Depression is like a black cloud over your life, making every day feel hopeless and unbearable. It is one of the worst kinds of suffering, largely because of the guilt and shame associated with it. In this book summary of Feeling Good, you’ll learn about cognitive behavioral therapy, a treatment plan that has proven to be just as effective as medication in treating depression. With some faith and persistence, you can start feeling good — today and every day.
Identify and dismiss the distortions that cause depression.
READ THIS BOOK SUMMARY IF YOU:
- Want to break free from depression
- Are interested in exploring techniques for positive thinking
- Are curious about how your thoughts affect your moods
Cognitive behavioral therapy is one of the most popular forms of psychotherapy and is used to successfully treat depression, anxiety, and other mental health illnesses. Most people believe their negative feelings and thoughts stem from outward circumstances, but the main principle of cognitive therapy is that your feelings are more tied to your thoughts than your experiences. This means that by changing your thoughts, you can change your mood.
A number of studies have shown that cognitive behavioral therapy is as effective as medication. Additionally, those treated with cognitive therapy are less likely to relapse into depression than those simply taking antidepressants.
If you are suffering right now, Feeling Good may be the breakthrough you’ve been searching for. Relief and joy are not out of reach.
Theory and Research
Depression is widespread and continuing to rise, despite the availability of antidepressants on the market. To address the growing frequency of depression, a group of physicians developed and tested a completely different approach to mental health: cognitive therapy.
In addition to being, simple, logical, and fast-acting, cognitive behavior therapy (CBT) has been proven to be at least as effective as medication for depression. In one study, dozens of depressed patients were treated with either antidepressant medications or cognitive therapy for 12 weeks. There was a higher percentage of improvement among the patients who received therapy, as well as a lower rate of relapse. This doesn’t mean that antidepressants don’t work; every person is different. But for both the short term and long term, cognitive therapy is an excellent option.
The basis of cognitive therapy is that all your moods and emotions are created by your thoughts, and when you’re depressed, your thoughts are largely negative. The key is to realize that the negative thoughts occurring during depression are distortions of the truth. Believing in these irrational, false thoughts is a source of suffering, but learning to identify the lies and dismiss them can drastically improve your mood.
Most cognitive distortions will fall under the following 10 categories:
- All-or-nothing thinking refers to evaluating yourself in the extreme. When you aren’t perfect, you’re a failure. For example, thinking you’re unintelligent because you failed one exam is all-or-nothing thinking.
- Overgeneralization is believing that an unpleasant experience is bound to happen over and over again. This may include believing that no one will ever love you after being rejected by one person.
- Mental filter is the tendency to focus on the negative in a situation while filtering out the positive. For example, forgetting the 15 kind customers you talked to and dwelling on the one rude customer is your mental filter at work.
- Disqualifying the positive is twisting something good into something bad or believing that positive experiences somehow don’t count. Examples include assuming that someone is taking pity on you when they give you a compliment, or that your promotion was dumb luck.
- Jumping to conclusions means making the assumption that something negative is about to happen, even if there are no supporting facts, such as believing someone dislikes you because they haven’t called you back, when in reality, they may be dealing with a crisis.
- Magnification and minimization involve blowing the negatives of a situation out of proportion and dismissing the positives. Thinking your reputation is ruined after one mistake but assuming your recent success is completely worthless is both maximizing and minimizing.
- Emotional reasoning means you are using your emotions as proof of the truth, even though feelings are not facts, such as believing that you must have done something wrong just because you feel guilty.
- “Should” statements reflect high expectations about what you or others “should” do. This causes shame when you disappoint yourself and selfrighteousness when others disappoint you.
- Labeling is creating a complete image based on negativity, such as saying, “I’m a loser,” instead of, “I missed one penalty kick,” or, “He’s a jerk,” instead of, “He is occasionally grumpy.”
- Personalization means assuming responsibility for something negative when you aren’t in control, like feeling guilty when your child fails a test.
Depression and feelings of worthlessness go hand-in-hand. One psychiatrist found that over 80% of people with depression had poor self-image, believing they lacked intelligence, attractiveness, and other positive qualities. A poor self-image doesn’t just make you sad: It magnifies even the smallest mistakes into glaring failures. These feelings are always tied to one of the 10 cognitive distortions, but depression makes it difficult to see the truth.
Self-worth isn’t something that can be earned through outward achievement or the approval of others. Instead, it must come from within. One of the most effective ways to develop a healthy sense of self-worth is to challenge your internal critic with rational, positive responses. Use the triple-column technique: Divide a piece of paper into three columns for your self-criticisms, cognitive distortions, and rational self-defenses. When you have a negative thought, write it down and identify which of the 10 cognitive distortions it falls under. Then, write a rational response in your own defense. For example, if you catch yourself feeling dumb after failing an exam, you could write:
- Self-criticism: “I’m an idiot.”
- Cognitive distortion(s): All-or-nothing thinking; labeling.
- Self-defense: “I’m not an idiot. I failed this test, but I usually make good grades. Next time, I’ll study harder and get more help with the difficult concepts.”
The triple-column technique helps you replace distortions with rational, positive thoughts. It’s important to actually write your thoughts on paper instead of letting them swirl around in your mind; doing so gives clarity and insight to confusing feelings. Writing about your thoughts every day enables you to think rationally about them, rather than using distortions.
This technique is also effective when criticism comes from the outside. When someone verbally attacks you, your self-esteem may suffer, but it’s important to remember that you are the only one that can hurt you. When someone verbally attacks you, it’s upsetting because their words trigger your cognitive distortions, meaning the negative self-talk that results is what really makes you upset, not their words. Use the triple-column technique to write your thoughts and rational responses.
While you can elevate your mood by changing your thoughts, changing your actions is also immensely helpful. Depression makes even the smallest chore feel overwhelming but being unproductive exacerbates self-hatred. This can turn into a vicious cycle. Studies have shown that doing literally any activity improves your mood. Even small chores distract you from negative self-talk and cognitive distortions. Furthermore, actions offer you a sense of accomplishment and capability, delegitimizing many of your self-criticisms.
There are many techniques to help you get moving and recognize the effects of action. One technique is to utilize the “anti-procrastination sheet.” Write down the activities you have been avoiding and how difficult and rewarding you expect them to be on a 0-100% scale. For example, you might think mowing the lawn will be 40% difficult and 10% rewarding. Once you’ve completed the tasks, take note of how difficult and rewarding they actually were. You’ll most likely find that you overestimated the difficulty and underestimated the satisfaction. This recognition will likely motivate you to accomplish even more.
Most depressed people struggle with unfounded guilt based on cognitive distortions. Fortunately, CBT offers many techniques for identifying and ridding yourself of unhealthy guilt. Write down any situation that makes you feel guilty and the selfaccusations that result from that guilt, and then identify your cognitive distortions and write rational responses to each. For example, you could write:
- Situation: My son got in trouble at school.
- Self-accusation: “I’m a bad parent for not spending enough time with him.”
- Distortion(s): All-or-nothing thinking; labeling; personalization.
- Rational response: “I’m not a bad parent. I spend time with my son when I can, and I always take care of his needs. I can’t control how he behaves at school. I can only guide him, but his actions are ultimately up to him.”
Once you clarify your role and responsibility in situations that bring you undue guilt, you’ll realize that your feelings are irrational and unproductive.
Some may argue that there are plenty of real, terrible situations that cause depression, such as terminal illness, job loss, or physical disability. Most think that, since these problems are not distortions, they must be “realistic depression.”
But this kind of thinking is mistaken. Realistic depression does not exist because depression is always rooted in distortion. Sadness, on the other hand, is a natural emotion caused by a negative event. Sadness is different from depression because it is a process with a time limit, and it does not affect your self-esteem.
A sad thought sounds like, “My friend died, and I’m going to miss our companionship and love.” But a depressed thought sounds like, “No one else loves me like my friend did. Now that she died, I’ll never be happy again.” You may become sad or depressed after a negative event, but these moods are not the same. One is natural, and the other is an illness tied to distortion.
Prevention and Personal Growth
When depression starts to ebb, the feelings of relief and joy can be so immense that you can’t help but be optimistic. You may even think you’ll never feel depressed again. The transformation from depressed to joyful is wonderful; however, don’t automatically assume that you’ll never be depressed again. There is a big difference between feeling better — a temporary absence of symptoms — and getting better. Getting better requires that you understand why you were depressed in the first place.
Most people hold silent assumptions deep down inside, and these assumptions are what feed cognitive distortions. Even if you learn to shut down negative selftalk, unaddressed assumptions can still lurk below the surface and cause a relapse. You can identify your assumptions by using the vertical arrow technique.
Begin by writing your automatic negative thoughts and ask why, if they were true, the negative thoughts would matter. For example:
“My manager yelled at me. She thinks I’m doing a bad job.”
If she did think that, why would it bother me?
“Because it would mean I wasn’t good at my position.”
And if I weren’t, what would that mean?
“It would mean I wasn’t smart or talented.”
If I’m honestly not smart, why would it matter?
“Because it would mean I couldn’t accomplish anything, and I’d be worthless.”
As you can see, the negative talk about work stems from an assumption that self-worth is tied to achievement. These kinds of assumptions put you at risk for depression relapse.
The most common silent assumption is that your worth is dependent on outside factors, such as the approval of others, love, achievement, or perfection. But worth is inherent to being a living, breathing person. Nothing you do increases or decreases your worth, and when you base your worth on outside factors, it tends to backfire. For example, being desperate for love is a red flag for potential partners and decreases your chances of finding a mate. Looking for validation is like a drug habit: You need continuously higher and higher doses to feel satisfied. Getting married may have been your ultimate goal years ago, but now, your spouse doesn’t spend enough time with you, and you still feel worthless. Or maybe you thought getting a promotion would satisfy you, but now you can’t stop thinking about the next rung on the corporate ladder.
Rather than worrying about worth, focus on satisfaction, mastery, and joy. These elements of life can be enhanced or eliminated, but worth is a constant. You are worthwhile simply because you’re you.
The Chemistry of Mood
There has been significant dispute in the medical and psychological fields regarding the best treatment for depression and other mood disorders. Some firmly believe in drug therapy; others prefer “talk therapy” like cognitive therapy. The truth is that no one can say which treatment is best because every patient is different.
The good news is that there is treatment; in fact, there are plenty of treatments to choose from. Every physician has a different philosophy, but Dr. Burns of Feeling Good believes the following:
- Antidepressant medication should have a significant impact on your mood. If you see little to no change after many weeks of treatment, it’s time to try another drug.
- Never use medication by itself. Cognitive therapy always enhances treatment and is proven to be more effective at preventing relapse.
- Try one medication at a time to reduce side effects and prevent harmful interactions.
- Antidepressants don’t need to be taken permanently, except in cases of mood disorders like bipolar or severe, long-term depression. Usually, people can taper off their medication once their mood has improved.
Not every psychiatrist will agree with this philosophy, so you should talk with your doctor and work out a treatment that is right for you. Patients respond best to a treatment plan they’re comfortable with. If you don’t prefer medication, cognitive therapy is highly effective on its own. If you do want to take an antidepressant, there are plenty of effective drugs, and they all work well in conjunction with cognitive therapy. Drugs on their own aren’t as effective long-term, however, so it’s important to use cognitive therapy to give you the tools to cope with upsetting thoughts and circumstances. Your treatment shouldn’t be considered complete until your mood is in the stable and happy range consistently.
Antidepressants can be a great asset for people struggling with depression, as long as they’re receiving competent medical guidance on their prescriptions, including dosage, length of use, and possible interactions with other medications or substances. Patients should never regulate their own drug treatment. However, no physician is all-knowing, so you should educate yourself on the different drugs available and their possible side effects. Refer to the Physician’s Desk Reference or the consumer’s guide in Feeling Good for a comprehensive overview.
One of the most harmful side effects of depression is hopelessness. Whether you’ve struggled with depression your entire life or just started feeling blue recently, you may worry that you’ll never be happy again. But this is a distortion! You have so many options available for treatment. Furthermore, persistence and faith are the keys to a successful recovery. When one option isn’t working, try something else.
One treatment that is always helpful, even if you need to combine it with other methods or antidepressants, is cognitive therapy. The techniques in cognitive therapy will help you unravel the silent assumptions and cognitive distortions that make life upsetting and hopeless. When you defeat the illogical lies weighing you down, you’ll feel immense relief and happiness. Don’t give up.
About the author
David D. Burns, M.D., is a psychiatrist, author, and professor. He was previously the acting chief of psychiatry at the University of Pennsylvania Medical Center and a visiting scholar at Harvard Medical School. Dr. Burns is an adjunct professor emeritus at the Stanford University School of Medicine. He also wrote The Feeling Good Handbook.