Prevalence and trends of common mental disorders from 2007-2009 to 2019-2022: results from the Netherlands
Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs.
during the COVID-19 pandemic
Up-to-date information on the prevalence and trends of common mental disorders is relevant to health care policy
and planning, owing to the high burden associated with these disorders. In the first wave of the third Netherlands
Mental Health Survey and Incidence Study (NEMESIS-3), a nationally representative sample was interviewed
face-to-face from November 2019 to March 2022 (6,194 subjects; 1,576 interviewed before and 4,618 during the
COVID-19 pandemic; age range: 18-75 years). A slightly modified version of the Composite International
Diagnostic Interview 3.0 was used to assess DSM-IV and DSM-5 diagnoses. Trends in 12-month prevalence rates
of DSM-IV mental disorders were examined by comparing these rates between NEMESIS-3 and NEMESIS-2
(6,646 subjects; age range: 18-64 years; interviewed from November 2007 to July 2009). Lifetime DSM-5
prevalence estimates in NEMESIS-3 were 28.6% for anxiety disorders, 27.6% for mood disorders, 16.7% for
substance use disorders, and 3.6% for attention-deficit/ hyperactivity disorder. Over the last 12 months, prevalence
rates were 15.2%, 9.8%, 7.1%, and 3.2%, respectively. No differences in 12-month prevalence rates before vs.
during the COVID-19 pandemic were found (26.7% pre-pandemic vs. 25.7% during the pandemic), even after
controlling for differences in socio-demographic characteristics of the respondents interviewed in these two periods.
This was the case for all four disorder categories. From 2007- 2009 to 2019-2022, the 12-month prevalence rate of
any DSM-IV disorder significantly increased from 17.4% to 26.1%. A stronger increase in prevalence was found for
students, younger adults (18-34 years) and city dwellers. These data suggest that the prevalence of mental
disorders has increased in the past decade, but this is not explained by the COVID-19 pandemic. The already high
mental disorder risk of young adults has particularly further increased in recent years.
Some studies have found an increase in the prevalence rates of mental disorders or mental health problems over
time, while others have reported stable prevalence rates. No study has found evidence for a decrease in
prevalence.
Limitations:
- Most of them focused solely on major depressive episodes, while trends in anxiety and substance use
disorders were explored far less.
- Only a few studies used fully structured diagnostic interviews to assess mental disorders, while most relied
on abbreviated versions of such interviews or self-report symptom questionnaires.
- Hardly any study investigated socio-demographic differences in time trends. Almost no study examined
trends over the past decade.
Due to factors such as the economic crisis that started in 2008, the increased income inequality, the further
individualization of society, and the recent COVID-19 pandemic, the prevalence of mental disorders in the general
population of Western countries may have changed.
- The reported rise in mental health care use might indicate that the prevalence of mental disorders has
increased, but this may also be explained by improved accessibility, efficiency and capacity of care.
Since the outbreak of the COVID-19 pandemic, the number of studies examining the mental health status of the
general population and of specific groups has increased enormously. Most of these studies were online surveys,
based on convenience samples with one-time data collection, suggesting dramatic increases in clinically significant
anxiety and depression early in the pandemic. However, a systematic review of general population studies
comparing prevalence rates before vs. during the pandemic reported a much more modest increase in the
prevalence of depressive and anxiety disorders during the first year of the pandemic.
In NEMESIS-3, the baseline wave was performed from November 2019 to March 2022, and included three
fieldwork-free periods owing to the COVID-19 pandemic. In NEMESIS-3, 1,576 participants (25.4%) were
interviewed before and 4,618 (74.6%) during the COVID-19 pandemic. A total of 500 interviews (8.1%) were
completed via video call. To allow generalization of the data to the Dutch population, based on post-stratification, a
weighting factor was constructed for each study. DSM-IV diagnoses of common mental disorders were ascertained
using the Composite International Diagnostic Interview (CIDI) 3.0.
Any lifetime disorder was found in almost half of the respondents (48.4%). Mood and anxiety disorders were the
most prevalent disorder categories (27.6% and 28.6%, respectively), followed by substance use disorders (16.7%)
and ADHD (3.6%). The most prevalent specific disorders were major depressive disorder (24.9%), social phobia
(13.1%), specific phobia (11.8%) and alcohol use disorder (12.8%).
1
,Of all respondents, 21.8% had one disorder during their lifetime, 11.8% had two and 14.8% had three or more. One
in four respondents (25.9%) met the criteria for any disorder in the 12 months before the interview.
Of those with any lifetime disorder, more than half (53.5%) also had a disorder in the past year. The most prevalent
disorder category was anxiety disorders (15.2%), followed by mood disorders (9.8%), substance use disorders
(7.1%) and ADHD (3.2%).
Women were more likely to have any mental disorder in the past 12 months than men. Lower age was associated
with higher prevalence of all disorder categories.
Respondents with primary or lower secondary education, and those with a low household income, more often had
mood disorders, anxiety disorders and ADHD, but not substance use disorders. Respondents living alone were
more likely to have all disorder categories than those living with a partner and children. For all disorder categories,
unemployed or disabled subjects were worse off than those in paid employment. While the degree of urbanization
of the place of residence was clearly associated with the prevalence of 12-month disorders, country of origin was
not.
These analyses showed that the prevalence rates of any 6-month DSM-5 disorder before vs. during the COVID-19
pandemic did not differ significantly (21.8% pre-pandemic vs. 19.7% during pandemic). However, after controlling
for differences in socio-demographic characteristics, the 6-month prevalence rate of any DSM-5 disorder was
significantly lower during the pandemic than pre-pandemic (19.5% vs. 22.5%). A lower prevalence during the
pandemic was also evident in the 6-month prevalence of substance use disorders, but not of mood disorders and
anxiety disorders.
The 12-month prevalence rate of any DSM- IV mood, anxiety or substance use disorder among 18-64 year olds
significantly and substantially increased from 17.4% in NEMESIS-2 to 26.1% in NEMESIS-3. A similar trend was
seen for any mood disorder (from 6.0% to 10.8%) and any anxiety disorder (from 10.1% to 15.6%). The prevalence
of any substance use disorder also increased (from 5.5% to 7.1%), but the change was not significant after
controlling for differences in socio-demographic characteristics between the two studies. This was paralleled by a
marked increase in the use of specialized mental health care (from 6.2% to 10.0%). At the same time, unmet need
for care rose from 1.8% to 4.0%. Among those with any 12-month mood, anxiety or substance use disorder, the
ratio of those with a mild, moderate or severe disorder remained the same between the two studies. The
percentage of those with two or more mental disorders significantly increased (from 32.6% in NEMESIS-2 to 41.3%
in NEMESIS-3).
A stronger increase in the 12- month prevalence of any DSM-IV disorder in the period between the two studies was
found for younger adults (18-34 years) compared to those aged 35 and older, for students compared to those with
a paid job, and for those living in a city compared to non-urban residents. Among retired people, a smaller increase
in disorder prevalence was found, perhaps because they have been less affected by the long-term consequences
of the economic crisis that started in 2008, or are less adversely affected by current social problems than the
employed. No interaction effects were found for sex, education and living situation.
In recent decades, young adults may have been more adversely affected by the further individualization of society,
the rise of social media and the increasing pressure to succeed. They may also be more adversely affected by
current social problems (e.g., shortage of affordable housing, climate change concerns), or have more difficulty
coping with setbacks, such as not immediately having a successful job or owner- occupied home.
Change in the population structure, such as relatively more highly educated people and more people with a paid
job, also does not explain the sharp increase in prevalence of mood and anxiety disorders, but it may have played
a limited role in explaining the increase in substance use disorders.
The increase in mood and anxiety disorders could be due to people being more likely to recognize and admit
mental health problems today than in the past, however, only to a limited extent.
The prevalence rates of any mental disorder in the lifetime and in the past 12 months in this sample from the
Netherlands are similar to those reported in the US, but higher than those found in other European countries.
We found that the prevalence rates of mental disorders before vs. during the COVID-19 pandemic did not differ
significantly. The study also shows that adversities of shorter duration (such as the COVID-19 pandemic) have little
or no effect on that mental state.
2
,This could suggest effective resilience and adaptation, although time-lag effects of the pandemic may yet be felt
The only clinically relevant effect of the COVID-19 pandemic on population mental health was a significant
decrease in the 6-month prevalence of substance use disorder, which mainly includes mild alcohol use disorder,
during the pandemic. One explanation for this could be that the social restrictions during the pandemic reduced the
possibility of drinking alcohol with others or in bars and restaurants, thus reducing alcohol consumption and its
consequences.
Limitations of the study:
1. While the CIDI 3.0 assesses DSM-IV mood, anxiety and substance use disorders with generally good
validity, the validity and reliability of our slightly modified CIDI 3.0 to assess DSM-5 diagnoses have not
been formally investigated.
2. Our prevalence rates are based on retrospective recall: diagnosing disorders in the lifetime, rather than
within the past 12 months, often results in underreporting.
3. Survey non-response could lead to bias in prevalence estimates: in line with an international trend towards
declining response rates in all types of surveys, the non-response in NEMESIS-3 was larger than in
NEMESIS-2.
4. Although the sample was representative of the Dutch population on most parameters, those with
insufficient mastery of Dutch, those with no permanent residential address, and those who were long-term
institutionalized were excluded from participation.
Cognitive theories of emotional disorders
In contrast to theories of normal emotion, cognitive approaches to the emotional disorders have typically focused
on a specific disorder such as depression or anxiety rather than attempting broader accounts of a range of
emotional disorders. This carving up of the emotional disorders can lead to a false sense of disjointedness between
the emotions in comparison to the more overarching theories.
Fortunately there are signs that recent theories may buck this trend, though, for at least two different reasons. First,
the sheer success of a theory in its own domain may lead it, in the tradition of the great empire builders, to cross
into adjoining territories; thus, the success of Beck’s theory of depression has led to its fruitful extension to other
areas such as anxiety, schizophrenia and personality disorders. Second, there are signs that the increasing
cross-fertilisation between cognitive psychology and clinical psychology may lead to more general theories of
emotional disorders rather than theories that are tied to one specific disorder.
If, in our examination of normal theories of emotion, we detected the possibility of integration, for example between
cognitive and psychodynamic approaches (e.g. in the increasing interest in unconscious processes), we can also
find these integrative forces within recent theories of emotional disorders. Although the modern interest in the
interaction between social factors such as life events and internal cognitive factors such as self-esteem can be
traced to the work of researchers such as Brown and Harris (1978), from a broader integrative and historical
perspective we should also note Freud’s 1917 work Mourning and Melancholia. The moral is that, although the
wheel may simply have turned full circle in the search for integrative approaches, we should now be in a position to
take these approaches further.
One general criticism of cognitive theories of normal emotions was that these theories often provided inadequate
accounts of how emotional disorders might be explained within their frameworks. However, in relation to theories of
emotional disorders, we can identify the opposite problem – namely, how do theories of emotional disorders
account for normal emotions?
Seligman's learned helplessness theory (1975)
The original proposal began with Seligman’s laboratory work with dogs. In these studies, the dogs were placed in a
shuttle-box, which was designed so that on some occasions the dog could jump from one side of the box to the
other, but on other occasions a barrier could be placed across to prevent escape. Seligman found that if the dogs
experienced inescapable shock for a number of trials, they failed to escape from subsequent shocks even when it
was possible to do so. This condition Seligman termed “learned helplessness” and he suggested that it could also
account for a number of conditions in humans, especially that of depression.
There ensued a large number of studies in which students were subjected to unsolvable anagrams and
inescapable bursts of noise, but unfortunately for the theory the students failed to demonstrate a consistent
induction of helplessness; researchers began to realise that the original theory needed alteration to account for the
3
, application to humans. Indeed, it was even noticed that dogs, perhaps beginning to learn from their student
counterparts, started to refuse to become as helpless as consistently as they had done in the earlier experiments.
In addition to the empirical failures, there were features of depression for which the original theory provided no
account. For example, the self-esteem deficit that is common in depression is not predictable from the experience
of non-contingency alone. Another problem is that “golden boys” and “golden girls” may have experienced
continuous non-contingent positive reinforcement throughout their childhood, but could then become depressed
when they left home and found that positive reinforcement was no longer non-contingent, but in fact required active
responses on the part of the individual. The possibility of a similar phenomenon of “success depression” has also
been disputed by other behavioural researchers on theoretical grounds.
The reformulation of the theory
Abramson et al. added Weiner’s attribution theory to the original learned helplessness approach; that is, although
helplessness continued to be seen to arise from the perception of uncontrollability, the subsequent effects were
now seen to depend both on the type and the importance of the event experienced, together with the explanation
that the individual produced for the cause of the event. The emotional, motivational and cognitive deficits seen in
depression could be accounted for by a particular set of attributions following the occurrence of a negative event:
- Internal-external or “locus” – that is, whether the cause is seen to be due to something about the individual
(internal) or due to something about other people or circumstances (external)
- Stable- unstable (or stable-variable in Weiner’s terminology) – that is, whether the cause is due to
something that would recur for future similar events.
- Global-specific – that is, whether the cause influences only one area of the individual’s life or many areas.
A vulnerability factor for depression was if the individual made internal-stable-global attributions (e.g. “due to my
personality”) for the causes of negative events and external-unstable-specific attributions (e.g. “due to luck”) for
positive events. More specifically, an internal attribution for a negative event was seen to lead to low self-esteem,
especially if, by social comparison, other individuals were perceived not to be helpless in such a situation (so-called
“personal helplessness”). The additional stable and global attributions for negative events were seen to add to the
chronicity and the generality of the deficits observed in
depressed individuals.
Problems
- One possible problem may be the ways in which
attributions are measured in many of these
studies. It is possible, therefore, that
depressogenic implicit attributional tendencies
are not being detected by the routine
questionnaire methodology used in much of this
literature.
- Other failures of the reformulated model include
the recognition that evidence for the proposed
external-specific-unstable depressive style for
positive events has been extremely mixed.
- Although collections of hypothetical events, as
measured by the Attributional Style
Questionnaire may demonstrate a bias towards a
particular attributional pattern, real-world events,
unless they are sufficiently ambiguous, may
completely override an individual’s characteristic
attributional style.
Hopelessness theory
One of the key differences with helplessness theory is that
hopelessness requires only the occurrence of negative
events rather than uncontrollable events; thus, it had
always been problematic that depressed individuals
seemed to blame themselves for events which according to
learned helplessness theory they should perceive to be
uncontrollable.
4
Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs.
during the COVID-19 pandemic
Up-to-date information on the prevalence and trends of common mental disorders is relevant to health care policy
and planning, owing to the high burden associated with these disorders. In the first wave of the third Netherlands
Mental Health Survey and Incidence Study (NEMESIS-3), a nationally representative sample was interviewed
face-to-face from November 2019 to March 2022 (6,194 subjects; 1,576 interviewed before and 4,618 during the
COVID-19 pandemic; age range: 18-75 years). A slightly modified version of the Composite International
Diagnostic Interview 3.0 was used to assess DSM-IV and DSM-5 diagnoses. Trends in 12-month prevalence rates
of DSM-IV mental disorders were examined by comparing these rates between NEMESIS-3 and NEMESIS-2
(6,646 subjects; age range: 18-64 years; interviewed from November 2007 to July 2009). Lifetime DSM-5
prevalence estimates in NEMESIS-3 were 28.6% for anxiety disorders, 27.6% for mood disorders, 16.7% for
substance use disorders, and 3.6% for attention-deficit/ hyperactivity disorder. Over the last 12 months, prevalence
rates were 15.2%, 9.8%, 7.1%, and 3.2%, respectively. No differences in 12-month prevalence rates before vs.
during the COVID-19 pandemic were found (26.7% pre-pandemic vs. 25.7% during the pandemic), even after
controlling for differences in socio-demographic characteristics of the respondents interviewed in these two periods.
This was the case for all four disorder categories. From 2007- 2009 to 2019-2022, the 12-month prevalence rate of
any DSM-IV disorder significantly increased from 17.4% to 26.1%. A stronger increase in prevalence was found for
students, younger adults (18-34 years) and city dwellers. These data suggest that the prevalence of mental
disorders has increased in the past decade, but this is not explained by the COVID-19 pandemic. The already high
mental disorder risk of young adults has particularly further increased in recent years.
Some studies have found an increase in the prevalence rates of mental disorders or mental health problems over
time, while others have reported stable prevalence rates. No study has found evidence for a decrease in
prevalence.
Limitations:
- Most of them focused solely on major depressive episodes, while trends in anxiety and substance use
disorders were explored far less.
- Only a few studies used fully structured diagnostic interviews to assess mental disorders, while most relied
on abbreviated versions of such interviews or self-report symptom questionnaires.
- Hardly any study investigated socio-demographic differences in time trends. Almost no study examined
trends over the past decade.
Due to factors such as the economic crisis that started in 2008, the increased income inequality, the further
individualization of society, and the recent COVID-19 pandemic, the prevalence of mental disorders in the general
population of Western countries may have changed.
- The reported rise in mental health care use might indicate that the prevalence of mental disorders has
increased, but this may also be explained by improved accessibility, efficiency and capacity of care.
Since the outbreak of the COVID-19 pandemic, the number of studies examining the mental health status of the
general population and of specific groups has increased enormously. Most of these studies were online surveys,
based on convenience samples with one-time data collection, suggesting dramatic increases in clinically significant
anxiety and depression early in the pandemic. However, a systematic review of general population studies
comparing prevalence rates before vs. during the pandemic reported a much more modest increase in the
prevalence of depressive and anxiety disorders during the first year of the pandemic.
In NEMESIS-3, the baseline wave was performed from November 2019 to March 2022, and included three
fieldwork-free periods owing to the COVID-19 pandemic. In NEMESIS-3, 1,576 participants (25.4%) were
interviewed before and 4,618 (74.6%) during the COVID-19 pandemic. A total of 500 interviews (8.1%) were
completed via video call. To allow generalization of the data to the Dutch population, based on post-stratification, a
weighting factor was constructed for each study. DSM-IV diagnoses of common mental disorders were ascertained
using the Composite International Diagnostic Interview (CIDI) 3.0.
Any lifetime disorder was found in almost half of the respondents (48.4%). Mood and anxiety disorders were the
most prevalent disorder categories (27.6% and 28.6%, respectively), followed by substance use disorders (16.7%)
and ADHD (3.6%). The most prevalent specific disorders were major depressive disorder (24.9%), social phobia
(13.1%), specific phobia (11.8%) and alcohol use disorder (12.8%).
1
,Of all respondents, 21.8% had one disorder during their lifetime, 11.8% had two and 14.8% had three or more. One
in four respondents (25.9%) met the criteria for any disorder in the 12 months before the interview.
Of those with any lifetime disorder, more than half (53.5%) also had a disorder in the past year. The most prevalent
disorder category was anxiety disorders (15.2%), followed by mood disorders (9.8%), substance use disorders
(7.1%) and ADHD (3.2%).
Women were more likely to have any mental disorder in the past 12 months than men. Lower age was associated
with higher prevalence of all disorder categories.
Respondents with primary or lower secondary education, and those with a low household income, more often had
mood disorders, anxiety disorders and ADHD, but not substance use disorders. Respondents living alone were
more likely to have all disorder categories than those living with a partner and children. For all disorder categories,
unemployed or disabled subjects were worse off than those in paid employment. While the degree of urbanization
of the place of residence was clearly associated with the prevalence of 12-month disorders, country of origin was
not.
These analyses showed that the prevalence rates of any 6-month DSM-5 disorder before vs. during the COVID-19
pandemic did not differ significantly (21.8% pre-pandemic vs. 19.7% during pandemic). However, after controlling
for differences in socio-demographic characteristics, the 6-month prevalence rate of any DSM-5 disorder was
significantly lower during the pandemic than pre-pandemic (19.5% vs. 22.5%). A lower prevalence during the
pandemic was also evident in the 6-month prevalence of substance use disorders, but not of mood disorders and
anxiety disorders.
The 12-month prevalence rate of any DSM- IV mood, anxiety or substance use disorder among 18-64 year olds
significantly and substantially increased from 17.4% in NEMESIS-2 to 26.1% in NEMESIS-3. A similar trend was
seen for any mood disorder (from 6.0% to 10.8%) and any anxiety disorder (from 10.1% to 15.6%). The prevalence
of any substance use disorder also increased (from 5.5% to 7.1%), but the change was not significant after
controlling for differences in socio-demographic characteristics between the two studies. This was paralleled by a
marked increase in the use of specialized mental health care (from 6.2% to 10.0%). At the same time, unmet need
for care rose from 1.8% to 4.0%. Among those with any 12-month mood, anxiety or substance use disorder, the
ratio of those with a mild, moderate or severe disorder remained the same between the two studies. The
percentage of those with two or more mental disorders significantly increased (from 32.6% in NEMESIS-2 to 41.3%
in NEMESIS-3).
A stronger increase in the 12- month prevalence of any DSM-IV disorder in the period between the two studies was
found for younger adults (18-34 years) compared to those aged 35 and older, for students compared to those with
a paid job, and for those living in a city compared to non-urban residents. Among retired people, a smaller increase
in disorder prevalence was found, perhaps because they have been less affected by the long-term consequences
of the economic crisis that started in 2008, or are less adversely affected by current social problems than the
employed. No interaction effects were found for sex, education and living situation.
In recent decades, young adults may have been more adversely affected by the further individualization of society,
the rise of social media and the increasing pressure to succeed. They may also be more adversely affected by
current social problems (e.g., shortage of affordable housing, climate change concerns), or have more difficulty
coping with setbacks, such as not immediately having a successful job or owner- occupied home.
Change in the population structure, such as relatively more highly educated people and more people with a paid
job, also does not explain the sharp increase in prevalence of mood and anxiety disorders, but it may have played
a limited role in explaining the increase in substance use disorders.
The increase in mood and anxiety disorders could be due to people being more likely to recognize and admit
mental health problems today than in the past, however, only to a limited extent.
The prevalence rates of any mental disorder in the lifetime and in the past 12 months in this sample from the
Netherlands are similar to those reported in the US, but higher than those found in other European countries.
We found that the prevalence rates of mental disorders before vs. during the COVID-19 pandemic did not differ
significantly. The study also shows that adversities of shorter duration (such as the COVID-19 pandemic) have little
or no effect on that mental state.
2
,This could suggest effective resilience and adaptation, although time-lag effects of the pandemic may yet be felt
The only clinically relevant effect of the COVID-19 pandemic on population mental health was a significant
decrease in the 6-month prevalence of substance use disorder, which mainly includes mild alcohol use disorder,
during the pandemic. One explanation for this could be that the social restrictions during the pandemic reduced the
possibility of drinking alcohol with others or in bars and restaurants, thus reducing alcohol consumption and its
consequences.
Limitations of the study:
1. While the CIDI 3.0 assesses DSM-IV mood, anxiety and substance use disorders with generally good
validity, the validity and reliability of our slightly modified CIDI 3.0 to assess DSM-5 diagnoses have not
been formally investigated.
2. Our prevalence rates are based on retrospective recall: diagnosing disorders in the lifetime, rather than
within the past 12 months, often results in underreporting.
3. Survey non-response could lead to bias in prevalence estimates: in line with an international trend towards
declining response rates in all types of surveys, the non-response in NEMESIS-3 was larger than in
NEMESIS-2.
4. Although the sample was representative of the Dutch population on most parameters, those with
insufficient mastery of Dutch, those with no permanent residential address, and those who were long-term
institutionalized were excluded from participation.
Cognitive theories of emotional disorders
In contrast to theories of normal emotion, cognitive approaches to the emotional disorders have typically focused
on a specific disorder such as depression or anxiety rather than attempting broader accounts of a range of
emotional disorders. This carving up of the emotional disorders can lead to a false sense of disjointedness between
the emotions in comparison to the more overarching theories.
Fortunately there are signs that recent theories may buck this trend, though, for at least two different reasons. First,
the sheer success of a theory in its own domain may lead it, in the tradition of the great empire builders, to cross
into adjoining territories; thus, the success of Beck’s theory of depression has led to its fruitful extension to other
areas such as anxiety, schizophrenia and personality disorders. Second, there are signs that the increasing
cross-fertilisation between cognitive psychology and clinical psychology may lead to more general theories of
emotional disorders rather than theories that are tied to one specific disorder.
If, in our examination of normal theories of emotion, we detected the possibility of integration, for example between
cognitive and psychodynamic approaches (e.g. in the increasing interest in unconscious processes), we can also
find these integrative forces within recent theories of emotional disorders. Although the modern interest in the
interaction between social factors such as life events and internal cognitive factors such as self-esteem can be
traced to the work of researchers such as Brown and Harris (1978), from a broader integrative and historical
perspective we should also note Freud’s 1917 work Mourning and Melancholia. The moral is that, although the
wheel may simply have turned full circle in the search for integrative approaches, we should now be in a position to
take these approaches further.
One general criticism of cognitive theories of normal emotions was that these theories often provided inadequate
accounts of how emotional disorders might be explained within their frameworks. However, in relation to theories of
emotional disorders, we can identify the opposite problem – namely, how do theories of emotional disorders
account for normal emotions?
Seligman's learned helplessness theory (1975)
The original proposal began with Seligman’s laboratory work with dogs. In these studies, the dogs were placed in a
shuttle-box, which was designed so that on some occasions the dog could jump from one side of the box to the
other, but on other occasions a barrier could be placed across to prevent escape. Seligman found that if the dogs
experienced inescapable shock for a number of trials, they failed to escape from subsequent shocks even when it
was possible to do so. This condition Seligman termed “learned helplessness” and he suggested that it could also
account for a number of conditions in humans, especially that of depression.
There ensued a large number of studies in which students were subjected to unsolvable anagrams and
inescapable bursts of noise, but unfortunately for the theory the students failed to demonstrate a consistent
induction of helplessness; researchers began to realise that the original theory needed alteration to account for the
3
, application to humans. Indeed, it was even noticed that dogs, perhaps beginning to learn from their student
counterparts, started to refuse to become as helpless as consistently as they had done in the earlier experiments.
In addition to the empirical failures, there were features of depression for which the original theory provided no
account. For example, the self-esteem deficit that is common in depression is not predictable from the experience
of non-contingency alone. Another problem is that “golden boys” and “golden girls” may have experienced
continuous non-contingent positive reinforcement throughout their childhood, but could then become depressed
when they left home and found that positive reinforcement was no longer non-contingent, but in fact required active
responses on the part of the individual. The possibility of a similar phenomenon of “success depression” has also
been disputed by other behavioural researchers on theoretical grounds.
The reformulation of the theory
Abramson et al. added Weiner’s attribution theory to the original learned helplessness approach; that is, although
helplessness continued to be seen to arise from the perception of uncontrollability, the subsequent effects were
now seen to depend both on the type and the importance of the event experienced, together with the explanation
that the individual produced for the cause of the event. The emotional, motivational and cognitive deficits seen in
depression could be accounted for by a particular set of attributions following the occurrence of a negative event:
- Internal-external or “locus” – that is, whether the cause is seen to be due to something about the individual
(internal) or due to something about other people or circumstances (external)
- Stable- unstable (or stable-variable in Weiner’s terminology) – that is, whether the cause is due to
something that would recur for future similar events.
- Global-specific – that is, whether the cause influences only one area of the individual’s life or many areas.
A vulnerability factor for depression was if the individual made internal-stable-global attributions (e.g. “due to my
personality”) for the causes of negative events and external-unstable-specific attributions (e.g. “due to luck”) for
positive events. More specifically, an internal attribution for a negative event was seen to lead to low self-esteem,
especially if, by social comparison, other individuals were perceived not to be helpless in such a situation (so-called
“personal helplessness”). The additional stable and global attributions for negative events were seen to add to the
chronicity and the generality of the deficits observed in
depressed individuals.
Problems
- One possible problem may be the ways in which
attributions are measured in many of these
studies. It is possible, therefore, that
depressogenic implicit attributional tendencies
are not being detected by the routine
questionnaire methodology used in much of this
literature.
- Other failures of the reformulated model include
the recognition that evidence for the proposed
external-specific-unstable depressive style for
positive events has been extremely mixed.
- Although collections of hypothetical events, as
measured by the Attributional Style
Questionnaire may demonstrate a bias towards a
particular attributional pattern, real-world events,
unless they are sufficiently ambiguous, may
completely override an individual’s characteristic
attributional style.
Hopelessness theory
One of the key differences with helplessness theory is that
hopelessness requires only the occurrence of negative
events rather than uncontrollable events; thus, it had
always been problematic that depressed individuals
seemed to blame themselves for events which according to
learned helplessness theory they should perceive to be
uncontrollable.
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