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Journal ofAbnormal Psychology1988,Vol.97, No.1,13-18 Copyright 1988 by the AmericanPsychological Association, Inc.21-843X/88/S00.75

Explanatory Style Change During Cognitive TherapyforUnipolar Depression

MartinE. P. Seligman,Camilo Castellon, John Cacciola,PeterSchulman,LesterLuborsky,MaxineOllove,and Robert Downing

University ofPennsylvania

Weadministered the AttributionalStyleQuestionnaireto 39unipolar depressedpatientsat thebeginning and end of cognitive therapy and at one-yearfollow-up,and we administered it to 12bipolar patients during a depressedepisode.A pessimistic explanatory styleforbad events correlatedwith severity ofdepressionforunipolarsat cognitive therapy intake r =.56,p

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14 SELIGMAN ET AL.Table1Demographic Breakdownof39 Unipolar Depressed Patients,12Bipolar Depressed Patients,and 10 Nonpatient Controls

UnipolarsVariable

EducationNon-high-school

graduateHigh school graduateSome collegeCollege graduateGraduate degreeNo information

Marital statusNevermarriedCurrently marriedDivorced/separated/

widowedNo information

RaceWhiteBlackOtherNoinformation

EmploymentEmployedUnemployedRetiredStudentNoinformation

SexFemaleMale

Mean age

n

24

1012110

161490

33420

1714170

2712

5102631280

4136230

851050

44363

180

6931

36

Controlsn

002314

3430

10000

71020

64

0020

301040

3040300

100000

70100

200

6040

37

Bipolarsn

024330

5340

9300

92010

48

0173325250

4225330

752500

7517080

3367

38Note.Percentagesnotaddingto100 are due torounding.

quite typical of controls, we include these groups here as typicalrefer-encepointsfor ASQ and BDIscores. Theyare notintendedas anexten-sive,nonhospitalizedcontrol because most of our hypothesis testing inthis study requires within-groupand cross-time comparisons ratherthanstaticbetween-groups comparisons.

The unipolar depressedpatientshave beenfollowedsince the start ofcognitive therapy. Of the 39 cognitive therapy patients,31had termi-natedandagreedto be reinterviewed atterminationoftherapy. Theyreceived cognitive therapyapproximatelyonce perweekduring abouta 6-month period for a mean of 22.5 sessions. Therapy was carried outinthemanner outlinedbyBeck, Rush,Shaw,andEmery (1979).

Each patient who terminated was given the SADS-C(Change) inter-viewand our test battery within 1 month of termination. One year fol-lowingtermination, eachpatientwas again given the SADS and the testbattery. We report here the results for all 39 unipolar and 12 bipolarpatients on intake, the termination results for31of the 39 cognitivetherapypatientsforwhomwehave explanatory styleand BDIinforma-tion,and the results for 29 patients who reached one-year follow-up (wehave explanatory style data for only 26 of the 29). Because the presentresearch ispartof an ongoing project, we will eventually report on 2- to4-yearfollow-upof the presentcohort.Because the effectsare highlyconsistent and statistically robust at this stage, it seemsusefulto dissem-inate the termination andfollow-upresults now.

TestBatteryBDI short form).At each session,patientsfilled out the short form

of the BDI. This is a 13-item self-report instrument designed to assessthe severityofdepressive symptoms. Scores can rangefrom0 to 39, witha score of 10 or above corresponding roughly to a clinicallysignificantdepression.DemographicQuestionnaire. Thepatientsfilled out ademographicquestionnaire, the resultsofwhichare summarized in Table1.

AttributionatStyleQuestionnaire ASQ). Thepatients completedtheASQ,whichasks subjectstomake causal attributionsfor12hypotheti-calgood and bad events. The subject thenrateseach cause on a7-pointscale for internality, stability, and globality (Peterson & Seligman,1984;Peterson etal., 1982; Seligman,Abramson,Semmel, & von Baeyer,1979). Ratingsaresummed acrossthethree causal dimensions sepa-rately for good and bad events to create a composite positive (CP) andcomposite negative (CN) explanatory style score, which can rangefrom3 to 21. An overallscoreis derived by subtracting CNfrom CP (theCPCNmeasure). Wewillreportstatisticsprimarily for the CN measure,becausethishasconsistently beenthemost valid correlateandpredictorof depression (Peterson & Seligman,1984).

SADS. The SADS assesses a number of dimensions of psychopathol-ogyfor the worstweekof the current episode of psychiatric illness andfortheweek priortoevaluation.TheSADS-Cisdesigned to measurechange and includes a subset of these dimensions for the week prior toevaluation.Weusedtwosummaryscoresfromthese instruments. First,weused an Anxiety Scale comprised of three 6-point scales indicatingseverityof anxiety (psychic, somatic, and phobic) for theweekpriortoevaluation. We dichotomizedpatientsin the unipolar group to comparehigh- versuslow-anxietypatients. Second,weextractedaHamiltonDe-pression Rating Scale (Ex-Ham)fromtheSADS interviewstocreateaclinicianrated measure of depression. The Ex-Ham includes thefollow-ing items: depressive mood,guilt,suicidaltendencies,somatic anxiety,psychic anxiety, obsessions-compulsions, insomnia, appetite loss,weightloss, somatic preoccupation, depersonalization,agitation,psy-chomotorretardation, worse in morning, worse in evening, suspicious-ness,and impairment in functioning.

HealthSickness Rating ScaleHSRS). TheHSRSisa100-point scaledesigned to assess overall mental health. A single number integratessevencriteria of mental health. The clinicianratesthe patient on thebasisofcurrentstatusat thetimeofevaluation.TheHSRShasbeenreportedto bereliableandcorrelate with severityofdepression,ade-quacy of personality functioning, and treatment outcome (Luborsky &Bachrach,1974).

GlobalAssessment Scale GAS). The GAS is a stripped-down variantofthe HSRS, used to rate overall functioning on a 100-point scale (En-dicott,Spitzer,Fleiss,& Cohen, 1976).

ResultsTheoverallresults areeasilysummarized. Unipolarand bi-

polardepressives had both a pessimisticexplanatorystyleandamore pessimisticstylethan did nonpatientcontrols.Themoreseverethedepression,theworsetheexplanatorystyle. For thedepressiveunipolars, explanatorystyleandseverityofdepres-sion improved during cognitive therapy and remainedim-proved at one-yearfollow-up.Explanatory styleanddepressivesymptomsmoved inlockstepfromintaketoterminationto fol-low-up. As explanatory stylebecame moreoptimisticduringtherapy,patients becamelessdepressedandremained lessde-pressedattherapyterminationand at one-yearfollow-up.Fi-nally,recoveredpatientswithanoptimisticexplanatorystyleat

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EXPLANATORY STYLE 15

Table 2Explanatory Style andBDIMeans and StandardDeviations

Group BDI CN CP CPCNIntake

Unipolars(n= 39)MSD

Bipolars ( = 22)MSD

Controls(n= 10)MSD

15.84.915.86.54.43.2

14.42.1

13.52.5

12.42.2

14.42.1

14.41.1

16.31.8

.13.2.9

2.53.93.0

TerminationUnipolars(n = 31)

MSD

5.84.6

12.92.0

15.81.9

2.92.7

Follow-upUnipolars n= 26)

MSD

6.75.2

13.42.2

15.62.0

2.33.2

Note.BDI = theshortformof the BeckDepression Inventory.CP =compositepositive(explanatorystyle forgoodevents). CN =compositenegative(explanatorystyleforbadevents).CPCN= CP - CN.

terminationwereless depressed one year later thanwerethosewithapessimistic style.

ReliabilityThe reliability of the ASQ composites, estimated by Cron-

bach's(1951)alpha, was satisfactory. Alphas at intake, termina-tion,andfollow-upwere.73, .73,and .76 for CN and.74,.72,and .77 for CP,respectively.

Cross-SectionalRelationofExplanatory StyleandDepression

For the unipolar depressed patients, wefound a significantcorrelation between the explanatory style for bad events (CN)and severity of depression, as measured by the BDI, at intaker =.56,p

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16 SELIGMAN ET AL.Table3Explanatory StyleCorrelationsWith Depression

CN CP CPCNGroup

Unipolars n=39)BDIEx-HamGASHSRS

Bipolars(n=12)BDIEx-HamGASHSRS

Controls( = 10)BDIEx-HamGASHSRS

r

.56

.40-.04-.04

.63.06

.59

.62

.41

.19-.50-.34

PIntake

.0002.01nsns

.03ns

.04

.03

nsnsnsns

r

-.18.12

-.20-.02

.31

.14

.16

.43

-.12-.06-.060

P

nsnsnsns

nsnsnsns

nsnsnsns

r

-.49-.19-.11

.02

-.490-.53-.44

-.37-.17

.33

.25

P

.002nsnsns

.11ns

.08ns

nsnsnsns

TerminationUnipolars(=31)

BDIEx-HamGASHSRS

.57

.40-.38-.30

.0008.03.04.11

.15

.09.12

.06

nsnsnsns

-.32-.24

.36

.26

.08ns.05ns

Unipolars(n=26)BDIEx-HamGASHSRS

Follow-up

.64 .0005 -.25

.48 .02 -.17-.60 .002 .47-.56 .004 .39

nsns.02.05

6044

,72.001.03.0001

64 0006

Note. BDI = theshort formof the BeckDepression Inventory. Ex-Ham=HamiltonDepressionRatingScale.GAS = GlobalAssessmentScale.HSRS HealthSicknessRating Scale.CP =compositepositive(explanatory stylefor goodevents).CN =compositenegative(explana-torystyleforbadevents). CPCN= CP minus CN.

that unipolars had asignificantlyworse CN at intake than didnonpatient controls,((47)= 2.6,p

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EXPLANATORY STYLE 17control group. These findings replicate the 12 patient studiesthatSweeneyet al.(1986)meta-analyzed.

The secondmajorfinding was that explanatory style and se-verityof depression changed in lockstep with each otherthemore explanatorystyleimproved during cognitive therapy,themore depressive symptoms disappeared. This raisesthepossi-bility that explanatory style may be the active therapeutic mech-anism bywhichcognitive therapy alleviates unipolar depression(Elkin, Imber,Sotsky,&Watkins, 1986; Seligman, 1980).Itmaybe thecase,however,thatchangesinexplanatorystylearea consequence of relieffromdepression orthatsome third vari-able,like change in expectations, changes both.

The third finding concerned changes in explanatorystyleanddepression over time. Both explanatory style and depressivesymptoms improved dramatically during the course of cogni-tive therapyforunipolars.Furthermore,the effectswere longlastingexplanatory style and depressive symptoms werehighlystablein the oneyearfollowingthe end oftherapy.It ispossible that these changeswerewrought by cognitive therapy.Because an untreated control group was not used,however,andthe time periodsweresubstantial, it is possible thatmuchofthischange was due to a spontaneous recovery of depression.Whateverthe cause, the changes in depression and explanatorystylewere stable.

Thefourthfinding wasthattherewerenodifferencesin ex-planatory styleforunipolars versusbipolarsor forendogenousversusnonendogenous unipolars. Thisfindingseems neutraltothereformulated learned helplessness model. Both endogenousand bipolar depression probablyhavea considerable genetic di-athesis. It is possible that depressive explanatorystyleis herita-bleaswellas acquired, although this is untested. Explanatorystyle,however,did discriminate between the anxious and non-anxious unipolars.Theanxious unipolarshad amore pessimis-tic style and more severe depressive symptoms. Thisdifferencein explanatory style mayreflecta more severe depression, ratherthananeffectofanxiety.

The fifth finding was that explanatory style change duringtherapy marginally predicted depression at one-yearfollow-up.Furthermore, explanatory style at termination marginally pre-dicted depression at follow-up, partialing out theeffectsof de-pression at termination. This fifth finding, if replicated, impliesthat we may be able toidentifyin advance those patients whoare atgreatestrisk forrelapseevenaftersuccessful therapyfordepression. Thereareseveral strategiesfordealingwithsuchhigh-riskindividuals. Such individuals could be morecarefullymonitored following the end oftherapyorgiven intermittentbooster sessions,orperhaps therapy shouldnot beterminateduntil both the depressive symptomshaveremitted and explana-tory style has reached a more optimistic level.

Howdothesefindingsbearon theclaim that explanatorystyleis atrait(Peterson Seligman,1984)?They provide mixedsupport. On the one hand, explanatory style is quite stable inthe absence of therapy. During the oneyearfrom terminationtofollow-up,the correlation of CN was.65.On the other hand,explanatory style changed substantially in therapy and in lock-stepwith changein depression. Traitsmay bechangeableintherapy,andthisis amajoraim ofextended psychotherapy.Atthispoint, the most we can say is that cognitive therapy (and

possibly the onset of depression) change explanatory style, butexplanatory style appears traitlike in the absence of those fac-tors.

Thesefive findings areessentially correlational,yet therefor-mulated learned helplessness model of depression is a causaltheory. Itclaims thataninternal, stable,andglobal explanatorystyle for badevents precedes,and is a riskfactorfor,later depres-sion. There arefournoncausal interpretationsthatare compati-blewith this correlational data.First,depressionmaycauseabad explanatorystyle,and relieffromdepression enhances ex-planatory style. Second, somethird variable, like catechol-amine changes, causes botha badstyleanddepression. Third,the whole business may be a tautology. Pessimistic explanationsmaybe a part of how we diagnosedepression.Thefourthinter-pretationisthata badexplanatory styleis apremorbid symp-tom of depression that later blossoms into full-blowndepres-sion. This last hypothesisishardtodifferentiate fromourrisk-factor interpretation but is avariantof thethird variablehy-pothesis,whichclaims that anotherfactorcauses both the pre-morbid explanatory styleanddepression.These alternativesarenottestedhere,but Peterson and Seligman(1984)andBrewin(1985)reviewedtheevidence suggestingacausal rolefor ex-planatory style.

One strategy for testing the causal role is to change explana-tory style in therapy and see if depression changes as a conse-quence. Seligman (1980) proposed that the mechanism ofchangeincognitive therapywaschangeinexplanatory style.Theobservations inthisstudy, however,are not fine-grainedenough to test thisdefinitively.It is entirely possiblethatdepres-sivesymptomsremittedbeforeexplanatory style improved dur-ingtherapy andthatexplanatory style change was a result andnot a cause ofsuccessfulcognitive therapy. To test this, it wouldbenecessary to measure session by session changes in depres-sivesymptoms, explanatory style, and amount of therapy actu-allydelivered.Ifchangeinexplanatory style occurredinses-sionsin whichmuch therapywasdeliveredand wasfollowedbychangesindepressive symptoms,acausal roleforchangingexplanatory style in alleviating depression would be confirmed.Weare currently engaged in such a study.

Inconclusion,wehave foundthat unipolarandbipolarde-pressives share an insidious way of explaining bad events thatdistinguishes them from less depressed patients and nonde-pressed individuals. During cognitive therapy, explanatory styleand depression changed in lockstepfromintake to termination,and as explanatory style became more optimistic, thepatientbecame lessdepressed.Finally, recovered patients with an opti-mistic style at termination may be lesslikelyto be depressedoneyearlater than thosewitha pessimistic style. We suggestthat habitually explaining the causes of bad events as internal,stable, and global puts people at risk for depression and thatundoingthis pessimistic explanatorystylemay be a curative ele-ment in the cognitive therapy of depression.

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helplessnessinhumans:Critiqueandreformulation.Journal ofAb-normalPsychology,87,32-48.

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Brewin,C.(1985).Depression and causal attributions: What is theirrelation?PsychologicalBulletin,98,297-309.Cronbach,L.3.(1951).Coefficientalphaand theinternal structureoftests.Psychometrika,16,297-334.

Eaves,G.,& Rush, A. J. (1984). Cognitive patterns in symptomatic andremitted unipolar major depression.Journalo fAbnormalPsychol-ogy,93.31-40.

Elkin,I.,Imber, S.,Sotsky,S., &Watkins,J.(1986, April).NIMH treat-mentof depression collaborative researchprogram:Initialoutcomefinding. Paperpresented at the meeting of the American Associationforthe Advancement of Science Symposium, Philadelphia.

Endicott,J.,& Spitzer. R. L.(1978).A diagnostic interview: The Sched-ule for Affective Disordersand Schizophrenia.ArchivesofGeneralPsychiatry,35,837-844.

Endicott,J.,Spitzer, R.L.,Fleiss, J. L., & Cohen, J. (1976). The globalassessment scale:Aprocedureformeasuring overall severityofpsy-chiatric disturbance.ArchivesofGeneral Psychiatry,33,766-771.

Hamilton, E.W.,&Abramson,L. Y.(1983). Cognitive patterns andmajordepressive disorder: A longitudinal study in a hospital setting.Journal ofAbnormalPsychology,92,173-184.

Luborsky, L., &Bachrach, H. (1974). Factorsinfluencing clinicians'judgments of mental health: Eighteen experiences with the healthsickness rating scale.ArchivesofGeneral Psychiatry,31,292-299.

Persons,J.B.,&Rao,P. A.(1985).Alongitudinal studyofcognitions,lifeeventsanddepressioninpsychiatric inpatients.JournalofAbnor-matPsychology,94,51-63.

Peterson, C.,&Seligman, M.E. P.(1984).Causal explanationsas ariskfactor fordepression: Theoryandevidence.PsychologicalReview, 91,347-374.

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Received November10,1986Revision received July27,1987

AcceptedAugust12,1987

CallforNominations:JournalofExperimentalPsychology: GeneralThe Publications and Communications Board has opened nominations for the editorship of theJournalofExperimentalPsychology: Generalfor theyears 1990-1995.SamGlucksbergis theincumbent editor. Candidates mustbemembersofAPAandshouldbeavailabletostartreceiv-ing manuscripts inearly 1989 to prepare for issues published in 1990. Please notethattheP & C Board encourages more participation by women and ethnic minority men and womenin thepublication process,andwould particularly welcome such nominees.Tonominate candi-dates, prepareastatementof onepageorlessinsupport of each candidate.Submitnominationsno laterthanFebruary 15,1988to

DonaldJ.FossDepartment ofPsychology

Universityof TexasAustin,Texas78712

Other membersof thesearch committeeareJamesJ.Jenkins, Jean Mandler,J. E. R.Staddon,and SaulSternberg.