An interview with William J. Knaus, author of The Cognitive Behavioral Workbook for Depression

New Harbinger Publications: Depression has become a word we throw around casually, especially with commercials and print ads for antidepressant medications. From a clinical point of view, what exactly is depression?

William J. Knaus: Depression is best described as a darkened mood that persists and colors life with an aura of pessimism. It’s a complex state with many different causes, forms, and degrees. A serious depression is far different from mere feelings of sadness, the blues, feeling down, or having a bad day. Depression of the mind and body feels dull, deadening, and it lasts. Depression often has unpleasant physical aspects such as fatigue, primary insomnia, excessive sleeping, appetite loss or excess food consumption, loss of sexual interest, and headaches. It practically always is accompanied by depressive thinking, such as helplessness, hopelessness, and self-blame. Depression can be accompanied by a collection of unpleasant states such as anxiety, panic, anger, self-doubts, and perfectionism. It can come out of the blue. The dark mood of depression can follow a traumatic event, such as a divorce, job loss, or death of a loved one. It can be the outgrowth of a physically abusive relationship, living in a high crime area, or living in a war zone.

The dark visitor of depression comes in many forms including major depression, bipolar depression, atypical depression, and seasonal affective disorder. Depressive thinking weaves through the forms, and defeating depressive thinking helps reduce or eliminate the gloom associated with each form.

The drug solution can be helpful to a subgroup of people with depression. The drug commercials, while helping heighten awareness of depression, can do more harm than good by suggesting a chemical solution that does not address chronically negative conditions and self-defeating behaviors, yet conveys the illusion that all can be well following the use of a pill. But drug therapy can have serious limitations including unpleasant side effects, and an increased risk of relapse. Because of the extensive drug company-sponsored publicity, the antidepressants are over prescribed as well as inappropriately prescribed for some forms of depression where they are useless or harmful, There are effective psychological alternatives that do not have the side-effects and risks that are associated with antidepressant medication. For a subgroup of people who prefer a skill building alternative to the antidepressants, and who are interested in reading and applying cognitive and behavioral methods to depression, The Cognitive Behavioral Workbook for Depression is filled with suggestions.

My book describes psychological self-help measures designed to decrease depressive thinking, to prompt positive actions, to address the often coexisting conditions of depression, and to prevent relapses. The book’s step-by-step approach shows how to train the brain to override the sort of negative thinking that so often intensifies depression. It shows readers how to structure their time and lives to help them get past depression. It can also help them deal with unpleasant physical conditions and psychological conditions that commonly occur with depression. The book will also help insulate readers against relapse. It provides many fundamental ideas and more advanced ideas then build from that base. However, no one method or book can be universally effective for everyone. Actively applying the ideas and exercises from the book, at the readers own pace, does boost their chances

NHP: Your book covers depression extensively, from its history in early civilization onward to self-evaluations and case studies. It includes many innovative ideas. With so much to offer, how are readers most likely to benefit from the book and its techniques?

WJK: The book contains a self-help inventory that describes the content covered in the book. If, on the inventory, you describe yourself as anxious and depressed, you are directed to chapters or pages in the book that address that issue. The book contains a chapter that provides a structure for the reader to map out an individualized program. A good way to start is to scan the book to get a map of the territory. The go over the material, chapter by chapter, and complete the exercises that apply. You can pay special attention to areas you identified as priority targets for positive change. In this process, it is important to start with even the smallest of steps. Each step builds upon the other.

NHP: Your book emphasizes defeating depressive thinking and engaging in problem-solving actions. How does changing depressive thinking lead to a reduction in depression?

Depressive thinking is like a double whammy. Caught in a dark mood of despair, your thinking is likely to reflect the mood, and depressive thinking is likely to darken your mood. By uncoupling depressive thinking from a depressed mood, you can free yourself from the added stress of negative thinking and gain relief. Research data from brain imaging methods demonstrate that the functional changes you make by changing depressive thinking are associated with structural changes in the brain that reflect this positive change.

NHP: Throughout The Cognitive Behavioral Workbook for Depression you mention that depression is often cyclical and commonly recurs for those who suffer from it, which is a depressing fact on its own. What do you suggest readers do to break free from the cycle or to better cope with it?

WJK: Positive changes in brain structure that grow from developing cognitive and behavioral skills to defeat depressive thinking, can help insulate you from related depressive thoughts, and prevent depression from coming back. This feature to a cognitive behavioral program is important. That is because if you had one depression, you have a fifty-percent chance of having another, and the risk rises with each successive depression. By reducing the risk of a future depression, you do yourself a big favor.

Unlike the use of antidepressant medication, which is associated with a high relapse rate, a cognitive behavioral approach for building durable coping tools significantly helps reduce the risk of a future depression. Thus, there is a double benefit. You can overcome the depression you currently experience, and that action helps reduce the risk of another. I think that is a good economy of effort.

NHP: What innovations are present in the book that can help a reader overcome depression.

WJK: The book includes a variety of tested innovations such as the application of procrastination technology to help people become more actively engaged in activities to counteract depression. It describes a PURRRRS plan that helps put depressive thinking into slow motion where it can be effectively addressed. The stepping stone approach illustrates how to deal with multiple conditions that can coexist with depression. Additionally, thirty other depression experts and people interested in overcoming depression contributed innovative ideas and suggestions especially for this book. It is jam packed with innovative techniques for overcoming depression, and each reader is likely to find at least one that can make a difference in overcoming depression, and probably many more than that.

Dealing with depressive thinking is now a standard approach for dealing with depression. This approach is augmented by evidence-based methods for overcoming depression, such as exercise, which seems to be a pretty effective antidepressant method.

Throughout, the reader will find tried and true methods. These methods were researched and clinically tested and found effective. Some of these methods have been around since the days when the ancient Egyptians described depression and recommended sleep, diet, and exercise as “cures.” This book recommends these time-tested methods.

In the middle ages, we learned that depression could be corrected by correcting wrong thinking. This idea reemerged in the late 19 th century, went dormant, and came again in the middle of the 20 th Century with the introduction of Albert Ellis’ rational emotive behavioral therapy (REBT) and his famous ABC method. I show how to apply the ABC method throughout this work. Ideas from the Cognitive Therapist, Aaron Beck and the Multimodal Therapy of Arnold Lazarus, are included throughout. But the book primarily draws from my experience over the past forty years as a rational-emotive behavioral therapist. From that, come most of the innovations.

NHP: Are there quick fixes for depression?

WJK: Practically any intervention for depression can have a placebo effect for some. That includes the antidepressants and the techniques described in this book. The person with depression beliefs, who believes that a certain procedure will effect a “cure,” may experience relief from depression. This can happen about twenty-five to fifty-percent of the time. The durability of the placebo suggestion is another matter, but it’s a start. Belief in a positive change, or that “help is around the corner,” can compete with hopelessness thinking. This competition is normally beneficial.

Overcoming a significant depression is different from running a foot race. Depression often includes many habits of mind that float below the level of conscious awareness. It takes time to recognize self-defeating depressive beliefs, and to learn to deal with them, and to replace them with thoughts and actions that advance positive interests.

The Cognitive Behavioral Workbook for Depression represents a forceful defense against depression. When you learn and practice cognitive and behavioral methods to break from depression, you will have learned sound psychological strategies that you can use again and again in many different areas of life. However, “Rome was not built in a day.”