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Introduction
Apart from pharmacological interventions, recent study
shows that cognitive therapy has a significant effect in
improving depression.1 Cognitive therapy was founded by
Beck in the 1970s and became popular because of empirical
evidence in its favour and a clear conceptual framework.
The concept of dysfunctional attitudes (DA) in depressed
persons was first described by Beck,2,3 who suggested
Mr Peter WC Tam, M Soc Sci, Occupational Therapy Department, North
District Hospital, Hong Kong, China.
Dr Daniel FK Wong, PhD, Department of Social Work and Social Administration,
The University of Hong Kong, Hong Kong, China.
Address for Correspondence: Mr Peter WC Tam, Occupational Therapy
Department, North District Hospital, North District, New Territories, Hong
Kong, China.
Tel: (852) 2683 7862; Fax: (852) 2683 7863;
E-mail: petertamwc@gmail.com
Submitted: 13 June 2007; Accepted: 29 August 2007
Original Article
Methods
Research Design
This study was exploratory and qualitative in nature. A semistructured interview schedule was developed. Information
concerning DA in depressed participants was sought by
open-ended questions. Data were analysed in a descriptive
manner. A qualitative design was considered appropriate in
studying DA, as this topic had not been comprehensively
explored in Hong Kong.9
Sampling
Data Collection
All participants were first contacted over the phone for their
consent to participate in the study. Each interview lasted
for about 1 to 1.5 hours, and took place mostly at a local
agency serving psychiatric patients. A few participants
were interviewed near their residential areas or at their
work places as requested. Socio-demographic data, Becks
Depression Inventory (BDI) scores, and written consent
were obtained before the start of the semi-structured
interview. The researchers, who carried out the interviews,
were an occupational therapist and a social worker. Both
had received training from a supervisor who was a cognitive
therapist.
Semi-structured interviews were then conducted in
Cantonese with the use of open-ended questions. The semistructured format allowed the researchers to explore matters,
beyond the first response to the interviewers questions.
Issues arising from the answers to the questions could
then be followed up in greater detail later in the interview.
The questions were based on a review of literature on DA
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Data Analyses
Results
Profiles of the Participants
Generalised Themes
Number of participants
18 (90%)
18 (90%)
11 (55%)
10 (50%)
8 (40%)
6 (30%)
4 (20%)
4 (20%)
2 (10%)
1 (5%)
Within any one theme (e.g. vulnerability), a subject can have one or more dysfunctional attitudes (such as inadequacy at work,
helplessness in social contexts).
Culture-specific Themes
Discussion
Identified DA could be grouped into 2 categories the
general and the culture-specific themes. Vulnerability,
need for approval, imperatives, and successperfectionism were common to both western societies and
the Hong Kong Chinese population. In contrast to these
themes already reported in the west,12-14 role performance
within the family hierarchy, familial harmony, relational
harmony, fate, face, and fairness were more culturally
specific DA relevant to Chinese participants.
Vulnerability was a prevalent DA theme among
many participants, akin to the negative cognitive triad
described by Beck2 as negative views of the self, the
world (environment), and the future. Vulnerability was a
reflection of depressed peoples pessimistic views of their
lives. Depressed people are believed to be more likely to
evaluate themselves, other people, their life events, and
the future negatively.15-18 According to the cognitive triad,
when individuals have negative views of themselves, they
attribute their unpleasant experiences to psychological,
moral, or physical defects in themselves. Many participants
held the core belief that they are inadequate, incompetent,
and useless. Inadequacy appeared to be the most apparent
of their core beliefs. When an individual has negative
views towards the future, he / she anticipates that current
difficulties will continue indefinitely and expect to fail.
112
Acknowledgement
I would like to express my gratitude to Mr Chun-kit Chan
for his assistance in data collection.
References
1. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of
cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol
Rev 2006;26:17-31.
2. Beck AT, editor. The cognitive therapy of depression. In: Beck AT,
editor. Cognitive therapy and the emotional disorders. New York:
International Universities Press; 1976:263-71.
3. Beck AT, Rush AJ, Shaw BF, Emery G, editors. Depressogenic
assumptions. In: Beck AT, Rush AJ, Shaw BF, Emery G, editors.
Cognitive therapy of depression. New York: Guilford Press; 1979:
244-71.
4. Liu YL. The role of perceived social support and dysfunctional
attitudes in predicting Taiwanese adolescents depressive tendency.
Adolescence 2002;37:823-34.
5. Abela JR, DAlessandro DU. Becks cognitive theory of depression: a
test of the diathesis-stress and causal mediation components. Br J Clin
Psychol 2002;41:111-28.
6. Klocek JW, Oliver JM, Ross MJ. The role of dysfunctional attitudes,
negative life events, and social support in the prediction of depressive
dysphoria: A prospective longitudinal study. Soc Behav Pers
1997;25:123-36.
7. Riso LP, du Toit PL, Blandino JA, Penna S, Duin JS, Pacoe EM,
et al. Cognitive aspects of chronic depression. J Abnorm Psychol
2003;112:72-80.
8. Wong DF, Sun SY, Tse J, Wong F. Evaluating the outcomes of a
cognitive-behavioral group intervention model for persons at risk of
developing mental health problems in Hong Kong: A pretest-posttest
study. Res Soc Work Pract 2002;12:534-45.
9. Selltiz C, Wrightsman LS, Cook SW, editors. Research design: I
exploratory & descriptive studies. In: Selltiz C, Wrightsman LS, Cook
SW, editors. Research methods in social relations. 3rd ed. New York:
Holt, Rinehart and Winston; 1976: 49-78.
10. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed.
Washington, DC: American Psychiatric Association; 1994.
11. Hu HC. The Chinese concept of face. Am Anthropol 1944;46:45-64.
12. Beck AT, Brown G, Steer RA, Weissman AN. Factor analysis of the
Dysfunctional Attitude Scale in a clinical population. Psychol Assess
1991;3:478-83.
13. Cane DB, Olinger LJ, Gotlib IH, Kuiper NA. Factor structure of the
Dysfunctional Attitude Scale in a student population. J Clin Psychol
1986;42:307-9.
14. Power MJ, Katz R, McGuffin P, Duggan CF, Lam D, Beck AT. The
Dysfunctional Attitude Scale (DAS): a comparison of forms A and B and
proposals for a new subscaled version. J Res Pers 1994;28:263-76.
15. Kendall PC, Howard BL, Hays RC. Self-referent speech and
psychopathology: the balance of positive and negative thinking. Cognit
Ther Res 1989;13:583-98.
16. Ingram RE, Slater MA, Atkinson JH, Scott W. Positive automatic
cognition in major affective disorder. Psychol Assess 1990;2:209-11.
17. Hokanson JE, Hummer JT, Butler AC. Interpersonal perceptions by
depressed college students. Cognit Ther Res 1991;15:443-57.
18. Siegel SJ, Alloy LB. Interpersonal perceptions and consequences
of depressive-significant other relationships: a naturalistic study of
college roommates. J Abnorm Psychol 1990;99:361-73.
19. Cheng SK. Life stress, problem solving, perfectionism, and depressive
symptoms in Chinese. Cognit Ther Res 2001;25:303-10.
20. Bond MH, editor. The social actor in Chinese society. In: Bond MH,
editor. Beyond the Chinese face: insights from psychology. Hong
Kong: Oxford University Press; 1991:33-47.
21. Bedford O, Hwang KK. Guilt and shame in Chinese culture: a crosscultural framework from the perspective of morality and identity. J
Theory Soc Behav 2003;33:127-44.
22. Nelson LJ, Badger S, Wu B. The influence of culture in emerging
adulthood: perspectives of Chinese college students. Int J Behav Dev
2004;28:26-36.
23. Ho PS. Breaking down or breaking through: an alternative way to
understand depression among women in Hong Kong. Journal of Ethnic
and Cultural Diversity in Social Work 2001;10:89-106.
24. Ho DY. On the concept of face. Am J Sociol 1976;81:867-84.
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