Making depression treatment work for men

I have been looking into the issue of modifying existing psychological treatment for depression with the aim of being more appealing to men. I wrote a little paper on this which is soon to be published in the American Journal of Men's Health (Cognitive-Behavioural Treatment of Depression in Men: Tailoring Treatment & Directions for Future Research).

The push behind calls to make psychological treatment more user-friendly for men comes from the argument that therapy is 'anti-masculine' or not something any self-respecting chainsaw wielding, beer slugging bloke would do. There is also the influence of the well-documented low help-seeking rates amongst men (which is also an activity deemed to be not compatible with the traditional male stereotype). 

Tinkering with the big player

Cognitive Behaviour Therapy or CBT is the most well-validated psychological treatment for depression (1). Not surprisingly, this has been the focus of many researchers when it comes to modifying treatment for men. The 'C' in CBT refers to cognition, or thoughts. In CBT, we work on the assumption that 'it's the thought that counts' when it comes to how psychological problems develop and are maintained. It's not the event itself that makes you feel depressed, but rather the thoughts you have about that event. Some people will experienced thoughts linked to an event that have a negative effect on their mood. It is these thoughts that contribute to the development (and persistence) of depression.

In working with depressed men, it has been suggested that there be a particular focus on thoughts related to a traditional male stereotype (2, 3). For example, it is not uncommon for men to experience unhelpful thoughts around the need to maintain control of emotions (e.g., "I cannot express feelings otherwise people will think I'm weak) and being self-reliant (e.g., "Asking for help is a sign of failure").

The 'B' in CBT refers to behaviour, or doing specific activities thought to help improve low mood. It has been suggested that men may have a preference for 'doing stuff' to address depression (4). So, rather than lots of talk and pondering of thoughts, it may be better to put the bulk of time into things like physical exercise, doing enjoyable activities, actively testing negative thoughts, and completing tasks that give a sense of achievement (amongst others).

It's all about the process...

Other recommended modifications to therapy involve not so much the activities you do, but the way in which you do them. A few examples include (5):

  • Promoting a 'power-sharing' treatment approach where the therapist-as-expert idea is de-emphasised
  • Using 'non-clinical' language
  • Making the physical environment 'male-friendly' (e.g., supply newspapers etc)
  • Work in groups to treat depression (rather than one-on-one therapy)

Some of these suggestions are specific to men, but others relate to good common sense when working with people, irrespective of their gender.

Prove it mate

What is clear when looking at this area is that, while many have offered recommendations on how to make psychotherapy more user-friendly, there is a serious lack of research testing these proposed adjustments. I am currently running a men's mood management group with a colleague at the University of Surrey and am hoping to run a study at the end of this that grabs men's opinions on how to best tailor treatment for men. But, we need a lot more research in this area.

A few thoughts

I think it is worthwhile to think about adjusting existing treatments for depression to suit men, but it is also important to have some evidence that these are needed and will result in men feeling more comfortable with treatment. Also, I think there is a risk that this issue can be over-emphasised and that sensible strategies are likely to get people comfortable and engaged in treatment regardless of their gender. The changes to conventional treatment might be most needed for those men who stick closely to that traditional male stereotype. Alternatively, it might be particularly helpful not to think about men and women separately, but instead focus on attitudes that stop people from seeking help, regardless of their gender (e.g., the belief that getting help is a sign of weakness).

Your thoughts and comments are very welcome as always.

Jason.

 

(1) Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioural therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.

(2) Emslie, C., Ridge, D. & Hunt, K. (2006). Men’s accounts of depression: Reconstructing or resisting hegemonic masculinity. Social Science & Medicine, 62(9), 2246-2257.

(3) Mahalik, J. R. (1999). Incorporating a gender role strain perspective in assessing and treating men’s cognitive distortions. Professional Psychology: Research and Practice, 30(4), 333-340.

(4) Brooks (2010). A transtheoretical model. In G. R. Brooks (Ed.). Beyond the crisis of masculinity: A transtheoretical model for male-friendly therapy. Washington: American Psychological Association.  (pp 139-169).

(5) Spendelow, J. S. (In Press). Cognitive-behavioural treatment of depression in men: Tailoring treatment & directions for future research, American Journal of Men’s Health.

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