“This therapy is unique in having professional evaluation and validation at the highest academic levels. It is not just another self-help fad.”
Feeling Good is a layman’s guide to cognitive behavioural therapy (CBT) written by David D. Burns and first published in 1980.
The subtitle is The New Mood Therapy, but in 2023 CBT is hardly ‘new’ anymore. CBT has been around since the 1960s and in that time a ton of clinical evidence has accumulated supporting its efficacy – particularly for depression. Most studies suggest that CBT is roughly as effective as antidepressant drugs, if not more so.
Although Feeling Good primarily focuses on depression, the techniques described in the book will be useful for just about everyone – because everyone is interested in feeling good.
The underlying theory
CBT is a cognitive approach. This means if focuses on cognitions (i.e. thoughts and beliefs) rather than, say, biological factors (e.g. neurotransmitters, hormones, brain structures).
The underlying theory is very simple:
“The moment you have a certain thought and believe it, you will experience an immediate emotional response. Your thought actually creates the emotion.”
In other words, your thoughts are what make you happy or sad.
And if you change your thoughts, you change your mood. That’s CBT in a nutshell.
Truth, not delusion
At this point it might sound as though CBT is nothing more than just ‘positive thinking’. But it isn’t.
“You do not try to cheer yourself up by rationalizing or saying things you do not believe are objectively valid. Instead, try to recognize the truth.”
The point of CBT is not to delude yourself with comforting falsehoods. If something truly bad has happened to you, then you should feel sad – that’s a normal and healthy response. This is not the same thing as depression.
With depression, though, the thoughts causing negative emotions are often not true at all – they are distortions of the truth.
“If your understanding of what is happening is accurate, your emotions will be normal. If your perception is twisted and distorted in some way, your emotional response will be abnormal. Depression falls into this category.”
Again, this is supported by evidence. A study by Boury et al (2001), for example, found that depressed participants consistently misinterpreted facts and experiences in a negative way.
Dr. Burns goes on to describe various cognitive distortions that cause people with depression to misinterpret reality. These include:
- All-or-nothing thinking
- Disqualifying the positive
- Emotional reasoning
- ‘Should’ statements
The goal of CBT is to recognise these distorted thoughts for what they are: Distortions. Depression is treated by challenging these distortions and recognising the truth.
Contrast with other approaches
“Most psychotherapists today share the conviction that becoming more aware of your feelings and expressing them more openly represents emotional maturity. The implication is that your feelings represent a higher reality, a personal integrity, a truth beyond question.”
Mental health is a big topic at the moment. And although this increased awareness is a positive thing, it doesn’t seem to translate into actual improvements in mental health. For example, rates of depression are trending up, not down.
I’m often irked by the truisms that accompany discussions of mental health these days. Platitudes such as “it’s OK not to be OK” and generic advice like “talk to someone” might be well-intentioned, but is this actually helping anyone?
As a man, it’s frustrating to constantly hear how men are depressed because they’re ‘bottling up’ their ‘true’ feelings – as though if only men were allowed to express their emotions, they wouldn’t be depressed. I’m sceptical of this, though, because there’s probably never been a time in history when it’s been more socially acceptable for men to be ‘in touch’ with and express their emotions – and yet it’s also a time with record-high levels of depression!
“Because depression has been viewed as an emotional disorder throughout the history of psychiatry, therapists from most schools of thought place a strong emphasis on “getting in touch” with your feelings. Our research reveals the unexpected: Depression is not an emotional disorder at all!”
Even though CBT is now clinically mainstream, it’s culturally quite radical. The idea that our emotions take precedence is often encouraged, but this has the effect of validating them. Rather than uncritically accepting these negative emotions, though, the focus of CBT is to question and challenge the distorted thoughts that cause mental ill-health.
I don’t suffer from depression myself, but reading Feeling Good was incredibly worthwhile nonetheless.
The bulk of the book deals with applying the principles above to various cognitive distortions that prevent people from feeling good. As you read through the various examples yourself, you’ll see similarities in your own thinking patterns – even if you’re not depressed.
Some of these chapters will be more relevant to you than others. For example, I don’t particularly struggle with feelings of guilt (chapter 8) but I often find myself feeling highly irritable (chapter 7). What was consistently useful, though, were the many examples of dialogues with patients that show irrationally negative thoughts for what they are. I often found myself smiling at Dr. Burns’ stubbornly cheerful (but rational) responses to harsh criticisms from patients and imaginary critics.
As I cultivated this ability myself and started talking back to my inner critic, I really did find myself feeling better! And again, you don’t need to be clinically depressed to enjoy these benefits.
“Many patients have asked me directly, “Dr. Burns, do you actually practice what you preach?” The fact is, I often do pull out a sheet of paper on the train ride home in the evening, and draw a line down the center from top to bottom so I can utilize the double-column technique to cope with any nagging emotional hangovers from the day.”
The double column technique that Dr. Burns describes here is really simple. You divide a sheet of paper into two columns. In one column you write your ‘automatic’ and negative thoughts, then in the other column you write a rational and truthful response. Below are a few examples of my own that I don’t mind sharing.
|Automatic Thought||Rational Response|
|I’m a bad writer. Nobody reads what I write.||I’m an above-average writer and can explain complicated things clearly. Maybe nobody reads these posts, but that’s not why I write them! Anyway, there are many things I have written that people still read today.|
|I sit around all day doing nothing. I don’t produce anything of value. I’m lazy.||Labelling: I’m not lazy. It took a lot of time and effort to create the things that enable me to ‘sit around doing nothing’! They also continue to create value for others. I’m also working on other projects that I enjoy, but it is true that I could spend more time making them successful. But anyway, even if all that were true, my worth as a human being is not determined by what I produce.|
|There is no point working any more. I don’t need any more money.||There is more to work than making money. Helping other people and creating value is worthwhile for its own sake even if it helps just one person. Anyway, I don’t even have that much money!|
It’s surprising how much this simple exercise can improve your mood. When thoughts are just floating about in your head, you often just take them for granted and accept them as true. But seeing them in black and white on a sheet of paper makes you realise how silly some of them are! I expect the effect of such exercises will be even more dramatic for those suffering from depression.
Practical and useful
CBT is a simple and powerful technique supported by clinical evidence. Feeling Good does a fantastic job of teaching the reader how to use this technique to understand and improve their own moods. There is even some clinical evidence that simply reading Feeling Good can reduce depression.
Even if you’re not suffering from depression, though, Feeling Good will equip you with a practical and useful tool for peak mental health. I highly recommend it for anyone that has a mind.