The fundamental idea of modern psychological therapy for depression is that individuals can change their thinking processes in ways that will eliminate the patterns which cause the depression. The layperson may consider this to be plain common sense. But when seen in light of the older Freudian view, this common-sense foundation is revolutionary. And though the fundamental assumption is "only" common sense, the scientific structure constructed upon it is not at all obvious. Building upon this foundation, various researchers have focused on different aspects of the thinking processes which are commonly faulty among depressives. And they have shown how altering the defective thinking can improve people's moods.

This book develops a broader framework that encompasses all the major insights of earlier writers. Within that framework, it focuses on the key cognitive channel -- self-comparisons -- through which all the other influences flow. Philosophers have understood for centuries that the comparisons one makes affect one's feelings. But this element has not previously been explored or integrated into scientific understanding of the thinking of depressives, or exploited as the central pressure-point for therapy. Instead, the concept "negative thoughts" has been used.

Appendix B continues the theoretical discussion with an analysis of how this approach to depression fits with, and broadly encompasses, the other modern cognitive psychological approaches to depression. The remainder of this Appendix A adds some theoretical underpinning to discussions in early chapters. It also briefly discusses how this approach, along with cognitive therapy in general, has been moving toward the use of concepts found in philosophy and other social sciences, some by borrowing but even more by independent invention. In this way, cognitive therapy moves toward what may eventually be the the first application of integrated social science.

In brief, Self-Comparisons Analysis does the following:

1. It presents a theoretical framework which identifies and focuses on the common pathway through which all depression-causing lines of thought must pass. This framework combines and integrates other valid approaches, subsuming all of them as valuable but partial. All of the many variations of depressions that modern psychiatry now recognizes as heterogenous but related forms of the same illness can be subsumed under the theory except those that have a purely biological origin, if there are such.
2. It sharpens each of the other viewpoints by converting the rather vague notion of "negative thinking" (1) to a precise formulation of a self-comparison and a negative Mood Ratio with two specific parts, an assumed actual state of affairs and a hypothetical benchmark state of affairs. This idea opens up a wide variety of novel interventions.
3. It offers a new line of attack upon stubborn depressions, called here Values Treatment, which leads the patient to make a committed choice to give up depression in order to attain more important deeply-held values.

The American Psychiatric Association's publication Depression and Its Treatment by John H. Greist and James W. Jefferson (Washington: Am. Psychiatric Press, 1984) may be taken as canonical: "Depressed thinking often takes the form of negative thoughts about one's self, the present and the future"

On The Theory of Depression and Its Treatment

Beck has properly claimed as an advantage of his Cognitive Therapy that "the therapy is largely dictated by the theory" rather than being simply ad hoc. (1976, p. 312). Beck also notes that "Currently, there is no generally accepted theory within the cognitive-clinical perspective." This book offers a more comprehensive theory of depression than do the others, and includes the others as elements in it. Furthermore, the therapeutic approaches suggested here are dictated even more clearly by the more specific theory given here, and more possibilities are suggested by it, than any of the previous approaches alone.

Each of the contemporary "schools", as Beck (On dustjacket of Klerman et. al., 1986.) and Klerman et. al. (1986, p. 5) call them, addresses one particular part of the depression system and, therefore, depending upon the "theoretical orientation and training of the psychotherapist, a variety of responses and recommendations would be likely...there is no consensus as to how best [to] regard the causes, prevention, and treatment of mental illnesses" (Klerman et. al., 1986, pp. 4,5). Any "school" is therefore likely to achieve best results with people whose depression derives most sharply from the point in the cognitive system that that school focuses upon, but less well with people whose problem is mainly at some other point in the system. (Of course the depression sufferer may have a defective mechanism that spreads into several aspects of the system, and therefore therapy at any one point can benefit the system as a whole, but that is beside the point here).

Self-Comparisons Analysis provides an expanded theoretical understanding of depression which encompasses and integrates the elements pinpointed and explored by these writers and others. This means that instead of the field being seen as a conflict of "schools", each of the "schools" has a distinctive method that fits the needs of different sorts of sufferers from depression. The overall framework of Self-Comparisons Analysis helps weigh the values of each of these methods for a particular person. Though the various methods may be serviceable substitutes for each other at times, to a considerable extent they are not simply competitive alternatives for the same situations, and Self- Comparisons Analysis helps one choose. This should be of particular benefit to the physician or other professional who must make the crucial decision of referring a patient to one or another specialist for depression treatment. Heretofore, the choice had to be made mainly on competing merits, and in practice the choice probably is made mainly on the basis of which "school" the referring professional is most familiar with, which has led to considerable frustration with the field voiced by recent writers (e. g. Papalos and Papalos, 1987).