What You Can Change _. And What You Can't - Martin E. Seligman [55]
Here is the bad news: First, about a quarter of depressed people cannot or will not take drugs, usually because of side effects. Second, once you go off the drug, your risk for the relapse, or recurrence, of depression is considerable, probably just the same as your risk was before taking the drug. In order to prevent further depression or relapse, you should keep taking the drug—maybe for the rest of your life.12
ECS. Electroconvulsive shock is scary. It has worse press than it deserves, but it is far from innocuous. Most of the time it is rapid and highly effective. It relieves severe depression about 75 percent of the time, usually in a series of ECSs that take a few days. Many lives have undoubtedly been saved by its use, particularly the lives of acutely suicidal people.
The bad news is identical to that for drugs. Many people will not agree to ECS because of its considerable side effects—memory loss, cardiovascular changes, and confusion—and because it is a major medical procedure. Even more important, there is no evidence that it cuts down the recurrence of depression. Rather, it provides acute relief.13
So both biological treatments bring quite effective relief. Both also have serious side effects, and both are only cosmetic—they don’t solve the underlying problems, and depression is likely to return unless you keep taking medication.
Cognitive therapy (CT). Cognitive therapy, which seeks to change the way the depressed person consciously thinks about failure, defeat, loss, and helplessness,14 employs five basic tactics.
First, you learn to recognize the automatic thoughts—the very quick phrases, so well practiced as to be almost unnoticed and unchallenged—that flit through consciousness at the times you feel worst.
A mother of three children sometimes screams at them as she sends them off to school. She feels very depressed as a consequence. In CT, she learns to recognize that right after these screaming incidents she always says to herself “I’m a terrible mother—even worse than my own mother.” She learns to become aware of these automatic thoughts.
Second, you learn to dispute the automatic thoughts by focusing on contrary evidence.
The mother reminds herself that when the kids come home from school, she plays football with them, tutors them in geometry, and talks to them sympathetically about their problems. She marshals this evidence and sees that it contradicts her first thought that she is a bad mother.
Third, you learn to make different explanations, called reattributions, and to use them to dispute your automatic thoughts.
The mother learns to say: “I’m fine with the kids in the afternoon and terrible in the morning. Maybe I’m not a morning person.”
That is a much less permanent and pervasive explanation for screaming at the kids in the morning. As for the chain of negative explanations that goes “I’m a terrible mother, I’m not fit to have kids, therefore I don’t deserve to live,” she learns to interrupt it by inserting the new explanation: “It’s completely illogical to infer that I don’t deserve to live because I’m not a morning person.”
Fourth, you learn how to distract yourself from depressing thoughts. Rumination, particularly when one is under pressure to perform well, makes the situation even worse. Often, in order to do your best, it is better to put off thinking. You learn to control not only what you think but also when you think it.
Fifth, you learn to question the depression-sowing assumptions governing so much of what you do:
“I can’t live without love.”
“Unless everything I do is perfect, I’m a failure.”
“Unless everybody likes me, I’m a failure.”
“There is a perfect right solution for every problem. I must find it.