Academic journal article Journal of Cognitive Psychotherapy

Adaptive Inferential Feedback Partner Training: An Augmented Cognitive-Behavioral Approach

Academic journal article Journal of Cognitive Psychotherapy

Adaptive Inferential Feedback Partner Training: An Augmented Cognitive-Behavioral Approach

Article excerpt

It has been clearly documented that social support exerts a salubrious impact on depression. Yet, standardized social support interventions, with the primary intent of alleviating a patient's depression, have not been incorporated into evidence-based treatments for mood disorders. Not all types of support are necessarily beneficial. Inferential feedback is a subtype of social support that addresses an individual's perception of the cause, meaning, and consequences of negative life events and may be either adaptive or maladaptive. A short-term adaptive inferential feedback (AIF) training manual was developed for the partners (e.g., friends, family members) of depressed patients. The present case examines the effectiveness of a standard 14-session cognitive-behavioral treatment augmented with 4 AIF partner-training sessions. Results suggest that this newly developed social support intervention may be feasible, well liked, and possibly beneficial to depressed patients. Further research is needed to investigate any incremental value of this intervention beyond standard cognitive-behavioral treatment.

Keywords: social support; depression; adaptive inferential feedback

Although there is a wealth of literature suggesting that social support positively affects depression (e.g., Barnett & Gotlib, 1988; Roberts & Gotlib, 1997), formalized approaches for working directly with members of a patient's social network, with the primary intent of alleviating the patient's depression,1 have not been incorporated into evidence-based treatments for mood disorders. The broad definitions and unclear mechanisms of action of social support in the literature have been identified as two factors that have made it difficult to harness social support as a clinical tool (e.g., Lakey & Lutz, 1996).

Recently, inferential feedback, a subtype of social support, was identified and operationally defined within the context of the "expanded hopelessness" theory of depression (Panzarella, Alloy, & Whitehouse, in press). Depressed individuals tend to attribute negative events to stable, global causes and negative characteristics of the self, and to predict negative consequences of the event (depressogenic inferences). A friend or family member discussing the event with the depressed individual may also express inferences about the cause of that event (inferential feedback).

Inferential feedback may be adaptive or maladaptive. Adaptive inferential feedback (AIF) occurs when a partner (e.g., friend, family member) attributes the cause of a negative event to unstable, specific factors (e.g., job loss due to downsizing at one company) instead of stable, global factors (e.g., job loss because employee is not smart). Additionally, the partner suggests that the event implies neither negative consequences nor negative characteristics about the person (e.g., "You are a motivated person who will have a successful career despite this setback"). AIF may buffer against the development of depression by modifying depressogenic inferences (e.g., global, stable) made in response to specific stressors or by decreasing a person's likelihood of developing or maintaining a depressogenic inferential style over time. Conversely, maladaptive inferential feedback (MAIF) either suggests or supports pre-existing negative inferences related to a negative life event (e.g., "Good jobs are impossible to find"). MAIF may be particularly detrimental as it may intensify or exacerbate the onset of depressive symptoms and jeopardize a depressed patient's ability to modify dysfunctional thinking (DeFronzo, Panzarella, & Butler, 2001).

There is some research to suggest that it may prove beneficial to train friends and family members of depressed patients to provide AIF. First, the specific mechanisms through which inferential feedback affects depressive symptoms, in the context of hopelessness theory, were supported in longitudinal, cross-sectional, and experimental studies (e. …

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