When the Odds Are Against You: The Effects of Purposeful Gratitude and Depressive

Symptoms on Risk-Taking Behavior

Lyss Sorensen Amanda Endicott Elsa Hammerdahl

Jake Land

Lawrence University

Research Methods I
 When the Odds Are Against You: The Effects of Purposeful Gratitude and Depressive

Symptoms on Risk-Taking Behavior

People engage in extraordinary levels of dangerous and costly behaviors in which the

odds are statistically against them, such as gambling, alcohol and drug use, smoking, and

unprotected sex. For example, although people in the United States spend over $1000 per

consumer on lottery tickets (US Census Bureau, 2017), research suggests that the odds of

winning the Mega Millions is 1 in about 300 million (Baker, 2019). Every day in the United

States, one person dies from motor-vehicle crashes involving an alcohol impaired driver every 50

minutes (National Highway Traffic Safety Administration, 2016). Such risk-taking behaviors

have the potential for negative physical, social, financial, and mental-health effects, and

increases in the risk of death. Unfortunately, those who cannot afford to take high risks when the

odds are against them are the very people who shouldn’t. In particular, people with pre-existing

mental health complications tend to be at greater likelihood for taking unfounded risks during

their life (Soleimani et al., 2017).

Currently, rates of reports of mental health issues, as well as the need for mental health

services, are on the rise (Olfson, 2016). This is apparent specifically in depression and anxiety,

which are categorized as “common mental health” disorders by the World Health Organization

(2017). In fact, the cyclic nature of risk-taking and mental health problems is seen most clearly in

those who suffer from clinical depression. Not only do people who take great risks put them at

great danger of mental health problems, but mental health problems like depression also put

people at greater risk for engaging in risk taking behavior (Soleimani et al., 2017). The present

research explores potential ways to break this negative cycle.

 For the purposes of the present research, “risk” is the chance or probability that a person

could be harmed or put in danger by adverse effects. Risk can have the outcome of the loss of

property or material, such as money, or ending up harming the environment. Research suggests

that engagement in patterns of risk-taking behavior may negatively influence processing of risk

information (Brown, 2005). People may engage in riskier behaviors because they do not process

that the behaviors they continuously partake in are risky but instead feel that they are normal.

However, risk-takers display higher risk perceptions than non-risk takers because of their

increased exposure to risk (Brown, 2005). One study found emerging perceptions of lower risk

taking during future risk decisions following successive amounts of risk taking. Such alterations

in perceptions could lead to decreases in feelings of risk taking (Brown, 2005). Some groups of

people are also more likely to partake in risky behaviors or are in more danger if they act in risky

ways. Overall, one’s awareness of their motivations and subsequent behaviors may be impacted

by mental health states.

For people with depressive symptoms, risky behavior may be an attempt to resolve the

negative consequences of their persistent levels of rumination. “Rumination” is identified as a

trans-diagnostic risk factor for various forms of psychopathology, including depression and

anxiety (Nolen- Hoeskema, 1991; for reviews see Nolen-Hoeksema & Watkins, 2011; Nolen-

Hoeksema et al., 2008). Rumination involves repetitive and passive thoughts regarding

distressing symptoms and their possible causes and effects. It exacerbates the effects of negative

mood by limiting cognitive thinking styles, further enhancing negative mood and proposing a

vicious cycle that increases depressive symptoms (Nolen-Hoeskema, 1991). Certain risky

behaviors have also been predictive of or predicted by rumination (e.g., substance abuse and

bulimic symptoms; Nolen-Hoeskema, Stice, Wade, & Bohon, 2007). By increasing negative
affect, rumination exacerbates the presence of negative mood (Lyubomirsky & Nolen-

Hoeksema, 1995), resulting in attentional narrowing, which may further exacerbate negative

mood and increase focus on one’s negative thoughts (Whitmer & Gotlib, 2013). Attempts to

cope with negative affect resulting from rumination may take the form of various risky

behaviors, increasing behaviors like drinking, engaging in unprotected sex, and gambling in an

effort to cope (Nolen-Hoeksema and Harrell, 2002). With a wide variety of negative effects, the

process of rumination and its role in depression presents an important area of investigation.

Associations between mental illness, clinical depression in particular, and engagement in

risky behaviors demonstrates a cyclic problem. Major depression is a common mental disorder

that affects more than 264 million people worldwide (World Health Organization, 2021).

Depression is characterized by persistent sadness and anhedonia, and other common symptoms

include insomnia, loss of appetite, tiredness, and poor concentration (World Health Organization,

2021). The effects of depression can be long-lasting or recurrent and potentially lead to drastic

effects on a person’s functioning (World Health Organization, 2021). Specific research has

aimed to examine the relationship between anxiety and depression with the occurrence of high-

risk behaviors and determine the factors predicting this relationship. Findings suggest that

presence of anxiety and depression positively predict engagement in risk-taking behavior

(Soleimani et al., 2017). For example, one study investigated the relationship between negative

mood, as associated with depression, and compulsive sexual behavior as a risky behavior.

Storholm et. al found a significant positive correlation between compulsive sexual behavior and

depression over a 30-day period (Storholm, Satre, Kapadia, & Halkitis, 2016). Even among

unrepresented samples, the presence of both depression and compulsive sexual behavior further

contributes to elevated sexual risk-taking among a sample of urban young gay and bisexual men
(Storholm, Satre, Kapadia, & Halkitis, 2016). The presence of these behaviors and their

correlation with depression puts people at greater risk of engaging in risk-taking.

With a presence of risky behaviors across disorders with high rates of comorbidity,

transdiagnostic risk factors remain a critical area of investigation. Research posits that an

exacerbating cause and consequence of depression is repetitive negative thinking (RNT). RNT

broadly refers to the cognitive process of a repetitive focus on negative content that is difficult to

disengage from (Ehring & Wakins, 2008). One form is rumination, which involves repetitive and

passive thoughts about the causes and potential consequences of negative emotions (Nolen-

Hoeksema, 1991). Rumination increases the likelihood of severe depressive symptoms (Nolen-

Hoeksema, 2000) and has been shown to increase negative affect by focusing on one’s negative

mood (Lyubomirsky & Nolen-Hoeksema, 1995). The cyclic nature of negative mood and

rumination (e.g. Lyubomirsky & Tkach, 2004) may correspond to attentional narrowing, which

exacerbates negative mood and further narrows attentional scope by increasing focus on one’s

negative thoughts (Whitmer & Gotlib, 2013). Efforts to decrease one’s negative affect may result

in maladaptive coping behaviors. For example, Gonzales, Reynolds, & Skewes (2011)

investigated the relationships between depressive symptoms, alcohol problems, and drinking to

cope and negative urgency, which are both reactions to negative affect, in a sample of college

students. They found that drinking to cope was a mediator of the relationship between depression

and alcohol problems, suggesting that problematic behavior in depressed individuals may result

from the effects negative affect has on short term decision making. Similarly, elevated

rumination scores have found to be correlated to increased substance abuse (Nolen-Hoeskema,

Stice, Wade, & Bohon, 2007; Nolen-Hoesksem and Harrell, 2002) and drinking to cope with

distress (Nolen-Hoeksema and Harrell, 2002). Such maladaptive stress responses may further
increase risk of depressive symptoms, as rumination and negative cognitive content have been

associated with persistent depressive symptoms during life stress (Ciesla, Felton, & Roberts,

2014). These relationships pose a threat to individuals’ mental and physical well-being,

underlying the importance of establishing an intervention that may help to reduce risk taking

behavior and consequently other effects of rumination. In sum, this research suggests that

engaging in rumination, especially for those who are already depressed, may put people at

greater risk for risk-taking behaviors. This leaves unanswered the question of how one might

break the cycle.

From the present research, we posit that one possible intervention that may break this

repetitive cycle is engagement in “purposeful gratitude.” Intentional, or purposeful, gratitude

occurs when individuals actively seek out and acknowledge the positive experiences in their

lives (Wood, Froh, & Geraght, 2010). It is a deliberate appreciation for the good things that

happen every day. Engagement in purposeful gratitude may reduce symptoms of depression,

anxiety, rumination, and result in positive overall effects on well-being (Heckendorf, Lehr,

Ebert, & Freund, 2019). Past research demonstrates that gratitude is strongly associated with

one’s well-being. Even across various forms of intentional gratitude (such as listing positive life

events or delivering letters of thanks), there are increases in overall life satisfaction/well-being in

immediate post-tests and in follow-up points (Wood, Froh, & Geraght, 2010). More specifically,

engagement in gratitude has the potential to decrease the negative effects of various mental

disorders, such as decreasing excessive worry in individuals with body dissatisfaction or

alleviating trauma’s effects for those with PTSD (Wood, Froh, & Geraght, 2010). Increases in

well-being may help foster overall positive affect, which would be further assisted by supportive

resources, as gratitude seems to be directly connected to increasing social support (Wood,

Maltby, Gillett, Linley & Joseph, 2007). Gratitude interventions also influence symptoms of

depression and anxiety immediately post- experiment and in follow-ups (Cregg & Cheavens,

2020), and have been reported to reduce transdiagnostic repetitive negative thinking

(Heckendorf, Lehr, Ebert, & Freund, 2019). Such effects may occur by interrupting the cyclic

nature of rumination.

At its core, gratitude is the practice of disengaging from negative thoughts and shifting

one’s attentional awareness to positive things (Wood, Froh, & Geraght, 2010). Increasing

awareness of mental processes using process-focused thinking compared to maladaptive state

orientations improved problem solving in depressed patients (Walkins & Baracaia, 2002) and

correspondingly may impact decisions on whether or not to take overly high risks. Similarly, by

increasing mental awareness and disengaging from negative thoughts, gratitude may help to

interrupt corresponding increases in negative thoughts and rumination thought to be caused by

the negative mood and narrower attention initiated by rumination (Whitmer & Gotlib, 2013). By

allowing for disengagement for negative thoughts and corresponding decreases in rumination,

gratitude may prevent individuals from engaging in risky behaviors, such as substance abuse and

drinking to cope with distress, which have been associated with increases in rumination (Nolen-

Hoeskema, Stice, Wade, & Bohon, 2007; Nolen-Hoesksem and Harrell, 2002). In other words,

by replacing one’s repetitive negative thinking with a focus on what one currently has,

individuals may no longer engage in risky behaviors in order to cope with such negative affect.

This would then help to further break down this cycle and decrease the likelihood of maladaptive

behaviors like engagement in risk-taking. Alleviations in rumination would also possibly account

for results indicating that gratitude serves as a protective factor from stress and depression

(Wood, Maltby, Gillett, Linley & Joseph, 2007). Because rumination and negative cognitive
content have been associated with persistent depressive symptoms during life stress (Ciesla,

Felton, & Roberts, 2014), purposeful gratitude could then serve as a cognitive intervention by

preventing further increases in stress and corresponding maladaptive increases in risky behavior

in response. In addition, it may help build up a pathway to resources such as resilience, a

transdiagnostic protective resource, by removing the desperate motive to experience some form

of positively in a mind flooded with negative thoughts (Heckendorf, Lehr, Ebert, & Freund,

2019).

The present research will test the question of how purposeful gratitude versus rumination

may affect people’s willingness to take risks depending on one’s degree of depressive symptoms.

We hypothesized that in general, individuals with less depressive symptoms will be less likely to

engage in risky behavior compared to those with higher depressive symptoms. When they

engage in purposeful gratitude (as compared to those who engage in “wishful” thinking),

however, those with greater levels of depressive symptoms will report being especially less

likely to report engagement in future risks as compared to their less depressed counterparts.

Methods
Participants

Participants were 36 male and 36 female undergraduate students from a small, Midwest

liberal arts college. They were predominantly between the ages of 18 and 23, and not

compensated for participation in a study investigating “how different forms of daily reflection

affect people’s behaviors”. In the consent form, it was specified that participants

currently/previously diagnosed with clinical depression or currently experiencing symptoms of

clinical depression should not participate. Participants were randomly assigned to one of three

conditions in a 3 (gratitude: focus on what one has, control, focus on what doesn’t have) x 2
(depressive symptoms: high vs low) between-subjects design, with risk taking behavior as the

main dependent variable.

Procedure

Participants received an email which included their participant number and 3 different

links. Participants were randomly assigned to a condition through their corresponding participant

number, with numbers in the 100’s, 200’s, and 300’s being assigned in order of participant

enrollment. The first number in each participant number corresponded to the first, second, and

third links, respectively. Clicking on the respective link brought participants to a Google Form

containing instructions for an approximately 5-minute-long journaling task. Participant

journaling responses were not recorded. Following this, participants were instructed to complete

an approximately 10-minute survey. Participant responses were recorded but will remain

confidential.

Purposeful gratitude and purposeful wishing manipulation. More specifically, past

research defines gratitude as a positive emotional reaction and appreciation for something that is

meaningful to oneself. For our study, we defined purposeful gratitude as someone intentionally

focusing on the good things in one’s life and thinking about what they are grateful to have. By

instructing participants to focus only on what they are “grateful for”, we intended to prompt the

participant to intentionally reflect and consider their feelings towards the positive aspects in their

life. In contrast, participants in the opposing group were asked to focus on “unwanted

consequences” and therefore dwell on the things they wish they did not have or may be lacking.

For the control condition, we instructed participants to reflect on what comes to mind naturally,
helping to prompt a reflective, but unguided state. All participants were instructed to reflect, in

the same manner and same duration, specifically on the events of the last year, with the only

differences being the specific focus of their reflection. To manipulate whether participants

engaged in purposeful gratitude, purposeful wishing, or a control prompt, participants were

presented with one of the following based on random assignment. Prompt responses are to be

journaled in the participants preferred method (i.e. handwritten, electronically, etc). For those

assigned to the control condition, they were prompted:

“For a minimum of 5 minutes, please purposefully reflect on your life experience within

the past 24 hours. Consider all aspects of past events, focusing on those to which come to mind

naturally. You are free to continue writing after 5 minutes if you please.”

For those assigned to the purposeful gratitude condition, they were asked: “For a

minimum of 5 minutes, please purposefully reflect on your life experience within the past year.

Consider all aspects of past events, focusing only on those for which you are grateful for. You

are free to continue writing after 5 minutes if you please.”

Finally for those in the purposeful wishing condition, they were prompted: “For a

minimum of 5 minutes, please purposefully reflect on your life experience within the past year.

Consider all aspects of past events, focusing only on those which had unwanted consequences.

You are free to continue writing after 5 minutes if you please.”

Participants were asked to reflect upon events within the past year to both limit the

potential overwhelming nature of reflecting on one’s entire life, but also allow enough flexibility

to consider a variety of past events. The journaling task was a self-directed task, and responses

will not be recorded.

 After completing the journaling prompt, all participants for each journaling link were

further directed to the same survey measuring our primary dependent measures and the

participant variable of depressive symptoms. All survey question responses, including questions

regarding participant’s age, biological sex, and ethnicity were recorded, but participant names

were not recorded and all responses will remain confidential.

Dependent measures. After completing the assigned journal exercises, participants

responded to a survey that assessed their willingness to engage in risk-taking behaviors. The

questions were assessed on a Likert scale of 0 (not at all likely) to 4 (extremely likely). The

questions were adapted from the “Reckless Behavior Questionnaire”, a 10-item inventory

focused on assessing the likelihood of engaging in behaviors with the potential for immediate or

dire negative consequences (Arnett, 1989). Examples of risk-taking behaviors included the use of

marijuana and cocaine, driving under the influence, and sex without contraception. Some

questions were modified to more holistically and thoroughly encompass drug and alcohol use

and compulsive sexual behavior. For example, we asked questions about the likelihood to

“consume illegal & potentially harmful substances (ex: marijuana, cocaine, etc.)” and “seek out

casual sexual relations”. These focuses align with past research suggesting that elevated

rumination is correlated with increased substance abuse (Nolen-Hoeskema, Stice, Wade, &

Bohon, 2007; Nolen-Hoesksem and Harrell, 2002) and it’s negative effects may result in risky

behavior in the form drinking to cope (Nolen-Hoeksema and Harrell, 2002). In addition,

correlations between compulsive sexual behavior and depression have been found (Storholm,

Satre, Kapadia, & Halkitis, 2016). A set of questions was included to address gambling and other

high risk, high reward behaviors (e.g. skydiving, ziplining, etc.) as these questions were not
addressed in the original scale and are meant to encompass risk taking behaviors in which the

odds are against the participant. See Appendix A for the full list of behaviors and full scale.

The survey also assessed their trait levels of depression using the Beck Depression

Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). This inventory includes 21

clusters with 4 statements each in which participants are instructed to select a statement that best

describes how they Feel. For example, they had to select one description from a group of

statements such as “I do not feel sad.”/”I feel sad.”/”I am sad all the time and can't snap out of

it.”/”I am so sad or unhappy that I can't stand it.”(See Appendix B for full list of question

clusters).

The last five items on the questionnaire were designed to specifically measure

participants levels of rumination. Participants were provided the following instructions: “People

think and do many different things when they feel sad, blue, or depressed. Please tell me if you

never, sometimes, often, or always think or do each one when you feel down, sad, or depressed.

Please indicate what you generally do, not what you think you should do” (Nolen-Hoeksema et

al., 1999). These five items were copied from Brooding subscale developed by Treyner et al.

(2003) and are measured on a scale of 1 to 4 (with 1= “Almost Never”, 2= “Sometimes”, 3=

“Often” and 4= “Almost Always”). This particular scale was employed as it is considered to

represent the more maladaptive aspects of rumination and eliminates potential overlap with

depressive symptoms. See Appendix C for all items.

Depression manipulation. Using the assessment of participant’s levels of depressive

symptoms, we performed a median split on the depression inventory. Participants were then

placed in two groups with either high or low depressive symptoms.

 Results

We hypothesized that, in general, individuals with less depressive symptoms will be less

likely to engage in risky behavior compared to those with higher depressive symptoms. When

they engage in purposeful gratitude (as compared to those who engage in “wishful” thinking),

however, those with greater levels of depressive symptoms will report being especially less

likely to report engagement in future risks as compared to their less depressed counterparts. We

plan to conduct a 3 (Journaling Task: Focus on what one is grateful for, focus on what one does

not have, focus on all aspects of life/control) X 2 (Level of Depressive Symptoms: High, Low)

ANOVA on the dependent variable of willingness to engage in risky behaviors.

Risk Taking

We hypothesized that individuals with less depressive symptoms will be less likely to

engage in risky behavior compared to those with higher depressive symptoms. When they

engage in purposeful gratitude (as compared to those who engage in “wishful” thinking),

however, those with greater levels of depressive symptoms will report being especially less

likely to report engagement in future risks as compared to their less depressed counterparts.

Hypothesized means appear in Figure 1. If the data supports our hypothesis, ANOVA would

reveal an interaction such that across both low levels and high levels of depression, those who

participated in gratitude would express lower levels of risk taking compared to the control group,

while those who participated in rumination would express higher levels of risk taking, though the

effect would be much greater for those expressing high levels of depression. In sum, we expected

to find that those with higher levels of depression would experience greater changes in risk

taking levels, such that those participating in gratitude would have marked decreases in risk

taking while those who participated in the rumination condition would have marked increase in
risk taking. Participants with lower levels of depression would experience the same changes but

to a lesser degree.

Discussion

Assuming results consistent with our predictions, participants with higher levels of

depression would experience an increase in risk taking when in the rumination condition, but

would experience a decrease in risk taking in the gratitude conditions. Participants with lower

levels of depression would also experience this change in risk taking, only to a lesser degree. Our

results confirmed this hypothesis.

Our results are consistent with past research. For those with higher levels of depression,

gratitude interventions may have provided individuals with a better method of coping with

increased negative affect occurring as a result of depression and exacerbated by

rumination. Rumination is a is a trans-diagnostic risk factor (Nolen-Hoeskema, 1991; for reviews

see Nolen-Hoeksema & Watkins, 2011; Nolen-Hoeksema et al., 2008) and involves repetitive

and passive thoughts regarding distressing symptoms and their possible causes and effects

(Nolen-Hoeskema, 1991). It often exacerbates the presence of negative mood (Lyubomirsky &

Nolen-Hoeksema, 1995), resulting in attentional narrowing, which may further cause negative

mood and increase focus on one’s negative thoughts, (Whitmer & Gotlib, 2013) and therefore

increase depressive symptoms. The cyclic nature between negative affect and rumination has

been associated with methods of coping lead such as increased behaviors like drinking, engaging

in unprotected sex, and gambling to cope (Nolen-Hoeksema and Harrell, 2002). In our study, we

found that for individuals who were in the control group for the journal task, and therefore

should experience little change in depressive symptoms as a result, those who had higher levels

of depressive symptoms also had higher levels of risk taking compared to those in the low level
of depressive symptoms group. This would indicate that for those with higher levels of

depression, and therefore higher levels of rumination, engagement in risk taking behaviors may

serve as maladaptive coping styles meant to decrease levels of negative affect despite increased

chances of risk and loss.

For those who completed the journaling task in which they were reflecting on the things

they are grateful for, they were engage in purposeful gratitude. Purposeful gratitude occurs when

individuals actively seek out and acknowledge the positive experiences in their lives and focuses

on the practice of disengaging from negative thoughts and shifting one’s attentional awareness to

positive things (Wood, Froh, & Geraght, 2010). The journaling task may have then provided

participants with a means of disengaging from the negative cycle of rumination, preventing the

need for coping mechanisms in the form of risk-taking behavior, such as increased substance

abuse and drinking to cope with distress, which have previously been associated with elevated

rumination scores (Nolen-Hoeskema, Stice, Wade, & Bohon, 2007; Nolen-Hoeksema and

Harrell, 2002). For participants with higher levels of depression who were instructed to focus on

what they don’t have, their task of focusing on such negative events and their possible causes

and effects reflects similar behaviors characteristic of rumination. As a result, participants may

have experienced increases in negative affect and correspondingly levels of depression and

therefore explaining increases in observed risk taking in this group. A similar pattern of changes

in risk-taking behavior but to a lesser degree in participants with lower levels of depression can

be accounted for by decreased levels of depression and therefore rumination, as rumination

increases the likelihood of severe depressive symptoms (Nolen-Hoeksema, 2000).

Our inability to run this study represents a particularly important limitation to this

research. Other potential limitations include our experimental design, which focused solely on
the effects of depressive symptoms and gratitude in the form of a journaling task on risk-taking

behavior as the dependent variable. Other dependent variables, such as participant’s affect levels,

and other moderator variables would help to directly investigate the relationship between

negative affect and rumination, which we proposed as crucial components to the cycle leading to

increases in risk taking behavior. A further limitation is the duration of our study. Individuals

were instructing to complete a 5-minute journaling task, preventing us from investigating any

long-term effects. A long-term study using a repeated journaling task over a longer period, such

as a week or two weeks, may yield stronger results. Also, the nature of the journaling task itself,

such as its length and method (e.g. verbally, spoken to another person, etc.) could be

investigated.

Future research should seek to replicate our findings by performing a long-term study in

which participants do this journaling task over an extended period rather than just a singular test.

Additionally, future research should explore the effect of the journaling manipulation and levels

of depression on other variables (e.g., how people are feeling immediately post-experiment, etc.).

Other interventions that could be examined in future research could focus on how participants

levels of depressive symptoms change over time when participating in this journaling task.

Gratitude represents a potential reason why people do not want to be involved in

particularly risky activities. Our study shows that people who expressed gratitude, whether they

have higher or lower levels of depressive symptoms, were less likely to take risks post-

experiment than those who were ruminating. People who did ruminate, however, were more

likely to perform risky behaviors post-experiment across higher or lower levels of depressive

symptoms. Therefore, one promising avenue to combat the urge to behave in riskier ways may
be to practice gratitude frequently and focus on the positive aspects in life that one is grateful

for.

Appendix A
For each of the following questions please indicate how likely you are to engage in the following
behaviors. Use the following scale when responding:
0= Not at all likely
1= Somewhat likely
2= Likely
3= Very likely
4= Extremely likely

1. Drive while under the influence

2. Engage in compulsive sexual behavior
3. Drive more than 20 miles per hour over the speed limit
4. Consume endangering levels of alcohol
5. Consume illegal & potentially harmful substances (ex: marijuana, cocaine, etc.)
6. Seek out casual sexual relations
7. Damage or destroy public or private property
8. Spend money with no regard to future debts
9. Go to places with potentially dangerous consequences
10. Shoplifting
11. High risk, high reward activities
12. Skydiving/cliff-jumping
13. Going all in poker with $5000
14. Buying a $20 lottery ticket
15. Sports betting

Appendix B
For each cluster of questions, check on the one statement that best reflects how you feel.

I do not feel sad.

I feel sad.

I am sad all the time and can't snap out of it.

I am so sad or unhappy that I can't stand it.

I am not particularly discouraged about the future.

I feel discouraged about the future.

I feel I have nothing to look forward to.

I feel that the future is hopeless and that things cannot improve.

I do not feel like a failure.

I feel I have failed more than the average person.

As I look back on my life, all I can see is a lot of failures.

I feel I am a complete failure as a person.

I get as much satisfaction out of things as I used to.

I don't enjoy things the way I used to.

I don't get real satisfaction out of anything anymore.

I am dissatisfied or bored with everything.

I don't feel particularly guilty.

I feel guilty a good part of the time.

I feel quite guilty most of the time.

I feel guilty all of the time.

I don't feel I am being punished.

I feel I may be punished.

I expect to be punished.

I feel I am being punished.

I don't feel disappointed in myself.

I am disappointed in myself.

I am disgusted with myself.

I hate myself.

I don't feel I am any worse than anyone else.

I am critical of myself for my weaknesses or mistakes.

I blame myself all the time for my faults.

I blame myself for everything bad that happens.

I don't have any thoughts of killing myself.

I have thoughts of killing myself, but I would not carry them out.

I would like to kill myself.

I would kill myself if I had the chance.

I don't cry any more than usual.

I cry more now than I used to.

I cry all the time now.

I used to be able to cry, but now I can't cry even though I want to.

I am no more irritated now than I ever am.

I get annoyed or irritated more easily than I used to.

I feel irritated all the time now.

I don't get irritated at all by the things that used to irritate me.

I have not lost interest in other people.

I am less interested in other people than I used to be.

I have lost most of my interest in other people.

I have lost all of my interest in other people.

I make decisions about as well as I ever could.

I put off making decisions more than I used to.

I have greater difficulty in making decisions than before.

I can't make decisions at all any more.

I don't feel I look any worse than I used to.

I am worried that I am looking old or unattractive.

I feel that there are permanent changes in my appearance that make me look unattractive.

I believe that I look ugly.

I can work about as well as before.

It takes an extra effort to get started at doing something.

I have to push myself very hard to do anything.

I can't do any work at all.

I can sleep as well as usual.

I don't sleep as well as I used to.

I wake up 1-2 hours earlier than usual and I find it hard to get back to sleep.

I wake up several hours earlier than I used to and cannot get back to sleep.

I don't get more tired than usual.

I get tired more easily than I used to.

I get tired from doing almost anything.

I am too tired to do anything.

My appetite is no worse than usual.

My appetite is not as good as it used to be.

My appetite is much worse now.

I have no appetite at all any more.

I haven't lost much weight, if any, lately.

I have lost more than 5 pounds.

I have lost more than 10 pounds.

I have lost more than 15 pounds.

I am no more worried about my health than usual.

I am worried about physical problems such as aches and pains; or upset stomach; or constipation.

I am very worried about physical problems and it's hard to think of much else.
I am so worried about my physical problems that I cannot think of anything else.

I have not noticed any recent changes in my interest in sex.

I am less interested in sex than I used to be.

I am much less interested in sex now.

I have lost interest in sex completely.

Appendix C
 People think and do many different things when they feel sad, blue, or depressed. Please

tell me if you never, sometimes, often, or always think or do each one when you feel down, sad,

or depressed. Please indicate what you generally do, not what you think you should do.

Please indicate on a scale of 1 to 4 with 1= “Almost Never”, 2= “Sometimes”, 3=

“Often” and 4= “Almost Always”

Think “What am I doing to deserve this?”

Think “Why do I always react this way?”

Think about a recent situation, wishing it had gone better.

Think “Why do I have problems other people don’t have?”

Think “Why can’t I handle things better?”

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