Effects of Communication Content on Speech Behavior of Depressives Philippos Vanger, Angela B. Summerfield, Depressed patients were interviewed at two different severity levels in the course of their illness about both problematic and neutral topics, and their speech behavior was analyzed in terms of speech activity and silences. Lowered speech activity and increased si-
C
THEORIES of depression OGNITIVE such as Beck’s’ suggest that negative thoughts cause depressive affect and contribute to maintenance and exacerbation of depressive symptomatology. The cognitive style of depressives is characterized by oversensitivity to negative events that are related to a general lack of self-worth.’ Subjects scoring high on depressive tendencies took more time to dismiss negative cognitions evoked by imagery.3 Increased sensitivity of depressed subjects to negative cognitions is also indicated by behavioral changes such as increased response latencies to depressed-content words.4 Strickland et al5 showed that subjects who were given negative statements to read reported more depression, anxiety, and hostility on the Multiple Affect Adjective Check List (MAACL) and also preferred to engage in solitary, inactive behaviors as opposed to subjects who read positive statements. These authors also suggested that being exposed to negative, unpleasant information induces depressive affect and leads to social withdrawal; similar effects of exposure to negative information are reported by Coleman.” Furthermore, depressed patients showed a predominant depressive affect in their speech, regardless of affective content.’ There is evidence suggesting that communicative behavior of depressed patients is affected by changes in their affective state. Aronson and Weintraub’ have shown that verbal productivity differed between groups of improved and unimproved depressives; worsening of depressive state was associated with greater divergence from normal verbal productivity. This finding suggests that verbal productivity differs between depressives and normals, and also within depressives, with severity of depression. Furthermore, speech pauses of depressives correlated with their general psychomotor retardation,’ which is usually an indication of severity of the illness. Comprehensive
Psychiatry,
Vol. 33, No. 1 (January/February),
B.K. Rosen, and J.P. Watson
lences occurred at higher severity levels and also during problematic communication content, suggesting the mediation of cognitive factors as postulated by Beck’s cognitive model of depression. Copyright 0 1992 by W. B. Saunders Company
Also, depressed mothers have been found to vocalize less often with their children than healthy mothers.“’ The purpose of the present study was to investigate changes in aspects of speech behavior of depressives under two different communication contents and it was hypothesized that reduced speech activity and increased silences would occur while communicating negative content. Furthermore, the effect of changes in severity level of depression on speech behavior was also investigated. METHOD Subjects Ten women with a major diagnosis of depression participated in this study. The subjects were between 23 and 73 years old, with a mean age of 44 years. They were all inpatients receiving psychiatric treatment for depression.
Assessment of Depression Severity Level The two occasions on which patients were seen were selected so as to ensure variation with respect to severity of their condition. Before each interview, patients were administered the Beck’s Depression Inventory (BDI)” and the MAACL.” Scores of the BDI and of the Depression scale of the MAACL correlated highly (r = .67, P < .Ol). The BDI and MAACL scores, as well as consultation with clinical staff, were used to assess severity level of depression. Different patients showed a different pace of change. For this. the time elapsed between the first and the second interview ranged between 1 and 4 weeks. The direction of change in severity of patients’ condition also varied. Most patients showed improvement with time; however, some showed an exacerbation of their condition. Their respective
From the Center for Psychotherapy Research, Stuttgart, Germany; and the Division of Psychiatry, United Medical and Dental Schools of Guy S and St. Thomas’s Hospitals, University of London, England. Address reprint requests to Philippos Vangec Ph.D., Center for Psychotherapy Research, Christian-Belser-Strasse 79A, D- 7000, Stuttgart 70, Germany. Copyright 0 I992 by W.B. Saunders Company OOIO-440X19213301-0004$03.00l0
1992: pp 39-41
39
VANGER ET AL
40
depression assessment scores were used to determine the timing of the interviews for each patient individually.
Procedure Patients had a semistructured interview lasting approximately 1.5minutes, twice during the course of their illness. During the first half of the interview, the patients were encouraged to talk about a neutral subject of their choice. In the second half, they were prompted to talk about themselves, their present state, and their worries. In this way, each interview consisted of a neutral and a problematic part. Interviews were audio-recorded and 2 minutes of each part (neutral, problematic) of each interview were analyzed in terms of speech activity measured by number of syllables and silences measured in seconds. RESULTS
Speech Activity
With respect to speech activity an analysis of variance (ANOVA) was performed for two levels of severity (low, high) and two levels of communication content (neutral, problematic). Main effects of severity and content were found to be significant (F = 8.56, df = 1,9 P < .016 and F = 12.39, df= 1,9, P < .0065, respectively). This shows that type of conversation content and level of severity affected the amount of syllables delivered by patients. Wilcoxon tests were performed between content levels (collapsed over severity) to determine the direction of the difference. It was found that syllabic output was significantly higher in the lowseverity condition than in the high-severity condition (n = 10, T = 5, P < .007, one-tailed). Also, syllabic output was higher in the neutral content condition than in the problematic content condition (n = 10, T = 3, P < .05, onetailed), indicating that subjects spoke more when referring to a neutral topic than when referring to personal problems. Also, when patients were less depressed, they were more active verbally (Table 1). Table 1. Mean Number of Syllables and Seconds of Silences During 2.Minute Speech Segments of Neutral and Negative Content for Depressed Patients at High and Low Severity Levels Silences
Speech Activity High
LOW
High
Severiol
Severity
Severity
Severity
Neutral
346.5
319.6
15.41
18.75
Negative
301.6
257.9
28.28
36.29
Communication content
LOW
Silences
With respect to silences in speech, an ANOVA was performed for two levels of severity (high, low) and two levels of communication content (neutral, problematic). The main effect of severity was found to be significant (F = 5.12, df = 1, 9, P < .0499), as well as the main effect of content (F = 70.34, df = 1, 9, P < .OOOl). The amount of silences then was affected by type of content of the conversation and also by the severity of the patient’s depression. A Wilcoxon test was conducted between the silence measures (collapsed over type of content) of the two severity levels and the difference was found to be significant (n = 10, T = 9, P < .024, one-tailed). This suggests that when patients were more depressed, the amount of silent segments in their speech increased significantly. A Wilcoxon test was also conducted between the silence measures under neutral and problematic communication content (collapsed over severity levels) and the difference was found to be highly significant (n = 10, T = 0, P < .OOl, one-tailed). This shows that the amount of silences increased when communicating events that are related to negative cognitions. DISCUSSION
Depressives’ speech behavior was found to be affected by negativity of communication content, as well as by the severity level of their depression. When patients were more depressed, they talked less and were more silent. This accords with the results for depression in relation to verbal behavior reported by Aronson and Weintraub,’ as well as with the findings that depressives, when compared with normal controls, show a greatly reduced speech activity and a much lower feedback rate in interactions.” Also, Greden and Carro11’4 demonstrated that improvement in endogenous depression correlated with decrease in pause-times during speech. Thus, the results of the present study, along with those of Hoffmann et al.,” support the notion that speech behavior may be used as an indicator of psychomotor retardationI and as an additional instrument for severity assessment of depression. Negative communication content was found to affect significantly speech behavior regardless of the severity level of
SPEECH
OF DEPRESSIVES
41
depression. In accord with Beck’s’ model, the effects of problematic communication content on speech behavior may be mediated by the triggering of negative cognitions during communication, which exacerbate depressive mood’ and subsequently influence social behavior. Pietromonaco and Markus” showed that the cognitive negativity in depression is restricted to thoughts about oneself and does not extend to other topics. This is in agreement with the present findings, since negative communication content consisted of talking about oneself, preoccupations, and feelings. The observed retardation in speech is congruent with the withdrawn and inadequate social behavior of depressives” and may contribute to the development of
problematic interpersonal relations. Paddock and Nowick?* showed that the paralanguage style of depressed persons consisting of soft, flat tones and long pauses triggered interpersonal rejection from conversation partners. Deficient speech activity may hamper communication and thus may be partly responsible for the rejecting responses to depressives in interactions with strangers, ‘v” or for the increased marital dissatisfaction reported by spouses of depressives.” In all, the present results on paralinguistic aspects of speech behavior of depressives point to the importance of cognitive factors as determinants of behavioral manifestations of depression and highlight their implications for the interpersonal functioning of depressives.
REFERENCES 1. Beck AT. Depression: Clinical, Experimental and Theoretical Aspects. New York, NY, Harper & Row, 1967. 2. Carver CS, Genellen RJ, Behar-Mitrani V. Depression and cognitive style: Comparisons between measures. J Pers Sot Psycho1 49:?22-728. 1985. 3. Clark DA. Factors influencing the retrieval and control of negative cognitions. Behav Res Ther 24:151-159, 1986. 4. Gotlib IH, McCann CD. Construct accessibility and depression: An examination of cognitive and affective factors. J Pers Sot Psycho1 47~427439, 1984. 5. Strickland BR, Hale WD, Anderson LK. Effects on induced mood states on activity and self-reported affect. J Consult Chn Psycho1 43587, 1975. 6. Coleman RE. Manipulation of self-esteem as determinant of mood of elated and depressed women. J Abnorm Psycho1 84:693-700, 1975. 7. Levin S, Hall JA, Knight RA. et al. Verbal and nonverbal expression of affect in speech of schizophrenic and depressed patients. J Abnorm Psycho1 94:487-497, 1985. 8. Aronson H, Weintraub W. Verbal productivity as a measure of change in affective status. Psycho1 Rep 20:483487, 1967. 9. Hoffmann GM, Gonze SC, Mendlewicz J. Speech pause-time as a method for the evaluation of psychomotor retardation in depressive illness. Br J Psychiatry 146:535538,1985. 10. Breznitz Z, Sherman T. Speech patterning of natural discourse of well and depressed mothers and their young children. Child Dev 58:395-400,1987. 11. Beck AT, Ward CN, Mendelson M, et al. An inven-
tory for measuring depression. Arch Gen Psychiatry 4:561571.1961. 12. Zuckerman M, Lubin B. Manual for the Multiple Affect Adjective Check List. San Diego, CA, Educational and Industrial Testing Service, 1965. 13. Vanger P, Summerfield AB, Rosen B, et al. Verbal and nonverbal feedback activity of depressives in dyadic interaction. Psychother Psychosom Med Psycho1 40:198, 1990. 14. Greden JF, Carroll BJ. Decrease in pause-times with treatment for endogenous depression. Biol Psychiatry 15:1418, 1980. 15. Szabadi E, Bradshaw CM, Besson JA. Elongation in pause-time in speech: A simple, objective measure of motor retardation in depression. Br J Psychiatry 129:592-597, 1976. 16. Pietromonaco PR, Markus H. The nature of negative thoughts in depression. J Pers Sot Psycho1 48:799-807, 1985. 17. Vanger P. An assessment of social skills deficiencies in depression. Compr Psychiatry 28:508-512, 1987. IX. Paddock JR, Nowicki S. Paralanguage and the interpersonal impact of dysphoria: It’s not what you say but how you say it. Sot Behav Personal 14:29-44, 1986. 19. Coyne JA. Depression and the response of others. J Abnorm Psycho1 85:186-193, 1976. 20. Coyne JC. Comment: Studying depressed persons’ interactions with strangers and spouses. J Abnorm Psycho1 94:231-232, 1985. 2 1. Bouras N, Vanger P, Bridges PK. Marital problems in the chronically depressed and physically ill patients and their spouses. Compr Psychiatry 27:127-130. 1986.
C
THEORIES of depression OGNITIVE such as Beck’s’ suggest that negative thoughts cause depressive affect and contribute to maintenance and exacerbation of depressive symptomatology. The cognitive style of depressives is characterized by oversensitivity to negative events that are related to a general lack of self-worth.’ Subjects scoring high on depressive tendencies took more time to dismiss negative cognitions evoked by imagery.3 Increased sensitivity of depressed subjects to negative cognitions is also indicated by behavioral changes such as increased response latencies to depressed-content words.4 Strickland et al5 showed that subjects who were given negative statements to read reported more depression, anxiety, and hostility on the Multiple Affect Adjective Check List (MAACL) and also preferred to engage in solitary, inactive behaviors as opposed to subjects who read positive statements. These authors also suggested that being exposed to negative, unpleasant information induces depressive affect and leads to social withdrawal; similar effects of exposure to negative information are reported by Coleman.” Furthermore, depressed patients showed a predominant depressive affect in their speech, regardless of affective content.’ There is evidence suggesting that communicative behavior of depressed patients is affected by changes in their affective state. Aronson and Weintraub’ have shown that verbal productivity differed between groups of improved and unimproved depressives; worsening of depressive state was associated with greater divergence from normal verbal productivity. This finding suggests that verbal productivity differs between depressives and normals, and also within depressives, with severity of depression. Furthermore, speech pauses of depressives correlated with their general psychomotor retardation,’ which is usually an indication of severity of the illness. Comprehensive
Psychiatry,
Vol. 33, No. 1 (January/February),
B.K. Rosen, and J.P. Watson
lences occurred at higher severity levels and also during problematic communication content, suggesting the mediation of cognitive factors as postulated by Beck’s cognitive model of depression. Copyright 0 1992 by W. B. Saunders Company
Also, depressed mothers have been found to vocalize less often with their children than healthy mothers.“’ The purpose of the present study was to investigate changes in aspects of speech behavior of depressives under two different communication contents and it was hypothesized that reduced speech activity and increased silences would occur while communicating negative content. Furthermore, the effect of changes in severity level of depression on speech behavior was also investigated. METHOD Subjects Ten women with a major diagnosis of depression participated in this study. The subjects were between 23 and 73 years old, with a mean age of 44 years. They were all inpatients receiving psychiatric treatment for depression.
Assessment of Depression Severity Level The two occasions on which patients were seen were selected so as to ensure variation with respect to severity of their condition. Before each interview, patients were administered the Beck’s Depression Inventory (BDI)” and the MAACL.” Scores of the BDI and of the Depression scale of the MAACL correlated highly (r = .67, P < .Ol). The BDI and MAACL scores, as well as consultation with clinical staff, were used to assess severity level of depression. Different patients showed a different pace of change. For this. the time elapsed between the first and the second interview ranged between 1 and 4 weeks. The direction of change in severity of patients’ condition also varied. Most patients showed improvement with time; however, some showed an exacerbation of their condition. Their respective
From the Center for Psychotherapy Research, Stuttgart, Germany; and the Division of Psychiatry, United Medical and Dental Schools of Guy S and St. Thomas’s Hospitals, University of London, England. Address reprint requests to Philippos Vangec Ph.D., Center for Psychotherapy Research, Christian-Belser-Strasse 79A, D- 7000, Stuttgart 70, Germany. Copyright 0 I992 by W.B. Saunders Company OOIO-440X19213301-0004$03.00l0
1992: pp 39-41
39
VANGER ET AL
40
depression assessment scores were used to determine the timing of the interviews for each patient individually.
Procedure Patients had a semistructured interview lasting approximately 1.5minutes, twice during the course of their illness. During the first half of the interview, the patients were encouraged to talk about a neutral subject of their choice. In the second half, they were prompted to talk about themselves, their present state, and their worries. In this way, each interview consisted of a neutral and a problematic part. Interviews were audio-recorded and 2 minutes of each part (neutral, problematic) of each interview were analyzed in terms of speech activity measured by number of syllables and silences measured in seconds. RESULTS
Speech Activity
With respect to speech activity an analysis of variance (ANOVA) was performed for two levels of severity (low, high) and two levels of communication content (neutral, problematic). Main effects of severity and content were found to be significant (F = 8.56, df = 1,9 P < .016 and F = 12.39, df= 1,9, P < .0065, respectively). This shows that type of conversation content and level of severity affected the amount of syllables delivered by patients. Wilcoxon tests were performed between content levels (collapsed over severity) to determine the direction of the difference. It was found that syllabic output was significantly higher in the lowseverity condition than in the high-severity condition (n = 10, T = 5, P < .007, one-tailed). Also, syllabic output was higher in the neutral content condition than in the problematic content condition (n = 10, T = 3, P < .05, onetailed), indicating that subjects spoke more when referring to a neutral topic than when referring to personal problems. Also, when patients were less depressed, they were more active verbally (Table 1). Table 1. Mean Number of Syllables and Seconds of Silences During 2.Minute Speech Segments of Neutral and Negative Content for Depressed Patients at High and Low Severity Levels Silences
Speech Activity High
LOW
High
Severiol
Severity
Severity
Severity
Neutral
346.5
319.6
15.41
18.75
Negative
301.6
257.9
28.28
36.29
Communication content
LOW
Silences
With respect to silences in speech, an ANOVA was performed for two levels of severity (high, low) and two levels of communication content (neutral, problematic). The main effect of severity was found to be significant (F = 5.12, df = 1, 9, P < .0499), as well as the main effect of content (F = 70.34, df = 1, 9, P < .OOOl). The amount of silences then was affected by type of content of the conversation and also by the severity of the patient’s depression. A Wilcoxon test was conducted between the silence measures (collapsed over type of content) of the two severity levels and the difference was found to be significant (n = 10, T = 9, P < .024, one-tailed). This suggests that when patients were more depressed, the amount of silent segments in their speech increased significantly. A Wilcoxon test was also conducted between the silence measures under neutral and problematic communication content (collapsed over severity levels) and the difference was found to be highly significant (n = 10, T = 0, P < .OOl, one-tailed). This shows that the amount of silences increased when communicating events that are related to negative cognitions. DISCUSSION
Depressives’ speech behavior was found to be affected by negativity of communication content, as well as by the severity level of their depression. When patients were more depressed, they talked less and were more silent. This accords with the results for depression in relation to verbal behavior reported by Aronson and Weintraub,’ as well as with the findings that depressives, when compared with normal controls, show a greatly reduced speech activity and a much lower feedback rate in interactions.” Also, Greden and Carro11’4 demonstrated that improvement in endogenous depression correlated with decrease in pause-times during speech. Thus, the results of the present study, along with those of Hoffmann et al.,” support the notion that speech behavior may be used as an indicator of psychomotor retardationI and as an additional instrument for severity assessment of depression. Negative communication content was found to affect significantly speech behavior regardless of the severity level of
SPEECH
OF DEPRESSIVES
41
depression. In accord with Beck’s’ model, the effects of problematic communication content on speech behavior may be mediated by the triggering of negative cognitions during communication, which exacerbate depressive mood’ and subsequently influence social behavior. Pietromonaco and Markus” showed that the cognitive negativity in depression is restricted to thoughts about oneself and does not extend to other topics. This is in agreement with the present findings, since negative communication content consisted of talking about oneself, preoccupations, and feelings. The observed retardation in speech is congruent with the withdrawn and inadequate social behavior of depressives” and may contribute to the development of
problematic interpersonal relations. Paddock and Nowick?* showed that the paralanguage style of depressed persons consisting of soft, flat tones and long pauses triggered interpersonal rejection from conversation partners. Deficient speech activity may hamper communication and thus may be partly responsible for the rejecting responses to depressives in interactions with strangers, ‘v” or for the increased marital dissatisfaction reported by spouses of depressives.” In all, the present results on paralinguistic aspects of speech behavior of depressives point to the importance of cognitive factors as determinants of behavioral manifestations of depression and highlight their implications for the interpersonal functioning of depressives.
REFERENCES 1. Beck AT. Depression: Clinical, Experimental and Theoretical Aspects. New York, NY, Harper & Row, 1967. 2. Carver CS, Genellen RJ, Behar-Mitrani V. Depression and cognitive style: Comparisons between measures. J Pers Sot Psycho1 49:?22-728. 1985. 3. Clark DA. Factors influencing the retrieval and control of negative cognitions. Behav Res Ther 24:151-159, 1986. 4. Gotlib IH, McCann CD. Construct accessibility and depression: An examination of cognitive and affective factors. J Pers Sot Psycho1 47~427439, 1984. 5. Strickland BR, Hale WD, Anderson LK. Effects on induced mood states on activity and self-reported affect. J Consult Chn Psycho1 43587, 1975. 6. Coleman RE. Manipulation of self-esteem as determinant of mood of elated and depressed women. J Abnorm Psycho1 84:693-700, 1975. 7. Levin S, Hall JA, Knight RA. et al. Verbal and nonverbal expression of affect in speech of schizophrenic and depressed patients. J Abnorm Psycho1 94:487-497, 1985. 8. Aronson H, Weintraub W. Verbal productivity as a measure of change in affective status. Psycho1 Rep 20:483487, 1967. 9. Hoffmann GM, Gonze SC, Mendlewicz J. Speech pause-time as a method for the evaluation of psychomotor retardation in depressive illness. Br J Psychiatry 146:535538,1985. 10. Breznitz Z, Sherman T. Speech patterning of natural discourse of well and depressed mothers and their young children. Child Dev 58:395-400,1987. 11. Beck AT, Ward CN, Mendelson M, et al. An inven-
tory for measuring depression. Arch Gen Psychiatry 4:561571.1961. 12. Zuckerman M, Lubin B. Manual for the Multiple Affect Adjective Check List. San Diego, CA, Educational and Industrial Testing Service, 1965. 13. Vanger P, Summerfield AB, Rosen B, et al. Verbal and nonverbal feedback activity of depressives in dyadic interaction. Psychother Psychosom Med Psycho1 40:198, 1990. 14. Greden JF, Carroll BJ. Decrease in pause-times with treatment for endogenous depression. Biol Psychiatry 15:1418, 1980. 15. Szabadi E, Bradshaw CM, Besson JA. Elongation in pause-time in speech: A simple, objective measure of motor retardation in depression. Br J Psychiatry 129:592-597, 1976. 16. Pietromonaco PR, Markus H. The nature of negative thoughts in depression. J Pers Sot Psycho1 48:799-807, 1985. 17. Vanger P. An assessment of social skills deficiencies in depression. Compr Psychiatry 28:508-512, 1987. IX. Paddock JR, Nowicki S. Paralanguage and the interpersonal impact of dysphoria: It’s not what you say but how you say it. Sot Behav Personal 14:29-44, 1986. 19. Coyne JA. Depression and the response of others. J Abnorm Psycho1 85:186-193, 1976. 20. Coyne JC. Comment: Studying depressed persons’ interactions with strangers and spouses. J Abnorm Psycho1 94:231-232, 1985. 2 1. Bouras N, Vanger P, Bridges PK. Marital problems in the chronically depressed and physically ill patients and their spouses. Compr Psychiatry 27:127-130. 1986.
