Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications.

Abstract

We review psychometric and other evidence relevant to mixed anxiety-depression. Properties of anxiety and depression measures, including the convergent and discriminant validity of self-and clinical ratings, and interrater reliability, are examined in patient and normal samples. Results suggest that anxiety and depression can be reliably and validly assessed; moreover, although these disorders share a substantial component of general affective distress, they can be differentiated on the basis of factors specific to each syndrome. We also review evidence for these specific factors, examining the influence of context and scale content on ratings, factor analytic studies, and the role of low positive affect in depression. With these data, we argue for a tripartite structure consisting of general distress, physiological hyperarousal (specific anxiety), and anhedonia (specific depression), and we propose a diagnosis of mixed anxiety-depression.The puzzle of the relation between anxiety and depression is as old as the study of the syndromes themselves. In recent times, they have been viewed as: (a) different points along the same continuum, (b) alternative manifestations of a common underlying diathesis, (c) heterogeneous syndromes that are associated because of shared subtypes, (d) separate phenomena, each of which may develop into the other over time, and (e) conceptually and empirically distinct phenomena (L. A. Clark, 1989). Whereas each of these viewpoints is supported by some research, the current nomenclature, the Diagnostic and Statistical Manualof Mental Disorders (rev. 3rd ed.; DSM-III-R; American Psychiatric Association, 1987) primarily reflects the cate-

Influence of fluoxetine on positive and negative affect in a clinic-based smoking cessation trial

“…More generally, this study suggests the utility of SSRIs for treating not only elevated negative affect, but also deficient positive affect, a common feature of depression (Clark and Watson 1991;Coyne 1994). In the context of smoking cessation, our data show that 60 mg fluoxetine, relative to placebo, improved positive and negative affect during nicotine abstinence.…”

“…Reductions in positive affect, however, have largely been overlooked as a possible response to smoking cessation. That neglect is surprising, given the integral relationship between deficient positive mood states and depression (Clark and Watson 1991;Coyne 1994), and evidence that quitting smoking heightens the risk of depressive episodes (Borrelli et al 1996;Tsoh et al 2002). Positive affect declines after quitting smoking (Gilbert et al 1998;Lerman et al 2002;Cook et al 2003) and persists across 30 days of abstinence (Gilbert et al 1998).…”

The influence of cognitive control training on stress reactivity and rumination in response to a lab stressor and naturalistic stress

“…This 21-item self-report measure has proven to have good psychometric properties. Second, a short version of the Mood and Anxiety Symptom Questionnaire (MASQ-D30; Clark & Watson, 1991;Wardenaar et al, 2010) was used as a transdiagnostic measure for depressive and anxious symptomatology. This validated questionnaire is based on the Tripartite model of anxiety and depression (Clark & Watson, 1991), containing three subscales: general distress, anhedonic depression, and anxious arousal.…”

Psychopathy and negative emotionality: Analyses of suppressor effects reveal distinct relations with emotional distress, fearfulness, and anger-hostility.

“…Tellegen and Waller's conception of NEM includes the lower order trait constructs of stress reaction and aggression, which closely correspond to the emotional distress and anger facets of Buss and Plomin's & Neale, 2003;Krueger, 1999;Vollebergh et al, 2001). The tripartite model is another intensively researched and well-validated model designed to account for the comorbidity between depression and anxiety disorders (Brown, Chorpita, & Barlow, 1998;Clark & Watson, 1991;Mineka, Watson, & Clark, 1998). The model posits that a general dimension of negative affectivity accounts for the comorbidity between depression and anxiety disorders, whereas specific factors of low positive affect and autonomic hyperarousal account for the distinctive phenotypic expression of depression and anxiety disorders, respectively.…”