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Mood and Suicide

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PSYC 3140
Gerry Goldberg

Chapter 10 – Mood Disorders General Characteristics of Mood Disorders mood disorders – disorders in which there are disabling disturbances in emotion - mood disorders are often associated with other psychological problems, such as panic attacks, substance abuse, sexual dysfunction, and personality disorders - the presence of other disorders can increase severity and result in poorer prognosis Depression: Signs and Symptoms depression – a disorder marked by great sadness and apprehension, feelings of worthlessness and guilt, withdrawal from others, loss of sleep, appetite, sexual desire, loss of interest and pleasure in usual activities, and either lethargy or agitation; called “major depression” in DSM-IV and “unipolar depression” by others; it can be an associated symptom of other disorders - paying attention is exhausting for depressed people; conversation is a chore; they may speak slowly, after long pauses, using few words and a low, monotonous voice; many prefer to sit alone and remain silent; others are agitated and cannot sit still; they pace, wring their hands, continually sign and moan, or complain; depressed people may neglect personal hygiene and appearance and make numerous complaints of somatic symptoms with no apparent physical basis - symptoms and signs of depression vary somewhat across the lifespan - depression in children often results in somatic complaints, such as headaches or stomach aches - in older adults, depression is often characterized by distractibility and complaints of memory loss - depression is substantially less prevalent in China than in North America due in part to cultural mores (customs/traditions) that make it less appropriate for Chinese people to display emotional symptoms - although it’s commonly believed that people from non-western cultures (eg: Chinese) emphasize somatic symptoms of depression, while people from Western cultures emphasize emotional symptoms, studies suggest that people from various cultures, including Canadians, tend to emphasize somatic symptoms rather than the emotional symptoms, especially when they’re being evaluated in a medical setting - overall 15% of depressed primary care patients in Canada are referred to as psychologizers (people who emphasize the psychological aspects of depression) - people in most cultures tend to emphasize physical symptoms - most depression, although recurrent, tends to dissipate with time - about 1/3 of depressed people suffer from chronic depression Mania: Signs and Symptoms mania – an emotional state of intense but unfounded elation (great happiness) evidenced in talkativeness, flight of ideas, distractibility, grandiose plans, and spurts of purposeless activity - mania's an emotional state or mood of intense but unfounded elation accompanied by irritability, hyperactivity, talkativeness, flight of ideas, distractibility, and impractical, grandiose plans - some people who experience episodic periods of depression may at times suddenly become manic - although there are clinical reports of individuals who experience mania but not depression, this condition is quite rare - the person in the throes (intense emotion) of a manic episode, which may last from several days to several months, is readily recognized by his/her loud and incessant stream of remarks, sometimes full of puns, jokes, rhyming, and interjections about objects and happenings that have attracted the speaker’s attention Formal Diagnostic Listings of Mood Disorders - 2 major mood disorders listed in the DSM-IV-TR: major depression, also referred to as unipolar depression, and bipolar disorder Diagnosis of Depression major depressive disorder (MDD) – an extreme form of depression that satisfies the number of symptoms required for the category of depression to apply - MDD requires the presence of 5 of the following symptoms for at least 2 weeks; either depressed mood or loss of interest and pleasure must be 1 of the 5 symptoms:  sad, depressed mood, most of the day, nearly everyday  loss of interest and pleasure in usual activities  difficulties in sleeping (insomnia); not falling asleep initially, not returning to sleep after awakening in the middle of the night, and early morning awakenings; or, in some patients, a desire to sleep a great deal of the time  shift in activity level, becoming either lethargic (psychomotor retardation) or agitated  poor appetite and weight loss, or increased appetite and weight gain  loss of energy, great fatigue  negative self-concept, self-reproach and self-blame, feelings of worthlessness, and guilt  complaints or evidence of difficulty in concentrating, such as slowed thinking and indecisiveness  recurrent thoughts of death or suicide - a study showed that even with fewer than 5 symptoms and a duration of less than 2 weeks, co-twins were also likely to be diagnosed with depression and patients were likely to have recurrences - other research suggests that depression exists on a continuum of severity - the issue of whether depression is best seen as being on a continuum or as a discrete diagnostic category is far from resolved - MDD is one of the most prevalent of the disorders described in this book - lifetime prevalence rates have ranged from 5.2% - 17.1% in some studies th - in many countries, the prevalence of MDD increased steadily during the latter part of the 20 century - regardless of prevalence, MDD is about 2 times more common in women than in men - the gender difference doesn’t appear in preadolescent children, but it emerges consistently by mid- adolescence - gender gaps emerge at age 14 and seem to be maintained across the lifespan - this gender difference is clearly established by late adolescence, and is found in all adult age groups, in numerous countries, and in a majority of ethnic groups - current and lifetime prevalence rates are higher among younger than older persons - although MDD was associated with 27.2 lost workdays per ill worker per year, bipolar disorder was associated with 65.5 lost workdays; they attributed the difference to more severe and persistent depressive episodes in workers with bipolar disorder - depression tends to be a recurrent disorder; about 80% of those with depression experience another episode, and the average number of episode, which typically last for 3-5 months, is about 4 - patients with MDD who had certain coexisting personality disorders (schizotpal, borderline, or avoidant) had a significantly longer time to remission of symptoms than did MDD patients without any personality disorder - it has been found that the 1 episodes of depression have a stronger link with major life events stress than do subsequent bouts of depression; this has been explained by kindling hypothesis, which is a concept derived from research on animals kindling hypothesis – the hypothesis that once a depression has been experienced, the person is sensitized and it takes less stress to elicit a subsequent bout of depression - what isn’t clear at present, according to Monroe and Harkness, is whether the apparent reduced role of life events stress in subsequent depression is because depression has become autonomous and no longer requires stress (the autonomy hypothesis) or whether the person has become sensitized to stress (the sensitivity hypothesis) and even small amounts of stress are sufficient to induce depression Focus on Discovery 10.1 – Depression in Females vs. Males: Why is There a Gender Difference? - major depression generally occurs about twice as often in women than in men - Nolen and Girgus concluded that girls are more likely than boys to have certain risk factors for depression even before adolescence, but it’s only when these risk factors interact with the challenges of adolescence that the gender differences in depression emerge - females are more likely than males to engage in ruminative coping ruminative coping – a tendency to focus cognitively (perhaps to the point of obsession) on the causes of depression and associated feelings rather than engaging in forms of distraction - females focus their attention on their depressive symptoms; males are more likely to rely on distraction, on doing something that diverts their attention - a study confirmed that the ruminative coping style predicts the onset of episodes of depression and is associated with more severe depressive symptoms brooding – a moody contemplation of depressive symptoms – what am I doing to deserve this – that is more common in females than males - brooding is like moody pondering; some people concluded that the relationship between gender and depression could be due to the brooding component - another possible explanation for the gender difference is that females and males differ in the stressors they experience - girls may face more social challenges than boys, including pressure to narrow their interests and pursue feminine-typed activities - thus, girls may face attitudes that devalue accomplishments and abilities in relation to boys, or face restrictions on roles and activities deemed inappropriate for their gender - another explanation is that females are more likely than males to be exposed to various forms of victimization, including childhood sexual abuse - greater levels of sexual violation were associated with lower levels of self-esteem and an external locus of control - victimization is apparently more common among women than men Diagnosis of Bipolar Disorder bipolar I disorder – a disorder in which people experience episodes of both mania and depression or of mania alone - most individuals with bipolar I disorder also experience episode of depression - a formal diagnosis of a manic episode requires the presence of elevated or irritable mood plus 3 additional symptoms (4 if the mood is irritable) - the symptoms must be sufficiently severe to impair social and occupational functioning:  increase in activity level at work, socially, or sexually  unusual talkativeness; rapid speech  flight of ideas or subjective impression that thoughts are racing  less than the usual amount of sleep needed  inflated self-esteem; belief that one has special talents, powers, and abilities  distractibility; attention easily diverted  excessive involvement in pleasurable activities that are likely to have undesirable consequences, such as reckless spending - bipolar occurs less often than MDD, with a lifetime prevalence rate for both Bipolar I and II of about 4.4% of the population - the average age of onset is in the 20s, and it occurs equally often in men and women - among women, episodes of depression are more common and episodes of mania less common than among men - like MDD, bipolar disorder tends to recur - violent behaviors (eg: child or spousal abuse) can occur during severe manic episodes Canadian Perspectives 10.1 – The Epidemiology of Mood Disorders in Canada: Major Depression and Bipolar Disorder - lifetime prevalence of MDD is higher than lifetime prevalence of manic episode; one-year prevalence for MDD is higher than one-year prevalence manic episode - in all age groups, a greater proportion of woman than men met criteria for MDD - there’s a turning point for MDD between late adolescence and adulthood; prevalence almost doubles for young adults - both depression and mania tend to be more prevalent in the western provinces of Canada - MDD and substance dependence independently predicted higher prevalence of suicidal thoughts - chronic medical disorders were associated with a more severe course of bipolar disorder - in people aged 15-24, not being in school strongly increased the likelihood of depressive disorders - in people aged 15-24, extreme stress strongly increased the likelihood of depressive (and anxiety) disorders - among people with bipolar disorder, male gender, lower level of education, and immigrant status were negatively correlated with the use of treatment services - female bipolar individuals are more likely than males to be prescribed antidepressant medication - both depression and comorbid chronic pain and depression were twice as prevalent in women as in men Heterogeneity Within the Categories - some bipolar patients experience the full range of symptoms of both mania and depression almost every day, termed a mixed episode bipolar II disorder – a disorder in which people experience episodes of major depression followed by a type of manic phase that is less severe than in bipolar I disorder - bipolar II patients have episodes of major depression accompanied by hypomania hypomania – an above-normal elevation of mood, but not as extreme as mania - hypomania is a change in behavior and mood that is less extreme than full-blown mania - the presence of delusions appears to be a useful distinction among people with unipolar depression - depressed patients with delusions do not generally respond well to the usual drug therapies for depression, but they do respond favorably to these drugs when they’re combined with the drugs commonly used to treat other psychotic disorders, such as schizophrenia - depression with psychotic features is more severe than depression without delusions and involves more social impairment and less time between episodes - according to DSM-IV-TR, some patients with depression may have melancholic features; the term melancholic refers to a specific pattern of depressive symptoms - people with melancholic features find no pleasure in any activity and are unable to feel better even temporarily when something good happens; their depressed mood is worse in the morning; these individuals had no personality disturbance prior to their 1 episode of depression and respond well to biological therapies - one study found that patients with melancholic features had more comorbidity, more frequent episodes, and more impairment, suggesting it may be a more severe type of depression - both manic and depressive episodes may be characterized as having catatonic (like in a trance) features, such as motor immobility or excessive, purposeless activity - both manic and depressive episodes may also occur within 4 weeks of childbirth; in this case, they’re noted to have a postpartum onset - it’s stated that both bipolar and unipolar disorders can be subdiagnosed as seasonal if there is a regular relationship between an episode and a particular time of the year - most research has focused on depression in the winter, and the most prevalent explanation is that it’s linked to a decrease in the number of daylight hours seasonal affective disorder (SAD) – the “winter depressions” that stem from reduced exposure to daylight - reduced light does cause decreases in the activity of serotonin neurons of the hypothalamus, and these neurons regulate some behaviors, such as sleep, that are part of the syndrome of SAD Canadian Perspective 10.2 – Postpartum Depression in Canadian Women postpartum depression (PD) – the depression experienced by some mothers after giving birth - some researchers reported that onset was predicted by levels of depression in the pregnancy period, as well as by a reported lack of warmth and care from one’s own parents while growing up - it was found that PD was predicted by several variables, among them depression during pregnancy, negative life events, and lower socio-economic status - self-critical perfectionism is also strongly related to depressive feelings in the postpartum period - one stressor of significance in PD is having an infant with a difficult, irritable temperament - an emotion-oriented coping style is linked with PD; the stress of natural disasters may also play a role - higher stress predicted lower IQs in the babies and higher stress also predicted more behavioral problems and anxiety in children at 4 years of age - physical differences were also found; the children of mothers with high stress had abnormalities in their fingerprint profiles, suggesting that stress affected prenatal development during the crucial 14-22 week segment of gestation - are the depressions experienced by new mothers difference from the depressions experienced by other women? - overall, very few differences were found - PD is not qualitatively different from other depressions; PD episodes tend to be relatively mild and are quickly resolved for most women - fathers married to women with PD reported greater levels of dissatisfaction with marital and family changes and greater stress, especially in terms or work and economic pressures - follow-up research indicated that psychiatric disturbance is just as persistent over time for mothers and fathers, with about 3/5 of mothers and fathers having a disorder at 6 months postpartum - maternal prenatal depression affects the fetus and the newborn, including elevated fetal activity, delayed prenatal growth, prematurity, and low birth weight - newborns of depressed mothers show a biochemical/physiological profile similar to their mothers’ prenatal profile (eg: elevated cortisol, lower levels of dopamine and serotonin) - elevated prenatal cortisol is the strongest predictor of neonatal complications Chronic Mood Disorders - DSM-IV-TR lists 2 long-lasting, or chronic, disorders in which mood disturbances are predominant - although the symptoms of these disorders must have been evident for at least 2 years, they’re not severe enough to warrant a diagnosis of a major depressive or manic episode - the 2 disorders are: cyclothymic disorder and dysthymic disorder cyclothymic disorder – chronic swings between elation and depression not severe enough to warrant the diagnosis of bipolar disorder - in cyclothymic disorder, the person has frequent periods of depressed mood and hypomania, which may be mixed with, may alternate with, or may be separated by periods of normal mood lasting as long as 2 months - people with cyclothymic disorder have paired set of symptoms in their periods of depression and hypomania; during depression, they feel inadequate; during hypomania, their self-esteem is inflated - they withdraw from people, then seek them out in an uninhibited fashion; they sleep too much and then too little - depressed cyclothymic patients have trouble concentrating, and their verbal productivity decreases; hypomania, their thinking becomes sharp and creative and their productivity increases - cyclothymic disorder has a lifetime prevalence of 2.5% dysthymic disorder - state of depression that is long-lasting but not severe enough for the diagnosis of major depression - the person with dysthymic disorder is chronically depressed – more than half the time for at least 2 years, in DSM-IV-TR - besides feeling blue and losing pleasure in usual activities, the person experiences several other signs of depression, such as insomnia or sleeping too much; feelings of inadequacy, ineffectiveness, and lack of energy; pessimism; an inability to concentrate and to think clearly; and a desire to avoid the company of others - women are 2-3 times more likely than men to be diagnosed wit dysthymia and the chronicity of dysthymia can cause severe impairment - there’s a lifetime prevalence of 2.5% with dysthymic disorder double depression – a comorbid condition that applies to someone characterized by both dysthymia and major depression Psychological Theories of Mood Disorders - psychoanalytic views emphasize the unconscious conflicts associated with grief and loss - cognitive theories focus on the depressed person’s self-defeating thought processes - interpersonal factors emphasize how depressed people interact with others Psychoanalytic Theory of Depression - Freud said that the potential for depression is created early in childhood - at the oral period, a child’s needs may be insufficiently/oversufficiently gratified, causing the person to become fixated in this stage and dependent on the instinctual gratifications particular to it; with this arrest in psychosexual maturation, the person may develop a tendency to be excessively dependent on other people for the maintenance of self-esteem - some research has been gathered by psychoanalytic points of view, but it has been limited and doesn’t give strong support to the theory - some depressed people are high in dependency and prone to depression following a rejection Cognitive Theories of Depression - cognitive processes play a decisive role in emotional behavior - in some theories of depression, thoughts and beliefs are regarded as major factors in causing or influencing the emotional state Beck’s Theory of Depression - Beck’s central thesis is that depressed individuals feel as they do because their thinking is biased toward negative interpretation - according to Beck, in childhood and adolescence, depressed individuals acquired a negative schema – a tendency to see the world negatively – through the loss of a parent, an unrelenting succession of tragedies, the social rejection of peers, the criticisms of teachers, or the depressive attitude of a parent - the negative schema acquired by depressed persons are activated whenever they encounter new situations that resemble in some way, perhaps only remotely, the conditions in which the schemata were learned - the negative schemata fuel and are fuelled by certain cognitive biases that lead these people to misperceive reality - an ineptness schema can make depressed individuals expect to fail most of the time, a self-blame schema burdens them with responsibility for all misfortunes, and a negative self-evaluation schema constantly reminds them of their worthlessness - the following is a summary of the interactions among the 3 levels of cognitive activity that Beck believes underlie depression: 1. negative triad (pessimistic view of self, world, and future) 2. negative schemas or beliefs triggered by negative life events (eg: the assumption that I have to be perfect) 3. cognitive biases (eg: arbitrary interference) 4. depression - negative schemata, together with cognitive biases or distortions, maintain what Beck called the negative triad: negative views of the self, the world, and the future negative triad – in Beck’s theory of depression, a person’s baleful (sinister) views of the self, the world, and the future; the triad is in a reciprocal causal relationship with pessimistic assumptions (schemata) and cognitive biases such as selective abstraction - the following list describes some of the principal cognitive biases of depressed individuals according to Beck:  arbitrary interference – a conclusion drawn in the absence of sufficient evidence or of any evidence at all; for example, a man con concludes that he’s worthless because it’s raining the day he’s hosting an outdoor party  selective abstraction – a conclusion drawn on the basis of only 1 of many elements in a situation; for example, a worker feels worthless when a product fails to function, even though she is only 1 of many people who contributed to its production  overgeneralization – an overall sweeping conclusion drawn on the basis of a single, perhaps trivial, event; for example, a student regards her poor performance in a single class on 1 particular day as final proof of her worthlessness and stupidity  magnification and minimization – exaggerations in evaluating performance; for example, a man, believing that he has completely ruined his car (magnification) when he notices a slight scratch on the rear fender, regards himself as good for noting; or a woman believes herself worthless (minimization) in spite of a succession of praiseworthy achievements - in Beck’s theory, our emotional reactions are a function of how we construe our world - a study concluded 2 things: that depressed individuals, relative to non-depressed individuals, endorse more negative words and fewer positive words as self-descriptive; also, they exhibit a cognitive bias: they have greater recall of adjectives with depressive content, especially if the adjectives were rated as self- descriptive - the presence or absence of depression reflects differences in the cognitive availability of negative vs. positive thoughts about the self - the next wave of research wanted to test the notion: depressed and non-depressed people do not differ in whether their schemas involve positive or negative content; rather, they differ in cognitive processing - depressed people pay greater attention to negative stimuli and can more readily access negative than positive information - differences in cognitive processing are assessed via the stroop task stroop task – a measure of cognitive processing that requires respondents to identify the color of a word while ignoring the word’s content or meaning; it takes longer to color-name a word if the word reflects a theme that’s cognitively accessible for a particular individual - the stroop task assesses the latency or length of time it takes to respond - non-depressed students didn’t differ in their response latencies across the word types, but depressed students took longer to color-name the depression-oriented words, suggesting that these themes were more cognitively accessible for them - another study found that depressed individuals have reduced accessibility to positive information that is specific to themselves, not to other people Evaluation - for depressed and non-depressed individuals, studies confirm the presence of related differences in terms of cognitive accessibility and organization - depression can make thinking more negative, and negative thinking can probably cause and can certainly worsen depression Canadian Perspective 10.3 – Research on Personality Orientations in Depression - Beck proposed that depression is associated with 2 personality styles: sociotropy and autonomy sociotropy – a personality style associated with vulnerability to depression; it involves high levels of dependency and an excessive need to please others - sociotropic individuals are dependent on others; they’re especially concerned with pleasing others, avoiding disapproval, and avoiding separation autonomy – a personality style associated with vulnerability to depression; it involves a need to work toward achievement goals while being free from constraints imposed by others - autonomy is an achievement-related construct that focuses on self-critical goal striving, a desire for solitude, and freedom from control - it’s said that dependency is not always a bad thing and the adaptive component of dependency may actually protect someone from being depressed - dependency was found to be more specifically associated with MDD; self-criticism was more clearly linked to severity of depression - women diagnosed with MDD and other psychiatric disorders had higher levels of self-criticism compared with men, whereas men with MDD had higher levels of dependency compared with women - it was found that socially prescribed perfectionism, excessive concern over mistakes, and self-criticism were the strongest correlates of depression congruency hypothesis – the prediction that people are likely to be depressed if they have a personality vulnerability that is matched by congruent (matching) life events (eg: perfectionists who experience a failure to achieve); it is derived from research on personality, stress, and depression - in terms of personality and stress, the essence of the congruency hypothesis is that if a non-depressed person with a personality style that makes him/her vulnerable to depression also experiences a negative life event that is congruent with or matches their vulnerability in some way, then this person will become depressed; for instance, depression could be experienced by a student who wants to be perfect but fails a test - there is a lack of support for the congruency hypothesis across studies - another research focus involves personality factors, interpersonal processes, and depression; personality factors may be linked with depression through their association with maladaptive interpersonal processes - another area of research attempts to link personality and interpersonal processes with cognitive and behavioral factors - in another area of research, the role of personality factors in treatment outcomes is explored Helplessness/Hopelessness Theories Learned Helplessness learned helplessness theory – the theory that individuals acquire passivity and a sense of being unable to act and to control their lives; this happens through unpleasant experiences and traumas against which their efforts were ineffective; according to Seligman, this brings on depression - I.O.W. learned helplessness is that an individual’s passivity and sense of being unable to act and control his/her own life is acquired through unpleasant experiences and traumas that the individual tried unsuccessful to control - Seligman proposed that animals acquire a sense of helplessness when confronted with uncontrollable aversive stimulation - like many depressed people, the animals appeared passive in the face of stress, failing to initiate actions that might allow them to cope; they had difficulty eating or retaining what they ate, and they lost weight; also, one of the neurotransmitter chemicals implicated in depression, norepinephrine, was depleted in Seligman’s animals Attribution and Learned Helplessness - the characteristic of feeling helpless yet blaming oneself is referred to as the depressive paradox depressive paradox – a cognitive tendency for depressed individuals to accept personal responsibility for negative outcomes despite feeling a lack of personal control attribution – the explanation person has for his/her behavior - when a person has experienced failure, he/she will try to attribute the failure to some cause - the attributional revision of the helplessness theory postulates that the way in which a person cognitively explains failure will determine its subsequent effects: 1. global attributions (“I never do anything right”) increase the generality of the effects of failure 2. attributions to stable factors (“I never test well”) make them long term 3. attributions to internal characteristics (“I am stupid”) are more likely to diminish self esteem, particularly if the personal fault is also global and persistent - the theory suggests that people become depressed when they attribute negative life events to stable and global causes - the individual prone to depression is thought to show a depressive attributional style – a tendency to attribute bad outcomes to personal, global, and stable faults of character - when people with this style (a diathesis) have unhappy, adverse experiences (stressors), they become depressed - depressive attributional style is related to sexual abuse in childhood, parent over-protectiveness, and harsh discipline Hopelessness Theory - some forms of depression (hopelessness depressions) are now regarded as caused by a state of hopelessness, an expectation that desirable outcomes will not occur or that undesirable outcomes will occur and that the person has no responses available to change this situation - negative life events (stressors) are seen as interacting with diatheses to yield a state of hopelessness; one diathesis is attributing negative events to stable and global factors - the hopelessness theory also considers the possibility of 2 other diatheses: low self-esteem and a tendency to infer that negative life events will have severe negative consequences - depressive attributional style and lows self-esteem predicted the onset of depression in adolescents - it was found that those high in negative cognitive styles experienced more episodes of depression, more severe episodes, and more chronic courses - an advantage of the hopelessness theory is that it can deal directly with the comorbidity of depression and anxiety disorders - if the perceived probability of the future occurrence of negative events becomes certain (a phenomenon known as depressive predictive certainty), hopelessness depression develops SUMMARY: according to the helplessness/hopelessness theories, early experiences in inescapable, hurtful situations instill a sense of hopelessness that can evolve into depression - individuals are likely to attribute failures to their own general and persistent inadequacies and faults Interpersonal Theory of Depression - depressed individuals tend to have sparse social networks and to regard them as providing little support - reduced social support may lessen an individual’s ability to handle negative life events and increase vulnerability to depression - depressed people also elicit negative reactions from others; one suggested reason for this is that they tend to reject their partners and display relatively few positive social behaviors - it seems that depressed individuals with an autonomous orientation are oriented toward themselves rather than toward other people; when they’re oriented toward others, they can act in a negative, rejecting manner - depression and marital discord frequently co-occur and the interactions of depressed people and their spouses involve mutual hostility - several studies have demonstrated that depressed people are low in social skills across a variety of measures: interpersonal problem-solving speech patterns (speaking very slowly, with silences and hesitations, and more negative self-disclosure), and maintenance of eye contact - constant seeking of reassurance is a critical variable in depression; depressed people seek reassurance that others truly care, but even when reassured, they’re only temporarily satisfied - their negative self-concept causes them to doubt the truth of the feedback they have received, and their constant efforts to be reassured come to irritate others - low social competence predicted the onset of depression among children and poor interpersonal problem- solving skills predicted increases in depression among adolescents - thus, social skil
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