Good Mood: The New Psychology of Overcoming Depression Introduction

Note to editor: all references which are now in parentheses, in the form of a name and a data, should be numbered as footnotes and placed at the end of the book with the other footnotes, chapter by chapter. The references might best be grouped as a bibliography-reading list, with the footnotes referring to them by name and date.

Are you sad? Do you have a low opinion of yourself? Does a sense of helplessness and hopelessness weigh you down? Do you feel this way for days or weeks at a time? Those are the elements of depression.

If this is how you are feeling, you surely want to regain a pleasant outlook on life. You also need to prevent depression returning later. Happily, there now are aids to attain those goals. (But fighting depression takes effort. And there are certain benefits of being depressed which you may be reluctant to give up.)

Nowadays, a depression sufferer usually can get relief with active cognitive psychotherapy, or with tested anti-depressant medications, or with both. The U. S. Public Health Service summarizes as follows: "Eighty percent of people with serious depression can be treated successfully. Medication or psychological therapies, or combinations of both usually relieve symptoms in weeks."1 Both kinds of treatment have been shown in controlled experimental research to benefit a large proportion of depression sufferers, within a few months or even weeks. Drugs, however, control the depression, whereas psychological therapy can cure it. (For information about the scientific results, see Appendix B and the books cited in the reference list.) All this is good news indeed for depression sufferers.

Only a quarter century ago, medical and psychological science had little to offer depressed people. Traditional Freudian-based therapy put you on a couch or in an easy chair, and started you talking at random. You and your therapist hoped that in the course of two to five expensive hour-long sessions a week, continuing for many months or years, you would come across sensitive incidents in your past. Those "insights" were expected to relieve you of the pain the incidents induced. But the success rate was not high, nor was psychoanalysis proven effective by scientific tests.

Traditional therapy was founded upon the crucial assumption that people are irresistibly disturbed by their past experiences, and cannot change their emotional life by changing their current patterns of thinking. Recent scientific research has shown, however, that this assumption is false. People can indeed overcome depression by changing their current thought patterns. That is, though you may have been disturbed by events in your past, you now (in Albert Ellis's phrase) disturb yourself by your current mental habits.

Modern cognitive therapy -- which fully coincides with the wisdom of the ages on this point -- begins with the assumption that we have considerable control over our own thinking. We can choose what we will think about, even though following through on the choice requires effort and is not always fully successful. We can select our goals, even though the goals are not infinitely flexible. We can decide how much we will agonize over particular events, though our minds are not as obedient as we would like them to be. We can learn better ways to understand the data of our objective situations, just as students learn to gather and analyze data scientifically, rather than being forced to accept the biased assessments we have tended to make until now.

This book teaches you a newly-sharpened version of cognitive psychotherapy that has a more comprehensive theoretical base and wider curative outlook than earlier versions. You may use it by yourself to overcome depression, or you may use it in conjunction with a therapist. Most sufferers can benefit from the assistance of a wise counselor, though finding such a helpful person is not easy.

There is still more good news: Psychiatrist Kenneth Colby, famous for his artificial-intelligence computer simulation of paranoia, has developed a computer-based system of psychotherapy for depression based on the key ideas of this book. You "speak" to the computer, and the computer speaks back on the screen, which helps you help yourself. A disk to run the program on an IBM-PC computer is included with this book. It can be a help and a comfort to many readers.

My Personal Story and Negative Self-Comparisons

This book emerges not only from the body of new scientific discoveries, others' and my own, but also from my personal experience of deep and prolonged melancholy. Here is my story.

I was depressed -- badly depressed -- for thirteen long years from early 1962 to early l975. When I say that I was depressed I mean that, except for some of the hours when I was working or playing sports or making love, I was almost continuously conscious of being miserable, and I almost continuously reflected on my worthlessness. I wished for death, and I refrained from killing myself only because I believed that my children needed me, just as all children need their father. Endless hours every day I reviewed my faults and failures, which made me writhe in pain. I refused to let myself do the pleasurable things that my wife wisely suggested I do, because I thought that I ought to suffer.

As I look back now, in comparison to re-living the better of the days when I felt as I did then, I'd rather have a tooth pulled and have the operation bungled, or have the worst possible case of flu. And in comparison to re-living the worse of those days in the first year or two, I'd rather have a major operation or be in a hellish prison.

Over the years I consulted psychiatrists and psychologists from several traditional schools of thought. A couple of them left me with the impression that they didn't have a clue about what I was saying and had simply somehow passed the necessary exams to get into a well-paying business. A couple of them were human, understanding, and interesting to talk to, but could not help me. And toward the end of that time, the psychiatrists and psychologists did not even offer me hope, and certainly no hope of a quick cure. My own training in psychology was no help, either.

Then I read about what was, at that time, a new and different approach to psychological problems -- Aaron Beck's Cognitive Therapy, which in Albert Ellis's somewhat different form is called Rational-Emotive Therapy. (I shall consider them together under the label "cognitive-behavioral therapy" or just "cognitive therapy", along with Frankl's Logotherapy, recent variants such as Interpersonal Therapy, and also behavioral therapy.)

The core of cognitive-behavioral therapy is a thoughtful problem-solving procedure that quickly can get to the root of the depression, and directly yank out that root. Within that vision of the individual as able to change his or her depressed thinking, I then developed an analysis of the cause of depression centering on the depressed person's negative self-comparisons. And I worked out the logic of what I call "Values Treatment," which can provide a powerful force for people to use the resources of cognitive therapy and thereby cure themselves of depression; that is what Values Treatment did for me.

Within two miraculous weeks I banished my depression, and I have since then been able to keep depression at bay. (Such a quick cure is not usual, but it is not wildly exceptional, either.) Starting April, l975, I have almost always been glad to be alive, and I have taken pleasure in my days. I have occasionally even been ecstatic, skipping and leaping from joy. And I am joyful more often than most people, I would judge. Though I must still fight against depression from time to time, I have not lost more than a minor skirmish since then, and I believe that--if my family and community stay safe from catastrophe--I have beaten depression for life. The Epilogue at the end of the book gives the details of my passage from sadness to joy.

After I had cured myself, I wondered: Could I use my new advances in cognitive therapy --- Self-Comparisons Analysis and Values Treatment -- to help others, too? I proceeded to counsel with other persons who were depressed, and I found that these ideas could indeed help many of them get over their depressions and find new joy in life. Then I wrote a short version of this book, and leading psychiatrists and psychologists who read it agreed with me that the book -- including Self-Comparison Analysis, and the therapeutic approach derived from it -- makes a new contribution not only to sufferers from depression but also to the theory of the subject. And people to whom I have given early copies, some of whose cases I'll mention later, have reported dramatic salvation from their own depressions - not in every case, but often.

*** I hope that there will soon be a smile on your face, too, and laughter bubbling inside you. I don't promise you instant cure. And you will have to work at overcoming the depression. You must exercise your intellect and will in outwitting the traps that your mind lays for you. But I can promise you that cure and joy are possible...A tip for the road: Try treating your fight to overcome depression as an adventure, and think of yourself as a valiant warrior. More power to you, and luck.

Afterword For Those Interested in the Scientific Evidence

The experimental evidence for the success of cognitive therapy in helping depression and other miseries has been mounting up. For thirty years now, a variety of studies have shown cognitive therapy to be helpful. And in 1986 the National Institute of Mental Health of the U. S. Department of Health and Human Services completed a tightly-controlled three-university study lasting six years (and costing ten million dollars!) comparing a) encouragement only, b) drug therapy, c) Beck's Cognitive Therapy, and d) Interpersonal Psychotherapy; both these latter psychotherapies emphasize the key element of altering one's own thinking and behavior. The results at the conclusion of treatment showed that the active psychotherapies were as successful as the standard drug imipramine in reducing the symptoms of depression and improving the patient's ability to function. Drug treatment produced improvement more rapidly, but the active psychotherapies caught up later. Severely depressed and less-severely depressed patients both benefited from the active psychotherapies.(7)

These findings are extraordinarily impressive because drug therapy has been the favorite of the medical establishment in recent years. And cognitive-behavioral therapy has none of the side-effect dangers, physical and psychological, that accompany drugs. Furthermore, as noted earlier, the drugs control rather than cure depression. Hence, even if drugs are to be used, psychotherapy is appropriate in combination with the drugs in order to root out the underlying causes and move toward real cure.

Afterword About Drug Therapy for Depression

Neither I nor anyone else can give you authoritative advice about whether drugs are right for you. It surely makes sense to hear what one or more physicians has to say to you about drugs. Finding a wise physician, however, is particularly difficult when the ailment is depression. The problem is, as two noted psychiatrists put it, that depression "may arise from a biological malfunction, from actual losses, deprivations, or rejections, or from personal limitation. The difficulty in sorting out such causal fact is a source of enormous confusion in the diagnosis and treatment of disorders of mood."(2) And as two other reliable psychiatrists put it, "depression is almost certainly caused by [many] different factors", and hence "there is no single best treatment for depression."(3) Your best bet is listen to medical advice, and also advice from one or more psychologists, and then make your own decision about whether you want to try drugs first, or psychological therapy first, or both together.

Perhaps the most important piece of knowledge is that, contrary to what some physicians will tell you, drugs are not an all-purpose cure for depression. Perhaps the only major exception is the case of a person who has suffered real tragedy from death or other great loss, and is slow in putting the tragedy behind her/her. A sprained brain is very different than a sprained ankle. An out-of-order brain is very different than an out-of-order kidney or pituitary gland. Even if drugs relieve the depression while you are taking the medication, you almost surely need to straighten out your thinking so that the depression will not recur after you stop the drugs, and so that you will know how to fight off depression if it does recur.

Depression is not likely to be caused simply by a biologically-induced chemical imbalance that a drug can neatly restore to balance. As Seligman4 puts it, "Does the physiology cause the cognition, or does the cognition cause the physiological change? ..the arrow of causation goes both ways.." And as another psychiatrist has recently written, "Drugs do not cure the illnesses, they control them."(5)

Only psychotherapy offers true cure in most cases of depression. And as the official statement of the American Psychiatric Association judiciously puts it, "All depressed patients need and can benefit from psychotherapy,"(6) rather than relying upon medication alone. Patients treated with cognitive-behavioral psychotherapy as well as drugs have fewer recurrences than patients treated with drugs alone, in one study.(5.1) Miller, Norman, and Keitner, 1989

I do not intend to suggest, however, that drug therapy may not be appropriate for you. Modern anti-depression drugs offer hope to some people who are otherwise doomed to misery for long periods of time. I myself probably would and should have tried such drugs during my long depression if they had been as well- established as they now are. Drugs are particularly indicated when the depression continues for a very long time, because "One thing seems sadly certain: the person who remains chronically depressed over time has a reduced chance of recovering."(8) What I am suggesting is that you should not only consider drugs, and that it might be wise to try cognitive therapy first. You can read more about anti-depressant drug therapy in Chapter 00.)

bntro 9-148 depressi February 19, 1990

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