Dedication
This book is dedicated to Aaron T. Beck, M.D., in admiration of his knowledge and courage and in appreciation of his patience, dedication and empathy.
Contents
Dedication
Preface
Introduction
Part I. THEORY AND RESEARCH
1. A Breakthrough in the Treatment of Mood Disorders
2. How to Diagnose Your Moods: The First Step in the Cure
3. Understanding Your Moods: You Feel the Way You Think
Part II. PRACTICAL APPLICATIONS
4. Start by Building Seff-Esteem
5. Do-Nothingism: How to Beat it
6. Verbal Judo: Learn to Talk Back When You’re Under the Fire of Criticism
7. Feeling Angry? What’s Your IO?
8. Ways of Defeating Guilt
Part III. “REALISTIC” DEPRESSIONS
9. Sadness Is Not Depression
Part IV. PREVENTION AND PERSONAL GROWTH
10. The Cause of It All
11. The Approval Addiction
12. The Love Addiction
13. Your Work Is Not Your Worth
14. Dare to Be Average: Ways to Overcome Perfectionism
Part V. DEFEATING HOPELESSNESS AND SUICIDE
15. The Ultimate Victory: Choosing to Live
Part VI. COPING WITH THE STRESSES AND STRAINS OF DAILY LIVING
16. How I Practice What I Preach
Part VII. THE CHEMISTRY OF MOOD
17. The Search for “Black Bile”
18. The Mind-Body Problem
19. What You Need to Know about Commonly Prescribed Antidepressants
20. The Complete Consumer’s Guide to Antidepressant Drug Therapy
Suggested Resources
Index
Acknowledgments
About the Author
About the Book
Notes and References (Chapters 17 to 20)
Other Books
Copyright
About the Publisher
Preface
I am pleased that David Burns is making available to the general public an approach to mood modification which has stimulated much interest and excitement among mental health professionals. Dr. Burns has condensed years of research conducted at the University of Pennsylvania on the causes and treatments of depression, and lucidly presents the essential self-help component of the specialized treatment that has derived from that research. The book is an important contribution to those who wish to give themselves a “top flight” education in understanding and mastering their moods.
A few words about the evolution of cognitive therapy may interest readers of Feeling Good: The New Mood Therapy. Soon after I began my professional career as an enthusiastic student and practitioner of traditional psychoanalytic psychiatry, I began to investigate the empirical support for the Freudian theory and therapy of depression. While such support proved elusive, the data I obtained in my quest suggested a new, testable theory about the causes of emotional disturbances. The research seemed to reveal that the depressed individual sees himself as a “loser,” as an inadequate person doomed to frustration, deprivation, humiliation, and failure. Further experiments showed a marked difference between the depressed person’s self-evaluation, expectations, the aspirations on the one hand and his actual achievements—often very striking—on the other. My conclusion was that depression must involve a disturbance in thinking: the depressed person thinks in idiosyncratic and negative ways about himself, his environment, and his future. The pessimistic mental set affects his mood, his motivation, and his relationships with others, and leads to the full spectrum of psychological and physical symptoms typical of depression.
We now have a large body of research data and clinical experience which suggests that people can learn to control painful mood swings and self-defeating behavior through the application of a few relatively simple principles and techniques. The promising results of this investigation have triggered interest in cognitive theory among psychiatrists, psychologists, and other mental health professionals. Many writers have viewed our findings as a major development in the scientific study of psychotherapy and personal change. The developing theory of the emotional disorders that underlies this research has become the subject of intensive investigations at academic centers around the world.
Dr. Burns clearly describes this advance in our understanding of depression. He presents, in simple language, innovative and effective methods for altering painful depressed moods and reducing debilitating anxiety. I expect that readers of this book will be able to apply to their own problems the principles and techniques evolved in our work with patients. While those individuals with more severe emotional disturbances will need the help of a mental health professional, individuals with more manageable problems can benefit by using the newly developed “common sense” coping skills which Dr. Burns delineates. Thus Feeling Good should prove to be an immensely useful step-by-step guide for people who wish to help themselves.
Finally, this book reflects the unique personal flair of its author, whose enthusiasm and creative energy have been his particular gifts to his patients and to his colleagues.
Aaron T. Beck, M.D.
Professor of Psychiatry,
University of Pennsylvania
School of Medicine
Introduction (Revised Edition, 1999)
I have been amazed by the interest in cognitive behavioral therapy that has developed since Feeling Good was first published in 1980. At that time, very few people had heard of cognitive therapy. Since that time, cognitive therapy has caught on in a big way among mental health professionals and the general public as well. In fact, cognitive therapy has become one of the most widely practiced and most intensely researched forms of psychotherapy in the world.
Why such interest in this particular brand of psychotherapy? There are at least three reasons. First, the basic ideas are very down-to-earth and intuitively appealing. Second, many research studies have confirmed that cognitive therapy can be very helpful for individuals suffering depression and anxiety and a number of other common problems as well. In fact, cognitive therapy appears to be at least as helpful as the best antidepressant medications (such as Prozac). And third, many successful self-help books, including my own Feeling Good, have created a strong popular demand for cognitive therapy in the United States and throughout the world as well.
Before I explain some of the exciting new developments, let me briefly explain what cognitive therapy is. A cognition is a thought or perception. In other words, your cognitions are the way you are thinking about things at any moment, including this very moment. These thoughts scroll across your mind automatically and often have a huge impact on how you feel.
For example, right now you are probably having some thoughts and feelings about this book. If you picked this book up because you have been feeling depressed and discouraged, you may be thinking about things in a negative, self-critical way: “I’m such a loser. What’s wrong with me? I’ll never get better. A stupid self-help book like this couldn’t possibly help me. I don’t have any problem with my thoughts. My problems are real.” If you are feeling angry or annoyed you may be thinking: “This guy Burns is just a con artist and he’s just trying to get rich. He probably doesn’t even know what he’s talking about.” And if you are feeling optimistic and interested you may be thinking: “Hey, this is interesting. I may learn something really exciting and helpful.” In each case, your thoughts create your feelings.
This example illustrates the powerful principle at the heart of cognitive therapy—your feelings result from the messages you give yourself. In fact, your thoughts often have much more to
do with how you feel than what is actually happening in your life.
This isn’t a new idea. Nearly two thousand years ago the Greek philosopher, Epictctus, stated that people are disturbed “not by things, but by the views we take of them.” In the Book of Proverbs (23: 7) in the Old Testament you can find this passage: “For as he thinks within himself, so he is.” And even Shakespeare expressed a similar idea when he said: “for there is nothing either good or bad, but thinking makes it so” (Hamlet, Act 2, Scene 2).
Although the idea has been around for ages, most depressed people do not really comprehend it. If you feel depressed, you may think it is because of bad things that have happened to you. You may think you are inferior and destined to be unhappy because you failed in your work or were rejected by someone you loved. You may think your feelings of inadequacy result from some personal defect—you may feel convinced you are not smart enough, successful enough, attractive enough, or talented enough to feel happy and fulfilled. You may think your negative feelings are the result of an unloving or traumatic childhood, or bad genes you inherited, or a chemical or hormonal imbalance of some type. Or you may blame others when you get upset: “It’s these lousy stupid drivers that tick me off when I drive to work! If it weren’t for these jerks, I’d be having a perfect day!” And nearly all depressed people are convinced that they are facing some special, awful truth about themselves and the world and that their terrible feelings are absolutely realistic and inevitable.
Certainly all these ideas contain an important germ of truth—bad things do happen, and life beats up on most of us at times. Many people do experience catastrophic losses and confront devastating personal problems. Our genes, hormones, and childhood experiences probably do have an impact on how we think and feel. And other people can be annoying, cruel, or thoughtless. But all these theories about the causes of our bad moods have the tendency to make us victims—because we think the causes result from something beyond our control. After all, there is little we can do to change the way people drive at rush hour, or the way we were treated when we were young, or our genes or body chemistry (save taking a pill). In contrast, you can learn to change the way you think about things, and you can also change your basic values and beliefs. And when you do, you will often experience profound and lasting changes in your mood, outlook, and productivity. That, in a nutshell, is what cognitive therapy is all about.
The theory is straightforward and may even seem overly simple—but don’t write it off as pop psychology. I think you will discover that cognitive therapy can be surprisingly helpful—even if you feel pretty skeptical (as I did) when you first learn about it. I have personally conducted more than thirty thousand cognitive therapy sessions with hundreds of depressed and anxious individuals, and I am always surprised about how helpful and powerful this method can be.
The effectiveness of cognitive therapy has been confirmed by many outcome studies by researchers throughout the world during the past two decades. In a recent landmark article entitled “Psychotherapy vs. Medication for Depression: Challenging the Conventional Wisdom with Data,” Drs. David O. Antonuccio and William G. Danton from the University of Nevada and Dr. Gurland Y. DeNelsky from the Cleveland Clinic reviewed many of the most carefully conducted studies on depression that have been published in scientific journals throughout the world.1 The studies reviewed compared the antidepressant medications with psychotherapy in the treatment of depression and anxiety. Short-term studies as well as long-term follow-up studies were included in this review. The authors came to a number of startling conclusions that are at odds with the conventional wisdom:
• Although depression is conventionally viewed as a medical illness, research studies indicate that genetic influences appear to account for only about 16 percent of depression. For many individuals, life influences appear to be the most important causes.
• Drugs are the most common treatment for depression in the United States, and there is a widespread belief, popularized by the media, that drugs are the most effective treatment. However, this opinion is not consistent with the results of many carefully conducted outcome studies during the past twenty years. These studies show that the newer forms of psychotherapy, especially cognitive therapy, can be at least as effective as drugs, and for many patients appear to be more effective. This is good news for individuals who prefer to be treated without medications—due to personal preferences or health concerns. It is also good news for the millions of individuals who have not responded adequately to antidepressants after years and years of treatment and who still struggle with depression and anxiety.
• Following recovery from depression, patients treated with psychotherapy are more likely to remain undepressed and are significantly less likely to relapse than patients treated with antidepressants alone. This is especially important because of the growing awareness that many people relapse following recovery from depression, especially if they are treated with antidepressant medications alone without any talking therapy.
Based on these findings, Dr. Antonuccio and his coauthors concluded that psychotherapy should not be considered a second-rate treatment but should usually be the initial treatment for depression. In addition, they emphasized that cognitive therapy appears to be one of the most effective psychotherapies for depression, if not the most effective.
Of course, medications can be helpful for some individuals—even life-saving. Medications can be combined with psychotherapy for maximum effect as well, especially when the depression is severe. It is extremely important to know that we have powerful new weapons to fight depression, and that drug-free treatments such as cognitive therapy can be highly effective.
Recent studies indicate that psychotherapy can be helpful not only for mild depressions, but also for severe depressions as well. These findings are at odds with the popular belief that “talking therapy” can only help people with mild problems, and that if you have a serious depression you need to be treated with drugs.
Although we are taught that depression may result from an imbalance in brain chemistry, recent studies indicate that cognitive behavioral therapy may actually change brain chemistry. In these studies, Drs. Lewis R. Baxter, Jr., Jeffrey M. Schwartz, Kenneth S. Bergman, and their colleagues at UCLA School of Medicine,” used positron emission tomography (PET scanning) to evaluate changes in brain metabolism in two groups of patients before and after treatment.2 One group received cognitive behavioral therapy and no drugs, and the other group received an antidepressant medication and no psychotherapy.
As one might expect, there were changes in brain chemistry in the patients in the drug therapy group who improved. These changes indicated that their brain metabolism had slowed down—in other words, the nerves in a certain region of the brain appeared to become more “relaxed.” What came as quite a surprise was there were similar changes in the brains of the patients successfully treated with cognitive behavioral therapy. However, these patients received no medications. Further, there were no significant differences in the brain changes in the drug therapy and psychotherapy groups, or in the effectiveness of the two treatments. Because of these and other similar studies, investigators are starting for the first time to entertain the possibility that cognitive behavior therapy—the methods described in this book—may actually help people by changing the chemistry and architecture of the human brain!
Although no one treatment will ever be a panacea, research studies indicate that cognitive therapy can be helpful for a variety of disorders in addition to depression. For example, in several studies patients with panic attacks have responded so well to cognitive therapy without any medications that many experts now consider cognitive therapy alone to be the best treatment for this disorder. Cognitive therapy can also be helpful in many other forms of anxiety (such as chronic worrying, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder), and is also being used with some success in the personality disorders, such as borderline personality disorder.
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p; Cognitive therapy is gaining popularity in the treatment of many other disorders as well. At the 1998 Stanford Psychopharmacology Conference, I was intrigued by the presentation by a colleague from Stanford, Dr. Stuart Agras. Dr. Agras is a renowned expert in eating disorders such as binge eating, anorexia nervosa, and bulimia. He presented the results of numerous recent studies on the treatment of eating disorders with antidepressant medications versus psychotherapy. These studies indicated that cognitive behavior therapy is the most effective treatment for eating disorders—better than any known drug or any other form of psychotherapy.*
We are also beginning to learn more about how cognitive therapy works. One important discovery is that self-help seems to be a key to recovery whether or not you receive treatment. In a series of five remarkable studies published in the prestigious Journal of Consulting and Clinical Psychology and in The Gerontologist, Dr. Forest Scogin and his colleagues at the University of Alabama studied the effects of simply reading a good self-help book like Feeling Good—without any other therapy. The name of this new type of treatment is “bibliotherapy” (reading therapy). They discovered that Feeling Good bibliotherapy may be as effective as a full course of psychotherapy or treatment with the best antidepressant drugs.3-7 Given the tremendous pressures to cut health care costs, this is of considerable interest, since a paperback copy of the Feeling Good book costs less than two Prozac pills—and is presumably free of any troublesome side effects!
In a recent study, Dr. Scogin and his colleague, Dr. Christine Jamison, randomly assigned eighty individuals seeking treatment for a major depressive episode to one of two groups. The researchers gave the patients in the first group a copy of my Feeling Good and encouraged them to read it within four weeks. This group was called the Immediate Bibliotherapy Group. These patients also received a booklet containing blank copies of the self-help forms in the book in case they decided to do some of the suggested exercises in the book.
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