Michael E. Addis

Men, masculinity, and the contexts of help seeking.

Research on mens help seeking yields strategies for enhancing mens use of mental and physical health resources. Analysis of the assumptions underlying existing theory and research also provides a context for evaluating the psychology of men and masculinity as an evolving area of social scientific inquiry. The authors identify several theoretical and methodological obstacles that limit understanding of the variable ways that men do or do not seek help from mental and physical health care professionals. A contextual framework is developed by exploring how the socialization and social construction of masculinities transact with social psychological processes common to a variety of potential help-seeking contexts. This approach begins to integrate the psychology of men and masculinity with theory and methodology from other disciplines and suggests innovative ways to facilitate adaptive help seeking.

A Component Analysis of Cognitive-Behavioral Treatment for Depression

The purpose of this study was to provide an experimental test of the theory of change put forth by A. T. Beck, A. J. Rush, B. F. Shaw, and G. Emery (1979) to explain the efficacy of cognitive-behavioral therapy (CT) for depression. The comparison involved randomly assigning 150 outpatients with major depression to a treatment focused exclusively on the behavioral activation (BA) component of CT, a treatment that included both BA and the teaching of skills to modify automatic thoughts (AT), but excluding the components of CT focused on core schema, or the full CT treatment. Four experienced cognitive therapists conducted all treatments. Despite excellent adherence to treatment protocols by the therapists, a clear bias favoring CT, and the competent performance of CT, there was no evidence that the complete treatment produced better outcomes, at either the termination of acute treatment or the 6-month follow-up, than either component treatment. Furthermore, both BA and AT treatments were just as effective as CT at altering negative thinking as well as dysfunctional attributional styles. Finally, attributional style was highly predictive of both short- and long-term outcomes in the BA condition, but not in the CT condition.

Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression

Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.

Testing the Integrity of a Psychotherapy Protocol: Assessment of Adherence and Competence.

Manipulation checks should be used in psychotherapy trials to confirm that therapists followed the treatment manuals and performed the therapy competently. This article is a review of some strategies that have been used to document treatment integrity; also, their limitations are discussed here. Recommendations for improving these checks are presented. Specific guidelines are offered regarding when and how to assess both therapist adherence to treatment protocols and competence.

A Closer Look at the Treatment Rationale and Homework Compliance in Cognitive-Behavioral Therapy for Depression

This study examined the relationships between acceptance of the treatment rationale (ATR), homework compliance, and change during cognitive-behavioral therapy (CBT) for depression. By evaluating the associations between these variables over time it was possible to compare competing theories of change in CBT. Clients meeting criteria for major depression (N = 150) were assessed longitudinally for their reaction to the treatment rationale and homework compliance over the course of a 20-session treatment. The results suggest that both ATR and homework compliance make independent contributions to predicting within-treatment change and treatment outcome. There was no evidence that compliance mediates the effect of ATR on treatment outcome. These findings support a multiprocess model of change in CBT. Acceptance of the treatment rationale may facilitate involvement in treatment and nonspecific change processes, while compliance with homework assignments contributes to additional change. We discuss these findings in regard to alternative theories of change and the dissemination of CBT to real-world clinical settings.

Measurement of Men's Help Seeking: Development and Evaluation of the Barriers to Help Seeking Scale

This article describes the development and psychometric evaluation of the Barriers to Help Seeking Scale (BHSS). The measure was designed to assess reasons men identify for not seeking professional help for mental and physical health problems. Exploratory factor analyses in a sample of 537 undergraduate men revealed a 5-factor solution of internally consistent subscales, including Need for Control and Self-Reliance, Minimizing Problem and Resignation, Concrete Barriers and Distrust of Caregivers, Privacy, and Emotional Control. A separate study of 58 undergraduate men confirmed the reliability of the scale and provided evidence of convergent and criterion validity between the BHSS and measures of masculine gender-role conflict and attitudes toward seeking professional help.

The Masculine Depression Scale: Development and Psychometric Evaluation

A preponderance of anecdotal evidence suggests that men manifest depression differently than women and that this atypical symptom presentation is even more evident in men who adhere to restrictive masculine norms (Cochran & Rabinowitz, 2000; Real, 1997). The aim of this study was to develop a self-report assessment instrument, the Masculine Depression Scale (MDS), which captures these atypical symptoms of depression. One hundred and two men who experienced a recent stressful life event were asked to complete measures of prototypic depression, masculine norm conformity, and our measure of masculine depression. Factor analyses yielded a two-factor solution: internalizing and externalizing symptoms. Externalizing symptoms were moderately correlated with measures of depression and masculine norm adherence, while internalizing symptoms were highly correlated with measures of depression but unrelated to masculine norm adherence. Men who adhered strongly to masculine norms were more likely to endorse externalizing symptoms on the MDS than prototypic symptoms of depression. The findings suggest that the MDS may be capturing aspects of depression associated with masculine gender socialization that are not captured by existing measures.

Why, why, why?: Reason‐giving and rumination as predictors of response to activation‐ and insight‐oriented treatment rationales

This study examines the relationships among the reasons a person offers for depression, the tendency to ruminate in response to depression, and reactions to activation-oriented (AO) or insight-oriented (IO) treatment rationales. Adults from the community (N=51) completed self-report measures of reason-giving and rumination and rated the credibility of, and personal reactions to, AO and IO rationales presented in written and videotape formats. Participants who gave more reasons for depression also tended to ruminate more in response to depressed mood. Reason-giving and rumination predicted lower credibility ratings and more negative personal reactions to the AO rationale. Although no relationship was found between these variables and response to the IO rationale, specific reasons were associated with different reactions to the two rationales. We discuss the roles of reason-giving and rumination in predicting responses to psychotherapies for depression.

Effectiveness of cognitive--behavioral treatment for panic disorder versus treatment as usual in a managed care setting.

Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings.

Male gender role conflict and patterns of help seeking in Costa Rica and the United States.

This study examined the relationship between male gender role conflict (J. M. O’Neil, 1981) and willingness to seek help for depression and substance abuse from a variety of potential helpers in a sample of U.S. and Costa Rican men. Results revealed variability in men’s willingness to seek help across both culture and type of helper. Restrictive emotionality and restrictive affectionate behavior between men were related to decreased willingness to seek help from several helpers, whereas success, power, and competition were positively related to help-seeking ratings for some targets (Internet, mothers) and negatively related to ratings for male friends. These results suggest that the relationship between masculine gender socialization and help-seeking behaviors may depend on a variety of factors surrounding different problems and help-seeking opportunities.