliminal (242.80) Supraliminal (279.30) n.s. *p < .05 259 Table 22 One-Way Analyses of Variance on TAT Latency and Response Time Data I. Card l; Latency to First Response Sums of Source Squares d.f. F p Group 126.67 2 1.23 0.3077 Error 1388.30 27 II. Card 1: Total Response Time Sums of Source Squares d.f. Group Error 630.46 2 0.21 0.8122 40604.90 27 260 Table 22 (Continued) One-Way Analyses of Variance on TAT Latency and Response Time Data I. Card 3BM: Latency to First Response Sums of Source Squares d.f. F p Group 136.87 2 0.90 0.4179 Error 2049.80 27 II. Card 3BM: Total Response Time Sums of Source Squares d.f, Group Error 1128.20 2 0.26 0.7735 58742.60 27 261 Table 22 (Continued) One-Way Analyses of Variance on TAT Latency and Response Time Data I. Card 10: Latency to First Response Source Sums of Squares d. f. F P Group 330.20 2 1. 03 0.3705 Error 4326.50 27 II. Card 10: Total Response Time Source Sums of Squares d.f. F P Group Error 651.86 2 0.20 0.8174 40096.00 25 262 Table 22 (Continued) One-Way Analyses of Variance on TAT Latency and Response Time Data I. Card 14: Latency to First Response Sums of Source Squares d.f. F p Group 355.45 2 2.63 0.0913 Error 1758.00 26 II. Card 14: Total Response Time Sums of Source Squares d.f. Group Error 1246.61 2 0.32 0.7279 50407.26 26 263 Table 23 One-Way Analyses of Variance on Sum of TAT Latency and Response Time Measures I. Latency to First Response Sums of Source Squares d.f. F p Group 1915.49 2 1.03 0.3699 Error 24095.96 26 II. Total Response Time Sums of Source Squares d.f. Group Error 9597.05 2 0.20 0.8187 594917.37 25 264 Table 24 One-Way Analysis of Variance and Tukey Post Hoc Comparisons On Number of Depression Diagnoses Assigned to Each Group Source Sums of Squares d.f F p Group 85.40 2 5.16 p < . 05 Error 223.40 27 Group Mean Grouping (Means with same letter are significantly different at p not <. 05) Normal 3.5 A B Remitted 1.9 A Depressed 6.0 B 265 Table 25 Mean Number of Depression Diagnoses in Relation to Actual Diagnostic Status for Depressed and Normal Subjects Psychologists• Judgment Depressed Not Depressed A D x = 6 X = 4 c i Dep SD = 1.70 SD = 1.70 t a u q X = 3.5 X = 6.5 a n Not Dep SD = 2.07 SD = 2. 07 1 o s i s Remitted Ss --Judgment of depressed: x = -Judgment of not depressed: x = 1.9, SD = 8.1, SD = 1.20 1.20 266 Table 2 6 One-Way Analysis of Variance on Modified DAS Sums of Source Squares d.f. Group Error 266.58 2 0.10 0.9045 34398.59 26 267 Table 27 One-Way Analysis of Variance and Tukey Post Hoc Comparisons on Standard DAS Sums of Source Squares d.f. F p Group 12683.57 2 6.96 0.0038 Error 23675.26 26 Group Mean Grouping (Means with same letter are not significantly different at p < .05) Normal Remitted Depressed 108.78 107.70 152.20 A A B 268 Table 28 One-Way Analysis of Variance on- Difference Between Standard and Modified DAS Sums of Source Squares d.f. Group Error 9591.17 2 2.10 0.1431 59464.69 26 s u B J E C T # 01 01 01 01 03 03 03 03 28 28 28 28 02 02 02 02 23 23 23 23 17 17 17 17 27 27 27 27 21 21 21 21 29 29 29 29 269 S U M A G R E E 249 270 226 357 84 77 123 363 248 251 22 454 339 235 15 409 287 314 131 426 233 226 82 468 246 238 224 330 228 227 104 360 223 93 12 470 Table 29 Raw Data CKev to Variables at End of Table) G M V 0 D B M S B C D R 0 A R I D M A D R A 0 D L D A I P D A D S U A E E G I P C A 1 P L N R N D E L C I C 0 R L T E S S . Y • I 0 • • • • s N • • 1 1 1 1 12 07 24 1 -708 -706 121 1 1 2 1 -652 1 2 1 1 -593 1 2 2 1 -746 1 1 1 1 12 02 21 0 403 -309 111 1 1 2 1 112 1 2 1 1 -300 1 2 2 1 -413 1 1 1 1 12 01 21 1 -820 -704 138 1 1 2 1 -340 1 2 1 1 -430 1 2 2 1 -455 1 1 1 2 12 05 21 0 -921 -1120 135 1 1 2 2 -1070 1 2 1 2 -1186 1 2 2 2 -977 1 1 1 2 12 03 22 1 -1029 -1259 139 1 1 2 2 -989 1 2 1 2 -1127 1 2 2 2 -1071 1 1 1 3 12 10 25 1 -740 -572 109 1 1 2 3 -410 1 2 1 3 -745 1 2 2 3 -687 1 1 1 3 12 8 19 1 -24 136 • 1 1 2 3 163 1 2 1 3 75 1 2 2 3 -10 1 1 1 4 12 0 16 0 -302 -600 177 1 1 2 4 -564 1 2 1 4 -443 1 2 2 4 -525 1 1 1 4 12 1 14 0 -752 -764 172 1 1 2 4 -942 1 2 1 4 -572 1 2 2 4 -744 270 Table 29 (Continued) Raw Data S U B J E C T # G R 0 U P M 0 D A L 1 T Y V A L E N C E 0 R D E R D I A G N 0 S 1 s B D I M M P I D S A D P E R S O N B D A C L C R D A C L D A S 1 D A S S U M A G R E E 30 1 1 1 4 12 5 22 0 -584 -406 157 123 30 1 1 2 4 -384 30 1 2 1 4 -508 30 1 2 2 4 -588 06 2 1 1 1 7 6 33 1 395 232 186 133 06 2 1 2 1 -493 06 2 2 1 1 -553 06 2 2 2 1 -149 09 2 1 1 1 7 3 21 1 -402 -696 93 109 09 2 1 2 1 -618 09 2 2 1 1 -488 09 2 2 2 1 -491 25 2 1 1 1 11 2 23 1 -224 -262 118 102 25 2 1 2 1 -288 25 2 2 1 1 -546 25 2 2 2 1 -677 07 2 1 1 2 7 9 27 2 -456 -622 182 108 07 2 1 2 2 -517 07 2 2 1 2 -371 07 2 2 2 2 -483 16 2 1 1 2 7 4 30 1 -487 -677 189 146 16 2 1 2 2 -704 16 2 2 1 2 -723 16 2 2 2 2 -667 19 2 1 1 3 7 10 30 2 32 -242 59 77 19 2 1 2 3 -136 19 2 2 1 3 -45 19 2 2 2 3 -151 24 2 1 1 3 7 9 24 1 -681 -532 193 127 24 2 1 2 3 -692 24 2 2 1 3 -437 24 2 2 2 3 -821 18 2 1 1 4 7 3 21 1 -256 -334 156 81 18 2 1 2 4 -121 18 2 2 1 4 -375 18 2 2 2 4 -388 188 238 150 399 316 307 41 461 223 228 13 460 214 296 152 462 384 460 26 353 182 251 52 346 236 254 93 456 240 66 53 458 178 294 54 444 271 Table 29 (Continued) Raw Data s G M V 0 D B M S B C D D S u R 0 A R I D M A D R A A U B 0 D L D A I P D A D S S M J U A E E G I P C A 1 2 A E P L N R N D E L C G C I C • 0 R L R T T E • s S • E # Y • I 0 • E • * • • • s N • • • 22 2 1 1 4 7 4 19 0 -388 -960 153 100 206 22 2 1 2 4 -878 222 22 2 2 1 4 -682 73 22 2 2 2 4 -675 365 26 2 1 1 4 7 4 22 0 -924 -824 99 94 262 26 2 1 2 4 -1036 264 26 2 2 1 4 -753 40 26 2 2 2 4 -844 448 04 3 1 1 1 5 24 47 1 550 1178 114 167 145 04 3 1 2 1 1097 205 04 3 2 1 1 757 253 04 3 2 2 1 541 244 08 3 1 1 1 5 34 40 2 754 831 164 94 236 08 3 1 2 1 838 287 08 3 2 1 1 839 207 08 3 2 2 1 977 366 20 3 1 1 1 1 28 43 1 1093 1384 198 133 179 20 3 1 2 1 1167 411 20 3 2 1 1 944 51 20 3 2 2 1 1493 470 05 3 1 1 2 1 29 36 1 389 408 150 207 222 05 3 1 2 2 -42 196 05 3 2 1 2 621 296 05 3 2 2 2 492 181 15 3 1 1 2 1 45 30 2 1229 1008 119 140 236 15 3 1 2 2 1247 254 15 3 2 1 2 1819 227 15 3 2 2 2 1671 250 11 3 1 1 3 5 38 41 3 445 953 98 195 217 11 3 1 2 3 910 224 11 3 2 1 3 447 228 11 3 2 2 3 680 302 13 3 1 1 3 1 36 37 2 1160 755 153 34 282 13 3 1 2 3 1406 195 13 3 2 1 3 1792 335 13 3 2 2 3 1349 177 272 Table 29 (Continued) Raw Data S U B J E C T # G R 0 U P M 0 D A L I T Y V A L E N C E O R D E R D I A G N 0 S I s B D I M M P I D S A D P E R S O N B D A C L C R D A C L D A S 1 D A S 2 S U M A G R E E 10 3 1 1 4 2 40 35 2 1358 566 138 189 10 3 1 2 4 550 10 3 2 1 4 917 10 3 2 2 4 532 12 3 1 1 4 5 28 35 3 834 961 154 172 12 3 1 2 4 823 12 3 2 1 4 1460 12 3 2 2 4 677 14 3 1 1 4 2 22 35 2 346 36 72 53 14 3 1 2 4 -90 14 3 2 1 4 219 14 3 2 2 4 583 250 279 208 243 238 107 221 199 168 47 374 Kev to Variables GROUP: 1 = Normal 2 = Remitted 3 = Depressed MODALITY: 1 = Subliminal 2 = Supraliminal VALENCE: 1 = Irrational 2 = Rational ORDER: See Table 9 DIAGNOSIS: 1 = Major Depression 7 = 1-Remitted 12 = No 2 = Dysthymia 8 = 2-Remitted dx 5 = Double Depression 11 = 5-Remitted CRDACL: Unadjusted DACL scores SUMAGREE: Sum of agreement ratings 273 Appendix K Some Mental Health Professionals in the Greensboro Area AGENCIES WITH A SLIDING FEE SCHEDULE: Guilford County Mental Health Center 373-3630 UNCG Psychology Clinic 334-5662 PSYCHOLOGISTS Dr. Isis Badawi 275-9889 Dr. Floyd Heiney 275-9889 Dr. Jane Perrin 378-0398 Dr. Richard Cook (Kernersville) 993-8281 PSYCHIATRISTS Dr. Raouf Badawi 854-2391 Dr. Gary Henschen 299-0108 Dr. Victor Morcos 854-2391 Dr. Edward Rhoads 299-0511 Please note that we are giving this list of names to everyone who participates in the study who is not already seeing a therapist. Your receiving this list is simply routine, and does not in anv wav imply that vou need to see a therapist. 274 Appendix L Information About Study of Subliminal Stimulation on Mood There are many things that reduce and intensify sad or depressed feelings. One important group of factors, we believe, are faint or indistinct experiences people have. By experimentally studying these factors in different groups of people we hope to understand better what causes clinical depression. If you decide to participate in this study you will be asked at different points in time to indicate the degree to which you are experiencing different feelings, and how much you agree with certain statements. You will also be asked to look at flashes of light that will be statements very quickly exposed. Some of the statements may make you feel slightly more sad, some may have no effect at all on your mood, and some of the statements may make you feel slightly less sad. From past research with this procedure we know that the effects of these statements are typically very fleeting, and as soon as the study is over I will tell you exactly what the statements were. Moreover, no deception is used in this study. In other words, we are not trying to trick you in any way. From this study we hope to learn something about depression, which will hopefully be useful in treating and perhaps preventing this disturbing experience. You do not have to participate in this study, and if you do agree to participate you can still change your mind at.any time and withdraw from it. All identifying information collected from you will remain strictly confidential. 275 Appendix M Consent Form I agree to participate in this psychological study investigating the effects of subliminal stimulation on mood. The nature of the study has been fully explained to me. I understand that I will be looking at flashes of light that will be statements exposed very quickly, and that these statements may temporarily slightly reduce or intensify certain feelings, particularly sad or depressed feelings. I understand that as soon as the experiment is over I will be told what the statements are, and the purpose of the study will be explained more fully. I understand that I am free to ask the experimenter any questions about the study at any time. I have been informed that this study is not meant to be psychological treatment of any kind. I further understand that my participation is completely voluntary, and that I can withdraw from the study at any time. Finally, I understand that any identifying information collected from me will remain strictly confidential. Signature Date Witness 276 Appendix N Post-Experimental Questionnaire Name S# Date Please answer the following questions: 1. Did you notice any change in your mood during the course of the experiment? Yes No If yes, how much of a change did you notice? A small negative change A moderate negative change A large negative change A small positive change A moderate positive change A large positive change 2. Please briefly describe any mood changes you noticed during the study. 3. How difficult was it for you to rate how much you agreed with the statements when they were exposed very quickly? Impossible Very difficult Moderately difficult Moderately easy Very easy 277 During the last part of the experiment in which the different stimuli were flashed, were you able to tell them apart? Could you actually read the statements during this last phase? Did you find the study in any way unpleasant? If so, please describe. Any further comments? Appendix O Agreement Ratings 278 Name S# Date Please put a mark along the line to indicate how much you agree or disagree with each statement. Sometimes the statements will be flashed so quickly that it will be very difficult or even impossible to see them. In this case, please mark your guess as to how much you'd agree with the statement if you could see it. Disagree completely Agree completely 1. I i Disagree completely Agree completely 2 . I I Disagree completely Agree completely 3. I : I Disagree completely Agree completely 4. I I Disagree completely Agree completely 5. I I 275 Appendix P MOOD SCALE A A number of research studies have found that if you pay close attention to your emotions, you can sometimes detect changes in emotional states not only from one day to another, but also from hour to hour and even minute to minute. We would like you to try this experiment on yourself. Observe your feelings throughout this experiment and see if you can detect any changes in feelings. You will be given different versions of this mood scale several times during the experiment. Your job is simply to mark the line at the point along each scale that best represents the extent to which you are experiencing that particular mood or feeling at that time. Although only a few points along the scale are labeled, feel free to place your line at any point along the scale. Work as rapidly as possible. HOW MUCH OF THIS FEELING DO YOU HAVE RIGHT NOW? DO YOU FEEL: Not-at-all Slightly Somewhat Moderately Very Much Extremely Wilted I I I I I I Safe Mirserable Gloomy Dull Gay Low-spirited Unwanted Fine Brokenhearted Down-cast Enthusiastic Failure 280 Not-at-all Slightly Somewhat Moderately Very Much Extremely Afflicted | | I I I I Active I I I I I I Strong Tortured Listless Sunny Wretched Broken Light-hearted Criticized Grieved Dreamy Hopeless Oppressed Joyous Weary Droopy 281 MOOD SCALE B A number of research studies have found that if you pay close attention to your emotions, you can sometimes detect changes in emotional states not only from one day to another, but also from hour to hour and even minute to minute. We would like you to try this experiment on yourself. Observe your feelings throughout this experiment and see if you can detect any changes in feelings. You will be given different versions of this mood scale several times during the experiment. Your job is simply to mark the line at the point along each scale that best represents the extent to which you are experiencing that particular mood or feeling at that time. Although only a few points along the scale are labeled, feel free to place your line at any point along the scale. Work as rapidly as possible. HOW MUCH OF THIS FEELING DO YOU HAVE RIGHT NOW? DO YOU FEEL: Not-at-all Slightly Somewhat Moderately Very Much Extremely Downhearted I I I I I I Lively Unfeeling Alone Unhappy Alive Terrible Poor Forlorn Alert Heartsick Bright Glum Desolate 282 Not-at-all Slightly Somewhat Moderately Very Much Extremely Composed | | | | | | Clean | | | | | | Dispirited | | | | | | Moody | | | | | | Pleased | | | | | | Dead | | | | | | Sorrowful | | | | | | Bleak | | | | | | Morbid | | | | I; | Heavy-hearted | | | | | | Easy-going | | | | | | Gray | | | | | | Melancholy | | | | | | Hopeful | | | | |_ | Mashed | I I | | | Unlucky | | | | | | 283 MOOD SCALE C A number of research studies have found that if you pay close attention to your emotions, you can sometimes detect changes in emotional states not only from one day to another, but also from hour to hour and even minute to minute. We would like you to try this experiment on yourself. Observe your feelings throughout this experiment and see if you can detect any changes in feelings. You will be given different versions of this mood scale several times during the experiment. Your job is simply to mark the line at the point along each scale that best represents the extent to which you are experiencing that particular mood or feeling at that time. Although only a few points along the scale are labeled, feel free to place your line at any point along the scale. Work as rapidly as possible. HOW MUCH OF THIS FEELING DO YOU HAVE RIGHT NOW? DO YOU FEEL: Not-at-all Slightly Somewhat Cheerless Animated Blue Lost Dejected Healthy Discouraged Bad Despondent Free Despairing Uneasy Peaceful Grim Moderately Very Much Extremely 284 Not-at-all Slightly Somewhat Moderately Very Much Extremely Distressed | | | | | | Whole | | | | | | Buoyant | | | | | | Tormented | | | | | | Weak | | | | | | Optimistic | | | | | | Low | | | | | | Deserted j | | | | | Burdened j | | | | | Wonderful | | I 1 | | Crushed | | | | ) | Somber | | | | | | Interested J | | | | | Joyless | | | | | | Crestfallen | I | | j | Lucky | | | | | | Chained | j | | | I Pessimistic I I I I I I 285 MOOD SCALE D A number of research studies have found that if you pay close attention to your emotions, you can sometimes detect changes in emotional states not only from one day to another, but also from hour to hour and even minute to minute. We would like you to try this experiment on yourself. Observe your feelings throughout this experiment and see if you can detect any changes in feelings. You will be given different versions of this mood scale several times during the experiment. Your job is simply to mark the line at the point along each scale that best represents the extent to which you are experiencing that particular mood or feeling at that time. Although only a few points along the scale are labeled, feel free to place your line at any point along the scale. Work as rapidly as possible. HOW MUCH OF THIS FEELING DO YOU HAVE RIGHT NOW? DO YOU FEEL: Not-at-all Slightly Somewhat Moderately Very Much Extremely Depressed | | | | | | Elated I I I I I I Awful Lifeless Grief-stricken Inspired Woeful Lonely Suffering Mellow Drooping Rej ected Fortunate 286 Not-at-all Slightly Somewhat Moderately Very Much Extremely Dreary | | | | | | Lousy | j | | | | Good | | | | | | Fit | | | | | | Lonesome | | | | | | Unloved | | j | | J Glad | | ! | | | Grave | | | | | | Sunk | j ! | | | Shot | | | | | | Merry I I I I I I Wasted | | | | | | Washed Out | j | | | | Clear | | | |_ | | Gruesome | | | | | | Tired | | | | | | High | | | | | | Worse | |_ | | | | Drained I I I I I I 287 MOOD SCALE E A number of research studies have found that if you pay close attention to your emotions, you can sometimes detect changes in emotional states not only from one day to another, but also from hour to hour and even minute to minute. We would like you to try this experiment on yourself. Observe your feelings throughout this experiment and see if you can detect any changes in feelings. You will be given different versions of this mood scale several times during the experiment. Your job is simply to mark the line at the point along each scale that best represents the extent to which you are experiencing that particular mood or feeling at that time. Although only a few points along the scale are labeled, feel free to place your line at any point along the scale. Work as rapidly as possible. HOW MUCH OF THIS FEELING DO YOU HAVE RIGHT NOW? DO YOU FEEL: Not-at-all Slightly Somewhat Moderately Very Much Extremely Sorrowful I I | I I I Lively Uneasy Tormented Low-spirited Clean Discouraged Suffering Brokenhearted Easy-going Downhearted Washed Out Playful 288 Not-at-all Slightly Somewhat Moderately Very Much Extremely Joyless | _| | | | | Despairing | | | | | | Gay | | | | | | Friendly | | | | | | Successful | | | | | | Rejected | | | I | | Crestfallen | | | j | | Jolly I I I I I I Deserted | | | 1 | | Grieved | | | | | | Low | | | | | | Steady | | | | | _| Wretched | | | | | | Terrible | | | | _| | Inspired | | | | j_ | Woeful | | | | | | Unworthy | | | | | | Joyous | | | | | | Destroyed | | | |_ | | Somber | | | | _ | | Unconcerned I I I I I I PLEASE NOTE: Copyrighted materials in this document have not been filmed at the request of the author. They are available for consultation, however, in the author's university library. These consist of pages: 290-293, Figures Appendix Q Figures 294 Appendix R TAT Study: Psychologists' Debriefing Form The TAT stories you read were obtained from thirty-subjects who participated in a series of studies on unipolar depression. The purpose of these studies is to examine hypotheses derived from Aaron Beck's cognitive theory of depression. As you know, Beck proposes that depression-prone individuals develop depressogenic cognitive schemas, largely as the result of childhood experiences. These schemas remain latent until activated by a stressor. Once activated, the schemas influence a wide range of perceptual and cognitive phenomena, eventually leading to depression. Beck's is a classic diathesis-stress model, with the underlying schemas constituting a psychological diathesis for depression, and the stressor that activates them being the stress component of the model. Beck groups depressogenic cognitions into several levels, with underlying schemas — statements that reflect general themes or contingencies in one's life — being the deepest, most stable. Other cognitions such as "automatic thoughts" are more transient and closer to awareness. There is a great deal of research supporting certain aspects of Beck's theory. Several studies, for example, suggest that both depressogenic schemas and automatic thoughts are present in most persons who are currently depressed. Moreover, most of the studies that examine these cognitions longitudinally have found that they appear to covary with the clinical course of depression, so that once the depressive episode resolves, the cognitions seem to normalize. These results call into question the etiological significance of abnormal cognitions. The "depressogenic" cognitions might simply be concomitants of depression, rather than causes of depression. Recall that the underlying schemas postulated by Beck constitute a diathesis condition for depression. They are held to be temporally stable, in that during inter-episode intervals they once again become dormant. Thus, the failure of standard self-report measures to identify these schemas in the depression-prone person who is currently between episodes is not surprising. If Beck's theory is to hold, however, these schemas must somehow be shown to be present, despite their latent status, in the currently asymptomatic depression-prone individual. The present series of studies employs a variety of methods in an effort to assess the presence of depressogenic 295 schemas in the depression-prone person. In the present study, ten of the thirty subjects were in fact currently clinically depressed. Ten others were remitted depressives, who had previously experienced at least one episode of unipolar depression, and the remaining ten had no history of depression. Since one of the primary uses of the TAT is to identify important underlying themes that guide or reflect one's behavior, we reasoned that the test might be sensitive to the schemas discussed by Beck. If Beck's theory is correct, we are hypothesizing that most of the ten actively depressed subjects, as well as most of the ten currently remitted depressed subjects, will be classified as depressed, whereas the normal control subjects will be classified as not depressed. There are, of course, many limitations to the present methodology, including the fact that only four cards were administered, and you, the clinical judge, were not able to have direct contact with the subjects yourself. Nevertheless, in combination with the other studies in this series, we hope that the results of the present study will shed some light on this intriguing theoretical issue. If you have any further questions, or if you would like to discuss further the purpose or results of this study, please do not hesitate to contact me at 212-420-2800 (work), or 718-435-5108 (home). Thank you once again for your help. 296 Appendix S Debriefing Statement As was explained to you when this study was introduced, we are interested in how certain motivating factors that people may not be fully aware of may be involved in the development of clinical depression. A major theory of depression proposes that persons at risk for depression may hold certain unrealistically negative attitudes or beliefs about themselves, the world, and the future. An example of such a belief might be something like "I must be successful at everything I do or else I'm no good as a person." Past research suggests that some people at risk for depression readily acknowledge having these beliefs. Other people, however, such as many of those who have been depressed in the past but who are not currently depressed, usually don't report having these beliefs. In order to investigate the possibility that different groups of people might hold such negative beliefs, we presented stimuli, consisting of short sentences, on the tachistoscope (or "t-scope" for short). Sometimes the stimuli were exposed very quickly (or "subliminally"), and sometimes they were exposed for a longer time (or "supraliminally") . Past research shows that people sometimes react differently to stimuli when they are presented subliminally compared to 297 when they are presented supraliminally. We presented two types of stimuli in this manner. One group consisted of statements reflecting the negative beliefs that some people may hold, and included the following: "I have to be perfect" "I have to be loved by everyone" "Making mistakes is terrible" "I must agree with everyone" "I have to be successful at everything." The other group of stimuli were more positive alternatives to each of these statements, and included: "I don't have to be perfect" "I don't have to be loved by everyone" "Making mistakes is OK" "It's OK to disagree" "I don't always have to be successful." Three different groups of people are being compared in this study: 1) people who are currently depressed; 2) people who have been depressed in the past but are not currently depressed; and 3) people who have never been depressed. We think that people who have had some experience with depression either currently or in the past may respond more to the stimuli, especially when they are presented subliminally, than people who have never been depressed. For example, people who have been depressed may feel slightly more sad when they see the negative statements and slightly more happy when they see the positive statements, whereas people who haven't been depressed may not be affected one way or the other. By 298 comparing how these three groups of people respond to the different stimuli described above, we hope to be able to see what role (if any) negative beliefs play in causing depression. We hope that the results of this study will lead toward a better understanding of the causes of depression, and will hold implications for improved treatments and preventative measures for the condition. Past studies using similar procedures to those used here have found that any effects the stimuli may have had on your mood are very small and very fleeting. That is, if you noticed any change at all in your feelings, it was probably very slight, and won't last more than a few minutes. If, however, you feel that the stimuli may have had any other effects, or if you have any questions at all about the study, please don't hesitate to call the Principal Investigator, Mr. James Herbert, at 334-5662 or 334-5013, or the project supervisor, Dr. Rosemery O. Nelson, at 334-5013. You can also drop by Mr. Herbert's office in the Eberhart building at UNCG (Rm. 382 or Rm. 377). Your participation in this project has been greatly appreciated. Let me ask you one last favor: Please don't discuss any details about the study with anyone you know who might also be a participant in the study in the future, as this could possibly contaminate our results.

The depressive realism hypothesis

Abstract

Extracted data

The depressive realism hypothesis

Abstract

Extracted data

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