The Rational Basis® of Happiness Podcast

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What is the best type of therapy for depression?








































(this is raw unedited text transcribed directly from the audio)


Dr. Kenner:      Grayson, you are looking for a therapist?            


Grayson:         I have a friend and she’s 36-years-old, a wife, a part-time secretary and a mother of two school-aged children.


Dr. Kenner:      How old ballpark?


Grayson:         The children vary in age. I don’t know how old her children are, but she’s been depressed for the past 10 months. She tells me she sleeps poorly because of nightmares and she’s constantly fatigued and has no energy to perform her expected tasks at work or home. She feels like a terrible failure and worries that her husband will divorce her because she imagines that he sees her as worthless. 


Dr. Kenner:      Okay. So she’s seeing herself as worthless. Because when you imagine that someone else sees you as worthless, part of you is believing that you’re worthless.


Grayson:         Yes. 


Dr. Kenner:      So she’s depressed, had nightmares, she’s fatigued. It’s sounds like she’s on overload as a part-time secretary with two kids and married and she puts herself on mental overload, in spades, when she starts beating up on herself, when she starts engaging in “stinkin’ thinkin’” – that’s what it’s called in cognitive therapy – I’m a failure, what’s the use? Why bother? He’s going to leave me. How can I keep him? How do I impress him? Notice where, if she’s having those type of thoughts, notice where her mind would go. Not to productive activity, but to churning, to just flailing. Just struggling. So tell me, what is the question you would like some help with?


Grayson:         There are many different treatments in abnormal psychology, and how would treatment proceed if my female friend received drug therapy versus electro-convulsive therapy – 


Dr. Kenner:      Oh my gosh!


Grayson:         Versus cognitive behavioral therapy?


Dr. Kenner:      Let’s slow down. Drug therapy, electro-convulsive therapy and then psychoanalysis, and then cognitive therapy? The theory which drives each of these really matters. And it involves your whole view of what is your mind, or I’ll say, what is my mind? How does it work? Now, it is true that if I had a brain tumor, if I had lesions in my brain, that sometimes something biological can go off in your brain and cause behavioral problems. You can have an accident, you can get injured, and then have behavior that you never had before. Granted that there are biological causes to some abnormal behavior, what we call abnormal behavior, it is also true that the vast bulk of problems, psychological problems, the majority of people who walk into a psychologist’s office – assuming it’s not wartime injuries where they’ve actually had some brain damage – they’re due to psychological problems, to thinking problems. Let’s look at what addresses thinking. Drug therapy, drug therapists look at the brain and problems, let’s say a depression, as a biological problem. So we fix it, just like someone has a problem with diabetes and they have to take their medication and watch what they eat. If you have depression, you have to take certain drugs because you have – here are the big words – chemical imbalance. That’s the view of the brain behind that. Are you following me?


Grayson:         I am.



Dr. Kenner:      It’s not that the drugs don’t have an affect, but pills don’t teach thinking skills. That’s the problem. So you want to be on pills for life? You can try to manage it that way, but it isn’t going to help you become a better choice maker or a better romantic partner or a better mother to your kids, which is what this woman wants. And to feel better about herself. 


ECT, electro-convulsive therapy, man, to me, that is the last resort for anyone. If someone is absolutely suicidal and they’re bent on doing that and they’ve been that way for a long time and you’ve tried everything else – including cognitive therapy – what do you have to lose? The person is going to kill themselves anyway. I would much rather recommend the book Choosing to Live by Cory Newman and Thomas Ellis. That’s a great book if somebody is suicidal. They’re cognitive therapists. If you talk about psychoanalysis, if we go back to Freudian therapy, I think it’s a little more tame nowadays, but basically they’re looking for patterns of defense mechanisms and denial or projection onto other people what you’re feeling. Freud had a theory that we have different instincts. We have a death instinct and there’s like death and aggression and sex and my worldview doesn’t revolve around that at all. Some people are aggressive. Some people really enjoy sex. I wish more people did, rationally of course.


Now, let’s get to what I think is the gold standard of current therapies that are available, which is cognitive therapy. Cognitive therapy is going to teach you how to decode your emotions. If you are depressed, you will learn that it’s due to loss. If you are very sad, very depressed, you are imagining huge loss, which usually involves self-esteem. That’s the biggest loss you can have. You don’t feel good about yourself. So people, when they’re very depressed, have core ideas about themselves, about other people and about the world and about their future that are no good. And they learn how to correct by looking at reality, their bad thinking. For example, “I’m unlovable.” They would search for examples any time in their live when they were lovable. They would try to find exceptions to the rule. If they thought, “I’m a failure,” because maybe they just got fired from a job, they would try to think of other times when they weren’t a failure, so that they could see that success is possible to them with effort and with good thinking. If they think that, what else, I’m a loser, or any of those types of very negative, profound thoughts about yourself are going to undermine you. I would recommend you go to my website and she could get the book Mind Over Mood, and she could also go to the cognitive therapy website that is on my website also, the link to that, and she could try to find a cognitive therapist in her area and turn her life around. Think better about herself and enjoy her life more. Thank you so much for the call.


Movie clip        

Male 1:             It’s just that it’s bugging me. This cool thing. I mean, what is it? How do you get it? Who doesn’t have it, and who decides who doesn’t have it? What is the essence of cool?

Male 2:             I’m not sure.

Male 1:             You need a thing. One thing nobody else has. What do I have?

Male 2:             An exciting new obsession.

Male 1:             I know I’m right about this. I’m on the track. Just need to find my thing. 


Dr. Kenner:      That’s from Buffy, and if you’re trying to find your thing, something that will impress the people around you, you are on the wrong track. The one thing you have that nobody else has is your own mind, and your own values. If you make yourself someone you’re proud of, by making good choices, by taking your psychology seriously, you are going to be much happier in life, far more happier than anyone who chases coolness, who chases the next thing that’s the fad to try to impress other people. When you try to live through other people’s eyes, you will never feel comfortable because whose eyes are looking at you? Maybe one group of your friends likes the cool hairdo you have, but the other group thinks it’s weird. Who do you please? What if you please yourself?