To make things worse, most psychiatrists do not require patients to take mood tests, like the one in Chapter 2, between therapy sessions to track progress. As a result, the psychiatrist may conclude that the patient is being “helped” by a drug when the patient has not really improved substantially. To my way of thinking, treating patients without session-by-session assessments is anti-scientific and represents a barrier to good treatment and progress in the field.
Some psychiatrists and many patients are almost exclusively committed to these biological theories and treatments for depression. They may discount the value of other approaches, sometimes with a religious fervor. A number of well-known psychiatrists are quite outspoken in this regard. The intensity of these debates about psychotherapy versus drug therapy is sometimes more reminiscent of a power struggle for turf than an intellectual search for the truth. Fortunately, there is a growing and healthy trend to recognize that all of our current psychiatric drugs are limited in their effectiveness. In addition, there is an increasing recognition that a combination of medication with the newer forms of psychotherapy (including cognitive behavioral therapy and others) usually provides a more satisfactory outcome than does treatment with drugs alone.
It is clear that antidepressant drugs can help some individuals, but it is also clear that many patients do not respond adequately. When patients do not respond, I would prefer to switch into a different gear and use cognitive therapy or a combination of cognitive therapy and one antidepressant medication at a time. Most depressed people have real problems in their lives, and nearly all of us need a compassionate, healing relationship with another human being to talk things out at times. The idea that drugs alone should work to cure depression and anxiety may be appealing, but this approach is often ineffective.
To be fair, an exclusive focus on psychotherapy alone can be just as biased. I have seen patients who did not respond to many psychotherapeutic interventions that I personally administered—week after week their depression scores on the test in Chapter 2 did not change. Sometimes I prescribed an antidepressant while we continued working with a variety of psychotherapeutic strategies. Within several weeks, the depression and anxiety often began to improve, and the psychotherapy suddenly began to work better. In these cases, I was glad to have the medications available.
A final problem contributing to polypharmacy is that many patients are unassertive. Even though they feel uncomfortable about all the drugs they are taking, they may sometimes assume that “the doctor knows best.” This is understandable. The doctor does have a great deal of training, and the patient’s knowledge is usually limited. In addition, the patient often admires the doctor and respects his or her advice. But in psychiatry and psychology, treatment approaches are far more subjective and varied than in internal medicine, where the treatments are far more precise and uniform. Your feelings about the treatment are important, and you have every right to share these feelings with your doctor.
This review of drug-prescribing practices obviously represents my own approach. Your physician’s ideas might differ. Psychiatry is still a blend of art and science. Perhaps some day the “art” will no longer be such a prominent ingredient. If you feel uncertain about your treatment, ask your physician questions. State your concerns and urge your doctor to explain the treatment in simple terms you understand. After all, it’s your brain and body that are at risk, not the doctor’s. The sense of teamwork and collaboration are important to successful treatment. As long as the two of you agree to a rational, understandable, and mutually acceptable strategy for your therapy, you will have an excellent chance of benefiting from your doctor’s efforts to help you.
Suggested Resources
Other Books by Dr. Burns
The Feeling Good Handbook (New York: Plume, 1990). Dr. Burns shows how you can use cognitive therapy to overcome a wide variety of mood problems such as depression, frustration, panic, chronic worry and phobias, as well as personal relationship problems such as marital conflict or difficulties at work.
Intimate Connections (New York: Signet, 1985). Dr. Burns shows you how to flirt, how to handle people who give you the run-a-round, and how to get people of the opposite sex (or the same sex, if that is your preference) to pursue you.
Ten Days to Self-Esteem and Ten Days to Self-Esteem: The Leader’s Manual (New York: Quill, 1993). In this ten-step program, Dr. Burns provides a practical, workable blueprint for breaking out of the bad moods that rob us of self-esteem. He provides you with clear, easy-to-understand instructions and specific tools gleaned from twenty years of systematic research and psychiatric practice. The Leader’s Manual shows you how to develop this program in hospitals, clinics, schools, and other institutional settings.
Workshops and Lectures by Dr. Burns
Dr. Burns offers workshops and lectures for mental health professionals and for general public audiences as well. For a list of dates and locations, you are invited to visit Dr. Burns’ Web site at www.FeelingGood.com
Audiotapes for the General Public
Burns, The Perfectionist’s Script for Self-Defeat.
Dr. Burns helps you identify perfectionistic tendencies and explains how they work against you. He shows you how to stop setting unrealistically high standards and increase productivity, creativity, and self-satisfaction.
Burns, Feeling Good.
Dr. Burns describes ten common self-defeating thinking patterns that lead to depression, anxiety, frustration, and anger. He explains how to replace them with more positive and realistic attitudes so you can break out of bad moods and enjoy greater self-esteem now and in the future.
Audiotapes for Mental Health Professionals
Strategies for Therapeutic Success: My Twenty Most Effective Techniques—Volumes I and II. 8 Cassettes
In this two-day intensive workshop, Dr. Burns illustrates the most valuable therapy techniques he has developed during two decades of clinical practice, training, and research.
Feeling Good: Fast & Effective Treatments for Depression, Anxiety, and Therapeutic Resistance. 4 Cassettes
Dr. Burns describes the basic principles of CBT and illustrates state-of-the-art treatment methods for depression and anxiety disorders. He also illustrates how to deal with difficult, angry patients who seem to sabotage the treatment because they feel mistrustful and unmotivated.
Feeling Good Together: Cognitive Interpersonal Therapy 4 Cassettes
In this workshop, Dr. Burns shows how to modify the attitudes that sabotage intimacy and lead to anger and mistrust. He also explains how to deal with patients who blame others for their personal relationship problems.
Rapid, Cost-Effective Treatments for Anxiety Disorders 4 Cassettes
In this workshop, Dr. David Burns shows you how to integrate three powerful models in the treatment of the entire spectrum of anxiety disorders, including generalized anxiety, panic disorder (with or without agoraphobia), phobias, social anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder (including victims of childhood sexual abuse).
You may order the audiotapes for professionals or for the general public by visiting Dr. Burns’ Web page at www.FeelingGood.com
Treatment and Assessment Tools for Mental Health Professionals
Therapist’s Toolkit 2000
Includes hundreds of pages of state-of-the-art assessment and treatment tools for the mental health professional. Purchase includes licensure for unlimited reproduction in your clinical practice. Site licenses are available.
Feeling Good Web Site
You are invited to visit Dr. Burns’ Web site at www.FeelingGood.com. This Web site contains information about:
• dates and locations for upcoming lectures and workshops by Dr. Burns
• audiotapes for the general public
• training tapes for mental health professionals (including CE credits)
• links for referrals to cognitive therapists around the country
• description of Dr. Burns’ new The
rapist’s Toolkit
• links to other interesting sites
• new information of potential interest to patients, therapists, and researchers
• Ask The Guru. You can submit questions about any mental health topic. Answers to selected questions are posted in a column format.
Index
The pagination of this electronic edition does not match the edition from which it was created. To locate a specific passage, please use the search feature of your e-book reader
Page numbers in italics refer to figures and tables. A small “n” following a page number refers to a note on that page.
accomplishments, self-esteem and, 327–30
advantages of, 328
disadvantages of, 328–29
does work equal worth, 331–41
accurate empathy, 185–91
achievement
DAS test score and, 285
worth and, 327–41
achievement trap, 346–51
action, motivation and, 125–27
active death wish, 387
Adapin, 379
side effects, 531
adaptive anger, 163–64
Adler, Alfred, 10n
adolescent rejection, 301–2
Agras, Stuart, xxii
air-traffic controllers, 409
alcohol, 330
all-or-nothing thinking, 32–33, 42
American Psychiatric Association, xxvi
amitriptyline (Elavil, Endep), 448–49, 518
side effects, 499–500, 530
amoxapine (Asendin), 519
side effects, 536
amphetamines, 330
Anafranil, 484, 518
side effects, 530
anger, 149–97
as adaptive, 163–65
cognitive therapy and, 153
Freud on, 153
frustration and, 195–96
internalized, 153
irrational statements, 159–60
labeling, 157
magnification, 158–59
as maladaptive, 164–94
mind reading, 158
as productive, 163–65
ten things to know about, 194–97
thoughts and, 154–56
Anger Cost-Benefit Analysis, 166
anger hierarchy, 191–93, 192
angry rejection, 303
Anhedonia, 90
antidepressant drug therapy, 10, 11–17, 404, 513n–681
cognitive therapy and, 10–18
antidepressant drugs, xxi, 404, 427, 441, 474–77
augmentation chart, 664–69
augmentation strategy
concerning, 662–71
being treated with, 478
bupropion (Wellbutrin), 605–7
consumer’s guide to, 513n–681
costs of, 515–24
deciding whether or not to take, 479–80
efficiency of, 483
generic, 516
how to tell if working, 484–86
how they work, 443–54
ineffective, 659–71
interactions with other drugs, 505–12
length of time for results concerning, 487
length of time to take, 489–90
MAO inhibitors, 444–48, 514, 520, 564–98
medical supervision concerning, 480
mirtazapine (Remeron), 615–17
mood elevation and, 486
mood stabilizers, 515, 522, 617–59
most effective, 483–85
myths concerning, 464–68
names, doses, and costs of, 518–22
preventing or minimizing side effects of, 501–5
reasons for side effects of, 498–501
serotonin antagonists, 514, 521, 599–605
side effects of, 492–98
simultaneously taking different, 486–87
SSR inhibitors, 449–50, 514, 520, 547–64
table of, 514–15
taking on long-term basis, 490–91
tapering off, 491
tetracyclic, 514, 519, 524–27, 534–47
treatment of suicidal patients, 384
tricyclic, 448–49, 501, 514, 518–19, 524–34, 538–47
venlafaxine (Effexor), 611–15
when not working, 487–89
who benefits from, 480–82
see also individual names
antiheckler technique, 145
antihistamines, 500
Antiperfectionism Sheet, 357
Antiprocrastination Sheet, 99
antipsychotic medications (neuroleptics), 675–77
Antonuccio, David O., xx, xxi, 463
anxiety disorders, 484
cognitive therapy for, xxii
symptoms of, 26
approval, 290–310
DAS test score and, 285
independence and self-respect, 296–309
need for, 290–92
origin of the problem, 293–96
self, 309–10
Archives of General Psychiatry, 457
Asendin, 519
side effects, 536
augmentation chart, 664–69
augmentation strategy, 486, 662–71
Authoritative Guide to Self-Help Books, xxix
autonomy, DAS test score and, 288–89
Aventyl, 517
side effects, 532
averageness, 353
Baxter, Lewis R., Jr., xxi, 457
BDC. See Beck Depression Checklist
BDI. See Beck Depression Inventory
Beck, Aaron T., 10n, 21n, 51, 53n, 115, 367,383, 413, 420
preface by, xi–xiii
interpreting, 21–27
Beck Depression Inventory (BDI), xxiv, 46, 67, 250, 386, 391
being alone
advantages of, 321
loneliness and, 313–18
benzodiazepines, 671–73
Bergman, Kenneth S., xxii, 457
beta-blockers, 502
bibliotherapy, xxiii–xxix
studies concerning, xxiii–xxix
biological treatments, 460–62
myths concerning, 464–68
vs. psychological treatments, 456–73
studies concerning, 457–60
bipolar (manic-depressive) illness, 428–29, 461–62
symptoms of, 430
boosting self-esteem, 53–80
borderline personality disorder (BPD), 484–85
BPD. See borderline personality disorder
brain
biology of, 433–38
research, 453–54
brain chemistry, imbalances in, xxi–xxii, 431–33, 478
theories concerning, 438–43
Brown, Helen Gurley, 334
bupropion (Wellbutrin), 521, 605–7
doses, 607
drug interactions, 610–11
side effects, 607, 608
Bums Depression Checklist (BDC), 20–21, 22
BuSpar, 450–51
buspirone (BuSpar), 450–51
But-Rebuttal Method, 107–9, 108
Cade, John, 617
Campbell, Barbara D., xxix
“Can’t Lose” System, 124–25, 126
carbamazepine (Tegretol), 522, 640–41
blood testing, 641–43
doses, 641
drug interactions, 646–51, 648–50
side effects, 643–46
Celexa, 520
Center for Cognitive Therapy, 13, 22n
chemotherapy, 233
citalopram (Celexa), 520
Cleveland Clinic, 463
clomipramine (Anafranil), 484, 518
side effects, 530
coercion, 92, 116–17
cognitive distortions, 201, 238–39, 393, 402–3
definitions of, 32–41, 42–43
of suicidal individuals, 392, 394, 401
cognitive rehearsal, 191, 194
cognitive therapy, xvii–xxiiin, 57
anger and, 153
for anxiety disorders, xxii
for depression, 13–18, 15
dialogue between client and therapist, 410–11
for eating disorders, xxiii
effectiveness of, xx
helplessness and, 419–20
hostility and, 411–16
ingratitude and, 416–17
mood-control techniques of, 10–11
origin of, 9–10
for personality disorders, xxii
principles of, 12–13
self-criticism vs. self-defense, 62–68, 69, 76–77, 134, 244, 261
studies concerning, xx–xxxi, 18
for suicidal individuals, 383–84, 393–99, 401–3
theory of, xvii–xix
uncertainty and, 419–22
compulsive slowness, 359–60
cooling hot thoughts, 167–69
coping, 70–78
with criticism, 144
with helplessness, 419–22
with hostility, 411–16
with ingratitude, 416–17
with uncertainty, 419–23
Cosmopolitan, 334
criticism
coping with, 146
fear of, 92
overcoming fear of, 131–44
Daily Activity Schedule, 94–98, 95
Daily Record of Dysfunctional Thoughts, 65–67, 66, 100–4, 101–3, 106–7, 170, 208
Danton, William G., 463
DAS. See Dysfunctional Attitude Scale
death wish, 386–87
defeating guilt, 205–28
antiwhiner technique, 22
Daily Record of Dysfunctional Thoughts, 208
developing perspective, 225–26
learning to stick to your guns, 218–22
Moorey moaner method, 223–25
“should” removal techniques, 208–18
DeNelsky, Gurland Y., xx, 463
Depakene, 522
Depakote, 522
dependency, 311
need for love and, 311, 312–15, 324–26
depression, xx, xxx–xxxi
antidepressant drug therapy and, 13–18
antiheckler technique, 145
BDC scores, evaluating, 24–25
the Beck Depression Inventory (BDI), xxiv, 46, 67, 250, 386, 391
brain chemistry imbalance and, xxi–xxii
cognitive therapy as treatment for, 12–18
Feeling Good: The New Mood Therapy Page 59