David D. Burns
Consider this statistic: In the United States, 5.3 percent of the population will at any given time have depression, and the lifetime risk is 7–8 percent in adults, higher for women. Forty years ago, the mean age for onset of depression was 29.5; today, it has halved to 14.5 years. And though rates differ around the developed world, the incidence of depressive illness has risen dramatically since 1900. Prior to the 1980s, David Burns writes, depression had been the cancer of the psychological world—widespread but difficult to treat—and the taboos associated with it made the problem worse for most people. As with cancer, finding a “cure” had been its holy grail; everything from Freudian psychoanalysis to shock treatment was applied to the problem, with not very good results.
Burns helped to establish a new method of treatment, cognitive therapy, and Feeling Good: The New Mood Therapy is his attempt to explain how it works and why it is different. The book has been a bestseller because it was the first to tell the general public about cognitive therapy, and also because it is a surprisingly enjoyable and useful read for the nondepressed, providing possibly life-changing insights into how our thoughts and emotions interact.
The cognitive way
In his work at the University of Pennsylvania as a psychiatric resident, Burns collaborated with pioneering cognitive psychologist Aaron T. Beck, who believed that most depression or anxiety was simply a result of illogical and negative thinking. He noted the remarkable contrast between how the depressed person feels—that they are a loser or that their life has gone horribly wrong—and the actual conditions of their life, which are often high in achievement. Beck’s conclusion was that depression therefore had to be based on problems in thinking. By straightening out one’s twisted thoughts, one could get back to normal.
Beck’s three principles of cognitive therapy were:
- All our emotions are generated by our “cognitions,” or thoughts. How we feel
at any given moment is due to what we are thinking about.
- Depression is the constant thinking of negative thoughts.
- The majority of negative thoughts that cause us emotional turmoil are plain wrong or at least distortions of the truth, but we accept them without question.
For Burns this sounded a little too obvious and simple, but when he actually tried Beck’s new talking treatment for depression called cognitive therapy, he was amazed at how many of his chronic patients were relieved of their destructive feelings. People who had been suicidal a couple of weeks earlier now looked forward to rebuilding their lives.
Seeing through black magic
Cognitive therapy’s revolutionary idea is that depression is not an emotional disorder. The bad feelings we have in depression all stem from negative thoughts, therefore treatment must be about challenging and changing those thoughts. Burns lists ten “cognitive distortions,” such as all-or-nothing thinking, overgeneralization, disqualifying the positive, jumping to conclusions, and giving ourselves labels. By understanding these distortions, we are led to the awareness that “feelings aren’t facts,” they are only mirrors of our thoughts. If that is true, should we trust our feelings? They seem valid, the “truth,” but as Burns points out, it is like trusting the funny mirrors we see in amusement parks to be an accurate reflection of ourselves. He notes, “Unpleasant feelings merely indicate that you are thinking something negative and believing it.” This is why, he suggests, “depression is such a powerful form of black magic.”
Because thoughts come before emotions, our emotions don’t prove anything about the accuracy of our thoughts. Feelings are not special at all, particularly when based on distortions. Burns asks the question: When we are in a great mood, do our good feelings determine what we are worth? If not, how can we say that the feelings we have when feeling blue do determine our worth?
Burns is not saying that all emotions are distortions. When we experience real sadness or joy, for instance, these are healthy and normal reactions. Genuine sadness, say at the loss of a relative, is of the “soul,” whereas depression is always of the mind. It is not an appropriate response to life but a disease of wrong, circular thinking.
Creating a new self-image
Burns notes the catch-22 nature of depression: The worse we feel, the more distorted our thoughts become, and this thinking plunges us even lower into black feelings about ourselves. Nearly all his patients considered that their situation was hopeless. They really believed that they were bad people, and the conversations they had with themselves were like a broken record of self-blame and self-deprecation. Depressed people feel wretched even when they are loved, have a family, have good jobs, and so on. We can have “everything,” but if self-love and self-worth have fled, we feel that we are nothing. Cognitive therapists will often be engaged in a spirited back-and-forth with their patients, trying to point out the silliness or fallacy of their assertions. Eventually patients learn to challenge their wrong thoughts on their own, which is the beginning of feeling good about themselves.
Final comments
Do the ideas in Feeling Good really work? Researchers followed two groups of similar patients, one that was given Burns’s book to read within a month, and another that was not. Not only did the Feeling Good group experience a significant amelioration of depressive symptoms compared to the “blind” group, but their symptoms stayed away. Perhaps the key to the book’s efficacy is that we feel we are not being “worked on” but given the tools to change ourselves.
Prescribing books like Feeling Good to mental illness patients is called “bibliotherapy,” and Burns’s is usually ranked highly by professionals in this respect. Could reading a book really be as effective, or even better, than drugs or psychotherapy in helping people with depression? It is certainly worth trying. As Burns himself points out in an introduction to the revised 1999 edition, his book costs about the price of two Prozac pills, and there are no side effects.
Indeed, the great benefit of cognitive therapy is that there is no need to take any drugs. But in the last chapter of Feeling Good, Burns explains that, for really serious depression, the most effective treatment is a combination of cognitive therapy and antidepressants, the former to improve patients’ thinking, the latter to lift their overall mood.
Burns points out that the basic idea of cognitive therapy—that our thoughts affect our emotions and mood, not the other way around—goes back a long way: The ancient philosopher Epictetus rested his career on the idea that it is not events that determine your state of mind, but how you decide to feel about the events. This secret is shared by all happy people, yet it is a skill that can be learnt by anyone.
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