The Deadly Reality of Depression

Don't Let Depression Attack You – David D. Burns

Depression is considered by the world to be the leading problem in public health. In fact, depression is so common that it is seen as a common cold in the field of mental disorders. But there's a huge difference between depression and a cold. Depression can kill you. Studies have shown that suicide rates have been rising at a breakneck pace in recent years, even for children and adolescents. This escalating mortality rate still occurs despite billions of doses of antidepressants and sedatives that have been developed over the decades.

It sounds pretty bleak. Let me tell you the good news, before you become more depressed. Depression is an illness and not part of a healthy lifestyle. More importantly – you can overcome this disease by learning simple methods to help your mood. Psychiatrists and psychologists from the Faculty of Medicine, University of Pennsylvania have announced a breakthrough in treating and preventing the emotional disorder. Dissatisfied with traditional treatments for depression because they thought it slow and ineffective, these doctors systematically developed and tested an entirely new and wildly successful treatment for depression and other emotional disorders. A series of recent studies confirm that these techniques relieve symptoms of depression more quickly than psychotherapy or conventional medications. This revolutionary method of treatment is called "cognitive therapy".

I was instrumental in the development of cognitive treatment, and this is the first book to describe these methods to the public. The systematic application and scientific evaluation of this solution in the treatment of depression stems from the innovative work of doctors Albert Ellis and Aaron T. Beck, who began perfecting their unique method of transforming mood in the mid-1950s and early 1960s. Their pioneering efforts have begun to gain prominence over the past decade thanks to the fact that many mental health professionals have conducted research to perfect and evaluate cognitive treatments at institutions in the United States and other countries.

Cognitive treatments are a fast-acting mood-modulating technique that you can learn to apply to yourself. It can help you eliminate your symptoms and experience your own growth, so that you minimize future disorders and deal with depression more effectively.

Effective and simple emotional control techniques in cognitive therapy will help you:

1. Improve symptoms quickly:

In the early stages of depression, you may see symptoms subside after just a short period of time like 12 weeks.

2. Understanding:

Clearly explain why you have mood swings and what can be done to change that. You will know the causes of your intense emotions; how to classify "ordinary" emotions from "abnormal" ones; and how to diagnose and assess the severity of your depression.

3. Autonomy:

You will learn how to apply safe and effective solutions that will help you feel better when you are depressed. I will guide you through the process of creating an applicable, practical, and step-by-step plan for you to help yourself. When you adopt this plan, you can actively control your mood more steadily.

4. Prevention and self-development:

Mood swings can be sustainably and sustainably prevented based on a reassessment of your basic values and attitudes, which are part of your tendency to respond to severe episodes of depression. I'll show you how to question and reevaluate certain assumptions about basic human values.

The problem-solving techniques you learn will handle every crisis of modern life, from minor unpleasant feelings to emotional breakdowns. It includes practical issues, such as divorce, death or failure, as well as vague and deep-seated issues that seem to have no apparent objective reason, such as low confidence, frustration, guilt, or frigidity.

You may be wondering, "Is this just a psychology self-development book?" In fact, cognitive therapy was one of the first forms of psychotherapy to be proven effective through rigorous scientific research under the scrutiny of the academic community. It is the only therapy that has received professional evaluation and recognition at the highest academic level.

It is not a fashionable method of self-development, but a great development and has become an important part of the mainstream research and application trend of modern psychiatry. The academic foundation of cognitive therapy enhanced its impact and helped it stand for years to come. But don't be discouraged by the status of cognitive therapy professionals.

Unlike many other traditional psychotherapies, this therapy is not mystical or paradoxical. It is very practical and rooted in common sense, and you can apply it to yourself.

The first principle of cognitive therapy is that your entire mood is made up of your "awareness," i.e. your thoughts. Your perception reflects how you see things — your views, attitudes, and beliefs. It includes how you explain things — how you yourself understand a thing or someone. You feel in the moment because of the thoughts that you are having at this moment.

Let me illustrate this point. What do you feel when you read this? You're probably thinking, "Cognitive therapy sounds so great that it's unrealistic. It's never going to work for me." If your thoughts fall into this range, then you are feeling doubtful or even depressed. What causes you to feel this way? It's your thoughts. You create these feelings by having a conversation with yourself about this book!

Conversely, you may feel elated suddenly because you think, "Oh, that sounds like this can help me."

The emotional response is not created by the words you are reading, but by the way you think. The moment you have a thought and believe in it, you will have an immediate emotional reaction. Your thoughts actually create those feelings.

The second rule is that when you feel sad, your thoughts are being driven by the negativity that surrounds you. You don't just see yourself, you see the whole world through a dark, sad lens. Even worse, you'll start to believe that things are actually as bad as you imagined.

If you're really depressed, you'll even begin to believe that things have always been and will always be negative. When you look back on your past, you will remember all the bad things that happened to you.

When you try to imagine the future, you see only emptiness or endless problems and pain. This bleak outlook creates hopelessness. This feeling is completely irrational, but it seems so real that you convince yourself that you will forever be so incompetent.

The third principle belongs to the enormous importance of philosophy and cures. Our research has documented that negative thoughts cause mood disturbances that are almost always blatantly distorted. Although these thoughts may seem true, you will eventually realize that they are absurd or completely wrong, and that the wrong thought is the main cause of your suffering.

The accompanying consequences are of paramount importance. Depression is certainly not caused by precise perceptions of reality, but is often the product of a distortion of the mind.

Suppose you believe what I say is reasonable. What good will it do you? Now we will come to the most important results of our pathological research. You can learn to deal with your mood more effectively if you master methods that will help you identify and eliminate distorted thoughts that make you feel depressed. When you start thinking more objectively, you'll start to feel happier.

Compared to other published and accepted methods, how effective is cognitive therapy in treating depression? Will this new therapy help people with severe depression improve their mood without medication? How fast does cognitive therapy work? Is its effect long-lasting?

A few years ago, a team of investigators at the University of Pennsylvania Medical Faculty's Center for Cognitive Therapy, including doctors John Rush, Aaron Beck, Maria Kovacs, and Steve Hollon began a pilot study comparing cognitive therapy to one of the most common and effective antidepressants on the market, Tofranil (imipramine hydrochloride). More than 40 patients with major depression were randomly divided into two groups. One group received cognitive therapy and non-drug therapy, while the other group was treated with Tofranil and not on therapy. The study method that separates these two groups was chosen because it offers the maximum opportunity to compare the two treatments. Until that time, no psychotherapy had proved as effective for depression as antidepressants. This is why antidepressants have attracted so much attention in the media, and for the past 20 years, they have been named the best treatment for most types of severe depression.

Both groups of patients were treated for a period of 12 weeks. All patients were methodically assessed with an intensive psychological test prior to treatment, as well as every month for one year after completion of the procedure.

This is to ensure an objective assessment of the advantages of each method.

Table 1-1. Condition of 44 patients with severe depression, 12 weeks after initiation of treatment
	Number of patients treated with Cognitive Therapy alone	Number of patients treated only with Antidepressants
Number of participants in treatment	19	25
Fully recovered*	15	5
The amount was considered to improve but remained at the boundary of mild depression	2	5
There was no significant improvement in the number	1	5
The number of withdrawals from the course of treatment	1	5
*The significant improvement of patients treated with cognitive therapy is extremely remarkable.

The patients have moderate to severe depression. Most of their conditions did not improve despite previous treatment by two or more specialists in other clinics. Three-quarters of them had suicidal thoughts when referred to the program. On average, patients are tormented by repeated or continuous depression that does not stop for eight years. A lot of people fully believe that their problems can't be solved, and they feel like their lives are hopeless. Your emotional problems may not be as overwhelming as theirs. Critically ill patients are selected so that the treatment can be tested in the most difficult and challenging conditions.

The results of the study are quite surprising and expected. At the very least, cognitive therapy is just as effective, if not worse, than antidepressant therapy, as you can see in Table 1-1. A particularly important point is that many patients treated with cognitive therapy have improved more quickly than those who have been successfully treated with drugs. Within a week or two, suicidal thoughts were reduced in the group treated with cognitive therapy. The effectiveness of cognitive therapy is encouraging for individuals who do not want to rely on medication for upliftment, but want to develop awareness of what is causing them trouble and what to do to cope with it.

What about patients who do not recover after the end of 12 weeks? Like any other treatment, this method is not a panacea. Clinical experience shows that not all patients react as quickly, but most can still improve their situation if they persist for a longer period of time. Sometimes this is a huge effort! An encouraging development for people with severe and persistent depression belongs to a recent study by Dr. Ivy Blackburn and colleagues at the Medical Research Council of the University of Edinburgh in Scotland. These investigations suggest that a combination of antidepressants along with cognitive therapy may be more effective than use alone. In my experience, the predictor of recovery lies primarily in the persistent will to try to save oneself. If you have this attitude, you will succeed.

How much can you hope to improve? On average, patients had a significant reduction in symptoms at the end of cognitive therapy. Many of them said they had the most joyful feeling they had ever had before. They emphasized that mood training gave them a sense of self-esteem and confidence. No matter how miserable, melancholy, and pessimistic you may feel right now, I believe you can benefit from beneficial effects if you are willing to apply the methods described in this book persistently.

How long does this effect last? Follow-up studies over the course of a year after completion of the treatment produced quite interesting results. While many individuals in both groups still experienced occasional mood swings at different times of the year, both groups continued to maintain what they had shown at the end of 12 weeks of intensive treatment.

Which group is actually in better shape? Psychological tests as well as the patient's own reports confirmed that the cognitive therapy group continued to feel much more elated, and these differences were noted to be extremely significant. The recurrence rate that year for the cognitive therapy group was less than half of the data observed from the drug group. These are enormous differences that occur with patients treated with the new method.

Does this mean I can guarantee that you will never feel depressed again after taking cognitive approaches to get rid of your current depression?

Of course not. It's like saying that once you've achieved good health by jogging every day, you'll never be short of breath again. Being depressed at one time or another is part of human life, so I can guarantee that you won't be in a state of euphoria forever! This means that you will have to apply many times the techniques that are useful if you want to continue to master your mood. There's a difference between feeling happier — it can appear spontaneously — and becoming happier — this is the result of systematically applying uplifting methods whenever necessary.

How has the academic community received this research? The findings have enormous implications for psychiatrists, psychologists and other mental health professionals.

It has been 20 years since this chapter was written. During that time, countless meticulous studies on the effectiveness of cognitive therapy have been published in scientific journals. These studies compared the effectiveness of cognitive therapy with the effectiveness of antidepressant drugs, as well as other forms of psychotherapy in treating depression, anxiety and other types of disorders. The results of these studies are encouraging. Researchers have confirmed our first impressions that psychotherapy is at least as effective as remedies, and often it is more effective, both in the short and long term.

What does all this mean? We are undergoing an important advance in modern psychiatry and psychology – a promising new method of understanding human emotions based on a tried and tested therapy. A large number of mental health professionals are extremely interested in this solution, and everything is just the beginning.

You're probably wondering if you're really depressed. Let's read on and see where you stand. The Burns Depression Checklist (BDC) (see Table 2-1 on the side page) is a reliable emotional scale that helps detect depression and accurately assess its severity. You only need a few minutes to complete this simple questionnaire. After you complete the BDC sheet, I will guide you to read the results in a simple way, based on your total score. You'll immediately know if you're suffering from depression and, if so, how serious. I'll also provide some important guidelines to help you determine if you can safely and effectively heal yourself, or if you have a more serious emotional disorder that requires professional intervention in addition to your own efforts.

As you fill out the questionnaire, read it carefully and √ square what you've felt over the past few days.

If you're not sure of the answer, try to guess. Don't ignore any questions. Whatever the outcome, this is the first step in the process of improving your mood.

Table 2-1. Burns Depression Checklist* *Copyright © 1984 by Dr. David D. Burns (Revised version, 1996)
Guidance: Mark √ to indicate how you experienced each symptom during the past week, including today. Please answer all 25 questions.	0 – Not at all.	1 – A little.	2 – Fit.	3 – Many.	4 – A lot
Thoughts and feelings
1. Feeling sad.
2. Feeling unhappy.
3. Want to cry.
4. Feeling depressed.
5. Feeling hopeless.
6. Low self-esteem.
7. Feeling worthless or inferior.
8. Guilt or shame.
9. Self-criticism or self-reproach
10. Difficulty making decisions
Activities and personal relationships
11. Loss of interest in family, friends or colleagues
12. Loneliness
13. Spend less time with family or friends
14. Loss of motivation
15. Loss of interest in work or other activities
16. Shy away from work or other activities
17. Loss of pleasure or satisfaction in life
Physical symptoms
18. Feeling tired
19. Difficulty falling asleep or sleeping too much
20. Increase or decrease appetite
21. Loss of interest in sex
22. Worry about your own health
Suicidal urges **
23. Do you have thoughts about suicide or not?
24. Do you want to end your life?
25. Do you plan to harm yourself?
Please summarize the scores from items 1 to 25 here ->

** People contemplating suicide should seek help from a mental health professional.

Explain the Burns Depression Checklist.

Now that you've completed the quiz, add up points for each of the 25 items, and have the total score. Since the highest score for each symptom out of a total of 25 symptoms is 4, the highest score for the whole paper will be 100.

(This score indicates the most severe depression.) Since the lowest score for each sentence is 0, the lowest total score for the whole paper will be 0. (This point indicates that you have absolutely no symptoms of depression.)

Table 2-2. Interpretation of the Depression Checklist
Total score	Depression Degree *
0-5	No sympathy
6-10	Normal but not fun
11-25	Mild depression
26-50	Moderate depression
51-75	Major depression
76-100	Severe depression
*People who consistently score above 10 may need to be treated by professionals. People with suicidal feelings should seek advice from a mental health professional immediately.

You can now assess your depression according to Table 2-2. As you can see, the higher the score, the more severe the level of depression. Conversely, the lower the score, the better your mood.

While the BDC table isn't difficult or doesn't take much time to complete and score, don't let its simplicity fool you. You've just learned how to use a perfect tool to detect and measure the severity of depression.

Studies show that BDC tables are highly accurate and reliable.

Studies in a variety of settings, such as psychiatric hospital emergency rooms, have shown that these tools actually capture symptoms of depression with a much higher probability than serious question-and-answer sessions conducted by experienced clinicians.

You can also use BDC boards to monitor your progress. In my healing work, I emphasize that each patient must fill out a checklist between treatments and report the score to me at the beginning of the next treatment. The change in scores tells me whether the patient is doing well or badly, or is stagnant.

As you apply the various techniques in this book to help yourself, take the BDC test periodically to assess your progress objectively. I suggest doing it at least once a week. It's like you regularly weigh your body weight while on a diet. You'll notice that the chapters in this book focus on the various symptoms of depression. As you learn to deal with these symptoms, you will find that your total score begins to dwindle. This proves you are making progress.

When your score is lower than 10, you will be at a level considered normal. When the score is below 5, you will feel especially elated. Ideally, I'd like to see you score below 5 most of the time. This is a goal in your treatment.

Is it safe for people with depression to try to help themselves using the principles and methods outlined in this book? The answer is – definitely safe!

That's because the important decision to try to help yourself is key to helping you feel happier as quickly as possible, no matter how serious your emotional turmoil may be.

In what cases should you seek help from professionals? If your score is between 0 and 5, then you must be having fun. This is a normal score, and most people who score this low will feel satisfied.

If your score is between 6 and 10, this is still normal, but you may be approaching the "sad" threshold. The situation can still be improved, by mentally winding up, if you wish. The cognitive therapy techniques in the book are extremely helpful for these cases. We are all dogged by the problems of everyday life, and a change in perspective can make a big emotional difference.

If your score is between 11 and 25, then your depression is mild and not yet alarming, at least at this point. You will definitely want to solve this problem and you can make significant progress on your own. The systematic self-help efforts laid out in the book, along with regular frank conversations with trusted friends, can be very helpful. But if your score stays at this level for weeks, then you should consider getting professional treatment. The support of a therapist or antidepressant remedy can help significantly speed up your recovery.

Some of the thorniest cases of depression I've ever treated have been in people with mild grades. Often these people have been mildly depressed for years, sometimes for most of their lives. Currently, mild recurring depression is called "chronic depression." Although this may seem like a big term, its meaning is simple. It means, "this person is almost always melancholy and negative."

You probably know someone like that, and you yourself may be under the curse of pessimism. Fortunately, the methods that have been shown to be helpful for major depression in the book are also helpful for chronic mild depression.

If your score is between 26 and 50, you're suffering from moderate depression. But don't be fooled by the word "average." A score in this range can signify an intense feeling of torment. Most of us feel depressed for short periods of time, but usually we get through it. If your score stays at this level for longer than two weeks, then you should definitely seek treatment from professionals.

If your score is above 50, it indicates that your depression is severe or downright severe. This level of torment is almost unbearable, especially when your score exceeds the threshold of 75. Your mood tends to be intensely irritable and quite dangerous because feelings of hopelessness can trigger suicidal thoughts.

Fortunately, the prognosis for successful treatment is very high. In fact, sometimes the most severe depressions get the quickest results. But trying to treat major depression on your own is not a wise choice. The consultation of experts is essential. Look for a good and reliable professional.

Whether you receive psychotherapy or antidepressant remedies, I believe you will still get tremendous benefits from applying what I guide. My studies show that self-effort greatly speeds recovery, even when patients receive specialized treatment.

In addition to evaluating your total score according to the BDC table, make sure you pay close attention to items 23, 24 and 25. These items raise questions about feelings, urges, and suicidal plans.

If you score points in any of them, then I seriously suggest that you immediately seek professional support.

Many people with depression score points in items 23, but none in items 24 and 25. Often this means that they have suicidal thoughts, such as "I'd better die," but have no suicidal intentions or urges or plans. This thought is quite common. However, if you score in items 24 or 25, this is a wake-up call. Go for treatment immediately!

I have provided effective methods for evaluating and turning around suicidal thoughts in a later chapter, but you must seek counseling when suicidal thoughts begin to become a necessary impulse or option. The belief that you are hopeless is the reason to seek treatment, not suicidal thoughts. Most severely depressed people strongly believe that their case is incurable. This negative delusion is purely a symptom of depression, rather than a fact. Feeling hopeless is clear proof that you're not!

Consideration of section 22 is also important. This section asks about whether you have often been worried about your health condition lately. Do you have pain, fever, unexplained weight loss, or other medical symptoms? If so, you should seek medical advice, including medical history, general medical tests, and laboratory tests.

Most likely, your doctor will tell you that your health is fine. This means that the symptoms of physical discomfort are related to your emotional state. Depression can simulate a variety of medical disorders, as mood swings often produce unpredictable physical symptoms.

To list a few good examples, symptoms include constipation, diarrhea, pain, insomnia or the tendency to sleep too much, feeling tired, loss of interest in sex, mild headaches, tremors and numbness. As depression improves, these symptoms will also go away. However, keep in mind that in the early stages, many illnesses can disguise themselves as depression, and a course of medical tests can help diagnose (and save you from) disorders in your organs.

There are many symptoms that indicate — but do not prove — the existence of a serious mental disorder, and it requires counseling and treatment from a mental health professional, in addition to the self-development program in this book.

A few key symptoms include: believing that people are plotting to harm or kill you; a strange experience that the average person cannot understand; Believing that an outside force is controlling your mind or body; feeling others can hear or see through your thoughts; hearing sounds from outside; seeing things that aren't real; and hearing messages about yourself while watching TV or listening to the radio.

These symptoms are not part of depression, but a manifestation of serious mental disorders. Psychiatric treatment measures are necessary. Often people with these symptoms believe they are nothing abnormal, and may approach offers of psychiatric therapy with reservations and skeptical resistance. Conversely, if you're harboring a deep fear that you're going crazy and experiencing panic attacks in which you're losing control or reaching a dead end, chances are you're not psychotic.

These are just the characteristic symptoms of common anxiety, a much less severe form of disorder.

Mania is a particular form of emotional disorder that has probably become familiar to you. Mania is in stark contrast to depression and requires quick intervention by a psychiatrist, who can prescribe lithium. Lithium helps stabilize sharp fluctuations of emotions and allows patients to lead a normal life. However, until treatment begins, the condition can take an emotional toll. Its symptoms include unusual feelings of elation or discomfort that last for at least two days, and are not caused by drugs or alcoholic beverages. The behavior of patients with mania is characterized by impulsive actions that reflect a lack of judgment (e.g., irresponsibility, overspending) and an overconfident attitude. Manmania is accompanied by an increase in sexual activity or aggression; hyperactivity, constant body movement; flash thoughts; talk excitedly and constantly; and reduced need for sleep.

People with mania have the illusion that they are exceptionally strong and intelligent, and often claim they are about to make a philosophical or scientific breakthrough, or a plan to make a fortune. Many individuals known for their creativity have suffered from this disease and managed to control it with lithium. Because the condition is so euphoric, individuals who are attacked for the first time often do not believe they need treatment. The initial symptoms exhilarating the victim to the point of not accepting the idea that their sudden confidence and euphoria are actually a sign of a harmful disease.

After some time, the euphoric state may escalate into an out-of-control delirium that causes the victim to be hospitalized, or it may suddenly transform into a helpless depression that causes the victim to become immobile and frigid. I want you to familiarize yourself with the symptoms of mania because a lot of people going through a major depressive episode will have these symptoms at some point. When this happens, the person's personality will change dramatically after a few days or weeks. Although psychotherapy and self-help programs are extremely helpful, at the same time patients need to be treated with lithium under medical supervision to get good results. With such treatment, the prognosis for mania is very positive.

Let's just say you don't have suicidal urges, hallucinations, or symptoms of mania. Instead of grimacing and feeling unhappy, you can now take action to feel happier, by applying the methods given in this book. You can begin to enjoy life and work, and use the energy used to feed your previous depression for a creative and active life.