Stanford Psychiatrist Reveals How Cognitive Therapy Can Cure Your Depression and Anxiety

Everybody, welcome to another episode of Impact Theory. I am here with someone who is a total legend for me. This is David Burns, MD. David, welcome to the show. Thanks for having me on. I'm psyched. Dude, I I am so excited. I encountered your book Feeling Good about 18 months ago and have since that point been desperate to get you on the show. I think it's one of the most profound books if somebody is struggling with anxiety, depression, any sort of mood disorder. And so when you released the new book Feeling Great, it was a perfect opportunity to get you on. I think the the two books together are really the most certainly the most effective thing I have ever encountered. I think cognitive behavioral therapy in general is just beyond extraordinary. If if I do my job well, because I know you have the information. If I do my job well, by the end of this, somebody that's struggling with a mood disorder, I think will be move forward pretty profoundly. Um, if you don't mind, let's start with the basics. What is cognitive behavioral therapy and why do you think that it it works as rapidly as it does? Yeah, and then after that we can add what's new in Feeling Great cuz there's a whole new dimension, kind of one step beyond cognitive behavioral therapy. But all of the cognitive stuff is still pure gold and it goes back to the teachings of Epictetus, the Greek Stoic philosopher who said roughly 2,000 years ago that people are disturbed not by things, not by events, not by what happens to us, but by our views of them. And that idea is so simple and basic that most people can't grasp what it means. We'll we'll come back to that in in in in a minute. Now, the the second idea is that when you're depressed and anxious, again, it's not the events of your life that are upsetting you. It's It's the messages you're giving yourself, the way you're interpreting events. And when you're depressed, you're giving yourself messages like, "I'm not as good as I should be." And there's a lot of people listening right now who are thinking that. And uh or if you're shy, you may be thinking, "You know, why am I so shy? I'm really screwed up. Uh there must be something wrong with me." Uh depressed people often feel discouraged or hopeless, and then you're telling yourself, uh "Things will never change. This is my true self. I really am a loser. I'll be this way forever." And uh and the really uh amazing thing that that's been kind of known, what I just said, more or less, for 2,000 years, but what's really kind of new and awesome is that the thoughts that trigger depression and anxiety are not valid thoughts. Depression and anxiety is the world's oldest con. And you're you're fooling yourself, but you don't You don't realize it. And then the final message from cognitive behavioral therapy is the very moment you change the way you think. In other words, the moment you can You suddenly see that those distorted thoughts aren't true, and you stop believing them. In that instant, uh you can change. And so that That was revolutionary, and when Feeling Good came out in 1980, uh that was the first book to really introduce these ideas to the world. And at that time, there were only about 12 cognitive therapists in the world. And all of us were pretty much considered quacks. [laughter] Cuz And Everyone was saying it's a chemical imbalance in the brain. I've been working on research on that disfunct and fraudulent theory at the University of Pennsylvania and we saw that that really wasn't a true theory. And then like so many young psychiatrists, I've been trained in this endless talk. Just come and talk, talk, talk. And and that didn't seem to do anything to my patients. I gave them tons of pills. That didn't seem to do anything for most of them. And then this new drug free idea came along and I first heard about it. I thought it was quackery, too. But then I started going to a weekly seminar by Dr. Beck at Penn. He was kind of creating cognitive therapy. And I said, "I'll just try this with some of my patients to prove to myself that it isn't true." And lo and behold, they started recovering like popcorn. I said, "Man, there must be something to this." And I gave up my academic tenure track position at the medical school to go into private practice and help help develop it because it was so darn exciting. But that that's the the the cognitive piece. And then what happened, I started writing I wrote this book Feeling Good just to cuz I was so excited. I want people to know what was happening to my patients. I could barely believe it myself. People who had been suicidal suddenly suddenly recovering. It was so so exciting. And then Feeling Good finally caught on. It has sold more than 3 million copies. The sequel Feeling Good Handbook has sold another 2 million. And cognitive therapy has become the most popular form of psychotherapy in human history. It's it's it's practiced all over the world and it's the most researched form of psychotherapy in human history. Well, that was the magic as of 19 80 and the cool thing was if researchers discovered that if they simply handed my book, Feeling Good, to people going to a medical center for treatment for severe or moderate depression, they just say, "Well, it's going to be 4 weeks before you can see your shrink, but in the meanwhile, read this book." They found that 2/3 of them recovered with with with no pills, with no therapy within 4 weeks and and didn't even want or need therapy. And so in Feeling Great, you you point out that if somebody had told you sort of where you've come to now in terms of how rapidly these disorders can be disrupted, that you yourself would have said, you know, "This guy is a quack, they're a con artist." Yeah. And what I want to get to, so going back to that first notion that you talked about that um nothing is either good or bad, but thinking makes it so, right? The old Shakespeare quote. Yeah. And I honestly, when I first heard that, I knew that it played a role. Like that seemed pretty self-evidently true to me, but a 100% as a student of the brain, I assumed that this was going to be a balancing act that was maybe you began a process with the thinking, but ultimately it became a hardwiring neurochemical process and that was where the real problem lied. But in Feeling Great, you walk through a story that I think is so profound, it's worth talking about here because this is probably the one people will be like, "But what about postpartum depression? That's obviously hormonal. That's obviously neurochemistry." Um and honestly, when you started the story in the book, I thought actually, yeah, like how is it possible that that isn't hormonal and neurochemical? Yeah. Well, um all your feelings result from your thoughts and um they we don't know how the brain creates depression and anxiety and these theories like of chemical imbalance is was just rubbish from the very start. There was never any reason from a scientific point of view to to to link depression to a deficiency of brain serotonin. And that that was the theory. This is a neurotransmitter serotonin and you it's too low in depression. And so if you raise up serotonin, people will recover. And we discovered that that theory was bunk when I was doing my research at at the at the medical school because we had a award for depressed veterans in the VA and and and we did research studies there. Why do you think increasing their serotonin levels? Yeah. Yeah, we we gave them half of veterans got milkshakes. They all got milkshakes every day, but half of them were were laced with 20 g of L-tryptophan, which is 20 times the amount you you you generally get in your diet. And and that's the thing that goes directly from the stomach to the blood, diffuses into the brain, and is converted into serotonin. So we caused massive increases in serotonin in half of the veterans and kept them on this program for you know, four or five weeks. Kept measuring their moods the whole the whole way. No, it was double blind. No one knew who was getting this massive boost in brain serotonin. And then we broke the code to see how the two groups did and there was absolutely no differences in the groups and neither of the groups improved whatsoever. So we published that in the world's top psychiatry journal, the Archives of General Psychiatry. And everyone ignored it until about 15 years ago because it clearly it? [clears throat] Well, there's money that drives stuff and and there's billions big pharma. Yeah, there's billions of dollars being made on on on this theory. That's that's that's part of it because drug drug companies can generate create a drug that has some effect on the serotonin system and then they can get approval from the Food and Drug Administration to market it as an antidepressant. But now all of the new research indicates that the chemicals called antidepressants actually are not antidepressants. They're just placebos. They're just chemicals with side effects and they don't outperform the placebos. So we don't know the cause of depression, but the cool thing is is that there's a chapter in the new book by Mark Noble, a a neuroscientist, and his his his thinking is that the new TEAM therapy which it's like cognitive therapy on steroids, you might say, actually selectively activates People aren't going to understand. They're They're going to read TEAM in lower case when it's actually an acronym. Just real fast, break it down. So CBT, cognitive behavioral therapy, TEAM is? Uh, T is testing. We test patients at the start and end of every therapy session and the readers of the new book will actually take these tests, too, to to trace changes in their mood while they're reading the book. E is empathy. Empathy will probably never cure anyone of anything, but you've got to have it if you're doing therapy and I tried to create empathy in the book, too, by showing warmth and compassion for for the readers and and a lot of the readers of my book, First Book Feeling Good, have written me probably 50,000 and say, "You're the only one who understands me." So I think you can get empathy out of a book sometimes better than from a person. And then A is assessment of resistance. And that's the new dimension I've created in the last 10 or 15 years of my work at Stanford that that's different from cognitive therapy. Cognitive therapy is in the book and it's still as good as gold. But in in addition, we've I've developed new techniques to eliminate what I guess mental health professionals call resistance, which might not make much sense to the general public, but it seems like when it comes to change, we're all ambivalent. We we want to change and yet we have one shoe put in the water, one foot on the shore, and you can see it clearly. Like let take an example. When I do workshops, I say, "How many of you would like to to lose some weight?" And you know, all the hands go up. And I say, "You just made a mistake. What it's not true that you want to lose some weight." You you you definitely don't want to lose weight. There's only two things you can do to lose weight, and they both suck. One of them is you you start eating carrots instead of that yummy Cinnabon you love, and the other is you get up and exercise when it's like it is right now, and the air is horrible, or it might be raining or snowing. You want to be thin and attractive, but you don't want to lose weight, you see. [laughter] And that it shows resistance. I mean, and it's huge, and it's really it's also true in depression. People are depressed people, it's the worst form of suffering in the world, and they say, "Oh, yeah, I'd give anything to to get better." And then I say to them, and this is in the new book, "Well, let's say there's a magic button here. You press this magic button, and you'll instantly go into a state of euphoria with no effort. Will you press that button?" Everyone says, "Oh, yes, I'll pre- press it." And then I say, "Well, we don't have a magic button, but I have some magical techniques, and I suspect by the end of today's session, we probably can make it all your negative all your depression, anxiety, shame, and guilt, and hopelessness, and rage, they'll all disappear." All right, so let's take this back to the the post we'll definitely get to that very counterintuitive punchline, but I want to I want to put it in what I consider possibly the hardest example for people to get over, Sure, let's talk about that. postpartum depression, obviously hormonal. Well, yeah. How is that just her thoughts? Yeah. Well, um it's not only her thoughts, but her motivation to to to be depressed. But what she was telling herself is is I'm a failure as a mother. She was having trouble with with with breastfeeding. And I And I shouldn't have mixed feelings about having a baby because she wasn't even sure she she wanted to have have have a baby. And then she was telling herself, I have the wrong emotions. I should be better at breastfeeding. I'm I'm failing as a mother. She She was beating up on herself. And it's those thoughts, not some presumed hormonal imbalance that's causing her depression. Now, I can hear people at home screaming right now that you're blaming the mother for her postpartum depression. What How do you respond to that? is never to to blame anyone. Self-blame is the cause of depression. It's not the the cure for depression. But it's actually very liberating to discover that your depression has resulted from messages you're giving yourself that are cruel and untrue. And that in today's session, I can show you how to crush those thoughts and and get rid of this depression so you can go into a state of joy, not just feeling less depressed, but but feeling feeling euphoric. But uh the goal is never to blame someone. In In fact, the discovery that you're wrong when you're depressed, that you're giving yourself unfair wrong messages, is the greatest discovery a human being can make. I can give you a personal example, or we can stick with the with with the woman with the postpartum depression cuz she also had a complete recovery. example does it have anything to do with trains? Trains? Trains. You have an amazing story. good story. Yeah. Yeah, that that to me that was the one-two punch of cuz my when I first heard you say that and I thought, "Okay, wait a second. If this is true, then I should be able to take somebody who was clinically depressed to to the nines and if they had amnesia, that their depression would instantly go away." And why electroconvulsive therapy works temporarily. It's actually not a very good treatment, but you get a memory loss, [clears throat] so you kind of forget your thoughts for a few hours. This is super interesting. I think it would if you tell that the the train track story, um it was pretty pretty enlightening. a great one. Yeah. The after I wrote Feeling Good, this this young man wrote me and said, "Oh, I read your book Feeling Good and I I just love it, but I can't believe that a thought you have to have a thought to have an emotion." He said, "What if you were stuck on a railroad track with a train coming? You'd feel terrified and you wouldn't have to put a thought in your mind." And I had read that letter when I was coming home from the airport in a taxi. And I put it in my briefcase and I was just reading this this letter and I thought, "My gosh, I'm I must be a fraud. This makes sense. How You know, obviously if something awful happens, you're going to be terrified and you don't have to put a thought in your head." And oddly enough, as we were rounding a corner about a mile from my house, it's it there's a railroad track. And there was a car on the railroad track driving on the railroad track. And I saw there there was a freight train about a mile and a half away coming like at 60 miles an hour on that track and they don't stop. And so I said to the taxi driver, "Stop. I I've got to I'll see if I can get that guy off the railroad track, otherwise he'll he'll be smashed. And so I ran up and you know it's was gravel about you know the at the edge of the tracks you know it was kind of elevated a little bit off the the ground and I I went up there and knocked on the window and the car stopped. He was only going 3 miles an hour or something and he rolled down his window and he says, "Oh um uh can you tell me the way to City Line Avenue?" [snorts] He he was an older gentleman and and I said City Line Avenue, you got to be kidding me. It's 8 miles in the other direction but you're on a railroad track and there's a train coming. You got to back up back up so I can get you off the track. So I wanted him to back up to the road so he could turn his car and then drive off before the train hit him. And so he starts backing up and I got him to the road now that the train's about 30 seconds away and they starts honking its horn like get out of the way get off the darn track and he was just perpendicular to the train. And and so I got in front of him and waved my hand and said back up now back up. You just got to back up 3 or 4 feet and the train will miss you. And the guy started going forward slowly. And and then the train put on the whistle nonstop put on its brakes but it came skidding and it hit broadside at about 60 miles an hour and the the car was ripped in half. And the front half went about 15 feet or so from where it had been from the from the impact and I rushed up to the driver's window again and all the windows were smashed and and I expected to see a bloody decapitated corpse but the train had hit just an inch behind his head and it was going so fast that it was kind of like when you pull a uh uh like if a glass it it on on a table and there's a cloth under you pull the cloth really fast it the glass doesn't fall over and it was kind of like that and he looked perfectly normal but there was glass all over and and he said what direction did you say for City Line Avenue? And I says you've just been hit by a train. And uh and he said I have not. He says that's ridiculous. And I says oh no why where do you think all this glass came from? And he says you're right it looks like somebody broke all the windows in my car all of a sudden. I said where's your back seat? And he turned around and he saw that half of the car was missing. And then he looked at me and he says where is this train? I said it's right there. It's 15 ft from here and the engineers and they're running here right now. Uh and he says this is wonderful. And I says wonderful? What's wonderful about it? He says well maybe I can sue. And then then the the engineers came up the police came the ambulance came uh I gave my story to to the police and I went home and I couldn't understand what what had happened. Uh and the next day I was on my 6-mile jog and I saw this man looking through the rubble a younger guy. And I stopped and and uh I said oh yeah what what are you doing? And and and he says well you know my my father was almost killed yesterday. Uh he was hit by a a train but somebody saved his life. And and I said well that might have been me uh be- because I was here and and I was trying to get him off of the railroad track. And I uh uh I I didn't understand why he was driving down the railroad track. He was asking how to get to City Line Avenue. And and then the fellow said well my dad's had uh dementia uh for quite a few years and he does he lost his driver's license 5 years ago. But he forgot and after dinner, he he decided to take the family car for a drive and he snuck out and went went driving. And and so that that explained what had happened, but here you have the same situation. And I had the thought, my gosh, this guy's going to get killed. You see, so I felt intense panic. He had the thought, oh, this is great. I'm going to earn a lot of money from a lawsuit. So he was feeling happy. Same situation, different thoughts, radically different feelings. Yeah, see that when you told that story, I actually thought the punchline was going to be, okay, look, I'm actually making this up, but you know, it illustrates a point and then to hear that it was really real. Um and then there's a it's interesting cuz it's really a two-way street, right? So you have your thought, it triggers something biological in the brain. So they did a study where they removed the amygdala on a bunch of chimpanzees, released them back into the wild. They had an inability to feel fear and so within something like within 48 hours, they were all dead. Because they they wouldn't avoid a predator, they wouldn't avoid limbs that were too small. And so you when if you can disrupt that communication, right? Because if you think something negatively, you are going to get a physiological response. It And nothing You're not trying to say that you won't Right. And that to me is is super interesting. So now going back to our woman with postpartum depression. So she's having these thoughts. Um they're giving her a neurochemical cascade where she is having a physiological response to this. She's confusing the physiological response with what's actually causing this. How does she then begin to back out of that? Like how does she the what what is the process? The mood journaling and all of that is going to help her get out of this. Well, there's there's two phases to it. Now, when I wrote Feeling Good, it was just how to crush the negative thoughts. But now we have worth walking us through that. I think people understanding the the sort of gist of the 10 cognitive distortions Well, sure. Let's let's do that. Then maybe later we can talk about this amazing new thing that speeds recovery so much. Uh but but uh you know, she she What is she telling herself? Well, she's telling herself, "It's my fault that that the baby isn't nursing. Yeah, I I'm a failure as a mother. And also, I shouldn't have mixed feelings about having a child. Mothers are supposed to just love their their children." And uh And those those thoughts have all of the classic uh cognitive distortions. For example, uh should statements. I I I I I shouldn't have mixed mixed feelings. Um also, uh self-blame. It it it's my fault that the baby is is having trouble nursing. That that type of thing. And she had about eight thoughts. And and they all had multiple distortions, you know, all-or-nothing thinking, looking at things in black or white uh categories. Emotional reasoning is huge. A lot of people are listening right now feel depressed and hopeless. So, they feel like losers, so they say, "I must be a loser. I feel like a loser. I must be hopeless. I I I feel hopeless." Uh She's also involved in mind reading. Uh thinking, "Oh, other mothers don't have mixed feelings. Other mothers are, you know, these ideal ideal mothers." And and so, that's the first step is to recognize that what you're telling yourself is not true. It's it's distorted. And the second thing is to realize that it's it's kind of mean-spirited what what you're doing to to yourself. And I used this a number of techniques with her that that were all pretty darn effective, but one very simple one is called the double standard technique. Like I don't remember what I called her. I always disguise people's names and then I can't remember God I know her real name, but whatever her name was in the in the book I I said imagine that you were that I was a dear friend of yours. And and I look a lot like you. And I went to the same schools. I got the same grades. And I also have a a new baby here. I'm not you. I'm I'm a dear friend of yours and then and she and I said would could could we do a little role play like this? She said, "Oh, sure." And and so I said, "Let Let's give her a name. Let's call her Martha and and I'm Susan. And and I said, "Martha, could I talk to you for a minute? Um I I I don't know if you're aware of this. I just have a new baby. You know, my my husband and I we we we we've tried for years and we we could pregnancy didn't happen and we were almost giving up and then all of a sudden here came the pregnancy. Now we have this this beautiful little boy, but he he's having trouble nursing. And I'm telling myself that that this is my fault and that I'm I'm a failure as a mother. Do Do that seem pretty valid? And then my patient who was playing the role of of herself talking to a dear friend said, "Oh my goodness. That that doesn't make any sense at all. You know, how many of you mothers and babies have this this problem and and you know, it's certainly not your fault if if if your little boy is having trouble with with nursing and it it certainly doesn't make you a bad mother. And I said, "Well, that's cheering me up a little bit but but I want to make sure that that's totally true. Is that 100% true or you just BSing me? You just try to cheer me up." And she says, "No, what I'm saying is totally true. 100% true." So, I said, "So, if it's 100% true for me and I'm like a clone of you, then that would be 100% true of you, too. Is is that right?" She says, "Yes." So, I said, "Write that down." We're doing this all in in writing and I said, "Now, how much do you believe what you wrote down in the positive thought column?" She says, "100%." And now, how much do you believe the negative thought, "This is my fault?" And she said, "0%." And that's kind of how it works. But then, I wanted to push it further and I said, "Okay, well, you helped me on that one, but I have another negative thought and and I want to see what you think. See, I'm not always excited about being a mother. And and to tell you the truth, I I've had mixed feelings about pregnancy all all the way along and sometimes I'm really excited about being a mother and other times I kind of yearn for my my work and for my career and and and feel kind of burdened and and and even a little resentful. And surely that makes me a failure as a mother, right? I mean, a mother is supposed to just have loving feelings. Isn't that right?" And she says, "That's ridiculous. You know, all mothers [snorts] have mixed feelings about everything. Nobody has pure feelings and if you have mixed feelings, that that's makes you a human. It doesn't make you a failure." And I said, "Is that right? You mean, I'm entitled to have mixed feelings? Even resentment about being a mother? I said She said, "Absolutely. That's human. All mothers feel that way sometimes." I said, "Is Are you bullshitting me? You just blowing smoke in my face?" She said, "No, that's 100% true." And I said, "Write that down." And I How much do you believe this negative thought, I'm a failure as a mother because I don't always have, you know, excited feelings about being a mother?" And she said, "Zero." And that's the type of thing it's it's it's learning uh to treat yourself with compassion um and kindness and and realism rather than bullying yourself with these distorted negative thoughts. And that that is really the essence of cognitive uh therapy. And then there's this other huge discovery from my weekly training group at Stanford. I have a uh Tuesday night training group that's free for community therapists cuz most of them aren't happy themselves. And they know they're not getting great results, so they can come to Stanford every Tuesday and get unlimited free psychotherapy training and unlimited free personal therapy for themselves if they want. And uh out of that group has emerged another massive insight that's I think as as big and important as cognitive therapy. I mean, that changed the world of psychotherapy um in the 1980s. And I think this is going to cause another massive revolution in how psychotherapy is done because we've discovered I still use all those amazing cognitive therapy techniques, but we've I've I've we've discovered a technique that makes them work uh even faster. And uh that then cognitive therapy worked because you see in the old days when we just had cognitive therapy, I I would think if I get somebody with severe depression better in six, eight, 10, 12 sessions, that was fantastic and it was. And that's about, you know, what it took. Now, with the new techniques, when I work with people, I generally generally I'd say 90 95% of the time I see a complete elimination of symptoms the first time I sit down with them. Now, that has to be a 90 or minute session or a 2-hour session. I can't do it in an hour. But it but I can do it in in 2 hours and then it generally one and done. You know, that it's a complete course of psychotherapy and then I do relapse prevention training and for the most part the the person is is is good to go. Was the key insight there that people are resistant? That they have their Talk about that. Talk about the two different types of resistance. This This to me is that sort of no [ __ ] approach of like you know, look, this is working, but there it could still be better and acknowledging that people put up roadblocks and that you found a way around them. Uh is is so powerful. Yeah. Yeah, that it's been mind-boggling because I I've never had so much fun doing psychotherapy because every almost everyone recovers just right the first time I meet with them. When they get high, I get high, but the essence of it See, [clears throat] Freud tried called this thing resistance. And people talk about resistance. Why do people want to be depressed? Why do they resist recovery? Because half of people have pretty strong resistance. Half of people do not. But about half of people will yes, but the therapist and they seem to fight against effective treatment. And we used to think we we were trained to think that oh, some they this is their identity. They they they see themselves as a negative person, so they're afraid to let go of their identity. Or they they they get secondary gain. They like attention that they get from being depressed. And and things like that. Or they like people like feeling sorry for themselves. And these interpretations of resistance are kind of a put-downs to to the patient. And I don't think they're true in most cases, and they definitely never helped anyone. But what we have found is that the Meaning realizing something negative about yourself is not going to help you. When you say that they don't If a therapist convinces you you just feeling sorry for yourself, you'll you'll feel more angry and more hurt. It's not going to help you in in any way. Sometimes there's a little truth to it. Sometimes I get upset and I want to feel sorry for myself for a little while. But it it's it's not the big thing that keeps people stuck in depression. And And what what we've discovered is let's take the postpartum woman that that we talked about. One of her core issues is is perfectionism. She's been a super high achiever her whole life. And part of her success is that she's always criticized herself when when she falls short. And so when she's beating up on herself and saying I'm a failure as a mother and this is my fault, it it shows how how what a loving mother she she really is. And and it shows that she has high standards and that she wants to do the very best for for her little boy. And it Now, I want to put this back in the context of something that you said at the beginning and I said we'll get to this and and I want people to know we're we're now at this, which is that notion of the magic button. And getting people to to positive reframing, I believe is the term that you've given it. Where you're taking something that you would perceive as negative and you're realizing there actually is something good. So if you can go back to you know, you present people with this, they're just feeling absolutely horrendous. And the And the most powerful example I think you have of this is the mother of the little girl who was shot in the face with a pellet gun and [clears throat] it explodes one of her or multiple of her teeth perhaps and multiple surgeries and the mother had let her go out to play and so it's like, "Oh man, she's beating herself up over it. I never should have let her go out. I'm a terrible mother. You know, my daughter is suffering. How could I ever allow myself to be happy again?" Um how how did you help her realize that hitting the magic button and making all of that anxiety and all of that, you know, shame and guilt, like how on earth did you make her see that guilt and shame and anxiety are actually positive? Well, that's the really fun fun thing. You see, she'd been suffering for for 9 years since her daughter been shot at the age of 12 and she blamed herself that she she said, "I shouldn't have let her go out to play that night. Uh so, I'm a bad mother." And just horrible 9 years. And so, said to her after we empathized, um I was treating her in front of a live audience. And I I I said, "Now, if there's a magic button here." I said, "Well, first of all, what do you want out of this session? If a miracle happens, what miracle would you want?" She said, "Well, I I'd feel better. I'm so so tired of feeling 100% guilty and 100% anxious and 100% ashamed and 100% depressed and hopeless and angry." And I said, "Well, let's imagine there's a magic button here and if you press it, you'll be instantly cured with no effort and you'll go into a state of euphoria." Uh will you press that button? She said, "Absolutely. I'd press it in a heartbeat." Every everyone says that. And I said, "Well, we don't have a magic button, but I've got some incredible techniques. But I I don't think it would be such a good idea to use those techniques." Uh And she said, "Well, well, well, why not? You know, this is what I need. I've been trying for 9 years to get over my my depression." I said, "Well, before we use those techniques, uh let's see what all your negative thoughts and feelings show about you that's positive and and awesome. Now now let's say your sadness and depression to start out with. You've been horribly depressed because your 12-year-old daughter for 9 years has had surgeries and unsuccessful treatment for post-traumatic stress disorder and she's been pretty miserable. So if you press the magic button, you'll be joyous and happy. So you're saying you want to be joyous and happy about the fact that your daughter's been suffering for 9 years? She said, "Oh, no, that that doesn't sound right." So So I said, "What does your sadness show about you that's positive and awesome?" She says, "It shows how much I love my daughter." So put that down. Is that real? Is that powerful? Is that important? She said, "Absolutely." And then you're you're you're telling yourself uh that the people here in the audience are judging you. That was another one of her negative thoughts. They think you're a bad mother and you think you're a bad mother. What does that thought show about you that's positive and awesome? The fact that you're concerned that the people in the audience here may judge you. She says, "I guess it shows that I want uh positive loving relationships with with with them." And I said, "Is that true?" She says, "Absolutely." I said, "Is that important?" She says, "Absolutely." So put that down. Shows that I want loving relationships with with the people here in the group. And then uh you're you're very self-critical. You're beating up on yourself uh constantly. "I'm a bad mother. I'm a failure. I I shouldn't have done this. I you know, I should have done done that." What What does that show about you that's positive and awesome? She says, "Well, maybe that I have high standards." I said, "Absolutely. Is that true?" She says, "Yes." And I said, "Have you Have your high standards helped you?" She says, "Oh, yes. I I do everything I can to help my daughter and and I got a PhD in clinical psychology. I've I've achieved a lot. And I said, "Is that important?" And she says, "Absolutely." I said, "What else does all this self-criticism show about you that that's positive and and and awesome?" And and she says, "Well, maybe humility." And I'm not like bragging about about myself. I said, "Is that important, humility?" She says, "Yes, I'm a very religious person. That's That's a spiritual principle." So, put down humility and then "And you're anxious all the time." And if you press the magic button, your anxiety will go away. What What are some good things about your anxiety?" She said, "It keeps me vigilant to protect my daughter let my daughter The last time I let down my my guard, she got shot in the face." Uh so, I guess you're saying your anxiety is is your love for your daughter. She says, "Absolutely." So, she puts that down and then "You're angry. Is Is that valid?" Uh What What are some beautiful things about your anger?" She says, "Well, the parents of those boys never should have let them go out and play with other children with a loaded rifle." Uh and so so what does your anger show about you, Karen, that's awesome?" She'd say, "Well, I'm I'm like an angry mother bear. I'm going to protect my daughter. I'm not going to let those parents get away with with that." And and and I said, "Is that important?" She says, "Absolutely." So, we came up with a list of about 25 beautiful things about her depression and anxiety and shame and guilt and anger and hopelessness. Even the hopelessness is even a a good thing cuz it prevents her from getting disappointed, getting her hopes up. Like it doesn't make sense that you could sit down with Dr. Burns for one session and be cured. That's like a snake oil salesman. So, your hopelessness shows that you're a critical thinker and it prevents you from getting horribly uh get your hopes up and then then get all disappointed at the end of the evening. She said absolutely. So then I said, well, look at given all these beautiful things about you. We've We've listed 25 beautiful things about you that that that are all expressions, you know, of these these negative feelings. That That you have these negative feelings because of these beautiful things about you. And if you press that magic button, all go down the drain along with your negative feelings. Is that what you want? She says, "No, I I don't want to suffer, but I don't want to give up all these positive core values that I have." And then we said, well, maybe we can make a little compromise here. Maybe instead of pressing that magic button, we'll have a magic dial and you can dial them down to a lower level, but not to zero. So So how sad would you want to be at the end of the evening? It's 100 right now. She said, "Oh, 10% is enough." I said, "Is Is Are you sure that's enough? Are you Could I sell you on 20?" Now I'm in the position of trying to persuade her to be more upset. You You You see, rather than try to sell her on something, which only would trigger resistance. And then so she dialed them to zero. She thought the shame, she didn't need any shame. And one of them, she only needed 2%. And some of them, she wanted 10% and that type of thing. And now I've made a deal with her subconscious mind, with her resistance, that we'll dial them down to these levels, but no further. And then I said, "Now, Karen, let I have to advise you about one thing. The techniques we're going to use are so powerful that you might overshoot your goals. Like your depression may go all the way from 100 to zero, rather than to 10. But don't worry, cuz if it go if you get too happy, [clears throat] I'll try to I'll help you work your depression up to 10 before the end of the evening." And then she started laughing. And that point, I knew I had her. Uh And then it was easy And then it took about 15 minutes for her to talk back to the negative thoughts the same way we role-played earlier using double standard, identify the distortions. Uh and and uh she not only went to zero on everything, she actually went beyond zero and went into a kind of state of euphoria. And the neat thing is I have all of this on video. And uh I'm I'm going to be showing it in a couple of presentations for therapists and one for the general public coming up, too. So, people have actually be able to see these little snippets. But, that that's how it it works. And uh I want to go a little bit deeper into the into the um the resistance. So, you talked about in the book how there's two types. You've got outcome resistance and you have process resistance. Oh, yeah. I'd love to know a little bit about that. And then I'd also like to better understand is it that people are subconsciously identifying that these actually are good traits or is it that they don't want to confront something negative about themselves? No, it's just Well, um no no um confronting something negative about yourself, that that would not be true in depression and an and anxiety actually. Uh it might be true when people are angry and vengeful. Um and or with habits and addictions. But, in depression and anxiety the resistance always results from things are really good and beautiful about you. But, this thing of outcome and process resistance is blowing my mind because you really [laughter] hadn't got the the new book, which is kind of exciting to me. But, yes, the there's eight kinds of resistance. Um there's outcome and process resistance for four targets: depression, anxiety, relationship problems, and habits and addictions. Outcome resistance is what we just worked through with Karen, who who was uh depressed about her daughter. It means you don't subconsciously you don't want a good outcome from the therapy. And in this case because all of her negative thoughts were because of what's most loving and beautiful about her. But that that's outcome resistance. Outcome resistance for anxiety is is a little different. All anxious patients feel or people feel like my anxiety is protecting me from something terrible and if I was cured you know, things would horrible things would happen. So, for example, I treated a woman with obsessive-compulsive disorder who who was washing her hands a hundred times a day. Thinking she's going to get contaminated and then if she wants treatment for that. And then I said, "Well, suppose you I press this magic button and you'll be cured." Would you do that? She says, "Absolutely. I don't want OCD." I said, "Okay, so now you're cured and so you're not going to wash your hands a hundred times a day. What's going to happen?" She says, "My hands will get contaminated." And I said, "Then what will happen?" She says, "Well, then I'll touch my children." "Okay, and then what's going to happen?" And then they'll get contaminated. "And then what's what's going to happen?" She said, "Well, then they're going to die of leukemia. They'll get leukemia and die." And then she started sobbing. And I said, "You still want to press that magic button?" She said, "Oh, no, no, I don't want to press it." And that's the outcome resistance. You see, she thought that her anxiety was protecting her and her children. Now, process resistance is is a little different. Process resistance means there's something you're going to have to do that you're not going to want to do to get better. See, it's Once you've decided I want to get better, that's half you're halfway there. But now, what's this thing you're going to have to do? Well, the thing that the depressed patient is going to have to do is psychotherapy homework. I'm practicing writing down negative thoughts, doing the exercises in my books like in Feeling Good and and in the new Feeling Great. The crucial thing is to do these exercises because that's where you reprogram your brain. That's where the change really really happens. And and so when I work with people I I say this is a gentle ultimatum. If you want to work with [snorts] me, you must agree to do the exercises. If not, I'm not the therapist you're looking for cuz all I can specialize is and is quick irreversible cures. And if you [laughter] want to keep talking endlessly to somebody without, you know, changing your life, then I'm not the person you're looking for. And and I I lay down the law but in a loving way and then most people want to stick with the therapy and they do the homework and 100% of the patients who do homework between sessions recover. 100% of patients who refuse to do homework do not improve or recover. So it's a really a big deal. In anxiety, the the process resistance is exposure. The anxious patient will have to face their fear, their their worst fear. And when it's happening, it's going to be terrifying. And if you want me to cure your anxiety, you're going to have to confront your fears. Now, in most cases, I'll be there with you. I'll go with you to confront your fear. But you must do that. Just talking about your anxiety is not going to is not going to cure you. And I know how important it is cuz I myself, when I wrote my book when panic attacks, it was all on all the anxiety disorders. I discovered that I've had 11 anxiety disorders when I was writing it. I didn't realize this. And then in the 6 months after it came out, I thought of six more. So [snorts] I've had 17 anxiety disorders. I've had fear of bees, blood, horses, dogs. I used to have incredible public speaking anxiety. This something like this would have freaked me out. Tell me about how how do you do with speaking? Because if you're going to expose yourself to speaking, the audience is not unconscious. You're you're there, you're exposed. Is it self-narrative? Um how do you how do you do more than just be exposed? is important, you know, motivation is important. I use a lot of techniques, but I can tell you how I got over my own if you have time for another story. Yeah, please. The uh the what when I was doing my research on brain chemistry, uh I was invited to go to a prestigious conference in England at Oxford University sponsored by NATO. And it was called the uh Advanced Study Institute for Metabolic Compartmentation in the Brain. And I was doing this computer simulation work on brain serotonin metabolism and uh so I was they invited the 80 of the top scientist, brain scientist in in the world to go. And then uh two younger people who were kind of just getting started and I was happened to get one of those two invitations. And I was terrified because um the work that I was doing was challenging the work coming out of the National Institute of Mental Health Laboratory of Preclinical Psychopharmacology. And uh I I could see that their their research what wasn't being done properly. They they weren't analyzing the mathematics that they were using wasn't correct. And and they didn't have good data. They were losing half they were injecting radioactivity into rat brains and then losing half of it. And so I decided to redo those experiments properly and I came to the opposite conclusion. The and this is the first research study I'd ever done. And but I heard that the head of that laboratory like to humiliate people in in conferences and that he was going to be at this conference. And my talk was the last talk of the conference after four long days of hearing these brilliant people and I felt so outclassed. And then finally my turn came and the night before I was so anxious I couldn't sleep. And I wandered around the Oxford campus and owls were like hooting at me derisively. I was in a panic and I had this fantasy that I would go up to the podium, freak out, read and mumble my talk and that he would sit right in front of the podium and at the end he would jump in the air and start screaming at me. And I absolutely believed that that would happen. And all day I waited for my turn and it was sort of like death. I said I wish I wasn't here. Why did I come to this conference? Finally they introduced me and I went up to the podium with my papers and there he was right in front of me sitting in the front row kind of glaring at me exactly as I had fantasized. And I got so scared I read and kind of mumbled my talk. And then at the end there was a silence and the moderator said, "Does anyone have any questions for the young doctor?" And this fellow jumped out of his chair and started shouting at me telling me my work was BS and I didn't know what I was talking about and it was just incredibly humiliating. And then he sat down and the moderator said, "Does anyone else have any questions for the young doctor?" Nobody said a word. They said, "This concludes our conference and we're now going to walk two blocks to the blah blah blah restaurant for our celebratory, you know, banquet or something." And when I walked there, I felt lower than a piece of dirt. And no one would walk next to me. And when we got there, no one would sit next to me. And it was the most humiliating experience of my life. And then when I flew back to the United States, halfway across the Atlantic Ocean, I was finally calmed down enough to think of what his criticisms were. And I had the thought, that guy doesn't know what the hell he's talking about. It was a bunch of BS he was throwing at me. And I And I went to talk to uh my collaborators who'd been helping me. And And one of them was this fellow at Penn, a physiologist named Martin Pring. And I had heard he was one of the top two mathematicians in the United States, and he was helping me with the mathematics behind we were doing computer simulation of brain serotonin metabolism. It was pretty groundbreaking what we were doing. And I said, I I don't think this guy knows what he's talking about. And And he says, David, you're exactly right. Um his criticisms were just they do not make sense. So, we did a few more simulations, and I wrote up my article and submitted it to a journal. And then I got a call. This is a little long story, but it has a good conclusion. I got a call in about 3 weeks from the editor of the journal. And I thought, good gosh, why are they calling me? Usually, don't they write rejection letters? Do they call you up call you out and tell you how awful your article was? And he called and he says, "Listen, Dr. Burns, we got your article, and there's something unusual. Um none of the reviewers had any suggestions for changing anything in it. And they have unanimously uh agreed that it needs to be published. It's going to be in our next issue. But I'm wondering, could we submit it for the AAE Bennett uh competition? This is an annual competition for investigators under 35 years of age on brain research, and it's the top award in the world, and you'll be competing with the and NIMH the group that you're criticizing and and scientists from all over the world. Could we submit your paper? I said, "You sure can. I had no idea." And then he called 3 weeks later, and he says, "You're the first unanimous winner of the A.E. Bennett Award." And I I just couldn't believe my ears, and and he said, "Can you give a talk presentation to a thousand psychiatrists in New York next month at our at our meeting to receive the award?" I said, "You bet I can. Absolutely." And then every night before I went to bed, I would start to fantasize, you know, blowing it in front of a thousand psychiatrists. Then I forced myself to change the image and to say instead to imagine just talking the talk with no notes and telling the people how lucky I was to work with Martin Pring and and Dave Brunswick and Hal Hal Herring and Jack Jack London, the people I've on my research team, and how fantastic the discoveries we made were and how grateful that I was and and what a fantastic experience it was. And I I told them I wouldn't accept the award unless they gave me my my other co-authors equal recipients, which they said they wouldn't do. And then I said, "I won't that I won't accept the award." And they said, "Okay, we'll do it." Wow. And so so they came to and and and and I just forced and I imagined that at the end of my talk everyone would rush up with congratulations and stuff, just the the opposite deal. And I didn't believe it, but I kept forcing myself to think that way. And then when the day came, I I walked up to that podium. My wife came with me to New York from Philadelphia. There were 1,000, you know, researchers in the audience. And then I I told them about about the research. And it just the how excited I was, how grateful I was to have people of unbelievable brilliance, you know, on on my research team. And but the implications of the research were the methods that we had developed to do this this this research. And at the end, everybody rushed up to the podium. And just, you know, it was exactly as I had fantasized it. So, that that was, you know, how I got over another another fear. And then the odd thing was that a two or three weeks later, this group from Sloan Kettering in New York called said, "Can we come and meet with you and Martin Pray in Philadelphia? Cuz we have an idea and we want to see if you think it's it's ridiculous or theoretically possible. Cuz you see, we'd been using mathematics um and and certain information to to figure out what's going on inside of the brain." And they they they said that they had wanted to create something called a CAT scan that that that that could take images of the inside of the human brain using electromagnetic stuff. And and did we think their mathematics was valid? And did we think this was possible? Did we think this was possible? And I didn't have much to say cuz I didn't have the mathematical power of Martin. But Martin looked at it, he says, "Yeah, I I he said this this this is definitely going to going to work." And then they went and and developed the world's first CAT CAT scanner. So, there But anyway, that was my my experience with public speaking anxiety. And you know, and then you know, what once you've had that that experience, Uh I I have I've had very little public speaking anxiety since then and just like this, like meeting with you, to me it's just like what a great moment this is. You know, I'm old and I'll be 78 in a week and Oh. all I've got is Congratulations. Thank you. All I've got is the experience. Do you Do you [clears throat] Do you see what I mean? And what an experience this is to to hang out with you and to share these stories that and may touch people and change their lives. David, I I am serious when I say I am so grateful for your work and you know, what you've managed to put together in just those two books, let alone the rest of your work, um feeling good and feeling great is is transformational and it was given to me originally by one of my employees who had been struggling with anxiety and he had found this and he knew that I had struggled with anxiety, so he gave me a copy. Oh, yeah. As I was reading it, I was just like, "Oh my god, it's so step-by-step. It's so usable. It's something that you can deploy immediately and the more you interact with it, the more sort of self-evident it becomes just how powerful it is." And that last example that you gave of as you imagine something, you are creating that body response to what you're thinking of and I said, you know, so many people rehearse failure and so few people rehearse success and because you rehearse failure, you're beginning to associate this negative response with this otherwise neutral thing. And so, it's no surprise that you then go and perform exactly the way you thought you were going to perform. So, it's this really rudimentary thing that I think nobody has explained as clearly and simply as you and given the ways to unwind that and I think Feeling Great really is as breakthrough as you think it is in terms of dealing with that resistance and understanding that as a part of the process of overcoming whatever mood disorder it is that you're struggling with. So, again, thank you so much for coming on the show, man. I I am eager to to see people adopt the new material. I'm sure it'll be as transformational as the old, so thank you. Thank you so much. This has been the best interview I've ever had because of all the effort you put in it. I couldn't believe how on top of this stuff you are and it makes it it's such a gift to the person you're interviewing and it takes a lot of work and I'm I'm very grateful. That's very kind. It is the least I can do to show my appreciation for what you've given the world. Um, it's amazing. All right, everybody, trust me when I say every word that I have said is absolutely true. It is astonishing. His books will change your life if you use them. Uh, and speaking of things you can use, if you haven't already, be sure to subscribe and until next time, my friends, be legendary. Take care. body says something out loud, it's 10 [music] times more powerful than if they think it. And then as we started to study the data, particularly data that was just [music] reinforced by Christine Porath from Georgetown and Harvard, that negativity is a multiple of four to seven times [music] more powerful than positivity.