David Burn’s Feeling Good: Depression

In the book Feeling Good , David Burns, MD, the author, outlines
certain cognitive techniques an individual suffering from depression could use
in combating the disorder. He begins the book by briefly describing the
pertinence and the prevalence of depression. The author captures the audience’s
attention in the first paragraph: ” In fact depression is so widespread it is
considered the common cold of psychiatric disturbances” (Burns, 1992) p. 9.

Burns(1992), continues to suggest that the difference between the common cold
and depression lies in the fact that depression is lethal. Irwing and Barbara
Serason (1996) suggest that at least 90 percent of all suicide victims suffer
from a diagnosable psychiatric disorder at the time of their death. Irwing and
Barbara Serason (1996) also state that one of the risk factors in committing
suicide is the presence of mood disorder. Silverman (1993) states that suicide
among young people 15 to 19 years of age has increased by 30 percent from the
years 1980 to 1990.

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In my opinion David Burns brings up a valid issue in addressing the
pertinence of depression as it pertains to peoples tendencies of committing a
suicide; other academics have agreed with the same findings. However these
academics have not specifically stated that depression is the only risk factor
of committing a suicide. They did not even suggest that depression is the
heighest weighted risk factor in committing a suicide. The impression the
reader gets after reading the introductory paragraph of the Feeling Good book is
that severe depression will inevitably result in suicide unless it is cured.

Implying that if a person has a depressive disorder, it will lead to a suicide
can be dangerous and counterproductive for a person who already feels hopeless;
this may reaffirm their belief of hopelessness and the inevitability of the

Once the first paragraph is passed the author indicates that there is
hope in curing depression, giving the reader an encouragement to continue with
the book.

According to the Diagnostic and Statistical Manual of Mental
Disorders(DSM-IV), mood disorders are classified into two broad categories,
bipolar and unipolar depressive disorders. The book Feeling Good only talks
about the unipolar depressive disorders, thus, I will only concentrate on that
one category. Unipolar mood disorders are classified under axis I of the DSM-IV.

Unipolar depressive disorders are further classified into two categories:
dysthymic, and major depressive disorder. Even though both of the disorders are
mood disorders they have some fundamental differences and similarities.

According to DSM-IV people experiencing major depression must have depressed
moods and/or diminished interest for at least two weeks, for most of the day,
and for most days than not. They must also experience four additional symptoms,
such as: weigh loss or gain, insomnia or hypersomnia, psychomotor retardation or
agitation, feelings of worthlessness, feelings of hopelessness, low self-esteem,
difficulty concentrating, or suicidal thoughts. This is an acute , and usually
recurrent disorder. Around 50 percent of people who experience one major
depressive episode will experience another in the course of their life.

Dysthymic disorder is similar to major depressive disorder in that
people experiencing the disorder go through periods of depressed moods. However,
intensity, and duration of such moods are one among many differences between the
two disorders. Dysthymic disorder is a chronic disorder lasting, on average,
five years. In order to be diagnosed with the disorder one has to feel
depressed for most of the day, most days than not for at least two years. The
person experiencing this disorder also has to have two of the symptoms mentioned
in the section that described major depressive disorder. Due to its chronic
nature, dysthymic disorder is sometimes difficult to distinguish from a
personality disorder.

Feeling Good does not clearly identify the categories of unipolar
disorders; it groups them together into one category called “depression”. The
danger of this is in the reader’s perception of what condition they may have.

For example, a person who is expressing a major depressive episode and is
incapacitated may not have the energy or concentration to employ some of the
cognitive techniques outlined in this book. This person may however benefit
more from of an Electroconvulsive treatment (ECT) which is not outlined in this
book. The readers are not informed of all the options they have to treat the
disorder they are experiencing. Rush and Weissemburger (1994), suggest that ECT
is very effective in treatment of the major depressive disorders. Research
indicates that in 80 to 90 percent of patients experiencing a major depressive
episode, ECT is effective. However this treatment is shown not to be effective
in treatment of milder forms of depressive disorders such as dysthymia. David
Burns’ neglect to classify the two separate disorders into distinct categories
does not allow him to identify ECT as a successful option in treating major

The author however discusses some alternative options in the treatment
of depression. He describes one study that was done at the University of
Pennsylvania school of Medicine. Doctors John Rush and Aaron Beck, and some
other specialists were involved in the study which compared the effectiveness of
cognitive therapy and pharmacological treatment of depression. Individuals
suffering from major depression were randomly assigned to two groups. One group
received individual cognitive psychotherapy while the other group was treated
with a tricyclic antidepressant drug called Tofralin. Both groups were treated
for twelve weeks before the symptoms were re-evaluated. The results showed that
cognitive therapy was superior to the pharmacological treatment in almost all of
the conditions measured( number of people recovered completely, number of people
who recovered considerably but still experiencing borderline to mild depression,
number of people who did not substantially improve, number of people who dropped
out of treatment). The empirical findings indicated that fifteen out of
nineteen people who were treated with the cognitive therapy completely recovered.

Only five out of twenty five people treated with antidepressants completely
recovered. The only category where pharmacological treatment was superior was
the category that measure the number of people who recovered considerably but
are still experiencing border line to mild depression. Only two individuals
recovered partially under the cognitive treatment, where 7 people recovered
partially under the pharmacological treatment.

Similar research was done in 1992 by the National Institute of Mental
Health(NIMH), NIMH did not find significant difference between the two
therapies immediately after the treatments. They however did find in a 24 month
follow up study that patients who were treated with cognitive therapy were much
less likely to have the disorder return than the patients who were treated with

Even though cognitive therapy seemed to have been superior in both
studies, the findings from the two studies were not corroborative. The study
David Burns describes in order to support cognitive therapy indicated that
significantly more patients recovered in cognitive therapy than in
pharmacological therapy immediately after the twelve week treatment. NIMH study
found no significant difference between the two treatment immediately following
the therapy. The reasons the two studies came up with different results may be
numerous. It is impossible to conclude which one of the two studies is more
valid. However both studies have experimentally demonstrated that cognitive
therapy is a superior form of treatment whether immediately following the
therapy or after 24 month follow up period.

In order to make a stronger point about the superiority of cognitive
therapy, David Burns could have offered at least one more experiment that
corroborated the results. In addition the methodology of the experiment he
illustrated has some obvious flaws. The group sizes of the two compared
conditions(Cognitive therapy and Pharmacological therapy) were not equal. The
cognitive therapy group had 19 individuals where the drug therapy group had 25
individuals. In calculating the significant difference between the two group
means, using the t-test, would require the groups to be of equal sizes.

Therefore, due to the group size inequality, the results may have been
interpreted more liberally than if the group sizes were the same. On the other
hand having a smaller degree of freedom in the cognitive therapy group required
a greater t score in order to infer significance. As a result it is difficult
to conclude whether the methodology of the experiment had anything to do with
the significance of the results. However, if the study is to be replicated, it
would be beneficial to keep the sample sizes the same. This would make the
study stronger, and results more interpretable.

The author of this book has been greatly influenced by the theories and
studies of Aaron Beck MD. Specifically, the author has based the theoretical
part of the book on Beck’s cognitive distortion model. This model postulates
that depression is best described as a cognitive triad of negative thoughts (
Saranson ; Saranson 1996). Beck suggests that a person who is depressed focuses
on negative thoughts, interprets situations in a negative way, and is
pessimistic and hopeless about the future. In other words people who are
depressed might blame themselves for their actions in the past and continue to
believe that the future is just as gloomy. Beck also believes that any
misfortune that happens to a depressed person is internalized and attributed to
their own character. These internal and stable interpretations of negative
events leaves the person feeling hopeless and in turn depressed.On the other
hand, according to Beck’s theory, any positive events in the depressed person
life are externalized or considered to be “lucky”. In a sense, such people may
feel that only bad things happen to them and that if anything good does happen
it is due to a circumstance that is beyond their control. However, people who
are not depressed tend to do the opposite, they blame the situation for anything
bad in their life and accept full responsibility for the positive aspects of
their life. Beck describes the above as the attributional model of depression.

David Burns summarizes this theory in a way that is very easy to follow
and conceptualize. He identifies the process that is going on in the depressed
person/s mind as the process of cognitive distortions. He identifies the ten
most common cognitive distortions. Most of them are self explanatory therefore
I will name all of them and only elaborate on some. The first cognitive
distortion mentioned is “All or Nothing Thinking”, a tendency to evaluate
personal qualities in black or white categories. Second is “Overgeneralization”.

Third is a “Mental Filter”, which is a way of picking out a negative part of a
situation and thus assuming that the situation as a whole is negative. Forth is
“Disqualifying the Positive”. Fifth is “Jumping to Conclusions”. Sixth is
“Magnification and Minimization”, which is the way a depressed person magnifies
the bad elements of their life and minimizes the good. The seventh cognitive
distortion mentioned in the book is “Emotional Reasoning”, which is interpreting
emotions as proof of how bad the situation is ( i.e., I feel stupid, therefore
I am stupid). Eight is “Should Statements”. Ninth is “Labeling and
Mislabeling”, a way of creating a negative self-image based on the errors of the
person’s errors. The last cognitive distortion David Burns mentiones is
“Personalization”, which is assuming responsibility for negative events even
though there is no basis for doing so.

Once the author identified and explained the cognitive distortions, he
then attempts to illustrate how they are used in every day life, which makes
the book much more relevant to the reader; this is one of the crucial
differences between academic writing and self-help books, such as Feeling Good;
the reader automatically understands the relevance of the theory and feels
compelled to apply it.

The strength of the cognitive theory of depression is that it
concentrates on the obvious problem at hand. The person who is depressed often
does not have the energy or will to search deeper than the problem that is
facing them. Therefore, this theory seems very useful especially in its ability
to raise motivation in patients. Patients usually understand the thoughts and
resulting feelings more clearly as a result of this approach. However the
cognitive theory of depression does not break the surface of the problem; the
theory does not go deep enough into the “wound”( in order to try to
conceptualize and “fix” the root of the problem). The psychodynamic approach is
far superior to the cognitive approach when the nature of the problem is deeply
rooted and stems from the person’s childhood. If the patient who is
experiencing depression has an unresolved conflict inside their psyche, the
depression may recur if such conflict is not addressed. Unfortunately the
original idea behind the cognitive theory would not support that. Fortunately
some cognitive therapists, such as Beck, have recognized the importance of this
issue and have appropriately reconstructed the clinical application of the
cognitive theory so that provision for such deep rootted problems are made.

David Burns implements the cognitive theory of depression by suggesting
some simple to use self help techniques. These techniques are similar to some
of the therapeutic approaches clinicians use in cognitive therapy. For example,
a clinician may try to coach the person who is depressed to identify some
automatic thought that leaves them feeling depressed, and substitute it with
thoughts that evaluate the situation more realistically. David Burns implements
this approach in a similar way. He first identifies the importance of gaining
self esteem in order to deal with depression. Burns presents some cases where
he first identifies what the patient is saying about themselves, and then
challenges their statements. This shows the patient how unrealistic their
negative self evaluations are and in turn boosts their self image from hopeless
to somewhat hopeful. The second step was to help the patient overcome their
sense of worthlessness. This was done in a way that the patient is encouraged
to identify thoughts that lead them to feel depressed. This approach is
concurrent with other cognitive therapists’ approaches. The cognitive therapist
reasons with the person, encouraging them to understand why these thought are
distorted, and finally helps them to implement more realistic self-evaluatory
statements. As a result, the approach of combating distorted thoughts by
talking back and implementing more realistic thoughts corroborates David Burns’
therapy with other cognitively oriented clinicians.

This book seems to be very effective in identifying some common thoughts
and feelings depressed people might experience. As such, this book would be
very appealing to people experiencing depressed moods as well as anyone who
feels hopeless about their day-today life. The author describes everyday
feelings and thoughts in a way that is very comprehensive. The reader is left
with the encouraging impression that their feelings are common and curable.

However, for a person experiencing clinical depression, this book may present a
false sense of hopefulness. The reader who is in this predicament, may solely
rely on this book and ris failing at implementing the techniques suggested by
the author. The therapeutic techniques suggested are best utilized under the
supervision of a clinician. The author does not encourage the person to get
help beyond this book. Therefore, the therapeutic techniques illustrated in this
book are left to be interpreted by the patient. This might be dangerous if the
depressed person is in a frame of mind where he or she is hanging on any breath
of hope put forth. In short, the book itself may not completely accomplish its
purpose; which may bring the patient back to their original state if not leave
them feeling even more hopeless about their future.

Category: Philosophy


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