Irrational Beliefs and Depression in Adolescence

Article excerpt

Depression in adolescents has long been conceptualized as a normal or transient phenomenon necessitating no therapeutic intervention (Lefkowitz & Burton, 1978; Lapouse, 1966; Werry & Quay, 1971). This has had the effect of limiting research in this domain of childhood and adolescent psychopathology. In the early '80s, the results of clinical reports and epidemiological studies reflecting high rates of depression and suicide in the adolescent population, and the publication of the DSM-III in which it was recognized that adult criteria could be used to diagnose depressive disorders in children and adolescents, markedly influenced the emergence of research on adolescent depression. These changes in the applicability of the adult diagnostic criteria for depression in adolescents have led to greater acknowledgement of the existence of depression in adolescents as a recognizable disorder while recognizing that developmental factors could influence the phenomenology of that disorder at different ages.

Studies conducted with the general population in Canada and the United States reported the presence of depressed mood in 20 to 35% of male and 25 to 40% of female adolescents. Out of this sample, 4 to 12% of adolescents present with characteristics of clinical depression (Marton, Churchard, & Kutcher, 1993; Petersen et al., 1993; Reynolds, 1985, 1992). Rates are higher in clinical samples, up to 42% across studies (Petersen, 1993), making depressive disorders the most frequent diagnosis applied to young people seeking help in mental health services (Kashani et al., 1981). Depressive symptoms increase from childhood to adolescence, and a marked increase appears between the ages of 13 and 15, reaching a peak around 17-18 years of age, and later stabilizing at the adult rate (Angold, 1988; Radloff, 1991; Rutter, 1986, 1991). Rates of depression for girls have been shown to be higher than for boys. This discrepancy seems to appear at 14-15 years of age and remains present throughout adulthood (Reynolds, 1985; Rutter, 1986; Teri, 1982). The devastating effect of depression during adolescence is also reflected in the fact that the incidence of a depressive episode during that stage of development is predictive of recurrent depressive episodes later in adolescence or adult life (Harrington, Fudge, Rutter, Pickles, & Hill, 1990; Kovacs et al., 1984). For example, Kandel and Davis (1986) found a consistency between 15- and 24-year-old subjects in depressive symptoms. Depression during adolescence was also associated with lower psychosocial functioning in young adulthood.

The etiology of depression in adults has received much attention from cognitive models (Beck, 1967, 1976; Rush, Shaw, & Emery, 1979; Ellis, 1962; Lewinsohn, 1977). In Beck's cognitive therapy, depressive disorder is explained in terms of depressogenic thinking schematas related to the self, the future, and the world. This depressed individual's negative view is called "the cognitive triad." The rational-emotive therapy (RET) model (Ellis & Grieger, 1977) also focuses on cognitive mediation as an explanation of emotional disorders. Although not developed specifically for application with depression, RET has shown to be an effective treatment strategy (Horton & Johnson, 1980; Kujoth & Topetzes, 1977; Lipsky, Kassinove, & Miller, 1980; Marcotte & Baron, 1993). The ABC model of RET suggests that C, the emotional consequence of A, the event, is mediated by the person's thinking, B. Four categories of irrational beliefs are defined, representing thinking modes which are nonempirical and reflect an absolutistic view of reality. These cognitive distortions are: (1) awfulizing beliefs ("some situations in life are horrible"); (2) low frustration tolerance cognitions ("I can't stand some things in others at school"); (3) absolute demands directed at self ("I should succeed totally in everything I decide to do") and at others ("my friends and my family should absolutely treat me better than they sometimes do"); and (4) self-worth beliefs: a person's tendency to globally evaluate himself or herself on the basis of only specific behaviors or characteristics ("a person who makes mistakes or hurts other people is very often a 'bad person'") (Demaria, Kassinove, & Dill, 1989). …