Feeling Good: The New Mood Therapy (5 page)

If in doubt, make your best guess. Do not leave any questions unanswered. Regardless of the outcome, this can be your first step toward emotional improvement.

Table 2–1. Burns Depression Checklist
*

*Copyright © 1984 by David D. Burns, M.D. (Revised, 1996.)

**Anyone with suicidal urges should seek help from a mental health professional.

Interpreting the Burns Depression Checklist
. Now that you have completed the test, add up the score for each of the twenty-five items and obtain the total. Since the highest score you can get on each of the twenty-five symptoms is 4, the highest score for the whole test would be 100. (This would indicate the most severe depression possible.) Since the lowest score for each item is 0, the lowest score for the test would be zero. (This would indicate no symptoms of depression at all.)

You can now evaluate your depression according to Table 2–2. As you can see, the higher the total score, the more severe your depression. In contrast, the lower the score, the better you are feeling.

Although the BDC is not difficult or time-consuming to fill out and score, don’t be deceived by its simplicity. You have just learned to use a highly sophisticated tool for detecting depression and measuring its severity. Research studies have demonstrated that the BDC is highly accurate and reliable. Studies in a variety of settings, such as psychiatric emergency rooms, have indicated that instruments of this type actually pick up the presence of depressive symptoms far more frequently than formal interviews by experienced clinicians.

You can use the BDC with confidence to monitor your progress as well. In my clinical work, I have insisted that every patient must fill out the test on his or her own between all sessions and report the score to me at the beginning of the next session. Changes in the score show me whether the patient is getting better, worse, or staying the same.

As you apply the various self-help techniques described in this book, take the BDC test at regular intervals to assess your progress objectively. I suggest a minimum of once a week. Compare it to weighing yourself regularly when you’re on a diet. You will notice that various chapters in this book focus on different symptoms of depression. As you learn to overcome these symptoms, you will find that your total score will begin to fall. This will show that you are improving. When your score is under ten, you will be in the range considered normal. When it is under five, you will be feeling especially good. Ideally, I’d like to see your score under five the majority of the time. This is one aim of your treatment.

Is it safe for depressed individuals to try to help themselves using the principles and methods outlined in this book? The answer is—
definitely yes
! This is because the crucial decision
to try to help yourself
is the key that will allow you to feel better as soon as possible, regardless of how severe your mood disturbance might seem to be.

Under what conditions should you seek professional help? If your score is between 0 and 5, you are probably feeling good already. This is in the range of normal, and most people with scores this low feel pretty happily contented.

If your score was between 6 and 10, it is still in the range of normal, but you are probably feeling a bit on the “lumpy” side. There’s room for improvement, a little mental “tune-up,” if you will. The cognitive therapy techniques in this book can often be remarkably helpful in these instances. Problems
in daily living bug all of us, and a change of perspective can often make a big difference in how you feel.

If your score was between 11 and 25, your depression, at least at this time, is mild and should not be a cause for alarm. You will definitely want to correct this problem, and you may be able to make substantial progress on your own. Systematic self-help efforts along the lines proposed in this book, combined with frank communication on a number of occasions with a trusted friend, may help a great deal. But if your score remains in this range for more than a few weeks, you should consider professional treatment. The help of a therapist or an antidepressant medication may considerably speed your recovery.

Some of the thorniest depressions I have treated were actually individuals whose scores were in the mild range. Often these individuals had been mildly depressed for years, sometimes for most of their entire life. A mild chronic depression that goes on and on is now called “dysthymic disorder.” Although that is a big, fancy-sounding term, it has a simple meaning. All it means is, “this person is awfully gloomy and negative most of the time.” You probably know someone who is like that, and you may have fallen into spells of pessimism yourself. Fortunately, the same methods in this book that have proven so helpful for severe depressions can also be very helpful for these mild, chronic depressions.

If you scored between 26 and 50 on the BDC, it means you are moderately depressed. But don’t be fooled by the term, “moderate.” A score in this range can indicate pretty intense suffering. Most of us can feel quite upset for brief periods, but we usually snap out of it. If your score remains in this range for more than two weeks, you should definitely seek professional treatment.

If your score was above 50, it indicates your depression is severe or even extreme. This degree of suffering can be almost unbearable, especially when the score is increased above 75. Your moods are apt to be intensely uncomfortable and possibly dangerous because the feelings of despair and hopelessness may even trigger suicidal impulses.

Fortunately, the prognosis for successful treatment is excellent. In fact, sometimes the most severe depressions respond
the most rapidly. But it is not wise to try to treat a severe depression on your own. A professional consultation is a must. Seek out a trusted and competent counselor.

Even if you receive psychotherapy or antidepressant medications, I am convinced you can still benefit greatly by applying what I teach you. My research studies have indicated that the spirit of self-help greatly speeds up recovery, even when patients receive professional treatment.

In addition to evaluating your total score on the BDC, be sure you pay special attention to items 23, 24, and 25. These items ask about suicidal feelings, urges, and plans. If you had elevated scores on any of these items, I would strongly recommend that you obtain professional help right away.

Many depressed individuals have elevated scores on item 23, but zeros on items 24 and 25. This usually means they have suicidal thoughts, such as “I’d probably be better off dead,” but no actual suicidal intentions or urges and no plans to commit suicide. This pattern is quite common. If your scores on item 24 or 25 are elevated, however, this is a cause for alarm. Seek treatment
immediately
!

I have provided some effective methods for assessing and reversing suicidal impulses in a later chapter, but you must consult a professional when suicide begins to appear to be a desirable or necessary option. Your conviction that you are hopeless is the reason to seek treatment, not suicide. The majority of seriously depressed individuals believe they are hopeless beyond any shadow of a doubt. This destructive delusion is merely a symptom of the illness, not a fact. Your feeling that you are hopeless is powerful evidence that you are actually not!

It is also important for you to look at item 22, which asks if you have been more worried about your health recently. Have you experienced any unexplained aches, pains, fever, weight loss, or other possible symptoms of medical illness? If so, it would be worthwhile to have a medical consultation, which would include a history, a complete physical examination, and laboratory tests. Your doctor will probably give you a clean bill of health. This will suggest that your uncomfortable physical symptoms are related to your emotional state. Depression can mimic a great number of medical disorders because your mood swings often create
a wide variety of puzzling physical symptoms. These include, to name just a few, constipation, diarrhea, pain, insomnia or the tendency to sleep too much, fatigue, loss of sexual interest, light-headedness, trembling, and numbness. As your depression improves, these symptoms will in all likelihood vanish. However, keep in mind that many treatable illnesses may initially masquerade as depression, and a medical examination could reveal an early (and life-saving) diagnosis of a reversible organic disorder.

There are a number of symptoms that indicate—but do not prove—the existence of a serious mental disturbance, and these require a consultation with and possible treatment by a mental-health professional,
in addition to
the self-administered personal-growth program in this book. Some of the major symptoms include: the belief that people are plotting and conspiring against you in order to hurt you or take your life; a bizarre experience which the ordinary person cannot understand; the conviction that external forces are controlling your mind or body; the feeling that other people can hear your thoughts or read your mind; hearing voices from outside your head; seeing things that aren’t there; and receiving personal messages broadcast from radio or television programs.

These symptoms are not a part of depressive illness, but represent major mental disorders. Psychiatric treatment is a must. Quite often, people with these symptoms are convinced that nothing is wrong with them, and may meet the suggestion to seek psychiatric therapy with suspicious resentment and resistance. In contrast, if you are harboring the deep fear that you are going insane and are experiencing episodes of panic in which you sense you are losing control or going over the deep end, it is a near certainty that you are not. These are typical symptoms of ordinary anxiety, a much less serious disorder.

Mania is a special type of mood disorder with which you should be familiar. Mania is the opposite of depression and requires prompt intervention by a psychiatrist who can prescribe lithium. Lithium stabilizes extreme mood swings and allows the patient to lead a normal life. However, until therapy is initiated, the disease can be emotionally destructive. The symptoms include an abnormally elated or irritable
mood that persists for at least two days and is not caused by drugs or alcohol. The manic patient’s behavior is characterized by impulsive actions which reflect poor judgment (such as irresponsible, excessive spending) along with a grandiose sense of self-confidence. Mania is accompanied by increased sexual or aggressive activity; hyperactive, continuous body movements; racing thoughts; nonstop, excited talking; and a decreased need to sleep. Manic individuals have the delusion that they are extraordinarily powerful and brilliant, and often insist they are on the verge of some philosophical or scientific breakthrough or lucrative money-making scheme. Many famous creative individuals suffer from this illness and manage to control it with lithium. Because the disease
feels
so good, individuals who are having their first attack often cannot be convinced to seek treatment. The first symptoms are so intoxicating that the victim resists accepting the idea that his or her sudden acquisition of self-confidence and inner ecstasy is actually just a manifestation of a destructive illness.