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Book Review   |    
Cognitive Vulnerability to Depression
Andrew C. Butler, Ph.D.
Psychiatric Services 2000; doi: 10.1176/appi.ps.51.4.538
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by Rick E. Ingram, Jeanne Miranda, and Zindel V. Segal; New York City, Guilford Press, 1998, 330 pages, $36.95

Ingram, Miranda, and Segal have written a state-of-the-science book in which they review and integrate the empirical and theoretical literatures on cognitive vulnerability to depression. After explaining the terms and definitions used by researchers in this area and operationalizing the central concepts—cognition, vulnerability, and depression—the authors provide a useful heuristic framework for organizing the relevant empirical literatures. They address and summarize the early research rather briefly.

The majority of the book focuses on studies conducted in the 1990s that use more sophisticated designs and procedures than prior research. The authors provide concise reviews of empirical literatures and place them in context, making these chapters very readable. The studies reviewed range from laboratory studies on neural networks and attentional biases to longitudinal naturalistic studies examining the interaction of stressful life events and dysfunctional attitudes in predicting depression.

Researchers in this area will appreciate the cogent analysis of the advantages and disadvantages of various study designs used to address cognitive vulnerability to depression. The authors tend to favor the use of experimental methodologies that include a "priming" procedure to assess cognitive vulnerability. They make a good case for this design: the theory that has been tested the most thoroughly is the one proposed by Aaron T. Beck. According to Beck's model, dysfunctional beliefs, such as "If someone I care about rejects me, I'm worthless," increase a person's vulnerability to depression.

It is important to note that this theory holds that such beliefs may be latent during nondepressed periods but will become active in response to life stressors. Much of the early research on Beck's theory assessed subjects' beliefs when they were not under stress, and, not surprisingly, findings often were unsupportive of the model. More recent research using experimental priming procedures has yielded largely consistent results in support of the theory.

The authors devote separate chapters of the book to examining proximal vulnerability, or cognitive factors involved in the onset of a depressive episode, and distal vulnerability, or developmental factors that predispose individuals for depression. In the final chapter they integrate the literatures on these topics while drawing on attachment theory (which is not reviewed in the book) to present a cognitive-interpersonal synthesis along with implications for treatment.

Although this book is not the most comprehensive work available on cognitive vulnerability to depression—readers should see Clark and Beck's book (1)—it is clearly an important work and should be required reading for all researchers, scholars, and students interested in this area. It will certainly inform future experimental work on vulnerability to depression, cognitive or otherwise, and will stimulate new thinking and theorizing in this area. Practitioners wishing to learn the cognitive therapy approach to treating depression can look elsewhere, such as in Cognitive Therapy of Depression by Beck and others (2).

Dr. Butler is research coordinator at the Beck Institute for Cognitive Therapy and Research in Bala Cynwyd, Pennsylvania, and is affiliated with the department of psychiatry of the University of Pennsylvania School of Medicine.

Clark DA, Beck AT: Scientific Foundations of Cognitive Theory and Therapy of Depression. New York, Wiley, 1999
 
Beck AT, Rush JA, Shaw BF, et al: Cognitive Therapy of Depression. New York, Guilford, 1979
 
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References

Clark DA, Beck AT: Scientific Foundations of Cognitive Theory and Therapy of Depression. New York, Wiley, 1999
 
Beck AT, Rush JA, Shaw BF, et al: Cognitive Therapy of Depression. New York, Guilford, 1979
 
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