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Feeling Good: The New Mood Therapy
BOOK REVIEWS tration, vocational rehabilitation, and absence of depression. She concludes with the important finding that the ability of the dialysis team to form a realistic clinical assessment may better help the dialysis patient adjust to this chronic and difficult treatment. Frustration tolerance, she points out, seems to be highly predictive of compliance and can be increased by hypnosis or behavioral modification. In essence, her position that supportive psychotherapy may be contraindicated is interwoven with this contribution. Hellmuth Freyberger's summary of the psychosomaticist's intervention in a renal transplantation unit highlights the difference between the consultation-liaison psychiatrist and psychosomaticist in West Germany, and skillfully reviews the role of psychosocial intervention in renal transplantation . units. Denton Buchanan's group therapeutic approach to chronic renal disease outlines his two-step methodology of education and open-ended support. Finally, Franz Reichsman contributes a superb overview of future strategies for psychosocial research in hemodialysis. This book clearly fulfills its goal ofstimulating new ideas for further research, and also provides a comprehensive review of the literature in this field. The careful editing and well-organized chapters are enhanced by useful tables. The wide range of clinical approaches, from individual therapy to group therapy, make the book clinically useful. All mental health professionals working on hemodialysis units or transplantation services should have this volume for their personal 676
libraries, and all training programs in consultation-liaison psychiatry should include it in their library section. Thomas N. Wise, M.D. The Fairfax Hospital Falls Church, Va.
Feeling Good:
The New Mood Therapy By David D. Bums, New York, William Morrow and Co, 1980,394 pp, $12.95.
• In this book we have an easily understandable description and vivid examples of an effective person-to-person psychotherapeutic approach to the care of depression-cognitive therapy. In it the author presents a comprehensive coverage of the rationale and implementation of the treatment modality for the patient as well as a handy and practical guide for the clinician. The basic principle in cognitive therapy is: "You feel the way you do right now because of the thoughts (cognitions) you are thinking at this moment." Consequently, by correcting the depression-producing thoughts, depression is eliminated. The author proposes that these thoughts result from cognitive distortions. He presents ten of these: all or nothing thinking, overgeneralization, mental filter, disqualifying the positive, jumping to conclusions, magnification or minimization, emotional reasoning, "should" statements, labeling and mislabeling, and personalization. Therapy then comprises the discovery of automatic negative thoughts that trigger and perpetuate depression; identification of the cognitive distortions re-
sponsible for these thoughts; substitution of more realistic, enhancing thoughts; replacement of selfdefeating belief systems with more reasonable ones; and development of improved social skills. The author takes up specific features of depression and by way of clear instructions, interesting vignettes, and clarification of principles revealed in the vignettes presents methods ofdealing with each. Self-esteem is boosted with a written exercise. Over a period of time, every self-critical thought is listed in a left-hand column, the cognitive distortion responsible for it is placed beside it in a central column, and finally in the right-hand column a rational response is written. A second method for building selfesteem is the use of a counter on which the patient is taught to register every negative, self-defeating thought throughout each day. Focusing on awareness of such thoughts causes the daily total to reach a plateau for a few days and then decline. Next, methods of dealing with inactivity (called "do-nothingism" by the author) are presented. Depression reduces motivation, leading to inactivity. Conversely, increasing productivity leads to raised self-esteem and thus counters depression. Through analysis of thoughts underlying reluctance to function, or procrastination, one or more of these defeating states of mind is likely to be found: hopelessness, helplessness, self-overwhelming, jumping to conclusions, self-labeling, undervaluing rewards, perfectionism, fear of failure, fear of success, fear of criticism, resentment, and low PSYCHOSOMATICS
IF YOU THINK VITAMIN SUPPORT DOESN'T CONTRIBUTE TO frustration tolerance. None are completely valid and aU are amenable to the cognitive approach. Another of numerous approaches is a daily activity schedule on which the patient lists in the left-hand column aU of the functions he would like to accomplish during a day; at the end of the day he fills in the right-hand column with what he actually did in . each case. Similarly, other traditional elements of depression, including absorbed anger, guilt, love addiction, and perfectionism, are dealt with. The author presents a very interesting and optimistic approach to depression therapy. The anecdotal results are impressive. On the other hand we must keep in mind that some depressions arise from a more organic mechanism and others result in severe regression, which would preclude the interpersonal interaction necessary for optimal execution of cognitive therapy. Success might also be greatly influenced by compliance with the written reports called for. One would wonder what percentage of depressed patients would cooperate sufficiently to bring about positive resUlts. Nevertheless, the book presents a heartening variation from the now traditional drug approach to depression, which also has its share of treatment failures. It might be added that it contains a wealth of practical general mental hygiene measures of value to physicians as well as patients as they move through life, whether clinically depressed or not. Fred O. Benker 111, M.D. University of Arkansas for Medical Sciences JUNE 1982 • VOL 23 • NO 6
677
THERAP~
THINK ABOUT THIS. Vitamins are essential-both from a biochemical perspective and increasingly as supportive nutritional agents in various clinical conditions. Vitamins have long been considered valuable in preventing and treating classic nutrient deficiency disorders, most notably scurvy, beriberi, pellagra and rickets. Today, research is suggesting that in certain pathophysiological disorders, e.g., alcoholism,'carcinomas,2 cystic fibrosis3 and other conditions,4.5 vitamins together with essential minerals can supplement the overall treatment process. As you know, your patient's nutritional status is often as important as his or her physiological or psychological status, particularly if there is interference with absorption. Recommending supplemental vitamins and minerals to your patients can insure that they get at least their RDA requirements. And, as is the case with any agents with potential value in medical practice, vitamins can be used most beneficially when professionals recommend them with full knowledge of what they can and cannot do. REFERENCES: 1. Shaw S. Lieber CS: Nutrition and alcoholism. chap. 40. in Modern Nutrition in Health and Disease. Goodhart R. Shils M. ads. Philadelphia. Lea & Febiger. 1980. 2. Meyskens FL: Ariz Med 37: 84-86, Feb 1980. 3. Shephard R. Cooksley WGE. Cooke WOO: J Pediatr 97: 351-357. sept 1980. 4. Horwin MK: Nutr Rev 38: 105-113. March 1980. 5. Goodhart R. Shils M.ads.• op. cit.. Part VI, Nutrition in the Prevention and Treatment of Disease. pp. 904. 910. 915-917. 923-924. 939. 966. 991.
1031.1114.1179-1180.
VITAMINS
Clinically essential.
®
ROCHE
Vitamin Communications Hoffmann-La Roche Inc. t> Nutley. New Jersey 07110
llCD >oJ,
libraries, and all training programs in consultation-liaison psychiatry should include it in their library section. Thomas N. Wise, M.D. The Fairfax Hospital Falls Church, Va.
Feeling Good:
The New Mood Therapy By David D. Bums, New York, William Morrow and Co, 1980,394 pp, $12.95.
• In this book we have an easily understandable description and vivid examples of an effective person-to-person psychotherapeutic approach to the care of depression-cognitive therapy. In it the author presents a comprehensive coverage of the rationale and implementation of the treatment modality for the patient as well as a handy and practical guide for the clinician. The basic principle in cognitive therapy is: "You feel the way you do right now because of the thoughts (cognitions) you are thinking at this moment." Consequently, by correcting the depression-producing thoughts, depression is eliminated. The author proposes that these thoughts result from cognitive distortions. He presents ten of these: all or nothing thinking, overgeneralization, mental filter, disqualifying the positive, jumping to conclusions, magnification or minimization, emotional reasoning, "should" statements, labeling and mislabeling, and personalization. Therapy then comprises the discovery of automatic negative thoughts that trigger and perpetuate depression; identification of the cognitive distortions re-
sponsible for these thoughts; substitution of more realistic, enhancing thoughts; replacement of selfdefeating belief systems with more reasonable ones; and development of improved social skills. The author takes up specific features of depression and by way of clear instructions, interesting vignettes, and clarification of principles revealed in the vignettes presents methods ofdealing with each. Self-esteem is boosted with a written exercise. Over a period of time, every self-critical thought is listed in a left-hand column, the cognitive distortion responsible for it is placed beside it in a central column, and finally in the right-hand column a rational response is written. A second method for building selfesteem is the use of a counter on which the patient is taught to register every negative, self-defeating thought throughout each day. Focusing on awareness of such thoughts causes the daily total to reach a plateau for a few days and then decline. Next, methods of dealing with inactivity (called "do-nothingism" by the author) are presented. Depression reduces motivation, leading to inactivity. Conversely, increasing productivity leads to raised self-esteem and thus counters depression. Through analysis of thoughts underlying reluctance to function, or procrastination, one or more of these defeating states of mind is likely to be found: hopelessness, helplessness, self-overwhelming, jumping to conclusions, self-labeling, undervaluing rewards, perfectionism, fear of failure, fear of success, fear of criticism, resentment, and low PSYCHOSOMATICS
IF YOU THINK VITAMIN SUPPORT DOESN'T CONTRIBUTE TO frustration tolerance. None are completely valid and aU are amenable to the cognitive approach. Another of numerous approaches is a daily activity schedule on which the patient lists in the left-hand column aU of the functions he would like to accomplish during a day; at the end of the day he fills in the right-hand column with what he actually did in . each case. Similarly, other traditional elements of depression, including absorbed anger, guilt, love addiction, and perfectionism, are dealt with. The author presents a very interesting and optimistic approach to depression therapy. The anecdotal results are impressive. On the other hand we must keep in mind that some depressions arise from a more organic mechanism and others result in severe regression, which would preclude the interpersonal interaction necessary for optimal execution of cognitive therapy. Success might also be greatly influenced by compliance with the written reports called for. One would wonder what percentage of depressed patients would cooperate sufficiently to bring about positive resUlts. Nevertheless, the book presents a heartening variation from the now traditional drug approach to depression, which also has its share of treatment failures. It might be added that it contains a wealth of practical general mental hygiene measures of value to physicians as well as patients as they move through life, whether clinically depressed or not. Fred O. Benker 111, M.D. University of Arkansas for Medical Sciences JUNE 1982 • VOL 23 • NO 6
677
THERAP~
THINK ABOUT THIS. Vitamins are essential-both from a biochemical perspective and increasingly as supportive nutritional agents in various clinical conditions. Vitamins have long been considered valuable in preventing and treating classic nutrient deficiency disorders, most notably scurvy, beriberi, pellagra and rickets. Today, research is suggesting that in certain pathophysiological disorders, e.g., alcoholism,'carcinomas,2 cystic fibrosis3 and other conditions,4.5 vitamins together with essential minerals can supplement the overall treatment process. As you know, your patient's nutritional status is often as important as his or her physiological or psychological status, particularly if there is interference with absorption. Recommending supplemental vitamins and minerals to your patients can insure that they get at least their RDA requirements. And, as is the case with any agents with potential value in medical practice, vitamins can be used most beneficially when professionals recommend them with full knowledge of what they can and cannot do. REFERENCES: 1. Shaw S. Lieber CS: Nutrition and alcoholism. chap. 40. in Modern Nutrition in Health and Disease. Goodhart R. Shils M. ads. Philadelphia. Lea & Febiger. 1980. 2. Meyskens FL: Ariz Med 37: 84-86, Feb 1980. 3. Shephard R. Cooksley WGE. Cooke WOO: J Pediatr 97: 351-357. sept 1980. 4. Horwin MK: Nutr Rev 38: 105-113. March 1980. 5. Goodhart R. Shils M.ads.• op. cit.. Part VI, Nutrition in the Prevention and Treatment of Disease. pp. 904. 910. 915-917. 923-924. 939. 966. 991.
1031.1114.1179-1180.
VITAMINS
Clinically essential.
®
ROCHE
Vitamin Communications Hoffmann-La Roche Inc. t> Nutley. New Jersey 07110
llCD >oJ,