In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented.

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Development and validation of brief measures of positive and negative affect: The PANAS scales.

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Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation

1. An Overview 2. The Role of Emotions in Cognitive Therapy 3. The Therapeutic Relationship: Application to Cognitive Therapy 4. Structure of the Therapeutic Interview 5. The Initial Interview 6. Session by Session Treatment: A Typical Course of Therapy 7. Application of Behavioral Techniques 8. Cognitive Techniques 9. Focus on Target Symptoms 10. Specific Techniques for the Suicidal Patient 11. Interview with a Depressed Suicidal Patient 12. Depressogenic Assumptions 13. Integration of Homework into Therapy 14. Technical Problems 15. Problems Related to Termination and Relapse 16. Group Cognitive Therapy for Depressed Patients Steven D. Hollon and Brian F. Shaw 17. Cognitive Therapy and Antidepressant Medications 18. Outcome Studies of Cognitive Therapy Appendix: Materials *The Beck Inventory *Scale for Suicide Ideation *Daily Record of Dysfunctional Thoughts *Competency Checklist for Cognitive Therapists *Possible Reasons for Not Doing Self-Help Assignments *Research Protocol for Outcome Study at Center for Cognitive Therapy *Further Materials and Technical Aids

Cognitive Therapy of Depression

The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories.

Improved methods of assessment and research design have established a robust and causal association between stressful life events and major depressive episodes. The chapter reviews these developments briefly and attempts to identify gaps in the field and new directions in recent research. There are notable shortcomings in several important topics: measurement and evaluation of chronic stress and depression; exploration of potentially different processes of stress and depression associated with first-onset versus recurrent episodes; possible gender differences in exposure and reactivity to stressors; testing kindling/sensitization processes; longitudinal tests of diathesis-stress models; and understanding biological stress processes associated with naturally occurring stress and depressive outcomes. There is growing interest in moving away from unidirectional models of the stress-depression association, toward recognition of the effects of contexts and personal characteristics on the occurrence of stressors, and on the likelihood of progressive and dynamic relationships between stress and depression over time-including effects of childhood and lifetime stress exposure on later reactivity to stress.

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Stress and Depression

The effect of stressful events on depression has been amply demonstrated, but the opposite relation is also important. I examined event occurrence over 1 year in 14 women with unipolar depression who were compared with demographically matched groups of women with bipolar disorder (n = 11), chronic medical illness (n = 13), or no illness or disorder (n = 22). Interview assessments of life events, severity, and independence of occurrence confirmed the hypothesis that unipolar women were exposed to more stress than the normal women, had significantly more interpersonal event stress than all others, and tended to have more dependent events than the others. The implication is that unipolar women by their symptoms, behaviors, characteristics, and social context generate stressful conditions, primarily interpersonal, that have the potential for contributing to the cycle of symptoms and stress that create chronic or intermittent depression.

Generation of stress in the course of unipolar depression.

Issues concerning use of the Beck Depression Inventory (BDI) for the self-report of depressive symptomatology are raised and considered. Discussion includes the stability of depression and the need for multiple assessment periods, specificity and the need for multiple assessment measures, and selection cut scores and the need for terminological accuracy. Recommendations for the continued use of the BDI, designed to facilitate the integration of diverse studies and improve research on self-reported depression, are provided.

Issues and recommendations regarding use of the Beck Depression Inventory

Gotlib, Hammen, Introduction. I.Descriptive Aspects of Depression. Kessler, Epidemiology of Depression. Boland, Keller, Course and Outcome of Depression. A.M. Nezu, C.M. Nezu, K.S. McClure, Zwick, Assessment of Depression. Ingram, Siegle, Contemporary Methodological Issues in the Study of Depression: Not Your Father's Oldsmobile. Klein, Durbin, Shankman, Santiago, Depression and Personality. Johnson, Kizer, Bipolar and Unipolar Depression: A Comparison of Clinical Phenomenology and Psychosocial Predictors. II.Vulnerability, Risk, and Models of Depression. Wallace, Schneider, McGuffin, Genetics of Depression. Thase, Jindal, Howland, Biological Aspects of Depression. Davidson, Pizzagalli, Nitschke, The Representation and Regulation of Emotion in Depression: Perspectives from Affective Neuroscience. Goodman, Depression and Early Adverse Experiences. Abramson, Alloy, Hankin, Haeffel, MacCoon, Gibb, Cognitive Vulnerability - Stress Models of Depression in a Self-Regulatory and Psychobiological Context. Joiner, Depression in Its Interpersonal Context. Monroe, Hadjiyannakis, The Social Environment and Depression: Focusing on Severe Life Stress. III. Prevention and Treatment of Depression. Munoz, Le, Clarke, Jaycox, Preventing the Onset of Major Depression. Gitlin, Pharmacological Treatment of Depression. Hollon, Haman, Brown, Cognitive-Behavioral Treatment of Depression. Weissman, Markowitz, Interpersonal Psychotherapy for Depression. Beach, Jones, Marital and Family Therapy for Depression in Adults. Kaslow, E.B. McClure, Connell, Treatment of Depression in Children and Adolescents. IV.Depression in Specific Populations. Tsai, Chentsova-Dutton, Understanding Depression Across Cultures. Nolen-Hoeksema, Gender Differences in Depression. Lewinsohn, Essau, Depression in Adolescents. Powers, Thompson, Gallagher-Thompson, Futterman, Depression in Later Life: Epidemiology, Assessment, Impact, and Treatment. Stolberg, Clark, Bongar, Epidemiology, Assessment and Management of Suicide in Depressed Patients. Hammen, Gotlib, Closing Comments and Promising Directions for the Next Decade.

Handbook of depression

Objective: The purpose ofthis study was to evaluate the outcome ofbipolar disorder in the context of maintenance pharmacotherapy. Method: Eighty-two bipolar outpatients were followed prospectively for a mean of 4.3 years (minimum of 2 years); symptom rating and psychosocial outcome scales were used, and pharmacotherapy was rated on a 5-point scale. J� �yj�: Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. Of those who relapsed, two-thirds had multiple relapses. Relapse could not be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure ofcumulative affective morbidity appeared to be a more sensitive correlate ofpsychosocial functioning than was the number of relapses. Poor psychosocial outcome paralleled poor syndromal course. Poor psychosocial functioning, especially occupational disruption, predicted a shorter time to relapse. Depressions were most strongly related to social and family dysfunction. Conclusions: Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients. (AmJ Psychiatry1995; 152:1635-1640)

Constance Hammen

Papers

Stress and Depression

Generation of stress in the course of unipolar depression.

Issues and recommendations regarding use of the Beck Depression Inventory

Handbook of depression

Relapse and impairment in bipolar disorder.