As noted several times before, major depressive disorder is characterized by impaired functioning in multiple domains, including biology, behavior, emotion, and cognition. Any of these domains can significantly affect the level of social functioning. The last chapter highlighted the behavioral theory of depression, which proposed that depression can result from the reduction of positive reinforcers and an increase in negative reinforcers in a person’s life. One of the negative reinforcers is lack of social skills among depressed patients. Social skills are defined as the emission of behaviors which are positively reinforced by others. They involve the ability to communicate with other people in a fashion that is both appropriate and effective. Segrin (2000, p. 384) defines appropriate behavior as “social behavior that does not violate social and relational norms.” Socially skilled behaviors are instrumentally effective because they allow successful achievement of goals in social situations.

Lewinshon (e.g., Lewinshon, 1974; Youngren & Lewinshon, 1980) has postulated that depressed patients, because of their lack of social skills, make it difficult to obtain positive reinforcement from the social environment and hence they become depressed. In Lewinshon’s model, social skills deficits were viewed as an important antecedent to depression. Early studies of the theory provided consistent evidence that depressed patients exhibited poor social skills (Youngren & Lewinshon, 1980). However, longitudinal studies failed to support the hypothesis that poor social skills are direct causal antecedents to depression (Segrin, 2000). During the mid-1980s, this theory was integrated with cognitive theory, and the hypothesized relationship between social skills and depression was modified. Poor social skills were viewed as a consequence rather than a cause of depression. Only a few studies have examined the hypothesis that depression leads to lowered social skills, and the findings have been mixed. Therefore, a considerable degree of equivocality exists in the literature on social skills and depression. Segrin (2000), from his review of the relationship between social skills and depression, arrived at two conclusions. First, although poor social skills are concomitant to depression, no direct relationship between depression and social skills has been established because the relationship between depression and social skills is multiform. Second, poor social skills are not specific to depression; it is well-documented that people with schizophrenia, alcoholism, and anxiety also exhibit problems with social skills.

Whether poor social skills are antecedents or consequences of depression, the majority of depressed patients have interpersonal difficulties such as making friends, marital distress,
low-frequency dating, a lack of close friends, insufficient social support, trouble initiating new relationships, strained relationship with coworkers, and impoverished social networks (Segrin, 2000). Moreover, social skills deficits may interact with other factors such as negative life events and operate as a risk factor for depression (Segrin, 2000). Furthermore, there is evidence that a particular instance of impaired social skills, known as negative feedback seeking, may also serve as a risk factor for depression (Joiner, 2002). Negative feedback seeking is defined as the tendency to actively solicit criticism and other negative interpersonal feedback from others. These propensities or diatheses reinforce the negative self-schemas of depressed patients. To modify this diathesis and to improve social skills, whether they are antecedents or consequences of depression, two to three sessions (or more if required) of cognitive hypnotherapy (CH) are devoted to teaching social skills training (SST).