IF SOPHIE had suffered her depression twenty years ago, she would have been out of luck. She would have had to wait until the depression run its course for months, even a year or more. But because she became depressed within the last decade, she stood a much better chance, for in the last ten years a treatment has been developed that works quickly and well. Its discoverers were a psychologist, Albert Ellis, and a psychiatrist, Aaron T. Beck. When the history of modern psychotherapy is written, I believe their names will appear on the shortlist with Freud and Jung. Together they took the mystery out of depression. They showed us it was much simpler and more durable than it was thought to be.
I was an early adherent, believing that the same process–conscious thought gone awry-might be at work in both learned helplessness and depression. I had gone to Cornell University to teach in 1967, right after taking my Ph.D. at the University of Pennsylvania. In 1969 Tim asked me to come back to the University of Pennsylvania and spend a year or two with him to learn his new approach to depression. I returned gladly and found myself in the middle of a group excitedly designing a new kind of therapy for depression.
Learned Helplessness and Explanatory Style
WE ALL BECOME momentarily helpless when we fail. The psychological wind is knocked out of us. We feel sad, the future looks dismal, and putting out any effort seems overwhelmingly difficult. Some people recover almost at once; all the symptoms of learned helplessness dissipate within hours. Others stay helpless for weeks or, if the failure is important enough, for months or longer.
This is the critical difference between brief demoralization and an episode of depression. You will recall that eight of the nine symptoms of depression in the DSM-II1-R “Chinese menu” (described in chapter four) are produced by learned helplessness. You must have five of the nine to be diagnosed as suffering a major depressive episode. However, one more factor is needed: The symptoms cannot be momentary; they have to last at least two weeks
Does Pessimism Cause Depression
I HAVE SPENT much of the last ten years testing this prediction. The first thing the University of Pennsylvania group did was the simplest. We gave the explanatory-style questionnaire to depressed people, thousands of them, people with all kinds and degrees of depression. We consistently found that when people are depressed they are also pessimistic. The finding was so consistent and was repeated so often that, according to one estimate, it would take over ten thousand negative studies to cast doubt on it.
Explanatory Style and Cognitive Therapy
TAN Y A CAME into therapy with a marriage going downhill day by day, three children she saw as wild and uncontrollable, and very severe depression. She agreed to participate in a study of different therapies for depression and was assigned to receive both cognitive therapy and antidepressant drugs. She allowed the investigators to tape-record her therapy sessions. In these quotes, the italics emphasize the sorts of explanations she gave for her problems. I will attach numbers to each quote. These numbers are her pessimism scores (related to the test in chapter three)
Rumination and Depression
IF YOU WALK around disposed to believe of any problem that “it’s me, it’s going to last forever, it’s going to undermine everything I try,” you are set up for depression. But just because you may be disposed to think this way doesn’t necessarily mean you frequently utter such thoughts to yourself. Some people do, some don’t. People who mull over bad events are called ruminators.
The Other Side of the Epidemic: Women vs. Men
THE CRUCIAL ROLE rumination plays in depression may be responsible for the arresting fact that depression is primarily female. Study after study has found that during the twentieth century, depression struck women more frequently than men. The ratio is now two to one.
At a philosophical level, cognitive therapy works because it takes advantage of newly legitimized powers of the self. In an era when we believe the self can change itself, we are willing to try to change habits of thought which used to seem as inevitable as sunrise. Cognitive therapy works in our era because it gives the self a set of techniques for changing itself. The self chooses to do this work out of self-interest, to make itself feel better.