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Mark A. Reinecke, Ph.D.
Center for Cognitive Therapy
Department of Psychiatry
University of Chicago
5841 South Maryland Avenue (MC 3077)
Chicago, Illinois 60637
Research indicates that a range of cognitive, behavioral and social factors, including interpersonal dependency, hopelessness, loss of social support, and impaired social problem-solving are associated with vulnerability for depression and suicide among adults. Cognitive-behavioral interventions based on these models have proven quite useful in alleviating depression and in reducing suicidal risk. Attempts have been made during recent years to cast Beck's cognitive theory of depression into developmental terms. Guidano (1987), for example, suggested that the development of depressogenic schema ma stem from dysfunctional patterns of early attachment. As he states, "The central feature of the developmental pathway of depressive-prone individuals is the ongoing elaboration of a sense of loss that parallels the abnormal course of their attachment relationship with their parents." This perspective is congruent with Adam's (1986) suggestion that suicidal behavior "can snore usefully be conceptualized as attachment behavior, with it's function not primarily a retreat from the world and it's disappointments, but a desperate attempt to maintain relatedness to a vital attachment figure."
In this presentation we will discuss functional similarities between the protest and despair behaviors of infants who have been separated from their parents and the behaviors of depressed and suicidal adults that serve to elicit support and reassurance from others. Recent studies (with both clinical and non-clinical populations) documenting a relationship between insecure adult attachment style, depressogenic attitudes, and depression will be reviewed. The goal will be to point out how early difficulties in the parent-child relationship may lead to the development of an insecure attachment style, and to the consolidation of dysfunctional beliefs and impaired social problem-solving. Suicidality, at least for some patients, may be seen as a manifestation of an insecure attachment style in adulthood.
This model, though preliminary, has a number of clinical implications. It suggests that, in addition to interventions focused upon alleviating dysphoria and anxiety, reducing hopelessness, eliminating immediate stressors and enhancing rational problem-solving, clinicians may wish to examine the functional role of suicidal behavior in reestablishing secure relationships. As Adam (1986) cogently noted, "Whatever other meanings suicidal behavior may have, it serves effectively in signaling distress to others in the social environment, admonishing them for neglect, punishing them for rejection, and coercing them to reestablish a needed bond." Therapy might focus, then, on identifying and changing specific dysfunctional attitudes associated with depression and suicide (e.g., beliefs that one will be abandoned or rejected). The ways in which objective measures of adult attachment style (e.g., Parental Bonding Inventory, Adult Attachment Scale) and dysfunctional attitudes (e.g. Young-Brown Schema Questionnaire, Dysfunctional Attitudes Scale, Personal Style Inventory, Sociotropy-Autonomy Scale) can be used in clinical practice will be described, and interventions designed to change dysfunctional attitudes identified will be proposed.