Feeling Good Handbook [Paperback]

Burns is one of the biggest popularizers of cognitive-behavioral therapy, one of extremely few therapeutic forms that have stood up to any scientific scrutiny. Over the last 20 years, CBT has become the predominant form of therapy practiced by psychologists. This book is intensive CBT, much more involving and direct than the form practiced in most psychologists' offices.

Burns takes a very simple approach: he does not place any weight on diagnostic categories or figuring out "why" people behave the way they do or the roots of their problems. Instead, every depressed thought is traced to irrational thought processes. Why those thought processes were developed is irrelevant; the challenge is identifying one's distortions and learning to think more rationally.

Contrary to some reviewers' opinions, I believe this book is best for people who have long-term depression in the medium range (recurrent major depression or dysthymia), with substantial experiences with psychologists. Clearly for more extreme cases - a manic depressive or a suicidal person - the first course of action should be a psychiatrist or psychologist, not a self-help book. This book requires a very high level of involvement and personal responsibility. I believe that it is patients who think of themselves as having a medical problem, seeing psychologists and taking medication for years and perhaps feeling dependent on them, who will at some crisis point become frustrated, develop the energy and motivation to work through a book like this and benefit the most from it. Patients with more minor depression will not feel sufficiently motivated to actually do the exercises, which take a substantial amount of time and clash with other life priorities.

CBT encourages short-term (only 12 weeks on average if seeing a psychologist!) therapy and extreme personal responsibility. For most problems, I believe CBT, either in the form of this book or combined with short-term therapy, is much better than seeing a psychologist long-term. Long-term psychotherapy without very clear goals strongly encourages dependence on the psychologist or medication and reinforces the idea that one is permanently ill. This dependence produces further irrational thinking and can very easily lead to continual depression. Reading a book like this and doing its exercises is an exercise in independence and self-reliance and a major accomplishment in itself. The ability to solve one's own problems is difficult to achieve but extremely powerful - perhaps the only solution - for relieving long-term depression.

Burns feels that virtually no one should be on medication long-term - more than about a year - a view that is somewhat debatable (he excludes, obviously, bipolar and schizophrenic patients). The long-term effectiveness of SSRIs is unproven, but Burns' one-year limit seems purely arbitrary.

CBT is also more art than science - although anyone with any experience with psychologists or self-help books will realize that this is true of the entire field. Often Burns' methods and categorizations of irrational thoughts seem completely arbitrary and hardly authoritative. They could probably use more refinement and clarity. What I think is important is that CBT, and even simply reading Burns' book "Feeling Good", have been demonstrated through scientific means - double-blind testing - to produce considerable improvement.

All in all, this is a book with a clear philosophy that has stood up to scientific scrutiny, unlike psychoanalysis or most other therapeutic methods practiced by psychologists. It requires high involvement and emphasizes personal responsibility, and one has to develop considerable motivation to make any use of it. But the results can be extremely worthwhile.