The second approach to healing depression--equally important as healing the brain--is healing the mind. Extensive research has shown that two short-term therapies, Cognitive Therapy and Interpersonal Therapy, are highly effective in the treatment of depression.
After a brief discussion of these potent therapies, we will present our favorite skills to heal the mind and enjoy a happier, more productive life. (These are offered as an adjunct to, not a substitute for, Cognitive/Interpersonal Therapy.)
Psychotherapy has changed considerably in the past decade. The stereotype most people have of lying on a couch for the fifty-minute hour while a dispassionate therapist sits silently taking notes has almost disappeared.
Therapy--especially in the treatment of depression--has become much more educational.
Education comes from the Latin word educare, which means to draw forth from within. A good therapist actively draws from within you things you may have known about yourself and forgotten, things you may have never known about yourself, or things that you knew to be true but, for whatever reason, disregarded.
In addition, a therapist teaches new skills for living a more productive, satisfying, and loving life.
Depressed people sometimes do things that make them even more depressed because no one ever taught them any other way.
An important part of therapy, then, is learning other ways.
AARON T. BECK, M.D.
Cognitive Therapy was developed by psychiatrist Aaron T. Beck, M.D.
The word cognitive relates to how we perceive and think. For example, the word recognize means simply to re (do again) cognize (perceive)--to cognize something we have cognized before. Descartes's famous phrase, "I think, therefore I am," is, in fact, a bad translation. A better translation would be, "I cognize, therefore I am."
Simply put, the way we perceive the world is the way we respond to the world. If our cognition of life is negative, our thoughts, feelings, and actions will be negative.
Cognitive Therapy identifies a person's distorted cognitions (perceptions and evaluations) and "reframes" them in a more accurate, factual light. Cognitive Therapy is not positive thinking--it simply seeks what's real, what's genuine, about one's life.
Depression distorts perception. The depressed person perceives life through a glass darkly. Cognitive Therapy does not add rose-colored glasses: its goal is clear glass, which allows the world to be perceived accurately--both its good and its bad.
Dr. Beck's therapeutic method is outlined in the book, Feeling Good by David D. Burns, M.D.
A depressive illness colors how a person thinks, feels, and acts toward a spouse, lover, friend, boss, co-worker, parent, or child. Troubled relationships are the rule in depression.
Interpersonal Therapy was developed by psychiatrist Gerald Klerman, M.D., of Harvard, and psychologist Myrna Weissman, Ph.D., of Yale as a short-term therapy to help people identify and resolve their difficulties with others.Interpersonal Psychotherapy of Depression is the book written by Dr. Klerman and Dr. Weissman.
Whereas Cognitive Therapy focuses on perception and reaction to those perceptions, Interpersonal Therapy lays an extra emphasis on communication skills. Interpersonal Therapy and Cognitive Therapy have so many overlapping concepts and work so well together, many therapists have combined both into Cognitive/Interpersonal Therapy.
Both Cognitive and Interpersonal Therapy deal with your habits of thought, feeling, and behavior as they are now, not what happened somewhere back then in your childhood. The origin of the pattern is not as important as the pattern itself and how to turn that pattern into one that elevates rather than depresses.
We would be remiss if we did not mention two people whose work laid the foundation for the success of Cognitive and Interpersonal therapies. They are Albert Ellis, Ph.D., and Arnold Lazarus, Ph.D.
Albert Ellis is the founder of Rational-Emotive Therapy. It is described brilliantly in his book, How To Stubbornly Refuse to be Miserable About Anything . . . Yes, ANYTHING.
The idea behind Rational-Emotive Therapy is this: there are three aspects of life--(a) what really happens, (b) what we perceive about what happens, and (c) how we react. The majority of our difficulties, according to Dr. Ellis, come at point (b): what we perceive. By rationally, factually comparing our perceptions and reactions with what actually happened, we become more effective at (c): our reaction and action.
Dr. Arnold Lazarus is the father of Multimodal Therapy. This looks at what one is thinking, feeling, and doing that is not productive, and teaches proven, effective strategies for reversing them. For example, Dr. Lazarus maintains that many people are depressed because they have an inability to express. Whether the depressed expression is tenderness, assertiveness, joy, anger, or love, learning appropriate expression is valuable in the treatment of depression.
Dr. Lazarus's most recent book is Don't Believe It for a Minute.
ARNOLD A. LAZARUS, PH.D.
In some cases, you may choose the psychiatrist who is treating the medical aspect of your depression to also guide you through Cognitive/Interpersonal Therapy. This has the advantage of combining your therapy and medical visits into one.
Or you may choose to have a psychiatrist or general practitioner diagnose, prescribe antidepressants, monitor medical progress, and have a psychologist or other mental health professional provide the psychotherapy.
A psychiatrist has more medical training, and a psychologist has more psychological training. This gives you two people with different, but overlapping, specialties working together on your healing.
More and more psychologists and psychiatrists are joining to treat depression in a "team" approach. (Keep in mind, however, that you are not stuck with either member of the team--any psychiatrist and any therapist you choose can work together on your healing.)
Most importantly, you must feel trust, confidence, and comfort with your therapist so that you can express and explore whatever you need to in order to fully heal and grow.
Books and tapes (both audio and video) can be excellent sources for learning new skills, ideas, and ways of looking at life. The use of books and tapes as an adjunct to therapy is growing more and more popular.
This even has a name: bibliotherapy.
(Biblio means book in Latin. Fortunately, there is no Latin word for tape, so there is no tapiotherapy.) We like James Burke's idea from The Day the Universe Changed: a book is like holding another's mind in your hands.
Audiotapes are especially useful because you can listen to them while you drive, jog, walk, or even clean house.
The advent of videotapes has made thousands of movies, documentaries, and other inspirational and educational material conveniently available.
So, here are Harold's and Peter's ten favorite books or tapes about learning life's lessons.
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- Concept: Synergy audiotapes by Lazaris, especially Handling Depression, Beyond Struggle: The Magic of Being Good Enough, Ending Shame, and Overcoming the Dark Law. Call 1-800-678-2356.
- What You Feel, You Can Heal, by John Gray, Ph.D.
- Health & Fitness Excellence, by Robert Cooper, Ph.D.
- All in the Family (television sitcom), produced by Norman Lear
- Nuclear Evolution by Christopher Hills, Ph.D.
- Healing the Shame That Binds You, by John Bradshaw
- SeinLanguage, by Jerry Seinfeld
- The Conduct of Life, by Ralph Waldo Emerson
- The Prophet, by Kahlil Gibran
- Be Here Now, by Ram Dass
- THE BOOK on the Taboo Against Learning Who You Truly Are, by Alan Watts (or any of Alan Watts's audiotapes, available from Electronic University, 1-800-969-2887)
- Sunday in the Park with George (Broadway show, available on videocassette, CD, audiocassette)
- Airborne by William F. Buckley, Jr.
- Field of Dreams, Defending Your Life, Fearless (movies)
- The Virtue of Selfishness, by Ayn Rand
- Murphy Brown, Mary Tyler Moore, St. Elsewhere, Connections, The Day the Universe Changed (television shows)
- Any "Far Side" collection by Gary Larson
- Illusions, by Richard Bach
- All the words in red from a Red Letter Edition of the first four books of the New Testament by Matthew, Mark, Luke, and John; New International Version
- How to Become a Virgin and The Naked Civil Servant by Quentin Crisp
With this point, we begin sharing with you some of our favorite personal growth techniques.
These are simply a gathering of ideas and activities you might like to try. Experiment with them. Play with them. Modify them to your needs and preferences. If they work for you, take them; they're yours. If they don't work for you, move on to techniques that do.
Again, these suggestions are not a review of Cognitive/Interpersonal Therapy, nor are they the outline for Bloomfield/McWilliams Depression Therapy; doing the techniques in this book is not a substitute for working with a professional in Cognitive/Interpersonal Therapy.
Frankly, we do not believe that depression can be successfully treated from a book. The downward spiral of depression requires, we believe, professional intervention at both the biological and the psychological levels.
One of the hallmarks of depression is rigid, inflexible thinking. Words such as must, should, never, bad, have to, and ought to create emotional states (anger, fear, hurt, guilt, and unworthiness), which, naturally, contribute to depression.
Using the words listed above sets up a battle of absolutes within ourselves: bad vs. good, right vs. wrong, light vs. dark. This mental and emotional battle zone often becomes the ground of being from which we perceive and act in the world. We declare war on the world--although we are firmly convinced that the world has declared war on us. As with all wars, we are overcome by fear and anger.
Not only is this a depressing way to live; it's phenomenally inaccurate. The world does what it does no matter how depressed we become about it.
Life is lived on the continuum between good and bad, right and wrong, light and dark.
Replacing rigid words with more flexible (and accurate) words such as often, sometimes, seldom, either, or, and both, makes life more realistic--and livable. Strive for excellence, not perfection. Practice tolerance, not insistence. Live in a world of preferences, not demands. Say, "I'd like," or "I want," rather than "I need," or "I must have...." Life is not a struggle, it's a wiggle.
DR. FRANK CRANE
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Copyright © 1994-1996 Harold H. Bloomfield, M.D.
& Peter McWilliams