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Cognitive Behavioral Therapy for Depression

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As the holiday season is upon us, now is a good time to consider cognitive behavioral therapy (CBT) for depression.

CBT is the new buzzword for therapy - as Freudian psychoanalysis once was. Every therapist now claims to use it (if they aren't psychiatrists who rely strictly on drug therapy).

But as simple as CBT is, this claim is merely eyewash. Most therapists don't know, and don't care about practicing actual CBT. But Frank Capra did in his 1946 film, "It's a Wonderful Life," starring Jimmy Stewart and Donna Reed.

Before turning to Capra's genius, let me first answer the question: "Haven't antidepressants (ADs) revolutionized, solved really, the problem of depression?"

No, they haven't. Here are three points to ponder. (1) As all medical providers will tell you, symptoms of depression persist for the large majority of AD recipients. (2) Clinical trials involving psychoactive placebos find negligible additional benefits produced by ADs. (3) Head-to-head comparisons of CBT and AD yield equivalent initial results, but far less relapse from CBT.

The lower relapse rate for CBT occurs because it teaches people specific techniques to employ in their lives which they retain, while withdrawal from ADs is often traumatic.

What makes CBT so deceptive is that it is a prescription for common sense. CBT tells people to schedule, and force themselves to attend to their needs and remain involved in work, play, social activities. It also teaches them to practice simple cognitive prophylactia - as demonstrated in "It's a Wonderful Life."

When people commit suicide, we often mourn that they had so many positives in their lives which they ignored in favor of some recent bad events. These traumas, or fears more often, dominate their thinking and become intolerably dire in their minds. Of course, if they waited for these events to cycle through, they usually are less extreme than the people originally feared and they are readily solved.

Meanwhile, if people weather the storm, they refocus on their positives: family, simple pleasures, past accomplishments, friends they may have forgotten, and so on.

Clarence the angel performs this refocusing task for George Bailey (Jimmy Stewart) when he's faced with a business crisis (insufficient funds at his bank) by recalling all the positive deeds he had performed over his lifetime (not many more than most of us, really), how many people were indebted to him for good things in their lives, and how much good will he could call on if he only tried to summon it.

CBT helps people to learn these lessons, so they can create for themselves the same magic that Clarence performed for George. And Clarence's demonstration of CBT is why "It's a Wonderful Life" has stayed with us for, well, an eternity.

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