Toward bridging the science and practice of depression prevention: What can we learn from cognitive vulnerability?

Abstract

Abstract Depression is a widespread disorder with devastating individual and societal consequences. Although a great deal of research and theory has focused on treatment of acute episodes, progress needs to be made in preventing the emergence of first episodes of the disorder. There has been considerable advancement in understanding psychological vulnerability factors associated with this mood disorder, especially on the basis of cognitive behavioural models and research findings based on this theoretical model. In this paper we review the concept of cognitive vulnerability, with a particular focus on what this body of research work suggests clinically for the prevention of depression. We outline, based on this science, what the effective ingredients of a prevention program could be. We also discuss some of the pragmatic aspects of developing an effective prevention program for depression. Depression is an extremely serious and costly public health problem, a fact that has been demonstrated persuasively in numerous reports and studies that have accrued over the course of the past decade (e.g., Davidson & Meltzer-Brody, 1999; Kessler et al., 1999; Murray & Lopez, 1997a,b; Parikh, Wasylenki, Goering, & Wong, 1996). Due to its relatively ubiquitous nature, as well as its devastating impact on afflicted individuals and in turn on society as a whole, the study and subsequent understanding of causal factors related to the onset and maintenance of are not only relevant, they are essential - especially if the overall goal of this work is prevention of this disorder. This review will examine the science and practice of prevention particularly intervention that has the goal of preventing a first onset of depression. In the first part of diis paper, we begin by reviewing the empirical data on vulnerability to depression, with a particular focus on cognitive vulnerability. In the second part of the paper, we explore the realm of treatment from the perspective of what is already available for prevention from a cognitive behavioural perspective, how the science of cognitive vulnerability could inform the creation of further treatments, and some practical issues related to implementation. Depression is, of course, a complex disorder that can take many forms with respect to factors such as symptomology, duration of episodes, course, and contributing environmental factors. Indeed, current nosological systems (e.g., DSM-IV-TR; American Psychiatric Association, 2000) explicidy acknowledge this variability both within and across the various disorders of mood or affect often collectively subsumed under the label of depression (e.g., major depressive disorder, dysthymia, subsyndromal depression, depressive disorder NOS). Although the construct of is inherendy heterogeneous, odierwise discrepant cognitive formulations of the disorder emphasize that one factor underlying its myriad manifestations is cognitive, or psychologically modifiable, vulnerability (e.g., Abramson et al., 1999; Beck, 1967, 1987; Clark, Beck, & Afford, 1999; Ingram, Miranda, & Segal, 1998; Teasdale, 1988). At their most general, cognitive models of suggest that there is an intimate connection between an individual's construal of events, his/her behaviour, and his/her emotional state. The models postulate that incoming information from the environment is processed via previously learned, meaning-making structures that result in particular interpretations for each individual and that in such cognitive structures are negatively oriented in their processing and tone, generating negative emotions and problematic behaviours (Beck, 1967). The above is very general; to study the concept of vulnerability that is derived from these models, an operational definition is required. Fortunately, there has been much prior scholarly debate and research in this regard. Although no firm consensus yet exists as to a standard definition, several authors (see Ingram et al. …