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Cognitive Therapy and Research, VoL 4, No. 4, 1980, pp.

383-395

Cognitive Self-Statements in Depression: Development of an Automatic Thoughts Questionnaire 1


Steven D. Hollon 2 and Philip C. Kendall
University of Minnesota

A 30-item questionnaire was devised to measure the frequency of occurrence of automatic negative thoughts (negative self-statements) associated with depression. Male and female undergraduates were asked to recall dysphoric experiences and to report associated cognitions. One hundred representative cognitions were selected and administered to a second sample, along with the MMPI D scale and the Beck Depression Inventory. Thirty items discriminating between criterion groups of psychometrically depressed and nondepressed subjects were identified. The resultant 30-item automatic thoughts questionnaire (ATQ-30) was cross-validated and found to significantly discriminate psychometrically depressed from nondepressed criterion groups. No differences were found between males and females on the measure. Factor analysts indicated a four-factor solution, with a large first factor reflecting Personal Maladjustment, a second factor indicative o f Negative Self-Concept and Negative Expectations, and two lesser factors. The ATQ-30 may provide a means of testing basic theory relating cognitive content to behavioral and affective processes and assessing change in cognitions associated with experimental manipulation or psychotherapeutic intervention.

~Preparation of this article was supported in part by two University of Minnesota Graduate School Grants in Aid of Research (492-0325-4909-02; 440-0160-4909-02) to the first and second authors, respectively. We wish to thank Auke Tellegen for his invaluable comments and suggestions, and Cliff Johnson for his reliable assistance. ~Address all correspondence to Steven D. Hollon or Philip C. Kendall, Cognitive Assessment Project, Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, Minnesota 55455. An expanded version of this manuscript, complete with correlation matrix, is available from the authors.
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0147-5916/80/1200-0383503.00/0 1980 Plenum Publishing Corporation

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Recent theory and research has focused increasingly on the role of cognition in the etiology, maintenance, and treatment of various types of psychopathology (Bandura, 1977; Beck, 1976; Ellis & Grieger, 1977; Goldfried & Davison, 1976; Kendall & Hollon, 1979; Mahoney, 1974, 1977; Meichenbaum, 1977). With regard to depression, Beck ha s argued that the various components of the clinical syndrome are the consequence of pervasive, systematically negative distortions in both cognitive content and process (Beck, 1963, 1964, 1967). Emphasis on cognitive factors has led to the development of therapeutic procedures designed to reduce depression by systematically altering these negative beliefs (Beck, Rush, Shaw, & Emery, 1979; Hollon & Beck, 1979). Outcome studies have indicated that such procedures are superior to either traditional or strictly behavioral interventions in terms of symptom reduction (Shaw, 1977; Taylor & Marshall, 1977) and superior to tricyclic pharmacotherapy in terms of both symptom reduction and prevention of relapse (Rush, Beck, Kovacs, & Hollon, 1977). Despite the current interest in both cognitive theory and cognitive-behavioral therapy in the affective disorders, there appears to have been little systematic effort to assess changes in cognitive content and process as a function of treatment (Kendall & Korgeski, 1979). One reason for this failure to provide a "confirmation of treatment mechanisms" is the absence of suitable specific measures of cognitions associated with depression. Jones's Irrational Beliefs Test (IBT) (1968) is one measure of those beliefs presumed to underly neurotic emotionality. However, while the IBT predicts affect-related arousal to specific situational stimuli (Goldfried & Sobocinski, 1975), it correlates only moderately with self-reported depression (Nelson, 1977), assesses beliefs associated with general emotionality rather than specific affective states, and assesses the degree to which people ascribe to the validity of various statements, not the frequency with which they experience specific cognitions. EUis's concept of "irrational beliefs" (1962) may well represent accurate summaries of what people act as if they believe, but may be quite distinct from any cognitions that individuals spontaneously experience. Measures such as the IBT may reflect attitudes that people hold but rarely think about, at least in the format presented. The present paper reports on the development of any inventory designed to identify the covert self-statements (see Kendall & Hollon, 1981) reported by depressives as being representative of the kinds of cognitions they experience. Such an inventory should prove of use both in theory testing and as an independent measure of cognitive change associated with either laboratory manipulations or clinical interventions.

Automatic Thoughts Questionnaire


METHOD

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Item Generation
An initial pool of items was generated by asking 788 male and female undergraduate students to recall an experience in their lives that they had found to be depressing. Subjects were asked to recreate the situation in memory as vividly as they could, as if they were reexperiencing the situation at that moment. Subjects were then instructed to record whatever thoughts had "popped into their head" in that situation. Subjects were asked to record their cognitions exactly the way they thought them, regardless of grammar or syntax. The authors screened the pool of reported cognitions to eliminate redundant or incomprehensible responses. A total of 100 reported selfstatements were selected for subsequent use, forming the initial automatic thoughts questionnaire (ATQ-100).

Subjects
A total of 348 male and female undergraduate college students were recruited to participate in item selection and cross-validation. All subjects received extra credit points toward course grades in return for participation. Protocols from 36 subjects who failed to complete the full test battery were excluded from all further analyses, leaving a sample of 312 (167 males and 145 females). The mean age of the full sample was 20.22 (SD = 4.34). Subjects were randomly divided into two subsamples of 156 each. The first subsample was used for item selection, while the second subsample was used for subsequent scale cross-validation. The item selection sample was composed of 85 males and 71 females and the cross-validation sample consisted of 82 males and 74 females. These two subsamples did not differ significantly in terms of sexual composition, X2(1) = .05, or age, t(310) = .69.

Measures of Depression and Anxiety


Two self-report inventories, recently recommended by Rehm (1976), were used to assess levels of depression. The Beck Depession Inventory (BDI) is a 21-item inventory designed to assess affective, behavioral, cognitive, motivational, and vegetative aspects of depression (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; Beck, 1967). Each item consists of four statements, scored on a range from 0 to 3. Subjects are instructed to

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complete each item in terms o f how they felt over the preceding week. A total score, ranging from 0 to 63, is obtained by summing over the items. The greater the score, the greater the severity of syndrome depression. The BDI has shown good concurrent validity when compared to psychiatric ratings o f severity of depression in both clinical populations (r = .79, N = 226 and r = .67, N = 183) (Beck et al., 1961) and college student populations (r = .79, N = 56) (Bumberry, Oliver, & McClure, 1978). Beck recommends a cutting score o f 10 and above for designating a subject as depressed. The Minnesota Multiphasic Personality Inventory Depression scale (MMPI-D) consists o f 60 true-false items, 49 initially selected to discriminate normals from hospitalized manic-depressives and 11 initially selected to distinguish between depressed and other psychopathological conditions (Hathaway & McKinley, 1940). Total scores can range from 0 to 60, with high scores reflecting greater severity of depression. The MMPI-D has been widely used as a screening instrument for selecting depressed samples for research purposes. It should be noted that both measures provide estimates o f the severity o f syndrome depression. Depression can be measured as a symptom (generally defined as sadness or dysphoric mood), a syndrome (consisting o f covarying signs and symptoms), or a discrete nosological category (Beck, 1967). With the exception o f self-reported anxiety, no attempt was made to evaluate the presence or absence of associated indices o f psychopathology for the sample. The State-Trait Anxiety Inventory (STAI) A-Trait scale (Spielberger, Gorsuch, & Lushene, 1970) is a 20-item inventory asking subjects to report how frequently they had experienced various phenomena related to trait anxiety. Total possible scores range from 20 to 80, with higher scores indicating greater trait anxiety. A measure of trait anxiety was included in an effort to check on the specificity of negative cognitions to depressive affect.
Procedure

All 348 subjects were administered the tests described above as part o f a larger battery. For the ATQ, subjects were instructed as follows. Listed beloware a varietyof thoughts that pop into people's heads. Please read each thought and indicate how frequently, if at all, the thought occurred to you over the last week. Please read each item carefully and flu in the appropriate circle on the answer sheet in the following fashion (1 = "not at all," 2 = "sometimes," 3 = "moderately often," 4 = "often," and 5 = "all the time"). Subjects were instructed to complete the other tests according to standard instructions.

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Method of A nalysis
Depressed and nondepressed criterion groups were formed with each subsample on the basis of scores on both depression measures. Subjects scoring 1 standard deviation or more above the mean on both the BDI (score of 11 and above) and the MMPI-D (score of 26 and above) were defined as depressed. Subjects scoring at or near the mean on both scales (BDI scores equal to 3, 4, or 5 and MMPI-D scores from 15 through 20) were defined as nondepressed. In the item selection sample, 12 subjects (7 males and 5 females) met the criteria for inclusion in the depressed group, while 20 subjects (9 males and 11 females) met the criteria for inclusion in the nondepressed group. In the cross-validation sample, 14 subjects (5 males and 9 females) and 21 subjects (12 males and 9 females) met the criteria for the depressed and nondepressed groups, respectively. There were no significant gender differences among the four groups, ~(2(3) = 1.97. Independent t tests were computed on each of the ATQ-100 items between depressed and nondepressed subjects for the item selection sample. Items discriminating between the two groups were then combined into a single scale and cross-validated on the cross-validation sample-depressed and cross-validation sample-nondepressed groups.

RESULTS

Sample Characteristics and Subsample Comparability


One-way analyses of variance evidenced no significant differences between the two subsamples on the BDI, the MMPI-D, the STAI A-Trait, and the ATQ-30, all F's(1,308)< 1. Males and females did not differ on three of the four measures: BDI, STAI A-Trait, and ATQ-30, all F's(1,308)< .05. Females did score significantly higher than males on the MMPI-D scale, F(1,308) -- 5.06, p < .05. There were also no significant Subsample X Sex interactions on all variables, all F's(1,308)< 1. It appears that the two subsamples were comparable.

Characteristics of Depressed and Nondepressed Criterion Groups


As expected, depressed subjects had significantly higher mean scores than nondepressed subjects on both the BDI, F(1,63) = 11.00, p < .001, and the MMPI-D, F(1,63) = 126.47, p < .001. Males did not differ from females on either the BDI or the MMPI, all F's(1,63) < 1, nor were there any significant interactions between sex and criterion group on the depression

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measures, all F's < 1, respectively. Mean BDI scores for both depressed criterion groups were comparable to the Bumberry et al. (1978) mildly to moderately depressed college students. In that study, BDI scores were significantly correlated with psychiatric ratings of depression. Thus the depressed criterion groups can be said to represent a mixed sex sample of psychometrically identified mildly to moderately depressed college students.

A TQ Item Selection
Using the item selection sample data, 30 of the original 100 ATQ items were found to significantly discriminate between the depressed and nondepressed criterion groups at the .01 level. The 30 items, with means (and standard deviations) and t-test values are presented in Table I. On each of the 30 automatic thoughts, the depressed subjects reported significantly more frequent instances of the specific cognitions. None of the remaining items were endorsed significantly more often by the nondepressed group than by the depressed group. Although the 30 items were selected because they significantly discriminated depressed from nondepressed subjects, the items were not differentially endorsed by males and females. An analysis of variance indicated that, while depressed and nondepressed group did differ on total ATQ-30 score, F(1,27) = 43.48, p < .001, there was no significant effect for sex, F(1,27)< 1, and no significant Depression X Sex interaction, F(1,27) < 1.

Cross- Validation
Total scores on the ATQ-30 were computed for all subjects in the depressed and nondepressed criterion group from the cross-validation sample. An independent t test indicated significantly higher scores, t(17) = 4.85, p < .001, for the depressed subjects. The mean ATQ-30 for the depressed subjects was 79.64 (SD = 22.29), while the mean ATQ-30 for the nondepessed subjects was 48.57 (SD = 10.89). These data cross-validate the finding that these 30 items are endorsed more frequently by depressed than by nondepressed subjects. Differences in scores on the ATQ-30 in the cross-validation sample are not inflated by capitalization on chance factors in item selection. The means (and standard deviations) and t-test values for the cross-validation of each item are presented in Table I.

Interrelationships Among Measures


All correlations among the BDI, the MMPI-D, and the ATQ-30 (as well as the 100-item ATQ) using the full sample were statistically

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significant, p ' s < .01. Intercorrelations calculated separately from the item selection sample and cross-validation sample data were also significant. Of note were the comparabilities of ATQ-30/BDI and MMPI-D correlations (r's range from .45 to .70) across both samples (r's within .02 of each other) and the relative lack of differences in the magnitude of the correlations involving the ATQ-30 and the 100-item ATQ (largest difference between r's was .05). The comparability of the interrelationships speaks to the stability of the endorsement of automatic negative cognitions, while the similarity of the ATQ-30 and ATQ-100 indicates a retention of concurrent validity despite the reduction in the total number of items.

Anxiety, Depression, and the A TQ-30


The STAI A-Trait had been administered to provide a basis for selecting ATQ cognitions associated with depression but not associated with anxiety. However, the correlation between trait anxiety and the ATQ-30 was actually quite high (r = .79, for the full sample), precluding any interpretation of specificity to depression-related cognitions. It is not clear, however, whether this lack of specificity reflects flaws in the ATQ-30 or overlap in the measures of syndrome psychopathology used. Correlations between the established depression measures and the anxiety measure were also high (r's ranged from .60 to .78), versus an r of .63 between the two depression measures, suggesting that it was not possible to meaningfully discriminate between self-reported depression and self-reported anxiety in this sample.

Reliability
Both split-half and coefficient alpha (Kuder & Richardson, 1937) reliability coefficients were used to estimate the reliability of the ATQ-30. The split-half reliability coefficient, calculated on odd versus even items, was .97, p < .001. Calculation of coefficient alpha yielded a correlation of .96, p < .001. In general, both reliability estimates arequite satisfactory, and the ATQ-30 appears to possess sufficient reliability to justify further use. There are theoretical grounds for not collecting test-retest data on the ATQ-30 without simultaneously collecting comparable data on self-reported levels of syndrome depression. Without specifying the direction of causality, the frequency of specific depression-relevant cognitions would be expected to be closely related to the level of experienced depression. Depression itself is a transitory phenomenon; thus test-retest coefficients on the ATQ-30 should be evaluated only when accompanied by reliability coefficients on syndrome depression measures. Such data are currently being collected and will be reported in a later paper.

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Table II. ATQ-30 Scale Items with Factor Loadings Over .50 a ATQ-30 scale item number Factor I 26 20 7 14 10 Factor II 28 23 24 9 21 3 2 Factor III 18 17 Factor IV 30 29 Items Something has to change. What's the matter with me? I wish I were a better person. Whats wrong with me? I'm so disappointed in myself. My future is bleak. I'm a failure. I'U never make it. My life's not going the way I wanted it to. I'm a loser. Why can't I ever succeed? I'm no good. I'm worthless. I hate myself. I can't finish anything. It's just not worth it. I Factors loadings II .23 .39 .26 .29 .22 III .20 .23 .16 .31 .24 .13 .33 .27 .27 .46 .31 .45 IV .30 .19 .13 .29 .17 .35 .21 .45 .28 .18 .22 .03 .23 .06 .73 .58

.64 .63 .62 .62 .57


.19 .23 .21 .49 .24 .46 .38 .10 .30 .27 .17

.70 .68 .57 .52 .52 .52 .52


.37 .14 .27 .23

.66 .65
.11 .43

aATQ-30 = Automatic Thoughts Questionnaire.

1tern A n a l y s i s
All A T Q - 3 0 i t e m - t o - t o t a l correlations were significant at o r b e y o n d the .001 level. I n d i v i d u a l i t e m - t o t a l c o r r e l a t i o n s r a n g e f r o m r = .47 ( " I ' v e let people d o w n " ) to r = .78 ( " M y life's n o t g o i n g the way I w a n t it t o " ) . These c o n s i s t e n t l y m o d e r a t e t o strong c o r r e l a t i o n s indicate t h a t each item is s i g n i f i c a n t l y related to the t o t a l score.

Factor Analysis
A p r i n c i p a l - c o m p o n e n t s factor analysis with V a r i m a x r o t a t i o n s was p e r f o r m e d o n the 312 s u b j e c t s ' responses to the A T Q - 3 0 . Since males a n d females d i d n o t differ in t e r m s o f total scores i n either s a m p l e , d a t a f r o m b o t h sexes were i n c l u d e d in the analysis. As s h o w n i n T a b l e II, f o u r factors emerged with eigenvalues > 1, a c c o u n t i n g for a total o f 58.9o7o o f the

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variance. The first factor accounted for the bulk of the variance, 45.970, while factors II, III, and IV accounted for 5.2070, 4.4070, and 3.5070 of the variance, respectively. Items loading on the first factor appear to reflect perceptions of Personal Maladjustment and Desirefor Change. The second factor consists of items reflecting Negative Self-Concept and Negative Expectations. Items on the third factor reflect Low Self-Esteem, while items on the fourth factor reflect Giving Up/Helplessness. Items loading on Factor II seem particularly consistent with two of the three components of Beck's negative cognitive triad (Beck, 1963): negative views of the self and negative views of the future. Similarly, these cognitions appear quite consistent with the tendency to attribute nonsuccess to internal, global, stable-over-time factors, a tendency regarded by Abramson, Seligman, and Teasdale (1978) to be central to depression in their recent reformulation of the learnedhelplesness model of depression.

DISCUSSION A 30-item inventory that identifies cognitions reported as being present in association with mild to moderate depression was developed and cross-validated. The inventory appears to have sufficient internal reliability and concurrent validity to justify use as a general measure of depression-related automatic negative thoughts. Specific items, as well as the total score on the inventory, appear to reliably separate depressed from nondepressed criterion groups. It appears that the ATQ-30 is a relatively brief measure of automatic thoughts (self-statements) in depression, one that applies to either males or females. As with research investigating the selfstatements associated with assertive behavior (Schwartz & Gottman, 1976) and stressful medical procedures (Kendall, Williams, Pechacek, Graham, Shisslak, & Herzoff, 1979), the present study supports the use of self-statement inventories to assess certain cognitive events (see also Kendall & Hollon, 1981). It remains to be determined whether clinically formed samples of depressed patients will differ in terms of reported frequency of automatic negative thoughts on the ATQ-30. The samples utilized in the present study were composed of subclinical volunteers likely to be somewhat less depressed, younger, and better educated than many populations of potential interest. A closely related issue concerns the ubiquitousness of negative cognitions across subtypes of depression. It is not unreasonable to speculate that relationships between cognitive content and affective states may hold for some subtypes of depression, but not all. If so, it is possible that the nonbipolar rather than bipolar (Depue & Monroe, 1978) and

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primary rather than secondary (Robins & Guze, 1972) depressives would evidence more extreme levels of negative cognitions. Finally, the present data did not speak to the utility of the ATQ-30 as a measure sensitive to change. As stated earlier, a major reason for developing a measure of depression-related self-statements or negative automatic thoughts was to provide an independent means of assessing the adequacy of manipulations or therapies targeted at the cognitions of depressives. It currently remains to be demonstrated whether the ATQ-30 is sensitive to changes in the nature and frequency of cognitions that result from experimental manipulation and/or psychotherapeutic interventions. At this time it appears that the ATQ-30 possesses good concurrent validity as a measure of the automatic negative thoughts presumed by cognitive theories to be related to the state of depression. Additional work needs to be done addressing further issues of reliability (e.g., test-retest), sensitivity to change, and applicability to clinical populations, but the ATQ-30 appears to be a promising tool for assessing cognitions associated with depression.

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Hathaway, S. R., & McKinley, J. C. The measurement of symptomatic depression with the Minnesota Multiphasic Personality Schedule. Psychological Bulletin, 1940, 37, 425. Hollon, S. D., & Beck, A. T. Cognitive therapy of depression. In P. C. Kendall & S. D. Hollon (Eds.), Cognitive-behavioral interventions: Theory, research, and procedures. New York: Academic Press, 1979. Jones, R. G. A factored measure of Ellis" irrational belief system. Wichita, Kansas: Test Systems, 1968. Kendall, P. C., & Hollon, S. D. (Eds.). Cognitive-behavioral interventions: Theory, research, and procedures. New York: Academic Press, 1979. Kendall, P. C., & Hollon, S. D. Assessing self-referent speech: Methods in the measurement of self-statements. In P. C. Kendall and S. D. Hollon (Eds.), Assessment strategies for cognitive-behavioral intervention. New York: Academic Press, 1981. Kendall, P. C., & Korgeski, G. P. Assessment and cognitive-behavioral interventions. Cognitive Therapy and Research, 1979, 3, 1-21. Kendall, P. C., Williams, L., Pechacek, T. F., Graham, L. E., Shesslak, C., & Herzoff, N. Cognitive-behavioral and patient education interventions in cardiac catheterization procedures: The Palo Alto medical psychology project. Journal of Consulting and Clinical Psychology, 1979, 47, 49-58. Kuder, G. F., & Richardson, M. W. The theory of estimation of test reliability. Psychometrika, 1937, 2, 151-160. Mahoney, M. Cognition and behavior modification. Cambridge, Massachusetts: Ballinger, 1974. Mahoney, M. Reflections on the cognitive-learning trend in psychotherapy. American Psychologist, 1977, 32, 5-13. Meichenbaum, D. Cognitive-behavior modification. New York: Plenum, 1977. Nelson, R. E. Irrational beliefs in depression. Journal o f Consulting and Clinical Psychology, 1977, 45, 1190-1191. Rehm, L. P. Assessment of depression. In M. Hersen & A. Bellack (Eds.), Behavioral assessment: A practical handbook. New York: Pergamon Press, 1976. Robins, E., & Guze, S. B. Classification of affective disorders: The primary-scondary, the endogenous-reactive, and the neurotic-psychotic concepts. In T. A. Williams, M. M. Katz, & J. A. Shields (Eds.), Recent advances in psychobiology of the depressive illnesses. Washington, D.C.: U.S. Government printing Office, 1972. Rush, A. J., Beck, A. T., Kovacs, M., & Hollon, S. D. Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients. Cognitive Therapy and Research, 1977, 1, 17-37. Schwartz, R. M., & Gottman, J. M. Toward a task analysis of assertive behavior. Journal o f Consulting and Clinical Psychology, 1976, 44, 910-920. Shaw, B. F. Comparison of cognitive therapy and behavior therapy in the treatment of depresion. Journal of Consulting and Clinical Psychology, 1977, 45, 543-551. Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. Manual for the State-Trait Anxiety Inventory (Self-Evaluation Questionnaire). Palo Alto, California: Consulting Psychologists Press, 1970. Taylor, F. G., & Marshall, W. L. Experimental analysis of a cognitive-behavioral therapy for depression. Cognitive Therapy and Research, 1977, 1, 59-72.