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‘Depressive Realism’Revisited: DepressedPatients are Realisticwhen they are Wrong butare Unrealistic when theyare RightJ. Wood , A.P.R. Moffoot & R.E. O'CarrollPublished online: 09 Sep 2010.

To cite this article: J. Wood , A.P.R. Moffoot & R.E. O'Carroll (1998)‘Depressive Realism’ Revisited: Depressed Patients are Realistic whenthey are Wrong but are Unrealistic when they are Right, CognitiveNeuropsychiatry, 3:2, 119-126, DOI: 10.1080/135468098396198

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``D epressiv e R ealism ’ ’ R ev is ited : D epressed P atien ts

are R ealistic w hen they are W rong bu t are U nrea listic

w hen they are R ight

J. W ood

U niversity of E dinburgh , Scotland

A .P .R . M offoot

R osslyn lee Hosp ita l, M idlo th ian , Sco tland

R .E . O ’ C a rro ll

University o f S tirling, Sco tland

A prev iou s repo rt indica ted that d ep re ssed pa tients w ere significan tly less

con fiden t in the ir re spon se s w hen they w ere co rrec t, in com pariso n w ith a

m atched con tro l g roup . T he re w ere no sign ificant diffe rences be tw een th e g roups

in confidence ra tings w hen th e su b jec ts answ ered the quest ions inco rrec tly . In the

present study , th e replicab ility of th is finding w as tested u s ing new sam p les and a

different experim en ta l p ro cedu re . In E xpe rim ent 1 , 10 depre ssed inpa tients w ere

com pared w ith 10 hea lthy con tro ls . S e lf-con fid ence w as ra ted in a face -recogn ition

experim en t. D ep re ssed pa tien ts w ere sign ificantly less confident than contro ls

w hen they pe rform ed the face -recogn ition co rrectly . H ow eve r, the re w ere no

differences be tw een the g roup s in se lf-con fid ence ra ting s w hen they m ade

recognition erro rs . In E xpe rim ent 2 , the procedure w as repea ted in a com pariso n of

10 dy sp horic versu s 10 nondy sp ho ric hea lthy young adults . N o be tw een -group

diffe rences in se lf-con fid ence ra ting s em erged w hen pe rfo rm ing th e face -

recognition ta sk co rrectly o r inco rrec tly . It is conc luded tha t: (a ) d ep re ssed

pa tients app ra ise the ir ab ilitie s rea list ica lly w hen they a re w rong , bu t un rea list i-

ca lly w hen they a re righ t; and (b ) dy sp horic s tuden ts m ay no t prov ide va lid m ode ls

from w hich to ex trapo la te to c lin ica lly dep re ssed pa tien ts.

INTRODUCTION

The trad itional v iew of m enta l hea lth is tha t contac t w ith an ob jec tive reality is

the hallm ark of a psycho logically w ell-ba lanced ind ividua l. Beck’ s (1967)

cogn itive theory of depression is based on this v iew , and asse rts tha t depressed

R equ e s ts fo r rep rin ts sh ou ld be sen t to D r R o n an O ’ C a rro ll, D ep a rtm en t of P sych o log y , U n iv e rs ity

of S tirl in g , S tir lin g , FK 9 4 L A , S co tland ; e -m a il: re o l@ stir.ac .uk .

Ó 1 9 98 Psych o log y P re ss L td

C O G N IT IV E N E U R O PS Y C H IA T R Y , 19 98 , 3 (2 ), 11 9±1 26

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indiv idua ls su ffer from a negative cognitive b ias and have an unrea listica lly

nega tive v iew o f them se lves, the ir experien ces , and the ir fu tu res. T h is

conceptua lisation of the depressed indiv idua l as cognitive ly d istorted has

genera ted la rge am ounts o f resea rch , inc lud ing the deve lopm ent o f cognitive

therapy , an effective treatm en t fo r the clin ica lly depressed (B eck , 1991).

C ognitive therapy w as estab lished under the assum ption tha t the therapeu tic

p rocess corrects the nega tive b ias in depressives’ th inking pattern . H ow ever,

som e experim en tal ev idence has suggested tha t it is the depressed w ho are ab le

to see the w orld in a m ore rea listic w ay re lative to nondepressed ind ividua ls.

T his ``depressive realism ’ ’ hypo thesis was developed by A lloy and A bram son

(1979). The resu lts o f the A lloy and A bram son (1979) experim en t showed that

dysphoric ind ividua ls were consisten tly m ore accurate in judg ing the am ount o f

contro l they had over a g iven situation . N ondepressed sub jec ts, in con trast,

genera lly overestim ated the ir level o f con tro l. T h is o rig ina l con tingency

judgem ent experim ent has been rep licated on num erous occasions (e.g . A lloy ,

A bram son, & V iscusi, 1981 ; M artin , A bram son , & Alloy , 1984 ; V asquez , 1987).

In ano ther no tab le experim ent, L ew insohn (Lew insohn , M ischel, Chaplin, &

B arton , 1980) asked dysphoric and nondepressed subjec ts to rate them se lves on

scales o f soc ial com petence . T he judgem ents o f the dysphoric subjects w ere

m uch closer to the op inions of im partia l observers, bu t w ere sign ifican tly

d iffe rent from the non-depressed subjec ts, w ho show ed a se lf strong se lf-

enhancem ent b ias. T he resu lts from the depressive realism lite ra ture suggest that

fundam en ta l ideas abou t no ndepressed c ogn i tive p a tte rn s n eeded to b e

reconsidered.

H owever, the depressive realism experim en ts have been critic ised fo r lack of

re levance to real life situa tions, h igh ly artific ia l natu re of the exper im en tal

parad igm s, and fa ilure to use c lin ica lly depressed ind ividua ls as subjects

(A ckerm an & D eR ubesis, 1991 ; Haaga & B eck , 1995). In an a ttem pt to shed

ligh t on this area , H ancock , M offoo t, and O ’ Carro ll (1996) conduc ted a study in

w hich depressed inpa tien ts, recovered depressed pa tien ts, and hea lthy con trols

w ere g iven a genera l know ledge test and asked to give a level of confidence for

each of the ir answ ers. T he resu lts show ed no support for the depressive realism

hypo thesis. D epressed pa tien ts w ere sign ifican tly less confiden t in th eir

responses w hen they w ere correct in com parison w ith a con tro l g roup and a

group of recovered depressives . In teresting ly , the re w ere no be tw een-group

d iffe rences in confidence ra tings w hen the sub jec ts answ ered the questions

incorrec tly .

T he cruc ia l te st o f any observation is w he ther o r not it is rep licab le. In the

presen t investigation w e tested the findings of H ancock e t al. (1996), using a

d iffe rent sam ple and experim enta l p rocedure : (a) in a com parison of depressed

versus nondepressed adu lts (Exper im en t 1 ); and (b ) in a com parison of

dysphoric versus nondysphoric students (Experim en t 2 ).

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METHOD

The m ethod w as iden tical for bo th Experim en ts 1 and 2 . A face-recogn ition task

was construc ted using 40 photographs of faces taken from the R iverm ead

Behav ioura l M em ory T est (R B M T ; W ilson , Cockburn , B adde ley , & H iorns,

1989), se ts A±D . Sub jects w ere show n 20 faces ind ividually fo r a period of 2

seconds per face . The order o f p resen tation was random ised . As each card w as

show n, subjec ts w ere requ ired to te ll the experim en ter w hether the face w as

m ale or fem ale , and w hether the ind ividual in the pho tograph was above 40 or

be low 40 years o f age . Fo llow ing a 5-m inute d istracto r task , subjects w ere then

show n 40 faces on an ind ividual basis, 20 of w hom had been prev iously seen ,

and 20 w hich w ere nove l. Subjec ts w ere asked to ind icate w he ther o r no t they

had seen each face befo re. A fter each response , they w ere asked to ra te the ir

confidence in the decision they had m ade using a five-po int sca le rang ing from

0% , com plete ly unsure , to 100% com ple te ly sure . A fte r the 40 faces had been

presented, and the sub jec ts had com pleted their responses, they w ere asked to

ind ica te , overa ll, how they though t they had perfo rm ed on a 0±100 sca le w here

0% = perform ed poorly and 100% = perfo rm ed very w ell. F ina lly, the B eck

Depression Invento ry (B D I; B eck , W ard , M ende lson , M ock, & E rbaugh, 1961)

was presen ted to gain an assessm ent o f m ood state .

EXPERIMENT 1

Subjects

Ten inpatien ts suffe ring from a D SM I±IV m ajor depressive ep isode w ere

com pared w ith 10 hea lthy con tro ls. Dem ograph ic deta ils a re g iven in Tab le 1.

Unsurprising ly, the depressed group had sign ifican tly h igher BD I scores than the

con trols. There was no sign ifican t d iffe rence betw een the groups in sex ratio or

years o f fu ll-tim e educa tion . T here w as a sign ificant d iffe rence betw een the

groups fo r age, suggesting that age m ay represen t a possible confound ing

variab le. H ow ever, there w ere no sign ifican t correlations betw een age and

TABLE 1Comparison of Depressed and Nondepressed Subjects on Demographic Variables and

Depression Level (BDI score) ± Mean (s.d.)

D epre ssed

P at ien ts

(n = 1 0 )

H ea lth y

C o ntro ls

(n = 1 0 )

t P

A ge 40 .6 (1 0 .7 ) 5 3 .6 (1 1 .6 ) 2 .6 1 .01 8

E d uca tion 1 3 .7 (2 .9 ) 1 5 .2 (3 .5 ) 1 .0 3 .31 5

B D I 3 3 .0 (9 .4 ) 3 .9 (2 .9 ) 9 .4 0 .00 1

Sex 3M , 7 F 4M , 6 F F ish er ’ s = 1 .0 n .s .

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num ber of faces correc tly recogn ised (r = .25), confidence ra tings when correc t

(r = .07 ), co nf id enc e w h en in co rrec t (r = .0 9), o r co nf ide nc e in ov era ll

pe rfo rm ance (r = .24). A ccord ing ly , age w as no t used as a covaria te as it w as

no t linearly rela ted to the depend en t variab les.

Results

T he m ain resu lts o f E xperim en t 1 are presen ted in Tab le 2 . There w as no

be tw een-group d iffe rence on face-recogn ition perfo rm ance (i.e . num ber of faces

correc tly iden tified ). H ow ever , a signi fican t d iffe rence em erged in self-

confidence ra tings. W hen sub jec ts w ere correct (i.e . said ``yes’ ’ w hen they

had seen the face befo re or ``no ’ ’ w hen they had not seen the face before ),

depressed sub jec ts w ere sign ifican tly less confident in the ir responses, com pared

to con tro ls. For th is variab le on ly, the d iffe rence be tw een the groups in variance

w as sign ifican tly differen t (Levene ’ s test, F = 10 .2 , P = .005). T here fore , an

independen t t-te st for unequa l variab les w as run on the confidence ratings w hen

correc t. W hen sub jec ts m ade a face-recogn ition erro r, the re w as no sign ificant

d iffe rence in confidence ra tings. The corre lation be tw een depression severity

(B D I score) and se lf-confidence w hen w rong w as r = ±.47, (P = .039) and w hen

correc t r = ±.76 (P = .000). Depressed pa tien ts ra ted the ir overa ll perfo rm ance as

be ing sign ificantly poorer than con tro ls, despite the fact that the tw o groups

perfo rm ed equ ivalen tly.

EXPERIMENT 2

Subjects

E m ploying exac tly the sam e m ethod as in E xperim en t 1 , 10 dysphoric

u nde rg rad ua te s tu de n ts w ere co m pa red w ith 10 no nd yspho ric s tu den ts .

D ysphoria w as ca tegorised as scoring above 12 on the B eck D epression

Inven to ry (BD I). Dem ograph ic deta ils are presen ted in T ab le 3. T here w ere no

sign ifican t differences betw een the group for sex, age , o r years o f full-tim e

TABLE 2Comparison of Depressed and Nondepressed Subjects on Experimental

Task Performance ± Mean (s.d.)

D ep res sed

P a tien ts

(n = 1 0)

H eal th y

C on tro ls

(n = 1 0)

t P

N o . corr ec t 31 .1 (2 .4 ) 31 .9 (1 .2 ) 0 .95 .3 5 5

C o n fid en ce w h en co rre c t 74 .3 (11 .0 ) 89 .6 (4 .9 ) 4 .01 .0 0 2

C o n fid en ce w h en inco rre c t 57 .7 (15 .4 ) 70 .4 (1 7 .5 ) 1 .72 .1 0 2

O v e ra l l p e rfo rm ance ra ting 47 .5 (14 .2 ) 72 .5 (1 4 .1 ) 3 .94 .0 0 1

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educa tion . T he B DI score fo r the dysph oric g roup w as, by defin ition ,

sign ifican tly h igher than fo r the nondysphoric g roup .

Results

The resu lts of E xperim en t 2 are presented in Table 4 . T here w as no sign ifican t

d ifference in num ber of correc t respon ses on the face-recogn ition task .

S im ila rly , there w as no difference in confidence ratings w hen correc t o r w hen

incorrec t, and there w as no be tw een-group difference in overa ll se lf-estim ation

of perform ance . T he correla tion betw een depression severity (BD I score) and

self-confidence w hen incorrec t was r = ±.08, and w hen correct r = ±.08 , bo th

nonsignifican t associa tions.

DISCUSSION

In th is experim en t, w e have replicated the find ings of H ancock et a l. (1996).

C lin ica lly depressed sub jec ts w ere sign ificantly less confiden t than contro l

sub jects w hen they w ere correct, bu t w ere not any less confiden t in their answ ers

when they w ere w rong . Pu t ano ther w ay , depressed patien ts knew w hen they

TABLE 3Comparison and Dysphoric and Nondysphoric Subjects on Demographic Variables and

Depression Level (BDI score)

D ysp h or ic

Su b je ct s

(n = 1 0 )

N o nd y spho r ic

Su b je c ts

(n = 1 0 )

t P

A ge 1 9 .5 (2 .3 ) 2 0 .1 (3 .5 ) 0 .4 5 .66

E d uca tion 1 4 .0 (1 .9 ) 1 4 .1 (1 .2 ) 0 .1 4 .89

B D I 1 4 .3 (2 .8 ) 3 .6 (1 .9 ) 10 .3 .00 1

Sex 3M , 7 F 5M , 5 F F ishe r’ s = 0 .6 5 n .s .

TABLE 4Comparison of Dysphoric and Nondysphoric Subjects on Experimental Task

Performance ± Mean (s.d.)

D ysp h or ic

Su b je c ts

(n = 1 0 )

N o n dy sph or ic

Su b jec ts

(n = 10 )

t P

N o. co rre c t 3 0 .4 (1 .7 ) 2 9 .9 (1 .1 ) 0 .80 .4 4

C on fid en ce w hen corre c t 8 5 .3 (4 .4 ) 8 4 .0 (4 .8 ) 0 .63 .5 4

C on fid en ce w hen in corr ec t 6 5 .6 (9 .6 ) 6 3 .7 (1 1 .9 ) 0 .38 .7 1

O ve ra ll pe rfo rm ance ra tin g 5 5 .0 (1 9 .7 ) 6 2 .5 (1 3 .2 ) 1 .00 .3 3

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w ere w rong , but d id no t know w hen they w ere righ t. A s postu lated by H ancock

e t a l. (1996), it is no t unreasonab le to specu late that this uncer ta inty abou t

decision m aking, particu la rly lack of confidence w hen correc t, could represent

an ongo ing stressor in clinical depression . If one is constan tly unsure w hether

one has perform ed the correc t action or taken the right decision in day-to -day

liv ing , everyday ac tivities cou ld becom e increasing ly stressfu l. It is not

inconceivab le tha t th is stress could w ork as a m ainta in ing facto r in depressive

ep isodes (a schem atic represen ta tion of this hypo thesised ``v ic ious cycle ’ ’ is

show n in F ig . 1 ).

A n a lterna tive inte rp re tation of the resu lts o f Experim en t 1 is tha t the

depressed pa tients w ere sim ply m ore conserva tive in their judgem ents (Johnson

& M agaro , 1987). T h is v iew is derived from studies o f m em ory func tion ing in

depressed pa tients w here signa l detection ana lysis has been em ployed . Such

stud ies suggest tha t depressed sub jects m ay have the correct answ er in their

m em ory, bu t because of an overly cau tious response stra tegy , m ay be unw illing

to tell it to the exam iner. ``Th is is no t a though t diso rder o r defic ien t m em ory

struc tu re, bu t sim ply a decision to respond at a particu lar level o f confidence’ ’

(Johnson & M agaro , 1987 , p. 32). W e do no t consider th is to be a sa tisfac tory

explanation of the resu lts of E xperim ent 1 . If the m ain effec t o f m ajor depression

w as a genera lised conserva tive response sty le , we w ould not have found a clear

d iffe rential e ffect fo r correc t and incorrec t responses. T h is d iffe ren tial effec t has

now been rep lica ted in tw o separa te stud ies. In fac t, the conservative response

b ias v iew w ould have predic ted tha t depressed patien ts w ould have been m ore

cau tious than con tro ls in the ir se lf-confidence ra tings w hen incorrec t as w ell as

w hen correc t, and this was not observed.

FIG. 1. H y po th e sised p sych ob io log ica l ``v ic io us cy c le ’ ’ a c ting to m a in ta in a dep re ssive ep iso de .

5 H T , 5 -h yd rox y tryp tam in e ; N A , no ra dr en a line .

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Clear be tw een-group d ifferences w ere found in se lf-confidence ratings w hen

responses to correc t answ ers w ere analysed , and there w as no sign ifican t

difference in se lf-confidence ra tings w hen sub jec ts w ere incorrec t. H ow ever, the

difference in se lf-confidence ra tings w hen incorrec t d id approach the 10% leve l

of significance (Table 4). C ritic s m ay argue tha t g iven a larger sam ple size, th is

difference m ay have reached sign ificance, suggesting tha t the se lf-confidence

effect m ay no t be specifica lly assoc iated w ith correct responses, as w e propose.

In rep ly , in our earlier study (H ancock et al., 1996) the se lf-confidence

difference betw een depressed pa tients and con tro ls fo r incorrec t answers d id no t

approach statistical significance , whereas the sign ifican t reduc tion in self-

confidence ra tings, w hen correc t, disp layed by clin ically depressed sub jec ts is

clearly a robust and rep licab le phenom enon . W e w ould concede, how ever, tha t

m ajor depression is assoc ia ted w ith a genera lised low ering of se lf-esteem (as

ev idenced by the overall pe rform ance ratings). W e propose , how ever, tha t

superim posed on this is a re la tive ly specific uncerta in ty in oneself w hen one is

correc t, and tha t th is m ay ac t as a pow erfu l facto r in m ain ta in ing an ep isode of

m ajor depression (F ig . 1).

In our second experim ent, w e fa iled to find any sign ifican t d iffe rence in

se l f -co n f id e n ce ra tin g s w h en c om p ar ing a g rou p of d ysp h o r ic ve rsu s

nondysphoric undergradua te student sub jec ts. It is w orthw hile em phasising

tha t a lthough w e found clear d iffe rences in E xperim en t 1 w hen w e com pared

depressed pa tien ts w ith con tro ls, in E xperim ent 2 , the se lf-confidence ra tings

of dysphoric and nondysphoric sub jects w hen correc t were a lm ost iden tica l (85

vs . 84 % c onf id en t). M uch o f the expe rim en ta l cogn itive lite ra tu re o n

depression is derived from studies using dysphoric studen ts as sub jec ts. It is

argued that such sub jec ts rep resen t valid m odels o f clin ica l depression (e .g .

V redenburg, F le tt, & K ram es, 1993). T he resu lts o f E xperim en ts 1 and 2

suggest that find ings from dysphoric studen ts a re m arkedly d iffe ren t from

those found w hen using clin ically depressed pa tients. A lthough dysphoric

undergradua tes are certain ly m ore p lentifu l and easier to recru it in to research

stud ies, we conclude that they m ay no t p rovide va lid m odels from which to

ex trapo late to c lin ica lly depressed pa tients. A n a lternative v iew point is tha t the

key fac tor in study ing depressive phenom ena is depression severity . T he m ean

BD I score of the dysphoric sub jects (14 .3 ) w as less than ha lf tha t o f the

clinically depressed sub jects (33 .0). Corre la tional ana lyses revea led particu larly

strong assoc iations betw een severity and self-confidence , w hen correc t, on ly in

Experim en t 1, w hich inc luded severe ly depressed pa tien ts. It m ay be tha t

if w e had stud ied m ore severe ly dysphoric underg radua tes w ho had h igher

BD I scores, w e m ay have rep licated the find ings ob ta ined w ith patien ts

su ffer ing from m ajor depression . H ow ever, w e m ain ta in tha t dysphoric

sub jects w ith BD I scores in the range of 12±15 do no t p rov ide a valid

ana logue of m ajor depression . It is iron ic tha t th is is exac tly the range of B D I

scores of the dysphoric sub jec ts used in the sem inal study of A lloy and

``DEPRESSIVE REALISM’’ REVISITED 125D

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A bram son (1979), w hich c laim ed to have estab lished the phenom enon of

``depressive rea lism ’ ’ .

M an usc rip t re c e iv ed 2 5 F eb ru a ry 1 99 7

R evised m an u sc rip t re c e iv ed 2 2 A u gu s t 1 99 7

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