Cognitive Therapy of Depression

Rating:
Summary: A classic by a preeminent expert.
Review: Aaron T. Beck's "Depression" is regarded as a classic. Its emphasis is on the diagnosis and treatment of depression, including manic depression (bipolar disorder), and other affective (mood) disorders. There is much more detail regarding the diagnosis of affective disorders than one would find in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV). Of particular importance is the inclusion of the Beck Depression Index, a psychological test used to evaluate people for depression. People with a background in both mental health and psychological testing are familiar with the Beck Depression Index. A good portion of the book is devoted to the Beck Depression Indicator (as a subjective assessment medium). Additionally, Beck discusses patterns of behavior and the manifestation of depression in dreams.

A portion of the book is devoted to theories of depression, dealing primarily with 20th century theories of depression. If you want to view depression in a historical context, there is nothing better than Jackson's "Melancholia and Depression." However, we digress at this point. We must remember that this work was copyrighted in 1967, and that there has been significant research on affective disorders since then. The discussion of psychopharmacological intervention does not discuss the selective seratonin reuptake inhibitors such as Prozac, Paxil, and Zoloft. The work of Martin E. P. Seligman, also of the University of Pennsylvania, is not mentioned because it was not completed by the time of the release of this publication. The strongest appeal of this book is the use of cognitive therapy in the treatment of depression.

This book has value to academic libraries, mental health professionals and students, as well as people who are interested in the study of depression and mood disorders. In addition, those who have a family member suffering from depression may be given an insight into the diagnosis and treatment of this disorder through reading this book. People who buy this book should also consider purchasing Martin E. P. Seligman's "Learned Optimism," as well as Jungian analyst Julia Kristeva's "Dark Sun."

Rating:
Summary: An excellent introductory text!
Review: Cognitive Therapy of Depression is a classic in its own right: It gives clear examples of the symptoms and how to treat them using cognitive therapy. For anyone remotly interested in psychology or the theories behind depression this book is a must have.

Rating:
Summary: Arguing them out of it.
Review: Many depressed people have a negative self-image and are always expecting something bad to happen. Beck's theory is that this is the cause, rather than a result, of depression. The depressed make "depressogenic assumptions" and have to be shown that these are false. It sounds as if zealous Beckian therapists must spend a lot of time arguing with their patients.
"Cognitive Therapy of Depression" is an excellent book, obviouly written by a wise and experienced clinician. It reads as if directed at other professionals, and is full of sound advice to them.
Like other neo-Freudians (and I would classify him as a neo-Freudian) Beck recommends ignoring the patient's childhood memories. I suspect this is an effort to distinguish them from the orthodox Freudians. Sometimes it makes sense but in cases it is like "apart from that Mrs. Lincoln how did you enjoy the play?" (For example childhood bereavement is well-documented as associated with depression).
I thought Chapter 10 "Specific Techniques for Dealing with the Suicidal Patient" could have been improved or else the reader referred to a general psychiatry text. The authors seem undecided as to whether they are writing a comprehensive review of how to handle the suicidal or merely giving advice about the content of therapy sessions. Suicidal risk factors are covered in an incomplete way. Suicide hotlines are not mentioned.
Chapter 14 on "Technical Problems" could be read with profit by anyone who works with the depressed.
Chapter 17 "Cognitive Therapy and Anti-depressant Medications contains a wonderfully succinct and clear summary of the taxonomy and natural history of depression. (My copy want printed in 1979 but I did not think the information was outdated). It contains a frank and full list of the kind of patient who does NOT respond to cognitive therapy, which is basically the kind of patient psychotherapists avoid. (Although in non-academic real life we do have to spend time, often a lot of time, talking to such patients and have to know how to do it)
Beck and his co-authors (all male judging by their first names) write in a pleasant, readable and old-fashioned style, with frequent references to "our clinic" and an assumption that the therapist is male. Most of the advice is completely in accordance with psychodynamic technique and common sense. The warm (but not too warm) and empathetic (but not too empathetic) therapist is to let the patient talk and to be nice to to her. The talking will uncover previously unsuspected conflicts, at which point the patient may show strong emotion, which is to be encouraged because it produces "catharsis" (sic). Freudian mechanisms of defense are assumed.One case described is a woman suffering from fatigue and lack of energy, which were finally found to be due to her struggle to avoid unpleasantness in her relationship with her husband. All was well when she learned to accept his imperfections. One detects a flavor of old Vienna.
The biggest selling point of Beckian therapy has been its use of controlled trials to demonstrate its superiority to other brands of psychotherapy. Controlled trials run by psychotherapists are often in the same category as Dr Johnson's preaching woman and dancing dog. The evidence is well presented in Chapter 18 "Outcome Studies of Cognitive Therapy." Obviously you don't go to a book by Beck to get and completely unbiassed meta-analysis of the evidence for Beckian therapy, so you'd have to supplement this with following the reviews in the professional journals.