As the holiday season is upon us, now is a good time to consider cognitive behavioral therapy (CBT) for depression. Ironically, the all-time Christmas classic "It's a Wonderful Life," directed by Frank Capra and starring Jimmy Stewart and Donna Reed, presents the fundamental elements in CBT.
CBT is the new buzzword for psychotherapy - as Freudian psychoanalysis once was. Every therapist now claims to use it (if they aren't psychiatrists who rely strictly on drug therapy). But most are just paying lip service to the treatment.
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 added benefits for ADs versus those produced by the placebos. (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 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 depressed people's thinking and become intolerably dire in their minds. Of course, if they waited for events to cycle through, they would find their problems are often less severe than they originally feared, and that they can be 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) in "It's a Wonderful Life." George is on the verge of suicide both because he feels he's wasted his life, and because he's faced with a business crisis. Clarence helps George to retrieve images of all of the positive deeds George has performed over his lifetime. Recalling these images causes George to see how many people in his community he has helped and how much good will he can call on.
After this vision, George returns home with a new appreciation for the small things around him - even the disappointments and stressors - as well as for his loved ones. This is the kind of awakening people often report after they nearly die. If only we could help depressed people crystalize such realizations without having them face death, then we'd have a therapy!
And we do. CBT helps people to learn these cognitive lessons so that 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 what seems like, well, an eternity.