What Is the Cause of Depression?

Feeling Good Podcast Special Edition #1: February 28, 2022

Today’s special podcast features Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the most recent beta test which included 140 participants with depression ranging from no depression at all to the most severe depression that one can possibly experience.

David explains that in the middle- to-late 1970’s he first conceptualized the possibility of creating an electronic version of himself that could treat people without any assistance from an actual shrink. He explains that

My first fantasy was a small booth you could go into, like the ones for taking photos, where you would be presented with a hologram of a shrink who would talk with you in just the same way that a human therapist does. I also imagined creating kiosks that could be placed in groceries stores or places like Epcot Center in Disney World. where people could insert 25 cents and have their emotional or marital problems analyzed, or their depression treated, and so forth. I imagined that the kiosk would be loaded with powerful statistical software that could analyze data on the fly, and create huge data bases, and do research on the causes and cures for emotional and relationship problems.

Once the internet evolved, my fantasy change slightly, and I imagined creating an electronic version of myself that would be available to anyone in the world as an app. In addition, because of some promising published research on the antidepressant effects of my first book, Feeling Good, I had a hunch that I could create an app that might be as effective, or even more effective, than human therapists.

Two years ago, Jeremy and David teamed up to see if this dream was possible. Today, they present the incredible results of the latest beta test of the Feeling Good App. They measured changes in seven negative feelings as well as happiness in 140 individuals who had access to one portion of the app—the Basic Training—for one day only. The seven negative feelings were depression, anxiety, guilt and shame, inadequacy, loneliness, hopelessness, and anger. All feelings were measured on the same scale from 0 (for not at all) to 100 (for completely). The reliabilities of the negative feelings scale were .91 at the initial evaluation and .93 at the end of the day.

David divided the participants into two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression.

The results indicated, unexpectedly, that they may have already achieved their goal. Here’s what they found:

1. The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants.
2. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62%and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively. (Click here for the complete report).
3. Individuals in both groups also reported boosts in happiness, with a 33% increase in the mild group and a mind-boggling 80% increase in the severe group. The lower (but significant) boost in happiness in the mild group was because many of these individuals were already pretty happy at the start of the app, so there wasn’t a lot of room for improvement.

CLICK HERE FOR THE FULL REPORT

One of the most exciting features of the Feeling Good App is that it does research on itself in real time and shows us which parts are the most and least effective. In fact, one part of the app in this beta test was not helpful, and actually made depression somewhat worse, on average. In spite of that, the changes in all the negative feelings were spectacular by the end of the day.

We have already modified the parts that were not effective, and anticipate the app will become more and more powerful over time. This is just the beginning, and the sky’s the limit!

The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice.

And of course, similar information is rapidly and radically transforming our app! Once again, our “patients,” or more accurately “app users,” have become our best teachers.

In the next podcast a week from today, we will discuss the basic science we are doing with the help of the Feeling Good App. We are asking questions like these:

1. How does the Feeling Good App really work? What are the ingredients of therapeutic success? What are the variables that can trigger such rapid and dramatic changes in negative feelings as well as happiness?
2. What is the cause of depression? Is there any support for the theory that depression (and all other negative feelings) are caused by distorted negative thoughts?
3. Is there any support for the theory that changes in negative feelings are actually mediated by reductions in our distorted negative thoughts?
4. Is there any support for David’s prediction, first made in the Journal of Consulting and Clinical Psychology in 1998, that an unknown “Common Cause” simultaneously triggers depression and other negative feelings, like anxiety, and accounts for the strong correlations among these feelings? Here's the reference:

Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473.

5. Are some groups easier to treat and more responsive? For example, the beta group included therapists and non-therapists, as well as individuals with no or very little familiarity with David’s work, plus individuals very familiar with his work. Which groups responded better to the app? This is important because most of the world is NOT familiar with David’s work. Will they be at a disadvantage when using the app?
6. Are the causes of negative feelings, like depression, anxiety, and anger, the same as the causes of happiness? Or does happiness have its own, totally independent causes?

Stay tuned for the answers to these questions. But in the meantime, make your own predictions, and then you will find out what the data told us!

If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques. So, hopefully, the new study will be pretty cool, too!

David and Jeremy

Rhonda, Jeremy, and David