The Behavior Analyst 1991, 14, 157-169 No. 2 (Fall)

Distressed Behavior and Its ContextAnthony Biglan

Oregon Research Institute

Behavior that is commonly labeled as indicating distress may have an important function in certain clinicalproblems. Evidence suggests that "distressed" behavior is displayed more frequently by persons who aredepressed or experiencing chronic pain. Such behavior includes nonverbal facial expressions and bodypostures which are typically labeled as "sad," and verbal responses involving self-denigration or com-plaints. Such behaviors appear to form a functional response class which has a unique impact on others.The behavior appears to be more likely among persons who are receiving aversive stimulation. Recipientsofdistressed behavior are more likely to experience negative emotion, yet be solicitous toward the personwho displays distressed behavior. Under circumstances where distressed behavior is unsuccessful inreducing aversive stimulation, the behavior may be shaped and maintained by the fact that it temporarilyreduces the probability of others behaving aggressively toward the person displaying distress. Thus, thedevelopment ofa pattern ofhigh rates ofdistressed behavior that characterizes clinically depressed personsand persons in chronic pain may be partly a result of the unique social contingencies that surround thisbehavior.Key words: depression, distressed behavior, negative reinforcement, chronic pain, social behavior,

mental discord

This paper examines the role that be-havior indicative of distress may play inthe interactions of people who are de-pressed or experiencing chronic pain.Among the behaviors which might beconsidered indications ofdistress are self-denigrating statements, complaints aboutanything other than the person being ad-dressed, and nonverbal displays of sad-ness. Such behavior appears to be a car-dinal feature of the social behavior ofdepressed people and people who are ex-periencing chronic pain. It may prove tobe typical ofpeople who are experiencingany chronically aversive events. Analy-ses of the environmental conditions thatprompt and reinforce such behavior couldcontribute to treatments for these prob-lems.Our work on distressed behavior (Big-

lan, Hops, & Sherman, 1988; Biglan etal., 1985; Hops et al., 1987) began withan interest in the social behavior of peo-ple who are diagnosed as depressed.Available evidence suggested that de-pressed people emit more behavior sug-gesting that they are distressed than doothers. Our central concern was to iden-tify contextual events which could con-

Requests for reprints should be sent to AnthonyBiglan, Oregon Research Institute, 1899 Willam-ette, Eugene, OR 97401.

tribute to the prediction and control ofdistressed behavior (Hayes & Brown-stein, 1986). Our rough initial notion wasthat, at least for many people who aredepressed, social behavior indicating dis-tress prompts others to be solicitous and/or to refrain from behaving aversively.We were prepared to find that relation-ships between the diagnosis ofdepressionand such behavior would be weak, sincewe did not assume that the diagnosis wasbased on similarities among people infunctional response classes. We were alsoprepared to find that such behavior wascharacteristic ofpeople who were havingother types of problems.

DISTRESSED BEHAVIORThere are three types of behavior

which, on the basis of the data describedbelow, we have come to feel have thesame functional effect for many people:(a) self-denigrating statements, (b) com-plaints, and (c) dysphoric behavior-nonverbal behavior suggesting sadness.

Self-denigrating involves negativestatements about the speaker's physical,psychological, or behavioral states orabilities. For example, "I am unhappy,""I can't do that," "My stomach hurts."Complaining involves negative state-ments about any person or object other

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than the person being addressed. For ex-ample, "They always make you wait inline at this store," "She never does whatI ask," "It's cold in here." As discussedbelow, these two types ofverbal behaviorappear to have similar functional effects.

Dysphoric behavior consists of non-verbal responses which appear to befunctionally similar to self-denigratingand complaining. Such behavior includescrying, sighing, and facial expressions andbody postures that are indicative of sad-ness or dysphoria. Ekman and his col-leagues (Ekman, 1973; Ekman & Friesen,1984; Ekman, Friesen, & Ellsworth, 1972)have provided precise and replicable op-erational definitions of facial expressionsof sadness as well as anger, happiness,surprise, disgust, and fear. They devel-oped the Facial Affect Coding System(FACS) which specifies facial muscularmovements believed to be associated witheach emotion. Ekman and Friesen (1984)reviewed evidence that the facial expres-sions defined by their system producehigh levels ofagreement in labeling emo-tions across quite different cultures. Thefacial movements associated with sad-ness include raising the eyebrow and low-er eyelid and turning the mouth down.

In earlier publications, we labeled thesebehaviors "depressive." However, thatprompted some investigators to expectthat only people who were diagnosed asdepressed would exhibit this type of be-havior. We have therefore changed thelabel of the behavior to "distressed" inorder to encourage the investigation ofthe social contingencies which shape andmaintain such behavior among peoplewith a variety of problems.A theoretical framework for the study

of distressed behavior can be articulatedin terms of three hypotheses (Biglan etal., 1988):1. Distressed behavior is a cardinal fea-

ture ofthe behavior ofpeople who aredepressed or in chronic pain.

2. Distressed behavior has an impact onothers which is uniquely different fromthe impact ofother forms ofbehavior:(a) it is aversive, (b) it produces solic-itous reactions, and (c) it reduces thelikelihood of attack from others.

3. Under circumstances of continuingaversive stimulation, distressed be-havior may be functional in reducingthe rate or timing ofaversive behaviorcoming from other family members,and this contingency may serve toshape and maintain distressed behav-ior.The chief form of aversive behavior

exhibited by other family members is ag-gressive behavior. Among the behaviorsthat we view as aggressive are verbal ex-pressions of anger including statementswhich are disapproving (e.g., "Youshouldn't have done that."), threatening(e.g., "If you do that again, I will slapyou."), arguing (e.g., "That's not true!"),and humiliating (e.g., "You moron!").Nonverbal behavior that appears to havethe same functional effect includes angryfacial expressions (lowered and drawn to-gether eyebrows, tense eyelids, staring,and lips pressed tightly together, Ekman& Friesen, 1984), a raised voice, and bod-ily actions such as slamming or throwingthings.Most of the remainder of this paper is

organized around these three hypotheses.However, before discussing the evidenceregarding them, it seems important tocontrast the focus of the customary ap-proach to depression with the goals andprocedures of behavior analysis.

BEHAVIOR ANALYSIS ANDDEPRESSION

Depression is one ofthe more commonpsychological problems among adults(Boyd & Weissman, 1982). However, thecustomary construction of the problemis inconsistent with the way in which be-havior analysts have tended to approachproblems. Contrasting the two approach-es may clarify the unique contributionthat behavior analysis can make to theunderstanding and treatment of prob-lems such as depression.According to the Research Diagnostic

Criteria (RDC; Spitzer, Endicott, & Rob-ins, 1978), a person is diagnosed as hav-ing a "major depressive disorder" if theperson has:1. One or more distinct periods with

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dysphoric mood or pervasive loss ofinterest or pleasure

2. At least five of the following symp-toms:a. Poor appetite or weight loss or in-

creased appetite or weight gainb. Sleep difficulty or sleeping too

muchc. Loss of energy, fatigability, or

tirednessd. Psychomotor agitation or retar-

datione. Loss ofinterest or pleasure in usual

activitiesf. Feeling of self-reproach or exces-

sive or inappropriate guiltg. Complaints or evidence of dimin-

ished ability to think or concen-trate, such as slowed thinking orindecisiveness

h. Recurrent thoughts ofdeath or sui-cide, or any suicidal behavior

3. Duration of dysphoric features of atleast one week

4. Sought or was referred for help fromsomeone, took medication, or hadimpaired functioning with family, athome, at school, at work, or socially.

Using structured interview proceduresand these criteria, inter-judge agreementon the diagnosis ofmajor depressive dis-order can be achieved (e.g., Spitzer et al.,1978). Moreover, people so diagnosed aremore likely than people not receiving thisdiagnosis to have a variety of problemsofimportance, including suicidal behav-ior, marital distress, and psychologicallydistressed children (Biglan et al., 1988).

Behavioral researchers have pointedout that depression is not a unitary phe-nomenon (Biglan & Dow, 1981; Craig-head, 1980). For example, according tocriterion 2 of the RDC, one person di-agnosed as depressed might presentweight loss, sleep difficulty, tiredness,psychomotor agitation, and loss of inter-est in usual activities, while a secondmight show weight gain, extensive timespent sleeping, psychomotor retardation,feelings of self-reproach, and recurrentthoughts of death. Given the reliabilityofthe diagnostic procedure and its wide-spread use in research and clinical prac-tice, behavioral researchers have gener-

ally accepted the diagnostic approach forthe purposes of conducting research.However, they have not assumed that itimplies the functional unity of the cri-terion events or that it implies that "de-pression" is the cause of these "symp-toms."Two people who are diagnosed as "de-

pressed" may or may not behave simi-larly. If they do, it may be possible tointervene in similar ways with them. Ifthey do not, it may be necessary to in-tervene in different ways. Craighead(1980) articulated this problem in somedetail and McKnight, Nelson, Hayes, andJarrett (1984) presented empirical evi-dence that diagnostic similarity does notnecessarily imply similarity with regardto what interventions will be effective.An important corollary of this view isthat people who receive different diag-noses may be quite similar in some oftheir functional behavioral processes.

Thus, the diagnostic approach cate-gorizes cases on the similarity oftheformof their behavior. This approach will notnecessarily reveal variables that predictand control the behavior of interest. Incontrast, the central focus of behavioranalysis is on identifying behaviors onthe basis of the similarity in their func-tional relationships to contextual con-ditions. In this way, variables are morelikely to be identified that can be manip-ulated in the interest of prevention oramelioration.

DISTRESSED BEHAVIOR AMONGPEOPLE WHO ARE DEPRESSED

OR IN CHRONIC PAIN

Our conceptualization of distressedbehavior (Biglan et al., 1988) wasprompted by existing evidence about thesocial behavior ofdepressed people. Got-lib and Robinson (1982) found that,compared with nondepressed women,mildly depressed college women mademore negative self-evaluative state-ments, fewer supportive statements, andwere more critical in interactions withstrangers. Jacobson and Anderson (1982)found that depressed college studentsmade more negative statements aboutthemselves in such interactions than did

160 ANTHONY BIGLAN

nondepressed students. Hokanson, Sac-co, Blumberg, and Landrum (1980) foundthat in playing a prisoner's dilemmagame, depressed people were more likelythan nondepressed people to obtain re-wards at the expense ofothers. However,the depressed people communicatedmore "self-devaluation-sadness" andmore "helplessness" to the other personthan did other players. Such behaviorcould deter others from complainingabout their style of play. In our own re-search, we examined whether such dis-tressed behavior was more frequentamong depressed women than amongnondepressed women.Distressed Behavior ofDepressed Women

In order to examine the social behaviorof depressed women and their families,27 depressed women and their husbandsand 25 nondepressed normal women andtheir husbands were studied (Biglan et al.,1985; Hops et al., 1987). To be includedin the depressed subgroup, the womenhad to have a score on the Beck Depres-sion Inventory (BDI; Beck, Ward, Men-delson, Mock, & Erbaugh, 1961) of 18 orgreater and had to meet Research Diag-nostic Criteria (Spitzer et al., 1978) forMajor or Minor Depressive Disorder.Fourteen ofthe couples with a depressedwife were also experiencing marital dis-cord, as indicated by a mean score of 98or less on the Dyadic Adjustment Scale(Spanier, 1976). To be included as "nor-mal" neither partner could have a BDIscore above 10 or a DAS score less than100. Depressed and normal couples werematched on number of children, numberof children under seven, and socioeco-nomic status.

Problem-solving interactions betweendepressed women and their husbands.Wife-husband dyads were observed dur-ing problem-solving interactions. Suchinteractions have been shown to produceinteractive behavior that is different onseveral dimensions for couples who re-port marital discord on questionnairescompared with couples who do not re-port discord (Birchler, Weiss, & Vincent,1975; Gottman, 1979; Margolin & Wam-

pold, 1981). The couples were asked todiscuss areas of their relationship aboutwhich they typically disagree. Two topicswere discussed, each for ten minutes.The interactions were coded using the

initial version ofthe LIFE coding system(Arthur, Hops, & Biglan, 1982). Codesfor nonverbal dysphoric affect and verbalself-denigration and complaining werecollapsed to form a single code for dis-tressed behavior. Reliability was calcu-lated by having a second coder code 38%of the videotaped interactions. Correla-tions were computed between the meanrate of each code category obtained byeach of the two coders. For distressedbehavior the correlations were .66 forwives and only .46 for husbands. Theywere .94 and .96 for wives' and husbands'aggressive behavior. The mean level ofdistressed and aggressive behavior did notdiffer between the two coders. In theseinteractions, depressed women exhibiteddistressed behavior at a statistically sig-nificantly higher level than did nonde-pressed women or any of the husbands.Two recent studies have replicated this

finding. Nelson and Beach (1990) andSchmaling and Jacobson (1990) also ex-amined the occurrence of distressed be-havior in problem-solving interactions ofcouples in which the wife was depressed.Unlike our study, they were able to in-clude a group ofcouples in which the wifewas not depressed, but the couple wasexperiencing marital discord. This al-lowed them to examine whether dis-tressed behavior is uniquely associatedwith depression or is also likely whenevermarital discord occurs. Nelson and Beach(1990) found that distressed behavioroccurred significantly more among de-pressed women than among nonde-pressed women, even when the nonde-pressed women were reporting maritaldiscord. Schmaling and Jacobson (1990)also obtained these results, though onlyfor discussion which involved a topicabout which the couple experienced con-flict.Home observations. Each of the fami-

lies in our sample was observed in thehome on ten occasions (Hops et al., 1987).Verbal and nonverbal behavior were an-

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alyzed separately. The depressed womendid not differ from others on measuresofverbal behavior involving distress (self-denigrations and complaints). However,depressed women exhibited significantlymore dysphoric affect than did normalwomen. (The reliability ofthe latter codewas .635 using Cohen's kappa.)

Distressed Behavior Among ChronicPain Patients

If distressed behavior is a functionalresponse to aversive stimulation, it couldbe found among persons who have prob-lems other than depression. Therefore,data were obtained on the problem-solv-ing interactions ofa sample of20 couplesin which the wife was being treated forproblems with chronic pain (Biglan &Thorsen, 1986). The mean length oftimethat these women reported experiencingpain was 1.9 years.Due to funding restrictions, it was nec-

essary to compare the behavior of thepain sample with the behavior ofthe nor-mal couples we had recruited in the studydescribed above. In comparison to thewomen in our normal couples, the wom-en with chronic pain exhibited more dis-tressed behavior. While some of thewomen with chronic pain had high scoreson the Beck Depression Inventory, co-variance analysis indicated that normalwomen and those in pain differed in dis-tressed behavior even when variance as-sociated with BDI scores was removed.Thus, it would appear that women ex-periencing chronic pain display more dis-tressed behavior than "normal" women,even when they are not complaining ofdepression.Some may find it surprising that wom-

en with two presumably distinct difficul-ties (depression and chronic pain) bothexhibit more distressed behavior thannormals. However, only if one expectsthat diagnoses such as "depression" arein some sense primary and in some sensedetermine the behavior ofthe individualshould these results be surprising. If be-havior is shaped and maintained by itsconsequences, it is likely that people ex-hibiting different diagnoses nonetheless

exhibit similar social behavior because itis functional in some contexts. The factthat distressed behavior is exhibited byboth women who are depressed andwomen who experience chronic pain sug-gests that such behavior may be func-tional in a variety of situations in whichthe person is experiencing aversive stim-ulation.

THE IMPACT OF DISTRESSEDBEHAVIOR

Coyne (1976a) was the first to suggestthat some of the behavior of depressedpeople is aversive to others. He showedthat people who talk over the phone witha depressed person rated themselves asmore depressed, anxious, and hostile andwere more rejecting of the person thanwas true for people who talked to a non-depressed person. This basic finding hasbeen replicated using a variety of meth-ods. Subjects have responded more neg-atively to depressed than nondepressedpersons following face-to-face interac-tions (Gotlib & Robinson, 1982; Strack& Coyne, 1983). Compared to their re-actions to nondepressed persons, naivesubjects have been shown to respondmore negatively to confederates role-playing a depressed person (Hammen &Peters, 1978; Howes & Hokanson, 1979),to audiotaped interviews of depressedpersons (Boswell & Murray, 1981), andto written descriptions ofthe behavior ofdepressed people (Gotlib & Beatty, 1985;Hammen & Peters, 1977; Winer, Bon-ner, Blaney, & Murray, 1981). Personswho meet diagnostic criteria for depres-sion are also rated as less socially skilledthan nondepressed people by those withwhom they interact and by observers oftheir behavior (Youngren & Lewinsohn,1980). In sum, there is considerable rea-son to believe that people who meet ques-tionnaire or diagnostic criteria for de-pression are behaving in ways that promptnegative reactions from others.

It seemed likely that distressed behav-ior was prompting these negative reac-tions. Therefore, two studies were con-ducted on the impact of distressedbehavior (Biglan, Rothlind, Hops, &

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Sherman, 1989). Our strategy was topresent subjects with samples of dis-tressed and other types of behavior andask them to rate how they would feel andreact ifthe behavior were directed towardthem by their spouses. Ratings of likelyfeelings and reactions may not preciselypredict how people will actually react.However, there is evidence that such rat-ings predict actual behavior (e.g., Hoff-man, 1983) and that the results of ratingstudies of social behavior parallel thoseof direct observation studies (Dow, Gla-ser, & Biglan, 1981). Samples ofpeople'sverbal statements about distressed be-havior can provide inexpensive methodsofexploring the social significance ofthesebehaviors which could lead to more re-fined tests of the impact of the behaviorusing more costly direct observationmethods.Study 1 involved 50 couples who were

asked to rate written descriptions of onenf five types of behavior: self-denigra-tion, complaint, aggression, facilitation,and neutral talk. For each type ofbehav-ior, several written examples were givenwhich came directly from the LIFE cod-ing manual (Arthur et al., 1982). Subjectswere asked to imagine that their spouseswere emitting the behaviors in question.There were no statistically significant dif-ferences between men's and women's rat-ings.

Consistent with the hypothesis that self-denigration and complaint are similar inimpact, there were no significant differ-ences between the ratings of these twobehaviors.Compared to neutral behavior, self-

denigration and complaint resulted inlower ratings of positive feelings such as"happiness" and higher ratings of nega-tive feelings such as "anxiety," "irrita-tion," "anger," and "defiance." At thesame time, self-denigration and com-plaint produced high ratings for feelingsinvolving solicitousness such as "sym-pathy," "supportiveness," and "caring"and for the likelihood that they wouldcomfort or support the person emittingthe behavior. Thus, these two behaviorsappear to function similarly.Not surprisingly, aggressive behavior

was also rated as likely to produce neg-ative feelings. However, despite the neg-ative reactions that both aggressive anddistressed behavior produced, subjectsindicated that they would be significantlymore likely to say something hostile orto argue in response to aggressive behav-ior than in response to self-denigrationsor complaints.

In study 2, a new sample of41 couplesrated videotaped depictions of a womanexhibiting distressed, aggressive, andneutral behaviors. Men were asked toimagine that the woman behaving wastheir wife and women were asked toimagine that she was a friend. In this studyit was possible to examine the impact ofboth verbal and nonverbal aspects ofdis-tressed and aggressive behavior. Behav-ior that was distressed both in terms ofits verbal and nonverbal content pro-duced higher ratings of "anxiety" and"sadness" and lower ratings of "happi-ness" than did neutral behavior. In otherwords, subjects indicated that they wouldfeel worse in response to distressed be-havior than in response to neutral be-havior. Moreover, the ratings indicatedthat subjects would be more solicitous inresponse to distressed than in responseto neutral behavior. They said they wouldfeel more "caring," "sympathetic," and"supportive" and would be more likelyto comfort and support the person andto discuss the subject with her.

Reactions to distressed and aggressivebehavior were then compared. Subjectsindicated that they would counteraggressin response to aggressive behavior, butwould be comforting and supportive inresponse to distressed behavior. More-over, distressed behavior would producesignificantly fewer argumentative or hos-tile reactions than would aggressive be-havior.

In sum, in both studies subjects' rat-ings supported the hypothesis that dis-tressed behavior has a more negative im-pact than neutral behavior in the sensethat it produces more negative and lesspositive ratings of feelings. To the extentthat negative feelings are aversive or in-dicate the occurrence ofaversive stimuli,these results suggest that one functional

DISTRESSED BEHAVIOR 163

effect of distressed behavior may be toproduce avoidance behavior in others.

SOCIAL CONTINGENCIESAFFECTING DISTRESSED

BEHAVIORAvailable evidence as well as theoret-

ical accounts of the social behavior ofdepressed people (e.g., Coyne, 1976b)suggest that distressed behavior can bemaintained by negative reinforcement inthe form of avoidance of aversive be-havior from others.There is considerable evidence that

persons who are depressed receive aver-sive stimulation from others (Biglan etal., 1988; Biglan, Lewin, & Hops, 1990).Our own research showed that others di-rect aggressive behavior toward de-pressed people and also toward chronicpain patients. In problem-solving inter-actions, depressed women and their hus-bands tended to display more aggressivebehavior than did other couples. In thestudy of chronic pain patients, the pa-tients' husbands exhibited significantlymore aggressive behavior than did hus-bands of "normals." In the home obser-vations of depressed and normal fami-lies, the children of depressed mothersexhibited significantly more nonverbalbehavior coded as "irritated."The evidence reviewed in the previous

section indicates that others are moti-vated to be solicitous of persons exhib-iting distressed behavior. In many cir-cumstances such solicitousness may resultin people being less aversive to a personwhen they exhibit distress. For example,a person comes home complaining of ahard day at work; his spouse comfortshim and thereby reduces the aversivefeelings that he is having. A person whois injured or has a loved one die receivesmessages of support and caring frommany people. Such reactions are proba-bly instrumental in assisting people incoping with the aversive change in theirworld.However, for a variety of reasons, ef-

forts to comfort or assist distressed peo-ple may not reduce the aversive stimu-lation to which they are exposed. Pain

may persist despite all efforts to be sup-portive. It may be beyond the power offamily members to reduce aversive stim-ulation that a family member is receiv-ing. Perhaps most commonly, other fam-ily members may, themselves, be primesources of aversive stimulation.But even if distressed behavior is not

successful in eliminating aversive stim-ulation, it may be functional in producingtemporary respites from such stimula-tion and these respites may function toreinforce distressed behavior (Hineline,1977). To explore this possibility, we an-alyzed the sequences of interactions inour direct observation data. For eachhusband-wife or mother-child dyad,z-scores were composed based on theconditional probability of a particularconsequence given that distressed behav-ior had occurred. (See Biglan et al., 1985,for a description ofthe data analytic pro-cedures.)

In the home observations (Hops et al.,1988), depressed mothers' dysphoric be-havior was followed by a greater reduc-tion in the probability of husbands' andchildren's aggressive affect than was truein families of nondepressed women. Inthe problem-solving interactions (Biglanet al., 1985), the wives' distressed be-havior was associated with greater sup-pression of husbands' subsequent ag-gressive behavior among couples withmarital discord and a depressed wife thanamong either normal couples or coupleswith no marital discord and a depressedwife. Thus, we identified some circum-stances in which distressed behavior maybe functional in producing brief respitesfrom the aggressiveness of the maritallydissatisfied partner.

There was also evidence that distressedbehavior functions in this way for peopleexperiencing chronic pain. Among thecouples with a wife in pain, the proba-bility of the husband's aggressive behav-ior was reduced more following the wife'sdistressed behavior than was true for"normal" couples.Nelson and Beach (1990) failed to rep-

licate our finding that depressed women'sdistressed behavior suppresses their hus-band's aggressive behavior when there is

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marital discord. However, they did findsomething very interesting that suggeststhe importance ofcouples' efforts to copewith distressed behavior. They includedcouples in which there was marital dis-cord but no depression, as well as couplesin which the wife was depressed and therewas marital discord. They noticed thatthese couples differed in the length ofmarital discord. Those with a depressedpartner had problems with marital dis-cord for a longer period oftime than thosewithout a depressed partner. When theyexamined the relationship between theirmeasure of the suppressive effect of thewife's distressed behavior on the hus-band's aggressive behavior they foundthat it was negatively related to the lengthof marital discord. In other words, in theinitial stages of marital discord, her dis-tressed behavior was functional in gettinghim to stop aggressive behavior, but asthe discord persisted, its effect on himdiminished.Nelson and Beach (1990) may have

provided a snapshot of the developmentof depression. Over time, the depressedwoman's distressed behavior may be-come less effective in reducing the like-lihood of his aggressive behavior. Thiscould have the effect of thinning the neg-ative reinforcement for her distressed be-havior. That is, as marital discord con-tinues, he may be less and less inclinedto refrain from aggressiveness immedi-ately following her displays of sadness,self-denigration, or complaint. Thus, overtime, she has to be distressed more fre-quently in order to produce a decrementin the probability of his aggressive be-havior.Schmaling and Jacobson (1990) found

no evidence that distressed behavior re-duces others' aggressive behavior. Theycompared couples who varied in levelsof marital distress and the wife's depres-sion. Although depressed women did dis-play more distressed behavior, analysisofthe conditional probability ofthe hus-band's aggressive behavior, given thewife's distressed behavior, did not indi-cate that her distressed behavior de-creased the probability of his aggressivebehavior. Schmaling and Jacobson (1990)

suggested that their failure to replicatecould have been due to differences in thecoding system they used or to their in-clusion ofa maritally distressed but non-depressed group of couples. Nelson andBeach's (1990) results suggest that lengthof marital discord may be another vari-able which would influence the effects ofdistressed behavior on the husband's ag-gression.Two recent studies by Dumas and his

colleagues provide additional evidencesuggesting that people who are depressedare engaging in behavior that is func-tional in reducing aversive behavior ofothers. The first (Dumas, Gibson, & Al-bin, 1989) involved families of 51 chil-dren who had been referred for problemsof noncompliance or aggressive behav-ior. Family interactions were observed inthe home for an average of4.96 one-hoursessions. Variability in mothers' scoreson the Beck Depression Inventory wasanalyzed in relation to the observed childbehavior. The children of women whowere high on the BDI had significantlyhigher rates of compliance and signifi-cantly lower rates of behavior coded as"aversive."Dumas and Gibson (1989) analyzed the

behavior that target children directed to-ward mothers, fathers, and siblings for47 of these same families for whom ob-servation data were available for siblingsand/or fathers. They found that the ratesof these children's compliance and''aversive" behavior directed towardmothers versus fathers differed depend-ing on maternal depression. High scoreson the measure of maternal depressionwere associated with more compliancetoward the mother than the father, whilelow scores were associated with morecompliance toward fathers than mothers.Similarly, maternal depression was as-sociated with less aversive behavior be-ing directed toward the mother than thefather, and absence of maternal depres-sion was associated with more aversive-ness being directed toward the motherthan the father. Comparing mother-childand child-sibling interactions, it ap-peared that mothers who were depressedreceived less aversive behavior from their

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children than did nondepressed mothers,but that the siblings in the families ofdepressed women received more aver-sive behavior than did siblings in fami-lies of nondepressed women.Neither of these studies directly coded

the distressed behavior of these women.However, given the evidence cited above,it is likely that the women who were de-pressed were engaging in more distressedbehavior than the other women. The re-sults are, in any case, consistent with thehypothesis that depressed women are do-ing something that is functional in re-ducing aversive behavior toward them.Moreover, they suggest that depressedwomen are doing something that is func-tional in increasing compliance from theirchildren.

Is Other Family Members' AggressiveBehavior Reinforced by the AvoidanceofDistressed Behavior?

Ironically, the aggressive behaviorwhich others direct to depressed personsmay itself reflect an effort to avoid dis-tressed behavior. Analyses of the se-quential dependencies in the problem-solving interactions of the depressedwomen indicated that for the couples withmarital discord and depression, the prob-ability of the wives' distressed behavior,given that the husband had just been ag-gressive, was reduced significantly morethan was true for normals or depressed-only couples. Similarly, for the chronicpain patients, the probability ofthe wife'sdistressed behavior was reduced signifi-cantly more by the husband's aggressivebehavior than was true for normal cou-ples. In other words, in these instances,the wife may be inadvertently negativelyreinforcing his aggressive behavior at thesame time that he is inadvertently rein-forcing her distressed behavior.

It may be counterintuitive that bothmembers ofa dyad could have their aver-sive behavior maintained by the negativereinforcement involved in avoiding as-pects of the other's behavior. However,evidence from experimental analysesclearly indicate contingencies in whichbrief avoidance of aversive stimulation

or alterations in its rate or patterning canmaintain the avoidance behavior, evenwhen many aversive events are notavoided (Hineline, 1977). Thus, the dis-tressed behavior of one member of thedyad and the aggressive behavior of theother member could be simultaneouslymaintained.

The Effects ofModifyingInteractive Patterns

Ifwe are correct that the distressed be-havior ofdepressed people is maintainedin part by the pattern of aversive inter-actions with other family members,modification of those patterns could re-sult in changes in depression. Beach,O'Leary, and their colleagues (Beach &Nelson, 1990; Beach & O'Leary, 1986;Beach, Sandeen, & O'Leary, 1990;O'Leary & Beach, 1990) have developeda model for the treatment of depressedindividuals who are also maritally dis-tressed which provides support for thishypothesis. They reasoned that for de-pressed individuals who were in a mar-itally distressed relationship, the maritaldiscord was a major source of aversivestimulation. Successful marital therapyshould thus contribute to a reduction indepression at the same time that it re-lieves the marital distress (Beach et al.,1990).In a preliminary study, working with

couples in which the wife met diagnosticcriteria for depression, Beach and O'Leary(1986) randomly assigned three couplesto receive marital therapy, while threewere assigned to receive cognitive ther-apy for depression, and two were as-signed to a wait-list control. Both treat-ment conditions produced improvementsin depression, but only marital therapyreduced marital discord as well.A subsequent study with larger num-

bers of subjects (12 in each condition)and longer follow-up replicated thesefindings (O'Leary & Beach, 1990). Thetreatment for marital discord includedmany elements in addition to the effortto reduce interactions involving dis-tressed and aggressive behavior. How-ever, the results are consistent with the

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thesis that distressed behavior is func-tional in the context of aversive inter-actions.

SUMMARYUnder circumstances ofaversive stim-

ulation a person is more likely to engagein the verbal or nonverbal behavior whichwe have labeled "distressed." Whetherone continues to behave in this way de-pends on the contingencies for the be-havior. Ifaversive stimulation continuesand such distressed behavior produces animmediate reduction in the probabilityof aggressive behavior from others, therate and perhaps the intensity of suchbehavior may be maintained or even in-creased. At the same time, the aversivebehavior of others may be negatively re-inforced by brief reductions in the prob-ability of the distressed behavior.

Although distressed behavior may notproduce immediate aggressive behaviorfrom other family members, evidencethat it is aversive and evidence that aver-sive stimulation can produce counter-aggression (e.g., Azrin, Hutchinson, &Hake, 1966) suggest that other familymembers may be more likely to behaveaggressively toward the woman at timeswhen she is not acting distressed. Underthese circumstances, both the distressedbehavior of the woman and the aversivebehavior of other family members maybe maintained, especially if aversivestimulation (such as problems in em-ployment, the legal system, the schools,or the social welfare system, or disabilityassociated with chronic pain) continuesto impinge on the family.

IMPLICATIONS FOR FURTHERRESEARCH

The Contingencies for IndividualsNone of the studies reviewed here in-

volved experimental analyses ofthe con-tingencies for individuals. The group de-signs which have been used may notprovide an accurate picture of the con-tingencies for any given individual. Forexample, consider the finding that fam-ilies with a depressed mother and those

without a depressed mother differ in theconditional probability of family mem-bers' aggressive affect following themother's dysphoric affect. This demon-strates that the contingencies for dys-phoric affect on the average differ for de-pressed and nondepressed women.However, it falls short of demonstratingthat depressed women's dysphoric affec-tive behavior is maintained by negativereinforcement involving the avoidanceof other family members' aggressive af-fective behavior. Experimental manipu-lation ofthe contingencies for individualwomen's affective behavior would be amore convincing demonstration of theimportance of these contingencies.

Elsewhere we have reviewed the ex-perimental evidence on the effects ofaversive stimulation and its implicationsfor research on families (Biglan, Glas-gow, & Singer, 1990). Although experi-mental analyses of aversive events indi-cate a variety of ways in which theseevents can maintain behavior, the onlycontingency that has been examined instudies of family interactions is the im-mediate response ofthe other person fol-lowing the behavior class under study.Despite experimental evidence of theirimportance (Hineline, 1977), the effectsof more delayed reductions in the fre-quency, density, or magnitude of aver-sive behavior of others have not beenstudied in families. Data collection andanalytic techniques are needed that wouldallow study of these more subtle contin-gencies.

The Generality ofFindingsGender differences in the contingen-

cies for these types ofbehavior should beexplored. The research reviewed here hasfocused entirely on women. The mainreason for this is that the rate of depres-sion among women has consistently beenfound to be twice the rate among men(Boyd & Weissman, 1982). It is notknown whether the just-reviewed find-ings can be generalized to men. Theremay be differences in sex role socializa-tion such that distressed behavior is moreaccepted for women and aggressive be-

DISTRESSED BEHAVIOR 167

havior (an alternative response to aver-sive stimulation) is less accepted (Blech-man, 1981). Moreover, in the context ofchildrearing tasks, women may be morelikely to receive aversive stimulation thanmen (Patterson, 1980).We have also suggested that distressed

behavior may be more likely to occur inany social circumstances in which aver-sive stimulation is frequent and otherforms of behavior such as aggression arenot successful in reducing the aversivestimulation. Future research should ex-amine whether distressed behavior is acharacteristic feature of the behavior ofother groups which are having psycho-logical problems.

Prevention and AmeliorationThe findings reviewed above under-

score the need for interventions whichassist families in managing the aversiveevents which impinge on them. Researchis needed on the types of aversive eventswhich family members experience andthe ways in which their occurrence canbe reduced.At the clinical level, interventions may

not be simply a matter ofdamping downthe rate of aversive behavior in the fam-ily. In a sense, the data reviewed heresuggest that families may get into diffi-culties precisely because they are too mo-tivated to avoid other family members'distressed or aggressive behavior. Clini-cal interventions which assist familymembers in construing these behaviorsdifferently may be fruitful. Hayes (1987)has articulated a behavior-analytic ap-proach to this problem which appearsquite promising.

Public policy is also relevant. Some ofthe factors which affect families' aversiveinteractions are unlikely to be modifiedthrough clinical interventions (Biglan etal., 1990). For example, Dumas andWahler (1983) have shown that socio-economic variables and mothers' lack ofsocial support deleteriously affect theoutcome of parent-training programs.Modification of these variables may de-pend on our developing ways for otherelements of the community to providesocial and material support of families.

CONCLUSIONDistressed behavior may be a charac-

teristic feature of the behavior of peoplewho are exposed to aversive stimulation.Systematic investigation ofthe situationsin which this behavior occurs and thecontingencies which maintain it couldcontribute to more effective efforts toprevent and treat a variety of behavioralproblems.

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