(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

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.

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.

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 the implications 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

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 little attention 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

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.