Cognitive Therapy is as effective as anti-depressants in chronic depression

Discuss

86 Responses to “Cognitive Therapy is as effective as anti-depressants in chronic depression”

  1. biggaloot says:

    Burns has a newer book out that addresses both panic attacks and depression, called When Panic Attacks. I’ve found it helpful and also entertaining.

  2. Justin France says:

    Anyone who has long term problems with anxiety and pursued both treatments generally comes to the same conclusion. Drugs can help, but have no long term value beyond miserable cycles of tolerance and addiction.

    There is nothing like self-awareness to fix any problem with the self, be it chronic, acute or just slightly annoying.

    And don’t get me started on big pharma, they are evil. And directly responsible for the over medicated responses to psychiatric phenomena.

  3. Amayain says:

    Hey guys, a few points

    This is something we have known for quite awhile. There have been many studies, since the 70′s, comparing the efficacy of various treatments and CBT usually comes out as very effective.

    For depression, CBT and SSRI’s appear to be equally effective; however, their effectiveness varies based on the severity of the depression. For people with severe depression, biological treatments are more effective. However, for people with mild to moderate depression, CBT is more effective.

    Also, MLH’s (#21) point about CBT being different from MBCT is very valid. The text describes CBT, yet the article is actually about MBCT. Let’s not confuse the two.

  4. zodwallop says:

    Great post.

    Just want to second that while both Cognitive Behavioral Therapy (CBT) and Mindfulness Based Therapies are both shown to be effective in treating many disorders, they are two different approaches to therapy. The first is based on systematically applying logic to thoughts that are not effective or that are likely to lead to unnecessary anxiety or depression where the second combines the basic principles of CBT with aspects of Zen and Theravadan Buddhism. Both are empirically based, but each seem to work through slightly different mechanisms.

    For those interested in empirically supported mindfulness and acceptance based therapies you may want to look up:

    Acceptance and Commitment Therapy
    Dialectical Behavior Therapy
    Mindfulness Based Stress Reduction

    Each of the above therapies has several very good introductory self help books available. Burns’ book is also an excellent CBT resource.

  5. Sister Y says:

    an eight hour anxiety attack with a crushing depression chaser

    Anonymous, thank you for explaining what it feels like – it sounds horrible and tends to bum people out, but I think it’s important for people to know what it’s like in order to empathize.

    a dogmatic One True Wayer

    I think of her as endearingly stubborn, like me.

  6. shiseiji says:

    Noen, my comment is on the balance between compassion and victim blame. “It works if you work it.” is classic 12 Step (Alcoholics Anonymous) and always puts me on guard as many use it to defend their particular method. I believe you are saying any program requires work from the person who desires the help. My experience has been that I needed the drugs to get over a major hump and a counselor (which my insurance will pay for and extend with little trouble, due in part to the acknowledgment of PTSD and that it can take a long time)to keep me going. She recently suggested (and I fought for several months) increasing my meds (and it has helped). I have many of the books listed above and am starting on The Mindful Way through Depression.

    The hardest part for me is the daily grind of up at 5 to exercise, the hour commute in DC (even on the Metro), 9+ hr days and then the hour+ home, fix a decent meal etc. “and” add in meditation, reading, etc. I miss my kids, but am glad I don’t have their care on my plate too (though the child support/alimony of $24K means I can’t easily change my work situation, the court owns me).

  7. Anonymous says:

    I walked into my GP’s office with a self-reported inability to pay attention to my work, and walked out with a prescription for ADD drugs. After less than 15 minutes. I know for a fact it’s the same with Depression drugs.

    And I was genuinely thinking I needed help; I can only imagine how easy it would be to fake it and get Ritalin or something just for the high. I’m sure many people do.

    However I don’t think the doctor was bribed or part of a conspiracy. More like too busy. They don’t have time to figure out what might really be wrong.

    In the doctor’s defense, I was in fact referred to a therapist after the drugs didn’t help.

  8. elNico says:

    I think general practitioners/doctors should not be allowed to prescribe anti-depressants – a referral to a psychiatrist and a number of sessions should be the minimum deterrent to prescribe this stuff like cough medicine.

    Unfortunately I gave in to repeated suggestions by a GP to take anti-depressants years ago during a very low phase in my life. The drug was Efexor and when it didn’t really do all that well, the remedy was apparently to double the dose.

    Looking back it seems ridiculous, but if one’s on a real prolonged low, any advice by anybody with some supposed authority on the matter feels like something that’s at least worth trying.

    It took me several long term attempts to get off that stuff again, since the withdrawal symptoms can only be described as severe.

    The fact that I eventually could find hundreds of people online with exactly the same symptoms, yet concerns were often simply rejected by several GPs since it wasn’t in their info material (a lot of the studies ARE funded by the pharma industry, no?) made me pretty cynic about the whole process.

    Anyway, I’m not suggesting that anti-depressants are flat-out bad, after all I can only go by a study of one subject, but I’m certainly glad they’re not-to-be-repeated history for me.

    Trying one of the different therapy approaches mentioned in this thread with a reputable professional should probably be the first line of defence before trying anything else.

  9. Tzctlp says:

    I think “#24 posted by noen” nonsense has been utterly debunked by others. What he is advocating is the “pull yourself up” method of dealing with depression. Anybody that has dealt with a depressed relative knows that such ill conceived “advice” is the very last thing a depressed person needs.

    Now, sorry to rain on the parade of some, but there are different kinds and levels of depression and different people need different solutions.

    To my afflicted relative the AA like help groups were utterly unacceptable, specially when they began the “lets pray” nonsense or any other new age mumbo jumbo.

    This person also tried countless therapy methods and had many false starts.

    The only thing that gave the necessary stability was Prozac. Yeah, side effects and all, I know all about those and about the worst ones rumoured to be associated with the drug. But it worked for this person, which allowed to continue looking for other kinds of help until a workable solution was found.

    Anybody advocating silver bullets on this thread is utterly wrong, fortunately somebody pointed very insightfully that psychology and psychiatry are not sciences (or exact sciences if some prefer this description) in the strict sense of the word, so treatment may involve lots of hit and miss, specially for people dealing with this problem for decades, not as a one off …

  10. jessainthebox says:

    noen #73:
    By calling a particular treatment a magic cure, I don’t mean to say that it is an easy cure, I mean that it is a guaranteed cure. No one says that chemotherapy is a guaranteed cure for cancer because it isn’t and doing so would give people false hope, which I find cruel. When a cancer patient goes through the awfulness of chemo on the promise of a cure, rather than simply the possibility of a cure, only to find that it doesn’t work, I’m pretty sure that patient feels worse afterward. Not to mention that this hypothetical patient has gone through the awfulness of chemo for naught. In this regard, you, yes you, are treating CBT as a magic cure.

    Beyond that clarification, I have little argument that will convince you where others here have not. The reason you and I clash, which I suspect is why you are clashing with so many other commenters, is that you are unwilling to allow others their experiences. I have my own opinions about why what worked for me worked, but I also acknowledge that different things (drugs, therapies) work differently for different people; that perhaps the right placebo is exactly what some people need, even though “cure by placebo” contradicts my ideals. However, it seems you are not willing to allow others their experiences. Perhaps you doubt our perceptions of reality, perhaps you are just totally convinced by your own viewpoint, perhaps you have some other reason. Either way, debating us will do little: you won’t learn anything from me because you refuse to take me seriously, believing instead that I am simply deluded, and I won’t learn anything from you because I’m not convinced I can trust you, someone who seems primarily interested in converting others beliefs on this, because if you haven’t seen fit to take me seriously, I doubt you have seen fit to take others seriously which makes me question where you could have ever come to such conclusions.

  11. Frank W says:

    I’m not a bit surprised. Symptom suppression may be a way to prevent unnecessary suffering or death, but healing is something else altogether. Healing comes from getting to know yourself.
    The classic Buddhist sit-down-and-focus-on-your-breath meditation is what keeps me sane enough. That and the good influence of my unspiritual unteacher, John Sherman, and his simple admonition, “Look at yourself.”

  12. wolfiesma says:

    J9C@68 That’s the problem with mind manifesting reality, I guess. I’ll be more careful next time.

  13. sirdook says:

    Neon,

    Your comment is deeply arrogant and offensive. You assume that what worked for you in your situation will work for anyone in that same situation if only they apply themselves as you do. Thus, if anyone tells you it didn’t work for them, it means they were doing something wrong. No doubt that explains some failures, but the term ‘depression’ covers a wide range both in terms of severity and of causes. One thing I’ve learned in my experience with a close relative’s mental illness is that there is a remarkable variability in which treatments are most effective for different people.

  14. wolfiesma says:

    There are many roads. However, I think if they put a little zoloft in the water we’d start to see some really positive societal changes. Who couldn’t use a little more serotonin in their life?

  15. Stefan Jones says:

    I’ve found tubs of chocolate frosting helps a lot.

  16. Takuan says:

    a thousand monks, a thousand doctrines.

  17. NicoNicoNico says:

    Thank you for bringing this up! I’m going through withdrawal because of SSRIs (it’s called SSRI discontinuation syndrome). It’s the toughest thing ever, especially when you have it bad enough to cause seizures. There are even brain zaps where not only does your mind go out of focus, it gives a terrible headache, as if your brain is being electrocuted from the inside out. They should ban these drugs, especially Cymbalta.

    This is such a good alternative to drugs. Thanks for bringing it up.

    (I can’t use it, however. I was taking SSRIs for the pain resulting from Complex Regional Pain Syndrome, and behavioral therapy is harder when there is physical pain.)

  18. Anonymous says:

    Yep, that book (at the suggestion of a therapist who knew what he was doing) dragged me out of the pit and kept me out…it just retrains you to not make certain mistakes in thinking. Seems too simple to work, but it does!

    PS: saw the therapist about 5 or 6 times….he said his job was to coach me into not needing him, and that’s exactly what I did!

  19. Bob Rossney says:

    Cognitive therapy is extremely effective for many people who suffer from depression. It is also ineffective for many people who suffer from depression. While “it only works if you work it” – tautological, since “working it” is what CBT is, so if you’re not “working it” you’re not doing CBT – there are many people for whom it just doesn’t work.

    Depression can be learned behavior (the mechanics are described by Seligman’s excellent Learned Optimism. But it’s often the case that the cognitive component of depression is a symptom of the physiological component. It’s also often the case that depression is a second-order effect of a different disorder, like ADHD. In those cases, treating the symptom fails to treat the illness.

    As far as the insurance issue goes, it’s true that insurance companies will pay for CBT. Why, my Kaiser plan covers up to 10 therapy sessions a year! The other 42 are up to me.

    As to the anonymous poster who said that he got a scrip for Ritalin after a 15-minute conversation with his GP: There’s a reason for this, and it’s not that Big Pharma is making a fortune off of methylphenidate (it’s not). It’s a safe and inexpensive mediation. People with ADHD often respond very well to it. People who don’t have ADHD never do. This makes for a diagnostic tool that’s fast and effective enough that GPs can try it without referring the patient to a psychiatrist. By contrast, if you show up at a GP presenting symptoms of bipolar disorder, you won’t walk away with a scrip for Lamictal, which is too expensive, too tricky to administer, and has too scary a side-effect profile for that to be a responsible or effective diagnostic technique.

  20. Clif Marsiglio says:

    @41

    “They don’t stick needles into your brain, do they?”

    You do realize the nervous system is a larger part of the brain don’t you? Err…kinda.

  21. Clif Marsiglio says:

    Great post Cory!

    I work in mental health (interning right now…not licensed), and working on my PhD right now after having my life collapse and rebuilding everything and suffering debilitating depression as a result. I had always had this, but it got out of control once my health took a turn to the south…could no longer play in the bands I was working with, and my side occupation as a university nerd suffered because I just couldn’t think.

    Being a nerd, I decided to hack my brain and figure something else out and moved on to these techniques as well…err…with several diversions that just didn’t help.

    CBT is most definitely the way to go to fix these things. People don’t realize that most of the time the chemical imbalances are created BY the minds attempt to find stasis, and you are not depressed because of the imbalance. Drugs do nothing to stop this aspect because you will right yourself for a moment, and then quickly start the slide again with much worse competing forces in motion. Drugs, however, may increase the effectiveness if given early and QUICKLY pulled off while performing CBT. It gives a slight edge and a bit more adhesion to the therapy if someone can see results immediately.

    All psychologists know this…insurance companies know this too…but as others have said, it is both cheaper and the drug companies have a vested interest in making certain this stays the same. I live within a few blocks of Eli Lilly’s headquarters, and it is one of the largest employers in my city, and the attitudes sicken me when talking to the people there…I almost didn’t feel bad about totaling the some 25 year old blondie drug rep / drug whore’s car (seriously, how does a 25 year old with no background in medicine, but a degree in marketing and a Miss State pageant title have the right to go into my doctor’s offices and push their candy? It should be criminal…BTW…I still don’t know who was at fault for the accident and not claiming responsibility in case corporate lawyers see this). Heck, even in academia it is impossible to avoid these people…they have consistently been a provider of grants to my institution and myself. Personally, I send the grant contact to my lawyer who strips out any wording about review rights and otherwise and they generally okay it.

    Beyond this, the MCBT is even better (and as noted somewhat different than traditional CBT…both retrain the mind)…but then again, I attend a small sangha where several of the participants are psychologists or psychiatrists. They say Buddhism is the original study of the mind. I always feel refreshed after meditation…especially the walking meditations where for a half hour (or more), you quietly experience everything, touching, smelling, seeing, listening…open all the senses up but without assigning values. Just noticing. It was, however, a bit chilly yesterday in the first snow.

    I would suggest this for anyone needing a reboot…once it becomes habit, it helps refocus your life on a regular basis. After a while, you do it without thinking about it.

    Anyhoo…

  22. noen says:

    sirdook
    “Your comment is deeply arrogant and offensive. You assume that what worked for you in your situation will work for anyone in that same situation if only they apply themselves as you do. Thus, if anyone tells you it didn’t work for them, it means they were doing something wrong.”

    As shiseiji correctly notes my comment is straight out of the book. Please notice that I didn’t say quite what you think I said. There is a difference between being responsible for and being responsible to. What I’m referring to is one’s relationship with your program. If the word ‘attitude’ bothers you then substitute ‘stance’ or ‘position’. You are correct that what works for one person may not work for everyone but that wasn’t what I was talking about.

    SisterY
    “But then, what do I know? I’m just a stupid layperson”

    I don’t think you’re stupid, why would you insert that? However I do have my doubts that as a lay person you are in a position to adequately judge the effectiveness of an entire discipline. You’re not a professional in this area and so, with all due respect, your opinion based on a web search doesn’t hold a lot of weight as far as I am concerned.

    “Maybe acupuncture only works if you work for it? Why have evidence-based medicine at all?”

    How’s that attitude working out for ya huh? As you seem to indicate upthread not so well I take it. I don’t know anything about acupuncture but I didn’t say that _blank_ only works if you work for it. You included the ‘for’ not me. DBT (which is CBT + Mindfulness) is as others have said a toolbox but tools only work if you pick them up and use them for the purpose for which they were designed. That is what is meant by “it only works if you work it”. It’s very pragmatic which is the heart of evidence-based medicine and indeed all science. It would appear to me that based on the passive-aggressive nature of your comments that you have not actually picked up the tools and used them. You’ve left them in the toolbox and then proclaim them useless to you. So just who is being aggressive here?

  23. maggiem says:

    I wish it were this easy. Yes, therapy can help depression, but ultimately, if you have true, clinical depression or another mental illness, sometimes medication is necessary. Depression and mental illness are diseases, just like diabetes or any other chronic medical condition requiring medication to control it. If someone is only slightly diabetic and can control it through diet, great–but if you need insulin, you need it, period. Ditto for heart problems, cancer, etc. No amount of talking about any of these diseases will cure them; same is true of depression.

    Therapy can help you deal with the manifestations of the chemical imbalance that causes depression, and, for those who have situational depression, can “cure” it. But for those with chemical imbalances, no amount of cognitive therapy will cure their condition.

    I do agree with MichaelRN, though–it’s crazy how hard it is to be able to get coverage for psychotherapy but so easy it is to get free or cheap prescription medication. For someone who is depressed, it’s overwhelming to have to deal with all the insurance loopholes and caveats–treatment plans, referrals, in-network providers, etc–which is really sad.

  24. PoisonedV says:

    Psychology != science

  25. Anonymous says:

    Depression is a choice. Addiction is a choice. They have biological elements also but for both recovery demands that you make the choice to to be free. There is no other path to healing. – Noen

    hey hey hey, hold the hell up there.

    Having been diagnosed with the perpetual nightmare of post traumatic stress disorder and borderline personality disorder as the result of deeply disturbing multiple traumas and abuse i find that comment so deeply offensive it’s hard to find the words.

    Before my therapy (3 years and still going) I lacked insight into my condition and had isolated myself to the point where no one noticed my bizarre addictive and compulsive behaviour least of all me.

    Being in a state of constant uncontrollable stress and overwhelming fear and anxiety, unable to sleep at night, nightmares and the like take a terrible toll on the body, the result of which adds to already deep depression.

    Trying to unthink your way out of depression is an impossible task when you’re unable to think due to being spaced out all the time or overwhelmed with fear. The only way out seemed to be suicide, which luckily for me(i think) didn’t work. It feels like it’s never going to end.

    Your comments only add guilt into the pile of people already suffering terribly and seem to smack of a ‘blaming the victim‘ perspective to me.

    Have you ever had to experience an eight hour anxiety attack with a crushing depression chaser? I doubt it or your comments would reflect more compassion.

  26. janusnode says:

    This isn’t really news: these studies have been done for decades. I happened to have on my desk a meta-analysis (= review of many studies) of psychotherapy versus pharmacotherapy for depression that is nearly 20 years old: “Robinson, Berman, & Neimeyer (1990) Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 101:1, 30-49″. It looked at cognitive therapy too (among other therapies), and came to more or less the same conclusion: to be precise, they said psychotherapy was better than pharmacotherapy with an effect size of 0.13- which is small, but statistically reliable.

  27. Another Damned Medievalist says:

    Thanks, Cory. I’ll be sending a copy to someone I know who really does need it :-)

  28. Sister Y says:

    Hi Noen, my concern wasn’t whether the study was controlled, it was how it was controlled. The exact nature of the control can make a big difference in whether an intervention looks effective.

    In some of the first studies testing whether accupuncture works for pain, for instance, accupuncture was tested against, say, a sugar pill. It appeared to be effective – accupuncture works! Except that later studies tested it against a real control – say, a nurse with no knowledge of accupuncture randomly sticking needles into people – and the effect disappeared. Fake accupuncture was just as effective as real accupuncture.

    Some of the studies reviewed in the Am J Psych paper I mention above were trying to study the effectiveness of CBT, but were “controlling” it against, say, putting a patient on a waiting list for treatment. Surprise, CBT looked effective! But later studies that tried to control for the effects of just talking to a person in a therapeutic atmosphere – e.g., the control group got to chat with a social worker or got some other form of counseling – and, with that sort of control, they found no significant difference for CBT in treating depression.

    But then, what do I know? I’m just a stupid layperson. I have a friend who is convinced that accupuncture cured her depression. Maybe accupuncture only works if you work for it? Why have evidence-based medicine at all?

  29. Anonymous says:

    I never thought I’d be the kind of person to support drugs, but going through depression personally has changed a lot of my preconceptions. :) I have the Feeling Good Handbook and love it– it’s been very helpful for me– but I lost a year assuming CBT and therapy was enough. Sometimes anti-depressants can be the missing key that ties it all together. They’re not the devil. They’re just another tool.

    I’m on my way back off of them now, two years later, and I’ll be keeping the Feeling Good book handy.

  30. Anonymous says:

    CBT changed my life starting 5 years ago. While I bought the book you recommend, and it was a great start, I actually needed to work with a counselor to see great results. The results were impactful, insightful, and I still use the techniques today. It has fully turned my life around. I did do meds as well, but am finally weaning off, and feeling better than ever. The mind can do evil things to itself – the key is to learn when it’s doing that, and control “reality.” Great post!

  31. Clif Marsiglio says:

    Sister Y –

    You are right about talk based therapy being effective…but it doesn’t last.

    If it is a short term depression (‘the blues’), talk therapy is the best way. Most depression is not the bad kinda (in the sense that we all need highs and lows in our lives). Most is temporary and will go away on its own.

    Most of the times these studies aren’t looking at the chronically, and significantly depressed because there is too much risk. Most therapy involves a big portion of talk…if you look at works like Carl Rogers, you realize how well it can work.

    But most real psychologists don’t stop with just talk — they give a toolbag to work from. CBT is just that. They give a way that a patient can reshape the thinking so that they can change. Unfortunately, most people want a push button solution to everything…we are as much to blame for the drug society as the manufacturers and insurance are.

    As for accupuncture. There are some neurological aspects to this…it almost doesn’t matter where you are poking, but it is the process of doing this while focusing on changing. The idea is that you think about what you should do (will be doing) to change, and as the needles open up different ‘meridians’…it is actually just causing neural pathways to open that would not normally be open and allowing one to put thoughts into this area. In psychology, there is a there called the availability heuristic. You shape your beliefs based upon what you can think of immediately — what is available to think of. Implanting these positive thoughts into different parts of the brain helps make this thought more available.

    The availability heuristic is also related to reasons why a lot of therapies don’t work outside of a doctors office…you get training in that room and feel better there and can imagine feeling better there, but not when you are out of this area. You don’t think about it. Great thing about CBT? You can practice this stuff anywhere and the more places you try, the more likely it will stick. Get someone that is only into talk therapy? Their life falls apart the minute they have a crisis and can’t get to their therapist or sponsor or best friend. You need to give someone something that works and can be done solo.

    Many different techniques out there….not all work for every person. CBT works for most (especially if one is willing to put the time in)…but not everything works for everyone and if it doesn’t work for you, then it doesn’t mean it doesn’t work (and if someone isn’t willing to put the time it, this is something that any competent therapist or doctor should realize and move on to something that will be easier to adhere to).

  32. noen says:

    sirdook
    I don’t care what book it’s out of, it’s arrogant crap. Based on Sister Y’s report that CBT didn’t work for her, you assume she wasn’t “working it,” that is, not trying hard enough.

    I don’t have to assume, I know.

    And you explicitly state that it’s “up to you” whether to get over depression or not. That implies that the program works for anyone who’s willing to try.

    Once again, it’s not so much the program as it is one’s relationship with whatever program we’re talking about. “Here I am, fix me” will not succeed ever, not in a million years. It’s a hard thing to say I suppose but I don’t know any other way to get the message across. A passive relationship with respect to one’s treatment will not work. It’s an act of compassion to call one’s attention to this fact. Not to do so, to simply further enable, is cruel.

    that can only be true if this is the magic treatment that works for everyone, no matter what the cause of their depression.

    Depression is a choice. Addiction is a choice. They have biological elements also but for both recovery demands that you make the choice to to be free. There is no other path to healing. Our culture and it’s psychology of control is currently structured in such a way that to point this out is considered taboo. That’s how ideology works.

    Tzctlp
    I think “#24 posted by noen” nonsense has been utterly debunked by others. What he is advocating is the “pull yourself up” method of dealing with depression.

    No, I’m advocating that one take one’s meds and work one’s program. Whichever one it happens to be.

    The only thing that gave the necessary stability was Prozac.

    You’re aware of course that Prozac is no better than placebo right? Any stability your relative found didn’t come from the drug. It has no efficacy better than that of a sugar pill.

    somebody pointed very insightfully that psychology and psychiatry are not sciences (or exact sciences if some prefer this description) in the strict sense of the word

    False, they are in fact true sciences. As true and “hard” as quantum mechanics or biology. This belief that the social science are somehow “soft” compared to the “hard” sciences is a hold over from Karl Popper’s bullshit ideas of logical positivism.

    jessainthebox
    it is painful for someone to be told “here is the magic answer!” only for it not to work. Please temper yourselves, for the sake of those people.

    You are right that there is pain but that pain is not coming from the outside. People do not change until the pain of staying where they are is greater than the pain of doing something. No one is saying that CBT ot DBT is magic. It is hard work. It’s just human nature to sit there in your disease and beg for someone to help you. But the irony is that no can because that very attitude is the disease. And yet, calling their attention to this fact is considered rude. Very well then, I’ll be rude, you can thank me later.

  33. Anonymous says:

    I’ve been a reader of boingboing for quite a few years now and never posted on any comments. I’ve been struggling with depression for even longer than that. I’ve been seeing a therapist and talking about starting medication, trying to reach a turning point in my life. I saw this post this morning and got out of bed and bought this book. Thank you for sharing.

  34. Kay the Complainer says:

    Cliff, out of curiosity, how does accupuncture open “neural pathways”? They don’t stick needles into your brain, do they?

  35. j9c says:

    Cory, thank you. I’m adding your recommendation to my toolbox.

    A few more things that work for me are Vitamin B-complex supplements (Jarrow makes one that easily assimilable), and large doses of EFAs (check Dr. Andrew Weil’s list here http://www.drweil.com/drw/u/ART00696/depression-treatment.

    Though it may not be entirely feasible for some of us, avoiding broadcast television has also helped me (and more important: my kids). Thank goodness for The Internets and DVDs.

  36. DonaldFleck says:

    This study showed that mindfulness meditation and CBT (cognitive behavioural therapy) can combine to give as much relief to long-term depression sufferers as medication.

    Other studies have shown that Mindfulness Based Cognitive Therapy (MBCT) for depression can cut relapse rates in half, for people who had long-term depression caused more by rumination than by specific life events.

    Such good news.

    I’ve been offering MBCT in New York City for a bit more than a year. I’ve found that it not only helps depression, but it also can improve quality of life, as the participants learn to accept more moment-by-moment experience.

    Donald Fleck DCSW

  37. brundlefly76 says:

    Ironically, 10 years ago was the beginning of my bout with depression and daily panic attacks which would sometimes result in loss of consciousness.

    For 5 years I used CBT, meditation, and exercise (plus the Feeling Good workbook!) to treat my symptoms, with limited success, as even back then I was told that CBT was proven to be as effective as antidepressants.

    However, it wasn’t until I went on Prozac 5 years later that I really could get on with my life.

    What upsets me is that SSRIs are often villianized in the media as unnecessary and its consumers ‘weak’, but for me they have gotten my life back to normal with no meaningful side effects.

    As a result, I avoided them for 5 years, and those were 5 very bad years of my life.

    Those 5 years didnt just go away, they left scars on my life and relationships. I honestly feel that I would have been much better off long-term if I had tried them first.

    The important message I want to give people is that you should never take one person’s experience as a guideline for your own recovery.

    Everyone’s depression is different, no one’s anecdotal recovery should be used as a roadmap for your own.

  38. Sister Y says:

    If we think of a science as something capable of producing predictive models, of generating testable hypotheses, then psychology has at least the potential to be a science. I think the work of people like Martin Daly and Margo Wilson realize that potential, and certainly there are many genuinely scientific studies conducted in the field of psychology. But psychology has some strikes against it in its struggle to be a real science.

    One problem is that its roots are in non-science and pseudoscience (psychoanalysis, etc.). That’s not fatal – psychoanalysis is, thankfully, no longer a viable paradigm in psychology. But a more serious problem is that psychology, by its very nature, rests on value judgments in a way that, say, physics and chemistry do not (e.g., pathologizing a sexual fetish or the judgment that life is not worth living). In addition, clinical psychology is faced with the problem that it’s difficult to get accurate information from someone you have the power to punish for the “wrong answer” – and psychologists and psychiatrists certainly have punitive power over their patients, if only (nowadays) in the form of involuntary hospitalization.

    Thought disorders like schizophrenia do seem like what we think of as real diseases. Many of us think, however, that at least the DSM-IV and DSM-IV-TR diagnoses of depression are seriously flawed – and not just anti-psychiatry, Scientology crazies, either.

    And while a diagnosis might have a claim to scientific reality – consistent etiology and treatment responses, etc. – it seems like a strange kind of medicine to force treatment on people who do not want it.

  39. mgfarrelly says:

    Cory, thank you for talking about depression with the same clarity and precision that you bring to any topic. Notable people talking about working through depression in such lucid ways is very inspiring.

    I work with young adults and have often seen kids who are medicated from a very young age. I’ve often worried about the long-term effects on their health and if other forms of therapy might be just as helpful. It’s encouraging to read this, thank you!

  40. travelina says:

    Cognitive therapy just makes sense. It’s easy to learn and gives you a sense of empowerment, the opposite of being dependent on drugs. Thank you Cory for posting about this.

  41. sirdook says:

    Noen,

    “I don’t have to assume, I know.”

    Are you saying you’re friends with Sister Y and so you know her particular history? Or are you saying you know, for anyone, that if therapy didn’t work for them that they weren’t really trying?

    If it’s the second, your psychic powers should have also told you your comments wouldn’t go over well.

    “I’m advocating that one take one’s meds and work one’s program. Whichever one it happens to be.”

    No, you’re saying that CBT will work for anyone who actually works hard and sticks with it. (Otherwise, you couldn’t ‘know’ that strangers weren’t ‘working it’ just by knowing that it wasn’t effective for them – “If you don’t work it, it won’t work” doesn’t imply “If it didn’t work, you weren’t working it.”). And that’s what we’re all calling bullshit on.

  42. Anonymous says:

    Thanks for the information Cory. I just ordered the book.

  43. Takuan says:

    the Talking Cure is better than any drug.

  44. Anne K. says:

    I have long-term (chronic?) depression and CBT has helped me some. Medication for me though is essential. In the periods I have gone without anti-depressant medication (one lasted over a year) since being put on them have been some of the most zombie like years of my life. In fact, they weren’t like living at all. So although CBT has been very helpful in keeping myself out of a major depressive episode or from sinking deeper into the black pit of one, it is very much a crutch for me where medication is more like a ramp and a automatic door. It makes it easier to get around in general.

    The problem with CBT is that it is difficult to actually find a program or therapist that 1. you fit with & 2. your insurance company will cover. Unfortunately, in the U.S. at least, insurance companies feel that “feeling better” equals “being cured” when it comes to most of the mental diseases on the DSM-V list when “feeling better” is something all people with mental diseases know can be a fleeting and untruthful feeling.

    The first thing that happens when you are diagnosed is that they throw a medication at you. If that one makes you feel crazier or more depressed, well, then why not try another? The way anti-depressants are handed out like candy (especially with their potentially lethal i.e. suicidal side effects) is often horrifying to me. I’ve finally found a combo that works really well for me but it took three different medications before I found a combination of two that worked.

    The other problem is that many of the mental diseases are not entirely pathological in origin. There is the chemical factor but even when that is made more level by a good anti-depressant or mood stabilizer regiment, many times the underlying psychological reasons for depressive thoughts and high levels of stress are never probed. Therapy is expensive and finding a therapist you actually like and trust enough to work with is extremely hard and sometimes incredibly stressful in it’s self.

    Mental diseases are not like other diseases and should not be treated as such. You are not dealing with the body so much as it’s effect on the soul and vice versa. It’s an endless gray cycle of your body being heavy and your life like a movie where they forgot to cast your part that makes you cycle into thinking that causes your life to be more gray and more distant and the question, “where does it hurt?” is ineffective because the answer is it doesn’t.

    The problem is at it’s core that the goal of medicine, to elevate pain and lengthen life, is incompatible with a state that sends you into unfocused black tilting safe warm hole where you don’t care about anything, even your own existence. The handful of drugs to lift your mood to somewhere above the heavy weight of the misleadingly comfortable darkness and the week in the psych unit to make sure you won’t off yourself is not a cure. It is not good enough. It is not life and it damages us not only as individuals or friends or lovers or families but as an interconnected society at large.

  45. nanuq says:

    Unfortunately, the medication option is just too easy. Whenever someone with depression goes to a family physician, they usually end up with a prescription for anti-depressants. You pretty much have to push to get a referral for counseling instead.

  46. mikelotus says:

    I am only interested in hearing the opinions of those that have depression on this. Others that talk about drug dependencies and pharmaceutical companies clearly are not suffering from depression and therefore are talking out of their asses. I hear these same experts when the topic is ADD also. As already noted, cognitive behavior therapy has been a part of depression treatment for quite awhile now. As a cognitive therapist said to me — its learning to think right instead of wrong. It is good that improvements in techniques and methods are still occurring that better the treatment, but by no means can it be a substitute for medications in many cases.

    And on #54, no GP should be diagnosing ADD or handing out ritalin unless the patient is already taking ritalin.

    Finally, the arrogance of “all these drugs are bad and you should find ways to stop taking them immediately” is a joke. Assuming there is no side effects noted, no one can provide any evidence that these medications, for depression or ADD are somehow bad for you.

  47. preluded says:

    Funny you mention that book, another vote for Feeling Good Handbook here.

    About 5 years ago I gave this book out to many of my friends. I ordered about 15 copies and just gave it out. I figured that the people who needed it would read it, and the people that didn’t would pass it on (I didn’t want to single anyone out amongst my very close friends, so I went for a shotgun approach).

    This is a very solid book, the new “positive psychology” books really only incrementally build on CBT.

  48. MichaelRN says:

    Unfortunately, it seems that most US health insurance plans restrict access to counseling, while allowing much easier access to pharmaceutical psychiatric treatment. It really should be the other way around; use the meds as a second line of treatment only if talk therapy is ineffective.

  49. Robbo says:

    Oh man, thank you, Cory. You have no idea – well, actually, you DO. Thanks.

  50. Takuan says:

    big pharm spends millions keeping it that way

  51. Pseudothink says:

    Thank you for sharing this useful recommendation as well as a little about your personal experience. Both help.

  52. Anonymous says:

    It may surprise some people to learn that a meta-analysis of the best studies on ear infection (British Medical Journal, 1997, 87:pp.466-74) found no benefit of using antibiotics as compared to placebo.

  53. sirdook says:

    Noen,

    I read what you wrote. Did you?

    It only works if you work it hun. There is no drug in the universe, no talk therapy, that will work for you. You have to work for it.

    and

    It’s ok though, you can stay where you are, it’s up to you.

    I don’t care what book it’s out of, it’s arrogant crap. Based on Sister Y’s report that CBT didn’t work for her, you assume she wasn’t “working it,” that is, not trying hard enough. And you explicitly state that it’s “up to you” whether to get over depression or not. That implies that the program works for anyone who’s willing to try. But that can only be true if this is the magic treatment that works for everyone, no matter what the cause of their depression.

    I’m glad to hear that it works for so many people, but that doesn’t mean it’s the answer for everyone. So why condescend to those who didn’t find it helpful?

  54. wolfiesma says:

    Antinous@61,
    Okay, that was hot.

  55. Anonymous says:

    Thanks for sharing, Cory! This is so important, and it also helped me, too. I thought I was perhaps the only one (doesn’t it always seem that way, though?). I hit a low, low point in graduate school with a substance-abusing boyfriend… and went to a group therapy weekly meeting that centered around this book. I still have the book and have not pulled it out in 5 years. I would also like to recommend a group therapy situation (like the AA you might see in the movies). We each set goals for ourselves, and over the 6 weeks checked in and discussed the program. It was super.

  56. slowth says:

    Thanks very much, Cory. Insurance companies know it’s cheaper to pay for medication than to pay for cognitive therapy from a professional. Big Pharma only provides a cheaper alternative, so there is no vast conspiracy.

  57. Anonymous says:

    Well – a doctor recommended this book to me years ago and I picked it up, but on my shelf it has sat till now, while I almost ended my life in my car and then went on medication. Thank you for talking about it. Now I believe it’s worth reading.

  58. noen says:

    sirdook
    “Are you saying you’re friends with Sister Y and so you know her particular history”

    No, I simply know that the one freedom we do not have is the freedom not to choose. If you come to me with a splinter in your finger and I give you the proper tool to remove it with and then you come back and tell me it didn’t work can I conclude you didn’t try? No, perhaps it is too deep or too painful, that’s ok. Someone else, a nurse or doctor can remove it for you. That is the model you are using and by that reasoning you would be correct.

    But if you come to me with a splinter in your heart I can offer you the proper tool with which to remove it but if you later come back and tell me it is still there, I know you did not use it. No one else can do this for you. Others can offer encouragement or tell you how to get to where you want to be, but no one can get you to stand up and put one foot in front of the other. This is the central dilemma of any therapy. You are the only one who can do what is needed. There is no other.

    The choice is binary. Not to decide is to decide. This is hard to hear. Perhaps I could have put it differently and soften it up a little. I’m not sure how I would have done that.

    “you’re saying that CBT will work for anyone who actually works hard and sticks with it.”

    I am saying two things. You are the only one who can work your program. That is to say, you and only you can perform those behaviors that are part of whatever treatment plan you are in. No one else can do them for you. How would that even be possible? Second, it works if you work it. That is to say, decades of research and clinical studies have shown that the techniques used in CBT, DBT or similar treatments do work in the vast majority of cases. This is not guesswork, this is real.

    jessainthebox
    “However, it seems you are not willing to allow others their experiences. Perhaps you doubt our perceptions of reality”

    I am more than willing to allow others their experiences. I’m not willing to allow others to piss down my leg and tell me it’s raining.

    Anonymous
    “Trying to unthink your way out of depression is an impossible task when you’re unable to think due to being spaced out all the time or overwhelmed with fear.”

    No one is suggesting that one can just choose not to be depressed any more than one can choose not to be alcoholic. The choice is in deciding to do what is required or not. Say a friend is out jogging and comes up to me perspiring, breathing heavily and with an elevated heart rate. Did my friend choose to raise her metabolism? Yes, by choosing to engage in a behavior, in this case running, whose consequences lead to changes in her body. She made a choice.

    Similarly, there is no disease in the universe that forces you to pick up that bottle of booze, raise it to your lips and drink. When you get right down to it all you have is the choice to drink or not to drink. As any alcoholic will tell you, you eventually get to the place where you say to yourself “I don’t care about yesterday and I don’t know about tomorrow but today, this hour, this minute, I choose not to take that drink.” Everything else either helps you or hinders you in making that choice. Even worse, the one freedom you do not have is the freedom not to choose.

    Depression and PTSD are the same. You can choose to continue to engage in those behaviors which make you feel depressed or not. You are free. Even better, there are people who have gone before you who know what works and what doesn’t work. Engaging in your previous self-destructive patterns of behavior does not work. Those who have gone before have assembled a toolbox full of techniques that are known to work. If one doesn’t work out pick another and eventually you will find out what works and what does not. I guarantee it.

    Sister Y
    If we think of a science as something capable of producing predictive models, of generating testable hypotheses, then psychology has at least the potential to be a science … One problem is that its roots are in non-science and pseudoscience (psychoanalysis, etc.).

    This is truly out there Sister Y and not that far removed from creationism or other crack pot ideas. Your notion that psychology is pseudoscience is in error and seems to be based on the long discredited philosophy of Logical Positivism. It explains a lot.

    Thought disorders like schizophrenia do seem like what we think of as real diseases.

    I’ve seen schizophrenics healed with DBT. Not cured of course, just as alcoholics (and other addictions) are never totally cured but remain addicts she was still schizophrenic, but her symptoms disappeared, her life greatly improved. Like her, the path is open to you too. You have only to take that first step, no one can make it for you. It’s all up to you.

    “it seems like a strange kind of medicine to force treatment on people who do not want it.”

    Thank you for confirming what I have been saying all along. You did not want it and seem to believe it is all pseudoscience. Is it really such a wonder then that it didn’t work?

  59. Takuan says:

    “cheaper alternative” equals millions in drug sales, yeah, there is a conspiracy.

  60. Scott Bieser says:

    Not to mention, many anti-depressants have undesirable side-effects ranging from weight-gain to psychotic episodes.

    You’ve done us all a great service, Cory.

  61. Cowicide says:

    Thank you, Cory! Perfect timing for the holidays.

  62. slowth says:

    It’s patently obvious that insurance companies want to save money. They choose the cheapest mode of therapy. They choose a generic SSRI because it’s cheap. Patient pays $4 and goes on his/her merry way. Contrast that with paying a professional: $70-130/hr. Drugs are cheaper, it’s quite simple. Docs are bribed, politicians are bribed, bb posters are bribed, no conspiracy in this case.

  63. Sister Y says:

    I wonder how this study was controlled. A meta-study in the American Journal of Psychiatry from 2003 found that cognitive-behavioral therapy was no more effective than “social worker” counseling or any other form of talk therapy for treating depression. The paper suggests that

    all models of psychotherapy, including cognitive behavior therapy, may be “equally unsound scientifically but they energize the therapists and provide useful fictions to activate the patients to lead somewhat more satisfactory lives.”

    The cite for that study is Am J Psychiatry 160:5, May 2003. It’s good to talk to somebody, but it’s not exactly a medical treatment if chatting with a social worker works just as well.

    From the article linked to in the main post, the 123-person study:

    Over the 15 months after the trial, 47% of the group following the MBCT course experienced a relapse compared with 60% of those continuing their normal treatment, including anti-depressant drugs.

    While apparently significant, that’s not much of a difference. To say that something is “as effective as antidepressants” is, sadly, not saying much. (Just another point of view from someone for whom CBT most certainly did not work – maybe, though, like with Christianity, my faith just wasn’t great enough? Burns seems like he means well, though.)

  64. wackyvorlon says:

    In many cases, there’s really two components to depression. There’s the chemical side, which anti-depressants can help with, and there’s the psychological side. When you are depressed, you learn a lot of ways of thinking that are very negative. Anti-depressants don’t get rid of the negative mindset, so for a lot of people you need both.

    I myself am on celexa for depression, and it helps a lot. I find the winter to be the toughest for me. I have a close friend who is in the hospital right now while they try to get his meds worked out right. It’s a hard thing to deal with.

  65. arikol says:

    The drugs are okay to help a person START to get out of heavy depression. They won’t magically make anyone become non-depressed, but will help with the chemical imbalance that is part of depression (the deeper the depression, the higher the imbalance, the harder it is to get started).
    If you want the therapy to work then you have to do talky treatments as well. The expensive therapist sessions may not need to be that many, but will then need to be followed up by talking someone who lends an ear (and possibly a shoulder).
    This is simple. Depression usually has outside sources and inside symptoms. Treating only the symptoms (medicating) will only make you need to stay on the medication indefinitely.
    If it is a conspiracy then it’s mostly a conspiracy of non-action (well, insurance companies are pretty nasty, though). I worked for big pharma, they thought some of those drugs were over-used. They did like the profits, though.

    Cory, you have my respect for talking about this in this way.

  66. Kenny Mann says:

    It’s interesting to turn the list of cognitive distortions around from what we see and expect in ourselves to what the world around us rules us by. Do “they,” for instance, expect all or nothing, jump to conclusions, discount the positive etc.

    Cognitive therapy is way more sustaining and sustainable than chemicals-for-the-synaptic-interstices, as you say, but our brains could all use a climate with a lower gradient of free-random misapprehension.

    The shrinks would probably be better off and be able to do more good with more kinds of therapies if being reductive wasn’t so imperative in this cognitive storm.

    In the meantime I’ll keep sharing Beck, Burns et al as first-aid and perusing Boing Boing for bursting bubbles of cognitive distortion out there.

  67. Squidhelmet says:

    This is a brave blog! Thank you!

  68. Lexica says:

    Noen @ #24: There are several in this thread claiming variations on the theme of “insurance plans restrict access to counseling”. This is, in my experience, false.

    How nice for you. It is, in my experience, true. Only once in my working life have I had insurance that covered ANY counseling, and it was limited to 20 visits in a year.

    @ 56 you say You are correct that what works for one person may not work for everyone but that wasn’t what I was talking about.

    Then @ 73, you respond to sirdook’s statement “Based on Sister Y’s report that CBT didn’t work for her, you assume she wasn’t “working it,” that is, not trying hard enough.” with I don’t have to assume, I know. and also say I’m advocating that one take one’s meds and work one’s program. Whichever one it happens to be.

    Make up your mind: either “what works for one person may not work for another” or “if CBT doesn’t work for you, it’s because you didn’t work it”, but not both.

    It’s interesting to me that somebody who’s recommending mindfulness practice and Buddhist writers seems to be such a dogmatic One True Wayer on this subject.

    • Antinous says:

      It’s interesting to me that somebody who’s recommending mindfulness practice and Buddhist writers seems to be such a dogmatic One True Wayer on this subject.

      I teach eclectic meditation classes. I try to cover as many styles of meditation as possible, from chanting to visualizations. You wouldn’t believe the scorn that I’ve gotten from Buddhist vipassana practitioners. Besides the obvious irony of The Buddha of Scorn, vipassana is not necessarily the best meditation practice for everybody. But it’s The Only Correct Way, dammit!

  69. Sister Y says:

    I have a friend who works at a dungeon. He says that CBT is an acronym for two things, both of which, coincidentally, will cure your depression if applied correctly.

  70. Ernunnos says:

    I know several people with stories similar to Cory’s, and the greatest thing about it is, not only has it worked, it continues to work. The depression hasn’t come back.

    And no discussion of CBT would be complete without a mention of Albert Ellis, particularly his book “How to Stubbornly Refuse to Make Yourself Miserable About Anything: Yes, Anything”.

  71. jessainthebox says:

    I have strong opinions in this area having spent a third of my 24 years in a hell of depression. Yes, this stuff Cory is talking about works for some people. But not everyone. I strongly suspect that depression is not one thing, that it is several different things and that not everyone who experiences the symptom set, depression, has the same cause. I am skeptical of the honesty of the psychiatric industry in terms of both drugs and therapy.

    That said, I look at the various tools, different types of therapy, distractions, and drugs, as just that, tools. We don’t really know what the problem is, but we have seen these tools work on similar problems in the past. I am all for trying different tools, and finding out what works. Personally, I don’t care which tool it is, if it works I will use it (perhaps this sort of attitude is dependent on the severity of one’s depression). However, in mental health care, there is something weird going on where, out of dozens of tools, they pick out just a few and keep trying those few over and over again even when it is clear that they are not working. For me, cognitive therapy was one of those tools that mental health care professionals used on me again and again even though it simply did not work.

    Basically, the reason I bring this up is because so many of you are excitedly espousing cognitive therapy as a magic answer. With good reason: it was the magic answer for you. But for someone else, it may not be, and it is painful for someone to be told “here is the magic answer!” only for it not to work. Please temper yourselves, for the sake of those people. I have been that person. My attitude toward people struggling in this way is to make their life the least worse possible. That is to say, mental health care is not fun. It feels worse in many ways than the illness itself, but there are ways to make it feel less worse, and one of those is to be realistic in telling tham about therapies. If you tell them it is the magic answer, they will want to believe you and when it doesn’t work, the magic solution doesn’t work, it feels all the more hopeless because if the magic answer didn’t work, it must be uncurably bad.

    Sorry for my passionate rant, but I just want to make things less worse.

  72. Deidzoeb says:

    Cory, thanks for speaking in public about your experience. Lots of people talking about it openly is probably the best way to reduce stigma against mental illness.

  73. monkey says:

    regarding the comment about buddhism being the original study of the mind, this is quite true. shamata meditation (quieting the mind) is a valuable compliment to therapy. it is not, however, a cure-all for emotional problems such as depression or anxiety. saddly, i have seen many misguided dharma practioners who believe that if they just sit more often or for longer periods, their problems will be cured rather than seek therapy or (if appropriate) medication. self blame is often the outcome when no relief is attained. i can only speak from the tibetan buddhist perspective, where practices are directed toward the healthy mind that is afflicted with the emotions of anger, jealously, and ignorance. until the influence of the west crept in to tibetan culture, depression and low self esteem have been foreign concepts so, most tibetan lamas who are not schooled in psychology or born in the west do not understand how debilitating feelings of depression, worthlessness or anxiety can be.

    • Antinous says:

      regarding the comment about buddhism being the original study of the mind, this is quite true.

      Um, Hinduism? Whose deity is consciousness and which preceded Buddhism by millennia.

  74. bolamig says:

    Indeed, I’m discovering CBT and it’s the most effective thing I’ve tried for depression and feeling more energized. I use the book Mind over Mood. The hardest thing for me is realizing that I don’t have to believe what I’m thinking.

  75. Anonymous says:

    No one is suggesting that one can just choose not to be depressed any more than one can choose not to be alcoholic.

    Wait, I thought you said:

    Depression is a choice. Addiction is a choice.

    You also give this scenario:

    Say a friend is out jogging and comes up to me perspiring, breathing heavily and with an elevated heart rate. Did my friend choose to raise her metabolism? Yes, by choosing to engage in a behavior, in this case running, whose consequences lead to changes in her body. She made a choice.

    Your analogy is specious to say the least. People don’t choose the events that cause depression. You only have to look at John Bowlby’s empirical research on attachment theory to see that ongoing depression can be caused by poor attachment in early childhood. Depression can be a natural response to loss and if it happens early enough, can be very hard to shake off, being at a preverbal stage of development.

    How do I know all this? Because i’m being treated by a team comprised of a psychotherapist and registrar in forensic psychotherapy and psychiatry, both working in a ‘Complex Cases Team’. Their opinion is probably a lot more informed than the average person.

    And as for:

    Depression and PTSD are the same. You can choose to continue to engage in those behaviors which make you feel depressed or not. You are free.

    I give in. You’re right, I chose to have the nightmares, the anxiety, the memories of the giant puddle of blood seeping from the girl’s smashed head and her death scream, the emotional numbness, memories of the zombie-like moan of my mother’s attempted suicide by overdose constantly running around in my head. I also chose to come into work drenched in sweat.

    Basically you seem unable to take on board that each case is different. Depression and the like are not conscious choices people make. You also talk of behaviour as if it’s unrelated to anything. When you start to look at emotions sitting underneath the behaviour then things start to change. Maybe for less serious cases of depression changing behaviour first works. Again, each case is different.

  76. mlh says:

    Just wanted to point out that CBT/CT and MBCT are two quite different things. While Cory is talking about Burns’s rather classical CBT book (which is great, IMO), the science story seems to refer to MBCT, which is something else entirely. It has its roots in the mindfulness based stress reduction of Jon Kabat-Zinn, and uses (buddhist) mindfulness meditation as the core practice. Many other so-called “third wave therapies” (such as ACT and Dialectical Behavior Therapy) are now also employing mindfulness with great success.

    However, the “main” people behind some of these mindfulness-based approaches (such as ACT) actually advise against teaching CBT techniques to their clients (at least at first), because the thought-manipulation/disputation of CBT is so different from the thought-distancing/acceptance of mindfulness. CBT helps you see that your negative thoughts are wrong/irrational, while MBCT helps you see that they are simply thoughts – and in and of themselves they are not “real”.

    David Burns’s book is great for CBT. For MBCT, I’d recommend The Mindful Way through Depression by Williams et al. (the inventors of this specific approach).

  77. j9c says:

    @#52. Yo, Wolfiesma, careful what you wish for. Maybe you could benefit from living in New Mexico?

    http://www.uswaternews.com/archives/arcquality/tdrudet10.html

    Eh on second thought, looks like plenty of drugs are available in various public water supplies (in wee doses):


    http://www.alternet.org/environment/43242/how_prescription_drugs_are_poisoning_our_waters/

    In 2002, the USGS published the results of its first-ever reconnaissance of man-made contaminants. Using highly sensitive assays, the agency found traces of 82 different organic contaminants — fertilizers and flame retardants as well as pharmaceuticals — in surface waters across the nation. These drugs included natural and synthetic hormones, antibiotics, antihypertensives, painkillers, and antidepressants.

  78. Anonymous says:

    thanks for the post, I’ve been in cognitive therapy with great results. I like to think of it as brain hacking, undoing bad connections between things and rerouting them elsewhere. The feeling of self-sufficiency, knowing what is going on in your mind and how to manage it is worth every penny and every minute of work. It’s a crime that Big Pharma is keeping people lost in their problems and dependent on pills.

  79. noen says:

    There are several in this thread claiming variations on the theme of “insurance plans restrict access to counseling”. This is, in my experience, false. Dialectical Behavioral Therapy, a variant of Cognitive Therapy, is the one treatment that insurance companies will actually pay for because it really works.

    Marsha Linehan’s “Skills Training Manual for Treating Borderline Personality Disorder” is the defacto standard and is highly recommended. I would strongly urge you Cory, or anyone else, to take a look at Dr. Linehan’s videos at the site linked to above. She has a lot of material on mindfulness that people might find interesting. Maybe you could even convince her to put some of her stuff on YouTube. These videos kind of tend to sit in therapists desk drawers.

    Sister Y speculates whether the study was controlled and how significant it might be. DBT has been throughly backed by many studies and confirmed time and again in practice. A lay person doing a quick web search isn’t going to uncover what a professional with years of experience knows. This is a case where a little knowledge really is a dangerous thing. Depression kills. Anti-depressants do not save lives, neither does talk alone, both together do.

    “Just another point of view from someone for whom CBT most certainly did not work”

    It only works if you work it hun. There is no drug in the universe, no talk therapy, that will work for you. You have to work for it. You have to make a choice to change your attitude from the passive “This drug or treatment plan will make me feel better.” to the active “I am going to take my meds and work my program so that I can feel better”. It’s ok though, you can stay where you are, it’s up to you.

    Thich Nhat Hanh has many books and teaches mindfulness. He is another great resource.

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