1 CHAPTER ONE: A NARRATIVE APPROACH TO UNDERSTANDING VULNERABILITY TO DEPRESSION Introduction and Overview Depression is among the most prevalent health complaints of the western world, with unipolar major depression imposing the fourth greatest burden of illness of all medical conditions worldwide (World Health Organisation, 2002). The importance of understanding the nature of depression and depressive vulnerability has become a major concern. Furthermore, as depression is known to occur across the life span, the investigation of depressive episodes over different life stages and the impact on depressive vulnerability has become a significant focus in psychological research. Psychological research has often relied on quantitative self-report measures to formulate and confirm theories of depression and vulnerability to depression. That research examines either the underlying personality dimensions (e.g., Blatt 1974, 1990) or the cognitive processes thought responsible for depression or depressive vulnerability such as dysfunctional attitudes, irrational beliefs and negative self-talk (e.g., Beck, 1983; David & Szentagotai, 2006; Ellis, 1994; Scher, Ingram & Segal, 2005). Self- report data on these types of variables shows the complexity of depressive episodes, and raises the question of whether self-reported dysfunctional attitudes are present only during a depressive episode, or emanate from underlying personality dimensions (Blatt & Zuroff, 1992; Hammen, Mark, de Mayo & Mayol, 1985). This issue has generated a line of research concerning whether depression is a trait (i.e., enduring latent depressive schema), state (i.e., confined to a depressive episode) or a state-trait phenomenon (i.e., a current mood, social context and biological processes which determine fluctuating accessibility to enduring cognitive-affecting schemata). Although early work by both 2 cognitive and psychoanalytic theorists found limited support for the pure state model, equivocal results have led to the formation of a state-trait model (Segal & Ingram, 1994; Teasdale & Barnard, 1993). Several authors (e.g., Wenzlaff, Meier & Salas, 2002; Wenzlaff & Wegner, 2000) have noted that self-report measures may not adequately access the persistent schemata involved in depressive vulnerability. There would appear to be significant benefits, therefore, of gathering information in diverse ways. The relationship between cognitive processes and depression may provide one means of accessing persistent schemata and assessing their association with depression and depressive vulnerability. A body of research conducted by Ingram and his peers has demonstrated a relationship between depression and cognitive processes, utilising information processing models (e.g., Ingram, 1984; Ingram, Kendall, Smith, Donnel & Ronan, 1987). Another means of focusing on cognitive processes has emerged from empirical interest in the investigation of the relationship between autobiographical memories and emotional disturbance (e.g., Blagov & Singer, 2004; McAdams, Lensky, Daple & Allen, 1988; Williams & Broadbent, 1986). Examination of autobiographical memory provides a broader base for understanding the nature of depression because it allows coincident access to both the cognitive and affective aspects of information processing. Narrative research, with its focus on the life story, can potentially tap into enduring cognitive schemata, and provides a valuable new means for investigating depression and depressive vulnerability across the life span. Bruner (1990) proposed that as narratives are the mechanisms through which people understand their lives, more research should be done using these life stories as data. McAdams, Diamond, St Aubin and Mansfield (1997) believe that narratives are an important area of research as they “are themselves the psychosocial constructions of 3 human identities in modern societies, worthy of study on their own terms” (p. 690). Indeed, Singer and Salovey (1993) declared that “an adequate understanding of personality cannot be achieved without a systematic investigation of how our most meaningful memories influence our emotions and behaviours.” (p. 9). Several studies have sought to determine whether either the content or structure of autobiographical memories can reveal key differences between depressed and non- depressed individuals. As a perspective which incorporates personality and information processing models, narrative research on depression and vulnerability to depression encompasses both of these frameworks. Research by personality oriented theorists has emphasised differences in memory content between depressed and non-depressed individuals, whereas information processing research has focused on differences in the processing of autobiographical memories. To date, little research has attempted to integrate personality and cognitive perspectives. Although research conducted within cognitive psychology is methodologically sound, it frequently does not account for personological variables. In contrast, narrative research, while taking into consideration individual differences such as motives and goals often does not examine mediating cognitive factors (Conway & Pleydell-Pearce, 2000). Another concern with narrative research is a lack of experimental control which makes it difficult to conclude whether any differences found are a result of the life experiences themselves, writing style or even differences in memory (Woike, Lavezzary & Barsky, 2001). The purpose of this thesis was to adopt a narrative approach to understanding vulnerability to depression across the life span. Conway and Pleydell-Pearce’s (2000) model of autobiographical memory, the Self-Memory System (SMS), was drawn upon to examine the relationship of narratives to depression within the context of an explicit 4 model of cognitive processing. This model incorporates the rigour of research on cognitive processes into the study of personality. Importantly, the SMS includes the autobiographical memory construct, while describing links to individual motivations that are often aligned to individual personality dimensions. In particular, this thesis drew upon Singer and colleagues’ (e.g., Singer, 2004; Singer & Salovey, 1993) construct of the self-defining memory, a sub-type of autobiographical memory considered to be associated with the most significant concerns of the individual. In this study, the self-defining memories of currently depressed participants were compared to those of participants who were not currently depressed but who had a history of depression, and participants with no current or previous depression. Possible group differences were examined in both the structure and content of key elements in self- defining memories which reflect underlying personality dimensions within the life narrative approach. In addition, patterns of autobiographical memory dimensions in self-defining memories were investigated to determine how they related to depression across the entire sample. The first chapter of this thesis deals with the nature of depression and the stability of depressive schemata over time. It also discusses whether vulnerability to depression emerges as a result of depressive cognitive schemata being triggered by the emergence of a first episode of depression, or as a result of higher levels of one or both of the two underlying personality dimensions of autonomy (related to achievement and power) and sociotropy (concerned with social relationships and intimacy), which are consistently associated with depressive vulnerability across a broad range of theoretical perspectives. The second chapter is concerned with the nature of autobiographical memory, and how narratives contribute to our understanding of the nature of depression. An 5 argument is made that study of the relationship between autobiographical memories and depressive vulnerability can clarify and extend understanding of the processes associated with depression. The chapter also outlines major models of autobiographical memory, including the Life Story Model of Identity drawn from the narrative perspective (e.g., McAdams & Pals, 2006), Conway and Pleydell-Pearce’s (2000) Cogitive Neuro-Scientific Model of Autobiographical Memory, and Singer and colleagues’ (e.g., Blagov & Singer, 2004) conceptual framework for self-defining memories. The information processing models of overgenerality proposed by Williams and his colleagues (Williams, 1992, 1996; Williams et al., 2007) and their relationship to depression are also discussed. Finally, the relationship between overgenerality and the trait versus state models of depression is presented. The third chapter proposes that while there is substantial research on the relationship between depression and the structure of autobiographical memory, less research concentrates on the content themes that may differentiate between vulnerabilities. Three key narrative dimensions are identified as prospective differentiating factors in the content of autobiographical memory within depression and depressive vulnerability. First, the narrative dimensions related to underlying motivations are considered. The motivations of agency and communion, identified by the narrative perspective, correspond to the depressive vulnerabilities of autonomy and sociotropy. If, as theory suggests, a relationship exists among negatively distorted agency and communion and depression, we would expect to see elevated negative levels of either one or both aspects of the underlying motivations in individuals