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(2) presence in the home of three

or more children under the age of 14; (3) lack of full-or part-time employment;

and

(4) loss of the woman's mother before the age of 11. Consider, for example, the

intimacy factor. The social support afforded by such a relationship is a powerful

mediator between stress and the onset of depression, even if the absence of

intimacy

does not provoke depression by itself.

Like Freud, social learning theoristslike Lewinsohn have also emphasized the

importance of interpersonal relationships and social skills in the development and

maintenance of depression. This model provides an interesting account of the

way in

which depressed people respond to stressful life events and the effect that these

responses have on other people who constitute their social support systems.

Other

people respond empathically and are initially attentive when the depressed

person

cries or talks about depressing experiences, yet, the long-range result of this

process is

usually negative. The depressed person's few remaining friends eventually

become

tired of this behavior and begin to avoid further interactions. Whatever sources of

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social support may have been available are eventually driven away. One

important

factor in this regard is a deficit in social skills. Depressed people may be

ineffective in

their interactions with other people. An important aspect of treatment would

therefore

be to identify specific skills in which the person is deficient and to teach the

person

more effective ways of interacting with others.

Another consideration in social learning views of depression involves the way in

which people respond to the onset of a depressed mood. Some people try to

distract

themselves from negative emotions by becoming involved in some activity.

Others

respond in a more passive fashion and tend to ruminate about the sources of

their

distress. Nolen-Hoeksema (1990) proposed that people who respond in a passive,

ruminative way will experience longer and more severe periods of depression.

She

also suggested that this factor may account for gender differences in the

prevalence of

depression because women are more likely than men to employ this response

style.

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Janet's behavior following her divorce fits nicely with Nolen-Hoeksema's

conceptual

framework. Although Janet initially tried to cope actively with her various

problems,

she soon relinquished most of her efforts to find new friends or to keep up with

her

studies. She frequently found herself brooding about the divorce and the

hopeless

nature of her circumstances. Her therapist encouraged Janet to engage more

frequently in pleasant activities in an effort to break this cycle of passive,

ruminative

behavior.

In addition to the social and behavioral aspects of depression, it is also important

to

consider the way in which depressed people perceive or interpret events in their

environment. Beck (1987) has proposed that certain negative cognitive patterns

play a

prominent role in people who are prone to the development of depression. The

way in

which depressed people process information about themselves and their

environment

is presumably distorted by the activation of self-defeating schemas that prevent

the

recognition or assimilation of positive events.

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The hopelessness theory of depression presents a similar view (Abramson, 1989).

According to this theory, the perceived occurrence of negative life events may

lead to

the development of hopelessness, which in turn causes the onset of symptoms of

depression. Two cognitive elements define the state of hopelessness: (1) the

expectation that highly desired outcomes will not occur or that highly aversive

outcomes will occur, and (2) the belief that the person cannot do anything (is

helpless)

to change the likelihood that these events will occur.

The crucial link in this causal chain occurs between the perception of negative life

events and the appearance of hopelessness. Why do some people become

hopeless after such experiences while others do not? The theory holds that the

likelihood of

developing hopelessness will depend on the person's inferences regarding three

factors: the cause of the event, the consequences of the event, and theimplications of

the event with regard to the self. For example, hopeless depression is likely to

occur if

the person views a negative event as being important and also attributes the

event to

factors that are enduring (stable) and likely to affect many outcomes (global). The

theory also recognizes that the perceived consequences of the negative event

may be

as important as inferred causes. If the person views the negative consequences of

the

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event as important, persistent, and wide-ranging, depression will be more likely

to

develop than if the consequences are viewed as unimportant, short-lived, or

limited in

scope. The third and final consideration involves negative inferences about the

self.

Depression is a more likely outcome if the person interprets a negative event to

mean

that she or he is a less able, worthy, or desirable person.

TREATMENT MODALITIES

The therapy that Janet received was, in many respects, quite similar to another

psychological approach to treating depression that is known as interpersonal

psychotherapy, or IPT (Frank, 1996). The focus of IPT is the connection between

depressive symptoms and current interpersonal problems. Relatively littleattention is

paid to long-standing personality problems or developmental issues. The

treatment

takes a practical, problem-solving approach to resolving the sorts of daily conflicts

in

close relationships that can exacerbate and maintain depression. Deficits in social

skills are addressed in an active and supportive fashion. The depressed person is

also

encouraged to pursue new activities that might take the place of relationships or

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occupational roles that have been lost. Therapy sessions often include

nondirective

discussions of social difficulties and unexpressed or unacknowledged negative

emotions as well as role-playing to practice specific social skills.