Feeling Good: The New Mood Therapy
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slowness, compulsive, 315–17
Smith, Nancy, xxviii
SSR inhibitors, 449–50, 501, 514, 547–49
doses, 549–52
drug interactions, 559–64, 560–63
names, doses, and costs, 520
side effects, 552–59, 553–54
Stanford University Medical Center, 255
stimulants, 675
success
fear of, 91–92
happiness and, 330
visualizing, 119
suicidal impulses, assessing, 386–88
suicidal individual
antidepressant drugs in treatment of, 383–85
assessing impulses of, 386–88
bleak outlook of, 384–85
cognitive distortions of, 393–94, 402–3
cognitive therapy treatment of, 384, 393–400, 401–4
conviction of insoluble dilemmas, 400
degree of hopelessness of, 387–88, 404–5
desire for self-mutilation, 389–90
illogic of suicide, 389–401
mid-life crisis and, 400–3
nihilistic theory of, 394–99
suicide, 251–57
depression and, 383
illogic of, 389–401
rate among general population, 383
unrealistic sense of hopelessness and, 385–86
youngsters and, 383
superachievers, 329
Surmontil, 519
side effects, 532
Task-Interfering Cognitions (TICs), 112–13
Task-Oriented Cognitions (TOCs), 112–13
Tegretol, 522, 640–41
blood testing, 641–43
drug interactions, 646–51, 648–50
side effects, 643–46
Ten Commandments, 161
testing your “can’ts,” 123–24
tetracyclic antidepressants, 514, 524–26
doses, 525–27
drug interactions, 538–47, 540–47
names, doses, and costs, 519
side effects, 534–38, 536
thought stoppage, 172
tiagabine (Gabitril), 651–52
TICs. See Task-Interfering Cognitions
TIC-TOC Technique, 110–11, 112–13
TOCs. See Task-Oriented Cognitions
Tofranil, 13, 448–49, 519
side effects, 531
Tofranil PM, 519
tranquilizers, 9
minor (benzodiazepines), 671–73
tranylcypromine (Parnate), 444, 484
side effects, 573
trazodone (Desyrel), 451–52, 484, 521, 599
doses, 600
drug interactions, 603–5
side effects, 600–3, 601
tricyclic antidepressants, 448–49, 501, 574, 524–25
doses, 525–27
drug interactions, 538–47, 540–47
names, doses, and costs, 518–19
side effects, 527–34, 530–32
trimipramine (Surmontil), 519
side effects, 532
Tuskegee Veterans Affairs Medical Center, xxviii
UCLA School of Medicine, 457
uncertainty, coping with, 419–23, 421–22
undervaluing rewards, 90
University of Alabama, xxiii, xxviii
University of California (Irvine), 150
University of Nevada, xx, 463
University of Pennsylvania School of Medicine, 9, 10, 241, 390
University of Texas (Dallas), xxix
valproic acid (Depakene), 522, 634
blood testing, 635–36
doses, 634–35
drug interactions, 638–40
side effects, 636–38
venlafaxine (Effexor), 450, 521, 611–12
doses, 612–14
drug interactions, 614–15
side effects, 608, 614
vertical-arrow technique for identifying silent assumptions, 263–70, 296
vigabatrin (Sabril), 651–52
visualizing success, 108–9
Vivactil, 519
side effects, 532
Washington University School of Medicine (St. Louis), 459
weekend/holiday blues, 97
Weissman, Arlene, 271–79
Wellbutrin, 521, 605–7
doses, 607
drug interactions, 610–11
side effects, 607, 608
willpower, depression and, 81
work, worth and, 331–40
workaholics, 328
worth
achievement and, 327–30
four paths to self, 345–51
as only a concept, 341–43
Pleasure-Predicting Sheet, 349, 350
work and, 331–40
worthless as a concept, 341–44
worthlessness, sense of overcoming, 59–61
youngsters, suicide and, 383
Your Erroneous Zones (Dyer), 163
Zoloft, 520
Acknowledgments
I am grateful to my wife, Melanie for her editorial assistance and patience and encouragement on the many long evenings and weekends that were spent in the preparation of this book. I would also like to thank Mary Lovell for her enthusiasm and for her technical assistance in typing the manuscript.
The development of cognitive therapy has been a team effort involving many talented individuals. In the 1930s, Dr. Abraham Lowe, a physician, began a free-of-charge self-help movement for individuals with emotional difficulties, called “Recovery Incorporated,” which is still in existence today. Dr. Lowe was one of the first health professionals to emphasize the important role of our thoughts and attitudes on our feelings and behavior. Although many people are not aware of his work, Dr. Lowe deserves a great deal of credit for pioneering many of the ideas that are still in vogue today.
In the 1950s, the noted New York psychologist, Dr. Albert Ellis, refined these concepts and created a new form of psychotherapy called Rational Emotive Therapy. Dr. Ellis published over fifty books that emphasize the role of negative self-talk (such as “shoulds” and “oughts”) and irrational beliefs (such as “I must be perfect”) in a wide variety of emotional problems. Like Dr. Lowe, his brilliant contributions are sometimes not sufficiently acknowledged by academic researchers and scholars. In fact, when I wrote the first edition of Feeling Good, I was not especially familiar with the work of Dr. Ellis and did not really appreciate the importance and magnitude of his contributions. I want to set the record straight here!
Finally, in the 1960s, my colleague at the University of Pennsylvania School of Medicine, Dr. Aaron Beck, adapted these ideas and treatment techniques to the problem of clinical depression. He described the depressed patient’s negative view of the self, the world, and the future, and proposed a new form of “thinking therapy” for depression, which he called “cognitive therapy.” The focus of cognitive therapy was helping the depressed patient change these negative thinking patterns. Dr. Beck’s contributions, like those of Drs. Lowe and Ellis, have been substantial. His Beck Depression Inventory, published in 1964, allowed clinicians and researchers to measure depression for the first time. The idea that we could measure how severe a patient’s depression was, and track changes in response to treatment, was revolutionary. Dr. Beck also emphasized the importance of systematic, quantitative research so we could get objective information on how well the different kinds of psychotherapy actually worked, and how effective they are in comparison to antidepressant drug therapy.
Since the time of those three early pioneers, many hundreds of gifted researchers and clinicians throughout the world have contributed to this new approach. In fact, there has probably been more published research on cognitive therapy than on any other form of psychotherapy ever developed, with the possible exception of behavior therapy. Clearly, I cannot mention all the individuals who have made important contributions to the development of cognitive therapy. In the early days of cognitive therapy, during the 1970s, I worked
with several colleagues at the University of Pennsylvania School of Medicine who helped to create many of the treatment techniques still in use today. They included Drs. John Rush, Maria Kovacs, Brian Shaw, Gary Emery, Steve Hollon, Rich Bedrosian, Ruth Greenberg, Ira Herman, Jeff Young, Art Freeman, Ron Coleman, Jackie Persons, and Robert Leahy.
Several individuals have given me permission to refer to their work in detail in this book, including Drs. Raymond Novaco, Arlene Weissman, and Mark K. Goldstein.
I would like to make special mention of Maria Guarnaschelli, the editor of this book, for her endless spark and vitality which have been a special inspiration to me.
During the time I was engaged in the training and research which led to this book, I was a Fellow of the Foundations’ Fund for Research in Psychiatry. I would like to thank them for their support which made this experience possible.
And my thanks to Frederick K. Goodwin, MD., a former chief at the National Institute of Mental Health, for his valuable consultation with regard to the role of biological factors and antidepressant drugs in treating mood disorders. Two Stanford colleagues, Drs. Greg Tarasoff and Joe Bellenoff, provided helpful feedback about the new drug chapters.
I would like to thank Arthur P. Schwartz for his encouragement and persistence. I would also like to thank Ann McKay Thoroman at Avon Books for editorial help on the new psychopharmacology chapters.
Finally, I would like to thank my daughter. Signe Burns, for extraordinarily helpful suggestions and meticulous editing of the new material in this 1999 edition.
About the Author
DAVID D. BURNS, M.D., is an adjunct clinical professor of psychiatry and behavioral sciences at the Stanford University School of Medicine and has served as Visiting Scholar at Harvard Medical School. His bestselling book, Feeling Good: The New Mood Therapy, has sold more than four million copies worldwide and is the book most often recommended by mental health professionals to patients suffering from anxiety and depression.
Visit www.AuthorTracker.com for exclusive information on your favorite HarperCollins authors.
About the Book
YOU OWE IT TO YOURSELF TO FEEL GOOD!
In a national survey of more than 1,000 self-help books, Dr. David Burns’s Feeling Good was rated as the most helpful book on depression—the most frequently recommended by American mental health professionals. Five controlled outcome studies published in scientific journals indicated that 70 percent of depressed individuals who read Feeling Good improved within four weeks, without receiving other treatment—and maintained their improvement during follow-up periods of up to three years.
The antidepressant effects of Feeling Good appear to be as strong as antidepressant medications or individual psychotherapy for patients suffering from episodes of major depression!
Although Dr. Burns does not recommend any self-help book as a substitute for professional therapy, Feeling Good should prove immensely illuminating to anyone suffering from depression or anxiety.
“I would personally evaluate David Burns’s Feeling Good as one of the most significant books to come out of the last third of the Twentieth Century.” Dr. David F. Maas, Professor of English, Ambassador University
Notes and References (Chapters 17 to 20)
1. Schatzberg, A. F., Cole, J. O., & DeBattista, C. (1997) Manual of Clinical Psychopharmacology. Third Edition. Washington, DC: American Psychiatric Press.
2. Some psychologists are lobbying for the right to prescribe drugs, and some psychologists in the armed services have already been licensed to prescribe drugs. There is intense controversy about the merits of this proposal. Some psychologists argue that the right to prescribe drugs is desirable because it will put them on an even footing to compete with psychiatrists for patients. Other psychologists argue that drug prescribing requires extensive medical training and that the profession will lose an important part of its identity if psychologists win the right to prescribe drugs. They also point out that the role of the psychiatrist, particularly in managed care situations, has become quite unappealing. Many psychiatrists who work for HMOs are now forced to see huge numbers of patients for extremely brief visits consisting only of discussions about medications without any time to do psychotherapy or to learn about the problems in their patients’ lives.
3. Baxter, L. R., Schwartz, J. M., & Bergman, K. S., et al. (1992). Caudate glucose metabolic rate changes with both drug and behavioral therapy for obsessive-compulsive disorders. Archives of General Psychiatry 49, 681–689.
4. Simons, A. D., Garfield, S. L., & Murphy, G. E. (1984). The process of change in cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry 41, 45–51.
5. Antonuccio, D. O., Danton, W. G., & DeNelsky, G. Y. (1995). Psychotherapy versus medication for depression: Challenging the conventional wisdom with data. Professional Psychology: Research and Practice 26 (6) 574–585.
6. Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57(3), 414–419.
7. Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive behavioral therapies. Chapter 10 in A. E. Bergin & S. L. Garfield (Eds.), Handbook of Psychotherapy and Behavioral Change (pp. 428–466). New York: John Wiley & Sons, Inc.
8. Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: Comprehensive review of controlled outcome research. Psychological Bulletin, 108, 30–49.
9. Scogin, F, Jamison, C., & Gochneaut, K. (1989). The comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. Journal of Consulting and Clinical Psychology 57, 403–07.
10. Scogin, F., Hamblin, D., & Beutler, L. (1987). Bibliotherapy for depressed older adults: A self-help alternative. The Gerontologist 27, 383–387.
11. Scogin, F., Jamison, C., & Davis, N. (1990). A two-year follow-up of the effects of bibliotherapy for depressed older adults. Journal of Consulting and Clinical Psychology 58, 665–667.
12. Jamison, C., & Scogin, F. (1995). Outcome of cognitive bibliotherapy with depressed adults. Journal of Consulting and Clinical Psychology 63, 644–650.
13. Smith, N. M., Floyd, M. R., Jamison, C., & Scogin, F. (1997). Three-year follow-up of bibliotherapy for depression. Journal of Consulting and Clinical Psychology 65 (2), 324–327.
14. Burns, D. D., and Nolen-Hoeksema, S. (1991). Coping styles, homework compliance and the effectiveness of cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology 59 (2), 305–311.
15. Burns, D. D., & Auerbach, A. H. (1992). Do self-help assignments enhance recovery from depression? Psychiatric Annals 22 (9), 464–469.
16. Dessain, E. C., Schatzberg, A. F., & Woods, B.T. (1986). Maprotiline treatment in depression: a perspective on seizures. Archives of General Psychiatry 43. 86–90.
17. Maxmen, J. S., & Ward, N. G. (1995). Psychotropic Drugs Fast Facts, Second Edition. New York: W. W. Norton & Company.
18. You will notice that the percentages of patients reporting stomach upset in Table 20–5 are a little lower than 20 percent to 30 percent on the average. This is because the percentages in the table represent the differences between the rates for the actual drug minus the rates for patients taking placebo medications.
19. You will learn below that the MAOIs can cause dangerous blood pressure elevations, but this is only if you take one of the forbidden foods or medications. Usually, the MAOIs can cause a mild drop in blood pressure.
20. A patient with a “difficult” or “resistant” depression is simply one who does not readily respond to the usual treatments. If your doctor tries many antidepressant drugs and you do not improve, your doctor will naturally conclude that your depression is more difficult than usual to treat. However, you may respond nicely to another type of treatment. I have treated large numbers of patients who had years and years of unsuccessful treatment with a wide variety of drugs prior to seeing me. Many of these �
�difficult” patients recovered when I used cognitive therapy techniques like those described in this book.
No single treatment is a panacea for everyone. That’s why it is important to have lots of approaches available, including many different kinds of medicines and many different kinds of psychotherapeutic methods as well. The term, “different strokes for different folks” is right on target in the context of depression treatment!
21. Arky, R. (Medical Consultant). (1998). Physician’s Desk Reference, 52 Edition. Montvale, NJ: Medical Economics Company, Inc.
22. The telephone number of the Madison Institute of Medicine is 608-827-2470; their fax is 608-827-2479; their address is 7617 Mineral Point Road, Suite 300, Madison, Wisconsin, 53717; and their email is IN-FOCTRS@Healthtechsys.com. They can do literature searches and supply pamphlets, reprints and other information for a modest fee.
23. Preskorn, S. H. (1997). Clinically relevant pharmacology of selective serotonin reuptake inhibitors. Clinical Pharmacokinetics Suppl. 1, 1–21.
24. Westra, H. A., & Stewart, S. H. (1998). Cognitive behavioral therapy and pharmacotherapy: Complementary or contradictory approaches to the treatment of anxiety? Clinical Psychology Review 18 (3), 307–340.
25. Levine, J., Brak, Y., Gonzales, M., et al. (1995). Double-blind controlled trial of inositol treatment of major depression. American Journal of Psychiatry 152, 792–794.
26. Joffee, R.T., & Shuller, D. R. (1993). An open study of buspirone augmentation of serotonin reuptake inhibitors. Journal of Clinical Psychiatry 54, 269–271.
27. Nelson, J. C., & Price, L. H. (1995). Lithium or desipramine augmentation of fluoxetine treatment (letter). American Journal of Psychiatry 152, 1538–1539.
28. Weilburg, J. B., Rosenbaum, J. F., Biederman, J., et al. (1989). Fluoxetine added to non-MAOI antidepressants converts nonresponders to responders: a preliminary report. Journal of Clinical Psychiatry 50, 447–449.
29. Nirenberg, A. A., Cole, J. O., & Glass, L. (1992). Possible trazodone potentiation of fluoxetine: a case series. Journal of Clinical Psychiatry 53, 83–85.
30. Joffee, R. T., Levitt, A. J., Bagby, R. M. et al. (1993). Predictors of response to lithium and triodothyronine: augmentation of antidepressants in tricycylic non-responders. British Journal of Psychiatry 163, 574–578.