Interpersonal processes in depression
James, J. L., Hagan, C. R., & Joiner, T. E. (2013)
Annual Review of Clinical Psychology, 9, 355-377

Abstract

Humans have an intrinsic need for social connection, so it is crucial to understand depression in an interpersonal context.

Interpersonal theories of depression posit that depressed individuals tend to interact with others in a way that elicits rejection, which increases the risk for future depression.

Introduction

Depression impacts how individuals interact with people in their environment. Some symptoms of depression are inherently likely to produce interpersonal distress and impairment. These symptoms could help maintain the current episode and create a troubled interpersonal context that could potentially trigger future episodes of depression.

Depression is persistent disorder within acute episodes.

Basic behavioural features and communication behaviours associated with depression

Differences have been identified are in: the amount of facial expression (more animated facial expressions to express sadness in depressed individuals), eye contact (less in depressed individuals), posture (depressed individuals hold their head downward and engage in more self-touching), non-verbal gestures (less in depressed individuals). The extent to which people demonstrate these deficits had been linked to the severity of their depressive state.

Following treatment or the remission of a major depressive episode, these behavioural features of depression tend to show improvement.

While communicating and interacting with others, depressed individuals have been found to speak more slowly and with less volume and voice modulation. Their voices have been perceived more negatively. They also produce a lesser number of social interpersonal actions. When they do interact, they tend to be much more negative in their chosen topics and self-disclosure negative feelings.

Social skills and depression

Depression is associated with social skills deficits. The social skills deficits that have been linked with depression may be a product of the basic behavioural features and communication behaviours that are associated with depression.

Social skills impairments have been viewed as more state-like than trait-like. Social skills deficits operate as a vulnerability to depression that only becomes problematic in the presence of a significant stressor.

The relationship between social skill deficits and later depression is mediated by the presence of relations with others.

Interpersonal feedback seeking and depression

Depressed individuals tend to engage in interpersonal feedback seeking. Such feedback-seeking behaviour may contribute to others rating the social skills of depressed individuals more poorly.

The interpersonal theory of depression states that the way mildly depressed individuals interact with their environment and vice versa, increased the likelihood that they will experience a depressive episode. When depressed individuals interact with others, they engage in behaviours that elicit rejection, which then leads to an increase in their depressive symptoms. Mildly depressed individuals frequently seek reassurance from others to ease their doubt as to whether others truly care about them. As the reassurance seeking becomes more frequent and extreme, others in the environment become increasingly aggravated. As this pattern escalates, it creates a downward spiral that culminates in the rejection of the depressed individual. This rejection constitutes a stressor that reduces the depressed individual’s social support and leads to an increase of his or her depressive symptoms.

Excessive reassurance seeking

Excessive reassurance seeking (ERS) is the behavioural means by which depressed individuals elicit rejection. ERS is the relatively stable tendency to excessively and persistently seek assurance from others that one is lovable and worthy, regardless of whether such assurance has already been provide. As the ERS escalates, others will likely become frustrated and annoyed, making it more likely that they will avoid or reject the individual who is seeking excessive reassurance.

There is an association between ERS and depression. ERS predicts depressive symptoms.

Only the combination of ERS and depression predicts interpersonal rejection.

Negative feedback seeking

Individuals with depression tend to engage in an opposite type of feedback-seeking behaviour, negative feedback seeking (NFS). NFS is the tendency to actively solicit criticism and other negative interpersonal feedback from others.

According to the self-verification theory, people desire interpersonal feedback that is consistent with their self-concept, even when their self-concept is negative. This enhances their ability to predict and control their environment.

Although depressed individuals seek out negative feedback from others, the receipt of negative feedback is just as likely to lead to an increase in negative affect as it would among individuals with positive self-concepts. People’s need for self-verifying feedback is so powerful that it overrides the pain of seeking and receiving negative feedback from others.

NFS correlates with depression.

NFS has been identified as a potential vulnerability factor for depression when such feedback seeking is combined with a negative life event.

NFS is predictive of peer rejection.

Specificity of ERS and NFS to depression

Both ERS and NFS have shown relative specificity to depressive symptoms and depression diagnoses, although these findings have been somewhat mixed.

ERS plays an important role in the maintenance of anxiety disorders.

NFS has been found to be relatively specific to depressive symptoms.

Integrative models of excessive reassurance seeking and negative feedback seeking

The self-reported tendency to engage in ERS and NFS predicts depressive symptoms and interpersonal rejection. The goal of ERS is for self-enhancement and the goal of NFS is for self-verification. Individuals who are experiencing depressive symptoms tend to engage in both ERS and NFS. It is possible that this pattern of excessive and inconsistent feedback-seeking behaviour elicits rejection from close others.

Cognitive-affective crossfire model

Individuals can have different cognitive and affective responses to self-relevant feedback, particularly if they are experiencing symptoms of depression. When individuals experiencing depressive symptoms solicit negative feedback from others, the negative feedback tends to be affectively displeasing because of its negative nature, but also cognitively satisfying because it is self-verifying.

According to the cognitive-affective crossfire model, the inconsistency between one’s cognitive and affective responses to self-relevant feedback leads to either cognitive or affective discomfort, which contributes to additional feedback-seeking behaviour to reduce this discomfort.

For an individual experiencing depressive symptoms, the receipt of positive, self-enhancing feedback is likely to be both affectively pleasing and cognitively incongruent. As a result of the discomfort that arises from this cognitive incongruence, the individual may then engage in NFS to obtain self-verifying feedback that is more cognitively consistent. But, this is affectively displeasing.

Cognitive processing model

The cognitive processing model proposes that self-enhancement and self-verification strivings require different levels of cognitive processing. Processing of self-enhancing feedback is thought to require fewer cognitive resources than self-verifying feedback. When an individual receives self-enhancing feedback, only one step of processing is required (is it favourable or not). In self-verifying feedback, additional steps of processing are involved.

The type of feedback individuals seek depend upon the amount of cognitive resources they have available at the time.

Integrative interpersonal framework for depression and its chronicity

The integrative interpersonal framework for depression argues that a number of interpersonal self-propagatory processes are involved in generating and maintaining depression. Self-propagatory processes are a complex of psychological and behavioural factors that represents depression-related, initiated and active behaviours that serve to prolong and exacerbate existing symptoms or induce the recurrence of past symptoms.

The integrative interpersonal framework argues that several depression-related mechanisms actively produce a variety of interpersonal problems and stressors. These problems, in turn, are strong predictors of future depressive symptoms and/or lengthened current episodes of depression. Among the predicted psychological and behavioural factors are: excessive reassurance seeking, negative feedback seeking, interpersonal conflict avoidance, and blame maintenance.

Each of these factors is reciprocally involved in both interpersonal stress and depression.

More distal and traitlike interpersonal risk factors for depression that contribute to the chronicity of depression via the generation of stress are: poor social skills, insecure attachment and sociotropy

Global enhancement and specific verification theory

The global enhancement and specific verification theory is based on the idea that self-views vary on a continuum from global to specific. According to this theory, individuals with depression tend to desire and seek out self-enhancing feedback about their global traits and self-verifying feedback about their specific attributes.

The tendency to engage in global self-enhancement and specific self-verification interacts with individuals’ core beliefs to predict interpersonal stress, rejection and depression.

Interpersonal styles and depression

Depression has been linked to broader risk factors associated with interpersonal styles, such as interpersonal inhibition, dependency, and insecure attachment styles.

Interpersonal inhibition

Interpersonal inhibition includes: avoidance, withdrawal and hyness

Interpersonal inhibition correlates with depression. It may contribute to the social skills deficit that depressive individuals experience because their inhibition leads them to have less practice at interacting with others. The low levels of social support and loneliness that depressed individuals tend to experience as a consequence of their interpersonal inhibition and may lead them to become interpersonally dependent on the few social contacts from which they feel support. This dependency may manifest itself through ERS and NFS behaviours, which ultimately may lead to interpersonal rejection and increased feelings of loneliness.

Interpersonal dependency

Interpersonal dependency is a risk factor for depression. High levels of sociotropy indicate an excessive needs for interpersonal attachment and pleasing others, with an accompanying sense of doubt regarding the strength of interpersonal relationships. This sense of doubt overlaps with the sense of doubt that precedes ERS.

Attachment style

There is a relationship between attachment styles and the development of depression. Insecurely attached adults tend to have a difficult time forming and maintaining close personal relationships. Insecure attachment styles pose a prospective risk for the development of depression.

Having an insecure attachment style may lead individuals to develop depression because of their increased levels of sociotropy, dysfunctional attitudes, low self-esteem or their decreased propensity to forgive.

Interpersonal consequences of depression

Depressed individuals tend to experience problems in their personal relationships. The relationships of depressed individuals tend to be characterized by rejection, dissatisfaction, low intimacy, and decreased activity and involvement.

Another interpersonal consequence of depression is contagious depression. This is the spread of depressive symptoms from one person to another.