An analysis of sex differences in depression: The search continues.

Abstract

exacerbation of the symptoms and often, to the situation. Stoppard further argues that the cognitive/ behavioural therapies are androcentric because they emphasize male-valued skills such as rationality, while implicity devaluing nurturance or other relationship skills. This is an entirely specious argument, implying that all nurturance and relationship skills are healthy and desirable, and that they are incompatible with being reasonable, forthright, and accurate in appraising and dealing with problem situations. Beck's cognitive therapy of depression seems well-suited to help women and men identify maladaptive beliefs about relationships and about nurturance that can help avert unrealistic expectations and disappointment, or avoidance and conflict. It can help individuals to learn to be selfnurturing as well as nurturant of others. In short, the cognitive therapy of depression is equipped, and is often called upon, to facilitate effective relationship skills for both sexes. And, while it promotes realistic appraisals of the self and circumstances, it is not rationalistic or devaluing of all emotional experiences. Rather, it helps clients to learn more about their emotions and their meaning, by learning about the link between thoughts and negative emotional states. It almost seems as if Stoppard misperceives cognitive therapies as producing highly intellectualized, rational, detached machines, but such a view is a gross misstatement of the reality of the therapeutic goals and processes. Finally, Stoppard argues that cognitive/behavioural therapies do not extend beyond the alleviation of current depression, and offer little to prevent future episodes. This charge is unfounded, for the therapies explicitly attempt to teach strategies for avoiding depression, with research evidence based on Beck's cognitive therapy indicating that they have been successful over extended follow-up periods (reviewed in Sacco & Beck, 1985). Institutional changes that improve employment opportunities, educational advancement, family cohesion, and the like would doubtless contribute to reductions in rates of depression in women (and men), and cognitive/behavioural therapists recognize this as well as anyone else. That cognitive/behavioural theorists have not led the fight for such political and social changes does not, however, invalidate the theories or their relevance for treatment of depression in women. In the final analysis, cognitive/behavioural theories continue to evolve and to respond to reasonable criticisms of their limitations. Given the incomplete state of our knowledge about biological and psychosocial vulnerabilities to depression, they have nonetheless made two major contributions. One is to help improve our understanding of when and why some individuals get depressed in certain circumstances and others do not, by promoting an integration of environmental events and cognitive appraisals. The second is the development of important therapeutic interventions that have helped reduce current depression and empowered individuals to prevent future depressions. These are major achievements serving both women and men.