Chapter One
Depression
Depression is a frequently used and abused term. When someone asks you what is wrong as they look at your gloomy face, you might respond, "I feel depressed about myself, about my life." Everyone is down in the dumps some of the time, but most people, after a few hours, days, or weeks, snap out of their despondent moods.
However, some people are not as fortunate. They suffer from major depression, a mood disorder that involves feeling deeply unhappy, demoralized, self-derogatory, and apathetic. A person who has major depression often does not feel physically well, loses stamina, has a poor appetite, is listless, and experiences a sleep disorder. Major depression is so common in the United States that it has been called the flu of mental disorders. (The extreme mood swings of bipolar disorder, or manic-depression, are covered in Chapter 10).
Just as with anxiety, there is a swirl of controversy about the etiology and treatment of depression. Some experts believe that most depressions are psychologically and experientially determined and therefore best treated through psychotherapy. Others believe that depression is largely biologically determined and should be treated mainly with medication. But all experts acknowledge the reciprocal interaction of both psychology and physiology, and most believe in the superiority of a combination of medication and psychotherapy.
In this chapter, we critically review the voluminous body of self-help books, autobiographies, films, and Internet resources related to depression. Our primary concern is with major depression, but we also cover seasonal affective disorder (SAD), dysthymia, and postpartum depression.
SELF-HELP BOOKS
Strongly Recommended
***** Feeling Good: The New Mood Therapy (revised ed., 1999) by David Burns. New York: Avon.
The cognitive therapy that psychiatrist Burns describes in this updated self-help classic is the most popular form of psychological treatment for depression. Cognitive therapists believe that people become depressed because of faulty thinking that triggers self-destructive moods. Examples of faulty thinking are all-or-nothing thinking (if a situation is anything less than perfect, it is a total failure), discounting the positive (positive experiences don't count), magnification (exaggerating the importance of problems and shortcomings), and personalization (taking personal responsibility for events that aren't entirely under one's control). In Feeling Good, Burns outlines techniques people can use to identify and combat their faulty thinking. These techniques have been extensively tested in published research studies; indeed, this is one of the few books in the entire self-help literature that can boast about its demonstrated effectiveness (Ackerson, Scogin, McKendree-Smith, & Lyman, 1998; Cuijpers, 1997). It is peppered with selfassessment tests, self-help forms, and charts. The self-assessment techniques include the widely used Beck Depression Inventory, an anger scale, and a dysfunctional attitudes scale. The self-help forms and charts include a daily record of dysfunctional thoughts, an antiprocrastination sheet, a pleasure-predicting sheet, an anger cost-benefit analysis, and an antiperfection sheet. Updated in 1999 with a new section on antidepressant medications, this was the highest-rated book in the depression category of our national studies. An outstanding self-help book that has sold more than 2 million copies since its original publication in 1980, Burns's easy-to-read writing style, extensive use of examples, and enthusiasm give readers a clear understanding of cognitive therapy and the confidence to try its techniques.
***** The Feeling Good Handbook (revised ed., 1999) by David Burns. New York: Plume.
In this sequel to Feeling Good, Burns says that one of the most exciting recent developments is the discovery that cognitive therapy, which he calls the new mood therapy, can help people with the entire range of mood problems they encounter in their everyday lives. These include feelings of insecurity and inferiority, procrastination, guilt, stress, frustration, and irritability. In this handbook, Burns explains why we are plagued by irrational worries and how to conquer our worst fears without having to rely on addictive tranquilizers or alcohol. Burns also describes the important application of cognitive therapy in recent years to problems in personal relationships, especially marital and couple relationships. The Feeling Good Handbook asks readers to complete a number of self-assessment tests once a week, just as patients do, to monitor progress. The tests ask about thoughts, feelings, and actions in a variety of circumstances that typically make people feel angry, sad, frustrated, or anxious. There are two main differences in The Feeling Good Handbook and the original book: It covers a wider array of problems (anxiety and relationships, as well as depression), and includes daily logs to fill out. This five-star resource can be used as an adjunct to Feeling Good or independent of it. In either case, it is a very valuable and prized self-help book.
***** Mind Over Mood: Change How You Feel by Changing the Way You Think (1995) by Dennis Greenberger and Christine A. Padesky. New York: Guilford Press.
The authors have taken the nuts and bolts of cognitive therapy and spelled out in a step-by-step fashion how a layperson can utilize these methods in dealing with depression, anxiety, guilt, and shame. Strategies described in this book can also help people solve relationship problems, handle stress better, improve self-esteem, and become less fearful and more confident. The book helps people identify and make necessary changes in the relationship among thoughts, emotions, behavior, body changes, and events in their lives. Each chapter contains practice exercises. This five-star cognitive therapy manual can be truly helpful for adults suffering from depressive complaints-truly a matter of "mind over mood."
***** Control Your Depression (1996) by Peter Lewinsohn, Ricardo Munoz, Mary Ann Youngren, and Antonette Zeiss. Englewood Cliffs, NJ: Prentice-Hall.
This self-help resource, also in the cognitive-behavioral tradition, is intended to teach a way of thinking about depression as well as controlling it. The book is divided into three parts: Part I explains how depressed people think; Part II provides step-by-step procedures to control depression; and Part III is about ensuring success. Techniques include self-control, relaxation, planning pleasant activities, and modifying self-defeating thinking patterns. There are illustrations of how to gauge progress, maintain gains, and determine the need for further help. Control Your Depression has been shown in controlled research to work effectively in many cases (Cuijpers, 1998). This five-star resource is a solid, research-based self-help book for treating depression.
***** Cognitive Therapy and the Emotional Disorders (1976) by Aaron Beck. New York: International Universities Press.
This text, as the title implies, presents a cognitive therapy approach to depression and other emotional disorders. Aaron Beck pioneered the cognitive therapy approach to depression. He describes the cognitive triad, which consists of negative thoughts about the self, ongoing experience, and the future. Beck believes that systematic errors in thinking, each of which darkens the person's experiences, produce depression. These errors include drawing a conclusion when there is little or no evidence to support it; focusing on an insignificant detail while ignoring the more important features of a situation; drawing global conclusions about worth or performance on the basis of a single fact; magnifying small bad events and minimizing large good events; and incorrectly engaging in self-blame for bad events. Cognitive therapy attempts to counter these distorted thoughts. People are taught to identify and correct the f lawed thinking, and are trained to conquer problems and master situations they previously thought were insurmountable. This valuable five-star book was written primarily for professionals rather than a self-help audience. Many of the ideas in Beck's book are presented in a much easier to read fashion in Burns's Feeling Good and Greenberger and Padesky's Mind Over Mood. Beck's book will thus appeal primarily to the clinical community and to the knowledgeable layperson.
***** When Living Hurts: Directives for Treating Depression (1994) by Michael D. Yapko. New York: Brunner/Mazel.
This book addresses brief and practical methods for treating depression. Yapko believes that depression can be managed, and that when it is well-managed, it doesn't hurt as much or as long. He gives directives and strategies intended to help the clinician intervene actively and provide catalysts for learning to interrupt the cycle of depression. The first part of the book provides a theoretical overview; the second part describes 91 directives; and the third part presents case narratives that illustrate applications of the directives. This excellent, four-star book is largely a reference volume for clinicians; if a client were to use it as a self-help resource, it should probably be used in conjunction with a professional. Yapko's Breaking the Patterns of Depression (reviewed below) is a more conventional self-help book.
***** When Feeling Bad Is Good (1994) by Ellen McGrath. New York: Bantam.
This book provides a program for women to convert "healthy depression" into new sources of growth. McGrath challenges the cultural myth that feeling bad must necessarily be negative and introduces a new perspective on women's depression. A woman's healthy depression may be a realistic and appropriate emotional response to the unhealthy culture in which she lives. McGrath identifies six types of healthy depression: victimization depression, relationship depression, age-range depression, depletion depression, body image depression, and mind-body depression. This valuable four-star book is appropriate for women of all ages, ethnicities, and socioeconomic strata.
Recommended
*** You Can Beat Depression: A Guide to Prevention and Recovery (3rd ed., 2001) by John Preston. San Luis Obispo, CA: Impact.
In the third edition of this valuable book, the author helps readers appreciate that all depression is not alike (for example, chronic vs. acute depression). After providing a clearer understanding of depression, Preston guides readers through various treatment choices, such as brief therapy, self-help approaches, family therapy, medication, and cognitive changes. Relapse prevention programs are also addressed for the person working to maintain or improve gains. This three-star book would actually be a four-star selection if not for the fact that relatively few mental health professionals rated it. A very useful resource for people trying to understand and make choices about treating their depression.
*** Winter Blues-Seasonal Affective Disorder: What It Is and How to Overcome It (1998) by Norman E. Rosenthal. New York: Guilford Press.
A book for patients, spouses, and family members who wish to better understand and cope with seasonal affective disorders (SADs). Psychiatrist Rosenthal begins with a selftest to evaluate the level of SAD and then reviews the effectiveness of antidepressant medication, light therapy, St. John's wort, and a nutritional regimen. Light therapy, the author's research area, is particularly favored. There is also a step-by-step guide on coping with SADs all year round. This is probably the best self-help book on SADs.
*** Getting Un-Depressed: How a Woman Can Change Her Life through Cognitive Therapy (revised ed., 1988) by Gary Emery. New York: Touchstone.
The cognitive therapy approach of this book is designed to help women cope effectively with depression. Women's risk of developing depression is about double that of men. Emery explains what depression is and how cognitive therapy can help. He describes how women can get immediate relief from their symptoms and improve their state of mind. Next, the author focuses on ways to overcome common complications of depression (weight gain, alcohol and drug dependence, and relationship problems). After this, women learn that they can avoid future depression by working on the psychological causes of depression, which, according to Emery, are underlying negative beliefs and ineffective ways of handling stress. Finally, Emery outlines how women can lead more selfreliant and self-directed lives. This three-star book, just missing the four-star rating, is a popular and practical application of cognitive therapy to depression for women.
*** I Don't Want to Talk about It: Overcoming the Secret Legacy of Male Depression (1997) by Terrence Real. New York: Scribner.
Feeling the stigma of depression's "unmanliness," many men hide their condition not only from family and friends but also from themselves. Real believes that by directing their pain outward, depressed men hurt the people they love and frequently pass their condition on to their children. Real mixes in his own experiences with depression, as a son of a depressed, violent father and the father of two young sons. By integrating personal and professional experiences, Real teaches men how they can unearth their pain, heal themselves, restore relationships, and break the legacy of abuse. A useful self-help book specifically for men.
*** How to Stubbornly Refuse to Make Yourself Miserable about Anything, Yes Anything! (1988) by Albert Ellis. New York: Lyle Stuart.
This internationally respected psychologist, originator of Rational-Emotive Behavioral Therapy (REBT), contends that we create our own feelings and choose to think and feel in self-harming ways. Ellis's goals here are to show people how to express and control their emotional destinies, how to stubbornly refuse to make themselves miserable, how to use scientific reasoning, and how to effectively change their emotional and behavioral problems. The book certainly covers depression and misery, but it is broader in its coverage. This three-star book can be helpful for laypersons who are self-motivated or already involved in cognitive-behavior therapy.
*** Hand-Me-Down Blues: How to Stop Depression from Spreading in Families (1999) by Michael D. Yapko. New York: Golden.
The family is a powerful system, both for unwittingly teaching depression and for helping to overcome it. Psychologist Yapko advocates a shift away from medications as the sole solution for depression toward the curative role of family therapy.
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Excerpted from Authoritative Guide to Self-Help Resources in Mental Health by John C. Norcross Copyright © 2003 by John C. Norcross. Excerpted by permission.
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