cognitive behavior therapy (CBT)

July 2, 2020

Persistent Depressive Disorder: Not All Depressions are Alike

Some therapists don’t talk much about diagnosis, but it is essential they think about diagnosis. Proper treatment depends on the correct classification.

In the case of longstanding depression, here’s why:

  1. Effective therapy for Persistent Depressive Disorder (PDD) differs from approaches to other types.
  2. Persistent Depressive Disorder consists of a distinct set of symptoms not typical of the broad range of mood problems.

How is PDD different from other periods of unusual sorrow? Duration is emphasized.*

The syndrome lasts longer (at least two years) and often starts early. Symptom-free periods, if they happen, last no more than two months. More comorbidities are present: that is, other diagnosable conditions.

Among additional distinguishing characteristics, traumatic and abusive childhood experiences are frequently a part of the individual’s back story. In general, the younger the patient was at onset, the more limited his problem-solving skills are today.

Though the above list may be daunting, the evidence supporting the effectiveness of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is impressive. Indeed, an extensive review of the scientific literature endorsed by the European Psychiatric Association recommended it as a top-line psychotherapeutic procedure for people with PDD.**

Perhaps not surprisingly, significant improvement tends to demand an extended therapeutic regime. More than a year would not be uncommon, with an indefinite but lengthy course of less frequent follow-up sessions to maintain gains.

The prescription of psychotropic medication in combination with the “talking cure” is customary, as well.

One of the most notable features of CBASP is its focus on fragile self-esteem. The client views himself as unable to produce satisfying encounters with acquaintances, coworkers, and friends. Nor does he realize the degree to which his words and deeds (or their absence) cause some of his unhappiness.

While his pain is acknowledged as genuine, CBASP views the new client as someone with chronic and pessimistic expectations of the world: self-fulfilling prophecies.

History informs him of how his life has worked out and, he believes, will work out. The evaluation of the patient, therefore, seeks to uncover the ways he contributes (without intention) to the repetition of disappointments characteristic of his past.

Moreover, the practitioner expects such counterproductive social interactions not to be restricted to life outside the consulting room. Comparable events are predicted in-session. The provider of treatment discusses this prospect with the sufferer.

Together they analyze what the depressed individual forecasts will happen between them, along with the actual effects of his behavioral choices. The atmosphere of the conversation must ensure a feeling of safety, not judgement.

An enlargement of the patient’s self-awareness develops as his anticipation of the psychotherapist’s behavior is explored. The Socratic dialogue with the healer should lead him to conclusions he comes to on his own.

This enlightenment is also fostered when the therapist tells him of his own internal reactions to what the client is doing: the feelings or thoughts emerging inside himself (the analyst) in-the-moment. In this way, the patient begins to become aware of his impact on others.

When the process works as designed, the outpatient starts to try out what are novel efforts to accomplish the kind of responses he desires. This begins in the office and extends to people he encounters elsewhere.

Thus, the transference relationship with the counselor is key. The system builds toward recognition of the healer as somebody who responds differently from those in his pretreatment life who caused harm or neglect.

Just as he comes to grasp he was mistaken in many of his beliefs about the adviser, so he begins to recognize routine errors in expecting the worst from much of the rest of the human world.

Progress relies, in part, on the subject’s growing ability to sense his own power to affect how people react to him. Another marker of improvement is his expanding understanding of how failed actions and inactions have added to his fixed sense of helplessness and hopelessness. Increased flexibility in both cognitive and emotional domains is a goal.

The therapeutic conversation includes a step-wise analysis of how troublesome situations in the client’s life developed – what happened at the start, in the middle, and at the end of them. Questions include, for example, “How did you interpret what occurred?” “What did you do?” “What did you want” and “Did you get what you wanted?”

A successful course of CBASP empowers the patient to gain insight through the emotions and thoughts evoked by inquiries like this. The ease of performing similar analyses on his own expands. He reaches the point of engaging the interpersonal world with an enhanced belief in what is possible.

Hopefulness comes to occupy an enlarged place in the client’s vision of what lies ahead. As a result, he risks letting go of passive-aggressive, hostile, submissive, and avoidant strategies. Friendly and assertive advances toward society increase.

Put simply, while there are no guarantees, the news is encouraging for those long-depressed souls who have yet to find a satisfying route to the alleviation of their unhappiness.

—–

*The complete diagnostic criteria for Persistent Depressive Disorder can be found here: https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_PersistentDepressiveDisorder.pdf

**Jobst, A., Brakemeier, E. L.., Buchheim, A., Caspar, F., Cuijpers, P., Ebmeier, K. P., … Padberg, F. (2016). European Psychiatric Association guidance on psychotherapy in chronic depression across Europe. European Psychiatry, 33, 18-36. http://doi.org/10.1016/j.eurpsy.2015.12.003

The bottom photo is Central Utah in Late Summer at Sunset by Laura Hedien, with her kind permission: https://laura-hedien.pixels.com/

January 27, 2018

But I Don’t Know How to Talk to People

My buddy Rock was facing a common young man’s dilemma: what do I say to a girl? Our school lunch group, all of us 15 or 16-years-old, had little experience in that department. Fewer than half had been on a date. I will let Rock and our friend Harmon provide an example that applies even to adult variety women and men with Social Anxiety Disorder.

Keep this in mind if you share the same worry: you might be better at talking to people than you think.

Rock’s problem was set up by asking out a comely classmate. She said yes, not the outcome he prepared for. A little bit like the dog who chases the speeding fire truck and somehow overtakes the juggernaut. Now what?

The date was scheduled for Saturday night, so Rich (his real name) had time to create a plan. Harmon, playing the role of our comparative dating veteran, was consulted. He listened as Rock asked for help with the talking business:

First, you need to think of girls as – like – real people. Like one of the guys. You talk to friends with no problem. Talk about the same stuff with your date: school, teachers, movies, tv, music. Try this: make a list of topics to bring up. Then, if the conversation gets slow, consult the list. You’ll do fine.

Note the confidence and authority. Those of us who overheard the lecture were impressed. This was better stuff than we were getting from our teachers.

Encouraged by Harmon’s advice and pep talk, Rich proceeded to work on his agenda. “I can do this,” he said to himself. By the weekend, a formidable and fairly lengthy itemization of topics existed. He even memorized it.

Saturday evening arrived.

Rock took the Lincoln Avenue bus to the stop closest to the girl’s home. From there he walked two blocks to the address. Deep breath. Front door. Several repetitions of the agenda had been carefully rehearsed. The document was as clear in his mind as the chiseled version of the Ten Commandments was to Moses. Rules to follow to the letter.

The door bell was duly rung. A brief conversation with the mom ensued, then off with his date for the short walk back to the bus. Movieland and the wonders of time spent with a pretty girl beckoned. Houston, we have lift off!

Meanwhile, in various homes in West Rogers Park, Chicago, friends of Rich were all wondering some version of the same thought: what might be happening now? We hoped, after all, to get tips from our chum come Monday’s lunch. Perhaps enlightenment awaited us. A strange new world beckoned. As they say on Star Trek, “to boldly go where no man has gone before.”

Rich arrived at our noontime meal looking like the person we’d last seen on Friday. No remarkable transformation. No bigger muscles, no greater height, no glow. He sounded the same, too. Finally, the question:

What happened?

(Pregnant pause, no pun intended. A sober look came over Rock’s face).

Well, by the time I’d walked the two blocks from her house back to the bus stop, I’d gone through the entire list.

Imagine now the collective sigh of a group of 10 young men: the air making a half hearted escape from a large balloon. Rock continued:

Yeah, I’d keep asking her questions and then … nothing. Silence. And I’d made especially sure that I didn’t smell bad. She did say she liked the movie. Oh, wait, she asked me one question:

Do you like Sugar Shack?

What’s Sugar Shack, I answered?

She tells me its a new song. That was it.

Some men are called to greatness, others have it dumped on them. Or not.

What is the point here? Rock did everything right. He made fine conversation, showed interest in his companion, and still … nothing worked. Moreover, before long he realized the date disaster wasn’t the fault of poor social skills.

Take the lesson to heart, my friends. If you’d like to learn more concerning the ease of drawing the wrong conclusions about your social skills; and about the treatment of Social Anxiety Disorder using Cognitive Behavior Therapy (CBT), read this:

I’m Not Very Good at Making Conversation/

Remember: sometimes it’s your fault, but not always. Maybe even less often than you think.

—

The top photo below is called Young Love at the Malt Shop by Kevin Simpson, sourced from Wikimedia Commons. Next comes a Cover Illustration created by Livia De Simone for Dream Hunters, published by Astro Edizioni. It was sourced courtesy of Bubysan and Wikimedia Commons.

June 4, 2017

The Taoist Farmer and a Patient’s Search for Answers

Part of the human dilemma is the trap of unhelpful, but habitual ways of thinking. Cognitive behavior therapists call them thinking errors or cognitive distortions. On occasion you probably have made one or more such wrong-headed mental turns into an emotional sink hole. Catastrophization is an example: predicting the worst possible outcome you can imagine happening to you, sure the expected calamity will finish you off, even when there are many less dire potential futures and most bad results are temporary. But other mental traps wait for us, ones not so commonly found in a therapist’s lexicon. Good/bad, right/wrong, lucky/unlucky are not as clear as we think.

Take the old story of the Taoist farmer.

There was a farmer whose horse ran away. That evening the neighbors gathered to commiserate with him since this was such bad luck. He said, “Maybe.” The next day the horse returned, but brought with it six wild horses, and the neighbors came exclaiming at his good fortune. He said, “Maybe.” And then, the following day, his son tried to saddle and ride one of the wild horses, was thrown, and broke his leg.

Again the neighbors came to offer their sympathy for the misfortune. He said, “Maybe.” The day after that, conscription officers came to the village to seize young men for the army, but because of the broken leg the farmer’s son was rejected. When the neighbors came in to say how fortunately everything had turned out, he said, “Maybe.”*

As with any parable, multiple interpretations exist. Sometimes apparent bad fortune – like a broken relationship – leads to someone who is a better match. Being fired from a job can be a step toward a better one, even fuel your search and foster your growth. This is not to suggest all tragedies are the yellow brick road to Oz. Yet, we tend to recover, even if recovery can be lengthy, fraught, and incomplete. Then again, luck depends on when you take a measure of your situation. The farmer believed there was still time ahead, and the present moment represented a temporary vantage point: another evaluation down the road might change the assessment of his life.

One alternative way to think about this story is to recognize the problem of “keeping score.” We look around and ask, am I getting ahead or falling behind? In the West, the so-called First World of capitalism, we are trained in ladder-climbing, money counting, and concern with the opinions of others. A bit crazy-making, since someone else always owns “more,” and we are inclined to compare “up” rather than “down.” Put another way, we measure ourselves against those better off rather than those less fortunate. We also tend – after a moment of delight – to take for granted the Christmas toy for which we waited a year. Great honors don’t seem so great after the award ceremony is over.

Is there another way?

A Buddhist (or a Stoic philosopher) might tell you to become less attached to all things in the world: status, property, money; even relationships and health. Put differently, to give up clinging and craving, while practicing loving kindness and steadfast integrity. The more attachment, the more you will lose, so they say. Such an existence – preoccupied with getting and spending and fear of losing (and regret over what is already lost) – is a guarantee of suffering.

Yet another view is this one: maybe life is not a matter of assigning a grade to what we think or do, but to be experienced with little evaluation: passed through, lived. To be in the swim, not outside the pool, watching and afraid of the shock of the cold water if we should jump in. Not asking whether our stroke is beautiful enough, our pace fast enough, the distance traveled far enough.

To this way of thinking, failure and rejection are normal parts of life. They indicate we are still trying; necessary parts, too, because resilience grows from the knowledge you can come back from defeat.

Perhaps winning the game is not as important as playing the game. Perchance the world is to be tasted: different cuisines and flavors, not just chocolate and vanilla. If so, a person would experience many colors, sizes, possibilities. Engage in multiple careers. Know lots of people. Have your heart broken and sewn up and torn again and stitched until the twine itself breaks. And to read and discuss all the worthy books, play all the sublime music, climb walls until your muscles and tendons hurt. No, even past the time they hurt, adapting to the hurt. Not an either/or existence but “all-in.”

Or, is life properly understood to be perplexing and without a “solution”? If so, any belief in your own secret formula is misguided: your solution is, at best, temporary. You are not only fooling yourself, but missing the point. Which is? That the pursuit of happiness is more a journey than an arrival. That when traveling to the airport we should always go to “departures” instead of “arrivals” because we are forever “taking off” for whatever is next and never reach a static endpoint while alive.

Left to you is the creation of a personal meaning, not to be found in a book or a place of worship or from a mentor, whole and flawless; unless, that is, you are among those for whom the answer is unquestioning faith and an ultimate, unworldly reward.

Still another path: one is told the most satisfying existence requires living for bigger things than ourselves, including the future of the planet, our children, and the lives of others. We are warned not to count on or crave a posthumous glory. Unless someone else is doing the scoring, the record book will be lost along with our names, in a fast-fading blue ink on a yellowing parchment. Or, as Arthur Miller suggested, on a block of melting ice.

Is human existence perhaps a multifaceted combination of tragedy, joy, inevitability, necessity, laughter, devotion, confusion, sacrifice, and the way things are until, too soon, they aren’t?

Having written all of the above, I fear my message – the answer without an answer to conceptualizing life – is unsatisfying. I’m not even satisfied. I have given you no certainty, nothing definite. Some of you will reject the inconclusivity. I won’t hold it against you.

To my way of thinking, therapy cannot provide “the answer” either. The counselor instead offers a remedy for specifics. He can help reduce or eliminate your anxiety or depression or some other malady in the Diagnostic and Statistical Manual. No text-book or training, however, offers a step-by-step solution to dealing with the human condition. I’m sorry about that, really.

We do what we can.

I offer this consolation to you, nonetheless:

No matter what we look like, no matter how happy or sad we are (or seem to be) for the moment – calm or stressed, wise or foolish – we are all in this porridge together. Sometimes we swim within a tasty bowl – “just right,” as Goldilocks said – though not for every meal and every appetite. Look around you and see all the swimmers. Tiny like us, precious like us. They come in all strengths and varieties, but they will not always be there.

No wonder we search for love.

—

*Source: Tao: The Watercourse Way, by Alan Watts. The first image below the youtube video is Ilja Richter rehearsing for his play Altweibersommer in Munich. The next photo is the work of SuzannePerry.enoughofit7. Both are sourced from Wikimedia Commons.

February 26, 2017

Why Therapists Leave

256px-goodbye_grenada_goodbye_karibik_-_panoramio

Any beginning predicts an ending. Permanent relationships can become impermanent with time’s passage. That knowledge unsettles those in long-term treatment. Abandoned before, they wonder not “if,” but “When?”

Why do therapists leave?

An example: the man and woman had been married for six years. In mid-life, however, he was afflicted with a rapid and permanent hearing loss. In the midst of the crisis, his mother-in-law was diagnosed with cancer. She lived 1000 miles away. What was the wife to do? She chose to spend the last six weeks of her mother’s life with mom. She’d have done the same thing if she’d been your therapist.

Granted the departure was temporary, but such disruptions happen and are sometimes more lasting. A lovely psychologist of my acquaintance, a being so calming as to make quiet moments with her almost holy, fought illness off and on for years. Her resilience seemed infinite. In her ninth decade she banged against infinity’s wall and retired abruptly, having met physical problems even she could not shake off.

The choice is usually not so harrowing. My own retirement was the consequence of the increasing depletion I felt from doing my work. The weight of the problems of others pressed heavily, even though my clients were less troubled as a group than they’d been earlier in my career. Then too, books called out to be read, courses of study beckoned, and new wonders of the world awaited.

Therapists are notorious for burning out, though not all do. Unfamiliar places trigger our wanderlust. Everyone seems to believe California or some warm spot would be nicer, at least if you live in the Midwest. Grandchildren need attention while they are small. You cannot place their youth in a safe deposit box for later use any more than you can your own.

Life intervenes in unexpected ways. I do not mean to minimize the pain when a therapist departs before a patient expects the end of the relationship. I helped clients grieve such losses when they came to me afterwards. I also caused unhappiness myself by deciding to leave practice. Unexpected finishes, however, cannot be allowed to finish us off.

When I was about to embark on the capstone or giant-killer to a graduate education, the dissertation, my advisor disappeared, vanished. I found out he was going through a messy divorce. Fair enough, but to another state? Without telling me? I adjusted. I lined up a new dissertation committee chairman and was ready to proceed when my initial advisor returned, as unexpectedly as he departed. Granted, he was not my therapist, but still …

Therapists also, on occasion, change as people. Funny, one wants a transformative counselor, not a transforming one. The patient expects to be the only person to make substantial self-alterations, setting aside any desire for a reduction in boundaries allowing more intimacy with the doctor.

A young therapist/colleague became a carpenter in his ’30s. I met a lawyer with a towering income who opted out of his partnership to opt into a seminary. Charles Krauthammer, a syndicated conservative columnist, was a psychiatrist. Granted, not many established counselors change careers, but an occasional dropout happens.

long_boy_goodbye_ma_goodbye_pa_goodbye_mule_with_yer_old_hee-haw

Close to the end of my career I’d hear the question from a patient, “Do you expect to retire soon.” I think I answered, “I have no plans.” Until, of course, I eventually did and then announced my future unprompted.

We (and by “we” I mean you and me) have no crystal ball, no bewitched mirror on the wall. We don’t expect to divorce when we marry, don’t enter careers anticipating they will end soon, don’t fall into friendship with a vision of its erosion or collapse. I can only tell you — only tell myself — the things I know for sure. And sometimes what we think we know we don’t know. Fate’s hand spins the top of our lives in directions never imagined and, when the spinning stops, a new idea forms and informs us.

Therapists leave and it’s not personal, except it is. When you don’t think you are “enough,” a therapist’s departure (at least not one caused by a lightening-strike) says “You’re not enough to cause my staying at the job.” I get it and I also get the absence of an intention to harm.

So yes, your therapist might leave you, but your departure is more probable. The latter is best, for sure, if you’ve gotten what you came for. The good news is we have encouraging career-longevity data on doctoral level psychologists. The American Psychological Association’s Center for Workshop Studies reports that among those already “retired” in 2013, 42% were still working. The median age of retirement was 61, meaning half retired before 61 and half after. The sample included all doctoral level psychologists in the year of the study, not only clinical or counseling psychologists in practice.

Therapists, like most of the rest of us, are living longer and need to make a living. They have multiple incentives to continue. The satisfaction of meaningful work, the intimate contact with good people, and the words of thanks are enriching. The work is interesting and research offers us new tools. It’s an exciting time to be in the field, in the lab, and in the office.

We cannot guarantee our lives, any of us. The retirement or side-lining of a therapist probably won’t happen while you are in treatment. The answer to the “What will I do if it does?” question is that you will do what is required. In the meantime, avoid living the infinite variety of doom-laden scenarios available to imagination: a “thought-error” called catastrophization which can be treated with cognitive-behavior therapy (CBT).

Good advice comes from John Steinbeck’s The Grapes of Wrath and his character “Ma” Joad, the rock of a migrant family almost out of chances. She is the lady responsible for their emotional and physical sustenance, including cooking the salt-pork packed for the clan’s trip to an uncertain life in California. Her 16-year-old son Al asks:

Ain’t you thinkin’ what it’s gonna be like when we get there? Ain’t you scared it won’t be nice like we thought?

No. No I ain’t. You can’t do that. I can’t do that. It’s too much — livin’ too many lives. Up ahead they’s a thousan’ lives we might live, but when it comes, it’ll ony’ be one. If I go ahead on all of ’em it’s too much. … An’ (what I concentrate on is) jus’ how soon (the family) gonna wanta eat some more pork bones. That’s all I can do. I can’t do no more. All the rest’d get upset if I done any more’n that. They all depen’ on me jus’ thinkin’ about that.

—

The top photo is entitled Goodbye Grenada, Goodbye Karabik by giggle. The cover art for the sheet music for Long Boy (I imagine this means “So Long, Boy”) was drawn by Gar Williams. Both images are sourced from Wikimedia Commons.

February 19, 2017

“It All Just Amounts to What You Tell Yourself”

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Great literature transports you into the lives of others to inform you about your own. Take The Grapes of Wrath. I’ll offer you a single scene to illustrate how we rationalize our actions. Tom Joad, the story’s hero, reframes cowardice into practicality, moves from fight to flight, and converts hesitation into wisdom; all with the help of a man who has already rationalized his own diminished life. We rationalize because we must — in order to live comfortably with our motives and our choices.

John Steinbeck’s novel is set in the Dust Bowl era of 1930s Oklahoma. Newly available machines allowed rapid and widespread plowing and cultivation of the native grass: an act of misguided surgery. The grass was essential to bind the earth to the land. When drought came, not only were conditions insufferable, but crops died for lack of moisture. The ground became unmoored and simply blew away. In some areas this “worst hard time” persisted for eight years. Dust storms blackened the sky. The fine dark particles invaded farm houses, killed animals, and impaired breathing. Visibility might be reduced to a few feet on a given day. The dust-occluded air produced occasional darkness as far away as New York City.

Tom Joad is a young man just released on parole after four years in McAlester prison. He killed a neighbor who attacked him in a bar fight. Tom and two acquaintances are on the land once occupied by his family. The Joads were evicted in a bank foreclosure. The men notice a police car coming to investigate.

Muley, one of the acquaintances, is an older man who experienced the merciless attitude of the bankers, their agents, and the law enforcement officers in evicting most everyone in the area while Tom was in prison. He and Tom talk about the vehicle heading in their direction:

TOM: We ain’t doin’ no harm. We’ll jus’ set here. We ain’t doin, nothin’.

MULEY: We’re doin’ somepin jus’ bein’ here. We’re tresspassin’. We can’t stay. They been tryin’ to catch me for two months. Now you look. If that’s a car comin’ we go out in the cotton an’ lay down.

TOM: What’s come over you, Muley. You was’nt never no run-an’-hide fella. You was mean.

Muley agrees with Tom that he is not the same man he was. Changing conditions changed him. He knows Tom’s nature is to fight, especially on the land Tom grew up on. Muley also reminds Tom of his parole. Any “trouble” and he will be sent back to prison.

TOM: You’re talkin’ sense. Ever’ word you say is sense. But, Jesus, I hate to get pushed around! I lots rather take a sock at Willy.

MULEY: He got a gun. … He’ll use it cause he’s a deputy. Then he either got to kill you or you got to get his gun away an’ kill him. Come on Tommy. You can easy tell yourself you’re foolin’ them lyin’ out (in the cotton) like that. An’ it all just amounts to what you tell yourself.”

Landscape

Indeed. Tom follows Muley’s advice to hide from the police rather than confront anyone.

As with other (mostly unconscious) life strategies, the way we explain our behavior to ourselves can help or harm. Some of us automatically rationalize so many choices we lose touch with who we are and how we hurt ourselves and our fellow man. Others reflexively come to unnecessary and unflattering conclusions about their deeds. They blame themselves and interpret events in a self-deprecating fashion. In effect, each of us has our own internal “make-up” artist. He is the part of us who tries to put a “good face” on the reasons we do what we do, the better to look at ourselves in a friendly mirror: one not too revealing of uncomfortable defects.

Think of a situation in which you fail to achieve your goal. Many explanations are available:

  • I’m a loser. (Here you’ve taken a single disappointment and indicted your entire being and character).
  • It was his fault. He was unfair. (In this example, right or not, someone else is blamed).
  • This is a temporary set-back.
  • Perhaps I need to approach situations like this in a different way. (Possible adaptation and learning enters the picture with this explanation).
  • I did the best I could. (Defeat is acknowledged, but there is also a self-comforting understanding of the event).
  • “Every knock is a boost.” (This was one of my dad’s expressions. He re-interpreted his defeats as exercises in strengthening his character).

Many other examples might be offered. Cognitive-behavior therapists try to help patients reframe their beliefs and assumptions about themselves and the world. They hope to free clients from self-damaging “self-talk.” CBT counselors encourage a reality-based, but adaptive way of approaching the task of thinking about and explaining our behavior to ourselves.

You and I are left with the question implied by Muley in his conversation with Tom: what do we tell ourselves?

I hope you give it some thought.

—

The top photo is called, Dust Bowl, Oklahoma. It shows a “father and sons walking in the face of a Dust Bowl storm in Cimarron County, OK,” April 1936. The picture was taken by Arthur Rothstein. The second image is Dust Storm Near Beaver, Oklahoma; July, 14, 1935. Both are sourced from Wikimedia Commons. If the Dust Bowl is of interest, you might want to watch The Grapes of Wrath, the 1940 movie adaptation of the Steinbeck novel. Henry Fonda stars as Tom Joad. The film is widely considered one of the 100 greatest American films. The Worst Hard Time: The Untold of Those Who Survived the Great American Dust Bowl is a terrific oral history of the period written by Timothy Egan. Finally, don’t miss Ken Burns’s documentary, The Dust Bowl.