Theory of Mind, Excessive Reassurance-Seeking, and Stress Generation in Depression: A Social-Cognitive-Interpersonal Integration

Abstract

Introduction: According to the interpersonal model of depression, individuals with depression engage in excessive reassurance-seeking (ERS) about others’ beliefs regarding their self-worth, which can ultimately result in interpersonal rejection. We present the novel hypothesis that maladaptive ERS behaviors in depression may be driven by difficulties with “theory of mind”—the foundational ability to decode and reason about others’ mental states. Method: Participants included 31 young adults in a current episode of a unipolar depressive disorder, and 91 never-depressed adults. Theory of mind was assessed with standard, objective laboratory tasks. Stressful life events were assessed with a gold-standard contextual interview and independent rating system. Results: Consistent with hypotheses, in the depressed group only, lower accuracy of theory of mind decoding was associated with greater ERS, which was significantly associated with exposure to greater interpersonal, but not non-interpersonal, stress. Surprisingly, higher accuracy of theory of mind reasoning was associated with greater ERS. Discussion: The intriguing dissociation is discussed in terms of expanding the interpersonal model of depression to include the foundational social cognitive processes that underlie effective social communication.