Feeling Good: The New Mood Therapy (3 page)

Finally, the researchers addressed another important concern: would the antidepressant effects of
Feeling Good
last? Skillful motivational speakers can get a crowd of people excited and optimistic for brief periods of time—but these brief mood-elevating effects often don’t last. The same problem holds for the treatment of depression. Following successful treatment with drugs or psychotherapy, many patients feel tremendously improved—only to relapse back into depression after a period of time. These relapses can be devastating because patients feel so demoralized.

In 1997, the investigators reported the results of a three-year follow-up of the patients in the study I’ve just described.
⁷
The authors were Drs. Nancy Smith, Mark Floyd, and Forest Scogin from the University of Alabama and Dr. Christine Jamison from the Tuskegee Veterans Affairs Medical Center. The researchers contacted the patients three years after reading
Feeling Good
and administered the depression tests once again. They also asked the patients several questions about how they had been doing since the completion of the study. The researchers learned that the patients did not relapse but maintained their gains during this three-year period. In fact, the scores on the two depression tests at the three-year evaluation were actually slightly better than the scores at the completion of the bibliotherapy treatment. More than half of the patients said that their moods continued to improve following the completion of the initial study.

The diagnostic findings at the three-year evaluation confirmed this—72 percent of the patients still did not meet the criteria for a major depressive episode, and 70 percent did not seek or receive any further treatment with medications or psychotherapy during the follow-up period. Although they experienced the normal ups and downs we all feel from time to time, approximately half indicated that when they were upset, they opened up
Feeling Good
and reread the most helpful sections. The researchers speculated that these self-administered “booster sessions” may have been important in maintaining a positive outlook following recovery. Forty percent of the patients said that the best part of the book was that it helped them change their negative thinking patterns, such as learning to be less perfectionistic and to give up all-or-nothing thinking.

Of course, this study had limitations, like all studies. For one thing, not every patient was “cured” by reading
Feeling Good
. No treatment is a panacea. While it is encouraging that many patients seem to respond to reading
Feeling Good
, it is also clear that some patients with more severe or chronic depressions will need the help of a therapist
and possibly an antidepressant medication as well. This is nothing to be ashamed of. Different individuals respond better to different approaches. It is good that we now have three types of effective treatment for depression: antidepressant medications, individual and group psychotherapy, and bibliotherapy.

Remember that you can use the cognitive bibliotherapy between therapy sessions to speed your recovery even if you are in treatment. In fact, when I first wrote
Feeling Good
, this is how I imagined the book would be used. I intended it to be a tool my patients could use between therapy sessions to speed up the treatment and never dreamed that it might someday be used alone as a treatment for depression.

It appears that more and more therapists are beginning to assign bibliotherapy to their patients as psychotherapy “homework” between therapy sessions. In 1994, the results of a nationwide survey about the use of bibliotherapy by mental health professionals were published in the
Authoritative Guide to Self-Help Books
(published by Guilford Press, New York). Drs. John W. Santrock and Ann M. Minnet from the University of Texas in Dallas and Barbara D. Campbell, a research associate at the university, conducted this study. These three researchers surveyed five hundred American mental health professionals from all fifty states and asked whether they “prescribed” books for patients to read between sessions to speed recovery. Seventy percent of the therapists polled indicated that they had recommended at least three self-help books to their patients during the previous year, and 86 percent reported that these books provided a positive benefit to their patients. The therapists were also asked which self-help books, from a list of one thousand, they most frequently recommended for their patients.
Feeling Good
was the number-one-rated book for depressed patients, and my
Feeling Good Handbook
(published as a Plume paperback in 1989) was rated number two.

I was not aware this survey was being conducted, and was thrilled to learn about the results of it. One of my goals
when I wrote
Feeling Good
was to provide reading for my own patients to speed their learning and recovery between therapy sessions, but I never dreamed this idea would catch on in such a big way!

Should you expect to improve or recover after reading
Feeling Good
? That would be unreasonable. The research clearly indicates that while many people who read
Feeling Good
improved, others needed the additional help of a mental health professional. I have received many letters (probably more than ten thousand) from people who read
Feeling Good
. Many of them kindly described in glowing terms how
Feeling Good
had helped them, often after years and years of unsuccessful treatment with medications and even electroconvulsive therapy. Others indicated that they found the ideas in
Feeling Good
appealing but needed a referral to a good local therapist to make these ideas work for them. This is understandable—we are all different, and it would be unrealistic to think that any one book or form of therapy would be the answer for everyone.

Depression is one of the worst forms of suffering, because of the immense feelings of shame, worthlessness, hopelessness, and demoralization. Depression can seem worse than terminal cancer, because most cancer patients feel loved and they have hope and self-esteem. Many depressed patients have told me, in fact, that they yearned for death and prayed every night that they would get cancer, so they could die in dignity without having to commit suicide.

But no matter how terrible your depression and anxiety may feel, the prognosis for recovery is excellent. You may be convinced that your own case is so bad, so over-whelming and hopeless, that you are the one person who will never get well, no matter what. But sooner or later, the clouds have a way of blowing away and the sky suddenly clears and the sun begins to shine again. When this happens, the feelings of relief and joy can be overwhelming. And if you are now struggling with depression and low self-esteem, I believe this transformation can happen for
you as well, no matter how discouraged or depressed you may feel.

Well, it’s time to get on to Chapter 1 so we can start to work together. I want to wish you the very best as you read it, and hope you find these ideas and methods helpful!

David D. Burns, M.D.

Clinical Associate Professor of Psychiatry

and Behavioral Sciences
,

Stanford University School of Medicine

1.
Antonuccio, D. O., Danton, W. G., & DeNelsky, G. Y. (1995). Psychotherapy versus medication for depression: Challenging the conventional wisdom with data.
Professional Psychology: Research and Practice
, 26(6), 574–585.

2.
Baxter, L. R., Schwartz, J. M., & Bergman, K. S., et al. (1992). Caudate glucose metabolic rate changes with both drug and behavioral therapy for obsessive-compulsive disorders.
Archives of General Psychiatry
, 49, 681–689.

3.
Scogin, F., Jamison, C., & Gochneaut, K. (1989). The comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults.
Journal of Consulting and Clinical Psychology
, 57, 403–407.

4. Scogin, F., Hamblin, D., & Beutler, L. (1987). Bibliotherapy for depressed older adults: A self-help alternative.
The Gerontologist
, 27, 383–387.

5. Scogin, F., Jamison, C., & Davis, N. (1990). A two-year follow-up of the effects of bibliotherapy for depressed
older adults.
Journal of Consulting and Clinical Psychology
, 58, 665–667.

6. Jamison, C., & Scogin, F. (1995). Outcome of cognitive bibliotherapy with depressed adults.
Journal of Consulting and Clinical Psychology
, 63, 644–650.

7
. Smith, N. M., Floyd, M. R., Jamison, C., & Scogin, F. (1997). Three-year follow-up of bibliotherapy for depression.
Journal of Consulting and Clinical Psychology
, 65(2), 324–327.

Depression has been called the world’s number one public health problem. In fact, depression is so widespread it is considered the common cold of psychiatric disturbances. But there is a grim difference between depression and a cold. Depression can kill you. The suicide rate, studies indicate, has been on a shocking increase in recent years, even among children and adolescents. This escalating death rate has occurred in spite of the billions of antidepressant drugs and tranquilizers that have been dispensed during the past several decades.

This might sound fairly gloomy. Before you get even
more
depressed, let me tell you the good news. Depression is an illness and not a necessary part of healthy living. What’s more important—you
can
overcome it by learning some simple methods for mood elevation. A group of psychiatrists and psychologists at the University of Pennsylvania School of Medicine has reported a significant breakthrough in the treatment and prevention of mood disorders. Dissatisfied with traditional methods for treating depression because they found them to be slow and ineffective, these doctors developed and systematically tested
an entirely new and remarkably successful approach to depression and other emotional disorders. A series of recent studies confirms that these techniques reduce the symptoms of depression much more rapidly than conventional psychotherapy or drug therapy. The name of this revolutionary treatment is “cognitive therapy.”

I have been centrally involved in the development of cognitive therapy, and this book is the first to describe these methods to the general public. The systematic application and scientific evaluation of this approach in treating clinical depression traces its origins to the innovative work of Drs. Albert Ellis and Aaron T. Beck, who began to refine their unique approach to mood transformation in the mid-1950’s and early 1960’s.
*
Their pioneering efforts began to emerge into prominence in the past decade because of the research that many mental-health professionals have undertaken to refine and evaluate cognitive therapy methods at academic institutions in the United States and abroad.

Cognitive therapy is a fast-acting technology of mood modification that you can learn to apply on your own. It can help you eliminate the symptoms and experience personal growth so you can minimize future upsets and cope with depression more effectively in the future.

The simple, effective mood-control techniques of cognitive therapy provide:

The problem-solving and coping techniques you learn will encompass every crisis in modern life, from minor irritations to major emotional collapse. These will include realistic problems, such as divorce, death, or failure, as well as those vague, chronic problems that seem to have no obvious external cause, such as low self-confidence, frustration, guilt, or apathy.

The question may now occur to you, “Is this just another self-help pop psychology?” Actually, cognitive therapy is one of the first forms of psychotherapy which has been shown to be effective through rigorous scientific research under the critical scrutiny of the academic community. This therapy is unique in having professional evaluation and validation at the highest academic levels. It is
not
just another self-help fad but a major development that has become an important part of the mainstream of modern psychiatric research and practice. Cognitive therapy’s academic foundation
has enhanced its impact and should give it staying power for years to come. But don’t be turned off by the professional status that cognitive therapy has acquired. Unlike much traditional psychotherapy, it is not occult and anti-intuitive. It is practical and based on common sense, and you can make it work for you.