Thursday, September 3, 2009

Book Review: Feeling Good - The New Mood Therapy by David D. Burns

Hello Friends:

This book gets two out of five 'wings' from your Adventure Hostess.

I almost gave it three, but I can't, simply can't, get over my biases against this book. Everybody else loves it. It's sold a ba-gillion copies or some such thing. And is one of the books commonly suggested by therapists to their patients with depression.

Which I find very depressing.

I know I said I would review a more recent book, first. But then I figured I'd go back to the 'beginning' in order to have some kind of a basis for comparison. And I don't want people thinking I only give out four and five wings. Nope.

Feeling Good - The New Mood Therapy by David D. Burns is not a new book. My copy is dated 1980. The most recent version of the book was released in 1999, almost 20 years later, with a new introduction and a guide in the back to anti-depressant drugs. Otherwise it is the same book as mine. How this therefore remains the "new" mood therapy is something of a mystery. It was, in fact, suggested to me by my therapist in '93 as the core book for the general public about Cognitive Behavioral Therapy (CBT). And so I bought a copy, read it, and found it both useful and insulting.

Note that I am specifically reviewing the book, here, not all of CBT. This book is one portal into the understanding and use of CBT to treat depression. It is not the only book, nor does it completely over all the ways and means CBT is used in other diagnoses, such as anxiety, panic and OCD.

Some of What's in the Book

The book is a pretty hefty 450 pages of mass market paperback. It is split into several parts: Theory and Research, Practical Applications, 'Realistic' Depressions, Prevention and Personal Growth, Defeating Hopelessness and Suicide, Coping with the Stresses and Strains of Daily Living, and The Chemistry of Mood. There are a few 'quizzes' you can take while reading the book that help pinpoint if you are in fact depressed, how badly depressed, what areas of your life are the most difficult for you to manage, how easily you get angry, etc. And in true CBT style, there are many examples of different ways to count thoughts, list thoughts, organize thoughts, challenge thoughts, and find new thoughts, all as informal 'worksheets'. The emphasis is on writing it all down in order to become aware of what you are thinking, and then implementing strategies to stop negative thoughts and instead substitute positive ones. Ideally, this breaks the endless cycle of rumination, and allows for a 'cure' for depression. The book maintains a philosophy that if we really and truly see how irrational our negative thoughts are, we can eventually dismiss them and be free of depression.

What I Liked

Early in the book there is a standard multiple choice quiz used as a indicator for the severity of depression. When I first took it in '93 it helped me see immediately how really depressed I was. At the time I was in what I called an "interim" between truly bad depressive episodes. At that point in my life, if I wasn't actively thinking about ways to kill myself, then I figured I probably wasn't that depressed. The quiz was quite valuable as a tool for me to get a handle on just how much pain I was in, and that I was plenty depressed even if I wasn't wishing I was dead each and every moment.

(Interestingly, when I retook the quiz a few days ago, my score was almost exactly the same. Some things seemed better, and others worse. But I'm convinced my score was higher on some items in the past because I was quite ignorant of just how I was thinking. I was quite in denial of how much I hated myself, for example, and I'm not repressing those thoughts anymore. So generally I'd say I was a few points better, overall. Something, anyway.)

If you are looking for a strategy, anything at all, to try, then there are many examples in this book. The author often suggests that the reader suspend disbelief about the efficacy of the methods and simply try them themselves. And some of the suggestions that might seem trivial do have power. For example, the idea that you inevitably have to be less happy if you are alone can be challenged my making predictions and then trying things alone. Then you can see for yourself if you actually do enjoy things less, or if that expectation was not actually correct.

What I Didn't Like

Oh, oh where to begin. Before I start ranting, a few concrete points.

The number of different kinds of strategies and possible variations of approaches is confusing, especially for someone who can barely get out of bed in the morning.

The section on anger management has what I consider to be a key gap. Very little time is spent on how help depressed people who cannot express any anger at all. The section instead deals with people who are constantly irritable, and easily lose their cool. For many of us with depression, we never lose our cool, and have no temper whatsoever. Any time something happens to us that a normal person would get angry about, we immediately translate that to self-hatred. I was not allowed to get angry as a child, or display any sense of irritation or to challenge boundaries. I therefore did not develop good boundaries. If I feel angry, it is because I did something wrong. That's the logic of it. It has taken a lot of work to reach find this anger and feel it when situations arise where one might actually get angry and have it be a positive means of affirming; a means for a functional insistence on healthy boundaries. This aspect of dealing with anger and depression is not addressed in the book.

The author does not show consistent respect for his own patients. He says things which either in real life or in imagined role playing that make a reader wonder what it is he thinks about these people when not in the office. "Not all my patients are as difficult as you!" and "Her contrariness made my work with her challenging and more than a bit frustrating at times."

So now I'm gonna start ranting. When I re-read the book last week so I could do this review, I went through and underlined passages that stuck out, and then bent the corners of the pages so I could find them again. I needn't have bothered since every other page has a bent ear. Example:

"... you can overcome it (depression) by learning some simple methods for mood elevation." The methods may be straightforward, but they are not simple, and even just putting it this way trivializes the problem. The author often makes statements like this, and then backpedals, saying he does not mean it in some kind of bad way. But that retraction is ineffective since the words are already out there and having their effect on the reader. I did all these exercises religiously for years, and while they offered some occasional relief, they did not deal with the underlying problems causing the depression. The methods outlined in this book provide a strategy for symptom control (bad moods) but do not target the core problems created by a childhood of illness, neglect, and abuse.

Over and over, the author describes depressed people as "pouting", "moping", and "whining" (as on page 70 where we are told "Cope - Don't Mope!") I don't think I need to explain why that bothers me. This follows along with the rest of the general tone of the book which comes over as flip and uncaring, not casual and friendly.

More insults for those of us who have nearly busted our rumps working to find a way out:

- "... the most crucial predictor of recovery is a persistent willingness to exert some effort to help yourself. Given this attitude, you will succeed." Exert some effort? That's not a little condescending, is it? This goes along with "If you are willing to commit some regular time and effort to this program, you can expect success proportionate to the effort you put in." Snort. I should be the sanest person on the planet.

- "It doesn't occur to you to challenge the validity of the perceptions that create your feelings." It has. I did. Still depressed. Again, I'm not upset that CBT has limitations, I'm tweaked at the way all of this is presented in this book.

- "When the two don't match (reality and the idea of what it should be), you condemn reality. It doesn't occur to you that it might be infinitely easier simply to change your expectations than to bend and twist reality." This one really gets me. Apparently changing one's expectations, created by twenty five years of abuse, is not terribly difficult. And even so, trying to do so has not occurred to us. So my inability to change my expectations is therefore my fault. Because I haven't put in enough EFFORT.

Dealing with the ideas of what we are responsible for (i.e. we are not responsible for other people's feelings, which is true enough).

- "... it dawned on her that she was acting irresponsibly not because she 'let him down' but because she was allowing herself to become depressed." Allowing. This to me implies we have a lot of control over if we 'choose' to get depressed or not. I do not agree with this. We can certainly choose to fight it, we can't choose to win.

- (emphases are mine) "No wonder you developed the the bad habit of looking down on yourself every time someone disapproved of you. It wasn't your fault you picked up this tendency as a child, and you can't be blamed for growing up with this blind spot. But it is your responsibility as an adult to think this issue through realistically, and take specific steps to outgrow this particular vulnerability." Oh my. So looking down on myself is a bad habit I need to outgrow? Well, I managed to stop biting my nails, so this should be a piece of cake.

- "Keep this in mind. Overcoming your fear of criticism will require a moderate amount of practice." I ... I can't even go there.

On the hit parade of perfectionism, the author offers: "Have the courage to walk away from an unfinished task!" (emphasis his) Yeah, that's what I don't have. Enough courage. Even I'm not depressed enough to believe that. I'm still alive at 41. I'd like him to try that with my starting material. Can you see why I don't like the book? I could go on and on.

Summary and Final Comments

The core principles of CBT are all in this book: the emphasis on lists, plotting, worksheets, tracking, etc.; the 'talk-back' to yourself techniques; the substitution of functional internal messages for dysfunctional ones, and more. If you wanted get a general look at how CBT is used to help those with depression, then it isn't a bad read. If you had never heard of CBT before, and wanted to get the gist of it, it isn't a bad read. Other people think that it is also a good read if you are currently depressed and need help. I am not so certain about that.

I found the book to be insulting and belittling, and lacking in any overt sense of compassion. When I was finished doing all the worksheets and the rest, I was more down than ever, now convinced that it was all my own fault that I was depressed since I couldn't "think" my way out of it as easily as the examples in this book. There are a now lot of books on the market about CBT. And CBT has helped a lot of people, including me. But you don't need this book for that. This is technically the "classic" but as such has been superseded. I can't recommend it without serious reservations.

Your Hostess With Neuroses


europas_ice said...

Oh my. From the quotes you mention, I have to agree that it sounds like the dude has no idea what it is like to be depressed. He surely never has been, and he seems to have never connected with or truly understood someone who is depressed.

It's like the people who think exercise is the/a cure for depression, since it produces "natural endorphins". Ha. Maybe it does, but it doesn't produce nearly enough of them to fight my "natural depressins".

I think these people confuse being depressed with just being "down" or "blue".

On to the next book! (Hopefully there's something better out there.)

The Blue Morpho said...

OMG! "Natural depressins"!! I am laughing so hard!

And yes, I think he does not actually get what it means to be depressed. He sees it very clinically, and does not connect with the emotional state at all. He would probably consider emotions to be 'erroneous' and therefore unimportant at best.

I think he has an idea that depression is caused by a single event. That *can* be the case - as in someone losing someone close and then being unable to adjust. That kind of loss can often be handled pretty well with a combination of talk therapy, CBT, and perhaps meds. People get through, and then move on.

Chronic depression is so different - what if you have no 'normal' state to go back to? For example, the 'depression quiz' in the book has questions like, "I enjoy things less than I did" or "I feel much more sad than I did". Now technically for me, none of that is true. I feel just as sad as I have since I was a small child - since I can remember. It's never been good. The test assumes you have some kind of stable baseline to return to. And I think, so does CBT in general.

Right. Enough of that. I'm gonna review a book I LIKE.

Thanks for reading and commenting!

e.m said...

Is it possible for you to find out on your own that you are depressed? Can the person actually admit it before anyone else? The thing is, mum is starting to suspect that I am depressed, and I happen to think it might be true...

The Blue Morpho said...

Hello e.m - Thanks for commenting. Depression in young people can be tricky to diagnose (I see from your profile you are 16). Being 16 is already hard enough as it is, which sounds cliche but is true. Those were some of the toughest years of my life. I'm not a medical doctor or a psychologist, so I can't give expert advice. But I read some of the posts on your blog, and I'd say you certainly have plenty on your mind. The ones where you talk about thinking of hurting yourself or trying to stop eating are especially troubling. I'm going to make some comments on your blog, specifically rather than post here. But never give up, I know from experience that life gets better. The people who say that high school days 'were the best days of my life' don't have very good memories, or had an unusually easy time of it. Each ten year span of my life has been better than the last.

The Tenacious Writer said...

It's difficult for me to talk about this book without going apoplectic.

The author's attitude toward the symptoms of depression is trivializing, condescending, and, as you say, sometimes downright insulting. If you read this book looking for help, you might, after you've finished reading, believe that there's is something even *more* wrong with you if you can't think yourself out of your depression. I thought so, and it delayed my ability to get real help in the form of a non-CBT psychologist.

The CBT therapist I saw based her entire approach to therapy around this book. It was like a sacred text. Not all people who practice CBT therapy do this, and I know CBT does help some people.

I felt worse every time I left her office. Not "wow, that was a tough session" worse, but "wow, I'm an idiot for feeling the things I feel" worse. We spent the whole time trying to talk me out of my feelings. It was hurtful. It was discouraging. After I quit, It took me three years before I sought another therapist, because I thought they would be like her.

The practice of labeling thoughts can be helpful, and allows one to objectify emotions and make them seem manageable. If you read this book, concentrate on learning about that skill, and try to ignore words like "mope" and "pout."

I puts me in a bad mood just writing about it. :-)

The Blue Morpho said...

Hey Tenacious - Thanks for reading. I actually felt better after I wrote the post. Finally felt like I had somewhere specific to put down how much this book rubs me the wrong way.

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