By Edward Ziegler
IT IS THE COMMON COLD of psychological disorders Almost everyone experiences it at some time. Each year millions of dollars are spent on medicines to alleviate the withering melancholy, blighted hopes and dismal inner weather that are the symptoms of depression. In his recent book, feeling Good, Dr. David D. Burns argues that most depression arises from erroneous thinking, and that we have it within our power to control the furtive thoughts that dupe us into needless gloom. In fact, Dr. Burns’s experiments indicate that when it comes to curing a depression, thoughts, not tranquilizers, work best.
This book derives from the experience of Burns’s mentor at the University of Pennsylvania school of Medicine Dr. Aaron T. Beck. It was Dr. Beck who developed the theory of “cognitive therapy.” He was treating a patient one day in 1956 when he first glimpsed the phantom “automatic thoughts” that can, if not carefully watched, hijack our attitudes and seize control of our moods. The patient had been criticizing Dr. Beck angrily, then paused. “I asked him what he was feeling,” Beck writes. The patient responded, “ I feel very…guilty.” He told Beck that he was having two parallel streams of thought at the same moment. One carried his denunciation of Beck, but in a second stream the patient was criticizing himself.
Pressed, he reported the actual words he was thinking: “I shouldn’t have said that …. I’m wrong to criticize him…He won’t like me.”
Beck writes: “This case presented me with my first clear-cut example of a train of thought running parallel to the reported thought.” He began to coach patients in observing and declaring their unreported, self-critical thoughts. This helped him gain more insight into these automatic thoughts and their characteristics. He found they are usually quite specific (“I’m no good”), and they occur in a kind of mental shorthand with no logical sequence. And the negative thoughts tend to distort reality. Beck also discovered that people could eventually be taught to identify and stop negative thoughts prior to experiencing the emotions that come from them.
The continuing work of Beck and Burns and their colleagues reinforces the basic discovery: our moods don’t decree out thoughts. It’s the other way around. Our thoughts govern our moods. Therefore, if you think right, you’ll feel right. Dr. Beck summed it up in his book Cognitive Therapy and the Emotional Disorders: “By correcting erroneous beliefs, we can damp down or alter excessive, inappropriate emotional reactions.” Dr. Burns goes on to list these three principles of cognitive therapy:
1. All your moods are created by your thoughts, or “cognitions.” “You feel the way you do right now because of the thoughts you have at this moment.”
2. when you feel depressed, it’s because your thoughts are dominated by a “pervasive negativity.” The whole world looks shadowed in gloom. “what is worse-you’ll come to believe that things really are as bad as you imagine them to be.”
3. Negative thoughts nearly always contain gross distortions. “Twisted thinking is the exclusive cause of nearly all your suffering.”
Dr. Burns describes the pilot study that showed how well these principles can work in alleviating depression. Forty-four severely depressed patients referred to the Center for Cognitive Therapy, at the University of Pennsylvania School of Medicine, were randomly assigned to two groups. One group received individual cognitive-therapy session for 12 weeks, while the other group was treated for the same period with Tofranil, one of the most effective anti-depressant drugs.
Of 19 cognitive-therapy patients, 15 showed complete recovery. Only 5 of the 25 drug-therapy patients did as well, and 8 others dropped out because of side effects from the drug. A year later, 11 cognitive-therapy patients were still symptom-free-a significant finding since depression tends to become chronic. Results lie these have produced a growing enthusiasm for this common-sense therapy that can help people without the side effects of medication. A $3.4-milion, multi-university depression-research pilot program sponsored by the National institute of Mental Health will further test the anti-depressant effects of cognitive therapy-along with another non-drug therapy-against those of mood-elevating drugs.
IN COGNITIVE THERAPY, the doctor challenges the patient to listen to his own negative thoughts-trains hi to identify these inner saboteurs and silence them. Results come quickly, usually within a few weeks. Beck and Burns think the technique can be applied on a self-help basis. Burns gives patients a list of the ten most common self-defeating thought patterns, and suggests: “When you are feeling upset, this list may make you aware of how you are fooling yourself.”
- All-or-nothing thinking. You see everything in black and white-lie the straight. A student who gets one B, and then thinks he is a total failure. It “will set you up for discrediting yourself endlessly. Whatever you do will never measure up.”
- Overgeneralization. You expect uniform bad luck because of one bad experience. “A shy young man asked a girl for a date. When she declined, he said to himself. ‘I’m never going to get a date. I’ll be lonely and miserable all my life.’”
- Mental filter. You seize a negative fragment of a situation and dwell on it. It’s like wearing a special lens that filters out everything positive. Burns writes, “You soon conclude that everything is negative.”
- Automatic discounting. One instance of this is the way we often brush aside a compliment. “He’s just being nice.” That’s a destructive distortion, Burns writes. Usually a depressive hypothesis is dominating your thinking, some version of “I’m second-rate.”
- Jumping to conclusions. Two examples are what Burns calls “Mind Reading” and the “Fortune-Teller Error.” In the first, you assume that others look down on you without checking the validity of your assumption. In the second, you look into the future and see only disaster.
- Magnification and minimization. Burns calls this the “binocular trick,” because you are either blowing things up, or shrinking them, out of proportion. You look at your imperfections through binoculars and magnify them. But when you think about your strengths, you look through the other end of the binoculars and shrink everything.
- Emotional reasoning. “I feel guilty; therefore I must have done something bad” is a prime example. Your emotion seems to be evidence for the thought. It rarely occurs to a depressed person to challenge this pattern of distorted reasoning.
- Should statements. “I should do this” or “I must do that” are examples of the kind of thinking that makes you feel guilty-rather than motivates you to do something.
- Labeling and mislabeling. If the stock you invested in goes down. Burns warns you might think, “I’m a failure” instead of “I made a mistake.” Such self-labeling is irrational. Your self cannot be equated with any one thing you do.
10. Personalization. You think: whatever happens, whatever others do, it’s y fault. Says Burns: “You suffer from a paralyzing sense of bogus guilt.” What another person does is ultimately his or her responsibility –not yours.
DR. BURNS goes on to offer techniques to get the upper hand over your depression. He suggests “three crucial steps when you are upset.”
1: Write down your negative thoughts. “Don’t let them buzz in your head; snare them on paper!”
2: “Read over the list of cognitive distortions.”
3: “Substitute more objective thoughts that put the lie to the ones that made your depressed.”
Here is a sampling of the provocative positive insights Burns offers to replace negative thoughts:
* Your feeling are not facts! “Your feelings don’t even count, except to mirror your thinking. If your thoughts make no sense, feelings they create will be just as absurd.”
* You can cope. Even with genuine sadness due to real loss or disappointment, a substantial portion of the suffering comes from thought distortion. “When you eliminate these distortions, coping with the real problem will become less painful.”
* Don’t base your opinion of yourself on your achievements. “Self-worth based on accomplishments is ‘pseudo-esteem,’ not the genuine thing,” Burns says, You can’t base your self-worth on looks, talent, fame or fortune. Marilyn Monroe Mark Rothko Freddie Prize and other famous suicides attest to this grim truth. “Nor can love or approval add one iota to your inherent worth. Most depressed individuals are in fact much loved, but it doesn’t help. At the bottom line, only your own sense of self-worth determines how you feel.”
And that is main lesson of cognitive therapy: self-esteem. Like yourself better and you’ll feel better: “Self-esteem can be viewed as your decision to treat yourself like a heloved friend,” Burns says. He asks: if a famous visitor came to stay with you, would you insult him? Would you peck away at his weaknesses ad imperfections? Of course not. You would do everything you could to make your guest feel comfortable.
“Now-why not treat yourself like that? Do it all the time!”